Objective To evaluate the corneal astigmatism changes after phacoemulsification performed using clear corneal incision with different locations.Methods Seventy-two eyes of 72 patients having phacoemulsification and implantation of foldable intraocular lens through a clear corneal incision were chosen.Patients were divided into two groups by table of random digit:group A (incision at 11:00),group B (incision at the steepest corneal meridian).The change of corneal astigmatism was compared between group A and B postoperatively.Surgically-induced astigmatism (SIA) was calculated by vector analyses using the HoHaday-Cravy-Koch method.Results Preoperative corneal astigmatism between group A and group B had no significant difference [(0.96 ± 0.52) D vs.(0.94 ± 0.56) D,P ＞ 0.05].One and three months after operation,the corneal astigmatism in group A were significantly higher than those in group B [(1.15 ± 0.32)D vs.(0.82 ± 0.43) D,(0.85 ± 0.38) D vs.(0.63 ± 0.40) D,P＜ 0.05].The SIA in group A was significantly higher than that in group B 1 month after operation [(0.85 ± 0.37) D vs.(0.75 ± 0.54) D,P ＜ 0.05],there was no significant difference between group A and group B 3 months after operation [(0.60 ±0.35) D vs.(0.58 ±0.30) D,P ＞0.05].Conclusions Corneal astigmatism is prｅsent in most cataract surgery candidates.Cataract surgery using steepest corneal meridian incision induces significantly less SIA,and correct corneal astigmatism already present preoperatively.

Objective To investigate the effects of colloid preconditioning on hemodynamics of patients with laparoscopic colon surgery during pneumoperitoneum period.Methods Fifty patients withlaparoscopic colon surgery were divided into control group(group A,25 cases)and colloid preconditioning group(group B,25 cases)by random digits table.The mean arterial pressure(MAP),heart rate(HR),central venous pressure(CVP),cardiac index(CI),systemic vascular resistance index(SVRI),hemoglobin(Hb)and haematocrit(Hct)were recorded before anesthesia(T0),5 min after anesthesia(T1),5 min after pneumoperitoneum(T2),10 min after pneumoperitoneum(T3),15 min after pneumoperitoneum(T4)and 5min after pneumoperitoneum completely(T5).Results MAP in group A at T1-3[(68.7±5.3),(72.5±4.8),(73.1±6.3)mm Hg(1 mm Hg=0.133 kPa)]was significantly lower than that at T0[(81.7±6.1)mm Hg](P＜0.05).MAP in group B at T3,4[(93.2±5.8),(87.6±4.2)mm Hg]was significantly higher than that at T0[(80.2±5.6)mm Hg](P＜0.05).At T1,2,MAP in group A was significantly lower than that in group B[(79.8±5.4),(83.2±5.3)mm Hg](P＜0.05).CVP in group A at T2-4[(7.8±2.4),(8.1±2.2),(8.2±2.0)cm H2O(1 cm H2O=0.098 kPa)]was significantly higher than that at T0[(6.5±2.1)cm H2O](P＜0.05).CVP in group B at T1-4[(11.7±3.4),(13.5±3.6),(15.8±3.8),(16.6±3.7)cm H2O]was significantly higher than that at T0[(6.3±2.5)cm H2O](P＜0.05).There was significant differences in CVP at T1-4 between group A[group A at T1:(5.6±2.2)cm H2O]and group B(P＜0.05).CI in group A at T2-4[(2.6±0.2),(2.1±0.1),(2.7±0.3)L/(min·m2)]was significandy lower than that at T0[(3.5±0.4)L/(min·m2)](P＜0.05).CI in group B at T2-4[(3.1±0.3),(2.9±0.3),(3.0±0.4)L/(min·m2)]was significantly lower than that at T0[(3.6±0.5)L/(min·m2)](P＜0.05).There were significant differences in C I at T2-4 between two groups.SVRI in group A at T2-4[(2853±432),(2918±510),(2718±436)dynes·s/cm5]was significantly higher than that at T0[(2318±236)dynes·s/cm5](P＜0.05).SVRI in group B at T2-4[(2756±391),(2718±402),(2694±382)dynes·s/cm5]was significantly higher than that at T0[(2356±372)dynes·s/cm5](P＜0.05).There was no significant difference in HR between two groups(P＞0.05).Hb and Hct in group B at T1-4[(123.6±11.5),(125.6±9.5),(126.1±10.2),(128.6±11.4)g/L and 0.339±0.037,0.337±0.036,0.322±0.041,0.312±0.040]were significantly lower than that at T0[(134.7±12.2)g/L and 0.371±0.039](P＜0.05).There were significant differences in Hb and Hct at T1-4between group B and group A[(131.8±10.2),(130.7±12.8),(131.6±14.3),(133.5±12.3)g/L and 0.360±0.042,0.359±0.041,0.361±0.040,0.360±0.036](P＜0.05).There was no significant different in Hb and Hct of group A(P＞0.05).Conclusion Colloid preconditioning may effectively maintain the stability of circulation,reduce blood viscosity,and improve microcirculation during the pneumoperitoneum period.

Objectives To explore the effects of gross hematuria on the results of several parmeters in laboratory urine examination. Methods Eighty (80) children with IgA nephropathy and 40 cases with acute post-streptococcal glomerulonephritis hospitalized in our hospital from January 2014 to December 2015 were recruited. The ratio of urinary calcium and protein to creatinine, quantitative test of 24 h urinary calcium and protein, quantitative test of 24 h urinary albumin,α1-microglobulinuria, microalbuminuria and urine protein electrophoresis were tested during and after the gross hematuria, respectively. Results The ratio of urinary calcium and protein to creatinine, quantitative test of 24 h urinary calcium and protein were much higher in the duration of gross hematuria as compared to those after the duration of gross hematuria, while α1-microglobulinuria, microalbuminuria and quantitative test of 24 h urinary albumin showed no difference between the two periods. Conclusions Gross hematuria could increase the level of urinary calcium and protein, while quantitative test of 24 h urinary albremin is not affected.

Objective To analyze the diagnostic approach on hepatolenticular degeneration combined with thin basement membrane nephropathy.Methods A girl presented with microscopic hematuria, liver dysfunction and hypocomplementemia was diagnosed with hepatolenticular degeneration combined with thin basement membrane nephropathy, her clinical data were summarized and analyzed retrospectively.Results A ten years old girl presented with microscopic hematuria and liver dysfunction for a year, dysarthria for a month, and combined with hypocomplementemia but without proteinuria. Renal biopsy showed thin basement membrane nephropathy. Ceruloplasmin was 23.10 mg/L and urinary copper concentration was 120μg, respectively, ocular slit lamp examination showed Kayser-Fleischer ring, cranial MRI showed preternatural signal in both basal and putamen nucleus, mutation analysis showed homozygous mutations in ATP7B and heterozygous mutation in COL4A3 gene,respectively.Conclussion Hepatolenticular degeneration should be suspected in those cases with persistence microscopic hematuria, liver dysfunction and hypocomplementemia.

Objective To explore the clinical features of steroid resistant nephrotic syndrome caused by NPHS2 gene mutation. Methods The clinical data of two pediatric patients with steroid resistant nephrotic syndrome were retrospectively analyzed. The pertinent literatures were reviewed. Results Both patients were male with onset age at 2 and 3 years old. The clinical features were heavy proteinuria, hypoalbuminemia, and hypercholesterolemia, which met the diagnostic criteria of nephrotic syndrome. Renal pathology found one patient with focal segmental glomerulosclerosis, and other with minimal-change. Both of them suffered from recurrent inguinal hernioplasty and one was accompanied with hypoplasia of left testis. Gene detection verified a NPHS2 gene mutation. Both of them were hormone resistant at the beginning of onset and later hormone combined with different kinds of immunosuppressive therapy was still ineffective. Both of them entered the end-stage of renal disease 3 years after onset. Conclusions For male pediatric patients with steroid resistant nephrotic syndrome, combined with non-renal manifestations such as multiple hernia or testicular abnormalities, the possibility of the hereditary nephrotic syndrome caused by NPHS2 mutations should be considered.

Objective To explore the diagnosis and differential diagnosis of IgA nephropathy.Methods The clinical data of 2 children with IgA nephropathy were retrospectively analyzed.The pertinent literatures were reviewed.Results In 2 males aged 6 and 7 years,the clinical features were a large amount of proteinuria (mainly albumin),low serum albumin,high cholesterol,and persistent microscopic hematuria,which were in line with the diagnosis of nephrotic syndrome.The effects of hormone and immunosuppressive therapy were poor.Renal pathology immunofluorescence and light microscopy findings were in accord with mild to moderate mesangial proliferative IgA nephropathy (M1E0S0T0).Electron microscope showed glomerular basement membrane lesions (layering,breakage,and uneven thickness),which could not exclude Alport syndrome.Further gene detection confirmed a pathogenic mutation of COL4A5.Conclusions It is rare that IgA nephropathy is combined IgA nephropathy at the same time.Attention should by paid to those who had a poor effect of treatment or had a related family history in IgA patients because it is possible that IgA nephropathy and IgA nephropathy may occurred at the same time.

Objective To evaluate the role of short-term follow-up MRI in the detection of postoperative breast residual cancer. Methods A retrospective analysis was performed on 13 patients who were diagnosed as nonmalignant breast lesions by preoperative clinical and ultrasound and mammography examinations and intraoperative frozen pathology.However,these patients were finally confirmed as malignant breast lesions by paraffin pathology and received corresponding second operations.Routine MRI,DCE-MRI and EPI-DWI scan were performed on the 13 patients within one month after the first operation and these MRI features and patholo-gy were comparatively analyzed.Results All the cases showed local mammary architecture distortion both in routine MRI and DCE-MRI.The enhancement characteristics of the 13 cases were as follows:3 cases of stippled enhancement,4 cases of small nodular en-hancement,1 dendritic enhancement,1 network enhancement,1 ring-like enhancement of cystic wall and 3 cases of no abnormal en-hancement.The lesions of 7 cases showed type Ⅰ curve (progressive enhancement pattern)and 6 cases showed type Ⅱ curve (plat-eau pattern).The lesions of 6 cases showed decreased ADC value.In summary,there were 6 cases of tumor residue diagnosed by both MRI and the second pathology,while only 1 case of residual neuroendocrine carcinoma was misdiagnosed by MRI but confirmed by the second pathology.Conclusion Short-term follow-up MRI could be of value in determining postoperative breast residual tumor, and could be helpful for surgeons to make accurate operation plan.

Objective To explore the causes of acute renal failure resulted from tacrolimus in the treatment of nephrotic syndrome. Method The clinical data of acute renal failure caused by tacrolimus in treatment of nephrotic syndrome in 3 children during January 2012 and December 2015 were retrospectively analyzed. Results There were 2 male and 1 female aged 3, 11,and 13 years respectively. Clinical manifestations were consistent with simple type of primary nephrotic syndrome. One child was frequently recurrent and another two were secondary steroid resistant. The renal pathology showed minimal changes. Acute renal failure occurred within 4 weeks after treatment with tacrolimus on the basis of hormone therapy in all patients who had infection within one week. Renal function recovered to normal within 2 weeks after discontinuation or reduction of tacrolimus combined with anti-infection and diuresis treatment. Two children continued with tacrolimus, but the other one was replaced with cyclosporin A. The renal function of all patients remained normal during the follow-up for 10-42 months. Conclusion In the first 4 weeks of tacrolimus therapy in children with nephrotic syndrome, infection may lead to reversible acute renal failure.

Objective　This study was to investigate the Chlamydia trachomatis (CT) infection rate in cervical secretion of early pregnant and secondary sterility women. Method　CT-DNA in the cervical secretion of the early pregnant, the secondary sterility, and the control women was detected with polymerase chain reaction (PCR). Results　The infection rates of CT in the early pregnant and secondary sterility women （14.28% and 13.33%）were higher than in the control women (3.33%, P<0.05),and there was no significant difference between the former two groups (P>0.05). Conclusion　There are higher infection rates in the early pregnant and secondary sterility women.Detecting CT and treating in the perinatal period are needed in the early pregnant women who want to be pregnant again.

Objective To evaluate the effects of percutaneous balloon mitral valvuloplasty (PBMV) on repeated rheumatism attacks after continual anti rheumatic treatment in vain over a long period of time.Methods 23 cases received treatment by PBMV and follow up visits were performed.Results After operation,patients' cardiac function and their physique were improved obviously and the activity of rheumatism ceased after routine anti rheumatic treatment and prevention of streptococcal infection.Follow up visits for 36～81 months showed that mitral re stenosis occurred to only 2 patients.Conclusion Patients with mitral stenosis whose rheumatism attacks repeatedly in spite of longterm anti rheumatic treatment may be treated with PBMV first and then given anti rheumatism.In this way,a better curative effect can be obtained.