Ear Diseases ; diagnosis ; therapy ; Humans ; Magnetic Resonance Imaging

Uveitis is a kind of refractory blinding eye diseases.Noninfectious uveitis is an important part of uveitis,which is thought to be an autoimmune disease,and systemic immunosuppressive therapy is usually required to prevent visual loss.As a selective T-cell inhibitor,cyclosporine A is one of the most widely used immunosuppressants,and has obvious therapeutic effect on many kinds of uveitis.Cyclosporine A combined with glucocorticoid,other immunosuppressants or biological agents can improve the therapeutic effect and reduce the side effects.Recently,the inhibitory effect on glucocorticoid-resistant Th17 cells and topical application of cyclosporine A,show its advantage and potential in the treatment of noninfectious uveitis.

Objective To investigate the clinical effect of plastic surgery of double-palpebra with reposition of lacrimal gland for blepharochalasis.Methods We operated on 10 cases (20 eyes) with dermatolysis palpebrarum which stopped attack and was static for more than one year.A double eyelid fold incision was made.Then redundant skin and sphincter palpebrarum as well as protrusion of intraorbital fat were removed.In the operation of dislocation of lacrmial gland we sewed up lacrmial gland in full thickness and fixed it to the periosteum of lacrmial fossa,and the levator muscle of upper eye lid aponeurosis prothesis or plication was choosed when the levator muscle of upper eye lid aponeurosis was broken or not.And for the shorted transverse diameter of coloboma of eye lid we sewed up the external palpebral ligament and fixed it to the periosteum of lateral orbital margin.Results All the 10 patients got satisfactory therapeutic effect,the cutis laxa had been amended obviously,the good upper double eyelid shape could be achieved,the reposition of lacrimal gland was finished,lapsus palpebrae superioris and shorted transverse diameter of coloboma of eye lid had been rectified satisfactorily.All cases we followed up for three monthes to one year,and dislocation of lacrmial gland had been amended in one case,others had been reposited well,without recurrence.Conclusions Blepharochalasis can be effectively treated by surgery,and it is convenient and effective to treat dislocation of lacrimal gland and blepharochalasis through a double eyelid fold incision.This multiple surgical treatment is not only a curative operation but also a cosmetic surgery.

Objective To investigate midwives' role cognition and their working experience.Methods It was a qualitative study using the phenomenological method.10 midwives were interviewed and all the data were analyzed using the categorization method.Results Three main categories were identified:diversified midwife roles; capacities and qualities required to fulfill midwifery roles; positive and negative experiences coexisted.Conclusions Managers should develop humanized management approaches to facilitate the fulfillment of midwives' roles and improve their working experience.The research also revealed the need to improve Chinese midwifery education and the midwifery regulation systems.

An isocratic high-performance liquid-chromatographic method is-described for the simultaneously determining carbamazepine and its biologically active metabolite, carbamazepine-10, 11-epoxide. Serum samples containing an internal standard (10-methoxycarba-mazepine) are extracted with dichlor-methane and 4 mol ? L-1 sodium hydroxide. The organic extract are evaporated at ambient temperature under a stream of nitrogen. The residues are reconstituted in mobile phase and injected on to a re-versed-phase C18 Column (150?4. 6mm I. D). The mobile phase consists of ace-tontrile/methanol/water (50/210/260 by vol) . The UV detector is operated at 214nm. The elution times of all com-pounds are within 7 min.The least detectable concentrations of carbamazepine and carbamazepine-10, 11-epoxide are 0. 08mg ? L-1 and 0.1mg ? L-1, respectively. The average absolute recovery for carbamazepine is 96.0% and for carbamazepine-10,11-epoxide is 97.3%. Within-run CV is 3. 3%~5.7%. and between-run CV is 4.3%~9.0%. The standard curve is linear at least within 40mg ? L-1 for carbamazepine and within 20mg ? L-1 for carbamazepine-10, 11-epoxide.

Objective To study the security in HBV carried infertility patients during the in-vitro-fertilization procedure. Methods Serologic testing of HBV infection (HBsAg, HBsAb, HBeAg, anti-HBe, anti-HBc-IgG) of blood, follicle fluid/sperm and fertilization culture medium/post-washing sperm in female/male carried patients were detected by ELISA on the day of oocytes collection. Results In 18 female patients who were seropositive for HBsAg, HBeAg and anti-HBc-lgG, the same antigen and antibody could be detected in all 18 folli-cle-fluid and fertilization culture medium(100%, 100%). In 131 female patients who were sernpesitive for HBsAg, anti-HBe, anti-HBc-IgG, the same antigen and antibody could be detected in 84 follicle-fluid(64. 1%), and 8 fertilization culture medium(6. 1%). If the patients'follicle-fluld was negative for all the markers, their fertilization culture medium remained negative. In 23 male patients who were sero-positive for HBsAg , HBeAg,and anti-HBc-lgG, the same antigen and antibody could be detected in only 6 sperm (26. 1%), all the postwashing sperm were exhibited negative. In 121 nude patients who were seropositive for HBsAg, anti-HBe, anti-HBc-lgG, the same antigen and antibody could be detected in only 7 sperm (5. 8%), and all the post-washing sperm were negative. Conclusion In IVF-ET procedures, the risk of HBV transmission by follicle-fluid and fertilization culture medium in those female patients who showed serepesitive for HBsAg , HBeAg, and anti-HBc-lgG can not be decreased. The risk in those female patients who showed seropositive for HBsAg, anti-HBe, anti-HBe-lgG and male patients in IVF-ET procedures can be decreased.

Midwifery competency is the foundation for sustainable development of the midwifery profession. The promotion of midwives′ competency can improve their ability, strengthen midwifery competitiveness and enhance the quality of midwifery care services. This study gave an overview of the worldwide research progress on midwifery competency, we can draw the conclusion that there are urgent needs to improve midwifery education programs in China, emphasize competency-based midwifery education, as well as standardize the in-service training system to support the development of midwifery competency.

Objective To investigate the expression of aquaporin-4 (AQP4) in contused brain and contralateral side and correlation of AQP4 level with brain edema.Methods A total of 70 health adult SD rats were divided into sham operation group (n =10) and brain contusion group (n =60) according to the random number table.Except for no impact in sham operation group,the remaining operations were the same in both groups.Ten rats in brain contusion group were separately sacrificed at 1,6,24,48 and 72 hours,and 7 days.Pathological changes in brain tissues of rats were detected and immunohistochemistry staining and Western-blot were used to measure AQP-4 expression.Results There were no abnormalities of brain tissue structure in sham operation group with AQP4 expressed mainly in glial cells and vascular endothelial cells.With respect to the injured side in brain contusion group,mixed brain edema that consisted of angioedema and cellular edema occurred along with tissue necrosis,massive inflammatory cell infiltration,and microgial proliferation.AQP4 was apparently expressed in gliocytes and vascular endothelial cells,which showed a fall at 1 hour,the lowest at 6 hours,the peak at 24 hours,slow fall at 48 hours,a second peak at 72 hours,and then a fall until 7 days.Level of AQP4 other than that at 1 hour had significant difference compared with sham operation group (P ＜ 0.01).Whereas the contralateral side in brain contusion group showed no pathological abnormalities at 1 hour,but cellular edema emerged at 6 hours followed by mixed brain edema mainly characterized as cellular edema at 24 hours,continued cellular edema but alleviated angioedema at 48 and 72 hours,and alleviated cellular edema at day 7.AQP4 was up-regulated in gliocytes and vascular endothelial cells,which decreased at 1 hour (1.313 ± 0.01),minimized at 6 hours (0.922 ± 0.03),peaked at 24 hours (2.848 ± 0.020),fell at 48 hours,peaked again at 72 hours (2.662 ± 0.02) and fell to almost normal level at day 7.By contrast with sham operation group,level of AQP4 had significant difference other than that at 1 hour and 7 days (P ＜ 0.01).Conclusions After brain contusion,angioedema and subsequent cellular edema emerge in the contused side.Pathological changes are delayed in non-contused side with cellular edema ahead of angioedema.Level of AQP4 is closely related with traumatic brain edema.

Objective To evaluate the effects of ischemic postconditioning on nuclear factor kappa B (NF-κB) and intercellular adhesion molecule-1 (ICAM-1) expression during lung ischemia-reperfusion (I/R) injury in a dog model of cardiopulmonary bypass (CPB), and further investigate the pulmonary protection induced by ischemic postconditioning and the underlying mechanism.Methods Twelve adult mongrel dogs of both sexes, weighing 12-15 kg, were randomly divided into either CPB group or ischemic postconditioning group (IPO group) using a random number table, with 6 dogs in each group.CPB was established after the chest was opened in dogs anesthetized with pentobarbital sodium.Ischemic postconditioning was induced by 2 cycles of 5 min reperfusion followed by 5 min ischemia immediately after occlusion of the left pulmonary artery was released in group IPO.Before CPB (T1), before occlusion of the artery was released (T2) , and at 2 h after termination of CPB, lung specimens were obtained for examination of pathological changes which were scored (with light microscope) and for determination of the expression of NFκB and ICAM-1 (using Western blot) and wet/dry lung weight ratio (W/D ratio) in left lung tissues.Blood samples were collected from femoral arteries at T1 and T3 for blood gas analysis, and oxygenation index (OI), respiration index (RI) and dynamic lung compliance (Cdyn) were calculated.Results OI and Cdyn were significantly decreased, and RI was increased at T3 , and W/D ratio, pathological scores, and expression of NF-κB and ICAM-1 were increased at T2,3 than at T1 in the two groups.W/D ratio, pathological scores, and expression of NF-κB and ICAM-1 were significantly higher at T3 than at T2 in the two groups.Compared with group CPB, OI and Cdyn were significantly increased, and R1, W/D ratio, pathological scores, and expression of NF-κB and ICAM-1 were decreased at T3 in group IPO.Conclusion Ischemic postconditioning up-regulates the expression of ICAM-1 through inhibiting NF-κB activity, thus reducing lung I/R injury induced by CPB and improving the lung function in dogs.

ObjectiveTo investigate the influence of selective soft tissue release on the tension around hip joint through posterolateral approach, and to ascertain the sequence of soft tissue release in total hip arthroplasty. MethodsFive fresh frozen cadavers with ten intact lower extremities were used in the study. All the pelves of cadavers were fixed on the operating table by a special designed fixer on a lateral position. Femoral supracondylar bone traction was employed for axial traction. The force for traction was 15 kg. Posterolateral approach was used for exposure and two sequences for soft tissue release were studied. One Kirschner wire was fixed at the bone near the anterior superior iliac spine, and the wire was perpendicu-lar to the operating table. Another Kirschner wire was fixed into the bone at lateral femoral shaft. The two Kirschner wires were parallel to each other. The distance between the two Kirschner wires was measured be-fore and after each soft tissue structure release. ResultsThere were no significant changes of the distance measured before and after applying traction alone, releasing external rotation muscles, opening the posterior capsule and releasing the gluteus maximus insertion. There were significant changes of distance measured before and after resection of femoral head, release of tensor fasciae latae and/or iliotibial band, excision of anterior capsule, and release of iliopsoas tendon had. The average lengthened distance was 1.5 mm (range, 1-3 mm) after resection of femoral head, and 8.0 mm (range, 2-19 mm) after release of tensor fasciae latae and/or iliotibial band, 5.5 mm (range, 1-13 mm) after excision of anterior capsule, and 1.8 mm (range, 1-3 mm) after release of iliopsoas tendon respectively. The distance lengthened after both release of tensor fasci-ae latae (and/or iliotibial band) and excision of anterior capsule was the most significant, average 13.5 mm (range, 11-20 mm). ConclusionRelease of anterior capsule, tensor fasciae latae and/or iliotibial band, and iliopsoas tendon will decrease the soft tissue tension around hip joint. Among all the soft tissue structures we investigated, the anterior capsule and tensor fasciae latae (iliotibial band) make the most effective result. To maintain the soft tissue tension around hip joint depends on different structures working together, releasing one structure alone may not obtain the optimal result. Careful evaluation of tension of tensor fasciae latae and iliotibial band can help avoiding the limb length discrepancy during hip arthroplasty surgery.