Objective To study comparatively the clinical efficacy of pelvic floor muscle exercise (PFMlE)and surgical therapy in women with moderate stress urinary incontinence(SUI),in order to provide theoretical reference for finding an appropriate SUI treatment method. Methods 114 cases of women with moderate SUI were randomly divided into the treatment group and the control group. The control group Wag given surgical thempy. while the treatment group was given the PFME treatment. After 12 weeks the clinical efficacy and quality of life of the two groups were evaluated, the cost-benefit was analyzed. Results The total effective rate of treatment group was 86.2%.higher than 83.9% of the control group. Compared with before treatment, the I-QOL scores of the two groups increased significantly, the ICIQ scores of the two groups decreased significantly, and the treatment group was significantly different compared with the control group. The cost-benefit analysis showed that the total medical cost and the spending cost of the total clinical effective rate increased l percent and the I-QOL increased 1 score were significantly lower than that of the control group. Conclusions The PFME therapy of women with moderate SUI is the preferred treatment and it is worthy of promotion and application.

Background Local medical treatment of refractory immunologic keratitis is unsuccessful,and systemic steroids and immunosuppressive agents could cause severe side-effects.Tacrolimus is a potent immunosuppressive drug,it has been proved that topical application of tacrolimus could reduce immunologic inflammation.The safety and efficacy of 0.05％ tacrolimus eye drops for refractory immunologic keratitis has not been described.Objective This study was to evaluate efficacy and safety of 0.05％ tacrolimus eye drops for refractory ulcerative keratitis.Methods A retrospective study was performed.Twenty-one eyes of 17 patients with refractory immunologic keratitis,which had uncontrolled inflammation despite initially treatment including topical steroids and 1％ cyclosporine A,were enrolled,including 11 males and 6 females,with the mean ages of 52 years.Infectious ulcer was excluded by laboratory tests.No systemic disease was found in 11 patients,and Wegener's granulomatosis,rheumatoid arthritis and ulcerative colitis were seen in 1 patient,4 patients and 1 patient respectively before presentation and they were all in remission under conventional systemic therapy.Four patients got binocularly involved and thirteen patients were monocularly involved.Of the 21 eyes,2 eyes with ulcer were ≥ 3 quarters of the limbus,and 19 eyes with ulcer were ≤ 2 quarters.All patients were treated with 0.05％ tacrolimus eyedrops after discontinuing cyclosporine A.The dosage was adjusted according to the severity of inflammation and was gradually tapered when improvement occurred.The corneal lesions were examined under the slit lamp microscope and Heidelberg HRT3 Rostock Cornea Module regularly,and inflammatory cell infiltrations were analyzed with Cell Count(R) software (Heidelberg Engineering GmbH).The safety variables were monitored regularly,including adverse response of eye,tacrolimus blood concentrations measured by chemiluminescent microparticle immunoassay (CMIA) and laboratory examinations of blood routine,blood glucose level,liver and kidney function.Results The patients were treated and followed-up for a mean duration of 18.1 months (range,8-24 months).Corneal ulcer area was obviously reduced 1 month after treatment in 19 eyes,and 2 eyes of 2 cases received anterior lamellar keratoplasty due to progressive corneal destruction despite of tacrolimus therapy.Corneal ulcer was cured 3 months after treatment,and stromal edema and infiltration disappeared 6 months after treatment under the slit lamp microscope.The inflammatory cell densities at lesion zone were (958±329),(858±339),(459±261),(192±124),(98±52),(44±24) and (3±2)/mm2 before treatment and 1 week,1 month as well as 3,6,12,24 months following treatment,respectively,showing a gradually decline as time lapse (F =125.439,P =0.000),and the inflammatory cells were significantly decreased in 1,3,6,12 and 24 months following the administration of 0.05％ tacrolimus eye drops in comparison with that before treatment (all at P =0.000).The therapy duration was 12 months in 9 eyes and 24 months in 12 eyes.Transient irritation sensation occurred in 4 eyes during the treating period.Blood concentrations of tacrolimus were below 1.0 ng/ml in all of the patients.No abnormality was found in laboratory tests.Conclusions The use of 0.05％ tacrolimus eye drops is a safe and effective approach to refractory immunologic keratitis.

ObjectiveTo analyze the influencing factors for conversion of laparoscopic cholecystectomy to open surgery, and to provide a clinical reference for developing surgical procedures. MethodsA total of 278 patients receiving laparoscopic cholecystectomy in our hospital from January 2009 to December 2013 were analyzed. Among them, 31 patients were converted to open surgery during laparoscopic cholecystectomy, while the remaining 274 patients were not. The influencing factors for conversion to open surgery were investigated. The t test was applied in the comparison of continuous data, whereas the χ2 test was used for categorical data. The univariate logistic regression analysis was performed to investigate significant influencing factors, and the independent influencing factors were determined by multivariate logistic regression analysis. ResultsThe univariate analysis showed that sex (P=0.022), arteriosclerosis (P＜0.001), diabetes (P＜0.001), heart failure (P=0.002), previous upper abdominal surgery (P＜0.001), age (P＜0.001), body mass index (BMI) (P=0.003), gallbladder wall thickness (P＜0.001), the count of white blood cells (P＜0.001), and serum total bilirubin level (P=0.046) were significantly different between groups. The multivariate logistic regression analysis further showed that previous upper abdominal surgery (P＜0.001), sex (P=0.001), BMI (P=0.002), and the count of white blood cells (P=0.019) were independent influencing factors, among which previous upper abdominal surgery was the most significant one (OR=4.646， 95%CI: 2.012-10.729). ConclusionPrevious upper abdominal surgery, sex, BMI, and the count of white blood cells were independent influencing factors for conversion of laparoscopic cholecystectomy to open surgery. Careful evaluation of these factors before surgery would help to increase the operation efficacy, possessing an important clinical value.

Objective To compare the morphological and functional outcomes of different degrees of ocular burns patients receiving amniotic membrane transplantation (AMT) at different time points after ocular burn.Methods A retrospective analysis was performed.Ninety-two eyes of 76 acute ocular chemical burn patients were enrolled from January 2012 to December 2016 in Henan Eye Hospital.The ocular chemical burns were classified by Dua classifications.According to the operation time of AMT,the patients were divided into within 1 day after injury group,2-6 days after injury group and more than 6 days after injury group.The best corrected visual acuity and limbal stem cell deficiency score were recorded during the at least one year of follow up.The risk factors affecting limbal stem cell deficiency and visual outcome were analyzed.Results Of all the burned eyes,29 eyes (31.5 ％) were result from acid burn,41 eyes(44.6％) were result from alkaline burns and 22 eyes (23.9％) were result from thermal burn.The average burn severity scores of patients with limbal stem cell deficiency score of 0,1 and 2 was 1.86±0.54,3.60±0.94 and 5.35 ± 0.63,respectively,and the overall difference was statistically significant (F =65.532,P ＜0.01).In mild to moderate ocular surface burn patients,the limbal stem cell deficiency score in more than 6 days after injury group was significantly higher than that in within 1 day after injury group and 2-6 days after injury group (Z=-2.21,P=0.03;Z=-2.33,P=0.02).In severe ocular surface burn patients,there was no significant difference in limbal stem cell deficiency score between the groups (P=0.26).At the last follow-up,the average visual acuity of all eyes was 3.19 ± 1.47.COX regression analysis showed that burn grade and operation timing were the main risk factors for visual prognosis (OR =4.925,1.368;both at P＜0.01).Prognostic visual acuity was linearly correlated with the timing of amniotic membrane occlusion and degree of burn (R2 =0.078,0.685;both at P＜0.01),but for the Ⅴ grade and Ⅵ grade eyes,amniotic membrane timing couldn't improve the score of limbal stem cell deficiency.Conclusions Dua classifications is of great significance in evaluating prognosis of ocular burn patients.AMT is an effective adjunctive treatment in the management of acute ocular chemical burns to support epithelial healing and restore ocular surface integrity with potential to improve vision.AMT can't prevent limbal stem cell deficiency or restore vision in eyes with severe burns.

Objective:To investigate the efficacy of Hebert screw internal fixation of osteoporotic distal humeral coronary fractures in the elderly.Methods:A retrospective case series study was conducted to analyze the data of 26 elderly patients with osteoporotic distal humeral coronary fractures treated in Changhai Hospital from December 2011 to December 2018, including 3 males and 23 females aged 56-84 years (mean, 67.8 years). According to Bryan-Morrey classification, there were 7 patients with type I, 11 with type III, and 8 with type IV. All patients received open reduction and internal fixation. Among the 26 patients, 10 patients with simple humeral head fractures were treated with Hebert screw internal fixation, and 16 patients with humeral head fractures combined with humeral epicondyle fracture were treated with Hebert screw combined with humeral condyle miniplate. Operation time and intraoperative bleeding volume were recorded. At last follow-up, elbow range of motion were measured, and Mayo elbow performance score and visual analog scale (VAS) score were assessed. Meantime, complications were observed.Results:A total of 22 patients were followed up for 6-57 months (mean, 31.8 months). Intraoperative bleeding volume was 100 to 245 ml (mean, 126 ml) and operation time was 60 to 195 minutes (mean, 85 minutes). At last follow-up, the elbow joint flexion was (117.3±4.2)° and extension was (8.2±2.1)°. Mayo elbow performance score improved from preoperative 16.5 (12.8, 24.0)points to postoperative 85.0 (82.5, 92.3)points ( P<0.05). VAS was increased from preoperative (9.6±0.5)points to (2.3±0.2)points at latest follow-up( P<0.05). Two patients had elbow joint stiffness after operation and recovered after functional exercise. One patient had bone displacement when receiving rehabilitation care, which did not affect the function, and hence no further treatment was given. All patients had no infection or skin and soft tissue complications after surgery. Conclusions:For osteoporotic distal humeral coronary fractures in the elderly, Hebert screw internal fixation is effective in facilitating function recovery and relieving pain. When the fracture is combined with lateral humeral condyle fracture, additional plate fixation can be used for rigid stabilization.

Objective To investigate the corneal permeability of cyclosprin A (CsA) loaded on polymeric vector after topical application.Methods The grafted copolymer chitosan-graft-cyclodextrin (CS-g-CD) was synthesized,and the physicochemical structures of the polymer were investigated using nuclear magnetic resonance spectroscopy (NMR) and fourier transform infrared spectroscopy (FT-IR).A novel CsA eye drop was prepared using the grafted copolymer as carrier material.The physicochemical properties of eye drop,including drug-loading content,osmotic pressure and viscosity were investigated by high performance liquid chromatography-mass spectrometry (HPLC-MS),osmotic pressure gauge and viscometer,respectively.New Zealand albino rabbits were randomly divided into intact cornea CsA group,epithelium debrided CsA group and epithelium debrided control group.The corneal epithelia of the left eyes was debrided in the cornea epithelium debrided group.Cornea irritation test was performed on New Zealand albino rabbits.The aqueous humor was taken and the corneas were collected at 0.5 hour and 1 hour after instilled.The concentration of CsA was measured by HPLC-MS.Cy5 labeled vector loaded with Coumarin 6 served as model copolymers system,the penetration capabilities of the double fluorescent labeling copolymers system were monitored in vivo using two-photon scanning fluorescence microscopy on murine corneas after topical application.The use and care of the animals complied with Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission.Results The polymer of CS-g-CD was successfully synthesized and confirmed using NMR and FT-IR.The drug loading of CsA in eye drop solution was 0.06 ％;the osmotic pressure was 305 mOsmol/kg and the viscosity was 36.5 cP.The CsA drug delivery system had a reversible temperature-sensitive drug release behavior and had no obvious irritation on the eyes of New Zealand rabbits.One hour after treatment,the concentration of CsA in the cornea and aqueous humor of epithelium debrided CsA group was (5.88 ± 1.46) μg/g and (149.19 ± 3.93) ng/ml,respectively,which was significantly higher than (3.98 ±0.95) μg/g and (30.25± 11.43) ng/ml in epithelium debrided control group (both at P＜0.05);the concentration of CsA in the aqueous humor of intact cornea CsA group was (7.23 ± 1.31)ng/ml,which was significantly lower than that in epithelium debrided CsA group (P＜0.05).Polymer vectors were mainly retained in the corneal epithelium,and coumarin 6 gradually diffused into the deep corneal stroma with time.Conclusions The grafted copolymer can load CsA,and the eye drop can effectively overcome the corneal barrier and increase the corneal permeability of CsA.

Objective To investigate the corneal permeability of cyclosprin A (CsA) loaded on polymeric vector after topical application. Methods The grafted copolymer chitosan.graft.cyclodextrin ( CS.g.CD ) was synthesized, and the physicochemical structures of the polymer were investigated using nuclear magnetic resonance spectroscopy ( NMR) and fourier transform infrared spectroscopy ( FT.IR) . A novel CsA eye drop was prepared using the grafted copolymer as carrier material. The physicochemical properties of eye drop,including drug.loading content, osmotic pressure and viscosity were investigated by high performance liquid chromatography.mass spectrometry ( HPLC.MS) ,osmotic pressure gauge and viscometer,respectively. New Zealand albino rabbits were randomly divided into intact cornea CsA group, epithelium debrided CsA group and epithelium debrided control group. The corneal epithelia of the left eyes was debrided in the cornea epithelium debrided group. Cornea irritation test was performed on New Zealand albino rabbits. The aqueous humor was taken and the corneas were collected at 0. 5 hour and 1 hour after instilled. The concentration of CsA was measured by HPLC.MS. Cy5 labeled vector loaded with Coumarin 6 served as model copolymers system, the penetration capabilities of the double fluorescent labeling copolymers system were monitored in vivo using two.photon scanning fluorescence microscopy on murine corneas after topical application. The use and care of the animals complied with Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission. Results The polymer of CS.g.CD was successfully synthesized and confirmed using NMR and FT.IR. The drug loading of CsA in eye drop solution was 0. 06 ％;the osmotic pressure was 305 mOsmol/kg and the viscosity was 36. 5 cP. The CsA drug delivery system had a reversible temperature.sensitive drug release behavior and had no obvious irritation on the eyes of New Zealand rabbits. One hour after treatment,the concentration of CsA in the cornea and aqueous humor of epithelium debrided CsA group was (5. 88±1. 46)μg/g and (149. 19±3. 93)ng/ml,respectively,which was significantly higher than (3. 98±0. 95)μg/g and (30. 25±11. 43)ng/ml in epithelium debrided control group (both at P<0. 05);the concentration of CsA in the aqueous humor of intact cornea CsA group was ( 7. 23 ± 1. 31 ) ng/ml, which was significantly lower than that in epithelium debrided CsA group ( P<0. 05 ) . Polymer vectors were mainly retained in the corneal epithelium, and coumarin 6 gradually diffused into the deep corneal stroma with time. Conclusions The grafted copolymer can load CsA,and the eye drop can effectively overcome the corneal barrier and increase the corneal permeability of CsA.

Objective: To explore the efficacy of open reduction and internal fixation in the treatment of senile osteoporotic ankle fractures. Methods: A retrospective case series study was conducted to analyze the data of 26 elderly patients with osteoporotic ankle fractures which all caused by sprain from June 2012 to June 2018 in Changhai Hospital, including 10 male and 16 female patients aged from 60 to 93 years (mean, 69.72 years). In these 26 patients, three had medial malleolus fractures, four had lateral malleolus fractures, six had double ankle fractures and 13 had cotton's fractures. According to the Lauge-Hansen type, all 26 patients can be classified into four types: 5 with supination external rotation type, 4 supination adduction type, 16 with pronation-external rotation type and 1 with pronation abduction type. All the patients received open reduction and internal fixation. Plate fixation was used for lateral and posterior malleolus fractures, plate fixation and cannulated screws were applied to fix the comminuted posterior malleolus fracture while in the comminuted internal malleolus fracture, the steel plate was used only when needed. Early professional functional rehabilitation training and active anti-osteoporosis treatment were applied. All the operation time and bleeding volume were recorded, and the reduction of fracture plus the healing of wounds were observed. At last follow-up, American Orthopedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Scale was used to evaluate the treatment effect and the Visual Analogue Scale (VAS)to evaluate the therapeutic effect and the subjective satisfaction of the patients. Complications were recorded as well. Results: All patients were followed up for 12-48 months (mean, 23.6 months). Operation time ranged from 30 to 95 minutes (mean, 70 minutes) and bleeding volume ranged from 10 to 150 ml (mean, 70 ml). All patients got satisfied reduction of fracture within 25 patients' incision healing in first intention, although one has fat liquefaction. AOFAS Ankle Hindfoot Scale improved from preoperative (84.4±10.8)points to (31.9±11.4)points at last follow-up (P<0.01), and the results were excellent in five patients, good in 17, fair in three and poor in one, with the excellent and good rate of 85%. VAS improved from preoperative(1.85±0.73)points to (9.23±0.28)points at last follow-up (P<0.01). Among 26 patients, 5 with ankle stiffness of different degree recovered after rehabilitation care, and 2 with internal malleolus fractures had bone displacement when receiving rehabilitation care, with no side effect on basic function. No serious complications such as wound infection or skin necrosis were found. Conclusion For osteoporotic ankle fractures in the elderly, open reduction and internal fixation can promote functional recovery and relieve pain.