Evidence-based medicine emphasizes making project of diagnosis and therapy on the basis of the most objective research results. The current condition in which domestic medicine is dominant in hepatobiliary surgery and teaching needs to be changed urgently. The procedure of application of evidence-based medicine in teaching of hepatobiliary surgery is explained by an actual example. Evidence-based medicine plays an important role in teaching and quick progress in all of the hepatobiliary surgery.

Objective To compare the effect of two different dialysis modalities, hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) on insulin resistance in patients with adult end-stage renal disease (ESRD), and to identify the possible predictive factors for insulin resistance. Methods Fifteen non-diabetic patients with ESRD (ESRD group) were selected. Eight patients were treated with HD (HD group), and 7 patients were treated with CAPD (CAPD group). The insulin inhibition was examined by hyper insulin-euglycemic glucose clamp technique before and after dialysis treatment, and the glucose disposal rate (GDR) was used as an index of insulin sensitivity during the clamp technique. Meanwhile, 8 healthy controls were selected as control group. The biochemical parameters which might be associated with insulin resistance were determined by multiple linear regression. Results The GDR in control group was (9.93 ± 1.33) mg/(kg · min), in ESRD group was (6.44 ± 1.76) mg/(kg·min), and there was statistical difference (P<0.05). The GDR in HD group after treatment was increased from (6.53 ± 1.84) mg/(kg · min) to (9.74 ± 2.88) mg/(kg · min), and there was statistical difference (P<0.01). The GDR in CAPD group after treatment was increased from (6.35 ± 1.65) mg/(kg·min) to (8.18 ± 1.76) mg/(kg·min), and there was statistical difference (P<0.05). Multiple linear regression result showed that the levels of urea nitrogen, hematocrit and bicarbonate were significant predictive factors in insulin resistance (P<0.05). Conclusions CAPD and HD therapy can improve insulin resistance in adult patients with ESRD.

Objective To compare clinical prognosis between intermittent high-volume predilution on-line hemofiltration (HF) and standard intermittent hemodialysis (HD) in critically ill patients with acute kidney injury (AKI).Methods This was a prospective,randomized,controlled single-centre clinical study.The mortality and recovery rate of kidney function were compared in critically ill adult patients with AKI between HF group (using intermittent high-volume predilution on-line HF,50 cases) and HD group (standard intermittent HD,45 cases).The prognosis of 60 d was followed up,including 60-day all-cause mortality,in-hospital all-cause mortality and recovery of kidney function.Results There were no statistical differences in basic clinical characteristics between 2 groups (P ＞ 0.05).The results of 60-day' follow-up showed,the mortality in HF group was 68.0％ (34/50),and in HD group was 82.2％ (37/45).There was statistical difference (risk ratio 0.75,95％ CI 0.80-1.28,P =0.036).There were no statistical differences in the in-hospital mortality and recovery rate of kidney function (P ＞ 0.05).There was no statistical difference in complication rate between 2 groups (P＞ 0.05).Conclusion The mortality is significantly lower in critically ill patients with AKI treated with intermittent high-volume predilution on-line HF,compared those treated with standard intermittent HD.

Objective To understand the current status of advanced schistosomiasis in Pukou District,Nanjing City,so as to provide the evidence for its appropriate treatment. Method An epidemiological investigation and medical examinations were carried out based on the national standard for the people who either had been already identified as advanced schistosomiasis or were new suspects. Results There were 55 cases of advanced schistosomiasis in Pukou District,2013. Among them,51 cases (92.73%)were splenomegaly type and 4 cases(7.27%)were ascites type. Fifty-three cases(96.36%)were clinically cured,1 case(1.82%)was in the stable condition and 1 case(1.82%)still needed further treatment. In terms of the age,the youngest was 49 years and the oldest was 86 years. The gender distribution was male accounting for 58.18%(32 cases)and female 41.82%(23 cases). Conclusion The condition of patients with advanced schistosomiasis in Pukou District,Nanjing City is complicated. The investigation and treatment to the patients should be conducted regularly.

Objective: To develop a headspace gas chromatography ( HS-GC ) assay for simultaneous determination of dichloroacetic acid ( DCA ) and trichloroacetic acid ( TCA ) in urine. Methods: Urine samples (5 mL) were transferred to a 22 mL headspace bottle, added with 0.5 mL 10% sodium acetate solution , immediately sealed, and shaken evenly. The bottle was placed in the HS-GC system, and equilibrated at 90 ℃ for 60 minutes. The mixture was separated with the HP-INNOWAX chromatographic column, and the DCA and TCA concentrations were detected with the hydrogen flame detector. Results: Under the optimal experimental conditions, the correlation coefficient of DCA and TAC was both > 0.999 0 within the range of 10-500.0 μg/L, and the lowest detection limits of DCA and TAC were 2.0 and 3.5 μg/L, with the spike recovery rate of 87.40% to 101.44%, and relative standard deviations of 1.89% to 3.25%. Of the 35 urine samples sampled from occupational populations, DCA and TCA were not detected. Conclusions The establishment of the HS-GAS assay through addition of sodium acetate and optimization of the headspace conditions, has high recovery and precision, which is effective to meet the requirements for daily determination of DCA and TCA in urine samples.

Background Small incision lenticule extraction (SMILE) is increasingly applied in the correction of myopia and astigmatism.However,the early clinical outcomes of SMILE for different refractive myopia and astigmatism is seldom reported.Objective This study was to investigate the safety,efficacy,predictability and early stability after SMILE in low,moderate and high myopia.Methods A series of cases-observational study was carried out.A total of 195 eyes of 108 myopic patients were enrolled in Tianjin Eye Hospital from May to December 2012 under the informed consent.The patients were divided into the low (≤-3.00 D),moderate (＞-3.00 to-6.00 D) and high myopia (＞-6.00 D) groups according to different diopters,with 57 eyes,76 eyes and 62 eyes,respectively.SMILE was performed on all the eyes.The uncorrected visual acuity (UCVA)(LogMAR),best corrected visual acuity (BCVA) (LogMAR),equivalent sphere (SE),intraocular pressure,anterior segment and corneal topography were examined before operation and 1 day,1 week,1 month and 3 months after operation to evaluate the effective index (postoperative UCVA/preoperative BCVA),safety index (postoperative BCVA/preoperative BCVA),predictability and early stability of SMILE.The linear regression analysis was used to analyze the relationships between the attempted refraction and the achieved refraction postoperative 3 months in three groups.Results The percentage of UCVA (LogMAR)＜0.1 was 100％,97.1％ and 92.8％ in the low,moderate and high myopia group,respectively in 3 months after SMILE.The postoperative BCVA of all the operated eyes reached preoperative one.The residual SE was (-0.07±0.16),(-0.05 ±0.20) and (-0.08±0.27)D in the low,moderate and high myopia group,respectively in 3 months after SMILE.The percentage of residual SE±0.5 D was 100％,98.7％ and 93.6％ in the low,moderate and high group,and that of SE±1.0 D was 100％ in all of the groups.The postoperative corrected SE was gradually increased with the raise of predicted SE in the low,moderate and high myopia groups (r=0.942,0.959,0.957,all at P＜0.001).Conclusions SMILE is safe,effective,predictable and stable for the correction of low,moderate and high myopia.The corneal wound healing was slightly slower in the low myopia group than that in the moderate and high group.A slight regression of myopic power appears in high myopia eyes 3 months after SMILE.

Background The relationship between corneal central thickness (CCT) and corneal biomechanical property does not reflect the effective amount of ablated tissue because CCT measures only the change in a single point.Corneal volume (CV) is a representative parameter of corneal morphology,and it can fully reflect corneal thickness and tissue distribution.Objective This study was to investigate the correlation between volumetric corneal changes and corneal biomechanical properties after small incision lenticule extraction (SMILE).Methods A prospective series cases-observational study was carried out.This study protocol was approved by Ethic Committee of Tianjin Eye Hospital,and written informed consent was obtained from each patient prior to entering the cohort.Sixty-seven right eyes of 67 myopia or myopic astigmatism patients who received SMILE in Tianjin Eye Hospital from June 2014 to July 2015 were included in this study.Before and 3 months after surgery,the CV at 3,3-5,5-7 and 7-10 mm (CV3,CV3-5,CV5-7,CV7-10) was measured by Pentacam anterior segment analysis system,and corneal hysteresis (CH) and corneal resistance factor (CRF) were obtained by ocular response analyzer (ORA).The changes of CV (ACV),CH (ACH) and CRF (ACRF) were calculated,and the correlations between ACV and ACH or ACRF were analyzed.Results CV3,CV3-5 and CV5-7 values after SMILE were significantly lower than those before SMILE (t =36.24,20.38,16.17,all at P＜ 0.001).The CH values before and after SMILE were (10.06± 1.11) mmHg and (8.10± 1.05) mmHg (1 mmHg =0.133 kPa),and the CRF values before and after SMILE were (10.40 ± 1.38) mmHg and (6.91 ± 1.19) mmHg,respectively,showing significant reduces after SMILE than before SMILE (t =16.71,27.41,both at P＜0.001).Positive correlations were seen between the CV values at different corneal areas and CH value or CRF value.Moderate positive correlations were found between CV3 and CH or CRF (r =0.571,0.569;both at P＜0.001) before surgery,and 3 months after surgery,a weak positive correlation was seen between ACV3 and ACH (r =0.394,P ＜ 0.001) or a moderate positive correlation between ACV3 and ACRF (r=0.501,P＜0.001).Conclusions The CV value is gradually increased from the central cornea to periphery cornea.The CV change is associated with CH and CRF changes after SMILE,and CV3 probably is a useful parameter for the evaluation of corneal biomechanics after refractive surgery.

C.citratus has been usedin many countries with a long history.Traditionally,it is applied as a food seasoning in cooking.It is also used in tea beverage and folk medicine as well.Modern application of C.citratus is focused on the development of citronella oil,which can be used for food additives,disinfectants,cosmetics,drugs and etc.C.citratus is also a potential plant in landscaping.Its special lemony flavor contains chemical constituents,mainly including citral,myrcene,linalool,geraniol,nerol,citronellol,and etc.The modern research showed that C.citratus had the main effects of anti-microbial,anti-inflammation,analgesia,anti-oxidation,anti-tumor,anti-anxiety,anti-hypertension,antihyperglycemia,and etc.With further studies,some new pharmacological properties of C.citrates are going to be discovered gradually.It is worthy of further research and development to meet the needs of the health industry.

Objective To evalutate the safty of hBMSCs transpalntation and to observe their migration and distribution in the brain of young macaca fascicularis. To establish a new technology platform and theoretical basis for the treatment of central nervous system diseases in children. Methods Labelled hBMSCs were transplanted into the striatum of young macaca fascicularis. Brain sections were examined to evalutate the inflammatory reaction and immunological rejection of local injection sites by HE observation and immunohistochemical staining. Migration and distribution of transplanted?hBMSCs was observed by real?time fluorescence quantitative PCR of male DNA and fluorescence microscope. Results The results showed that the direct intracerebral injection of hBMSCs did not cause systemic symptoms in animals. There is no inflammatory reaction and immunological rejection was detected, and degeneration and necrosis of neural cells and proliferation of glial cells were absent in the local injection sites. The transplanted hBMSCs survived, and migrated into the brain after 4 weeks transplantation. Its migration and distribution have certain regularity and were overlapping between transplant recipients. In addtion, hBMSCs tended to extend rostrally into the forebrain and showed preference of migrating toward the blood vessels and below the ependyma. Conculsions Intracerebral transplantation of hBMSCs is safe. And hBMSCs can survive and migrate into the brain.

Objective To select the components for quality control of Fructus Lycii based on the absorption of its extract. Methods To investigate metabolism of components of Fructus Lycii, everted rat gut sacs was carried out as well as the blood was taken from abdominal aorta,.and all samples were analysised by HPLC. Results There are twelve constituents absorbed between ileum and jejunum of rat , and four constituents were detected in the blood. Compound 2, 3, 4, 5, 6, 9, 10, 11 were absorbed in prototype forms in the intestine directly,and compound 1, 7, 8, 12 were new ones. On the other hand, four compositions(3, 7, 10, 13)could be absorbed into blood through analysis serum samples obtaining from aorta abdominalis of rats. Two of them (3, 10)could be absorbed directly by intestine, while(7)was absorbed into blood in new form . Conclusion Based on the intestinal absorption experiment and analysion of compsition in blood, components (3, 10, 13) can be the quality control ingredients of Fructus Lycii.