Molecular targeted therapy has become a new hot spot with the in -depth basic research on advanced biliary tract cancer (ABTC).Phase ⅡandⅢtrials of the molecular targeted therapies for ABTC are summarized to provide new insights into clinical practice. Phase II trials have shown that vascular endothelial growth factor receptor inhibitor and mitogen-activated protein kinase inhibitor do not ex-hibit good anti-tumor activity,but epidermal growth factor receptor (EGFR)inhibitor has proven to be safe and effective in the treatment of ABTC.The only multicenter,open-label,randomized,controlled phase Ⅲ trial has shown that nilotinib combined with gemcitabine and oxaliplatin,as the first-line chemotherapy for ABTC,cannot significantly increase the overall survival in patients.Subgroup analysis has shown that standard chemotherapy combined with nilotinib can significantly increase the progression-free survival in patients.These results indicate that EGFR inhibitor is effective to control the progression of ABTC,suggesting that EGFR might be a novel therapeutic target.

Dry eye is a common, highly prevalent and multifactorial ocular disease.Severe dry eye not only has a serious impact on the patient's work performance and quality of life, but also increases the risk of other ocular disease complications.Due to its complex pathogenesis and prolonged treatment cycle, dry eye has become an important social and public health problem.Traditional dry eye drugs can usually alleviate, but not completely eliminate, the symptoms of dry eye, and are far from meeting current clinical demands.Newly marketed domestic and foreign anti-inflammatory drugs that inhibit T cell function as well as drugs that promote tear secretion represent, to some extent, the rapid progress of dry eye drug research.Even so, the overall state of clinical dry eye management has not been significantly improved.Dry eye treatment still faces great challenges; a huge gap exists between clinical needs and the development of new drugs.Insightful research on the pathogenesis of dry eye is the basis for identifying new pharmatheutical targets.Progress in the research and development of dry eye drugs brings about new options for treatment strategies.Ophthalmologists should keep updated to the research progress in dry eye and to the mechanism of actions of new drugs in order to better serve dry eye patients.

Objective To observe the effect of kindred-like nursing on coma after severe craniocerebral trauma. Methods 48 cases of sereve craniocerebral trauma were divided into two groups: the control group (n=24) who accepted routine nursing, and the observation group (n=24) who accepted the kindred-like nursing in addition. Results More patients revived in the observation group than in the control group (P<0.05) 14 and 28 d after admission. Conclusion Kindred-like nursing can facilitate the reviving from coma after severe craniocerebral trauma.

Objective To evaluate CT and MRI findings of portal vein aneurysm(PVA)in order to improve its diagnostic accuracy.Methods CT and MRI findings of 9 patients with PVA proved by pathology and direct angiography were reviewed retrospectively.CT scanning was performed in 7 patients,including plain scan (n=2),both plain and enhanced scan (n=5),CT angiography (CTA)(n=3).Plain and enhanced MRI scan were performed in 3 patients.Results (1 )PVA showed a high predilection for old adults.(2 )Of the 9 tumors,4 located in portal vein trunk,2 located in junction of superior mesenteric vein and portal vein trunk,1 located in intrahepat-ic-extrahepatic portal vein,2 located in intra-hepatic portal vein.(3)8 tumors were characterized as well-defined and quasi-circular mass.1 patient occurred portal hypertension,thrombus as the portal vein trunk was oppressed by the tumor.(4)Plain CT showed the mass was slightly higher than pancreas parenchyma density,and uniform with the density of the liver parenchyma.Enhancement scanning showed 4 tumors represented mild or moderate enhancement in portal venous phase except for 1 patient accompany with portal vein thrombus.CTA showed clearly the relationship mass with portal vein,and classified the type of PVA .The 3 lesions represented hypo-intensity on T1 WI and even hyper-intensity on T2 WI.Enhancement scanning showed the tumor was significantly enhancement in portal venous phase on T1 WI.Conclusion CT and MRI have their own advantages in the diagnosis of portal vein aneurysm.Com-bination of CT and MRI could improve the diagnostic accuracy of portal vein aneurysm.

Objective To study one simple, safe and effective method of periorbital rhytidectomy. Methods With turgescent anesthesia, 1 cm -extent was dissected laterally deep under musculus orbicularis oculi at the approach of eyebrow area. The musculus orbicularis oculi was fixed to the deep temporal fascia and frontal periosteum. The superciliary corrugator muscle and depressor muscle were exposured and cut. Then the eyelid blepharoalasty was performed through the skin incision, meanwhile the lateral pars orbitalis muscle was liberated to form an orbitalis muscle flap under the orbitalis muscle and the fat pad, which was fixed to the os orbitale periost by lifting tight to lateral and upper side. For patients with generous pars buccalis and obvious nose lip ditch, the cheekbone fat cushion was also hanged and fixed. Results 65 middle age female patients were followed up for 3～16 months. The scar was no obvious, glabellar wrinkle and canthal wrinkle disappeared at static state, relaxed upper eyelid and eyebrow prolapse reached to complete correct, nasolabial groove wrinkle obvious lessened. 95 % patients were satisfacted with the appearance. Conjunctival edema was found in 4 cases, and disappeared within 1 months. There were no facial nerve injury and other complications. Conclusions It is a new incisional approach that avoids the facial nerves and lessens fossa orbitalis retrogradation. The operative procedure is simple and safe, and its incision is occult. The wound is small and restores rapidly, but the effect is reliable and lasting. It proves to be an ideal approach for face rejuvenation.

Objective To investigate the methods and effects of anterolateral thigh flap reconstruction of the complicated hip decubitus.Methods The study contained 24 cases of grade Ⅳ hip decubitus reconstructed with anterograde pedicled anterolateral thigh flaps through May 2010 to July 2014.There were 13 males and 11 females,aged 26-64 years (mean 54 years).Defects ranged in size from 12 cm×6 cm to 24 cm× 12 cm.Dimensions of flaps harvested were 14 cm ×8 cm to 30 cm× 14 cm.Eighteen cases of the donor sites were directly sutured and six covered with full thickness skin.Results Twenty-two flaps survived completely,and wound was healed by the first intension.Two flaps developed partial distal necrosis,and wound was healed after dressing treatment.Period of follow-up was 6 months to 2 years.Shape,texture and color of the flaps were well matched with the recipient area.Conclusion The anterolateral thigh flap transplantation has advantages of similarity to the recipient area,large enough flap area and sound expected effective and is a good method for repair of hip decubitus.

Objective To analyze the risk factors of 30-day mortality in patients with malignant hilar obstruction (MHO) after percutaneous transhepatic biliary metal stent deployment. Methods One hundred and fifty-nine consecutive patients with MHO caused by cholangiocarcinoma or gallbladder carcinoma were enrolled in this study. Percutaneous transhepatic biliary stent (PTBS) implantation was carried out in all the patients. Independent predictors for 30-day mortality were evaluated by logistic regression analysis. Covariates that were incorporated into the multivariate analysis were the variables that reached statistical significance (P < 0.1) in univariate analysis. Two-tailed, P value of less than 0.05 was considered to be statistically significant. Results The 30-day mortality of patient with MHO after metal stent deployment was 9.4%. Univariate analysis indicated that the differences in WBC (OR = 1.224.95%CI [1.07 - 1.44], P < 0.01), INR (OR=78.75, 95%CI [5.02-1 235.70], P<0.01), PT(OR=1.55, 95%CI [1.18-2.04], P<0.01), BUN (OR=1.19, 95%CI [1.02- 1.38], P < 0.05), CRE(OR = 1.02, 95%CI [1.000 - 1.041], P < 0.1) and lymph nodes metastasis(OR = 0.334. 95%CI[0.105 - 1.131], P < 0.1) were statistically significantly between 30-day mortality group and non-30-day mortality group. Multivariate analysis showed that statistically significant differences in WBC (OR = 1.19, 95%CI[1.026 - 1.380], P < 0.05), INR(OR = 151.5, 95%CI [3.13 - 5 440.7], P < 0.05) and CRE (OR = 1.025, 95%CI [1.002 - 1.048], P < 0.05) also existed palliative treatment for patients with malignant hilar obstruction. Active preoperative measures to improve hepatic and renal functions as well as to control infection are necessary in order to reduce 30-day mortality.

Since intra-arterial chemotherapy with the help of implantation of port-catheter system (PCS) was first used in the surgical field in 1981, PCS has been widely employed in the field of interventional radiology. Intra-arterial chemotherapy by implantation of PCS has some certain advantages such as minimal invasion, no need of general anesthesia, etc. Ten randomized clinic trails have been already reported, which indicate that intra- arterial chemotherapy with PCS is obviously superior to systemic chemotherapy in treating hepatic metastasis form colorectal cancer. As for the treatment of advanced biliary tract cancer, pancreatic carcinoma and hepatocellular carcinoma, the relevant reports can be found only in several phaseⅠ/Ⅱclinical trials or in some retrospective cohort studies. This paper aims to make a comprehensive review about the indications, clinical applications and complications of PCS in treating abdominal tumors in order to improve the clinical practice.

Objective To summarize and investigate the lethal factor of acute obstructive suppurative cholangitis (AOSC).Methods The clinical data of 56 patients with AOSC were retrospectively analyzed.Results Six cases died,5 cases with acidosis,5 cases with thrombocytopenia and 5 cases with temperature change obviously,4 cases with heart,lung and kidney disease or diabetes,5 cases with operation and operation time ≥ 150 min,5 cases with from onset to treatment time ≥72 h.Eighteen cases of elderly patients ≥70 years old,4 cases died.The patients whose age≥70 years,temperature ≥39 ℃ or ＜ 36 ℃,combined with acidosis,platelet counts ≤6.0 × 1012/L,with heart,lung,kidney diease or diabetes,time of anesthesia and operation ≥ 150 min and from onset to treatment time ≥72 h had higher death rate (P ＜ 0.05).Conclusion Age,obvious temperature abnormalities,significantly platelet decrease,with heart,lung,kidney diease or diabetes,acidosis,long time of anesthesia and operation and from onset to treatment time ≥ 72 h are the lethal factor of AOSC.

Background Using tablet computer at a short distance is one of the risk factors resulting to pathogenesis and progression of myopia.Studying the effect of such device on accommodative system of human eyes can provide further insights into myopia control.Objective This study was to explore the influences of playing iPAD game for a short duration on accommodative response,accommodative microfluctuation and pupil diameter in adolescent myopia patients.Methods Sixty adolescent myopic patients were included in Peking University People 's Hospital from August 2014 to April 2015,with the mean age (11.6±2.6) years and mean spherical equivalent refraction (SER) (-2.38±1.08)D.The patients were randomly divided into 3 groups according to different playing duration of iPAD game,including 3-minute group,5-minute group and 10-minute group.An open-field infrared refractometer was used to record pupil diameter and accommodation-associated data before and after playing iPAD game.Accommodative response was defined as the difference between the recorded value and theoretical accommodative response,and root mean square (RMS) was used to describe the amplitude of accommodative microfluctuation.One-dimension discrete Fourier transformation was used to analyze spectral characteristic of accommodative response curve.Paired t tests were used to compare these accommodative parameters before and after playing game,while Wilcoxon signed-rank tests were applied for analyzing high frequency component of accommodative microfluctuation.This research conforms to the declaration of Helsinki,and was approved by Peking University People's Hospital Ethics Committee,all the subjects and their guardian signed informed consent.Results The accommodative response values before and after playing iPAD game in 10-minute group were (0.81 ±0.29)D and (0.74 ± 0.27) D,respectively,with significant difference between them (t =2.263,P =0.036),and no significant differences were found in the accommodative response values before and after playing iPAD game in the 3-minute group and 5-minute group (both at P＞0.05).The RMS after playing iPAD game was (0.31 ±0.08) D in the 10-minute group,which was significantly higher than (0.27 ± 0.09) D before playing iPAD game (t =-2.259,P =0.036).The high-frequency spectral power of accommodative response curves in all the three groups were increased after playing iPAD game in comparison with before playing iPAD game,with significant differences in the 5-minute group and 10-minute group (Z =-2.213,-2.016;both at P ＜ 0.05),and the pupil diameters were significantly decreased after playing iPAD game in comparison with before playing iPAD game,with significant differences in the 5-minute group and 10-minute group (t =2.428,P =0.026;t =2.515,P =0.021).Conclusions Short-term exposure to iPAD does not deteriorate accommodative lag in adolescent myopic patients.However,the increase of amplitude and high-frequency spectral power of accommodative microfluctuation,together with accommodation lag will result in blurred images and may bring adverse effects on myopic eyes.