Advances in ophthalmic surgery,together with achieving greater patient safety,have changed the requirements,methods and choice of regional anaesthesia of the eyes.So far,there still lacks of an absolutely safe ophthalmic regional block method,and the intraoperative anesthesia method depends on the needs of the surgeon and the expectations and the cooperation of the patients.The majority of ophthalmic procedures can be performed under regional anesthesia,but the proximity of important structures,such as the blood vessels,optic nerve and the brainstem,leads to increased risks associated with these blocks.The most serious one of these complications is brainstem anesthesia.An clear and full understanding of these complications,which may sometimes be life-threatening,is thus vital to the anesthesia practitioner.Procedural improvements include a close evaluation of the precise anatomy of the region,with particular attention to injection sites,depth of injection,position of the eyeball,and techniques to avoid nerve damage and accidental injection into surrounding structures,including blood vessels,eyeball and cerebrospinal fluid.To emphasize the importance of the prevention,recognition and management of these complications,which includes the extremely serious complication of brainstem anesthesia.

Objective To assess the effective of helicobacter pylori in gallbladder malignant disease ,cholelithiasis ,cholecysti‐tis .Methods The literature about helicobacter pylori and gallbladder disease were collected in EMbase ,Pubmed ,VIP and CBM from inception to May ,2015 .Two reviewers independently screened the literature according to the inclusion and exclusion criteria , extracted the data ,and assessed the quality ,and then the meta‐analysis were performed by using Stata11 software .Results A total of 24 case control study were included .The results of meta‐analysis showed that ,helicobacter pylori had a higher incidence rate in gallbladder maliganant disease and cholelithiasis(OR=5 .31 ,95% CI:2 .34 -12 .05 ,P= 0 .000)and (OR=1 .84 ,95% CI:1 .13-2 .98 ,P=0 .014) compared with control group .Also it have influence on cholecystitis (OR= 9 .92 ,95% CI:4 .04 -24 .39 ,P=0 .000) .Conclusion Helicobacter pylori is a risk factor of inducing cholelithiasis and gallbladder malignancy disease ,cholecystitis .

Objective To explore the application of ultrasound-guided femoral and sciatic nerve blocks combined with general anesthesia in lower limb fracture surgery.Methods Sixty four patients who received orthopaedics surgerywere randomly divided into two groups including combined group(n =32),control group (n =32).Control group was given general anesthesia alone,combined group was givengeneral anesthesia combined with ultrasound-guided femoral and sciatic nerve blocks.The intraoperative hemodynamic state at different time,anesthetic dosage,and agitation after waking upbetween two groups were compared.Results Compared with T1 moment,HR and MAP at T2 moment in both groups were significantly decreased (P ＜ 0.05),while all these indicators at T3-T5 moment had no significant difference compared with the T1 moment in combined group (P ＞ 0.05),while the difference was significant in control group (P ＜ 0.05).Compared with control group,combined group had less intraoperative propofoland fentanyl dosage during the surgery,shorter awakening timeand extubation time,and the difference had statistical significance (P ＜ 0.05).The incidence of agitation after waking up and degree of agitation was significantly decreased in combined group than that in control group (P ＜ 0.05).Conclusion Ultrasound-guided nerve blockade combined with general anesthesia for lower limb fracture surgery,canmaintain the stability of intraoperative hemodynamics,reduce the dosage of analgesic drugs,and promote early awakening and extubation.

Objective To compare the predictive power of model for end-stage liver disease(MELD) and Child-Turcotte-Pugh(CTP) on the cirrhotic patients who underwent transjugular intrahepatic portosystemic shunt(TIPS).Methods A total of 110 patients(98 males and 12 females) undergoing TIPS from January 2004 to March 2008 in our hospital were analyzed.Data of all patients were analyzed retrospectively.The main statistical tests included: Kaplan-Merier analysis to compare survival respectively,and the area of receiver operating characteristics(ROC) to compare the performance of the 2 models for predicting 3-month,1-year,and 2-year mortality.Results The survival rate rate of the patients whose MELD score under 15 showed significantly higher than the patients above MELD score 15.The area of ROC that predicting survival was 0.866 and 0.863 at 3 months,0.755 and 0.739 at 1-year,0.729 and 0.750 at 2-years respectively for the MELD and the CTP score.Conclusion Both MELD and CTP score can predict short-term survival accuracy,but poor in long-term.However,the MELD has overcome the shortcomings of CTP,and may be worth using in clinical.

Objective To study the growth inhibition of human hepatoma cells tranfected with type Ⅱ insulin like growth factor receptor (IGF ⅡR) antisense gene. Methods We constructed the recombinant eucaryotic expression plasmids of IGF ⅡR sense and antisense genes, which were transfected into SMMC 7721 human hepatoma cell line using calcium phosphate coprecipitation, and selected in DMEM supplemented with 500 ?g/ml G418(Geneticin) for 2～3 weeks. Then the total number of colonies formed was counted. The effect of IGF ⅡR antisense gene transfection on endogenous IGF ⅡR mRNA levels was examined by Northern blot, and the growth rate and the ability of the transfected cells to form colonies in soft agar medium were also examined. Results The hepatoma cells transfected with IGF ⅡR antisense gene exhibited significant reduction in endogenous IGF ⅡR messenger RNA(mRNA) levels and loss of their ability for anchorage independent growth in soft agar. The IGF ⅡR antisense gene supressed the formation of colonies of SMMC 7721 cells resistant to G418 without alteration on cell growth curve. Conclusion The IGF ⅡR antisense gene expression effectively blocks IGF Ⅱ to IGF ⅡR autocrine and/or paracrine signal transduction pathway and reverses certain aspects of the cell malignant phenotype.

Objective To investigate the effect of IVIG on pre-existing anti-HLA-A2 Ab levels and graft skin survival.Methods C57BL/6 wild type mice were sensitized to HLA-A2 by intraperitoneal injec-tion (IP) of HLA-A2 TgN mouse spleen cells (C57BL/6-TgN [HLA-2.1]1Enge SC) expressing human HLA-A2 at day 0, week 3 and 4.Sensitized mice were respectively treated with human IVIG , albumin, gly-cine, or PBS for 5 days during week 7.Skin transplantation from TgN mice to C57BL/6 wild type mice was performed at week 10 .Efficacy of IVIG DES was assessed by measuring anti-HLA Ab levels by ELISA pre-/post-Rx and graft skin survival was monitored daily post-Tx.Results Changes of HLA-A2-IgG levels:IgG HLA-A2 class I Ab levels in all groups predictably increased from baseline following spleen cell IP and peaked at week 4 ( P <0.01 ) , indicating sensitization .IVIG-treated mice showed significantly lower IgG Ab levels vs.albumin, glycine and PBS-treated at week 9 post-desensitization ( P <0.01).IgG quickly increased to extremely high levels in all groups following skin transplantation ( P <0.01 ) .Graft skin sur-vival between Rx-groups were similar with all rejecting at about 7 days post-transplantation ( P >0.05 ) . Conclusion However, IVIG alone does not inhibit anti-HLA class I Ab production after skin transplanta-tion or prolong SG survival , indicating combination of IVIG with other immunosuppressant or more optimal protocol for desensitization might show more efficacy and should be under explored .

Objective primary hospitals at the county level in xiaogan City 17 years for the production of scientific papers in qualitative and quantitative statistical analysis,summary of research progress and existing problems in county hospitals,and provides references for research management in local hospitals.Methods Wanfang medicine network included in 1998-2014 year published Xiaogan city 7 county hospital as the object;All biomedical scientific papers published as the first author to statistical analysis.Results 7 County Hospital of xiaogan City 17-year total output articles 1909,General journals 1273articles(66.68％ per cent),Core journal 636 papers (33.31％ per cent).Hanchuan city people's Hospital total the largest number of papers;total 544 articles (28.50％ total),yingcheng hospital quality highest core journal papers and the highest proportion;total 186 (proportion of the total core thesis 29.25 ％),minimum quantity and quality of outputs anlu city people's Hospital,only 15 articles in periodicals of General The core journals and 2 papers (0.89％ of the total number of accounts for the paper,core paper accounted for 0.31％ of the total).On the whole 2006-2009 published papers began to gradually slow growth,The number 2010-2014 entered the stage of rapid growth,but the core papers for slow growth.Conclusions xiaogan city grass-roots scientific articles in recent years in county hospitals are generally presented a trend of rapid growth,but the quality of growth is relatively slow,output quantity and quality distribution imbalances between hospitals.

Objective To detect nucleos(t)ide-resistance mutations in hepatitis B virus (HBV) covalently closed circular DNA (cccDNA) isolated from hepatocytes of patients with chronic HBV infection and to analyze the correlation between the mutations found in cccDNA and relaxed circular DNA (rcDNA). MethodsForty patients with chronic HBV infection were investigated. Preoperation serum samples and non-tumor liver tissues were collected.Intrahepatic HBV cccDNA and rcDNA were selectively extracted by co-precipitation of sodium dodecyl sulphate-protein and QIAamp DNA Mini Kit, and further purification with plasmid-safe ATP-dependent DNase (PSAD).Thereafter,cccDNA were amplified by selective polymerase chain reaction (PCR) or nested PCR using the primers spanning both the two gaps in HBV genome and covering the common mutations associated with nucleoside analogues resistance (rt169- rt250).Intrahepatic HBV rcDNA and pre-operation serum HBV rcDNA were also extracted and then amplified by PCR.The PCR products were then purified and sequenced.Results Among the 40 patients,intrahepatic HBV cccDNA were detected in 31 patients,and HBV rcDNA were detected in liver samples of 35 patients and pre-operation serum samples of 21 patients. The PCR products amplified from these samples were all successfully sequenced.rtM204Ⅰ mutation was detected in intracellular HBV cccDNA,rcDNA and serum HBV rcDNA in 2 patients.Both rtM204Ⅰ and rtQ215H were detected in intrahepatic HBV cccDNA and rcDNA in 2 patients,while no corresponding mutation was observed in serum HBV rcDNA of these two patients.Three variants including rtM204V,rtM204V and rtV173L-rtL180M-rtM204V were detected in serum HBV rcDNA in 3 patients,while corresponding mutants were not detected in intracellular HBV cccDNA or rcDNA of these patients.Condsions The results suggest that antiviral nucleos(t) ide resistance mutations can be found in HBV cccDNA in chronic hepatitis B patients. The dominant resistant mutation found in intrahepatic HBV cccDNA/rcDNA may be different from that in serum HBV rcDNA.

Advanced studying doctors play important roles in the clinical services, and how to train them to improve training quality is worth investigating. We classified them into three types such as the clinical skills-improved, the special skills-trained and clinical knowledge eextensively-spread, then employed the individual teaching methods and emphasized the medical ethics during the training, which is not only beneficial to us, but also of great importance and necessity to advanced studying doctors themselves.

Objective To explore the role of TRAIL receptors expression on peripheral blood mononuclear cell (PBMC) in the apoptosis of PBMC,and the relation of the expression of TRAIL receptors with the severity of liver damage in chronic hepatitis B patients.Methods The expressions of DR4,DRS,DcR1 and DcR2 in 55 patients and 30 cases of control were assayed by RT-RCR and floweytometery.The relationship of the expression of TRAIL receptors with the severity of liver damage were analized.Results The level of DcR1 in the PBMC of chronic hepatitis B patients was much lower than that of control group (P＜0.05).There was close relation between the expression of DcR1 and liver damage (P＜0.05).The level of DcR1 was negatively correlated with ALT but positively correlated with serum albumin.Conclusion The expression level of DcR1 on PBMC in chronic hepatitis B patients was down-regulated,which may contribute to the increased apoptosis of PBMC in chronic B hepatitis patients.The expression of DcR1 can reflect the degree of liver injury in chronic hepatitis B patients to some degree.