Thinning and atrophy of sclerotic tissues play an important role in the development of high myopia. High myopic eyes had the thickest sclera at the posterior pole and the thinnest sclera at the equator. Most clinical studies found that scleral thickness was negatively correlative with the axial length. Patients complicated with posterior staphyloma had even thinner sclera, and its height was negatively related with the scleral thickness. At present, the main measurement methods for scleral thickness of high myopic eyes include histological measurement, enhanced depth imaging optical coherence tomography (OCT), and swept-source OCT. Following the development of OCT technique, it gradually becomes feasible to carry out studies on sclera thickness in mildly and moderately myopic populations, which is helpful to illuminate the mechanism of action of sclera on the onset and progression of high myopia.

Objective To summarize the experience of the diagnosis and treatment of mass-type chronic pancreatitis(MTCP) to improve the knowledge about MTCP. Methods The clinical data of tweent-five patients with MTCP undergoing operation in recent 8 years were analyzed retrospectively. The positive discovery rates with computed tomography(CT),ultrasonography(US),endoscopic retrograde cholangiopancreatography(ERCP),and endoscopic ultrasonography(EUS) were 95.7%,85.7%,83.3%,and 100%,respectively. All patients received operation,including pancreatoduodenectomy(15 cases),pancreatoduodenectomy with reservation of pylorus(2 cases),Beger′s procedure(1 case),Frey′s procedure(3 cases),and resection of pancreatic body and tail(4 cases). Results Upper quadrant abdominal pain is the main symptom of MTCP. Pancreatic masses were located in the head of pancreas in 21 cases(84.0%),in the body or tail in four cases(16.0%). 16 patients were diagnosed as MTCP and 9 diagnosed as pancreatic adenocarcinoma before operation. 22 patients were diagnosed as MTCP and 3 were diagnosed as chronic pancreatitis complicated with adenocarcinoma by pathology after operation.Preoperative misdiagnosis rate was 24.0%. Pain relieved immediately after operation in 92.0% of patients. One patients developed pancreatic leakage and two had anastomotic hemorrhage postoperatively,morbidity rate was 12.0%. 23 patients were followed-up for 1-5 years (mean 3.4 years). The therapeutic outcome was satisfactory in 82.6% of patients. Conclusions Operation should be performed as early as possible when the MTCP is diagnosed. It is effective to delay the progress of the disease.

Objective To explore the clinical characteristics of periampullary carcinoma in the prejaundice stage and improve early diagnosis rate and operative effects.Methods Clinical data of 27 cases with periampullary carcinoma in the prejaundice stage in our institute during the period of Jan 1998 to Dec 2005were analyzed retrospectively.Results The clinical symptom was mostly nonspecific, mainly included abdominal discomfort ( 92.6% ), abdominal pain ( 55.6% ), and irregular fever ( 29.6% ).The positive diagnosis rate with US, CT, MRCP, ERCP and EUS was 75.6%, 85.2%, 83.3%, 84.6%, and 88.9%,respectively, and they were helpful for early diagnosis.Among these 27 patients, 19 cases received regional pancreaticoduodenectomy, and 5 cases received pancreaticoduodenectomy in combination with vessel resection,3 cases received bile duct or gallbladder jejunal Roux-en-Y anastomosis, the overall resection rate was 88.9% with no operative mortality, and the post-operation complication rate was 7.4%.The 1,3, and 5 year survival rates were 100%, 70.8% and 41.7%, respectively.Conclusions The periampullary carcinoma in the prejaundice stage has its own clinical characteristics and abnormal image changes.If the diagnosis can be confirmed in the prejaundice stage, it is still an important method to improve the resection rate and prognosis.

Background Measurement of corneal thickness is important for the early diagnosis and treatment of some eye disorders,including corneal diseases and refractive errors.However,the corneal parameters from schoolage population are rarely reported.Objective The aim of this survey was to characterize the central corneal thickness (CCT),minimum corneal thickness (MCT) and paracentral corneal thickness in healthy Chinese schoolage population.Methods A cross-sectional study was designed in this study.Children aged 7 to 15 years with the diopter of-3.00 D to +3.00 D were recruited from two primary schools in Baoshan district in Shanghai based on random cluster sampling under the approval of Shanghai First People's Hospital and informed consent of child custodian.Routine examinations were firstly performed to determine the healthy participants.CCT (within 2 mm range away the corneal vertex),MCT and paracentral corneal thicknesses (2 to 5 mm zone away the cornea vertex in superior,inferior,nasal and temporal quadrants) were then measured by RTVue Fourier optical coherence tomography (OCT) for the comparison between both eyes and different gender.The subjects were grouped into the 7-9,10-12 and 13-15 years groups,and the correlations between age and CCT,MCT and paracental corneal thicknesses were analyzed.The coordinate position of the thinnest cornea was determined.Results A total of 147 children were enrolled in the study.The mean CCT value of the right eyes was (537.77±29.33) μm,and that of the left eyes was (539.22±29.16) μm,showing a significant difference between them (t =-3.21,P =0.00).The paracentral corneal thicknesses of the right and left eyes were (565.52±30.11) μm and (568.42±31.07) pm in the superior quadrant,and those in the temporal quadrant were (549.01 ±30.46) μm and (547.24±30.23) μm,with significant differences between them (t =-2.47,P =0.01 ; t =2.12,P =0.04).No significant difference was found in the CCT,MCT,paracentral corneal thicknesses from various quadrants (all at P＞0.05).In addition,no considerably correlation was seen between age and CCT,MCT and paracentral corneal thickness (all at P＞0.05).The thinnest cornea area was located in the inferotemporal region in 40.82％ right eyes and 57.82％ left eyes.The distance of thinnest cornea area away corneal vertex was (0.62±0.33)mm in the right eyes and (0.91±0.63)mm in the left eyes,with a significant difference between them (t =-5.17,P =0.00).Conclusions The central,superior and temporal corneal thicknesses are significantly different between the right and the left eyes among healthy Chinese school-age children,but corneal thickness change is not associated with age or gender.The thinnest corneal area does not locate at the vertex.

0.05). Low shear stress and high shear stress of BRV in GC control group were (20.32?5.42)mPa?s and(7.96?3.16)mPa?s, respectively;those in GC LMWH group were (11.42?5.03)mPa?s and (3.96?3.07)mPa?s,respectively after operatin. Low shear stress and high shear stress of BRV were (21.82?6.17)mPa?s and ( 8.62 ?3.48) mPa?s,respectively in PC control group;those in PC LMWH group were (13.11?5.17)mPa?s and (4.96?3.61)mPa?s. After operation,there were no hemorrhagic complications in GC and PC LMWH groups. Conclusions Low shear stress and high shear stress of BRV rise generally seeing in GC and PC patients after operation,and in PC patients are higer than those in GC patients. The use of Low molecular weight heparin could reduce the occurrence of thrmbosis.

Objective To improve the prognosis and radical resection of the extended pancreaticoduodenectomy for patients with pancreatic cancer in the ucinate process involving mesentery mot. Methods From Jan. 2004 to Dec. 2007, a total of 23 ( 14 male and 9 female, aged between 30 and 72 years old) patients with pancreatic cancer in the ucinate process involving mesentery root were treated in our department. Curative resection was performed for all patients by the extended pancreaticoduodenectomy with superior mesenteric artery (SMA) isolation and mesentery root resection. The surgical procedure, the safety and prognosis were analyzed retrospectively. Results 12 patients underwent the procedure, among them 11 also underwent combined SMV partial resection and reconstruction. The operation time was (4.2 ± 1.1 ) hours, and the blood loss was ( 1 635 ± 1 362) ml with the blood transfusion of ( 1 609 ± 1 462 ) ml. There was no operation related death in this case series, and mild to severe diarrhea occurred in 6 cases. The post-operative stay ranged 9 to 30 days. The pathological examination showed that the tumor size was (5.3 ± 1.4) cm. 13 patients (57%) had one or more lymph nodes metastasis. 20 patients (87%) had nerve involvement. Among 11 patients with SMV partial resection and reconstruction, 10 patients had endangium involvement. 22 patients had negative surgical margins for all specimens. Rapid intra-operative frozen pathological examination showed negative surgical margins in one patient, however, post-operative paraffin section pathological examination revealed nerve involvement between SMA and celiac trunk. After a follow-up of 5 to 42 months, liver metastasis occurred in 4 patients, and local recurrence occurred in 3 patients. The 1-year and 2-year accumulated survival rates were 77.2% and 42.5%, respectively. Conclusions Isolation SMA and the mesentery resection in extended pancreaticodudenectomy were safe and useful. Using this modified technique, Radical operation resection could be achieved in the treatment of pancreatic cancer in uncinate process.

Background Epidemiologieal survey suggests that visual impairment in teenagers is a worldwide public health problem,and its leading cause is uncorrected refractive error.To conduct an extensive screening of visual impairment in teenagers and analyze the relevant affecting factors are significant works for the prevention and management of refractive errors.But high-quality epidemiological data on visual impairment and refractive error from large groups of children are lacking in Shanghai.Objective This study was to investigate the prevalence of ametropia and visual impairment in schoolchildren aged 6 to 12 years old.Methods In this cross-sectional study,4 686 students from 6 elementary schools in Baoshan District of Shanghai,a rural-urban fringe zone,China were selected by clustering sampling from May 2010 to April 2011.The eye examinations included visual acuity,ocular surface,ocular anterior segment,ocular media,fundus and intraocular pressure measurement,and the data autorefraction under cycloplegia and eye position were recorded.The cause of visual impairment was evaluated.Results A total of 4 594 students received examination with the response rate 98.0％,and autorefraction under cycloplegia was completed in 84.8％ schoolchildren (3 975/4 594).The prevalence rate of uncorrected visual acuity 0.5 or worse in both eyes was 14.4％ (662/4 594),with the wearing glasses rate 51.8％ (343/662).The percentage of students with the uncorrected visual acuity 0.5 or worse in at least one eye was 22.4％ (1 031/4 594).The prevalence rate of refractive error in the visual impaired students was 96.9％ (999/1 031),followed by amblyopia (37/1 031,3.6％).The prevalence rate of myopia,hyperopia,and astigmatic in the pupils after cycloplegia was 31.1％,4.3 ％ and 33.0％,respectively.In addition,the prevalence rate of myopia in public elementary schools was higher than that in migrant elementary schools (33.9％ versus 30.3％) (x2 =5.46,P =0.02).Logistic regression analysis showed that myopia was associated with age (OR =1.60,95 ％ CI:1.53-1.68,P ＜ 0.01) and female (OR =1.33,95％ CI:1.16-1.54,P＜0.01).Conclusions The leading cause of vision impairment is myopia in the elementary school students in Shanghai,China.The screening-ratio of refractive error and the coverage of refractive correction in the elementary school students in Shanghai are matters of urgent concern.

Objective To summarize the experience of surgical treatment of chronic pancreatitis (CP) and improve the operative efficiency Methods The clinical data of 138 CP patients under going surgical treatment in this hospital from March 1992 to May 2002 were analyzed retrospectively Results Relapsing upper abdominal pain was the major symptom of CP All patients were treated surgically, in which pancreatic fistula developed in three patients and anastomotic hemorrhage in two postoperatively The morbidity rate was 3 6% Pain was relieved in 97 8% patients One hundred and twenty four patients (89 9%) were followed up for 1～9 years (mean 4 9 years) Recurrence was seen in 13 patients (9 4%) Seven patients developed diabetes mellitus and five occurred fat diarrhea during the follow up Five patients died with two dying of CP complications Conclusion Timing of operation and selection of operation modality are of critical importance in modifying the course of the disease and improving life quality of patients

Acanthoma ; pathology ; Humans ; Keratosis ; pathology ; Skin Neoplasms ; pathology

Abstract In recent years, the role of hyperopia reserve in the prevention and control of myopia among children and adolescents has gradually gained recognition and importance. Implementing more refined preventive measures based on hyperopia reserve to further advance the prevention frontiers is crucial for reversing the trend of focusing on treatment over prevention and achieving the national health strategy goal to reduce the myopia rate among children and adolescents. The paper introduces the concept of hyperopia reserve, the ability and the detection methods to predict the onset of myopia. At the same time, it also discusses the establishment and application of reference values for hyperopia reserve and proposes a classification based prevention and management strategy based on hyperopia reserve, aiming to provide reference ideas and directions for advancing myopia prevention.