Subjective visual perceptions experienced by patients during cataract surgery under local anesthesia have been given more and more attention now.Intraoperative visual experiences,including non-light perception,light perception,one or more color sensation,flash,movement,instrument,hands or fingers of surgeon etc.,are complained in parts of patients.These sensations and experience often lead to a fear of patient.Being aware of these intraoperative sensations of fear from patient is necessary for us to take the preventing strategy in advance.In addition,counseling of these patients prior to surgery may alleviate fears and improve the satisfaction of patient with surgery outcome.This paper reviewed the current studies on this phenomenon,discussed its clinical implications and possible mechanism,and suggested novel approaches to reduce its negative impact on the surgery.

ObjectiveTo investigate the expression of Twist and N-cadherin in pancreatic cancer,and to study its relationship with clinicopathological parameters and patients' prognosis.Methods The expression of the Twist and N-cadherin in 62 tissue samples from patients with pancreatic ductal adencocarcinoma and 10 normal pancreatic tissue samples was determined by using immunohistochemistry MaxVision two step method,and the relationship with clinicopathological parameters and patients' prognosis was analyzed.ResultsThe positive expression rate of Twist in pancreatic cancer was higher than that of normal pancreatic tissues (96.8％ vs.30％,P ＜0.01 ),and the positive expression rate of N-cadherin was higher than that of normal pancreatic tissues (75.8％ vs.0,P ＜0.01),but there was no correlation between them (r =0.100,P =0.441 ).The expressions of Twist and N-cadherin was significantly correlated with TNM stage,lymph node metastasis,infiltration of portal vein or nerves and tumor location ( P ＜0.05 ),but not with age,gender and degree of differentiation ( P ＞ 0.05 ).The post-operative survival of patients decreased with the increasing Twist expression,but the survival was not associated with the expression of N-cadherin.TNM stage,the expression of Twist was independent predictive factors of prognosis for pancreatic cancer patients.ConclusionsTwist and N-cadherin are highly expressed in pancreatic cancer,and the expression was associated malignant behavior of pancreatic cancer.The abnormal expression of Twist may be a potential marker for prognosis evaluation of pancreatic cancer patients.

OBJECTIVE　To assess the efficacy and safety of Lipobay (cerivastatin) and Jingbishuxin (simvastatin) on lipid profiles.METHODS　40 patients with hypercholesterolemia were randomizedly divided into Lipobay group (0.3 mg,QN) and Jingbishuxin group (domestic simvastatin tablet) (20 mg,QN)for 4 weeks.Total cholesterol (TC),low density Lipoprotein cholesterol (LDL-C),triglyceride (TG) and high density lipoprotein cholesterol (HDL-C),blood sugar,hepatic and renal function,blood and urine regular test were measured before and after the treatment.RESULTS　After 4 weeks of treatment,TC,LDL-C and TG were reduced by 29.02%,29.95%,17.21% in Lipobay the group and 22.48%,28.68%,14.74% in Jingbishuxin group,respectively.Compared the measurements after treatment with that before treatment,there were significant differences in both groups,but there was no significant difference between them.No serious adverse effect was found.CONCLUSION　Lipobay had a same efficacy and safety on lipoprotein profiles as that of Jingbishuxin in elderly.It has a good tolerance with smaller dose.

Objective To analyze the impact of extent of mitral valve stenosis on the short and longterm outcome of percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral valve stenosis.Methods Two hundred and eighty-four patients with mitral valve stenosis were divided into two groups according to the Wilkins scoring system,and 191 cases whose score ≤8 were classified as group A,while the rest were classified as group B.All the patients were using the modified Inoue balloon method.Patients of successful PBMV were followed up at least 48 months and the efficiency was compared between two groups.Results The success rate of PBMV was 97.9％(187/191) and 92.5％(86/93) in group A and group B,there was significant difference between two groups (P ＜ 0.05).Echocardiography parameters improved significantly in both groups at 6 months after PBMV compared with those before PBMV (P＜ 0.05).Compared with those in group A,the changes of left atrial mean pressure [(14.31 ± 4.79) mm Hg (1 mm Hg =0.133 kPa) vs.(15.42 ± 5.14) mm Hg],across the valve pressure difference [(9.18 ± 4.66) mm Hg vs.(10.21 ± 4.38)mm Hg],pulmonary arterial systolic pressure [(26.21 ± 8.76) mm Hg vs.(32.04 ± 9.58) mm Hg],mitral valve orifice area [(1.01 ±0.16) cm2 vs.(1.21 ±0.18) cm2] after PBMV in group B were less (P＜0.05).Long-term follow-up (48-92 months) was completed in 273 successful cases and echocardiography parameters after PBMV improved significantly in both groups compared with those before PBMV during follow-up (P＜ 0.05).Compared with those in group A,the changes of left atrial mean pressure [(12.91 ±5.00) mm Hg vs.(15.1 7 ± 5.14) mm Hg],across the valve pressure difference [(7.26 ± 4.58) mm Hg vs.(9.63 ± 4.22) mm Hg],pulmonary arterial systolic pressure [(20.54 ± 7.68) mm Hg vs.(29.11 ± 8.53)mm Hg],mitral valve orifice area [(0.92 ±0.15) cm2 vs.(1.09 ±0.18) cm2] after PBMV in group B were less (P＜ 0.05).The incidence of mitral restenosis was also significantly higher in group B than that in group A [19.8％(17/86) vs.8.0％(15/187)],and there was significant difference (P ＜ 0.05).Conclusions The extent of mitral valve stenosis plays a key role on the outcome of PBMV in patients with mitral valve stenosis.Patients with lower echocardiography scores benefit more from PBMV than patients with higher echocardiography scores.

Objective:To classify the types of radiographic feature of central salivary gland type malignant tumors of the jaws(CSMTJ) with studying the clinical data,radiographic characteristics and pathological classifications,and to help the diagnose CSMTJ correctly and effectively in future. Methods:The clinical,radiological and pathological features of 62 cases of CSMTJ were studied and summarized. Among these cases,52 cases were collected from the medical records of patients of the internal databank according to the World Health Organization (WHO) Histological Classification of Salivary Gland Tumors standard and 10 cases of CSMTJ were from Guangdong Provincial Stomatological Hospital. Results:The maxilla to mandible ratio was 1∶1.7,Among CSMTJ cases,central mucoepidermoid carcinoma of the jaws (CMCJ) was the most common pathological type and the second was central adenoid cystic carcinoma of the jaws(CACCJ). 62 cases of CSMTJ could be classified into four types:Unicystic type,Multicystic type,"Flame shape" type and Osteolytic type. Conclusion:The radiographic presentation of CSMTJ was very complicated and its classification was connected with tumor malignant degree. The classification was very helpful to determine the treatment methods and the prognosis of the CSMTJ.

There is a close relationship between osteoporosis and osteoarthritis .The joints of bearing weight often suffer the osteoarthristis with osteoporosis .There are some symptoms in the disease ,such as pain and motion disorder ,and joint abnormality in late＋ stage .The principle of rehabilitation is to improve osteoporosis , release pain and increase the function if motion .The treatment includes medicament ,acupuncture ,injection ,rehabilitation ,psychology and surgery therapies .The injection can release pain effectiverly .The methods of rehabilitation include physical therapy,exercise ,massage ,and occupational therapy.These therapies can release pain ,improve motion and increase the quality of life .The article reveiws the clinical symptoms ,diagnosis and treatment ,especially the rehabilitation therrapy.

Objective To evaluate the efficacy of endovascular stent-graft placement for the treatment of Debakey Ⅲ type aortic dissection. Methods From June 2001 to July 2006, 31 patients with Debakey Ⅲ type aortic dissection were diagnosed by contrast-enhanced CT scan. Vascular access was obtained through the right or left femoral artery after arteriotomy and stent-graft was deployed into the true lumen to occlude the primary entry tear. Immediate aortography was performed after the procedure and the follow-up data of CT scan were evaluated. Results Stent-graft deployment was successfully performed in all the patients. Immediate aortography after the procedure showed no leakage in 27 patients and minor leakage in 4. After the operation, one patient showed paraplegia, and one developed left arm ischemia. No stent movement or organ ischemia was found at the early postoperative stage in the other patients. Six months after the operation, in all the 31 patients, contrast-enhanced CT scan showed the disappearance of the false lumen and thrombosis at the level of the stent; and the minor leakage of was improved in the 4 patients. Four years after the operation, one patient developed severe internal leakage at the approximal end of the stent, and was treated by thoracotomy. Conclusions Endovascular stent-graft placement is effective for the treatment of Debakey Ⅲ type aortic dissection. However, further studies are needed to evaluate its long-term outcomes.

[Objective]To approach the methods of difficult laparoscopic cholecystectomy.[Methods ]The clinical data of 116 patients with Mirizzi syndrome,severe adherence of abdominal cavity and Calot'triangle,liver cirrhosis underwent difficult laparoscopic cholecystectomy since 2004 were retrospectively analyzed.[Results]Except 3 patients treated by abdominal operation,other patients were treated by laparoscopic cholecystectomy successfully.[Conclusion]The rates of open operation midway and complications are not increased in difficult laparoscopic cholecystectomy as long as dealing with them properly.

Acute massive pulmonary thromboembolism after pneumonectomy usually results in death if not diagnosed early and treated aggressively.It was a case of acute embolism in the main pulmonary ar-tery with thrombus following right pulmonary wedge resection.Diagnosis was made clinically and with computerized tomography before emergency surgery.Thromboembolectomy was successfully performed on cardiopulmonary bypass and the patient was subsequently discharged home after uneventful recovery.Al-though the patient had no previous history of thrombosis,he took high dose of warfarin for anticoagulating postoperatively,which suggested that the patient with pulmonary embolism attack may be associated with the hypercoagulable state of his own.

Objective To investigate the relationship between the expression of Fas or FasL and the apoptosis of peripheral blood T and B lymphocytes in systemic lupus erythematosus (SLE) patients. Methods The expression rates of Fas and FasL and apoptosis rates of peripheral blood T and B lymphocytes were detected by flow cytometry (FCM) in 30 active SLE patients and 30 inactive SLE patients and 30 healthy controls. Results There were significant difference in the expression rates of Fas of T and B lymphocytes among three groups (P0.05). In addition, the activity of SLE had no correlation with the expression rates of Fas or FasL on T or B lymphocytes but has positive correlation with the apoptosis rates of T or B lymphocytes. And no correlation was found between the expression rate of Fas or FasL and the apoptosis rate of neither T nor B lymphocytes. Conclusion The apoptosis of peripheral blood lymphocytes is influenced by many factors in SLE patients, but is abnormally increased at last, especially in active SLE. It is inferred that the increase of apoptosis rate of peripheral blood lymphocytes plays an important role in the pathogenesis of SLE.