To evaluate the visual performance of aspheric multifocal intraocular lens (SN6AD1+3. 0D) implanta-tion in age-related cataract surgery. Forty-eight patients (60 eyes) with age-related cataract were divided into two groups, 28 patients(30 eyes)in the multifocal group (implanted with SN6AD1+3. 0D multifocal intraocular lens), and 20 patients(30 eyes)in the monofocal group (implanted with SN60WF monofocal intraocular lens). The uncor-rected and the best corrected distance,intermediate and near visual acuity and the amplitude of pseudoaccommoda-tion were measured after surgery,and the subjective visual performance was evaluated by the questionnaire. The un-corrected intermediate and near visual acuity were statistically better in the multifocal group than the monofocal group. The amplitude of pseudoaccommodation of multifocal and monofocal group was (2. 65 ± 0. 48) D and (0. 38 ± 0. 15)D. The spectacle independent rates of multifocal and monofocal group were 86% and 13% respectively.

Background Sclera remodeling process in axial elongation is one of the main pathological mechanisms of axial myopia progression.Studies confirmed that transforming growth factor-β1(TGF-β1) participates in the sclera remodeling process,and Smad3 is one of TGF-β1 downstream signal gene transcriptive factors,so to explore its role in sclera remodeling process of myopic eyes is of great significance for pathogenesis and prevention research of myopia.Objective This study was to investigate the expressions of type Ⅰ collagen and Smad3,a TGF-31 downstream target,in sclera of form deprivation myopic (FDM) eyes and explore the impact of TGF-β1-Smad3-type Ⅰ collagen signaling pathway on collagen remodeling in myopic sclera.Methods Seventy-five 1-week-old guinea pigs were randomly divided into normal control group (25 guinea pigs) and FDM group (50 guinea pigs).Monocular FDM was induced by occluding the left eyes of guinea pigs in FDM group with translucent latex balloons for 2,4,6 weeks,respectively,and consecutive occluding for 4 weeks followed by uncovering for 1 week (4/-1 weeks).The refractive power was detected by retinoscopy and axial length was measured with A-type ultrasound.Immunohistochemistry and reverse transcription-PCR were employed to detect the dynamic expressions of type Ⅰ collagen and Smad3 protein ad mRNA in the sclera of guinea pigs with emmetropia and experimental myopia,ard the relationship between collagen Ⅰ and Smad3 levels was analyzed.Results The refraction was hypermetropic in both normal control group and FDM group before occluding of eyes (P＞0.05),and the hypermetropic power was gradually reduced over time in the normal control group.In the FDM group,the refractive power was gradually changed from (+2.09 ± 0.31)D before occluding to (-1.23±0.69),(-4.17±0.59),(-7.07±0.56) and (-4.30±0.58)D,and the axial length was increased from (5.93-±0.39)mm to (6.62±0.36),(7.30±0.34),(7.99--0.32),and (7.21 ±0.36) mm at weeks 2,4,6,and 4/-1 after occluding,respectively,indicating significant differences in refractive power and axial length over time in the FDM group from normal control group and self-control group (all at P＜0.05).The expressions of Smad3 and type Ⅰ collagen protein and mRNA in the sclera of the FDM group was significantly lower than those of the control group and self-control group in various time points (all at P＜0.05).The positive correlation were found in the expression of Smad3 on the myopic sclera with that of type Ⅰ collagen in both protein and mRNA levels (protein:r=0.993,P＜0.05;mRNA:r=0.954,P＜0.05).Conclusions The myopic power and ocular axis increase dependent upon occluding time,and the expressions of Smad3 and type Ⅰ collagen in the sclera are correspondingly weakened in FDM eyes.A consistent expression trend is found between Smad3 and type Ⅰ collage,suggesting Smad3 and type Ⅰ collagen participate in the regulation of sclera remodeling in myopia by TGF-β1-Smad3-Collagen Ⅰ signaling pathway.

Background JAK/ signal transducer and activator of transcription 3 (STAT3) signal pathway plays a critical role during the sclera remodeling of experimental myopia.As a tyrosine kinase inhibitor,AG490 can inhibit the activation of this pathway.But whether AG490 plays a role in delaying the development of myopia is not completely clear.Objective This study was to investigate the inhibition of AG490 to activation of STAT3 signaling pathway and the sequential arresting effect on the sclera remodeling in form-deprived myopia (FDM) models.Methods Forty guinea pigs were randomly divided into the normal control group,model control group,PBS control group and AG490 treatment group.FDM models were established by the occlusion of the right eyes of guinea pigs for consecutive 4 weeks using translucent goggles in the model control group,PBS control group and AG490 treated group,and 25 μl PBS or AG490 were respectively injected into vitreous since the first day of modeling in two-day interval till the fourth week in the PBS control group and AG490 treated group.Refractive state and axial length were examined with retinoscopy and A-scan ultrasonography before and 4 weeks after experiment.The experimental eyes were extracted in the fourth week,and the expressions of scleral STAT3,p-STAT3,metal matrix proteinase-2 (MMP-2) proteins and STAT3 mRNA,MMP-2 mRNA were detected by immunocytochemstry and semi-quantitative reverse transcription PCR (RT-PCR) respectively.The use and care of experimental animals followed ARVO.Results Compared to the normal control group,the negative refraction power and axial length were significantly increased in the model control group,PBS control group and AG490 treated group,and the axial length in the AG490 treated group was smaller than those in the model control group and PBS control group,showing significant differences among the 4 groups (refraction:F =89.063,P =0.000;axial length:F =96.145,P =0.000).The expressions of STAT3,MMP-2 and p-STAT3 in scleral tissue were weaker in the normal control group.The expressional values (A values) of STAT3,p-STAT3 and M MP-2 were 0.064 ± 0.016,0.019 ± 0.002 and 0.155 ± 0.052 in the AG490 treated group,which were lower than 0.129±0.008,0.071 ±0.021,0.425 ±0.004 of the model control group and 0.130±0.004,0.069±0.002,0.421 ±0.042 of the PBS control group (STAT3:t =4.641,9.364,both at P＜0.01;p-STAT3:t =4.638,4.488,both at P＜ 0.05;MMP-2:t =9.123,9.029,both at P ＜ 0.05),however,these expressions were still higher than those of the normal control group (t =2.674,2.251,2.682,all at P ＜0.05).The expressional levels (A values) of STAT3 mRNA and MMP-2 mRNA in the AG490 treated group were 0.295±0.032 and 0.569±0.019,which were significantly lower than 0.547±0.015 and 0.782±0.051 in the model group as well as 0.544±0.015 and 0.779±0.048 in the PBS control group (STAT3 mRNA:t =10.115,11.703,both at P＜0.01;MMP-2 mRNA:t =9.218,9.494,both at P＜0.01).The expressional levels (A values) of STAT3 mRNA and MMP-2 mRNA in the AG490 treated group were still higher than those in the normal control group (t=2.576,3.565,both at P＜0.05).Conclusions AG490 can ultimately inhibit the development of axial myopia by arresting the activation of STAT3 signaling pathway in the FDM eyes and further regulating the expression of MMP-2 in sclera and delaying the remodeling of sclera.

Objective To study the anatomical variations adjacent to the umbilical portion of the left portal vein (U-point) radiologically and to determine their impact on treatment of hilar cholangiocarcinoma (HCCA).Methods From January 2014 to February 2016,47 consecutive patients who were diagnosed to suffer from Bismuth type Ⅰ,Ⅱ or Ⅲ a HCCA in our institution were retrospectively studied.All these patients underwent enhanced CT examination preoperatively and three-dimensional (3D) models were then reconstructed.Results Any variations of the left biliary system in relation to the U-point were analyzed.The findings showed that:B2 and B3 united above or lateral to the U-point in 31 patients (65.9％);B2 and B3 united medial to the U-point in 4 patients (8.5％);and B4 converged into B3 prior to B2 in 6 patients (12.8％).Rare variations were observed in 6 patients (12.8％).For the confluence patterns of B4:the central type was found in 10 patients (21.3％),the peripheral type in 35 patients (74.5％) and the combined type in 2 patients (4.2％).Analysis of the relationship between B1l and the confluence of B2 and B3 showed the distance to be (31.6 ± 6.2) mm in the above or the lateral patterns and (13.7 ± 4.7) mm in the medial pattern.The difference was significant (P ＜0.05).The distance from B1l to B4 was (7.1 ± 2.0) mm in the central and combined types but (16.4 ±4.0) mm in the peripheral type.The difference was significant (P ＜ 0.05).The left hepatic artery showed variations in the origin and course pattern in 4 (8.5％) and 6 patients (12.8％),respectively.The two-dimensional (2D) and 3D imagings showed excellent consistency in the evaluation of variations of the left biliary system in relation to the U-point and the left hepatic artery.Conclusions It is very important to know the variations of the left biliary and the vascular systems adjacent to the U-point in preoperative evaluating on resectability of HCCA.An accurate assessment could be accomplished using 2D imaging alone.However,3D reconstruction is a useful technique to use in complex case with locally advanced tumors.

Objective To research the angiographic manifestations of rabbit implanted VX_2 liver carcinoma.Methods 34 New Zealand big white rabbit were implanted VX_2 tumor pieces under orthophoria into liver left middle segment.Angiography of coeliac artery-hepatic artery catheterization via right femoral artery was performed at the third week after inoculation.Results The tumor blood vessel and tumor stain in 6 rabbit could be not showed clearly by digital cinematography mode but which could be showed in 28 rabbit by digital subtraction mode.The tumor angiographic signs included:dilating growth of tumor,the feeding arteria surrounding the tumor surface were resemblance to the clenched fist,embraced globosity and wreath in form;many slender vessels from feeding arteria appeared as small bud form,root form and filose form pushed forward to the center from the surface of tumor.The tumor vascular density in periphery was higher than that in center and formed circular or oval tumor stain which more denser at periphery than center.The tumor node stain was complete with definite margin when tumor size was large or equal to 1 cm in diameter,and the tumor stain appeared as clump with indefinit margin.Conclusion There are abundant vascularity for rabbit implanted liver VX_2 tumor,and more abundant at periphery part than center part, coeliac artery catheterization angiography can show the typical manifestations of tumor clearly.

Objective To research the angiographic anatomy of celiac artery in rabbit.Methods 36 New Zealand big white rabbitswere included in this study,the angiography of celiac artery and hepatic artery via right femoral artery was performed,and the branchand diameter of celiac artery system were analysed.Results 66.7% of the celiac arterial opening localized at the level of T_(12) vertebral body low edge,gastrohepatic arterial truncus could been divided into three types : type Ⅰ(47.22%),tree-like branch;type Ⅱ(38.88%),trifurcate branch and type Ⅲ(13.90%),dichotomy branch.The length of proper hepatic artery was from 22.70 to 33.00 mm(26.64 mm?2.28 mm),the inner diameter of proper hepatic artery,left hepatic artery and right hepatic arteria was 0.60~1.20 mm(0.90 mm?0.16 mm),0.60~1.10 mm(0.72 mm?0.09 mm) and 0.50~1.00 mm(0.67 mm?0.09 mm) respectively.The segmental artery of liver could be displaied clearly by proper hepatic artery angiography.Conclusion To realize the angiographic anatomy of rabbit celiac artery would provide a useful help for transhepatic arterial interventional treatment of the liver VX_2 tumor model of rabbit.

Objective To explore the influence factors on hepatitis B virus (HBV) relapse after nucleos(t)ide analogues (NA) withdrawal in the chronic hepatitis B (CHB) patients who met NA cessation criteria. Methods Eighty-one consecutive CHB patients were treated with NA, 38 with lamivudine (LAM), 25 with adefovir dipivoxil (ADV), 12 with entecavir (ETV), 6 with LAM +ADV. Among recruited patients, 40 were hepatitis B virus e antigen (HBeAg) positive, 41 were HBeAg negative, 67 of them were initial treatment, 14 were retreatment due to resistance to NA at baseline. The treatment was discontinued after meeting China therapeutic end-point criteria. HBV DNA, HBV serological markers, alanine aminotransferase (ALT) were measured respectively at baseline, every month before virological response, every 3 months after virological response, every month within first 6 months and every 2 months over 6 months after drugs withdrawal. Twelve probable influence factors on relapse which were sex, age, HBV family history, baseline HBV DNA,baseline HBeAg status, baseline ALT, virological response time, total duration of treatment, duration of additional treatment, the level of hepatitis B virus surface antigen (HBsAg) at cessation therapy,initial treatment or retreatment, drug category were analyzed with univariate, multivariate Cox regression modle and stratified analysis. The cumulative relapse was calculated by the Kaplan-Meier method. Results A total of 36 patients (44. 4%) relapsed within 1 year. Initial treatment or retreatment, HBV family history, virological response time, the level of HBsAg at cessation therapy were independent risk factors. The relapse rate of retreatment was higher than that of initial treatment (78.6% vs 37. 3% , χ2 = 7. 983, P = 0. 005) , those of patients with HBV family history higher than without family history (64. 5% vs 15.0%, χ2 =12. 096,P = 0.002), those of patients obtained virological response within 3 months lower than after 3 months(34. 0% vs 64. 3% , χ2 =6. 823,P=0. 009) , those of patients with HBsAg≤150 μg/L at cessation therapy lower than >150 μg/L(27. 6% vs 53. 8%, χ2=5. 199,P=0. 023). Conclusions Retreatment, HBV family history, later virological response and higher HBsAg level at cessation therapy are risk factors of relapse after NA withdrawal. Such patients should be treated with prolonged duration after meeting end-point criteria to strengthen the efficacy.

AIM: To evaluate the diopter errors and safety of secondary intraocular lens(IOL)implantation in the ciliary sulcus using a modified incision procedure in children with bilateral aphakia.METHODS: The data of 12 children(24 eyes)with bilateral aphakia who had undergone secondary foldable IOL implantation in the ciliary sulcus using a modified incision procedure from 2020 to 2021 were retrospectively reviewed. Incision-related complications were analyzed intraoperatively and at 1 d and 1 mo postoperatively. Best-corrected visual acuity(BCVA), axial length(AL), white-to-white(WTW), and refractive outcomes in terms of preoperative reserved diopters(PRD)and actual equivalent spherical diopters(AESD). The patients were divided into two groups by age(≤7 and >7 a), AL(<23 and ≥23 mm)and WTW(≤11.5 and >11.5mm), and the diopter errors between their AESD and PRD predicted based on the measurement results were compared.RESULTS: The patients comprised 9(75%)boys and 3(25%)girls. Two(17%)patients had anterior subcapsular cataracts, 4(33%)had posterior polar cataracts, and 6(50%)had nuclear cataracts. The mean age at cataract extraction was 6.4±1.61(3.4-8.9)mo. The mean interval between cataract extraction and secondary IOL implantation was 6.8±1.82(4.4-11.5)a. The mean preoperative BCVA was 0.49±0.33(1.0-0.1)LogMAR. The mean postoperative BCVA was 0.38±0.32(1.0-0.0)LogMAR. The mean AL was 23.56±1.96(19.00-26.38)mm, and the mean WTW was 11.5±0.92(9.3-13.9)mm. The mean PRD was 1.57±0.60(0.73-2.77)D, the mean AESD was 0.57±0.55(-0.50 to 1.75)D, and the mean difference between the AESD and PRD was -0.99±0.52(-2.22 to 0.32)D. The differences in the AESD and PRD between the groups according to age, AL and WTW were not statistically significant(P=0.59, 0.56, and 0.53, respectively).CONCLUSION: IOL implantation in the ciliary sulcus after a modified incision is safe and feasible for children with aphakia. It is necessary to subtract approximately 1 D of IOL power from the formula-selected power when implanting an IOL in the ciliary sulcus. Age, AL, and WTW do not significantly affect the difference.

Objective:To study the angiographic anatomy of the lateral costal artery (LCA) and its effect on hemoptysis.Methods:The CT data of angiography and angiographic-CT in 303 patients with hemoptysis in Guangzhou First People′s Hospital were analyzed retrospectively. The origin and travel of the lateral costal artery and the blood supply of the LCA involved in the pulmonary lesion were analyzed.Results:In 303 patients with hemoptysis, 30 LCA were detected in 24 cases, including 12 on the left and 18 on the right, 18 on one side and 6 on both sides. All of them were the first branch of the first segment of the internal thoracic artery (ITA). The level of LCA originating from ITA was located in 1(3.3%) branch above clavicle, 27(90.0%) branches behind clavicle and 2(6.7%) branches below clavicle. LCA entered into the chest behind the first anterior rib, and walked along inner surface of the thorax from the anterior and superior direction to the outer and posterior direction, between the rib-intercostal medial muscle and pleura (i.e., anatomical intrathoracic fascia), and mostly terminated at the axillary midline plane. 28 LCA in 23 patients which can be used for morphological analysis, roughly manifested as follow three shapes: ⑴ 13(46.4%) of them were arc-shaped. The developed LCA was longer and showed shallow or deep arc-shaped curve; ⑵ High flat shape, total 11 LCA (39.3%), the LCA were relatively shorter, position higher and more gentle; ⑶ 4(14.3%) were straight and oblique. The developed LCA was relatively long, and the angle between LCA and ITA was linear. 11 vessels (36.67%) of 10 patients participated in the blood supply of pulmonary lesions, among which 2, 5, 1, 2 and 1 vessels were responsible for the first, second, third, fourth and fifth hemoptysis respectively.Conclusions:The LCA is a relatively common blood vessel and it can be well shown by angiography and angiographic CT. It is of great clinical significance to understand LCA.

Objective:To investigate the diagnostic value of bronchial arteriography CT (BA-ACT) combined with bronchoscopy (BS) in bronchial Dieulafoy′s disease (BDD), and the role of bronchial artery embolization (BAE) in the treatment of BDD.Methods:Retrospective analysis was made on the clinical data of 5 patients suspected of being BDD treated by BS in Guangzhou First People′s Hospital or Guangzhou Thoracic Hospital from January 2008 to January 2018 due to hemoptysis. Bronchial arteriography (BAG) and BA-ACT were performed during the operation of interventional embolization. BAG rotary acquisition data were post-processed according to BS findings, and BA-ACT reconstruction images of the diseased bronchi and bronchial arteries were obtained. BS reexamination and clinical follow-up observation were carried out after embolization to analyze the effect of embolization.Results:There were one BDD lesion for the five patients respectively, and the BAG lacked characteristic manifestations. Bronchoscopy revealed BDD foci to present as papillary (case 1-case 3), nodular (case 4), or lirellate (case 5) subbronchial submucosal protrusion lesions. On the BA-ACT reconstruction plot, the BDD lesions of papillary, nodular and carination manifested correspondingly as a bronchial artery branches locally " pointed arch" shaped (cases 1-case 4) or " bead-like" (case 5) fold and protruding toward the bronchial lumen. The BDD lesions of the cases 1-case 4 retraction and disappearance after one BAE were observed by BS examination, and no hemoptysis recurrence during the follow-up period (54-91 months). The ridge like BDD lesion of the case 5 remained unchanged after BAE, and hemoptysis recurred at 71 months after the first BAE; the uncollapsed foci were supplied by two collateral vessels that confirmed by second BAG and BA-ACT, and no hemoptysis for 71 months followed up after second BAE.Conclusions:BA-ACT combined with BS enables a locative and qualitative diagnosis of BDD, and BAE is a very effective treatment method for BDD.