Clinical ophthalmic surgery is a special branch of general surgery,the microsurgery of ophthalmology has properties of high-precision,high-risk and longer learning curve.The ophthalmology department of Tongji University Hospital has explored a set of step-by-step and efficacious postgraduate student education method,including theoretical basis,in vitro stimulation and in vivo practice.The intervention of quality control and incentive mechanism were also included.

Objective:To analyze normal pure tone hearing thresholds patients with aural fullness using evoked otoacoustic emission in order to detect the early cochlear impairment. Method: Forty-three normal pure tone hearing thresholds patients(72 ears,aural fullness group)with aural fullness were served as subjects and 30 normal volunteers(60 ears,control group)as controls. Transiently evoked otoacoustic emission (TEOAE) and distortion product evoked otoacoustic emission (DPOAE) were tested with Capella otoacoustic emission machine.The DPOAE detection rate and amplitudes at all frequencies,the passing rate and wave signal noise ratio (SNR), wave reproducibility,band SNR and band reproducibility of TEOAE were recorded and analyzed.Result:①Only on the frequency points of 0. 50 kHz and 0. 75 kHz,the detection rate of DPOAE in aural fullness group was lower than that in control group(P＜0. 05). There was no significant difference in the rate among other frequency points(P＞0. 05). ②The passing rate of TEOAE was 100% in control group and 90.28% in aural fullness group.There were statistical differences between two groups(X~2=6. 16, P＜0. 05).③Compared with the control group,the DPOAE amplitudes at all frequencies,the wave signal noise ratio(SNR), wave reproducibility,band SNR and band reproducibility of TEOAE in patients with aural fullness were significantly decreased.There were statistical differences(P＜0.05 or P＜0.01). Conclusion:Some patients of normal hearing thresholds with aural fullness have had early harm of outer hair cell in cochlear.TEOAE and DPOAE may be used to detect these lesions early before the hearing impairment occurred.

Objective To analyze the characteristic and the clinical application of high -frequency stimulation ABR for the patients with unilateral sudden deafness .Methods 40 patients aged 17~45 with unilateral sudden deaf-ness(40 health ears ,subject group)and 20 normal volunteers (40 ears ,control group)were selected to receive high and low frequency stimulation ABRs and pure tone audiometry .Results There were no statistical differences be-tween subject group and control group in pure tone audiometry .The wave Ⅰlatency of high -frequency ABR was longer in the subject group than that in the control group(P<0 .001) .The abnormal rate of Ⅰ - Ⅴ interval between high and low frequency stimulation ABRs was 62 .5% (25/40) in the subject group ,and 5% (2/40) in the control group .There were statistical differences between the two groups (χ2 =29 .574 ,P<0 .001) .Conclusion The waveⅠlatency of high-frequency ABR was longer and the abnormal rate of Ⅰ - Ⅴ interval markedly increased in the health ear of patients with unilateral sudden deafness .This may suggest that the contralateral ear may have an ab-normal blood supply of the inner ear when single side sudden deafness happened .High frequency stimulation ABR can be used to detect the potential changes of contralateral ear before the hearing loss occurred .

Objective:To explore the efficacy and safety of 192Ir three-dimensional brachytherapy combined with intensity-modulated radiotherapy in patients with unresectable advanced obstructive extrahepatic cholangiocarcinoma. Methods:A retrospective analysis of the efficacy and safety of 18 patients with unresectable advanced malignant obstructive extrahepatic cholangiocarcinoma admitted to the Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei province from January 2014 to January 2018.All patients were pathologically confirmed and received biliary stent implantation, followed by sequential intensity-modulated radiotherapy and 192Ir three-dimensional brachytherapy.The clinical data of all patients were collected, including gender, age, clinical stage, adverse reactions, brachytherapy dose-volume parameters, changes in bilirubin levels before and after treatment, evaluation of efficacy, local control rate and survival rate. Results:All patients successfully completed the treatment.Re-examination was conducted one month after the combined treatment, of the 18 patients, 16 had partial remission (PR) and 2 were stable(SD). Among them, 14 patients had tumor shrinkage after brachytherapy compared with intensity-modulated radiotherapy, and 4 patients showed no significant change.The 6-month local control rate (LC) was 94.4% (17/18). The 1-year survival rate was 55.6% (10/18), and the 2-year survival rate was 38.9% (7/18). Statistical analysis showed that after combined treatment, total bilirubin and direct bilirubin were significantly reduced, and jaundice symptoms were significantly relieved.The adverse reactions of the patient were nausea, vomiting, fever, biliary tract infection, etc.There were no adverse reactions of grade 3 or above.Conclusions:192Ir three-dimensional brachytherapy combined with intensity-modulated radiotherapy in patients with inoperable advanced extrahepatic cholangiocarcinoma has a good local control rate and tolerable adverse reactions, but the impact on long-term survival requires a large sample of controlled studies.

Objective To investigate the application of ultrasound and 64-slice spiral CT in the diagnosis of acute appendicitis. Methods Sixty-five patients with pathologically or clinally confirmed acute appendicitis were underwent ultrasound and CT examina-tion before operation or conservative treatment.Compared with pathology,the accuracy of CT and B-ultrasound imaging were ana-lyzed.Results Fifty-eight cases were correctly diagnosed by CT and 48 cases were correctly diagnosed by ultrasound,the accuracy was 89.23% (58/65)and 73.85% (48/65),respectively.There was a statistically significant difference between two groups (χ2 =5.1 1,P =0.024).Conclusion The accuracy of multi-slice spiral CT is higher than ultrasound in the diagnosis of acute appendicitis.

Objective To explore the application value of cellular automata(CA)in simulating the epidemic spread of out-break of influenza A(H1N1).Methods The publications regarding influenza A(H1N1)from January 2009 to March 2015 were collected from the China National Knowledge Infrastructure(CNKI),epidemiological data of H1N1 were retrieved ac-cording to inclusion criteria,the Matlab 7.0 software was adopted to construct CA model for simulating and analyzing the epidemic of H1N1 occurred in a university in Chongqing between October 12 and November 20,2009.Results There were a total of 17 820 students in this university,the epidemic of influenza lasted 40 days in 2009;When the parameter,the ef-fective infection rate was 0.04,the model of CA fit well,and gave estimate for basic reproduction number (R0 )1.202. Conclusion CA has certain reliability in simulating epidemics of airborne infectious diseases,it can provide reference for the prevention and control of disease.

Objective To develop a method for determination of 18 organophosphorous and carbamate pesticides in human plasma by UPLC-MS/MS. Methods Following deproteinization by acetonitrile, an aliquot of the biological sample was injected into a C18 column(1.7μm 2.1×50mm) using 5mmol/L Ammonium acetate-methanol as the mobile phase with the flow rate of 0.3mL/min, the injection volume was 10μL. Electro spray ionization(ESI) Indicators source was applied and operated in positive ion mode, and multiple reaction monitoring(MRM) mode was used to quantify. Results The limits of detection(LODs) in human plasma ranged from 0.1 to 40ng/mL, and the limits of quantitation(LOQs) ranged from 0.5 to 50ng/mL. An excellent linearity was observed for these LOQs up to 50ng/mL. The average extraction recoveries were with in 64.3%~111.9%, relative standard deviation(RSD) is 3.9%~10.3%. Conclusion This method is specific, sensitive and accurate, and can be used to detect pesticides in forensic.

Objective To explore the effects of donor dendritic cells(DC)treated with Ad-IL- 12p35siRNA on the survival of allogragft recipients.Methods The recombinant adenoviral vectors carrying IL-12p35siRNA and HKsiRNA were transfected into bone marrow derived DC of BALB/C murine.C57BL/6 recipients were infused with DG(Ad-IL-12p35siRNA DC,Ad-HKsiRNA DC and control DC)from BALB/C donors 7 days before cardiac allograft,the survival time of murine and the change of T_H 1 and T_H2(IL-2,IL-4,IL-10 and IFN-?)cytokine were observed.Results The survival time of p35 group(20.17?2.71)days was longer than that of control group(7.81?1.61)days and HK group(7.17?1.60)days.The concentration of IL-2 and IFN-?in p35 group were significantly lower than those of control group and HK group,otherwise were the concentration of IL-4 and IL-10. Conclusion Pretreatment of dondor dendritic ceils with Ad-IL-12p35siRNA could prolonged cardiac allograft survival in recipicents.

Tripterygium wilfordii has exihibited multiple pharmacological activities, such as anti-inflammatory, immune modulation, anti-tumor and anti-fertility. T. wilfordii have been used for the therapy of inflammation and autoimmune diseases including rheumatoid arthritis, immune complex nephritis and systemic lupus erythematosus clinically. However, it is well known that T. wilfordii has small margin between the therapeutic and toxic doses and could cause serious injury on digestive, reproductive and urogenital systems. Among all the organs, liver is one of the most remarkable targets of T. wilfordii-induced toxicities, and the damage is more serious than others. It is generally accepted that T. wilfordii-induced liver injury is a result of the combined effects of toxic elements of T. wilfordii. It is reported in several studies that the mechanism of T. wilfordii-induced liver injury may be related to lipid peroxidation, cell apoptosis and immune damage, and so on. Licorice is one of the most commonly used Chinese herbal medicine, with effects of heat- clearing and detoxicating, anti-inflammatory and hepatoprotective, reconciling various drugs, and so on. Licorice often accompany T. wilfordii in clinical application which can significantly reduce the liver injury induced by T. wilfordii. The attenuated effect is exact, but the mechanism is still a lack of in-depth study. This paper reviews the studies on T. wilfordii-induced liver injury and the related mechanism as well as licorice and other traditional Chinese medicine accompany T. wilfordii to reduce the injury in recent years, so as to provide reference for related research in the future.
Animals ; Chemical and Drug Induced Liver Injury ; etiology ; prevention & control ; Glycyrrhiza ; Humans ; Inactivation, Metabolic ; Medicine, Chinese Traditional ; Tripterygium

Objective To review the clinical manifestation,diagnosis method,misdiagnosis,risk factors,treatments and prognosis of Stanford B aortic intramural hematoma (IMHB).Methods All of the Stanford B aortic IMHB patients admitted in Wuhan Union hospital from January 2008 to December 2013 were analyzed.The clinical manifestation,diagnosis method,misdiagnosis,managements and prognosis were studied.Furthermore,the effect and long-term survival of different therapies were compared,including medical treatment and endovascular repair.The statistics was performed with SPSS 16.0.Results There were 36 B aortic IMHB patients,and the percent of male patients was 72.22％.The mean age of IMHB was 60.19 ± 11.12.Most patients complained of acute chest and back pain,accompanied with hypertension.Twenty-eight patients (77.78％) received medication therapy,among them,there were 5 patients died of aortic rupture; eight patients (22.22％) received endovascular surgery,one died of cerebral hemorrhage (12.5％).No difference was found between medication therapy and endovascular surgery (17.86％ vs 12.5％,P ＞0.05).Conclusions For simple type B aortic IMHB patients,medication therapy and a dynamic monitoring of full aortic CT angiography was recommended,and for pejorative patients the endovascular treatment should be taken actively.