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 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 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 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 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 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 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.

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 investigate the association between peripheral white blood cell (WBC) count and the carotid intimal-medial thickness (cIMT) in middle-aged and elderly Chinese of suburban area of Shanghai.Methods A total of 2 519 subjects aged 40 years or older from Jiading District,Shanghai were recruited to undergo questionnaire interview,anthropometric measurements,fasting blood sampling,and carotid B-mode ultrasonography.After excluding subjects with biochemical index missing,WBC count ＞ 10× 109/L as well as those with known myocardial infarction,cerebral infarction,coronary heart disease,and those taking lipid-lowing agents,2 239subjects were included in this analysis.Results Increased WBC count was associated with more unfavorable metabolic risk profiles.With the increasing quartiles of WBC count,cIMT were 0.558,0.570,0.573,and 0.587mm respectively(P for trend ＜ 0.01).As compared with participants in the first WBC quartile,the risks of cIMT thickening were increased by 79％,109％ in males and 29％ in females (P＞ 0.05 in females).Multiple linear regression model showed that peripheral WBC count was an independent risk marker for cIMT thickening,especially for neutrophil and monocyte count.Conclusion A high-normal WBC count was significantly associated with cIMT thickening in middle-aged and elderly Chinese of suburban area of Shanghai,especially in males.

Objective:To analyze phylogenetic structure and molecular characteristics of H5N6 avian influenza virus (AIVs) isolated from live poultry market (LPM).Methods:Oropharyngeal and cloacal swabs from poultry, and environmental samples were collected from LPM in Urumqi in December 2018, AIVs were isolated and identified by inoculation of chicken embryo, hemagglutination test and RT-PCR, the viral whole genome was amplified with the universal primers of influenza A virus, and then sequenced, pairwise sequence alignments, phylogenetic and molecular characteristics analysis were performed by BLAST, Clustal W, MEGA-X and DNAStar software.Results:Six strains of H5N6 AIVs were isolated from poultry samples, the identity between the viral genes was high (99.4%-100.0%), so the isolates were the same source. BLAST analysis revealed that the viral NP sequence had the highest identity (99.7%) with H5N6 AIVs isolated from poultry in Suzhou, while the sequence of the remaining 7 viral genes had the highest identity (99.0%-100.0%) with H5N6 AIVs isolated from environment in Guangdong during 2017 to 2018. Phylogenetic analysis showed that the viral HA belonged to Clade 2.3.4.4C, and the viral HA, NA, PB1, PA, NP, and MP were all clustered together with H5N6 AIVs isolated from mink in Eastern China in 2018, while the PB2 and NS were clustered together with H5N6 AIVs isolated from environment in Guangdong from 2017 to 2018. The HA cleavage site contained multiple basic amino acid residues, which was highly pathogenic AIVs (HPAIVs). S137A and T160A mutations of HA could increase binding to human-type receptor SAα2, 6-Gal. Additionally, the viral multiple mutations, including 59-69 deletion in NA, the L89V, G309D, R477G, I495V, I504V, D391E, and A661E in PB2, as well as the P42S, D92E, and 80-84 deletion in NS1, could enhance the viral virulence and pathogenicity to mammals. Conclusions:The 6 strains of H5N6 HPAIVs isolated from LPM have relatively close genetic relationship with H5N6 AIVs isolated from mink in Eastern China and environment in Guangdong during 2017 to 2018, the viral multiple mutations could increase its pathogenicity to mammals, which could pose a potential risk to public health.