AIM:To investigate the efficacy of controlled continuous curvilinear capsulorhexis(CCC) technique in short axial length and shallow anterior chamber eyes.METHODS:Sixty-eight patients(68 eyes) with short axial length and shallow anterior chamber were included.The routine CCC technique was used in 32 cases (32 eyes) and controlled CCC technique was used in 36 cases (36 eyes).The success rate and complication were compared between two groups. RESULTS:The success rate of the routine technique group and controlled technique group was 53. 13% and 86.11% respectively. Incomplete CCC leading to posterior capsule tears was 9.38% and zero in two groups respectively.CONCLUSION: Controlled CCC technique can increase the success rate and reduce complications in short axial length and shallow anterior chamber eyes.KEYWORDS:phacoemulsification; continuous curvilinear capsulorhexis; complication

Objective To reconstruct skin defects with local flaps after resection of tumors. Methods From October 2006 to December 2009, medial canthal defects in 15 patients were repaired with local flaps in the hospital. The size of the defects varied from 1 cm × 1 cm to 1.8 cm × 2.0 cm. According to the size and location of the defects, different local flaps such as glabellar flaps ,rotation flaps, advancement flaps, nasolabial flaps and combination of these local flaps were selected and designed to repair the skin defects. Results Of the 15 patients, 12 received the reconstruction of skin defects with single flap, the other 3 with two flaps; totally,18 local flaps were designed and applied. All the flaps survived with primary healing postoperatively. A followup in 11 patients for 6 to 12 months showed that the color and texture of flaps were similar to those of surrounding tissues and incision line scar was inconspicuous. Medial canthal contours were restored without distortion of surrounding structures. Satisfactory function and aesthetic outcomes were achieved. Conclusions In the repair of inner canthus skin defects, to maintain and restore the "cosmetic unit" integrity of inner canthus by using suitable local flaps would lead to a satisfying restoration of function and appearance.

Objective The purpose of this study was to evaluate the safety and clinical oulcomes of aortic valve replacement (AVR) performed with minimally invasive technique.Methods From June 2010 to October 2011,20 cases of minimally invasive AVR were performed.The mean age was (47.60±12.28) ;12 males and 8 females.All patients are ventilated with a double-lumen endotracheal tube,through the 3nd anterior intercostals space with a 5 -6cmskin incision,right femoral artery and vein cannulation are used to establish CPB,direct aortic cross-clamped by Chitwood sliding clamp through the right 4th intercostals space,and completed the aortic valve replacement.Results Mean length of incision was (4.73±0.54)cm.Mean duration of cardiopulmonary bypass was (124±39.83)min,crossclamp time was (97.21±33.17) min.Median intubation time was (13.55±3.87)hours.Median duration of intensive care and postoperative hospital stay was (16.34±3.82)hours and (6.63±1.45) days,respectively.Hospital mortality was 0.There was no perivalvular leakage,Conclusion Minimally invasive aortic replacement with a modified Port-Access approach is feasible,small incisions,more cosmetic,shorter length of bospital stay and less need for blood transfusion are attainable.

Objective Discuss the different between minimally invasive and conventional thoracotomy mitral valve replacement surgery.Methods Select 141 cases from February 2009 to December 2012 in our hospital suffer mitral valve replacement surgery.69 cases minimally invasive surgery and the 72 cases conventional thoracotomy mitral valve replacement surgery,mechanical valve 90 cases,the bioprosthesis 51 cases.The establishment of cardiopulmonary bypass is through the femoral artery and vein and the right jugular vein with cannulation.Under the guide of transesophageal echocardiography (TEE) and adjust the the intubation position to the inferior vena cava and superior vena cava junction.Double-lumen endotracheal intubation in trachea.Transthoracic approach through the right side of the stemum 4 intercostal,the left lung unilateral breathing and fight lung collapse.Open the pericardium with minimally invasive surgical instruments away 2 cm from the phrenic nerve.Transthoracic chitwood clamp blocking the ascending aorta,HTK or crystalloid cardioplegia aortic root perfusion.Arrest heart minimally invasive mitral valve replacement surgery.After CPB,unplug the femoral artery and vein catheter,6-0 prolene suture femoral artery reconstruction pathway.Results Minimally invasive compared to the conventional median thoracotomy mitral valve replacement surgery have no significant difference in operative time,cardiopulmonary bypass time,aortic clamping timeand the intensive care unit (ICU) time.Conclusion Overcome the learning curve,minimally invasive mitral valve surgery have many advantages than the conventional median thoracotomy surgery is a safe,effective,and easy to spread surgery.

Objective To evaluated the early-term results of the right or left anterolateral minithoracotomy used for the repair of various congenital heart defects.Methods All the patients with congenital heart defects who were operated with this incision between April 2010 and December 2012 were reviewed.There were 63 patients (41 females,22 males) underwent openheart surgery through right or left anterolateral minithoracotomy.Ages ranged from 12 to 69 years,mean (30.63 ± 11.74) years.Corrected defects included atrial septal defect(ASD) closure in 38,closure of ventricular septal defect(VSD) in 19,correction of partial atrioventricular canal defect (PECD) in 3,correction of partial anomalous pulmonary venous connection (PAPVC) in 1,correction of Ebstein's anomalyin 1,and repair of ruptured aneurysm of the sinus of Valsalva in 1.Results In all patients,length of incision was (4.76 ± 0.95) cm.There was no early or late death.No patient required conversion to full sternotomy.The median CPB and aortic clamp times were (76.38 ± 29.97) and (33.49 ± 31.50) minutes,respectively.Median intubation time was (10.53 ± 6.13) hours.Median duration of intensive care and postoperative hospital stay was (14.93 ± 7.65) hours and (5.42 ± 1.98) days,respectively.Only 9 patients(14.3％) received blood transfusion.Follow-up echo showed no residual defect.All patients have gratifying cosmetic results and are in excellent condition after a median follow-up of (13.75 ± 8.91)months.Conclusion The small anterolateral thoracotomy in congenital cardiac surgery is a safe and feasible approach,and with a excellent cosmetic results.

ObjectiveTo study the relevant effect of proinflammatory cytokines interelenkin-17(IL-17), -6 and endothelin-1 (ET-1) on statins attenuating no-reflow phenomenon after myocardial ischemia-reperfusion in rats.MethodsEighteen healthy male Wistar rats were randomly divided into 3 groups according to body weight: sham operation, injury, preconditioning groups. The preconditioning group was given atorvastatin 2 mg·kg-1 ·d-1 and the other two groups were given the same volume of saline once. After 7 days, the rats were anesthetized with an intraperitoneal injection of chloral hydrate, and then the thoracic cavity was opened. The coronary artery of injury group and preconditioning group were ligated for 60 minutes, and then opened for 15 minutes, to establish the rat acute myocardial ischemia-reperfusion model. The sham operation group was was treated with a seam through the coronary artery without ligation. Eleetrocardiogram was checked before ligation, and ligation was carried out for 15, 30, 45 minutes and then reperfusion for 15 minutes. After reperfusion for 15 minutes, the thioflavine S and Even's were injected from femoral venous, then the heart and blood were obtained(keeping left ventricular only). Hearts were flushed with saline and sliced transversely into five to seven sections. Finally, observed at 365 nm wave length the existence of non-fluorescent areas, which was no-reflow zone. The level of serum IL-17, IL-6 and ET-1 was detected by ELISA. Results The electrocardiogram confirmed that the sham operation group had no ischemic damage and the model of myocardial ischemia- reperfusion was established in preconditioning group and injury group. The noreflow phenomenon could be observed under 365 nm wave length in preconditioning group and injury group. The ligated area[LA％, (57.34 ± 11.49)％, (53.08 ± 8.66)％] of injury group and preconditioning group was higher than that of sham operation group(0, all P ＜ 0.05); the area of no-reflow[ANF％, (48.96 ± 6.94)％, (21.37 ±3.35)％] of injury group and preconditioning group was higher than that of sham operation group(0, all P ＜ 0.05),and the ANF％ of preconditioning group was lower than that of injury group(P ＜ 0.05) ; the level of serum IL-17,IL-6 and ET-1[(151.67 ± 11.19) × 10-9, (167.89 ± 5.13) × 10-9, (322.37 ± 19.08) × 10-9 g/L] of injury group was higher than those of sham group and preconditioning operation group[(49.75 ± 14.06) × 10-9, (59.32 ± 5.26) ×10-9, (109.9 ± 12.12) × 10-9, (90.45 ± 11.63) × 10-9, (112.47 ± 10.40) × 10-9 and(198.91 ± 27.88) × 10-9 g/L,P ＜ 0.05], the level of serum IL-17, IL-6 and ET-1 of preconditioning group was higher than those of sham operation group(P＜ 0.05). Conclusionsno-reflow phenomenon is related with IL-17 and ET-1 which can promote the expression of IL-6, statins decreases the expression of IL-17 and ET-1, and then decreases the on-reflow phenomenon.

Objective To investigate the proliferation of rabbit adipose-derived stem cell(ADSCs) transfected by adenoviral vector mediated hTGF-?_1 gene and its chondrocyte differentiation potential.Methods The Ad-hTGF-?_1 plasmid vetor which had the hTGF-?_1 gene was developed and transfected the ADSCs.The experimental group was the hTGF-?_1 transfected group.The cells enclosed by alginate were cultured in com- plete chondrogenie medium(CMM).The morphology of the cells were observed,and RT-PCR was used to measure hTGF-?_1 and collagenⅡexpression,at the same time western blot and immunohistochemistry were applied to detect the expression of collagenⅡin ADSCs before and after transfected with hTGF-?_1 gene. Results The hTGF-?_1 transfected ADSCs became the polygon and it proliferated well.The RT-PCR result of hTGF-?_1 on the transfected group was better than the control after transtected for 7 day and 21 day.The dif- ference between the two groups was significant(P

Objective To review and analyze minimally invasive right thoracotomy and peripheral cannulation as an alternative strategy in redo heart surgery.Methods From June 2012 to December 2016, 23 reoperative heart procedures were performed through a right lateral thoracotomy with about 5 cm in the third or fourth intercostal space,according to the different diagnosis with the corresponding operations.Results We performed 23 redo heart surgeries,there were 10 female and 13 male patients with a mean age of 41.43 years(range,20 to 69 years).4 mitral perivalvular leakage, 1 prosthetic valve dysfunction, 3 mitral insufficiency after mitral valvuloplasty, 1 aortic insufficiency after ventricular septal defect and aortic repair, 1 mitral insufficiency after ventricular and atrial septal defect repair, 3 residual fistula after surgery repair of ventricular septal defect, 1 tricuspid insufficiency after mitral and aortic valve replacement, 1 tricuspid insufficiency after left atrial myxoma removal,1 tricuspid insufficiency after Bentall surgery, 2 tricuspid insufficiency after mitral valve replacement, 1 mitral insufficiency after ventricular septal defect and mitral valvuloplasty, 2 tricuspid insufficiency after the repair of Ebstein abnormality.We respectively carried out repair of valve leakage, mitral valve replacement, aortic valve replacement, mitral valve repair, tricuspid valvuloplasty, postoperative repair of residual shunt of ventricular septal defect, redo repair of Ebstein abnormality.The effect of the whole group operation of operation was satisfactory, no death during operation and severe complications.All patients were under cardiopulmonary bypass,three patients' ascending aortas were bloked, and nine patients were with cardiopulmonary bypass.It indicated tha the operation was possible at operation time,total blood loss and the frequency of blood transfusion.Conclusion The application of closed thoracic cardiopulmonary bypass and minimally invasive right thoracotomy in redo or multiple cardiac surgery,can avoid reoperative sternotomy risk such as hemorrhage, tissue damage and so on.It shortened the operation time, reduced the risk of surgery and blood transfusion rate, can be used in some of the heart surgery patients again and repeatedly.

Objective The aim of this study is to evaluate the early and midterm results of reconstructive new tricuspid valvar annulus technique and prosthetic ring in the anatomic correction of Ebstein's anomaly.Methods 60 operations for Ebstein's anomaly were performed by the reconstructive new tricuspid valvar annulus technique,prosthetic ring was used to reinforce the new tricuspid valvar annulus,the plastic effect of tricuspid valve was observed real-time by trans-esophagus echocardiography during operation.The follow-up results of the plastic effect of tricuspid valve were studied after operation.Results Mean operation time was (3.1 ± 2.3) h,mean cardiopulmonary bypass time was (148.8 ± 44.6) min,mean aortic cross-clamp time was(112.6 ± 34.1) min.3 patients had tricuspid valve replacement because of bad plastic effect;1 patient had bidirectional shunt Glenn procedure because of right sided heart failure.Hospital mortality was 1.When the patients were discharged,tricuspid regurgitation severe 1,medium 5,mild or no 50;53 being of heart functional class Ⅰ and class Ⅱ,3 of classⅢ.45 patients (80.3 ％) were followed-up out-hospital from 6 months to 7 years,mean (24.4 ± 21.4) months.Tricuspid regurgitation severe 1,medium 6,mild or no 38.And the nice stability of tricuspid valve was found during the follow-up period,41 patients being of heart functional class Ⅰ or Ⅱ (NYHA),4 of class Ⅲ.1 need reoperation.Conclusion The reconstructive new tricuspid valvar annulus technique can maintain farthest the dimension and geometric configuration of functional right ventricle,longitudinal plication of the atrialized right ventricle can restore a large ventricular cavity,improve it's pump function,and make valvuloplasty perfect,which widen obviously the indication of tricuspid valvuloplasty for Ebstein's anomaly.The research concluded that this technique can correct anatomically Ebstein's anomaly effectively,and it can get the stable effect of tricuspid valvuloplasty obviously if use prosthetic ring to reinforce the new tricuspid valvar annulus.

Cytokines ; Fatty Liver ; Humans ; Hypertriglyceridemia ; Insulin Resistance ; Non-alcoholic Fatty Liver Disease