Objective To evaluate the efficacy of surgical repair for non-circumferential defect of bile duct in Mirizzi syndrome.Method The clinical data of 32 patients with Mirizzi syndrome with non-circumferential defect of bile duct were repaired using the patient's own tissues such as gallbladder pedicle flap,umbilical venous flap and omental flap.Results All the patients were operated success fully.There was no operative mortality.The defects in the bile duct were repaired using gallbladder pedicle flap in 25 patients,umbilical venous flap in 5 patients and omental flap in 2 patients.There were 2 patients who developed postoperative complications.There was one postoperative bile leakage in a patient who was repaired using an umbilical venous flap.The other complication was residual bile duct stones.The patient with postoperative bile leakage was drained through a drainage tube which was removed after 7 days.The residual bile duct stones were removed by endoscopy through a T-tube sinus after 9 months.All patients were confirmed by T-tube cholangiography after 9 to 12 months to have no stones,bile duct stenosis or any other abnormalities.The T-tube was then removed.All patients were followed -up for 1 to 5 years.All patients had no cholangitis,abdominal pain,jaundice or fever.Conclusions Using the patients' own tissues such as gallbladder pedicle flap,umbilical venous flap and omental flap to surgical repair the defect in the bile duct of patients with Mirizzi syndrome was effective.This surgical treatment is a good choice.

Background Cystoid macular edema(CME) is an important cause of visual impairment of central retinal vein occlusion(CRVO).Spectral-Domain optical coherence tomography(SD-OCT) has increased speed and higher resolution,offering a better chance of understanding the morphological changes and pathogenesis of CME. Objective This study was to survey the morphologic features of macular edema associated with CRVO by SD-OCT. Methods Clinical data of the patients with CRVO diagnosed in Department of Ophthalmology,Peking Union Medical College Hospital from March 2008 to August 2009 were retrospectively analyzed.SD-OCT features of macular edema induced by CRVO were analyzed and recorded.Results The average macular foveal thickness was(527.5±218.2) μm in macular edemas eyes.Main morphological changes included 55 cases(84.6%) of CME,15 cases of(23.1%) serous macular detachment(SMD),and 10 cases(15.4%) of simple macular edema,and these findings occurred at the same time in some eyes.Cystoid spaces in the parafoveal region were seen in the inner nuclear layer,outer plexiform layer and outer nuclear layer,and discontinuous or weak inner segment/outer segment(IS/OS) line was often seen in CME.The incidence of CME associated with incomplete posterior vitreous detachment(PVD) was 14.5%,and that of neural epithelial edema associated with incomplete PVD was 10.0%,showing an insignificant difference between them(χ2=0.000,P=1.000).The average area of SMD was 1838.4μm ×1428.1μm×190.1μm,and the incidence of partial PVD was higher(χ2=4.266,P=0.039).Conclusion SD-OCT can reveal the micro-morphological change of macular zone in macular edema eye.SD-OCT enabled visualization of its spatial extent in each retinal layer and the condition of IS/OS layer.Serous macular edema is related with partial PVD.

Background The accurate calculation of intraocular lens (IOL) power is essential for attaining the desired refractive outcome after cataract surgery,especially for patients with high myopia and posterior scleral staphyloma.Objective This study was to evaluate the clinical feasibility of IOL Master compared with contact A-scan in cataract patients with high myopia and posterior scleral staphyloma,then compare the accuracy of different IOL power calculation formulas.Methods This was a prospective case control clinical research.Fourty-one eyes with age-related cataract of 28 patients underwent phacoemulsification with monofocal foldable IOL implantation in Tianjin Medical University Eye Hospital were involved,who were all high myopia with posterior scleral staphyloma.Preoperative measurement was measured with IOL Master as well as with contact A-scan and manual keratometry.IOL power was calculated according to the SRK-Ⅱ,SRK-T,Haigis,Hoffer Q,Holladay 1 formulas.The refractive outcome was followed-up 3 months after operation.Results The difference was significant between the 2 methods in axial length (AL) and anterior chamber depth (ACD) measurement (P =0.005,0.000) ; In corneal curvature measurement,there was no significant difference between them (P =0.398).When mean absolute refractive error (MAE) was divided by ±1.00 D,The SRK/T and Haigis formula performed better than other formulas measured by IOL Master;The Holladay 1,Hoffer Q and Haigis formula performed better than other formulas measured by contact A-scan combined with manual keratometry,respectively.Conclusions For cataract patients with high myopia and posterior scleral staphyloma,SRK/T and Haigis formula were recommended when employing IOL Master; whereas when using contact A-scan combined with manual keratometry,we prefer Holladay 1,Hoffer Q or Haigis formula.

Background Krüppel-like factor 6 (KLF6) is related to the physiological or pathological process,such as growth,cell differentiation,proliferation,apoptosis,angiogenesis,tissue repair,and so on.But in ophthalmology,it is less reported about the expressing level of KLF6 protein in lens epithelial cclls (LECs) or the effect of KLF6 on the proliferation of human LECs.Objective This study was to investigate whether KLF6 can inhibit proliferation of human LECs.Methods KLF6 eukaryotic expression plasmid (pEGFP-C2-KLF6) was constructed using reverse transcription PCR(RT-PCR) and identified by double enzyme digestion method and PCR.Human LECs strain (HLE-B3) was cultured and passaged using low glucose DMEM containing 10％ fetal bovine serum and then divided into 4 groups.KLE-B3 transfection reagents were added in the culture medium of all groups.In addition,no agent was used in the blank control group;only insulin-like growth factor-1 (IGF-1) was appended to the medium in only IGF-1 group ;null vector was transfected and IGF-1 was appended in the null plasmid transfection+ IGF-1 group;while pEGFP-C2-KLF6 eukaryotic expression plasmid was transfected into the cells,and simultaneously IGF-1 was added in the pEGFP-C2-KLF6 plasmid transfection+IGF-1 group.After 24 hours of intervene,water soluble tetrazolium salt-1 (WST-1) test was used to detect the growth status of the cells,and Western blot assay was used to assay the relative expressing level of KLF6 protein in the cells.In the other hand,the cells were cultured at the density of 1 ×104/piece,and 0,0.10 and 0.25 μg pEGFP-KLF6 were transfected into each piece of cells respectively,and then IGF-1 was added with a final concentration of 50 μg/L for 24 hours after cell culture.Expressions of Ki-67 protein and mRNA in the cell pieces were detected by immunocytochemistry and fluorescent semiquantitative PCR,respectively.Results The PCR product bands were consistent with KLF-6 gene in length,and the product fragments were corresponding with expectant ones via PCR and double enzyme digestion method,showing a successful construction of pEGFP-C2-KLF6 eukaryotic expression plasmid.After 24 hours of IGF-1 stimulation,the absorbance values of the cells were 0.86±0.00,2.10±0.01,2.24±0.12 and 1.06±0.02 in the blank control group,only IGF-1 group,null plasmid transfection + IGF-1 group and the pEGFP-C2-KLF6 plasmid transfection + IGF-1 group,with a significant difference among the 4 groups (F =38.322,P ＜ 0.05),and that in the pEGFP-C2-KLF6 plasmid transfection +IGF-1 group was significantly lowed in comparison with the only IGF-1 group and the null plasmid transfection+IGF-1 group (q=6.42,7.31,both at P＜0.05).Western blot assay showed that the relative expressing levels of KLF6 protein were statistically different among the four groups (F =591.858,P＜0.05),and those in the pEGFP-C2-KLF6 plasmid transfection+IGF-1 group were 1.47,2.04,3.27 folds higher than those in the blank control group,only IGF-1 group,respectively and null plssmid transfection+IGF-1 group,respectively.Immunocytochemistry revealed that the expressing intensity of Ki-67 protein was gradually weakened with the decrease of pEGFP-C2-KLF6 plasmid dose in the 0,0.10 and 0.25 μg pEGFP-C2-KLF6 plasmid transfection+IGF-1 groups.Fluorescence semiquantitative PCR results showed that the relative expression values of Ki-67 mRNA in the cells were O.15±0.08 and 0.11±0.03 in the 0.10 μg and 0.25 μg pEGFP-C2-KLF6 plasmid transfection+ IGF-1 groups,which were significantly lower than O.77± 0.12 of the 0 μg pEGFP-C2-KLF6 plasmid transfection group,with a statistically significant difference among the three groups (F =54.825,P＜0.05).Conclusions KLF-6 can effectively inhibit IGF-1-induced proliferation of human LECs,and it can be regarded as one of the regulatory factors of the proliferation of HLE-B3 cells.

Objective To compare the application of two different radial artery puncture and cannulation methods in septic shock patients. Meth-ods A total of 80 septic shock patients who need emergency operation were enrolled in this study. The shock index was>1.0. The patients were randomly divided into two groups:ultrasound group(group U)and palpation group(group A),with 40 cases in each group. For the patients in group U,Sonosite S-Nerve ultrasound in the wrist was used to determine the location of the radial artery puncture. For the patients in group A ,pal-pation method was used to determine the location of the radial artery puncture. The heart rate,blood pressure,first puncture success rate,total suc-cess rate,number of punctures,puncture time and complication rate of the two groups were monitored. Results The success rate of first puncture and total success rate of group U were higher than those of group A ,the number of puncture was less than that of group A ,the puncture time was shorter than that of group A,and the incidence of complications was lower than that of group A(P<0.05). Conclusion The application of ultra-sound for radial artery puncture and catheterization in septic shock patients is accurate ,and with higher first success puncture rate and total success rate,less number of puncture,shorter puncture time,and lower incidence of complications compared with palpation method.

Objective To compare the incidence of pancreatic fistula after hand and stapler suture in preventing pancreatic fistula after distal pancreatectomy.Methods The literatures published before December 2011 were retrieved from SinoMed and electronic database.Prospective controlled trials and retrospective reports were screened out for Meta analysis.The diagnostic criteria of pancreatic fistula were based on the criteria formulated by the International Study group of Pancreatic Fistula.The heterogeneity of the studies was analyzed using the Ⅰ2 test.The data were integrated using the fixed or random effect model.The results of the Meta analysis were presented with odds ratio (OR) and 95％ confidence interval (95％ CI).Results According to the selection criteria,lO literatures were selected which included 1 prospective randomized controlled study,3 prospective nonrandomized controlled studies and 6 retrospective studies.There were 1 441 cases in the hand suture group and 612 cases in the stapler suture group.There was no significant difference in the incidences of the pancreatic fistula between the hand suture group and the stapler suture group (OR =1.10,95％ CI:0.86-1.40,P ＞0.05).Six studies compared the incidences of severe pancreatic fistula (grade B or C) between the hand suture group and the stapler suture group.There were 1 182 cases in the hand suture group and 383 cases in the stapler suture group.There was no significant difference in the incidence of severe pancreatic fistula between the hand suture group and the stapler suture group (OR=1.33,95％CI:0.94-1.88,P＞0.05).Conclusion The efficacies of hand suture and stapler suture in preventing pancreatic fistula after distal pancreatectomy are comparable.Stapler suture provides an another option in distal pancreatectomy.

American medical colleges attach great importance to the humanistic education.The rich humanities curriculum is fully integrated into the teaching practice thus the mutual penetration of medicine and the humanities is achieved.They have specific and detailed examination evaluation system and the teaching method was more practical and participatory.By contrast,nost of the medical colleges in our country neglect the humanities construction and the cultivation of medical students' humanistic spirit.The coverage of the humanities curriculum is relatively narrow and the faculty is insufficient.We should promote the development of humanistic cducation,attach importance to the construction of medical humanities,set up appropriate curriculum system,increase the investment in faculty and reform the teaching method and examination method.

Objective To evaluate the effect of debridement hepatectomy with selective hepatopetal blood occlusion in the treatment of severe hepatic trauma.Methods The clinical data of 55 patients with severe hepatic trauma treated by debridement hepatectomy with selective hepatopetal blood occlusion were retrospectively analyzed.20,20 and 15 patients were with grade Ⅲ,Ⅳ and Ⅴ hepatic trauma respectively,combined with major peripheral hepatic vascular injury in 14 cases and with other trauma in 35 cases.Additional procedures including liver suture repair in 7 cases,perihepatic gauze packing in 3 cases,inferior vena cava repair in 5 cases,hepatic vein repair in 4 cases,hepatic vein ligation in 3 cases and hepatic artery ligation in 2 cases were performed.Other operations such as craniotomy debridement in 3 cases,cholecystectomy in 6 cases,T tube drainage of common bile duct in 4 cases,splenectomy in 5 cases,pancreatic tail resection in 2 cases,left kidney resection in 1 case,thoracic cavity closed drainage in 9 cases,partial small bowel resection or repair in 4 cases and stomach repair in 1 case were performed as needed.Results The operations were successful in 47 patients.Postoperative complications were observed in 19 cases (34.5％) including coagulation disorders in 1 case,postoperative abdominal bleeding in 2 cases,intestinal obstruction in 1 case,liver and renal dysfunction in 4 cases,abdominal infection in 3 cases,incision infection in 2 cases,pulmonary infection in 4 cases,pleural effuion in 10 cases.Death occurred in 8 patients (14.5％),the cause of death were hemorrhagic shock in 3 cases,combined with severe craniocerebral injury in 2 cases,septic shock in one case,and multiple organ failure in 2 cases.Conclusions Debridement hepatectomy with slective hepatopetal blood occlusion is an effective treatment for severe hepatic trauma.

Objective To study the results of laparoscopic approach in the treatment ot gallbladder and common bile duct stones.Method The authors reviewed data of 60 patients with gallbladder and bile duct stones treated laparoscopically.Results All the 60 patients treated with laparoscopic cholecystectomy and laparoscopic transcystic common bile duct exploration (LcTDE) were successful.There were 1 bile duct stone in 32 patients,and 2 to 6 bile duct stones in 28 patients.The operation time was (38.7±15.1) min and the hospitalization time was (5.5±2.1) days.One patient developed biliary fistula postoperatively which healed after 7 days of conservative treatment.One patient had bile duct residual stone which was treated by ERCP.The remaining patients were well.Conclusion Laparoscopic transcystic common bile duct exploration using a mini incision and primary suturing of the bile duct was simple,safe and efficacious.

Objective To research and evaluate measuring Toric intraocular lens (Toric IOL) alignment by iTrace aberration without mydriasis.Methods Forty-five eyes of 35 patients underwent phacoemulsification in Tianjin Medical University Eye Hospital from June 2015 to February 2016 were enrolled.Follow-up and iTrace aberration examination were performed at postoperative 1 week.The internal optics aberration astigmatism axis was transformed into postoperative Toric IOL alignment.The result and the Toric IOL alignment measured by tradition slitlamp method were compared by linear correlation and difference.Results At postoperative 1 week,the uncorrected distant visual acuity and corrected distant visual acuity were (0.19 ± 0.12)LogMAR and (0.10 ±0.09) LogMAR.The UCVA was 20/40 or better in 42 eyes (93.3％).The mean IOL misalignment measured by slitlamp was (3.13 ± 2.86) degrees (ranged 0-9 degrees) and by the iTrace aberration was (4.44 ± 3.42) degrees(ranged 0-13 degrees),there was statistical significant difference (t =-2.321,P =0.025).The mean difference in the error of the Toric intraocular lens alignment measured by iTrace aberration and the slitlamp was (3.67 ± 3.59) degrees (ranged 0-14 degrees).The results showed that there was less than 5 degrees of difference between the two methods in 32 eyes (71.1％),locate 5 to 10 degrees in 9 eyes (20％),more than 10 degrees in 4 eyes (8.9％).The correlation between the 2 methods showed significant linear relationship (r =0.926,P ＜ 0.01).Conclusion Using iTrace aberration can accurately measure Toric intraocular lens alignment without mydriasis,the result has some reference value.