Objective To investigate the advantages and indications of combined laparoscopic surgery(CLS). Method 488 casesof laparoscopic procedures were given from May 1992 to February 2002.Among them 21 were CLS.Laparoscopic common bile duct exploration (LCBDE)+Laparoscopic cholecystectomy(LC)(7);Laparoscopic fenestration of liver syst+LC(4),LC+Laparoscopic appendectomy(4);LC+hand-assisted laparoscopic splenectomy(2);laparoscopic cystectomy for pancreatic pseudocyst+LC (1);LCBD+LC+Laparoscopic fenestration of right renal cyst(1)and LC+laparoscopic partial hepatectomy for small liver cancer(1). Results The combined procedures were succesful in all the 21 cases with no complications. Conclusions CLS has expanded the field of laparoscopy and advantages of minimally invasive nature and indications should be strictly choosen for the procedure.

Objective To investigate the feasibility and clinical value of laparoscope combined with choledochoscope in the treatment of intra- and/or extrahepatic bile duct cholelithiasis. Methods 10 patients with intra- and/or extrahepatic bile duct stones underwent common bile duct incision exploration to remove stones under laparoscope combined with fiber-choledochoscope from September 2000 to March 2002. Common bile duct was directly sutured or T-tube drainage was performed. Results All cases were operated on successfully without conversion to open operation. There was no serious complication except 1 case of postoperative bile leakage cured by conservative treatment. The residual stones of 2 cases were removed by choledochoscope. Conclusions Laparoscope combined with choledochoscope in the management of intra- and/or extrahepatic bile duct stones is a safe, reliable and minimally invasive procedure. However, it is important to choose indications.

Objective To investigate management strategy of minimally invasive surgery for common bile duct stones. Methods Three hundred and four cases of common bile duct stones were divided into 3 groups receiving respectively endoscopic papillary balloon delation plus laparoscopic cholecystectomy ( EPBD group, 35 cases ), endoscopic sphincterotomy plus LC ( EST group, 138 cases), and Laparoscopic common bile duct exploration plus LC (LCBDE group, 131 cases). Results There was no significant difference in treatment success rate, short-term complications and bile duct retained stones among these three group ( x2 = 1. 930, 0. 038, and 0. 427 respectively, P > 0. 05 ). There was significant difference among these three groups in operation time ( F = 17.941, P = 0. 000 ), and the operation time in LCBDE group was shorter than that in other two groups( EPBD-EST: P = 0. 122, EST-LCBDE:P = 0. 000, EPBD-LCBDE:P = 0. 020 ). There was significant difference among these three groups in postoperative hospital stay (F =24. 016,P =0. 000) ,and the postoperative hospital stay in EPBD group was shorter than that in other two groups ( EPBD-EST: P = 0. 000, EST-LCBDE : P = 0. 198, EPBD-LCBDE : P = 0. 000 ). In EPBD group,bile duct recurrent stones was found in 2 cases(6. 7% ) and cholangitis in 1 case(33% ) and no duodenal papilla stenosis was encountered; In LCBDE group, bile duct recurrent stones were found in 7 cases (6. 0% ), cholangitis in 3 cases ( 2. 6% ), and there was no duodenal papilla stenosis; In EST group, bile duct recurrent stones were complicated in 18 cases ( 15.8% ), duodenal papilla stenosis in 9 cases (7.9%), and cholangitis in 14 cases( 12. 3% ). There were significant differences among these three groups for these three complications( x2 = 6. 482, 9. 160, and 12. 020 respectively,P < 0. 05 ), and the rate of complications in EST group was higher than that in other two groups. Conclusion For common bile duct stones, EPBD is the first choice followed by LCBDE while EST is only indicated for very few cases.

Objective: To analyze the prevalence and risk factor of co-exiting pre-hypertension and pre-diabetes condition in middle to elder adults, and to provide the theoretical basis for preventing cardiovascular disease in relevant population in Chengdu area.
Methods: A total of 5240 middle to elder adults from (40-79) years of age in Chengdu area were enrolled for a stratiifed cluster sampling study. The blood pressure, glucose and other clinical information were collected by more than 30 medical professionals with uniifed training to investigate the prevalence of co-exiting pre-hypertension and pre-diabetes condition with the risk factors.
Results: The overall prevalence rate of coexisting pre-hypertension and pre-diabetes condition was at 12.5% in Chengdu area and the standardized prevalence was at 11.5%. The prevalence rate in urban area was 12.4% and in rural was 13.2%, P=0.47, the prevalence in male gender was 12.7% and in female was 12.4%,P=0.81. With the increased age, the prevalence trend was elevated accordingly. Multi-regression analysis indicated that the elder age, overweight or obesity (female with abdominal obesity), sibling history of hypertension, hyper-triglyceridemia, multiple childbirth and menopause had the higher risk of coexisting pre-hypertension and pre-diabetes condition, allP<0.05; the higher educational level could decrease the risk of prevalence in male gender,P<0.05 and the proper exercise could decrease the risk in female gender,P<0.05.
Conclusion: There is a high prevalence rate of coexisting pre-hypertension and pre-diabetes condition in middle to elder population in Chengdu area and the prevalence is closely related to age. It is important to prevent such condition by elevating educational level nationwide, controlling waist and body weight, adjusting diet structure with proper exercise.

Objective To explore the change of miRNA-16(miR-16) level in the patients with multiple my-eloma(MM ) and its relationship with the Mayo risk stratification and prognosis judgment .Methods Each 10 mL of bone marrow samples was collected from 31 cases of MM in the hematology department of the First Af-filiated Hospital of Guangxi Medical University from August 2016 to January 2017 ,and each 5 mL of bone marrow sample was collected from 5 healthy bone marrow donors as the healthy control .The real time fluores-cence quantitative PCR(qRT-PCR) was used to analyze relative the change of miR-16 relative expression level and fluorescence in situ hybridization(iFISH) was used to detect the abnormal gene .Then the relationship be-tween miR-16 relative expression level with Mayo based risk stratification ,and the difference of miR-16 rela-tive expression level between before and after self treatment were statistically analyzed .Results The miR-16 relative expression level in MM patients was increased and positively correlated with the Mayo risk stratifica-tion .Meanwhile in the MM patients with disease progression ,the miR-16 expression was increased . Conclusion miR-16may serve as the indicator for judging the recurrence or progression of MM ,and guides the clinical personalized therapy of MM according to its expression level change .

Objective:To investigate the impact of recombinant human epidermal growth factor (rh-EGF) on the epithelial recovery and the tear film stability after trans-epithelial corneal collagen crosslinking in patients with progressive keratoconus.Methods:A randomized controlled clinical trail was designed.Consecutive 66 patients (37 males and 29 females) with an average age of (21.27±3.80) years old diagnosed with primary progressive keratoconus and hospitalized in Xiamen Eye Center Affiliated to Xiamen University from October, 2016 to January, 2017 were enrolled and treated with unilateral enhanced transepithelial corneal crosslinking surgery by iontophoresis, and the patients were randomly divided into control group and experimental group according to random number table method, with 33 patients 33 eyes in each group.The eyes in the control group were treated with carboxy-methylcellulose sodium lubricant eye drops and the eyes in the experimental group were treated with rh-EGF eye drops.The ocular surface disease index (OSDI) questionare, slit lamp examination, Schirmer Ⅰ test, corneal fluorescein sodium staining scoring, non-contact tonometry, uncorrected visual acuity, best corrected visual acuity, bulbar conjunctival congestion scoring, lacrimal sevretion test, non-invasive break-up time of tear film (NIBUT), as well as tear meniscus height analysis were performed before surgery, and on day 1, day 3, day 5, day 7, day 14 and day 28 after surgery.This study followed the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Xiamen Eye Center Affiliated to Xiamen University (No.2016-ME-003).Results:On day 7 after surgery, the OSDI values were increased in both groups than the preoperative value, while the value in the experimental group was significantly lower than that in the control group ( P<0.05). There were statistically significant differences in the overall corneal epithelial staining score values between the two groups at different time points ( Fgroup=16.701, P<0.01; Ftime=454.418, P<0.01). The corneal epithelial staining score in the experimental group on day 3 and day 5 after surgery were significantly lower than those in the control group (1.79±0.65 vs. 2.70±0.68; 0.91±0.46 vs. 1.55±0.51) (both at P<0.01). The conjunctival congestion score in the experimental group was significantly lower than that of the control group on day 3 and day 5 after surgery (both at P<0.05). There were statistically significant differences in the overall NIBUT values between the two groups at different time points ( Fgroup=13.084, P<0.01; Ftime=34.383, P<0.01). The NIBUT values were significantly decreased rapidly on day 7, day 14 and day 28 after surgery in both groups (all at P<0.01), but gradually recovered.The NIBUT of the experimental group on day 7 and day 14 after surgery were significantly higher than those of the control group ([8.18±2.26]seconds vs. [5.93±2.33]seconds; [9.49±1.95]seconds vs. [7.52±2.27]seconds) (both at P<0.01). No statistical differences were found in the tonometry value, visual acuity, value of Schirmer I test as well as tear meniscus height at any time point before or after surgery between the two groups (all at P>0.05). Conclusions:Recombinant human epidermal growth factor has positive effects in the patients received enhanced transepithelial corneal crosslinking surgery, presenting with promotion of epithelial healing, relief of post-operative discomfort, and the recovery of tear film stability.

AIM: To investigate the preoperative ocular symptoms and the characteristics of asymptomatic ocular surface abnormalities in hospitalized patients with primary pterygium.METHODS: Cross-sectional study. Hospitalized patients diagnosed with primary pterygium and scheduled to receive pterygium excision surgery at the Xiamen Eye Center of Xiamen University from August 2022 to October 2022 were enrolled. Ocular surface disease index questionnaire(OSDI), six examinations including non-invasive tear film break-up time, Schirmer I test, tear meniscus height, lid margin abnormality, meibomian gland dropout and tear film lipid layer thickness, and anterior segment optical coherence tomography(AS-OCT)were performed and statistically analyzed.RESULTS: A total of 178 cases(178 eyes), with a mean age of 54.39±10.75 years old, were recruited, including 75 males(42.1%)and 103 females(57.9%). The average values of ocular surface parameters in these patients included OSDI: 11.47±9.69, tear film break-up time: 7.10±3.86 s; tear meniscus height: 0.16±0.07 mm, Schirmer I test values: 14.39±7.29 mm/5 min, and pterygium thickness: 504.74±175.87 μm. Totally 161 eyes(90.4%)presented with abnormal lid margin, 44 eyes(24.7%)presented with meibomian gland dropout score ≥4, 52 eyes(29.2%)presented with low lipid layer thickness. In the 6 objective examinations, abnormalities in at least 4 of these tests were found in 85.4% of eyes. Pterygium morphology was classified into four grades: 10 eyes(5.6%)of grade Ⅰ, 93 eyes(52.2%)of grade Ⅱ, 60 eyes(33.7%)of grade Ⅲ, and 15 eyes(8.4%)of grade Ⅳ. In patients with a higher grade of pterygium, the tear film break-up time was lower, and the proportion of abnormal lid margin was also significantly higher(P<0.05). The patients were further divided into two subgroups, including 121 eyes(68.0%)with normal OSDI <13 in the normal group and 57 eyes(32.0%)with OSDI ≥13 in the abnormal group. No significant difference was found in the proportion of meibomian gland dysfunction between the two groups of patients(71.9% vs. 71.9%, P=0.872). In addition, there were differences in the number of abnormal objective examinations(4.11±0.85 vs. 4.91±0.99, P<0.001).CONCLUSIONS: Asymptomatic ocular surface abnormalities were present preoperatively in patients hospitalized for primary pterygium. A comparable high incidence of structural or functional meibomian gland dysfunction existed in pterygium patients with or without apparent ocular discomfort. More attention should be paid to the ocular surface abnormalities in those asymptomatic patients before primary pterygium surgery.