Twenty-four cases of juvenile pseudomyopia were corrected by puncturing Jingming (BL1)on the affected side, Hegu (LI 4) and Fengchi (GB 20) on the both side, and then moving both eyeballs in a rotary route. After 42 affected eyes were treated, 32 eyes were cured, 6 eyes were markedly effective, 2 eyes were improved, 2 eyes were ineffective and the total effective rate was 95.2%.

Objective To evaluate the value of real-time three-dimensional echocardiography（RT3DE）to predict the long-term response to cardiac resynchronization therapy（CRT）.Methods Twenty-six patients with heart failure were scheduled for CRT.RT3DE was performed before and one year after the pacemaker implantation,and left ventricular（LV）dyssynchrony was defined as the maximum difference（Tmsv 16-Dif）and standard deviation（Tmsv 16-SD）when the minimum systolic volume of 16 segments was reached.Patients were divided into re-sponders and non-responders according to a reduction ≥15 % in LV end-systolic volume（LVESV）after CRT.Results Seventeen patients（65.4 %）were classified as responders.Compared with non-responders,the responders demonstrated a significant increase in LV ejection fraction,and reduction in Tmsv 16-SD.Tmsv 16-SD was a determinant factor for Δ LVESV ≥15%.Tmsv 16-SD 〉3.5% could be employed to evaluate the short-term response to CRT with 80 % sensitivity and 77 % specificity.Conclusions CRT can increase the LV systolic function and synchrony.RT3DE is highly predictive for long-term response to CRT

BACKGROUND: Homocysteine (HCY) has been verified as an independent risk factor of atherosclerosis and atherothrombosis of cardiovascular disease.OBJECTIVE: To observe the effects of HCY on the secretion and activity of matrix metallopotinase-1 (MMP-1) and tissue inhibitors of metalloproteinase-1 (TIMP-1) in vascular smooth muscle cells (VSMCs).DESIGN : Auto-control observation.SETTING: Pathology Room, Institute of Regeneration Medical Sciences, Jilin University.MATERIALS: In vitro cultured vascular smooth muscles cells (VSMCs) of rats were obtained from male Wistar rats with the body mass of about 150 g from weeks 4-6 supplied by Laboratory of Animals, Norman Bethune Medical Sciences Division, Jilin University.METHODS: The experiment was performed at the Pathology Room, Institute of Regeneration Medical Sciences, Jilin University from May 2001 to May 2003. VSMCs ofin vitro cultured rats were adopted and divided into 5 groups, 0(control group), 0.10, 0.25, 0.50 and 1.00 mmol/L HCY were added, respectively for 48 hours. Effect of HCY on activity of MMP-1 was observed with zymography. The secretions of MMP-1 and TIMP-1 and their mRNA expressions were studied with Western blot and semi-quantitative reverse transcription polymerase chin (RT-PCR).MAIN OUTCOME MEASURES: Activity of MMP-1, secretions of MMP-1 and TIMP-1 and their mRNA expressions.RESULTS: ①Secretions of MMP-1 and TIMP-1: The secretion of MMP-1 in the 0.25, 0.50 and 1.00 mmol/L HCY groups was lower significantly than that in the control group (P ＜ 0.05-0.01). The secretion of TIMP-1 in the 0.10, 0.25, 0.50 and 1.00 mmol/L HCY groups was higher than that in the control group (P＜ 0.05-0.01). ②The MMP-1 activity decreased with the increase of HCY, but reduced obviously in the 0.50 and 1.00 mmol/L HCY groups (P ＜ 0.01). ③The expression of MMP-1 mRNA in the 4 HCY groups was lower markedly than that in the control group (P ＜ 0.01). The expression of TIMP-1 mRNA in the 0.25 mmol/L HCY group was higher than that in the control group (P ＜ 0.05), and it was higher remarkably in the 0.50 and 1.00 mmol/L HCY groups than that in the control group (P ＜ 0.01).CONCLUSION: HCY can inhibit enzyme activity, decrease collagen degradation and induce collagen accumulation by inhibiting the secretion of MMP-1, which indicates that reduction of collagen degradation induced by HCY is one of the pathogenesies of atherosclerosis.

Objective To evaluate the left ventricular (LV) systolic dyssynchrony after the acute myocardial infarction (AMI) with two-dimensional speckle tracking echocardiography (STE). Methods STE were performed in 65 patients within 72 h of AMI and compared with 60 age- and sex-matched healthy volunteers. The peak longitudinal strain (LS_(peak)) was measured at LV myocardium. LV dyssynchrony was defined as an interval ≥130 ms for the absolute difference in time to peak radial strain for the anteroseptal wall versus the posterior wall (TAS-POST). Size of myocardial infarction (MIS)was confirmed by wall-motion score index (WMSI). Results The LS_(peak) and LV ejection fraction (LVEF) were lower, and WMSI and TAS-POST were larger in AMI patients compared with controls. Forty-two patients had developed LV dyssynchrony (64.62%), and there were strong correlation between LV dyssynchrony (TAS-POST) and LS_(peak), LVEF, and WMSI (MIS). MIS was the most independent predictor for systolic dyssynchrony. Conclusion AMI with normal QRS can induce LV dyssynchrony, which is mainly determined by MIS. STE is a reliable technique for accurate evaluation of LV synchrony.

Objective: To study the surgical strategy of portal vein organized thrombosis ( PVOT ) during liver transplantation ( LT ) . Methods: The clinical data of 41 patients with PVOT performed LT from January 2005 to June 2006 ( 359 cases ) in our institute was retrospectively analyzed . The reconstruction of portal vein ( PV ) were removing thrombosis in 22 cases , throm- boendovenectomy in 10 cases , PV to splanchnic varicose vein in 8 cases , cavoportal hemitranspo- sition in 1 case . Results: 1 case died of multiple organ failure , 1 case died of hepatic artery bleeding . Retransplantation and portosystemic shunt vein ligation were performed in 1 case 14 days after LT because of its insufficient PV flow 2 cases were found anastomotic stenosis and they were cured by balloon angioplasty and stent placement via hepatic vein . Other patients were followed up 6 to 20 months , all of them had normal PV flow . Conclusion: Thromboen- dovenectomy or removing thrombosis is applicable to manage PVOT during LT .

Objective To evaluate the feasibility of real time elastosonography in estimating the characteristic of nodules in resected hepatocirrhosis specimens.Methods Thirty-eight reseeted hepatocirrhosis specimens underwent elastosonography.The nodules that have drawn attention were performed elastosonography through rhythmic pressing and releasing the probe by manual form on the liver.The hepatic strain on the region of interest was shown by chromatic scale.To compare nodules rigidity with surrounding hepatic tissues, hepatocirrhosis nodules were classified into hard nodules, medium rigidity nodules, mixture of hard and soft nodules, and soft nodules.All nodules were confirmed by pathology.Results Forty-four nodules of 38 hepatocirrhosis exemplar received real time elastosonography.Of 44 nodules, hard nodules were 18,of which 12 (66.7%) were hepatoeellular carcinomas, 2 (11.1%) were dysplasia nodules, 4 (22.2%) were regenerative nodules.Medium rigidity nodules were 7,all were regenerative nodules.Mixture of hard and soft nodules were 11, of which 8 (72.7%) were hepatocellular carcinomas, including 4 accompanied necrotic tissue, 1 (9.1%) was dysplasia nodules accompanied necrotic tissue, the other 2 (18.2%) were regenerative nodules accompanied necrotic tissue.And soft nodules were 8, of which 4(50.0%) were necrotic nodules, 1 (12.5%) was dysplasia nodules accompanied canceration, 1 (12.5%) was hepatocellular carcinoma,2(25.0 %) were regenerative nodules.Conclusions Real time elastosonography can effectively evaluate the comparative rigidity on hepatoeirrhosis nodules,and thus may have potential usefulness on estimating the characteristic of hepatocirrhosis nodules.

Objective To study the effect of various treatments for the Budd-Chiari syndrome (BCS). Methods The clinical data of different treatments in 260 BCS patients were analysed retrospectively. Results Of the 260 patients,273times of BCS underwent interventional treatment?operative treatment or the combination of operation and interventional therapy, including percutaneous transluminal angioplasty(PTA) or/and stenting of the inferior vena cava(IVC)in 149 cases (160 times), percutaneous transhepatic angioplasty or/and stenting of the hepatic venous in 15 cases (17 times ),the combination of the two methods in 10 cases,radical resection in room temperature in 8 cases, mesocaval shunt in 16 cases,mesojugular shunt in 5 cases,mesoatriumr shunt in 8 cases,IVC-atrium shunt in 6 cases,splenopneumoexy in 18 cases, mesocaval shunt combined with PTA and stenting of the IVC in 17 cases, and transcardic membranotomy combined with PTA and stenting of the IVC in 8 cases . Two patients died in the operation:One died of cardiac tamponade,and the another died of operrative hemorrhagic shock.During the follow-up period of 3 months～6 years,20 patients recurred,of whom 7 died of hepatic failure,the other patients recovered satisfacorily. Conclusions The interventional treatment is the first choice for BCS.For patients unable to get interventional treatments or failure for interventional treatments, operation or operation combined with interventional therapy should be considered.

Objective To explore the diagnostic value of parametric imaging of contrast-enhanced ultrasound(CEUS) on recurrent hepatocellular carcinoma after liver transplantation.Methods CEUS images of 41 recurrent hepatocellular carcinoma after liver transplantation was analyzed by Sonoliver CAP software.The color code image,curve image and quantitative parameter of DVP of each recurrence lesion was recorded,then typed and analyzed statistically.Results The DVP patterns were classified into 3 types,they were washed out types,non-washed out types and negative types.The washed out types,non-washed out types and negative types on color code image and curve image of DVP were 70.73％ (29/41),24.39％ (10/41),4.88％ (2/41) and 63.41％(26/41),34.15％ (14/41) and 2.44％ (1/41) respectively.The maximum intensity,rise time,time to peak of the recurrence lesion and the surrounding liver parenchyma were (149.98± 65.29) ％,(12.32 ± 5.83)s,(13.01 ±6.07)s and (100±0.00)％,(26.10± 10.81)s,(29.69± 11.60)s respectively,and showed statistical differences (P ＜0.05).Conclusions The difference of blood perfusion between the recurrence lesion and the surrounding liver parenchyma can be displayed by DVP's dynamic,direct and quantitative imaging,which can be used to provide valuable information about the detection of intrahepatic lesion of recurrence after liver transplantation.

Objective To analyse our clinical experience in pediatric living donor liver transplantation (PLDLT).Methods The clinical data of 45 patients who underwent PLDLT in our hospital from April 2005 to April 2014 were retrospectively studied and their preoperative,intraoperative and postoperative data were analyzed.Results All donors recovered well.The graft to recipient weight ratio (GRWR) ranged from 1.0％ ～ 6.4％ (2.5％ ± 1.2％).Size reduction of graft were performed in 2 patients.An interposition venous conduit from the confluence of the native right and left portal vein (PV) to the graft PV was carried out in 1 patient,venous grafts for revascularization of the tributaries of the middle hepatic vein from segment Ⅴ and Ⅷ were used in 3 patients,and a venous patch for revascularization of the left hepatic vein was used in 2 patients.Hepatic artery re-reconstruction was performed in 3 patients after hypoperfusion was detected on intraoperative Doppler ultrasound.The postoperative complications included acute rejection (n =2),vascular complications (n =7),biliary complications (n =11),and infectious complications (n =27).The 1-,2-and 5-year survival rates were all 84.4％.Seven of 45 recipients died within one year post transplantation,with 3 patients who died of vascular complications,and 4 patients who died of infection.The differences in age [(50.8 ± 49.8) months vs (12.6 ± 14.9) months],body weight [(16.2 ± 10.5) kg vs (7.3 ± 1.7) kg],serum total bilirubin [(177.0 ± 126.5) μmol/L vs (301.9 ± 110.6)μmol/L],Pediatric end-stage liver disease (PELD) score (16.1 ± 12.1 vs 26.2 ± 11.3) and GRWR (2.2％ ± 0.8％ vs 4.2％ ± 1.6％) between the survival and the dead groups were significant (P ＜ 0.05).Conclusions PLDLT is an effective method to treat children with end-stage liver disease.Using a multidisciplinary approach in the preoperative management,excellent surgical techniques,and proper postoperative management are extremely helpful to improve postoperative survival rate.

Objective To study the diagnosis,prophylaxis and treatment of splenic artery steal syndrome (SASS),and to evaluate their clinical outcomes in recipients who underwent orthotopic liver transplantation (OLT).Methods 1 385 consecutive patients who suffered from liver cirrhosis and had undergone OLT in our hospital between Jan,2004 and Dec,2013 were studied.We hypothesized that patients were at risk of SASS when the calibre of the splenic artery (SA) was 1.5 times larger than the common hepatic artery (CHA) together with splenomegaly (318 patients,23.0％).Further surveillance with Doppler ultrasound (DUS) was carried out immediately at CHA reperfusion during operation.When a sluggish peak systolic velocity (PSV) ＜ 30 cm/s or no flow was detected in a patent hepatic artery,prophylactic SA banding (SAB) was considered.127 patients (39.9％) who fulfilled these criteria were recruited to the intervention group to undergo SAB.Eventually,patients who developed SASS were treated with coil-embolization of the SA (SAE),re-anastomosis of the HA to aorta (HTA),ligation of SA (SAL) or splenectomy (SPT),or retransplantation.Results SAB resulted in immediately increase in the mean PSV of the HA from 19.3 ±5.5 cm/s to 45.9 ± 9.1 cm/s (P ＜ 0.05),and resistance index (RI) of the HA rehabilitated to reasonable levels (0.5 ～0.8),without any HA or biliary related complication in all the 127 patients.17 patients in the control group were identified to have SASS (8.9％).5 of these 17 patients required emergency treatment by coil-embolization.Of the remaining 12 patients,11 who developed hepatic artery thrombosis secondary to SASS required to undergo embolectomy or thrombolysis followed by HTA (4 patients),SAL (3 patients),SPT (5 patients).Three of these patients finally required re-OLT.All these patients obtained acceptable results by these salvage strategies,except 2 out of the 12 patients who died from liver failure.Conclusions SASS is an important but it is often and under-diagnosed cause of graft ischemia after OLT.Prophylactic SAB should be introduced to patients at risk of developing SASS in order to obtain satisfactory results.Coil-embolization of SA shortly after diagnosis is an effective salvage intervention to prevent further progression to develop devastating consequences.