To investigate the methods of learning coaxial microincision phacoemulsification and assess the related complications.METHODS:The clinical data of 1 080 eyes of coaxial microincision phacoemulsification performed by beginners from October 2011 to December 2013 was retrospectively analyzed. ln order of surgery dates, the patients were equally divided into groups A, B, C and D, 270 eyes in each group. Comparisons were made among the four groups in operation time, cumulative dissipated energy (CDE), rate of intraoperative, and postoperative complications at 1d; and best corrected distance visual acuity (BCDVA) at 1mo postoperatively.RESULTS:No significant differences were found in age, sex, lens grading, BCDVA at 1mo postoperatively among the four groups ( P> 0. 05 ). The operation time was significantly longer in group A than in groups B, C and D (25. 15 ± 3. 11min vs 15. 20 ± 3. 40min, 14. 71 ± 3. 02min and 14. 41±2. 91min, P<0. 05). No significant differences were found in the operation time among the other three groups (P>0. 05). The CDE of grade ‖ and Ⅲ was significantly higher in group A than that in groups B, C and D (95. 9%, 97. 8% and 98. 5%) (P<0. 01). The number of continuous curvilinear capsulorhexis ( CCC ) were performed successfully was significantly less in group A ( 80. 7%) than the other three groups (95. 9%, 97. 8% and 98. 5%) (P<0. 01). The incidence of posterior capasular rupture of group A (7. 8%) was higher than that of group B (3. 7%), group C (1. 1%) and group D (0. 4%) (P<0. 05), but there was no significant difference between group C and group D (P>0. 05). There were no significant differences both in the number of corneal edema and BCDVA at 1d between group A and group B. (P=0. 66, P=0. 53).CONCLUSlON: With learning step by step, appropriate training program, careful case selection, and accurate managing complications, coxial microincision phacoemusification can be safe for a beginner.

Thoracic vascular ultrasound was used to evaluate left internal mammary artery to left anterior descending artery (LAD) bypass (LIMA) blood flow pattern in CABG patients. A transthoracic vascular transducer (5～10 MHz) was placed in the second rib space left to the sternum. Doppler spectrum was obtained under 2 D color Doppler image guide. Systolic and diastolic flow was analysed as systolic peak velocity (SPV), systolic velocity time integrate (SVTI), diastolic peak velocity (DPV) and diastolic velocity time integrate (DVTI). Successful examination was done in 106 patients ( 106/110, 94% ) , In patients with patent LIMA, Doppler spectrum showed a notable diastolic flow spectrum. The results of this study suggested that trans thoracic echocardiographic examination could provide avaluable blood flow information. A notable diastolic flow spectrum can be taken as a sign of satisfactory LIMA coronary diastolic myocardium perfusion.

Objective To measure Tei index in patients with idiopathic or ischemia dilated cardiomyopathy, and to evaluate its correlation with other conventional indexes of echocardiography of left ventricular(LV) function,and its applicability in assessing cardiopulmonary exercise capacity in those patients.Methods Seventy consecutive patients (53?14 years) with heart failure(New York Heart Association [NYHA] class, Ⅱ to IV) who had received echocardiographic diagnosis, and believed to be suffering from dilated or ischemia cardiomyopathy were studied. Echocardiography were performed; LV volume as well as ejection fraction were measured from the apical view of the two-dimensional echocardiogram using a modified Simpson’s rule algorithm in all patients. The following variables: peak early transmitral filling velocity (E), late transmitral filling velocity (A), their ratio (E/A), the deceleration time of E (DT), and Tei index were measured by spectral Doppler echocardiography. Furthermore, all patients underwent a cardiopulmonary exercise using 6min walk test. Results Advanced NYHA class was associated with higher Tei index values. A positive correlation was found between Tei index and early /late filling velocity ratio, while a negative correlation was found between Tei index and A wave, E wave, DT, and LV EF. Tei index showed no correlation with heart rate, blood pressure or age. Compared with the parameters of left ventricular function Tei index had a closer relation to the distance of 6min walk. Stepwise regression analysis revealed that the Tei index and the late LV filling velocity were the only independent predictors for cardiopulmonary exercise capacity.Conclusion Tei index correlates inversely with LV performance and reflects disease severity, which is a useful complimentary variable in the assessment of cardiopulmonary exercise performance in patients with heart failure.

Objective To investigate a minimal invasive surgical therapy for tumors in the an terior wall close to bladder neck. Methods A 5～10 mm incision was made in abdominal wall below the umbilicus and laparoscopic devices were introduced into the bladder.Tumors were excised and coa gulated under the monitoring of cystoscopy. Results Tumors at the anterior wall of bladder were easily exposed and removed.The recovery time was nearly the same as that of TURBT.No tumor recurrence was observed in 3～10 months period. Conclusions Tumors at the anterior wall of bladder could be easily removed by the combined use of cystoscopy and laparoscopy and open surgery might be avoided.

Cephalosporins are widely used antibiotics owing to their broad activity spectra and low toxicity. Many of these medically important compounds are made chemically from 7-aminodeacetoxycephalosporanic acid. At present, this intermediate is made by synthetic ring-expansion of the inexpensive penicillin G to form G-7-ADCA, followed by enzymatic removal of the side chain to obtain 7-ADCA. The chemical synthetic process is expensive, complicated and environmentally unfriendly. Environmentally compatible enzymatic process is favorable compared with chemical synthesis. In our previous research, metabolic engineered Escherichia coli strain (H7/PG15) was constructed and used as whole-cell biocatalyst for the production of G-7-ADC with penicillin G as substrate. The whole-cell biocatalysis was studied by single factor experiment, including the composition of substrates and the conversion conditions (OD600, pH, concentration of penicillin G, MOPS, glucose, time and FeSO4). After optimization, 15 mmol/L of G-7-ADCA was obtained. The process is convenient, efficient and economic. This work would facilitate the industrial manufacturing and further product research.
Anti-Bacterial Agents ; biosynthesis ; Biocatalysis ; Cephalosporins ; biosynthesis ; Escherichia coli ; metabolism ; Metabolic Engineering

Objective To evaluate the effect of the combination of dexmedetomidine and sufentanil on monitoring anesthesia care during burr-hole surgery for patients with chronic subdural hematoma. Methods 96 pa-tients underwent burr-hole surgery for chronic subdural hematoma with MAC were randomly divided into two groups:Group D and Group DS (n=48 in each group). Local anesthetic block was started at least 10 min after DEX and sufentanil infusion. Ramsay sedation scale of the two groups was maintained to 3. Anesthesia onset time, hemo-dynamics, the amount of rescue midazolam or fentanyl, the time to first dose of rescue midazolam or fentanyl, the to-tal number of intraoperative patient movements, postoperative recovery time, patient and surgeon satisfaction scores, and the adverse events were recorded. Results Compared with group D, anesthesia onset time was significantly less in group DS (13.68 ± 3.13 vs. 11.82 ± 2.43 min, P=0.002). More patients in group D required rescue midazol-am to achieve RSS=3 compared with group DS (31.25%15/48 vs. 12.50%6/48, P=0.023). Compared with group D, significantly fewer patients in group DS required rescue fentanyl to relieve pain (10.42%5/48 vs. 27.08%13/48, P = 0.036). Additionally, the total dose of rescue fentanyl in group DS was significantly higher (89.48 ± 23.27 vs. 125.28 ± 33.52μg, P=0.000), and the time to first dose of rescue fentanyl was longer than group D(18.34 ± 4.45 vs. 14.34 ± 3.63 min, P=0.000). The total number of patient movements during the burr-hole surgery was higher in group D than group DS (35.42%17/48 vs. 16.67%8/48, P=0.036). The time to recovery for discharge from the PA-CU (time to an Aldrete score ≥ 9) was significantly shorter in group DS compared with group D (17.54 ± 5.92 vs. 12.57 ± 5.28 min, P=0.000). Results from the patient and surgeon satisfaction scores showed significant differenc-es favoring group DS (P<0.05). More patients in group D showed higher levels of the overall incidence of bradycar-dia (37.50% 18/48 vs. 18.75% 9/48, P = 0.041) and hypotension(37.50%18/48 vs. 14.58%79/48, P=0.011)com-pared with group DS. Conclusions Compared with DEX alone, DEX-sufentanil associated with fewer number of in-traoperative patient movements, less amount of rescue scheme, could be safely and efficiently used for MAC during burr-hole surgery for patients with chronic subdural hematoma.

Objective To evaluate the clinical effect and safety of the occiput-cervicle or C1-C2 internal fixation and bone graft fusion in treatment of the unstable atlas fracture.Methods A retrospective study was performed in 38 patients with unstable atlas fractures treated by the occiput-cervicle or C1-C2 internal fixation and bone graft fusion from October 2004 to March 2009.Six patients with comminuted atlas fracture combined with instability of the occipito-atlantoid articulations were treated with occiput-C2 fusion(five patients)and with occiput-C3 fusion(one patient).There were seven patients with typical Jefferson fractures,three with semiring fractures,eight with atlas fractures combined with Anderson type Ⅱ odontoid process fractures,three with atlas fractures combined with Hangman's fractures (two patients with Levine and Edwards type Ⅲ Hangman's fractures were treated with occiput-C3 fusion and one patient Levine and Edwards type Ⅱ Hangman's fracture was treated with C1-C2 fusion),three with atlas fracture combined with lower cervicle injury,six with rupture of transverse ligament combined with instability of atlanto-axial joint(Dickman transverse ligament type Ⅰ injury)and two with comminuted fracture of the lateral mass associated with bony avulsion of the medial tubercle and transverse ligament(Dickman transverse ligament type Ⅱ injury).Of all,five patients were treated with occiput-C2 fusion,three treated with occiput-C3 fusion and 30 treated with C1-C2 fusion.Results All the patients were followed up for a range of 12-46 months(average 28 months),which showed improvement of clinical symptoms in some extent postoperatively.The operation time ranged from 80 to 190 min ates(average 135 minates),with intraoperative blood loss for 200-3 300 ml(average 460 ml)and average fluoroscopic time for 60 seconds.There were no neurological deficits,vertebral artery related complications or other complications in all the patients during the surgical operation.No neurological deficit was aggravated after the patient's mobilization with brace three days after operation.The enous plexus of blood vessel at C1-C2 rupture induced by the use of electrocautery was found in three patients who showed no cerebral hemodynamic deficit after hemostasis with hemostatic sponge and cotton piece.The follow-up X-ray and CT manifested osseous fusion in all the patients,with no looseness or breakage of the screws.The late follow-up showed pain associated with movement and limited range of motion in four patients(11%)and occipital neuralgia in one.Conclusions An occiput-cervicle fixation fusion or a C1-C2 fixation fusion combined with short external fixation can reestablish the upper cervical stability and prevent further injury of the spinal cord and nerve function and hence is an ideal option for C1 burst fracture with or without rupture of the transverse ligament.

Objective To assess the radiographic and clinical outcomes of opening osteotomy supplemented with autologous anterior strut grafting and internal fixation through posterior-lateral approach in the treatment of unstable thoracolumbar fractures. MethodsFrom January 2008 through March 2010,a consecutive series of 13 thoracolumbar fractures were managed with opening osteotomy supplemented with autologous anterior strut grafting and internal fixation through posterior-lateral approach.They were 8 males and 5 females,aged from 20 to 58 years(median age,37.2 years).The fractures happened at T11 in 2 cases,at T12 in 3 cases,at L1 in 6 cases and at L2 in 2 cases.The autologous ilium was used for all the anterior strut grafts.The time from injury to surgery ranged from 21 days to 2 years (average,8 months).The mean heights of anterior and posterior borders of the vertebral body,the cobb angles and treatment-related complications were compared between preoperation and postoperation and the patients' satisfaction was assessed with the visual analogue scale(VAS).Statistical analyses were performed with the paried-sample t test. Results The patients were followed for 12 to 36 months (average,17 months).The latest follow-up radiographs were available for all patients.The mean heights of anterior and posterior borders of the vertebral body restored respectively from preoperative 21.02 ± 3.02 cm and 31.34 ± 5.18 cm to postoperative 31.88 ±3.46 cm and 33.75 ± 3.66 cm.The mean cobb angle was corrected from preoperative 28.46° ± 5.81° to postoperative 4.62° ± 3.48°.The mean VAS score decreased from preoperative 7.63 ± 0.72 to 1.39 ± 1.02 at the final follow-up.There were significant differences between preoperation and postoperation in the radiographic and clinical outcomes ( P ＜ 0.05).No mortality or major complications occurred involving large blood vessels or abdominal viscera or internal organs. Conclusion The opening osteotomy supplemented with autologous anterior strut grafting and internal fixation through posterior-lateral approach is safe and effective for old unstable thoracolumbar fractures.

Objective To investigate the surgical approach for adult patients with presacral cystic teratoma.Methods In this study,16 female patients,aged at 26-45 years,with presacral cystic teratoma underwent surgical resection between March 2007 and August 2012.Tumor was primary in 9 cases and recurrent in 7 cases,Rectal examination revealed retrorectal tough semi-circular poorly movable massess with intact rectal mucosa.MR examination showed cystic or solid mass in the anterior sacral,clear boundary,rectum and or vagina compressed.Tumors were completely removed in all cases.Results All patients were cured by surgery,13 cases were cured by one stage resection and 1 was cured by two stage resection.Two cases suffered from recurrence and was cured by reoperation.There were no injury to rectum,anal sphincter,cauda equina,presacral vein.Pathological diagnosis was cystic teratoma.Conclusions By sacrococcygeal surgical resection of presacral cystic teratoma was safe and effective ; complete resection of the tumor capsule is the key to successful operation.

Vibrio parahaemolyticus has been considered as one of the most important foodborne bacterial pathogens.The loop-mediated isothermal amplification(LAMP) that amplifies DNA with high specificity and rapidity under an isothermal condition was applied for rapid detection of this pathogen for the first time.A set of four primers,two outer and two inner primers,was designed specifically to recognize the thermolabile hemolysin gene(tlh) of V.parahaemolyticus.The LAMP reaction mix was optimized.The most optimal reaction temperature and time of the LAMP assay for the tlh gene were 60℃ and 60min,respectively.Genomic DNAs from 28 bacterial strains including 14 V.parahaemolyticus strains were amplified using LAMP,and no amplicon was observed in other bacterial strains.The detection limit of this LAMP assay was around 90 fg of V.parahaemolyticus genomic DNA and 24 colonies forming units for pure cultures.In addition,this method was applied to detect artificially contaminated food samples,and the detection limit was 89 cfu/g for non-cultured artificially contaminated food samples.These results suggested that detection of V.parahaemolyticus by LAMP is an effective and low-cost procedure with high specificity and sensitivity that requires no specialized equipment.This assay is expected to become a valuable tool for rapid detection and identification of V.parahaemolyticus.