Subjective visual perceptions experienced by patients during cataract surgery under local anesthesia have been given more and more attention now.Intraoperative visual experiences,including non-light perception,light perception,one or more color sensation,flash,movement,instrument,hands or fingers of surgeon etc.,are complained in parts of patients.These sensations and experience often lead to a fear of patient.Being aware of these intraoperative sensations of fear from patient is necessary for us to take the preventing strategy in advance.In addition,counseling of these patients prior to surgery may alleviate fears and improve the satisfaction of patient with surgery outcome.This paper reviewed the current studies on this phenomenon,discussed its clinical implications and possible mechanism,and suggested novel approaches to reduce its negative impact on the surgery.

Objective To survey the faculty doctors in psychiatric specialist training basement of Sichuan Province so as to provide a foundation for improving the faculty's ability and to promote the psychiatric specialist doctors training project.Methods To survey the 90 psychiatric specialist training faculty doctors by giving out a self-made questionnaire.Factor analysis were done by adopting SPSS 13.0.Results There were 90 self-made questionnaires given and 90 received.The effeetual questionnaires were 84.The results showed as follows:the average age of faculty doctors was 38.56±8.04,the average teaching time Was 14.32±8.44,faculty doctors with bachelor degree and more were 80.95%,the ratio of full-time teachers was 5.95%,the ratio of primary titles was 27.40%,the ratio of middle tides was 22.60%,the ratio of vice-senior titles was 33.30%,the ratio of senior titles was 16.70%;the ratio of the faculty doctors who enrolled in system training program was 28.57%,the ratio of the training time less than half year was 71.43%,the ratio of wanted to take part in system training was 95.24%.Conclusion The constitute of the faculty doctors'age.degrees and title were reasonable.But the teachingtime Was short and there were short age of full-time teachers.The time of system training was rather short.The faculty doctors demanded to take part in system training program.

AimTo observe the effect of infiltration of Methylprednisolone on injured spinal nerve root and the protective function of Methylprednisolone to non-impressed spinal nerve root lesion. Methods The spinal nerve roots were injured in 20 rabbits. Three days later local Methylprednisolone infiltration of spinal nerve root profromed in rabbits in experiment group, while rabbits in the control roup received equal amount of 0.9% natriichloridi instead. The conduct velocity of spinal nerve root was measured one week after operation. The histological change of spinal nerve root and immunohistochemical stain of posterior horn of spine were observed by microscope. Results The conduct velocity was recovered obviously in experiment group. In observation of spinal nerve we found the edema and hyperaemia of matrix were impaired obviously, the lesion focus was minimized, the amount of inflammatory cells was decreased. The area of substance P positive fiber and its terminus in posterior of spinal was smaller in experiment group remarkably than in control group. ConclusionsThe local infiltration of Methylprednisolone can relieve inflammation, inhibit the transmission of pain and accelerate recovery of spinal nerve root.

ObjectiveTo investigate the expression of Twist and N-cadherin in pancreatic cancer,and to study its relationship with clinicopathological parameters and patients' prognosis.Methods The expression of the Twist and N-cadherin in 62 tissue samples from patients with pancreatic ductal adencocarcinoma and 10 normal pancreatic tissue samples was determined by using immunohistochemistry MaxVision two step method,and the relationship with clinicopathological parameters and patients' prognosis was analyzed.ResultsThe positive expression rate of Twist in pancreatic cancer was higher than that of normal pancreatic tissues (96.8％ vs.30％,P ＜0.01 ),and the positive expression rate of N-cadherin was higher than that of normal pancreatic tissues (75.8％ vs.0,P ＜0.01),but there was no correlation between them (r =0.100,P =0.441 ).The expressions of Twist and N-cadherin was significantly correlated with TNM stage,lymph node metastasis,infiltration of portal vein or nerves and tumor location ( P ＜0.05 ),but not with age,gender and degree of differentiation ( P ＞ 0.05 ).The post-operative survival of patients decreased with the increasing Twist expression,but the survival was not associated with the expression of N-cadherin.TNM stage,the expression of Twist was independent predictive factors of prognosis for pancreatic cancer patients.ConclusionsTwist and N-cadherin are highly expressed in pancreatic cancer,and the expression was associated malignant behavior of pancreatic cancer.The abnormal expression of Twist may be a potential marker for prognosis evaluation of pancreatic cancer patients.

[Summary] Minimally invasive hybrid coronary revascularization ( MIHCR) represents a minimally invasive revascularization strategy that combines coronary artery bypass graft ( CABG) surgery with percutaneous coronary intervention ( PCI) .Although MIHCR is better than coronary artery bypass graft surgery in theory , there is no useful randomized controlled trial to prove the advantage of MIHCR in recent medical papers .In this paper , we reviewed different aspects of MIHCR , such as basic definitions , basic rationale , indications , operation selection and current problems .

[Objective]To approach the methods of difficult laparoscopic cholecystectomy.[Methods ]The clinical data of 116 patients with Mirizzi syndrome,severe adherence of abdominal cavity and Calot'triangle,liver cirrhosis underwent difficult laparoscopic cholecystectomy since 2004 were retrospectively analyzed.[Results]Except 3 patients treated by abdominal operation,other patients were treated by laparoscopic cholecystectomy successfully.[Conclusion]The rates of open operation midway and complications are not increased in difficult laparoscopic cholecystectomy as long as dealing with them properly.

Acute massive pulmonary thromboembolism after pneumonectomy usually results in death if not diagnosed early and treated aggressively.It was a case of acute embolism in the main pulmonary ar-tery with thrombus following right pulmonary wedge resection.Diagnosis was made clinically and with computerized tomography before emergency surgery.Thromboembolectomy was successfully performed on cardiopulmonary bypass and the patient was subsequently discharged home after uneventful recovery.Al-though the patient had no previous history of thrombosis,he took high dose of warfarin for anticoagulating postoperatively,which suggested that the patient with pulmonary embolism attack may be associated with the hypercoagulable state of his own.

Objective To investigate the relationship between the expression of Fas or FasL and the apoptosis of peripheral blood T and B lymphocytes in systemic lupus erythematosus (SLE) patients. Methods The expression rates of Fas and FasL and apoptosis rates of peripheral blood T and B lymphocytes were detected by flow cytometry (FCM) in 30 active SLE patients and 30 inactive SLE patients and 30 healthy controls. Results There were significant difference in the expression rates of Fas of T and B lymphocytes among three groups (P0.05). In addition, the activity of SLE had no correlation with the expression rates of Fas or FasL on T or B lymphocytes but has positive correlation with the apoptosis rates of T or B lymphocytes. And no correlation was found between the expression rate of Fas or FasL and the apoptosis rate of neither T nor B lymphocytes. Conclusion The apoptosis of peripheral blood lymphocytes is influenced by many factors in SLE patients, but is abnormally increased at last, especially in active SLE. It is inferred that the increase of apoptosis rate of peripheral blood lymphocytes plays an important role in the pathogenesis of SLE.

Aim To observe the expressions of KLF4 in the myocardium of diabetic mice and their changes under Tongxinluo capsule intervention. Methods For-ty KK/Upj-Ay mice were randomly divided into diabet-ic model group(n=10)and diabetic model with Tongx-inluo(TXL low,middle,high) groups(n =10,respec-tively). C57BL/6 mice were selected as control group ( n=10 ) . At the end of the 3 th month the mice were sacrificed and were weighed. The fasting blood-glucose (FBG),glycosylated hemoglobin(HbA1c),triglyceride ( TG) ,total cholesterol ( TC ) and insulin ( FINS ) were measured to calculate HOMA-IR. Radioimmunoassay was used to measure serum TNF-αand IL-6 . The path-ological changes in the myocardium of mice were ob-served by HE staining. KLF4 mRNA was examined by Real-time PCR, while KLF4 and NF-κB protein were measured by Western blot. Results Compared to the control group,FBG,HbA1c,TG,TC,FINS,HOMA-IR,
TNF-α and IL-6 in model group were markedly in-creased;the expressions of myocardial KLF4 were markedly decreased and the expression of nuclear NF-κB protein were markedly increased ( P < 0. 01 ) . Tongxinluo capsule could significantly reduce myocar-dial pathological damage, FINS, TG, TC, TNF-α, IL-6 level and the expression of nuclear NF-κB protein and up-regulate the expression of KLF4 ( P <0. 05 ) , but had no effect on FBG and HbA1c(P>0. 05). Conclu-sions KLF4 may be involved in the development of myocardial injury during diabetes. Tongxinluo capsule can ameliorate the myocardial damage and improve the function of diabetic myocardium by up-regulating the expression of KLF4 and inhibiting the activation of NF-κB inflammatory signal pathway.

OBJECTIVE　To assess the efficacy and safety of Lipobay (cerivastatin) and Jingbishuxin (simvastatin) on lipid profiles.METHODS　40 patients with hypercholesterolemia were randomizedly divided into Lipobay group (0.3 mg,QN) and Jingbishuxin group (domestic simvastatin tablet) (20 mg,QN)for 4 weeks.Total cholesterol (TC),low density Lipoprotein cholesterol (LDL-C),triglyceride (TG) and high density lipoprotein cholesterol (HDL-C),blood sugar,hepatic and renal function,blood and urine regular test were measured before and after the treatment.RESULTS　After 4 weeks of treatment,TC,LDL-C and TG were reduced by 29.02%,29.95%,17.21% in Lipobay the group and 22.48%,28.68%,14.74% in Jingbishuxin group,respectively.Compared the measurements after treatment with that before treatment,there were significant differences in both groups,but there was no significant difference between them.No serious adverse effect was found.CONCLUSION　Lipobay had a same efficacy and safety on lipoprotein profiles as that of Jingbishuxin in elderly.It has a good tolerance with smaller dose.