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.

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.

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.

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.

Objective To evaluate the efficacy of endovascular stent-graft placement for the treatment of Debakey Ⅲ type aortic dissection. Methods From June 2001 to July 2006, 31 patients with Debakey Ⅲ type aortic dissection were diagnosed by contrast-enhanced CT scan. Vascular access was obtained through the right or left femoral artery after arteriotomy and stent-graft was deployed into the true lumen to occlude the primary entry tear. Immediate aortography was performed after the procedure and the follow-up data of CT scan were evaluated. Results Stent-graft deployment was successfully performed in all the patients. Immediate aortography after the procedure showed no leakage in 27 patients and minor leakage in 4. After the operation, one patient showed paraplegia, and one developed left arm ischemia. No stent movement or organ ischemia was found at the early postoperative stage in the other patients. Six months after the operation, in all the 31 patients, contrast-enhanced CT scan showed the disappearance of the false lumen and thrombosis at the level of the stent; and the minor leakage of was improved in the 4 patients. Four years after the operation, one patient developed severe internal leakage at the approximal end of the stent, and was treated by thoracotomy. Conclusions Endovascular stent-graft placement is effective for the treatment of Debakey Ⅲ type aortic dissection. However, further studies are needed to evaluate its long-term outcomes.

[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 explore the clinical efficacy of azithromycin in the different course treatment of children with mycoplasma pneumonia.Methods 1 20 children with mycoplasma pneumonia were divided into two groups according to the treatment plan.Adding different treatment course azithromycin treatment based on conventional treatment,treatment group 1 (42cases)for a single course of 3 days,the treatment group 2 (78cases)single course more than 3d,treatment group 2 including group 2 -A (22cases)and group 2 -B (41 cases)and group 2 -C (1 5cases),the single course of treatment,respectively,5d,7d,8d.Patients'body temperature returned to normal time, and the disappearing time of cough,lung rale and the time in the hospital were observed.Results The fever and lung rale disappearing time of the treatment 2 group were lower than those of treatment 1 group,while there were no signifi-cant differences[(2.99 ±2.84)d vs.(3.24 ±3.03)d,(6.57 ±4.33)d vs.(6.84 ±4.67)d,t =0.449 3,0.31 6 9, all P >0.05 ].The hospitalization time and cough time of treatment 2 group were lower than those of treatment 1 group,the differences were statistically significant[(8.32 ±4.1 6)d vs.(1 0.21 ±5.1 6)d,(9.52 ±3.67)d vs. (1 3.33 ±6.77)d,t =2.1 78 7,4.004 4,all P <0.05].The fever disappearing time of the A,B and C groups had no statistical differences(all P >0.05),while the cough time,lung rale disappearing time and hospitalization time of B group were obviously lower than A and C group,the differences were statistically significant(all P <0.05),there were no statistically significant differences between treatment A group and treatment C group(all P >0.05).Conclusion Azithromycin in the different course treatment of children with mycoplasma pneumonia has no obvious difference for fever disappearing time.However,for the clinical symptoms such as cough and lung rale selecting 7 days as a course of treatment is the best.

Fast track surgery(FTS) is a novel surgery concept in recent years.Through using a series of perioperative optimization measures,to reduce the postoperative complications,the length of stay,and to achieve the goal of patients' rapidly rehabilitation.Nowadays,FTS protocols is widely used in general surgery,cardio-thoracic surgery,ophthalmology and orthopedics etc.This article reviewed the application of FTS in the perioperative patients which taking hip and knee arthroplasty.