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 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.

Objective To analyze the impact of extent of mitral valve stenosis on the short and longterm outcome of percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral valve stenosis.Methods Two hundred and eighty-four patients with mitral valve stenosis were divided into two groups according to the Wilkins scoring system,and 191 cases whose score ≤8 were classified as group A,while the rest were classified as group B.All the patients were using the modified Inoue balloon method.Patients of successful PBMV were followed up at least 48 months and the efficiency was compared between two groups.Results The success rate of PBMV was 97.9％(187/191) and 92.5％(86/93) in group A and group B,there was significant difference between two groups (P ＜ 0.05).Echocardiography parameters improved significantly in both groups at 6 months after PBMV compared with those before PBMV (P＜ 0.05).Compared with those in group A,the changes of left atrial mean pressure [(14.31 ± 4.79) mm Hg (1 mm Hg =0.133 kPa) vs.(15.42 ± 5.14) mm Hg],across the valve pressure difference [(9.18 ± 4.66) mm Hg vs.(10.21 ± 4.38)mm Hg],pulmonary arterial systolic pressure [(26.21 ± 8.76) mm Hg vs.(32.04 ± 9.58) mm Hg],mitral valve orifice area [(1.01 ±0.16) cm2 vs.(1.21 ±0.18) cm2] after PBMV in group B were less (P＜0.05).Long-term follow-up (48-92 months) was completed in 273 successful cases and echocardiography parameters after PBMV improved significantly in both groups compared with those before PBMV during follow-up (P＜ 0.05).Compared with those in group A,the changes of left atrial mean pressure [(12.91 ±5.00) mm Hg vs.(15.1 7 ± 5.14) mm Hg],across the valve pressure difference [(7.26 ± 4.58) mm Hg vs.(9.63 ± 4.22) mm Hg],pulmonary arterial systolic pressure [(20.54 ± 7.68) mm Hg vs.(29.11 ± 8.53)mm Hg],mitral valve orifice area [(0.92 ±0.15) cm2 vs.(1.09 ±0.18) cm2] after PBMV in group B were less (P＜ 0.05).The incidence of mitral restenosis was also significantly higher in group B than that in group A [19.8％(17/86) vs.8.0％(15/187)],and there was significant difference (P ＜ 0.05).Conclusions The extent of mitral valve stenosis plays a key role on the outcome of PBMV in patients with mitral valve stenosis.Patients with lower echocardiography scores benefit more from PBMV than patients with higher echocardiography scores.

Objective:To classify the types of radiographic feature of central salivary gland type malignant tumors of the jaws(CSMTJ) with studying the clinical data,radiographic characteristics and pathological classifications,and to help the diagnose CSMTJ correctly and effectively in future. Methods:The clinical,radiological and pathological features of 62 cases of CSMTJ were studied and summarized. Among these cases,52 cases were collected from the medical records of patients of the internal databank according to the World Health Organization (WHO) Histological Classification of Salivary Gland Tumors standard and 10 cases of CSMTJ were from Guangdong Provincial Stomatological Hospital. Results:The maxilla to mandible ratio was 1∶1.7,Among CSMTJ cases,central mucoepidermoid carcinoma of the jaws (CMCJ) was the most common pathological type and the second was central adenoid cystic carcinoma of the jaws(CACCJ). 62 cases of CSMTJ could be classified into four types:Unicystic type,Multicystic type,"Flame shape" type and Osteolytic type. Conclusion:The radiographic presentation of CSMTJ was very complicated and its classification was connected with tumor malignant degree. The classification was very helpful to determine the treatment methods and the prognosis of the CSMTJ.

There is a close relationship between osteoporosis and osteoarthritis .The joints of bearing weight often suffer the osteoarthristis with osteoporosis .There are some symptoms in the disease ,such as pain and motion disorder ,and joint abnormality in late＋ stage .The principle of rehabilitation is to improve osteoporosis , release pain and increase the function if motion .The treatment includes medicament ,acupuncture ,injection ,rehabilitation ,psychology and surgery therapies .The injection can release pain effectiverly .The methods of rehabilitation include physical therapy,exercise ,massage ,and occupational therapy.These therapies can release pain ,improve motion and increase the quality of life .The article reveiws the clinical symptoms ,diagnosis and treatment ,especially the rehabilitation therrapy.

[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 .

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.

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.

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.

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.