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AIM: To investigate the difference and consistency between iTrace and Pentacam in measuring corneal spherical aberration(SphA)and curvature.METHODS: The corneal spherical aberration and curvature were measured by iTrace and Pentacam in 63 cases(125 eyes)separately, and the SphA, the minimum corneal curvature(K1), maximum corneal curvature(K2)and corneal astigmatism(CA)were recorded respectively. Paired t-test was used for statistical analysis of econometric data, Bland-Altman analysis was used to evaluate the consistency of measurement results(SphA and curvature)measured by iTrace and Pentacam.RESULTS: The measurement result of SphA, K1, K2 and CA were(0.230±0.086)μm,(43.01±2.38)D,(44.08±2.48)D and(1.03±0.57)D measured by iTrace, and(0.247±0.114)μm,(42.88±1.44)D,(43.86±1.51)D and(1.07±0.62)D measured by Pentacam, there was no significant difference of the measurement result of SphA, K1, K2 and CA between iTrace and Pentacam(P>0.05). The difference of SphA, K1, K2 and CA between iTrace and Pentacam was close to 0, the consistency was good because of the narrow 95% confidence interval.CONCLUSION:There is no significant difference of the measurement result between iTrace and Pentacam, the consistency is good, and both can be used as a mutual reference in clinical.

AIM: To explore the application of improved skills in central hole ICL V4c implantation and its clinical efficacy. METHODS: This study included 141 eyes of 72 patients with myopia from September 2015 to August 2016. An implantable contact lens with a central hole(ICL V4c)was inserted by improved surgical skills including single 2.8mm clear corneal incision, no anterior chamber viscoelastics before ICL implantation. The intraocular pressure(IOP)was measured at the early stage within 6h after operation. The visual acuity, diopter, intraocular pressure and corneal endothelial cell density were observed after operation and follow up 2a. RESULTS: ICL V4c was implanted successfully in all patients by this improved skills and fine clinical results were achieved. Elevated IOP is possible at early stage post-operation, especially within 2h after operation. 95.7% had normal IOP 6h after operation. The postoperative IOP was stable within 2a follow-up period. The cumulative corneal endothelial loss rates of 6mo, 1a and 2a were 4.70%, 7.59% and 9.63% respectively. There was no complications such as subcapsular cataract during the 2a follow-up period.CONCLUSION: The improved skills used in our study is safe and feasible.

AIM: To observe the efficacy and safety of central hole phakic posterior chamber intraocular lens(ICL V4c)implantation for correction low to moderate myopia.METHODS: Twenty low to moderate myopia patients(forty eyes)who underwent the ICL V4c implantation in our hospital from January 2016 to June 2017 were observed 1wk, 1mo and 1a after operation respectively. Uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), equivalent spherical mirrors(SE), intraocular pressure, corneal endothelial cell count, ICL-vault, adverse reaction and complication were investigated.RESULTS: Postoperative UCVA and BCVA were significantly higher than that in preoperative group(PPPP>0.05). None of subjects developed cataract, glaucoma and decompensation of corneal endothelium. The degree of postoperative satisfaction was 100%.CONCLUSION: ICL V4c implantation is a safe and effective method for the correction of low to moderate myopia. The visual acuity stabilized 1mo after operation.

AIM: To observe the efficacy and safety of central hole phakic posterior chamber intraocular lens(ICL V4c)implantation for correction high myopia.METHODS: Fifty-eight high myopia patients(116 eyes)who underwent the ICL V4c implantation in our hospital from January 2016 to June 2017 were observed 1wk, 1mo and 1a after operation respectively. Uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), equivalent spherical mirrors(SE), intraocular pressure(IOP), corneal endothelial cell count, ICL-vault, adverse reaction and complication were investigated.RESULTS: Postoperative UCVA and BCVA were significantly higher than that in preoperative group(PP>0.05). Postoperative SE at all time points were lower than that in preoperative group(PP>0.05). None of subjects developed cataract, glaucoma and decompensation of corneal endothelium. The degree of postoperative satisfaction was 100%.CONCLUSION: ICL V4c implantation is a safe and effective method for correction of high myopia. The visual acuity stabilized 1mo after operation.

Aim: To assess the efficacy of full-thickness excision using transanal endoscopic microsurgery (TEM) in the treatment of rectal neuroendocrine tumors., Methods: We analyzed the data of all rectal neuroendocrine tumor patients who underwent local full-thickness excision using TEM between December 2006 and December 2014 at our department. Data collected included patient demographics, tumor characteristics, operative details, postoperative outcomes, pathologic findings, and follow-ups., Results: Full-thickness excision using TEM was performed as a primary excision (n = 38) or as complete surgery after incomplete resection by endoscopic polypectomy (n = 21). The mean size of a primary tumor was 0.96 ± 0.21 cm, and the mean distance of the tumor from the anal verge was 8.4 ± 1.4 cm. The mean duration of the operation was 57.6 ± 13.7 min, and the mean blood loss was 13.5 ± 6.6 mL. No minor morbidities, transient fecal incontinence, or wound dehiscence was found. Histopathologically, all tumors showed typical histology without lymphatic or vessel infiltration, and both deep and lateral surgical margins were completely free of tumors. Among 21 cases of complete surgery after endoscopic polypectomy, 9 were histologically shown to have a residual tumor in the specimens obtained by TEM. No additional radical surgery was performed. No recurrence was noted during the median of 3 years' follow-up., Conclusion: Full-thickness excision using TEM could be a first surgical option for complete removal of upper small rectal neuroendocrine tumors.

Multiple rectal carcinoids are rare. Due to the unreliability of endoscopic polypectomy in treating these submucosal lesions, a laparotomy is usually performed. We present a case report on multiple rectal carcinoids with three carcinoid foci<10 mm in diameter located in the mid-rectum. Preoperative examination showed the lesions to be confined to the submucosal layer with no perirectal nodal involvement. A transanal endoscopic microsurgery was successfully performed to remove the three lesions with accurate full-thickness resection followed by secured suture closure. The postoperative pathology revealed neuroendocrine tumors G1 (carcinoids) located within the submucosal layer without lymphatic or vessel infiltration. Both the deep and lateral surgical margins were completely free of tumor cells. The patient recovered quickly and uneventfully. No tumor recurrence was observed at the six-month follow-up. For the multiple small rectal carcinoids without muscularis propria or lymphatic invasion, transanal endoscopic microsurgery offers a reliable and efficient alternative approach to traditional laparotomy for select patients, with the added advantages of minimally invasive surgery.

Aim: To investigate the effect of surgery and chemotherapy for gastric cancer with multiple synchronous liver metastases (GCLM)., Methods: A total of 114 patients were entered in this study, and 20 patients with multiple synchronous liver metastases were eligible. After screening with preoperative chemotherapy, 20 patients underwent curative gastrectomy and hepatectomy for GCLM; 14 underwent major hepatectomy, and the remaining six underwent minor hepatectomy. There were 94 patients without aggressive treatment, and they were in the non-operative group. Two regimens of perioperative chemotherapy were used: S-1 and cisplatin (SP) in 12 patients, and docetaxel, cisplatin and 5-fluorouracil (DCF) in eight patients. These GCLM patients were given preoperative chemotherapy consisting of two courses chemotherapy of SP or DCF regimens. After chemotherapy, gastrectomy and hepatectomy were preformed. Evaluation of patient survival was by follow-up contact using telephone and outpatient records. All patients were assessed every 3 mo during the first year and every 6 mo thereafter., Results: Twenty patients underwent gastrectomy and hepatectomy and completed their perioperative chemotherapy and hepatic arterial infusion before and after surgery. Ninety-four patients had no aggressive treatment of liver metastases because of technical difficulties with resection and severe cardiopulmonary dysfunction. In the surgery group, there was no toxicity greater than grade 3 during the course of chemotherapy. The response rate was 100% according to the response evaluation criteria in solid tumors criteria. For all 114 patients, the overall survival rate was 8.0%, 4.0%, 4.0% and 4.0% at 1, 2, 3 and 4 years, respectively, with a median survival time (MST) of 8.5 mo (range: 0.5-48 mo). For the 20 patients in the surgery group, MST was 22.3 mo (range: 4-48 mo). In the 94 patients without aggressive treatment, MST was 5.5 mo (range: 0.5-21 mo). There was a significant difference between the surgery and unresectable patients (P = 0.000). Three patients in surgery group were still alive at the end of the cut-off date., Conclusion: Perioperative weekly DCF and SP achieved a good response, and combined with surgery, they could improve prognosis of GCLM.

Objective: To obtain some effective objective markers used to predict the early liver metastasis of colorectal tumor, the relationship of liver metastasis of colorectal tumor with associate detection three markers such as CK20mRNA, CD44v6 and VEGF was studied., Methods: The expression of CK20mRNA in patrol venous blood from 30 colorectal cancer patients was detected by fluorescent quantitative RT-PCR, and the results of CD44v6 and VEGF in colorectal cancer tissue were determined by means of immunohistochemistry, and then compared with those in control groups., Results: The rate of positive expression of CK20mRNA in colorectal cancer patients' patrol venous blood was obviously superior to the level of benign pathological changes controls (P < 0.01), and significantly higher than that of normal controls (P < 0.01). The rate of positive expression of CD44v6 and VEGF in colorectal tumor tissue was distinctly superior to the level of benign pathological controls, and remarkable higher than that of normal controls (P < 0.01). The positive expression of liver metastasis was also clearly higher than that of no liver metastasis (P < 0.05). The rate of positive expression of CK20mRNA in patrol venous blood was evidently correlated to the expression of CD44v6 and VEGF in tumor tissue (r(1) = 0.933, r(2) = 0.906, P < 0.05). The results of associate detection of CK20mRNA, CD44v6 and VEGF were closely related to the incidence of liver metastasis., Conclusions: If combined detecting these markers of CK20mRNA, CD44v6 and VEGF to forecast liver metastasis of colorectal tumor, the sensitivity and specialty of prediction will be improved, there were highly clinical values in predicting in early diagnosis liver metastasis of colorectal tumor.

Objective: To find out the connection of serum pepsinogen and it's subgroups (PGI, PGII) with CA72-4 to early diagnosis and postoperative recurrence on gastric cancer., Methods: RIA was applied to detect the results of serum PGI, PGII and CA72-4 on gastric cancer and other stomach diseases, then the clinic value of associating detection on gastric cancer diagnosis and prognosis judgment were assessed., Results: The serum PG levels of GC patients were significantly lower comparing to those of healthy controls (P < 0.01), apparent changes had taken place on earlier period GC (P < 0.05), and aggressive GC were even lower (P < 0.01). On the earlier period of GC diagnosis, CA72-4 levels were not apparently different to healthy controls (P > 0.05), and aggressive GC were significantly higher (P < 0.01). Compared preoperative with postoperative, the serum PGI and PGII and CA72-4 levels were significantly different (P < 0.01). In the patients underwent total gastrectomy, both of pepsinogen levels were lower than those of subtotal or large partial gastrectomy (P < 0.05). The serum PGI, PGII and CA72-4 levels of patients with recurrence of GC after total gastrectomy were significantly higher than those without. Compared before recurrence patients with after ones, the serum PGI and PGII levels of partial gastrectomy were no apparent difference (P > 0.05), however apparent changes had taken place on CA72-4 levels. The associate detection had even higher specificity (P < 0.01)., Conclusions: Apply to detect the serum PG levels on crowds, especially pGI, PGI/II levels decrease, which may be expected to become the index to earlier period GC screening. The associating detection to PG and CA72-4 levels may significantly improve sensitivity and specificity, which have chances to be applied to monitoring to postoperative gastrectomy.