Objective To observe the degree of choriocapillary ectasia (CCE) and sub-foveal choroidal thickness (SFCT) in central serous chorioretinopathy (CSC) with different activity and discuss their relations.Methods Forty eyes of 40 CSC patients were recruited.The activity of CSC was determinate by fundus fluorescein angiography (FFA).There were 23 eyes with active CSC (active-CSC group),and 17 eyes with inactive CSC (inactive-CSC group).All eyes in both groups were examined with optical coherence tomography angiography(OCTA),and the CCE area of the choriocapillary layer was measured within a 3 mm× 3 mm zone centered on the central fovea of macula.Ectasia was classified based on CCE area,more than 66％ of examination area was high ectasia,and 33％-66％ as medium ectasia,below 33％ as low ectasia.SFCT was measured with frequency domain optical coherence tomography.The relationship between CCE degree,SFCT and CSC group was analyzed.Results Among the 23 eyes of active-CSC group,there were 5 eyes of low ectasia,12 eyes of medium ectasia,6 eyes of high ectasia.Among 17 eyes of inactive-CSC group,there were 11,4,2 eyes of low,medium and high ectasia respectively.Active-CSC group had more advanced degree of ectasia than that in inactive-CSC group(Z=-2.472,P=0.013).SFCT of active-CSC group and inactive-CSC group were (418.13±-126.15),(429.76±105.80) μm respectively,the difference was not significant (t=-0.308,P=0.760).SFCT in eyes with low ectasia,medium ectasia,high ectasia were (419.13±105.60),(381.00±125.12),(515.13±67.68) μm respectively.The difference among the three group was statistical significant (F=4.106,P=0.025).SFCT in eyes of high ectasia was obviously thicker than low ectasia and medium ectasia,the difference was statistical significant (P=0.007,0.048);the SFCT difference between low ectasia and medium ectasia did not appear statistical significance (P=0.326).There was no linear relation between SFCT and CCE degree (r=0.247,P =0.124).Conclusions Active-CSC eyes has more advanced CCE degree than inactive-CSC eyes,but SFCT is the same between the two groups.High ectasia eyes have thicker SFCT.

This paper discussed the methods of developing clinical thinking ability and the key emphasis on the related main medical and teaching activity.

Standardized patients for interview has been widely used in medical education and examinations.Nevertheless the standard training of SP is still not widely used in China up to the present.Referring to the character of SP working as "the people providing case history","the assessor" and"the teacher",we have described how to write scenarioes,establish the score criteria,institute the training steps,form the measures of examination and supervision in detail in this article,and resummarized the experiences we got during the training period.

Objective To observe the therapeutic effects and side effects of FLAG regimen(fludarabine, Ara-C, and granulocyte-colony stimulating factor( C-CSF) for refractory or relapsed acute myeloid leukemia( AML). Methods Twenty-six AML were treated with fludarabine plus intermediate-dose Ara-C and G-CSF,of whom 15 cases belonged to refractory and 11 cases belonged to relapsed. Results After two courses of treatment, 14 cases were completely relieved (53. 8% ) and 5 cases were partially relieved (19.2% ). The overall effective rates was 73.1%. The main side effects were severe myelosuppression and non-hematological toxicity was mild. Conclusion FLAG regimen was very effective for refractory or relapsed acute myeloid leukemia and was well tolerated. The treatment-related mortality rate was low,so it provided a treatment choice for these patients.

Objective To evaluate the application value of prehospital index (PHI) in hospitalized patients with acute trauma.Methods A study was done in 1802 hospitalized patients with acute trauma by random sampling.PHI and injury severity score (ISS) were made respectively.Receiver operating characteristic curve (ROC curve) was used for detecting optimal cut-off point by taking the date of discharge as the endpoint and the outcome as observed indicator.In order to compare the predicting prognosis value of PHI in hospitalized patients with acute trauma,the corresponding predicting indicators were calculated and ISS was used for reference.Results The area under the ROC curve was 0.871 (95％ CI:0.855-0.886) by the score of PHI and 0.792 (95％ CI:0.773-0.811) by the score of ISS,and there was statistically difference between the two scoring systems (Z =2.674,P =0.007),and the optimal cut-off point was used for judging the potential for critically ill patients when PHI was ≥ 4,ISS ≥ 22.The sensitivity predictors of critically ill patients death of PHI was superior to ISS (x2 =6.975,P =0.008),the specificity and the accuracy of PHI and ISS showed no significant difference (P ＞ 0.05).Conclusions PHI has high potential for assessing patient condition and predicting the death of hospitalized patients with acute trauma,and it is equivalent to ISS in prediction value.The advantages of PHI are simple in operation,easy to learn,reflecting the condition timely and reliably,suitable for dynamic evaluation and comparison,which is suitable for critical patients with trauma of preliminary screening.

Objective To investigate the value of ISS in predicting mortality after multiple trauma.Methods A total of 550 patients with multiple trauma treated from March 2007 to May 2011 were divided into survivor group (n =473) and death group (n =77) according to the outcome.ISS and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ]) were used to predict patients' risk of death.Receiver operation characteristic curve (ROC) was developped to compare the area under the curve (AUC),optimal cut-off point,and prediction index for the two scoring systems.Results ISS and APACHE Ⅱ score were higher in death group than in survivor group (P ＜ 0.05).ISS showed the diagnostic cut-off point of ≥20,with a sensitivity of 76.7％,specificity of 83.7％,concordance rate of 82.7％,and AUC of 0.835.With regard to APACHE Ⅱ,the diagnostic cut-off point was ≥20,with a sensitivity of 80.5％,specificity of 89.2％,concordance rate of 88.0％,and AUC of 0.922.ISS and APACHE Ⅱ were equivalent in predicting mortality (P ＞ 0.05).Conclusion ISS presents a moderate value for predicting the mortality of multiple trauma patients and it is more rational to set ISS≥20 points as the criteria for severe multiple trauma.

Objective To study the utility and feasibility of CRAMS score to assess prognosis of patients with acute trauma.Methods A retrospective review of 1 802 patients with acute trauma was conducted to calculate CRAMS and ISS score.Receiver operation characteristic curve (ROC) was used to measure the prognostic role of CRAMS in comparison with ISS.Results Area under the curve (RUC) was 0.885 for CRAMS (95 ％ CI 0.870-0.900) and was 0.792 for ISS (95％ CI 0.773-0.811),with statistical difference of the two scoring systems (Z=4.280,P ＜0.01).To identify patients with potential critical illness,optimal cut-off point was≤7 for CRAMS and≥24 for ISS.CRAMS presented better sensitivity (x2 =16.910,P ＜ 0.01),but lower specificity (x2 =5.260,P ＜ 0.05) and accuracy (x2 =0.693,P ＞ 0.05) for predicting mortality when compared with ISS.Conclusions CRAMS is better than ISS in predicting prognosis for patients with acute trauma and exhibits a high discrimination.RAMS has advantages of simple operation,easy grasping and accurate and timely reflection of illness severity,which facilitates the early detection and treatment of critical illness in inhospital trauma patients.

To study the effects of the active components of Xiaoxuming Decoction (XXM), a compound traditional Chinese herbal medicine, on chronic cerebral ischemia in rats.

Aim To explore the relations between anti-apoptotic role of dipfluzine (DIP) and the death signaling transduction pathway initiated by CD95 molecules, and the transcription factor involved in the transcription regulation of CD95 molecules in the hippocampal CA1 region after transient forebrain ischemia. Methods The rat forebrain transient ischemia model was established through 15 min ischemia followed by 3 days reperfusion by using the four-vessel method. The rats were divided randomly into five groups: sham control group, ischemia / reperfusion (I/R) group, DIP treated groups (20, 40 and 80 mg·kg-1 body weight, ig, separately). Western blotting and RT-PCR were performed to detect the expression changes of Fas, FasL, caspase 10 p20, caspase 8, I-κB-α, and p-I-κB-α molecules in protein and mRNA levels, separately, and immunohistochemistry for molecular localization of Fas and FasL in rat hippocampus. Results The expression of Fas, FasL, and caspase 10 p20 in protein and mRNA levels increased after I/R, which was inhibited significantly after treatment with 20 and 40 mg·kg-1 of DIP (P<0.01). In 80 mg·kg-1 of DIP group, the expression of Fas and FasL protein was not significantly different from that of I/R group (P>0.05). The expression of caspase 8 and I-κB-α showed no significant differences in all groups (P>0.05), and no gene expression was observed for p-I-κB-α protein in the study. DIP significantly affected molecular distribution of Fas and FasL protein in CA1 subregion of hippocampus. Conclusion DIP inhibits the death signaling transduction pathway initiated by CD95 molecules in rat hippocampal CA1 subregion, and NF-κB transcription factor may not be involved in the transcription regulation of CD95 molecules after transient forebrain ischemia.

Two DNA fragments, designated as P190CRI (AA1-55) and P190CRV (AA1597-1667) respectively, which encoded amino acid residues of conserved region I and V on the P190 antigen, were amplified by polymerase chain reaction from genomic DNA in FCC1/HN strain of Plasmodium falcipamm isolated from Hainan Province, China. It was found that there were five bases substitution in the P190CRV, in comparison with the nucleotide sequences of MAD20 strain. These two sequenced fragments were inserted into pGEX-2T plasmid. E.coli JM109 (DE3) were transformed with the recombinant plasmids and the parental plasmid. The results show that the two fragments were expressed at high level as C-terminal fusions with glutathione s-transferase (GST). The fusion proteins were easily purified from bacterial lysates by affinity chromatography using glutathione sepharose 4B.