AIM: To determine the aqueous, vitreous, serum levels of pigment epithelium-derived factor (PEDF)and vascular endothelial growth factor(VEGF)in patients with proliferative diabetic retinopathy(PDR), and to speculate on the source of the change in concentration and to discuss its clinical significance.METHODS:Forty-one eyes withproliferative diabetic retinopathy were included in the study, 16 of which were complicated by neovascularization of iris (NVI).Twenty-one eyes with idiopathic macular hole (MH)were as controls. The aqueous, vitreous, serum levels of PEDF and VEGF of all the groups were determined with ELISA. PEDF, VEGF and the levels in the three groups were compared with analysis of variance (ANOVA). The PEDF, VEGF concentrations in aqueous,vitreous and serum were analyzed with Pearson correlation test,and the correlation of PEDF and VEGF levels was also analyzed with Pearson correlation test.RESULTS:The aqueous levels of PEDF decreased significantly in sequence in groups of control, PDR without NVI, PDR with NVI. VEGF levels increased coordinately. The similar findings existed in vitreous samples. The PEDF,VEGF levels in aqueous were not correlated significantly with those in serum,but correlated positively with those in vitreous. The intraocular levels of PEDF had a negative correlation to those of VEGF.CONCLUSION:The reduction of intraocular PEDF level and elevation of intraocular VEGF level may play an important role in the occurrence and progression of PDR. In the development of PDR, the PEDF,VEGF levels in aqueous may be mainly effected by local pathological changes, as anti-angiogenic and pro-angiogenic factors, their unbalanced intraocular distribution may promote the angiogenesis of the iris and retina.

Objective To evaluate the clinical application value of amniotic membrane transplantation in the treatment of intrauterine adhesions.Methods Totally 48 intrauterine adhesions patients of infertility were treated with amniotic membrane transplantation from January to December 2013 in our hospital.They were divided into mild adhesion in 11 cases (group A),moderate adhesion in 17 cases (group B),and severe adhesive group in 20cases (group C) by American Fertility Association.They were treated with amniotic membrane transplantation and estrogen/progesterone sequential treatment after operation.Clinical effect and feasibility of each group were analyzed.Results There was statistical significance in the endometrium thickness after 3 months (P ＜ 0.05).The menstruation of all patients with mild and moderate intrauterine adhesion (IUA) was improved,and the menstrual improvement rate in patients with severe intrauterine adhesions was 90％.IUA cure rate of groups A,B,and C were different after 3 months of surgery,[groupA100％ (11/11),group B 94.1％ (16/17),group C70％ (14/20),x2 =6.73,P ＜0.01],The cure rate of group A was significantly higher than that of group C (x2 =4.00,P ＜ 0.05),although the cure rate of group B was higher than that of group A,but the difference was not statistically significant (P ＞ 0.05).Conclusions The cure rate of amniotic membrane transplantation combined with estrogen in the treatment of intrauterine adhesions was high.It could promote the recovery of the endometrium and improve the recovery of menstruation.There was no transplantation rejection and safety.It also had the advantages of easy drawing materials,simple operation,and can be applied to clinical application and promotion.

OBJECTIVE:To control the drug quality risk in drug withdrawal links of hospital pharmacy,and provide reference for the application of quality risk management(QRM)in hospital pharmacy. METHODS:Drug QRM was developed in drug with-drawal links through risk identification,risk assessment,risk control,risk assessment and other steps. Using the incidence of risk factors and reusable rate of withdrawal drug as indexes,related data of before(Jul.-Dec. 2015)and after(Jan.-Jun. 2016)devel-oping QRM in our hospital were compared to evaluate the effect of drug QRM. RESULTS:Determining whether specific storage drugs kept the required storage conditions,whether the numbers of withdrawal drugs counted to minimal packaging and other 5 fac-tors were high-risk factors(the risk score of each factor>4 points);control measures were taken separately for high risk factors, then high-risk factors were reduced to acceptable levels(risk score<4 points). After developing QRM,the incidence of risk factors were reduced than before(reduce 1.35%-6.19%),reusable rate of withdrawal drug was increased(98.64% vs. 86.32%)(all P<0.05). CONCLUSIONS:Developing QRM in drug withdrawal links of hospital pharmacy can reduce the drug quality risk.

Objective To study the tooth whitening effect of boron-dipyrromethene (BODIPY) as a photosensitive drug combining photodynamic therapy (PDT) and the influence on the surface of the enamel.Methods After oxidation of hydrogen peroxide or BODIPY by photodynamic therapy,the extracted teeth were evaluated by Vita shade guides matching.The change of surface enamel on the crystals and microstructure was observed by scanning electron microscopy (SEM).Results The teeth treated with BODIPY by PDT were smooth and whitened with the remineralization of teeth surface in morphology.While the teeth treated with hydrogen peroxide were whitened obviously but the surface morphology of the teeth was demineralized seriously.Conclusion The results suggest that PDT is effective for teeth whitening and can promote the remineralization of teeth surface enamel with BODIPY as a photosensitive drug.PDT is expected to become a new method for tooth whitening.

Objective To study the relationship between Lidocaine blood drug level and the cause of death from Lidocaine anaphylactic shock. Method Comparing and analyzing the blood drug levels by HPLC between two groups of people whose various indexes are normal before the surgery. Group 1 included 8 cases who accepted Lidocaine as anesthetic and died from Lidocaine anaphylactic shock. Group 2 included 11 cases who also took Lidocaine as anesthetic and passed the surgery smoothly. Results Lidocaine blood level of Group 1 (1.61?0. 45mg/L) is lower than that of Group 2 (2. 44 ?0. 47mg/L). Conclusion Lidocaine blood drug level has nothing to do with the cause of Lidocaine anaphylactic shock.

Objective To evaluate the diagnostic accuracy of GenoType? M TBDRsl for the resistance to fluoroquinolones anti‐tuberculosis drugs .Methods Systematic and comprehensive literature was searched in PubMed ,Embase ,Web of Science ,CBM , CNKI ,VIP and Wanfang database .The relative studies of GenoType? MTBDRsl to fluoroquinolones anti‐tuberculosis drugs were included .After quality assessment ,Meta‐Disc1 .4 software was used to analyze the data .Results A total of 16 trials ,involving 1 766 participants ,were included .The results of Meta‐analysis showed that the weighted sensitivity ,specificity ,positive likelihood ra‐tio ,negative likelihood ratio ,diagnostic odds ratio ,and the area under summary receiver operation curve were 0 .83 ,0 .96 ,17 .50 , 0 .20 ,108 .46 and 0 .934 9 ,respectively .Conclusion GenoType? M TBDRsl assay for the resistance to fluoroquinolones anti‐tuber‐culosis drugs might be with high sensitivity and specificity ,which could be recommended as efficacy diagnostic tool .

Objectives: To evaluate the outcome of mini-PNL and standard PNL in horseshoe kidney. Methods: A total of 14 patients with horseshoe kidney were offered PCNL from January 2007 to December 2010 in our department. The male/female ratio was 2.5(10/4). The mean age was 38 years (range 29-55). All underwent color Doppler sonography, plain x-ray of kidney, ureter, and bladder, intravenous urography and CT. The left-to-right ratio was 1.8(9/5). All 14 patients had multiple stones or complex renal calculi, including 1 with staghorn stones. Mean stone size was 4.2cm(2-6.5cm). 10 patients had a history of failed extracorporeal shock wave lithotripsy. All percutaneous renal surgery was performed in one session under ultrasonography guidance. Among the treatments, 4 were mini-PNL, 10 were standard PNLs. Results: All surgery was successfully performed in one session under ultrasonography guidance by F18 tract or F24 tract. The stone-free rate after one-session operation was 78.6%(11/14). mini-PNL group was 75%(3/4), while PNL group was 80%(8/10). 3 cases received ESWL to remove the residual calculi, no second-session operation. 9 were performed in one tract and 5 in two tracts. 9 in upper calix, 7 in middle and 3 in lower. Mean operative time was 112.5±67.5min, mini-PNL operative time was longer than that of standard PNL (135±45min vs102.5±75min, respectively). Conversely, there was an advantage for miniperc over standard PNL in terms of a significantly reduced hematocrit drop (2.8±0.4g/dl VS 4.2±0.8g/dl, respectively). No mini-PNL patients required blood transfusions, whereas 3 did in the standard PNL group. Postoperative rate of surgery-related infection was 14.4%(2/14). No pleural or abdominal injury occurred. Conclusion: Both treatments have their own advantage. Mini-PNL and standard PNL are both effective and safe for calculi within horseshoe kidneys.

Objective To investigate the mastery of clinical students' doctor-patient communi-cation skills and to assess the teaching effectiveness about the doctor-patient communication, and then propose some improvement ideas. Methods We conducted a study in students of clinical medicine of Nanjing Medical University in Grade 2009, using Objective Structured Clinical Examination (OSCE) after internship, which included graduation assessment of doctor-patient communication skills. Then we analyzed the doctor-patient communication skills and related scores of students trained in different clinical medical programs. Results The average score of doctor-patient communication skills of 549 students was (82.72±4.23), of which, the average score of 329 five-year students of clinical medicine was (81.88±4.23) and the average score of seven-year students was (83.96±3.91) in. The average score of seven-year students of clinical medicine was significantly higher than five-year students (P=0.000). Moreover, there was a significant positive correlation between the total score of OSCE and the score of doctor-patient communication skills in both five-year and seven-year students of clinical medicine (five year program students' score correlation coefficient was 0.520, P=0.000;seven year pro-gram students' score correlation coefficient 0.416, P=0.000). Conclusion The teaching effectiveness of doctor-patient communication has proved to be quite effective, and it is definitely of great significance in improving clinical students' doctor-patient communication skills. The score of the assessment of the doctor-patient communication reflects not only the training effectiveness of the communication skills, but also the comprehensive capacity.

Objective:This study has two objectives. One is to detect the methylation status of reversion-inducing cysteine-rich protein with Kazal motifs (RECK, a new tumor suppressor gene) gene promoter in primary laryngeal squamous cell carcinoma and nor-mal laryngeal mucosa. The other is to analyze the correlation between RECK gene methylation status and radiosensitivity in laryngeal squamous cell carcinoma. Methods:Methylation-specific polymerase chain reaction was used to detect the RECK gene methylation of 70 specimens of laryngeal squamous cell carcinoma and 15 normal tissues of laryngeal mucosa. The patients underwent six cycles of ra-diotherapy and were followed-up for 5 years. The correlation between RECK gene methylation status and radiosensitivity in laryngeal squamous cell carcinoma was analyzed. Results: After six cycles of radiotherapy, 47 patients (67.14%) showed sensitivity and 23 (32.86%) showed tolerance to radiotherapy. The methylation level of the RECK gene was lower in the radiation-sensitive group than in the nonradiation-sensitive group (P<0.05). The methylation level of the RECK gene was lower in the remission group than in the non-remission group. RECK gene methylation could increase the risk of cancer by approximately 5.010 times (OR=5.010, 95%CI:1.616-15.533). Conclusion:RECK gene promoter methylation in human laryngeal squamous cell carcinoma is an early event that is correlated with the patient's sensitivity to radiotherapy. Thus, the patient's sensitivity to radiation can be predicted by detecting the meth-ylation status of the RECK gene promoter.

Based on the clinical application of ERA (easy resilient attachment), the construction of two kinds of ERA were introduced including outside-crown-EAR and root-EAR. The clinical operation and attention of EAR application were demonstrated by clinical cases.