To improve the clinical skills of medical students and to train qualified and profes-sional ophthalmologist,the school of optometry and ophthalmology in Wenzhou Medical College car-ried out reforms and innovations in clinical practice and training. In order to strengthen and train clin-ical thinking and clinical skills,and to cultivate the humanistic qualities of medical students,the di-verse-training mode were applied in clinical practice and training. In this paper explored the design goal, objective and actual effect of diverse-training mode for clinical practice and training.

Background Different depthes or distances are prompted with many visual cues on the flat screen.Which kind of depth cues plays a major role in the accommodation of human eyes,in addition,whether this effect exists in the different distance are still below understood.Objective This study was to research the effect of the monocular space depth perception on accommodative response at different distances,and to analyze the effect of linear perspective and size-constancy perceptual depth cues on the level and amplitude of accommodative fluctation.Methods Four groups of visual targets were designed by FLASH software and placed at the front of eyes with the distance of 50 cm or 33.3 cm,representing static change from far to near and dynamic change from far to near,from near to far respectively.Twenty-six healthy volunteers aged 22-26 years were included in this study,with the spherical power of (-4.06± 1.99) D and cylindrical power of (-0.38±0.41) D under the informed consent.The accommodative response and accommodative fluctuations during monocularly watching the targets were recorded at 5 times/second by Grand Seiko WAM 5500 automatic infrared refractor.This study was approved by Ethic Committee of Wenzhou Medical University,and written informed consent was obtained from each subject before entering the study group.Results At the distance of 50 cm,the accommodative response caused by the depth perception of near was (1.52±0.46) D,the one of distance was (1.37±0.46) D,with a significant difference of 0.15 D under the combined effect of linear perspective and size-constancy (P =0.016).The accommodative response caused by the depth perception of big car was (1.43 ± 0.35) D,and the one of small car was (1.43 ± 0.36) D,without statistically significant difference under the effect of size-constancy alone (P =0.467).At the distance of 33.3 cm,the accommodative response caused by the depth perception of near was (2.40±0.53)D,and the one of distance was (2.35 ±0.51) D,without significant difference under the combined effect of linear perspective and size-constancy (P=0.379).The accommodative response caused by the depth perception of big car was (2.38±0.48)D,the one of small car was (2.39±0.52)D,without statistically significant difference under the effect of size-constancy alone (P =0.820).In addition,the total curve of accommodative microfluctuation showed apparent fluctuation periodically caused by the distance perception involving linear perspective only.Conclusions Monocular space depth perception has some impacts on the accommodative response at certain distance.Linear perspective,which is one of the depth cues of space perception,plays a major role in the accommodative response.Compared with the size-constancy,linear perspective can provide depth perception at higher level.The size-constancy has a little or contrast impact to the accommodation,because it depends on the assistance from other depth cues like linear perspective.

Background When focusing on a target,the accommodative system exhibits small variations in power within a range,termed microfluctuations.Exploring the correlation between the characters of microfluctuations and the aberrations of the eyes through a critical period-teenager can deepen the understanding of the onset and development of myopia.Objective This study was to investigate the correlation between accommodative microfluctuations and wavefront aberrations of human eyes,and to explore the role of accommodative microfiuctuations in the development of myopia.Methods A cross-sectional study was designed and performed.Fifty-four teenagers aged from 12 to 15 years were enrolled in this study in Eye Hospital,Wenzhou Medical University from 2010 to 2011,including 19 emmetropic subjects,18 incipient myopic subjects and 17 progressive myopic subjects,who were chosen based on the refractive changes for the last two years.The accommodative response and microfluctuations were measured by WAM-5500 infrared autorefractor with RSVP at 25,33 and 50 cm respectively,each RSVP distance was tested for 5 minutes.The accommodative values were divided into low frequency component (LFC) (0-0.6 Hz),middle frequency component(MFC) (0.6-0.9 Hz) and high frequency component (HFC) (1.0-1.4 Hz) after Fourier spectrum analysis.The wavefront aberrations of the whole eye and corneal were recorded by i-Trace aberrometer and Humphrey corneal topography.The differences of accommodative response,microfluctuations and aberrations were evaluated and compared among the emmetropic group,incipient myopic group and progressive myopic group.The correlations of accommodation and aberrations were analyzed.This study followed Declaration of Helsinki,and informed consent was obtained from each subject.Results Under the 25 cm and 33 cm reading distance,the accommodative response values were (2.78 ± 0.35) D and (2.19 ± 0.27) D in the emmetropic group,which were significantly higher than (2.44±0.33) D and (1.89±0.35)D in the progressive myopic group (P=0.002,0.003).LFC,MFC and HFC were remarkably increased as the reading distance decreased (Fdistance =8.480,14.270,21.400;all at P ＜0.01).A significant difference was seen in LFC among different reading distances (Fgroup =4.115,P＜0.05),and the LFCs in the progressive myopic group were considerably higher than those in the emmetropic group in the 25,33 and 50 cm reading distances (P=0.044,0.038,0.032).No significant differences were found in MFC and HFC among the three groups (Fgroup =0.859,0.682;both at P＞0.05).Under the 25 cm and 33 cm reading distances,significant positive correlations were found between LFC and corneal coma,intraocular coma,whole ocular aberrations or intraocular higher order aberrations (all at P＜0.05),however,no significant correlations were seen between MFC or HFC and wavefront aberrations (all at P＞0.05).Conclusions In teenagers,the accommodative response of emmetropia is much stronger than that of progressive myopia,and the accommodative microfluctuation in emmetropia and incipient myopia is much less than that in progressive myopia.These shifts are possibly associated with the variability,and microfluctuations of accommodation is greater in progressive myopes than emmetropes.There are certain correlations between wavefront aberrations and accommodative microfluctuations.The refractive group differences in the accommodative microfluctuations may be related to differences in the wavefront between myopes and emmetropes.Under near reading distance,LFC is correlated with higher order aberrations.

Objective To observe the effect of comprehensive rehabilitation on the motor function and activity of daily living in patients with acute cerebral infarction. Methods 110 patients with acute cerebral infarction were randomly divided into rehabilitation group and control group. The patients in control group were treated with medicine, while the patients in rehabilitation group were treated with comprehensive therapy, including medicine, physical therapy and neuromuscular electrical stimulation. They were assessed with the simplified Fugl-Meyer assessment (FMA), modified Barthel index (MBI), and the clinical defect of neurol function before and 4 weeks after treatment. Results The scores of FMA and MBI improved significantly in both groups after treatment, and improved more in rehabilitation group than in control group (P<0.05). The effective rate was 75% in the rehabilitation group, and 56% in the control group (P<0.05). Conclusion Comprehensive rehabilitation can promote the recovery of motor function and activity of daily living in patients with acute cerebral infarction.

The aim of this study was to investigate the effect of Paris saponin I (PS I) on human gastric carcinoma cell growth and apoptosis and to explore the potential mechanisms. The proliferation of SGC7901 cells was monitored by the MTT cell viability assay, while the nuclear morphology of apoptotic cells was assessed by Hoechst 33258 staining. Flow cytometry was performed to analyze the cell cycle progression of propidium iodide (PI)-stained SGC7901 cells and the apoptotic rate of annexin V/PI-stained cells. Western blotting was used to examine the expression of several cell cycle proteins, including cyclin B1 and Cdk1, and the apoptosis-regulated proteins Bcl-2, Bax, cytochrome c, procaspase-9, and procaspase-3. The MTT assay demonstrated that PS I could induce significant dose- and time-dependent inhibition of SGC7901 cell proliferation. Marked morphological changes, including condensation of chromatin, nuclear fragmentation and apoptotic bodies were clearly shown on Hoechst 33258 staining. PSI treatment also resulted in the disruption of the cell cycle at G(2)/M and the induction of apoptosis. Following PSI treatment, the cell cycle-related proteins cyclin B1 and Cdk1 were down-regulated. Expression of the pro-apoptotic protein Bax was increased, while anti-apoptotic protein Bcl-2 decreased. PSI treatment resulted in elevated cytoplasmic cytochrome c and activation of the apoptotic proteases caspase-9 and caspase-3. These data indicate that PS acts as an inhibitor of proli I feration in SGC7901 cells by inducing cell cycle arrest and mitochondria-dependent apoptosis. PSI is a potential therapeutic agent against human gastric carcinoma.

Objective The renin-angiotensin system ( RAS) is involved in myocardial anoxic injury .This study aimed to in-vestigate the expressions of AT 1-R, AT2-R, and angiotensin-converting enzyme ( ACE ) in bone marrow mesenchymal stem cells (MSCs) under hypoxia. Methods Rat MSCs were isolated, cultured, and identified with CD29 and CD11b/c antibodies.The is-chemic injury model was established by exposing the MSCs to hypoxia and serum deprivation ( Hypoxia/SD) for 24 hours, while the control cells were cultured in L-DMEM with 10%FBS.The vitality and apoptosis of the cells were detected by trypan blue staining , CCK8 assay, and Annexin V-FITC staining.The mRNA and protein expressions of AT 1-R, AT2-R, and ACE were determined by real-time quantitative PCR and Western blot , respectively. Results The positive rate of CD29 was >97%and that of CD11b/c was <1% in the MSCs.Compared with the control group, Hypoxia/SD significantly increased the rate of cell apoptosis ([6.73 ±0.78]%vs [19.93 ±4.92]%, P<0.01), decreased the rate of cell viability ([78.49 ±4.94]%vs [37.33 ±2.91]%, P<0.01), and up-regulated the mRNA and protein expressions of AT 1-R, AT2-R, and ACE. Conclusion Hypoxia/SD activates the RAS in MSCs and improves the protective function of the cells against myocardial anoxic injury .

Objective To detect the protective role of high mobility group box-1 protein (HMGB1 )antibody in concanavalin A(ConA)-induced liver injury in mice.Methods The healthy male Balb/c mice were grouped into con-trol group (saline injection),model group(ConA injection)and experimental group(ConA+HMGB1 antibody injec-tion).After 6 hours of injection,mice blood was collected for detecting alanine transaminase (ALT)and HMGB1 , liver tissue was used to do HE stain,Tunel,and immunofluorescence detection.Results Pathological inflammation in experimental group was slighter than model group.The levels of ALT and HMGB1 in mice serum were (52.00± 8.34)U/L and (7.54 ±0.53)ng/mL in control group,(5 551 .50 ±1 445.74)U/L and (18.06 ±1 .65 )ng/mL in model group,(1 977.40±654.89)U/L and (10.77±0.71)ng/mL in experimental group,respectively;the expres-sion levels of HMGB1 mRNA and HMGB1 (relative value)in liver tissue were 1 .886±0.253 and 0.086±0.028 in control group,4.718±0.341 and 0.268±0.043 in model group,3.005 ±0.331 and 0.116±0.008 in experimental group,respectively;the expression levels of ALT and HMGB1 in serum,as well as HMGB1 mRNA and HMGB1 in liver tissue of experimental group were all lower than model group(all P <0.001).Apoptosis and HMGB1 migra-tion in the liver cell (normalized)were 1 ±0 and 1 ±0 in control group,4.67 ±0.33 and 4.50 ±0.22 in model group,2.67±0.21 and 2.33 ±0.21 in experimental group,respectively;apoptosis and HMGB1 migration in liver tissue of experimental group were both lower than model group(both P <0.001).Conclusion HMGB1 antibody can improve the pathological injury of liver tissue,and protect mice liver against the injury induced by ConA.

BACKGROUND:In recent years,artificial cervical disc replacement surgery as a new method for the treatment of cervical disease has gradualy been accepted and understood,but relevant complications have gradualy attracted attention.OBJECTIVE:To investigate the clinical outcomes of artificial cervical disc replacement in the treatment of cervical disease and the range of motion of the replacement segment.METHODS: A total of 25 patients with artificial cervical disc replacement in the treatment of cervical spondylosis,who were treated in the Department of Orthopedics,Air Force General Hospital of Chinese PLA from August 2006 to April 2012,were enroled in this study,including 15 males and 10 females,aged 31-76 years,averagely 51.04 years.There were 6 cases of double segments and 19 cases of single segment.They were folowed up for 24 to 93 months.Clinical results were assessed using the Japanese Orthopaedic Association score,cervical dysfunction index and pain visual analog scale scores.Imaging was used to observe range of motion,cervical curvature,heterotopic ossification,and degeneration of adjacent segments.RESULTS AND CONCLUSION:Neurological function in al patients was improved to different degrees.One case suffered from mild heterotopic ossification,but no clinical symptoms were found.No significant difference in range of motion of surgical segment,and range of motion of upper and lower adjacent segments was detected between pre-replacement and final folow-up results (P＞0.05).No significant difference in range of motion of C2-C7 was found between pre-replacement and final folow-up results (P＞0.05).Japanese Orthopaedic Association score,cervical dysfunction index and pain visual analog scale scores were significantly improved during final folow-up compared with pre-replacement (P＜0.05).These results indicated that artificial cervical disc replacement in the treatment of cervical disease can achieve better clinical efficacy,can keep the range of motion of replacement segment and avoid the accelerated degeneration of adjacent segments.

Objective To investigate the influence of size and depth of thyroid carcinoma for diagnostic accuracy of ultrasound-guided fine-needle aspiration (US-FNA).Methods A retrospective review of clinical and preoperative US-FNA data of 87 malignant thyroid nodules confirmed by surgical pathology from 87 patients was performed.According to the the Bethesda System for Reporting Thyroid Cytopathology (BSTC),the grade that higher than grade Ⅳ was the cytologic criteria for diagnosis of thyroid carcinoma.According to the cytopathological data of thyroid carcinoma confirmed by surgical pathology,the patients were divided into group A (cytopathological data was same as the surgical pathology result) and group B (cytopathological data was not same as the surgical pathology result).The longest diameter of malignant thyroid nodules and the distance from the shallow of thyroid nodules to superficial capsule of thyroid gland were analyzed.The ROC analysis was performed to find the optimal cut-off value of the longest diameter of thyroid carcinoma and the distance from the shallow of thyroid carcinoma to superficial capsule of thyroid gland.Results The consistent rate between US-FNA and surgical pathologic results was 79.31 ％ (69/87).The longest diameter of thyroid carcinoma of group A and group B was (1.63±0.58)cm and (1.01±0.42)cm respectively,which was statistically different (P＜0.01).The distance from the shallow of thyroid carcinoma to superficial capsule of thyroid gland of group A and group B was (4.15±1.83) mm and (7.86±2.08)mm respectively,which was statistically different (P＜0.01).According to the ROC analysis results,the optimal cut-off value of the longest diameter of thyroid carcinoma and the distance from the shallow of thyroid carcinoma to superficial capsule of thyroid gland was 1.05 cm and 6.1 mm respectively.Conclusion Diagnosis accuracy of US-FNA could be influenced by size and depth of thyroid carcinoma.

Objective To investigate therapeutic effect of endoscope?guided bougie dilatation on children with benign esophageal stricture. Methods Data of 71 patients with benign esophageal stricture were retrospective analyzed.Patients were divided into group A (reflux stricture),B (congenital esophageal atresia stricture) and C ( caustic injuries stricture) ,based on different causes. The expansion effectiveness and factors of the three groups were analyzed. Results A total of 885 expansions were performed on 71 patients with the total efficacy rate 94?37%( 67/71) . No statistic differences were shown in expansion effectiveness among the 3 groups; group C ( 14?9 times/case, P < 0?05 ) showed more expansion frequencies than group A (9?1 times/case,P<0?05)and group B(10?7 times/case, P<0?05),more complications than group A(1?22%VS 0,P<0?05) and group B(1?22% VS 0?31%,P<0?05). Conclusion Endoscope?guided bougie dilatation is safe and effective for childrens′ benign esophageal stricture. Caustic injuries, refractory benign esophageal stricture,need more expansions and may be accompanied with more complications.