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.

Objective To compare the efficacy and indications between the biliary bypass laparotomy surgery.and the two different kinds of biliary stent insertion surgery in the palliative alleviating jaundice of cholangiocarcinoma.Methods From March 2008 to March 2013,69 patients treated with palliative alleviating jaundice therapy of cholangiocarcinoma were included,who were all came from the Third Affiliated Hospital of Guangzhou Medical University.Including 17 patients who treated with the open biliary bypass surgery and 52 patients who treated with interventional therapy.We analysed the differences between these cases of biliary drainage operations in the recent jaundice reduction rate,average stay,mortality rate,the incidence of related complications,et al.Results All these different drainage ways had good effect in alleviating jaundice,incidence of alleviating jaundice have no obvious difference (P ＞ 0.05).Compared to the open biliary bypass surgery,interventional therapy had obvious advantages in the average stay and postoperative survival (P ＜ 0.05).The pancreatitis rate was lower in Percutaneous Group than that in Endoscopic Group (P ＜ 0.05).incidence of biliary tract infection and biliary tract bleeding have no obvious difference (P ＞ 0.05).There were no significant differences between the success rates of in biliary stent insertion operation in patients with each model cholangiocarcinoma (P ＞ 0.05).Conclusions Among the therapies of the palliative alleviating jaundice of cholangiocarcinoma,the internal biliary drainage of biliary stent insertion operation was superior to the treatment of the biliary bypass laparotomy.As to biliary stent insertion operations,endoscopic biliary stenting surgery should be the preferred choice.

Objective: To discuss the application of failure mode and effect analysis to improve the hand hygiene compliance of medical staff in eye hospital. Methods: To form failure mode and effect analysis (FMEA) quality control team. By using FMEA method of risk management, to analyze the risk factors of hand hygiene compliance of medical staff in eye hospital. By performing analysis, to determine the high risk factors, develop and implement the improvement measures to reduce the risk of these factors. Results: the awareness rate of hand hygiene knowledge was increased significantly after the implementation of failure mode and effect analysis (P<0.01) , the correct rate of hand-washing method, and the implementing rate of 5 hand hygiene were increased significantly (P<0.05) . After the implementation of FMEA, the usage amount of hand washing liquid and quick hand disinfectant was increased from 13 292 ml to 28 390 ml, and difference of the hand hygiene qualification rate was statistically significant (P<0.05) . Conclusion The application of FMEA contributes to analyze the causes of hand hygiene failure, and guide the development of improvement measures, which can effectively improve the hand hygiene compliance of medical staff, thereby reducing nosocomial infection.

Objective:To evaluate the effect of orexin A on morphine-induced gastrointestinal dysfunction in mice.Methods:Forty SPF C57B/6 mice, aged 6-8 weeks, half male and half female, weighing 18-22 g, were divided into 5 groups ( n=8 each) using a random number table method: control group (group C), morphine group (group M) and morphine + different doses of orexin A groups (MOH, MOM and MOL groups). Normal saline 8 ml/kg was subcutaneously injected daily in group C, morphine 6 mg/kg was subcutaneously injected daily in the other four groups, and orexin A 75, 50 and 25 μg/kg were subcutaneously injected daily for 10 days at the same time in MOH, MOM and MOL groups.The fetal water content was calculated and averaged daily.After the last administration, the mice were gavaged with black nutrient paste, and the gastric emptying rate and small intestinal propulsion rate were detected 30 min later.Blood samples were collected from the orbit, and the concentration of serum gastrin (GAS) was detected by enzyme-linked immunosorbent assay.The mice were then sacrificed, and colon tissues were removed for determination of c-kit positive cell area (by immunohistochemistry) and expression of c-kit, substance P (SP) and neural nitric oxide synthase (nNOS) in colon tissues (by Western blot). Results:Compared with group C, the rate of fecal water content, gastric emptying rate, small intestinal propulsion rate and serum GAS concentration were significantly decreased, the area of c-kit positive cells was decreased, and the expression of c-kit and SP was down-regulated, and the expression of nNOS was up-regulated in group M ( P<0.05). Compared with group M, the small intestinal propulsive rate and serum GAS concentration were significantly increased, and the area of c-kit positive cells was increased, and the expression of c-kit was up-regulated in group MOH, the rate of fecal water content, gastric emptying rate, small intestinal propulsion rate and serum GAS concentration were significantly increased, the area of c-kit positive cells was increased, and the expression of c-kit and SP was up-regulated, and the expression of nNOS was down-regulated in group MOM, and the serum GAS concentration and c-kit positive cell area were significantly increased in group MOL ( P<0.05). Conclusions:Orexin A 50 μg/kg can effectively alleviate the gastrointestinal dysfunction induced by morphine in mice, and the mechanism may be related to promotion of GAS secretion, interstitial cells of Cajal growth and SP release and inhibition of NO release.

Objective:To explore the value of using the mean gamma index (GI) in targer area receiving 50% prescribed dose as reference in VMAT planned dose verification through model-based dose calculation and measurement-based dose reconstruction.Methods:Based on Compass dose verificantion system, the VMAT plans for 70 patients were validated using two method. The mean GI and passing rate in target area receiving 50% of prescribed dose area for each validation plan were obtained to evaluate its application value in dose validation. First, plan information obtained by TPS calculation was input into the Compass system for performing independent dose calculation based on the accelerator data model, and obtain a three-dimensional dose based on the independent model calculation. The planned fluence measured for each patient′s treatment plan on the accelerator was reconstructed through the Compass system to obtain a three-dimensional dose based on measurement reconstruction. The three-dimensional dose obtained by the two method were compared with the three-dimensional dose calculated by TPS.Results:Combined with the gamma criteria of 3%/3 mm in the error setting condition of GI analysis, the mean GI in the area receiving 50% of prescribed dose was evaluated. GI≤0.4 was classified as PASS, 0.4 < GI ≤ 0.6 as being clinically acceptable, and GI > 0.6 as FAIL. The VMAT planned dose verification for 70 patients showed that the model-based independent calculation was in a better agreement with the TPS calculation. The GI values were all < 0.6: GI≤0.4 for 67 patients and 0.4 90% for 88 patients and < 90% for other 2, all meeting the requirements of clinical dose verification. The model-based independent dose verification is better than the measurement-based reconstructed dose verificantion, and the difference is statistically significant ( t=15.20, 10.71, P < 0.05). Conclusions:The mean GI in target area receiving 50% of prescribed dose can be used as a reference to judge the operatability of clinical plan in clinical dose verification. The mean GI value, in combination with the comprehensive result of gamma passing rate, is more convincing to evaluate dose verification. A combination of model-based dose verification, despite time-saving and labor-saving, and the measurement-based dose verification could become a reliable dose verification method for clinical application.

Through literature study,this paper summarizes the current status ofreseareh on the relationship between maternal exposure factors and small for gestational age infant both in China and abroad.And at the same time,the relationship between pregnancy outcome of small for gestational age and maternal exposure factors was analyzed.This might contribute to reduce the incidence of small for gestational age infant and provide important guidance and references for perinatal care.

Objective To analyze the association between pesticide exposure and adverse pregnancy outcomes in women from the rural areas of China.Methods Data of "National Free Preconception Health Examination Project (NFPHEP)" from January 2010 to December 2012 was used for analysis.A total of 248 501 families that were planning to deliver a baby in the next 6 months were enrolled.Data on paternal exposure to pesticides before or during pregnancy was collected through questionnaires,with related outcomes on pregnancy recorded by doctors.Results Among all the 248 501 participants,1 806 (0.74％) women and 2 653 (1.09％) men reported to have been exposed to pesticide before pregnancy,with 505 (0.21％) reported of having been exposed to pesticide during the period of pregnancy.Maternal exposure to pesticide was found a risk factor related to stillbirth (OR=3.37,95 ％ CI:2.05-5.55),peculiar smell pregnancy (OR =3.17,95％CI:1.18-8.55) and low birth weight (OR=7.56,95％ CI:5.36-10.66).Paternal exposure to pesticide was also found related to miscarriage (OR=1.37,95％ CI:1.03-1.80),low birth weight (OR=3.65,95％ CI:1.51-8.84),or giant infant (OR?=0.64,95％ CI:0.44-0.93).Maternal exposure to pesticide during pregnancy appeared a risk factor on miscarriage (OR=4.65,95％ CI:3.47-6.24).Other adverse outcomes on pregnancy would include premature birth and high birth weight.Conclusion Parental pesticide exposure appeared a risk factor on stillbirth,peculiar smell pregnancy,low birth weight and miscarriage.

Objective To access the current status of folic acid supplementation in women at childbearing age in suburban area of Beijing,2016.Methods In this cross-sectional study,a total of 722 women aged 17-41 years from six hospitals in suburban areas of Beijing were selected through cluster sampling.A questionnaire survey was conducted.Results The rates of folic acid intake and regular folic acid intake among women under survey were 63.9％ (456/714) and 83.3％ (380/456).In women who remembered the duration of folic acid supplementation,the overall rate of preconceptional folic acid supplementation was 35.5％ (159/450),in whom 27.3％ (123/450) began to take folic acid 0-3 months before pregnancy;8.0％ (36/450) began to take folic acid 3 months before pregnancy.Multivariate logistic regression analysis indicated that household registering type,preparation for pregnancy or pregnancy,parity,smoking and alcohol use were the influencing factors for folic acid supplementation.Conclusions The rate of folic acid supplementation remained low in childbearing aged women in suburban area of Beijing.It is necessary to further strengthen the health education about the importance of folic acid supplementation to improve the intake rate and the regular intake rate of folic acid in pregnant women and to promote maternal infant health and reduce the related complications.

Allergic rhinitis(AR)is a type Ⅰ allergic reaction,which mediated by immunoglobulin E immediately when an individual with a special constitution is exposed to a same allergen for second time,whose pathogenesis has not been clarified yet,and closely related to genes,immune cells and cytokines.Pathogenesis of AR become more deeper and more accurate due to rapid develop-ment of molecular biology and second-generation gene sequencing technology.Current studies have found that miR-155 and transcrip-tion factor GATA3 have important regulatory effects on occurrence and development of AR,then affect dominant differentiation of CD4+T lymphocytes and proliferation of ILC2.This article discusses and reviews pathogenesis of AR,which mainly focuses on miR-155/GATA3 pathway and effects of related upstream genes and downstream regulatory substances.

Background Emerging evidence has shown the damage of air pollution and the benefits of physical activity to human health, and the effects of air pollution and physical activity on the nervous system need more research. Objective To explore the effects of short-term air pollution exposure and physical activity on neural damage biomarkers in healthy elderly. Methods Using a design of panel study, physically and mentally healthy retired employees were recruited from Xinxiang Medical University, and were followed up five times regularly from December 2018 to April 2019. The demographic characteristics and physical activity information were obtained by questionnaire, and the weekly physical activity level was calculated according to intensity and duration of physical activity. Biomarkers of neural damage in serum were measured, including brain-derived neurotrophic factor (BDNF), neurofilament light chain (NF-L), neuron specific enolase (NSE), protein gene product 9.5 (PGP9.5), and S100 calcium-binding protein B (S100B). Air pollution data (including PM_2.5, PM₁₀, O₃, SO₂, CO, and NO₂) of the follow-up period were collected. Generalized estimation equation was used to analyze the association of air pollution concentration and physical activity level with the concentration of neural damage biomarkers. Results A total of 29 volunteers were included in the study, with an average age of (63.5±5.9) years; there were 11 men accounting for 37.93%; more than half of them (62.07%) received above junior middle school education; the mean physical activity level was (80.23±54.51) MET-h·week⁻¹. The daily average concentrations of PM_2.5, PM₁₀, O₃, SO₂, CO, and NO₂ during the study period were (68.27±60.98) μg·m⁻³, (130.57±58.71) μg·m⁻³, (36.86±13.89) μg·m⁻³, (17.86±10.59) μg·m⁻³, (4.94±1.34) mg·m⁻³, and (50.83±8.03) μg·m⁻³, respectively. The average serum concentrations of BDNF, NF-L, NSE, PGP9.5, and S100B were (139.12±46.71) μg·L⁻¹, (402.60±183.31) ng·L⁻¹, (11.26±10.32) ng·L⁻¹, (14.32±13.57) ng·L⁻¹, and (127.57±41.74) ng·L⁻¹, respectively. The results of generalized estimation equation showed that a higher concentration of PM_2.5 or O₃ was associated with increased serum NSE (OR=1.359, 95%CI: 1.224-1.509, P<0.001; OR=1.286, 95%CI: 1.076-1.537, P=0.006), while a higher concentration of NO₂ was associated with decreased serum NSE (OR=0.692, 95%CI: 0.549-0.873, P=0.002); a higher concentration of O₃ or SO₂ was related to the reduction of serum NF-L concentration (OR=0.855, 95%CI: 0.740-0.989, P=0.035; OR=0.813, 95%CI: 0.700-0.946, P=0.007); a higher concentration of NO₂ was associated with decreased PGP9.5 in serum (OR=0.866, 95%CI: 0.777-0.965, P=0.009); a higher level of physical activity was associated with increased serum S100B (OR=1.038, 95%CI: 1.003-1.074, P=0.034); and no significant association of physical activity level or air pollution with BDNF (P>0.05). Conclusion Acute exposure to air pollution and high-level physical activity might affect the neural damage of elderly populations. Specifically, particulate matter (PM_2.5) could increase NSE, while gaseous pollutants (O₃, NO₂, and SO₂) could decrease NF-L and PGP9.5.