It is urgent to train the eye residents'communication skills because of the increasing number of medical disputes. Eye residents improved their doctor-patient communication skills by enhancing awareness on the importance of communication,performing education of psychology and communication skills,understanding a variety of medical laws and regulations,improving clinical skills,and training good medical ethics. No medical disputes happened through such training and assessing. Based on the practice of communication training,this paper puts forward some possible solutions.

Bilingual education is an imporant teaching reform in universities. In recent years, cardiothoracic department has enacted the practice and exploration for bilingual teaching of cardiothoracic surgery. By creating high-quality teaching team, improving teaching methods and quality, creating bilingual learning environment, we have achieved satisfactory teaching effect.

Objective To explore the distribution and features of the optic cup stem cells in embryonic rat at tailbud stage. Methods The distribution of optic cup stem cells in optic cup tissue in 12.5-embryonic-day-old rats was observed by immunohistochemistry. The separated cells from optic cup were cultured with serum-free media, and immunofluorescence technique was used to detect the ability of hyperplasia of stem cells and expression of CHX10 antigen and specific antigens of mature retinal cells before and after differentiation. Results The optic cup stem cells in embryonic rat at tailbud stage were mainly located at inner, outer, and marginal layer of optic cup. No expression of specifically marked protein of mature retinal cells was detected. The cells separated from optic cup had the ability of single-cell clone, positive expression of CHX10 and expression of several specific antigens of mature retinal cells after the inducement, including Thy1.1, glial fibrillary acidic protein (GFAP), protein kinase C (PKC) ?, and rhodopsin. Conclusion Optic cup of 12.5-embryonic-day-old rats composes of undifferentiated cells, and the stem cells are mainly located in optic cup inner and marginal. High ability of hyperplasia of the optic cup stem cells cultured in vitro is found. The cells, which are retinal stem cells, can express several specifically marked proteins of mature retinal cells after inducement and differentiation.

Objective To evaluate clinical application value of critical flicker frequency (CFF),psychometric hepatic encephalopathy score (PHES) and Stroop test in the diagnosis of covert hepatic encephalopathy (CHE).Methods A total of 110 patients with decompensated liver cirrhosis and 54 individuals without liver diseases were enrolled as control group.According to PHES＜-4 points as reference threshold for CHE,the threshold of CFF and time of Stroop test for CHE diagnosis was caculated.Positive results of at least two of PHES,CFF and Stroop tests was considered as the gold standard for CHE diagnosis,and then the value of these three methods in CHE diagnosis was evaluated.Student's t test and receiver operating characteristic curve (ROC) were used for statistical analysis.Results Among the 110 patients with liver cirrhosis,40 patients had no hepatic encephalopathy (HE0),52 patients had CHE,and 18 patients had grade 2 hepatic encephalopathy (HE2).The CFF value and total time of Stroop test of control group were (43.70±1.92) Hz and (201.17±20.65) s,respectively.The CFF value of HE0 group was (41.40 ± 1.85) Hz,which was higher than that of CHE group ((38.33 ± 2.32) Hz),and the difference was statistically significant (t=-7.116,P＜0.01).The total time of Stroop test of HE0 group was (197.91±26.68) s,which was shorter than that of CHE group ((253.24± 33.33) s),and the difference was statistically significant (t=8.936,P＜0.01).When PHES＜-4 points was considered as a reference threshold of CHE,the threshold of CFF for CHE diagnosis was 39 Hz,the sensitivity was 94.9％ and the specificity was 73.1％,the area under the curve (AUC) was 0.879.The threshold of the total time of Stroop test for CHE diagnosis was 233.80 s,the sensitivity was 83.3 ％ and the specificity was 71.1％,the AUC was 0.803.The completion time of the number connection test (NCT)-A,NCT-B and digit symbol test (DST),which were there of five subtests of PHES,of CHE group were (80.27±36.05) s,(124.18±55.96) s and (25.03±8.23) s,respectively,compared with those of HE0 patients ((56.68±18.82) s,(80.00±25.58) s and (34.68±8.75) s,respectively),the differences were statistically significant (t =3.691,4.108 and-4.780;all P＜0.01).Compared with the results of combined PHES and Stroop test in the diagnosis of HE0,CHE and HE2,the consistency rates of CFF＜39 Hz as threshold for diagnosis were 95.0％,61.5％ and 100.0％,respectively.Conclusions NCT-A,NCT-B and DST three subtests of PHES have higher efficiency in CHE diagnosis.CFF and Stroop test are also reliable screening methods for CHE,with advantage of objectivity and high specificity.

Objective: To analyze the association between latent class of health-risk behaviors and depressive symptoms among middle school students, so as to provide the evidence for the prevention and intervention of depressive symptoms among middle school students. Methods: Students in two junior high schools, two senior high schools and one vocational high school in Yinzhou District, Ningbo City, Zhejiang Province, were selected using a stratified multi-stage cluster sampling method. Demography and health-risk behaviors were collected using questionnaire surveys, depressive symptoms were investigated using the Center for Epidemiological Studies Depression-10 Scale, and latent class analysis was conducted for health-risk behaviors. The association between different latent classes and depressive symptoms was analyzed using a multivariable logistic regression model. Results: A total of 1 247 students were surveyed, including 641 boys (51.40%) and 606 girls (48.60%). There were 452 junior high school students (36.25%), 532 high school students (42.66%) and 263 vocational high school students (21.09%). Latent class analysis showed that health-risk behaviors in students were classified into three groups, namely healthy behavior group (52.93%), poor diet group (39.94%) and high-risk behavior group (7.14%), and the detection rates of depressive symptoms were 7.12%, 18.88% and 52.81%, respectively, with a statistically significant difference between groups (P<0.05). Multivariable logistic regression analysis showed that after adjusting for age, gender, native place, only child and living on campus, the poor diet group (OR=3.107, 95%CI: 2.086-4.627) and high-risk behavior group (OR=15.401, 95%CI: 9.031-26.262) had higher risks of depressive symptoms compared with the healthy behavior group. Conclusion Having high-risk behaviors and poor diet may increase the risk of developing depressive symptoms among middle school students.

Objective To evaluate the efficacy of the retroperitoneal laparoscopic pyelolithotomy (RLP) and the percutaneous nephrolithotomy (PCNL) in treating renal pelvic stone.Methods The data of 89 patients diagnosed as renal pelvic stone were retrospectively reviewed from January 2009 to July 2016,of whom 43 patients underwent RLP and 46 underwent PCNL.Statistical analysis was performed regarding operation time,blood loss,mean hospital stay,complication rate,and stone-free rate.Results The operation time in RLP group and PCNL group was (117.5 ± 16.7) min and (118.3 ± 16.6) min,respectively,and there was no significant difference (P =0.547).For the two groups,the mean hospital stay was (4.5 ± 0.5) d and (6.1 ± 0.9) d,the mean hemoglobin decrease was (4.5 ± 1.2) g/L and (18.1 ± 3.4) g/L,the post-operative blood transfusion rate was 2.3％ and 14.0％,the post-operative septic shock rate was 0 and 9.3％,respectively,with significant difference between the two groups (P ＜ 0.05).The stone-free rate in both groups was 97.7％ and 95.3％ with no significant difference (P =0.557).Conclusions RLP has the advantages of quick recovery,less blood loss and lower complication rate than PCNL.It could be a minimally invasive option for the treatment of renal pelvic stone.

Large amount of data including chemical composition and size information of individual particles would be generated in the measurement of aerosol particles using atmospheric aerosol time-of-flight mass spectrometry ( ATOFMS ) . Our home-made ATOFMS was used to measure the indoor individual aerosol particles in real-time for 24 h, and the obtained mass spectrometric data were clustering analysis by self-organizing map ( SOM ) because of its ability of vector quantization and data dimensionality reduction. 20 classification results were got which includedCalcium-Containing,Salt+Secondary particles,Secondary particles,Organic Amines,K+-Rich Organics andSoil particles, etc. Compared with previous mass spectrometric methods, SOM is a natural visualization tool, more classification results can be obtained. This classification information would be useful to assess the response and toxicity of atmospheric aerosol particles and identify the origin of atmospheric aerosol particles.

Objective Arrhythmias are one of the main causes of postoperative morbidity after thoracic surgery.The aim of this study was to evaluate whether video-assisted thoracoscopic surgery decreases the risk of postoperative arrhythmias compared with traditional open lung lobectomy.Methods 138 consecutive patients were enrolled from January 2011 to February 2012,after five age and risk factors matched,68 patients undergoing video-assisted thoracic surgery and 70 patients undergoing traditional open lung lobectomy were eligible for analysis.The rhythm was documented preoperatively and postoperatively with standard electrocardiogram (ECG) recording and ECG monitoring.All patients followed 3 months after hospital admission.Results There was a 17.6％ incidence (12/68) of postoperative new-onset arrhythmias undergoing video-assisted thoracic surgery and 18.6％ of patients (13/70) undergoing thoracotomy,but the difference was not statistically significant.In both groups,atrial fibrillation was the most common arrhythmia (60％).There was no significant difference in the other morbidity (P ＞0.05) and mortality rate(P =0.57,1.5％ vs 2.9％) between the two groups.Conclusion New-onset arrhythmias,most frequently atrial fibrillation,are common after lung lobectomy.Regardless of surgical approach,postoperative arrhythmias after lobectomy occurred with equal frequency.New insights in the pathophysiology of postoperative thoracic arrhythmias and advances in prevention and therapy are need future study.

Objective To explore the effects of Bawei Shangke Huoxue Tablets on hypercoagulable state of patients with hip fracture. Methods Seventy-two hip fracture patients at hypercoagulable state were randomly divided into treatment group and control group, 36 cases in each group. Both groups were given conventional orthopedic treatment including raising up the affected limb, external application of Huoxue Zhitong Paste on the affected area, and instructions for affected limb functional exercise. Additionally, the treatment group was given oral use of Bawei Shangke Huoxue Tablets together with subcutaneous injection of low-molecular-weight heparin calcium, and the control group was given subcutaneous injection of low-molecular-weight heparin calcium. Before and after treatment, we observed the plasma D-dimer (D-Di) and blood von Willebrand factor(vWF) levels as well as the incidence of deep venous thrombosis (DVT) of both groups before and after treatment. Results (1) All of the cases of both groups completed the clinical trial, and no severe adverse reaction such as increased bleeding occurred. (2) On the admission day, the D-Di and vWF levels of both groups were higher than the normal levels, and were decreased obviously one day before the operation (P < 0.05). On the first post-operative day, the levels were increased as compared with those before operation (P < 0.05), and then decreased on the twelfth post-operative day (P < 0.05) compared with those on the first post-operative day). The treatment group had better effect on improving D-Di and vWF levels than the control group (P < 0.05). (3) The results of follow-up for 3 months showed that 61 cases got the follow-up, 31 cases from the treatment group and 30 from the control group. The DVT incidence of treatment group was 9.68% and that of the control group was 16.67%, the difference being insignificant(P>0.05). Conclusion Bawei Shangke Huoxue Tablets are effective on improving hypercoagulable state of patients with hip fracture, and can be used at early stage and are beneficial to lowering the risks of anticoagulant drugs. Bawei Shangke Huoxue Tablets plus low-molecular-weight heparin calcium have certain effect on preventing DVT.

Objective To study the location of embryonic optic cup stem cells during tailbud stage. Methods The embryonic optic cup at embryonic day 11～15 (E11～15) in rats was sectioned horizontally at 15 ?m thick. The distributive characteristics of embryonic optic cup progenitor cells were revealed by immunohistochemistry. Results ①The distribution of optic cup progenitors was mainly aggregated on the optic cup at E12.5. CHX10-positive cells were organized as stratified epithelium arrangement on optic cup inner layer. Clusters of CHX10-positive cells were observed at the edge of optic cup; ② Pigment appeared in the outer layer of optic cup at E13.5, and differentiation into ganglion cells was initiated. Conclusion The distribution of optic cup stem cells is mainly aggregated on the optic cup at E12.5 in which the differentiation into ganglion cells is not initiated.