Purpose CT spectroscopy imaging was used in the preoperative differentiation evaluation of renal clear cell carcinoma, to access its malignant degree preoperatively, and to guide the operation treatment. Materials and Methods The spectral characteristics of 40 patients with renal clear cell carcinoma (RCCC) were analyzed retrospectively, all the RCCC patients underwent gemstone spectral imaging (GSI) scans, to obtain spectral serial images for the arterial phase and medulla phase. Spectral characteristic parameters and spectrum curve between different grades of renal cell carcinoma was compared, and the results were compared with pathology. Results Among the 40 cases of patients, carcinoma of grade I, II and III were 13 cases, 15 cases and 12 cases respectively. CT value ratio of renal clear cell carcinoma of grade I, II and III under 70 keV were 1.17±0.25, 0.84±0.85 and 0.64±0.19 (F=23.697, P<0.05) in arterial phase and 0.83±0.12, 0.64±0.07 and 0.54±0.08 (F=30.975, P<0.05) in medulla phase;iodine concentration ratio was 1.19±0.40, 0.60±0.10 and 0.25±0.94 (F=32.932, P<0.05) in arterial phase, and 0.69±0.18, 0.43±0.94 and 0.26±0.51 (F=28.673, P<0.05) in medulla phase. Spectrum curve slope of renal clear cell carcinoma of grade I, II, III in arterial phase was 4.00±1.24, 2.16±0.95 and 0.92±0.64 (F=23.392, P<0.05), and 3.54±1.20, 2.70±0.71 and 1.20±0.44 (F=24.272, P<0.05) in medulla phase. Differences of water concentration in arterial and medulla phase between renal clear cell carcinoma with different grade were not statistically signiifcant (P>0.05). Conclusion The differences of CT value, energy spectrum curve slope, iodine value under CT spectroscopy single energy imaging between renal clear cell carcinoma with different nuclear grade were statistically signiifcant, which can be expected to provide the basis for preoperative therapy selection.

The paper follows the preparation rules of health information data element standards,studies the catalog of statistical data element of Traditional Chinese Medicine (TCM) and the preparation contents,ideas and methods of value field code,prepares and forms Comprehensive Statistical Data Element Dictionary of Traditional Chinese Medicine and Classification and Coding for Value Domain of Comprehensive Statistical Data Element of Traditional Chinese Medicine,so as to provide reference standard and basis for the standardization and informatization in the statistical field of TCM.

AIM: To observe clinical efficacy of the intravitreal injection of conbercept treatment for exudative age -related macular degeneration.
METHODS:Prospective study. Totally 112 senile patients (112 eyes) with exudative macular degeneration were randomly divided into study group and the control group, 56 cases in each group. The study group were treated with intravitreal injection of conbercept. The control group received conservative treatment. Uncorrected visual acuity and foveal retinal thickness were observed before and after treatment in the two groups.
RESULTS: Visual acuity of study group improved significantly, and the most obvious improvement was observed at 6mo after treatment. Foveal retinal thickness of study group was reduced after treatment, and the most obvious decrease was observed at 6mo after treatment.CONCLUSION: Intravitreal injection of conbercept can improve visual acuity reduced foveal thickness in senile patients with exudative age - related macular degeneration.

Objective To assess systematically the effect of problem-based learning (PBL) versus traditional methods in nursing students.Methods Relative literature was searched by computer at home and abroad.according to the inclusion and the exclusion criteria,which were analyzed by RevMan5.2 software,and literature selection and repetition were used according to the Note Express software.Results A total of 9 studies of randomized controlled or not randomized controlled trial were brought into the study by random effects model.A total of 1 187 were collected into the study,574 in the experimental group and 613 in the control group.According to subgroup analysis showed by measurement scale,problem-based learning (PBL) can significantly improve the critical thinking ability of nursing students.The results had high stability and reliability.Conclusions PBL teaching method can significantly improve the critical thinking ability of nursing students,and provide a better learning method for clinical teachers and students,which is worthy of further promotion.

Objective To evaluate the feasibility of combining the sedation performed by propofol targeted concentration in-fusion with epidural anesthesia in patients undergoing total pelvic floor reconstruction.Methods A total of 80 eligible patients were recruited and were assigned randomly into the study group(n=40)and the control group(n=40).All patients in both groups were administered epidural anesthesia with the puncture and catheter placing in the space between the 2nd-3rd lumbar vertebras.After the epidural anesthesia,patients in the study group were administered propofol by targeted concentration infusion (TCI)system. The plasma concentration of propofol was modulated to obtain the BIS maintaining between 65-80,and the OAA/S maintaining at 3 scores.The propofol was continuously infused until closing the incision.Values of HR,MAP at different time points in the opera-tion were recorded,and the plasma concentrations of propofol,the incidences of adverse events were recorded.Results The HR and MAP of patients in the study group decreased at T1 (given the anesthetic),T2 (the beginning of the operation),T3 (the beginning of the operation),compared with those at T0 (before the anesthetic)and T4 (30 min after the operation)(P <0.05).The HR and MAP of patients in the control group elevated at T2 ,T3 ,compared with those at T0 and T4 (P <0.05).The HR of study group at T1 ,T2 , T3 and the MAP at T2 were lower than those in control group.In study group,two asphyxia patients were founded.The incidence of shivering in the study group was lower than that in control group (P =0.014).No statistical difference was found in the incidences of other adverse event between this two groups (P >0.05).BIS of study group was (73.3 ±4.8)-(76.1 ±3.4),and the plasma concentrations of propofol was(1.32 ± 0.29 )μg/mL - (1.52 ± 0.26 )μg/mL.Conclusion The combination of propofol sedation performed by TCI and epidural anesthesia could be safely and effectively used in patients undergoing total pelvic floor reconstruc-tion.

Objective To investigate the application of respiratory navigator echo triggered black blood contrast FSE in cardiac MRI. Methods The respiratory navigator echo trigger technique combining with black blood FSE (NAV-FSE) was tested on 11 volunteers and 5 patients in free breathing,using breath-hold FSE (BH-FSE) with the same imaging protocals as control. The imaging efficiency and the image sharpness were compared between NAV-FSE and BH-FSE and t-test was used for the statistics. Results All NAV-FSE acquisitions were completed in sixteen subjects while 4 BH-FSE acquisitions failed because of poor breath holding. The efficiencies of NAV-FSE were (42. 95±11.50)%, (56. 14±11.40)% and (55.25± 14. 70)% when echo train length (ETL) were 24, 16 and 8, respectively. When ETL were 16 and 24, the sharpness of NAV-FSE ( 0. 43±0. 02 vs 0. 36±0. 02 ) and BH-FSE ( 0. 36±0. 03 vs 0. 35±0. 02 ) were statistically different (t =4. 26, 5. 53 ,respectively; P <0. 05). NAV-FSE could have a shorter ETL setting without consideration of breath holding. Conclusion The navigator echo trigger technique could be compatible with black blood contrast FSE to image the heart without the restriction of breath holding and it allows to optimize the parameters to improve the image quality.

Objective To explore the impact of laparoscopic surgery and that of open surgery on the coagulation function and incidence of deep venous thrombosis(DVT) in lower limbs in patients undergoing hysterectomy .Methods From April 2014 to A‐pril 2015 ,110 eligible patients were recruited .There was 57 patients received laparoscopic surgery ,and 53 patients received open surgery for hysterectomy .All patients underwent surgery under the general anesthesia .The APTT ,PT ,FIB ,and D‐dimer was de‐tected at 5 time points:before surgery ,surgery completion ,24 h after surgery ,48 h after surgery ,and 72 h after surgery .All patients were scheduled to ultrasound exam in lower limbs to detect the DVT at 24 ,48 and 72 h after surgery .Results Both groups showed decreased PT at surgery completion as compared with other time points (P<0 .05) ,decreased APTT at surgery completion and 24 h after surgery as compared with other time points(P<0 .05) ,and increased FIB at surgery completion and 24 h after surgery as compared with other time points(P<0 .05) .No significant difference was found in APTT ,PT ,and FIB at each time points between two groups(P>0 .05) .Both groups showed increased D‐dimer after surgery compared with that before surgery ;the laparoscopic group showed higher D‐dimer at 24 h after surgery ,and lower D‐dimer at 48 h after surgery than open group(P<0 .05) .The inci‐dence of DVT in laparoscopic group and open group was 14 .04(8/57) and 5 .66% (3/53) ,respectively ,with no significant difference between two groups(P>0 .05) .Conclusion Both the laparoscopic surgery and open surgery will activate the coagulation system , and lead to DVT ;as compared with open surgery ,the laparoscopic surgery could not reduce the incidence of DVT in lower limbs in patients undergoing hysterectomy .

AIM: To assess the efficacy and safety of prophylactic laser photocoagulation for retinal breaks before laser in situ keratomileusis (LASIK) in myopic eyes.METHODS: From April 2000 to April 2004, totally 1 845 eyes ( 1 233 patients ) requesting LASIK had a fundus examination with indirect ophthalmoscopy before the surgery. They were divided into two groups according to the presence (Group 1) or absence of retinal breaks (Group 2). All patients with retinal breaks, though they were asymptomatic, underwent prophylactic laser photocoagulation to seal the breaks before LASIK.RESULTS: Patient age ranged from 18 to 43 ( 25.3±5.7) yaers old. Mean preoperative spherical equivalent refraction (PSER) was -7.44± 2.13 D (range, -1.50 to -14.50 D). Retinal breaks were identified and treated in 37eyes (2.05%) of 32 patients;1 808 eyes of 1 201 patients had no retinal breaks. No statistical difference was found in age ( P ＞0.05) or gender (P ＞0.05) between the two groups. Significant difference of PSER was noted between Group 1 (-9.41± 4.15D) and Group 2 (-7.52±3.71D) (P＜0.05). During a mean 14mo follow-up, none of the patients developed retinal detachment.CONCLUSION: The efficacy and safety of prophylactic laser photocoagulation for retinal breaks was confirmed.Retinal breaks should be identified and treated by photocoagulation in eyes before LASIK for myopia.

· AIM: To report the clinical results of vitrectomy for Terson syndrome.· METHODS: Twenty-one eyes of 15 patients with Terson syndrome underwent vitreous surgery with the mean follow-up of 19.1mo.· RESULTS: Incomplete posterior vitreous detachment(PVD) was found in 15 eyes (71.4 %), epiretinal membrane was formed in 7 eyes (33.3 %), and retinal detachment occurred in 4 eyes (19.0 %). Significant visual improvement occurred in all eyes after vitrectomy: visual acuity of 20/40 or better was achieved in 17 eyes (80.9 %)and 4 eyes (19.0 %) developed lens opacity.· CONCLUSION: Vitrectomy for Terson syndrome can provide good visual recovery, with low complication rate,including that of cataract.

Background Fundus photography is a traditional method for detecting local retinal nerve fiber layer (RNFL) defects,but the evaluation of its result depends on the observer's experience.The spectral domain optical coherence tomography (OCT) exhibit the defects of RNFL very clearly.Objective This study was to evaluate the diagnosis value and correlation between topographic profiles of localized RNFL defects determined by spectral domain and time domain OCT with fundus photography.Methods Forty-one normal eyes of 41 subjects and 55 eyes of 55 glaucomatous patients with localized,wedge-shaped RNFL defects identified by two glaucoma specialists in fundus photographs were enrolled in the clinical study.The angular location and width of RNFL defects determined on the images of fundus photography,Cirrus HD-OCT and Stratus OCT were analyzed respectively using Pearson's correlation coefficient and linear regression analysis.This study followed the Helsinki declaration and was approved by Ethic Committee of Shenzhen Eye Hospital.Written informed consent was obtained from each individual before the clinical examination.Results Seventy-five RNFL defects were identified in 55 eyes by two glaucoma specialists unanimously with the defect position at superior-temporal and inferior-temporal quadrants.The sensitivity of Cirrus HD-OCT and Stratus OCT to determining RNFL defects were 88.0% and 69.3% respectively and their specificities were 92.7% and 97.6% respectively.The angular locations of RNFL defects by Cirrus HD-OCT and Stratus OCT were highly correlated with those by fundus photography(r=0.993,r=0.992,P＜0.001);while the angular widths of RNFL defects by Cirrus HD-OCT and Stratus OCT were moderately correlated with those by fundus photography(r=0.420,r=0.432,P=0.019,P=0.002).No significant differences were found in the defect width of RNFL between Cirrus HD-OCT or Stratus OCT and fundus photography(Cirrus HD-OCT:P=0.114;Stratus OCT:P=0.074),and significant difference was found in that between Cirrus HD-OCT and Stratus OCT(P=0.002).Conclusion Spectral domain OCT and time domain OCT can localize RNFL defects with high sensitivity and specificity.The measure value of Cirrus HD-OCT and Stratus OCT for RNFL defects shows a good diagnostic agreement with fundus photography.