Objective Face-down positioning after vitrectomy and gas tamponade is still the standard position for patients with rhegmatogenous retinal detachment.The study was to compare the nursing effects of face-down position and flexible position after vitrecto-my for the repair of rhegmatogenous retinal detachment. Methods We investigated 120 cases of patients with rhegmatogenous retinal detachment in this study.All patients received vitrectomy with long-acting gas for tamponade, 60 patients in face-down position and 60 in the flexible position.Patients were followed up for 6 months.Observation was made on the rates of anatomical retinal reattachment and postoperative complications between the groups. Results The rates of anatomical retinal reattachment after surgery were 88.33%in the face-down position group and 100% in the flexible position group respectively.As to the satisfaction of position, the flexible position group was 100%, which was much higher than 41.67%in face-down position group(P<0.01). Conclusion Flexible position nurs-ing after vitrectomy and gas tamponade for rhegmatogenous retinal detachment repair is safe and effective.Flexible position can replace face-down position for the comfort of patients with rhegmatogenous retinal detachment after vitrectomy with gas tamponade.

Objective: To establish a method to determine 4 active ingredients in Jindan tablets by HPLC.
Methods: Agilent Eclipse X DB C₁₈ (4.6 mm×250 mm, 5 μm) column was adoped using acetonitrile (phase A) -0.1% phophoric acid solution (phase B) as the mobile phase with gradient program at the flow rate of 1.0 mL·min^-1, the detection wavelength was 270 nm, Column temperature was set at 30 ℃.
Results: The linear ranges of gentiopicrin, polydatin, quercetin and emodin were 7.875-78.75 μg·mL^-1（r=0.999 9）, 6.75-67.50 μg·mL^-1（r=0.999 7）, 7.726-77.26 μg·mL^-1（r=0.999 4）, 3.809-38.09 μg·mL^-1（r=0.999 8), respectively, the peak area had a good linear relationship with the mass concentration of 4 components, the average recovery were 99.31%, 99.21%, 99.04%, 99.59%, (n=6) respectively, and RSDs were 1.86%, 1.24%, 1.37%, 1.15%, respectively.
Conclusion: This method is reliable, repeatable and stable, and has strong specificity. This method can provide a reference for the quality control and standard improvement of Jindan tablets.

Objective To investigate the career decision-making self-efficacy as well as the psychological well-being of medical students and to discuss the correlation between them.Methods A cross-sectional survey with cluster random sampling was performed anonymously among 714 students of different majors and different grades in an medical University.The contents of the survey included the career decision making self-efficacy scale (CDMSE) as well as the self-reporting inventory(SCL-90).All data in the two groups were analyzed with t test; comparison of data between groups were analyzed with One-Way ANOVA; multiple comparison was analyzed with S-N-K; Pearson and Partial correlation analysis were used to analyzed the correlation between the career decision making self-efficacy and wellbeing.Results Totally 659 students completed the inventory,with response rate being92.3％.Average score of the participants' career decision-making self-efficacy was (124.72 ± 26.76)points,situating at the middle and lower level.There were differences in the scores of career decision making selfefficacy among different sexes,sources,grades and being student cadres or not (P =0.019,0.000,0.027,0.026) ; No differences was found among students of different majors and whether being the only child(P =0.243,0.223).Results of the SCL-90 inventory demonstrated that medical students had some psychological problems including obsessive-compulsive,interpersonal sensitivity and anxiety.Correlation analysis showed that psychological well-being and career decision-making self-efficacy was negatively correlated.Conclusions Measures should be taken to improve the medical students' career decision-making self-efficacy according to their psychological characteristics and to improve the medical students' psychological status by the improvement of career decision-making self-efficacy.

Objective:To study the surgical approach to the orbital floor and infraorbital rim.Method:15 cases of fractures of the orbital floor and infraorbital rim were treated with the transconjunctival approach.Result:All fractures of the orbital floor and infraorbital rim were repositioned and fixed through transconjunctival approach. Except for 1 case with mild canthal malposition, no other complication was observed.Conclusion:The transconjunctival approach can provide adequate exposure of the infraorbital rim and orbital floor without scar formation in the face.

Objective: Our aim was to investigate the polymorphism and forensic meaning of the Y-chromosomal loci DYS390 and DYS389Ⅰ/Ⅱ in Han nationality in Liaoning Province. Methods: By amplifying these loci with polymorase chain reaction (PCR) followed by polyacrylamide gel electrophoresis and silver staining, the allele frequencies of these loci among 98 unrelated men of Han nationality were investigated. Results: Five alleles with different frequencies from 0.010 to 0.480 were detected of DYS390， and three alleles with different frequencies from 0.224 to 0.439 were detected of DYS 389Ⅰ. Locus DYS 389Ⅱ was detected in five alleles and the frequencies ranged from 0.020 to 0.367. The probability discrimination of these loci were 0.637, 0.644 and 0.723. These loci were found to generate at least 31 different haplotypes and the power of discrimination was 0.948. Conclusion: The loci DYS390 and DYS389Ⅰ/Ⅱ are very important when detect mixed samples, especially in deficiency cases of paternity test.

Objective To determine the effect of Vibrio vulnificus cytolysin (VVC) inducing ap-optosis in human umbilical vein endothelial cell(HUVEC) and its possible mechanism. Methods The en-tire vvhA gene that encoding VVC from V. vulnificus strain GTC333 was amplified by PCR and sequenced af-ter T-A cloning. E. coli BL21DE3pET-42a-vvhA, a prokaryotic expression system of the vvhA gene, was then con-structed. Ni-NTA affinity chromatography was applied to purify the target recombinant protein rVVC, and SDS-PAGE plus Bio-Rad Agarose Image Analyzor were used to measure the output of rVVC and to determine the purity of rVVC extract. The activity of rVVC dissolving rabbit erythrocytes was detected by hemolysis test. DPNH chromotometry and TphBNa chromotometry were performed to examine the contents of LDH and K+ in the supernatants of rVVC-treated HUVEC cultures, respectively. The effect of rVVC inducing apepto-sis of HUVEC was detected by flow cytometry, rVVC was labeled with FITC and the location of FITC-labe-ling rVVC in HUVEC was observed by laser canfocal microscopy. Results The cloned whA gene had 96.09% and 98.26% similarities of nucleotide and amino acid sequences compared to the corresponding se-quences in GenBank. rVVC, with a dosage of 1 μg/ml, could dissolve rabbit erythrocytes (P<0.01). 10 μg/ml rVVC was able to promote the increases of K+ content (P<0.01) but no change of LDH content could be found in the cell supernatants. HUVEC was apoptotic after the cell was treated with 1～100 μg/ml of rVVC for 2 h. In the 5～240 min duration of co-incubation of FITC-labeling rVVC and HUVEC, the rV-VC gradually moved from surface to inner side of the membrane and then entered the cytoplasms. When FITC-labeling rVVC treated HUVEC for 30 min, most of the rVVC was found to be intracellular location. Conclusion rVVC has cytolytic activity. VVC has an ability to enter HUVEC and causes injury of HUVEC via inducing apoptosis, which may be the major pathogenic mechanism of VVC.

Objectives To investigate the pathophysiologic mechanisms and the clinical character- istics and variations of nutcracker esophagus(NE).Methods Clinical data obtained from 22 patients with NE were retrospectively analyzed.Seven followed-up patients had esophageal motility,multi-channel electrogastrography(MEGG),the autonomic nervous system(ANS) and psychology tests and were com- pared to 10 healthy subjects(HS).Results①In NE group,12 patients had reflux symptom(55%),7 patients had chest pain(32%)and 3 patients had dysphagia(13%).There was no statistical difference in mean contraction amplitude(MCA) between patients with reflux symptom and chest pain.②Eight out of the 13 patients with NE who received 24 h pH monitoring were positive reflux,and 4 out of 17 patients had reflux esophagitis in endoscopic examinations.The symptoms were improved in 58%patients(7/12) by regular acid-suppression therapies.③There was no statistical difference beween NE and HS groups in dominant frequency and power of MEGG.However,the percentages of normal rhythm in preprandial and slow wave coupling in pre and postprandial of NE patients were significantly decreased than those in HS.④The ANS function in NE group had no statistical difference compared to those in HS.⑤In follow- up group,no difference was found before and after nitroglycerin sublingually.Four patients had depres- sion.Conclusions The clinical presentations of NE are vary.The symptoms of NE were poorly correla- ted with MCA,but partially correlated with GER,which may represent a special subtype of GERD. Gastric dysmotility and psychological factors might contribute to the pathogenesis of NE.

ObjectiveTo investigate thc clinical and radiological characteristics of cortical vein thrombosis for early diagnosis and treatment.Methods Retrospective analysis was carried out with the clinical cases of cortical vein thrombosis in 2010.The symptoms,sign,neuroimaging were analyzed and related literatures were reviewed.ResultsFour patients were collected,average age was forty years old.The main symptoms were headache and focal neurological signs in varying degrees,intarction or hemorrhage in one or two sides of parietal lobe could be found in CT or MRI.Hemorrhage was found in two patients,infarction was found in one patient,hemorthage and infarction were both found in another patient.ConclusionsHeadachc and focal neurological signs are the common sings and symptoms of patients with cortical vein thrombosis.CT and MRI are effective methods for the diagnosis of cortical vein thrombosis.

Objective To evaluate the therapeutic efficacy of a combination of proton pump inhibitor(PPI) and hydrotalcite for endoscopic submucosal dissection (ESD) induced ulcer.Methods Eightyone consecutive patients who underwent ESD were randomly assigned to either the group of PPI and hydrotalcite therapy ( drug combination group,n =41 ) or the PPI group ( n =40).Delayed bleeding rates were monitored and compared.The main upper abdomen symptoms 1-wk later and ulcer healing rates and ulcer diameter 4-wk later were compared between the two groups.Results There was no significant difference in delayed bleeding rate (P ＞ 0.05 ).At the end of first week after ESD,the combination therapy was significantly more effective than the PPI alone in reducing frequencies and severity of upper abdominal pain and upper abdominal distention,while there was no significant difference between the two groups in relieving belch and nausea.A better ulcer healing rates and a smaller ulcer diameter were observed in the combination group at the end of 4 weeks ( P ＜ 0.05 ).Conclusion The combination therapy of hydrotalcite and PPI can relieve upper abdominal symptoms and improve the healing rate of ESD induced ulcer.

Objective: To construct a prediction model for preeclampsia (PE) risk in twin-pregnant women, so as to provide the basis for early screening and prevention of PE. Methods: A total of 467 twin-pregnant women who underwent prenatal examination and delivered at Huzhou Maternal and Child Health Hospital were selected. Sixty cases with preeclampsia (PE) were included in the case group, and 60 women without PE were included in the control group. General information, blood biochemical indicators and uterine artery resistance index (UtA-RI) were collected. A logistic regression model was used to screen predictive factors and establish a nomogram. The Bootstrap method was performed for the internal validation; the receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis were employed to evaluate the discrimination, calibration and clinical utility of the nomogram, respectively. Results: In the case group, there were 47 individuals (78.33%) aged younger than 35 years, 21 individuals (35.00%) with pre-pregnancy body mass index (BMI) of 25 kg/m2 and above, and 33 individuals (55.00%) with in vitro fertilization. In the control group, there were 57 individuals (95.00%) aged younger than 35 years, 8 individuals (13.33%) with pre-pregnancy BMI of 25 kg/m2 and above, and 39 individuals (65.00%) with natural pregnancy. Multivariable logistic regression analysis identified age, pre-pregnancy BMI, method of conception, placental growth factor (PLGF) and UtA-RI as risk prediction factors for PE in twin-pregnant women. The established nomogram had an area under the ROC curve of 0.827 (95%CI: 0.755-0.899), a sensitivity of 0.767, a specificity of 0.733, a good discrimination and calibration, and a relatively high clinical net benefit. Conclusion The nomogram established by age, pre-pregnancy BMI, method of conception, PLGF and UtA-RI has a good predictive value for the risk of PE in twin-pregnant women.