Objective To evaluate the efficacy of recessive placement of nasolacrimal stent in the treatment of nasolacrimal duct obstruction and factors affecting the prognosis of the procedure.Design Retrospective case series.Participants One hundred eighty six patients(207 eyes) with nasolacrimal duct obstruction.Methods One hundred eighty six patients(207 eyes) of nasolacrimal duct obstruction confirmed by dacryocystography had undergone recessive placement of nasolacrimal stent after probing and dilation of nasolacrimal duct.All patients received regular postoperative nasolacrimal duct syringe.Main Outcome Measures Status of postoperative lacrimal syringe.Results The stents were removed 3～12 months postoperatively,the patients were followed-up average 6 months.The operation success rate was 97.1%.167 eyes achieved complete success(80.7%).25 eyes became better(12.1%),and nasolacrimal duct obstructed again in 15 cases(7.2%).Conclusions Recessive placement of nasolacrimal stent combined with postoperative nasolacrimal duct syringe is a simple,effective and safe technique in the treatment of nasolacrimal duct obstruction.Selecting correct patients,skillful technique of nasolacrimal duct probing and regular postoperative syringing of nasolacrimal duct are the main factors of successful procedures.

Objective To investigate the efficacy and safety of hydrogel soft contact lens(HSCL) for persistence corneal epitheliopathy after intraocular surgery.Design Retrospective case series.Participants 36 patients(36 eyes) with bullous keratopathy(n=5) or other keratopathy(n=31) including corneal erosion,epithelium missing,and dendritic keratopathy after intraocular surgery,which failed to medicine treatment 2 weeks ago.Method All patients were fitted with HSCL after suitable processing of the corneal foci.The lenses were removed immediately as long as the keratopathy recovered.A new lens was replaced after 3 weeks if still needed.Main Outcome Measures Changes of keratopathy,pain relief and complications.Result 35 patients(97.22%) fitted with HSCL were very comfort within 3 days.At the follow-up of 6 months,30 patients(83.33%) achieved complete remission of keratopathy,6 patients (16.67%) remarkable remission.30 patients(86.11%) had vision increase.All of the non-bullous keratopathy recovered within 3 weeks,while the lenses were fitted much longer in bullous keratopathy.No other lens-related complications appeared.Conclusion The application of hydrogel soft contact lens to persistence corneal epitheliopathy after intraocular surgery is safe,effective,and practical.

Objective To investigate a panel of differentially expressed circulating microRNAs (miRNAs) as potential biomarkers in patients with systemic lupus erythematosus (SLE).Methods A miRNA array was performed on plasma of 10 healthy controls and 10 SLE patients.To confirm the results of microarray,the selected 7 miRNAs were examined by real-time quantitative PCR (RT-qPCR).Independent sample's t-test was used for statistical analysis between the two groups.Results A total of 51 circulating miRNAs were signi-ficandy differentially expressed between SLE patients and healthy controls (19 up-regulated miRNAs and 32 down-regulated miRNAs).The findings of RT-qPCR on 7 miRNAs (miR-126,miR-21,miR-223 and miR-451 of upregulation and miR-125a-3p,miR-146a and miR-155 of down-regulation) were consistent with the data obtained from the array.Conclusion There is aspecific circulating miRNAs expression profile in SLE,and these aberrantly expressed miRNAs might have great potential to serve as novel,noninvasive biomarkers of SLE.

ObjectiveTo explore the efficacy and safety of infliximab combined withdiseasemodifying antirheumatic drugs (DMARDs) in the treatment of psoriatic arthritis.MethodsThis was an openlabeled trial.All subjects fulfilled the Moll and Wright criteria for definite PsA and-had poor response to DMARDs.The patients received combined infliximab and DMARDs.Infliximab 3 mg/kg was infused at weeks 0,2,6,14.After week 14,patients received infliximab 3 mg/kg every 8 weeks.The primary end point was the improvement of psoriatic arthritis response criteria(PsARC) response.The secondary end point was the percentage of patients who had 20％ improvement of modified American College of Rheumatology (ACR20)response.Parameters for efficacy for psoriatic rash was defined as the proportion of modified 50％ and 75％improvement of psoriasis area and severity index scores (PASI).All adverse reactions in the whole observation period were recorded.Chi-square test and repeated measurement data analysis of variance were used for the statistical analysis.ResultsTwenty-one patients completed the 14 weeks treatment.Five patients completed 26-104 weeks treatment,including 2 cases for 104 weeks.At week 14,the percentage of patients achieving PsARC was 84％,the percentage of patients achieving ACR20 was 77％,and the percentage of patients achieving PASI 50 was 76％.At week 14,tender joint counts,swollen joint counts,patient's assessment of pain,patient's global assessment(PGA),physician's global assessment,dermatology life quality index (DLQI),health assessment questionnaire(HAQ) were significantly improved compared with base-line(P＜0.05).Five patients received 26-104 weeks follow-up,including 2 cases for 104 weeks,four patients was stable,the rash and joint symptoms of 1 patient recurred at 104 weeks.The most frequently occurred adverse reactions were upper respiratory tract infection and skin as well as appendage damages.The second most common adverse effect was elevation of liver enzymes.ConclusionThe infliximab combined with DMARDs is effective and safe for the treatment of psoriatic arthritis.

Objective : To construct an appropriate technology catalogue for general practice based on Delphi method,and to provide reference for promoting appropriate techniques and training general practitioners. Methods : The catalogue was briefly constructed based on literature reviews and the data of the top twenty diseases diagnosed in out-patient department of Sir Run Run Shaw Hospital and two community health service centers in Hangzhou. Two-round Delphi consultation was conducted by fourteen general practitioners coming from upper first-class hospitals and community hospitals. The final catalogue was established according to evaluation of the degree of involvement,authority coefficient and Kendall's W values of the fourteen specialists. consultations : Results Of the fourteen specialists,nine had bachelor's degrees and five had master's degrees or above;twelve were deputy chief physicians or chief physicians and two were physicians. They were engaged in general practice for 17.21 years in average. The positive coefficients of the two rounds of were both 100.00%. The authority coefficient of the specialists was 0.891. After the first round of consultation,the W values for importance and feasibility of 6 first-class indicators were 0.170 and 0.244,and the ones of 56 second-class indicators were 0.236 and 0.250（all P<0.05）. Six of second-class indicators were excluded because their coefficent of variation（CV）for importance and feasibility were more than 0.25. After the second round of consultation,the W values for importance and feasibility of 6 first-class indicators were 0.245 and 0.247,and the ones of 50 second-class indicators were 0.355 and 0.370（all P<0.05）. The CV for each indicator was less than 0.25. Finally,an instructional catalogue was defined,consisting of 6 first-class indicators（basic diagnosis and treatment skills,first aid skills,symptomatic diagnosis and treatment skills,chronic disease management skills,common disease diagnosis and treatment skills,and common manipulative skills）and 50 second-class indicators. Conclusion The degrees of involvement,authority and consistency of the specialists were relatively high. The catalogue of appropriate technology for general practitice had good reliability and feasibility,which was worthy of promotion and application.

Objective To discuss the detection rate of chromosomal abnormalities in women with different indications for invasive prenatal diagnosis(amniocentesis and eordocentesis), and the procedure-related complications. Metheds A retrospective analysis was conducted on 1264 women, who underwent invasive prenatal diagnosis (1082 amniocentesis and 182 eordocentesis), and the procedure-related complications were reviewed. Results The indications for invasive prenatal diagnosis in these 1264 women were: increased risk at prenatal screening (651, 51.5%), advanced maternal age (≥35) (318, 25.2%), abnormal foundings through uhrasonograph (136, 10.8%),history of adverse pregnancy (88, 6.9%), one or two abnormal serologic markers (52,4.1%), and chromosomal balance translocation carrier in either one of the couple(19, 1.5%). Thirty-seven cases were found to be chromosomal abnormalities with clinic significance and the indications for them were: ultrasonic abnormality (20/136, 14.7%); increased risk at prenatal screening (12/651, 1.8%); one or two abnormal serologic markers (1/52, 1.9%); history of adverse-pregnant (1/88, 1.1%)chromosomal balance translocation carrier in either one of the couple (3/19, 15.8%); advanced maternal age (0/318). Among the 1264 cases, 5 experienced spontaneous abortion and the procedure-related fetal loss rates were 0.28% for amniocentesis (3/1082) and 1.09% for cordocentesis (2/182), P=0. 154. The rate of complications after cordocentesis was significantly higher than amniocentesis (9.89 % vs 0.18 %, P= 0.0001). Conclusions Routine fetal karyotyping should be prompted after prenatal ultrasonographic abnormalities. However, invasive prenatal diagnosis due to advanced maternal age alone is controversial. Amniocentesis is the fist choice for invasive prenatal diagnosis.

Objective To study the reliability of 99Tcm-(hydrazinonicotinamide (HYNIC)-BMS-200261) (tricine) (trisodium triphenylphosphine-3,3',3"-trisulfonate (TPPTS)) as a radiotracer for protease activated receptor-1 (PAR-1) expression in breast cancer.Methods Fifteen nude mice bearing MDA-MB-435,MDA-MB-231 and MCF-7 human breast cancer xenografts (5 mice for each cell line) with different PAR-1 expression were used for 99Tcm-(HYNIC-BMS-200261) (tricine) (TPPTS) γ imaging,and tumor/non-tumor (T/NT) ratios were obtained with region of interest (ROI) technique.Afterwards,the biodistribution of 99Tcm-(HYNIC-BMS-200261) (tricine) (TPPTS) was analyzed in tumor-bearing nude mice,and the radioactivity in tumor (percentage activity of injection dose per gram of tissue,％ID/g) was calculated.The immunostaining was performed to examine PAR-1 expression in tumor tissue and semi-quantitative analysis was used.One-way analysis of variance and Pearson correlation analysis were used to analyze data.Results At 2 h postinjection,the T/NT ratios were 3.03±0.32,2.27±0.25 and 1.51±0.13 respectively in nude mice bearing MDA-MB-435,MDA-MB-231 and MCF-7 xenografts;the tumor uptakes of 99Tcm-(HYNIC-BMS-200261)(tricine)(TPPTS) were (1.03±0.15),(0.56±0.14) and (0.30±0.06) ％ID/g;PAR-1 expression levels were (17.22±2.71) ％,(10.78± 1.95) ％ and (2.80± 1.18) ％,respectively (F values:47.66,46.36,62.35,all P＜0.05).The T/NT ratios and tumor uptake of 99Tcm-(HYNIC-BMS-200261) (tricine) (TPPTS) at 2 h post-injection were correlated with PAR-1 expression (r values:0.934 and 0.929,both P＜0.05).Conclusions 99Tcm-(HYNIC-BMS-200261) (tricine) (TPPTS) imaging could be a noninvasive and effective method for monitoring PAR-1 expression in human breast cancer.

Objective To investigate the changes and clinical significance of bile acid spectrum levels in patients with early non-alcoholic fatty liver disease(NAFLD).Methods A total of 149 patients with early NAFLD(NAFLD group)and 140healthy controls(healthy group)who underwent physical examinations at the Physical Examination Center,the Fourth Affiliated Hospital of Zhejiang Uni-versity School of Medicine from July 2021 to February 2022 were selected,and liver function test,bile acid spectrum detection and con-trolled attenuation parameter test were performed on all patients,the differences in liver function and bile acid spectrum between the two groups were compared,and the risk factors of early NAFLD and the efficacy of bile acid subgroups in diagnosing early NAFLD were ana-lyzed.Results The levels of aspartate transaminase(AST),alanine aminotransferase(ALT),and γ-glutamyl transpeptidase(r-GT)in the NAFLD group were higher than those in the healthy group(P<0.05).cholic acid(CA),glycocholic acid(GCA),tauro-cholic acid(TCA),glycodeoxycholic acid(GDCA),chenodeoxycholic acid(CDCA),glycochenodeoxycholic acid(GCDCA),tauro-chenodeoxycholic acid(TCDCA),glycineursodeoxycholic acid(GUDCA),tauroursodeoxycholic acid(TUDCA)and taurolithocholic acid(TLCA)were higher than those in the healthy group(P<0.05),and the level of lithocholic acid(LCA)was lower than the healthy group(P<0.05);Logistic regression analysis showed that AST,GCA,TCA,CDCA,GCDCA,TCDCA,GUDCA and TLCA were inde-pendent risk factors in NAFLD patients;receiver operating characteristic curve shows that AST,GCA,TCA,CDCA,GCDCA,TCDCA,GUDCA and TLCA could predict the occurrence of NAFLD to a certain extent,among which AST had the best comprehensive prediction effect(AUC =0.750),and GCA had the highest sensitivity(77.2%),and TLCA had the strongest specificity(88.6%);the levels of GCA and TCA in the severe group were significantly higher than those in the mild group(P<0.05),the concentration of serum TCA in-creased gradually increased with the aggravation of NAFLD severity,and there was a linear correlation between them(r = 0.52,P<0.05).Conclusion The bile acid spectrum components of patients with early NAFLD was changed,mainly primary bile acids and con-jugated bile acids.The level of TCA can not only predict the occurrence of NAFLD to a certain extent,but also has a positive correlation with the severity of NAFLD,which is expected to become a serological marker of NAFLD.

The fourth affiliated hospital of Zhejiang university is responsible for training general practitioners in view of the basics of local general practitioners and the characteristics of chronic and frequently-occurring diseases in Yiwu city. This program is carried out relying on the high-quality faculty of medical alliances within Zhejiang university, and funded by the municipal government of Yiwu. The "4+6"training program is designed to elevate the competence of primary general practitioners. Such training fit the overall medical level of general practitioners, enhances people′s trust of general practitioners and the rate of diagnosis at primary level.

Objective To evaluate the effect of " elite small class" training mode in capacity building for general practitioners in Yiwu city. Methods The Fourth Affiliated Hospital of Zhejiang University School of Medicine worked with Yiwu Health Bureau, and held the first training class for general practitioners from December 6th in 2018 to April 5th in 2019.The mode of " elite small-class" was adopted. Theoretical assessment was carried out for trainees before and after the training and discussion was conducted after the training. Descriptive analysis of quantitative data and thematic analysis of qualitative data were carried out. Results The trainees′theoretical performance had been significantly improved after 4 months of theoretical learning and clinical rotation.The average score of the theoretical performance was increased from 66.94 to 72.59. Conclusions It was preliminarily found that the " elite small-class" training mode was suitable for the training of general practitioners in rural areas.Government support and trainee selection are key to training outcomes.