The introduction of anti-vascular endothelial growth factor (VEGF) therapy represents a landmark in the management of wet age-related macular degeneration (AMD).However,as a new therapy,several problems such as durability of the therapeutic effects,medication side effects,and medication selection have emerged.We should make appoint of improving the therapeutic effect and safety by realizing the limitation of the therapy,monitoring the clinical potential adverse reactions of anti-VEGF agents,and recommending individualized treatment.

In the treatment for anterior teeth alignment in 2 case with mild or intermediate anterior teeth crowding,stainless steel wire ben-ding slide rod with the diameter of 0.5 mm was placed on either side of crowding anterior teeth,Ni-Ti open coil springs were attached to the rod,the gap between the teeth was opened and maintained by the springs.The crowding anterior teeth and irregular midline were adjusted to the normal position.

ObjectiveTo evaluate oncoplastic techniques on breast conservative surgery.MethodsClinical data of 50 breast cancer patients who received oncoplastic breast conservative surgery from October 2009 to August 2011 were retrospectively analyzed.The indication,methods,outcome and morbility of oncoplastic surgery were assessed. ResultsAll patients had solitary tumors.Twelve patients received neoadjuvant therapy and thirty-eight received upfront surgical therapy.Different oncoplastic surgery techniques were applied based on the location of tumor.There were 20 tumors located in upper outer quadrant receiving lateral radial or horizontal excision; Four lower inner and seven lower outer tumors received V and J shape excision respectively; Three low pole and seven upper pole tumors received inverted T and batwing excision respectively; Six tumors located periareolar area and three tumors located retroareolar area were removed using round block and J shape excision.Two patients experienced postoperative hematoma and three patients had incisional dehiscence followed by secondary infection. Another developed skin ischemia and necrosis. Thirty-five patients have finished the postoperative adjuvant radiotherapy. The appearances of the breasts were satisfactory in all patients except one having deviation of nipple and two patients suffering from dimpling in incisional region.Patients gave high scores about their breast appearance.After 4- 27 months follow-up,two patients had local recurrence and received mastectomy.Other patients were free of recurrence.ConclusionsBreast oncoplastic surgery technique benefits those whose tumors located in special area of the breast resulting in a satisfactory cosmetical appearance of the breast.

Objective To investigate the significance of routine exposure of recurrent laryngeal nerve (RLN)in thyroidectomy.Methods The data of consecutive 232 patients with thyroidectomies during 2009-2010 were retrospectively reviewed.All operations,either lobectomy or total thyroidectomy were performed by the same surgeons.The RLN was identified routinely during the operation.Results Totally 280 RLNs were exposed in 181 thyroid lobectomies and 51 total thyroidectomies(98.9%).Ten patients experienced post-operative hoarseness(3.6%).Seven patients were diagnosed with paralysed vocal cord post-operatively,although the RLN were identified intact during the surgeries,and their voice became normal in 2 months.Another 3 patients'RLNs were transected injured and re-anastomosed during the same procedures and their voice became normal in 4 months.Conclusions Exposing the recurrent laryngeal nerve in the thyroidectomy is an effective way to prevent permanent injury to RLN.

Objective To investigate the role of bone marrow-derived cells (EMC) plays in choroidal neovascularization (CNV).Methods Green fluorescent protein (C-FP) chimeric mice were built by transplanting BMC from GFP transgenic mice to adult wild type C57BL/6J mice.Retinal laser photocoagulation was used to induce CNV in the chimeric mice (treated group) and adult wild type mice (control group).Four weeks later,choroidal flatmount was prepared to detect GFP positive BMC expression in the CNV lesions,and immunofluorescence stain was used to determine the expression of vascular endothelia growth factor (VEGF) and basic fibroblast cell growth factor (bFGF).Results Twenty-nine days after photocoagulation lots of GFP positive BMC presented in the CNV area,which accounted approximate 16.22% of the total CNV area.Some BMC in the CNV area expressed VEGF and bFGF.Conclusions BMC may play an important role in CNV by forming new vessles and secreting angiogenic factors.

Clinician-scientists are doctors who perform laboratory-based or clinically oriented research and have direct patient contact.Not only do they play a critical role in the research and practice of translational medicine,but also they are the educators of the next generation of clinician-scientists.However,clinician-scientists are vanishing.It is urgent to train new clinician-scientists who can be engaged in clinic work,research,and also education.Thus,in order to correct understand the importance of the work of clinical scientists,from multi angle analysis of clinical scientists training problems that may be encountered in the process,the active improvement of the education system and condition,and sustained and efficient guidance to the outstanding seedlings are advocated.Besides,aspiring candidates are also encouraged to seek ideal guidance and support through their career,arrange their work reasonably,strengthen their cooperation and the management ability,and strive to grow into excellent clinician-scientists.

Background Matrix metalloproteinases (MMPs) play important roles in the formation of choroidal neovascularization (CNV),but its mail origin is not ocular cells in situ.Bone marrow-derived cells (BMCs) participate in the formation of CNV and is probably a primary source of expressing MMPs in CNV.MMP-2/MMP-13 is speculated to be the regulating target genes of miR188-5p.Objective This study was to verify whether BMCs are the main source of MMPs,and whether the MMP-2/MMP-13 expression is potentially regulated by miR188-5p.Methods BMCs expressed green fluorescent protein (GFP) from transgenic female C57BL/6J mice were transplanted to female wild-type C57BL/6J mice to establish C57BL/6J.GFP chimeras models,and 42 mice with chimerisms more than 85％ by flow cytometry were included as the experimental group.Other 42 wild-type C57BL/6J mice without the BMCs transplantation were enrolled as the control group.CNV was induced by laser coagulation of retinas on the mice of both groups.MMP-2/MMP-13 levels in the retinochoroid tissue were quantified by ELISA at day 1,3,5,7,10,14,and 28 after photocoagulation.The expression of miR188-5p mR NA in the retinochoroid tissue was assayed by real-time quantitative PCR (RT-qPCR).Immunofluorescence stain and fluorescent in situ hybridization were used to identify the MMP-2/MMP-13 and miR188-5p expressed by GFP-positive BMCs in CNV,and the expression level was quantified by images analysis.Results The proportion of GFP+ mouse mononuclear cells was (90.67±3.02) ％ in the C57BL/6J.GFP chimeras.The concentration changes of MMP-2/MMP-13 in retinochoroid homogenate showed a same tendency with the lapse of time between the experimental group and the control group (MMP-2:F=0.060,P =0.810 ; MMP-13:F =0.012,P =0.915).The expression level was zoomed in retinochoroid tissue after induce of CNV with the maximal value on the third day in both groups,and the proportion in the experimental group was 64.21％ ;while the expression level of MMP-13 was slowly raised after induce of CNV with the peak at the seventh day,and the proportion in the experimental group was 79.61％.A complementary association point of miR188-5p was exhibited in the 3 '-untranslated regions of MMP-2 or MMP-13 by target gene prediction.The expression level of miR188-5p mRNA in the BMCs of CNV area was sharply declined after induce of CNV with the lowest value on the seventh day.A negative correlation was found between the expressing level of miR188-5p and MMP-13 protein (r=-0.868,P＜0.05) as well as early stage of expression level of MMP-2 protein (r=-0.997,P＜ 0.05).Conclusions The elevation of MMP-2/MMP-13 expression levels is associated with the formation of CNV,and the regulation of miR188-5p expression in the BMCs of CNV area is responsible for increase of MMP-2/MMP-13 expression.The tendency of miR188-5p expression is inversed with MMP-2/MMP-13.

OBJECTIVE:To analyze the features and general patterns of adverse drug reactions (ADR) occurred in our hospital. METHODS: 209 ADR case reports collected in our hospital in 2007 were analyzed statistically in respect of patients' age and sex, route of administration, category of the drugs, organs and systems involved, and clinical manifestation of the ADRs. RESULTS: The ADR were more likely caused via intravenous dip (129 cases, 61.72%). Anti-infectives had the highest proportion to induce ADR(94 cases,44.98%), followed by nervous system drugs and cardiovascular system drugs. Quinolones were the leading anti-infective drugs causing ADR(35 cases, 37.23%), of which, Levofloxacin dominated the first place. The main presentation of the ADR was damage of skin and its appendages such as erythra and pruritus etc, followed by the lesions of digestive system and circulatory system. CONCLUSION: ADR monitoring awareness should be strengthened and the related ADR reporting system should be improved.

OBJECTIVE: To probe into the current status of prescription indicators of outpatients in our hospital.METHODS: Drug utilization in the outpatients between 2005 and 2007 in our hospital was studied retrospectively.RESULTS: Over the three years,the prescription drugs declined from 2.40 to 2.25 kinds;the application ratio of antibacterial drugs declined from 20.74% to 20.25% and its variety has declined from 116 to 110 kinds;the application ratio of injections has declined from 11.84% to 9.48% with variety declined from 304 to 299 kinds.CONCLUSION: The indicators of the mean variety of prescription drugs,the mean variety of anti-infection drugs and injections and their ratios in outpatient department are rational on the whole.Comprehensive and effective interventions are workable and achievable in the promotion of rational drug use.

OBJECTIVE:To investigate the clinical feature of drug-induced acute renal failure(ARF).METHODS:285 ARF cases retrieved from CBMdisc and CNKI between Jan.1995 and Dec.2007 were analyzed statistically.RESULTS:Of the 285 drug-induced ARF cases reviewed,186 were male and 99 female.The drugs induced ARF totalled 50 kinds,leading the list in order were mannitol,acyclovir,dopamine,rifampicin,gentamicin,and dextran 40 etc;242(84.91%)received medicine by intravenous drip route.ARF appeared more often from day 1 to 5 after drug use;251 were cured(88.07%),6 took a favorable turn(2.11%),5 discharged from hospital automatically(1.75%),4 developed chronical renal failure(1.40%)and 24 died(8.42%).CONCLUSION:Lots of medicines and common drugs can induce ARF,with incidence rate of drug-induced ARF increased increasingly,however,which has a satisfactory prognosis if with timely and accurate diagnosis and suitable treatment.