OBJECTIVE:To observe therapeutic efficacy and safety of tobramycin dexamethasone in the treatment of meibo-mian gland dysfunction(MGD). METHODS:108 MGD patients were randomly divided into control group(53 cases)and observa-tion group(55 cases). Control group was given eyelid cleaning with conventional physical cleaning method,at the same time,giv-en Doxycycline hydrochloride tablets 0.1 g orally after meal,twice a day. Based on control group,observation group was addition-ally given Tobramycin and dexamethasone eye ointment with length of 1.0-1.5 cm,smearing into conjunctival sac,4 times a day. Treatment courses of 2 groups lasted for 4 weeks. Clinical efficacies of 2 groups were observed as well as eyelid observation score, symptom score,the levels of IL-6 and TNF-α,the occurrence of ADR before and after treatment. RESULTS:The total response rate of observation group was significantly higher than that of control group(89.1% vs. 77.4%),with statistical significance(P<0.05). Before treatment,there was no statistical significance in eyelid observation score,symptom score,the levels of IL-6 and TNF-α between 2 groups(P>0.05). After treatment,eyelid observation score of 2 groups were significantly higher than before treatment,and the observation group was significantly higher than the control group;symptom score and the levels of IL-6 and TNF-α in 2 groups were significantly lower than before treatment,and the observation group was significantly lower than the con-trol group,with statistical significance(P<0.05).There was no statistical significance in the incidence of ADR between 2 groups (P>0.05). CONCLUSIONS:Based on routine treatment,tobramycin dexamethasone shows significant therapeutic efficacy for MGD,and can improve clinical symptoms significantly but does not increase the occurrence of ADR.

Objective To investigate the operation timing of laparoscopic cholecystectomy (LC)after endoscopic sphincterotomy (EST).Methods A total of 240 patients with cholecystolithiasis and choledocholithiasis received EST combined with LC.They were divided into 3 groups by random digits table method with 80 cases each:3 days after EST(group A),7 days after EST(group B),and 30 days after EST (group C).Intraoperative and postoperative clinical data were compared among three groups.Results The operation time of LC in group B [(52.5 ± 6.4) min] was longer than that in group A and group C [(35.8 ± 5.7),(34.6 ± 2.6) min],and there was significant difference (P ＜ 0.01).The intraoperative conversion rate in group B [10.0 ％ (8/80)] was higher than that in group A and group C [1.3 ％ (1/80),1.3 ％ (1/80)],and there was significant difference (P ＜ 0.05).The amount of bleeding in group B [(51.7 ± 4.8) ml] was larger than that in group A and group C [(27.9 ± 6.4),(28.2 ± 3.6) ml],and there was significant difference (P ＜ 0.01).The cost of hospitalization in group C [(15 361.2 ± 1 007.8) yuan] was more than that in group A and group B [(10 085.1 ± 695.4),(10 632.4 ± 855.9) yuan],and there was significant difference (P＜ 0.01).Conclusion LC performed 3 days after EST can reduce the operation difficulty and conversion rate,and shorten the operation time,and this modality is safe and effective.

Objectives:To investigate the impact of doctor-attacking on medical students’ occupation atti-tude. Methods: We conducted a sample survey towards different major of Wenzhou Medical University by using self - made questionnaire. Reults: The occupation attitude of interviewee is not so bad, the confidence about the occupation is really deep down and the occupational sense of mission worries a lot of people. Doctor-attacking cases damage the honorable sense of occupation, even threatens basic personal security. The spread passive emotion by Network media , as well as the varied choices of occupations, expand the influence of hospital violence. Conclusions: The fre-quent occurrences of doctor-attacking cases weaken the occupational attitude of medical students and became the obstruc-tion to be a doctor,countermeasures should be taken from multiaspect of society,media,schools and teachers through a va-riety of ways.

BACKGROUND:The aquaporin (AQP), mainly AQP1, AQP4 and AQP9, are expressed in mammalian brain, while the others are sporadical y expressed. There is no evidence concerning the distribution, function and regulation mechanism of AQP in the brain.
OBJECTIVE:To comprehensively analyze the research progress of the distribution, function and regulation mechanism of AQP in maintaining normal physiological function of the brain.
METHODS:An online retrieval of PubMed database and CNKI database between January 1980 and July 2013 was performed for articles on the distribution, function and regulation mechanism of AQP, with the key words of“AQP1, AQP4, AQP9, function, brain, adjusting mechanism”in English and Chinese. A total of 163 papers were screened out and 85 of them met the inclusive criteria.
RESULTS AND CONCLUSION:The existing studies about the expression, function and regulating mechanism of AQP1, AQP4 and AQP9 in the brain can be summarized as the fol owing three aspects: (1) AQP1 is expressed in the choroid plexus and participates in forming cerebrospinal fluid;in other types of cells, gas micromolecules CO 2 , NO, NH 3 and O 2 also cross through AQP1. (2) AQP4 is mainly expressed in the astrocytes, ependymal foot process and gelatin membranes, which can help the water in and out of the brain tissue, accelerate glial cellmigration and change neural activity. (3) AQP9 is mainly distributed in astrocytes and catecholamine neurons, the main function is involved in energy metabolism in the brain. Therefore, AQP is the key for water transport in the brain. Understanding the distribution, function and regulation mechanism of AQP wil play an important role in the treatment of brain diseases. The regulatory mechanism on the expression of AQPs in normal pathology and related disease remains unclear and related molecular signal pathway needs further exploration.

Objective To develop an indicator system for evaluating midwifery quality. Methods Guided by the latest evidence-based framework of midwifery quality,based on indicator selection principle,the indicator system for evaluating midwifery quality was preliminarily developed by literature review,expert meeting,theoretical analysis and expert consultation,for further validation through large-scale Delphi method. Results The indicator pool for mid-wifery quality evaluation was identified by literature review,including indicator name and definition of special indi-cator. The indicator system was finalized through comprehensive analysis and selection,and consisted of 45 indica-tors. The expert consultation questionnaire response rate was 100%,the rate of experts who provided written sug-gestions was 81.3%,the authority coefficient was 0.92,the coefficients of variation of indicators ranged from 0 to 0.29. Conclusion The preliminarily developed indicator system for midwifery quality evaluation guided by the lat-est evidence-based framework of midwifery quality was scientific,oriented and accessible,which could be further ex-amined through large-scale Delphi method.

Objective To determine prevalence of dementia in diabetics and non-diabetics, and in different age and gender groups. Methods A case-control study was conducted among participants aged 50 and over in Jing' an temple community in Shanghai. Subjects in diabetics group were matched to non-diabetics groups for age and sex with 1:1 matching. Personal information and case history were collected through questionnaire. The subjects were screened for dementia using the Mini Mental State Examination (MMSE). Subjects that screened positively (indicated by an MMSE score below 19, 21 and 24 among those with illiteracy, elementary school and above junior middle school education, respectively) were subsequently examined by a series of neuropsychological tests. Based on all available information, a diagnosis of dementia was defined according to the Diagnostic and Statistical Manual of Mental Disorders ( DSM )-Ⅳ criteria Results Prevalence of dementia of 4. 75% (23/484, 95% CI: 3. 03%-7.04%) in diabetics was higher than that of 2. 24% (11/490,95% CI: 1.13% -3.98%) in non-diabetics (X~2 = 4.54, P=0.03).Prevalence of dementia among diabetics in age groups of 60-69, 70-79 and 80 and above was 1.94% (2/103), 4. 43 % (9/203) and 14.12% (12/85, trend X~2 =18.04, P <0.01), and in non-diabetics was 1.43% (2/140), 2. 86% (6/210) and 5.00% (3/60, trend X~2 = 4.58, P=0.03), respectively.Prevalence of dementia among female and male in diabetics was 6.55% (19/299) and 2.06% (4/194) (X~2 = 5.18, P = 0.02), respectively, and in non-diabetics was 3.01% (9/299) and 1.05% (2/191).Conclusions Prevalence of dementia is significantly higher in diabetics than in non-diabetics, higher in women than men, and increases as age rises.

Background:Recurrent acute pancreatitis(RAP)is a special type of acute pancreatitis(AP). Finding the cause is the key to avoid the recurrence of RAP. Aims:To investigate the risk factors of RAP. Methods:The clinical data of 43 patients with RAP and 130 patients with only one time AP(control group)were retrospectively analyzed. Risk factors of recurrence of RAP were analyzed. Results:Univariate analysis showed that no significant differences in etiology,severity, serum levels of cholesterol,calcium,white blood cell count,amylase,ALT,AST,total bilirubin,direct bilirubin and C-reactive protein were found between RAP group and control group(P > 0. 05). Serum triglyceride level,blood glucose level and CT score in RAP group were significantly higher than those in control group(t = 3. 260,P < 0. 05;t = 2. 720, P < 0. 05;t = 2. 162,P < 0. 05). Logistic regression analysis demonstrated that serum triglyceride level,blood glucose level and CT score were risk factors of RAP(oR = 1. 86,95% CI:1. 05-3. 68,P = 0. 03;oR = 1. 23,95% CI:1. 01-1. 50,P = 0. 04;oR = 2. 46,95% CI:1. 00-6. 03,P = 0. 04). Conclusions:The recurrence of RAP is related with serum triglyceride level,blood glucose level and CT score.

Surgery is so far the most widely used and effective treatment of neoplastic diseases.However,residual tumour cells during surgery remain a major trigger of cancer recurrence and matastasis.Although intraoperative rapid pathological R0 resection can be achieved based on preoperative imageological examination,but for small satellite lesions and the naked eye can not find the error quickly and so often cause pathological presence of residual tumour cells.Thus,quick and accurate identification of residual cancer cells is crucial for prognosis of cancer patients.Indocyanine green (ICG) is a new type of fluorochrome that can stain tumours under the near-infrared fluorescence during surgery,the paper will be reviewed latest developments in the reagent for fluorescence in tumours.

Objective:To evaluate the protection of small bowel and bladder by Contoura carbon fiber belly board in patients with rectal cancer undergoing postoperative radiotherapy and the position deviation during radiotherapy. Methods: This study enrolled 45 consecutive patients with rectal cancer who had undergone prior surgery. Twenty patients who applied the belly board were defined as group A, and the other 25 patients were defined as group B. All the patients received threE-dimensional conformal radiation therapy(3D-CRT), and the prescriptive radiation dosage of 95% of planning target volume (PTV) was 50 Gy/25 times. Patients in group A underwent two sets of CT scans as follows: group A1, prone alone; group A2, prone with the use of the belly board. The radiation dosage and radiated volume in PTV, small bowel, and bladder were observed by dosE-volume histograms. Ten patients were selected randomly from group A and group B, respectively. Their position deviation during radiotherapy was measured by double exposure field verification system. The acute radiation reactions of all patients were observed and recorded during radiotherapy. Results: No significant difference was found in the total PTV and total volume of small bowel and bladder and mean irradiation dosage to PTV between groups A1 and A2. The mean irradiation dosage to the small bowel and bladder, the volume of small bowel irradiated at 10%-100% dose levels, and the volume of bladder irradiated at 30%-100% dose levels, were significantly decreased in group A2. The difference was significant. Compared with group B, the right-left and superior-inferior position deviations were significantly reduced in group A. The difference was significant (P<0.05). The anterior-posterior position deviation was also reduced, but the difference was not significant (P=0.705). The incidence of grade 3 or more adverse reactions were 15% (3/20) in group A and no patient broke off or stopped treatment; the incidence of grade 3 or more adverse reactions was 24% (6/25) in group B, and two patients broke off the treatment because of severe adverse reaction. One patient terminated the treatment. Conclusions: The Contoura carbon fiber belly board can reduce the irradiation dosage and volume of small bowel and bladder in patients with rectal cancer undergoing postoperative radiotherapy. The position deviation has better reproducibility and the acute radiation reactions are tolerable. It is worthy of application in clinic.

vides com-parable efficacy with medical castration in regard of decreasing PSA level and reducing prostate vol-ume. It is a safe and well tolerated treatment option as well.