Diabetic macular edema (DME) is a common complication of diabetes that can lead to severely impaired visual acuity.Its pathogenesis is complex,which is closely related to the destruction of blood-retinal barrier,and there are many cytokines involved in its formation,but the exact mechanism is not yet fully clear.Recent researches suggested that some typical pathological characterizations of retina can be used as criteria for evaluating its occurrence,and it is known that a variety of risk factors participated in the pathological process,such as glucose,blood pressure,blood lipids,which are well-known and can be closely correlated with its development through impacting the systemic and retinal vascular functions by complex mechanisms and leading to endothelial dysfunction.While other systemic risk factors,such as diabetic nephropathy which leads to changes in osmotic balance,anemia which increases cytokines caused by ischemia and hypoxia,excessive body weight which leads to vascular damage through fat factor,smoking that produces blood vessel damage by promoting oxidative stress on the body and various hypoglycemic drugs,will influence the development of macular edema on different levels.So conducting a comprehensive and newest understanding of this disease and its risk factors are conducive to better prevention efforts for diabetes patients.This review mainly summarizes the latest researches on definition,classification,pathologic characterization and risk factors of DME.

To study the effect of postural change on intraocular pressure ( lOP ) fluctuation in open angle glaucoma patients after trabeculectomy, and to discuss the value of this investigation on prognosis.METHODS:Fifty-one cases (62 eyes) of primary open angle glaucoma were selected as the research object. Perkins ophthalmotonometer was used to test lOP at the time when patient seat ( first seat ) . The patients were asked to lie supine for 25min, detected lOP, and the patients seated again (final seat), sustaining for 15min, detected lOP. According to whether the lOP range was more than 5mmHg, they were divided into high volatility fluctuation group and low volatility fluctuation group. We recorded their visual field progression ( with AGlS score) , HPA staging, in order to evaluate the correlation of lOP range with them. Reviews were made 3mo a time, and lasted for 1a, in order to evaluate the relation between lOP range and AGlS scores.RESULTS: The lOP of first seat was 18. 1+2. 2mmHg. There was no significant difference in the same position (P>0. 05 ). The lOP range was 4. 1 ± 1. 5mmHg. Low volatility fluctuation group was more likely to have low AGlS score and to be early vision HPA ( P<0. 001, P<0. 05 ) . There were significantly positive correlation between lOP range and AGlS (r=0. 412, P<0. 001); With time increasing, the number of patients whose visual field progression was increased, and the lOP was also raised. At any time the two were positively correlated (P<0. 01).CONCLUSlON:Visual field progression is related to the degree of lOP fluctuation in open angle glaucoma patients after trabeculectomy, so we can predict the prognosis of patients simply by detect lOP fluctuation. This is good to adjust the lOP control scheme.

The Personality decides the particularity of people's acclimatization,which is the power organization in individual immanent psychology physics system.Human kind must gain a harmonious development in every field including trueness,goodness and fairness——this is the Marx's thought about the human general development,and it is also the ultimate objective of education in university.To achieve this target depends on attaching importance to humanities education.

ObjectiveTo investigate the efficacy of aerosol inhalation of Pulmicort Respules combined with urbason in treating severe bronchial asthma.MethodsThe clinical data of 40 cases aith severe bronchial asthma treated in our hospital were analyzed retrospectively,among which 20 cases underwent Pulmicort Respules combined with urbason(Tset Group),20 cases underwent urbason( Control Group).ResultsCompared with the control group,the blood gas analysis in test group had statistically significant difference before treatment (P ＜ 0.05 ).Compared with the control group,the clinical effect and the blood gas analysis in test group had no statistically significant difference after treatment(P ＞ 0.05 ).Compared with the control group,the complications in test group had statistically significant difference( P ＜ 0.05),the complications in test group was less than the control group.ConclusionAerosol inhalation of Pulmicort Respules can reduce the amount of urbason and lower the incidence d complications.The combination treatment of this two drugs can achieve the same clinical results alike the clinical effect of large doses of methy lprednisolone.

ObjectiveTo analyze the application effects of two dimensional Duplex imaging and Site- Rite 5 ultrasound guided instrument during PICC insertion. Methods60 cases underwent color ultrasound- guided PICC were divided into the control group and the experimental group,they used the SiteRite 5 ultrasonic guided instrument and two dimensional Duplex imaging for PICC respectively.The success rate of vessel puncture,success rate of one- time insertion,accuracy in vessel selection and the rate of local tissue damage between the two groups were compared. ResultsThe experimental group had a higher success rate in the vessel selection and also with a higher rate of local tissue damage,but success rate of vessel puncture,success rate of one- time insertion were lower than the control group.However,there were no significant differences. ConclusionsFor the hospitals which can't purchase the Site- Rite 5 ultrasound guidance instrument for PICC,the two dimensional Duplex guidance can he attempted for PICC.It can achieve a higher success rate of insertion,especial in patients with bad condition of the peripheral vessels,so that this technology can be developed rapidly and widely.

Objective Analyzed 32 cases of gastrointestinal stromal tumors(GIST) patients,to analysis the clinical and pathological characteristics of gastrointestinal stromal tumors of the stomach and explore associated prognostic factors.Methods Thirty-two GIST patients confirmed pathologically were included from May,2007 to April,2013.Their clinical records were retrospectively analyzed.Results Of the 32 GIST patients,the overall survival (OS) is 85.3％ for the second year.The progression free survival (PFS) is 79.2％ for the second year,respectively.Univariate survival analysis showed that OS and PFS have significant association with tumor size,metastasis,mitotic index and NIH risk group.Conclusions Metastasis and NIH risk group both are potential prognostic factor for gastric GIST.

Objective To observe the clinical effect of orally montelukast combined with doxofylline in older bronchial asthma.Methods A total of 87 stationary phase older bronchial asthma patients were divided into trial group (44 cases) and control group (43 cases).Trial group was given orally montelukast 10 mg 1 time/d,doxofylline 0.2 g,2 times/d.Control group was given inhaled fluticasone 250 μ g,2 times/d,a total of 3 months.The forced expiratory volume in one second (FEV1),peak expiratory flow rate (PEFR),one second rate (FEV1/FVC),asthma control test (ACT) score and the adverse reaction were compared between the 2 groups.Results There were no significant differences in FEV1,PEFR,FEV1/FVC before treatment between the 2 groups (P ＞ 0.05),they were significantly improved after treatment [trial group:(2.20 ± 3.21)L vs.(1.68 ± 0.71) L,(3.97 ± 0.32) L/s vs.(3.27 ± 0.32) L/s,(76.18 ± 1.02)％ vs.(63.91 ± 1.40)％,control group:(2.24 ±0.75) L vs.(1.71 ± 1.58) L,(4.06 ±0.34) L/s vs.(3.29 ±0.28) L/s,(77.85 ±0.67)％ vs.(62.37 ± 1.29)％],there were statistical differences (P ＜ 0.05).But there were no statistical differences after treatment between the 2 groups (P＞ 0.05).According ACT score,total effective rate in trial group was 90.9％ (40/44),in control group was 95.3％(41/43),there was no statistical difference (P ＞ 0.05).The rates of adverse reaction in trial group and control group were 4.5％(2/44) and 7.0％(3/43),there was no statistical difference (P ＞ 0.05).Conclusions The curative effect of orally montelukast combined with doxofylline in older bronchial asthma closes to the classic solution of inhalation fluticasone,which is easily accepted by older patients,and safety.It provides another option for older bronchial asthma patients.

[Objective]The article summarizes the essentials of clinical dialectical experience by professor Ye Bai,the famous TCM physician. [Medthods] From following professor Ye Bai clinical studies and his expository teaching,summarize the experience and thoughts of treat peptic ulcer,and for a case. [Results]Ye Bai deems of the main reason for the occurrence of PU is the deficiency cold of spleen and stomach, liver-stomach disharmony, and puts forward that we should pay attention to replenishing spleen,regulate qi precautions injurying yin,don't forget to activate blood in the long illness when we treat it, and emphasizes the combination of disease differentiation and syndrome differentiation, to improve the prognosis, reduce the adverse reactions and recurrence rate of treatment principle. [Conclusion]Ye Bai has adepted in treating the PU that has a perfect effect,the experience covers ancient and new ways, worth popularzing and studing.

Objective:To explore the relationship among glycemic index (GI) ,glycemic load (GL) and cardiovascular disease risk .Methods:From Jan 2010 to Jan 2014 ,a total of 120 healthy subjects were selected .According to random number ta‐ble ,subjects were randomly and equally divided into control group and intervention group .Control group received normal diet ,while in intervention group ,GL and GI in diet were calculated using related indexes and referring to International Glycemic Index Table ;physicians and nurses formulated the diet list ,controlled the diet ,followed up regularly ,traced and surveyed .Incidence rate of cardiovascular diseases was compared between two groups .Results:Compared with control group after intervention group , there were significant reductions in GI [ (71.12 ± 4.55 ) vs . (57.82 ± 3.98 )] and GL [ (20.02 ± 3.35) vs .(15.97 ± 2.46)] in intervention group , P<0.01 both .The four-year trace survey found that mor‐bidity rate of cardiovascular diseases in intervention group was significantly lower than that of control group (3.33% vs . 16.67% ,P=0.015) .Conclusion:As important indexes reflecting postprandial glucose response caused by food ,GI and GL should be involved into daily diet system ,which can not only avoid occurrence of cardiovascular disease effectively ,but is help to control total dietary energy and blood glucose response ,and provide a more scientific and effective dietary reference for prevention and treatment of various chronic diseases .

With the development of transportation and construction, due to the increasing incidence of spinal cord injury, patients mainly rely on family caregivers.The paper reviewed the type of care burden and the influencing factors, and nursing intervention mode to decrease the caregivers' burden of spinal cord injury patients. We wish to provide suggestions for building nursing intervention model of Chinese spinal cord injury caregivers .