Although there are numerous case resource,there still exist a relatively long distance in clinical research in China in comparison with developing countries because of inadequate recognition and funding,which has greatly affected the development of standardization of clinical medical in China for the past few decades.With the deepening of recognition and increasing of special support to clinical medical research in China,the development based on clinic research will face new opportunities.As a result,it is necessary for ophthalmologists to explore clinical issues,leverage from the mega trend of clinical research and deliver high-quality results.To achieve this goal,ophthalmologists will have to constantly update their knowledge base,standardize clinical practice and improve diagnosis methods.So far,challenges persist in clinical research in ophthalmology as follows:It is difficult to get funding for clinical research project;It is difficult to get ethnics approval for clinical research project;The research design for forward-looking projects is yet to be standardized;Cross-disciplinary collaboration needs to be enhanced.This review was expected to inspire more attention from clinical research specialists and consequently more highquality clinical studies.

Objective To observe the subfoveal choroidal thickness (SFCT) in eyes of patients with diabetic macular edema (DME).Methods Twenty patients (32 eyes) with DME were enrolled in this crosssectional observational study.The patients included 12 males and eight females,with a mean age of (47.3± 10.2) years.All the patients were examined documenting best corrected visual acuity (BCVA),spectraldomain optical coherence tomography (OCT) and ophthalmological examination.According to OCT DME morphology,samples are divided into diffuse macular edema,cystoid macular edema,serous retinal detachment and hard exudate groups.The SFCT was measured by a Cirrus HD-OCT with enhanced depth imaging (EDI) and was compared with the average SFCT (286.84 ± 28.80) μm of same age group.Correlation between SFCT and age,diopter,diabetic duration,fasting blood glucose,BCVA and central retinal thickness were analyzed by Pearson Analysis.SFCT of different DME types were analyzed by ANOVA Analysis.Results The mean SFCT of 32 eyes was (223.81±43.74) μm (ranging from 120.50 to 361.50 μm),which was lower by 63.03 μm (95％ confidence interval,-78.80 to-47.26 μm,P＜0.01)from normal SFCT.SFCT was independent of age (r=0.124),diopter (r=0.277),diabetic duration (r=0.286),fasting blood glucose (r=0.408),BCVA (r=0.087),and central retinal thickness (r=0.036).There was no significant difference of SFCT between different DME types (F =0.042,P ＞ 0.05).Conclusion SFCT is thinner in eyes with DME as compared to normal eyes of the same age.

Objective To evaluate the postoperative complications and visual quality after manual small incision cataract surgery (MSICS) versus phacoemulsification (PHACO).Methods A systematic review of MSICS and PHACO was conducted by a computer search on Medline,Pubmed,CBM and CNKI and a supplementary manual search was also done.The effect was measured as an odds ratio (OR) and weighted mean difference (WMD).RevMan 5.0 software was used to perform the Meta-analysis.Results A total of 9 articles were included in the Meta-analysis.Naked visual acuity at 1 week after surgery (OR =0.93,95％ CI 0.68-1.27),posterior capsular ruptured after surgery (OR =1.07,95％ CI 0.73-1.58),corneal edema after surgery (OR =0.90,95 ％ CI 0.70-1.16),surgically induced astigmatism at 1 month after surgery (WMD =0.08,95％ CI-0.02-0.17) in MSICS and PHACO was no statistically significant difference (P ＞0.05).Conclusion MSICS is safe and reliable surgery as same as PHACO for the patients with cataract,MSICS is more consistent with China' s national conditions.

To explore the feasibility of rapid proto-typing ( RP) technology in the treatment of Standford type A aortic dissection. 5 patients with Standford type A aortic dissection received computed tomography angiography (CTA) of their aortas. The CTA images were then processed by 3D reconstruction with MIMICS16. 0 in order to create aortic dissection models through RP technology based on real patient aorta size with a ratio of 1 ∶ 1 . Accord-ing to these models, the surgeons were able to fully understand the aortic diseases of patients, thus establish indi-vidualized treatment strategies for each patient. Besides, the surgeons simulated operations on the models, which helped them achieve better results in real surgery. These patients experienced no post-operative complications and were discharged from hospital with recovery. In conclusion, RP technology can provide adequate preoperotive prep-arations for patients with Standford type A aortic dissection, improve operation efficiency and accuracy in aortic dis-section and guide precise proximal anchoring of stents during intracavitary therapy.

The aim of our study was to observe the effect of diabetes melitus and hy- pertension on cerebral hemodynamics.The flow velocity of cerebral basal arteries were inves- tigated with transcranial Dopplersonography(TCD) in the group of diabetesmellitus,hyper- tension and diabetes combined with hypertension.The results that the flow abnormality in diabetic group(n=48) was41 .7% and in hypertensive group(n=1 6 0 ) was30 % ,respective- ly,butin the group(n=35 ) of diabetes combined with hypertension,the abnormality reae- hed as high as 82 .9% and the abnormal rate of the latest group was significantly higher than former two groups(P

Objective:To explore the characteristics of original site of premature ventricular contraction (PVC) in pa‐tiets with acute myocardial infarction (AMI) .Methods:Among ECG‐detected single‐source PVC patients ,a total of 150 idiopathic PVC patients and 150 AMI patients were randomly selected as control group and AMI group respec‐tively .Original sites of PVC was compared between AMI group and control group and between left and right ventri‐cle of AMI group ,and the relationship between original sites of PVC and diseased coronary in AMI patients was an‐alyzed .Results:Compared with control group ,there was significant rise in percentage of PVC originated from left ventricular apex (6.0% vs .46.0% ) ,and significant reductions in percentages of PVC originated from right ventric‐ular outflow tract (54.7% vs .27.3% ) and right ventricular anterior wall (10.0% vs .3.3% ) in AMI group , P<0.05 or <0.01. In AMI group ,compared with PVC originated from right ventricular outflow tract ,there was sig‐nificant rise in incidence rate of PVC originated from left ventricular apex (27.3% vs .46.0% ) , P=0.001 ;com‐pared with right ventricle , there was significant reduction in incidence rate of outflow tract PVC (66.1% vs . 13.6% ) ,and significant rise in incidence rate of apex PVC (24.4% vs .78.4% ) in left ventricle , P<0.01 both . Relevance test analysis of two‐way disordered classified data indicated that diseased coronary was not related to orig‐inal sites of PVC in AMI patients (χ2 =0.519 ,P=0.134) .Conclusion:Original sites of premature ventricular con‐traction has its own characteristics in patients with acute myocardial infarction ,which may possess certain guidance significance for its treatment .

Objective To discuss the feasibility and value of routine clinical preoperative examination predicting benign and malignant thyroid nodules. Methods The clinical data of 1630 patients undergoing thyroidectomy for nodular thyroid disease were analyzed retrospectively.The relationship between pathological diagnosis and physical examination,ultrasonographic parameters,the results of laboratory test and nuclear medicine test were examined to build a risk prediction model.The sensitivity,specificity and accuracy of the formula were tested. Results In 387 cystic nodules 0.78％ were malignant; In 1243 solid nodules 17.2％ were malignant.Among the 1243 cases,characters significantly related to malignancy were:age younger than 40 years,solitary lobe involvement,hypoechoic nodule,irregular margins,solid nodule,microcalcification,macrocalcification,max diameter ≤ 2 cm. The prediction formula was: malignancy indicator =0.80 × age + 0.59 × solitary lobe + 0.72 × hypoechoic + 0.82 × irregular margin + 1.32 × solid nodule + 1.90 × microcalcification + 0.70 × macrocalcification + 0.71 × max diameter.The threshold limit value was 2.8,and the sensitivity,specificity and accuracy of which were 74.4％,80.4％ and 75.2％,respectively. Conclusions Benign and malignant thyroid nodules could be differentiated roughly with the combination of patients' general information and the results of routine examination before operation.

Atopic dermatitis (AD) is an inflammatory skin disease closely related to impairment of skin barrier function.Hereditary factors,life style and exposure to the environment all contribute to the occurrence of AD.Even though AD occurs mostly in infants,sometimes it may initially occur in adults,which is called adult-onset AD (AOAD).There are evident differences in types,immunological mechanisms and association with other diseases between childhood AD and AOAD.The lesional distribution of AOAD is similar to that of childhood AD,while AOAD is characterized by subacute and chronic dermatitis,and mainly manifests as dry hypertrophic lesions rarely complicated with exudation.Th1/Th2 imbalance and hyperfunction of antigen-presenting cells are immunological basis of AD occurrence.Moreover,FLG gene mutations are associated with the occurrence of AD.Acquired expression defect in the FLG gene induced by elevated levels of interleukin-13 (IL-13) only occurs in adults,suggesting that AOAD is different from AD that initially occurs during infancy and continues into adulthood.Infection,changes of bacterial flora in the skin and intestinal tract,and smoking are all important causative factors of AOAD,thus enquiries about histories of related diseases and smoking are helpful for the diagnosis of AOAD.

Objective To study the clinicopathological characteristics and immunophenotype of solid pseudopapillary neoplasm (SPN) of the pancreas.Methods Retrospective analysis was performed for the clinical materials,pathological features and immunohistochemical phenotype characteristics of the 23 SPN cases.Results Ratio of male to female was 1:10;the average age was 32 years.10(43％) patients had no clinical symptoms,12 (52％) patients had abdominal pain,abdominal distention or diarrhea;1 patient had jaundice.Tumors were in the head of pancreas in 10(43％) cases,and were in the tail or body of pancreas in 13 cases.Grossly,tumors were solid-cystic or solid;the maximum diameter were from 1.3 cm to 17 cm,with the average of 5.9 cm;12 (52％) cases appeared encapsulated.Histopathologically,21 (91％) cases appeared to exhibit a fibrous capsule surrounding the tumors,and the fibrous capsule invasion were observed in all these cases;Pancreas tissues were involved in 8(35％) cases.Tumor cells arranged in sheets,nests and pseudopapillary patterns.Hemorrhage,necrosis and cystic degeneration were often seen.Tumor cells were positive for vimentin,β-catenin,CK,CD10,PR,CD56 and Syn.Tumor were mostly negative for CgA and Ki-67.23 cases were followed up for 2 to 44 months,and all were alive.Conclusion SPN is a low degree malignant tumor often seen in young women with various histological patterns and multiple immunophenotypes.Definite diagnosis of SPN can be made by combining clinicopathological characteristics with a panel of immunohistochemicat marks.SPN grows slowly,often responds to surgical resection and rarely recur.

AIM:To report the safty and efficiency of intravitreal injection of bevacizumab (Avastin) in patients with macular edema (ME) due to branch retinal vein occlusion (BRVO).METHODS: A consecutive series of patients with ME due to BRVO who were treated with intravitreal bevacizumab injection (2.5g/0.1L) were retrospectively studied. Patients underwent complete ophthalmoscopic examination, including Snellen visual acuity testing, optical coherence tomography (OCT) imaging, and/or flurescence angiographic testing at baseline and follow-up visits.RESULTS: There were 32 eyes of 32 consecutive patients who received at least one intravitreal bevacizumab injections (range from 1 to 3). The mean length of follow-up was 4.7 (range from 3 to 8) months. The mean visual acuity improved from 20/200- at baseline to 20/100- at 1 month and 20/100+ at 3 months and last follow-up (P＜0.01). The mean central 1mm macular thickness was 483μm at baseline and decreased to 275, 314,and 301μm at 1 month,3 months, and last follow-up (P＜0.01)respectively.No adverse side effects were observed following injections in any eyes.CONCLUSION: Intravitreal bevacizumab (Avastin) showed a marked decrease in ME secondary to BRVO, improvement in visual acuity and lack of adverse side effects.