A total of 65 patients of condyloma acuminatum (CA) received cryotherapy plus 5-aminolevulinic acid-photodynamic therapy (ALA-PDT) or ALA-PDT alone.During cryotherapy,handling was gentle with a moderate depth.The nursing of PDT was both meticulous and comprehensive.Patients with adverse reactions received Kangfuxin liquid for wet packing and topical antibiotic ointment.The combination group received cryotherapy for 2 sessions and then PDT for 1-3 sessions while PDT was administered for 1-4 sessions in single PDT group.Then all patients received PDT once for consolidation therapy.For groups 1 and 2,the effective rates were 83％ and 70％ and the recurrent rates 17％ and 30％ respectively.Cryotherapy plus ALA-PDT is feasible for CA and it offers better efficacies and lower recurrent rates.And comprehensive,meticulous and comfortable nursing may achieve clinical efficacies,reduce the recurrent rate and minimize discomforts during treatment.

Objective To understand the clinical medicine graduates competency status of Kunming Medical University in the past 5 years and provide important reference for cultivating students in medical university. Methods The questionnaire results in the relevant departments responsible person of Yunnan provincial municipal and district 26 hospitals were system analyzed by fuzzy comprehensive evaluation method. Results In the past 5 years, the graduates occupation competence of clinical medicine in Kunming Medical University is good. Among them, the graduates’core competency gets the lowest score, but the graduates’post competency gets the highest score. Conclusion The graduates’core competency should be strengthened in training of doctor-patient communication skills and quality evaluation of clinical practice for medical students.

Objective:To discuss the applicative value of 1.5TMR-diffusion weighted imaging (DWI) sequence and apparent diffusion coefficient (ADC) measurement in the diagnosis and differential diagnosis of endometrial carcinoma.Methods: Thirty seven cases were collected in endometrial carcinoma group, 11 cases were selected in benign group and other 20 normal volunteers. Data of the DWI and ADC value, common-MRI(c-MRI) sequence in the 48 patients and 20 normal volunteers was contrasted and analyzed.Results: The differences between endometrial malignant tumors, benign lesions and the normal have statistical significance.Conclusion: 1.5 T MR-DWI sequence and ADC value has a superior ability in detecting endometrial lesions. It can be used to differentiate the endometrial carcinoma from either benign or normal cases, it can provide reliable assistance in the clinical cure.

Objective To observe the clinical efficacy of low-dose erythromycin combined with salmeterol-fluticasone in the treatment of stable COPD, focus on the quality of life and respiratory function of patients.Methods 87 patients with stable COPD admitted to Hangzhou Red Cross Hospital from January 2014 to January 2016 were selected.Patients were divided into two groups by therapeutic methods, observation group ( salmeterol-fluticasone+erythromycin) 46 cases and control group (salmeterol-fluticasone) 41 cases.Six months of treatment, the quality of life of two groups of respiratory function assessment, acute COPD and peripheral inflammatory factor and other indicators of change.Results After treatment, both of the two groups got significantly decreased in SGRQ and MMRC scores, while the observation group was significantly lower than the control group, the difference was statistically significant(P<0.05).After treatment, FEV1/FVC%levels were significantly increased in both groups, but the observation group was significantly higher than the control group, the difference was statistically significant(P <0.05).The cumulative incidence of acute exacerbation of COPD was 10.87%(5/46) in the observation group, which was significantly lower than that in the control group 29.27%(12/41), the difference was statistically significant(Log-rankχ2 =4.833, P=0.028).After treatment, the levels of IL-1βand TNF-αin the peripheral blood of the patients in the observation group were significantly lower than those in the control group, the difference was statistically significant (P <0.05).Conclusion In the treatment of stable COPD, low-dose erythromycin could significantly improve the clinical efficacy, improve the quality of life and respiratory function.

Group B Streptococcus ( GBS) is a conditional pathogenic bacteria related to late-term abortion, premature delivery, premature rupture of membranes, perinatal infection, neonatal sepsis and other diseases.Prevention and treatment guidelines by the US Centers for Disease Control and Prevention ( CDC) suggest that all the pregnant women at 35-37 gestational weeks should screen for GBS .The detection methods for GBS include microbiology , immunology, molecular biology, etc.The appropriate method should be chosen depending on circumstances .Penicillin is recommended for the preventive treatment of GBS , and the treatment for the insensitive should base on the antibiotic susceptibility results .No vaccine against GBS is currently available for clinical use .

Objective To detect the changes of serum lipid levels in diabetic peripheral neuropathy patients,investigate the relationship between ApoB and HOMA-IRI and diabetic peripheral neuropathy.Methods One hundred and eighty-two patients with type 2 diabetes mellitus admitted to the medical department of Xuanwu Hospital Capital Medical University from January 2015 to August 2016 were enrolled in this study.All patients underwent EMG detection,the MCV of bilateral median nerve,tibial nerve and common peroneal nerve,and the SCV of median nerve,ulnar nerve and sural nerve.According to the detection results and symptoms and signs,the subjects were divided into type 2 diabetic peripheral neuropathy group (DPN,86 cases) and type 2 diabetic non peripheral neuropathy group (NDPN,96 cases).The general demographic data of the two groups was recorded,including TC,TG,HDL-C,LDL-C,FBG,HaBlc,FINS,UA,UAE and HOMA-IRI,to analyze the relationship between the nerve conduction velocity in type 2 diabetes patients with peripheral neuropathy and HDL-C,LDL-C,FINS,HbAlc,ApoB,HOMA-IRI.Results The course of disease in patients with type 2 diabetic peripheral neuropathy ((9.53 + 2.38) years,UAE (22.24) mg/L) was higher than that in patients with type 2 diabetic non peripheral neuropathy ((6.37 + 1.59) years and UAE (9.83) mg/L);FINS and HOMA-IRI levels in the DPN group were lower than those in the NDPN group ((16.33±2.33) vs.(35.16±5.02),4.94 vs.15.27,t=10.629,4.459,31.842,3.128,P<0.05);the level of TG,LDL-C and ApoB in patients with type 2 diabetic peripheral neuropathy was higher than those in patients with type 2diabetic non peripheral neuropathy,and the difference was statistically significant (P<0.05);the disorder of lipid metabolism in the DPN group was serious,whose occurrence rate was higher compared with the NDPN group (P<0.05);the MCV of median nerve was negatively correlated with ApoB (r=-0.278,P=0.041),SCV was positively correlated with HDL-C (r=0.425,P=0.002);MCV of tibial nerve was positively correlated with HDL-C (r=0.335,P=0.031),SCV of ulnar nerve was positively correlated with HDL-C (r=0.425,P=0.004) and FINS (r=0.387,P=0.006),negatively correlated with HOMA-IRI (r=-0.405,P=0.008);sural nerve SCV was positively correlated with HDLD-C (r=0.532,P=0.001),and HbAlc (r=-0.383,P=0.005),negatively correlated with LDL-C (r=-0.361,P=0.018).Conclusion Nerve conduction velocities in patients with type 2 diabetic peripheral neuropathy were associated with HDL-C,LDL-C,FINS,HbAlc,ApoB,and HOMA-IRI.

[Objective] To improve the clinical ability of traditional Chinese medicine gynecology by improving the flipped classroom model ,and design the corresponding evaluation system. [Methods] Based on the outpatient or inpatient real case, the case script was written, and the video production right before the class was given to the students. Watch the video, on the basis of clinical competence evaluation table for inter-group evaluation. Teacher comments, put forward to discuss the issue. In view of the problems raised by the teachers, the team members cooperate to study. Referring to the VALUE rating scale of the American college of higher learning, the author designs an evaluation system to evaluate the ability of team cooperation and problem solving. [Results] In the process of drilling and recording video, the students learn the history, clinical manifestations and diagnosis and treatment of the disease. Preliminary design completes the evaluation system. [Conclusion] The improved flip classroom model is helpful to cultivate and evaluate the clinical ability of traditional Chinese medicine gynecology.

Objective To investigate the correlation of serum cystatin C(CysC) and N-terminal brain natriuretic peptide (NT-proBNP) levels with severity of coronary heart disease.Methods 240 patients with coronary artery disease were selected.According to coronary angiography,they were divided into four groups:52 cases of non-CAD group,coronary single vessel disease group (73 cases),62 cases of double vessel disease,53 cases of triple vessel disease group.The serum CysC,NT-proBNP levels were determined and compared among the four groups.The relationship between CysC,NT-proBNP levels and severity of coronary artery disease was analyzed.Results The CysC,NT-proBNP levels in the single coronary vessel disease group,double vessel disease group and multivessel disease group were higher than non-CHD group,the differences were statistically significant(t=2.019,3.870,7.449,P=0.046,0.000,0.000;t=6.068,15.365,24.851,P=0.000,0.000,0.000);and with the crown pulse lesion count increased,the serum CysC,NT-proBNP levels increased gradually,the differences were statistically significant(t=2.080,3.070,P=0.039,0.000;t=10.953,12.078,P=0.000,0.000).Coronary artery disease severity was positively correlated with CysC,NT-proBNP levels (r1=0.562,r2=0.503).Conclusion The severity of coronary artery disease is closely related to the levels of CysC,NT-proBNP,which has some predictive value for coronary artery disease,patients with high CysC,NT-proBNP levels should be given high priority.

Several multi-gene assays have been developed to predict the risk of recurrence in patients with early-stage, estrogen receptor (ER) positive breast cancer. Among them, Oncotype DX 21-gene assay is widely applied among node-negative patients because of its unique prediction of therapeutic benefit. Although many retrospective stud-ies have proved its prognostic and predictive value in node-positive population, evidence from large prospective clinical trials remains insufficient. When combined with clinicopathological variables, the assay has been shown to impact adjuvant treatment decision making in a cost-effective manner. This article reviewed the available clinical evidence for the prognostic and predictive value, unique advantages, the effect on treatment decision making, cost-effectiveness and contradictories of 21-gene assay in early-stage luminal breast cancer patients.

Uveitis is one of the leading causes of visual impairment.The method of evaluate to visual function include visual acuity,visual field,contrast sensitivity,color vision and visual electrophysiology.Among these methods,the most direct and common one is visual acuity.The visual outcomes are various because of the differences of cause of disease,severity of inflammation,location of lesion and complications.Visual impairment is most common in panuveitis.The risk of serious visual impairment is increased with aging.Bilateral inflammation is more serious and difficult to cure.Of varied causes of disease,the visual outcomes in sarcoid-related uveitis,Behcet' s disease and juvenile arthritis-related uveitis are poor.The complications of uveitis can cause visual impairment directly as well.Cystoid macular edema is the most common complication of uveitis,and which to bring up to visual impairment.There are abnormalities left in contrast sensitivity,visual field and electroretinogram.This article mainly summarize the visual function outcomes of uveitis and factors affecting the visual function.