The platelets in the human mixed thrombus,hyaline thrombus antemortemand postmrtem skin incision wounds were detected by the PAP-immunohisto-chemical technique using monoclonal antibodies against the human platelet mem-brane glycoprotein(GPIb,GPIIIa).The positive reaction were observed inthe mixed thrombus,hyaline thrombus and in all the antrmortem skin incisionwounds,but not in the postmortem skin wounds.The significance of theapplication of this technique in the forensic medicine practice was discussed.

Based on binocular disparity, three-dimensional (3D) display technology makes the right and left eyes see different images in a certain way, which generates a stereo image after the processing of the brain's visual cortex.Due to its high-definition stereoscopic surgical field of vision and accurate spatial positioning ability, 3D display technology has been widely used in surgery.Ophthalmic microsurgery is performed with the help of microscope because of the complex intraocular operation and small operating space, especially minimally invasive vitreoretinal surgery, which is the most difficult surgery with the longest learning curve in ophthalmology.The 3D display viewing system can improve surgical accuracy, reduce retinal phototoxicity, relieve the pressure on the neck and back of the surgeon as well as promote communication and cooperation between medical staff and so on.At present, the major 3D display systems applied in ophthalmology include the NGENUITY 3D Visualization System and TrueVision 3D Visualization System, both of which require wearing 3D glasses.The naked eye 3D display system is the main direction of future development.The combination of 3D display system and ophthalmic surgical robot system provides a new idea for the development of remote ophthalmic surgery.At the same time, broader application of 3D display system requires continuous improvement.In this article, the research and application of 3D display system in anterior segment surgery and vitreoretinal surgery were reviewed.

Objective To evaluate the blood-saving effect of acute hypervolemic hemodilution (AHH) with 6％ hydroxyethyl starch 130/0.4 (HES 130/0.4) in preschool children.Methods Forty ASA Ⅰ patients,aged 3-6 yr,weighing 11.5-22.5 kg,with body height of 78-120 cm,scheduled for orthopedic or general surgeries,were divided into 2 groups by drawing lots:group AHH (n =20) and group control (n =20).6％HES 130/0.4 10 ml/kg was infused over 30 min at a rate of 0.3 ml·kg-1 · min-1 through the internal jugular vein before surgery in group AHH.The fluid balance,blood loss,urine output and blood transfusion during operation were recorded.The blood routine,liver and kidney function and coagulation function (prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (Fib)) were measured before AHH (T0) and at 0,4 and 24 h after AHH (T1-3).Hypokalemia,hypocalcemia and prolongation of PT and APTT during surgery,and pulmonary edema,heart failure and abnormal bleeding from the site in the wound during the perioperative period were recorded.Results The two groups were comparable with regard to the volume of multiple electrolyte solution consumed,blood loss,parameters of liver and kidney function,platelet count and incidences of hypokalemia and hypocalcemia (P ＞ 0.05).The urine output was significantly increased,Hct at T1 and Fib at T1,2 were significantly decreased,PT and APTT were prolonged,and the percentage of patients without allogeneic blood transfusion and incidences of prolongation of PT and APTT were significantly increased in group AHH as compared with group C (P ＜ 0.05).No pulmonary edema,heart failure and abnormal bleeding were found during the perioperative period.Conclusion AHH with 6％ HES 130/0.4 10 ml/kg provides better blood-saving effect in preschool children,has little effect on the internal environment,but prolongs the coagulation time and exerts effect on coagulation function to some extent.

Nowadays, ceremony education, as a specific education method, is becoming increasingly popular in medical humanistic education.It is a truth generally acknowledged that the importance of ceremony education is located at its extensive scope and plasticity.The cultivation of medical students' human-oriented spirit, strengthening their career identity and enhancing their ideological moralitycan be processed by ceremony education, in which much attention is attached to its four features, identity recognition, emotion polymerization, spirit conduction and cultural inheritance.However, there still exist some problems to be solved in the practice of ceremony education such as overformalization, insufficient individuation and systematization.That is what we mean to discuss in this paper.

Objective To observe the foveal contour characteristic of idiopathic epiretinal membrane (iERM).Methods A total of 53 eyes in 52 patients with iERM who underwent pars plana vitrectomy with epiretinal membrane and inner limiting membrane peeling were enrolled in this retrospective study.All eyes received the examination of optical coherence tomography (OCT) and minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA).Foveal contour grading was according to the ratio of central macular thickness (CMT) to the thickness of the retina 1 mm away on OCT line scan:Grade 0,depressed;Grade 1,flat;Grade 2,elevated.Baseline foveal contour grade was as follows:28 eyes with Grade 1 (Group 1),and 25 eyes with Grade 2 (Group 2).The mean logMAR BCVA was 0.40±0.26 in Group 1,and 0.60±0.27 in Group 2 respectively.The mean CMT was (433.52± 133.05) μm and (571.70± 85.40) μm respectively.The logMAR BCVA and CMT both demonstrated significant difference between the two groups (t=-2.825,-4.512;P＜0.05).OCT images and BCVA at 1,3 months after surgery were collected and analyzed.The change in foveal contour,BCVA and CMT were evaluated.The relationship between surgical outcome and different preoperative grading was analyzed.Results Foveal contour grade at 3 months after surgery was as follows:15 eyes with Grade 0,21 eyes with Grade 1,and 17 eyes with Grade 2,demonstrating significant difference compared with baseline (Z=-3.588,P＜0.05).In Group 1,there were 12 eyes with Grade 0,10 eyes with Grade 1,and 6 eyes with Grade 2 postoperatively.In Group 2,there were 3 eyes with Grade 0,11 eyes with Grade 1,and 11 eyes with Grade 2 postoperatively.The postoperative foveal contour grade was significantly different between the two groups (Z=-2.466,P＜0.05).The logMAR BCVA at 1,3 months after surgery both improved significantly compared with baseline (P＜0.05) in Group 1 (t=3.226,5.439) and Group 2 (t=-4.137,5.919).The logMAR BCVA at 1,3 months after surgery demonstrated significant difference between the two groups (t=-2.231,-2.291;P＜0.05).The CMT decreased significantly at 1,3 months after surgery in Group 1 (t=-2.674,4.090) and Group 2 (t=-9.663,-9.865) compared with baseline (P＜0.05).TheCMT at 1,3 months after surgery demonstrated significant difference between the two groups (t=-2.825,-3.003;P＜0.05).The improvement of logMAR BCVA 3 months after surgery was negatively correlated (P＜0.05) with preoperative logMAR BCVA (r=— 0.758) and preoperative CMT (r 0.359).Conclusion In iERM eyes,flat foveal contour had better surgical prognosis than elevated ones.

Objective To analyze the association of postnatal weight gain proportion of very low birth weight (BW) preterm babies and the onset of severe retinopathy of prematurity,and investigate the optimal cut-off points and predictive ability of postnatal weight gain (WG) proportion for the onset of retinopathy of prematurity (ROP).Methods A retrospective cohort study.257 preterm infants underwent screening whose weight was less than 1500 g were enrolled in this study.Risk factors include BW,gestational age (GA),history of oxygen inhalation,need for blood transfusions,Apgar score in 1 to 10 minutes,embryo number,delivery mode,in vitro fertilization infants,and WG proportion within 6 weeks after birth and other systemic diseases were recorded.Their correlation with severe ROP is analyzed.Clinical outcomes were divided into severe ROP group (patients who suffered from ROP and required treatment) and mild and no ROP group (patients who suffered from ROP but do not require treatment and-patient without ROP).The severe ROP group included 18 patients and mild and no ROP group included 239 patients.Multiple logistic regression and receiver operating characteristic (ROC) curve were used to determine if the WG proportion was independently related to severe ROP development and if it was capable of predicting severe ROP.This study determines the predict value by comparing the area under the ROC curve (AUC) of independent risk factors.Results GA (t=-4.835,P＜0.001),BW(t=-5.192,P＜0.001),history of oxygen inhalation (x2=6.001,P=0.009),proportion of infants who had oxygen inhalation for more than 10 days(x2 =10.019,P=0.002),postnatal WG proportion at 1 week(t =-3.663,P＜ 0.001),postnatal WG proportion at 2 weeks(t=-3.425,P=0.001) had significant difference between two groups.Multiple logistic regression analysis revealed that GA (β =-0.858,P =0.008),BW (β =-0.005,P =0.010),postnatal WG proportion at 2 weeks (β=-8.745,P =0.035) were correlated to severe ROP significantly.And their area under the ROC were 0.836[95％ confidence interval (CI):0.752-0.920],0.826 (95％CI:0.947-0.903),0.744 (95％CI:0.598-0.891) respectively.The optimal cut-off points of GA,BW,and postnatal WG proportion at 2 weeks were 28.41 weeks,1241.96 g,12.80％ respectively.Conclusion Low WG proportion at 2 weeks of very low BW preterm babies is an important and independent risk factor for severe ROP and has certain predictive value of the onset of severe ROP.

Objective To evaluate the diagnostic value of gastrin?17( G?17) and pepsinogen( PG) for gastric cancer. Methods A multicenter cross?sectional study of patients with continuous stomach discomfort from four centers including Changhai Hospital Affiliated to Second Military Medical University, the First Hospital Affiliated to Anhui Medical University, Qinghai Provincial People′s Hospital and the First Hospital Affiliated to Zhejiang University of Chinese Medicine from May 2014 to September 2015 was conducted. Before gastroscopy, fasting serum gatrin?17 and pepsinogen were analyzed by enzyme?linked immunosorbent assay(ELISA). The efficacy of G?17 and PG were evaluated according to endoscopic and pathological results. Results Based on the results of the pathological diagnosis, 1 122 cases were enrolled and divided into chronic atrophic gastritis group ( 548 cases ) , chronic non?atrophic gastritis group ( 370 cases), and gastric cancer group(204 cases). Serum G?17 and PGⅡ levels significantly increased(P<0?05) and PGR significantly decreased( P<0?05) in gastric cancer group compared with other groups. There was no significant difference in PGⅠlevel among three groups. The cut?off value of G?17 to diagnose gastric cancer was 7 pmol/L. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of G?17 for gastric cancer were 59?31%, 70?59%, 68?54%, 30?95% and 88?65% respectively. The cut?off value of PG Ⅰ/PG Ⅱ( PGR ) to diagnose gastric cancer was 7. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PGR for gastric cancer were 41?18%, 83?01%, 75?40%, 35?00% and 86?39% respectively. The cut?off value of PGⅡto diagnose gastric cancer was 10 μg/L. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PGⅡfor gastric cancer were 73?53%, 53?05%, 56?77%, 25?82% and 90?02% respectively. If G?17>7 pmol/L and PGR<7 was regarded as the cut?off value of diagnosis of gastric cancer, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 25?00%, 91?29%, 79?23%, 38?93%and 84?56%respectively. If G?17>7 pmol/L and PGⅡ>10μg/L was regarded as the cut?off value, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 48?04%, 79?74%, 73?98%, 34?51% and 87?35% respectively. If PGR<7 and PGⅡ>10 μg/L was regarded as the cut?off value, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 33?82%, 84?86%, 75?58%, 33?17% and 85?23% respectively. Based on logistic regression analysis of the independent variables of high serum G?17 value(>7 pmol/L), low serum PGR value(<7) and high serum PGⅡvalue(>10 μg/L), their OR value were 2?592, 2?237 and 1?864 respectively, and high serum G?17 value showed the highest risk of gastric cancer. Conclusion High serum G?17 and PGⅡ, low PGR are indicators of gastric cancer. Combination of G?17 and PGR has the best diagnostic value for gastric cacer. Gastric cancer can be screened in large scale by combining G?17 and PGR in order to improve the early diagnostic rate of gastric cancer and reduce the mortality of gastric cancer in our country.

OBJECTIVE To investigate the effect of injection of β2-adrenergic receptor agonist clenbuterol into the infralimbic cortex(IL) on drug-seeking behavior triggered by conditioned cues. METHODS Adult male SD rats were trained to self-administer heroin under a FR1 schedule for consecutive 14 d,followed by 2-h extinction training. Cue-induced heroin seeking was measured for 2 h. Clenbuterol was microinjected bilaterally into the IL(8 ng/side)of rats 15 min prior to reinstatement test. Meanwhile,locomotor activity was detected 15 min after clenbuterol or artifial cerebrospinal fluid(mod?el group) was microinjected bilaterally into IL. Western blotting was used to detect the expression of phosphorylated cyclic AMP response element-binding protein(p-CREB)in the prelimbic cortex(PL), IL,nucleus accumbens core (NACc) and shell (NACsh) of rats immediately after reinstatement test. RESULTS After heroin administration training for 14 consecutive days,these animals exhibited reliable heroin self-administration,indicated by the increase in active nose poke responses and infusions. The rats that had received infusion of clenbuterol into the IL had significantly lower active pokes (8 ± 3)than those in model group(45±10)in cue-induced reinstatement(P<0.01),but there was no significant differ?ence between clenbuterol group and vehicle group in the locomotor activity. The expression of p-CREB in either IL or NACsh was significantly decreased in clenbuterol group compared with model group(P<0.01,P<0.05),but significantly increased in NACc(P<0.01). CONCLUSION Microinjection of clenb?uterol into the IL can attenuate the cue-induced reinstatement of heroin-seeking behavior in rats. The underlying mechanism might be related to the regulation of p-CREB expression in the NACc and NACsh.

Objective To investigate the correlation between Young′s elastic modulus (EI) using shear wave elastography (SWE) and liver pathology .Methods Liver biopsy was performed on 231 patients with chronic hepatitis B (CHB) under supersonic guidance ,and SWE with EI of liver was obtained concurrently .The correlation between measured liver stiffness and pathology was analyzed by using the liver pathology as golden standards .One‐way analysis of variance and Spearman rank correlation analysis were performed for the comparison between groups and correlation between two variables , respectively .Receiver operating characteristic (ROC) curve was used to explore the predictive value of shear modulus for the liver inflammation grades and fibrosis stages .Results The EI medians of different liver inflammation grades were 6 .78 kPa (G1) ,7 .30 kPa (G2) ,9 .93 kPa (G3) and 14 .93 kPa (G4) , respectively ,which were statistically different (H=55 .19 ,P<0 .01) .And EI medians of various fibrosis stages were 6 .62 kPa (S0 -S1) ,7 .15 kPa (S2) ,9 .78 kPa (S3) and 14 .62 kPa (S4) ,respectively , which were also significantly different (H=62 .14 ,P<0 .01) .EI was positively correlated with both liver inflammation grades (r=0 .454 6 ,P<0 .01) and liver fibrosis stages (r=0 .505 6 ,P<0 .01) .The areas under the ROC for G≥2 ,G≥3 and G=4 were 0 .68 (95% CI:0 .61 -0 .75) ,0 .77 (95% CI:0 .70 -0 .84) and 0 .85 (95% CI:0 .77-0 .92) ,respectively .The areas under the ROC for S≥2 ,S≥3 and S=4 w ere 0 .73 (95% C I:0 .66 -0 .79 ) ,0 .78 (95% C I:0 .72 -0 .85 ) and 0 .83 (95% C I:0 .75 -0 .91 ) , respectively .Conclusion The EI measured by SWE is correlated with liver pathology of CHB patients , which may be used to dynamically monitor the progress of liver fibrosis .

Background: Chronic atrophic gastritis (CAG) is a precancerous lesion of gastric cancer.The diagnostic value of serum gastrin-17 (G-17) level for CAG differs substantioulsy, and Helicobacter pylori (Hp) infection may play an important role.Aims: To explore the effect of Hp infection on serum G-17 level, and the diagnostic value of serum G-17 level for CAG under different Hp infection status.Methods: A total of 204 patients with chronic non-atrophic gastritis and 81 patients with CAG from May 2014 to May 2015 at the three different hospitals were enrolled.Gastroscopy was performed, fasting serum G-17 level, postprandial serum G-17 level and Hp-IgG antibody were determined by ELISA.Results: Fasting serum G-17 level was significantly increased in Hp positive group than in Hp negative group (P=0.001), and postprandial serum G-17 level was significantly decreased in CAG group than in non-atrophy group (P=0.002).AUC of fasting serum G-17 level for diagnosing Hp positive and negative CAG were 0.634 (95% CI: 0.537-0.732) and 0.576 (95% CI: 0.478-0.675), respectively, the accuracy were 62.6% and 54.9%, respectively.AUC of postprandial serum G-17 level for diagnosing Hp positive and negative CAG were 0.675 (95% CI: 0.581-0.769) and 0.595 (95% CI: 0.495-0.694), respectively, the accuracy were 61.8% and 53.1%, respectively.Conclusions: Hp infection has impact on serum G-17 level, as a result, the diagnostic value of G-17 level for CAG is different for patients with and without Hp infection.Diagnostic values of fast and postprandial serum G-17 for Hp positive CAG are higher than Hp negative CAG.