Diabetic retinopathy (DR) is a sight-threatening chronic complication of diabetes mellitus and is the leading cause of acquired blindness in adults. Long-term exposure to the hyperglycemia of diabetes patients leads to the development of DR. Several studies have provided evidence that good diabetes control is important to prevent DR. However, emerging evidence suggests that genes are a significant contributor to an individual's risk of retinopathy. This evidence is from evaluations of familial aggregation and different incidence of DR in racial and ethnic groups. Some groups of patients develop DR despite good control and some escape retinopathy despite poor control. This suggests that the genes are involved in the susceptibility to DR. Genes suggested as having a role include those encoding aldose reductase, nitric oxide synthase, receptor for advanced glycation end products, angiotensin converting enzyme, vascular endothelial growth factors and pigment epithelium-derived factor. An understanding of the role of susceptibility genes will ultimately allow the development of novel therapeutic strategies. This article reviews the role of genetic factors in the etiology and progression of DR.

Background Congenital cataract is the major cause of blindness in children with plentiful clinical manifestations and closely linked with genetics. Objective Present study was to investigate the classification of congenital cataract in Yunnan province.Methods The manifestation characteristics of 184 eyes of 116 patients with congenital cataract in Yunnan province were analyzed.The relationship of performance of various types of congenital cataract between phenotype and hereditary feature were explored. Results All of the 116 congenital cataract eyes from 116 patients were divided into ten types based on the clinical appearance,including the complete cataract,nuclear cataract,posterior polar cataract,anterior polar cataract,coralliform cataract,coronary cataract,pulverulent cataracts,lamellar cataract and blue cataract.Bilateral nuclear cataract and unilateral entire cataract is most prevalent in these patients.Blue cataract and coralliform cataract belong to the less types.Forty-four in 116 cases were found to have the hereditary history and determined as autosomal dominant inheritance.Sporadic cases were determined in 72 cases.Conclusions The analysis of phenotype of the hereditary congenital cataract offers some clues to the classification of congenital cataract.

After the recent studies on virtual learning communities of medical education were described, the per-sonal service of learning resources in virtual learning communities was elaborated in aspects of personal learning re-sources and platform with medical online open learning platform, namely the basic medical teaching resource net-workas an example .

Objective To explore the impacts of 75％ low-protein diet intake during gestation on fetal growth restriction (FGR) rat model establishment.Methods Thirty-eight pregnant Sprague-Dawley rats were included into the study.At first,five pregnant rats were fed with sufficient normal diet with protein content of 22％.Their daily food consumption was recorded and taken as the basis to determine daily feed consumption of 75％ low-protein group (protein content 9.2％).In order to ensure that each group finally had at least ten pregnant rats to deliver,there were 11 rats assigned to the control group (pregnant rats fed with sufficient normal diet,protein content was 22％),13 to the low-protein group (pregnant rats fed with low protein diet,protein content was 9.2％,but the food consumption was the same as control group) and 14 to the 75％ lowprotein group (pregnant rats fed with low-protein diet,protein content was 9.2％,the food consumption was 75％ of the control group).All female rats were fed with sufficient normal diet after delivery.The body weight,overall weight gain during gestation,the mortality rate and the non-delivery rate of pregnant rats were compared.The third day's newborn weight after birth,FGR incidence and the mortality rate within three days after birth of newborns were also compared.One way analysis of variance,LSD-t test,independent sample t-test and Chisquare test were used as statistical methods.Results (1) The body weight of pregnant rats:There was no significant difference in body weight among the three groups at gestational day 0,3 and 6.On day 9,body weight of 75％ low-protein group [(271.9±8.4) g] and low-protein group [(274.1 ±7.8) g] were significantly lower than that of the control group [(287.2± 18.7) g] (t=2.514 and 2.170,both P＜0.05),but there was no significant difference between the former two groups.On Day 12,body weight of 75％ low-protein group [(275.7 ± 10.7) g] and low protein group [(285.1 ± 12.5) g] were significantly lower than that of the control group [(306.4±29.7) g] (t=3.262 and 2.218,both P＜0.05),and the difference between the former two groups was also statistically significant (t=2.098,P＜0.05).Before delivery,body weight of 75％ low-protein group,low protein group and control group were (300.4±14.1) g,(317.0±16.3) g and (372.9±19.1) g,respectively with statisticall significance (F=64.219,P＜0.05).The overall weight gain during pregnancy for 75％low-protein group,low-protein group and control group was (61.6± 19.8) g,(81.8±21.6) g and (139.3± 12.0) g,respectively.The difference among the three groups was statistically significant (F=55.863,P＜0.05).(2) The mortality rates of pregnant rats for 75％ low-protein group,low-protein group and control group were 3/14,2/13 and 1/11 respectively without significant difference (P＞0.05).Neither was the non-delivery rate within 30 days (embryonic resorption) for the three groups (1/14,1/13,0/11,P＞0.05).(3) The numbers of pups were 101 in 75％ low-protein group,104 in low-protein group and 107 in control group.The newborn mortality rate within three days after birth was 28.7％ (29/101) in 75％ tow-protein group and 23.0％ (24/104)in low-protein group,with were significantly higher than that of the control group (7.5％,8/107) (x2=16.022and 9.976,both P＜0.05),but there was no significant difference between groups.The third day's newborn weight after birth for 75％ low-protein group,low-protein group and control group were (6.3 ±0.8) g,(6.9±0.9) g and (8.1 ±0.9) g,the difference was statistically significant (F=90.602,P＜0.05).FGR incidence for 75％ low-protein group was 55.6％ (40/72),which was significantly higher than that of the low-protein group (28.8％,23/80) and the control group (5.0％,5/99) (x2=11.220,54.834 and 18.833 all P＜0.05).Conclusion 75％ low-protein diet feeding during pregnancy is an ideal method to induce FGR rat model with high FGR incidence,whereas and low mortality rates of pregnant rats,the fetuses and newborns.

Objective To explore the clinical application of humoral mode of the Sysmex XE-5000 automatic blood cell analyzer in the count and differential count of hydrothorax and ascites white blood cell(WBC).Methods The 196 clinical specimens of hy-drothorax and ascites from the hospitalized patients were collected and conducted the WBC count and differential count by the hu-moral mode of the Sysmex XE-5000 automatic blood analyzer (streaming technology with semiconductor laser-instrument method) and the artificial microscope counting method (manual method).The specimens were divided into two groups according to the in-strument counting results,the group A:(0 -1 500)× 106/L and the group B:>1 500 ×10 6/L and the correlation between two methods was analyzed.Results The data analysis demonstrated that the two kinds of methods for detecting the WBC count and dif-ferential count of hydrothorax and ascites had good correlation,and the difference had no statistical significance (P >0.05).Conclu-sion The humoral mode of the Sysmex XE-5000 automatic blood cell analyzer has a good application value for detecting WBC count and differential count of hydrothorax and ascites.

Background Retinal angiomatous proliferation (RAP) is a subtype of neovascular age-related macular degeneration (AMD).There are currently very few studies on RAP.Objective This study was to explore the pathogenic mechanism of RAP in apolipoprotein E-deficient (ApoE-/-) mice with dyslipidemia.Methods Twenty-four 2-month-old SPF ApoE-/-mice were randomly divided into the high fat diet group and the normal diet group,and twelve 2-month-old C57BL/6 mice received the normal diet as controls.A diet with a higher content of fat was given for 4 consecutive months in the high fat diet group,and normal diet was given in the same way in the mice of the normal diet group.The mice were sacrificed at 6 months of age.The expression of vascular endothelial growth factor (VEGF) in the retinal pigment epithelial (RPE) cells,the expression of vascular endothelial growth factor receptor-2 (VEGFR-2) in the outer plexiform layer (OPL),microvascular density (MVD) and microvascular area (MVA) in the OPL were examined by immunohistochemistry and semi-quantitatively by histopathology with the Mias 2000 Imaging Analyzer System.The expression of VEGF protein in the retina was examined by Western blot.Results The MVD in the retinal OPL were (20.67±3.20) and (19.50± 1.87),respectively,in the ApoE-/-mice of the high fat diet group and the normal diet group,which were significantly higher than that (12.50±1.87) of the C57BL/6 normal diet group (all at P＜0.01).MVA in the retinal OPL were (626.49± 120.99) μm2 and (514.06±88.83) μm2 in the ApoE-/-mice of the high fat diet group and the normal diet group,respectively,showing a significant increase in comparison with the (336.52±84.96) μm2 of the C57BL/6 normal diet group (P＜0.01).The staining area of VEGF in RPE cells was (21 048±1849) μm2 in the ApoE-/-mice of the high fat diet group,showing a significant increase in comparison with the (17 116±2023) μm2 of the C57BL/6 normal diet group.However,no significant difference was found in the staining area of VEGF between the ApoE-/-mice with normal diet group and the C57BL/6 normal diet group ([17 854±2967] μm2 vs.[17 116±2023] μm2) (P＞0.05).Significant elevation was also seen in the staining area of VEGFR-2 in the retinal OPL of the ApoE-/-mice of the high fat diet group (12 193±3806)μm2 and the ApoE-/-mice of the normal diet group (11 969± 3616)xm2 compared with C57BL/6 mice of the normal diet group (5387±2225)μm2(all at P＜0.01).The relative expression values (VEGF/β-actin) of VEGF in the retinas were (1.51 ±0.32) and (1.17±0.39) in the ApoE-/-mice of the high fat diet group and the normal diet group,respectively,showing a significant increase in comparison with (0.28±0.14) of the C57BL/6 normal diet group (P＜0.01).Conclusions The expression of VEGF and VEGFR-2 in the retinas increases in the ApoE-/-mouse,which leads to the enlargement of MVD and MVA in the retinal OPL and subsequent RAP occurrence.

Background Certain relationship has been found between phenotype and genes mutation of congenital cataract.It is clear that different genetic mutations can cause the same complication in congenital cataract,meanwhile,different complications may be caused by the same gene mutation.However,their mechanism is still remained unclear.Objective This study was to observe the phenotype of congenital cataract accompanied with iris dysplasia.Methods Fifteen patients with congenital cataract accompanied with iris dysplasia were included in this study.The slit lamp,gonioscope and ophthalmoscope were used for the examination of the anterior ocular segment,the anterior chamber angle and fundus on all the patients.This study was approved by the Ethic Committee of Second People' s Hospital of Yunnan Province.Written informed consent was obtained from each patient or the custodian prior to any medical procedure.Results All the patients showed binocular involvement.Congenital nuclear cataract with whole coloboma of iris was seen in 7 cases,and 2 cases showed an entire cataract associated with incomplete coloboma of iris.Entire cataract with aniridia was diagnosed in 5 patients,and suture cataract complicated with aniridia was in 1 patient.Conclusions Some regular patterns can be implied between the morphological type of cataract and iris dysplasia,which may be helpful for further study of these diseases.

Objective The purpose of this study is to evaluate the safety and effect of the homemade wrist restraint belt in postoperative patients during anesthesia recovery period.Methods Three hundred postoperative patients were randomly assigned into two groups,patients in the control group(n =150)were constrained with traditional restraint belt while patients(n =150)in the observation group were constrain-ed with homemade wrist restraint belt before recovered from general anesthesia in the post anesthesia care unit (PACU).The effectiveness of constraint,patients comfort,constraint related complications,PACU faculty responses on the satisfaction were recorded during anesthesia re-covery period.Results The complications in the observation group were lower than those in the control group (P <0.05).Compared with con-trol group,the patient satisfaction,patient comfort,PACU faculty satisfaction were significant higher in the observation group (P <0.05).Con-clusion The homemade wrist constraints could increase the patient’s safety and comfort,reduce restraint belt related complications during anesthesia recovery period.It revealed more effectiveness than the traditional restraint belt.

Objective To investigate the distribution and antibiotic resistance of clinical isolates in People’s Hospital of Qingyang during 2014 to provide evidence for rational antimicrobial therapy.Methods Bacterial strains were isolated and identified by routine methods and tested by disk diffusion method and E-test for antimicrobial susceptibility. The data were analyzed according to CLSI breakpoints using WHONET 5.6 software.Results Of the 2 121 nonduplicate strains isolated from January through December 2014, 1 565 (73.8%) were gram-negative and 556 (26.2%) were gram-positive strains. The top ifve pathogens wereE. coli, K. pneumoniae, A. baumannii, S. aureusand P. aeruginosa. The prevalence of methicillin-resistantStaphylococcus aureus (MRSA) and methicillin-resistant coagulase negativeStaphylococcus (MRCNS) was 44.6% and 15.4%, respectively.E. coli was the most common gram-negative bacterial species, whileS. aureus was the most common gram-positive bacteria species. Gram-positive bacteria were still highly susceptible to vancomycin, and gram-negative bacteria (such as Enterobacteriaceae) were still highly susceptible to carbapenems.ConclusionsE. coli is the most prevalent pathogen isolated from inpatients in this hospital during 2014. The prevalence of ESBLs-producing strains is the highest inE. coli isolates. The pathogenic bacteria in this hospital showed increasing resistance to a variety of antibacterial agents. Surveillance of antibiotic resistance and effective control measures are necessary to control the growing antimicrobial resistance.

Objective To explore the effect of comprehensive management of cardiac rehabilitation on the quality of life of patients after percutaneous coronary intervention(PCI). Methods A total of 60 patients with PCI were randomly divided into the rehabilitation group and the control group with 30 cases each by convenience sampling method. The control group received routine treatment and nursing care of postoperative PCI, and the rehabilitation group received cardiac rehabilitation management on the basis of the control group, including training guidance, management of double heart psychological intervention, nutritional intervention diet guidance, evidence-based medicine, and set up system etc. The Hospital Anxiety and Depression Scale(HADS) score, 6 minutes walking distance (6MWD), coronary heart disease risk factors and Seattle Angina Score (SAQ score) were observed at 6 months after PCI. Results HADS score anxiety rate, depression rate, anxiety and depressive state at 6 months after PCI was 10.0%(3/30), 10.0%(3/30), 0 respectively in the rehabilitation group, and 33.3%(10/30), 36.7%(11/30), 13.3%(4/30) in the control group respectively, and there was significant difference between 2 groups (χ2=4.504, 5.963, 1.071. all P<0.05). 6MWD was (451 ± 48) m in the rehabilitation group and (402 ± 42) m in the control group, and there was significant difference between 2 groups (t=6.155, P=0.022). Compared two groups of coronary heart disease risk factors control level: there was significant difference in total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, glycosylated hemoglobin, body mass index, systolic pressure, diastolic pressure(t=-2.927-5.981, P<0.01 or 0.05). SAQ score in physical limitation, angina stability , angina pectoris, treatment satisfaction, disease awareness scores were (73.79 ± 6.04), (80.35 ± 7.63), (75.31 ± 8.11), (80.23 ± 5.44), (76.59 ± 14.29) points in the rehabilitation group, and (53.19 ± 5.13), (65.87 ± 18.85), (64.41 ± 6.31), (70.49 ± 8.01), (45.83 ± 8.65) points in the control group, there were significant differences between 2 groups (t=-21.630-18.959, all P<0.01). Conclusions The comprehensive management of cardiac rehabilitation alleviates the anxiety and depression of patients after PCI, reduces the risk factors of coronary heart disease, and improves the exercise ability and quality of life.