Thirty assistant general practitioners (GPs) of Jiading District Shanghai were trained for clinical skills and communication skills by using standardized patients (SP) in outpatient department from January to April 2014.The scores of clinical skills and communication skills were evaluated and compared before and two months after training.The results showed that the score of clinical skills [(72 ± 5) vs (56 ± 7), t=7.871, P＜0.05] and communication skills [(71 ±4) vs (45 ±5), t =9.573, P＜0.05] were significantly improved after training.After training, the scores of medical history taking [(36 ±5) vs (28 ± 6), t =4.352], clinical thinking [(17 ± 2) vs (14 ± 3), t =3.974], health education [(3 ± 1) vs (2 ± 1), t =3.090] and medical record v,riting [(13 ± 1) vs (8 ±2), t =5.317] were significantly higher than those before training (all P ＜ 0.05).But there was no difference in reception time management [(4 ± 0) vs (4 ± 0), t =1.025] before and after training (P ＞ 0.05).After training, the scores and the proportions of the trainees qualified for building physician-patient relationship [(20 ± 3) vs (15 ± 4), t =4.056],collecting information and providing feedback [(22 ±4) vs (13 ±3), t =4.682], understanding complaints from patients' perspective [(5 ± 2) vs (3 ± 2), t =3.107], sharing information and obtaining informed consent [(19 ± 4) vs (11 ± 5), t =4.322] and closing consultation [(6 ± 2) vs (3 ± 1), t =2.987] were higher than before training (all P ＜ 0.05).The results indicate that training by using SP can effectively improve the clinical skills and communication skills of assistant GPs.

BACKGROUND: Long-term follow-up of the patients undergoing anterior cervical discectomy and fusion (ACDF) shows some incidence of degeneration at the segments adjacent to the fusion level. Cervical total disc replacement may resolve this problem. OBJECTIVE: To compare the effects of cervical total disc replacement versus ACDF on the biomechanics of the segment adjacent to the operation level. DESIGN, TIME AND SETTING: The randomized controlled trial was performed at biomechanical laboratory in Beijng Trauma and Orthopaedic Institute from August 2007 to February 2008. MATERIALS: Eighteen samples of fresh goat cervical spine; Bryan artificial cervical disk (Medtronic); CSLP-VA cervical plate (Synthes); coral bone (Beijing Yihuajian Science And Trade Co., Ltd.). METHODS: The goat spines were divided into 3 groups: control group with no specific treatment; total disc replacement group, in which C5/6 segment underwent Bryan artificial cervical disk replacement and fusion; internal fixation group, in which the C5/6 segment underwent cervical discectomy, coral bone implantation and internal fixation with CSLP-VA cervical plate. MAIN OUTCOME MEASURES: The adjacent intervertebral disk pressure (IDP) was measured in flexion, extension, rotation and lateral bending under certain loading, and the pressure changes were compared among three groups. RESULTS: At level C4/5, the IDP between total disk replacement group and the control group had no statistical significances in flexion (P 0.05) but internal fixation group was significantly higher than control group (P=0.014). There were no significant differences among the three groups in IDP in extension, rotation and lateral bending. CONCLUSION: Compared with ACDF, the total disk replacement can reduce the adjacent segment IDP and may avoid the degeneration in adjacent cervical segment.

BACKGROUND: Although the clinical effect of cervical disk replacement in short term has been ascertained, but the middle and long term result is not known, especially for the adjacent level. OBJECTIVE: To observe clinical result and effect of cervical disk replacement on adjacent level in middle and long term. DESIGN, TIME AND SETTING: Retrospective case analysis was performed at Beijing Jishuitan Hospital from December 2003 to March 2005. PARTICIPANTS: Thirty-three patients (aged 35-73 years) undergoing cervical disc replacement were followed up for 3 years. Of them, 25 patients received one-level disk replacement, and 8 received two-level disk replacement. METHODS: The clinical results and imaging before and after operation were compared. MAIN OUTCOME MEASURES: Clinical indexes including JOA grade, Odom’s grade, NDI, SF-36; X-ray: Kellgren X-ray grade, disk cervical height, disk motion, Pfirrmann disk grade, sigittal diameter of spinal cord, and compression of the spinal cord. RESULTS: The point of JOA is 13.62?2.31 before operation, 15.75?1.55 after operation; the differences were significant (P=0.000). For Kellgren X-ray, 10 levels occurred degeneration above the disk replacement level, accounted for 33% (P=0.004), and 9 levels developed degeneration below the disk replacement level, accounted for 32% (P=0.011). No obvious changes in imaging indexes were observed before and after surgery. CONCLUSION: The clinical outcome of cervical disk replacement is good in middle-term follow up. Some adjacent level degeneration may occur after cervical disk replacement, and the degeneration type is osteophyte formation in the adjacent level. This kind of adjacent level degeneration does not affect the clinical outcome in middle term follow-up.

Objective To assess the usefulness of a computer-aided detection(CAD)system on detecting the pulmonary nodules in digital chest radiography.Methods Three hundred and twenty-eight digital chest radiographies along with corresponding chest computed tomography were selected for this study. Two senior chest radiologists interpreted these cases using the CAD system and marked the locations and sizes of all nodules with consensus,which were stored in a computer system as Gold Standard to evaluate the performance of the CAD system.Eight radiologists of various experience read these selected cases without and with the aid of CAD system and their results were stored in a computer system.The radiologists' performance was evaluated by using the receiver operating characteristic analysis.Comparison is made regarding the difference in Az values when CAD was not used versus when CAD was used by using the paired-samples t test.Results For small nodules,the sensitivity of this computer system used by the two senior chest radiologists in 100 digital radiographs was 78.1%(118.0/151).Without and with the assistance of CAD system,the nodule detection sensitivity of the radiology residents was 62.4% (94.2/151),77.4%(116.8/151)respectively,and the area under the curve of radiology residents was 0.769,0.836 respectively.Statistical analysis showed there was statistically significant difference between interpretation without and with the CAD system(P0.05).Conclusions This CAD system can help to enhance the radiologists' ability to detect small pulmonary nodules.This is especially helpful for radiology residents.

HIV-1 integrase (IN) is a key enzyme for the viral replication. The protein-protein interaction (PPI) between HIV-1 IN and a cellular cofactor lens epithelium-derived growth factor (LEDGF/p75) is a validated target for anti-HIV drug discovery. In order to build the platform for screening inhibitor against PPI between IN and LEDGF/p75, the vector containing the LEDGF/p75 protein cDNA was constructed and expressed in Escherichia coli and the function of the LEDGF/p75 protein was assayed. The LGDGF/p75 encoding gene optimized according to the preference codon usage of E. coli, was synthesized and cloned into the expression vector pGEX-4T-1 to form a recombined plasmid, then transformed into host cell E. coli BL21 (DE3). The recombined clones were identified and confirmed by BamH I/Sal I digestion and sequencing, the successfully recombined plasmid in the host cell was induced by IPTG and the condition of the expression was optimized. The expressed protein was purified by the Ni2+ affinity chromatography column and SDS-PAGE was used to analyze the molecular weight and specificity. In addition, ELISA assay was used to analyze the function of the recombinant protein. The recombinant LGDGF/p75 was soluble, and expressed highly and stably in E. coli. The protein was proved to enhance HIV-1 IN strand transfer activity in vitro by ELISA. It will be helpful to build the platform of screening inhibitors against PPI between IN and LEDGF/p75.
Cloning, Molecular ; Escherichia coli ; metabolism ; HIV Integrase ; metabolism ; HIV-1 ; physiology ; Humans ; Intercellular Signaling Peptides and Proteins ; biosynthesis ; Protein Binding ; Virus Replication

Objective To investigate question comprehension and production among agrammatic aphasics, and to explore the mechanisms of any dysfunction in questioning.Methods Twenty aphasics were recruited in this study.According to the Chinese Agrammatism Battery,10 were classified as agrammatic (the agrammatic group) and 10 as non-agrammatic (the non-agrammatic group).Ten normal subjects served as a control group.All the subjects were tested in terms of their comprehension and production of questions using a set of general and what-where-who- why questions (wh-questions).Results No significant difference was found between the two experimental groups with regard to the correct comprehension and production of both general and wh-questions.However,there was a sig- nificant difference in correctness between comprehension and production.The performance of the agrammatic aphasics was worse than that of the non-agramatics and the normal subjects.Conclusion The impaired question comprehen- sion and production of Chinese agrammatic aphasics has its own characteristies which can form a basis for rehabilita- tion planning and outcome prediction.

Objective To summarize the experience and clinical characteristics in liver re- transplantation following adult-to-adult living donor liver transplantation.Methods Due to biliary complication (2 cases),vascular complication (2 cases),chronic rejection (1 case) and hepatitis recur- rence (1 case),liver re-transplantation was performed on 6 patients through modified piggyback liver transplantation.Vascular anastomosis was performed between the hepatic arteries of donor livers and receptor abdominal aorta in 1 case,and the rest were subjected to end-to-end homonymic vascular anastomosis.Results No operative death occurred.Due to primary non-function,1 died after the ope- ration.During the follow-up period,1 had anastomotic stricture of hepatic artery after the operation and was cured by percutaneous venoplasty.The survival of the rest patients was 12,9,6,4 and 3 months respectively.Conclusion Peritoneal adhesion is the operative difficulty for liver re-transplantation following adult-to-adult living donor liver transplantation.

Objective To observe the effect of health education and installation of improved stove in control of coal-burning-borne endemic fluorosis in Pingba County of Guizhou Province.Methods Two towns(Shizi and Qibo) of Pingba County that had implemented the health education and installed the improved stoves for control of coal-burning-borne endemic fluorosis were selected as the investigation sites.Two villages in each selected town and 30 householders as well as all students of grade 4-6 were investigated.Questionnaires were made by survey of the fluorosis control knowledge,household investigations were used to know the use of household stoves,corn and peppers drying method,and the dental fluorosis of children aged 8-12 were examined by Dean methods before the intervention(2006) and after implementation(2009) of health education and improvement of stoves.Results The awareness of fluorosis control among students and households after the intervention was 97.36％ (405/416) and 86.46％(415/480),respectively,and the difference was statistically significant(x2 =658.86,163.10,all P ＜ 0.01) compared with that before the intervention [32.19％(1083/3364),43.33％(130/300)].Correct using rate of the household stoves was 95.42％ (229/240) after the intervention and 45.85％ (3976/8672) before the intervention,the difference was statistically significant(x2 =230.25,P ＜ 0.01).The correct rates of drying corn and chili were 91.67％ (110/120) and 97.50％ (117/120) before the intervention,and 20.00％ (12/60),26.67％ (16/60) after the intervention,the difference was statistically significant(x2 =94.07,104.02,all P ＜ 0.01).The incidences of dental fluorosis of children aged 8-12 were 31.21％(1305/4182) after the intervention and 87.71％(2856/3256) before the intervention,the difference was statistically significant(x2 =2371.91,P ＜ 0.01).Conclusions The measures of health education and intervention of stove improvement in Pingba County of Guizhou Province for prevention and control of coal-burning-borne endemic fluorosis is effective.

BACKGROUND: The biomechanical characteristics of kyphosis of the upper thoracic vertebra are unique. Decompression and internal fixation are relatively difficult. Previous relevant studies and case reports are few, and there is a lack of research on correction of kyphosis of the upper thoracic section with the assistance of computer navigation. OBJECTIVE: To explore the clinical effect of computer navigation-assisted surgical treatment of upper thoracic kyphosis by screws and osteotomy. METHODS: Totally 18 patients with kyphotic deformity of the spine (T1-T4) were admitted in Beijing Jishuitan Hospital from June 2011 to June 2018, including 11 males and 7 females, aged 12 to 59 years. They were all treated with computer-assisted surgical treatment with PSO osteotomy. Local Cobb angle of the upper thoracic kyphosis was determined during final follow-up. Cervical visual analogue scale, Nurick grades, EMS scores and satisfaction of the surgery were evaluated. This study was approved by the Ethics Committee of Beijing Jishuitan Hospital (approval No. 201709-23). RESULTS AND CONCLUSION: (1) A total of 18 patients were followed up for 6-90 months at an average time of (33. 73±35. 33) months. (2) The local Cobb angle of 18 patients at the last follow-up was significantly improved [(47. 32±9. 92)°, (24. 01 ±7. 64)°, P < 0. 001]. Cervical visual analogue scale score at the last follow-up was significantly lower than that before surgery (3. 64±2. 16, 0. 73±1. 01, P< 0. 001). Nurick score at the last follow-up was significantly lower than that before surgery (2. 91 ±0. 94, 0. 82±1. 47, P < 0. 001). EMS score at the last follow-up was significantly higher than that before surgery (14. 45±0. 93), 17. 09±1. 45, P< 0. 001). (3) Surgical satisfaction was excellent (n=16) or good (n=2). (4) At the last follow-up, 18 patients had no adverse reactions related to implants, and the wound healed well without screw loosening. (5) The results showed that reasonable osteotomy correction with computer-assisted surgery and PSO osteotomy could effectively treat kyphosis of upper thoracic segment.

Although private hospitals are generally encountering development difficulties, some private non-profit medical institutions thrived in the medical market. These hospitals have rich experiences in terms of manage-ment system, operation mechanism, and competition methods. In this paper, we summarize the experiences of those well-functioning private non-profit hospitals and analyze the essential conditions for developing private non-profit med-ical institutions. These conditions include meeting local health market needs, ensuring that the hospital management system and operation mechanism result in high-quality health services, ensuring hospital development meets local health plans ( in order to obtain policy support) , ensuring the goal of the hospital is public welfare and that the hospital has strong financial support, obtaining certain social and political capital, and ensuring high-quality managers and staff.