The design aims at improving and enriching nurturance theories and practice paradigms related with medical students' doctor-patient communicating competence.It is based on the view about cultivating and evaluating undergraduates' doctor-patient communicating competence and the theoretical basis about the existing research achievement and follows teaching practice regular pattern.Doctorpatient communicating competence of undergraduates has its own multidimensional meanings.Construction methods are as follows:taking one course as the core; enrolling multidimensional discipline in classroom teaching; combining classroom teaching with varieties of practice; establishing medical case communication training model; introducing appropriate evaluation system.Its construction principles should be found on the humanistic essence.

Objective To explore the necessities and clinical value of acute intestinal obstruction with com-puted tomography of whole abdomen in over 80 years old patients.Methods 50 patients with acute intestinal obstruc-tion were diagnosed in department of emergency surgery and underwent the abdominal CT examinations.The clinical data,CT and surgery pathology of all patients were compared and analyzed.Results All cases were verified by surgi-cal operation and pathological diagnosis,including colorectal cancer(n =21)and incarcerated abdominal external her-nia(n =21),appendicitis(n =2),adhesive intestinal obstruction(n =2),intestinal volvulus (n =2),and intestinal intussusception(n =1)and stercoral intestinal obstruction(n =1),12 cases were accompanied by bowel necrosis and perforation.12 patients were treated by laparoscope surgery,38 cases by open laparotomy,48 patients acquired good recovery,and 2 cases died from extensive bowel necrosis and multi -organ failure.Conclusion CT examination in whole abdomen could rapidly and accurately diagnose the cause of intestinal obstruction,evaluate complications and risks,so as to provide reasonable treatment choice and time,making patients acquired the effective effects as soon as possible,reducing the bad consequences.

Objective To establish fingerprint and mutual mode of aqueous extracts of Eucommia ulmoides Oliv.from different regions by high performance liquid chromatography ( HPLC). Methods The column of SinoChrom ODS￣BP (250 mm×4.6 mm, 5 μm) was used.The mobile phase consisted of acetonitrile￣0.1% phosphoric acid with gradient elution.The flow rate was 1.0 mL.min-1 , the detective wavelength was 230 nm, and the column temperature was 25 ℃ . Results The fingerprint consisted of 14 common peaks.The overall similarity for ten batches of Eucommia ulmoides Oliv.from different regions was 0.592-0.986.The standard fingerprint of Eucommia ulmoides Oliv.was established by HPLC. Conclusion This fingerprint method is simple and repeatable, and it provides a scientific basis for the quality control of Eucommia ulmoides Oliv.

Objective To investigate the status of life quality in the elderly in Shanxi Province Changzhi City, and to analyze its influencing factors. Methods The quality of life, activities of daily living and status of community services were measured simultaneously by 36-Item Short Form Health Survey (SF-36). Activities of Daily Living Scale, Community Healthy Needs Scale and survey results were used and analyzed using t-test, correlation and stepwise regression analysis. Results According to the criterion of life quality in the elderly which were proposed by Zhang Lei, the quality of life in the elderly scored 72. 1-117.0, reached 98.5%. The quality of life in the elderly was impacted by the ability of caring oneself, marital status, degree of culture, economic situation and so on. The demand rate for health guidance and periodic physical examination was higher. Conclusions The quality of life in the elderly is at a medium level. There is a wide gap between the demand of community healthy services and the utilization of community healthy services.

Objective To investigate the quality of life of elderly caregivers and its factors. Methods Elderly caregivers living in Changzhi City were enrolled in this study. 36-item short-form (SF-36) health survey and Activity of Daily Living Scale ( ADL) were used as study tools. The data was analyzed by statistical description,t test or multiple regression. Results Those with score of quality of life reaching 72. 1 to 117. 0 accounted for 98. 8%. The total score and score of eight dimensions of SF-36 showed statistically significant difference between different daily living activity groups ( P < 0.05) . The state of health and self-care ability of the elderly imposed a major impact on eight dimensions of SF-36. Age, sex, level of education, marital status and wage had different impact on each dimension of SF-36. Conclusion The quality of life of elderly caregivers is at a medium level. The main factors of quality of live of elderly caregiver are their state of health and self-care ability of the elderly.

TheMeridian and Acupoint Science is a basic course in the major of acupuncture-moxibustion and tuina. We applied target-guided teaching method in teaching this course to evoke student's interest in studyingMeridian and Acupoint Science through initiative guidance, and boost student's initiative and enthusiasm by exhibiting the teaching targets. During the practice, we emphasized the specification of each unit target, around which we adopted various methods; meanwhile, we also focused on prompt evaluation, based on which necessary adjustments would be made to approach the targets. Teachers should act as guider, maintainer and promoter in class, rather than transmitter, to help students to study positively rather than passively listen. Via this kind of teaching reform, students not only obtained knowledge, but also enhanced their capability and feelings.

Objective To study the protective effect of compound nitroglycerin gel on rats with skin ulcer wound and its action mechanism. Methods Skin ulcer modle of 54 rats was established.Then the rats were randomly divided into three groups (n=18 each), including model control group, Jin wan hong group, and compound nitroglycerin gel group. Wound healing process and healing time were recorded.At the day 7 and 14 after the model was established, the number of fibroblasts and new blood capillaries of granulation tissue from center of the wound were measured,and RT-PCR was used to detect mRNA expression levels of VEGF, Ang1 andHIF-1α. Results As compared with model control group [(24.17±5.91) days], healing time of skin in the compound nitroglycerin gel group was significantly shorter [(14.67±3.76) days, P<0.01].The numbers of fibroblasts (61.20±7.56) and new blood capillaries (9.35±1.43) were increased, and mRNA expression levels of VEGF (1.692±0.196), HIF-1α (1.527±0.174) and Ang1 (1.548±0.203) were remarkably up-regulated on 7th day (P<0.05 or P<0.01).While on 14th day, the numbers of fibroblasts (28.00±5.96) and new blood capillaries (4.20±1.30) were decreased and the mRNA expression levels of VEGF (1.156±0.123), HIF-1α(1.021±0.105) and Ang1 (1.034±0.134) were significantly down-regulated (P<0.05 or P<0.01) . Conclusion Compound nitroglycerin gel can treat skin ulcer wound via regulating the numbers of fibroblasts, new blood capillaries and VEGF/Ang1/HIF-1α signal transduction pathway.

OBJECTIVE:To prepare Premna fulva craib liniments and to establish a method for its quality control.METHODS:The liniments was prepared from yellowhairy premna stem,rhizoma drynariae,borneo and menthol in70%al-cohol solvent.Naringin in the liniments was identified qualitatively by TLC,and the content of naringin was determined by HPLC.RESULTS:Naringin was identified in TLC.The sample size of naringin showed a good linear relationship with its peak area in the range of0.51?g～2.55?g(r=0.9993).The average recovery was98.58%(RSD=1.31%).CONCLUSION:The preparation technology is practicable and the method of quality control is reliable.

Objective To explore the risk factors of dysphagia in patients with cardiac surgery, so as to provide a basis for clinical nursing. Methods From January 2014 to June 2016, we collected data from 158 patients with cardiac surgery in Heping Hospital Affiliated of Changzhi Medical College. All of the patients were divided into the group of dysphagia (n=60) and the group of normal deglutition (n=98). We compared the sexes, ages, body mass index (BMI), smoking history, time of tracheal intubation, types of surgery, family history of heart disease, previous history of cardiac surgery, New York Heart Association (NYHA) classification, European System for Cardiac Operative Risk Evaluation (EuroSCORE), bed and oxygen uptake after surgery, intra-operative transesophageal echocardiography, natriuretic peptide application and mechanical assistance after surgery between two groups. Multiple Logistic was used to analyze the risk factors of dysphagia after surgery. Results There were no statistical differences in the BMI, smoking history, family history of heart disease, bed and oxygen uptake after surgery, intra-operative transesophageal echocardiography, natriuretic peptide application and mechanical assistance after surgery as well as of previous history of cardiac surgery of patients between the group of dysphagia and the group of normal deglutition (P＞0.05);however, there were significant differences among patients with different ages,gender, NYHA classification, EuroSCORE, time of tracheal intubation (P＜ 0.05). Multiple logistic analysis showed that the risk factors of dysphagia after cardiac surgery included the ages equal or greater than 70 years old, Ⅲ-Ⅳ for the NYHA classification, 3-6 for the score of EuroSCORE, time of tracheal intubation equal or greater than 12 hours (P＜ 0.05). Conclusions Health care providers should pay attention to the influencing factors of dysphagia after cardiac surgery involving ages, NYHA classification, score of EuroSCORE, time of tracheal intubation.

Objective? To analyze the mediating and modulating effects of self-efficacy between health literacy and quality of life in patients with esophagus cancer receiving chemotherapy. Methods? Totally 105 patients receiving chemotherapy for esophagus cancer in Heping Hospital Affiliated to Changzhi Medical University from January 2015 to December 2017 were selected by convenient sampling and investigated with General Self Efficacy Scale (GSES), Health Literacy Management Scale (HeLMS) and Spitzer Quality of Life Index (SQLI). Pearson correlation analysis was used to analyze the correlation between the patients' self-efficacy, health literacy and quality of life, and regression analysis was used to mediating and modulating effects between the variables. Results? The average self-efficacy score, health literacy score and quality of life score of the 105 patients were (2.38±0.47), (86.65±12.29) and (4.94±0.55), respectively. Pearson correlation analysis showed that self-efficacy was positively correlated with health literacy and quality of life (r=0.517, 0.462; P＜0.05). Self-efficacy showed mediating effects between health literacy and quality of life in the patients with esophagus cancer, which accounted for 34.82% in the total effect. Regression analysis showed that the regression coefficient of the interacting "health literacy×self-efficacy" was statistically significant (β'=0.015,t=2.718;P＜ 0.01), whose mediating effect was significant (ΔR2=0.018, P＜ 0.01). Conclusions? Self-efficacy has mediating and modulating effects between health literacy and quality of life in patients receiving chemotherapy for esophagus cancer.