The combination of medical humanistic spirit and medical scientific spirit is the sign of the maturity of medicine.The modern medical mode of ' biology-psychology-society-environment' sets new requirements for medical humanistic education.Clinic medical postgraduates,the front -line medical workers,play a very important role in medical work,but they show huge deficiency in interpersonal communication,humanistic knowledge and humanistic possession nowadays.The paper tried to draw some lessons from the successful education mode of George Washington university and discussed practicable methods to improve humanistic education among medical postgraduates aiming at cultivating qualified medical workers who have both noble medical ethics and perfect medical technology and ability.

Objective To evaluate the dosimetric benefits of intensity-modulated radiotherapy (IMRT) for early stage breast cancer after breast-conserving surgery. Methods Ten patients with stage Tis～2N0M0 breast cancer receiving breast-conserving surgery were selected for the study. Six cases were on the left, four were on the right. A dosimetric comparison of IMRT with conventional wedged tangential technique was performed on each patient using three dimensional treatment planning. The total prescribed dose for both plans was 50 Gy/25 fractions. Dose volume histograms (DVH) were used to compare the planning target volume (PTV) and organs at risks(OARS). Results The PTV coverage in IMRT plan was similar to that of the conventional plan (97.83 % vs 97.61%). A better dose uniformity throughout the whole breast was achieved by IMRT plan. The percentage of PTV receiving less than 95 % prescribed dose and more than 103 % prescribed dose (inhomogeneity index IHI), decreased from 25.42 % to 2.71%: the percentage of PTV receiving more than 105 % prescribed dose (V105 %) decreased from 25.79 % to 1.08 %. A better amelioration of IHI and reduction of V105 % in IMRT plans were observed in the relatively large PTV subgroup. The Dmean and percentage of volume receiving more than 30 Gy (V30) of heart from 6.72 Gy to 4.95 Gy, and from 7.23 % to 1.04 %. the Dmean and percentage of volume receiving more than 20 Gy (V20) of ipsilateral from 9.19 Gy to 7.65 Gy, and from 22.34 % to 20.18 %; the Dmean of contralateral breast decreased from 5.12 Gy to 3.52 Gy;the Dmean of contralateral lung decreased from 2.76 Gy to 1.79 Gy; the Dmean of liver decreased from 7.23 Gy to 1.04 Gy for right side patients. Conclusion Forward planning IMRT based on a standard tangential beam arrangement significantly improves the dose homogeneity throughout the target volume of intact breast and reduces the dose to OARS, especially in patients with large breast volumes who might be proposed as candidates of IMRT for intact breast.

Objective To investigate the hemodynamic characteristics of superior thyroid artery and its corresponding clinical significance with patients of Graves'hyperthyroidism.Methods Thirty patients with Graves'hyperthyroidism received Doppler ultrasonography.Patients were grouped with different serologic indices at 4 month after radioiodine therapy as relief(R),uncured(U)and hypothyroidism(H).The relationships between thyroid volume(V),superior thyroid artery peak systolic velocity(PSV),end diastolic velocity(EDV),RI,PI and systolic accelerating time(SAT)and the 4-month outcome were analyzed respectively.Results Besides the effect of 24 h-131I uptake rate on patients'short-term outcome,V,PSV and RI were of predominate prognosis value(P＜0.01).PSV and V of group R were positively correlated with 131I dose respectively(r1=0.825,r2=0.697;P＜0.001),while SAT of group R was negatively correlated with 131I dose(r=-0.489,P＜0.05).Conclusions Patients with high V,PSV and RI maybe still suffering hyperthyroidism after regular dosage of 131I therapy.Doses of 131I should be added appropriately for patients with high PSV and V,but short SAT to achieve complete remission,while it should be reduced for patients in opposite condition to avoid occurrence of hypothyroidism.

Objective To explore the clinical and pathological characteristics of triple-negative breast cancer(TNBC) and to compare the response to neoadjuvant chemotherapy and survival in patients with TNBC and non-TNBC. Methods Five hundred and thirty-five patients were included in this retrospective study. 75 patients were TNBC and 460 were non-TNBC. The clinical and pathological characteristics, 5-year disease free survival (DFS) and overall survival (OS) were analyzed. 88 patients were treated with neoadjuvant chemotherapy in which 26 patients were TNBC, the other were non-TNBC. Their responses to neoadjuvant chemotherapy, and the relations of response and survival were analyzed. Results The patients with TNBC were younger than those with non-TNBC (35 vs 44), and most of the patients with TNBC were premenopausal at diagnosis (88.0 % vs 67.2 %, P =0.009). The frequency of invasive ductal carcinoma was higher in patients with TNBC than those with non-TNBC (92.0 % vs 80.4 %, P =0.020). Generally patients with TNBC had higher grade tumors (grade Ⅱ ) than patients with non-TNBC (56.0 % vs 17.2 %, P = 0.000). Lower rate of lymph node metastasis were observed in patients with TNBC than those with non-TNBC (33.3 % vs 53.9 %, P = 0.001). Patients with TNBC had worse 5-year DFS (66.67 %) and OS (80.0 %) than those with non-TNBC (74.78 %, 90.00 %). In this study. 88 patients were treated with neoadjuvant chemotherapy. The overall response rate(OR) of patients with TNBC was 88.46 %, including 65.38 % clinical complete response (cCR)and 23.08 % clinical partial response (cPR). It was significantly higher than patients with non-TNBC respectively (82.26 %, 37.10 %, 45.16 %) (P <0.05). Patients with TNBC had worse 5-year DFS (65.38 %)and OS (73.08 %) than those with non-TNBC (72.58 %, 80.65 %) (P <0.05). If cCR were achieved, patients with TNBC or with non-TNBC had similar 5-year DFS and 5-year OS (P>0.05). In contrast, TNBC patients with residual disease after neoadjuvant chemotherapy had worse 5-year DFS and OS compared with non-TNBC (P <0.05). Conclusion TNBC is common in young premenopausal women. Its main pathological style is nonspecial type of invasive ductal carcinoma with high grade, with low lymph node metastasis rate. Patients with TNBC are more sensitive to neoadjuvant chemotherapy than those with non-TNBC. Patients with TNBC have increased cCR rates compared with non-TNBC, and those with cCR have a good prognosis. TNBC patients in whom cCR are not achieved have significantly worse survival rates compared with that of non-TNBC patients.

Under the current system, the number of sole foreign -investment hospitals and foreign -domestic joint venture hospitals is growing.They are different from public hospitals in terms of their foperation , market share, medical-service pricing poli-cy and their quality and management of medical care.Mechanisms still need to be developed so that these hospitals could move forward to improve our health-system overall.In the meanwhile, public hospitals should be powered by the patient-centeredphilosophy and improve their management and services to enhance their competiveness.

OBJECTIVE:To provide reference for the innovation of chronic disease management mode by combing internet big data with foreign and domestic chronic disease management experience. METHODS:Innovative strategies for chronic disease man-agement in internet big data era were explored from respective of pharmacists,based on national condition,referring to internation-al chronic disease management. RESULTS:The development of internet big data era brought thinking of pharmacists about new type chronic disease management mode. Pharmacists established chronic disease patients medication safety management center based on big data platform,and provided full-range and multi-level pharmaceutical care,including real-time intervention,personal-ized pharmaceutical care,human concern and timeless and spaceless patient education,clinical evidence-based medicine. CONCLU-SIONS:Big data-based chronic disease management mode could reduce the risk of drug use,promote rational drug use,and open a new era of“patient-centered”pharmaceutical care conception and pharmacist’s function transformation.

Objective To analyze the conditions of antithrombotic therapy in patients with atrial fibrillation (AF)and provide reference for clinical rational use of drugs.Methods The clinical data of 1 69 hospitalized patients with AF from July 201 4 to September 201 4 in Beijing Tongren Hospital affiliated to Capital Medical University were retrospectively analyzed.The risk stratification for thromboembolism,types of AF,drug selection,drug combination and adverse reactions were analyzed.Results In 1 69 patients with AF,the proportion of valvular AF was 1 4.20%(24 /1 69)and non -valvular AF was 85.80%(1 45 /1 69),the patients with AF aged over 60 years old accounted for 84.62%.In the antithrombotic therapy,warfarin accounted for 94.87% (74 /78),the average daily dosage was (2.51 4 ±0.842)mg,the cases with INR between 2.0 to 3.0 accounted for 41 .89%(31 /74).The incidence rate of adverse reactions was 2.56%(2 /78).Conclusion The antithrombotic therapy is obviously insufficient,the clinical pharmacists should analyze the factors which influence the treatment and promote the rational use of antithrombotic therapy in AF patients.

OBJECTIVE:To explore the content and mode of pharmaceutical care for patients with acute coronary syndrome (ACS). METHODS:Taking pharmaceutical care for 4 ACS patients as example,the contents of pharmaceutical care provided by clinical pharmacists during ACS treatment were summarized involving antiplatelet drugs,anticoagulant,anti-myocardial ischemia drug,statins. RESULTS:Through pharmaceutical care,clinical pharmacists found and resolved ADR during ACS treatment timely. The symptoms of patients were improved. CONCLUSIONS:Clinical pharmacists provide reasonable suggestion for ACS treatment to guarantee safe,reasonable and effective use of drugs in the clinic.

OBJECTIVE:To evaluate the cost-effectiveness of 5 angiotensin converting enzyme inhibitors in the treatment of essential hypertension.METHODS:120 patients with essential hypertension were randomly assigned to receive domestic captopril(Group A),captopril from joint venture(Group B),fosinopril(Group C),benazepril(Group D)or enalapril(Group E)for 4 weeks.The cost-effectiveness of the 5 groups was evaluated.RESULTS:The total effective rates for A,B,C,D and E groups were 75.00%,75.00%,91.67%,91.67% and 87.50%,respectively.As compared with Group A,the incremental cost-effectiveness ratios of C,D and E groups were 1 249.67,1 256.39 and 636.16,respectively.CONCLUSION:The total effective rate in Group E is slightly less than in other groups,yet Group E is superior to other groups because of its lower cost-effectiveness ratio and lower incremental cost-effectiveness ratio.

Objective To report the presentation,clinical course and prognosis of intracranial hypertension (IH) with essential thrombocythemia (ET).Methods Retrospective data analysis was conducted.Seven cases of IH with ET were reviewed between January 2010 and December 2016.The clinical features,and the relationship between IH and ET were analyzed.Results IH complicated with ET was more common among young and middle-aged women.Sub acute or chronic course was more common.IH was easily misdiagnosed as optic neuritis in the early stage.The median platelet count of seven patients was 559 × 109/L.Paroxysmal black haze (four cases) was the most common of the first symptom.The head MRI showed empty sella in six cases.CT venography/DSA showed venous sinus thrombosis in three cases.All the patients were given intracranial pressure lowering and other symptomatic treatment.Five cases were treated with anti ET.Results showed remission in six cases and death in one case.Conclusions In the early stage IH was often misdiagnosed.Female was more common than male in IH with ET.Dural sinus blockage was common.In addition to symptomatic treatment such as lowering intracranial pressure,the patients should also be treated with anti ET.