Doctor-patient communication skills are one of the seven lowest requirements of global medical education.From the characteristic of doctor-patient communication in general medical practice,the paper explores the importance of strengthening the training of doctor-patient communication capability and analyzes the training methods.

There are some existing problems in controlling the quality of oxygen. In order to improve quality, efficiency and safety in the use of oxygen, we presented some factors which may give rise to variations in concentration of oxygen and proposed some suggestions based on the investigation and analysis of such problems.
Equipment and Supplies ; Oxygen

Objective To apply the new type exercise activity and make a guidance,to discuss the application effect of new type exercise activity in nursing of general surgery patients after abdominal surgery.Methods 120 patients with abdominal surgery were divided into the experimental group(58 cases)and the control group (62 cases )according to the mantissa of hospital number.The patients in the control group received routine nursing care.In addition,the patients in the experimental group received systematic new exercise activity.Postoperative rehabilitation progress and complications were compared between two groups.Results The recovery process of the experimental group was faster than the control group,the first time of getting out of bed,anal exsufflation time and wound healing time were shorter than those of the control group.The incidence of complications of the experimental group was lower than the control group.Conclusions The new type exercise activity can speed up the recovery process of general surgery patients after abdominal surgery and reduce the incidence of oostooerative complications.

Objective: To assess the diagnostic performance of contrast-enhanced spectral mammography (CESM) in suspected breast lesions. Methods: A total of 97 patients with suspected breast cancer identified by clinical examination or screening underwent two-views CESM examination on the basis of digital breast tomosynthesis (DBT) combined with full-field digital mammography (FFDM), and they were finally confirmed by biopsy or pathology. Three senior radiologists analyzed images, including lesion visibility, lesion characteristics, enhancement type, degree of enhancement, BIRDS classification, etc. Finally, based on the pathology, we compared the CESM+DBT+FFDM and DBT+FFDM two models according to sensitivity, specificity and ROC for diagnostic performance. Results: There were a total of 120 lesions. Eighty-nine lesions were malignant, 31 benign; CESM was not enhanced in 2 cases, mild enhancement was performed in 22 cases, moderately intensive in 15 cases, highly intensive in 81 cases, and 2 cases were not enhanced; mass-enhanced in 96 cases, including ring-enhanced in 12 cases, 22 cases of non-mass type. The sensitivities of the combination of CESM and not combination of CESM were 91.0% and 80.9%, respectively, and the specificities were 93.5% and 87.1%, respectively. The area under the ROC curve of combination of CESM was higher than the without combination of CESM (0.923 and 0.900, P<0.05), The difference was statistically significant. Conclusion For suspicious lesions, CESM examination can improve the diagnosis accuracy of breast cancer.

OBJECTIVETo study the relationship between abnormal reactions of free radicals in bodies of patients with acute organophosphorus pesticide poisoning (AOPP) and damages induced by free radicals.

METHODS58 AOPP patients and 58 healthy adult volunteers (HAV) were enrolled in an independent samples control design, in which spectrophotometric methods were used to determine the concentrations of nitric oxide (NO) and lipoperoxides (LPO) in plasma, and LPO in erythrocytes, vitamin C (VC), vitamin E (VE) and beta-carotene (beta-CAR) in plasma as well as activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) and acetylcholinesterase (AChE) in erythrocytes.

RESULTSCompared with the average values of every biochemical parameter in the HAV group, the average values of LPO in plasma and in erythrocytes, and NO in plasma in the AOPP group were significantly increased (P = 0.000001), while the average values of VC, VE, beta-CAR in plasma as well as SOD, CAT, GSH-Px and AChE in erythrocytes in the AOPP group were significantly decreased (P = 0.000001). The findings of Pearson product-moment correlation analysis between the value of AChE in erythrocytes and the values of above biochemical parameters for 58 AOPP patients showed that there was a significant linear negative correlation between AChE in erythrocytes and LPO, NO in plasma, and LPO in erythrocytes (P = 0.000001-0.001319), while there was a significant linear positive correlation between AChE in erythrocytes and VC, VE, beta-CAR in plasma as well as SOD, CAT, GSH-Px in erythrocytes (P = 0.000013-0.000824). The results of discriminant analysis of above chemical parameters for 58 AOPP patients and 58 HAV suggested that the correct rates of discriminant analysis were increased to 100% when the values of AChE and LPO in plasma and in erythrocytes, or AChE and others, were jointly used for the discriminant analysis.

CONCLUSIONThe findings of the present study suggest that a series of free radical reactions in AOPP patients' bodies are pathologically aggravated, and the discriminant analysis used the above biochemical parameters could markedly increase its correct rates for AOPP patients.

Acute Disease ; Adolescent ; Adult ; Female ; Free Radicals ; blood ; Humans ; Lipid Peroxides ; blood ; Male ; Nitric Oxide ; blood ; Organophosphate Poisoning ; Pesticides ; poisoning ; Poisoning ; blood

ObjectiveTo investigate the value of prothrombin time-international normalized ratio to albumin ratio (PTAR) in evaluating the prognosis of patients with decompensated cirrhosis. MethodsA retrospective analysis was performed for the clinical data of 172 patients with decompensated cirrhosis who were admitted to The Second Affiliated Hospital of Kunming Medical University from April 2016 to April 2017, including sex, age, etiology, complications, and first examination of laboratory markers after admission. With death as the outcome event, the patients were divided into survival group with 98 patients and death group with 74 patients according to the outcome of the disease after 2 years of follow-up. The influencing factors for prognosis were analyzed, and the value of PTAR in predicting the prognosis of patients with decompensated cirrhosis were evaluated. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. Univariate and multivariate Cox regression analyses were performed for related variables. The receiver operating characteristic (ROC) curve was plotted and the area under the ROC curve (AUC) was calculated, and the optimal cut-off value was determined according to the sensitivity and specificity of the ROC curve. The Kaplan-Meier survival curve analysis was performed to compare 2-year survival rate between patients with different values of PTAR, indocyanine green retention rate at 15 minutes (ICGR15), and Model for End-Stage Liver Disease (MELD) score, and the log-rank test was used for comparison between groups. ResultsCompared with the survival group, the death group had significantly higher PTAR (Z=-7.823, P＜0.001), ICGR15 (t=3.458, P=0.001), and MELD score (t=5.921, P＜0.001). PTAR, ICGR15, and MELD score had optimal cut-off values of 0.05, 41.00%, and 37.25, respectively, in predicting 2-year prognosis, with AUCs of 0849, 0.651, and 0.724, respectively. The survival analysis showed that the high-PTAR (PTAR≥0.05) group had a significantly lower survival rate than the low-PTAR (PTAR＜0.05) group (χ2=60.07, P＜0.001). The multivariate Cox regression analysis showed that PTAR ≥0.05 was an independent risk factor for death within 2 years (hazard ratio = 2.564, 95% confidence interval: 1.276-5.151, P=0.008). ConclusionPTAR ≥0.05 can be used as an independent predictive factor for death within 2 years in patients with decompensated cirrhosis, and PTAR has a relatively high value in predicting the prognosis of patients with decompensated cirrhosis.

Background/Aims: Lyon consensus differentiates acid exposure time (AET) as physiological, borderline, and pathological. Mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave index (PSPWi) are believed to increase diagnostic yield of gastroesophageal reflux disease (GERD) and correlate with symptom outcome of proton pump inhibitor (PPI) treatment. We aim to explore the clinical characteristics and the correlation of pH-impedance parameters with PPI response in Chinese patients with different AET levels. Methods: We retrospectively investigated 177 patients with typical reflux symptoms who received esophageal function tests. The demographics, GERD questionnaire scores, the proportion of esophagitis and PPI responders, and manometric and pH-impedance parameters were compared among patients with AET < 4%, 4-6%, and > 6%. In patients with AET ≥ 4%, manometric and pH-impedance parameters were compared between PPI responders and non-responders. Results: Among 177 patients, 69 (39.0%) had AET 4-6%, and 53 (29.9%) had AET > 6%. The demographics, esophagogastric junction type, and occurrence of ineffective esophageal motility were similar between patients with AET 4-6% and > 6%, but different from AET < 4%. MNBI and PSPWi were different among different AET levels, but similar between PPI responders and non-responders in patientswith AET ≥ 4%. Conclusions It is reasonable to set 4% as a threshold to define pathological AET in Chinese patients. MNBI and PSPWi could identify GERD patients, but may not correlate with PPI response of Chinese GERD patients.