Clinical thoughts based on symptoms, physical signs and examine outcomes is a process of analysis, judgement and conclusion of disease diagnosis. To cultivate an exact thinking model can avoid taking a part for the whole or a miss in disease analysis, so to cultivate clinical thoughts in clinical practice can elevate medical students'clinical skills.

Objective] To observe the clinical efficacy and 5-HT of Shugan Jianpi Tiaoshen acupuncture treatment for senile patients with constipation type of irritable bowel syndrome(IBS-C). [Method] A total of 68 patients with IBS-C were allocated into control group and acupuncture group from June 2015 to June 2014. 34 patients in the control group, who accepted Lactulose oral solution and Citrate Mosapride Citrate, of in 15 males and 19 females, the mean age was 66.8, the average duration of disease was 15.6 months;34 patients in acupuncture group, who accepted acupuncture treatment based on control group, in 17 males and 17 females, the mean age was 65.9, the average duration of disease was 17.1 months. Acupoint selection:Tianshu, Zusanli, Taichong, Xingjian, Qimen, Baihui, Neiguan. Observe constipation symptoms, depressive symptoms, and quality of life and serum 5-HT levels before and after treatment. [Result] The pre-treatment constipation symptoms and depressive symptom scores in two groups were decreased than post-treatment( P<0.05), which showed two methods can improve constipation and depressive symptoms of IBS-C patients. After treatment, constipation symptoms and depressive symptoms score in acupuncture group were lower than that in control group(P<0.05), which showed the effect of acupuncture was better. The eight dimensions of SF-36 were higher than those before treatment in total patients(P<0.05), which showed two methods can improve quality of life of patients; differences of physiological function, physiological function between acupuncture group and control group had no statistical significance( P>0.05), but body pain, vitality, emotional function, mental health, social function, and general health values were higher than that of the control group( P<0.05), which showed acupuncture treatment can reduce physical discomfort and improve the quality of life of patients. After treatment,serum 5-HT in control group was 33.8 pg/ml, in acupuncture group was 27.6 pg/m, which were lower than pre-treatment. 5-HT in acupuncture group was lower than control group( P<0.05), which showed the effect of acupuncture on regulation of 5-HT was more significant. [Conclusion]Shugan Jianpi Tiaoshen acupuncture can modulate 5-HT level of elderly patients with IBS-C, and play its role in modulating gastrointestinal function, improving constipation symptoms, depressive symptoms and quality of life.It is an effective method for the treatment of elderly patients with IBS-C.

OBJECTIVE:To establish an optimal method for microbial limit test for ciclopirox olamine vaginal suppository.METHODS:The microbial limit test for antibacterial agents was validated by plating method and membrane filtration method,and the optimal method for the test of bacteria and mold were confirmed based on the recovery rate of artificially sprayed bacteria.RESULTS:By plating method,the recovery rate of artificially sprayed E.coli was more than 70%,whereas that of mould was 0%;however,by membrane filtration method,the recovery rates of bacterial and mould were all higher than 70% when flushing doses of bacteria,mold,and control bacteria were 200 mL,300 mL,and 200 mL,respectively.CONCLUSIONS:The membrane filtration method could be used for the microbial limit test of the preparation the drug quality can be kept under effective control,and the established method is accurate and reliable.

Objective:To reflect the training of basic-level medical stuff by investigating the doctor-patient cognition status of patients in a county-level hospital.Methods:The questionnaire of 180 patients collected from a county hospital in Shaanxi province was analyzed by Rank sum test and Descriptive analysis with SPSS17.0.ReSults:There were no statistically significant differences in the evaluation of current doctor-patient relationship from patients of different ages,occupations and degrees of education (P ＞ 0.05).82.2％ of the patients believed that the doctor-patient relationship is harmonious or somewhat harmonious.Moreover although the patient's trust in doctors is not high,there is a certain sense of recognition;and they put forward some expectation and requirements on doctor's professional skills,communication skills and professionalism.Conclusion:Considering the patients' feedback,local medical colleges and universities should reflect medical education ideas,play an active synergy model in the training of students' professional skills.In the meantime,they should strengthen the medical internship management,while paying equal attention to enhance students' responsibility and professionalism to serve the grassroots.

OBJECTIVE: Comparison of operation of epitympanic/antrum cholesteatoma excised by endoscopy and microscope. METHOD: Eleven patients with epitympanic/antrum cholesteatoma were analysed, 5 cases were excised by endoscopy and 6 cases were excised under microscope. RESULT: No complication occurred after operation and all patients got dried ear. There were no difference in hearing recovery and closure of perforation of tympanic membrane between two group. The operation time, injury degree, length of stay in hospital and hospitalization expense with endoscopy was superior to that of microscope. CONCLUSION Considering financial constraints of patients, resection of epitympanic/antrum cholesteatoma cholesteatoma can be adopted by endoscopy.
Adolescent ; Adult ; Cholesteatoma, Middle Ear ; surgery ; Endoscopy ; Female ; Humans ; Male ; Microscopy ; Middle Aged ; Treatment Outcome ; Young Adult

Applying the principle of Evidence-Based Medicine to the clinical teaching,we have made the students raise the cognition level on the diagnose of diseases and treating policy and trained their clinical logic thinking ability.

Radiotherapy is the main treatment method of early lung cancer not undergoing surgery for medical reasons and advanced non-resectable lung cancer. The local regional control of lung cancer requires high-dose irradiation, but this treatment is restricted by normal tissue tolerance. The measurement and control of errors are crucial for safe implementation of lung cancer precision radiotherapy. Lung tumor radiotherapy error sources, the methods to control these errors, and the error development trend are discussed in this review.

Ventilator-associated pneumonia (VAP) is a common hospital acquired infection in neonatal intensive care unit with high incidence in China. There is no diagnostic gold standard of VAP. The risk factors include premature birth, low birth weight, dura-tion of mechanical ventilation, episodes of intubation, blood stream infections. The recommended precautions include rising head of bed, closed tracheal suction, sucralfate, selective decontamination in digestive tract, improvement of mechanical ventilation, oral and skin care, hand hygiene. However, it is controversial that sucralfate, selective decontamination in digestive tract, passive humidifiers, oral and skin care can reduce the incidence of VAP.

Objective To evaluate the efficacy and safety offlupentixol and melitracen (deanxit) in the treatment on the patients with post-stroke depression.Methods A total of 98 patients of post-stroke depression were randomly divided and assigned to a therapy group and a control group.The two groups was given a routine treatment of stroke.The therapy group was treated with deanxit (52 patients,4 weeks).Both groups were measured by Hamilton rating scale of depression (HAMD),China stroke scale (CSS) and Barthel index(BI)before treatment and after 2 weeks and 4 weeks.Results The efficiency rate in treatment group was much higher than that in control group [86.5％ (45/52) vs.43.5％ (20/26),P ＜ 0.01].HAMD score,CSS score and BI in therapy group were better those in control group 4 weeks after treatment [(9.38 ±1.80) scores vs.(14.56 ± 2.40) scores,(15.79 ± 0.83) scores vs.(28.91 ± 1.02) scores,74.6 ± 15.4 vs.59.2 ± 14.6,P ＜ 0.05].There was obvious untoward reaction in therapy group.Conclusions It is indicated that deanxit can reduce the degree of depression and promote the neurological functional rehabilitation.It is safe and effective in the treatment of post-stroke depression.

Objective To analyze the hypothalamic-pituitary-adrenal axis function in type 2 diabetes mellitus(T2DM) patients combined with depression with different courses.Methods Forty T2DM without depression patients (T2DM without depression group) and 42 T2DM combined with depression patients (T2DM combined with depression group) were divided into 3 groups according to the courses:＜ 5years,5-15 years,＞ 15 years.Thirty healthy person were selected as control group.The levels of serum adrenocorticotropic hormone (ACTH),cortisol (Cor),fasting blood glucose (FPG),glycosylated hemoglobin (HbA1c),24 h urinary-free cortisol (UFC) were determined at 8:00 Am.Results The levels of serum ACTH,24 h UFC in T2DM without depression group were higher than those in control group [(241.7 ±132.6) pg/L vs.(174.1 ± 108.2) pg/L and (96.67 ± 15.92) μg vs.(76.04 ±24.60) μg],and there were significant differences (P ＜ 0.05 or ＜ 0.01).There were no significant differences in the levels of serum ACTH,Cor,24 h UFC among ＜ 5 years,5-15 years,＞ 15 years in T2DM without depression group (P＞0.05).The levels of serum Cor,24 h UFC in T2DM combined with depression group were higher than those in T2DM without depression group and control group,and there were significant differences (P ＜ 0.01),but compared with those in T2DM without depression group with the same courses,only ACTH was different in ＜5 years (P ＜ 0.01),Cor,24 h UFC was different in ＞ 15 years (P ＜ 0.01).There was significant difference in the level of serum ACTH between ＜ 5 years and 5-15 years,＞ 15 years in T2DM combined with depression group (P ＜ 0.01),Cor had no difference among different courses (P ＞ 0.05),24 h UFC had difference between ＞ 15 years and ＜ 5 years,5-15 years (P＜ 0.01 or ＜ 0.05).In T2DM without depression group,the level of serum Cor was positively correlated with FPG (P ＜ 0.01),the level of serum ACTH was positively correlated with FPG (P ＜0.05).In T2DM combined with depression group,the level of serum Cor was positively correlated with FPG,HbA1c (P ＜ 0.01),the level of serum ACTH was no relationship with others,the level of serum 24 h UFC was positively correlated with FPG,HbA1c (P＜ 0.01).Conclusion With the prolonged courses of diabetes,the function of hypothalamic-pituitary-adrenal axis gets worse in T2DM patients combined with depression.