Objective To compare the effects of biofeedback (BF) training on clinical symptoms , psychological status and quality of life in different subtypes of patients with functional defecation disorders (FDD) .Methods According to Rome Ⅲ criteria ,50 FDD patients were divided into non coordinated defecation (F3a) and the lack of promoting defecation (F3b) two subtypes .The patients of these two subtypes received BF training three times every week ,five to ten times each course ,two to three times training at home were required during and after treatment .The changes ,of clinical symptoms scores ,self‐rating anxiety scale (SAS) ,self‐rating depressive scale (SDS) and the patient assessment of constipation quality of life question naire (PAC‐QOL ) were compared between before and after BF training in the patients of two subtypes .The difference between two subtypes were also analyzed as well .Paired t‐test or Wilcoxon signed‐rank test was performed for comparison between before and after treatment ,and group t‐test or Wilcoxon rank sum test was for comparison between groups .Results Among 50 FDD patients , there were 13 cases of F3a type and 37 cases of F3b type .After BF training ,the clinical symptoms scores of two subtypes patients were both lower than those before BF training (5 .62 ± 3 .91 vs 8 .77 ± 3 .59 , 5 .89 ± 3 .67 vs 9 .35 ± 3 .22 ,t = 3 .264 and 6 .272 ,both P< 0 .01) .There were no statistically significant differences in the scores of clinical symptoms between two subtypes at before and after BF training (t =- 0 .545 and - 0 .230 ,both P > 0 .05) .After BF training ,the SAS scores of two subtypes patients were both lower than those before BF training (30 .85 ± 6 .67 vs 42 .46 ± 8 .37 ,30 .65 ± 7 .51 vs 38 .59 ± 8 .38 , t= 4 .536 and 6 .402 ,both P< 0 .01) ,and the scores of SDS were both lower than those before BF training (42 .85 ± 8 .30 vs 53 .92 ± 7 .98 ,43 .95 ± 12 .17 vs 55 .39 ± 10 .83 ,t = 4 .788 and 6 .830 ,both P< 0 .01) . There were no statistically significant differences in the scores of SAS and SDS between two subtypes at before and after BF training (t= 1 .431 ,0 .084 ,- 0 .447 and - 0 .301 ,all P> 0 .05) .After BF training ,the PAC‐QOL scores of two subtypes [0 .54 (0 .15 ,0 .88) 、0 .98 (0 .51 ,1 .34)] were both lower than those before BF training [2 .08(1 .18 ,2 .34) 、1 .86(1 .34 ,2 .29)] ,Z= - 2 .903 、- 4 .825 ,both P < 0 .01) .There were no statistically significant differences in the PAC‐QOL scores between two subtypes at before and after BF training (Z= 0 .409 ,1 .891 ,both P > 0 .05) .Conclusions BF training is both effective on two subtypes of FDD ,which can improve clinical symptoms ,psychological status and quality of life ,and with There is no difference in efficacy between the two subtypes .

Objective To investigate the methods and effects of nasolabial flaps for repair of defects after skin tumor removal on midface.Methods From Augest 2012 to March 2015,the different flaps from nasolabial fold were utilized to repair 22 skin defects due to surgical removal of skin tumors on midface.There were 12 flaps with subcutaneous pedicle and 10 flaps with skin pedicle in the group.The size of the defects ranged from0.5cm × 1.0cmto4.0cm × 5.0cm.Results After operation,all flaps survived with primary healing,cosmetic results were satisfactory with conceal scar and no facial organs distortion after 1 month to 2 years following-up.No tumor recurrence occurred.Conclusions Thenasolabial flaps with appropriate pedicles could obtain the satisfactory results for the reconstruction of medium-sized skin defects on midface,especially suitable for middle-aged and elderly patients.

The dental clinical internship is the critical stage of combining theory and practice and changing the knowledge into ability for medical smdents through clinical practice.It should be based on the characteristics of oral medicine such as integrating the teaching content firstly,promoting the discussion teaching;then carrying the seminar teaching,including three steps,question-making,question-suspecting and question-solving Meanwhile,the training of scientific research and cultivate the innovative ability should be strengthened to cultivate students'creative ability by guiding studetents to refer to data.fill in the proposal of medical students and process an opening report,make medical records discussion and write professional summary and thesis.

Objective To explore the mechanisms of individual, social and environmental factors influencing physical activity and the relationships among the factors in patients with type 2 diabetes. Methods A survey was conducted from January to July 2015 among 225 patients with type 2 diabetes using convenience sampling. The questionnaire included 9- item Patient Health Questionnaire, the International Physical Activity Questionnaire,Perceived Social Support Scale, Chinese Walkable Environment Scale, Bandura′s Exercise Self- efficacy Scale. Results The effective questionnaire recovery rate was 98.7%(222/225). Exercise self- efficacy was a mediator of factors influencing physical activity. Exercise self- efficacy and physical activity were positively correlated (β=0.24, P<0.05). Walkable environment only affected physical activity indirectly medicated by exercise self- efficacy (β=-0.26, P<0.05). Perceived social support directly associated with physical activity (β=0.14, P<0.05). Depression not only affected physical activity directly (β=-0.28, P<0.05), but also associated with physical activity indirectly medicated by exercise self-efficacy (β=-0.32, P<0.05). Conclusions Interventions should be taken to increase the perceived social support, improve depression and walkable environment, especially to enhance exercise self- efficacy, so as to improve the physical activity level of patients with type 2 diabetes.

Objective To analyze the status and influencing factors of physical activity in patients with diabetes.Methods A survey was conducted in patients with diabetes from one hospital in Tianjin city using the International Physical Activity Questionnaire, Exercise Self-efficacy Scale, 9-item Patient Health Questionnaire,Perceived Social Support Scale, Chinese Walkable Environment Scale, Visual Analogue Scale.The cumulative logits model was used to explore the influencing factors of physical activity in diabetic patients.Results The average of sitting time for diabetic patients was 6.1 hours per day.41.2％ of patients with diabetes were at high level of physical activity ,42.7％ were at moderate level of physical activity, and 16.1％ were at low level of physical activity.The cumulative logits model showed that perceived social support (β=0.029, OR=1.03, P=0.039,95％ CI=0.001-0.057) ,exercise self-efficacy (β=0.014, OR=1.01, P=0.001,95％ CI=0.005-0.023),and beautiful neighborhood surroundings(β=-0.366, OR=0.69, P=0.008,95％ CI=-0.635--0.096) were protective factors of physical activity, and depression(β=-0.093, OR=0.91, P=0.020,95％ CI=-0.172--0.015) was a risk factor of physical activity.Conclusion The physical activity status of diabetic patients are not ideal.Measures should be taken to improve the exercise self-efficacy, perceived social support and environment of surroundings, to reduce the symptoms of depression, so as to promote regular physical activities in patients with diabetes mellitus.

Objective To evaluate the long-term efficacy and the influencing factors of biofeedback (BF) treatment in functional constipation (FC).Methods Totally 120 BF treated FC patients were retrospectively followed up.The clinical symptom score,the use of laxatives,the result of colonic transit test and anorectal manometry were compared before BF treatment and during follow-up.The long-term efficacy of biofeedback treatment was evaluated.Thirty-two possible influencing factors of long-term efficacy were selected and univariate and multivariate analysis were conducted.The groups were compared with t test,rank-sum test and x2 test.The influencing factors of long-term efficacy were analyzed with a stepwise multiple regression analysis.Results The median score of clinical symptoms in follow-up period (3) was significantly lower than that before BF treatment (10,Z=-7.900,P＜0.01).The total long-term efficacy rate was 70.6％ (77/109).During follow-up,the rate of laxatives use [39.4 ％ (43/109)] was lower than that before BF treatment [83.5％ (91/109),x2 =44.623,P＜0.01].During follow-up,the 48 hour median colonic emptying rate (30.0％)was higher than that before BF treatment (0,Z=-2.298,P=0.022).During follow-up,the proportion of patients with uncoordinated defecation (51.4％) was lower than that before BF treatment (77.1％,x2 =5.040,P=0.025).The results of univariate and multivariate analysis showed that the long-term efficacy of BF treatment was positively correlated with the compliance for home training and utilization of social support,negatively correlated with the course of disease.Conclusions BF therapy can improve clinical symptoms of FC patients,correct physiological dysfunction and have a satisfactory lon~term efficacy.Compliance for home training,utilization of social support and the course of disease were independent influencing factors.

Objective To constructthe nurse job satisfaction index evaluation system by analytic hierarchy process (AHP) so as to provide theoretical basis for nursing managers. Methods Semi-structured interviews and literature review were used in establishing the preliminary nurse job satisfaction evaluation index system.The Delphi method was applied in expert consultation and a three-level index system was established, the weight, the largest eigenvalue and the weight vector were all calculated. Index consistency was inspected. Results 4 first-level indicators, 13 second-level indicators and 39 third-level indicators were established.The weight was 1.630 0-3.280 0 for the first-level indicators, 0.4494-1.4723 for the second-level indicators and 0.0913-0.783 9 for the third-level indicators.The weight vector was 0.038-0.616 for the first-level indicators,0.045-0.750 for the second-level indicators and 0.041-0.875 for the third-level indicators.The max-eigenvalue was 4.231 for the first-level indicators,6.226 for the second-level indicators and 4.176 for the third-level indicators. The consistency test value of judgment matrix ranged from 0.000 to 0.077, and the consistency ratio was less than 0.1. Conclusions With distinct gradation,clear structure, reasonable weight and rich content, the index system provides a theoretical basis for the nurse job satisfaction evaluation.

Objective To understand the schistosomiasis endemic situation of surveillance sites in order to offer the scientific evidence for schistosomiasis control in Yunnan Province.Methods According to the protocol of national surveillance of schistosomiasis,four national sites in Yunnan Province were surveyed and the results were analyzed.Results In the four surveillance sites in Yunnan Province,the average infection rate of schistosomiasis of residents was 1.92%,and the infection rates of cattle and water buffaloes were 3.65% and 6.59% respectively.The snail area was 99.44 hm2,and the average density of the snails was 0.37 snail/0.1 m2,and the snail infection rate was 0.08%.There was the feature of higher infection rate and lower infection intensity in residents in Yunnan.Conclusions The endemic situation of schistosomiasis falls obviously after the control.However,the domestic animals still play an important role in the transmission of schistosomiasis,and the snails are not well controlled in some sites.So the surveillance and control to cattle and the snail should be continuously strengthened.

Objective To explore the relationship between health?related quality of life and resili?ence of patients with inflammatory bowel disease( IBD) ,and provide a new entry point to improve the quality of life. Methods The general information questionnaire,the Chinese version of inflammatory bowel disease questionnaire ( IBDQ) and the Chinese version of Connor?Davidson mental resilience scale ( CD?RISC) were used to investigate 102 patients with IBD. Results The average scores of IBDQ and CD?RISC of IBD pa?tients were (157.6±31.7) and (62.5±15.0). Except for the correlation between the score of optimistic di?mension and the social function dimension,the total score and the scores of other dimensions of IBDQ were significantly correlated with the total score and the scores of dimensions of CD?RISC( r=0.200?0.490, P<0.05). Multiple regression analysis showed that tenacity,residence,moderate and severe disease severity,and disease duration with more than 10 years could significantly predict the level of health?related quality of life (β=0.319,0.268,-0.218,-0.373,-0.260, P<0.05) . Conclusion The health?related quality of life of IBD patients has a strong relationship with resilience. Health care workers can help improve health?related quality of life of the patients through fostering resilience.

Objective To assess the psychometric properties of the Chinese Heartburn Version of Quality of Life in Reflux and Dyspepsia Questionnaire (QOLRAD) in patients with gastroesophageal reflux disease.Methods 130 patients with symptoms of heartburn completed the Chinese version of QOLRAD,the Short-Form-36 (SF-36).30 of them received proton pump inhibitors (PPI) for 8 weeks,which was used to test responsiveness of the Chinese heartburn version of QOLRAD.Results The Chinese version of QOLRAD had acceptable internal consistency.The overall Cronbach's alpha was 0.89 and the internal consistency of dimensions ranged from 0.70～0.90.Content validity index (CVI) was 0.82.Confirmation factor analysis revealed a 5 factor solutions accounting for 62.02％ and most of items in their dimensions had acceptable loads (＞0.4).There was acceptable concurrent validity with correlations between the Chinese heartburn version of QOLRAD and Short Form-36 health survey ranging from 0.172～0.613.As to responsiveness,after therapy of PPI for 8 weeks,except the dimension of sleep disturbance,scores for dimensions of vitality,food/drink problems,physical/social functioning,emotional distress had significant changes.Conclusions The Chinese version of QOLRAD has a good reliability,validity and responsiveness to therapy,which can be used to assess the quality of life in patients with gastroesophageal reflux disease.