Objective To compare the effects of total intravenous anesthesia or Intravenous-in-halation combined anesthesia on intraoperative somatosensory evoked potential (SSEP)and motor evoked potential (MEP)in spinal surgery.Methods Sixty patients scheduled for spinal surgery under general anesthesia were divided randomly and equally into 2 groups.The anesthesia was maintained with TCI propofol (plasma target concentration 3.0-3.5 μg/ml)and 1% sevoflurane+propofol in group T or group I respectively.BIS was monitored and maintained at 40-50.SSEP and MEP was re-corded before induction of anaesthesia (T0 ),5 minutes after tracheal intubation (T1 ),during skin in-cision (T2 )and at the time of decompressing spinal canal (T3 ).Results The latency of P38 and N45 prolonged,and the amplitudes of P38 and N45 was significantly depressed at T1-T3 compared to those at T0 (P <0.05).No statistically significant differences in cortical SSEP amplitudes or latency was observed in each time point.There was no case who could not detect the wave of MEP intraoperative-ly in this study.Conclusion The data from these cases indicates that 1% sevoflurane can be used in conjunction with SSEP and MEP monitoring for some adult patients undergoing spinal surgery.

Objective To summarize and analysis CT characteristics of traumatic adrenal hematomas.Methods There were 22 cases ofadrenal hematomas.The size, distribution and density of the adrenal hematomas on CT scanning, and the complications of other visceralinjury were analysed.Results 23 adrenal hematomas were found in 22 cases, of them,16 were in right,6 in left and 1 in bilateral. Conclusion CT has high value in diagnosis of the adrenal hematomas.

Objective To survey the training needs for key general practice (GP) trainers.Methods The survey was conducted among participants of the first training course for national key GP trainers hold on March 2014 in Shanghai.The contents of questionnaire used for the survey included training needs of GP relevant knowledge,teaching ability and modes of assessment.The differences in training needs between GP trainers from community teaching bases and hospital teaching bases were analyzed.Results Total 151 key trainers completed the questionnaire (male/female:48/103) with average age of (38 ± 6)years.Among them 67.5％ (102/151) were from community teaching bases and 29.8％ (45/151) from hospital teaching bases;60.9％ (92/151) participated in the General Practitioner Structured Vocational Training Program (GPSVTP).According to the survey,general practice clinical kills (72.2％,106/151) and general practice clinical thinking (70.2 ％,106/151) were most required relevant knowledge;while general practice basic concept was least required (25.8％,39/151).The rate with need of policy system related GP training in hospital trainers was higher than that in community teaching base trainers(66.7％ vs.44.1％,P ＜ 0.05).For teaching ability needs,85.4％ (129/151) selected teaching methods,75.5％ (114/151) chose teaching assessment and evaluation methods.The participants showed more interesting in new-type teaching and evaluation methods,such as PBL,OSCE,mini-CEX and DOPS,and would use them in future teaching work (P ＜ 0.01).Workshop (58.3％,88/151),demonstration(57.0％,86/151) and experience exchange (50.3％,76/151) were three most interested modes in current training;meanwhile theoretic teaching was lease interested (38.4％,58/151).Study tour was most interested training models for the future (71.5％,108/151),followed by short-term courses (49.0％,74/151),overseas study (39.1％,59/151) and distance learning (27.8％,42/151).Conclusion There are different needs for GP trainers from hospital and community teaching bases.To meet the different requirements,the focused training course and training method should be adapted.

Dendritic cells (DC) are important antigen-presenting cells in the development of anti-leukemic T-cells responses and it' s reported that DC can differentiate from monocytes or granulocytes in vitro. In the present study, the human leukemic DC were generated from acute promyelocytic leukemic( APL)cells after treatment with cytokines. M3 APL cells were isolated from peripheral blood of patients and incubated with rhGM-CSF( 100ng/ml)or rhGM-CSF( lOOng/ml) plus rhIL-4(500U/ml)for 14 days and the cells were co-cultured wirh TNF-?(100ng/ml)during last 3 days. The results demonstrated that both proliferation and differentiation of APL cells were induced by GM-CSF as the number of cultured cells increased and the cells expressed high level of CD45. Some cells displayed the characteristics of monocytes which expressed CD14 and some were leukemic DC as they expressed GDI a. The co-culturation of APL cells with GM-CSF and TNF-? augmented the differentiation of cells and about 35 percent of leukemic DC generated (was obtained). The maturation of APL cells could also be induced by GM-CSF plus IL-4 but there were few monocytes generated and about 10 percent of the cells were leukemic DC. If cultured for 3 weeks, the number of leukemic DC increased to 60 percent. The addition of TNF-? could augmented GM-CSF and IL-4 induced maturation of cells significantly and 90 percent of leukemic DC generated. Analysis of the cells with electric microscopy indicated that these leukemic DC displayed the similarly morphologic characteristics as monocyte-derived DC and there were still a few granules in their cytoplasm. The leukemic DC expressed high levels of HLA-DR, B7-1, B7-2 and CD54 molecules and could stimulate allo-T cells to proliferate in vitro. Such kind of leukemic DC might be useful tools for the generation of specific anti-tumor CTL and play important roles in immunotherapy of APL.

Fractures of the calcaneus are the most common type of tarsal bone injuries, and about 75% of total calcaneal fractures are intraarticular. Despite increasingly more experiences with this type of fractures, however, there is considerable debate regarding their diagnosis and management. Controversies involve the most appropriate classification system, treatment options, indications for surgery, surgical approaches, and postoperative management. On the basis of current main views on the diagnosis and treatment of intraarticular calcaneal fractures, this article holds that for displaced intraarticular calcaneal fractures, operative treatments are superior to conservative ones.

Objective To investigate the Toxoplasma gondii infection status in pregnant women with history of adverse preg?nancy and risk factors in Bazhou area,Hebei Province. Methods A total of 302 pregnant women with the history of adverse pregnancy were chosen as respondents(an experimental group)in the hospital from March 2012 to December 2015,and 197 pregnant women without the history of adverse pregnancy as a control group. TOX?IgG and TOX?IgM were detected by using ELI?SA in two groups. The risk factors of Toxoplasma infection were surveyed by questionnaires. Results The total positive rate of Toxoplasma antibodies was 28.15%(85/302)in the experimental group,which was significantly higher than that[9.64%(19/197)]in the control group,and the difference was statistically significant(χ2=24.76,P<0.05). The positive rates of TOX?IgM,TOX?IgG and TOX?IgM+TOX?IgG were 6.95%(21/302),18.54%(56/302),and 2.65%(8/302)respectively in the ex?perimental group,which were higher than 2.03%(4/197),7.61%(15/197),and 0%(0/197)respectively in the control group (χ2=6.07,11.67,3.76,all P<0.05). The questionnaire survey showed that the proportions of keeping pets,cutting board re?gardless,liking to eat hot pot or barbecue,eating raw meat,often eating in the restaurant in the pregnant women with Toxoplas?ma infection were higher than those in the pregnant women without Toxoplasma infection,and the differences were statistically significant(χ2=22.57,3.96,5.87,7.40,4.86,all P<0.05),and therefore,the above unhealthy habits may be important risk factors. Conclusions Toxoplasma infection could lead to adverse pregnancy outcomes. Therefore,the above?mentioned unhealthy habits should be avoided,especially during pregnancy period.

Objective To assess clinical competencies of trainees with standardized patients(SPs)and explore reform in methods of assessment for trainees at their completion in standardized training for general practice.Methods Totally,52 trainees in clinical training bases for general practice in Shanghai attended the examinations.Their skills in commanication skills,information and data gathering,comprehensive consultation,clinical thinking and decision-making in diagnosis and treatment were examined by rotation of three serial assessment stations in a specified time to perform standardized tasks,including medical history-taking,physical examinations(PE),medial record writing and oral tests.Results Scoresof history-taking,PE and skills of communication with SPs were higher than those agsessed by examiners themselves.but they both correlated each other with a P-value less than 0.01,with the highest coefficient of correlation of 0.774 between score of PE and that assessed by examiners.There was significant difference in average score among all clinical skills(F=9.867,P＜0.01),with the lowest one of comprehensive consultation skills of 64±22(P＜0.01).Skills of communication with patients had the highest correlation with data gathering ability(r=0.582,P＜0.01).Results of analysis for influential factors showed no significant difference in average score for all skills between men and women trainees(P＜0.05).Average score of comprehensive consultation ability in those with work experience was lower than that in thoge without it(P＜0.05)and no significant difference in scores of all the other skills wag found between those with varied length of working(P＞0.05).There was significant difiefence in average scores of communication skills,medical record writing,and case analysis between various trainees(P＜0.01).In addition,average scores of information collecting and medical record writing also differed among trainees from varied bases for general practice training(P＜0.05).Conclusions Clinical skills,ability to direct teaching work,and improvement of teaching model can be assessed in a comprehensive and objectively way using standardized patients in general practice training.

Objective To set up methods for objective structured clinial examination(OSCE)for its application in assessment for clinical competencies of trainees in standardized training for general practice at its completion in Shanghai.Methods Trainees in standardized training for general practice in Shanghai were assessed at its completion in July 2009 at Zhongshan Hospital of Fudan University,which was organized and implemented by establishment of OSCE management framework and design of assessment stations,including writing-up medical records for cases,training standardized patients,selecting assessment itemsfrom checklists of clinical skills.as well as working-out a form for assessment scoring.Results Six assessment stations were set up for OSCE,including clinical data collection,medical record writing,case analysis,clinical skills,diagnostic decision-making based on electrocardiograms(ECGs)and x-ray films.Totally,32 trainees took part in OSCE and all passed examination.Score of medical record writing Was higher than that of clinical data collection [86(IQR 74-91)vs.79(IQR 67-85),P＜0.05].There was no significant difference in scores between medical reeord writing and case analysis [86(IQR 74-91)vs.80(IQR 73-86),P＞0.05].Score of X-ray film diagnosis Was higher than that of ECG diagnosis and clinical skills[99(IQR 96-100) vs.95(IQR 91-98),and 99(IQR 96-100)vs.90(IQR 83-94),all P＜0.01].Conclusions Clinical competeneies of trainees of general practice Can be assessed by OSCE in multiple aspects,which provides a new examination method for GP training.

Objective To study current status of health education and explore its pattern in community health-care service(CHS)in Shanghai.Methods A total of 200 health-care workers(HCWs)from five CHS centers in Shanghai were investigated by questionnaire of health education knowledge.Results Among 200 HCWs investigated,96.5%(193/200)of them have recognized importance of health education,98.0%(196/200)could undertake health education in their clinical work,only 60.5%(121/200)had receired regular training on it,and 85.5%(171/200)thought they should be further trained regularly.Correct awareness of knowledge was 94.O%.47.0%and 33.6%for health education perception,healthy life-style and health education knowledge for chronic disease.respectively in them.There was very significant difference in correct awareness of knowledge between HCWs with varied ages and districts(χ2=17.663 and 82.376,P=0.001 and 0.000,respectively),but no significant difierence was found between men and women and those with varied professional titles(χ2=0.015 and 2.406,P=0.903 and 0.300.respectively).Short of time(48.5%),lack of relevant knowledge(15.0%)in HCWs and poor compliance of patients(33.0%)were main factors influencing their implementation of health education.Conclusions HCWs in CHS have already recognized importance of health education.but have not known enough its theoretical knowledge and skills.It is necessary to set guidelines of health education intervention for HCWs in CHS,and perfect monitoring and evaluation.as well as mechanism for rewards and penalties to promote development of health education in CHS.

Objective To explore application of standardized patients (SPs) in intensive training of clinical competency for general practice trainees. Methods Fifty-three general practice trainees in Shanghai Zhongshan Hospital were enrolled in the study, randomly assigned to intervention and control groups. Control group proceeded in routine clinical rotation, while intervention group accepted intensive training course with SPs as trainers. Three months after intervention, clinical skills of the two groups were compared in a simulated medical environment. Results There was no statistically significant difference in their baseline characteristics between the two groups (P ＞0.05). Competency in history taking, physical examinations,communication with patients, comprehensive consultation, medical record writing as well as case-analysis,improved significantly in intervention group after intervention, as compared to those before it ( P ＜ 0. 01 ),with the highest score of communication skill of 82 ± 10. Although competency of history taking, physical examinations, comprehensive consultation, medical record writing also improved significantly three months later in control group as compared to their baselines (P ＜ 0. 01 ), while no statistically significant difference in their communication skills was found ( P ＞ 0. 05 ). Scores of skills in physician-patient communication,comprehensive consultation as well as medical record analysis were significantly higher in intervention group than those in control one after intervention ( P ＜ 0. 01 ), but no significant difference in physical examinations was found between the two groups ( P ＞ 0. 05 ). Conclusions Application of SP in intensive training course for clinical competency can remarkably improve their competency in interpersonal communication and comprehensive consultation for general practice trainees.