Based on the shortcomings of graduate education in clinical medicine of our country and the characteristics of this specialty, the author point out that the cultivation of graduates in otolaryngology, head and neck surgery should be focused on the training of humanities, professional knowledge and skills. And they also make some suggestions and discussion about the reform of graduate education mode.

To investigate the clinical efficacy of massage manipulation reposition for treatment of child hip-joint semiluxation, sixty-seven cases of child hip-joint semiluxation were treated by massage manipulation reposition. Sixty-two cases were cured and 5 cases improved. The total effective rate was 100%. Massage manipulation reposition is an effective method for treating child hip-joint semiluxation.

Objective To evaluate the significance of t he abnormality of VHL gene and VEGF expression in primary renal cell carcinoma ( RCC). Methods Mutation and abnormal methylation of VHL g ene and the expression of VEGF were dtected by means of multiplex PCR,PCR-SSCP and immunohistochemistry in 42 cases of primary RCC,in 18 specimens adjacent to the neoplastic lesion and in 10 specimens of normal renal tissues. R esults The alteration rate of VHL gene was higher in RCC tissue (61. 9%) than in the normal renal tissue (3.6%,P

Objective To study the effect of mild hypothermia on aquaporin 4 (AQP4) expressions and cerebral edema after intracerebral hemorrhage and the mechanisms of mild hypothermia on hemorrhagic brain edema. Methods The model of intracerebral hemorrhage (ICH) was established by infusing collagenase into right globus pallidus of the rat. The temperature was regulated by ice cubes and daylight lamp, which was modulated to an appropriate distance to the animals. Immunohistochemistry staining was used to detect the cerebral AQP4 expressions. Dynamic change of brain edema was observed through wet-dry weighing method. Results The brain water content (BWC) of injured side and level of AQP4 expression in perihematom tissue in ICH rats were obviously higher than those of the sham group (all P

A study of PDCA Cycle in managing hospital medical complaints may introduce such a cycle into the medical complaints control system of a hospital, effectively handling the medical complaints process. Since 2006 when the cycle was introduced into the hospital for medical complaints control, such complaints have been cut back significantly by the end of 2009. Furthermore, such complaints are under control from the start, and prevented from growing into medical disputes, effectively improving quality of care. Such a cycle can effectively avoid medical complaints, enhance medical safety, and build a harmonious doctor-patient relationship.

Objective To observe effects of propofol versus urapidil on perioperative hemodynamics in patients with gallbladder opera-tion during tracheal extubation. Methods From 2010 January to 2012 December, 128 patients who were diagnosed by color B ultra /CT and then underwent gallbladder selective operation (ASAⅡ~IV) were selected, and they were divided into the propofol group (n=64) and the urapidil group (n=64). At the end of operation, patients of the two groups were given intravenous injection of propofol 1. 5 mg/kg and ura-pidil 2. 5mg/kg which were diluted with normal saline to 8 mL respectively. Sputum suction immediately after medication, and then wiped out the endotracheal tube and gave oxygen masks for 10 min. Record the systolic/diastolic blood pressure ( SBP/DSP) , heart rate ( HR) , pH, PaO2 , PaCO2 and SaO2 under double blind trial before induction, after medication, at the time of sputum suction, at the time of extuba-tion, 5 min after extubation and 10 min after extubation. At the same time, agitation during the extubation period and patients awake time were recorded. Results After extubation, cough (4. 7% vs. 26. 6%), agitation (3. 1% vs. 17. 2%) and glossoptosis (12. 5% vs. 21. 9%) in propofol group was significantly lower than urapidil group (P<0. 05). SBP/DSP and heart rate of propofol group and urapidil group were significantly increased (P<0. 05) before induction, after medication, at the time of sputum suction, at the time of extubation, 5 minafter extubation and 10 min after extubation. The recovery time of propofol group and urapidil group were of no significant differences (P>0. 05). During perioperation extubation, there was no significantly difference in terms of changes of pH, PaO2, PaCO2 and SaO2 be-tween the groups (P>0. 05). Conclusion Propofol is better than urapidil in preventing adverse effect of extubation for patients with gall-bladder operation, and it will not affect the recovery time of patients.

Objective To reach parameter on sterilization wrap of medical instrument. Methods The parameter of one hundred twenty sterilization wraps with size 30 cm?40 cm?60 cm and weight 20kg was tested by Belimed sterilizer. Results There are 155 masculine gender and 445 negative in 600 quick reading biological indicators of 120 sterilization wraps and 53 masculine in bacteria detection, 9 cases failure in 1243 indicator, 52 wet wraps. Conclusion The parameter was to take three times negative pressure pulse and five times pressure pulse, sterilization temperature 134℃, sterilization time 11min and dry time 11min, matching to sterilization request of "Technical Standard For disinfection".

Quality of care is key to medical safety which has a close bearing on patients’life and health,and on the branding and efficiency of the hospital.Medical safety is one of the key indicators of the overall performance appraisal of the hospital.This novel type of nurse-physician collaboration,abandoning the traditional model of health care,is a new integrated model of health care which improves the overall quality of care,enhances medical safety and patient satisfaction.This paper described in detail the implementation methods and steps of the collaboration,the progress of such a collaboration and its contribution to medical safety are also discussed.

Objective To study the characteristic of cognitive function impaired and its relationship with the psychiatric symptoms in patients with first-episode schizophrenia.Methods 43 first-episode male schizophrenia patients diagnosed with DSM-Ⅳ were recruited in the study and received the atypical antipsychotics treatment 8weeks.The total score and sub-scores of Chinese Cognitive Ability Scale (CCAS)were obtained for all the patients pre-and post-treatments,and the patients were also assessed by the Positive and Negative Syndrome Scale (PANSS).Results The differences of the intelligence quotient(IQ) and its cognitive function factors between pre-and post-treatment of the patients were significant(P＜ 0.01).The total IQ score (85.7 ± 11.5),learning ability (17.9± 2.3),reasoning ability (16.1 ± 3.4),processing speed (16.9 ± 2.1),working memory (13.8 ± 2.6),space/calculate (17.5 ± 2.9),verbal IQ (86.8 ± 11.7),performance IQ (83.9 ± 12.4) before treatment and cognitive score (97.6 ± 14.3) as well as cognitive function factor (learning ability (20.1 ± 2.9),reasoning ability (18.9± 3.1),processing speed (19.7 ± 1.8),working memory (15.7 ± 2.5),space/calculate (20.8 ± 2.5),verbal IQ (98.3 ± 13.7),performance IQ (95.8 ± 14.6) after treatment,there were significant differences pre-and posttreatment (P ＜ 0.01).The difference of IQ pre-and post-treatment was significantly correlated with that of total score and positive score of PANSS(r =0.596 or 0.783).Conclusions (1) This finding supports that the cognitive function impairment exists in the early stage of schizophrenia.(2)The typical antipsychotic drugs can improve the cognitive function impairment and psychiatric symptoms of schizophrenia.(3) The cognitive function impairment of schizophrenia has significant relation to the positive symptoms,but no relation to the negative symptoms.

BACKGROUND:Psychiatric patients are the high risk group of people who are liable to commit suicide.Recently,research on neurobiology and genetics of suicide mainly concentrates in the study of 5 hydroxytryptamine(5 HT) system.It is found that T102C polymorphism of 5 HT2A receptor gene is associated with suicide in depressive patients. OBJECTIVE:To investigate the correlation of A 1438G polymorphism of 5 HT2A receptor gene with attempted suicide in psychiatric patients. DESIGN:An observational comparative study of taking the patients as subjects and healthy physical examinee as the controls. SETTINGS:A psychiatric department in a municipal hospital and a neurological department in a university hospital. PARTICIPANTS:All the samples in the research were collected from the Department of Psychiatry of Yangzhou Wutaishan Hospital from March to September 2002.Analysis of genotype was completed in the Neurobiological Laboratory of Xuzhou Medical Institute from October to December 2002.Inclusive criterion:patients met the diagnostic criteria of schizophrenia or affective disorder in the third edition of the Chinese Classification and diagnostic criteria of Mental Disorders(CCMD 3) and Diagnostic and Statistical Manual of Mental Disorders Fourth Edition(DSM IV).Exclusive criterion: parasuicider with idea or behavior of hurting oneself,but without intention to die.According to whether there was suicidal behavior or intention,116 patients were divided into 2 groups:attempted suicide group[n=52,35 males and 17 females,with an average age of (44± 13) years old] and no suicide group [n=64, 44 males and 20 females, with an average age of (48± 15) years old].Other 63 cases were taken as the normal controls[33 males and 30 females, with an average age of (55± 17) years old]. INTERVENTIONS:DNA of all the participants was extracted with the routine method of chloroform saturatedphenol leukocyte pheresis.The polymorphism of 5 HT2A receptor gene was analyzed with the restriction fragment length polymorphism. RESULTS:The G allele frequency of A 1438G polymorphism in the attempted suicide group(0.52) was significantly higher than that in the normal control group(0.39)(χ 2=3.91,P< 0.05).There were significant differences in the distribution of the 3 genotypes of AA, AG and GG between the attempted suicide group(0.23,0.50, 0.27) and normal control group(0.32, 0.59, 0.09)(χ 2=6.12,P< 0.05). CONCLUSION:Attempted suicide of psychiatric patient is associated with A 1438G polymorphism of 5 HT2A receptor gene.G allele may be a risk factor for the attempted suicide of psychiatric patient.