The Milestones has become an important component of Graduate Medical Education (GME) of the United States, and the Milestones Guidebook (2016) can help understand and implement the Milestones and improve graduate medical education and practice.This article outlines the basic principles of the Competency-Based Medical Education (CBME) and the Milestones, introduces the guidelines and responsibilities of related stakeholders in Implementing and Using Milestones Effectively, and highlights the Importance of Assessment and Feedback.The Milestones includes 6 core competencies to be achieved in skills, knowledge, and behaviors, its formative process, the causes of its development, and its effective implement and application.The Milestones is the development of CBME and designed to help all practitioners make highly competent physicians.The primary objective of this program is to cultivate trustworthy medical graduates and provide high-quality health care to the general public.

Objective To explore the incidence,distribution and the risk factors of intracranial and extracranial artery stenosis in patients with ischemic cerebrovascular disease(ICVD)in Uygur and Han.Methods Both 165 Han and 108 Uygur patients of ICVD were detected by using DSA.The level of serum glucose and lipidemia were measured.Statistical analysis was used to evaluate the incidence,distribution and risk fators of intracranial and extracranial artery stenosis in Han and Uygur groups.Results 103(62.4%) cases in Han group and 70(64.8%)cases in Uygur group existed intracranial and extracranial artery stenosis,but there was no significantly difference between the two groups.There was no significantly difference in the distribution of cerebral arterial stenosis between Han and Uygur groups.In Han group,age,hypertension,smoking and low HDL were related to cerebral arterial stenosis(P

Objective To study the efficacy of antibiotic prophylaxis in old patients with negative urine cultures,who were submitted to transurethral prostate resection(TURP).Methods One hundred and twenty old benign prostatic hyperplasia(BPH) patients with sterile urine were divided into two groups(60 patients in each group) randomly.Antibiotic group received empirical venous antibiotics 4 days postoperative.Control group received 5% glucose saline as placebo.Their postoperative infection-associated parameters were compared.Results There were no significant differences between two groups in bacteriuria and infection-associated complications at the 28th day postoperatively.The ratio of bacteriuria in antibiotic group decreased significantly at postoperative at the 4th day when compared with that of control group.The bacteriuria at postoperative at the 4th day had no specific correlation with the long-term bacteriuria,the clinical observation of bacteremia and urinal tract infection,or the culture of prostatic tissue chip.Conclusions Antibiotic prophylaxis reduces the early postoperative bacteriuria for old patients with sterile urine before TURP,but its effectiveness for postoperative infectious complications is debatable.The antibiotics according to empirical validity are not specifically sensitive to the bacteria from various sources.

[Objective]Comparison of the content of general flavone and elements in the different parts of Stenoloma chusanum(L.)Ching.[Methods]Total flavone was determined by vis spectrophotometer.Elements were determined by inductively coupled plasma-atomic emission spectrometry(ICP-AES).[Results]The contents of general flavone in the different parts of Stenoloma chusanum(L.)Ching are respectively 11.89%,4.47%,3.46% and 11.75%.And there are some differences in the contents of elements between the different parts.[Conclusion]There are abundant elements and general flavone in the different parts of Stenoloma chusanum(L.)Ching.As the result reveals that Stenoloma chusanum(L.)Ching is very valuable.

OBJECTIVE:To explore the safety and effects of liver function in patients with liver cirrhosis following virus B hepatitis(called“hepatitis B”for short)on drug half-life and analgesic effect of target controlled infusion of remifentanil. METH-ODS:100 patients with liver cirrhosis following hepatitis B underwent liver and gallbladder surgery under selective general anesthe-sia were collected from our hospital and divided into group A(mild abnormal liver function)and group B(severe abnormal liver function,3 cases withdrew from the test and 47 cases completed the test),with 50 cases in each group,according to Child-Pugh grading of liver function. Both group were given phenobarbital sodium 0.1 g+scopolamine 0.3 mg intramuscularly 0.5 h before oper-ation;midazolam 0.04 mg/kg+propofol 1.5 mg/kg+atracurium 0.6 mg/kg intravenously;target controlled infusion of Remifentanil hydrochloride for injection during operation with 0.125-0.250 μg/(kg·min). The distribution half-life and the elimination half-life of remifentanil were determined, and temperature pain perception threshold (tPDT) and electrical pain perception threshold (ePDT) were measured immediately after the operation;the occurrence of ADR was observed. RESULTS:The distribution and elimination half-life of remifentanil were (4.52 ± 1.25)min and(24.64 ± 1.30)min in group A and (4.68 ± 1.31)min and(25.45 ± 2.08)min in group B respectively,there was no statistical significance between 2 groups(P>0.05). tPDT and ePDT of group A were(8.88± 1.66)mA and(1.54±0.09)mA respectively,and those of group B were(9.16±1.58)mA and(1.34±0.15)mA,there was no sta-tistical significance between 2 groups (P>0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:The abnormal liver function of patients with liver cirrhosis following hepatitis B have no significant effect on drug half-life and analgesic effect of remi-fentanil with good safety.

In this research, we apply the antisense strategy to study the function of IGF- I in human hepatoma lines(7402) by Lipofectin mediated gene transfer. The effect of antisense IGF-I on the expression of MHC and the sensitivity of LAK cytotoxicity of tumor cell were studied. The results showed that human hepotoma lines(7402) were transfected with an amplifiable antisense IGF- I gene. The expression antisense IGF-I RNA in the transfected cells after hygromycin resistant selection was confirmed by northern blot analysis. The transfectants expressed higher level of MHC class I and class II molecules. The susceptibility of the transfected cell to LAK cytotoxicity was greater than that of 7402 parent cells(P

Objective To research the degree of sensory disturbance(about algaesthesis and thermesthesia) in patients with cerebral infarction(CI),diabetes mellitus(DM) and CI combined DM(CD).Methods The threshold values of rhigosis,heat sensation,cryalgesia and thermalgesia were detected by quantitative sensory testing(QST) in the patients with CI(CI group),DM(DM group),CD(CD group).Each group had 30 cases.The results were compared with normal control group(NC group).Results Compared with NC group,acral thermic sense and cryalgesia in CI group and CD group were declined obviously(all P

The determination of vitamine D in fortified milk powder was carried out by means of HPLC. Its pre-treatments include extraction of fat, sap onification, isolation of the unsaponifiable matters, and digitonin-celite and bentonite column chromatography. The HPLC was performed with 15cm ? 4mm column of silica 5m 0.7% ethyl alcohol in iso-octane as mobile phase, at 254nm. Only 12 grams of sample which contained 400-500 IU vitamin D/100 g were used. Within the sample there were relatively large amounts of interfering materials such as fats, sterols,?-carotene, vitamin A, vitamin E and their decomposed products, but they could be separated by the above method. The recovery rate of vitamin D was 81% with standard deviation of 0.39?g/100g. This method could also be applied to other samples such as fortified cakes, confectionaries, infant foods and "Mairujing" (milk maltose mixture powder) etc.

Objective To explore clinical characteristics of chronic total occlusion(CTO) in population with routine coronary angiography,and to cumulate therapeutic experience.Methods Retrospective analysis was performed on clinical data of 57 cases with CTO selected from 825 patients undergone coronary angiography.Results Among 57 cases,the percentage of male,myocaridial infarction,diabetes mellitus,hyperlipidermia and left ventricular dysfunction was 73.7%,84.2%,22.8%,73.7% and 22.8%,respectively.The types of lesions included single branch(n=11),double branches(n=29) and three branches(n=17).Of 70 branches lesion vessels,44 were TIMI 0 of blood flow classification and 26 were TIMI1.The position of lesions occurred at left anterior descending branch(n=32),left circumflex branch(n=16),right coronary artery(n=22).The occlusion time was less than three months(n=41) and more than three months(n=29).The lengths of lesion was divided into less than 20 mm(n=43) and more than 20 mm(n=27).The shapes of terminal lesion looked like rat-tail(n=42) and blaze knife-edge(n=28).The coronary stents were performed at 57 lesions among 70 branches and the successful rate of operation was 82.9%.Conclusions Timely coronary angiography and selecting suitable treatment on different kinds of lesions for male patients with myocardial infraction,especially complicated with diabetes mellitus,might play important roles in prevention of CTO and in improvement of the successful rate of percutanous coronary intervention for the complex lesion.

Objective:To synthesize poly (2-ethyl-2-oxazoline)-poly(lactic acid) copolymer (PEOz-PLA), prepare pH-sensitive paclitaxel-loaded polymeric micelles, and evaluate the in vitro properties. Methods: The structures of all the synthesized copolymers were confirmed by 1 HNMR and Fourier transform infrared spectroscopy ( FTIR) . The drug-loaded micelles were prepared by a dialysis method. The micelles solution was freeze-dried and the lyoprotectants were screened. The critical micelle concentrations ( CMC) of the copolymers were measured by pyrene fluorescent probe technique. The distribution of particle size was measured by dynamic light scat-tering ( DLS) . The in vitro release behavior of the loaded micelles at different pH conditions was studied by a dialysis method. Re-sults:The CMC of micelles was 25. 63 mg·ml-1 . When 10% polyethylene glycol 4000 was used as the lyoprotectant, the re-solubili-ty of micelles was good and the distribution of particle size was narrow. The drug loading rate of micelles was 8. 12% and the encapsu-lation efficiency was 69. 33%. The average particle size of freeze-dried micelles was 183. 7 nm. The in vitro release of the drug-loaded micelles showed that the drug released slowly at pH 7. 4 and fast at pH 5. 0, which indicated that the change of pH could affect the drug release. Conclusion:The preparation of PEOz-PLA polymer micelles is simple. The particle size, entrapment efficiency and drug loading are controllable. The micelles have a certain sustained-release effect, which provides basis for further pharmacological study and clinical application.