In order to improve the effectiveness of continuing medical education in military comprehensive hospital , we trans-formed the idea of continuing medical education , regulated the system , strengthened the hardware , paid more attention to the manage-ment, provided different ways for continous medical education .With the practice of continuing medical education , we should design a scientific management system and diversified activities to impove continous medical education .The article elaborated the practice of new transitional pattern of continuing medical education in our hospital in order to provide some references for the optimization of con -tinous medical education in comprehensive military hospitals .

【Objective】 To investigate the epidemiology of HTLV by conducting HTLV nucleic acid detection among voluntary blood donors, so as to provide basis for the decision making of blood screening strategy. 【Methods】 The HTLV blood nucleic acid(NAT) screening platform was established based on the existing NAT for HBV / HCV / HIV screening. HTLV (type 1 + 2) detection was carried out in 5 368 blood donors, and the results were analyzed. 【Results】 No NAT-yielding of HTLV- 1, -2 type was found in a total of 5 368 voluntary blood donor from January to August 2019. 【Conclusion】 Qianxinan, currently, is very low epidemic or non epidemic as none of HTLV infections was found among blood donors and no significant differences in the epidemiology of HTLV were notable between the counties and cities. It, however, still needs further investigation in the future.

Objective To observe the effect of GPR30 agonist G1 on high glucose-induced endoplasmic reticulum stress ( ERS) in endothelial EA .hy926 cells.Methods EA.hy926 endothelial cells were divided into three groups:nor-mal control group (Con, 17.51 mmol /L glucose), high glucose (HG, 33.3 mmol /L), high glucose +G1 group (HG+G1, HG +1 μmol/L G1).The apoptosis rate of endothelial cells was measured by flow cytometry , the protein expres-sion changes of ERS related molecules Bip , IRE1, PERK and apoptotic molecules Bax , Bcl-2 were measured by Western blot, the mRNA expressions of Bip and CHOP were measured by RT-PCR assay.Results Compared with Con group , the apoptosis in HG group was significantly increased (P <0.01), Bip, IRE1, PERK and apoptotic molecule Bax were upreg-ulateded (P <0.05, P<0.01 or P <0.001), Bcl-2 downregulatted (P <0.01) and Bip mRNA, CHOP mRNA expres-sion were upregulated (P <0.001 and P<0.01).Compared with the HG group, apoptosis rate in HG +G1 group was significantly lower (P <0.05), BIP, IRE1, PERK and apoptotic molecules Ba.0 downregulated ( P <0.05 or P <0.01), Bcl-2 expressions was increased (P <0.05), Bip mRNA and CHOP mRNA expression were decreased (P<0.001 or P<0.01).Conclusion GPR30 agonist G-1 inhibits EA.hy926 ERS in endothelial cells.

Objective To study the characteristics and regularities of Chinese drugs preparations ADR in order to improve the rational drug use.Methods A total of 112 cases of TCM ADR reports collected in 2009～2011 which have been presented to the Guangzhou ADR Monitoring Center.Results Of the 112 cases,26 kinds of drugs were involved,quinquagenarian were the main crowd,intravenous infusion was the main route of administration,the main types of TCM ADR were lesions of skin and accessories.Conclusion Great importance should be attached to TCM ADR monitoring to promote rational drug use in the clinic.

Objective To explore the impact of iodine nutrition on children in areas with different iodized-salt covering rate after adjusting the iodine content in iodized salt in Hangzhou.Methods After adjusting the iodine content of salt,every county (area,city) of Hangzhou was divided into east,west,south,north and middle districts;one school was selected in each district,40 children aged 8-10 years old in each school were selected.The goiter rates of 8-10 years old students were examined (WS 276-2007).The family salt and urine samples of each student were collected.The levels of salt and urinary iodine were measured by picric sodium thiosulfate titrimetric (GB 13025.7-2012) and spectrophotometer method (WS/T 107-2006),respectively.Areas were classified according to the coverage rate of iodized salt ＜95％ and ≥95％,and their urinary iodine levels were compared.Results A total of 2 395 samples were collected with a median salt iodine concentration of 23.50 mg/kg and a urinary iodine level of 167.45 μg/L.The goiter rate of children 8-10 years old was 1.75％ (42/2 395).The total iodized-salt covering rate was 93.15％ (2 231/2 395) and the difference was statistically significant between different districts and towns (x2 =153.13,P ＜0.01),but the level was less than 95％ in 6 areas.The urinary median iodine was 151.00 μg/L in the areas where the iodized-salt covering rate was less than 95％,lower than 173.50 μg/L in the areas where the iodized-salt covering rate was more than or equal to 95％ (x2 =-5.28,P ＜0.01).Conclusions After adjusting the iodine content of salt in Hangzhou,the iodine-nutrition status of 8 to 10 years old students is optimal.But the urinary iodine levels are different in areas with different iodized-salt covering rates,so the coverage of iodized salt at household level need to be enhanced and the health education should be strengthen.

With the development of economy and society, the change of heath concept and increased demands for health care , the cultivation of postgraduates majoring in clinical medicine is facing a lot of problems which seriously affects the quality of culti-vation.The article analyzed the problems and reasons in the clinical medicine postgraduate cultivation.We stated the competency of clinical medicine postgraduates according to the transition of health demands, global medical development and practical requirements for clinical personnel in China.We elaborated the required post competence for clinical medicine postgraduates on the basis of its con-tent and characteristics.We proposed to strengthen the cultivation of clinical medicine postgraduates by the reform and support of the government, enhanced construction of teachers, improved course plan and cultivation process, perfected assessment system in order to make the students competent to their posts.

Objective To explore the impact of iodine nutrition on pregnant women before and after adjusting the iodine content in iodine salt.Methods Twelve counties (areas,cities) in Hangzhou were divided into urban,suburban and rural areas before and after adjusting the iodine content of salt.One survey spot was selected in each district and one hundred pregnant women were selected;family salt and urinary samples of each pregnant woman were collected.The levels of salt and urinary iodine were measured by the methods of picric sodium thiosulfate titrimetric (GB 13025.7-2012) and spectrophotometer (WS/T 107-2006),respectively.Results One thousand two hundred and thirty-nine and one thousand two hundred and thirty-three household salt samples were collected before and after adjusting the iodine content in iodine salt.The median of salt iodine of pregnant women (23.30 mg/kg) before adjusting the iodine content in iodine salt was lower than that after adjusting the iodine content in iodine salt (30.09 mg/kg,x2 =-4.71,P ＜ 0.01).The iodine salt coverage rate and the consumption rate of qualified iodized salt after adjusting the iodine content in iodine salt [93.92％ (1 158/1 233),93.84％ (1 157/1 233)] were higher than those before adjusting the iodine content in iodine salt [91.85％ (1 138/1 239),91.37％ (1 132/1 239),x2 =4.01,5.51,all P ＜ 0.05].The iodine salt coverage rate and the consumption rate of qualified iodized salt in urban and suburb areas after adjusting the iodine content in iodine salt [99.42％ (510/513),100.00％ (203/203),97.86％ (5021513),100.00％ (203/203)] were higher than those before adjusting the iodine content in iodine salt [86.71％ (450/519),98.00％ (196/200),77.26％ (401/519),85.00％ (170/200)],but the iodine salt coverage rate and the consumption rate of qualified iodized salt in rural area before adjusting the iodine content in iodine salt [94.62％ (492/520),86.92％ (452/520)] were higher than those after adjusting the iodine content in iodine salt [85.69％(443/517),76.98％ (398/517),x2=64.22,2.32,100.02,32.90,23.31,17.33,all P ＜ 0.05].One thousand two hundred and thirty-four and one thousand two hundred and thirty-one household urine samples were collected before and after adjusting the iodine content in iodine salt.The median of urinary iodine (MUI,114.80 μg/L) of pregnant women after adjusting the iodine content in iodine salt was lower than that before adjusting the iodine content in iodine salt (168.60 μg/L,x2 =36.92,P ＜ 0.01).The MUIs of pregnant women in urban,suburban,and rural areas (171.30,170.20 and 162.40 μg/L) before adjusting the iodine content in iodine salt were higher than those after adjusting the iodine content in iodine salt (101.00,149.48 and 119.90 μg/L,x2 =-7.78,-2.63,-6.28,all P ＜ 0.01).The differences of urinary iodine between groups were statistically significant in urban,suburban and rural areas after adjusting the iodine content in iodine salt (x2 =32.86,P ＜ 0.01),the MUI of pregnant women in urban areas was lower than those in the suburban and rural areas (x2 =6.70,8.13,all P ＜ 0.05).Conclusions After adjusting the iodine content of salt in Hangzhou,the iodine-nutrition level of pregnant women is decreased.But the consumption rates of qualified iodized salt and the MUIs in urban,suburb,rural areas are different,so the coverage of iodized salt at household level needs to be enhanced and the health education should be highlighted.

Objective To study changes and significance of endothelin(ET) in rat cerebral concussion.Methods 80 Wistar male rats were used for animal model of cerebral concussion,which were sacrificed on 1,3,7,14 and 30 days after injury and the brain tissue were taken off. The expression of ET was studied in the course of cerebral concussion by means of immunohistochemistry.Results Typical clinical manifestation was observed in the 100 g group in which the pathological changes included cerebral vascular constriction and dilatation,congestion and edema of cerebral tissue,neuronal degeneration,necrosis,and obviously decreased even disappeared Nissl bodies.Increased expression of ET was observed on the first day,the positive area was seen in the plasma of endothelial cells in cerebral cortex,hippocampus,cerebellum and thalamus.ET expression peak occurred on the 7th day,the positive area was also found in the plasma of Purkinje cells in the cerebellum.Decreased ET expression was found on 14th day and returned to normal level on the 30th day.Conclusion The main pathological changes of cerebral concussion contained blood circulation disorder,and degeneration and necrosis of substantial cells.ET was involved in the brain tissue injury during the pathological process of cerebral concussion and might be related to regulation of cerebral vascular reaction,and neuron degeneration and necrosis.

Objective To investigate the urinary iodine level and thyroid function during different trimesters of pregnancy in Hangzhou residents and to provide evidence for monitoring iodine nutrition or screening thyroid function. Methods The urinary iodine level and thyroid function of 395 subjects from 5 hospitals in Hanzhou were investigated. The urinary iodine level was measured by arsenic-cerium contact process method. The serum TSH, FT3 and FT4 were measured by chemiluminescence method. Results (1) The urinary iodine median concentration during pregnancy in the 1st, 2nd and 3rd trimesters were 170.3, 170.2, 162.4 μ/L respectively, all significantly lower than that of non-pregnant women (251.9 μg/L, all P < 0.05); (2) The mean value of TSH during the 1st trimester of pregnancy was significantly lower than that of non-preguant women (P < 0.05). The mean values of FT4 and FT3 in the 2nd and the 3rd trimesters of pregnancy were significantly lower than those of the control (P < 0.05); (3) During 2nd trimester, there were 8.7% (9/104, in FT4) and 9.6% (10/104, in FT3) pregnant women below normal lower range while during 3rd trimester, these figures reached 22.7% (22/97) and 17.5% (17/97) resfectively. Conclusions More than half of the pregnant women in Hangzhou have good nutritional status of iodine. There are significant differences in thyroid hormone levels between the non-pregnant and pregnant women as well as between gestation periods. Therefore, it is necessary to establish a trimester-specific reference range of thyroid hormones for normal pregnancy. The screening for thyroid function is recommended for pregnant women besides monitoring routine urinary iodine.

Objective To systematically review the clinical effects of Shuxuetong and Low-molecular-weight Heparin(LMWH)in patients with deep vein thrombosis (DVT)in lower limbs.Methods The CNKI,Wanfang,VIP,SinoMed,PubMed,EMBASE,and ISI Web of Science databases were electronically searched from inception to February 3th,2017,to collect the randomized clinical trials on the clinical effects of Shuxuetong and LMWH on DVT in lower limbs.Two investigators independently screened the literatures,extracted data and assessed the quality of enrolled studies.All analyses were performed using the Stata 11.0 software.Results Twenty studies involving 1 515 patients were finally included.The meta-analysis results showed that the total effective rate was significantly higher in Shuxuetong group than in LMWH drug control group(RR =1.22,95 ％ CI:1.13-1.32,P ＜ 0.001).The subgroup analysis showed that there was no significant difference in total effective rate between the Shuxuetong alone group and LMWH alone control group(RR =1.05,95％ CI:0.98-1.12,P =0.136).However,the total effective rate was significantly higher in Shuxuetong combined with LMWH group than in LMWH alone control group(RR =1.30,95％CI:1.18-1.44,P ＜ 0.001).Conclusions Shuxuetong combined with LMWH has better clinical effects than do LMWH alone group in treating patients with DVT in lower limbs.