Objective to get the message of the state of refreser doctor patient communication and put forward the solution.Method 200 patients were investigated who were hospitalized in the department of gynaecology and obstetrics of the seconed affiliated hospital of Chongqing Medical University,and the state of the doctor patient communication as well as the affecting factor were questionnaired.Results 182 questionnaire was reclaimed,the ratio of reclaim was 91%.50.3% patient considered the advanced study doctor communation was satisfactory,41.2% patient considered the communicatin is common,8.5% patient considered the communicatin is dissatisfing.65.3% patient considered the service attitude affected the communication,42.3% patient considered the speech of the doctor effect the communication,41.2% patient considered the behavior of the doctor effected the communication.Conclusion the refresher doctor was deficient in the doctor patient communication,and the training was required in the service attitude,speech and behavior arts.

Objective: To explore value of exercise stress test guiding aerobic exercise rehabilitation in patients with myocardial infarction.Methods: A total of 102 patients with myocardial infarction in recovery were selected.According to random number table, they were randomly and equally divided into routine rehabilitation group (received routine rehabilitation guidance) and aerobic exercise rehabilitation group (received aerobic rehabilitation exercise in guidance of exercise stress test).Amount of exercise, hemodynamic parameters and psychological state were compared between two groups.Results: After treatment, amount of exercise: compared with routine rehabilitation group, there were significant rise in amount of exercise[(6.79±0.58)METs vs.(7.42±0.69)METs], maximum heart rate[(126.27±5.26) beats/min vs.(138.18±5.81) beats/min], heart rate blood pressure product[(221.87±21.46) vs.(244.85±23.09)]and exercise duration[(10.36±1.36) min vs.(11.18±1.45) min]in aerobic rehabilitation group, P<0.05 or <0.01;hemodynamic parameters: compared with routine rehabilitation group, there were significant rise in cardiac output[(5.36±0.57) L/min vs.(5.72±0.68) L/min], cardiac index[(2.96±0.53) L min-1 m-2 vs.(3.25±0.52) L min-1 m-2], stroke volume[(73.16±8.47) ml vs.(78.12±9.14) ml]in aerobic exercise rehabilitation group, P<0.05 all;psychological state: compared with routine rehabilitation group, there were significant reductions in scores of Hamilton rating scale for anxiety[HAMA, (9.74±3.26) scores vs.(6.35±1.18) scores]and Hamilton rating scale for depression[HAMD, (14.83±4.58) scores vs.(10.56±3.27) scores]in aerobic exercise rehabilitation group, P<0.05 both.Conclusion: Exercise stress test guiding aerobic exercise rehabilitation can help to improve exercise function and hemodynamic indexes, alleviate the negative mood, then promote patients recover.

Lung ultrasound has been proven to have high sensitivity and specificity in the application of lung diseases, and significantly reduces the radiation exposure of children, especially in newborns, which makes it widely used in diagnosis, treatment and prognosis of childhood disease.In emergency and intensive care units, lung ultrasound can even replace chest radiographs as a routine examination method for chest lesions.However, the research of children′s lung ultrasound still falls behind the development of adult ultrasound, and there is a lack of standard procedures and specifications for children′s lung ultrasound.Therefore, this study mainly reviewed the research status of children′s lung ultrasound.

Objective To compare the effect of electroacupuncture at head points and body points on glucose metabolism of the cerebral motor function regions in normal subjects.Methods To observe the change of glucose metabolism of cerebral motor area in normal subjects between before and after acupuncture during the movement by PET.Talairach coordinates(Atlas of brain) and statistical parametric mapping(SPM) software were used to deal with the acquired imaging data.Results ① Acupuncture at Baihui(GV20) and left Qubin(GB7) could increase metabolism of glucose in bilateral Lps and precuneus,the activation of left area in the brain being more significant.②Acupuncture at right Quchi(LI11) and Zusanli(ST36) change metabolism of glucose in left gyrus precentralis,right loblus paracentralis,right gyrus frontalis medialis,both cerebellums and both putarnens.Conclusion All acupoints can change glucose metabolism in cerebral structures related to motor function in the bilateral cerebral hemispheres,different acupoints active different motor areas.The function of acupuncture is a kind of comprehensive regulative process.

Aim: To investigate the effect of endogenous nociceptin/orphanin FQ(N/OFQ) on arrhythmias induced by myocardial ischemia/reperfusion (I/R) in rats and the role of microRNA-1 (miR-1) in it. Methods: Twenty-four Sprague-Dawley rats were randomly divided into sham-operation group (Sham group), ischemia/reperfusion group (I/R group) and the pretreatment of N/OFQ receptor antagonist (UFP-101) group(U + I/R group). The model of myocardial ischemia/reperfusion was prepared by ligating the left anterior descending branch of the coronary artery of rats. The incidence and arrhythmogenic scores during reperfusion in rats were recorded and analysed. The myocardium at the risk of ischemia was collected at 120 min after reperfusion. MiR-1, GJA1 and KCNJ2 levels were detected by qRT-PCR and Cx43 and kir2. 1 protein levels were detected by Western blot. Results: Antagonism of endogenous N/OFQ could significantly reduce reperfusion arrhythmias and arrhythmogenic scores, compared with I/R group (P < 0. 01). The qRT-PCR and Western blot results suggested that compared with sham group, miR-1 expression significantly increased in I/R group(P < 0. 01), while the expression of Cx43, Cx43 mRNA and kir2. 1 decreased(P< 0. 05); compared with I/R group, pretreatment with UFP-101 led to reduction of miR-1 (P<0. 05) and rise of Cx43 and kir2. 1 (P < 0. 05). Conclusions: Endogenous N/OFQ up-regulates miR-1 and inhibits the expression of Cx43 and kir2. 1 proteins, leading to reperfusion arrhythmias in rats.

Objective To observe the clinical efficacy of bloodletting and cupping at Fengchi (GB 20) plus acupuncture in treating peripheral facial paralysis in acute stage.Method Sixty patients with peripheral facial paralysis in acute stage (disease duration ≤7 d) were randomized into a treatment group and a control group, 30 cases in each group. The treatment group was intervened by bloodletting and cupping at Fengchi (GB 20) plus acupuncture, while the control group was treated with ordinary acupuncture. The two groups were treated once a day, 5 times a week, 2 weeks as a treatment course and 3 treatment courses in total. The House-Brackmann (H-B) facial nerve grading system was observed before and after the intervention, and the clinical efficacies in the two groups were compared. Result The total effective rate was 96.7% in the treatment group versus 93.3% in the control group, and the difference was not statistically significant (P>0.05). There were statistically significant differences in the H-B score between the two groups respectively after 2 and 3 treatment courses (P<0.05).Conclusion Bloodletting and cupping at Fengchi (GB 20) plus acupuncture is an effective approach in treating peripheral facial paralysis in acute stage.

Objective To investigate the diagnosis and treatment of the patients with lung cancer hospital-ized in affiliated hospital of Hainan Medical College.Methods A retrospective study was performed from January 1st 2005 to December 31th 2009 in the Hospital.201 patients were enrolled in this study.Results The average onset age of patients with lung cancer was 66 years old.No difference in different gender.The incidence of male was 72.1%, which was higher than of female(27.9%).Male to female ratio was 2.6:1.70.3% of male patients with lung cancer had a history of smoking.146 cases(72.6%)were diagnosed by clinical data,only 55 cases(27.4%)were diagnosed by histopathology.134 cases(66.7%)hadn′t indications for surgery.only 17 cases(25.4%)agreed to have surgery among 67 cases (33.3%)with indications for surgery,50 cases(74.6%)didn't agree to have surgery.34 cases (16.9%)had no indications for chemotherapy.40 cases(24.0%)agreed to have chemotherapy among 167 cases (83.1%)with indications for chemotherapy,but only 14 cases(35.0%)had completed 4 to 6 cycles of chemotherapy, and 26 cases(65.0%)hadn't completed 4 to 6 cycles.8 cases(4.0%)agreed to have radiotherapy.3 cases(1.5%) agreed to have targeted therapy.3 cases (1.5%)transfered to other hospital.Conclusion The ratio of lung cancer patients in male is higher than female in the hospital.smoking is closely related to male patients.Clinical diagnosis rate of patients is high,whereas histopathologic diagnosis rate is low.The rate of the intervention that patients accepted is low and many patients give up available management after the diagnosis is made.

Objective To evaluate the significance of cystatin C (CysC) in the diagnosis for early kidney injury of diabetes and hypertension by testing serum CysC and serum creatinine concentration and urinary albumin excretion (UAE) in patients with type 2 diabetes and primary hypertension.Methods Sixty-six patients with type 2 diabetes were selected,among whom the total 38 patients whose UAE were 30-300 mg/24 h were classified into early diabetic nephropathy (DN) group,and 28 patients whose UAE were ＜ 30 mg/24 h were classified into non diabetic nephropathy (NDN) group.Fifty-two patients with primary hypertension were selected,among whom the total 25 patients whose UAE were ≥ 30 mg/24 h were classified into hypertension with kidney injury group,and 27 patients whose UAE were ＜ 30 mg/24 h were classified into hypertension without kidney injury group.Sixty health people were selected as control group.The UAE,CysC and creatinine levels were detected.Results The CysC in early DN group was significantly higher than that in control group and NDN group [(1.84 ± 0.83)mg/L vs.(0.41 ± 0.62) and (0.66 ± 0.59) mg/L],and there was statistical difference (P ＜ 0.05).There was no statistical difference in CysC between NDN group and control group (P ＞ 0.05).There were no statistical differences in creatinine and UAE among the DN group,NDN group and control group (P ＞ 0.05).The CysC in hypertension with kidney injury group was significantly higher than that in control group and hypertension without kidney injury group [(0.93 ± 1.04) mg/L vs.(0.41 ± 0.62) and (0.69 ± 0.57) mg/L],and there was statistical difference (P ＜ 0.05).There was no statistical difference in CysC between hypertension without kidney injury group and control group (P ＞ 0.05).There were statistical differences in creatinine and UAE among hypertension with kidney injury group,hypertension without kidney injury group and control group (P ＞ 0.05).Conclusion CysC can be regarded as the value to judge early kidney injury,and it is very important inunderstanding patient's condition,by which appropriate treatment can be carried out to prevent or decrease the occurrence of chronic renal failure.

Objective To evaluate the clinical effects of total knee arthroplasty (TKA) in treatment of severe adults Kashin-Beck disease (KBD). Methods Sixteen cases of KBD patients underwent TKA in Shaanxi Provincial People's Hospital, including 2 males (2 knees) and 14 females (17 knees), aged 41 to 56 years, mean (56.38 ± 6.40) years, left knee in 8 cases and right knee in 11 cases, knee varus in 15 cases and valgus knees in 4 cases. Visual Analogue Scale/Score (VAS), Hospital for Special Surgery (HSS) scores, knee range of motion, varus deformity and postoperative complications were observed before and after TKA. Results In this group of TKA patients, the levels of VAS scores in pre-total knee arthroplasty (pre-TKA), 2 weeks post-total knee arthroplasty (post-TKA), 3 months post-TKA, and at the end of the follow-up were 7.51 ± 1.00, 3.56 ± 1.29, 1.83 ± 1.40 and 1.10 ± 0.87, respectively. The level of VAS scores in 2 weeks post-TKA was significantly lower than that in pre-TKA (P<0.01), and the VAS levels were continued to decrease in post-TKA (all P< 0.01). Total HSS score at the end of the follow-up post-TKA was 78.60 ± 5.30, which was significantly higher than that in pre-TKA (43.59 ± 10.08, t=19.21, P< 0.01). At the end of the follow-up post-TKA, in addition to the muscle strength, the levels of pain, knee function, activity, flexion deformity and stability (25.94 ± 4.17, 15.88 ± 3.70, 14.09 ± 1.03, 6.79 ± 2.25, 8.58 ± 1.30) were significantly higher than those in pre-TKA (11.56 ± 5.39, 7.56 ± 1.75, 9.86 ± 3.85, 3.05 ± 3.22, 5.00 ± 3.07, t= 16.00, 8.32, 6.43, 7.07, 6.95, all P< 0.01). At the end of follow-up post-TKA, the knee degree of extension [(3.05 ± 2.71)°] was significantly lower than that in pre-TKA [(15.11 ± 11.30)°, t= -5.40, P< 0.01], the knee degree of flexion [(115.79 ± 9.65)°] was significantly higher than that in pre-TKA [(93.95 ± 22.40)°, t=6.02, P< 0.01), the degree of varus [(2.40 ± 2.40)° ] and valgus [(3.75 ± 2.50)° ] deformity was significantly lower than those in pre-TKA [(11.33 ± 10.43)°, (18.00 ± 5.72)°, t = - 4.15, - 3.61, all P< 0.05]. One patient was diagnosed as knee tuberculosis in 6 months post-TKA. There was no complication in this group of patients. Conclusion The TKA in severe adults knee of KBD can significantly reduce knee pain, improve knee function, correct joint deformities and improve quality of life in patients, and shows good clinical results.

Objective To investigate the diagnosis and treatment of gastric stromal tumor(GST). Methods Retrospective analysis was made on the clinical data of 18 cases of GST. The diagnosis of 18 cases was confirmed by pathology. Local resection of the tumor was performed in 2 cases,partial gastrectomy in 5 cases, subtotal gastrectomy in 9 cases, and total gastrectomy with lymph node clearance in 2 cases. Results Most of the patients were over forty years old.In 55.5% of cases,the location of tumor was at the middle of the stomach,and 61.0% of cases were intragastric growth type.The preoperative diagnostic rate was 27.8%,misdiagnostic rate was 72.2%.The resectability rate was 100%. No postoperative complications and operative death occurred in this series. Fifteen cases were followed up for 1 to 10 years. During follow up,2 cases died of recurrence of the tumor, and the other patients were still alive. Conclusion The GST patients lack typical clinical manifestations, and the preoperative diagnosis is difficult.Barium meal examination and gastroscopy are the main supplementary examinations.A combination of histological and immunohistochemical examinations is helpful to confirm the diagnosis.Surgical resection is the only effective therapeutic method.