Objective To compare the therapeutic effect of routine dose of calcitriol and large dose impulsion therapy on hemodialysis patients with secondary hyperparathyroidism(SHPT). Methods 48 uremic hemodialysis patients were divided into group A(routine group, n = 22) and group B(control group, n = 21 ). In group A,22 pa-tients were administered with calcitriol for 6 months at the dosage of 0.25～0.5μg/d,adding calcium agents simul-taneously;the patients in group B were not given calcitriol for economic reason. In group C,21 patients were given calcitriol twice a week at the dosage of 2μg/time after hemodialysis for 3 months. Results Comparing to group B,serum PTH,AKP in group A had no significant difference,but serum hypocalcium and hyperphasphate were partly corrected,symptoms of bone pain, muscular convulsion and akin pruriter were improved. Comparing to group A,serum hypocalcium and hyperphasphate in group C were corrected, serum PTH, AKP were significantly decreased( t=2.031,P<0.05;t =3.317,P<0.001),and no hypercalcium oecurred. Conelosion Routine dose of calcitriol can not control uremic-SHirr,while impulsion therapy with lower dose oral calcitriol is effective and safe.

OBJECTIVETo investigate the effectiveness of polycystic ovary syndrome (PCOS) of damp-phlegm constitution treated with embedding therapy on back-shu points and front-mu points and needle-pricking therapy on Sifeng (EX-UE 10).

METHODSEighty-five patients were randomly divided into 2 groups of observation group (42 cases) and control group (43 cases). Embedding therapy on back-shu points and front-mu points and needle-pricking therapy on Sifeng (EX-UE 10) were applied to the observation group. Points such as Zhongwan (CV 12), Guanyuan (CV 4), Tianshu (ST 25), Zhangmen (LR 13), Jingmen (GB 25), Qimen (LR 14), Ganshu (BL 18), Weishu (BL 21), Pishu (BL 20), Shenshu (BL 23), Dachangshu (BL 25) and Xiaochangshu (BL 27), etc. were adopted for embedding therapy. At the same time, needle-pricking therapy on Sifeng (EX-UE 10) was also applied once a week. 0. 5 g metformin hydrochloride tablet was given to the control group, once a day for the first week, and twice a day from the second week. Estimation on therapeutic effect was made for both groups after 3 months treatment. Change of symptoms and signs scores, fasting insulin (FINS), 2 hour insulin after meal (2hINS) and insulin resistance index (HOMA-IR) of both groups before and after treatment were observed, and therapeutic effect estimated.

RESULTSThe total effective rate of the observation group is 97. 6% (41/42), and that of the control group was 95. 4% (41/43). There was no significant difference between the two groups (P>0. 05). Scores of symptoms and signs after treatment were significantly improved in both groups (all P<0. 01), and the observation group was better than the control group (7.01+/-4.23 vs 8. 47+/-2. 82,P<0. 05). Compare with those before the treatment, FINS, 2hINS and HOMA-IR after the treatment were all decreased in both groups (all P<0. 05). The comparison between the two groups showed that differences of FIN had no statistic significance (P>0. 05) after the treatment, while both differences of 2hINS and HOMA-IR had statistic significance [ 2hlNS: (443. 531+/- 93. 90) pmol/L vs (621.29+/-93. 87) pmol/L ; HOMA-IR: 4. 88+/-0. 30 vs 5.06+/-0. 32, both P<0. 05]. The improvement of 2hINS and HOMA-IR in the observation group was better than that of the control group.

CONCLUSIONTreatment of PCOS of damp-phlegm constitution with embedding therapy on back-shu points and front-mu points and needle-pricking therapy on Sifeng (EX-UE 10) have positive effect, which can effectively reduce the insulin resistance, meanwhile, reduce the side-effects of western medication.

Adolescent ; Adult ; Carcinoma, Small Cell ; pathology ; therapy ; Female ; Humans ; Ovarian Neoplasms ; pathology ; therapy

Objective To explore status quo of Shanghai community health services based on the investigation of rural community doctors in Shanghai suburb,and to propose measures on training rural doctors. Methods Retrospective investigation was carried out in 114 rural community health service centers and 1 563 clinics.Primary investigation included the registration,distribution,age,academic titles and education background. Results The results showed insufficient number of human resources and inadequate investment in human capitals in the primary medical services of Shanghai suburbs,and there was a serious shortage of general practitioners.The other problems included older age,insufficient academic qualifications,and without professional titles. Conclusion We should improve the status and treatment of rural doctors.Job training and well-trained professional students should be encouraged for the primary health services.More and more doctors should be attracted to work in community health service centers.General practitioners' personnal information network and general medical training network should be established,and the general medical education system gets improvement.

Objective To investigate the critical thinking ability of medical students and its related factors in order to provide evidence for higher medical education reform. Methods A total of 325 medical students were selected by cluster sampling method, and Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV) was adopted for survery. Results The average total score of critical thinking ability of medical students was above 280, and 51.08% of students showed positive critical thinking ability. Among all the seven critical thinking dispositions, average scores of each item were all positive (>40) except that the significance of truth seeking (37.23) and systematicity (39.05) were indefinite. There were significant differences in critical thinking ability between medical students with different gender and academic years (P<0.05). Conclusion The critical thinking ability of medical students is positive, however, there still exist some shortages. An equal relationship between teachers and students should be established, the traditional course system be continuously reformed, a good environment for clinical training be created, and a variety of teaching methods be implemented to further strengthen the critical thinking ability of medical students.

Objetcive To analyze the contrast-enhanced ultrasound (CEUS)features in clear cell renal cell carcinoma (CCRCC) of different size and to discuss the diagnostic value of CEUS in CCRCCs. Methods The contrast-enhanced and conventional US features of 80 CCRCCs confirmed pathologically were retrospectively analyzed. Samples were divided into three groups by diameters: small CCRCCs (≤30 mm), medium CCRCCs(＞30 mm) and large CCRCCs(＞50 mm). The tumoral vascularity, lesion homogeneity and presence of an anechoic rim were observed on conventional US. The enhancement of echogenicity, homogeneity and pseudocapsule were evaluated on CEUS. Results Among the 80 renal masses, 32 were small CCRCCs, 28 were medium CCRCCs while the large CCRCCs were 20. On conventional US, 18.8%(6/32) of small CCRCCs, 71.4%(20/28) of medium CCRCCs and 95%(19/20) of large CCRCCs demonstrated as heterogeneous and the differences were highly statistically significant, whereas there were no differences in the tumoral vascularity and the presence of pseudocapsule sign among the three groups. On CEUS, 28.1%(9/32) of small CCRCCs, 85.7%(24/28) of medium CCRCCs and 100%(20/20) of large CCRCCs showed a homogeneous enhancement. The incidence of pseudocapsule sign in medium tumors was higher than small and large groups(71.4%,50% and 25%,respectively). There were statistically significant differences among the three groups in the enhanced homogeneity and the presence of pseudocapsule sign. However, all the three groups revealed mainly isoechoic and hyperechoic and there were no differences among them. Compared with conventional US, CEUS depicted significantly the increased tumoral vascularity (51.3% vs. 87.5%) and pseudocapsule sign(22.5% vs. 51.3%). Eight lesions demonstrated heterogeneous contrast enhancement on CEUS while homogeneous on conventional US, but there were no differences in lesion homogeneity between conventional US and CEUS findings. Conclusions Different sizes of CCRCC showed distinct CEUS features in the enhanced homogeneity and the presence of pseudocapsule sign. CEUS is more effective on improving the sonographic characteristics of tumoral visualization and may provide important information of US findings for the diagnosis of renal cell carcinoma.

Abstract? AIM: To investigate changes of anterior chamber parameters after posterior chamber phakic implantable collamer lens ( ICL ) surgery and its correlation with intraocular pressure ( IOP) .?METHODS: This was a retrospective case series study. Seventy four eyes in 43 myopia patients were examined by Allegro Oculyzer anterior segment tomography to obtain the changes of anterior chamber volume ( ACV ) , anterior chamber angle ( ACA) , central anterior chamber depth ( ACD) and vault, meanwhile, to measure the IOP to analyze the correlation with anterior chamber parameters.?RESULTS: Compared with preoperative, ACV, ACA, ACD all decreased apparently ( P <0.01 ) in the postoperative period of 1, 3, and 6mo.ACV, ACA and ACD showed their stability in each period after the surgery.There were changes of vault in 1 and 6mo ( t=27.66, P=0.01).IOP had not altered when compared with the preoperative.This research revealed that IOP had no relation with ACV, ACA, ACD and vault in every phase( all P>0.05).?CONCLUSION:For patients underwent ICL, the anterior chamber parameters all decreased which included ACV, ACA, ACD, and had stabilized since early postoperative period. Correspondingly, IOP was stable and had not correlate with ACV, ACA, ACD and vault, however the long-term observation is still necessary.

Objective:To meet the individualized needs of residents in standardized residency training of cardiac intervention specialty for cardiac ultrasound teaching, to construct a bionic 3D printing model of ultrasound source, and to discuss its application value in ultrasound teaching and simulation exercises.Methods:Sixty residents majored in cardiovascular medicine receiving standardized residency training of ultrasound in ultrasound imaging department of Renmin Hospital of Wuhan University were randomized into experimental group and control group in average. The experimental group adopted ultrasound bionic 3D printing heart model combined with problem-based learning (PBL) teaching method, and the control group adopted traditional multimedia PPT combined with PBL teaching method. At the end of teaching activities, theoretical examination, operation assessment and questionnaire survey were conducted to evaluate and compare the teaching effect between the two groups. SPSS 21.0 software was performed for t test. Results:The theoretical examination scores of the experimental group and the control group were (81.4±8.2) points and (74.8±9.4) points, respectively, P=0.002, and the operation assessment scores were (89.1±5.6) points and (71.5±8.8) points, respectively, P<0.001. The questionnaire survey showed that the experimental group had better feedbacks than the control group in the aspects of mastery of heart anatomy knowledge, learning experience, learning interest, learning efficiency, understanding of interventional heart disease, clinical skills of interventional operation and overall satisfaction (all P<0.05). Conclusions:Ultrasound bionic 3D printing combined with PBL teaching method can help strengthen the mastery of cardiac anatomy knowledge, promote the learning experience of cardiac ultrasound and improve the skills of interventional operation. The teaching effect is significant and the students' satisfaction is high.

OBJECTIVETo investigate the female sexual dysfunction (FSD) in type 2 diabetes patients, by comparing the sexual function between type 2 diabetic women and non-diabetic women with Female Sexual Function Index (FSFI).

METHODS115 type 2 diabetic women and 107 age-matched non-diabetes women were enrolled with similar backgrounds. Their sexual functions were evaluated with FSFI. Metabolic parameters such as body mass index, blood lipid profile, hemoglobin A1C, plasma glucose were also collected.

RESULTSTotal score of FSFI of the type 2 diabetic women were significantly lower than that of the non-diabetic controls (18.27±8.96 vs. 23.02±5.78, P=0.000). Scores of the FSFI domains (desire, arousal, lubrication, orgasm, satisfaction, pain) of the type 2 diabetic group were also lower than those of the control group. According to the FSD criterion (FSFI<25) available in China, the percentage of FSD in the type 2 diabetic group was significantly higher than that of the control group (79.2%vs. 55.0%, P<0.001). These trends seemed more prominent in pre-menopause subgroups. The logistic regression analysis indicated that age and diabetes were independent risk factors of FSD. Body Mass Index (BMI) also had influence in the diabetes group.

CONCLUSIONFindings from this study showed that there are more FDS in Chinese type 2 diabetic women than in their non-diabetic counterparts, especially in pre-menopause participants.

Objective To analyze the relationship between clinical competence of baccalaureate nursing students and its potential related factors,and investigate the results of curriculum reform of 4-year nursing undergraduate education.Methods The records of 263 baccalaureate nursing graduates were retrieved.Variables including age,years of college education,sex,college entrance examination scores,average scores of basic courses,average scores of public courses and average scores of professional courses were collected.Clinical competence was measured by the clinical practice tests at various clinical units.The linear regression analysis was performed to find out the influencing factors of clinical competence.Results The clinical competence was significantly related to sex,average scores of public courses and average scores of professional courses(P