By analyzing the present condition of communication courses in some medical colleges and universi -ties and the clinical practice situation , this paper emphasized the significance of the clinical professional courses :it is beneficial to promote the reform of medical education , is advantageous to the medical students′humanistic spirit , to improve clinical teachers′humanistic quality , is helpful to reduce medical disputes .And on the future develop-ment of clinical communication course put forward the following suggestions: extended content , the integration of related courses , reform teaching methods , intensify communication course value .

OBJECTIVE:To optimize the extraction technology of Bushen huoxue capsules. METHODS:Central composite de-sign-response surface method was used to optimize the extraction technology with the amount of water and boiling time as main fac-tors using normalized value of the contents of icariin and salvianolic acid B,the yield of dry extract as index. Validation test was al-so conducted. RESULTS:The optimal extraction technology was as follows as 15-fold water,reflux extracting for 75 min,extract-ing for 2 times. The deviation of measured value and predicted value was 0.000 3% in validation test. CONCLUSIONS:The cen-tral composite design-response surface method can be used to optimize the extraction technology of Bushen huoxue capsules with good prediction,and the technology is simple and stable.

OBJECTIVETo evaluate the clinical efficacy and safety of Qiangji Recipe (QR) in ad- junctive treatment of axial undifferentiated spondyloarthritis (axuSpA) through a four-week open study.

METHODSFifty-four axuSpA patients of Shen-deficiency Du-channel cold syndrome (SDDCS) in line with inclusive criteria were recruited and assigned to the treatment group and the control group according to random digit table, 27 in each group. Patients in the control group took Celecoxib Capsule (0.2 g each time, twice per day). Patients in the treatment group additionally took QR (consisting of Herba Epimedii 15 g, antler glue 15 g, Cibotium Barometz 15 g, eucommia bark 20 g, dipsacus asper 10 g, two toothed achyranthes root 15 g, drynaria 15 g, Taxillus Chinensis 20 g, ground beetle 10 g, scorpion 5 g, wild celery 10 g, notopterygium incisium 10 g, cow-fat seed 10 g, white mustard seed 6 g, and licorice root 6 g, one dose per day, twice daily). The therapeutic course for all was 4 weeks. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath AS Metrology Index (BASMI), total body pain and spinal pain, patient and physician global assessment on a four-point scale, the Ankylosing Spondylitis Quality of Life (ASQoL), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured before and after 4 weeks of treatment. The primary end point in this study was the proportion of patients with a 20%improvement response accord- ing to the ASAS International Working Group Criteria (ASAS 20 responders) at week 4.

RESULTSTotally 50 patients completed this trial, 26 in the treatment group and 24 in the control group. Improvement of BASDAI, BASFI, BASMI, ASQoL, ESR, and CRP was shown in both groups after treatment. Better effect was shown in the treatment group in all indices except ESR and BASMI after treatment (P < 0.05, P < 0.01). Twenty cases (accounting for 76.92%) in the treatment group achieved ASAS 20 response at week 4, while 12 cases (accounting for 50.00%) in the control group achieved ASAS 20 response at week 4 (P < 0.05). No obvious adverse reaction occurred in the two groups.

CONCLUSIONQR combined Celecoxib Capsule showed better effect in treating axuSpA patients than using Celecoxib Capsule alone.

Blood Sedimentation ; C-Reactive Protein ; metabolism ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Pain ; Quality of Life ; Spondylitis, Ankylosing ; drug therapy

Objective To understand the species,clinical distribution features and drug susceptibility situation of bloodstream infection pathogenic bacteria in this hospital to provide reference for clinical empirical treatment.Methods The retrospective analysis was performed on 1 938 strains of pathogenic bacteria isolated from blood culture in our hospital from January 2012 to August 2016,their species distribution,department distribution and drug sensitivity were analyzed.Results A total of 1 938 strain of bacteria were comprised of 56 kinds of bacteria and 8 kinds of fungi.Gram-negative bacteria had 1 216 strains,accounting for 64.2%,Gram-positive bacteria had 677 strains,accounting for 34.9%,Fungi had 45 strains,accounting for 2.4%.The top 5 of isolation rates were Escherichia coli(628 strains,32.4%),Klebsiella pneumoniae(230 strains,11.9%),Salmonella(143 strains,7.4%),Staphylococcus epidermidis(142 strains,7.3%) and Staphylococcus hominis (130 strains,6.7%).Enterobacteriaceae bacteria had 1 098 strains(58.0%),which was dominated by Escherichia coli and Klebsiella pneumoniae,in which 363 strains(57.8%) were Escherichia coli and 85 strains(37.0%) were extended spectrum β lactamases (ESBLs) producing Klebsiella pneumoniae.Nonfermenters had 118 strains(6.1%),Acinetobacter baumannii and Pseudomonas aeruginosa were predominant.Staphylococcus aureus had 75 strains (3.9%),the MRSA occurrence rate was 25.3%,coagulase-negative staphylococci (CoNS) had 401 strains (20.7%),the methicillin-resistant CoNS occurrence rate was 72.8%.Enterococcus had 85 strains(4.5%).The top 5 departments in positive rates were respiratory department,ICU,hepatobiliary department,gastroenterology department and hematology department.The other departments were consistent to the overall distribution except for ICU and pediatrics.The majority of Acinetobacter baumannii showed multi-drug resistant.Vancomycin-resistant Staphylococcus and Enterococcus did not be detected,Candida maintained good sensitivity to commonly used antifungal agents.Conclusion Bloodstream infection pathogenic bacteria in this hospital are widely distributed.Commonly used drug have different sensitivities,the overall drug resistance rate is higher,clinic may conduct early medication according to the pathogenic bacterial department distribution and drug sensitivity.

[Objective]To investigate the manner and the key of reoperation for failed back surgery syndrome(FBSS).[Method]Twenty reoperated FBSS cases were investigated retrospectively.The data about the history,physical sign,image and exploration were analyzed.The treatment protocols were made correspondingly.Twenty cases were all operated with decompression of nerve root and dura assisted with fusion of auto-bone kraft between posterior arches of vertebra.In them,12 cases who were suffered from spinal instability were treated with pedicle screw fixation supplementarily.All patients were rehabilitated after operation.[Result]The complications included neural root injury in 1 case and tear of dural cyst in 3 cases.The outcome was evaluated according to the standard of Ragab's,10 cases were excellent,5 cases good,2 cases fair and 1 case poor.The rate of excellent and good was 85%.[Conclusion]FBSS is a complication of back surgery manifesting as a syndrome with multi-factor and multi-present.We should analyze the clinical present of patient integratively to find out the cause before operation,and map out appropriate operational protocol.

[Objective]To retrospectively analyze efficacy and complications of lumbar transpedicular osteotomy combination pedicle screw system for correction of kyphosis in ankylosing spondylitis. [Method]From Jan 1998 to Dec 2007,54 patients of ankylosing spondylitis with kyphotic deformity were treated with surgery.Forty eight patients were followed up,and time was 6 to 36 months.Preoperative and postoperative Chin-brow vertical angle and Cobb's angle were measured.The outcome was evaluated according to pose correction,visual field improvement and back pain relief in follow-up.The results were divided into being excellent,good,fair and poor.[Result]The mean Chin-brow vertical angle was corrected from preoperative 59? to postoperative 16?,and the Cobb's angle from 43? to 11?.All patients could walk with forward vision and sagittal balance and gait were improved significantly.The symptom of dyspepsia and respiratory limitation relieved.The excellent outcome was attained in 45 cases(93.75%),the good in 3 cases(6.25%).[Conclusion]Lumbar transpedicular osteotomy combined with fixation of pedicle screw system was a safe and effective method for treatment of kyphosis in ankylosing spondylitis.

Objective To investigate the relationship among the expression of miR-340 protein, occurrence, development and metastasis in triple-negative breast cancer (TNBC). Method 60 patients with breast cancer, from January 2006 to December 2012, according to the immunohistochemistry expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor (HER-2), were divided into TNBC (33 patients) and non-TNBC (27 patients), and the breast cancer tissues (15 patients) were also selected at the same period, and the expression of miR-340 protein were detected by the immunohistochemistry. Results The positive expression of miR-340 protein was 73.33%in adjacent tissues of breast cancer, 51.52%in TNBC, 29.63%non-TNBC, the expression differences of each group were statistically significant(χ2=7.671,P<0.05). The expression of miR-340 protein in TNBC and non-TNBC patients were no significant difference in age, menopausal status and tumor size;while there were obvious correlation among clinical stage, lymph node metastasis and protein expression of miR-340 in TNBC(P<0.05). Conclusion The gene of miR-340 involves in the occurrence, development and metastasis of TNBC, they would be one of the purposes gene therapy in TNBC.

Workers with high quality, high job satisfaction levels and high stability are indispensable to the sustainable development of community health services. The present research aimed to find out about the scope of job satisfaction and stability of community health workers by means of designing relevant questionnaires and sample survey and to identify the major factors affecting the scope of job satisfaction and stability. The research found that among the community health workers, those engaged in preventive healthcare were a group with the lowest job satisfaction level and there were six factors affecting the scope of job satisfaction, including working conditions, the effect of the implementation of rules and regulations, respect from and care by leaders and so on. It also found that 45.1% of the workers once had the thought of leaving their community health centers or stations and there were 5 factors affecting job stability, including environment for medical practice, doctor-patient relationship, scope for bringing one's ability into play and so forth.

Objective To study the mechanism of calcium oxalate monohydrate and calcium oxalate dihydrate stone formation. Methods 258 urinary stones were examined by infrared spectrophotometry, from which, 20 patients with calcium oxalate monohydrate stones (COM) and 10 patients with calcium oxlate dihydrate stones (COD) were selected for the study of some urinary parameters. The statistical study was carried out with SPSS t test . Results The urinary excretions of both calcium and phosphate varied obviously between the two groups of patients.In the COM group,the urinary calcium was (4.83?1.98)mmol/24h whereas in COD group it was (9.88?4.28)mmol/24h,( P

0.05); ② Significant correlation was found between natural head posture and angle SNA, SNB, SN/MP, N S PNS, NSU, NSGn, ANS PNS Gn, NSH( P