The article is to discuss the effect of the trained SPs acted by retired nurses in the test of internal medicine inquiry in OSCE for the graduates. The results were evaluated by those samples drawn from medical students who took part in OSCE and the professors. The evaluation of the SPs was objective and accurate, and they acted well. There are remarkable advantages in retired nurses simulating standardized patients, and it deserves extensive application in clinical medical education in our country.

Objective To evaluate the relation of circadian blood pressure rhythm with vascular status in elderly patients with isolated systolic hypertension.MethodsAnkle-brachial index (ABI),brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (IMT) were measured in 74 elderly patients with non-dipper hypertension (non-dipper group)、78 elderly patients with dipper hypertension ( dipper group),and 72 healthy controls ( control group).Results In comparison with the dipper group,baPWV and IMT of the non-dipper group were significantly increased [ baPWV (1801.61± 314.27) vs (1658.67±274.80) (cm/s)],P＜0.01; IMT:(0.96 ±0.22) vs (0.87 +0.19) (mm),(P＜0.05),while ABI of the non-dipper group was decreased (1.03 ±0.17 vs1.12 ±0.18,P＜0.01).Identification rate was significantly different among 3 groups when baPWV ＞1400 cm/s (x2 =12.57,P ＜0.01) or ABI ＜0.9 ( x2 =9.74,P ＜0.01).The detection of carotid plaques was also significantly different ( x2 =16.49,P ＜ 0.01).Conclusions These findings suggest that vascular damage could be found in elderly patients with isolated systolic hypertension,especially in those with non-dipper hypertension.ABI,baPWV and IMT measurement may be helpful for the assessment of vascular status.

Objective To detect the micro flow signals of carotid plaque by ultrasound B-flow imaging (BFI) and elucidate its relationship with acute cerebral infarction.Methods A total of 63 patients with carotid plaques were divided into 2 groups.acute cerebral infarction (ACI,n =48) and control (n =15).BFI was used to detect the micro flow signals of plaques and comparisons were made with the categorizing results of contrast enhanced ultrasound (CEU).The data were analyzed between two methods.Results The micro flow signals were detected in 15.7％ (22/140)patients in the ACI group vs.2.3％(1/44) in the control group.There were more signals in hypoechoic plaques.The detection percentage of micro flow in grade Ⅲ was significantly higher than that in grades Ⅰ and Ⅱ with CEU (P =0.005,P =0.027).No significant differences existed between grades Ⅲ and Ⅳ (P =1.000).Conclusion BFI can detect effectively the micro flow signals of carotid plaques and this characteristic is correlated with the symptoms of ACI.

Objective To investigate perceptions of patient safety culture(PSC) among nurses in tertiary hospitals in Kunming. Methods Totally 2629 nurses were recruited by convenience sampling method from 7 tertiary hospi-tals in Kunming between July 2015 to January 2016. Hospital Survey on Patient Safety Culture (HSOPS) was used to assess PSC. Results The top three superior dimensions of PSC were Organizational Learning-Continuous Im-provement(86.60%),Teamwork within Hospital Units(83.34%) and Feedback and Communication about Error(75.98%). The last three inferior dimensions of PSC wereNonpunitive response to error(23.74%),Staffing(33.71%) and Teamwork across hospital units(49.45%). There were significant differences in certain items among nurses with different educational level,academic title,working hour per week(P<0.05). Conclusion Establishing nonpunitive re-sponse culture,reasonably arranging staffing and working hours,and encouraging nurses with high educational level and title to play their full role,are critical measures to improve patient safety culture in hospital.

Random amplified microsatellite polymorphism (RAMP) markers were used to access the genetic diversity among 112 samples of nine populations of Dendrobium officinale Kimura et Migo. Using 16 informative primers, 123 bands were amplified and 86 (69.92%) were polymorphic. The polymorphic bands from three to eight could be detected for each RAMP primer, with a mean of 5, indicating abundant genetic diversity among populations. Genetic similarity coefficients ranged from 0.250 to 0.813. UPGMA dendrogram illustrated 9 populations clustered into 3 groups, and the cluster pattern showed correlation with the locations of the D. officinale populations. These results were supported by the previous conclusions that were achieved by other molecular markers, and RAMP is proved to be effective for evaluating the genetic diversity of wild populations of Dendrobium officinale.

Objective To evaluate periphery artery and renal injury in elderly patients with dipper and non-dipper isolated systolic hypertension(ISH). Methods Totally 187 elderly cases were divided into 51 patients with non-dipper hypertension,70 patients with dipper hypertension aged (72.4±5.6) years and 66 cases with normal blood pressure as control according to results of dynamic blood pressure recorder. Ankle-brachial index (ABI),brachial ankle artery pulse wave velocity (baPWV),retinol-binding protein (RBP) and Cystatin C were assessed. ABI and baPWV were determined by a non-invasive automatic waveform analyzer. Results The baPWV value in nondipper group was higher than dipper group [(1869.3±285.6)cm/s vs.(1703.1±235.2)cm/s,q=4.73,P＜0.01],while the value of ABI in non-dipper group was lower than dipper group (1.0 ±0.2vs.1.1±0.2,q=4.74,P＜0.01).The level of Cystatin C was elevated in non-dipper group versus dipper group [(1.4±0.5) mg/L vs. (1.0±0.5)mg/L,q=6.92,P＜0.01]. There were no differences in RBP concentration among the three groups (F=2.39,P＞0.05).At baPWV＞ 1400cm/s,the level of Cystatin C was increased in 47 cases with non-dipper hypertension as compared with 64 cases with dipper hypertension [(1.4±0.5)mg/L vs.(1.1±0.5)mg/L,q=5.59,P＜0.01].Conclusions The elderly patients with non-dipper hypertension may be more easily suffered from periphery artery and renal injury in comparison with dipper hypertension.

Objective To analysis the clinical effects of biliary-pancreatic double stents in pancreatic cancer patients with obstructive jaundice.Methods From July 2008 to October 2011,a total of 60 patients with advanced pancreatic cancer were randomly divided into two groups to receive biliary-pancreatic double stents (n =28) or biliary stent only (n =32) according to the odd and even numbers of their admission date.Changes in liver function,abdominal pain,quality of life scores (QOL) were compared between two groups.Results The stents were placed successfully in 54 patients (90.0％),in which symptoms were relieved or gradually disappeared in all patients after the procedure.One week after stents placement,the serum total bilirubin decreased significantly from 164.32 ±45.16 μmol/L before ERCP to 63.25 ±27.06 μmol/L (P ＜ 0.05),other parameters including ALT,AST,AKP and r-GT were also decreased significantly compared with those of pre-ERCP (P ＜ 0.01),but there was no significant difference between the two groups (P ＞ 0.05).25 cases in double-stents group and 29 cases in single-stent group had varying degrees of pain relief at 7d after ERCP,but the overall pain relief rate and complete pain relief rate in double-stent group were significantly higher than those in single-stent group (92.0％ vs.55.2％; 64.0％ vs.34.5％,P＜0.05).At 7d and 14d after ERCP,Karnofsky QOL score were improved significantly in double-stent group (P ＜ 0.05).It was significantly better than single-stent group at 14d after ERCP (P ＜0.05).No death or other severe ERCP-related complications were observed.Conclusion Biliary-pancreatic stent placement for pancreatic cancer could significantly improve liver function and relieve obstructive pain.In the ways of alleviating pain and improving quality of life scores,it was better than ERCP biliary stent placement,especially for patients with pancreatic cancer combined obstructive pain.It indicated that biliary-pancreatic stent placement was better than simple biliary stent placement for advanced pancreatic head cancer patients with obstructive pain.

Objective To explore the relationship between anhedonia,alexithymia and self-efficacy in college students.Methods 260 college students were tested with Snaith-Hamilton Pleasure Scale (SHAPS),Temporal Experience of Pleasure Scale (TEPS),20-item Toronto Alexithymia Scale (TAS-20)and General Self-Efficacy Scale (GSES).Results (1) Males showed obviously higher level of SHAPS scores (24.91±5.14) and lower level of anticipatory pleasure of TEPS (TEPS-ANT) scores(31.81±5.79)than females (22.97±5.34 and 33.36±5.71,respectively).(2)Significant difference existed between the high-scoring,the middle-scoring and the low-scoring anhedonia group in TAS factor 1 (difficulty in identifying feelings) and GSES (F=3.11,5.30,P＜0.05 or 0.01),the scores of TAS factor 1 (difficulty in identifying feelings) in high-scoring anhedonia group were higher than that in low-scoring anhedonia group (20.24±4.94 vs 18.10±5.07,P＜0.01),and the scores of GSES in high-scoring anhedonia group were lower than that in low-scoring anhedonia group (24.97±6.72 vs 27.90±4.37,P＜0.01).(3)The SHAPS scores were positively related to TAS factor 2 (difficulty in describing feelings) and factor 3 (externally oriented thinking) (r =0.18,0.27,both P＜0.01),negatively related to GSES scores(r=-0.33,P＜0.01).Both TEPS-ANT and consummatory pleasure of TEPS (TEPS-CON) were negatively related to TAS factor1 (difficulty in identifying feelings)scores (r=-0.22,P＜ 0.01;r =-0.15,P＜ 0.05),positively related to GSES scores (r =0.28,0.26,both P＜0.01).(4)Layer multivariate linear regression analysis showed that the SHAPS scores were significant predictors of the general self-efficacy(β=-0.33,P＜0.01).Conclusions The anhedonia in college students has a closely relationship with alexithymia and self-efficacy,college students with high anhedonia have high level of alexithymia and low level of self-efficacy.

Purpose To evaluate clinical value oftransesophageal echocardiography (TEE) on total correction of tetralogy of Fallot (TOF) through preoperative and postoperative monitoring of TEE in paediatrics total correction of TOF and comparison with preoperative and postoperative transthoracic echocardiography (TTE).Materials and Methods Thirty-two children patients receiving total correction of TOF were retrospectively analyzed.TEE was adopted to measure atrial and ventricular cavity size,diameter of right ventricular outflow tract,residual shunt surrounding ventricular septum,diameter of pulmonary artery trunk,orifices flow rate and differential pressure of pulmonary artery and differential pressure of right ventricular outflow tract for all patients preoperative and intraoperative.Meanwhile,all these were compared with value measured by TTE before and after the surgery.Results Among the 32 TOF patients,preoperative TEE figured out one revised diagnosis (3％) of TTE and one supplementary diagnosis (3％).Coincidence rate of disease diagnosis of preoperative TEE and surgical outcome of the 32 patients was 100％ (32/32).Intraoperative TEE examination found out 7 (21.9％) with residual surgical issues.Differential pressure of right ventricular outflow tract measured by preoperative and intraoperative TEE and value measured by preoperative and postoperative TTE was of statistical significance (P＜0.05).Right ventricular outflow tract measured by intraoperative TEE was obviously reduced by approximately 28％ compared with the value measured by postoperative TTE.Correlation of atrial and ventricular cavity size,diameter of right ventricular outflow tract and orifices flow rate of pulmonary artery measured by intraoperative TEE and value measured by postoperative TTE were well (r=0.75-0.87,P＜0.05).Differential pressure of right ventricular outflow rate measured by intraoperative TEE was positively correlated with value measured by postoperative TTE (r=0.518,P＜0.05).Difference of atrial and ventricular cavity size,diameter of right ventricular outflow tract orifices flow rate and differential pressure of pulmonary artery and differential pressure of right ventricular outflow rate measured by intraoperative TEE and consistency scattergram of value measured by postoperative TTE was of no statistical significance (P＞0.05).Conclusion Application of TEE for total correction of TOF monitoring is of important practical value in correction and supplement of preoperative diagnosis and immediate postoperative surgical efficacy assessment.

Objective:To provide consistent data basis for the application of reference intervals for children blood cell analysis in different testing systems.Methods:According to the requirements of American Institute for Clinical and Laboratory Standardization (CLSI) EP9-A3 document, 45 samples were collected and Sysmex XN20-A1 were used as reference system. Beckman DxH800, Siemens ADVIA 2120i, and Mindray BC5310 were comparison systems. Complete blood count and leukocyte classification were performed by four systems. The outliers of the detection results were tested by the generalized extreme student deviate (ESD) method. An optimal regression model was selected by scatter diagram, deviation diagram and frequency distribution diagram, which was used to fit the regression equation and calculate the deviation at the medical decision level and reference interval. The acceptable range for blood count deviation was cited from the Analytical Quality Specifications for Routine Tests in Clinical Hematology. The acceptable range for leukocyte classification was based on the EQA program of Royal College of Pathologists of Australasia (RCPA).Results:After the outliers were deleted, the scatter plot showed a linear relationship between the reference system and the three comparison systems. The deviation plot showed that the differences were variable. Deming regression or Passing-Bablok regression was selected according to the data distribution. The determination coefficient R2 of reference system and three comparison systems ranged from 0.95 to 0.99 in blood count and leukocyte classification. At the upper and lower limits of the reference interval, the deviations between XN-20A1 and ADVIA 2120 system were all acceptable, except for MONO# at 0.12×10 9/L. The deviations of all parameters at medical decision level were within acceptable ranges. The lower limit of PLT is partially unacceptable at the level of medical decision related to treatment and prognosis. Conclusions:The results of complete blood count and leukocyte classification in reference system and the comparison system had good consistency within the children′s reference interval. Our study provided a scientific basis for the feasibility of adopting a unified reference interval for different detection systems.