Doctor′s license for multi-sited service is an important part of hierarchical diagnosis.Aiming at the requirements and management in Guangdong medical reform, this essay clarified the situation and restriction factors when Doctor′s license for multi-sited service was carried out and gave some suggestions under the current conditions.

Objective To evaluate the effects of silicone pessary treatment on relieving the symptoms and improving the life quality of the pelvic organ prolapse patients.Methods From November 2005 to March 2009,33 pelvic organ prolapse (POP-Q stage Ⅲ～Ⅳ) patients received silicone pessary coneervative treatment were followed up and required to complete the Pelvic Floor Distress Inventory-20 (PFDI-20) before and after initiating pessary treatment.Results 31 of 33(93.94%) patients finished the follow-up completely.23 of 31(74.19%) patients continually used the pessary.The follow up time was 3 to 17 (10.04±2.57) months.27 patients completed the PFDI-20 questionnaires.Before silicone pessary treatment, PFDI20 total score,POPDI6 (Pelvic organ prolapse distress inventory),CARDI8 (colorectal anal distress inventory 8) and UDI6 (urinary distress inventory 6) scores were (54.16±36.12),(27.78±17.30),(0.61±1.01) and (25.77± 24.10),respectively.After the treatment of pessary,the scores decreased to (20.20±25.98), (4.48±5.88), (0.45±0.84) and (15.28± 21.53),respectively.Except for CARDI8,the PFDI scores decreased significantly after the pessary treatment (P＜0.05).Conclusion Silicone pessary is a viable noninvasive treatment for pelvic organ prolapse.It could relieve the symptoms and improve the life quality of protrusion and voiding dysfunction patients.

Objective To evaluate the therapeutic effect and influence factors of silicone pessary in treatment of pelvic organ prolapse ( POP).Methods From October 2005 to October 2010,132 with symptomatic POP managed by pessary were enrolled in this retrospective study.Validated prolapse quality of life questionnaire (pelvic floor distress inventory short form 20,PFDI-20),pelvic floor impact questionnaire short form 7 (PFIQ-7) and the patients' satisfaction degree were used to evaluate the therapeutic effect.Clinical characteristic of the patients with successful using for more than 6 months ( successful fitting group),giving up within 6 months (giving up group),unsuccessful fitting (unsuccessful fitting group)were compared.Factors influencing satisfaction degree and causing discontinuation were investigated.Results One hundred and six among 132 ( 106/132,80.3％ ) patients were in successful fitting group,26 (26/132,19.7％ ) patients were in the unsuccessful fitting group.In the successful fitting group,86.8％ (92/106) patients were followed up,the median follow-up time was 12.5 months.And 78.3％ ( 72/92 ) patients continued to use pessary with the wearing time ranged 3 -69 months; 21.7％ (20/92) patients discontinued with the wearing time ranged 1 -38 month,14 patients (14/20) gave up in the initial 6 months.The median scores of PFDI-20 and PFIQ-7 questionnaires before pessary use were 50.0 and 47.6,which decreased to 8.9 and 0.0 after pessary use (P＜0.05).And 87.1％ (61/70) patients were satisfied.There was no significantly difference among 3 groups on clinical characteristics,such as age,body mass index ( BMI ),pelvic surgery and so on (P ＞ 0.05 ).The main factor influencing satisfaction degree and causing discontinuation was difficulties in placing and removing.Conclusions Silicone pessary is effective for patients with POP.It could relieve discomfort symptoms and improve quality of life.The main factorinfluencing pessary use is difficulties in placing and removing.Thus,More suggestions are needed for patients in the initial 6 months.

Heart Diseases ; Humans ; Ryanodine Receptor Calcium Release Channel

Objective Explore the clinical application values of Golgi Protein 73 ( GP73 ) , AFP variants (AFP-L3) , Alpha fetoprotein ( AFP) and α-l-Fucosidase ( AFU) detection in the diagnosis of hepatocellular carcinoma ( HCC) .Methods From January of 2013 to June of 2014, 84 case of HCC Patients( HCC group ) who presented at interventional department; 64 case of cirrhotic patients ( liver cirrhosis group ) , 86 case of chronic hepatitis patients ( chronic hepatitis group ) and 120 healthy people ( normal control group) were selected from Shanghai Tongren Hospital.GP73 was detected by the enzyme-linked immunosorbent assay (ELISA), AFP-L3 was isolated with ACSC, AFP and AFP-L3 were detected with ECLIA and calculated the percentage content of AFP-L3 ( AFP-L3%) , AFU was detected with enzyme kinetic method.Adopted the SPSS 19.0 statistical software for data analysis.The rank sum test was used in the multi group comparison;the chi square test was used in the comparison group.Results Serum levels of GP73, AFP-L3, AFP and AFU in HCC group were 202.1 μg/L, 9.5%, 68.3 μg/L, 33.2 μg/L respectively.Their difference from those of the normal control group(69.0 μg/L,2.5%,4.5 μg/L,24.2μg/L) was of statistical significance (U was 1126.59, 204.67,1247.68,564.08,respectively,all P <0.05).GP73 and AFP in the hepatic carcinoma group was significantly higher than that in the cirrhosis group(151.1 μg/L、18.5 μg/L) (U was 463.47, 368.56,respectively, P<0.05).GP73, AFP-L3 and AFP in the hepatic carcinoma group was significantly higher than that in the chronic hepatitis group(93.6μg/L,3.5%,5.7μg/L) (U was 1 116.52,213.42,1 166.52, respectively, all P<0.05).The content of AFU in HCC group (33.2 μg/L), normal control group and chronic hepatitis group were compared (24.2μg/L,24.1 μg/L), respectively ,no significance was found(U was 564.08,487.24,P>0.05) Sensitivity of GP73 and AFP in individual inspection was 95.24%, significantly higher than that of AFU, AFP-L3. Specificity of AFP-L3 was 94.81%respectively, with an accuracy of 85.88% respectively.Specificity and accuracy of the allied detection of GP73, AFP-L3, AFP and AFU for HCC diagnosis were 98.52% and 84.75% respectively.Conclusions The allied combination of serum GP73, AFP-L3, AFP and AFU makes up for the insufficient clinical applications of individual serum markers. It is of great clinical significance to improve the diagnosis of HCC.

Based on the analysis of survey results and random interviews on medical students , this paper dis-cussed from the perspective of medical students under the present situation of doctor -patient relationship:satisfied with prescriptions basic medical quality , but there are still a large room to improve;to cure medical ethics appraisal is higher , but still need to strengthen medical ethics education; the parties are still lack of trust in the prescrip-tions;the doctor-patient relationship nervous .And put forward the following countermeasures on how to relieve the strain on the doctor -patient relationship , strengthening medical ethics education , strengthen the study and practice of doctor-patient communication , pay attention to legal consciousness propaganda and training , use media power to improve direction of publit opinion .

Objective To observe the expression of PAX-2 and PTEN in different types of endometrial lesions, and to study their relationship with endometrial intraepithelial neoplasia (EIN). Methods 60 cases of endometrial hyperplasic lesions and 70 cases of endometrial carcinoma were enrolled. All cases were reclassified by using the diagnostic criteria of EIN, and PAX-2 and PTEN were stained to compare the difference among them. Results The deletion rates of PAX-2 in benign hyperplasia, EIN and endometrial carcinoma were 39.5 % (15/38), 72.7 % (16/22) and 78.6 % (55/70), respectively, and there was a statistical difference (χ2= 21.664, P= 0.000). The deletion rates of PTEN in benign hyperplasia, EIN and endometrial carcinoma were 47.4%(18/38), 54.5%(12/22) and 75.7%(53/70), respectively, and there was no statistical difference (χ2=2.878, P=0.411). Conclusion The staining of PAX-2 could be considered as a reliable adjuvant diagnostic method in the diagnostic criteria of EIN, however, the loss of PTEN just should be regarded as a suggestion of EIN, not a confirmed diagnostic basis.

Objective: To assess surgical outcomes of implanted porcine small intestinal submucosa (SIS) mesh in the rabbit vesicovaginal space (VVS) and explore its application value in pelvic floor reconstruction surgery. Methods: Sixteen male rabbits were randomly divided into four groups, and each group had four rabbits. All groups of rabbits were implanted with SIS mesh in the vesicovaginal space. They were humanely killed after a postoperative period of 7, 30, 90 and 180 days by group. The grafted area was removed with the surrounding bladder and vaginal tissues. The specimens were embedded in paraffin and then stained with HE and Masson's trichrome stains for visual observations, cells counts, and assessment of tissues and collagen fibers. Results: (1) After HE staining, a large number of inflammatory response cells mainly eosinophils and lymphocytes infiltrated around the SIS mesh in 7 days group, and neovascularization was observed, the infiltration area of inflammatory response cells further increased in 30 days group, the infiltration area of inflammatory response cells significantly reduced in 90 days group, while the inflammatory response basically subsided in 180 days group. (2) After Masson's trichromestaining, the collagen structure of SIS mesh in 7 days group was clear and intact. While, the collagen structure of SIS mesh was partially degraded in 30 days group, the SIS meshes of 4 rabbits were completely degraded, but the collagen fragments of SIS remained in 90 days group. In 180 days group, the SIS mesh of all rabbits was degraded, and one of them had the formation of new collagen fibers. Conclusions SIS mesh implanted into the VVS of rabbits can lead to a transient non infective inflammatory reaction, which could be completely degraded and a small amount of new collagen fibers could be produced after 180 days of implantation. Which shown that SIS mesh should be used cautiously in pelvic floor reconstruction surgery.

Objective To explore the value of primary and Advanced levels of laparoscopic simulating training in different seniority of gynecologic residents.Methods 77 residents in their first to forth training-year were divided into two groups:1-2 year resident and 3-4 year resident,trained with different levels of simulating training plans respectively and then assessed in the Department of Obstetrics and Gynecology in Peking University Third Hospital.Results The qualified rate of primary and advanced simulation training was 85.7％ and 57.1％ respectively.The qualified rate of primary training (80.4％ vs.100.0％,P=0.028) and advanced training (12.5％ vs.57.14％,P=0.000) were significantly different between 1-2 year residents and 3-4 year residents.The operative skills improved significantly in all the residents.In the 1-2 year residents,the scores of the primary training increased more obviously,while in the 3-4 year residents,the scores of the advanced training increased significantly.Conclusion It might be more effective for residents with different seniority to receive different levels of simulating training accordingly,so as to improve their laparoscopic operative skills more effectively.

Objective:To analyze the detection rate of hyperuricemia (HUA) and the distribution of serum uric acid (SUA) levels by multiple correlation analysis in middle-aged and elderly population receiving health examination.Methods:In this cross-sectional study, the study object were 25 587 middle-aged and elderly people who receiving health examination in Nanfang Hospital from January to December in 2014. According to the latest diagnostic criteria, the population was divided into HUA and non-HUA groups. Furthermore, the subjects were divided into 4 groups with the level of SUA (Q 1: SUA<313 μmol/L, Q 2:313 μmol/L≤SUA<375 μmol/L, Q 3:375 μmol/L≤SUA<440 μmol/L, Q 4: SUA≥440 μmol/L). According to the data types, two independent sample t test, Mann-Whitney U test, Chi-square test and multiple correspondence analysis were used for statistical analysis. Results:The mean age of the study subjects was (54.78±8.80) years with 16 570 males (64.8%) and 9 017 females (35.2%). The overall detection rate of HUA was 31.5%, and it was higher in men (43.1%) than in women (10.1%). The body mass index(BMI), systolic blood pressure, diastolic blood pressure, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG) and fasting blood glucose (FBG) in the HUA group were all higher than those in the non-HUA group (all P<0.001); and high-density lipoprotein cholesterol (HDL-C) was lower than that in the non-HUA group( P<0.001). In multiple correspondence analysis, Cronbach′s α coefficients of the first dimension and the second dimension was 0.608 and 0.237, respectively. Further analysis was performed stratified by gender, it indicated that 45-<55 years old male and overweight were closely associated with the Q 3 group, fatty liver and hyperlipidemia were closely associated with Q 4 group; the 55-<65 years old female, hyperlipidemia, fatty liver and obesity were closely associated with the Q 3 group, while hyperglycemia and hypertension were closely associated with the Q 4 group. Conclusion:The detection rate of HUA in middle-aged and elderly population receiving health examination was high, and the detection rate of HUA in male was higher than that in female. SUA levels are higher in middle-aged and elderly men who have fatty liver and hyperlipidemia. While SUA levels are higher in middle-aged and elderly women who have hyperglycemia and hypertension.