Objective To discuss the promoting effect of clinical pathway in the standard and reasonable medication by the application of clinical pathway in the anticoagulation treatment of warfarin and health education for patients with atrial fibrilation.Methods Sixty eight patients with atrial fibrilation and receiving anticoagulation treatment of warfarin were divided randomly into the intervention group(36 cases)and the control group(32 cases).The control group received routine nursing while the intervention group underwent nursing intervention with clinical pathway based upon routine nursing intervention.The time cost to achieve the aims,compliance,incidence rate of complications and satisfaction degree were compared between the two groups.Results All the items in the intervention group were superior to those of the control group except for the items of satisfaction degree and health knowledge score(P<0.05).Conclusion Application of clinical pathway in the anticoagulation treatment of warfarin for patients with atrial fibrilation could ensure standard and reasonable medication in order to decrease medical cost,lower the incidence rate of complications,improve patients compliance and increase nursing quality.

To improve the quality of health care by improving the quality of residency training,the Accreditation Council for Graduate Medical Education of USA has renewed the standards and methods of residency training to improve health care,and issued the compe- tence-based training standards. The residents have to achieve six key competences when they finish the training. The University of Washington,School of Medicine,responds to the new re- quirements and standards by reforming its residency training pathway,enriching formal teach- ing/training activities,and improving its supervision and the evaluation. We should use for refer- ence reforming the residency training in China.

Based on summarizing the importance of education environment and the development and current status ofresearch on medical education environment, the authors measured the status of, and the problems existing in, educationenvironment of China Medical University by DREEM (Dundee Ready Education Environment Measure), and then sug-gested strategies to modify the education environment and hence to improve the quality of medical education on thebasis of the advanced concepts of education environment design and construction in the world and the authors' experi-ence in the reform of medical curriculum.[

Objective To establish a method for simultaneous determination of 12 kinds of organophosphorus pesticides in water. Methods Organophosphorus pesticides in the water were extracted by liquid-liquid extraction, then analyzed with DB-1701 capillary column. In the same time, they were determined with GC by controlling the temperature and the speed of nitrogen. Retention time of the peaks was used for qualitative analysis, while external standard method was used for the quantitative analysis. Results The linear ranges of organophosphorus pesticides were 0.2～50.0 ?g/L, r≥0.999 1. The lowest detection limit was 0.009～0.04 ?g/L, the rate of recovery were 78.4%～93.9% and RSDs were 3.4%～7.5%. Conclusion This method is simple, rapid, sensitive and can efficiently separate and determine 12 kinds of organophosphorus pesticides in the water with 32.5 minutes of operation only.

Objective To probe the diagnostic value of MRI in synovial hemangioma of the knee.Methods Seven patients(2 male,5 female,age ranged from 8 to 58 years with mean age 25.1 years) selected from 2025 cases with MRI examination of knee,which were proved to be intra-articular hemangiomas histologically or clinically.All of the patients had plain film before MRI examination.MR findings of synovial hemangioma of knee were analysed ultrasound.Results Four hemangiomas occurred in infrapatellar bursa,others 3 cases in both infrapatellar and suprapatellar bursa were involved.MR signal intensity of hemangiomas appeared three types:(1)nodular hypointensity on both T_1WI and T_2WI in 2 cases;(2)iso-hypointensity on T_1WI and hyper-hypointensity on T_2WI in 2 cases;(3)hypointensity mixed with isontensity on T_1WI and nodular of linear mixedintensity on T_2WI in 3 cases.The difference of synovial hemangioma of knee in histologic elements,the MR findings were different.Conclusion MRI features of synovial hemangioma are correlated with pathology histologic elements.

Medical professionalism is an important part of competencies which physicians are acquired to own.Team of physician's competency model construction and education revolution project concluded the current situation and theoretical cognition of physician's professionalism of experts from medical education and administration organizations in China according to the results of the first round of Delphi.Meanwhile,suggestions for the further improvement of physician's professionalism were pro

Objective To investigate the effect of the extracts of Centella asiatica(L.) Urban (ECA) on the depressive-like behavior alteration in rats and mice. Method 60 Wistar rats were randomly divided into 6 groups (10 rats each), the normal group, model group, Fluoxetine group, ECA high dose group (component 10.08 mg+component 24.48 mg/kg), ECA middle dose group (component 1 0.04 mg+component 2 2.24 mg/kg) and ECA low dose group component 1 0.02 mg+component 2 1.12 mg/kg. Chronic unpredictable mild stress (CUMS) induced depression in rats and sugar consumption to detect the antidepressant effect of ECU. 60 Kunming mice were randomly divided into six groups as above. Locomotor activity, forced swim, tail suspension test were used to detect the effect of ECA on the behavioral alteration in mice. Results Compared with model group, sugar consumption in ECA groups was significant increased (P<0.01). ECA treatments also decreased duration of immobility in the tail suspension test and forced swim. Conclusion ECA could improve the depressive-like behavior in rats and mice.

OBJECTIVE:To compare therapeutic efficacy and safety of laparoscopy combined with dienogest and laparoscopy combined with dienogest and TCM in the treatment of endometriosis. METHODS:126 endometriosis patients were selected and divid-ed into control group and observation group,with 63 cases in each group. Control group received combined with dienogest(25 mg/time,qd);observation group was additionally given TCM on the basis of control group. Therapeutic efficacy,recovery time of ovula-tion,menstrual recovery time and ADR were compared between 2 groups,and recurrence and pregnancy of them were followed up for 2 years. RESULTS:The total effective rate of observation group (93.65%) was significantly higher than that of control group (80.96%),with statistical significance (P<0.05). The menstrual recovery time and recovery time of ovulation in observation group were significantly shorter than control group,with statistical significance (P<0.05). The incidence of ADR in observation group (9.52%)was significantly lower than control group(26.98%),with statistical significance(P<0.05);the recurrence rate of observa-tion group (4.76%) was significantly lower than that of control group (17.46%),with statistical significance (P<0.05). In 2-year follow-up,there were 23 pregnancy patients in observation group,which was significantly higher than that of control group (9 cas-es),with statistical significance (P<0.05). CONCLUSIONS:Laparoscopy combined with dienogest and TCM in the treatment of endometriosis have better clinical effect,higher safety and lower recurrence rate. The patients are easily pregnant.

Objective:To evaluate the effectiveness and safety of anticoagulant therapy with rivaroxaban in atrial fibrillation( AF) pa-tients after radiofrequency catheter ablation( RFCA) . Methods:A retrospective analysis was performed in the study. Totally 141 AF pa-tients with RFCA in our hospital were enrolled from January 2014 to October 2015. The patients were divided into rivaroxaban group(70 patients)and warfarin group (71 patients). In rivaroxaban group,rivaroxaban(10 mg, po,qd)was given for at least 3 months after RFCA. In warfarin group,low molecular heparin (100 IU·kg-1,ih) was given before RFCA, and standard dose of warfarin (3-5 mg,po,qd) was given for at least 3 months by adjusting the INR within the range of 2. 0-3. 0 after RFCA as bridging therapy. The death rate, throm-boem bolism events and bleeding events between the groups were evaluated and companed groups. Results: There were no significant differences in baseline characteristics between the groups except the diastolic pressure. There were no significant differences in the death and thromboembolism events(transient cerebral ischemia , ischemic encephalopathy, 2/70 vs 4/71,P>0. 05)between the groups. There were no TIMI major bleeding events in both groups. There were no significant differences in minor bleeding events between the groups (3/70 vs 4/71,P>0. 05). Conclusion: Compared with those of warfarin,the effectiveness and safety of rivaroxaban show the similar effect in AF patients after RFCA. Rivaroxaban can be safely and effectively used in AF patients with low or middle risk of thromboembo-lism after RFCA.

Objective To establish a bedside available risk scoring system of no-reflow in the acute stage of STEMI.Methods Data from STEMI patients treated with PCI divided into model group and validation group were analyzed.Multivariable binary logistic regression analysis was used to identify independent no-reflow predictors of the model group.Finally,a score according to the odds ratio on logistic regression analysis was designed,and then risk stratification was established,and no-reflow high-risk patients with myocardial infarction were selected.The authenticity and reliability of the logistic regression courses were validated using receiver operator characteristic curve (ROC)and Hosmer-Lemeshow goodness-of-fit.Results Multivariate logistic regression analysis demonstrated that female (OR =0.587,P =0.019),Killip class of myocardial infarction≥2 (OR =3.656,P <0.01),TIMI flow ≤2 before primary PCI (OR =0.774,P =0.013),thrombus burden score ≥4 on baseline angiography (OR =2.629,P <0.01),pain to balloon time ≥ 6 h (OR =1.485,P =0.083)were independent correlate predictors of no-reflow phenomenon in the STEMI after PCI.The risk score system demonstrated a good risk prediction in the model group with AUC of 0.716 (95%CI:0.671 -0.761)based on ROC analysis.There was no significant discrepancy between multivariate logistic regression analysis and Hosmer-Lemeshow goodness-of-fit (χ2 =1.027,P =0.994).In risk stratification,total value <2 was assigned into low risk level,and 2-5 was put into the medium risk level,and >5 was arranged into high risk level.The risk score system demonstrated a good risk prediction in the validation group with AUC of 0.891 (95%CI:0.822 -0.959)based on ROC analysis.ROC analysis in the validation group was applied to Killip class,thrombus burden,score and risk stratification in the validation group ,and the no-reflow score was more accurate,with a larger area under the curve (AUC = 0.851,95% CI:0.776 -0.927 ).Conclusions Establishment of no-reflow scoring system with STEMI patients undergoing PCI was benefit to select high risk patients with no-reflow.