A probe into the management of outpatient medical records written by rural doctors:Such a record is indispensible for technical appraisal of medical accidents; yet writing of such a record might involve illegal medical practice or go beyond the scope of practice.It is recommended to normalize the behavior of rural doctors in their writing of outpatient medical records,stipulating that the Basic Regulations on Medical Records do not apply to rural doctors at present.It is also recommended that separate regulations for rural doctors be formulated,along with a promotional period before these regulations are in practice.An alternative would be clarifying that Article 28 of the Regulations of Medical Malpractice Settlement do not apply to rural doctors.

The principle of Endoscopic Ultrasonography (EUS) is similar to abdominal ultrasonography. The difference between them is the installment of a high-frequency ultrasound miniature probe at the tip of the endoscope for real-time ultrasound scanning. The pancreas is a retroperitoneal organ. The insertion of the ultrasonic endoscope into the stomach and duodenum can clearly demonstrate the structure of the pancreas on ultrasound scanning. With the extensive application of EUS and development of endoscopic accessories, EUS is becoming more important and it plays an important role in the minimally invasive treatment of pancreatic diseases. EUS-FNA and injection technique, EUS-CPN,EUS-guided radiation seed implantation, endoscopic ultrasound-guided puncture and drainage of pancreatic pseudocyst broaden the application of EUS techniques. EUS will become another important minimally invasive endoscopic treatment for pancreatic diseases following ERCP.

AIM:To explore the clinical effect of capsule membrane phacoemulsification and capsular bag in phacoemulsification in treatment of hard nuclear cataract with high myopia.
METHODS:A total of 297 patients(322 eyes) with hard nucleus cataract(Ⅳ-Ⅴ grade nucleus) and high myopia were selected from Mar. 2014 to Mar. 2016 in our hospital. They were randomly divided into the observation group with 149 cases(162 eyes) and the control group with 148 cases(160 eyes). The observation group received capsule membrane phacoemulsification and the control group received capsular bag in phacoemulsification. The therapeutic effect and safety of patients in two groups were compared. The comparison of phacoemulsification time, energy parameters and corneal endothelial cell density used t-test, post-operative visual acuity and the occurrence of complications were tested by Chi-square test.
RESULTS: The harder the nucleus was, the longer the phacoemulsification time and higher the average phacoemulsification energy was, and the differences were statistically significant(P<0. 05). The phacoemulsification time and energy parameters of the observation group were significantly lower than that of the control group( P<0. 05 ). One month after operation, the postoperative visual acuity in two groups was significantly higher than the visual acuity at 1d after operation(P<0. 05). But there was no statistical significance on the visual acuity at 1mo after operation between two groups ( P> 0. 05 ). After operation, the density of corneal endothelial cell in two groups was significantly lower than the density before operation ( P < 0. 05 ). But there was no statistical significance on the density of corneal endothelial cell after operation between two groups ( P > 0. 05 ). The intraoperative complication rate of observation group was significantly lower than that of the control group ( P<0.05 ) , but there was no statistical significance on postoperative complication rate between two groups ( P>0. 05). CONCLUSION: For the treatment of hard nuclear cataract with high myopia, capsule membrane phacoemulsification and capsular bag in phacoemulsification have similar effect, but capsule membrane phacoemulsification has better safety.

OBJECTIVE: To optimize the extraction technology of ardicrenin from Ardisia crenata.METHODS: The content of ardicrenin was determined by RP-HPLC. The extraction technology was optimized by orthogonal experiment with the extraction rate of ardicrenin as evaluation index and with the volume fraction of ethanol,the extraction temperature,extraction time and extraction times as factors.RESULTS: The optimum extraction technology was determined as follows: 80%ethanol was used as solvent;the extraction temperature was 80 ℃;the extraction time was 20 min and the extraction was conducted for 3 times.The extraction rate of ardicrenin was 6.04%.CONCLUSION: The optimized extraction technology is feasible and reproducible,and it provides theoretical basis for mass extraction of the ardicrenin from A.crenata.

As the key phase for medical students to be doctors,clinical internship plays a vital role in the whole medical education process.Interns in the department of gastrointestinal surgery face series of difficulties,such as wide variety of diseases and emergence of new technology and new concepts.In addition,because of the uneven levels of teachers and low enthusiasm of interns,the result of clinical practice teaching is not satisfactory.Based on the above-mentioned problems,measures have been introduced during the process of clinical practice teaching,including selection of typical diseases and surgical procedures,construction of clinical practice teaching team,adoption of pluralistic teaching methods,reinforcement of participation of interns during the clinical practice.Finally,the quality of teaching in our department has been irmproved significandy.

Peripheral T-cell lymphoma (PTCL) is a relatively common subtype of non-Hodgkin lymphoma in China. PTCL is clinically highly aggressive, and it progresses rapidly. The current treatment methods are ineffective and the overall prognosis is poor. The 62nd American Society of Hematology Annual Meeting reported on the progress of PTCL molecular targeted therapy and immunotherapy, including programmed death receptor 1/programmed death receptor ligand 1 antibodies, JAK inhibitors, brentuximab vedotin, etc. These novel drugs bring a better prospect for patients.

Objective To investigate the changes of hematoma and perihematomal edema in spontaneous hypertensive rats (SHRs),as well as the correlation between blood pressures and perihematomal edemaMethods A total of 24 6-month-old male SHRs were included.They were randomly divided into intracerebral hemorrhage 1-,3-,5-,and 7-day groups (n =6 in each group).Blood pressure was determined by tail-cuff sphygmomanometry.Collagenase Ⅳ was injected into caudate nucleus in order to induce a model of intracerebral hemorrhage.Magnetic resonance T2 weighted imaging was used to observe hematoma and perihematomal edema.Results On day 1 after modeling,the blood pressure was decreased significantly compared to that before modeling,and it was elevated gradually on day 3.Parallel profile test showed that the overall profile was parallel between the change rate of blood pressure and the change rate of perihematomal edema volume (F =2.820,P =0.063).The coincident profile test showed that both the overall profiles did not coincide (F =10.961,P =0.000).The change rate of systolic blood pressure was significantly positively correlated with the change rate of perihematomal edema volume (r =0.527,P =0.024) and the change rate of perihematomal edema volume (r =0.755,P =0.000) showed a significant positive correlation.Conclusions Brain edema appeared and expanded rapidly on the day of intracerebral hemorrhage in SHRs.It reached the peak on day 3,and then dissipated gradually.The blood pressure decreased significantly on day 1 after intracerebral hemorrhage,and it began to increase from day 3 till day 7.The changing trends of the blood pressure and perihematomal edema volume were parallel to each other,and the change rate of systolic blood pressure and the change rate of perihematomal edema volume showed a positive correlation.

Objective:To investigate the expression of tissue factor pathway inhibitor-2 (TFPI-2) and synuclein gamma (SNCG) in esophageal cancer and their correlation with local invasion, lymph node metastasis and apoptosis. Methods:The expression of TFPI-2, SNCG, and matrix metalloproteinase-9 (MMP-9) was detected by immunohistochemical SP methods in 82 cases of esophageal cancer tissues, 20 cases of atypical hyperplasia tissues, and 54 cases of para-cancerous tissues. The apoptosis of esophageal cancer cells was detected by TUNEL staining and apoptosis index (AI) was calculated. Results:The positive rates were 30.4%, 60.0%, and 87.0% for TFPI-2 protein and 63.4%, 30.0%, and 3.7% for SNCG protein in the tumor tissues, atypical hyperplasia tissues,and tumor-adjacent normal tissues, respectively. There was a significant difference between the three groups(P<0.01). The positive expression of TFPI-2 and SNCG correlated with the lymph node metastasis, invasion depth, TNM staging, and differentiation degree of esophageal cancer (P<0.01), but did not correlate with age at surgery, gender, tumor location, and pathologic classification(P>0.05). The expression of TFPI-2 and MMP-9 was negatively correlated (r=-0.636, P=0.000). The expression of SNCG and MMP-9 was positively correlated(r=0.393,P=0.000). AI was related with TFPI-2 and SNCG expression (P<0.05). Conclusion:TFPI-2 not only inhibited the expression of MMP-9 but also induces apoptosis of esophageal cancer to prevent tumor invasion and metastasis, however, SNCG plays a contradictory role in cancer development. TFPI-2 and SNCG might serve as new tumor markers and the new targets for tumor gene therapy.

Objective To compare the serum metal ion levels and host immunologic response of patients received non-modular,large-head metal-on-metal total hip arthroplasty (THA,Durom) with those received modular titanium acetabular component (Trilogy) using conventional head sizes and metal-on-highly cross-linked polyethylene articulations at mean 2-year follow-up interval.Methods A continuous series of 32 consecutive patients (32 hips) accepted THA with a Durom large head metal-on-metal articulation between January 2008 and December 2010 was as study group (Durom Group).From all the patients who received THA with Trilogy prosthesis at the same period,32 patients matched the Durom group in age,gender and body mass index (BMI) were chosen to form the Trilogy group.Another 32 healthy volunteers also matched the Durom group were chosen to form the control group.At the final follow-up,the serum metal ion levels,host immunologic response were evaluated.Results The mean follow-up time for Durom group was 24.9 months (range,15-34 months) compared to 25.53 months (range,15-48 months) for Trilogy group.Co and Cr levels in Durom group were 4.33 and 1.95 times as high as those in Trilogy group.There was no statistically significant difference in serum C3,C4,IgA,IgG,IgM value in three groups.CD3+,CD4+ and CD8+cells in Durom group decreased significantly compared with Trilogy and control groups.The interferon-γ(IFN-γ) level in Durom group was significantly higher than that in Trilogy and control groups.Conclusion The serum cobalt and chromium levels in patients received Durom metal-on-metal THA elevated significantly in early period.Meanwhile,some amount of impact on host cell mediated immunity occurred.

In the face of both market competition and health logistic support,whether military hospitals can adapt their operation and management strategies to balance the relationship of battlefield and market place,is the lifeline of their survival and development.The study summarized significance of strategic management of the hospitals in view of characteristics of such hospitals,and introduced explorations made at the hospital in their strategic management.