Objective To construct the evaluation index system of medical education for clinical departments in grade-three hospitals.Methods Questionnaire were answered by the clinical experts,medical education directors and VP for education in the grade-three hospitals.According to the principle of Delphi method,the survey included the basic situation of experts,the relative importance of each index and the degree of expert authority.SPSS 16.0 was used to analyze the data.Results The questionnaire recovery rate was 90％,with authority of the average value 0.88,and coordination coefficient 0.348.The coordination coefficient was tested by chi square test,P=0.000.Five first level indexes by the authoritative coefficient after correction (residency training,postgraduate education,academic education,continuing medical education,teaching for refresher doctors) of the weighted value (％) were 22、22、22、19 and 15 respectively.Conclusion The experts in this study represent strong and high enthusiasm and authority.After practical application,the index system is supposed to have practical application value.

0.05). The CYFRA21-1 level measured at the fifth day after treatment in death group was higher than that in survival group (P

Objective To assess the feasibility and accuracy of transesophageal echocardiography (TEE) in screening patients,intraoperative guidance of occluder releasing and efficacy assessment in the patients of percutaneous left atrial appendage (LAA) occlusion with Watchman.Methods Ultrasonic instrument Philips iE33(proble model X7-3t) were used to measure the maximum diameter and the depth of LAA ostium in enrolled patients by TEE,and intraoperative guided puncture of interatial septum,positioning Watchman transmission system and instruction closure release under TEE,immediate evaluate the postoperative therapeutic effect and record the complications by TEE.At 45 days after implantation,patients should repeat TEE to assess the efficacy.Results Eighteen patients underwent device implantation.Seventeen patients implant successfully,except one patient can't implant device beacuse of the LAA morphologe was not suitable.There was one patient showing thrombus formation on the surface of device,one patient of LAA and the device axial angulation was 90 °.At 45 days after implantaion,16 patients were fullowed up,there were no major stroke at all.Conclusions TEE has important application value in screening of preoperative patients,intraoperative guidance of occluder releasing and efficacy assessment in the patients of percutaneous left atrial appendage occlusion with Watchman.

Objective To investigate the value of echocardiography in monitoring the treatment of extracorporeal membrane oxygenation (ECMO) in patients with cardiogenic shock (CS).Methods A total of 21 patientss were included into the present study,who were treated by ECMO due to CS in Wuhan Asia Heart Hospital from January 2013 to December 2015.The left ventricular ejection fraction (LVEF) and Tei index were measured by echocardiography before,in the middle of (flow reduced to one half)and immediately after the process of ECMO.The systolic blood pressure (SBP) and the arterial oxygen saturation (SaO2) were also recorded,and the parameters were compared.The differences of LVEF,Tei index,SBP and SaO2 among different phases of ECMO were compared by using one-way ANOVA and LSD-t test.The differences of heart beat rate,the diameters of left ventricle,diameters of inferior vena cava,subsidence rate of inferior vena cava,pulmonary capillary wedge pressure and central venous pressure among different phases of ECMO were also compared by paired-samples t test.Results Compared with the pre-ECMO level,the LVEF increased during and immediately after the ECMO (t=31.952,59.404,both P ＜ 0.01),while the Tei index decreased significantly (t=34.406,58.969,both P ＜ 0.01).Compared with the pre-ECMO level,the SBP,SaO2 and subsidence rate of inferior vena cava all increased during and immediately after the ECMO,while the diameter of left ventricle,pulmonary capillary wedge pressure and central venous pressure all decreased significantly (t=7.382,37.785,-11.286,3.294,13.923,16.971,all P ＜ 0.01 or 0.05).In contrast,there was no significant change for the parameters of heart beat rate and diameter of inferior vena cava.Conclusion When treating CS patients with ECMO,the echocardiography can monitor the cardiac function effectively,and provide important parameters for the clinical doctors to estimate the ECMO efficacy and decide the weaning time.

Objective To understand the status quo of dyslipidemia among urban and rural residents in Ganzhou City.Methods The multistage stratified cluster random sampling method was adopted to select the urban and rural residents aged more than 35 years old as the respondents,among them 4 829 respondents had the intact data,the investigation items included age,sex,height,body mass,waist circumference(WC),FBG,Scr,blood pressure,TC,TG,HDL and LDL.The body mass index was calculated.Results The prevalence rates of hypercholesterolemia,high TG and low HDL among the urban and rural residents in Ganzhou City were 8.76 ％,16.38％ and 24.04％ respectively.Compared with the persons of normal blood lipid,FBG,Ser,WC and BMI in the persons of high blood lipid were much higher (P＜0.05).Conclsion The blood lipid abnormality in the urban and rural residents in Ganzhou City is dominated by low HDL and high TG.

Objective Training a few medical students as standardized patients to teach and test other medical students'physical examination skills is a good way to compensate the deficient teaching resources and improve the medical students'clinical capabilities.Methods We spent 12 class hours to train 6 students as standardized patients.Then we used these 6 students'standardized patients to help the teacher to educate medical students in experimental group,while students in the control group only had traditional class under the construction of the teachers as before.At last,we collected their final physical examination skills'score.Results The final physical examination skill score of experimental group(85.78?5.89)is higher than that of control group(84.53?4.64)(P

Objective To investigate the relationship between RKIP expression and the efficiency of radiotherapy in NPC patients and evaluate the possibility of using RKIP as a predictor of radiosensitivity.Methods A total of 180 patients with NPC in Sun Yat-sen University Cancer Center without evidence of distant metastasis at initial diagnosis were enrolled in this study,who had received intensity-modulated radiotherapy alone.Patients were classified into 2 groups according to criteria below:patients with biopsy proven recurrent diseases occurring at nasopharynx and/or neck within 5 years after radiotherapy were classified as the radioresistant group.The pathological type at relapse was the same as the previous one before treatment.Patients with a minimum follow-up of 5 years after radiotherapy without evidence of recurrence at the original site of the tumor were classified as the radiosensitive group.Patients in the 2 groups were matched according to the factors related with radiosensitivity.RKIP was examined by immunohistochemical staining before radiotherapy.The relationship between RKIP expression and the effect of radiotherapy were analyzed.Results The positive rate of the RKIP expression in the radiosensitive group versus the radioresistant group was 80.0％ versus 26.7％.The positive rate (x2 =12.498,P ＜0.01) and the intensity of the RKIP expression (x2 =51.429,P ＜ 0.01) were significantly different between 2 groups with a negative correlation with radio-resistance to NPC (r =-0.344,-0.535,respectively,P ＜ 0.01).Based on the RKIP expression,the radiosensitivity,specificity,accuracy,positive predictive value,negative predictive value,false positive and false negative were predicted as follows:80.0％,73.3％,77.2％,75.0％,78.6％,26.7％,and 20.0％,respectively.Conclusions RKIP protein shows negative correlation with radioresistance to NPC and could serve as a biomarker in preliminarily screening the intrinsic radiosensitivity of NPC.

Objective To discuss the diagnostic value of HIT-antibodies in suspected HIT patients with heart diseases.Methods A single center study.We collected 242 blood samples of suspected HIT patients whose platelet count decreased after heparin application during July 1 st ,2012 to June 30th ,2016 in Wuhan Asia Heart Hospital and detected the concentration of HIT antibodies , meanwhile the 4T′s score were calculated.Among the study objects , there are 206 patients received cardiac surgery , 28 received cardiac interventional therapy and 8 received drug therapy.And we divided them into HIT group (44, median age 57.5, 23 females ) and non-HIT group ( 198, median age 63.5, 87 females ) according to clinical diagnosis.Quantitative data was analyzed by independent t-test or Mann-Whitney U test.Qualitative data was analyzed by Fisher′s exact test.We drew ROC curve according to the statistical analysis to determine the optimal threshold value of antibodies in diagnosis of HIT andsensitivity , specificity, negative likelihood ratio, positive likelihood ratio of the HIT antibody detection .Therefore, we can assess the value of HIT antibody detection in HIT clinical diagnosis and treatment .Moreover, we used the optimal threshold value of antibodies to testify the suspected HIT patients .Results The HIT antibody concentration of HIT group (44) and non-HIT group ( 198 ) are 3.2 ( 95% CI:1.8 -5.5 ) U/ml and 0.4 ( 95% CI:0.3 -0.4 ) U/ml, respectively.The concentration of HIT group is much higher than the non-HIT group(P<0.000).When the cut-off value of HIT-Ab is set at 0.9 U/ml, sensitivity and specificity are 93.2%and 91.9%, respectively. And negative likelihood ratio and positive likelihood ratio are 0.07 and 11.53, respectively.When the cut-off value of HIT-Ab is set at 0.6 U/ml, sensitivity and specificity are 100.0%and 73.7%.HIT-Ab and 4T′s score of ROC-AUC are 0.971 and 0.745, respectively.The diagnosis value of HIT-Ab in HIT is significantly higher than the 4T′s score ( P<0.000).Conclusions HIT antibody detection is a simple and effective auxiliary diagnostic method in HIT exclusion .And HIT antibody detection is more optimal than the 4T′s score in HIT diagnosis and treatment .

Objective To investigate the application value of ultrasound elastography and contrast enhanced magnetic resonance imaging (CEMRI) in assessing the effect of neoadjuvant chemotherapy (NAC) for T1-2 N1-2 M0 breast cancer.Methods Twenty-three cases of breast cancer operation and receiving preoperative NAC in Chongqing Municipal Tumor Institute from January 2015 to December 2016 were collected.They all underwent ultrasound elastography and CEMRI before the first time NAC and operation respectively.Results Based on the postoperative pathological response grading,the sensitivity and specificity of CEMRI for evaluating the NAC effect were 94.1 ％ and 83.3％ respectively,which of ultrasound elastography were 88.2％ and 83.3％ respectively.The two kinds of examination method showed medium consistency(Kappa values were 0.77 and 0.68 respectively).Conclusion Ultrasound elastography extends the ultrasound diagnostic basis,can more comprehensively display the lesion character and more effectively reflect the NAC effect.

Objective To set up a living mice colonoscopy platform to establish an orthotopic model of colorectal cancer in mice under direct vision,and to observe its biological behavior such as metastasis.Methods Eighteen-week-old male C57/BL mice were anesthetized,and the intestinal lumen of the mice was examined by a self-developed living mice colonoscopy and Olympus URF-P5 ureteroscopy,respectively.The imaging effects of the two methods were compared.Human colon cancer HT-29 cells were injected into the colonic mucosa of BALB/c-nu mice under direct vision.The colonoscopy was performed on the 3rd,7th and 15th day after the injection to observe the tumor formation in the intestinal lumen.The mice were sacrificed when the body weight decreased significantly or cachexia appeared,and then the abdominal cavity was examined including the tumor formation and metastasis.Results The self-developed living mice colonoscopy platform can provide clear vision of enteric cavity,and no mice died in the colonoscopy examination.In vivo subcutaneous injection of HT-29 cells in mice was performed with a perforation rate of 15％,a mortality rate of 33.3％,a tumor formation rate of 62.5％,an abdominal metastasis rate of 60％,a liver metastasis rate of 25％,and an abdominal wall transfer rate of 25％.Conclusion The self-developed mice colonoscopy platform can be used for the study of colorectum in living mice.The imaging effect is no less than that of Olympus URF-P5 ureteroscopy.In addition,an orthotopic colorectal cancer model can be established by this platform combing with submucosal injection technology.