Electrocardiography ; Humans ; Myocardial Ischemia ; physiopathology

The Risk-sharing agreements have achieved remarkable success in improving patients'access to drugs, lowering the uncertainty of the drugs cost-effectiveness, financial risk control and other aspects of medical in-surance fund , so they have attracted widespread attention by the concerned governments and insurers .This paper sys-tematically reviewed the patient access schemes in UK from several aspects , including the origin of the program , clas-sification , application processes and the implementation effects as well .The results of the research indicated that Chi-na has basically met the conditions for implementation of the risk-sharing agreements .In order to gradually promote the risk-sharing agreements implementation , this paper suggests that China should clarify the main root of risk-sharing agreements implementation , establish risk-sharing agreements standardization process and strengthen the application of health technology assessment in health resources allocation to improve the Chinese medicines bargaining system more scientifically and efficiently .

Objective To investigate the mastery of clinical students' doctor-patient communi-cation skills and to assess the teaching effectiveness about the doctor-patient communication, and then propose some improvement ideas. Methods We conducted a study in students of clinical medicine of Nanjing Medical University in Grade 2009, using Objective Structured Clinical Examination (OSCE) after internship, which included graduation assessment of doctor-patient communication skills. Then we analyzed the doctor-patient communication skills and related scores of students trained in different clinical medical programs. Results The average score of doctor-patient communication skills of 549 students was (82.72±4.23), of which, the average score of 329 five-year students of clinical medicine was (81.88±4.23) and the average score of seven-year students was (83.96±3.91) in. The average score of seven-year students of clinical medicine was significantly higher than five-year students (P=0.000). Moreover, there was a significant positive correlation between the total score of OSCE and the score of doctor-patient communication skills in both five-year and seven-year students of clinical medicine (five year program students' score correlation coefficient was 0.520, P=0.000;seven year pro-gram students' score correlation coefficient 0.416, P=0.000). Conclusion The teaching effectiveness of doctor-patient communication has proved to be quite effective, and it is definitely of great significance in improving clinical students' doctor-patient communication skills. The score of the assessment of the doctor-patient communication reflects not only the training effectiveness of the communication skills, but also the comprehensive capacity.

Objective To evaluate the clinical effect of itraconazole oral solutions on pulmonary candidiasis albicans in ICU patients.Methods A total of 71 patients with candida ablicans in their sputum clutures were randomized into two groups.The itraconazole group(n= 36)received itraconazole 200 mg,p.o.(including nasal feeding),q12h for 14 days.The fluconazole group(n=35)received fluconazole 400 mg for the first dose,then 200 mg,i.v.drip,qd for 14 days.Results There were 31 patients in the itraconazole group and 29 paitents in the fluconazole group who completed their treatment.In the itraconazole and fluconazole group,the clearance of candida ablicans was 64.52%(20/31)vs.65.55%(19/29),cleaning time(10.12?2.57)vs(8.87?1.95)days,effective rate 58.06%(18/31)vs 62.07%(18/29),recovery rate is 19.35%(6/31)vs 17.24%(5/29),occurrence of hepatic dysfunction is 25.81%(8/31)vs 24.14%(7/29),and withdrawal for inefficacy was 3.23%(1/31)vs 6.90%(2/29),respectively.These parameters did not have statistical significance.Conclusion Itraconazole oral solutions can be used effectively and safely in the treatment of pulmonary candidiasis albicans in ICU.Patients with renal dysfunction do not need to adjust the dosage.

[Objective]To investigate the effect of treating degenerative spondylolisthesis by transforaminal lumbar interbody fusion with microendoscopic surgery.[Method]From January 2005 to December 2005,17 cases who underwent transforaminal lumbar interbody fusion with a pedicle screw system by microendoscopic surgery were analyzed retrospectively.The index diagnosis was degenerative lumbar spondylolisthesis with herniated nucleus pulposus in 11 cases,and with spinal canal stenosis in 5 cases.There were 10 male and 7 female,average age was 47.6(ranged,35～68)years.According to Meyerding grading system,roentgengram showed that there were 10 cases of grade Ⅰ?,7 cases of grade Ⅱ?,11 cases of L_4 and 6 L_5.[Result]Seventeen cases were reviewed after surgery.The postoperative follow-up ranged from 12 months to 24 months(averaged 16.2 months).Operative time averaged 160 minutes.Estimated blood loss averaged 120 ml.Mean length of hospital stay was 8 days.There were no nerve injury occurred during operation.No cases converted to open operation.In complications,one case suffered from intervertebral infection.Outcomes were quantified using Oswestry Disability Index.The average Oswestry score decreased from 48.3% preoperatively to 16.5% at 3 month and 14.0% at 6 month postoperatively.The rate of excellent and good was 97.5%.At last follow-up,all patients had solid fusions by radiographic criteria.[Conclusion]Transforaminal lumbar interbody fusion for lumbar vertebral degenerative spondylolisthesis by microendoscopic surgery has the advantages of shorter skin incision,less tissue damage,less blood loss and quicker postoperative recovery.

10mm,solitary sessile,growth during follow-up,associated with gallstone,obvious symptomatic or novel imaging techniques indicating NPG occurs.

Exercise training plays a critical role in the prevention and control of type 2 diabetes mellitus (T2DM). New guidelines on exercise training for T2DM patients was jointly published by American College of Sports Medicine and American Diabetes Association at the end of 2010. In the Guidelines on Prevention and Treatment of Type 2 Diabetes Mellitus in China issued by Chinese Diabetes Society, the role of exercise training is also clearly defined. The implementation of guidelines requires individualized exercise training prescription and program. In this article, we review the procedure of individualized aerobic exercise training prescription, resistant exercise, safety issues, and other relevant topics.
Diabetes Mellitus, Type 2 ; therapy ; Exercise Therapy ; methods ; Humans

α-Galactosidase A (α-Gal A ) activities in plasma and peripheral blood granulocytes of 100healthy subjects and one patient with Fabry disease was determined by means of fluorogenic substrate.The results showed that the enzymatic activities of peripheral blood granulocytes and plasma in 100 subjects were (51.97 ± 15.24)and(148.08±26.30) nmol · h-1 · ml-1 respectively.The α-Gal A activities in plasma and granulocytes were positively correlated( r=0.533,P＜0.01 ).The enzymatic activities in peripheral blood granulocytes and plasma of the patients with Fabry disease were 1.05 and 10.06 nmol · h-1 · ml-1 respectively,both much lower than those of 100healthy subjects.These results suggest that α-Gal A activity in plasma and peripheral blood granulocytes can be used for diagnosis and screening of Fabry disease.

A total of 203 hypertensive patients with established health files received standard disease management for 1 year. We found that the patients who underwent grade 2 or 3 management showed statistically significant difference in exercise, salt and oil restriction, body mass index (BMI), waist to hip ratio, blood pressure, and blood-lipid from baseline (all P < 0.05). Hypertension awareness, behavior improvement, and disease control had statistically significant difference from baseline in all the patients (P < 0.05 or P < 0.001). After one year's intervention, the patient number in each grade was largely changed. Our study suggests that hierarchical hypertension management might be practical and effective in communities.