Objective To establish patient-experience based key indicators for quality of care.Methods Literature review,collection of proven surveys on patient experience and satisfaction,study of China's conditions,with demonstrations by experts team.Results A framework was built for patientexperience based key indicators on quality of care.Level-1 indicators within the framework are tangibility,reliability,responsiveness,assurance,care and continuity.There are 28 level-2 indicators and 83level-3 indicators.Conclusion Such key indicators are highly practical as the basis for developing the scale of patient experience.

Objective To investigate the effect of endoscopic sphincterotomy(EST) combined with endoscopic papillary large balloon dilation(EPLBD) in the treatment of common bile duct stones. Methods A total of 128 patients treated with EST combined with EPLBD for common bile duct stones were divided into 0 min group, 1 min group, 3 min group and 5 min group, according to the different balloon expansion times. The balloon was extended to the required diameter and was maintained to the corresponding time, and then decreased the pressure to remove the balloon. Patients were given routine monitoring and treatment after operation. All patients were observed more than 48 h to determine whether there were early complications such as pancreatitis and bleeding. The effectiveness of EPLBD was evaluated by the stone diameter, expansion balloon diameter, ERCP operation time and use of stone breaker. The safety was evaluated by the occurrence of complications including postoperative pancreatitis, bleeding and perforation. Results All patients were successfully removed stones. There were no significant differences in the maximum diameter of stone, the diameter of bile duct dilatation and the diameter of balloon dilatation between groups. No bleeding, perforation, biliary tract infection and acute pancreatitis were found in patients. There were no significant differences in the utilization rates of stone breaker between groups. ERCP operation times showed a trend of decreased first and then increased in 0, 1 and 3 min groups (P<0.05). There was no significant difference in ERCP operation time between 3 min group and 0 min group. There were no significant differences in incidence rates of high amylase between groups. Conclusion EST combined with EPLBD is a safe and effective treatment for early stage of larger common bile duct stones, of which 1 minute group shows better effect.

Objective To provide diagnostic basis for blood stasis syndrome (BSS) ,from the point of laboratory medical science . And to further analysis the correlation between qi deficiency and blood stasis ,qi stagnation and blood stasis ,cold coagulation and blood stasis syndrome with clinical testing indicators .Methods Chinese medicine qi deficiency and blood stasis ,qi stagnation and blood stasis ,cold coagulation and blood stasis syndrome and healthy (healthy group) 50 cases each were analyzed .Blood samples were collected ,Hemorheological indexes ,coagulation indexes ,blood‐lipoid indexes and endothelin (ET ) ,nitric oxide (NO ) ,atrial natriuretic peptide (ANP) ,serum free calcium (F‐Ca2+ ) ,C‐reactive protein (CRP) were tested .Results Compared with the healthy ,the results of hemorheological indexes ,blood‐lipoid indexes ,ET ,NO ,ANP ,F‐Ca2+ ,CRP of three types of blood stasis syn‐drome group were different significantly(P<0 .05) .qi deficiency and blood stasis group and qi stagnation and blood stasis group were compared ,the difference of hemorheological indexes (except plasma viscosity ) ,blood‐lipoid indexes ,and ET ,NO ,ANP ,CRP was statistically significant(P<0 .05) .Cold coagulation and blood stasis syndrome group and qi deficiency and blood stasis group were compared ,the difference of hemorheological indexes ,coagulation indexes ,blood‐lipoid indexes ,and ET ,NO ,ANP ,CRP was statistically significant (P<0 .05) .Cold coagulation and blood stasis syndrome group and qi stagnation and blood stasis group were compared ,the difference of hemorheological indexes ,coagulation indexes ,blood‐lipoid indexes ,and ET ,NO ,ANP ,CRP was statisti‐cally significant (P<0 .05) .Conclusion Study shows that clinical laboratory test index provide the experimental basis for the diag‐nosis of qi deficiency and blood stasis ,qi stagnation and blood stasis ,cold coagulation and blood stasis syndrome .Improve the objec‐tivity of classification of blood stasis syndrome .To provide a new way of for the development of modern science in promoting tradi‐tional Chinese medicine diagnostics .

Objective To explore the effects of psychological intervention on military personnel' s social support,coping styles and psychosomatic health and their relationships.Methods Military gymnastics were taken as intervention method in this study.A total of 812 military personnel were administered the Military Personnel Scene-Trait Coping Style Scale (MPSTCSS),the Military Personnel Social Support Scale and the Simplified version of Psychosomatic Health Questionnaire.The data was processed by using t-test,correlative analysis,stepwise linear regression analysis and path analysis in SPSS version 17.0 and Amosl7.0.Results The scores of passive coping factor,subjective support factor score,physical symptoms and mental symptom in the experimental group were significantly lower than the those of control group(respectively,74.91 ± 20.46 vs 83.03 ± 25.1,2.02 ± 3.14 vs 2.60 ± 2.71,5.58 ± 6.00 vs 26.98 ± 4.96,3.91 ± 4.80 vs 23.01 ± 4.31,P≤ 0.05).The scores of active coping factor in the experimental group (133.66 ± 23.30) were significantly higher than the those of the control group (130.07 ± 24.88,P ＜ 0.05).Passive coping of the experimental group positively correlated with all single factors of social support and psychosomatic health (r =0.410 ～ 0.512,P ＜ 0.01).Active coping of experimental group negatively correlated with all single factors of social support and psychosomatic health(r =-0.300～-0.418,P ＜ 0.01).All single factors of social support positively correlated with psychosomatic health(r=0.349 ～ 0.561,P ＜ 0.01).Regression analysis showed that social support,passive coping and active coping were entered into the regressive function(P≤0.030),accounting for 37％ of total variance.The influence of coping styles on psychosomatic health was enhanced by intervention of social support.A pathway model of social support as mediator of relationship between psychosomatic health and coping styles was established,the fitting indexes of which were as follows:x2/ df =1.799 (P =0.055),GFI =0.988,AGFI =0.965,CFI =0.996,RMSEA =0.044.Conclusion Military gymnastic could effectively improve the military personnel' s capacity for coping,subjective support,and psychosomatic health.Social support and scene-trait coping style would exert significant effects on military personnel' s psychosomatic health.Social support mediates the relationship between coping styles and psychosomatic health.

Bone mesenchymal stem cell is a kind of multi-potential stem cells and can differentiate into osteoblast. The differentiation has membrane bone formation and enchondral bone formation two channels, and is regulated by numerous signal transduction pathways. According to related literatures, we review the signal transduction pathways of BMP/Smads, Runx2/osterix, Hedgehog, Wnt/β-Catenin and MAPK.

Objective To develop a more ideal procedure of living donor nephrectomy. Methods Ten cases of living relate donor who received laparoscopic nephrectomy were regularly followed up from 2 to 12 months. Results These donors were discharged on the day 5 after operation. Renal function of the recipients was normal in 4 days after operation. The advantages of laparoscopic living related donor nephrectomy included smaller incisions, less pain, faster recovery and short hospitalization. Conclusion Laparo- scopic living related donor nephrectomy is effective and safe.

Aiming at the problems faced by the medical postgraduate students in the cooperative medical education and the classified training mode,combined with the characteristics of the cultivation of medical postgraduates,the article constructed the quality guarantee system of graduate education based on project management.From the three dimensions of time dimension,corpus dimension and objective dimension,the article established a model of training quality guarantee system and analyzed the four work modules:construction of project organization,standardization of whole life cycle process,control of project quality and integration of project information.In addition,the article introduced the practice of this quality guarantee system in Binzhou Medical University.

Objective To explore the inhibition effect on angiogenesis and plaque growth of carotid atherosclerosis by transfection of endostatin gene using microbubbles combined with ultrasound exposure.Methods Twenty rabbit models of carotid atherosclerosis were randomly divided into 3 groups:group A,microbubble+ ultrasound; group B, control plasmid + microbubble + ultrsound; group C, ES plasmid +microbubble+ ultrasound. Two weeks after surgery, ultrasound/microbubble mediated gene transfer was performed,and it was performed once again three weeks after the first transfection. Ultrasonography and digital subtraction angiography(DSA) were performed at the time of 14 weeks. The carotid arteries were taken to detect the neointima and angiogenesis, and the expression of endostatin was detected using pathological means. Results The imagings of ultrasound showed that the intima in group A and B were thick significantly with larger plaques, and the lumen became stenosis with the peak systolic velocity increasing,however,in group C,the parameters mentioned above were significantly less than those of group A and B ( P＜0.05). Pathological results displayed that intima-media thickness (IMT), intima thickness (IT), intima thickness/media thickness (IT/MT), intima area (IA), intima area/media area (IA/MA) and neointimal stenosis rates were greater in group A and B, however, they were less in group C ( P＜0.05).The number of neovascularization and vascular endothelial growth factor(VEGF) expression in group A and B were more than those of group C. There was more endostatin positive expression in carotid arteries and anterior tibial muscles of group C, while there was nearly no expression in group A and B. Conclusions Under the conditioned ultrasonic irradiation, ultrasound/microbubble mediated endostatin gene transfection can inhibit the development of carotid atherosclerosis in rabbits, which might provide a safe and effective strategy for gene therapy of atherosclerotic disease in future.

Objective:To observe the influence of multi-disciplinary cooperation and optimization management mode on the negative situation and rehabilitation effect of patients with affective disorder after coronary heart disease and cerebrovascular disease.Methods:A total of 188 patients with emotional disorders caused by coronary heart disease and cerebrovascular disease from January 2017 to December 2018 to our hospital were selected. According to the random number method, 94 cases in the control group adopted the conventional management model, and 94 cases in the experimental group adopted the multidisciplinary collaborative optimization management model. The negative emotions [evaluated by Self-rating Anxiety Scale (SAS), Self-rating Depression Scale(SDS) ] scores before and after management, the coping style (Jalowies) scores, and quality of life [evaluated by World Health Organization Quality of Life-Brief (WHOQOL-BREF) ] scores were compared between the two groups. The clinical rehabilitation effect and satisfaction rate of related management between the two groups were compared.Results:There were no significant differences between the two groups before management of SAS scores, SDS scores, Jalowies scores, and WHOQOL-BREF quality of life scores ( P> 0.05). After management, the SAS scores and SDS scores of the two groups were significantly reduced, and the Jalowies scores and WHOQOL-BREF quality of life scores were significantly increased. After management, the SAS score and SDS score of the experimental group were 47.32±5.68, 49.93±6.49 and 54.95±6.59, 55.33±8.30 in the control group, the difference was significant between two groups ( t value was 8.503, 4.969, P<0.01). The Jalowies scores and WHOQOL-BREF scores of the experimental group were higher than those of the control group ( t value was -27.662--4.290, P<0.01). The total effective rate of rehabilitation in the experimental group was 98.94%(93/94), which was significantly higher than 90.43%(85/94) in the control group, the difference was statistically significant ( χ2 value was 6.760, P <0.05). The total satisfaction rate of the experimental group for management intervention was 100.00%(94/94), which was significantly higher than the total satisfaction rate of the control group, 91.49%(86/94), the difference was statistically significant ( χ2 value was 6.397, P <0.05). Conclusions:In the patients with affective disorder caused by coronary heart disease and cerebrovascular disease, multi-disciplinary cooperation and optimization management mode can significantly reduce the negative emotions of patients after management, improve the way of patients to deal with the disease, effectively improve the clinical rehabilitation effect and the quality of life of patients, improve the satisfaction rate of patients with management, shorten the distance between nurses and patients, and achieve ideal results.

Objective To study the effect of foot motor imagery on lower extremity motor function in hemiplegics after stroke. Methods 72 hemiplegics were randomly divided into two groups: the experiment group and the control group. Normal rehabilitation was performed in the both groups and motor imagery was added in the experiment group. They were assessed with lower extremity Fugl-Meyer Assessment (FMA) and gait analysis. Results The scores of FMA in knee, ankle and lower extremity, gait frequency and speed improved in experiment group more than in controls（P<0.05）. Conclusion Foot motor imagery can improve lower extremity motor function.