Thirty assistant general practitioners (GPs) of Jiading District Shanghai were trained for clinical skills and communication skills by using standardized patients (SP) in outpatient department from January to April 2014.The scores of clinical skills and communication skills were evaluated and compared before and two months after training.The results showed that the score of clinical skills [(72 ± 5) vs (56 ± 7), t=7.871, P＜0.05] and communication skills [(71 ±4) vs (45 ±5), t =9.573, P＜0.05] were significantly improved after training.After training, the scores of medical history taking [(36 ±5) vs (28 ± 6), t =4.352], clinical thinking [(17 ± 2) vs (14 ± 3), t =3.974], health education [(3 ± 1) vs (2 ± 1), t =3.090] and medical record v,riting [(13 ± 1) vs (8 ±2), t =5.317] were significantly higher than those before training (all P ＜ 0.05).But there was no difference in reception time management [(4 ± 0) vs (4 ± 0), t =1.025] before and after training (P ＞ 0.05).After training, the scores and the proportions of the trainees qualified for building physician-patient relationship [(20 ± 3) vs (15 ± 4), t =4.056],collecting information and providing feedback [(22 ±4) vs (13 ±3), t =4.682], understanding complaints from patients' perspective [(5 ± 2) vs (3 ± 2), t =3.107], sharing information and obtaining informed consent [(19 ± 4) vs (11 ± 5), t =4.322] and closing consultation [(6 ± 2) vs (3 ± 1), t =2.987] were higher than before training (all P ＜ 0.05).The results indicate that training by using SP can effectively improve the clinical skills and communication skills of assistant GPs.

BACKGROUND: Long-term follow-up of the patients undergoing anterior cervical discectomy and fusion (ACDF) shows some incidence of degeneration at the segments adjacent to the fusion level. Cervical total disc replacement may resolve this problem. OBJECTIVE: To compare the effects of cervical total disc replacement versus ACDF on the biomechanics of the segment adjacent to the operation level. DESIGN, TIME AND SETTING: The randomized controlled trial was performed at biomechanical laboratory in Beijng Trauma and Orthopaedic Institute from August 2007 to February 2008. MATERIALS: Eighteen samples of fresh goat cervical spine; Bryan artificial cervical disk (Medtronic); CSLP-VA cervical plate (Synthes); coral bone (Beijing Yihuajian Science And Trade Co., Ltd.). METHODS: The goat spines were divided into 3 groups: control group with no specific treatment; total disc replacement group, in which C5/6 segment underwent Bryan artificial cervical disk replacement and fusion; internal fixation group, in which the C5/6 segment underwent cervical discectomy, coral bone implantation and internal fixation with CSLP-VA cervical plate. MAIN OUTCOME MEASURES: The adjacent intervertebral disk pressure (IDP) was measured in flexion, extension, rotation and lateral bending under certain loading, and the pressure changes were compared among three groups. RESULTS: At level C4/5, the IDP between total disk replacement group and the control group had no statistical significances in flexion (P 0.05) but internal fixation group was significantly higher than control group (P=0.014). There were no significant differences among the three groups in IDP in extension, rotation and lateral bending. CONCLUSION: Compared with ACDF, the total disk replacement can reduce the adjacent segment IDP and may avoid the degeneration in adjacent cervical segment.

BACKGROUND: Although the clinical effect of cervical disk replacement in short term has been ascertained, but the middle and long term result is not known, especially for the adjacent level. OBJECTIVE: To observe clinical result and effect of cervical disk replacement on adjacent level in middle and long term. DESIGN, TIME AND SETTING: Retrospective case analysis was performed at Beijing Jishuitan Hospital from December 2003 to March 2005. PARTICIPANTS: Thirty-three patients (aged 35-73 years) undergoing cervical disc replacement were followed up for 3 years. Of them, 25 patients received one-level disk replacement, and 8 received two-level disk replacement. METHODS: The clinical results and imaging before and after operation were compared. MAIN OUTCOME MEASURES: Clinical indexes including JOA grade, Odom’s grade, NDI, SF-36; X-ray: Kellgren X-ray grade, disk cervical height, disk motion, Pfirrmann disk grade, sigittal diameter of spinal cord, and compression of the spinal cord. RESULTS: The point of JOA is 13.62?2.31 before operation, 15.75?1.55 after operation; the differences were significant (P=0.000). For Kellgren X-ray, 10 levels occurred degeneration above the disk replacement level, accounted for 33% (P=0.004), and 9 levels developed degeneration below the disk replacement level, accounted for 32% (P=0.011). No obvious changes in imaging indexes were observed before and after surgery. CONCLUSION: The clinical outcome of cervical disk replacement is good in middle-term follow up. Some adjacent level degeneration may occur after cervical disk replacement, and the degeneration type is osteophyte formation in the adjacent level. This kind of adjacent level degeneration does not affect the clinical outcome in middle term follow-up.

Objective To assess the usefulness of a computer-aided detection(CAD)system on detecting the pulmonary nodules in digital chest radiography.Methods Three hundred and twenty-eight digital chest radiographies along with corresponding chest computed tomography were selected for this study. Two senior chest radiologists interpreted these cases using the CAD system and marked the locations and sizes of all nodules with consensus,which were stored in a computer system as Gold Standard to evaluate the performance of the CAD system.Eight radiologists of various experience read these selected cases without and with the aid of CAD system and their results were stored in a computer system.The radiologists' performance was evaluated by using the receiver operating characteristic analysis.Comparison is made regarding the difference in Az values when CAD was not used versus when CAD was used by using the paired-samples t test.Results For small nodules,the sensitivity of this computer system used by the two senior chest radiologists in 100 digital radiographs was 78.1%(118.0/151).Without and with the assistance of CAD system,the nodule detection sensitivity of the radiology residents was 62.4% (94.2/151),77.4%(116.8/151)respectively,and the area under the curve of radiology residents was 0.769,0.836 respectively.Statistical analysis showed there was statistically significant difference between interpretation without and with the CAD system(P0.05).Conclusions This CAD system can help to enhance the radiologists' ability to detect small pulmonary nodules.This is especially helpful for radiology residents.

HIV-1 integrase (IN) is a key enzyme for the viral replication. The protein-protein interaction (PPI) between HIV-1 IN and a cellular cofactor lens epithelium-derived growth factor (LEDGF/p75) is a validated target for anti-HIV drug discovery. In order to build the platform for screening inhibitor against PPI between IN and LEDGF/p75, the vector containing the LEDGF/p75 protein cDNA was constructed and expressed in Escherichia coli and the function of the LEDGF/p75 protein was assayed. The LGDGF/p75 encoding gene optimized according to the preference codon usage of E. coli, was synthesized and cloned into the expression vector pGEX-4T-1 to form a recombined plasmid, then transformed into host cell E. coli BL21 (DE3). The recombined clones were identified and confirmed by BamH I/Sal I digestion and sequencing, the successfully recombined plasmid in the host cell was induced by IPTG and the condition of the expression was optimized. The expressed protein was purified by the Ni2+ affinity chromatography column and SDS-PAGE was used to analyze the molecular weight and specificity. In addition, ELISA assay was used to analyze the function of the recombinant protein. The recombinant LGDGF/p75 was soluble, and expressed highly and stably in E. coli. The protein was proved to enhance HIV-1 IN strand transfer activity in vitro by ELISA. It will be helpful to build the platform of screening inhibitors against PPI between IN and LEDGF/p75.
Cloning, Molecular ; Escherichia coli ; metabolism ; HIV Integrase ; metabolism ; HIV-1 ; physiology ; Humans ; Intercellular Signaling Peptides and Proteins ; biosynthesis ; Protein Binding ; Virus Replication

Although private hospitals are generally encountering development difficulties, some private non-profit medical institutions thrived in the medical market. These hospitals have rich experiences in terms of manage-ment system, operation mechanism, and competition methods. In this paper, we summarize the experiences of those well-functioning private non-profit hospitals and analyze the essential conditions for developing private non-profit med-ical institutions. These conditions include meeting local health market needs, ensuring that the hospital management system and operation mechanism result in high-quality health services, ensuring hospital development meets local health plans ( in order to obtain policy support) , ensuring the goal of the hospital is public welfare and that the hospital has strong financial support, obtaining certain social and political capital, and ensuring high-quality managers and staff.

Objective To evaluate the effect of hydrogen on the activation of caspase-3 in brain tissues during cerebral ischemia-reperfusion (I/R) in rats.Methods Thirty-six healthy adult male Sprague-Dawley rats,weighing 220-250 g,were divided into 3 groups (n=12 each) using a random number table:sham operation (group S),I/R group and hydrogen group (group H).Cerebral ischemia was induced by occlusion of the middle cerebral artery followed by reperfusion in I/R and H groups.In group H,hydrogen-rich saline 5 ml/kg (0.6 mmol/L) was injected intraperitoneally at 3 days before establishment of the model and immediately after the onset of reperfusion.At 24 h of reperfusion,the rats were sacrificed,and hippocampal tissues were obtained for determination of neuroapoptosis (by TUNEL),apoptotic neuron count and expression of activated caspase-3 (by Western blot).The brain tissues in the ischemic area were obtained and stained with haematoxylin and eosin for examination of the pathological changes.Results Compared with group S,the expression of activated caspase-3 was significantly up-regulated,and the apoptotic neuron count was increased in I/R and H groups (P<0.05).Compared with group I/R,the expression of activated caspase-3 was significantly down-regulated,the apoptotic neuron count was decreased (P<0.05),and the pathological changes of brain tissues were significantly reduced in group H.Conclusion The mechanism by which hydrogen inhibits neuroapoptosis during cerebral I/R is probably related to inhibited activation of caspase-3 in brain tissues of rats.

Objective To summarize the experience and clinical characteristics in liver re- transplantation following adult-to-adult living donor liver transplantation.Methods Due to biliary complication (2 cases),vascular complication (2 cases),chronic rejection (1 case) and hepatitis recur- rence (1 case),liver re-transplantation was performed on 6 patients through modified piggyback liver transplantation.Vascular anastomosis was performed between the hepatic arteries of donor livers and receptor abdominal aorta in 1 case,and the rest were subjected to end-to-end homonymic vascular anastomosis.Results No operative death occurred.Due to primary non-function,1 died after the ope- ration.During the follow-up period,1 had anastomotic stricture of hepatic artery after the operation and was cured by percutaneous venoplasty.The survival of the rest patients was 12,9,6,4 and 3 months respectively.Conclusion Peritoneal adhesion is the operative difficulty for liver re-transplantation following adult-to-adult living donor liver transplantation.

Objective To investigate question comprehension and production among agrammatic aphasics, and to explore the mechanisms of any dysfunction in questioning.Methods Twenty aphasics were recruited in this study.According to the Chinese Agrammatism Battery,10 were classified as agrammatic (the agrammatic group) and 10 as non-agrammatic (the non-agrammatic group).Ten normal subjects served as a control group.All the subjects were tested in terms of their comprehension and production of questions using a set of general and what-where-who- why questions (wh-questions).Results No significant difference was found between the two experimental groups with regard to the correct comprehension and production of both general and wh-questions.However,there was a sig- nificant difference in correctness between comprehension and production.The performance of the agrammatic aphasics was worse than that of the non-agramatics and the normal subjects.Conclusion The impaired question comprehen- sion and production of Chinese agrammatic aphasics has its own characteristies which can form a basis for rehabilita- tion planning and outcome prediction.

Objective To observe the effect of lovastatin on plasminogen activator inhibitor -1 (PAI-1) and collagen type Ⅳ in rats with glomerularsclerosis induced by adriamycin,and to discuss its mechanism of protective effects on kidneys.Methods Twenty-four male Wistar nephritic rats induced by adriamycin were randomly divided into 3 groups:control,hyperlipidemia and lovastatin treatment group.They were fed 12 weeks.Urinary protein excretion and serum lipid were assayed,then renal glomerularsclerosis index,the expression of PAI-1 and collagen type Ⅳ were observed.Results Serum total cholesterol,triglycerides,low-density lipoprotein,urinary protein excretion,renal glomerularsclerosis index were significantly lower in treatment group than those in hyperlipidemia group.Expression of PAI-1 and collagen type Ⅳ,and number of foamcells were also sharply lower in treatment group than those in hyperlipidemia group.Conclusions Lovastatin not only reduces proteinuria,improves renal function,but also modulates glomerularsclerosis by inhibiting activity of PAI-1 and decreasing accumulation of collagen type Ⅳ.The mechanism of renal protective effect is independent of a reduction of circulating cholesterol.