The article discusses how to innovate in the departmental rotation examination for the students practicing in hospital in the new time.It is important for the teacher to provide guidance to students and motivate them to take part in comprehensive training of competence actively so as to cultivate the high-level medical students adaptive to the modern society.

Humanistic spirit advocates the concern for human,and the medical value of people foremost.Now status quo of oral medical students' humanities concern is worrying.This paper aims to analyze the reason,and the best way to culture oral medical students' humanities concern is not only to have an aim of training medical professionals who have oral medical knowledge and skills,but also to look upon the education of medical humanistic spirit as important educative content,to improve teachers' humanities diathesis,to enhance the contact between medical students' and society or patients,to foster affection,to train skills,and to establish the good environment of humanities education.

Objective To study the state and trends of Kesan disease in Henan province from 2004 to 2009. Methods Surveillance sites were selected: Guxian village of Luoning country from 2004 - 2007, Zuyang town of Lingbao city in 2008, and Shahe village of Lushi country in 2009. All residents of surveillance sites were examined by clinical and electrocardiogram, and suspected patients were inspected by chest X-ray to measure ardiothoracic ratio. Hair and wheat flour samples were collected and selenium levels were detected with hydride generation atomic fluorescence spectrometry. Results From 2004 to 2009, a total of 4034 people were examined.The numbers of chronic and latent KSD patients were 21 and 75 cases,respectively, and the incidence rates were 0.52%(21/4034) and 1.86%(75/4034), respectively . The number of abnormal electrocardiogram was 751 cases, and the incidence rate was 18.62%. The highest proportion of abnormal electrocardiogram was ST-T changes,accounting for 24.63%(185/751), followed by high-voltage, accounting for 18.11%(136/751), and left ventricular accounting for 13.85% (104/751). Sixty-one grain samples were collected and the wheat flour selenium level was averaged 0.034 mg/kg. Thirty hair samples were collected and the selenium median was 0.285 mg/kg. Conclusions The state of Keshan disease is in a steady state in Henna province, but higher rates of abnormal electrocardiogram is a serious problem and should be studied and prevented.

Objective To understand Kaschin-Beck disease(KBD) status in Henan Province and provide the basis for the further prevention and treatment of KBD. Methods Children aged 7 to 12 in 3 villages(Yaodian, Miaowa and Zhuyang) with the same environment such as topography, physiognomy,production mode and living habits in Shan County and Lingbao City were selected to undertake KBD clinical examination in 2008, X-ray examination of right hand and child hair samples and food samples were collected to determine the content of selenium. Selenium was determined using 2,3-Diaminonaphthalene method. Adults who were 16 years or older in 5 counties(Luoning, Lingbao, Mianchi, Shah and Lushi) were selected and examined for KBD. Results One hundred and ninty children aged 7 to 12 were clinically examined and clinical KBD were found, whereas 3 children were diagnosed as KBD by X-ray examination, the positive rate was 1.58% (3/190). All 20 521 adults were clinically examined and KBD prevelance rate was 6.10%(1251/20 521), including degree Ⅰ (3.97%,814/20 521), degree Ⅱ (1.77%, 364/20 521 ), degree Ⅲ (0.36%, 73/20 521). The average selenium contents in hair and food samples were (0.319±0.128)mg/kg and (0.031±0.009)mg/kg, respectively. Conclusions Child KBD in Henan Province is under control or almost under control, whereas the prevalence of adult KBD was relatively serious, which suggested that secondary prevention with the objective of clinically treating KBD patients should be strengthened.

Objective To study the clinical characteristics of tracheotomy in patients with critical diseases and obesity aged 80 years and over. Methods A total of 120 patients with critical diseases and obesity undergoing tracheotomy from July 2006 to August 2011 were retrospectively reviewed,and divided into advanced age group(aged 80-99 years,n=60) and control group(aged 60-79 years,n=60).Surgery time,operation preparation,surgery skill and complication after surgery were compared between the two groups. Results A total of 60 patients undergoing tracheotomy were successfully performed by relative surgery skills according to characteristics of critical obesity in advanced age group.There was 1 case (1.7％) and 0 case with trachea cannula exodus,3 cases (5.0％) and 4 cases(6.7％) with cuff leak,4 cases (6.6％) and 3 cases(5.0％) with stoma bleeding,5 cases (8.3％) and 7 cases (11.4％) with subcutaneous emphysema in advanced age and control groups,respectively.Total complication rate was similar between the two groups of patients [13 cases (21.7％) vs.14 cases (23.3％),x2 =1.00,P＞0.05]. Conclusions Individualized procedure of tracheotomy may reduce complication of patients with critical diseases and obesity aged 80 years and over.

Objective To determine relative risk factors for positive surgical margins in extraperitoneal laparoscopic radical prostatectomy(LRP). Methods From February 2004 to September 2007,33 patients(mean age 70 years old)with prostate cancers underwent extraperitoneal LRP.All patients were diagnosed by pathology preoperatively.Gleason score:3+3 14 cases(43%),3+4 11 cases(33%),4+3 6 cases(18%),4+4 2 cases(6%).Clinical stage:T1a-T1b 4 cases(12%),T1c 14 cases(43%),T2a-T2b 5 cases(15%),T2c10 cases(30%).Logistic regression analyses were performed. Results LRP was successfully performed on 31 cases.There were 2 cases converted to open surgery.Nine cases(27%)had PSMs.There were 6 cases(67%)and 4 cases(17%)of clinical stage T2c in PSM and negative surgical margin(NSM)groups respectively(P=0.010).There were 3 cases(33%)and 0(0)with high Gleason score(higher than 7)in PSM and NSM cases(P=0.015).There were 4 cases(44%)and 5 cases(21%)with t-PSA higher than 20dg/ml in PSM and NSM cases respectively(P=0.178).In these 9 cases,there were 4 cases(44%)positive with DRE.However there were 9 in the 24 NSM cases(38%)(P=0.509).Clinical stage T2c was independently positively correlated with PSM(OR=24.69).High Gleason score(higher than 7)and t-PSA higher than 20 ng/ml were positively correlated with PSM. Conclusions Clinical stage is positively correlated with PSM.It is an independent factor.High Gleason score(higher than 7)and t-PSA higher than 20 ng/ml mignt be the risk factors in predicting PSM and should be used together with clinical stage.Positive DRE findings may be also useful to predict PSM.

Breast Neoplasms ; chemistry ; pathology ; Carcinoma, Ductal, Breast ; chemistry ; pathology ; Electrophoresis, Polyacrylamide Gel ; methods ; Female ; Fluorescent Dyes ; Gelatin ; metabolism ; Humans ; Matrix Metalloproteinase 2 ; analysis

OBJECTIVE To discuss the operative plan for nasal cavity abnormality and evaluate the effect of revision FESS. METHODS A retrospective study of 36 revision FESS performed during 2002.3-2005.5 (age from 17 to 55 years old) is presented. Patients were evaluated with endoscopic examination of the nasal cavities and computed tomography of the sinuses and nasal cavities. Information was also collected during the revision surgery. The plan was designed according to nasal cavity abnormality. RESULTS The reasons of revision FESS: Among 36 cases there are 24 ethmoid sinusitis, 16 cases with recurrence of polyps,13 middle meatal stenosis, 11 middle turbinate adhesion, 10 septal deviation, 5 frontal recess stenosis, 5 sphenoid sisusitis, 3 maxillary ostium obstruction,3 inferior turbinate hypertrophy. Follow up for 6 month～43 month after revision FESS, 22 cases were successful, 10 satisfied and 4 inefficacy. CONCLUSION The primary FESS failure was associated with nasal cavity structure diseases. Meticulous attention in these areas and correcting it during surgery may reduce recurrence and ensure operative effect after revision FESS.

Objective To explore the effects of nurses′ risk perceptions of occupational HIV exposure and the self-efficacy on their attitudes and behavior of self-protection in nursing care. Methods An anonymous survey was conducted in eligible nurses with self-designed questionnaire in three conveniently selected comprehensive hospitals in Wuhan. Structural equation modeling was applied in the data analysis. Results Risk perceptions exerted positive effects on the attitudes of self-protection. The standardized path coefficient was 0.45 (P=0.009). The attitudes of self-protection and the risk perceptions exerted no impact on the behavior of self-protection (P > 0.05).The impacts of the self-efficacy on the attitudes and the behavior of self-protection was positive. The standardized path coefficient was 0.15(P=0.02)and 0.53 (P<0.01), respectively. Conclusions Risk perceptions exerted positive effects on the attitudes of self-protection. But the attitudes of self-protection and the risk perceptions exerted no impact on the behavior of self-protection. Self-efficacy can improve the attitudes of self-protection and enhance the behavior of self-protection.

Objective To observe the change of conditions and study the epidemiology of Keshan disease from 1995 to 2009 in Henan province.Methods From 1995 to 2009,seriously ill township (village) of Keshan disease were selected as monitoring sites,and one cross-sectional survey was conducted annually.Resident population were asked of their disease history,and were taken clinical examination.Suspicious or suspected cases of Keshan disease and people with abnormal ECG were taken 2 m X-ray.Hair and wheat flour samples were collected for selenium testing.Results From 1995 to 2009,about 6632 people were checked,130 chronic and 52 latent cases of Keshan disease were identified,the total detection rates were between 1.12％ and 5.06％.The detectable rate for abnormal electrocardiogram and heart enlargement found through chest X-ray examination were 10.24％ -30.65％ and 32.4％ - 77.8％,respectively.The content of hair selenium tended to increase,the highest was in 2009 (357.12 μg/kg),and the lowest was in 1997( 142.68 μg/kg).Conclusion Keshan disease is stable in Henan province,and prevention and control measures should be strengthen gradually.