d be used to evaluate the function of severely obstructive hydronephrotic kidneys with no image on IVU, which can reflect its objective function, especially one to two weeks after nephrostomy in hypertonic hydronephrostic kidneys, and is better than IVU.

Specialty English of Medical Laboratory is a comprehensive and overlapping discipline and plays a major role in multiple medical courses, including Life Science, Clinical Medicine and Laboratory Medicine.However, its teaching practices are limited due to the extensive contents, scattered basic knowledge points, complexities of language learning processes and high demanding of sophisticated teaching skills.Since internet technology′s breakout and the web-based education expanding in the past decade, personalized flipped classroom has drawn considerable attention in the education field and became a hop-spot in teaching practice system.In the present study, the concepts of flipped classroom and basic characteristics of Specialty English of Medical Laboratory were elaborated, as well as the reconstructing teaching processes, exploring the concrete plan for teachers and students in undergraduate program.

Objective To study the clinical value of simultaneous amplification and testing for detection of Mycobacteria tuberculosis(SAT-TB)in sputum samples and bronchoalveolar lavage fluid(BALF)samples. Methods Totally 169 sputum samples and 151 BALF samples from suspected pulmonary tuberculosis patients were detected by both SAT and Bactec MGIT960.The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of the samples using SAT-TB were calculated. Results Taken the results of BD960 as the reference,the sensitivity,specificity,PPV and NPV using SAT-TB of sputum samples were 84.00% (42/50),93.06%(67/72),89.36%(42/47)and 89.33%(67/75)respectively;and those of BALF samples 89.19% (33/37),95.12%(39/41),94.29%(33/35)and 42.39%(39/92)respectively.Taken clinical diagnostic results as reference standard,the sensitivity,specificity,PPV and NPV using SAT-TB of the sputum samples were 57.73% (56/97),93.06%(67/72),91.80%(56/61),and 62.04%(67/108)respectively;and those of BALF samples 51.82%(57/110),94.29%(39/41),96.61%(57/59)and、42.39%(39/92)respectively.The sensitivity,specificity, PPV and NPV using BD960 of the sputum samples were 51.55%(50/97),95.83%(69/72),94.34%(50/53),and 59.48%(69/116)respectively;and those of BALF samples 33.64%(37/110),90.24%(37/41),90.24%(37/41) and 33.64%(37/110)respectively.Conclusion SAT-TB is a rapid and sensitive method for the detection of Myco-bacteria tuberculosis in sputum and BALF samples.It can improve the detection rate of mycobaterium tuberculosis.

Objective To explore the effect and complication of synchronized intermittent mandatory ventilation (SIMV) combined with pressure support ventilation (PSV) and targeted tidal volume (TTV) in treatment of neonatal respiratory distress syndrome(NRDS).Methods Fifty-three neonates with severe NRDS between Jan.2010 and Dec.2012 were randomly assigned to 2 groups according to the ventilation mode:SIMV + PSV + TTV group (n =27),and assist/control group (A/C group) (n =26).The oxygenation status,the durations of oxygen exposure and ventilation and the incidence of complications were observed.Results The oxygenation status arterial oxygen partial pressure/fraction of inspired oxygen (P/F),arterial oxygen partial pressure/alveolar O2 tension(a/APO2) in the SIMV + PSV +TTV group were significantly improved at 6 h after ventilation (t =9.393,4.856,all P ＜ 0.05) ;and compared with A/ C group,they were significantly improved at 6 h (t =6.132,2.805,all P ＜ 0.05),24 h (t =2.890,2.682,all P ＜0.05),72 h (t =3.804,4.053,all P ＜ 0.05) after ventilation in the SIMV + PSV + TTV group.The incidences of air leak syndrome and ventilation-associated pneumonia(VAP) were lower in the SIMV + PSV + TTV group than those in the A/C group(t =3.908,4.178,all P ＜ 0.05).There were no significant differences in the mortality between the two groups (t =0.534,P ＞ 0.05).Conclusions Compared with A/C,SIMV + PSV + TTV can improve the oxygenation status more quickly,and decrease the incidences of air leak syndrome and VAP in neonates with severe RDS.

OBJECTIVE：To investigate the s ynergy between centralized drug volume-based purchasing （called“volume- based purchasing”for short ）and medical insurance negotiation policy. METHODS ：From the aspects of economic and social benefits ， the synergy of volume-based purchasing and medical insurance negotiation was analyzed by using the methods of literature analysis，policy interpretation and interview. The corresponding suggestions were put forward for the problems of the supply and use of drugs. RESULTS & CONCLUSIONS ：The synergy of volume-based purchasing and medical insurance negotiation in terms of economic benefits include medical insurance fund management optimization to improve fund utilization efficiency improvement ； medical insurance fund payment optimization to reduce transaction cost ；network promotion of medical security information platform to reduce the cost of information exchange. The synergy of volume-based purchasing and medical insurance negotiation in terms of social benefits includes relevant index assessment of drug quality evaluation to improve drug quality evaluation system ； medical service level improvement to form compound medical insurance payment mode under total budget management ；enterprise supervision driven by market to reduce the pressure of government supervision. The relevant departments should continue to strengthen the comprehensive management of medical institutions to reduce the phenomenon of irrational drug use ；strengthen policy convergence ，avoid the poor implementation of medical insurance drug adjustment policy ，so that the policy dividend of volume-based purchasing and medical insurance negotiation can benefit the people more through system reform ，optimal allocation of funds ，etc.

Objective: To investigate the influences of cardiovascular risk factors on left ventricular wall motion function in patients treated with epirubicin chemotherapy by layer-specific two-dimensional speckle tracking imaging (2D-STI). Methods: Sixty-four female patients with breast cancer treated with epirubicin and 36 controls from June 2018 to March 2019 in Renmin Hospital of Wuhan University were included. According to the numbers of cardiovascular risk factors, the patients were divided into group A (without cardiovascular risk factors, 31 cases), group B (single cardiovascular risk factor, 20 cases), and group C (multiple cardiovascular risk factors, 13 cases). All patients underwent echocardiography before and after epirubicin respectively. Global longitudinal strain, circumferential strain, radial strain (GLS, GCS, GRS), endocardial and epicardial layers of GLS and GCS (endoGLS, epiGLS, endoGCS, epiGCS) were obtained by EchoPAC software analysis. The differences of GLS, EndoGLS, EpiGLS, GCS, EndoGCS, EpiGCS and GRS before and after chemotheraphy were calculated as ΔGLS, ΔEndoGLS, ΔEpiGLS, ΔGCS, ΔEndoGCS, ΔEpiGCS and ΔGRS. Results: Compared with before chemotherapy, GLS, EndoGLS, EpiGLS, GCS, EndoGCS, EpiGCS and GRS were significantly reduced in group A, B and C after chemotherapy (all P<0.05). ΔEndoGLS and ΔEndoGCS showed an increasing trend in groups A, B and C, with statistical significance (all P<0.05). Correlation analysis showed that after chemotherapy with epirubicin, the numbers of cardiovascular risk factors were significantly correlated with strain parameters, and the correlation coefficient of EndoGLS was relatively higher (r=-0.582, P<0.001). Conclusions Layer-specific imaging can reliably detect the influences of cardiovascular risk factors on the left ventricular wall motion function in breast cancer patients treated with epirubicin. Parameters reflecting the endocardial longitudinal systolic function are sensitive indicators for the early detectin of myocardial damage and toxicity by epirubicin in patients with multiple cardiovascular risk factors.