Clinical thoughts based on symptoms, physical signs and examine outcomes is a process of analysis, judgement and conclusion of disease diagnosis. To cultivate an exact thinking model can avoid taking a part for the whole or a miss in disease analysis, so to cultivate clinical thoughts in clinical practice can elevate medical students'clinical skills.

Objective] To observe the clinical efficacy and 5-HT of Shugan Jianpi Tiaoshen acupuncture treatment for senile patients with constipation type of irritable bowel syndrome(IBS-C). [Method] A total of 68 patients with IBS-C were allocated into control group and acupuncture group from June 2015 to June 2014. 34 patients in the control group, who accepted Lactulose oral solution and Citrate Mosapride Citrate, of in 15 males and 19 females, the mean age was 66.8, the average duration of disease was 15.6 months;34 patients in acupuncture group, who accepted acupuncture treatment based on control group, in 17 males and 17 females, the mean age was 65.9, the average duration of disease was 17.1 months. Acupoint selection:Tianshu, Zusanli, Taichong, Xingjian, Qimen, Baihui, Neiguan. Observe constipation symptoms, depressive symptoms, and quality of life and serum 5-HT levels before and after treatment. [Result] The pre-treatment constipation symptoms and depressive symptom scores in two groups were decreased than post-treatment( P<0.05), which showed two methods can improve constipation and depressive symptoms of IBS-C patients. After treatment, constipation symptoms and depressive symptoms score in acupuncture group were lower than that in control group(P<0.05), which showed the effect of acupuncture was better. The eight dimensions of SF-36 were higher than those before treatment in total patients(P<0.05), which showed two methods can improve quality of life of patients; differences of physiological function, physiological function between acupuncture group and control group had no statistical significance( P>0.05), but body pain, vitality, emotional function, mental health, social function, and general health values were higher than that of the control group( P<0.05), which showed acupuncture treatment can reduce physical discomfort and improve the quality of life of patients. After treatment,serum 5-HT in control group was 33.8 pg/ml, in acupuncture group was 27.6 pg/m, which were lower than pre-treatment. 5-HT in acupuncture group was lower than control group( P<0.05), which showed the effect of acupuncture on regulation of 5-HT was more significant. [Conclusion]Shugan Jianpi Tiaoshen acupuncture can modulate 5-HT level of elderly patients with IBS-C, and play its role in modulating gastrointestinal function, improving constipation symptoms, depressive symptoms and quality of life.It is an effective method for the treatment of elderly patients with IBS-C.

Applying the principle of Evidence-Based Medicine to the clinical teaching,we have made the students raise the cognition level on the diagnose of diseases and treating policy and trained their clinical logic thinking ability.

Objective:To reflect the training of basic-level medical stuff by investigating the doctor-patient cognition status of patients in a county-level hospital.Methods:The questionnaire of 180 patients collected from a county hospital in Shaanxi province was analyzed by Rank sum test and Descriptive analysis with SPSS17.0.ReSults:There were no statistically significant differences in the evaluation of current doctor-patient relationship from patients of different ages,occupations and degrees of education (P ＞ 0.05).82.2％ of the patients believed that the doctor-patient relationship is harmonious or somewhat harmonious.Moreover although the patient's trust in doctors is not high,there is a certain sense of recognition;and they put forward some expectation and requirements on doctor's professional skills,communication skills and professionalism.Conclusion:Considering the patients' feedback,local medical colleges and universities should reflect medical education ideas,play an active synergy model in the training of students' professional skills.In the meantime,they should strengthen the medical internship management,while paying equal attention to enhance students' responsibility and professionalism to serve the grassroots.

OBJECTIVE:To establish an optimal method for microbial limit test for ciclopirox olamine vaginal suppository.METHODS:The microbial limit test for antibacterial agents was validated by plating method and membrane filtration method,and the optimal method for the test of bacteria and mold were confirmed based on the recovery rate of artificially sprayed bacteria.RESULTS:By plating method,the recovery rate of artificially sprayed E.coli was more than 70%,whereas that of mould was 0%;however,by membrane filtration method,the recovery rates of bacterial and mould were all higher than 70% when flushing doses of bacteria,mold,and control bacteria were 200 mL,300 mL,and 200 mL,respectively.CONCLUSIONS:The membrane filtration method could be used for the microbial limit test of the preparation the drug quality can be kept under effective control,and the established method is accurate and reliable.

OBJECTIVE: Comparison of operation of epitympanic/antrum cholesteatoma excised by endoscopy and microscope. METHOD: Eleven patients with epitympanic/antrum cholesteatoma were analysed, 5 cases were excised by endoscopy and 6 cases were excised under microscope. RESULT: No complication occurred after operation and all patients got dried ear. There were no difference in hearing recovery and closure of perforation of tympanic membrane between two group. The operation time, injury degree, length of stay in hospital and hospitalization expense with endoscopy was superior to that of microscope. CONCLUSION Considering financial constraints of patients, resection of epitympanic/antrum cholesteatoma cholesteatoma can be adopted by endoscopy.
Adolescent ; Adult ; Cholesteatoma, Middle Ear ; surgery ; Endoscopy ; Female ; Humans ; Male ; Microscopy ; Middle Aged ; Treatment Outcome ; Young Adult

ObjectiveTo identify the relevant factors of expansion of contusive cerebral hemorrhage following unilateral decompressive craniectomy in patients with severe craniocerebral injury and discuss their relation with prognosis.MethodsA total of 161 consecutive patients with craniocerebral injury undergoing unilateral decompressive craniectomy were prospectively studied.Their initial cranial CT data (data after injury,data before operation,and data after first operation) were recorded.Mortality or Glasgow Outcome Scale (GOS) at 6 months after injury was used as the criteria for evaluation of prognosis.ResultsThe volume of increased contusive cerebral hemorrhage among the patients after craniectomy was (18.66 ± 22.69) ml.The Rotterdam score of their initial cranial CT after injury was significantly associated with the occurrence or not of expanded contusive cerebral hemorrhage following decompressive craniectomy and the expanded hematoma volume.The expanded volume of contusive cerebral hemorrhage ( ＞ 20 ml) after craniectomy showed significant relevance to mortality and poor prognosis six months later.The magnitude of external cerebral herniation ( ECH ) on the initial post-operative CT was associated with the prognosis. ConclusionsThe severity of patients with craniocerebral injury manifested by the initial cranial CT may predict the risk of expansion of contusive cerebral hemorrhage following decompressive craniectomy.The expansion volume of contusive cerebral hemorrhage and ECH are correlated with mortality and poor prognosis.

The status quo of pain,trigger mechanism of pain,the manner of pain valuation and painalleviating measures during wound dressing were analyzed by checking literatures at home and abroad.These studies implied that the dressing-related pain impacted not only wound healing but also patients' daily life.At the same time,the studies and clinic practice of dressing-related pain in China were relatively deficient,therefore it is important that clinic practitioner should pay more attention to awareness of dressing-related pain and pain causes and take measures to relieve pain.

Ventilator-associated pneumonia (VAP) is a common hospital acquired infection in neonatal intensive care unit with high incidence in China. There is no diagnostic gold standard of VAP. The risk factors include premature birth, low birth weight, dura-tion of mechanical ventilation, episodes of intubation, blood stream infections. The recommended precautions include rising head of bed, closed tracheal suction, sucralfate, selective decontamination in digestive tract, improvement of mechanical ventilation, oral and skin care, hand hygiene. However, it is controversial that sucralfate, selective decontamination in digestive tract, passive humidifiers, oral and skin care can reduce the incidence of VAP.

Objective To observe the features of hypocalcemic myopathy secondary to hypoparathyroidism (HP). Methods The symp-toms and signs, laboratory findings and treatments of 13 patients with hypocalcemic myopathy secondary to HP were analyzed retrospective-ly. Results 13 cases of HP were classified into idiopathic HP (8 cases), secondary HP (3 cases) and pseudo-HP (2 cases). The symptoms of hypocalcemic myopathy secondary to HP included tetany, episodic carpopedal spasm, muscle cramps and myalgias in the forearms and calves. It presented blepharospasm, trunk spasm and laryngospasm. Some patients demonstrated positive Trousseau's and Chvostek's sign. Serum level of creatine kinase (CK) and lactate dehydrogenase (LDH) increased. The symptoms of myopathy released and the levels of CK and LDH decreased to normal level after enough calcium carbonate and calcitriol administration. Conclusion All types of HP (idiopathic, secondary and pseudo HP) can cause hypocalcemia and myopathy. Hypocalcemic myopathy secondary to HP would well recover by enough calcium carbonate and calcitriol treatment.