The Medical College of Panzhihua University has developed a series of curriculum reform based on Medical Professionalism, investigating the basic idea, curriculum design and assess-ment system of Medical Professionalism curriculum reform, emphasizing the combination of medical professionalism curriculum with clinical courses, in the hope of providing a unified and acknowledged medical professionalism curriculum.

Objective To evaluate the clinical results of surgical treatment of isolated fractures of the sustentaculum tali of calcaneus via medial approach.Methods The data of 23 patients with isolated fractures of the sustentaculum tali of calcaneus was retrospectively analyzed who were treated with open reduction and internal fixation with cannulated screw or Kirschner wire via medial approach from September 2006 to March 2011.There were 19 males and 4 females,with an average age of 26.3 years (range,17-41 years).Associated injuries included 4 cases of talus fracture,4 of metatarsal fracture,and 3 of cuboid fracture.The functions of hiudfoot were assessed by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores pre-operation and post-operation respectively.Results Fifteen patients got followed up with an average 20.5 months (10-56 months).Thirteen patients were rated as good,2 as excellent,and the excellent and good rate was 100％(15/15).All the fractures were stabilized reliably,and got clinical union with no obvious complications occurred.Time of fracture union was 8-10 weeks,with an average of 8.5 weeks.Three patients felt mild transient pain during the recovery of walking,but their pain disappeared quickly after physical therapy.No patients developed wound infection,nonunion and other complications.Conclusion For isolated fractures of the sustentaculum tali of caleaneus with articular surface displaced greater than 1 mm or involving the articular surface of middle subtalar joint,open reduction and internal fixation operation via medial approach under direct visualization is recommendable.

Objective To investigate the diagnostic value of serum Cystatin C for early detection of renal damage in patients with liver cirrhosis. Methods 24-h creatinine clearance (CCr), serum level of cystatin C (CysC) and serum creatinine were measured in 76 patients with cirrhosis and t-test,Pearson's correlation test and ROC curve were used to evaluate the diagnostic significance of Cys C.Results The increase in Cys C level was associated with a decrease of CCr in the patients. Both Cys C and SCr were inversely correlated with CCr ( CysC: r =- 0. 763, P ＜ 0. 001; SCr: r=-0. 571,P＜0.01). Meanwhile, the area under the ROC curve was significantly higher in Cys C than in SCr (0. 830 vs. 0. 612). Conclusion Cystatin C is a more accurate and sensitive marker of renal diagnosis in liver cirrhosis. Detection of Cys C level in cirrhotic patients is of great significance for the prevention of liver-kidney syndrome.

Objective To analyze factors of volume maintenance percentage after autologous fat grafting breast augmentation.Methods From March 2011 to December 2014,39 patients were included.Age,BMI,donor site,breast preoperative volume,whether or not application of Brava and water-jet-assisted liposuction were collected as variables.We performed multivariate regression and univariate regression analyses in a general linear regression model and multilevel linear regression model to identify significant factors.Results The mean percentage of volume maintenance was (34± 12) ％.In univariate regression analysis,rate of volume maintenace was decreased 3.3％ as increase of age per 5 years;Brava application increased volume maintenace,compared with donor sites of the back and abdomen 8.4％ (40.7％ vs 32.3％,P＜0.05),application of leg fat increased by 9.6％ of volume maintenace (39.1％ vs 29.5％,P＜0.05).In the multivariate regression analysis,Brava use increased volume maintenance of 6.2％ (P＜0.05);use of leg fat increased by 6.0 ％ of volume maintenace as compared with donor sites of the back and abdomen (P＜0.05).Conclusions The age,Brava,and donor site are significant impact factors to percentage volume maintenance in autologous fat graft breast augmentation.

Objective To identify the pathogen that caused an outbreak of viral encephalitis in Henan area in 2011.Phylogenic analysis was carried out on Coxsackie-virus B5 (CVB5) which was isolated during this outbreak.Methods Five throat swab,21 stool and 14 cerebrospinal fluid (CSF) specimens were collected from 29 inpatients during this outbreak.Viral isolation and real time RT-PCR were then performed for all specimens.Viral nucleic acid of enterovirus 71 (EV71),coxsackievirus A 16 (CA16) and pan-enterovirus (PE)were detected by real time RT-PCR.Phylogenetic tree based on entire VP1 sequences was constructed among CVB5 isolates from 2 stool and 3 CSF specimens of 5 inpatients and others published data retrieved from GenBank.Results The real time RT-PCR results showed that the PE nucleic acid positive rates of throat swab,stool and CSF specimens were 60.0％ (3/5),61.9％ (13/21) and 85.7％ (12/14) respectively.All of these specimens were negative for EV71 and CA16.The isolation rates of throat swab,stool and CSF specimens were 20.0％ (1/5),25.0％ (5/21) and 29.0％ (4/14),respectively.BLAST with both VP1 and 5′-UTR sequences and molecular typing indicated that CVB5 was the main pathogen.Analysis among the 5 positve isolates based on the complete VP1 sequences showed 97.9％-99.5％ homology.Data from homologous comparisons indicated that these isolates had the highest nucleotide acid identity with the Changchun CVB5 CC10/10/Changchun strain (97.1％-98.1％) which caused hand,foot,and mouth disease (HFMD) outbreak in Changchun in 2010,and lower identity (89.0％-89.6％ and 91.8％-92.5％) with the COXB5/Henan/2010 and 03001N strain isolated from Pingdingshan,Henan in 2010 and 2012,respectively.Phylogenetic tree in VP1 region showed that isolates of this outbreak belonged to genotype D,the same clade with Changchun strain.Conclusion CVB5 was the major etiological agent correlated with this outbreak.The shift of predominant genotype might serve as one of the causes that associated with this outbreaks.

Objective To analyze the CT pulmonary angiography(CTPA) image quality and radiation dose of obesity patients with high and low tube voltage iterative reconstruction(IR) and the filtered back projection(FBP) reconstruct algorithm,and to explore the feasibility of low tube voltage IR algorithms in CTPA of obese patients.Methods Obese patients with suspected pulmonary embolism were randomly assigned into 80 kV or 120 kV group, and the images were treated with IR and FBP reconstructions.CT value of the basal segment of the right pulmonary artery, right upper lobe and main pulmonary artery were measured, and the average CT value of the pulmonary artery was further calculated, and the independent sample t test analysis was used.Results Comparing the CT value of the IR and FBP subgroup of two tube voltage groups, the differences were not significant (P>0.05), the differences of noise, signal noise ratio(SNR) and contrast noise ratio (CNR) were statistically significant (P<0.05), respectively.The CT value,noise,SNR and CNR of 80 kV group were significantly higher than those of the 120 kV group, and the differences were statistically significant (P<0.05), while the radiation dose were significantly lower than those of 120 kV group (P=0.000).Conclusion The CTPA image quality of 80 kV IR algorithm is significantly improved compared with the 120 kV FBP algorithm, and the radiation dose is significantly reduced, which could be used for CT pulmonary angiography in obese patients.

Objective To investigate the clinical efficacy and safety of Ganciclovir combined with interferon-α1 b inhalation for children with infectious mononucleosis(IM).Methods A total of 177 childhood cases of IM were selected,and they were divided into 3 groups,59 cases in each group according to the random number table.Three therapeutic methods were applied in different groups for 5-7 days in different groups:Ganciclovir (group A),Ganciclovir + interferon-α1 b inhalation (group B) and Ganciclovir + interferon-α1b intramuscularly (group C).The time of post-drug recovery from isthmitis,less than 0.05 of heterotypic lymphocytes,shrink of cervical lymph nodes shrink,liver retraction,spleen retraction among groups were compared.The Epstein-Barr virus (EBV)-DNA copy number and T lymphocyte subsets were compared before and after treatment.Adverse reactions were observed in each group.Results Compared with group A,the time to defervescence [(3.20 ± 1.81) d,(3.17 ± 1.76) d vs.(4.01 ± 2.34) d],duration of isthmitis was [(3.15 ± 1.33) d,(3.09 ± 1.37) d vs.(3.98 ± 1.31) d],and the time of heterotypic lymphocytes less than 0.05 [(3.12 ± 1.55) d,(3.10 ± 1.33) d vs.(3.95 ± 1.26) d] in group B and group C,were obvious shorter,and there were significant differences(F =4.150,4.580,4.060,all P ＜ 0.05).EBV-DNA negative conversion rate of group B and group C were higher than that of group A [53 cases(89.8％),52 cases (88.1％) vs.41 cases (69.5％),x2 =10.403,P ＜ 0.05],and the cellular immune function was improved significantly than that of group A after treatment for 7 days [CD3 +:(63.00 ±4.39)％,(62.75 ±4.84)％ vs.(68.70 ± 7.70)％;CD4+:34.08(30.21,41.70)％,33.94(29.17,45.17)％ vs.32.34(28.16,43.53)％;CD8+:30.59 (27.14,40.22)％,30.09(27.54,40.48)％ vs.32.57(28.68,41.17)％;CD4+/CD8+:1.12(1.03,1.31),1.11 (0.99,1.64) vs.0.94 (0.87,1.59),F/x2 =11.020,1.217,1.121,6.728,all P ＜ 0.05].The differences in indexes between B group and C group were not significant,and there was no statistical significance (all P ＞ 0.05).There were 2 cases with fever in the group C,and 2 cases of granulocytopenia in all group.Conclusions Ganciclovir combined with interferon-α1 b inhalation or intramuscular injection is effective and safe in treating children with IM.It can improve clinical symptoms,cellular immune function and EBV-DNA negative conversion rate.Since inhalation is of less side effects and no pain,it can be accepted by children and their parents easily.Therefore,it is recommended that Ganciclovir be used together with interferon-α1 b inhalation in the treatment of children with IM.

Objective To assess the effects of different level iterative reconstructions (IR) on image quality of obese patients of 80 kV CT pulmonary angiography (CTPA).Methods Forty obese patients with clinically suspected pulmonary embolism were examined with CTPA,filtered back projection method (FBP) and three IR levels (iDose1,20％ IR/80％ FBP;iDose3,40％ IR/60％ FBP;iDose5,60％ IR/40％ FBP) to reconstruct images were used.The CT value of pulmonary artery trunk,upper lobe artery and lower lobe basal segment artery of right pulmonary were measured,and the image noise,SNR and CNR of four groups were calculated and compared.Results The image noise,SNR and CNR had significant difference in 4 groups (all P＜0.05),and the image noise had significant difference between each two groups (all P＜0.05),the SNR and CNR had statistical difference between FBP and iDose3,between FBP and iDose5 (P＜0.01).Conclusion Compared with FBP,80 kV combined with different level IR technologies can significantly decrease image noise and improve objective image quality in CTPA,the radiation dose that obese patients received can be reduced.

Objective To investigate the prevalence of chronic non-communicable diseases among farmers,land less peasants and urban population in a certain area of Anhui Province,to explore the relationship between the lifestyles of landless peasants and their chronic non-communicable diseases.Methods A total of 761 valid questionnaires were collected by cross-sectional epidemiological study,including 119 farmers,259 landless peasants and 383 urban groups.The enumeration data was analyzed by x2 test and the measurement data analyzed by variance.The risk of chronic non-communicable diseases in each group was analyzed by Logistic regressions.Results General demographic characteristics showed that there were differences in three groups of people in the respects of drinking,eating habits and physical activity and other lifestyles (all P ＜ 0.05).Logistic regression analysis showed that the onset risk of hypertension and overweight obesity in the famer group and the landless peasant group was lower than that in the urban group,but higher than that in the peasant group.After adjusting for confounding factors,the prevalence of hypertension in the farmer group (OR =0.20,95％ CI:0.12-0.33) and the lost land group (OR =0.65,95％ CI:0.44-0.95) was lower than that in the urban group,the overweight obesity in the farmer group (OR =0.44,95％ CI:0.27-0.74) and the lost land group(OR =0.67,95％ CI:0.47-0.96) was lower than that in the urban group.The incidence of atherosclerosis in the farmer group (OR =2.48,95 ％ CI:1.45-4.23) and the lost land group(OR =2.00,95％ CI:1.33-3.02) was higher than that in the urban group.Conclusions The living style of landless peasants is different from those of rural group and urban group,and the incidence of hypertension and overweight obesity is higher than that of farmers.We should take interventions against chronic non-communicable diseases in landless peasants.

Objective To study the efficacy and safety of rociverine combined with tamsulosin in treatment of overactive bladder after transurethral resection of prostate (TURP).Methods 93 cases of overactive bladder patients who received TURP were collected.They were given rociverine tablets 10 mg 3 times a day and tamsulosin 0.2 mg once a day for 7 to 10 days.The efficacy and safety of treatment were assessed by changes before and after treatment in subjective indicators of overactive bladder syndrome score(OABSS),the international prostate symptom score(IPSS) and quality of life score(QOL) and objective indicators including daily frequency of micturition,urgency,urgency incontinence,nocturia,voiding volumes,combining with the adverse drug reaction incidence.Results The average treating time for the 93 cases was (5 ± 3) days.The average score of OABSS reduced 8.12(P ＜0.01,and each score≤ 4).The average score of IPSS reduced 16.69(P ＜0.01).The average score of QOL reduced 2.18 (P ＜ 0.01).There was statistical difference in objective indicators of patients between before and after treatment(P ＜ O.05).The adverse drug reaction incidence was 2.1％ (2 cases with thirsty symptom).Conclusion Rociverine tablets combined with tamsulosin in treatment of patients with overactive bladder after TURP are effective and safe.