Objective To explore the effect of evidence-based medicine combined withcase based learning(CBL) in pediatric residency training.Methods Totally 52 residents were equally divided into two groups:experiment group and control group.Method of CBL combined with the evidencebased medicine (Taking two residents as one group,firstly teacher posed the questions and then residents searched for references when off duty and made evidence-based case presentation at fixed time when doing teaching ward around,after wards all personnel in the department made case discussion,finally teacher made the summary) was used in experimental group while traditional teaching method (teacher guided the residents to analyze the case by clinical experiences,residents took notes and sometimes asked questions,teacher directly gave the answers)was used in control group.The teaching effect is evaluated by questionnaire,theory test and clinical skills assessment.Statistical analysis was carried out on appraisal results with SPSS 16.0 software,test results and appraisal results were expressed as ((x-) ±s) and t test was performed,P ＜ 0.05 was taken as statistically significant.Results Residents in experimental group had more advantages in self-study ability,literature retrieval ability,physician teamwork spirit,clinical thinking,PowerPoint making and language expression after receiving CBL combined with evidence-based medicine.Theory examination showed that average score of experimental group was better than that of control group (75.46 ± 6.646) vs.(71.38 ±4.758),with statistically significantly differences (P =0.014),especially in subjective items.Clinical skills assessment showed that experimental group was better than control group in writing medical records and doing clinical thinking.Conclusions Teaching method of evidence-based medicine combined with CBL is significantly better than traditional indoctrination teaching in improving the abilities of self-study,cultivating clinical thinking,literature retrieval,language performance and other skills.This teaching method is more suitable for pediatric residency training.

Objective To analyze the screening results of yon Willebrand factor among patients before blood transfusion in Ruijin Hospital and discuss von Willebrand factor in ABO blood group and the relationship between age and gender,refine the classification of vWF antigen and activity by reference factors.Methods The von Willebrand factor among 247 cases of patients before blood transfusion in Ruijin Hospital with no clinical manifestations of abnormal blood clots and routine coagulation as laboratory tests for normal surgical patients.The vWF:Ag and vWF:Act were measured by immune turbidimetric method and ABO blood group was identified by blood type serology.Furthermore,the differences between A,B,O,AB different blood groups,sex and high (≥40 years) and low age group (＜40 years) were compared by statistical methods.Results The levels of vWF:Ag in different blood groups were as follows:A blood type:98.5-142.00,B blood type:97.90-160.30,O blood type:82.13-125.45,A B blood type:103.00-135.80.The levels of vWF:Act in different blood groups were as follows:A blood type:76-130.14,B blood type:78.06-144.3,O blood type:60.89-116.11,AB blood type:88.99-124.09.O blood type vWF:Ag and vWF:Act were lower significantly (P＜0.05) than non-O blood type,the difference was.Besides,young vWF:Ag and vWF:Act were lower significantly than in the elderly.There was no significant difference in vWF:Ag and vWF:Act levels between male and female groups.At last,the reference range of four groups of vWF activity (antigen) was obtained.Conclusion Plasma vWF antigen and activity levels were significantly affected by ABO blood type and age,and the refined reference range established for these influencing factors was beneficial for more detailed diagnosis of VWD and predicting vWF levels associated with bleeding and thrombosis risk.

Objective To investigate the effect of personalized continuing education on the compliance of permanent colostomy patients. Methods A total of 160 cases to accept a permanent colostomy were selected from October 2011 to December 2013, and were averagely divided into experimental group and control group according to random number table method in accordance with the composition. The patients of the control group were given conventional educational methods while the patients of the experimental group were given personalized continuing health education on the basis of the control group. The Excise of Self-care Agency Scale ( ESCA) had been used for the assessment of patient′s self-care ability about colostomy. Results The score of the experimental group was higher than that of the control group at ESCA ( P <0. 05 ); the color judgment of colostomy, subsidiary products application of colostomy, the prevention and its nursing of colostomy complications in the experimental group were better than those of the control group (P <0. 05). The higher score in the experimental group also represented at aspects of patient′s self-care knowledge control (97. 5%), self-care implementation (92. 5%), achieving personalized health goal (97. 5%) and complier (96. 3%) compared with those of the control group (χ2 =4. 574, 6. 874, 7. 873, 9. 872,respectively;P <0. 05). Conclusions The personalized continuing health education can improve the compliance of permanent colostomy patients.

OBJECTIVETo study the chemical changes of salvianolic acid B and lithospermic acid of Salvia miltiorrhiza under the conditions of high temperature and high pressure and explore the reaction mechanism.

METHODS. miltiorrhiza extracts, salvianolic acid B and lithospermic acid were put in the reactor under the conditions of high temperature and high pressure (120 degrees C, 0.2 MPa), and the chemical changes and stability was studied.

RESULTSalvianolic acid A was the primary product in salvianolic acid B and lithospermic acid's conversion process, and lithospermic acid was an intermediate in the conversion process of salvianolic acid B. Compared with salvianolic acid B, lithospermic acid could convert into more salvianolic acid A and fewer other products in the same conditions. Salvianolic acid A was not stable under the conditions of high temperature and high pressure, and could sequentially convert into other small molecules.

CONCLUSIONReferring to the chemical conversion of salvianolic acid B and lithospermic acid, a method of large-scale preparation of salvianolic acid A can be developed.

Benzofurans ; analysis ; Caffeic Acids ; analysis ; Depsides ; analysis ; Hot Temperature ; Lactates ; analysis ; Pressure ; Salvia miltiorrhiza ; chemistry

Objective: To understand the prevalence and disease burden of major chronic diseases in the elderly in China and provide scientific basis for the prevention and control of chronic diseases and for the rational allocation of health resources. Methods: We analyzed the prevalence of chronic diseases in residents aged ≥60 years in China by using national and provincial surveillance data of chronic diseases and related risk factors in China. We conducted the analysis on the burden of chronic diseases in the elderly in China by using the data of global burden of disease. Results: The prevalence rates of hypertension, diabetes and hypercholesterolemia were 58.3%, 19.4% and 10.5% respectively in residents aged ≥60 years in China. Up to 75.8% of the residents aged ≥60 years had at least one chronic disease. The prevalence rate was higher in women than in men, higher in urban area than in rural area. With the increase of age, the prevalence rate of chronic diseases also increased. The top three chronic diseases with heavy disease burden in residents aged ≥70 years were stroke, myocardial infarction, cancer and chronic obstructive pulmonary disease. Conclusion The prevalence of major chronic diseases in the elderly is high with three quarters of the elderly suffering from at least one chronic disease, and the burden of chronic diseases is increasing.

Objective:To explore the application effect of integrated mode of medical and nursing in colostomy patients.Methods:Using the convenient sampling method, a total of 60 patients who underwent colostomy in the Second Affiliated Hospital of Wenzhou Medical University from January 2019 to April 2020 were selected as the research objects. The patients who hospitalized from January to August 2019 were included in the control group, and the patients who hospitalized from September 2019 to April 2020 were included in the observation group, with 30 cases in each group. The patients in the control group were treated with routine nursing mode, and the patients in the observation group were treated with integrated mode of medical and nursing. Before discharge, 1, 3 and 6 months after the operation, the status of independent replacement of colostomy bags, scores of the Stoma Self-care Scale-Early Version and the incidence of stoma complications were compared between the two groups.Results:There was no statistically significant difference in the number of patients who changed colostomy bags independently before discharge and 1, 3 and 6 months after the operation between the two group ( P>0.05) . There was no statistically significant difference in the number of cases of periostomy dermatitis, ostomy and mucosal separation and stoma depression between the two groups of patients after surgery ( P>0.05) . The score of the Stoma Self-care Scale-Early Version of the observation group were higher than that of the control group at 3 and 6 months after surgery, and the difference was statistically significant ( P<0.05) . Conclusions:The integrated mode of medical and nursing can improve the self-care ability of patients at 3 and 6 months after the operation , which is worthy of clinical application.

Objective: Analyzes of the monitoring results of silicosis in key occupational disease monitoring in Tianjin in 2017, providing reference for continuous monitoring, and prevention and control work of silicosis. Methods: Monitor and analyze the current state of silica dust hazard enterprises, the health status of silica dust workers, and the characteristics of newly developed silicosis cases in accordance with the national 2017 work plan for key occupational disease monitoring and occupational health risk assessment. Results: In 2017, 210 enterprises have silica dust hazard in Tianjin, silica dust workplaces exceed the standard rate is 34.73%, 5 695 workers' health examination who contact with silica dust were collected. 2 were detected occupational contraindication, the abnormal detection rate of chest examination is 3.60%, the abnormal index of lung function mainly is FVC, the abnormal rate is 15.8%. The abnormal rate increases with working years. In 2017, 193 new cases of silicosis were reported most cases were developed after years of decontamination. Most enterprises with cases had already out of market, only 7 were still producing. Conclusion The key prevention and control in Tianjin was enterprises with silica dust excess of standard, as well as older and longer working years workers, adopting effective measures to reduce the concentration of silica dust in workplace is a fundamental measure to reduce the risk of silicosis.