General practice (GP) training program in Shanghai has been carried out in Zhongshan Hospital of Fudan University,which consists of theoretical study,clinical rotation and community practice.The contents of assessment include clinical competences,theoretical knowledge,and research capability; the methods of assessment include objective structured clinical examination,multiple choice tests,and assay writing.During the program implementation Zhongshan Hospital exert great efforts to set up the teaching management framework,quality control system,and to improve teaching methods in order to upgrade the clinical capability training for the residents.

Objective To assess consultation competence of resident general practitioners in Shanghai. Methods Standardized patients (SPs) were employed as an assessment tool in exploring consultation competence of resident general practitioners ( GPs) , including clinical and communication skills. Clinical skills included information collection, clinical thinking, health education, out-patient history taking and recording and reception time management, and patient-physician communication skills included building a good relationship, information collection and feedback, understanding issues from patient's perspective, sharing information and obtaining informed consent and close of consultation. Score rate defined as actual score of each item divided by total score of the domain was employed to assess competence of GPs in varied aspects. Results There were 157 resident GPs, 52 men and 105 women, with an average age of (28 ±2) years. Overall score rate of clinical skills averaged (76 ±10) percent, and score rate of each item ranking from the highest to the lowest was reception time management (91 ±4) percent, out-patient history taking and recording (80 ±14) percent, information collection (76 ±12) percent, clinical thinking (74 ±17) percent, health education (68 ±1) percent. Overall score rate of communication skills averaged (74 ±12) percent, and score rate of each item ranking from the highest to the lowest was building a good patient-physician relationship (86 ±3) percent, information collection and feedback (80 ±5) percent, sharing information and obtaining informed consent (74 ±15 ) percent, close of consultation (62 ±27 ) percent and understanding issues from patient's perspective (43 ±0) percent. Conclusions Resident GPs have improved their consultation competence to certain extent after standardized training, but there still exist some weakness to be improved in them.

Objective To investigate high risk factors associated with cervical intraepithelial neoplasia (CIN) in married women aged 25 to 54 years in Beijing. Methods From Mar. 2007 to Sep.2008, 6339 married women at age of 25 to 54 years were selected randomly by cross sectional survey in a total of 137 communities of 12 districts or counties in Beijing. The interview was carried out with unified questionnaires, gynecological examination. The cervical smear cytology and high-risk human papillomavirus (HR-HPV) infection of cervical secretion were detected. Women with abnormal cervical cytology underwent colposcopy and cervical biopsy. Odd ratio (OR) and 95% confidence interval (CI) of related high risk factors with CIN were studied by logistic regression analysis. Results Among 6339 women, the prevalence rate of CIN including 4 squamous cell carcinoma (SCC) was 5. 90% (374/6339). By multinomial regression analysis, HR-HPV infection (95% CI: 9. 953 - 15.811 ), History of trichomonas vaginitis (95 % CI: 1. 046 -2. 104), oral contraceptives (95% CI: 1. 087 - 1. 806), age less than 45 years old ( 95% CI: 1. 069 -1. 828) were related with CIN. Conclusion Infection rate of HR-HPV is an independent risk factor of CIN, however, the history of trichomonas vaginitis, oral contraceptives and age less than 45 years old are related risk factors of CIN.

Objective To investigate prevalence of cervical intraepithelial neoplasia (CIN) among the married women aged 25-54 years in Beijing.Methods With method of cross sectional survey,6339 married women at age of 25 to 54 years were selected randomly in 137 communities of 12 districts or counties in Beijing from March 2007 to September 2008.The cervical smear cytology and high-risk human papillomavirus (HPV) infection of cervical secretion were detected.Women with abnormal cervical cytology were underwent colposcopy and cervical biopsy.Results Among 6339 women,9.58% (607/6339) cases had abnormal cytological results,the colposcopy and cervical biopsy showed the rate of CIN was 5.84% (370/6339) in total selected women and 60.96% (370/607) in women with abnormal cervical cytology,including 4.65% (295/6339) in CIN Ⅰ,0.80% (51/6339) in CIN Ⅱ,0.38% (24/6339) in CIN Ⅲ; 0.06% (4/6339)in early invasive carcinoma (SCC).Based on geographical distribution,the rate of cervical lesions was 4.46% (42/942) in urban areas,6.27% (188/3000) in suburbs and 6.01% (144/ 2397) in outer suburbs (P > 0.05).Conclusion It was found that the incidence of CIN was 5.84% in married women aged 25-54 years in Beijing,which did not show significant prevalence in urban,suburb and outer suburbs region.

Objectives To explore the prognostic factors of patients with pancreatic ductal adenocarcinoma and synchronous liver metastases ( PALM ) receiving palliative treatment .Methods The clinical characteristics , therapeutic approaches and survival outcomes of 108 consecutive patients with PALM who were pathologically diagnosed and received only palliative treatment at Tianjin Medical University Cancer Hospital from January 2001 to December 2015 .were retrospectively analyzed .Survival rates were calculated by Kaplan-Meier method, and factors influencing the survival were analyzed by univariate and multivariate Cox proportional hazard regression model .Results Of these patients, 68 were male and 40 were female, with an average age of 58 years old.Seventy-seven (71.3%) cases or their relatives refused to receive anticancer therapies.Palliative treatments included choledochojejunostomy and /or gastrojejunostomy after exploratory laparotomy for 5 (4.6%) cases, percutaneous transhepatic biliary drainage (n=22, 19.4%), drug analgesia (n=79, 73.1%), drug analgesia combined with percutaneous neurolytic coeliac plexus block (n=17, 15.7%).The median survival time (MS)was 94 days in all patients.Karnofsky performance score (KPS)<80, lymph node metastases, ascites, fasting blood glucose ≥6.1 mmol/L and lactate dehydrogenase ( LDH ) ≥250 U/L were independent risk factors influencing prognosis of PALM . Three groups were categorized according to the number of the above 5 risk factors for 0~1 in low risk group, 2~3 in middle risk group and 4~5 in high risk group, and the MS of 3 groups was 137, 95 and 48 days, respectively, with an extremely statistical significance (P<0.0001).Conclusions KPS, lymph node metastases, ascites, fasting blood glucose and LDH were the risk factors for prognosis of PALM .Patient stratification according to the above factors is more advantageous for judging individualized prognosis and can provide reference for making clinical decision .

BACKGROUND: Total knee arthroplasty is a procedure for treatment of knee osteoarthritisa with standardized, mature technology and affirmative efficacy. Total knee arthroplasty can result in overt excessive bleeding, decreased hemoglobin levels, patient mouth infection and other complications. As a new technology, autologous blood transfusion device can effectively reduce the rate of blood transfusion through reinfusing the unwashed and filterable drainage blood after operation. Up to now, no systematic reviews incorporating meta-analyses have found directly sufficient evidence to compare autologous blood transfusion drainage and no drainage after primary total knee arthroplasty. OBJECTIVE: To study the clinical efficacy, safety and potential advantages of the application of autologous blood transfusion device/no drainage based on the meta-analysis. METHODS:PubMed, Embase, the Cochrane Library, CBMdisc, China HowNet, VIP, Wanfang database were searched comprehensively by computer. The search strategies were developed by the way of MeSH terms combining with free words: “total knee replacement” OR “total knee arthroplasty” OR “total knee prosthesis” OR “unicompartmental” OR “unicondylar” OR “unicompartmenta” OR “arthroplasty, replacement, knee” [MeSH terms] AND “autologous blood transfusion” OR “Autotransfusion” OR “blood transfusion, autologous” [MeSH Terms] OR “Intraoperative Blood Salvage” OR “Intraoperative Blood” OR “Postoperative Blood Salvage” OR “Intraoperative Blood Cel Salvage” OR “Operative Blood Salvage” [MeSH Terms]. Data included in the final literature were analyzed using RevMan 5.3.5 software recommended by Cochrane. The main outcome measure was the rate of transfusion. The secondary outcome measures were the average change in hemoglobin, hemoglobin levels at the 3rd day, hospitalization time and intraoperative mouth infection rate. RESULTS AND CONCLUSION:Five randomized controlled trials, a total of 667 patients were enroled. Meta-analysis results showed that there were no significant differences in the transfusion rate (OR=0.73, 95%CI: 0.47-1.13;Z=1.41,P=0.16), average change in hemoglobin (WMD=0.20, 95%CI:-0.28-0.68;Z=0.82,P=0.41), the hemoglobin levels at the 3rdday (WMD=0.41, 95%CI:-0.26-1.09;Z=1.20,P=0.23), hospitalization time (OR=1.01, 95%CI: 0.06-16.27;Z= 0.01,P=1.00), intraoperative mouth infection rate (OR=1.01, 95%CI: 0.06-16.27;Z=0.01,P=1.00) between the postoperative use of autologous blood transfusion and no drainage. These results suggest that the meta-analysis of outcome measures has not provided the evidence-based medical support for the clinical efficacy of autologous blood transfusion device (including blood transfusion rate, the average change in hemoglobin, average hemoglobin change at the 3rd day, hospitalization time). Given the inherent limitations of the quality of the included studies and the publication bias, future high-quality, large-volume, multi-center randomized controled trials are awaited to confirm and update the findings of this analysis.

Objective To investigate the effect of Cordyceps sinensis on renal fibrosis and its possible mechanism.Methods Thirty Sprague-Dawley rats were randomly divided into three groups:Sham operation group (Sham,n =10),5/6 subtotal uephrectomy group (SNx,n =10),and 5/6subtotal nephrectomy treated with Cordyceps sinensis group (CS,n =10).Body weights were assessed and 24-hour urine excretion was collected before and every four weeks after surgery.Rats were sacrificed at 12 weeks after surgery.Blood samples were taken for biochemical study,and kidney tissues were used for HE and Masson stains to assess histological changes.Immunohistochemical staining was used to detect the expression of transforming growth factor β1 (TGF-β1) and its receptors of type Ⅰ (TβR Ⅰ),type Ⅱ (TβR Ⅱ).Immunofluorescence was used to detect E-cadherin and α-SMA.The relative protein level of TGF-β1,TβR Ⅰ,TβR Ⅱ,p-Smad2/3,Smad7,E-cadherin,α-SMA were examined by Western blotting.Results CS group had higher body weights and lower urinary protein,BUN and Scr level compared with SNx group.Glomerulosclerosis index and tubulointerstitial injury score were significantly reduced in CS group compared with those in SNx group (all P ＜ 0.05).The protein expressions of TGF-β1,TβR Ⅰ,TβR Ⅱ,p-Smad2/3 were decreased in CS group compared with those in SNx group (all P ＜ 0.05).CS treatment up-regulated the expression of E-cadherin,Smad7 and down-regulated the expression of α-SMA compared with that in SNx group (all P ＜ 0.05).Conclusion Cordyceps sinensis has inhibitory effect on renal fibrosis in 5/6 subtotal nephrectomy rat model,which might be related with the suppression of TGF-β 1 signal pathway.

Objective To extraction method optimization and the content of the different parts of Xinjiang Bergenia crassifolia (L.), provide the basis for efficient extraction of Bergenia crassifolia pigment. Method Using the orthogonal experiment, the alcohol extraction process of ethanol concentration, dosage of ethanol, extraction time, extraction times, as well as to Bergenia crassifolia pigment content of the different part. Results Of optimization, the best ethanol extract of xinjiang Bergenia crassifolia pigment process conditions is 8 times the amount of 50%ethanol, extracting 3 times, each time 0.5 h. In Bergenia crassifolia pigment content of different parts exists obvious difference. Bergenia crassifolia pigment content of Taproot and fibrous root is higher, at 8.65%to 9.58%, while Bergenia crassifolia pigment content of the leaves is relatively low, at just 0.15%. Bergenia crassifolia pigment content of leaves significantly higher than the old leaves. Conclusion This experimental study on efficient extraction of xinjiang Bergenia crassifolia pigment to provide strong technical support and theoretical basis.

Objective To develop whole breast irradiation with volumetric-modulated arc therapy (VMAT)-based hybrid intensity-modulated radiotherapy (IMRT) after breast conserving surgery for breast cancer,and to evaluate its value in clinical application.Methods Ten patients with breast cancer undergoing breast conserving surgery were enrolled.Two radiotherapy plans were designed based on hybrid fixed-beam IMRT/IMRT technique and hybrid VMAT/IMRT technique,respectively.One group received whole breast irradiation with a prescribed dose of 50 Gy in 25 fractions.The other group received whole breast irradiation with a prescribed dose of 50 Gy in 25 fractions,as well as simultaneous integrated boost to the tumor bed with 60 Gy in 25 fractions.The dosimetric parameters and delivery efficiency were compared between the two plans using paired t test.Results For patients treated with whole breast irradiation alone,there were no significant differences in conformity index and homogeneity index of target volume between the two plans (P=0.866,0.056);however,compared with the hybrid fixed-beam IMRT/IMRT technique,the hybrid VMAT/IMRT technique significantly increased the doses to organs at risk (OARs) and the number of monitor units (MUs) in the intensity-modulated field (P=0.000-0.050,P=0.002).For patients treated with whole breast irradiation with a simultaneous integrated boost to the tumor bed;however,the hybrid VMAT/IMRT technique significantly reduced the doses to the lung and spinal cord,number of MUs in intensity-modulated field,and delivery time compared with the hybrid fixed-beam IMRT/IMRT technique (P=0.004,0.001,0.000,0.000).Conclusions For patients treated with whole breast irradiation with a simultaneous integrated boost to the tumor bed,the hybrid VMAT/IMRT technique is highly promising for clinical application due to better OAR sparing and higher delivery efficiency.

Objective To investigate subtype of HPV infection among women at age of 25 to 54 years in Beijing. Methods From Sept. 2006 to Dec. 2008, 5552 reproductive women at age of 25 to 54 years classified into each 5-year as group were screened. Each participant completed a questionnaire and a sample of exfoliated cervical cells for liquid-based cytology and HPV subtype gene testing was performed.Results The overall prevalence of HPV was 6.68% (371/5552). High-risk HPV and Low-risk HPV prevalence were 5.76% (320/5552) and 2.00% (111/5552), respectively. The most common HPV types were HPV16 (2.61%, 145/5552), HPV58 (0. 97%, 54/5552), HPV33 (0.85%, 47/5552), HPV43 (0.74% ,41/5552) and HPV56(0.70% ,39/5552). There were two peaks of HPV prevalence: groups of 30 -34 years and 40 -44 years. Conclusion The most common HPV subtypes in Beijing were HPV 16,58, 33 and 43 and HPV prevalence showed a bi-medal age-specific curve.