Objective To point out the weak link of general medical education and explore the training mode and evaluation mechanism for communication. Methods Totally 100 general practi-tioners from four Shanghai hospitals took a questionnaire survey to know the present situation and the training needs of doctor-patient communication skills. Results Among all the subjects, there were 73%who thought strengthening the doctor communication ability was the key to improving the doctor-patient relationship, 71%who chose doctor-patient communication practice course as the training con-tent, 78%who tended to personalized analysis and guide, 57%who accepted experienced GP in class. Conclusion For GPS communication skills training requirements, curriculum integration, clinical practice teaching should be strengthened to set up the corresponding training evaluation system.

Esophagus ; pathology ; Female ; Foreign Bodies ; complications ; diagnostic imaging ; Humans ; Infant ; Radiography, Thoracic ; Tomography, X-Ray Computed ; Trachea ; pathology ; Tracheoesophageal Fistula ; diagnostic imaging ; etiology ; surgery

Objective To provide an effective imaging technique for the morphological observation of the urogenital hiatus in pelvic organ prolapse women using three-dimensional ultrasound. Methods In a prospective observational study, forty patients with pelvic organ prolapse and thirty nulliparous women underwent three-dimensional transperineal ultrasound, with the patients supine after bladder emptying. The three-dimensional ultrasound volume was acquired and the form, structure, composition and size of urogeital hiatus were observed in the axial plane set by interior-inferior edge of symphsis pubis and analrectum junction. Results The urogenital hiatus in pelvic organ prolapse women was obviously different from the control's. The size increased sharply, the morphology represented as oval replacing the normal rotundity, the middle line diverged from the normal position, organs inside the hiatus arranged abnormally and the connective tissue defected. Conclusions Three-dimensional ultrasound is an effective imaging method to observe female pelvic floor. Urogenital hiatus in pelvic organ prolapse women displayed abnormities with morphology and structure.

Objective To investigate the diagnostic value of transrectal ultrasonography (TRUS)for female traumatic urethral stricture.Methods Fifteen female patients with traumatic urethral stricture were examined by using TRUS and urethrography and the examination results were compared with op-eration findings.Results The ultrasonography results of all patients were in consistency with their operation findings,while the urethrography results of six patients were different from their operation findings.Conclusion TRUS is of great value in the diagnosis of female traumatic urethral stricture.

Objective To Study on CXCR1/CXCR2 antagonist G31P anti-inflammatory reaction mediated by neutrophils.Methods Detect whether G31P can block chemotaxis of neutrophils induced by human IL-8 and inhibit the release of IL-8 by epithelia of segmental bronchus;establish HEK293 cell line transfected by pcDNA3.0-CXCR1 ,2,4 and detect the chemotaxis of IL-8 for HEK293 ;establish the experi-mental model of pneumonia induced by the P.aeruginosa,take count of the nucleated cells in the bronchoal-veolar lavage fluid(BALF),analyze myeloperoxidase(MPO) of lung tissue and observe the histopathology changing of it.Results G31P can inhibit the chemotaxis for neutrophils and transfected HEK293 cell line,inhibit the A549 releasing of inflammatory mediators;the proportion of neutrophils declines in G31P treat-ment group,pathology examination appears clear discrepancy.Conclusion G31P can block the chemotaxis of chemotactic factor with ELR+ CXC to neutrophils,block the combination of chemotactic factor with its re-ceptor CXCR2,block the CXCR2 on the surface of alveolar epithelia and vascular endothelial cells.Accordingly,neutrophils recruiting to topoinflammation can be prevented.

The aerolysin genes (aerA) of BZ and NK isolates were cloned and sequenced. The sequence analysis showed that the partial aerA of BZ and NK isolates consisted of 1393 bp, encoding a protein of 464 amino acids. The similarity of nucleotide and amino acid sequences of aerA between BZ and NK isolates was 97.6% and 98.3% respectively. The nucleotide sequence of aerA of BZ strain exhibited 71.6% to 97.5% homology with other Aeromonas isolates, and the amino acid sequence exhibited 68.0% to 98.9% homology. The phylogenetic tree based on aerA nucleotide sequences from Aeromonas isolates was constructed with neighbor-joining method. It showed that there were three branches of aerolysin genes, and a close relation- ship among Aeromonas hydrophila isolates which were clustered into the same branch.

Objective To analyze the etiologies,clinical characteristics and prognostic factors of patients with acute renal failure(ARF)admitted to the hospital at high altitude.Method This retrospective study included clinical data of patients with acute renal failure in the General Hospital of Tibet Military Command from May 2001 to April,2006.Results There were 85 male patients and 63 female patients with mean age(42.4?18.1)years old.Among 148 patients with acquired ARF,52.7% was iatrogenic or nosoeomal origin, demonstrating a trend of increasing.The ARF included pre-renal(n=48,32.4%),renal parenchymal(n= 90,60.8%)and post-renal(n=10,6.8%)in origin.Acute high altitude sickness(n=20)was the major causes of pre-renal ARF.Renal parenchymal ARF could be classified into glomerular vascular lesions(n=24), acute tubular necrosis(n=53),acute interstitial nephritides(n=12),and contusion of unitesticle(n=1).of 90 cases of renal parenchymal ARF,39 patients(43.3%)were induced by medicines.Lithiasis was the major causes of post-renal ARF.The mortality of ARF in our study was 42.6%.The mortality of patients contracted ARF in hospital was much higher than that of patients community ARF in community(55.1 vs 23.6%;P=0.01). There was no significant differences of the mortality between the patients with and without dialysis treatment. Univariate analysis showed that prognosis was correlated with age,the presence of hematuria and oliguria or anuria Hb,and the number of organ system failures.The logistic regression showed that age,Hb and the number of organ system dysfunction were the predictors of mortality.Conlusions The major causes of ARF at high altitude were acute high altitude sickness and the use of medicines with nephrotoxicity.The morbility and mortality of nosocomisl ARF increased significantly.Prevention of MODS is a key management to decrease mortality in severe ARF.

Objective Previous studies regarding the effects of tamoxifen ( TAM) on the thin endometrium are rare .The aim of this study was to explore the effects of TAM on patients with thin endometrium undergoing frozen thawed embryo transfer ( FET ) . Methods One hundred and thirty three patients with thin endometri-um undergoing FET treatment were recruited from January 2014 to June 2016, who canceled embryo transfer ( ET) or after FET due to thin endometrium in natural cycle or hormone replacement therapy cycle .Patients were randomly divided into letrozole ( LE,n=72) group or tamoxifen (TAM,n=61) group.All of the patients started to have oral pills of Estradiol Valerate 4 mg/d on the third day of menstruating cycles , then 6mg/d on the eighth day ,after 10~12 days then having ultrasonic monitoring of endometrial thickness and blood estradiol (E2), progesterone levels, It′s called endometrial preparation for hormone replacement cycle .To letrozole, tamoxifen group,the way of endometrial preparation were as follows:patients started to have oral pills of LE 2.5mg/d,TAM 40 mg/d on the third day of menstruating cycles for 5 days, then having ultrasonic monitoring and used drug of human chorionic gonadotropic hormone ,It′s called HCG day .After the dominant follicle ovulation then took progesterone intramuscular injection 40 mg/d, oral progesterone 20 mg/d to change endometrium ,then to transplant cleavage embryos or blastocysts after taking 3 or 5 days of progesterone , It′s called embryo transplanting day .The way of TAM endometrium preparation was called TAM cycle .The general data , hormone levels and clinical out-come between two groups were analyzed . Results The serum estradiol level of LE group both on HCG and transfer day [(1193.80± 629.64)ng/L vs (2776.30±157.34)ng/L;(1195.90±820.30)ng/L vs (2129.40±1208.71) ng/L,P=0.000] were statistically lower, serum luteinizing hormone level were statistically higher than TAM group [(20.48±15.50)IU/L vs (10.59±8.34)IU/L,P<0.05];im-plantation rate of LE group were statistically lower than TAM (39.32%vs 45.83%,P=0.001).The endometrial thickness and serum E 2 and P levels in TAM cycles were significantly higher compared with those in hormone replacement therapy cycle [(8.49±1.36)mm vs (6.43±0.96)mm,P=0.018]. Conclusion Tam compared LE with patients of thin endometrium undergoing FET can increased en -dometrial thickness and improve implantation rate ,thus Providing a new solution to thin endometrium .

Objective To investigate the effect of propofol on the secretory function of adrenal medullary chromaffin cells of rats.Methods The rat adrenal pheochromocytoma cells cultured in vitro were seeded in 24-well plates at a density of 1×1010 cells/ml and divided into 5 groups (n=12 each) using a random number table:control group (group C),different concentrations of propofol groups (P1 and P2 groups),and different concentrations of etomidate groups (E1 and E2 groups).Propofol was added with the final concentrations of 30 and 100 μmol/L in P1 and P2 groups,respectively.Etomidate was added with the final concentrations of 4 and 40 μmol/L in EI and E2 groups,respectively.The cells were then incubated for 10 min in an incubator at 37 ℃.At the end of incubation with drugs,6 wells in each group were selected,and physiological salt solution 200 μl was added;another 6 wells in each group were selected,and high K+ physiological salt solution was added.[3 H] PSS and [3 H] K+-PSS were measured by [3 H] norepinephrine release assays.Results Compared with group C,[3 H] K+-PSS and [3 H] K+-PSS/PSS were significantly decreased in P1,P2 and E2 groups (P＜0.05),and no significant changes were found in [3H] K+-PSS and [3H] K+-PSS/PSS in group E1 (P＞0.05).Compared with group P1,[3 H] K+-PSS and [3 H] K+-PSS/ PSS were significantly decreased in group P2 (P＜0.05).Conclusion Propofol can inhibit the secretory function of adrenal medullary chromaffin cells of rats in a concentration-dependent manner.

Objective Glycodelin-A is one of glycoproteins secreted from endometrial epithelial cells , and it plays an im-portant role in embryo implantation , inhibition of reject reaction and pregnancy maintenance .Glycodelin-A will become an important potential marker in evaluating the endometrial receptivity and predicting the pregnancy outcome .The aim of this study was to investigate the correlation of glycodelin-A detected on the day of HCG and endometrial receptivity and the effects of glycodelin -A on the pregnancy outcome in the intrauterine insemination (IUI) period. Methods One hundred and seven woman patients with bilateral unobstruct-ed tubes and without endometrial lesions , endometrial polyps or intrauterine adhesions from Oct 2012 to Feb 2014 in our hospital were recruited in this study .Serum glycodelin-A in women receiving IUI on the day of HCG was measured by ELISA .Serum estradiol (E2), progesterone (P), and corpus luteum (LH) levels were measured by immunochemiluminometric assays .The condition of the endometrium was examined by transvaginalultrasonography . Results The serum glycodelin-A level on the day of HCG was higher in pregnant group [(1.47 ±0.38)ng/mL] than that in nonpregnant group ([0.62 ±0.13]ng/mL).The serum glycodelin-A level on the day of HCG was higher in endometrial thickness ≥7 mm group ([1.53 ±0.49]ng/mL) than endometrial thickness <7 mm group ([0.51 ±0.17]ng/mL). Conclusion The serum glycodelin-A level on the day of HCG may reflect endometrial receptivity to a cer-tain extent , which might have prognosis value for pregnancy following IUI .