Clinical skills training center of Dongyang People's hospital introduced lean man-agement conception into the resident clinical skills training. The recruited residents were grouped by degree, the training contents were detailed, and teaching plans were normalized, and small class teach-ing and real-time feedback were implemented, which improved the normalization and standardization of resident training. The implementation of lean management leads to great progress in resident train-ing, but still needs further efforts. Only in the long-term management of standardization, can lean man-agement conception be embedded in daily work, making clinical skills training center play its role in cultivating medical talents effectively.

OBJECTIVE:To enrich the identification diversity of traditional Chinese medicine(TCM),and provide theoretical guidance for the quality evaluation of TCM. METHODS:According to literature references and traditional identification experienc-es,characteristics including medicinal shape,size,color and lustre,surface,texture,section,odor and other aspects were identi-fied by sense organs such as eyes,hands,nose and mouth. The vivid traditional identification term were obtained through systemat-ic summarization in order to explore the internal relationship with pharmaceutical botany. RESULTS&CONCLUSIONS:As the sim-plest identification method,traditional identification method can rapidly identify the species and quality of TCM,evaluate the quali-ty,and has great significance to solve the security issues of clinical medication and health care in daily life. There was a correlation between the traditional identification and botanical research,which could be able to provide theoretical guidance to characters identi-fication and quality evaluation of TCM.

Objective To study the expression of HGF , RAGE in placentas of patients with gestational diabetes mellitus and its relationship with maternal and neonatal prognosis .Methods The complete clinical datas of late pregnancy,GDM treated group 40 cases,GDM untreated group 23 cases,the control group 30 cases.Immunohisto-chemical method was used to detect HGF and RAGE in the placentas of three groups ,the maternal and neonatal prog-nosis were recorded.Results In GDM untreated group,GDM treated group and the controlled group placenta ,HGF and RAGE expressed.The expression of HGF was gradually increased ,and any comparative differences between two groups were statistically significant ( F =7.56, P <0.05 );the expression of RAGE in placentas was gradually declined ,the differences among the control group and GDM untreated ,GDM treated group were statistically significant (F=11.62,P<0.05).The rates of maternal and neonatal complications in the GDM untreated group were signifi-cantly higher than that of the GDM treated group and the control group (χ2 =7.34,13.21,9.75,6.67,15.23, 12.53,all P<0.05).Conclusion HGF and RAGE may participate in the occurrence and development of GDM and maternal and neonatal prognosis closely ,regular treatment can improve the prognosis of mothers and infants .

Objective To investigate the therapeutic efficacy of lactulose combined with Bacillus subtilis duplex living bacterium in patients with constipation-predominant irritable bowel syndrome.Methods A total of 98 patients with constipation-predominant irritable bowel syndrome were divided into 3 groups according to the therapeutic drugs:lactulose group (33 cases),Bacillus subtilis duplex living bacterium group (30 cases) and combined treatment group (35 cases),and patients in all groups received mosapride.The course of treatment was 2 weeks in all groups.The symptoms of patients with abdominal pain,abdominal distention,defecate condition and quality of life before and after treatment was observed.Results The total efficacy of abdominal pain,abdominal distention in combined treatment group was higher than that in lactulose group and Bacillus subtilis duplex living bacterium group,in lactulose group was higher than that in Bacillus subtilis duplex living bacterium group,and there was significant difference (P ＜ 0.05).There was no significant difference in defecate Bristol grade before treatment among three groups (P ＞ 0.05).There was significant difference in defecate Bristol grade after treatment among three groups(P ＜ 0.05).There was significant difference in defecate Bristol grade before and after treatment in three groups(P ＜ 0.05).There was no significant difference in the quality of life before treatment among three groups (P ＞ 0.05),the quality of life after treatment in three groups was higher than that before treatment,and there was significantdifference (P ＜ 0.05).After treatment,the quality of life in combined treatment group was higher than that in lactulose group,in lactulose group was higher than that in Bacillus subtilis duplex living bacterium group,and there was significant difference (P ＜ 0.05).Conclusions The combined regimen of lactulose and Bacillus subtilis duplex living bacterium is more effective than lactulose or Bacillus subtilis duplex living bacterium alone.Thus the combined regimen of lactulose and Bacillus subtilis duplex living bacterium is an effective therapeutic method for constipation-predominant irritable bowel syndrome.

Objective To study the correlation of the adiponectin receptor 1 gene rs1139646C/G and rs10920531C/A single nucleotide polymorphisms with Chinese Han women with polycystic ovary syndrome (PCOS).Methods For PCOS group (n =80) and control group (n =80),polymerase chain reaction (PCR) was used to amplify the upstream and downstream 250 bases of rsl139646C/G and rs10920531C/A,respectively.PCR products were directly sequenced.Results For rs1139646C/G loci sites between PCOS and control groups,all were the homozygous genotype CC,and no statistical significance was found for genotype frequency and allele frequency between two groups.For rs10920531C/A loci sites between PCOS and control groups,no statistical significance was found for genotype frequency and allele frequency between two groups (P =0.683,0.580),and no statistical significance was found for two loci with genetic linkage disequilibrium analysis (x2 =0.307,Fisher 's P =0.579610,Pearson' s P =0.579608).Conclusions Adiponectin receptor 1 gene rs1139646C/G and rs10920531C/A single nucleotide polymorphisms have nothing to do with Chinese Han PCOS women.Genetic linkage disequilibrium analysis has nothing to do with PCOS.The rs1139646C/G in Chinese Han population is relatively stable site,and no locus mutation is found.

Objective Investigate the current situation of emergency nurses' perception of hospital safety climate in tertiary hospitals. MethodsA total of 866 emergency nurses from 114 hospitals in 29 provinces,municipalities and autonomous re.gions were randomly selected,and the self-designed general information questionnaire and Chinese version of the hospital safety climate scale were used to investigate. ResultsThe overall hospital safety climatel was(3.97+0.61). Univariate analysis of variance showed that there were statistically significant differences in the hospital safe.ty climate of emergency nurses with educational background and employment form (P<0.05). ConclusionThe e-mergency nurses have a better sense of the overall hospital safety climate,but the obstruction of' the safety work and the cleanliness and neatness of the. working: environment need to be improved. Therefore,il is suggested Lhal the construction of hospital safety climate should be further strengthened in the rational allocation of human re-sources and emergency working environment.

Objective To investigate the interaction between myocardial norepinephrine (NET) and protein interacting with kinase Cα (PICK1),and examine the myocardial expression pattern of NET and PICK1 in mice with adriamycin-induced congestive heart failure.Methods (1) Cellular experiments: 293T cells were transfected with NET,GFP-PICK1,NET + GFP-PICK1 or NET + GFP-PICK1 (KD-AA),respectively.Immunofluorescence staining was performed 48 h after the transfection.(2) Animal experiments: 40 male C57BL/6J mice were divided into control group and adriamycin group (intraperitoneal injection of 2 mg/kg adriamycin with a cumulative amount of 22 mg/kg).The myocardial mRNA and protein expression level of NET,PICK1 and adrenergic receptor (β1-AR) were detected by real-time PCR and Western blot after 10 weeks.Results (1) PICK1 mediates the intracellular trafficking of NET.(2) Compared to controls,cardiac mRNA expression of NET remained unchanged,but PICK1 and β1-AR mRNA level were significantly reduced in the heart failure mice.(3) Myocardial NET protein expression level was significantly reduced,whereas tyrosine hydroxylase (TH) protein expression was significantly upregulated in heart failure mice.(4) The myocardial density of sympathetic nerve fibers remained unchanged in heart failure mice.Conclusions Cardiac expression of NET and PICK1 are down-regulated in heart failure mice.Reduced PICK1-mediated intracellular trafficking of NET may be involved in the impairment of NET function in this congestive heart failure mice model.

With age, physiological decline and pathological factors can reduce the balance ability of the elderly people. Balance ability is closely related to the quality of life of the elderly people. Timely assessment of balance ability is helpful for medical staff to develop targeted rehabilitation training programs, so as to promote healthy aging. This article reviews the scoring methods, application status, advantages and disadvantages of balance ability assessment tools, so as to provide a reference for researchers to select scientific and reliable assessment tools.

Objective To analyze the resistance proifle of bacterial strains isolated from geriatric patients in 17 hospitals across China from 2005 to 2014.Methods A total of 17 representative general hospitals were involved in this program. Bacterial susceptibility testing was carried out by means of a uniifed protocol using Kirby-Bauer method and MIC determination. The results were analyzed according to CLSI 2014 breakpoints.Results The proportion of the strains isolated from geriatric patients among all the clinical isolates increased with time from 30.0% in 2005 to 32.7% in 2014. A total of 159 888 clinical isolates were collected from geriatric patient during the period from 2005 to 2014, about 33.1% of the whole patient population. Gram negative organisms and gram positive cocci accounted for 77.1% (123 229/159 888) and 22.9% (36 659/159 888), respectively. Majority (92.8%, 148 376/159 888) of the isolates were from inpatients and more than half (55.2%, 88 201/159 888) of the isolates were from sputum or other respiratory tract specimens. Methicillin-resistant strains inS. aureus (MRSA) and coagulase negativeStaphylococcus (MRCNS) accounted for an average of 67.1% and 75.9%, respectively. The resistance rates of methicillin-resistant strains to β-lactams and other antimicrobial agents were much higher than those of methicillin-susceptible strains. No staphylococcal strains were found resistant to vancomycin, teicoplanin or linezolid. Some strains ofE. faecalis (0.4%) andE. faecium (4.6%) were resistant to vancomycin, which was higher than average national level (0.3%, 3.2%). Vancomycin-resistant strains ofE. faecalisandE. faecium were mainly VanA type and VanB type based on their phenotype. The prevalence of penicillin-susceptibleS. pneumoniae strains was 78.2%, slightly lower than the 95.0% in Chinese adults in year 2014. The prevalence of ESBLs-producing strains was 67.5% inE. coli, 40.4% inKlebsiella (K. pneumoniae andK. oxytoca) and 34.3% inProteus mirabilis isolates on average. The strains ofEnterobacteriaceae were still highly susceptible to carbapenems (<10% resistant), followed by amikacin and the beta-lactam and beta-lactamase inhibitor combinations. Overall, 35.9% and 33.0% of theP. aeruginosa strains were resistant to imipenem and meropenem. More than 50% of theA. baumannii strains were resistant to imipenem and meropenem. The prevalence of extensively drug-resistant (XDR)P. aeruginosa (4.0%-1.8%) was higher than the average national level (2.1%-1.6%). The prevalence of XDR A. baumannii (19.2%-15.5%) and XDREnterobacteriaceae (0.1%-1.0%) was lower than the average national level (21.4%-19.7% and 0.3%-3.2%).Conclusions The proportion of clinical isolates from geriatric patients is different from average national level at the same period. The isolates from geriatric patients are more likely from inpatients, respiratory tract specimens and more likely non-fermentative gram-negative bacilli compared to average national level. The proportion of fastidious bacteria andEnterobacteriaceae species is generally lower than average national level. MRSA, VRE, ESBLs-producing strains and XDRP. aeruginosa are more prevalent in geriatric patients than in general Chinese patient population. This study suggests that surveillance of antimicrobial resistance for the clinical isolates from geriatric patients is very important for rational antimicrobial therapy.

Objective To investigate the distribution and changing resistance proifle ofSalmonella isolates in hospitals across China during the period from January 2005 to December 2014.Methods Seventeen general hospitals and two children’s hospitals were involved in this program. Antimicrobial susceptibility testing was carried out by means of a unified protocol using Kirby-Bauer method or MIC determination. The results were analyzed according to CLSI 2014 breakpoints.Results The proportion ofSalmonella isolates increased with time from 0.2% in 2005 to 0.7% in 2014. A total of 3 478Salmonella strains were collected from 19 hospitals. The proportion ofSalmonella typhimurium andSalmonella enteritidis was 27.4% and 24.4%, respectively. During the 10-year period, theSalmonella strains showed highest resistance rate to ampicillin (33.3%-64.8%), but low resistance to cefoperazone-sulbactam (0-5.3%) and ciprofloxacin (2.4%-14.3%).S. typhimurium showed higher resistance rate thanS. typhi,S. paratyphi andS. enteritidis. About 76.8% and 50.5% ofS. typhimurium were resistant to ampicillin and trimethoprim-sulfamethoxazole. The average prevalence of multi-drug resistantSalmonellawas 3.9% in the ten-year period, the highest (7.5%) was in 2005, the lowest (1.5%) in 2013.Conclusions During the period from 2004 to 2015, majority of theSalmonella isolates in hospitals across China wasS. typhimurium andS. enteritidis. Ampicillin and trimethoprim-sulfamethoxazole are no longer appropriate for empirical treatment ofS. typhimurium infection due to high resistance rate.Salmonella isolates are relatively more susceptible to third-generation cephalosporins and quinolones. Ongoing monitoring is necessary to identify multi-drug resistant strains ofSalmonella.