Clinical thoughts based on symptoms, physical signs and examine outcomes is a process of analysis, judgement and conclusion of disease diagnosis. To cultivate an exact thinking model can avoid taking a part for the whole or a miss in disease analysis, so to cultivate clinical thoughts in clinical practice can elevate medical students'clinical skills.

Objective] To observe the clinical efficacy and 5-HT of Shugan Jianpi Tiaoshen acupuncture treatment for senile patients with constipation type of irritable bowel syndrome(IBS-C). [Method] A total of 68 patients with IBS-C were allocated into control group and acupuncture group from June 2015 to June 2014. 34 patients in the control group, who accepted Lactulose oral solution and Citrate Mosapride Citrate, of in 15 males and 19 females, the mean age was 66.8, the average duration of disease was 15.6 months;34 patients in acupuncture group, who accepted acupuncture treatment based on control group, in 17 males and 17 females, the mean age was 65.9, the average duration of disease was 17.1 months. Acupoint selection:Tianshu, Zusanli, Taichong, Xingjian, Qimen, Baihui, Neiguan. Observe constipation symptoms, depressive symptoms, and quality of life and serum 5-HT levels before and after treatment. [Result] The pre-treatment constipation symptoms and depressive symptom scores in two groups were decreased than post-treatment( P<0.05), which showed two methods can improve constipation and depressive symptoms of IBS-C patients. After treatment, constipation symptoms and depressive symptoms score in acupuncture group were lower than that in control group(P<0.05), which showed the effect of acupuncture was better. The eight dimensions of SF-36 were higher than those before treatment in total patients(P<0.05), which showed two methods can improve quality of life of patients; differences of physiological function, physiological function between acupuncture group and control group had no statistical significance( P>0.05), but body pain, vitality, emotional function, mental health, social function, and general health values were higher than that of the control group( P<0.05), which showed acupuncture treatment can reduce physical discomfort and improve the quality of life of patients. After treatment,serum 5-HT in control group was 33.8 pg/ml, in acupuncture group was 27.6 pg/m, which were lower than pre-treatment. 5-HT in acupuncture group was lower than control group( P<0.05), which showed the effect of acupuncture on regulation of 5-HT was more significant. [Conclusion]Shugan Jianpi Tiaoshen acupuncture can modulate 5-HT level of elderly patients with IBS-C, and play its role in modulating gastrointestinal function, improving constipation symptoms, depressive symptoms and quality of life.It is an effective method for the treatment of elderly patients with IBS-C.

OBJECTIVE:To establish an optimal method for microbial limit test for ciclopirox olamine vaginal suppository.METHODS:The microbial limit test for antibacterial agents was validated by plating method and membrane filtration method,and the optimal method for the test of bacteria and mold were confirmed based on the recovery rate of artificially sprayed bacteria.RESULTS:By plating method,the recovery rate of artificially sprayed E.coli was more than 70%,whereas that of mould was 0%;however,by membrane filtration method,the recovery rates of bacterial and mould were all higher than 70% when flushing doses of bacteria,mold,and control bacteria were 200 mL,300 mL,and 200 mL,respectively.CONCLUSIONS:The membrane filtration method could be used for the microbial limit test of the preparation the drug quality can be kept under effective control,and the established method is accurate and reliable.

Objective:To reflect the training of basic-level medical stuff by investigating the doctor-patient cognition status of patients in a county-level hospital.Methods:The questionnaire of 180 patients collected from a county hospital in Shaanxi province was analyzed by Rank sum test and Descriptive analysis with SPSS17.0.ReSults:There were no statistically significant differences in the evaluation of current doctor-patient relationship from patients of different ages,occupations and degrees of education (P ＞ 0.05).82.2％ of the patients believed that the doctor-patient relationship is harmonious or somewhat harmonious.Moreover although the patient's trust in doctors is not high,there is a certain sense of recognition;and they put forward some expectation and requirements on doctor's professional skills,communication skills and professionalism.Conclusion:Considering the patients' feedback,local medical colleges and universities should reflect medical education ideas,play an active synergy model in the training of students' professional skills.In the meantime,they should strengthen the medical internship management,while paying equal attention to enhance students' responsibility and professionalism to serve the grassroots.

Applying the principle of Evidence-Based Medicine to the clinical teaching,we have made the students raise the cognition level on the diagnose of diseases and treating policy and trained their clinical logic thinking ability.

OBJECTIVE: Comparison of operation of epitympanic/antrum cholesteatoma excised by endoscopy and microscope. METHOD: Eleven patients with epitympanic/antrum cholesteatoma were analysed, 5 cases were excised by endoscopy and 6 cases were excised under microscope. RESULT: No complication occurred after operation and all patients got dried ear. There were no difference in hearing recovery and closure of perforation of tympanic membrane between two group. The operation time, injury degree, length of stay in hospital and hospitalization expense with endoscopy was superior to that of microscope. CONCLUSION Considering financial constraints of patients, resection of epitympanic/antrum cholesteatoma cholesteatoma can be adopted by endoscopy.
Adolescent ; Adult ; Cholesteatoma, Middle Ear ; surgery ; Endoscopy ; Female ; Humans ; Male ; Microscopy ; Middle Aged ; Treatment Outcome ; Young Adult

ObjectiveTo study the changes and clinical significance of DNA ploidy,S-phase fraction(SPF),proliferating index(PI) in colorectal carcinoma.MethodsIn 40 cases of colorectal carcinoma (colorectal carcinoma group ),40 cases corresponding cancer-adjacent tissue (cancer-adjacent tissue group ),12 cases of precancerous lesions (precancerous lesions group) and 10 cases of normal colorectal mucosa coli (normal colorectal mucosa coli group),DNA ploidy,SPF and PI were detected with flow cytometry and compared.ResultsDNA diploid was 7 cases,DNA heteroploid was 33 cases in colorectal carcinoma group,35,5 cases in cancer-adjacent tissue group,10,2 cases in precancerous lesions group,10,0 case innormal colorectal mucosa coli group,there were significant differences among them(P＜ 0.01 ).SPF and PI in colorectal carcinoma group (35.36 ± 7.45,42.92 ± 6.81 ) were significantly higher than those in cancer-adjacent tissue group (20.82 ±5.51,31.34 ±4.88),precancerous lesions group (21.13 ± 5.07,31.70 ±5.59) and normal colorectal mucosa coli group ( 19.93 ± 3.73,32.01 ± 4.99),there were significant differences among them(P＜ 0.01 ).DNA ploidy was significantly correlated with Dukes staging (P=0.027) and the differentiation of colorectal carcinoma (P =0.030).ConclusionsDNA ploidy,SPF,PI may get some molecular biologycharacteristic and proliferation activity of colorectal carcinoma at molecule level,which may be helpful for treatment and evaluation of prognosis of colorectal carcinoma.

Objective To explore the current status and influencing factors of fall among the elderly in Niujie area of Beijing so as to provide evidences for prevention. Methods Based on the basic survey of fall in 1703 elderly people, the people were divided into intervention group and control group according to different habitation areas using cluster sampling method. The elderly people in intervention group of 874 were accepted intervention management for one year, including cognitive behavioral intervention, fall-inducing diseases intervention and intervention of elderly static and dynamic behaviors that affected the balance function, so as to help the elderly to master the relevantfactors of fall and preventive measures. Results The annual occurrence rate of fall was 11.7% (200/1703) and the fall injury incidence was 9.0% (152/1703). The prevalence of fall was increased with aging, and it was high in people with balance dysfunction. After one year intervention, the incidence of fall was decreased to 5.2%, while it was 7.6% in control group. Conclusions Cognitive behavior intervention can effectively prevent fall in the elderly, which has an important significance for improving the life quality of the elderly.

ObjectiveTo identify the relevant factors of expansion of contusive cerebral hemorrhage following unilateral decompressive craniectomy in patients with severe craniocerebral injury and discuss their relation with prognosis.MethodsA total of 161 consecutive patients with craniocerebral injury undergoing unilateral decompressive craniectomy were prospectively studied.Their initial cranial CT data (data after injury,data before operation,and data after first operation) were recorded.Mortality or Glasgow Outcome Scale (GOS) at 6 months after injury was used as the criteria for evaluation of prognosis.ResultsThe volume of increased contusive cerebral hemorrhage among the patients after craniectomy was (18.66 ± 22.69) ml.The Rotterdam score of their initial cranial CT after injury was significantly associated with the occurrence or not of expanded contusive cerebral hemorrhage following decompressive craniectomy and the expanded hematoma volume.The expanded volume of contusive cerebral hemorrhage ( ＞ 20 ml) after craniectomy showed significant relevance to mortality and poor prognosis six months later.The magnitude of external cerebral herniation ( ECH ) on the initial post-operative CT was associated with the prognosis. ConclusionsThe severity of patients with craniocerebral injury manifested by the initial cranial CT may predict the risk of expansion of contusive cerebral hemorrhage following decompressive craniectomy.The expansion volume of contusive cerebral hemorrhage and ECH are correlated with mortality and poor prognosis.

Objective To observe the changes of plasma lipoprotein concentrations after an oral glucose tolerance test and research their relation to insulin resistance in Type 2 diabetic patients.Methods The age,duration of diabetes,sex,waist circumference,hip circumference,waist-hip ratio,height,body weight,body mass index ( BMI ),systolic blood pressure,diastolic blood pressure,fasting plasma glucose,HbAl C,fasting insulin,and fasting and 60-,120-,180-minute post-load plasma glucose,plasma insulin,triglycerides ( TG),high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol(LDL-C) and total cholesterol(TC) after a 75-g oral glucose tolerance test were measured in 26 Type 2 diabetic patients.Comparison of plasma fasting lipoprotein concentrations and postload lipoprotein concentrations was made,and the relation between fasting and post-load lipoprotein concentrations and Homa-IR was researched.Stepwise multiple regression analysis was applied to investigate the areas under the lipoproteins' curves over 180 minutes.Results The declination of post-load lipoprotein concentrations after the 75-g glucose tolerance test was statistically significant( all P ＜0.01 ).Plasma TG concentration both in fasting and post-load state was positively related to Homa-IR( all P ＜ 0.05 ),and plasma HDL-C concentration in fasting and post-load state was negatively related to Homa-IR( all P ＜ 0.05 ).However,the correlation between both fasting and post-load state LDL-C and TC concentration and Homa-IR had no statistical significance.Moreover,stepwise multiple regression analysis revealed Homa-IR was the independent factor capable of modulating the area of HDL-C curve over 180 minutes after the 75-g glucose tolernce test ( P ＜ 0.05 ).Conclusion There was a significant declination of plasma lipoproteins after a 75-g glucose tolerance test,and plasma fasting and post-load TG and HDL-C concentrations were related to insulin resistance.Insulin resistance should play a significant role in the post-load HDL-C concentration after 75-goral glucose tolerance test.