The article analyses the current situation of the unbalanced development of Chinese higher medical education and the reasons for it,and points out that to promote its development,gradation and diversify development of education must be realized.

OBJECTIVE:To provide reference for implementing relevant policies and measures,and promote rational drug use. METHODS:The cognition(questionnaire)and application(prescription spot checks)about antibiotics and glucocorticoids by 191 rural doctors from 14 township hospitals and 18 health room in area A,B and C(representing the economically developed areas, moderately developed areas and undeveloped areas)were investigated,and the results were statistically analyzed. RESULTS:Total-ly 382 questionnaires were sent out(191 for antibiotics and 191 for glucocorticoids),and 382 were effectively received with effec-tive recovery of 100%;and 2 300 prescriptions were checked. Results of questionnaire showed,there were still some misunder-standings and blindness among the rural doctors'cognition and application about antibiotics and glucocorticoids,the usage of β-lac-tam was not fully grasped,part of the empirical use of antibiotics and drug treatment was still not entirely clear,more than 40%had no clear ideas about the classification and contraindications of hormones,and more than half of them didn't know the Glucocor-ticoids Clinical Practice Guidelines;results of prescription spot checks showed,there were regional differences about the proportion of antibiotics and glucocorticoids,area A had the highest proportion among 3 areas,accounting for 60.9% and 18.9%,respective-ly. And area C showed highest proportion about unreasonable prescriptions,accounting for 22.5%. CONCLUSIONS:The cognition and reasonable use of rural doctors for antibiotics and glucocorticoids still needs to be strengthened. It is suggested to take effective measures,formulate and implement the corresponding supervision system,strengthen antibiotics and glucocorticoids knowledge training for rural doctors and fully implement the the principles of rational drug use to improve the rational drug use.

Objective:To experimentally intervene safe injection by medical staff in basic-level hospitals and observe the recent and long-term effect atfer the intervention and to provide practical measures to improve safe injection. Methods:We used random sampling methods to set up groups in county hospitals and township hospitals of Hunan Province, and offered lectures, delivered safe injection guide, brochure and on-site guidance in the experimental group. We surveyed the 2 groups atfer the intervention at 1 month and 6 months to compare the effect of unsafe injection behaviors and safe injection behaviors. Results:One month after the intervention, the unsafe injection rate in the experimental group decreased from 27.8%to 21.7%, while in the control group injection the unsafe injection rate rose from 26.0%to 27.9%, with signiifcant difference (P<0.01). Six months atfer the intervention, the unsafe injection rate in the experimental group declined to 18.4%while the unsafe injection rate in the control group also dropped to 22.4%, with signiifcant difference (P<0.01). Unsafe injection rate was decreased in the experimental group at different intervention points, with signiifcant difference (P<0.01). The safe injection behavior scores in the experimental group were higher than those in the control group after the intervention of 1 month and 6 month intervention (P<0.01);the experimental group got higher scores atfer the intervention (P<0.01). Conclusion:Training of safe injection, distribution of safe injection guide, and comprehensive intervention model can significantly change the primary care practitioners’ behaviors in unsafe injections and it is worth promoting.

OBJECTIVETo determine the efficacy of adenovirus mediated suicide gene transduction combined with prodrug 5-fluorocytosine (5FC) as a therapeutic protocol for pancreatic cancer.

METHODSCytosine Deaminase(CD) gene was cloned into pAdTrack-CMV-CD, pAdTrack-CMV-CD and pAdEasy-1 were recombined in bacteria. The newly recombined adenovirus (Ad)-CD containing green fluorescent protein (GFP) were packaged and propagated in 293 cells and purified by cesium chloride gradient centrifugation. Human pancreatic carcinoma cell line-Patu8988 was infected with this virus, then 5FC was added. XTT assay was used to estimate relative numbers of viable cells. In vivo model of pancreatic cancer was established by injecting 1.0 x 10(7) Patu8988 cells subcutaneously in Balb/c nude mice. When tumors were palpable, Ad-CD was injected into each tumor and 5FC was administered.

RESULTSPositive clones were selected using endonuclease to digest the recombinants and the concentration of viral liquids containing the CD gene was 2 x 10(11) pfu /ml. Significant cytotoxic activity as shown for 5FC in the CD gene transduced 8988 cell line, while little effect was found in the nontransduced pancreatic carcinoma cells. Antitumor effect was observed in Patu8988 xenograft nude mice with in situ CD gene transduction.

CONCLUSIONSCD gene mediated by adenovirus has high infectivity and may be useful for gene therapy in pancreatic carcinoma. These data demonstrate the use of an enzyme prodrug strategy in experimental pancreatic cancer.

Adenoviridae ; genetics ; Animals ; Cytosine Deaminase ; Gene Transfer Techniques ; Genetic Therapy ; Genetic Vectors ; Humans ; Mice ; Mice, Inbred BALB C ; Nucleoside Deaminases ; genetics ; Pancreatic Neoplasms ; therapy

To investigate the present situation of empowerment in elderly patients with hypertension in the community, and to analyze its impact factors. Methods 176 elderly hypertensive patients in our community of Guangzhou city were investigated by convenience sampling method. The chronic disease empowerment scale, general self-efficacy scale and social support rating scale were used to investigate. Results The score of empowerment in elderly patients with hypertension was (147. 48 ± 15. 65). The score of self-management is the lowest dimension with the score rate of 44. 6％. The impact effects of education level, living conditions, course of disease, self-efficacy, objective support, subjective support and utilization of social support on empowerment were significant(P＜0. 05), which could explain 78. 1％ of the variance. Conclusion The empowerment level of elderly patients with hypertension in community is relatively low, the clinical medical staff should focus on the patients of lower education level, living alone, with a longer duration of disease. Nurses should pay attention to strengthening self-efficacy and social support of the patients so as too improve the clinical therapeutic effects of patients.

Objective:To evaluate the efficacy of roxatidine and omeprazolein on preventing gastrointestinal bleeding in critically ill patients.Methods:A prospective cohort study was conducted in adult patients admitted to an intensive care unit (ICU), who had risk factors for stress related mucosal disease (SRMD), and had an estimated stay of no less than 5 days and mechanical ventilation for more than 48 h. Patients were randomized into the experiment group (Roxatidine 75 mg IV Q12 h) and control group (Omeprazole 40 mg IV Q12 h). Demographic data, acute physiology and chronic health score (APACHEⅡ) and SOFA score on day 1 were collected, intragastric pH values were tested every 2 hours for the first 5 days, the daily average of pH and proportion of patients with average pH≥4 were calculated. Stool occult blood were detected at day 1 and bacterial culture of gastric juice were performed before medication administration and on day 5 after medication administration. The implementation of enteral nutrition support, situation of gastrointestinal hemorrhage and adverse effects were analyzed. Furthermore, length of hospital stay and mortality in ICU and on the 28th day were acquired. SPSS 22.0 software was used for data analysis. Consecutive data were expressed as mean and standard deviation, categorical data were expressed as frequencies (percentage). Comparison of measurement data between groups was performed by analysis of variance or rank sum test. Comparison of count data between groups was performed by the Chi-square test. P<0.05 was regarded as statistically significant. Results:A total of 91 patients were recruited and randomly separated into experimental group ( n=46) and control group ( n=45) from October 2017 to March 2018. There were no statistical differences in gender, age, body mass index (BMI), enteral nutrition status, APACHEⅡ and SOFA score on day 1 between the two groups (all P>0.05). Roxatidine in the experiment group rapidly increased the intragastric pH to ≥4.0 and continued to stabilize at pH ≥4.0 during the monitoring period. Omeprazole increased and maintained intragastric pH≥5.0. The proportion of patients with average pH≥4.0 was 82.5% in the second 24 hours in the experiment group, and stably increased to 90% on day 5. There were no significant differences between groups in gastrointestinal bleeding, length of hospital stay, and mortality in ICU and on 28th day(all P> 0.05). No drug related adverse effects occurred during the study period. Logistic-regression analysis did not screen for risk factors of SRMD. Conclusions:Roxatidine acetate hydrochloride can rapidly elevate and maintain the gastric pH above 4.0, and has similar efficacy and safety as omeprazole in inhibiting gastric acid secretion and preventing SRMD with gastrointestinal bleeding.

Objective:To investigate status quo of professional self-identity of newly recruited nurses and analyze its influencing factors.Methods:From July to December 2018, a two-stage cluster sampling method was adopted. In the first stage, according to the economic and administrative regions, the area was divided into six regions, namely Northeast China, East China, North China, South China, Southwest China and Northwest China, and one ClassⅢGrade A hospital was randomly selected from each administrative region. In phase 2, a cluster sampling was used to select newly recruited nurses from 6 sample hospitals in 2018. A questionnaire survey was conducted using the Nurses' Professional Self-identity Scale. A total of 267 questionnaires were collected, 258 of which were valid, with an effective recovery rate of 96.63%.Results:The total mean score of Nurses' Professional Self-identity Scale for 258 newly recruited nurses was (3.84±0.66) . Univariate analysis showed that there were statistically significant differences in the total mean score of Nurses' Professional Self-identity Scale of newly recruited nurses with different ages, internship time, education background and labor and personnel relations. Multiple linear regression analysis found that educational background, internship time, labor and personnel relations were the influencing factors of the professional self-identity of newly recruited nurses.Conclusions:The professional self-identity of newly recruited nurses is at a medium level. Equal pay for equal work is one of the important guarantees to improve the professional self-identity of newly recruited nurses. Nursing managers should pay attention to the work pressure of new nurses with high academic qualifications and adopt targeted training programs to improve the professional identity of new nurses and ensure the stable development of the nursing team in my country.

Objective:To investigate the effect of exercise rehabilitation on frailty of elderly patients with coronary heart disease after percutaneous coronary intervention (PCI) .Methods:From January to December 2021, 80 elderly patients with coronary heart disease who received PCI in Qinhuai Medical Area of General Hospital of Eastern Theater Command were selected as the study subject by convenience sampling. A total of 39 patients from January to June 2021 were set in the control group, and 41 patients from July to December 2021 were set in the experimental group. The control group was given routine nursing, and the experimental group was given systematic exercise rehabilitation on the basis of the control group. The effects of intervention were evaluated by Tilburg Frailty Index (FI) , Cardiac Exercise Self-Efficacy Instrument (CESEI) , cardiac function, exercise tolerance, and 6-minute Walking Distance (6MWD) .Results:There was no significant difference in FI and CESEI scores between the two groups before intervention ( P>0.05) . After intervention, the FI score of patients in the experimental group was lower than that in the control group, and the CESEI score was higher than that in the control group, with statistically significant differences ( P<0.05) . There was no significant difference in cardiac function, exercise tolerance and 6MWD between the two groups before intervention ( P>0.05) . After intervention, there were statistically significant differences in cardiac function, exercise tolerance and 6MWD between the two groups ( P<0.05) . Conclusions:Exercise rehabilitation can effectively alleviate the frailty of elderly patients with coronary heart disease after PCI, improve their exercise compliance, cardiac function and exercise tolerance, which is worthy of clinical promotion.

Objective To analyze the epidemiological characteristics of hepatitis E virus, and to provide scientific reference for the development of prevention and control strategies for hepatitis E. Methods Descriptive analysis and clustering analysis were used for data analysis. Results From 2004 to 2019, 32,224 cases of hepatitis E were reported in Hubei Province, with an average annual incidence rate of 3.47/100,000, showing an overall upward trend. The incidence of hepatitis E was higher in winter and spring, with a peak occurring during January to May. The incidence of the male to female ratio was 2.5:1. The number of reported cases between 40-69 years old accounted for 68.25% of the total cases. Farmers, household chores, unemployed and retired personnel accounted for 72.68% of the total cases. Wuhan, Xiaogan, Jingmen, Yichang and Enshi were the top five cities for average annual incidence. Conclusion The incidence of hepatitis E in Hubei Province is generally on the rise, with obvious characteristics of time, population, and space distribution. It is necessary to strengthen education and monitoring of susceptible population to reduce the harm of hepatitis E to the health of the population.