Clinical thinking of Clinicians in Dongyang People's Hospital is gradually shifting from ‘empirical medicine’ to ‘evidence-based medicine’ after popularizing of evidence-based medicine, training core members and implementing multi-layered, multi-channeled, comprehensive and sustainable resident doctor training mode with clear steps and purposes within three years. This paper discussed on reasonable clinical practice of evidence-based medicine in primary hospital and provided realistic basis for the further development and improvement of training of evidence-based medicine in primary hospital.

Education of evidence-based medicine in clinical research is important in enhancing primary hospital clinical research capacity and quality.Dongyang People's Hospital of Zhejiang Province has carried out evidence-based medicine education and training,and greatly improved the performance of clinical research and development of scientific researchers.

Objective To assess the efficacy and safety of intrapleural instillation of Yadanzi (Brucea Javan-ica)oil emulsion injection and cisplatin for malignant pleural effusion by literature searching and meta -analysis. Methods Databases were searched for random controlled trails (RCTs)including Pubmed,the Cochrane Library, CNKI,VIP,Wanfang Database and CBM.The quality of included RCTs was evaluated and the data were collected by 2 evaluators independently.Meta -analysis was performed using RevMan 5.2.Results 18 RCTs involving 1 322 par-ticipants was included.The results of meta -analysis indicated that intrapleural instillation of Yadanzi oil emulsion injection and cisplatin could improve the treatment efficiency of malignant pleural effusion (OR =3.82,95%CI 2.94 ~4.96,P <0.01)and improve the quality of life of patients(OR =4.07,95%CI 2.87 ~5.79,P <0.01),and reduce the gastrointestinal tract reaction (OR =0.55,95%CI 0.38 ~0.78,P <0.01)and white blood cell reduction occurs (OR =0.34,95%CI 0.25 ~0.46,P <0.01).Conclusion Intrapleural instillation of Yadanzi oil emulsion injection and cisplatin was effective and safe in the treatment of malignant pleural effusion,while the further studies should make efforts in improving research quality.

60 years of age) groups(10.4%),and in summer season(8.3%),when existing antibiotic-resistant pathogenic germs(90%),respectively. CONCLUSIONS The surgical site infection after abdomen operations is closely related to factors such as incision site,incision type;malignant or benign diseases;age,sex,and antibiotics-resistant pathogenic germs,etc.Effective measures should be taken accordingly to reduce the infection.

Objective To evaluate the hearing effects in hearing impaired children using FM system .Methods The FM listening evaluation for children questionnaire was used to evaluate 27 cases with sensorineural hearing loss who were fitted hearing aids or cochlear implants ,or using FM system .The auditory skills of the patients were evaluated in four kinds of listening environments :quiet ,noise ,auditory only and distance by this questionnaire . Each question required a subjective score based on the child's response .The higher the scores the better the results . The age range of the participants was 3 .48~5 .50 .On an average ,their experience of using hearing instruments was 2 .56 ± 0 .97 years .Results With local microphones only ,the total score was 67 .55% ;in quiet situation ,the score was 85 .33% ;in noise ,the score was 60 .54% ;with visual only ,the score was 69 .58% and in distance ,the score was 69 .5% .With frequency modulated + microphone ,the total score was 84 .35% ,in quiet situation ,the score was 94 .89% ,in noise ,the score was 81 .35% ,with visual only ,the score was 83 .56% ,and in distance ,and the score was 83 .29% .The score of the subjects with hearing instruments only in quiet was significant higher than those of in noise and long distance without eye clue situation(F=49 .53 ,P<0 .05) .The score of the subjects was significant improved after using FM system (P<0 .05) .The score of the subjects with hearing instruments and FM system in quiet was also significant higher than those of in noise ,long distance ,without eye clue situation(F=24 . 80 ,P<0 .05) .Conclusion FM system could improve the listening experience in hearing impaired children in a com‐plex environment .However ,processes and programs for preschool hearing impaired children should be further standardized and improved when fitting FM system ,as findings of variability in questionnaire performance .

Due to the insufficient education of medical ethics and tending to medical moral educa-tion, the residents lack the ability to make ethical decisions. Therefore, we applied Four Topics method in the clinical ethics training of residents. The clinical ethics training was divided into three stages, and each stage had different training content and objectives. Dongyang People's Hospital adopted the form of lectures and panel discussions. During the group discussion, the group leader was in charge of case preparation, which came from clinical practice, and then all members applied the Four Topics method to analyze and discuss the ethical conflicts, and make the ethical decision. Through this process, residents' ability to solve ethical problems in clinical practice was enhanced.

Objective:To evaluate skeletal,dentoalveolar and soft tissue profile changes by activator therapy in patients with different skeletal patterns of Class Ⅱ1 malocclusions.Methods:22 subjects(10 girls,12 boys,mean age 11.5 ±0.67 years) in the mixed or early permanent dentition,were included and divided into low angle(n =15) and average angle(n =7) groups on the basis of skeletal pattern.All patients were treated with a traditional activator.The skeletal,dentoalveolar and soft tissue profile changes were compared on lateral cephalograms before and after treatment.Statistical analysis was performed with t-test of SPSS 13.0 at a level of significance of P ＜ 0.05.Results:Activator treatment in these growing patients resulted in a correction of the skeletal Class Ⅱ relationship (decrease of ANB,Wits and NA-Pg),an advancement of the mandibular structures(increase of Co-Pg and L1-APg),and changes of the teeth(increase of L6-MP).The changes of Wits,NA-Pg and L1-APg value of low and average angle groups were 1.34° ± 1.82 ° and 3.50 ° ± 1.77°,(3.06 ± 2.00) mm and (5.80 ± 3.17) mm,(-1.16-± 1.74) mm and (-2.83 ± 1.48) mm respectively(P ＜0.05).No statistical significance was found in the soft tissue profile changes whether intra-class or inter-group comparison.Conclusion:The activator appliance is effective in treating growing patients with mandibular deficiency,and mandibular reconstruction,in patients with average angle it is more effective than in those with low angle.

Objective To study the calcium metabolism in tacrolimus(FK506)induced rats nephrotoxicity and the preventive effect of calcium channel blocker.Methods Twenty-four Spragueinduced or FK506-induced nephropathy model.Blood creatinine,blood electrolytes,renal tissue histopathology(HE stain)and the change of ultrastructural organization in renal cells by transmission electron microscope were observed.Results The blood creatinine levels of both CsA and FK506 groups [(36.00±2.61)and(34.17±4.54)μmol/L] were significantly higher than those of the FK506+Dilgroup and control group(all P＜0.05).The blood calcium levels of both CsA and FK506 groups (2.00±0.04 and 2.05±0.04 mmol/L) were significantly lower than those of the FK506+Dil group and control group(all P＜0.05).The blood creatinine and calcium levels of FK506+Dil group were not significantly different with those of control group(P＞O.05).Histopathology examination showed cloudy swelling and vacuolization of the renal tubular epithelial cells and intra-cellular mitochondria swelling and vacuolization in the CsA and FK506 groups.However,the pathological changes of the FK506+Dil group were remarkably milder in comparison with the CsA and FK506 groups.Concluum channel blocker,Dil,could prevent the FK506-induced nephrotoxicity.

Auto-inhibited Ca²⁺-ATPase (ACA) is one of the Ca²⁺-ATPase subfamilies that plays an important role in maintaining Ca²⁺ concentration balance in plant cells. To explore the function and gene expression pattern of the RcACA gene family in castor, bioinformatics analysis was used to identify the members of the RcACA gene family in castor. The basic physical and chemical properties, subcellular location, protein secondary and tertiary structure, conserved domain, conserved motif, gene structure, chromosome location and collinear relationship, as well as the evolutionary characteristics and promoter cis-acting elements were predicted and analyzed. The expression pattern of the RcACA gene under abiotic stress was analyzed by expression (fragments per kilobase of exon model per million mapped fragments, FPKM) in castor transcriptome data. The results showed that 8 RcACA gene family members were identified in castor, acidic proteins located in the plasma membrane. In the secondary structure of all proteins, the α-helix and random coil is more; the RcACA genes were clustered into three categories, and the design of the genes in the same category was similar to the conserved motif. Both of them had four typical domains, RcACA3-RcACA8 had a Ca²⁺-ATPase N-terminal autoinhibitory domain. The RcACA gene is mostly located on the long arm of the chromosome and has 2 pairs of collinear relationships. There are more light response elements but fewer hormone-induced elements located upstream of the RcACA coding region. Interspecific clustering showed that the evolution of ACA genes among species was conservative. Tissue expression pattern analysis showed that RcACA genes showed apparent tissue expression specificity, and most of the genes showed the highest expression level in male flowers. Expression analysis under abiotic stress showed that RcACA2-RcACA8 were up-regulated under high salt and drought stress, and RcACA1 was up-regulated at 0-24 h under low-temperature stress, indicating that RcACA genes positively responded to abiotic stresses. The above results provide a theoretical basis for exploring the role of the RcACA gene in castor growth, development and stress response.
Genome, Plant ; Stress, Physiological/genetics* ; Transcriptome ; Promoter Regions, Genetic ; Phylogeny ; Plant Proteins/metabolism* ; Gene Expression Regulation, Plant