Objective To evaluate the simulation of standardized patients (SP) in objective structured clinical examination (OSCE) for general practice residency training.Methods The simulation levels of 15 SPs were evaluated by 37 examiners with a rating scale of OSCE Examiner Feedback on SP performance from Melbourne University School of Medicine.The evaluation was conducted in history-taking and doctor-patient communication stations of OSCE for general practice residency training.Results The overall scores of SP performance were high and most examiners considered that the performance of SP was realistic and consistent.Among 9 items of rating scale,more than 90％ of the examiners considered that SP performance met or completely met the requirements of OSCE,except the item of preparation for clothing and making up before role playing.Six items of performance in history-taking station and 4 items in doctorpatient communication station reached 100％ satisfaction from the examiners.T test was used to compare the difference of SP performance between the morning and afternoon,and there was no significant difference (P ＞ 0.05).Conclusion The study showed for this group of SPs,the realistic degree and consistency of performance meet the requirements of OSCE,and its stability is not affected by long time continuous performance.

Objective To study the related risk factors of pulmonary embolism(PE) in diabetic patients.Methods 58 diabetic cases were underwent lower limbs 99mTc-MAA veins imaging(and/or ultrasonography) and pulmonary perfusion imaging.The related laboratory data [fasting blood glucose(FBG),blood cholesterol,blood long chain triglycerides(LCT)]and clinial informations [age,disease courses,chest symptoms(chest pain and short of breathe),lower limbs symptoms(swelling,crooted veins and diabetic foot) and acute complication(diabetic ketoacidosis and hyperosmolar non ketotic diabetic coma)]were collected simultaneously.SPSS was used for χ2-test and Logistic regression analysis.Results 28 patients(48.3%) were showed to be with lower limbs deep vein thrombosis (DVT) and by 99Tcm-MAA imaging,10 cases(17.2%) with PE.The PE ratio(32.1%) of the patients with DVT was more higher than no DVT(3.3%)(χ2 = 6.53,P＜0.05).Single factor analysis showed the PE ratios had significant difference to factors of chest symptoms,lower limbs symptoms and acute complication(all P＜0.05),respectively.There were no significant difference in other factors of age,disease courses,FBG,blood cholesterol,LCT,blood pressure,weight index,DM type(all P＞0.05),respectively.Multiplicity analysis indicated:the related risk factors of PE included chest symptoms(Score = 13.316,P＜0.01) and lower limbs symptoms(Score = 7.780,P＜0.01).There were no significant differences in other factors(all P＞0.05),respectively.Conclusion The serious DM with chest symptoms,lower limbs symptoms and/or DVT could be controlled as early as possible by all kinds of treatment.It would decrease the PE complication.

Objective To assess the awareness and knowledge about chronic obstructive pulmonary disease ( COPD ) among community general practitioners and general practice residency trainees in Shanghai.Methods Questionnaire was designed and used to investigate the knowledge of COPD among 59 general practitioners from 10 community health centres and 75 general practice trainees in Shanghai from July to September 2012.Results Of the 134 respondents, 49 were male and 85 were female with average age of (30.4 ±8.0) years.In the self-evaluation of “the knowledge about COPD”, “the diagnosis of COPD”,“the differential diagnosis of COPD and asthma”, “the interpretation of lung function report”, “aerosol using method”, “method about absorption apparatus”, “the side effects of bronchodilator”, “COPD rehabilitation” and “long term oxygen therapy, the rates of knowledge mastery were 61.9% ( 83/134 ) , 81.3%(108/133), 83.6% (112/134), 59.0% (79/134), 83.6% (93/134), 35.8% (48/134), 61.2%( 82/134 ) , 56.7% ( 76/134 ) and 61.2% ( 72/134 ) .Except interpretation of “lung function report”, the sores of all items in self-evaluation of the community general practitioners were higher than those of residency trainees ( all P<0.01 ) .Among the COPD related questions, the hightest accuracy rate was 93.3%(125/134) ( smoking cessation can attenuate the declined lung function) and the lowest accrurcy rate was 16.4% ( 22/134 ) ( the differential diagnosis of COPD and asthma ) .Compared with the general practice residents, community general practitioners got lower scores in question “how differentiate COPD from asthma” (6.8%vs.24.0%,χ2 =7.136, P=0.008) and got higher scores in question“the treatment of moderate COPD” (55.9%vs.30.7%,χ2 =8.655, P=0.003).More than half [56.7%(76/134)] of respondents thought that“it is necessary to develop COPD screening in community”, and 20.1%(27/134) thought that“absolutely necessary”.Conclusion The awareness and knowledge about COPD among the community general practitioners and general practice residency trainees are not satisfectory. The future training should focus on the risk factors, the differential diagnosis and treatment of COPD.

OBJECTIVE: To investigate the clinical features and therapeutic effects of sudden deafness after radiotherapy combined with chemotherapy in nasopharyngeal carcinoma patients. METHOD: Clinical data of 42 nasopharyngeal carcinoma patients suffered from sudden deafness after radiotherapy combined with chemotherapy were analyzed retrospectively. Among the 42 patients, 2 showed moderate deafness, 4 presented excessive deafness, 30 suffered from severe deafness, and 6 exhibited profound deafness. The audiogram pattern of 33 patients met with the type of high tone frequencies hearing loss, and that of the rest 9 cases showed hearing loss at all frequencies. All patients received medical therapy combined with hyperbaric oxygen therapy. RESULT: Of all the cases with hearing loss, 2 were cured, 2 showed excellent recovery, 9 came out partial recovery, and 29 showed no response to the treatment. The total effective rate was 30.95%. For the accompanied symptoms, none of the 30 cases of tinnitus were relieved, 3 out of 10 cases of aural fullness were cured, and the 5 cases of dizziness or vertigo were all improved. CONCLUSION The sudden deafness after radiotherapy combined with chemotherapy in patients with nasopharyngeal carcinoma is closely related to radiotherapy. The hearing loss is serious, and the therapeutic effects are not satisfactory.
Antineoplastic Agents ; adverse effects ; Carcinoma ; Dizziness ; etiology ; therapy ; Hearing Loss, High-Frequency ; etiology ; therapy ; Hearing Loss, Sudden ; etiology ; therapy ; Hearing Tests ; Humans ; Hyperbaric Oxygenation ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; drug therapy ; radiotherapy ; Radiotherapy ; adverse effects ; Retrospective Studies ; Tinnitus ; etiology ; therapy ; Vertigo ; etiology ; therapy

DNA damage repair gene mutations are prevalent in advanced prostate cancer. Among these, mutations in homologous recombination repair genes could impair the ability of cell to restore the DNA double-strand break, which can be exploited by Poly-ADP-ribose polymerase (PARP) inhibitors through synthetic lethality and result in cell death. The phase Ⅲ study " PROfound" showed that the PAPR inhibitor Olaparib could significantly improve the survival of patients with homologous recombination repair gene mutations compared with novel hormone agents, starting the era of targeted, precise and individualized treatment based on genetic profile detection for prostate cancer treatment.

Background and purpose:Prostate-speciifc membrane antigen (PSMA), a cell surface protein with high expression in prostate carcinoma (PC) cells, is an attractive target for PC imaging and therapy. Small-molecule radiopharmaceuticals targeting PSMA can detect the location and extent of disease with high sensitivity and speciifcity. The aim of this study was to evaluate the value of technetium-99m-labelled small molecule against PSMA (HYNIC-Glu-Urea-A,99mTc-PSMA) for the detection of primary and metastatic prostate cancers.Methods:Twenty-four prostate cancer patients and 1 patient with benign prostate hyperplasia received whole-body scan followed by abdominopelvic SPECT/CT 2 h after intravenous injection of99mTc-PSMA. Tumor to muscle uptake ratio of99mTc-PSMA was calcu-lated using region of interest (ROI) technology. The sensitivity and specificity of99mTc-PSMA were evaluated. The relationships between positive99mTc-PSMA and prostate speciifc antigen (PSA) level and Gleason Score were analyzed. Results:Based on per patient, the sensitivity and speciifcity of99mTc-PSMA were 72.7% (16/22) and 100% (3/3), re-spectively. The level of PSA in patients with positive99mTc-PSMA imaging was signiifcantly higher than that in patients with negative99mTc-PSMA imaging [(PSA median 17.31 ng/mL, range: 2.26-3 239.0 ng/mL)vs(PSA median 0.49 ng/mL, range: 0.07-9.28 ng/mL)] (Z=-3.51,P<0.001). Among newly diagnosed patients and recurrent patients with PSA more than 2.0 nm/mL, it was apparent that99mTc-PSMA imaging was able to detect lesions with improved sensitivity of 94.1% (16/17). Gleason Scores between positive99mTc-PSMA patients and negative99mTc-PSMA patients were not significantly different (Z=-0.69,P=0.52).Conclusion:With the combination of whole-body scan and tomography, 99mTc-PSMA SPECT/CT can be an excellent and speciifc molecular imaging strategy to detect prostate cancer and its metastases.

Objective To explore the nicotine dependence levels and the influencing factors of dependence among rural-to-urban migrant workers in Shanghai so as to provide scientific rationales for an effective implementation of tobacco control.Methods Multi-stage randomized sampling was used to select a total of 5 856 rural-to-urban migrant workers from 7 districts in Shanghai.Fagerstrom Test for Nicotine Dependence ( FTND) and logistic regression model were used to analyze the association between nicotine dependence and relevant risk factors.Results The current smoking prevalence was 23.7%.The average FTND score for current smokers , high dependence and low dependence were 3.38 ±2.49, 7.00 ±1.07 and 2.23 ±1.71 respectively.The high and low dependence rates were 21.7% and 78.3%.The results of logistic regression showed that education , duration of smoking and length of migration were associated with nicotine dependence.Lower level of education was more prone to high nicotine dependence.Those with a lower education had a higher risk of nicotine dependence ( junior high school: OR=1.742, primary school or lower: OR =1.994 vs.senior high school or higher ).High nicotine dependence increased with the duration of smoking (smoking 6-10 years:OR=3.007, 11-15 years:OR=4.076, 16-20 years:OR=5.451, 20 years or more:OR=5.726 vs.5 years or less).Length of migration over 3 years was less likely to have a high nicotine dependence (3-5 years: OR=0.602, more than 5 years: OR=0.407 vs.<1 year) .Conclusion The rate of high nicotine dependence is high among rural-to-urban migrant workers in Shanghai.Level of education , duration of smoking and length of migration are significant influencing factors of nicotine dependence.

Objective To survey the mental health status of rural-to-urban migrant workers in Shanghai.Methods The survey subjects were selected from migrant workers in Shanghai with a multi-stage stratified cluster sampling method.The Symptom Check List ( SCL-90 ) scores were used for evaluation of metal health status.Results The prevalence of mental health problem of 5 626 rural-to-urban migrant workers in Shanghai was 18.8% ( 1 058/5 626 ).The mean total score of SCL-90 was 114.86 ±31.21.Compulsive-obsessive, interpersonal sensitivity, hostility ranked the top three among 9 factors, with scores of 1.37 ±0.43, 1.31 ±0.43 and 1.30 ±0.41 respectively.The mean total scores and scores of 9 factors of rural-to-urban migrant workers in Shanghai were lower than those of Chinese adults norm the mean total scores(129.96 ±38.76) ( t =-15.34, -3.84 --24.08 respectively, all P <0.01) .There were significant differences in mental health among migrant workers with different age , education , marital status , living conditions and occupation (all P<0.05).Conclusion The prevalence of mental health problems in Shanghai rural-to-urban migrant workers is high, with are related to their age, education, marital status, living conditions and occupation.

Objective To investigate the supporting policies of assistant general practioner training program (3 + 2 mode) in Shanghai.Methods Total 53 subjects were involved in 15 in-depth interviews and 5 focus group discussions held from October 2012 to October 2013,including 8 graduates from the specialty of country doctor of Shanghai Institute of Health Sciences,12 country doctors,2 leaders of 3 + 2 mode training hospital,5 leaders of rural community health centers,3 leaders of Shanghai Institute of Health Sciences,9 leaders of Commission of Health and Family Planning in Shanghai suburbs,3 leaders of Shanghai Municipal Commission of Health and Family Planning,1 leader of National Health and Family Planning Commission.Results Three leaders of Shanghai Municipal Commission of Health and Family Planning admitted the training program involved multiple departments and there were no unified supporting policies,2 leaders of Commission of Health and Family Planning in Shanghai suburbs thought the enrollment amount should be appropriately controlled.The exploration of social person (non-formal employees)mode was encouraged by the leaders of Shanghai Municipal Commission of Health and Family Planning.Leaders of rural community health centers strongly recommended to increase the selection and withdrawal mechanism to ensure the quality of students and training.Three leaders of rural Commission of Health and Family suggested to enroll student from other provinces.Leaders of rural community health centers and Shanghai Municipal Commission of Health and Family Planning agreed that qualifying as assistant general practioner was an important target of training which should be obtained before graduation.All 3 + 2 mood trainees had a strong expectation to get a bachelor degree at the same time of completing the training.Leaders of Shanghai Municipal Commission of Health and Family Planning and 3 + 2 mode training hospitals proposed to pay attention to the construction of training base and teacher training.About one third of the 3 + 2 mood trainees,graduates from the specialty of country doctor of Shanghai Institute of Health Sciences and country doctors hoped to get more space for development.Leaders of rural community health centers and Shanghai Municipal Commission of Health and Family Planning considered that the qualification of assistant general practioner should be the minimal recruitment for recruitment of new medical personel.Leaders of Shanghai Institute of Health Sciences and 3 + 2 mode training hospital suggested the relevant departments to support the new country doctors in terms of income,promotion policies and so on.Conclusions The supporting policies of the pilot 3 + 2 training in Shanghai are imperfect.It can be improved from organization,management,training implementation and career development.Effective support policies can help to generalize the 3 + 2 training.

OBJECTIVE:To study the effects of Buyang huanwu decoction on the contents of CD40 and CD40L in the serum of rats with cerebral ischemia. METHODS:Rats were randomized into a sham-operation(normal saline)group,a model(normal saline)group,a positive control [6.75 mg/(kg·d)clopidogrel hydrogen sulfate] group and Buyang huanwu decoction high-dose and low-dose [26 and 6.5 g/(kg·d)] groups,with 20 rats in each group. Suture occlusion of middle cerebral artery was used to establish the rat models of focal cerebral ischemia,which were given drugs ig on the 2nd day after the operation and for 14 consecutive days. Then pathological changes in the cerebral tissues of all groups of rats were observed and the contents of CD40 and CD40L in the serum thereof were detected by euzyme-linked immunosorbent assay. RESULTS:The rats in the model group demonstrated isch-emia-like pathological change in the cerebral tissue on the side of lesion. The ischemia-like cerebral tissue on the side of lesion in the positive control group and Buyang huanwu decoction high-dose group were improved compared to the model group. The patho-logical change in the cerebral tissue on the side of lesion in Buyang huanwu decoction low-dose group was similar to that in the model group. The contents of CD40 and CD40L in the serum of rats in the model group were higher than in the sham-operation group. The content of CD40L in the serum of rats in positive control group and Buyang huanwu decoction high-dose group were lower than the model group. There were statistical differences(P<0.01 or P<0.05). Except as described above,no other statistical-ly significant differences (P>0.05) were noted. CONCLUSIONS:Buyang huanwu decoction can improve brain cell morphology and reduce cerebral ischemic tissue injury in model rat with cerebral ischemia by a mechanism which may be related to decreasing the content of CD40L.