ObjectiveTo investigate and analyze the doctor-patient communication skills of medical students and hereby to explore the efficient training system.MethodsUsing the questionnaires and statistic analysis,we focused on the doctor-patient communication skills of the observed 914 medical students in our college,their awareness of doctor-patient communication and the existing problems in the field.Results96.6％ of medical students realized the importance and necessity of doctor-patient communication,while 62.7％ of them lacked such kind of communication skills.Additionally,some other problems are exposed in medical history taking.ConclusionDoctor-patient communication skills might be the most important prerequisite for establishing harmonious relationship between doctors and patients,improving the quality of medical service and reducing the number of medical disputes.Consequentially,it's time to redesign relevant curriculum,to improve the old-fashioned training methods,to enhance the practice of doctor-patient communication training.Furthermore,improvements of teaching quality and a scientific evaluation system are also effective approaches to resolving the issue.

Objective To study the D gene polymorphism of Rh-negative blood group in Kunming resident population with PCR technology for gene typing,and to establish and perfect PCR detecting method for RhD gene.Method 46 samples of Rh-negative blood samples were collected and PCR amplification with exon-SSP had been done firstly.The samples of D gene part existing were screened,then PCR amplifying by intron-SSP had been conducted.The PCR amplification production with intron-SSP was used to DNA sequence.Results Among 46 Rh-negative samples,the number of D gene lost intacfly was 29;the complete existing one with all exons was 12.The sequencing results were that 2 samples of only containing D10 were RhD-CE(3-9)-D and the sample with only D4 and D6 was the newly discovered variant allele RhD-CE(2-3,5,7-9)-D.RhD ? was not found in our study.Conclusion(1)There is high frequency of RhD-CE(3-9)-D in Kunming area.(2)A new variant allele of RhD-CE(2-3,5,7-9)-D is first found in Kunming area.

To implement the excellent doctor education training plan and construct the training model of practical ability in clinical education,the researchers analyzed the problems existing in the training of clinical practice ability and put forward a new train of thought,and constructed a training method system of personal experience,reading classics,teacher guidance,simulation training,clinical practice and reflection strengthening.In addition,we also established a safeguard mechanism with the characteristics of the organizational corporation of teaching,the expert-oriented teaching team,team-oriented mentoring,pro-ject-oriented ability training,the diversification of evaluation system,the modernization of teaching platform and the realistic training environment,to train the qualified clinical medical talents.

Objective To investigate the immune protection of heparin-hinding hemagglutinin ad-hesin(HBHA) and to estimate its potential diagnostic value. Methods Native HBHA were used to stimu-late peripheral blood mononuelear cells (PBMCs) from different infected-cases including PPD negative healthy control, PPD positive latent tuberculosis(LTB) infection, pulmonary tuberculosis, and the IFN-γ/in the supernatant of culture was detected. Meanwhile, HBHA specific IgG antibody in the sera was detected by ELISA. Results The middle level of HBHA specific IFN-γ of the three groups were 49.5 pg/ml, 781.9 pg/ml and 341.8 pg/ml, respectively. IFN-γ of latent tuberculosis group was much higher than that of the control, and slightly higher than that of the patients with pulmonary tuberculosis. And the absorbency of the IgG antibody to HBHA in the three groups was 0.212±0.066, 0.224 ± 0.076 and 0.285±0.078. lgG an-tibody in the patients with pulmonary tuberculosis is higher than that of the healthy, including the control and the latent tuberculosis infection. Conclusion HBHA has good immunogenieity, and it can stimulate the LTB to release high level IFN-γ, suggests that the LTB doesn't develop active tuberculosis may rely on its protection. HBHA specific. IFN-γ release may identify 1,333 from the healthy. Anti-HBHA antibody plays an auxiliary role in the diagnosis of pulmonary tuberculosis.

Objective To obtain highly expressing cell lines by inserting the glutamine synthetase (GS) screening system and replacing the promoter of the vector.Methods The mutation of the point BamHⅠwas induced to build a new vector pIRES2-EGFP.The marker gene GS was inserted by AseⅠ and NheⅠ, and the promoter hCMV was replaced by PacⅠand NheⅠ.The new vector pHGS1.0 and the vector pIRES2-enhanced screen fluorescein protein( EGFP)-B were inserted by the recombinant protein TEM8 ( 1-227 )-VEGFR1 domain2-IgG2 ( TV-IgG2 ) gene to analyze the advantages of the expression.Results The glutamine synsthetase is successfully inserted, the human cytomegalovirus replaced, and recombinant protein is increased 5-fold by human immunoglobulin quantification kit.Conclusion The GS system is a highly protein expressing system.

Objective To identify and assess whether circumferential electrocautery is useful to improve outcomes after primary total knee replacement.Methods We searched MEDLINE,EMBASE,PubMed,SpringerLink,Web of Knowledge,OVID CINAHL,OVID EBM and Google Scholar,and included articles published through January 2014.This study used the methods of meta-analysis to assess whether circumferential electrocautery could improve anterior knee pain and knee function after total knee replacement,and identified the function of circumferential electrocautery in total knee replacement.Results A total of eight articles met the inclusion criteria.Among the 1 048 cases included in the analysis,526 cases had patellar denervation,and 522 cases were in the control group.The meta-analysis revealed no significant difference in the incidence of anterior knee pain (P =0.18) and visual analogue scale (VAS) (P =0.23) between two groups.However,patellar score (P =0.01),Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score (P ＜ 0.01),and range of motion (ROM) (P ＜ 0.01) indicated that circumpatellar electrocautery improved clinical outcomes compared to non-electrocautery groups.Conclusions The results indicated that circumferential electrocautery of the patellar did not significantly improve anterior knee pain relative to non-electrocautery techniques.However,circumferential electrocautery significantly improved patients' knee function after surgery.Therefore,circumferential electrocautery might be beneficial to the outcome of primary total knee replacement surgery without patella replacement.

Objective To evaluate the diagnostic value of CEA, CA19-9, CA72-4, AFP, and CA125 in gastric stromal tumors. Methods 41 patients with gastric stromal tumors and 11 patients with gastric leiomyoma were recruited in this study from Qilu Hospital of Shandong University during May 2014 to December 2017. The tissue was collected by surgery, and HE staining was done. Immunohistochemistry was employed to detect the expression of CD34, CD117, and DOG-1. Serum of all cases and 41 healthy volunteers in the same hospital were collected. The levels of CEA, CA19-9, CA72-4, AFP and CA125 were examined by electrochemiluminescence assay, and the differences in each group were compared by M-W test or K-W test. Then the relationship between those biomarkers and the clinical parameters of gastric stromal tumors was analyzed. Moreover, AUC (Area Under the curve), cut-off value, sensitivity, specificity, positive predictive value, negative predictive value with drawing ROC curve (receiver operating characteristic curve) were also calculated. Results Spindle cells or epithelioid cells were observed in the tissue of gastric stromal tumors. The expression of CD34, CD117, DOG-1 were positive. The level of the serum CEA 1.53 (1.15, 2.22) ng/ml in patients with gastric stromal tumor patients was higher than that in healthy controls 1.06 (0.62, 1.48) ng/ml and that in patients with gastric leiomyoma 0.79 (0.39, 1.39) ng/ml (the U value was 446.5, and 113.0 respectively, P<0.05). The level of CA19-9 in gastric stromal tumors 9.30 (4.95, 12.70) U/ml was higher than that in healthy controls 6.62 (4.56, 8.82) U/ml (the U value was 615.5, P<0.05). There were no significant differences in AFP, CA125, and CA72-4 of three groups (the H value was 4.348, 1.073, and 3.897, P>0.05). Furthermore, the level of CEA was closely related to TNM stage (the U value was 129.0, P<0.05). The diagnostic value of CEA and CA19-9 was statistically not significant (P>0.05). However, the combination of two markers might increase diagnostic efficiency. The sensitivity, specificity, positive predictive value, negative predictive value and AUC was 92.7％, 48.8％, 64.4％, 87.0％ and 0.752 respectively. Conclusion The combination of CEA and CA19-9 has better sensitivity and negative predictive value in auxiliary diagnosis of gastric stromal tumors.

Objective To investigate the expression level and clinical significance of hsa_circ_0005075 in serum extracellular vesicles(EVs)of patients with recurrent spontaneous abortion(RSA).Methods Fourteen RSA patients and 14 normal pregnant women from the Department of Obstetrics and Gynecology,Qilu Hospital of Shandong University were enrolled in a training set,and 64 RSA pa-tients and 48 normal pregnant women were enrolled in a validation set.The expression levels of hsa_circ_0005075 in serum EVs were detected by the quantitative real-time PCR(qRT-PCR),and their correlation with clinical pathological parameters of RSA patients were analyzed.Serum anti-thyroid globulin antibody(A-TG)and anti-thyroid peroxidase antibody(A-TPO)were detected by the elec-trochemiluminescence assay.Serum anticardiolipin(ACA)IgA,IgG,and IgM antibodies and anti-β2 glycoprotein 1(β2GP1)IgA,IgG,and IgM antibodies were determined by the chemiluminescence immunoassay.The correlation of these autoantibodies with the lev-els of hsa_circ_0005075 in serum EVs was analyzed by the Pearson correlation.The clinical application value of hsa_circ_0005075 in the diagnosis of RSA was evaluated by the receiver operating characteristic(ROC)curve.Results The detection results of the training set showed that the expression levels of hsa_circ_0005075 in serum EVs of RSA patients(7.69[4.74,42.15])were significantly high-er than that in normal pregnant women(1.02[0.51,4.23],U=28,P＜0.01].Similarly,in the validation set,the expression levels of hsa_circ_0005075 in RSA patients(4.96[1.73,8.89])were also significantly higher than that in normal pregnant women(1.00[0.24,2.96],U=693,P＜0.01).The ROC curve showed that hsa_circ_0005075 in serum EVs had good diagnostic value for RSA(AUCROC=0.774),with 70.3%of sensitivity and75.0%of specificity.In addition,the expression level of hsa_circ_0005075 in serum EVs was significantly correlated with A-TPO(r=0.298,P＜0.05).Conclusion The hsa_circ_0005075 in serum EVs is highly ex-pressed in RSA patients,which may have a potential differential diagnostic value for the diagnosis of RSA.

Multi-disciplinary team(MDT)mode is regarded as the key to standardized diagnosis and treatment of malignant tumors. The model, however, encounters such roadblocks in the current form of MDT organization, as costly clinical resources and time consumption, low efficiency, poor management of participating experts in MDT, and lack of enforceability of the therapeutic decisions made. This paper summarized the practical MDT experiences of the Affiliated Cancer Hospital of Shandong First Medical University. It introduced the construction of an intranet-based MDT system covering a large proportion of newly diagnosed malignant tumor patients, and the practices and achievements of such MDT management system under hospital administrative guidance. The authors proposed to use reporting ratio as the main assessment indicator in promoting MDT, and that to define the performance, responsibilities and rights in MDT practice. These measures aim at to upgrading individual behaviors of doctors to organizational behaviors of hospitals, and providing cancer patients with more standardized, comprehensive and personalized diagnosis and treatment decisions.