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 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] 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: 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

Objective To explore the application of different linear evaluation methods for clinical chemistry measurement .Meth‐ods The analytical measurement ranges of clinical common items ,including alanine aminotransferase(ALT) ,creatine kinase(CK) , glucose(Glu) ,urea(Urea) and uric acid(UA) were established by using visual method ,modified Doumas method ,and according to′Guide to linearity evaluation of clinical chemistry analyzers′(health profession standard method) and Clinical and Laboratory Stand‐ards Institute(CLSI) EP6‐A document(EP6‐A method) .Results The visual method shown that the expected values and the meas‐ured values of these inspection items were probably in a straight line .The modified Doumas method shown that nonlinearity be‐tween expected values and measured values of CK was found ,but linearity was evaluated when discarding the last two points ;and the rest of inspection items all had linearity .The health profession standard method indicated that nonlinearities between expected values and measured values of CK and Urea were found ,but could not determine whether the nonlinearities of the two items were clinically acceptable ;and the rest of inspection items all had linearity .The EP6‐A method shown that linearities were directly found between expected values and measured values of ALT ,Glu and UA ,while CK and Urea had clinical acceptable linearities and linear‐ities were evaluated when discarding the maximum values .Conclusion The linearity evaluation is integrated with clinical objectives through EP6‐A document .Through setting methodology allowable deviation ,the EP6‐A method could expand the scope of accredi‐tion of linearity within the clinical acceptable range ,which has higher clinical practicability .

Objective To explore effect of small dose of diuretics combined with Dahuangzhechong pill on testosterone, Cystatin C(CysC), leptin and β2 microglobulin(β2-MG) in serum in patients with chronic renal failure.Methods 69 cases of kidney disease patients were collected and divided into two groups.Testosterone, Cystatin C, leptin and β2 microglobulin in serum were compared before and after the treatment.The control group was given hydrochlorothiazide tablets, treatment group was given Dahuangzhechong pill based on the control group.All patients were treated for 3 months. Results After treatment, levels of testosterone elevated (P <0.05), CysC, leptin and β2 microglobulin decreased (P <0.05) in the two groups compared with before treatment;Compared with the control group , level of testosterone was higher (P<0.05), levels of CysC ,leptin and β2-MG were lower (P<0.05).Conclusion Low dose diuretics combined with Dahuang Zhechong pill has good effect in treatment of chronic renal failure curative.The mechanism may be related to elevate serum testosterone levels and reduce serum CysC , leptin and β2-MG level in patients.

Objective To investigate the therapeutic effects of recombinant human interleukin-11 (rhIL-11) on the vaginal epithelium mitosis of estrone periodical mice and the exprssion of PCNA.Methods The vaginal epithelium mitosis of estrone periodical mice was used as the epidermis hyperplasia model, rhIL-11 action in regulating the epidermis hyperplasia was observed and the expression of PCNA was detected by immunohistochemistry.Results The rhIL-11 significantly inhibited the mitosis of mouse vaginal epithelium, decreased the expression of PCNA ( P <0.01).Conclusion The rhIL-11 has good efficacy in treating the epidermis hyperplasia of psoriasis by inhibiting the mitosis of epithelium and decreasing the expression of PCNA.

Sagittal spinal deformity is one of the common reasons of sagittal disequilibrium which can cause torso forward,cardiopulmonary dysfunction,fiat back syndrome,intractable low back pain and a series of cases,affecting the patients' life quality and increasing huge economic burden on society.The treatment of sagittal spinal deformity has been a hot spot in the field of clinical spinal surgery and its main purpose is to reconstruct the overall balance of the body,which would relieve pain and improve life quality.Pedicle subtraction osteotomy is considered to be one of the most effective and safe method for correcting spinal deformity with excellent reconstruction of sagittal plane balance.However,the calculation of the angle required during surgery is still a problem,because insufficient or excessive correction will lead to the secondary sagittal disequilibrium.Therefore,an accurate calculation of the angle required during pedicle subtraction osteotomy is particularly important.In recent years,scholars believe that the sagittal equilibrium depends on a fragile balance among spinal curvature,pelvic shape and position of the lower limbs.Scholars have developed a standard of sagittal equilibrium based on their own research,and proposed a variety of quantitative analysis methods to calculate the angle required during pedicle subtraction osteotomy:trigonometric method,exact angle calculation method,overall balance method,spine femoral angle measurement method,digital virtual method,graphic method,acoustic meati to hip axis method and hilus pulmonis to hip axis method,which provide important theoretical bases for the treatment of sagittal spinal deformity.