Child, Preschool ; Diagnosis, Differential ; Humans ; Male ; Myositis Ossificans ; diagnosis ; diagnostic imaging ; pathology ; physiopathology ; Prognosis ; Tomography, X-Ray Computed

Asaprimarilyused plasticizerin polyvinyl chloride,d(i2-ethylhexy)lphthalate(DEHP)is extensively used in consumer products,flooring and wall coverings,food contact applications,and medical devices.Because DEHP has been detected in waters,soils and air,and its metabolites have also been detected in human urinary,sufficient evidences show that DEHP is ubiquitous in the environment worldwide.DEHP is already in the blacklist of priority pollutants in water in China.Many researches indicate that DEHP is one kind of endocrine disrupting chemicals in animals,with carcinogenicity,teratogenicity and mutagenicity.Based on the researches and review on DEHP,this paper principally discussed the environmental level,metabolism and biological markers of DEHP,as well as the research progress on human health effects.

Objective To survey the double-preceptor system in standardized residency training of general practitioners (GPs).Methods A questionnaire survey was conducted among 48 residents,53 clinical and community preceptors during May and June 2013.Results The preceptors mostly agree with the necessity to carry out double-preceptor system.82.8％ (24/29) clinical preceptors,95.8％ (23/24) community preceptors and 89.6％ (43/48) residents considered that it was very effective.Less than half of the clinical(13/29) and community (11/24) preceptors knew very clearly about their responsibilities and obligations ; 93.1％ (27/29) clinical preceptors and 95.8 ％ (23/24) community preceptors hoped to receive corresponding training courses.72.4％ (21/29) clinical preceptors and 75.0％ (18/24) community preceptors communicated with residents frequently,75.9％ (22/29) clinical preceptors thought residents were not actively involved was the main obstacle in the implementation of double-preceptor system.The guide contents were focused on clinical skills,scientific research and how to pass assessments.The main approaches were interviews,checking the quality of medical instruments and small lecture.Only 6.9％ (2/29) clinical preceptors conducted outpatient teaching,83.3％ (40/48)residents thought tutors did not knew clearly about their responsibilities and obligations was the main obstacle in the practice of doublepreceptor system.Regarding how to evaluate the double-preceptor system,clinical and community preceptors tended to use examination results and feedback of residents.Clinical preceptors,community preceptors and residents all gave low comments about the preceptor-resident contact handbook.87.5％ (21/24) community preceptors thought lack of corresponding incentive mechanisms was the main obstacle in the practice of double-preceptor system.Conclusions Double-preceptor system has been widely recognized by both preceptors and students.In order to improve the system,we should conduct tutor training courses regularly and establish an effective mechanism to assess and evaluate tutors.

Acute Disease ; Humans ; Male ; Middle Aged ; Occupational Diseases ; therapy ; Plasma Exchange ; Propane ; analogs & derivatives ; poisoning

Objective To study the effect of angiotensin Ⅱ and aldosterone (ALD) in patients with congenital heart disease by preoperative nursing interventions at high altitude area. Methods 86 patients with congenital heart disease were divided into the experimental group and the control group on average by random. The experimental group was treated with preoperative nursing interventions and routine nursing before operation and the control group was treated with routine nursing only. Angiotensin Ⅱ and aldosterone were detected before anesthesia, 30min after operation and after pulling out of endotracheal tube respectively. Results The concentration of Angiotensin Ⅱ and aldosterone was significantly lower in the experimental group than the control group. Conclusions The risk of open surgical operation for congenital heart disease at high altitude can be reduced by preoperative nursing interventions.

Objective To analyse the clinical and pathological characteristics,diagnosis,treatment and prognosis of vulvar Bowen's disease.Methods Clinical data including pathological characteristics,diagnosis,treatment methods and follow-up of 18 cases with vulvar Bowen's disease admitted to Cancer Hospital,Chinese Academy of Medical Sciences during January 1991 to June 2011 were retrospectively analyzed.Results The median age of the 18 patients was 37 years (range:23 to 64 years).Sixteen patients had symptoms of vulvar itching and two patients had no symptom.Five cases were single neoplasm focus and the other 13 cases were multiple focuses.The diagnosis of vulvar Bowen's disease was according to the pathological diagnosis.Its diagnostic characteristic was giant round or ovoid cells with mono nucleolus in the whole layer of epidermis.All the patients received operation,eleven with simple vulvectomy and other seven cases with lumpectomy.The median follow-up time was 123 months (range:5 to 197 months).Relapse was found in two cases.One patient relapsed five months postoperation and received vulvectomy.Another patient relapsed fifteen moths post-operation and received lumpectomy again.And they were follow-up for 192months and 55 months respectively after second operation without relapse.Conclusions The diagnostic characteristic of vulvar Bowen's disease is giant round or ovoid cell with mono nucleolus in the whole layer of epidermis,itsdiagnosis is according to the pathological diagnosis.Operation could get very good curative effect for patients with primary vulvar Bowen's disease and even for the recurrent patients.The prognosis of vulvar Bowen's disease is good.

Objective To assess roles of standardized patients (SPs) in training of communication skills for resident general practitioners (GP). Methods Fifty-two resident GPs were trained for communication skills in consultation with SPs during May to July, 2008, including information feedback from SPs, lectures and group discussion coordinated by instructors on problems developed during residents' clinical encounters. Communication skills of the trainees with patients was assessed before and after training, respectively, including building physician-patient relationship, collecting information and providing feedback, understanding complaints from patients' perspective, sharing information and obtaining informed consents and closing consultation. Assessment was scored and proportion of trainees qualified for consultation with SPs were estimated. Results Total score of the trainees was higher after training than that before it (76 ± 13 vs. 49 ± 12, P ＜ 0. 01 ), and 86. 5 percent of them qualified for their communication skills after training, as compared to that of 15.4 percent before it. Proportions of the trainees qualified for building physician-patient relationship, collecting information and providing feedback, understanding complaints from patients' perspective, sharing information and obtaining informed consents during consultation were higher after training than those before it (90. 4% vs. 59. 6%, 65.4% vs. 5.8%, 38.5% vs. 11.5%, 86. 5% vs.17.3% and 65. 4% vs. 3. 9%, respectively, all P ＜0. 01 ). Scores of physician-patient communication in the trainees correlated with those of their consultation skills both before and after training ( r = 0. 55 and r =0. 63, both P ＜ 0. 01 ). Increase in scores of physician-patient communication and consultation skills in trainees after training also associated with that in those of clinical skills ( r = 0. 62, P ＜ 0. 01 ). Conclusions Application of SPs can effectively enhance communication skill of resident general practitioners, thus improve their competencies in clinical consultation.

OBJECTIVE:To optimize the extraction technology of Compound qima capsules. METHODS:With the blood pres-sure lowering of rats as index,pharmacological efficacy test was used to screen the preparation technology(A was whole herb de-coction;B was Gastrodia elata fine powder mixed with other decocted medical materials). The extraction technology was opti-mized by single factor and orthogonal test using the contents of astragaloside and isoflavone grape glycosides and the quality of sol-id as indexes,with added water,decoction time,decoction times as factors;and the verification test was carried out. RESULTS:Pharmacological efficacy test showed that antihypertensive effect of sample by technology B was superior. The optimal extraction condition of other medical materials of technology B was as follows as 12-fold water per time,decocting for 1.5 h,for 3 times. In verification test,average extraction rates of astragaloside and isoflavone grape glycosides were 64.02% and 51.97%,and average value of the quality of solid was 5.69 g(RSD≤1.92%,n=3). CONCLUSIONS:The optimized extraction technology is stable and feasible.

BACKGROUND:Structural and functional changes of endothelial cels are the common pathological basis of cardiovascular disease. Severe structural and functional damage of endothelial cels are found in patients with hypertension or coronary heart diseases.
OBJECTIVE:To explore a new treatment method for hypertension from the perspective of vascular endothelial progenitor cels.
METHODS: PubMed and Wanfang databases were retrieved using the keywords “hypertension, EPCs” and approximately relevant 200 English and 100 Chinese literatures were obtained. Forty-nine eligible literatures were screened finaly.
RESULTS AND CONCLUSION:Endothelial progenitor cels have strong differentiation and proliferation capacities. This review may provide a new insight into potential sources of cels for diagnosis and treatment of hypertension.

OBJECTIVE:To improve the information system of Out-patient pharmacy intravenous admixture center (OUIVA) to improve the pharmaceutical service rendered to the transfusion patient and ensure the safety of drug use. METHODS:The defi-ciency in OUIVA information system of our hospital were analyzed,in which improvement was made with respect to ungrouped doctor’s orders,inconsistency between the total doses charged and the prescribed doses and the error of transfusion days that occurred fre-quently. The conformity rate of out-patient fluid transfusion prescriptions and the time of patients’waiting for transfusion before and after the improvement were compared and evaluated. RESULTS:Improvement was made to OUIVA information system through the optimization of transfusion process,the application of condition limit,the adding of logical operation and verification and the other measures. After improvement,the unconformity rate of out-patient prescriptions in our hospital descended from 11.24% in 2013 to 3.69% in 2014,with an obvious increase in the accuracy rate of dispensing for fluid transfusion;and the time of patients’waiting for transfusion was shortened from 30-40 min to 15-20 min,with an increase in the degree of satisfaction of transfusion patients. CONCLUSIONS:The OUIVA information system can reduce the errors of drug dispensing for fluid transfusion and improve pharmaceutical services.