ObjectiveTo investigate the intestinal absorption characteristics of multi-index components in Danggui Buxuetang with drug absorption simulating system （DASS） established by everted intestinal sac model. MethodThe intestinal absorption solution at different time points after administration of Danggui Buxuetang was collected and detected by high performance liquid chromatography （HPLC）， acetonitrile （A）-0.2% glacial acetic acid solution （B） was used as the mobile phase for gradient elution （0-16 min， 15%-23%A； 16-20 min， 23%-28%A； 20-25 min， 28%-30%A； 25-30 min， 30%A； 30-35 min， 30%-65%A； 35-45 min， 65%-95%A）， the detection wavelength was 302 nm. HPLC fingerprint of intestinal absorption solution was established and the common peak was calibrated， and the relative cumulative absorption rate of each index component was calculated. The relative cumulative absorption curves of components were fitted with various mathematical models by DDSolver 1.0 to explore the absorption law of different components. ResultThe absorption process of C2 （calycosin-7-glucoside） and C6 in Danggui Buxuetang was in line with zero-order equation， C9 was best fitted by Weibull equation， and the remaining 7 components were in line with Makoid-Banakar equation. C1 with C2， C3， C5， C7 and C10， C2 with C5 and C7， C3 with C4， C5， C7 and C10， C4 with C6 and C10， C5 with C7， C6 with C10， C7 with C10， C8 with C9 were absorbed simultaneously during the absorption process. With the prolongation of time， the overall cumulative absorption rate of Danggui Buxuetang increased. At 120 min， the overall cumulative absorption rate of Danggui Buxuetang exceeded 38%， and reached 49.14% at 180 min. ConclusionTen ingredients in Danggui Buxuetang are absorbed in the jejunum， but absorption law of various components is different， which shows that the intestinal absorption of compound preparations of traditional Chinese medicine （TCM） has multiple characteristics. Intestinal absorption study of TCM compound preparations with chemical composition as the index can reveal some of its absorption law， but it is not complete.

Objective:To investigate the effects of early hyperbaric oxygen combined with piracetam on hepatic and renal function and myocardial enzyme spectrum in patients with acute carbon monoxide poisoning (ACOP).Methods:A total of 103 patients with ACOP treated in the Emergency Department of Affiliated Hospital of Jining Medical University from January 2015 to January 2019 were selected and divided into control group (53 cases, hyperbaric oxygen treatment) and observation group (50 cases, hyperbaric oxygen combined with piracetam treatment). The changes in the renal function, myocardial enzyme spectrum, superoxide dismutase (SOD), and the hepatic function, as well as the clinical efficacy, and the incidences of adverse reactions were compared between the two groups.Results:The total effective rate of the observation group (98.00%) was significantly higher than that of the control group (79.25%), and there was a statistically significant difference ( P<0.05). After treatment, the levels of blood urea nitrogen (BUN), creatinine (Cr), uric acid, β2 microglobulin (β2-MG), creatine kinase (CK), creatine kinase isoenzyme (CK-MB), α-hydroxybutyrate dehydrogenase (α-HBDH), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) in the observation group were lower than those in the control group, while the level of SOD in the observation group was higher than that in the control group, and there were statistically significant differences ( P<0.05). In terms of the incidences of delayed encephalopathy, acute cerebral infarction, rhabdomyolysis, and pressure ulcer, there was no statistically significant difference between the two groups ( P>0.05). Conclusion:The early hyperbaric oxygen combined with piracetam has a significant clinical efficacy in treating patients with ACOP. It can alleviate the myocardial damage caused by hypoxia, and plays a positive role in protecting hepatic and renal function.

Objective:To investigate the effects of early hyperbaric oxygen combined with piracetam on hepatic and renal function and myocardial enzyme spectrum in patients with acute carbon monoxide poisoning (ACOP).Methods:A total of 103 patients with ACOP treated in the Emergency Department of Affiliated Hospital of Jining Medical University from January 2015 to January 2019 were selected and divided into control group (53 cases, hyperbaric oxygen treatment) and observation group (50 cases, hyperbaric oxygen combined with piracetam treatment). The changes in the renal function, myocardial enzyme spectrum, superoxide dismutase (SOD), and the hepatic function, as well as the clinical efficacy, and the incidences of adverse reactions were compared between the two groups.Results:The total effective rate of the observation group (98.00%) was significantly higher than that of the control group (79.25%), and there was a statistically significant difference ( P<0.05). After treatment, the levels of blood urea nitrogen (BUN), creatinine (Cr), uric acid, β2 microglobulin (β2-MG), creatine kinase (CK), creatine kinase isoenzyme (CK-MB), α-hydroxybutyrate dehydrogenase (α-HBDH), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) in the observation group were lower than those in the control group, while the level of SOD in the observation group was higher than that in the control group, and there were statistically significant differences ( P<0.05). In terms of the incidences of delayed encephalopathy, acute cerebral infarction, rhabdomyolysis, and pressure ulcer, there was no statistically significant difference between the two groups ( P>0.05). Conclusion:The early hyperbaric oxygen combined with piracetam has a significant clinical efficacy in treating patients with ACOP. It can alleviate the myocardial damage caused by hypoxia, and plays a positive role in protecting hepatic and renal function.

To investigate the status of application of Chinese Hypertension Prevention and Treatment Guideline (Guideline) by general practitioners (GPs) in Shanghai.A questionnaire survey was conducted among 260 GPs from 8 communities in Xuhui District of Shanghai during March 2011 to December 2012.Among all participants,94.2％ knew the Guideline.The overall correct rate was 56.2％; that of epidemiology,diagnosis,treatment,two-way referral and community management of hypertension was 49.2％,54.5％,60.6％,56.9％ and 32.3％,respectively.There were significant differences in correct rates of the questionnaire between GPs with different age,gender,education and community (P =0.000,0.035,0.000,0.000).The correct rates of epidemiology and treatment in GP teaching bases (58.5％ and 62.6％) were higher than those in non-teaching bases (39.2％ and 58.4％) (P =0.002,0.040).But there was no difference in overall correct rate between these two groups (P =0.095).The results indicate that the understanding and application of Hypertension Guideline by General practitioners in community is insufficient.Teaching hospitals should carry out systematic,comprehensive,sustained,targeted training course in order to improve the diagnosis and treatment levels of hypertension for general practitioners in community.

Objective To assess the continuing medical education (CME) and training needs for gereral practitioners (GPs) in urban and suburb of Shanghai.Methods Gereral practitioners in urban (n =710) and suburb (n =843) of Shanghai attending two municipal training programs were interviewed with self-designed questionnaire during July 2011 to May 2012.Results Urban group included 710 GPs whose mean age were (36.7 ± 6.8) y and 33.0％ were male.Suburban group had 843 GPs whose mean age were (36.6 ± 5.1) y and 33.2％ were male.The survey showed that 84.6％ of urban group and 85.6％ of suburban group had attended CME before.There was no statistical difference in the overall satisfaction of CME between two groups (Z =-0.895,P =0.371).The propotion of satisfied and very satisfied was 45.1％ and 13.8％ in urban groupt,while it was 49.5％ and 9.1％ in suburb group.The overall satisfaction rates of enhancing basic theories (Z =-2.296,P =0.022) and skills (Z =-2.013,P =0.044) and CME textbooks (Z =-2.819,P =0.005) were higher in suburban group than those in urban group.Both of them agreed that the contents of CME were divorced from reality of practice (60.3％ vs.65.2％,x2 =3.213,P =0.082).The percentages of complain of insufficient training time (19.7％ vs.11.0％,x2 =18.045,P ＜ 0.05) and contents (7.5％ vs.4.3％,x2 =5.747,P =0.019),and weak leadership commitment (14.3％ vs.6.5％,x2 =19.95,P ＜ 0.05) were higher in suburban group than those in urban group.On the contrary,the delivery of repeated contents (24.8％ vs.34.8％,x2 =15.327,P ＜0.05) and long training time (16.4％ vs.28.2％,x2 =26.055,P ＜ 0.05) were lower in suburban group than those in urban group.Using case study in the teaching was the common choice of both groups (73.3％ vs.78.0％,x2 =0.635,P =0.426).Compared to urban group,suburban group was more likely to choose lecture of theory (63.6％ vs.50.8％,x2 =6.712,P =0.010) rather than problem based learning (43.1％ vs.51.9％,x2 =4.273,P=0.010).Conclusions Both urban and suburban GPs in Shanghai are generally satisfied with the CME programs.There are some discrepancies in training needs of CME between urban and suburben area in Shanghai,indicating that the CMB programs need to be designed according to the needs of trainees in urban or suburb areas.

Objective To investigate the training needs of general practioners (GPs) in Shanghai and to analyze the related factors.Methods A questionnaire survery on the training needs was conducted among 428 GPs who attended a municipal training program of clinical compentance in Shanghai during July 2011 to February 2012.Results Among 428 GPs receiving the survey,23.9％ (102/427) expressed great willingness for training; 40.2％ ( 169/421 ) preferred part-time and 41.3％ ( 174/421 ) preferred on-job training; 31.7％ (377/1188) wished to have case analysis method of teaching.In the aspect of training contents,common clinical skills were ranked the first,accounting for 32.1％ (1376/4280) of the choices,on the other hand,health care for women,children and the elderly in community was ranked the last,accounting for 18.9％ (485/2568) of the choices.Logistic regression showed that the gender (OR =2.194,P=0.010),age (OR=0.435,P=0.011) and education levels of GPs (OR=0.293,P=0.006) were related factors of training needs.Conclusion The survay reveals that training needs of GPs are strong in Shanghai and GPs prefer short-term training in real clinical situations.

Objective To survey on the knowledge,attitude and practice about hypertention in elderly patients and its relation to blood pressure control.Methods A sampling survey on the knowledge,atitude and practice about hypertention were carried out in a target population of 47 572 elderly hypertensive patients from 5 communities in Xuhui District of Shanghai during May 2011 to July 2011.Total 3800 questionairres were distributed and 3328 responded with a response rate of 87.5％.Results Among 3328 responders,3036 were aged above 65 years with a mean age of (76 ±7) years and 43.3％ were males.The rates of knowledge about hypertension were 88.5％-97.8％.General practitioners in out-patient service were the major source of knowledge.Raults revealed that 81.9％ had received health education before;81.8％ requied a regular health education; 67.2％ had self-tested blood pressure weekly; 89.6％ controlled salt intake; 66.8％ attended outdoor activities weekly with (5.6 ±2.1) times a week and (45 ±28) min each time.The blood pressure control rate in uncomplicated hypertensive patients was higher than those complicated with diabetes,coronary heart disease or stroke (62.3 ％ vs.17.0％,P ＜ 0.01).Knowing high blood pressure was related to salt intake (OR =3.364,P ＜ 0.01),hoping a regular health education about hypertension (OR =1.718,P ＜ 0.01) were factors contributing to blood pressure control in uncomplicated hypertensive patients; while self-testing blood pressure once or twice a month(OR =2.572,P ＜ 0.01)was contributing factor to blood pressure control in complicated hypertensive patients.Conclusions Elderly hypertensive patients from communities in Shanghai have enough knowledge,positive attitude but lack practices.General practitioners should carry out personalized and stronger health education focued on behavioral changes for those patients.

Objective To study needs of training of trainers(ToT)in mini-clinical evaluation exercise(mini-CEX)and its effectiveness.Methods One hundred and fourteen doctors involved in TOT for mini-CEX were interviewed with questionnaire before and after training for their satisfaction of training and fifty of them scored the training videos.Results Before the training.39%(44/114)of doctors involved in TOT knew mini-CEX and 97%(111/114)of them hoped to know how to carry out mini-CEX thronsh training.When the training finished,30%(34/114)tO 55%(63/114)of them could completely understand seven items of examinations of mini-CEX.Fifty doctors involved in TOT scored the training videos after the training.There was signifieant difference in scores between TOT and standard scoring on training video 1 for teaching of coronary heart disease and video 2 for teaching of hematochezia(P<0.05).No significant difference Was found in scores between TOT and standard scoring on the video 3 for teaching of abdomihal pain(P>0.05).as well as those between TOT with five or less years experience and those with more than five years experience(P>0.05).Conclusions Currently,doctors involved in TOT have more demands on mini-CEX.However,effectiveness of short-course training for mini-CEX is not satisfactory,and pattern of its training should be improved further.

Objective To explore the outcomes of computer-assisted design of therapeutic personalized footwear for diabetic foot.Methods Fifty-eight cases of diabetic foot were included in the study.Ten items of data from theses patients were measured with methods provided by Salford University.All characteristics of the footwear were calculated with computer.Shoes were specially designed with the formula and computational method provided by Safford university.All patients had worn the shoes for 13 months.Special questionnaires were used to measure the outcomes.Results Thirty-two cases had been followed up for one month,25 cases for 2 months,25 cases for 3 months and 42 cases for 13 months.The score had improved from 67.94±15.14 before wearing the shoes to 78.13±1.44 thirteen months after wearing.The health score of the foot had improved.There was significant difference between before and after wearing the footwears.Conclusion Special-designed diabetic shoes play an important role in the prevention of ulcer for diabetic foot patients.Computational method and data model obtained from Salford university needs to be modified when applying it for Chinese.

Objective To investigate the result of arthroscopic surgery in the treatment of sinus tarsi syndrome. Methods The study involved 15 patients (6 males and 9 females) with sinus tarsi syndrome admitted to First Hospital of Nanjing from July 2006 to May 2008. The age of the patients ranged from 23 to 63 years ( average 46.3 years). All the patients had one side involvement, including 10 patients with left side involvement and five with right side involvement. All the operations were performed under the tourniquet control and the patients were placed at the lateral decubitus position. The lateral, anterolateral and posterolateral portals were applied intraoperatively and the medial portal was applied when necessary. Visual analogue scale (VAS) and American orthopedic foot and ankle scale (AOFAS) ankle-hindfoot scale were used for follow-up evaluation. Results More than two lesions were found under arthroscope in all patients. The lesions included scar tissue hypertrophy and inflammation in the sinus tarsal canal, soft tissue impingement in the subtalar joint, synovitis, partial tears of subtalar capsule, interosseous talocalcaneal ligament or cervical ligament, cartilage injury and subtalar degeneration. All patients were followed up for 19-35 months (mean 26. 1 months). At the final follow-up, the VAS score was improved from preoperative 7.6 points ( range 6-9 points) to postoperative 2.5 points (range 1-4 points) (P＜0.01 ), and the AOFAS score improved from preoperative 41. 9 points (range 20-67 points) to postoperative 83. 1 points ( range 70-100 points) ( P ＜ 0. 01 ). The excellence rate of the AOFAS score reached 73% at the final follow-up. Conclusion For patients with sinus tarsi syndrome after a failed conservative treatment, arthroscopic surgery should be performed as soon as possible and the clinical result is satisfactory.