Acute myocarditis(AM)may rapidly progress to fulminant myocarditis(FM),but lacks special clinical presentation.Multimodal echocardiography combined conventional transthoracic echocardiography,two-dimensional and three-dimensional speckle tracking imaging,myocardial contrast echocardiography and so on is helpful to detecting AM in early stage and assessing the severity,being of great value for clinical decision-making and prognostic evaluation.The research progresses of multimodal echocardiography in AM were reviewed in this article.

Objective:To investigate the current situation and needs of pharmaceutical training for general practice faculty.Methods:A self-designed questionnaire survey was conducted in April 2019. The participants were general practice faculty attending the national training course in Zhongshan Hospital and selected by convenience sampling method.Results:A total of 219 general practice teachers participated in the survey, 51.14% (112/219) of the participants thought that the current pharmaceutical knowledge did not meet the needs of pharmaceutical services in daily work, and 67.58% (148/219) attended pharmacy related training every year, and the frequency was mainly 1—2 times per year (56.62%, 124/219). The main reasons for attending the training were working needs (68.24%, 101/148) and willingness (55.41%, 82/148); 63.51% (94/148) of the participants thought that the training was moderate or less effective, mainly because of the weak strength of trainers (40.54%, 60/148), insufficient attention paid by trainers (37.16%, 55/148) and lack of depth (37.16%, 55/148). The survey showed that 76.26% (167/219) of general practice teachers had pharmaceutical training needs; and gender, working years and working experience in secondary and/or tertiary hospitals were influencing factors for pharmaceutical training needs. And female faculty, those working less than 10 years and with working experience in secondary hospitals had higher demand for pharmaceutical training. The expected pharmaceutical training focused primarily on the selection and optimization of medication schemes (72.60%, 159/219), interaction/incompatibility between medicines (62.10%, 136/219) and pharmaceutical care in medical treatment (57.08%, 125/219). The expected training methods were mainly interactive case analysis and discussion (69.41%, 152/219) through the internet or APP (such as WeChat) (54.34%, 119/219); the expected training frequency was no more than once in two months (36.07%, 79/219), better in working time (48.86%, 107/219) and each session was 30—45 minutes (38.36%, 84/219).Conclusion:General practice faculty has a high demand for pharmaceutical training. Targeted, individualized and systematic pharmaceutical training courses should be developed according to the pharmaceutical training needs of participants.

Objective:To survey the teaching ability of general practitioners(GPs) in community health centers of Shanghai, and its influencing factors.Methods:A questionnaire survey on the teaching ability of general practice trainers was conducted from January to February 2017. The participants of the survey were GPs with teaching experiences from community health centers in Shanghai selected by a stratified and proportional cluster sampling method. The questionnaire included two aspects: the general information and teaching ability of the participants. The influencing factors of teaching ability were analyzed by univariate and multivariate regression analysis.Results:A total of 1 138 GPs from 116 selected community health centers participated in the questionnaire survey, among whom 63.6% (724/1 138) worked in community teaching bases and 78.5% (893/1 138) had received training for trainers. The total score of teaching ability was 38.00 (30.00, 40.00). The score of the item"interesting in teaching"was (3.46±0.80), 75%—80% of the other questions answered "yes". The score of"application of multi-teaching methods"was (3.78±0.72). Multivariate analyses showed that working for 5—9 and 10—19 years [ OR=7.14 (2.47—11.81), P=0.003; OR=5.32 (1.30—9.33), P=0.009], working in community teaching bases [ OR=13.23 (9.88—16.57), P<0.001] and receiving training for trainers [ OR=17.76 (13.80—21.71), P<0.001] were influencing factors of teaching ability. Conclusion:The main problems related to teaching ability in community GPs are lack of teaching interest and the poor application of multi-teaching methods, the relevant training is necessary for them in the future.

With the increasing prevalence of atrial fibrillation (AF), the incidence of its complications, such as ischemic stroke and thromboembolism is also increasing. According to the two-way referral system proposed by health authorities, AF management should be carried out mainly in primary care settings;and studies show that general practitioners play an indispensable role in AF management. At present,however,the inappropriate anticoagulation,AF complications and risk awareness are three major problems in the primary care of AF management in China. This article reviews the status quo and future prospect of AF management in primary care to provide suggestions for better management of AF in primary care level.

Objective:To explore the clinical efficiency evaluation and prognostic factors of aspiration guided by neuronavigation in the treatment of pediatric brain abscess (PBA).Methods:A total of 47 patients with PBA were treated with aspiration guided by neuronavigation between January 2013 and January 2019 at the First Affiliated Hospital of Zhengzhou University.All clinical data were retrospectively analyzed.According to Glasgow Outcome Scale on discharge, all children were divided into 2 groups, namely good prognosis group and poor prognosis group.Prognostic factors were analyzed by using univariate analysis and binary Logistic regression multivariate analysis. Results:Among the 47 children, 38 children (80.9%) were assigned to the good prognosis group, and 9 children (19.1%) were assigned to the poor prognosis group.Univariate analysis proved that abscess volume>4 cm( χ2=5.650, P=0.017), multiple or multilocular abscess ( χ2=3.258, P=0.027), and abscess located in functional areas ( χ2=6.187, P=0.013) were correlated with poor prognosis.Multivariate analysis revealed that abscess volume>4 cm( OR=5.913, 95% CI: 2.241-25.917, P=0.023) and abscess located in functional areas ( OR=10.519, 95% CI: 3.918-62.513, P<0.001) were independent risk factors for poor prognosis. Conclusion:The treatment of PBA with aspiration guided by neuronavigation is safe, effective and minimal invasive, and the clinical efficiency is satisfactory.Abscess volume>4 cm and abscess located in deepbrain/functional areas are independent risk factors for poor prognosis.

Objective:To explore the diagnosis, treatment and prognostic of pediatric intracranial atypical teratoid/rhabdoid tumor(AT/RT).Methods:A total of 15 pediatric patients with intracranial AT/RT were treated between January 2012 and June 2019 at the First Affiliated Hospital of Zhengzhou University.The clinical data were retrospectively analyzed.Overall survival (OS) rate and progression free survival (PFS) rate were calculated by adopting Kaplan- Meier method.The differences between the 2 groups were tested by performing Log- rank method, and the prognostic factors were analyzed by COX regression. Results:There were 12 males and 3 females, with the median age of 5.5 years (ranging from 8 months to 17.1 years). All patients underwent surgical resection.Gross-total resection (GTR) was achieved in 10 cases and subtotal resection (STR) was carried out in 5 patients.The conducted treatments were as follows: surgery+ radiotherapy+ chemotherapy+ intrathecal injection in 6 cases, surgery+ chemotherapy+ intrathecal injection in 4 cases, surgery+ radiotherapy in 2 cases, and surgery alone in 3 cases.Until January 2020, the median survival time of all the 15 patients was 18 months (ranged 1-27 months), and the survival rate was 33.3%.The 1-year OS rate and PFS rate for all 15 cases were 71.5% and 49.7%, respectively.The 2-year OS rate and PFS rate were 17.9% and 0, respectively. Log- rank analyses revealed that the 1-year OS rates of children less than 3 years old and those older than 3 years were 87.5% and 57.1%, respectively ( χ2=6.057, P=0.014). The 1-year OS rates of children with GTR and those with STR were 90.0% and 40.0%, respectively ( χ2=6.057, P=0.014). The 1-year OS rates of children with tumor dissemination and those without tumor dissemination were 100.0% and 33.3%, respectively( χ2=9.865, P=0.002). The 1-year OS rates of children in the standard-risk group and those in the high-risk group were 88.9% and 41.7%, respectively ( χ2=5.111, P=0.024). COX regression analyses proved that age, the extent of tumor resection, tumor dissemination and risk stratification are independent risk factors for prognosis [hazard radio( HR)=3.411, 3.795, 5.245, 3.397; P=0.025, 0.011, 0.001, 0.017]. Conclusions:Pediatric intracranial AT/RT is rare.The preliminary diagnosis and prognosis are difficult and poor, respectively.The complete resection of tumors with maximal safety remains the primary treatment.Age, the extent of tumor resection, tumor dissemination and risk stratification are independent prognostic factors for AT/RT children.

Objective:To explore the influencing factors and the weights for medical graduates to choose general practice and work in grassroots posts in China.Methods:On the basis of pre-investigation, the second interviews were conducted among medical students of grade two to established ahierarchical structure model. A survey was conducted with self-made questionnaire among 407 medical students of grade five from eight medical colleges selected by stratified random cluster sampling from January to June 2017. The influencing factors of choosing general practice choice as the future career were analyzed and the weights were calculated by analytic hierarchy process (AHP).Results:Total 395 valid questionnaires were received from 161 males and 234 females students. Under the general goal layer of influencing factors for medical graduates to choose general practice, the weights of the four first-level indicators were: career status and prospects for development (weight: 0.299), salary (weight: 0.294), family contribution (weight: 0.207) and professional interest (weight: 0.200). Among the secondary indicators of career status and prospects for development, job satisfaction had the highest weight (comprehensive weight: 0.073), followed by the work environment (comprehensive weight: 0.064), social status (comprehensive weight: 0.061), patterns of doctor-patient relationship in comprehensive care of general practice (comprehensive weight: 0.052), and work intensity had the lowest weight (comprehensive weight: 0.048). Among the five secondary indicators of professional interest, the weight of clinical practice was the highest(comprehensive weight: 0.066), followed by the guidance of theoretical teachers (comprehensive weight: 0.063). In the level 3 indicators in clinical practice, the attitude of general practice teachers to general practice had the higher weight than those teachers in other departments (the comprehensive weights were 0.037 and 0.030, respectively).Conclusion:Career status and development prospects and salary are the main influencing factors for medical students to choose general practice. Teachers′ guidance in clinical practice and theoretical study is the most critical factor for medical students to be interested in general practice.

Objective To survey the requirement of objective structured teaching evaluation (OSTE) use for general practice (GP) trainers and the station design.Methods A questionnaire survey on the requirement of OSTE use was conducted among 161 hospital trainers and 110 community trainers from a national key GP trainers training workship in April 2016.The survey included basic information,OSTE use requirements,frequency of clinical teaching scenarios,and frequency of teaching methods.Results The survey showed that 86.3％(234/271) of trainers were willing to use OSTE for assessing teaching competence and 92.3％ (250/271) for training teaching competence.The proportion of “having been observed and being given feedback from superior trainers for teaching process” was higher in hospital trainers than that in community trainers [68.3％(110/161)vs.40.9％(45/110),x2=20.060,P＜0.001].In the part of frequency of teaching scenarios,the proportion of “often” plus “always” was higher in “instructing students to write the medical records” [64.6％(175/271)],“teaching doctor-patient communication skills” [60.9％(165/271)] and “observing students' consultation and giving feedback” [57.9％(157/271)];there were no significant differences in above questions between the two types of trainers (all P＞0.01).In the part of frequency of teaching methodS,the proportion of “often”plus “always”was higher in “clinical supervisor's report” [60.9％ (165/271)],“applied knowledge test” [52.4％(142/271)] and “problem-based learning” [38.0％(103/271)];there were no significant differences in above questions between the two types of trainers (all P＞0.01).Conclusion The requirements of assessment and training by using OSTE are strong in GP trainers.The OSTE stations should be designed based on the routine teaching scenarios and methods for both hospital trainers and community trainers without discriminations.

Objective To survey the employment intention of medical students of five-year program in China.Methods A self-administered questionnaire survey on the employment intention was conducted among grade-5 medical students of 5-year program in 8 medical schools from January to June 2017,395 participants (161 males and 234 females) were selected by stratified random cluster sampling method.Results The survey showed that 57.65％ (226/392) respondents would return hometown after graduation as their first choice,20.66％ (81/392) preferred to work in large cities,only 0.76％ (3/292) chose the Western and rural areas;20.05％ (78/389) responders were willing to be a general practitioner working at the community health center,56.55％ (220/389) did not decide,while 23.40％ (91/389) did not want to be general practitioner.Students from rural areas vs.from urban areas (24.30％ vs.15.08％),whose parents with lower educational level vs.higher educational level (30.62％ vs.25.71％),from medical school in Western regions vs.in Eastern regions (28.65％ vs.11.68％) were more willing to choose general practice(P＜0.05).Students who had clerkship or rotation of general medicine vs.who had not more like the specialty of general practice (27.63％ vs.15.66％,P＜0.05),but there was no significant difference in the employment intention to be a general practitioner (19.93％ vs.20.45％,P＞0.05).Students who knew grassroots employment policies were more willing to be general practitioners (25.48％ vs.13.02％,P＜0.05).Conclusion The survey shows that the employment intention to be a general practitioner is stronger than before among medical students.But it is still need to take necessary measures to attract more medical graduates to work as general practitioners in grass-roots communities.

Objective To investigate the influencing factors and their weights of professional choice among medical school graduates in Shanghai.Methods Base on literature review and interviews with medicine students in a university of Shanghai,a questionnaire of"employment intention for general practice in medical graduates"was developed.A questionnaire survey on influencing factors of general practice among five year medical students was conducted in the medical college of a university in Shanghai during May to June 2016.The weights of each factor were calculated with analytic hierarchy process(AHP). Results The valid questionnaires were retrieved from 14 male and 26 female students.The results showed that 53.8%(21/40)preferred Beijing, Shanghai, Guangzhou and other economically developed cities as future working place,and 38.5%(15/40)chose to go home town; for general practice 22.5%(9/40) chose"very like",70%(28/40)chose"like"and 7.5%(3/40)chose"not like"; only 10%(4/40) were willing to be a general practitioner, 55.0%(22/40)were depended on the working conditions of community health center,and 35%(14/40)were not ready to be a GP.AHP analysis showed that the weights of influencing factors were: the salary(0.380 2), the doctor-patient relationship(0.262 3),professional interest and occupation development prospects(0.220 4),social status and family contribution (0.137 1).Weight analysis for the affecting factors on professional interest and occupation development showed that the guidance of mentors in theoretical study and clinical practice were the major factors (comprehensive weight was 0.067 3 and 0.062 1,respectively),and the attitude GPs to general practice in community learning was more important(comprehensive weight was 0.042 5 and 0.019 6).Conclusion The willingness to be a general practitioner is not strong in the medical school graduates in Shanghai.It is important to improve the status and working conditions of general practitioners, and to strengthen education and guidance of the general practice in theoretical study and clinical practice for medical students.