Standardized specialist training for developmental and behavioral pediatrics in China and the United States: current status and thoughts / 中华医学教育探索杂志

The United States has established a perfect specialist training system for developmental and behavioral pediatrics (DBP), while the DBP specialist training system in China is still in the early stage of development and has been constantly improved. This article analyzes and compares the current status of DBP specialist training system between the United States and China from the aspects of training pattern, eligibility criteria, training plans and contents, assessment and evaluation, and certification. With reference to the training system in the United States, we can further improve the DBP specialist training system in China by perfecting the training system and related documents, constructing reasonable eligibility criteria, establishing a training pattern guided by post competency, improving the DBP assessment and evaluation system based on competency, and enhancing the certification of DBP physicians.

Phage antibody library technology in tumor therapy: a review / 生物工程学报

Tumor is a serious threat to human health. At present, surgical resection, chemoradiotherapy, targeted therapy and immunotherapy are the main therapeutic strategies. Monoclonal antibody has gradually become an indispensable drug type in the clinical treatment of cancer due to its high efficiency and low toxicity. Phage antibody library technology (PALT) is a novel monoclonal antibody preparation technique. The recombinant immunoglobulin variable region of heavy chain (VH)/variable region of light chain (VL) gene is integrated into the phage vector, and the antibody is expressed on the phage surface in the form of fusion protein to obtain a diverse antibody library. Through the process of adsorption-elution-amplification, the antibody library can be screened to obtain the antibody molecule with specific binding antigen as well as its gene sequence. PALT has the advantages of short antibody production cycle, strong plasticity of antibody structure, large antibody yield, high diversity and direct production of humanized antibodies. It has been used in screening tumor markers and preparation of antibody drugs for breast cancer, gastric cancer, lung cancer and liver cancer. This article reviews the recent progress and the application of PALT in tumor therapy.

Effect of body mass fluctuation on the prognosis of atrial fibrillation / 中国综合临床

Objective To investigate the effect of body mass fluctuation on the prognosis of patients with atrial fibrillation.Methods The patients diagnosed with atrial fibrillation in the People′s Hospital of Xinjiang Uygur Autonomous Region from 2012 to 2014 were selected.Among the 540 patients,the patients were divided into normal body( BMI ≤ 25 kg／m2 ),overweight (25 kg／m2＜BMI＜30 kg／m2 ) and obesity (BMI ≥30 kg／m2) according to the baseline body mass.The median body mass fluctuation of the three groups was 2.40 kg,and according to the median body mass fluctuations,the patients were divided into two groups:the high body mass fluctuation group and the low body mass fluctuation group.Changes of body mass were observed and the incidence of cardiac death,acute coronary syndrome,chronic heart failure,cerebral embolism and peripheral vascular embolization were monitored.Results During the follow?up period,as the increased of body mass fluctuation,the incidence rate of end point events also increasing continuously.The main end point event was used as the composite end point (HR(95%CI): 1.03 (1.06～1.15); P＝0.02), including the cardiogenic death ( HR( 95%CI): 1.04 ( 1.09～1.12); P＝0.03),the incidence of acute coronary syndrome (HR(95%CI): 1.04 (0.96～1.08); P＝0.06) and the heart failure incidence ( HR (95%CI): 95%CI: 1.04 (1.01～1.09),P＝0.04).The secondary endpoint as composite endpoint ( HR (95%CI): 1.16 (1.15～1.31); P＝0.01),including the cerebral embolism (HR(95%CI): 1.21 (1.23～1.54); P＝0.01) and the peripheral vascular embolism (HR(95%CI): 1.03 (0.91～1.03); P＝0.01) .After adjusting for all confounding factors,the quartile group with the highest body mass fluctuations was 6.2% higher in the main endpoint event than the lowest body quartile and 14.2% higher in the secondary endpoint.The occurrence of major endpoint events and secondary endpoint events in the quadruple group with high body mass fluctuation was significantly higher than that in the quadruple group with the lowest body mass fluctuation(main endpoint: 4.4% vs 10.6%; ( HR ( 95%CI): 1.86 ( 1.53 ～ 2.41); P＜0.01;secondary endpoints: 15.6% vs 29.8%; ( HR ( 95%CI) 2.12 ( 1.56 ～ 3.58); P＜0.01).The main endpoint events were cardiogenic death (HR(95%CI): 1.85 (1.73～2.3); P＜0.01); incidence of acute coronary syndrome (HR(95%CI): 1.02 (0.94～1.35); P＝0.08); incidence of heart failure (HR(95%CI): 1.48 (1.28～1.62); P＜0.01); secondary endpoint events were cerebral embolism (HR(95%CI):2.23 (1.93～3.91).( P＜0.01),peripheral vascular embolism ( HR( 95%CI): 1.05 (0.96～1.42); P＝0.13).For patients with normal body mass,body mass fluctuations had no significant effect on prognosis (main endpoints: 6.1% vs 5.3%; (HR(95%CI): 1.04 (0.94 ～ 1.43); P＝0.064; secondary endpoint: 16.7% vs 17.4%; ( HR ( 95%CI): 1.12 ( 0.84～ 1.09); P＝0.072), but for overweight and obese patients,the greater the fluctuation of body mass,the higher the incidence of adverse events (main endpoint:super?recombination: 5.8% vs 11.2%; ( HR ( 95%CI): 1.532 ( 1.135 ～ 3.156); P＜0.001; obese group: 8.3% vs 15.1%; (HR(95%CI): 1.584 (1.258～3.489); P＜0.001; secondary end points: super recombination: 17.1% and 21.3%; (HR(95%CI): 341.00 ( 1.132～ 1.984); P＝0.013; obese group:19.4% and 25.2%; ( HR ( 95%CI): 1.315 ( 1.128～2.123); P＝ 0.018).Conclusion Body mass fluctuations can significantly affect the prognosis of patients with atrial fibrillation and has a greater impact on patients with overweight and obesity.

Effect of protective mechanical ventilation on plasma markers of lung injury and inflammatory mediators during general anesthesia for liver transplantation surgery / 临床麻醉学杂志

Objective To approach the effect of protective mechanical ventilation on acute lung injury after orthotopic liver transplantation, by observing changes of plasma markers of lung injury and inflammatory mediators.Methods Sixty patients scheduled for liver transplantation under general anesthesia, 42 males and 18 females, aged 21-62 years, weighing 43-80 kg, ASA physical status Ⅱ-Ⅳ, were randomly divided into 2 groups: protective mechanical ventilation group (group P) and unprotective mechanical ventilation group (group U).Pulmonary artery blood for plasma markers of lung injury and inflammatory mediators were collected at the following time points: before operation (T1), 3 hours after mechanical ventilation (T2), 2 hours (T3) and 4 hours in neohepatic stage (T4).These mediators included clara cell secretory protein (CC16), surfactant proteins (SP-D), soluble receptor for advanced glycation end-products (sRAGE), TNF-α, IL-6 and IL-8.Moreover, blood gas results were recorded at these 7 time points: T1-T4, 2 hours after operation (T5), before tracheal extubation (T6) and 2 days after operation (T7).The postoperative awakening time, tracheal extubation time, ICU stay time and the incidence of ALI were recorded.Results Compared with T1, plasma level of CC16 in the two groups increased at T2 and T3 (P<0.05 or P<0.01), however, plasma level of SP-D, sRAGE, TNF-α, IL-6 and IL-8 did not increase until T3 (P<0.01).Moreover, plasma level of sRAGE, TNF-α, IL-6 and IL-8 at T4 were higher than those at T1 (P<0.05 or P<0.01).Compared with T1, OIs in the two groups increased at T2, T5 and T6 (P<0.05 or P<0.01), while decreased at T4 in group P (P<0.01) and at T3 and T4 in group U (P<0.01).In group P, patients showed a lower plasma level of CC16 at T2 and T3 (P<0.05 or P<0.01), a higher OI at T3 (P<0.05) and an earlier tracheal extubation after operation [(8.9±3.2) h vs (9.3±2.8) h, P<0.05] compared with group U.There was no significant difference of acute lung injury incidence between the two groups after operation, which was 5(16.6%) and 7 (23.3%), respectively.Conclusion Protective mechanical ventilation may promote oxygenation index, and shorten tracheal extubation time, thus protect lung function of patients in liver transplantation to some extend.

Effect of lung-protective ventilation on acute lung injury after liver transplantation / 中华麻醉学杂志

Objective To evaluate the effects of lung-protective ventilation on acute lung injury after liver transplantation.Methods Sixty patients of both sexes,aged 21-64 yr,with body mass index of 18-28 kg/m2,of American Society of Anesthesiologists physical status Ⅱ-Ⅳ,scheduled for elective orthotopic liver transplantation,were divided into 2 groups (n =30 each) using a random number table:conventional mechanical ventilation group (group CMV) and lung-protective ventilation group (group LPV).In group LPV,the patients were mechanically ventilated (tidal volume 6-8 ml/kg,respiratory rate 10-15 breaths/min,positive end-expiratory pressure 3-10 cmH2 O),and lung recruitment mnaneuver was pertormed every 2 h.Before skin incision (T1),at 3 h of preanhepatic phase (T2),at 30 min of anhepatic phase (T3) and at 2 and 4 h of neohepatic phase (T4.5),bronchoalveolar lavage fluid (BALF) was collected and blood samples from the radial artery were simultaneously collected for determination of tumor necrosis factor-alpha and interleukin-8 concentrations in BALF and serum by enzyme-linked immunosorbent assay.At 2 h after operation (T6),before tracheal extubation (T7) and at 2 days after operation (T8),blood samples from the radial artery were collected for blood gas analysis,and oxygenation index was calculated.The concentrations of serum Clara cell secretory protein 16,surfactant protein D and soluble receptor for advanced glycation end-products were determined at T1-T8 using enzyme-linked immunosorbent assay.The postoperative emergence time,extubation time,duration of intensive care unit stay and development of acute lung injury were recorded.Results Compared with group CMV,the cxtubation time was significantly shortened,serum concentrations of Clara cell secretory protein 16 at T2,T3,T6 and T7,serum surfactant protein D concentrations at T5 and serum concentrations of soluable receptor for advanced glycation endproducts at T5 and T6 were decreased (P＜0.05),and no significant change was found in tunor necrosis factor-alpha and interleukin-8 concentrations in serum and BALF at each time point or postoperative incidence of acute lung injury,oxygenation index,emergence time and duration of intensive care unit stay in group LPV (P＞0.05).Conclusion Although lung-protective ventilation dose not decrease the development of acute lung injury after liver transplantation,it attenuates lung tissue injury to some extent.

Extramedullary fixation combined with intramedullary fixation in the surgical reduction of sagittal mandibular condylar fractures / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aimed to evaluate the clinical effect of extramedullary fixation combined with intramedullary fixation during the surgical reduction of sagittal mandibular condylar fractures.</p><p><b>METHODS</b>Twenty-four sagittal fractures of the mandibular condyle in18 patients were fixed by two appliances: intramedullary with one long-screw osteosynthesis or Kirschner wire and extramedullary with one micro-plate. The radiologically-recorded post-operative stability-associated com-plications included the screw/micro-plate loosening, micro-plate twisting, micro-plate fractures, and fragment rotation. The occluding relations, the maximalinter-incisal distances upon mouth opening, and the mandibular deflection upon mouth opening were evaluated based on follow-up clinical examination.</p><p><b>RESULTS</b>Postoperative panoramic X-ray and CT scans showed good repositioning of the fragment, with no redislocation or rotation, no screw/plate loosening, and no plate-twisting or fracture. Clinical examination showed that all patients regained normal mandibular movements, ideal occlusion, and normal maximal inter-incisal distances upon mouth opening.</p><p><b>CONCLUSIONS</b>Extramedullary fixation combined with intramedullary fixation is highly recommended for sagittal condylar fractures because of the anti-rotation effect of the fragment and the reasonable place-ment of the fixation appliances.</p>

The Family Doctor′s Medical Humanistic Care for the Elderly in the Community under the Background of Population Aging / 中国医学伦理学

The elderly in the community who is the focus of the family doctor services , because of his special physical and mental condition , their demands for health care services showing the features of dependence , Recur-rence and urgency .Therefore, as the provided entity of community health service , the family doctor should care for the elderly in the community .In order to promote the realization of Healthy aging , we can build the system of the humane care for the elderly in the community , through the education and guidance of health、conducting psychologi-cal counseling , providing emotional support、building family sickbeds , providing regular visits、emphasizing clinical narrative, establishing mutual participation model and other measures .

Cross-sectional survey on healthcare-associated infection in a children’s hospital / 中国感染控制杂志

Objective To investigate healthcare-associated infection(HAI)in different departments in a children’s hos-pital,and provide scientific basis for effective prevention and control of HAI in children.Methods By bed-side visiting and medical record reviewing,survey on HAI prevalence rate was conducted among hospitalized patients in a given day in 2012, 2013,and 2014 respectively,and surveyed data of three years were analyzed.Results HAI prevalence rates in 2012,2013, and 2014 were 6.52%,5.59%,and 5.85% respectively,there was no significant difference (χ2 =1.02,P =0.60);the average HAI prevalence rate in three years was 5.98%,there was significant difference in average HAI prevalence rate among different departments(χ2 =291.83,P <0.001 ),the top 4 departments of HAI prevalence rate was hematology (27.49%),cardiothoracic surgery (21.13%),neonatal intensive care unit (16.43%),and pediatric intensive care unit (12.76%);the main infection sites were lower respiratory tract (58.44%),upper respiratory tract (22.63%),and gas-trointestinal tract (6.58%);the main pathogens causing HAI was Klebsiella pneumoniae (n=32,28.32%),followed by Acinetobacter baumannii (n=9,7.96%),Escherichia coli (n=9,7.96%),and Pseudomonas aeruginosa (n=7,6.19%). Conclusion Strengthening prevention and control intervention of HAI in high risk departments has important significance to reduce the incidence of HAI in children’s hospital.

The Ethical Countermeasures of the Mental Health of Patients with Chronic type B Hepatitis / 中国医学伦理学

With a long duration of the CHB, patients who have economic pressures and physical problems will get changes in their psychological status, which are involved in the development of the disease. Moreover, poor thera-py compliance and insight of their disease, negative mood of anxiety and depression also have effects the prognosis of disease. Therefore, mental factors play a vital important role in the development and prognosis of CHB patients, health education and mental intervention are the most effective way to avoid the psychological disorder of patients.

Ethical Issues in the Pension Institutions and Social Transformation of Pension Pattern in China / 中国医学伦理学

This paper mainly discussed the present situation of the pension mode transformation from traditional family pension to social pension. The existing ethical issues in pension institution include: old filial piety thought deeply rooted;institutional care services cannot be carried out caused by unfair distribution balance; humanistic thought of human ethical care implementation does not do well; some agencies have occasional bad behavior. Therefore, this paper proposed some advices based bioethical perspective:for old people and their children, advo-cate the new filial piety;pension institutions not only improving the quality of the hardware but also should strength-en humanistic ethics concern;establish and perfect the laws and regulations, combining the rule of law with moral and ethical;the relevant government departments should insist on and strengthen the principle of fair justice.

Ethics Principle Analysis and Policy Recommendations of the Family Doctor System in China / 中国医学伦理学

Establishing and perfecting the family doctor system should adhere to the following ethical princi-ples:the principle of public welfare, fairness and efficiency principle, the combination of comprehensive care prin-ciple, attaches great importance to the precautionary principle, the principle of family support, social participation principle. In the horizon, life ethics, puts forward suggestions for the development of family doctor system:impro-ving humanism quality of family physicians,calling the humanistic concern in the process of family doctor service increasing the government's policy support,increase the health resources into, adjust the health insurance policies, guide the community residents in the family doctor first.

Ethical Issues and Countermeasures and Suggestions for Mobile Medicine / 中国医学伦理学

Through the brief introduction of the concept of the mobile medical , this paper pointed out that the ethical issues that exist:health data reliability problems , the patient′s privacy protection , the protection of intellec-tual property rights issues , is involved in the problem of illegal practice medicine , online consulting the legal re-sponsibility of the doctor -patient relationship to define problems , make the reductionism , highlighted the defect of mind-body dualism and instrumental rationality overflow problem .And from the technical level , the law , the poli-cy level and consciousness discusses the related countermeasures .

Medical and Humanistic Analysis on Psychological States of Medical Staff and Patients'Families during the Development of Health Services / 中国医学伦理学

In recent years , with the development of medical health and the progress of economy , the citizens'demands for daily health are improved continually , and health services need to be rapid development .However , in the principle of medical ethics and humanism humanistic care of patients , it is easy to ignore the other two key as-pects -the medical staff and patients with the family .This paper analyzed the emotion and psychology of patients'families and medical staff in caring for the patients and corresponding solutions , so that the three can effective communication to build a harmonious doctor -patient relationship , and then promote patient recovery and be advan-tageous to the long-term development of the reform of health services .

A study on the satisfaction model of clinical research centers for CRA / 中华医院管理杂志

The performance of CRA directly affects the quality of clinical trials. In the appraisal of the CRA performance, satisfaction of clinical institutions plays a vital role. This article presents the outcome of a satisfaction survey on 16 clinical research centers in Shandong province, and the analysis of 503 survey samples regarding their exploratory factor and confirmatory factor respectively. The purpose is to identify the main factors for the satisfaction and to build a model to evaluate the satisfaction of hospitals for CRA.

Pre-test of non-invasive ventilation in the treatment of serious dyspnea patients caused by main airway stenosis / 中国医师进修杂志

ObjectiveTo evaluate the effect of high-frequency jec ventilation and bilevel positive airway pressure (BiPAP) ventilation in the severe dyspnea caused by central airway stenosis and explore the deferent application of two ventilation models.MethodsA retrospective analysis was designed to collect the serious dyspnea patients caused by central airway stenosis from January 2006 to January 2009.The patients were divided into group H and group B according to the different ventilation models,and the effect of relieving dyspnea and ameliorating hypoxemia was compared.ResultsSeven cases were in group H,and 9 cases were in group B.The therapeutic effect of relieving dyspnea was 14.29 ％(1/7) in group H.There were only 4 cases accepting high-frequency jec ventilation and the effect of relieving dyspnea was 25.00％(1/4).Two cases failed in high-frequency jec ventilation treatment and succeeded in BiPAP treatment thereafter,and 1 case failed in BiPAP treatment initially but was treated effectively by high-frequency jec ventilation after dyspnea relapsed.In group B,there were only 6 cases accepting BiPAP ventilation and the effect ofrelieving dyspnea was 83.33％ (5/6),and after adding the cases who accepting the sequential therapy of high-frequency jec ventilation and BiPAP ventilation the effect rate was 88.89％ (8/9).The difference had statistical significance(P =0.006).In ameliorating hypoxemia,the effect rate of group H was 100.00％ (7/7),of group B was 88.89％(8/9),and the difference had no statistical significance (P =0.563 ).Conclusions The high-frequency je ventilation is effective to relieve hypoxemia but is short of relieving dyspnea and subjective symptom,and it is suit for life support preoperative and intraoperative.The BiPAP ventilation is effective to relieve dyspnea and subjective symptom and hypoxemia,so the treatment effect is better than high-frequency jec ventilation,and it is suit in relieving symptom temporarily,pre-operative preparation and malignant tumor palliative treatment.

Relationship between resistin, adiponectin and insulin resistance in patients with obstructive sleep apnea-hy-popnea syndrome / 中国综合临床

Objective To explore relationship between resistin'adipenectin and insulin resistance(IR) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Based on polysomnography (PSG) and disease history ,68 patients were divided into three groups: mild ( L, n = 24 ), moderate ( M, n = 13 ), severe ( S, n = 31 ) OSAHS, and normal control ( n = 20 ). Fasting serum glucose, insulin, lipoids, resistin and adipanectin were measured. HOMA-IR was calculated, the correlation between HOMA-IR and resistin, adiponectin, lipoids, body mass index, waist-to-hip ratio, apnea-hypopnea index ( AHI), the lowest saturation of blood oxygen ( LSaO2) and the per-centage of total sleep time spent with an oxygen saturation less than 90% (T90) were analysed. Results The levels of serum resistins in each OSAHS group were (8.04 ±2. 14), ( 10.85±4.89 ), ( 13.34±3.52 )mg/L, and were sig-nificantly higher than those in control group ( 9.49 ± 2.40) mg/L ( P < 0.05 ), S were significantly higher than L (P<0.05) ;The levels of serum adiponectin of OSAHS groups were(6. 21 ± 1.74), (4. 19±1.80), (2.26± 1.17 ) mg/L, and were significantly lower than those in control group(9.49±2.40) mg/L (P < 0.05 ), and the inter-group differences were statistically significant (P <0. 05). HOMA-IR of M and S were(4.07±0.97), (5.61± 2.26) significantly higher than those of L and control group( 1.57 ±0. 58 ), (2.47 ±1.52 ) ( P < 0.05 ), and inter-group differences between M and S were statistical significant( P < 0.05 ). Spearman correlation analysis showed that HOMA-IR was significantly positive correlated with resistin, total cholesterol, triglyceride, body mass index,waist-hip rafio,AHI,T90( r =0. 794,0.438,0. 430,0. 351,0. 456,0.775,0.624 ,P <0.01 ) ,negative with adiponectin, LSaO2 (r=-0.563, -0.623 ,P <0.01 ). Partial correlation analysis showed that after the effect of adiponeetin and resis-tin were controlled,HOMA-IR was significant positive correlation with T90 and AHI(r =0.231,0.358 ,P <0.05 ). Multiple stepwise regression analysis showed that, to HOMA-IR, resistin and AHI were the most significant impact factors (R2 =0.613,F=69.810,P<0.01). Conclusions HOMA-IR is significantly positively correlated with the severity of OSAHS,independent of the blood lipids, body mass index, waist-hip ratio, resistin, adiponectin and other factors;the effects of blood lipids,body mass index,waist-hip ratio and other factors on HOMA-IR probably depend on resistin and adiponectin;AHI and plasma resistin level may determine the level of insulin resistance in patients with OSAHS.

Influence of Sanye Insect Tea on the Renal Hypertension Rats / 中国中医药信息杂志

Objective Inquire into the function and mechanisms of Sanye Insect tea of lowering the blood pressure. Method The rat model of renal hypertension was replicated by aqueezing two kidneys (2K1C-RHR) to observe the blood pressure-lowering process of Sanye Insect tea on the change of the content of CGRP, analysis the change with the relation of the AngⅡ level, and compare with Liuwei Dihuang and Captopril Tablets. Result The blood pressure value of renal hypertension rats obviously increased, the blood plasma CGRP lowered and the level of AngⅡ increased. High and low dosages of Sanye Insect tea had this improvement of different degree. Conclusion Sanye Insect tea has the effect of lowering the blood pressure of 2K1C-RHR. Incressing the content of CGRP and regulating the level of Ang Ⅱ to make blood vessel extend is one of the function mechanism of Sanye Insect tea.

Ethical Research on Treatment of Steroid-resistant Nephritic Syndrome / 中国医学伦理学

Some questions like the hardship of treatment and lacking of standard on diagnosis are existing in steroid-resistant nephritic syndrome(SRNS).This article make an ethical analysis on these questions and assumes that we should persist in treating the patients carefully with humanism,carry on informed consent principle,implement the optimal treatment and perfect the standard of diagnosis and treatment,carry on clinical ethics education and promote the judgment level of clinical ethics.

Countermeasures and suggestion to intensify moral education work of medicine graduate students under the new situation / 中国医学伦理学

With a view to some common problems and characteristics of medicine graduate students education,how to intensify the moral education work of medicine graduate students under the new situation is researched and discussed,and some countermeasures and suggestion are put forward in this article.to systemically organize the ideological and political education work for freshmen;to exert the theory guidance of medical ethnics in moral education of graduate students;to intensify education and management in graduate students,and fully play the education role in management and serving;to adopt detailed measures to promote the performance of tutors and specialty departments in teaching,scientific research and academic education;to include medical social practice of poor-salvation into moral education program for medicine graduate students.

Discussion about case teaching in the medical ethics / 中国医学伦理学

Case teaching has evident characteristics compared with traditional theory teaching. This article expound the purpose,significance,teaching process and the noticeable problems of case teaching in medicaI ethics teaching.