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In recent years, progress has been made in general practice education research with the integration of narrative medicine and general practice. The narrative medicine is conducive to upgrading the abilities of general practice residents in doctor-patient communication, disease management and clinical decision makings; it also conducive to improvement of their humanistic quality and doctor-patient relationship. This article reviews the application of narrative medicine in the general practice residency training, and discusses relevant problems and countermeasures.
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Objective To collect and summarize the opinions of experts on the improvement of China's disease prevention and control system published in the public media, so as to provide reference for the relevant construction planning of the government. Methods: Articles were collected from January to May, 2020, which were published on Chinese mainstream media. Based on the analysis of literature and the basic characteristics of experts, Analytic hierarchy process (AHP) was used to summarize the construction points of experts in different construction fields. Results: A total of 19 opinion articles were finally included in the study and 29 experts were involved. The suggestions of experts on the construction of China's disease prevention and control system were summarized into four aspects. Conclusion: The COVID-19 pandemic is a challenge to the existing public health epidemic prevention and control system in China, and also an important opportunity for the development and construction of the related system.
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Objective:To investigate the effects of ulinastatin on liver function in patients with liver cancer after major hepatectomy.Methods:The clinical data of 232 patients with major liver resection due to liver cancer were retrospectively analyzed. According to whether ulinastatin was applied after operation, patients were divided into treatment group (105 cases) and control group (127 cases). The postoperative inflammatory factors, liver function, postoperative complications and hospital stay were compared.Results:The levels of CRP、IL-6 and TBIL、ALT、AST were significantly lower than the control group 3 days after surgery (CRP: t=4.520, P=0.000; IL-6: t=17.982, P=0.000; TBIL: t=9.843, P=0.000; ALT: t=11.913, P=0.000; AST: t=4.520, P=0.000). The incidence of massive ascites in the treatment group (χ 2=4.212, P=0.040) and the average postoperative hospital stay ( t=9.994, P=0.000) were significantly lower than that in the control group. Conclusion:Early application of ulinastatin effectively inhibits the inflammatory process, protects liver function, reduces the incidence of massive ascites, and shortens the postoperative hospital stay.
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A comprehensive regulation mechanism,as one of the five basic healthcare system components,plays an important role in safeguarding the health and life rights of all nationals of a country.The authors explored the construction of such a mechanism and related reform experiences of the healthcare industry in the context of building a healthy China.On such basis,the paper analyzed in depth the connotation of the comprehensive regulation and the existing challenges,in order to propose countermeasures for the establishment of a proactive,comprehensive and coordinated comprehensive regulation mechanism.
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Objective To investigate the value of stretched-exponential model of DWI in differential diagnosis of benign and malignant breast lesions.Methods Totally 58 patients with 63 breast lesions (33 benign,30 malignant lesions) were enrolled.All the patients underwent multiple b value DWI and dynamic contrast enhancement MRI (DCE-MRI) scans.The values of ADC,DDC and water molecular diffusion heterogeneity index (α) were calculated,and the time signal intensity curve (TIC) was obtained.All the parameters were compared between benign and malignant breast lesions.The diagnostic performance of different parameters was evaluated with ROC curve.Results ADC,DDC and α value of malignant lesions was (1.01±0.19)×10-3 mm2/s,(0.89±0.23)×10-3 mm2/s and 0.75±0.09,while of benign lesions was (1.41±0.27)× 10-3 mm2/s,(1.49±0.29)× 10-3mm2/s and 0.87±0.07,respectively.All 3 parameters in malignant lesions were lower than those in benign lesions (all P＜0.01).Taking 1.22 × 10-3 mm2/s as the optimal threshold,the area under the curve (AUC) of DDC was the largest as 0.958,and the corresponding diagnostic sensitivity and specificity was 96.67％ and 81.82％,respectively.AUC value was 0.976 by combining DDC with TIC,and the corresponding diagnostic sensitivity and specificity was 93.33％ and 93.94％,respectively.Conclusion The stretched-exponential model DWI can differentiate breast lesions,and diagnostic performance of combination of DDC and TIC is better than ADC or DCE.
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OBJECTIVE@#To explore the change rules of peak area ratio of STR loci to Amelogenin (AMEL) locus (STR/AMEL), a sex-determining gene in DNA degradation, and to evaluate the application of STR/AMEL value in the estimation of DNA degradation degree.@*METHODS@#DNA was extracted from iliopsoas, and the variations of STR/AMEL value (Penta E/AMEL, Penta D/AMEL, FGA/AMEL) were analyzed after the artificial degradation was made by DNase I, and the changes of these three ratios of the iliopsoas naturally degraded in an outdoor environment were also analyzed. The regression curves were analyzed using the periods of DNA degradation and outside the body as the independent variable (x) and the STR/AMEL value as the dependent variable (y) and three curve equations under two conditions were established.@*RESULTS@#Both under the conditions of artificial and natural degradation, STR/AMEL value had a negative relationship with the degradation time. The relationship between STR/AMEL and degradation time can be well simulated by the cubic function. R2 was over 0.99 under controlled degradation condition and over 0.86 under natural degradation condition.@*CONCLUSION@#The STR/AMEL value (Penta E/AMEL, Penta D/AMEL, FGA/AMEL) is negatively related with the DNA degradation degree, which follows mathematical regression models strictly, and it might be applied to evaluate the DNA degradation degree.
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Humanos , Amelogenina/genética , Dano ao DNA/genética , Primers do DNA , Repetições de Microssatélites , Análise de Regressão , Fatores de TempoRESUMO
<p><b>OBJECTIVE</b>To investigate the relationship between serum sex hormone levels, liver function, and pathogenic mechanisms related to cutaneous lesions involving the facial skin in male patients with liver cirrhosis.</p><p><b>METHODS</b>Fifty male cirrhotic patients with facial skin lesions, including spider angiomas, angiotelectasis and special type rash, (mean age: 48.1 +/- 12.2 years) were randomly selected for study and enrolled as the case group. Thirty cirrhotic male patients without facial skin lesions (mean age: 44.5 +/- 11.7 years) were enrolled as the control group. Serum levels of luteinizing hormone (LH), follicular stimulating hormone (FSH), prolactin (PRL), estradiol (E2), progesterone (PRGE), and testosterone (T) were detected and compared between cases and controls by the t-test. All patients were sub-categorized according to severity of cirrhosis (Child-Pugh classification) and comparisons between cases and controls were carried out by single factor analysis of variance. Logistic regression modeling was used to evaluate whether the presence of skin lesions is related to changes in markers of liver impairment, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), serum albumin (Alb), prothrombin time (PT-SEC), creatinine (CREA), platelet count (PLT), and alcoholism.</p><p><b>RESULTS</b>In the cases with spider veins, LH level was significantly elevated (t = 2.01) and T level was significantly decreased (t = -2.20) (both, P less than 0.05 vs. controls). In the cases with telangiectasia, the LH level (t = 3.76, E2 (t = 2.08) and E2/T ratio (t = 2.98) were significantly elevated and T level was significantly decreased (t = -3.77) (all, P less than 0.05 vs. controls). In the cases with special type rash, FSH level was significantly elevated (t = 2.03) and T level was significantly decreased (t = -2.01) (both, P less than 0.05 vs. controls). In the case group, E2 levels decreased as severity of liver damage increased, while in the control group, E2 levels increased as severity of liver damage increased; however, the difference in average E2 values of the two groups did not reach statistical significance (P more than 0.05). In both cases and controls, the T levels were decreased as the severity of liver damage increased (F = 3.70, P less than 0.05). Multivariate logistic regression analysis showed that increased incidence of facial skin lesions is associated with alcoholism (odds ratio (OR) = 4.46, 95% confidence interval (CI) = 1.45-13.7, P less than 0.05) and elevated serum levels of AST (OR = 11.87, 95% CI = 1.24-113.1, P less than 0.05).</p><p><b>CONCLUSION</b>Alcoholism, impaired liver function, and perturbed levels of circulating sex hormones are associated with cirrhosis-related facial lesions and may play important roles in the pathogenesis of cutaneous lesions in patients with cirrhosis.</p>