Objective Identifying the factors of psychological pressure from medical disputes on clinical doctors and possible solutions. Methods Self-rating Anxiety Scale (SAS) and the Occupational Stress Indicator (OSI) were called into play, to study 52 clinical doctors in a tertiary hospital in a city, who had encountered medical disputes in recent two years. In parallel, 63 clinical doctors without such disputes and 50 non-clinical workers were randomly selected as the control group for questionnaires. Results Clinical doctors with such an experience were commonly found to be anxious, and their SAS score (58. 27±11.38)averaged higher than those in the control group. Doctor-patient relationship, legal liabilities and clinical positions were found to be positively correlated to psychological pressure of clinical doctors. Conclusions Medical disputes tend to add to psychological pressure of the doctors. Clinical doctors deserve psychological counseling and training and improvement of their working conditions.

Objective To study the efficacy of JueDuYin in the treatment of benign prostatic hyperplasia (BPH). Methods 120 cases were randomly recruited into a treatment group and a control group, with 60 cases in each group.The treatment group was given JueDuYin, one dosage per day, while the control group was administrated with Finasteride, 5mg per day. After three courses of twelve weeks' treatment, the indications of international prostate symptom score (IPSS), residue urine (RU), Qmax and total prostatic value (IPV) were observed. Results There was significant changes in the valve of IPSS,RU, Qmax for both groups after the treatment compared (P<0.05～0.01). The therapeutic effects of the treatment group was obvious better than the control group (P<0.05).

BACKGROUND: One of the basic functions of bone is its adaptation to mechanical loading environment. Bone cells are the mechanosensitive cells in bone tissue. However, the mechanisms by which mechanical signals are transduced to chemical signals that influence bone growth and metabolism remain unidentified.OBJECTIVE: To understand the mechanotransduction pathways in osteoblasts and osteocytes, and to provide a theoretical basis for further study. METHODS: PubMed database was retrieved by computer with key words of osteoblast, osteocyte, bone cells, mechanical stress. According to inclusion criteria, 69 articles were included to summarize the transduction of mechanical signals of bone cells. RESULTS AND CONCLUSION: One of the basic functions of bone is its adaptation to mechanical loading environment. Bone cells are mechanosensitive cells. However, how the transduction of mechanical signals of cells realizes and how regulates skeleton remain poorly understood. Studies confirmed that due to the construction features and cell location of skeleton, osteoblasts and osteocytes are the most important mechanosensitive cells in bone tissue. The process of mechanotransduction can be divided into four distinct steps: ① mechanocoupling; ② biochemical coupling; ③ signal transmission; ④ effector response of bone cells. Through these four steps, the loads acting on the bones are transduced into biochemical signals, and then change the function of bone cells, finally induce the changes of bone structures to adapt the mechanical environment. The regulatory mechanisms of mechanical signals in bone marrow mesenchymal stem cells require further investigation.

Objective To look for a method of LC with minimal invasion and better exposure. Methods During laparoscopic cholecystectomy with three holes, a needle with a No.7 thread was pierced to the abdominal cavity at the right eighth intercostal space and the fundus of the gallbladder was sutured. The gallbladder traction was performed by the thread to help exposure of the operative filed. LC of 90 cases were operated on by the method. Results All of the 90 cases were cured without any complication. Conclusions External abdominal gallbladder traction is more effective with minimal invision and better exposure as compared with the routine LC.

This study was conducted in the First Affiliated Hospital of Zhejiang Chinese Medical University for the project of Establishment and Assessment of Ethics Review Platform for TCM Clinical Research. The Ethics Review Platform for Clinical Research is a complete system, which is a Participant Protection System. It includes four as-pects, which are the medical and health institution, ethics committee, ethics committee office, research departments and researchers. In this system, the establishment of research departments and researchers platform is the most cru-cial part. All treatment, protection, risk control, adverse event supervision, which are closely related to the Partici-pant Protection System are completed by researchers. However, during the assessment process, a series of problems were found, such as the current weak ethical consciousness of researchers, less familiar with ethical review process and do not pay equal attention to the participant protection as clinical research. This kind of problem was also found in other hospital assessments in China, which has become a short board of the Participant Protection System.Therefore, from the aspect of the ethics committee, this article presented several ethics problems which should be paid more attention to by researchers such as participant protection, plan design and conduction during the clinical research and also gave some useful advices to change the situation, according to the Assessment Standard of Ethics Review Platform for TCM Clinical Research. In this way, researchers will develop their ethical consciousness and be more familiar with the ethics review process in order to complete key task of participant protection.

Objective To describe the new cognition of mapping, ablation and mechanism of typical atrial flutter using non-contact mapping system. Methods In 9 patients with typital AFL, the bi-directional conduction properties of isthmus, atrial activation sequence and reentrant circuit of AFL were mapped using the non-contact mapping system. Linear isthmus radiofrequency ablation was guided by navigation system without fluoroscopy, and isthmus bi-directional block was verified. Results A clockwise moving reentrant activation wavefront in 1 of the 9 patients was observed and a counter-clockwise rotating wavefront in 7 of the 9 patients, respectively. AFL was not inducible in one patient. The mean cycle length of AFL was (215?36) ms. The whole reentrant way and its relation with anatomical structure of right atrium (RA) were displayed by non-contact mapping. In each mapped AFL, the wavefront conducted through the crista terminalis (CT) and propagated slowly, which that indicated the smooth part of RA was involved in the reentrant circuit. In patients with recurrences, the gap in the line of block in the isthmus was identified and ablated, which was navigated by the system. Complete isthmus bi-directional conduction block was achieved at the end of the procedure except in two patients. No recurrences of AFL occurred during the follow-up of 12-36 months. Conclusion The whole activation circuit and its relation with RA anatomical structure of typical AFL can be directly visualized and its reentry mechanism was verified by non-contact mapping system. In recurred cases ,the gap of isthmus block was identified and ablated accurately. CT, which was previously supposed to be a complete posterior conduction barrier, was now proved to be of transverse slow conduction by non-contact mapping.

Objective To study the advantages and summerize the practice of laparoscopic appendectomy (LA) for elderly patients. Methods Forty one elderly patients with appendicitis aged from 60 to 76 were treated with LA. The operative procedure, surgical indications, recovery, postoperative pain, and complications, as well as the period and the cost for hospitalizing were studied. Results All 41 patients were comfirmed appendicitis through LA. Thirty nine patients undergone LA were operated smoothly. Only two patients were cured with exploratory laparotomy. The preoperative diagnosis was confirmed in 6 patients and the complication of other diseases were found in 5 cases by LA. Two cases were operated by abdominal incision during LA. Postoperative complications, such as infection of the incision and pain were less occurred. The concurred diseases with appendicitis need simple treating. The hospitalizing period was 4 days on the average and the cost was 20%～30% higher than other procedures. Conclusions Most of elderly patients can be early diagnosed and timely treated by LA. LA could be a more popular choice for the elderly patients with appendicitis since its advantages of safe and minimal invasion. It has been an outstandihg method in treating appendicitis compared to other traditional methods.

Juvenile myoclonic epilepsy (JME) diagnosed with seizure history,semiology and electroencephalography is a syndrome of idiopathic generalized epilepsy.MRS can quantitatively detect the concentration of neurometabolites noninvasively,and assess the metabolic changes in brain.Currently,studies of pathogenesis of JME are focused on the dysfunction of thalamo-cortical network and the neurometabolites and imbalance of Glutamate and γ-aminobutyric acid in the network are alterted.Epilepsy is associated with the imbalance of the ratio of excitatory and inhibitory amino acid,and seizures lead to neuronal lesions which result in altered concentration of neuron related metabolites.This article reviewed MRS studies of JME by combining material metabolism,neural structure and function.

Objective To investigate morphologic characteristics of myocardial bridge(MBs)in optical coherence tomography(OCT)and to investigate the relationship between MBs and atherosclerosis in the proximal segments to MBs.Methods Twelve patients(age:58.07?12.08)with MBs were examined with OCT.The location and length of the most stenosis area of MBs were observed and compared between the CAG and OCT results.The intima thickness of the proximal 2 cm arterial segment of MBs was measured.Results All the 12 MBs were found in LAD.The length of the MBs measured in OCT and CAG respecgtively was 20.5?4.2 mm vs 15.6?3.5 mm(P

Objective To compare the efficacy of heart valve replacement(HVR) with axillary mini-thoractomy (AMT) and HVR with routine medial sternoctomy(MS). Methods The patients wre randomly divided into two groups. In group I 38 cases received HVR with routine MS, and in group II 49 cases received HVR with AMT. Results ⑴The surgical incision was invisible and cosmetic in group I and the volume of post-operative thoracic tube drainage was significantly less than that in group II; ⑵In group I the mean hospitalized days of the patients also was less than those in group II; ⑶There was no significant difference in cardiopumonary bypass time and aortic clamp time between the two groups. Conclusion Axillary mini-thoractomy could be used in most patients of heart valve replacement and has the advantage of the cosmetic and minimal injury.