By analyzing the characteristics of gynecologic teaching we discussed the ethical problems existing in Gynecologic clinical teaching and suggested some advice such as enhancing ethical teaching,protecting patients' rights,and attempting to adopt some new technology,to solve those problems.

With the transformation of medical model, a lot of new ethical collisions appeared in clinical teaching. As to the characteristics of gynecological teaching, we analyzed the ethical problems, and present some solutions that are enhancing the ethical teaching, vindicating the right to be informed of the patients and improving the methods of clinical teaching with advanced technique.

Objective To estimate abortion ways and announcements of early-staged gestation termination in lactation scarred uterus. Methods A retrospective analysis was made on clinical date of 312 early-staged gestation termination cases in lactation scarred uterus. These cases were divided into three groups based on abortion ways: induced abortion group (group A,92 cases), drugs abortion group (group B,98 cases), misoprostol combined uterine aspiration group (group C,122 cases). The abortive efficiency,operation time, operative bleeding, colporrhagia time, postoperative infection and drug adverse reaction were observed and compared. Results Complete abortion rates in group A (97.8%,90/92) and group C(99.2%,121/122) were significantly higher than that in group B (77.6% ,76/98),colporrhagia times in group A [(5.9 ± 1.1) d] and group C [(5.6 ± 1.2) d] were significantly lower than that in group B [(12.4 ± 1.8) d],postoperative infection and drug adverse reaction rate were lower in group A and group C, with significant difference compared to group B (P ＜ 0.05). The operation time was shorter, bleeding was less,third-grade pain rate was lower in group C, there was significant difference between group A and group C (P ＜ 0.05).Conclusions Misoprostol combined uterine aspiration terminated early-staged gestation in lactation scarred uterus is effective and safe, makes the operation easy and simple, decreases the blood loss. The influence to mother and infant is smaller, it is the best abortion style.

Objective To compare the serum thyroid hormones level in patients with pre-diabetes,newly diagnosed type 2 diabetes mellitus(T2DM)and healthy people,and to investigate the association of glucose metabolism with thyroid function.Methods Sixty newly diagnosed T2DM patients(T2DM group),60 pre-diabetes patients(pre-diabetes group),and 60 healthy people(healthy group) from outpatient departments were randomly enrolled in the study.Their thyroid peroxidase antibodies(TPOAb),thyroglobulin antibodies(TGAb),thyrotropin receptor antibodies(TRAb),and thyroid color dopplar ultrasound were all normal.Thyroid hormones was measured.Glycosylated hemoglobin A1c(HbA1c),fasting plasma glucose(FPG),glycated albumin(GA) was additionally measured in T2DM patients.We compared the difference of thyroid hormones among the 3 groups and investigated the factors that influence thyroid hormones level in each T2DM patients.Results There was no significant difference found on thyroid hormones level between the pre-diabetes group and healthy group(P＜0.05).T3 and FT3 level were(1.34±0.24)nmol/L and(3.88±0.51)pmol/L in the T2DM group,respectively,which were significantly lower than those in the pre-diabetes group([1.48±0.29]nmol/L and [4.12±0.55]pmol/L,t=-0.135 and -0.145,respectively,Ps＜0.01＝ and in the healthy group([1.49±0.26]nmol/L and [4.13±0.55]pmol/L,t=-0.240 and -0.260,respectively,P＜0.05 or 0.01) .In the T2DM group,T3 and FT3 were negatively correlated with FPG,GA,HbA1c(For T3:r=-0.275,-0.318 and -0.453,respectively,Ps＜0.05;For FT3:r=-0.280,-0.291 and -0.336 ,respectively,Ps＜0.05).Conclusion In patients with abnormal glucose metabolism, thyroid hormone was influenced only when the glucose metabolism level reached a certain abnormal degree.

Objective To investigate the association of leptin receptor gene Gln223Arg polymorphism with metabolism syndrome and insulin resistance. Methods The genotypes of leptin receptor in 167 patients with metabolic syndrome and 216 healthy subjects were determined by polymerase chain reaction restriction fragment length polymorphism. The biochemical indicators were detected. Results The frequency of A alleles was significantly higher in patients with metabolic syndrome than in healthy subjects. The risk of metabolic syndrome in inviduals with allele A was 3. 302 folds of that with allele G( P<0.01 ). Compared with allele G, the patients withA allele had higher body mass index,blood pressure, blood glucose, insulin level, waist circumference, and more serious dyslipidemia. The risk of insulin resistance in patients with A allele was 3. 446 folds of that with allele G (P<0.01). Conclusions Leptin receptor gene Gln223Arg polymorphism is associated with an increased risk of metabolic syndrome and insulin resistance.

Objective To investigate the therapeutic effects of alendronate combined with Caltrate D on regional bone mineral density (BMD) in elderly type 2 diabetic women with osteoporosis. Methods Thirty-four elderly type 2 diabetic women with osteoporosis aged 60-79 years (average 68. 0±4.5 years), with body mass index (BMI) of (25.0±3.7) kg/cm2 and duration of diabetes (8.9 ±4.4) years were enrolled. At the basis of a comprehensive management, the patients were treated with alendronate combined with Caltrate D for 6 months. BMD of the lumbar spine and hip, several biochemical indexes were measured before and after treatment. Results After the 6 months treatment, the BMD of different regions at lumbar spine and hip all increased. The T value and BMD were significantly higher at lumbar spines than at hip (both P＜0.01). The differences of T value and BMD of different regions were significant (P = 0.003 and 0.005,respectively). BMD percent change at lumbar spine were L4 (44.7%) ＞ L3 (31.9%) ＞ L total (27.3 % ) ＞ L1 (20.0%) ＞ L2 (14.3 % ), and the BMD percent changes were significantly higher in L3 and L4 than in other regions at lumbar spine (P=0. 038 and 0. 008, respectively). The changes of T value and BMD were significantly higher in L3, L total, L1 and L4 than in L2 (T value: P=0. 036,0. 042, 0. 006 and 0. 004, respectively; BMD: P=0. 002, 0. 002, 0. 003 and 0. 001, respectively).Conclusions On the basis of comprehensive management, the 6 months treatment with alendronate combined with Caltrate D in elderly type 2 diabetic women with osteoporosis may achieve good therapeutic effect at lumbar spines, especially at the lower lumbar spines, while less effective at hip.

OBJECTIVE To investigate the drug resistance of infection due to Pseudomonas aeruginosa.METHODS Totally 269 strains of P.aeruginosa derived from the clinical infection from Jan 2005 to Jun 2006 were analyzed according to the requirements described in the National Regulations on Clinical Laboratory Operations.The bacteria were identified by the automated analyzer VITEK-32 and the drug resistance was analyzed with the K-B test and PEMS3.1.RESULTS Drug sensitive rate of P.aeruginosa to imipenem,piperacillin/tazobactam,amikacin and tobramycin was the highest(86.6%,85.5%,87.0%,and 82.5%,respectively);to levofloxacin,ceftazidime,ciprofloxacin,gentamicin and cefepime was 77%,72.5%,72.5%,72.1%,and 70.4%,respectively.Drug sensitive rate of P.aeruginosa to other antibiotics was

eticulum stress.

AIM: To investigate the effects and mechanisms of renin-angiotensin system (RAS) blockade on pancreatic islet β-cell function in rats with injection of streptozotocin (STZ) and long-term high-fat diet. METHODS: Normal male Wistar rats fed with 16 weeks-long high calorie, and high-fat diet were treated with telmisartan (TI, n=15), and injected with STZ after 24 weeks. One week later, islet function was evaluated by intravenous insulin releasing test (IVIRT). The immunoglobulin binding protein (BIP)/glucose-regulated protein (GRP78), C/EBP-homologous protein (CHOP)/growth arrest and DNA-damage-inducible gene 153 (GADD153) mRNA expression levels in the islets were detected by RT-PCR. The expression levels of insulin and Bax protein in the islets were examined by immunohistochemistry. RESULTS: The incidence of diabetes was 80%(12/15)in the high-fat diet+STZ group (HS) and 33% (5/15) in the high-fat diet+STZ+ telmisartan group (TS). Compared to HS group, maximum of insulin secretion in TS group was increased 56.9%. Early insulin secretion index (EISI) and acute insulin response (AIR) were increased by 1.98 times and 0.88 times, respectively. The expression of insulin and insulin positive cell density (PCD) were increased obviously in β-cells. The expression levels of BIP, CHOP and Bax in the islets were decreased significantly. CONCLUSION: Blockade of RAS increases the resistance to streptozotocin-induced diabetes in rats with long-term high-fat diet, and the expression of apoptosis-related molecules is downregulated in endoplasmic reticulum. The mechanism that RAS blockade improves pancreatic islets function and reduces diabetes incidence to some extent may be via attenuating endoplasmic reticulum stress.

Objective To investigate the efficacy,toxicity and cosmetic outcome of short-course radiotherapy with concomitant tumor bed boost after breast-conserving surgery for early stage breast cancer.Methods A total of 306 patients with T1-2 N0-1 M0 breast cancer after breast-conserving surgery were included.160 patients received whole-breast radiation to 45 Gy in 25 fractions followed by tumor bed boost of 14 Gy in 7 fractions (C group).146 patients received whole-breast radiation to 46 Gy in 23 fractions with concomitant tumor bed boost to 60 Gy in 23 fractions (S group).Kaplan-Meier method was used to calculate the local recurrence and overall survival rates and the differences were compared by Logrank test.Chi-square test was used to compared the differences of the clinical characteristics,toxicity and cosmetic outcome between the two groups.Results The follow-up rate was 100％.After a median follow up of 26 months,the 1-,2-and 3-year overall survival rates were 100％.No patient developed local recurrence.In C and S group,the incidence of grade 1 acute skin toxicity was 46.9％ and 45.1％ (x2 =0.73,P =0.695),grade 2was 16.3％ and 13.7％ (x2 =0.73,P =0.695).Grade 1 late skin and subcutaneous tissue toxicity developed in 16.9％ and 17.1％ of patients in C and S group (x2 =0.00,P =0.954).Grade 1 neutropenia occurred in 11.9％ and 13.7％ of patients in C and S group (x2 =0.23,P =0.633).In C and S group,66.2％ and 65.5％ of patients had excellent and good cosmetic outcome (x2 =0.01,P =0.927).Conclusions Short-course radiotherapy with concomitant tumor bed boost provides similar results to conventional radiotherapy in local control,toxicity and cosmetic outcome.Long-term follow up is warranted to confirm this finding.