Universal health has been highly valued by the public and the government,and medical science and technology have been much improved.However,these are accompanied by a complex situation of doctor-patient relationship.We discuss here that humanism be fostered in medical education and clinical practice.A harmonious doctor-patients relationship can be maintained only when patientcentered medical service is applied and humanistic care is integrated but not overly dependent on technology and seeing patient as mere cases.

Objective To investigate the expression of serum interleukin-2(IL-2),tumor necrosis factor-α(TNF-α)in the pa-tients with pulmonary tuberculosis and diabetes,and prelininary explore its clinical significance.Methods Experiment were divided into control group(health check-up outpatient,n=10),pulmonary tuberculosis group(n=20),diabetes group(n=20),tuberculosis combine diabetes group(n=20),tuberculosis combine diabetes group was divided into improved group,diabetes group and deterio-rated group after 2 months with therapy according to disease outcome,ELISA assay was used to measured the level of serum IL-2 and TNF-α.Results Before treatment:serum IL-2 levels of pulmonary tuberculosis group,diabetes group and pulmonary tuberculo-sis combine diabetes group were reduced (P<0.05),and the pulmonary tuberculosis group was lower than the pulmonary tubercu-losis group and diabetes group (P<0.05);serum TNF-αlevels of pulmonary tuberculosis combine diabetes group,pulmonary tu-berculosis group and diabetes group increased (P<0.05),and that of pulmonary tuberculosis combine diabetes group was higher than that of diabetes group (P<0.05).After treatment:the level of serum IL-2 increased and TNF-αsignificantly decreased in pul-monary tuberculosis combine diabetes improved group (P<0.05),the deterioration group had no change(P>0.05).Conclusion IL-2 and TNF-αplay a role in the immune pathogenesis of tuberculosis combine diabetes,which dynamic changes can reflect the progression and outcome of pulmonary tuberculosis combine diabetes.

OBJECTIVE　To evaluate the availability and safety of a new carbapenem meropenem.METHODS　The randomized study was conducted in 60 patients with respiratory tract infections.They were divided into two groups:meropenem or imipenem/cilastatin.RESULTS　The cure rate,effective rate and bacterial clearance rate for meropenem were 80.0%,93.3%,92.3%,respectively and for those of imipenem/cilastatin were 76.7%,90.0% and 91.3%,respectively.The rate of adverse reactions for both meropenem/cilastatin was 3.3%.CONCLUSION　Meropenem appeared to be a highly effective and safe agent in treatment of respiratory tract infections.Its efficacy and safety are similar to that of imipenem/cilastatin.

Objective To explore the role of multi-media teaching in the ENT physician training. Methods 32 further-study professionals were randomly divided into 2 groups. The control group received traditional teaching methods(n = 16), and the experimental group received the multi-media teaching method (n = 16). After the training, all trainees would take the theory test and skill assessment Results The basic theory and clinical skill scores of the experimental group are better than the control group at the end of the training. Conclusion Multi-media teaching method is very suitable for ENT refresher training.

Objective To make cephalometric analysis on the morphology of mandibular angle and its relationship with adjoining craniomaxillofacial structures in adults, and to discuss the application of the results in preoperative analysis and operation design. Methods Cephalometric analysis was made on the following parameters in 30 adults (15 men and 15 women) for frontal and lateral cephalometric radiograms: the distance between the mandibular angles (Go Go) and between the malar points (Zy Zy), and the mandible mental angels (Zy Go Me) on an anteroposterior cephalometric radiograph; the gonial angle (Ar Go Me), mandibular plane sella nasion angle (MP SN) and ramus plane sella nasion angle (RP SN). Results Go Go in male was (130?6) mm, female (116?6) mm; Zy Zy in male was (156?5) mm, female (146?5) mm; Zy Go Me in male was (117?5)?, female (119?5)?; Ar Go Me in male was (117?5)?, female (119?5)?; MP SN in male was (27?5)?, female (29?5)?; RP SN in male was (94?5)?, female (93?5)?. Conclusion The morphology of mandibular angle should be envisioned in three directions. The results of evaluation can be served as the reference of preoperative analysis and surgery design.

Objective To introduce a method of dorsal augmentation rhinoplasty using autogenous septal cartilage. Methods Autogenous septal cartilage was obtained through a standard septoplasty approach. Graft was cut into single oval, or divided into two or three parts, then the cartilage was sutured by means of a mattress suture; or graft was made into an inverted V frame, depending on size and shape of dorsal depression, and finally graft was inserted for augmentation of dorsum. Results Since May 1989 to Dec. 2001, this technique was performed in 43 patients, 6 men and 37 women, with a range of 17-35 years and a mean age of 24 years. Follow-up ranged from 6 months to 5 years. The authors asserted the sustained satisfactory outcomes. Conclusion Autogenous septal graft is technically simple and relatively free of complication. Long-term evaluations show no absorption of grafts and preservation of desired shape.

Objective To introduce a new method of recombinative repair for the old malunion of the fracture of nasal bone. Methods Since 1996.5 to 2001.12, this technique was performed in 28 patients, 23 men and 5 women, with a range of 18～45 years, a mean age of 29 years. The nasal skin was protected with a rubber pad, and malformed nasal bones were beat out with a small hammer, so as to create a new refracture, then manual reduction was performed with finger and the septal periosted elevator. Results Follow-up ranged from 3 months to 5 years. Of all the patients, 23 cases were cured, 5 cases improved, and the overall effective rate was 100 %. Most of them were satisfied with the successful operation. Conclusion The operative procedure of recombinative repair is technically simple and easy, and the patients suffer little. It is an update and efficacious therapeutic method.

The myocardial protection technique of off-pump coronary artery bypass grafting ( OPCABG ) has been applied to the coronary artery bypass grafting (CABG) with heart valve surgery.This study is aimed at determining its clinical effect .A retrospective analysis design was adopted .39 patients were recruited .All patients ’ surgeries went smoothly but one ,whose blood pressure was in poor control after surgery and then returned to normal after as -sisted with intra-aortic balloon counterpulsation (IABP).Others had stable vital signs and circulation .Finally,all pa-tients discharged safely .Significant improvement can be seen during 3 months’ follow-up.Applying OPCABG to CABG with heart valve surgery has been proved effective in clinic .

Objective To explore the effect of elbow release and debridment with arthroscopy for elbow malfunction. Methods The study was carried out on 15 patients (male 11, female 4; age 21-63 years old, average 40.1 years old) with the use of arthroscopy to brisement accretion and articular capsule from August 2001 to December 2003. The mean course was 55.2 months (range, 8-24 months). The flexion angle of joint preopration was 15?-60?, average 30.4?, the extension angle was -80?--20?, average -51.2?. The diagnosis was osteophyma and liberum in 4. The old fracture of radius capitulum was in 2; the old fracture of ulnar olecranon in 2; the old fracture of condyle of humerus in 3; degeneration in 4. The brachial plexus anesthesia,the elbow hung to traction, interna and extra-pathway, to cut synovium and accretion fibers with shver, removal liberum and milling osteophyma, meanwhile brisement articular capsule. Pathology manifestation in arthroscopy: there were a lot hyperemia synovium and fiber accretion. There was cartilage exfoliation in 8, hyperplasy and liberum in 5, ossification of cicatricle in 2. The motion range of elbow was reexamined, if the extension function was restricted, release was performed on anterior soft tissue and capsule. If the flexion function was restricted, release was carried out on posterior capsule via posterior straight approach(3 cm supra point of olecranon). Results All patients recovered daily life and occupation postoperative 7 to 14 days. Transient ulnar nerve paralysis occurred postoperatively in one case, which recovered three months later. There were no blood vessel and nerve injury. The mean follow-up period was 14.1 months (range, 7-20 months). At the final follow-up, the flexion of joint post operation was 70?-120?, to improve average 60.5?; the extension of joint post operation was -20?--5?, to improve average 37.6?. In accordance with HSS scoring system, excellent 7, good 5, fail 3. Conclusion Using of arthroscopy to release elbow joint have many advantages such as less trauma, quick recovery and less sequela. The application in release with arthroscopy is a good way for elbow malfunction.

Objective To investigate the change in heat shock protein 70(HSP7O) in the brain tissue of fetal and newborn rats after prenatal hypoxic adaptation and the possible mechanism of the protective effect. Methods Twenty-two 22d pregnant Wistar rats were randomly divided into two groups: GroupⅠ(hypoxic adaptation group) and group Ⅱ(control group). The animals in group Ⅰ were placed in a tightly closed hypoxic adaptation chamber, of which the oxygen and carbon dioxide concentrations were monitored. The pregnant rats were taken out and exposed to fresh air for 5 mm when the 02 % in the chamber was reduced to 15 %, then the pregnant rats were placed back in the chamber and the above process was repeated once. The animals were then left for their natural labor. In control group the pregnant rats underwent the same process but the chamber was not tightly closed(O2 %= 21 %). Prenatal rats were delivered by cesarean section at lb. 3h, 8h, 24h, 48h, 72h, 120h and 168h after hypoxic adaptation and decapitated and brain was removed. Seven newborn rats from each group were decapitated and brain was removed for determination of HSP70 expression with immunohistochimical technique. Results No HSP7O expression was observed in the brain tissue of normal prenatal and newborn rats. HSP70 was observed in the different regions of hippocampus and cortex from 8h to 168h after hypoxic adaptation. Strongest HSP70 expression was observed in hippocampus CAl . Conclusions HSP70 plays a role in the formation of prenatal hypoxic adaptation.