This paper firstly introduces the perspectives of medical ethics moral imagination, then illustrates the specific connotation of the medical students moral imagination:moral sensitivity, perspective transformation, situat-ed cognition and beyond and moral reflection and evaluation ability, finally analyzes the narrative method based class to cultivate the medical students moral imagination, the narrative is to cultivate the medical students moral i-magination again the main teaching method.

Objective To discuss the value of spiral CT portography(SCTP) in diagnosis of liver diseases.Methods SCTP was performed in 81 cases suspected with liver diseases,SCTP of hepatic lesions and collateral pathways of portal vein were observed.On reconstruction axial images,the minor calibers of portal vein and splenic vein were measured.Results SCTP could exactly locate and diagnose the hepatic lesions, the portal venous system could be distinctly displayed by SCTP; in cirrhotic cases, main portal vein and splenic vein were dilated(?

Objective To study the inner diameter and hemodynamics of ophthalmic artery(OA)and central retinal artery(CRA)in hyperuricemia by Enhance-flow(eFlow)imaging and spectral Doppler.Methods One hundred and one patients with hyperuricemia and 30 volunteers were selected,the inner diameter in eFlow imaging and the peak systolic velocities(PSV),the end diastolic velocities(EDV),the resistive index(RI)were measured,and pulsatility index(PI)of OA and CRA were measured by spectral Doppler.The 101 patients were divided into two groups according to the time of diagnosing hyperuricemia,one group had a diagnosis of hyperuricemia for more than five years and the other had such a diagnosis for less than five years.The data were compared by t-test.Then,the patients were further divided into a group of hyperuricemia combined with hypertension and the other without hypertension.The differences between the experimental group and the group of volunteers were carried out by One-way ANOVA,the comparison between two groups were analyzed with SNK.Results The RI(0.68±0.09)and PI(1.3±0.4)of OA in patients who were diagnosed as hyperuricemia for more than 5 years was higher[RI:0.63±0.09,PI:1.1±0.3(t=3.504,P=0.001 ;t=3.164,P=0.002)],the EDV[(6±3)cm/s]of OA was lower than those patients with a diagnosis of hyperuricemia for less than 5 years[(8±5)cm/s,t=1.988,P=0.049].The PSV[(11.5±3.5)cm/s]and EDV[(3.7±1.1)cm/s]of CRA in hyperuricemia combination hypertension group was lower,and the RI (0.88±1.40)was higher than hyperuricemia without hypertension group[PSV:(13.5±4.0)cm/s,EDV:(4.1±1.2)cm/s,RI:0.67±0.08].Conclusion By eFlow and spectral Doppler,we have found that hyperu-ricemia could accelerate OA and CRA atherosclerosis.The eFlow and spectral Doppler are valuable methods to study the hemodynamics in ophthalmic artery of patients with hyperuricemia.

Objective To evaluate the efficacy of Xuebijing injection plus oral acitretin for the treatment of erythrodermic psoriasis.Methods Forty-eight patients with erythrodermic psoriasis were equally and randomly divided into two groups by a random number table:test group treated with Xuebijing injection once a day plus oral acitretin,and control group treated with oral acitretin.The dose of acitretin began at 0.5 mg per kilogram per day,and was modified according to the tolerance in and response of patients.After 8 weeks of treatment,clinical efficacy was evaluated by psoriasis area and severity index (PASI) score,response rate and recurrence rate.Adverse reactions were also recorded and evaluated.Results The difference in PASI score between pre-and post-treatment was significantly higher in the test group than in the control group (34.9 ± 2.2 vs.27.3 ± 1.7,t =3.37,P ＜ 0.05).The total response rate was 87.5％ in the test group and 62.5％ in the control group (x2 =4.87,P ＜ 0.05).There was a statistical decrease in the average onset time ((13.5 ± 2.4) d vs.(20.7 ± 3.1) d,t =3.67,P ＜ 0.05),daily dose and total dose of acitretin ((26.4 ± 3.3) mg vs.(34.7 ± 3.5) mg,(1854.5 ± 85.2) mg vs.(2768.8 ± 88.7) mg,t =3.07,4.32,respectively,both P ＜ 0.05) in the test group compared with the control group.The recurrence rate was 9.5％ (2/21) in the test group and 26.6％ (4/15) in the control group (x2 =5.23,P ＜ 0.05).Conclusion In the case of erythroderma psoriaticum,Xuebijing injection combined with oral acitretin is superior to oral acitretin alone in clinical efficacy,onset time and reducing recurrence.

Objective To study the effect of various methods determining lung volume and fraction dose on the lung dose-volume parameters for lung cancer patients. Methods Twenty patients with lung cancer were rantdomly enrolled into our study and the plan of three dimensional eonformal radiation therapy(3DCRT)was designed by Varian Eclipse TPS.The lung volumes and the dose-volume parameters were measured under CT value of-300- -980, -400- -980 and -500- -980.Under CT value of -400- -980,total lung volumes were confirmed.The dose-volume parameters of V30,V20,V10 and mean lung dose(MLD)were reevaluated after GTV,CTV and PTV were subtracted from the total lung volumes and when the fraction dose was elevated from 2.0 Gy to 10.0 Gy. Results When the CT value ranged from-300--980 to-500--980,the median reduction of the total lung volumes(-9.10%)was significantly higher than that of V30,V20,V10 and MLD(-3.18%,-1.13%,0.82%and-0.79%,respectively).When the total lung volume was fixed at CT value of-400--980,the alterations of V30,V20,V10 and MLD became more apparent as the increase of the subtracted lung volume,among which the alteration of V30 was most significant while V10 the least.Among five cases with a fixed total dose of 60 Gy and PTV less than 140 cm3,the V30,V20,V10 and MLD were increased to a similar extent(about 40%)when the fraction dose was increased from 2.0 Gy to 10.0 Gy.MLD was increased(36%)when the fraction dose was above 6.0 Gy. Conclusions When CT value ranges from-300- -980 to-500- -980,the total lung volume is influenced most.The alteration of V30,being statistically significant,might have some significance but is not enough to determine the plan of radiotherapy clinically.The alteration of V20、V10 and MLD is not statistically significant.When the overlapped target volume is subtracted from the total lung volumes,the alteration of V30 is the most sign:tifhcant while V10 the least.The fraction dose,being the most consuming factor(＞10%)when comparing with the CT valHe and targeted volume,can significantly influence the dose-volume parameter.

Objective To explore the role of interleukin (IL)-1β in the pathogenesis of gout.Methods Real-time quantitative polymerase chain reaction (RT-qPCR) and enzyme-linked immunosorbent assay(ELISA) were used to measure the expression of IL-1β mRNA in peripheral blood mononuclear cells (PBMCs) and IL-1β in plasma samples from 120 acute gouty (AG) arthritis,70 chronic gouty (CG) arthritis,80 intercritical gouty (IG) arthritis patients and 96 healthy control subjects respectively.Results The expression of PBMCs IL-1β mRNA and plasma concentration of IL-1β were both much higher in gout patients than those in controls (P ＜ 0.01,respectively).And the plasma levels of IL-1β mRNA and IL-1β significantly increased in the AG group compared with CG and IG groups (P ＜ 0.01,respectively) and much higher in the CG group than those in the IG group.Positive correlations existed between plasma concentration of IL-1β and the levels of white blood cell,neutrophil,monocyte,erythrocyte sedimentation rate,blood uric acid,globulin and PBMCs IL-1β mRNA (P ＜ 0.01,respectively) while negative correlation between plasma IL-1β and plasma level of apolipoprotein in gout patients (P ＜ 0.05).Conclusion Elevated plasma level of IL-1β may be involved in the pathogenesis of acute and chronic gouty arthritis.

Objective To compare the results of CT/MRI registration by using two different marker materials. Methods CT and MR transversal images (using electric wire and thin tube filled with lohexol injection as matching points respectively) were obtained from nine cases with brain tumor. Another CT and MR transversal images were also obtained by using the cod-liver oil capsule filled with gadopentetate dimeglumine injection as matching points with the same scanning position. The images were transferred to the TPS for image registration and the effect was evaluated. Results The CT/MRI CRE range for using different kinds of marker material was 0.16-0.28cm,while was 0.06-0.16cm for using the same marker material. Conclusion Comparing with the method using different kinds of material,the method using the same spherical material can get better results in CT/MRI registration.

AIM: To prepare Nano-Liposome encapsulated MAGE3/HSP70(NL M3H) and study its character and antitumor immunity in mouse. METHODS: NL M3H was prepared by the thin film-dispersion ultrasonic. The shape and size of NL M3H were detected by electron microscope. The encapsulation rate, drug-carrying capacity, stability and the releasing character were tested by Sephedex-G100 gel filtration. The mouse was immunized by NL M3H, and the antitumor immunity was detected by ELISPOT and LDH release assay. RESULTS: The mean size of NL M3H was lower than 100 nm. The encapsulation rate was 38％.The drug content was 0.038 g/L. NL M3H has good stability after stored in 4℃ for 6 months. The releasing profile showed that 74 percent of proteins was released during the first 24 hours in saline. The results of ELISPOT and LDH release assay showed that NL M3H generated tumor specific cytotoxic T lymphocyte(CTL)to damage tumor cel1. CONCLUSION: NL M3H has novel characters, it can generate specific CTL to kill tumor cell, and can be used as new kind of vaccine agsinst tumor.

Objective To investigate the association of TLR4 gene polymorphisms with susceptibility to primary gouty arthritis (GA) in Chinese Han population.Methods A total of 459 patients with GA and 459 healthy control subjects were enrolled into this study.All the genotyping assays of TLR4 gene polymorphisms loci [rs4986790 (Asp299Gly),rs4986791 (Thr399Ile),rs2 1 49356T＞G] were measured using TaqMan probes that specifically target the alternate alleles.Results All the subjects were found to be homozygous for the wild-type TLR4 alleles (Asp/Asp,Thr/Thr) on TLR4 Asp299Gly and Thr399Ile genotyping.There was no significant deviation from HWE both in GA and controlsin the rs2149356 (x2=0.778,1.295; P＞0.05,respectively).Significant differences were observed between the GA and control groups with respect to genotype and allele frequencies of TLR4 gene rs2149356 (x2=16.23,17.08; P＜0.01,respectively),and TT genotype was the risk factor for gout (adjusted OR=2.09).Conclusion The TLR4 gene rs2149356 SNP may be associated with GA susceptibility,and TT genotype may be the risk factor for developing gout.

Objective To investigate the role of adiponectin (ADP) and its receptors (ADR) in pati ents with primary gouty arthritis (GA).Methods Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of plasma ADP in 88 GA and 80 healthy controls (NC).Real time quantitative polymerase chain reaction (RT-qPCR) was employed to study the expression of ADR1 and ADR2 mRNA in peripheral blood mononuclear cells (PBMCs).The biochemical indicator of TG,HDL,LDL,VLDL,apoA1,apoB100 and uric acid (UA) were detected at the same time.T test,Spearman's correlations and regression analysis were used for statistical analysis.Results The concentration of plasma ADP was significantly lower in GA than that in NC [(6±7) μg/ml,(8±6) μg/ml,t=-3.71,P＜0.01 ],the expression of ADR1 and ADR2 mRNA in GA (ADR1:0.09±0.08,ADR2:0.0122±0.0164) was significantly increased when compared to the NC (ADR1:0.05±0.03,ADR2:0.0054±0.0024) (t=2.71,2.35,P＜0.05).In the GA patients,the level of ADP was negatively correlated with the lymphocytes count (LY) and UA (r=-0.32,-0.36,P＜0.05),and it was positively correlated with ESR and LDL level (r=0.31,0.39,P＜0.05).The expression of ADR1 mRNAwas negatively correlated with TG (r=-0.43,P＜0.05 ),but positivdy correlated with ESR and CRP level (r=0.45,0.57,P＜0.05).The expression of ADR2 mRNA was negatively correlated with glucose and UA(r=-0.50,-0.59,P＜0.05).Conclusion Altered expression of ADP and its receptors may be involved in thepathogenesis of gouty inflammation.