The paper stated several typical problems in the medical charges,such as be short of considerate service,low quality but high price, abuse expensence medicine etc. the author forther proposed some countermeasures including respection to patient's health and making facts, right,implement of standardization manag ement by Health Ministry,enhanuing moral eductation and marco-controlling the price of medicines, etc. Only through theoe counfermeasures,may health service have more full emotional and humanisium spirit.

Prophylactic cranial irradiation is an effective means of dealing with brain metastasis of cancer,which can reduce the incidence of brain metastasis by killing the micrometastasis and then improve the prognosis.The effectiveness has been verified in small cell lung cancer,but the application is still in the exploration in non-small cell lung cancer (NSCLC) and breast cancer.Prophylactic cranial irradiation is expected to become the conventional treatment for patients with NSCLC of ⅢA-N2 stage after operation and adjuvant chemotherapy or breast cancer of epithelial growth factor receptor-positive after receiving trastuzumab.

OBJECTIVE:To study the mechanism of Cassia obtusifolia L in decreasing blood-lipid.METHODS:Primary cultures of rat hepatocytes in vitro were used to determine the concentrations of proteins in hepatocytes by the method of Folin-phenol reagent and to assay the cholesterol synthesis from 14 C-acetate with liquid scintillation count.RESULTS:Ex?tract of Cassia obtusifolia L inhibited cholesterol synthesis from 14 C-acetate,but cassiaside B didn't affect cholesterol synthe?sis.CONCLUSION:The mechanism of extract of Cassia obtusifolia L in decreasing blood-lipid may result from inhibition of cholesterol synthesis,but inhibiting cholesterol synthesis may be not the main approach of cassiaside B in decreasing blood-lipid.

Objective To investigate the effects of unilateral stellate ganglion block (SGB) on the expression of heat shock protein 70(HSP70) in bilateral hippocampus and temporal lobe induced by global cerebral ischemia-reperfusion in rabbits. Methods Twenty-eight healthy Japanese long-ear rabbits of either sex weighing 2.5-3.0 kg were anesthetized with intravenous 1.5% pentobarbital, intubated and mechanically ventilated. Global cerebral ischemia was produced by clamping bilateral external and internal carotid arteries and vertebral arteries for 10 min. Global cerebral ischemia was confirmed by blanching of lips and conjunctival, respiratory and EGG changes. The arteries were then declamped for reperfusion. The animals were randomly divided into 4 equal groups ( n = 7) : SGB group, NS control group, blank control group and sham operation group. In SGB group left stellate ganglion was blocked by 0.25% bupivacaine 0.5 ml injected through an epidural catheter with its tip placed close to left stellate ganglion when reperfusion was started followed by continuous infusion of 0.25 % bupivacaine at a rate of 0.5 ml ? h -1 . SGB was confirmed by ptosis and miosis. In NS control group normal saline was used instead of 0.25 % bupivacaine. In blank control group no medication was give. In sham operation group the six arteries were exposed but not occluded. The HSP70 expression in the neurons in hippocampus CA1 section and cortex of temporal lobe was detected by immunohistochemistry using an antibody specific for HSP70 30h after reperfusion was started. Results HSP 70 expression in bilateral hippocampus CA1 section and cortex of temporal lobe was significantly lower in SGB group compared with the two control groups ( P 0.05) . Conclusion Left SGB can depress the over-expression of HSP 70 in bilateral hippocampus and temporal lobe induced by global cerebral ischemia-reperfusion.

Objective To investigate formalin-induced nociceptive behavior and c-fos expression of interbrain following stellate ganglionic block (SGB) in rabbits. Methods Catheters were inserted closely to right stellate ganglia in rabbits by operation.One week later,twenty-four rabbits were randomly divided into three groups, each group containing 8 animals. groups A,B and C received 0.5ml of normal saline,3% formalin and 3% formalin stimulation by intraplantar injection , respectively. 10 minutes before stimulation,0.5 ml of 0.25% bupivacaine was administered via the catheter in group B, while in groups A and C 0.5 ml of normal saline was applied. Nociceptive behavior was observed for 1 hour using weighted pain score. 2 hours after stimulation, whole interbrain was removed to immunohistochemically detect the expression of c-fos. Results Formalin-induced nociceptive behavior in phase 2 was relieved following SGB, c-fos expression level of hypothalamus in group B was significantly lower than that in group C(P0.05). Conclusion SGB could relieve formalin-induced nociceptive behavior, and downregulate formalin-induced c-fos expression of hypothalamus, which may be related to the mechanisms of SGB for the treatment of inflammatory pain.

Objective To compare the effects of propofol intravenous balanced anesthesia with infusion of remifentanil combined with fentanyl to simple infusion of remifentanil or fentanyl during laparoscopic cholecystectomy(LC).Methods Sixty patients scheduled for LC were randomly divided into three groups(n=20): simple remifentanil group(R),remifentanil combined with fentanyl group(RF) and simple fentanyl group(F).Mean arterial pressure(MAP),heart rate(HR) and SpO2 during the anesthesia induction phage,maintenance phage and analepsia phage,the recovery time of spontaneously breathing and consciousness from withdrawal,extubation time,pain score(verbral report score,VRS) and conscious state score(observers assessment of alertness/sedation scale,OAAS) at instant,1 h,3 h,7 h,12 h after extubation and complications of analepsia phage were recorded.Results As compared with the RF Group,the F Group and pre-induction intro-group,the R Group showed lower MAP and quicker HR when induction intubation,higher MPA and quicker HR after operation,and no obvious difference in maintenance phage was found.MAP and HR showed no obvious difference between the RF and F Group as well as within groups in induction and maintenance phage.MAP increased and HR became quicker in the RF Group when extubating and leaving operating room.All observed index at every time showed no significant differences between the R and RF Group after operation,but it prolonged significantly in the F Group.Complications of the three groups showed no statistical difference.VRS of the R Group was significantly higher than that of RF and F groups after operation(P

Sixty-eight patients with pneumoconiosis combined with chronic obstructive pulmonary disease underwent large volume lavage in one lung under double cavity tracheal intubation and intravenousinhalant anesthesia. The vital signs of patients were recorded before, 10, 30min after and at the end of lavage. Results showed that the vital signs were stable during the lavage; and after the lavage all patients had relief significantly from the symptoms of dyspnea, polypnea and cough. Our results indicate that general anesthesia with bilateral lung ventilation are a safe and effective method in large volume whole lung lavage for treatment of pneumoconiosis patients combined with chronic obstructive pulmonary disease.

Objective To investigate the role of NF-κB pathway in the development of intrathecal(IT)platelet-activating factor (PAF)-induced hyperalgesia in rats. Methods Sixty-four male SD rats (200-250 g) in which intrathecal catheters were successfully implanted without complications were randomly divided into 6 groups:group Ⅰ received artificial cerebro-spinal fluid (ACSF) 10 μl IT (n = 16); group Ⅱ received PAF 10 μg in ACSF 10 μl IT; group Ⅲ received 0.1% DMSO 2 ml intraperitoneally (IP) (n = 8); group Ⅳ, Ⅴ, Ⅵ received IP SC-514 (a selective IKK-β inhibitor) 10, 50, 100 mg/kg in 0.1% DMSO 2 ml respectively at 2 h before IT PAF. Paw withdrawal threshold to mechanical stimulation (PWMT) and paw withdrawal latency to thermal stimuli (PWTL) were measured before (baseline) and at 5, 15, 30, 45, 60 min and then every 30 min for another 4 h after IT administration. The animals were killed after the last pain threshold measurement at 5 h after IT PAF. The lumbar segment (L4-6) of the spinal cord was removed for determination of TNF-α and IL-lβ content (by ELISA).Results lntrathecal PAF induced tactile allodynia and thermal hyperalgesia rapidly, increased the expression of TNF-α and IL-lβ in lumbar spinal cord. Pretreatment with SC-514 attenuated PAF-induced hyperalgesia and inhibited the increase in TNF-α and IL-1β expression in the spinal cord. Conclusion NF-κB is involved in intrathecal PAF-induced hyperalgesia.

The design aims at improving and enriching nurturance theories and practice paradigms related with medical students' doctor-patient communicating competence.It is based on the view about cultivating and evaluating undergraduates' doctor-patient communicating competence and the theoretical basis about the existing research achievement and follows teaching practice regular pattern.Doctorpatient communicating competence of undergraduates has its own multidimensional meanings.Construction methods are as follows:taking one course as the core; enrolling multidimensional discipline in classroom teaching; combining classroom teaching with varieties of practice; establishing medical case communication training model; introducing appropriate evaluation system.Its construction principles should be found on the humanistic essence.

ObjectiveTo investigate the role of Nav1.7 in dorsal root ganglia (DRG) in a rat model of diabetic neuropathic pain (DNP).MethodsThirty-two female Wistar rats aged 3 months weighing 180-220 g were randomly divided into 4 groups ( n ＝ 8 each):control group ( group C),sham operation group ( group S),DNP group and ProTx- Ⅱ (a selective Nav1.7 blocker) group (group E).Diabetes mellitus was induced by intraperitoneal streptozocin 65 mg/kg.Blood glucose level and mechanical paw withdrawal threshold (MWT)to von Froy filamentstimulation were measured 2 weeks later.DNP was confirmed by blood glucose level ≥ 16.0 mmol/L and MWT decreased by more than 50％ of the baseline value.Intrathecal catheter was implanted at L5,6 interspace on day 10 after successful induction of DNP.On day 4 after placement of the intrathecal catheter,ProTx- Ⅱ 10 μg/kg was injected intrathecally in group E,while the equal volume of normal saline was given in groups DNP and S.MWT and never conduction velocity (NCV) were measured 1 h after intrathecal injection.The rats were then sacrificed and DRGs of the lumbar segment (L4-6) were removed for determination of Nav1.7 protein expression (by immuno-histochemistry and Western blot) and Nav1.7 mRNA expression (by RT-PCR).ResultsThe MWT and NCV were significantly lower and the Nav1.7 mRNA and protein expression was significantly higher in groups DNP and E than in group C.ProTx- Ⅱ significantly attenuated the diabetes-induced changes in MWT,but had no effect on NCV and Nav1.7 mRNA and protein expression.ConclusionNav1.7 in DRG is involved in the maintenance of DNP in rats.