The doctor-patient relationship is always the focus in the society. The relationship seems more complex and sensitive in the pediatric surgical ward because its patients are kids. However, the pediatric surgical residents' ability of doctor-patient communication is lack of systemic and norma-tive training, which is not good for the mutual understanding between doctors and patients. This study explores how to enhance the residents' doctor-patient communication skills from the perspective of awareness, professional knowledge and some specific skills. In the meantime, it discusses the need to train the teachers and set up a regular examination-assessment system.

Abstract BACKGROUND: Recently, microcarrier culture as a high concentration cel culture technology has been used in hepatocyte culturein vitro. OBJECTIVE:To periodicaly observe the morphological changes of human hepatocyte L-02 cultured by the spherical porous chitosan microcarrier. METHODS:The self-made spherical porous chitosan microcarrier sample as a support to culture human hepatocytes L-02 acted as experimental group; non-spherical porous chitosan microcarrier as a support to culture human hepatocytes L-02 as control group. Cels in two groups underwent cel count at regular time, and the morphological changes were observed in the experimental group, including inverted phase contrast biological microscope observation and scanning electron microscope observation. RESULTS AND CONCLUSION:The quantity of cultured cels in the two groups was increased in the first 3 days and reached the peak at the 3rd day. The cel quantity in the experiment group was obviously higher than that in the control group (P < 0.05). There was no significant difference in the three samples of the experimental group (P > 0.05). The quantity of hepatocytes adhered to the microcarrier surface was gradualy increased in the former 3 days under the inverted phase contrast biological microscope. There were lots of cel clusters on the surface of a greater part of microcarriers, with the total survival rate of more than 90%, and hepatocytes kept a good morphological structure. Under the scanning electron microscope, lots of hepatocytes adhered tightly to each other on the surface and section of microcarrier as wel as inside the microcarrier. It is indicated that the self-made spherical porous chitosan microcarrier as a support in three-dimensional environment can undergo cel culture with high concentration.

Objective To investigate the relationship between Clq/tumor necrosis factor (TNF)-related protein 9 (CTRP9)and coronary heart disease.Methods A total of 232 patients diagnosed with coronary heart disease(CHD)by coronary angiography at our hospital were selected as the CHD group,and 90 cases with normal coronary angiography served as the control group.The double antibody sandwich enzyme-linked immunosorbent assay(ELISA)was used to determine serum CTRP9 levels.Results Serum CTRP9 levels were lower in the CHD patients than in the controls [(116.9±19.5)ng/ml vs.(142.3±17.9)ng/ml,t＝-5.404,P＝0.000].SerumCTRP91evelswere negatively correlated with body mass index,fasting plasma insulin,fasting blood glucose,insulin resistanceindex(IRI),triglyceride and TNF-α(r＝-0.230,-0.225,-0.267,-0.235,-0.230and-0.222,P＝0.017,0.011,0.002,0.010,0.011 and 0.022).Multiple logistic regression analysis revealed that uric acid,IRI,CTRP9,and TNF-α were independent influencing factors for CHD,of which CTRP9 was a protective factor for CHD occurrence(OR ＝ 0.907,95％C1:0.854～0.963,P＝ 0.001).Conclusions Decreased serum levels of CTRP9 are associated with coronary heart disease,indicating that CTRP9 may play a protective role in coronary heart disease occurrence.

Objective　To evaluation the application value of two-phase enhanced spiral CT in pancreatic adenocarcinoma. Methods　Two-phase enhanced spiral CT was performed in 27 cases of pancreatic adenocarcinoma. After plain CT examination, performed arterial phase（25s after infusion）and portal venous phase（60～70s after infusion）with a 150ml bolus injection of contrast material at 3ml/s. CT attenuation values of tumor and normal pancreas in all scanning phase were obtained and the tumor-pancreas contrast was calculated. Results　Mean tumor enhancement were 48±8 HU（arterial phase）and 72±6 HU（portal venous phase）, normal pancreas enhancement were 125±18 HU、98±11 HU, mean tumor-pancreas contrast was significantly differenced on arterial phase （73±21 HU）and portal venous phase （25±12 HU）. Conclusion　Excellent tumor-pancreas contrast is obtained with arterial phase scans, as such it is of significance reference value for diagnosis pancreatic adenocarcinoma.

The differential diagnosis of inguinal and scrotal emergencies in children is difficult and misdiagnosis might be associated with danger or even mortality.Early diagnosis and proper treatment are very important and explorational surgery should be carried out when diagnosis is in doubt.

Objective To explore the occurrence and prevention and the principle of management of chylous fistula after neck dissection. Methods Retrospective research on 1750 cases of neck dissection in Henan Tumor Hospital from January 1983 to January 2005. There were 48 cases chylous fistula and 1 case chylothorax. The incidence was 2.8 %. 5 cases on the right, 44 cases on the left. 18 cases had completed radiotherapy or chemotherapy before operation. Conservative methods and surgical methods were used in the treatment. Low fat food was supplied to the patients with chylous fistula. The conservative methods was local pressure, the surgical methods was applied while maximal production of chylous exceeding 500 ml a day. Results All the patients were cured finally. The conservative method was 12.6(5~34) days, the surgical method 7.5(3~10)day. Conclusion The key to prevent chylous fistula was to band the rupture of thoracis or lymphatic duct during operation. The conservative methods could be used in patients with slight and middle chylous, when the chylous exceed 500 ml a day or the conservative methods was unavailable, the surgical methods was appropriate, it could shorten the time of tube draw.

Exosome is a sort of vesicle structure attached to cell membrane and released by cells, which contains numerous bioactive molecules, such as proteins, lipids, mRNA, microRNA and DNA fragments. These bioactive molecules are involved in the regulation of many biological processes, not only the participation in the occurrence and development of diverse diseases, but also the close relationship with the invasion and metastasis of tumors. The recent study has indicated that lots of exosomes released from cancer cells participate in a variety of pathological processes as a messenger of cell functions. This article will elaborate the function and application of exosomes in some malignant cancers.

Medical students′ professional spirit cultivation is an important content as well as a basic require-ment of the Preeminent Doctor Education and Training Plan. Currently, there are several problems in medical tal-ents′professional spirit cultivation, such as the unstandardized curriculum, the lack of subjective experience, and the ignorance of the unity of education stages, student differences and coherence. This study intends to explore thedouble teacher method, in which both clinical teaching doctors and medical ethics teachers engage in the medi-cal students′professional spirit cultivation. Its purpose is to build a bridge between medical ethics education in uni-versities and the clinical practice, and further to integrate them through doctors′ and teachers′ joint participation, which will significantly enhance medical students′practice ability of medical moral.

College of American Pathologists (CAP) and International Standard Organization (ISO)15189 accreditation provides requirements to the verification and validation tests for clinical molecular diagnostic assays.The article will introduce the requirements in these aspects including the differences between the two accreditation systems,the differences between the verification and validation tests,the essential factors and standardized framework of the verification and validation tests for clinical molecular diagnostic assays.

10.3969/j.issn.2095-4344.2013.25.018