Objective To discuss the influence of pudendal nerve block anesthesia on pain degree and labor course when presentation at different positions during the second stage of labor,in order to find the better anesthesia timing and method to reduce pain,shorten labor,increase maternal comfort to a maximum extent and provide the best service for the maternal.Methods 200 cases of primiparas with fullterm and single-birth were selected and numbered randomly,patients with odd numbers were set to the observation group,patients with even numbers were set to the control group,100 cases in each group.In the observation group,when the presentation reached S+1,1％ lidocaine was used to perform pudendal nerve block anesthesia.In the control group,the pudendal nerve block anesthesia was performed before perineal incision.Results The pain intensity,time of the second labor stage,perineum damage degree between the two groups were statistically different.The observation group with Ⅱ-grade level,Ⅲ-grade level pain were 32 cases less than that of the control group.The perineum incision later crack number in the observation group was 24 cases less than that of the control group.The number of delivery within 1 hour in the second labor process in the observation group was 21 cases more than that in the control group.Conclusions Implementation of bilateral pudendal nerve block anesthesia in the second stage of labor when the presentation reaches S+1 can alleviate childbirth pain,shorten the second stage of labor,reduce the degree of perineal trauma.

Chi-pulse diagnosis is a kind of pulse diagnosis by only feeling Chi part of pulse.This method focuses on inborn Yin-yang,fire-water,and growth and decline of kidney essence,emphasizes on the physiological and pathological changes of eight extra meridians and extra viscera,clarifies and expands the content of narrow sense of yin-yang method.Chi-pulse diagnosis is prone to guided by the spot pulse feeling,do not limited by regular pulse name,and has special pulse diagnose experience and fixed knowledge of formula prescription.

Laparoscopic surgery has been adopted for the treatment of gastric cancer in recent years around the world.New advances in these techniques have been achieved. This paper provides an overview of the clinical outcome of laparoscopic surgery for early gastric cancer and advanced gastric cancer,the application of laparoscopy-assisted pylorus-preserving gastrectomy,the technical characteristics of laparoscopy-assisted total gastrectomy,the values of single-incision laparoscopically assisted surgery and the application status and prospect of robotassisted laparoscopic gastrectomy for gastric cancer.

Objective To evaluate the reliability and validity of the Chinese version of job satisfaction scale in order to supply quantitative tool for evaluation of nurses" job satisfaction degree. Methods 336 nurs-es from 14 general hospitals were tested with Chinese version of job satisfaction scale and analysis was carried out for reliability and validity according to the test result. Results The total Cronbach's α coefficient of Chi-nese version of job satisfaction scale was 0.901, Cronbach's α coefficient range of every dimension was 0.732～ 0.921, re-test reliability was 0.832, 9 factors were extracted through factors analysis and they explained 59.57%of the overall variance. Conclusions Chinese version of job satisfaction scale has good reliability and validi-ty, it can be used in evaluation of nurses' satisfaction degree preliminarily.

Fu biao who got an advanced liver cancer had undergone liver-transplantation twice and died at last,which raises great ethical concern.With respect to distribution,there are four substantial distributive principles,including the principle of equality,the principle of need,the principle of contribution,the principle of effort.When allocating scarce health-care resouses,medical criteirion should be considered firstly the equality of everyone's life.Furthermore,the principle of utility and equality should be embodied for ensuring distributive justice.

Calcium-sensing receptor(CaSR) is a widely distributed G-protein coupled receptor.The activated CaSR plays an important role in many kinds of signaling pathway regulation, such as Ca2+ signaling pathway.It not only maintains the body calcium balance, but also is involved in the regulation of a variety of cell secretion, proliferation, apoptosis, and ion channel opening processes.CaSR expression is involved in stem cell migration, adhesion and homing in hematopoietic stem cells and mesenchymal stem cells.The activated CaSR also regulated the function of itself and characteristics in stem cells through a variety of cell signaling pathways.We introduce the functions and characteristics of CaSR, the relationship between CaSR and disease, and review the effects of the biological characteristics on hematopoietic stem cells and mesenchymal stem cells.

Objective:To investigate the effect of Luteolin on the degranulation function of RBL-2H3 mast cells and its mechanism of action.Methods:DNP-BSA-IgE was used to establish the sensitized cell model in RBL-2H3 cells.Cell viability was exa mined by MTT assay at different concentrations (5,15,25 μmol/L) of Luteolin pretreated RBL-2H3 cells.The effect of Luteolin on β-hexosa minidase(β-hex) and TNF-αwas evaluated by ELISA.The change of Ca2+influx was detected by Flou-4AM calcium ion fluorescent probe.The expression of AKT and P-AKT were detected by Western blot.Results:The sensitized cell model was established successfully .Cell viability had not significantly changes stimulated by different concentrations of Luteolin ,and a significantly inhibition role showed the release of β-hex and TNF-αfrom RBL-2H3 cells.The concentration of intracellular Ca 2+ was significantly decreased.However,the Western blot results showed that the level of Phosphorylation AKT was decreased .Conclusion: Luteolin suppress RBL-2H3 cell degranulation in dose dependence ,which may via impacting the Ca2+influx and the activity of AKT.

Three Modules and Three Stages proposed by guidelines on college English teaching that will be issued by the Ministry of Education gives direction for college English teaching.Through the investigation of the students' cognition and learning of English curriculum,combined with the teaching experiment,the new system of English curriculum,which reflects the characteristics of medical colleges and universities,has been preliminarily established,aiming at cultivating medical students' comprehensive English abilities in medical study and career development.Considering students' language abilities in different stages,college English curriculum can be designed in three modules,that is,English for general purpose (EGP),English for academic purpose (EAP) and intercultural communication,in three stages,that is,the basic stage,the improvement stage,and the development stage.The practice shows that the new curriculum system can promote the interaction,reform and development of teachers,teaching teams and Foreign Language Department.

[Summary] Gender difference study of meniscus injury shows certain clinical significance in understanding epidemiologic characteristics of meniscus injury .Several large amount case studies demonstrated that the risk of meniscus tears was significantly higher in male than in female .However , in certain kinds of sports and special types or locations of meniscus tears , especially in medial meniscus posterior root tear ( MMPRT ) , there were more females than males .Further large amount case studies were needed for a deeper understanding of meniscus tears .In this paper,we reviewed the current situation and progress of gender difference of menisus tear .

Da Vinci robotic surgical system have some advantages of defibrillation,three-dimensional (3D) view and flexible operation,and it has been gradually applied in radical gastrectomy,colorectal cancer radical resection,complex hepatic resection,biliary tract surgery,partial resection of pancreas and pancreaticoduodenectomy in the fiell of digestive surgery,with satisfactory clinical efficacy.Compared with traditional laparoscopic and open operations,Da Vinci robotic surgical system is more precise and flexible,with advantages of minimal invasion and good application value,however,longer operation time,expensive surgery cost and indefinite long-term efficacy of malignant tumor need to be further improved.