The tensional relationship between doctors and patients caused by medical ethics and medical ethos is becoming a hot spot at present.It's of great significance to reduce the contradictions between the medical staff and the patients and construct a harmonious doctor-patient relationship by strengthening the construction of medical ethics and medical ethos and improving the professional quality of medical staff.

OBJECTIVE:To explore the effects of xingnaojing combined with naloxone on related indexes of patients with he-patic encephalopathy. METHODS:In retrospective analysis,76 patients with hepatic encephalopathy were divided into control group(40 cases)and observation group(36 cases)according to drug use. Based on routine treatment,control group was additional-ly given Naloxone injection 1 mg added into 10% Glucose solution 100 mL intravenously twice a day. Observation group was addi-tionally given Xingnaojing injection 20 mL added into 0.9% Sodium chloride injection 250 mL intravenously once a day on the ba-sis of control group. Treatment courses of 2 groups lasted for 2 weeks. HDS score,MMSE score,the levels of blood ammonia,β-endorphin,CRP,IL-6 and TNF-α,the occurrence of ADR were observed in 2 groups before and after treatment. RESULTS:Af-ter treatment,HDS score and MMSE score of 2 groups were significantly higher than before treatment,and the observation group was significantly higher than the control group;the levels of blood ammonia,β-endorphin,IL-6,CRP and TNF-α in 2 groups were significantly lower than before treatment,and the observation group was significantly lower than the control group,with statis-tical significance(P<0.05). There was no statistical significance in the level of IL-10 between 2 groups before and after treatment (P>0.05). There was no statistical significantly in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Based on routine treatment,Xingnaojing combined with naloxone can significantly improve cognitive function for patients with hepatic en-cephalopathy and reduce peripheral blood neurotoxin and inflammatory factor,moreover,do not increase the incidence of ADR.

OBJECTIVE:To explore the effects of the early use of heparin on the prognosis related indicators of patients with acute respiratory distress syndrome(ARDS). METHODS:Data of 86 ARDS patients were retrospectively analyzed and divided in-to observation group(45 cases)and control group(41 cases)by whether the early use of heparin. Control group received invasive mechanical ventilation,using end-expiratory pressure(PEEP)ventilation method,enteral nutrition support,nasogastric enteral nu-trition suspension 35-40 kcal/(kg·d);patients with combined infection were given Sodium ceftizoxime for injection 2 g,adding in-to 0.9% Sodium chloride injection 100 mL by intravenously infused,twice a day. Observation group was additionally given Hepa-rin sodium injection 6250 units by continuous intravenously pumped. They were treated for 14 d. The cumulative incidence of dis-seminated intravascular coagulation(DIC),and D-dimer,platelet count(PLT)before treatment and after 3,7,14 d of treatment, IL-6,IL-8,IL-10,TNF-α levels before and after treatment,and the incidence of adverse reactions in 2 groups were observed. RE-SULTS:The cumulative incidence of DIC in observation group was significantly lower than control group,with statistical signifi-cance(P<0.05). Before treatment,there were no significant differences in the D-dimer,PLT,IL-6,IL-8,IL-10,TNF-α levels, with no statistical significance (P>0.05). After treatment,D-dimer,IL-6,IL-8 and TNF-α levels in 2 groups were significantly higher than before,while observation group was significantly lower than control group;PLT in 2 groups was significantly lower than before,while observaton group was higher than control group,with statistical significance (P<0.05). There was no signifi-cant difference in the IL-10 level in 2 groups before and after treatment (P>0.05). And there were no obvious adverse reactions during treatment. CONCLUSIONS:Based on conventional treatment,early use of heparin can significantly decrease the DIC rick for ARDS patients,which can improve coagulation disorders,reduce inflammatory response,and dose not increase the incidence of adverse reactions.

OBJECTIVE:To observe the efficacy and safety of amikacin different administrations in the treatment of ventila-tor-associated pneumonia. METHODS:Data of 109 patients with ventilator-associated pneumonia were divided into observation group (58 cases) and control group (51 cases) based on different administrations. All patients received 3.0 g Ceftriaxone sodium for injection,adding into 100 ml 0.9% Sodium chloride injection,intravenously,once every 12 h. Based on it,control group re-ceived 7.5 mg/kg Amikacin sulfate injection,once a day. Observation group received 7.5 mg/kg Amikacin sulfate injection,adding into 20 ml 0.45% Sodium chloride injection,aerosol inhalation,twice a day. The treatment course for both groups was 7 d. Clini-cal pulmonary infection score (CPIS),alanine aminotransferase (ALT),serum creatinine (Cr),oxygenation index (PaO2/FiO2), IL-10,IL-6,C-reactive protein(CRP),tumor necrosis factor(TNF)-α,cumulative mortality after 3 months of treatment and the incidence of adverse reactions before and after treatment in 2 groups were observed. RESULTS:Before treatment,there were no significant differences in the CPIS score,ALT,Cr,PaO2/FiO2,IL-10,IL-6,CRP and TNF-α levels in 2 groups(P>0.05). After treatment,CPIS score,TNF-α,IL-6 and CRP levels in 2 groups were significantly lower than before,observation group was low-er than control group,the difference was statistically significant(P<0.05),and there was no significant difference in IL-10 before and after treatment in 2 groups(P>0.05). PaO2/FiO2 in observation group and ALT,Cr and PaO2/FiO2 in control group were signif-icantly higher than before,PaO2/FiO2 in observation group was higher than control group,ALT and Cr were significantly lower than control group,the differences were statistically significant(P<0.05). The cumulative mortality after 3 months of treatment in observation group was significantly lower than control group,the difference was statistically significant(P<0.05). And there were no severe adverse reactions during treatment. CONCLUSIONS:The efficacy of amikacin by aerosol inhalation is superior to by in-travenous infusion in the treatment of ventilator-associated pneumonia,it can effectively reduce inflammatory cytokine levels and mortality rate,do not increase the incidence of adverse reactions.

Objective To study the changes of serum albumin and its relationship with B-Type Natriuretic Peptide(BNP),High sensitivity C-reactive protein(hs-CRP)and left ventricular ejection fraction (LVEF) in patients with acute myocardial infarction(AMI).Methods Serum levels of albumin,BNP,hs-CRP at baseline were analyzed in 95 patients with AMI,and LVEF were measured by echocardiography.All AMI patients were divided into 2 groups based on the values of serum albumin:the hypoalbuminemia group and the normal albuminemia group.Fifty patients without coronary artery disease were selected as controls.The correlations between serum albumin and BNP,hs-CRP,LVEF were analyzed.Results Serum albumin in AMI patients was lower than that in the controls[(38.45±4.60) g/L vs.(43.15±3.11) g/L ;t =8.53,P ＜ 0.001].BNP and hs-CRP levels in the hypoalbuminemia group were higher than that in the normal albuminemia group [(5.24±1.71)ng/L vs.(4.17±1.61) ng/L;t =2.660,P =0.009;(1.64±0.93) mg/L vs.(1.13±1.03)mg/L;t =2.159,P =0.045].LVEF in hypoalbuminemia group was lower than that in the normal albuminemia group[(49.10±11.63) ％ vs.(54.63±9.60) ％ ; t =2.268,P =0.025].Levels of serum albumin were negatively correlated with BNP and hs-CRP in AMI patients(r =-0.465,P ＜0.001 ; r =-0.391,P ＜ 0.001).Levels of BNP were positively correlated with hs-CRP(r =0.492,P ＜ 0.001).LVEF was negatively correlated with BNP values(r =-0.371,P ＜ 0.001).Conclusion Hypoalbuminemia is associated with the prognosis of AMI and may be an important predictor of adverse outcome in patients with it.

Objective To investigate the association between polymorphisms of Ca2 + -ATPase isomer 2 gene (PMCA2) in plasma membrane and the development of sudden deafness .Methods Totally ,164 patients were investigated and hearing tests were conducted .According to the results of audiometry ,they were divided into two groups ,sensorineural hearing loss group(n= 82) and normal hearing group(n= 82) .Polymorphisms of two single nucleotide loci rs2289274 and rs6790640 in the PMCA2 gene were de-termined by polymerase chain reaction followed by allele specific amplication analysis .Results In the sudden deafness group ,fre-quencies of genotypes AA ,AG and GG in the rs2289274 locus were 55 .8% ,17 .4% and 26 .8% respectively ,while frequencies of al-leles A and G in the same locus were 64 .5% and 35 .5% respectively ;in the sensorineural hearing loss group ,were 26 .8% ,28 .0%and 45 .2% respectively ,while frequencies of alleles A and G were 41 .1% and 58 .9% .And ,in the sudden deafness group ,frequen-cies of genotypes CC ,CT and TT in the rs2289274 locus were18 .3% ,35 .4% and 46 .3% respectively ,while frequencies of alleles C and T in the same locus were 36 .3% and 63 .7% ;in the normal hearing group ,were 2 .4% ,63 .4% and 34 .1% respectively ,while frequencies of alleles C and T were34 .1% and 65 .9% ,respectively .Genotypes distribution of two sites and their allele frequencies of the two groups ,some differences of them had statistical significance(P< 0 .05) .Conclusion It is suggested that genetic polymor-phism of the rs2289274 and rs6790640 loci in the PMCA2 gene might be a susceptible factor for sudden deafness .

The construction and management must be unified,the teaching content must be specified and the teaching methods should be improved.Integrable ware teaching library for sexual health education was constructed taking teaching and research section as unit.In the process of teaching,initial resuhs were achieved and teaching efficiency was improved.In the future,teaching material library and platform construction should be improved in order to meet the requirements of modem teaching.

Objective To explore the clinical features and evaluate the diagnostic methods for adrenal tumors and bilateral adrenal hyperplasia (BAH) before surgical operation.Methods Clinical data of 45 cases with adrenal tumor and BAH were analyzed.Results Of 45 cases,15 were with aldosterone producing adenoma (APA),3 with of BAH,8 pheochromocytoma,4 adrenal tumor with hypercortisolism and 15 adrenal incidentaloma.Conclusions Before operation,endocrine function examinations of adrenal tumors are necessary for preventing preoperational complications.

Objective To investigate the causes of and preventive measures for complications following the placement of permanent inferior vena cava filter (VCF). Methods A total of 71 patients, with proven diagnosis of lower limb deep vein thrombosis (DVT) by Doppler ultrasonography, underwent the placement of permanent VCF from December 1999 to June 2003. Forty of the patients were acute lower limb DVT. Cavography was performed routinely during operation to confirm no thrombosis in inferior vena cava and access veins. The insertion site of filters was below the renal veins. Four types of permanent VCF were used: Titan-Greenfield filters, Simon-Nitinol filters, LGM filters and TrapEase filters. Anticoagulation treatments were used in all the cases post-VCF insertion. Results The placement of VCFs was successfully accomplished in all the cases in the study. Follow- up observations for 1～41 months revealed vena cava thrombosis at the site of insertion in 2 cases and filter tilting less than 15? in 5 cases. There were no events of filter migration, filter fracture, vessel wall perforation, filter embolism or access vein thrombosis, as well as pulmonary embolism (PE). Conclusions Different types of VCFs have different kinds of complications and their incidence rates. Preoperative ultrasonography and intraoperative cavography should be performed to evaluate the vena cava and access vein. Careful surgical management and strict anticoagulation therapy are the key to the successful VCF placement and the prevention of PE or other complications.

Objective : To set up the subjective well-being scale for Chinese middle school students. Methods: 1404 middle school students from 11 middle schools in Shenzhen finished the middle school students subjective well-being scale. Results : The result of Item Analysis showed that 20 items of the scale met psychometric criteria. The scale's internal consistency was 0.897, split reliability 0.827. It had acceptable discriminant validity: subjects with higher scale scores also had significantly higher scores in every items than those with lower scale scores, and this scale could effectively differentiate students with high and low school achievements. Exploratory factor analyses indicated that the scale had one dominant factor. Conclusion : The Chinese middle school students subjective well-being scale has met basic psychometric criteria for further research.