By analyzing the reality and practice dilemmas that medical students′ probity education faced, this paper pointed out the following countermeasures:to enhance the scientificity of medical students′probity education by grasping thethree principles including systematicness, subjectivity, and pertinence;to improve the effective-ness by three carrier including courses, culture, and practice;and to increase the pertinence by three combi-nations including population characteristic, career development, and daily management.

BACKGROUND: Total hip arthroplasty is a commonly used treatment, but it is difficult to accurately determine the position of the pelvis, which is easy to cause pelvic displacement postoperatively. Additionally, the implant is likely to present with angle deviation, and the precise location and direction of prosthesis is difficult to identify.OBJECTIVE: To study the position and biomechanical characteristics of prosthesis in total hip arthroplasty.METHODS: (1) One male volunteer received CT examination, and a finite element model of the pelvic was established.Three acetabular placement positions (abduction angles of 0°, 20° and 25° combined with anteversion angles of 35°, 15°and 10°) were used to perform total hip arthroplasty, and the peak von Mises stress was detected under a load of 240 N.(2) Six cadaver specimens were collected and received the same interventions with the former experiment, and the stress changes at the bone cortex surrounding femoral shaft and acetabular anterior and posterior wall were measured using resistance strain technology.RESULTS AND CONCLUSION: (1) The peak von Mises stress in the acetabulum at abduction angle of 25° combined with anteversion angle of 10° increased by 25.7%. The peak von Mises stress in the acetabular cup at abduction angles of 0°, 20° and 25° combined with anteversion angles of 35°,15° and 10° was 135.21, 68.3 and 134.2 MPa, respectively.The peak von Mises stress in the lining at abduction angles of 0°, 20° and 25° combined with anteversion angles of 35°,15° and 10° was 6.8, 3.9 and 6.7 MPa, respectively. The peak von Mises stress in the femoral shaft at abduction angles of 0°, 20° and 25° combined with anteversion angles of 35°,15° and 10° was 127.1, 100.2 and 128.2 MPa,respectively. (2) The stress at the bone cortex surrounding femoral shaft and acetabular anterior and posterior wall at abduction angles of 0° and 25° combined with anteversion angles of 35° and 10° was significantly higher than that at abduction angle of 20° combined with anteversion angle of 15°. To conclude, an abduction angle of 20° combined with anteversion angle of 15° is conductive for functional recovery of the joint.

Objective To study the effects of ephedrine and phenylepbedrine for maintenance of arterial pressure during combined spinai/epidural anesthesia (CSEA) for caesarean section. Methods Forty patients, ASA grade Ⅰ - Ⅱ, who were scheduled for caesarean section by CSEA were randomly divided into two groups, when patients were hypotension, phenylephedrine 100 μg (group P, 20 cases ) or ephedrine 10 mg (group E, 20 cases). The variety of blood pressure (Bp), heart rate (HR) and oxyhemoglobin saturation (SpO2) were monitored; recorded before anesthesia (T0), at 15 min after anesthesia (T1), fetuses were taken out of uterus (T2) and at the end of operation (T3); umbilical arterial blood gas analysis was monitored; neonatal Apgar score was investigated. Results Umbilical arterial blood gas analysis of pH,PaO2, PaCO2, HCO3-, SaO2 were normal in two groups, there were no significant difference in PaO2, PaCO2 and SaO2 between two groups, but pH and HCO3- in group P were higher than those in group E [7.38±0.07 vs7.30±0.02 and (21.5±3.4) mmol/L vs (19.3±3.3) mmol/L] (P <0.05). There were no significant difference in Apgar score and Bp between two groups. Compared with group P, the HR in group E was increased obviously at T1 and T2 (P < 0.05). Conclusion Phenylephedrine is the vasopresser that most closely meets the criteria for the best vasopressor to use in obstetric patients.

Objective To investigate the effect of xuebijing injection applied after abdominal operation on the inflammatory reaction,infection rate,length of stay and hepatorenal function. Methods Sixty patients received abdominal operations were randomly divided into therapeutic group (30 cases) and control group (30 cases). The inflammatory reaction indexes (temperature,heart rate,leucocyte) and hepatorenal function indexes(aminopherase, total bilirubin, creatinine, blood urea nitrogen) were observed in both groups before operation and after operation 3,7 days respectively. The infection rate and length of stay were compared in two groups. Results Temperature and leucocyte post operative 3 days [temperature:(37.0 ± 0.2) ℃ vs. (37.9 ± 0.4) ℃ ;leucocyte: (8.8 ± 1.1 ) × 109/L vs. ( 10.3 ± 1.7) × 109/L, P＜ 0.05] and length of stay in therapeutic group was obviously better than that in control group[ (8.7 ± 1.9 ) d vs. ( 10.9±1.6) d, P ＜ 0.05 ]. The hepatorenal function indexes and infection rate in both groups had no significant difference(P ＞ 0.05). Conclusion Xuebijing injection could significantly palliate the inflammatory reaction after abdominal operation, shorten the length of stay and has no hepatorenal toxicity in short term.

Twenty-six total intravenous anesthesia was performed in 23 ASAⅡorⅢpatients with various advanced malignancies undergoing whole body hyperthermia (WBH). Their age ranged from 32 to 67 yrs and body weight between 42 and 77 kg. The patients had no hypertension, coronary artery disease or diabetes mellitus. Anesthesia was induced with midazolam 5-10 mg, fentanyl 0.1 mg, propofol 1.5-2.5 mg?kg-1 and vecuronium 0.12 mg?kg-1 and maintained withⅣinfusion of midazolam (0.08-0.16 mg?kg-1?h-1), remifentanil (0.05-0.15?g?kg-1?h-1) and vecuronium (0.08-0.15 mg?kg-1?h-1). The patients were mechanically ventilated (VT = 8-12 ml?kg-1, RR= 10-18 bpm, FiO2 = 1.0) after tracheal intubation. PETCO2 was maintained at 35 mm Hg. ECG, MAP, HR, CVP, SpO2 , PETCO2 , peak airway pressure, VT, RR, minute ventilation (MV), urine output, core temperature (lower esophageal and naso-pharyngeal) and surface temperature were continuously monitored. Swan-Ganz catheter was placed in 15 patients. MPAP, PCWP and cardiac output (CO) were measured and Qs/Qt, cardiac index (CI) and stroke index (SI) were calculated. WBH was induced in an ultra-red radiation hyperthermic cabin (type ET-SpaceTM-1) and was divided into 3 phases:Ⅰwarming phase (lower esophageal temperature increased gradually to 41.8℃) ;Ⅱhyperthermic phase (lower esophageal temperature was maintained at 41.8℃for 1 h) andⅢcooling phase (core temperature was gradually decreased to 38.5℃without any cooling measures). Blood samples were taken from artery and Swan-Ganz catheter 15 min after induction of anesthesia (baseline), at 39℃, 40℃, 41℃and 41.8℃during warming phase, at the late hyperthermic phase and at 40℃and 38.5℃during cooling phase for blood gas analysis, determination of blood electrolytes and sugar. As the temperature was increasing, HR, CI, SI, CVP, MPAP, PCWP, Qs/Qt and peak airway pressure were gradually increased while MAP, PaO2 , pHa, BE and blood glucose and K+ were decreasing during warming phase (Ⅰ). These changes reached the peak levels at the late period of hyperthermic phase (Ⅱ) and then gradually returned to baseline during cooling phase (Ⅲ) . Vasoactive drugs and fluid infusion including crystalloid and colloid were needed to maintain hemodynamic stability in 69% patients. Acidosis had to be corrected in 54% patients. Severe hypotension and pulmonary edema occurred in 4 patients. Continuous hemodynamic monitoring, respiratory support, maintenance of circulatory stability and correction of acidosis and hypokalemia were the key factors in the management of patients during WBH.

Treatment of all the cases were based on differential diagnosis of zheng. Oral medicines were given to the cases in two groups, the damp - heat type and the type of Yin - deficiency blood - heat together with dampness. Of the 15 cases, 14 were markedly effective, a relapsed case was ineffective, the average days of antipyresis was 5 days, demonstrating that the therapy was rather satisfactory and helpful to their convalescence.

Objective:To explore characteristics of TCM syndrome differentiation of graft versus host disease(GVHD)after transplantation of the hemopoietic stem cell,so as to provide basis of clinical syndrome differentiation for further studying on treatment of this disease.Methods:62 cases of GVHD were grouped according to acute or chronic GVHD,and a total of 85 cases-times were investigated for TCM syndrome differentiation.Results:in 50 cases-times of acute GVHD,damp heat type accounted for 68% and 50% have jaundice due to hepatic injury;blood-heat and Yin-deficiency accounted for 32%,with more patients of more severe condition.In 35 cases times of chronic GVHD,damp heat type accounted for 25.7% with more patients companied with Yin- deficiency,blood stasis and Yin-deficiency rate accounted for 74.3%.Conclusion:Commonly-seen basic TCM syndrome types of GVHD are damp-heat and Yin-deficiency types.Damp-heat type was more common in acute GVHD and blood-heat and Yin- deficiency type was.more frequently found in severe patients;chronic GVHD manifest mainly as Yin-deficiency type and with exacerbation of condition and prolongation of disease course,Yin-deficiency type tends to increase.

Objective To observe the sedative effectiveness of dexmedetomidine (DEX) in digital subtraction angiography (DSA),and to investigate the optimal and safe administration dose.Methods Seventy-five patients undergoing DSA were divided into three groups by random digits table with 25 cases each group.Three groups were treated with constant infusion of DEX by micro-pump 10 min before surgery with the same dose of saline.Then group A,B,C respectively were given 0.3,0.5,0.7 μg/ (kg·h) of the maintenance infusion rate,and stop infusion 10 min before the end of the surgery.At administration (T0),10 (T1),20 (T2) and 30 (T3) min after administration,10 min after surgery (T4),the heart rate (HR),mean arterial pressure (MAP),peripheral oxygen saturation (SpO2),Ramsay score,number of cases that appeared body movement were recorded,and their forgotten degree of operating memory were compared.Results The HR,MAP in three groups at T1-T3 was significandy lower than that at T0 (P＜ 0.05),T4 levels returned to T0 (P＞ 0.05).The HR,MAP in group C at T2,T3 was significantly lower than that in group A and group B at the same time (P ＜ 0.05).The Ramsay score in three groups at T2,T3 was significantly higher than that at T0(P ＜0.05),group B and group C at T2,T3 was significantly higher than that in group A at the same time (P ＜0.05).The SpO2 in three groups at each time point compared within and among groups was no significant difference (P ＞ 0.05).Group B and group C intraoperative involuntary movement in response patients were significantly less than in group A (5,3 cases vs.10 cases).Group A and group C surgery requires intervention patients was significantly more than in group B (8,10 cases vs.3 cases).Group B and group C amnesia grade Ⅲ rate was significantly higher than that in group A [64％ (16/25),72％ (18/25) vs.40％(10/25),P ＜ 0.05].Conclusion Infusion with 0.5 μ g/(kg· h) DEX 10 min after intravenous injection with 0.5 μ g/kg can get a better sedative effect,stable vital signs and less intraoperative adverse memory,and it can also improve patients' comfortable degree,which is safe and appropriate sedative dosage in DSA.

BACKGROUND:Cortical electrical stimulation has achieved good effects in treatment of stroke through animal and clinical experiments.
OBJECTIVE:To observe the effects of a ful y implanted cortical electrical stimulation device with long time, low intensity and various frequencies stimulation protocols on the neurological function recovery in a rat model of local cerebral infarction.
METHODS:The cerebral infarction model was established through middle cerebral artery occlusion in 60 Sprague-Dawley adult male rats. Forty rats with 1-3 points by Bederson scale were detected with magnetic resonance imaging, which was used to confirm cortex infarction and to identify a location for implantation of stimulating electrode over the peri-infarct cortex. Twenty-three rats with cortex infarction were randomly divided into cortical electrical stimulation group (CES group, n=13) and no stimulation group (NS group;n=10). The device was implanted on 6 days after middle cerebral artery occlusion, and the stimulation was given for 16 days. The stimulation program consists of two sessions lasting half an hour each in the morning and in the afternoon respectively. Stimulator delivered biphasic charge balanced pulses (pulse width=200μs) with various frequencies of 50 Hz, 20 Hz and 5 Hz within 10 second blocks and then repeated. The rats of NS group were implanted with the device, but received no electrical stimulation. The behavioral tests, includingforelimb use asymmetry test and foot fault test were performed at 2 and 16 days after implantation. Final y, al of the devices were taken out to test if they were normal y working and al of the rats were sacrificed for hematoxylin-eosin staining, which can reflect the structure of peri-infarct cortex and cellmorphology.
RESULTS AND CONCLUSION:There was only one stimulator in CES group cannot normal y work, and the remaining 22 ones worked wel . The skin covered the implanted stimulator was slightly ulcerated in one rat, and the incisions of the other rats were healed wel . Hematoxylin-eosin staining showed clear and intact structure in peri-infarction cortex (i.e., electrodes were implanted at the cortex), neurons arranged in neat rows, with abundant neuronal cytoplasm and clear nucleolus. The glial cells have complete structures, and there was no edema in the intercellular spaces. Foot-fault and forelimb use asymmetry tests showed the improved neurological function in rats of CES group than that of NS group. We designed a ful-implanted cortical electrical stimulator used in cerebral ischemic rats, and established an implanted method with long time, low intensity and various frequencies pulsed electrical stimulation. The results indicated the stimulation pattern in our study is safe and effective, and it can significantly promote functional recovery in local cerebral infarction rats.

Objective To study the gender differences in echocardiography in essential hypertensives. Methods Echocardiography measurement was performed in 108 subjects with Grade 1-2 essential hypertension (52 in female patient group, PGf, and 56 in male patient group, PGm). Forty two normotensive subjects (20 in female control group, CGf, and 22 in male control group, CGm) were as controls.Data were obtained by averaging measurements of the traced heart chambers and velocity curves in 5 cardiac cycles. Results Compared with PGm, the following echocardiographic features in PGf were showed:LAID (37.24±5.88 vs 32.14±3.80)mm,P＜0.01] and MVa[(84.18±12.13 vs 81.71±12.30)cm/s, P＜0. 05] were greater; LVMI [ ( 119.26 ± 22.33 vs 128.17 ± 27.00 ) g/m2 , P＜0. 05], EF ( 75.13 % ±6.69% vs 83.00% ±3.68%,P＜0. 01), FS (41.67% ±7.99%0 vs 49.03% ± 7.35%, P＜0.01), MVe[(68. 28±8.66 vs 73. 73±11.46)cm/s, P＜0. 05] and MVe/a(0.83±0. 08 vs 0. 93±0.11, P＜0.01)were lower. The differences between CGf and CGm were not significant. Conclusion There are echocardiographic differences between sexes in hypertensives including cardiac structural and functional changes. Hypertensive woman is more susceptible to both cardiac structure damage and cardiac dysfunction.