Medical ethics in the public health is ignored for a long time,and its main reason is that there is no suitable criterion in this field,however,on-the-spot investigation becomes more impatient for ethics.This article proposes some criteria which should be observed in the field of the use of informed consent especially when some ethical dilemma appears.

Objective:To explore the clinical value of Foley bladder in the treatment of the cesarean scar pregnancy(CSP).Methods: Twenty patients with CSP in Chongqing Health Center for Women and Children from Jan 2006 to Dec 2009 were stutied.All patients were treated with Methotrexate(MTX)and mifepristone.When their?-Serum human chorionic gonadotropin(?-HCG)were under 5000IU /L,they were undertaken curettage guided by ultrasound and hemostasis with Foley bladder.Results:Seventeen patients were cured,and the amount of bleeding was 279.0?63.9 ml in curettage,(65?19.8)ml after performed Foley bladder,The Foley bladder were held in the uterine cavity for(38?11.1)hours.The other cases included one patient of total hysterectomy,one patient of subtotal hysterectomy and one patient of uterine scar excision.Conclusions:The hemostasis with Foley bladder is a valuable treatment for CSP patients with the Primary Hospital of less bleeding,less cost and protecting the pregnancy.

This paper analyses and discusses of the mammary duct ectasia. The review of 51 cases of mammary diagnostic name and pathogenesis duct ectasia shows that mammary duct ectasia and plasma cell mastitis are the two stages of one disease. It is generally caused by disturbance in the secretion of mammary glands. It is difficult to distinguish it from breast neoplasms. Therefor, we also analyse why the disease is more likely to be misdiognosed as breast cancer and also represent its differential diagnosis. The paper involves some measures of treatment.

Colorectal cancer is one of the most common malignant tumors. Though the development of multidisciplinary therapy has largely improved the therapy effects, many patients still died of local recurrence and metastases after surgery. Circulating tumor cell (CTC) originates from primary tumor tissues and has a close relationship with cancer metastases and prognosis. This review summarizes the CTC detection methods and relevant clinical research on CTC in recent years.

Objective To investigate the efficacy and risk factors of carotid artery stenting ( CAS) in patients with uni-lateral and bilateral carotid stenosis .Methods We retrospectively studied 312 cases of patients with CAS diagnosed in xinqiao Hospital between January 2005 and January 2011 .According to the carotid artery lesions , patients were divided in-to the unilateral carotid stenosis group .Periprocedural data and those after one-month follow-up and one-year follow-up were collected in two groups and analysed by statistics .Results A total of 312 patients were enrolled in this study , including 136 patients with bilateral lesions and 176 patients with unilateral lesion .303 of these patients were followed up after one month, and 224 cases after one year.All the 312 patients were implanted with 391 stents.The two groups of patients with transient ischemic attack ( TIA) were different in the incidence of perioperative TIA (1.2%for bilateral lesions and 7.6%for unilateral lesions;P<0.01).Compared with bilateral carotid lesions group , the incidence of early postoperative adverse events (death, stroke, perioperative TIA,and perioperative myocardial infarction ) in unilateral carotid lesion group was lower (5.2%vs 11.4%), but of no statistical significance (P>0.05).The incidence of medium-term adverse events (death, stroke, perioperative TIA, perioperative myocardial infarction, and restenosis) in the bilateral carotid lesions group was significantly higher than in the unilateral group (21.8%vs 9.7%, P<0.01), mainly driven by a higher inci-dence of death, periprocedural TIA, and restenosis (P<0.05).Multivariate analysis showed that left ventricular dysfunc-tion, masculinity , bilateral carotid artery disease , renal insufficiency , and cerebral ischemic symptoms within the last 6 months before intervention , and low-density lipoprotein cholesterol ( LDL-C ) levels were the independent risk factors for medium-term adverse events .Conclusion Patients with bilateral carotid artery disease treated by CAS are more prone to adverse events than those with unilateral disease .

With the population ageing,increasing health needs and demands,changing family structure and the transformation of general hospital service model,home care as an important part of primary care,has been brought more and more attention.Home healthcare would relieve the pressure caused by increasing needs of elderly care and transformation of hospital functions,so it should have greater development in the future.This article reviews the present situation and the future development direction of home healthcare in China.

OBJECTIVE:To explore the method and role of clinical pharmacists in pharmaceutical care for nephrotic syndrome complicated with Pneumocystis carinii pneumonia (PCP). METHODS:Clinical pharmacists participated in the treatment for a pa-tient with nephrotic syndrome complicated with PCP,and implemented pharmaceutical care in terms of the development of anti-in-fective therapy regimens,glucocorticoid optimization,guardianship for drug use,the medication education for patients. Clinical pharmacists provided suggestion that primary anti-infective plan of azithromycin 0.5 g,ivgtt,qd+Compound sulfalene tablet 2 tab-lets,po,q12 h;which was not effective,was adjusted plan as Compound sulfalene tablet 3 tablets,po,q6 h+clindamycin 0.6 g, ivgtt,q8 h+caspofungin 50 mg,ivgtt,qd. The dose of Methylprednisolone for injection was adjusted 4 times according to disease progression. RESULTS:Physicians adopted the suggestions of clinical pharmacists. After 30 days of treatment, lung abnormal le-sion was absorbed basically and infection control was achieved. CONCLUSIONS:Clinical pharmacists participate in anti-infective treatment and pharmaceutical care,and assist physicians to develop therapy plan to promote rational drug use in the clinic and im-prove the effectiveness and safety of clinical treatment.

Objective:To research the number and function of monocyte-macrophages in patients with chronic active hepatitis B. Methods:The 51 chronic viral hepatitis B( CHB) patients were selected randomly,which consisted of 20 cases of mild-moderate,31 cases of severe group and 13 cases of healthy controls. PBMCs were separated by percoll. Monocytes were tagged by CD14,the molecules CD80,CD86,HLA-DR and CD163 were detected by flow cytometry which expressed on the surface of PBMCs. Serum cytokine were detected for IL-10, IL-12 and IL-23 by ELISA. The distribution of CD68 was detected in the liver by immunohistochemical staining. Results:The expressions of CD80 for all chronic hepatitis B patients were lower than the controls respectively,no matter mild-moderate or even severe group. Similarly,the HBV patients expressed lower level of CD86 in the peripheral blood mononuclear cells when compared with the control group. Furthermore, there was statistically difference between the levels of CD86 in severe group compared with control group (P<0. 01). As the expression of CD80 and CD86,the levels of HLA-DR in the patents had also declined when compared with controls. While the HLA-DR levels in both the mild-moderate HBV hepatitis groups were statistically significant higher than the severe group (P<0. 01). Different from the above all,the expression of CD163 in all chronic HBV hepatitis was higher than the control group. The CD68 positive cells in chronic HBV patients were observed and infiltrated increasingly in portal area and hepatic lobules (P<0. 05). There were statistically significant differences of IL-10 levels between the mild-moderate group,severe group and the control group,respectively (P<0. 01). Conclusion:Macrophages have participated in the pathological lesions of liver in CHB patients,among peripheral blood mononuclear cells,the phenomena of imbalance between type M1/M2 and polarization to type M2 have been observed,which participated in the development of the chronicity of CHB.

Objective Postoperative cognitive dysfunction (POCD) is a common complication of cardiac surgery, which seriously affects the prognosis of the patient.This study aimed to explore the risk factors for early POCD in patients undergoing cardiac valve surgery and the correlation between early POCD and the serum S100B protein level.Methods Eighty patients underwent mitral valve replacement surgery in combination with tricuspid plasty.At 1 day before and 5 days after surgery, we assessed the cognitive function of the patients and divided them into a POCD and a non-POCD group.We obtained such data as the age, sex, education, New EuroSCORE Ⅱ, and preoperative NYHA cardiac function grades and left ventricle ejection fraction (LVEF) of the patients, collected the venous blood to determine serum S100B protein concentration by ELISA, and analyzed the independent risk factors of early POCD using single-factor and binary logistic regression analyses.Results POCD was found in 20 (25%) of the patients, , Logistic regression analysis showed the independent risk factors for early POCD to be hyperglycemia (OR=6.038, 95% CI: 1.202-30.337), operation time (OR=6.423, 95% CI: 1.276-32.332), and aspartate aminotransferase (AST, 2 times higher than normal) (OR=12.878, 95% CI: 2.289-72.445).The serum S100B protein concentrations in the POCD group were (1.9±0.3) μg/L and (1.7±0.4) μg/L at 48 and 72 hours after cardiopulmonary bypass, significantly lower than (2.4±0.4) μg/L and (2.1±0.3) μg/L at 30 minutes and 24 hours (P<0.05), and so was it in the non-POCD group at 72 than at 48 hours postoperatively ([1.4±0.4]) vs [1.5±0.4] μg/L, P<0.05).Conclusion Long operation time, perioperative hyperglycemia and high AST are independent predictors and the serum S100B protein level is a significant marker of early POCD.

Objective To analyze the clinical features of patients with hemophagocytic syndrome (HPS) in autoimmune diseases (AID). Methods We collected the data of 11 patients with AID complicated with HPS in Peking Union Medical College Hospital from 2004 to 2009. The underlying diseases, clinical features, laboratory findings and treatment outcomes were retrospectively analyzed. Results Of the 11 patients,3 were male,8 were female. Mean age was (30. 7 ± 18. 3) years. The underlying diseases included Still disease ( n = 4 ), systemic lupus erythematosus ( n = 3 ), and rheumatoid arthritis, primary Sj(o)gren's syndrome, Wegener granulomatosis and Crohn disease in each one case. HPS was associated with the onset of AID ( n = 4), active infection alone ( n = 1 ) and both factors ( n = 6 ). HPS was clinically characterized by high fever ( 100% ), hepatosplenomegaly ( 72. 7% ) , lymphadenopathy ( 63.3% ) and central nervous system involvement (36. 3% ). 4 patients presented with disseminated intravascular coagulation(DIC) (36. 3% ). Laboratory data mainly manifested with cytopenia ( 100% ), liver dysfunction ( 100% ), hypofibrinogenemia ( 62. 5% ), hypertriglyceridemia ( 81.8% ), serum ferritin ＞ 500 μg/L (100%), low NK-cell activity(80% ) and hemophagocytosis in bone marrow( 100% ). Based on treating underlying infections and use of corticosteroids and immunosuppressive agents in combination with intravenous immunoglobulins(IVIG) therapy, 5 patients recovered , 6 patients died. The mortality rate was 54. 5%. DIC were associated with mortality ( r = 0. 69, P = 0. 019 ). Conclusion The episode of HPS always occurs simultaneously with multiple system involvement that was often difficult to distinguish from active AID. The present of DIC on HPS related with poor prognosis and high mortality. Corticosteroids and immunodepressant and IVIG may improve the prognosis of HPS, while anti-infection therapy is very important and necessary for the patients accompany with active infection.