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.

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 .

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.

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 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.

Objective To structure a preliminary indicators system for evaluating the projects of Hospital in finished phase.Methods With Delphi method,collect the experts' opinion of the importance of every item.With AHP (Analytic hierarchy process) method,calculate the weight coefficient of every item.Results The positivity of the experts was fine; The authority coefficient of two rounds were 0.859 and 0.833,the consultation results are reliable; The coordination coefficient of two rounds were 0.254 and 0.553,according to the significance test,p values were less than 0.05,indicating that the results were desirable.According to the score of every item,we got the weight index of every items based on the AHP method.Finally we structure the indicators system including 3 primary indicators and 10 secondary indicators.Conclusion The preliminary results of this study provide a reference for the performance evaluation of projects in finished phase of China-Japan Friendship Hospital.

This study aims to observe different factors which affected the bionic enzymatic hydrolysis of icariin into baohuoside I and to optimize the reaction conditions in order to provide research foundation for building a novel bionic enzymolysis drug delivery system. To simulate the environment in vivo, 37 degrees C was set as the temperature and artificial intestinal juice and gastric juice were selected as the buffer solutions. Taking the conversion of baohuoside I as index, the effects of the kinds of enzyme, enzyme activity, substrate concentration, reaction time, pancreatin in artificial intestinal juice and surfactant on the conversion of baohuoside I were investigated. The results showed that cellulase, beta-glucosidase and snailase were all inactive in artificial gastric juice and no baohuoside I generated. Pancreatin in artificial intestinal juice couldn't significantly influence the activity of beta-glucosidase or snailase (P > 0.05), but noticeably decrease the activity of cellulase (P < 0.05). In artificial intestinal juice, the conversion of baohuoside I was highest by using beta-glucosidase, and the optimum reaction conditions were determined as follows: enzyme activity 10 U x mL(-1), substrate concentration 1 mg x mL(-1), 3 g x L(-1) rhamnolipid and reaction time 3 h. Under this condition, the conversion of baohuoside I was 99.8%.

ObjectiveTo explore the application of the Structure Equation Model on validity assessment of the evaluation indicator system,we studied Medical Capital Development Fund projects in 2007 to evaluate their construct validity.MethodsPart of the evaluation results (1200 items) were divided into two parts randomly.PART1 was used for Exploratory Factor Analysis (EFA) to explore the Indicator System' structure,and formed model F1.Confirmatory Factor Analysis (CFA) was used to assess the construct validity of model F1.With considerations of Modification Index(MI) and reality,F1 was modified into F3.At last,we take PART2 as the sample to confirm F3.ResultThe results of model F3 fit indices showed a better fit.All the path coefficients,estimated load factors and other parameters were statistically significant.ConclusionStructural Equation Model is professional,reliable and satisfactory for the evaluation of indicator system's contract validity.