From the perspectives of pragmatics , social linguistics and functional linguistics , the author made a detailed literature review on critical discourse analysis on doctor -patient conversations , summing up the character-istics and the similarities and differences of doctor -patient criticism conversational analysis .On this basis in this paper , the dynamic of the power relations in both doctors , discusses how to dialectical view of the power character-istics of between doctor and patient , and points out that the use of critical linguistics in doctor -patient conversa-tions need to be aware of problems , namely must have the dialectical thinking , focus on empirical research , dimen-sional analysis .

Plant alkaloids have anti-tumor activities.In recent years,the anti-tumor mechanisms of plant alkaloid are demonstrated to be related to the block of tumor cell cycle,the induction of tumor cell apoptosis,the inhibition of tumor angiogenesis and multi-drug resistance.In addition,most recently,plant alkaloids are found to inhibit telomerase activity and induce autophagy.Therefore,plant alkaloids may be developed into a sort of potential antitumor drugs.

Sophoramine ( Sa ) is an alkaloid from sophora alopecuroides. Linn., in anesthetize animals ( cat, rat and rabbit), intravenous adminstra-tion of Sa reduced rapidly and markly the arterial blood pressure. The mechanism of hypotension effect of Sa is mainly attributable to its sympathetic ganglionic blocking and direct vasodilatation. Experiment on the isolated hearts of guinea pig revealed that Sa produced negative chronotropic and positive inotropic action, and increased coronary flow simultaneously.In a study of experimental arrhythmia in animals,we observed that Sa could reduce the arrhythmia induced by aconitine in rats and decreased the incidence of ventricular fibrillation induced by chloroform in mice.

Objective To investigate the prevalence of adult skeletal fluorosis in drinking-water-borne endemic fluorosis areas in Liaoning Province and to observe the effects of preventive measures.Methods Three water-changed villages were selected from six drinking-water-borne endemic fluorosis counties,Faku County,Liaoyang County,Haicheng City,Linghai City,Fu Mongolia County,and Jianping County.Totally 18 diseased villages were selected as the investigation sites.The operating condition of the improvement projects was investigated and the fluoride level of drinking water was tested.People over the age of 25 and living in the local for more than 5 years in each survey site were selected and divided into five groups according to age groups of 25-,35-,45-,55-,and ≥65 years old.Ten people in each age group were selected,half male and half female,to examine skeletal fluorosis by X-ray.Clinical symptoms and bone change,including sclerotin,bones,and joints changes were also examined.Results The water fluorine values of two villages were 1.32 and 1.69 mg/L,more than the national standard (1.2 mg/L),while other 16 villages were between 0.5-1.0 mg/L.X-ray images were analyzed for diagnosis of skeletal fluorosis in 905 adults,and 46 cases were diagnosed as skeletal fluorosis in the 18 monitored villages.Xray detection rate was 5.08％,of which the X-ray detection rate of adult fluorosis in water fluoride qualified monitoring villages was 4.11％ (33/803).The detection rate of adult skeletal fluorosis was 12.75％ (13/102) in water fluoride unqualified monitoring villages.There was a significant difference of the total detection rates between the two groups of monitored villages (x2 =13.99,P ＜ 0.05).Skeletal fluorosis was mainly happened in the age group over the age of 45,account for 89.13％ (41/46).Peri-bone changes were observed in the 46 cases of patients with skeletal fluorosis.Conclusions The condition of skeletal fluorosis has been effectively alleviated after implementing the improvement measures.Prevention and treatment can effectively control the occurrence of fluorosis.

OBJECTIVE:To explore the clinical efficacy and safety of alfacalcidol in the adjuvant treatment of bronchiolitis in children. METHODS:Data of 156 children with bronchiolitis were retrospectively collected and divided into observation group(78 cases) and control group (78 cases) by different medication. All children received oxygen inhalation,relieving asthma,antiviral and other conventional treatment,then control group inhaled Budesonide suspension 0.5-1.0 mg + Salbutamol aerosol 0.25 mL for atomization,bid,10 min every times,7-d was a course. Observation group additionally given Alfacalcidol soft capsule 0.010-0.015μg/(kg·d),3 times a week,3-month was a course. They were treated for 3 months. Clinical efficacy,improvement time of clinical symptoms and signs,levels of 25-(OH)D3 and serum LEP,IgA,IgG,IgM and IgE before and after treatment,and the incidence of adverse reactions in 2 groups were observed and compared. RESULTS:The total effective rate in observation group was signifi-cantly higher than control group,improvement time of cough,asthma,wheezing and moist rale were significantly shorter than con-trol group with statistical significansce (P<0.05) after 7-d treatment;after 3-month treatment,25-(OH)D3,IgA and IgG levels were significantly higher than before,and observation group was higher than control group,LEP and IgE levels were significantly lower than before,and observation group was lower than control group,with statistical significances(P<0.05). There was no sig-nificantly difference of the level of IgM in 2 groups before and after treatment. And there were no severe adverse reactions in 2 groups. CONCLUSIONS:Based on conventional treatment,alfacalcidol shows good efficacy in the adjuvant treatment of bronchiol-itis in children,which can obviously enhance immune function,reduce serum LEP level,then shorten remission time of clinical symptoms and signs,with less adverse reactions and good safety.

Objective To investigate urinary tract injuries in laparoscopic-assisted vaginal hysterectomy(LAVH).Methods Clinical data of 5 cases of urinary tract injuries from 415 cases of LAVH from December 1995 to January 2006 in this hospital were retrospectively studied. Results Intraoperative bladder injury occurred in 2 cases and an immediate repair was given.Postoperative ureteral injury occurred in 3 cases: 2 cases of ureteral injury were found 4 days after operation because of abdominal pain,and 1 case was found on the 30th day after operation because of massive vaginal discharge.Conclusions Urinary tract injury is one of common complications in laparoscopic-assisted vaginal hysterectomy.High-risk factors include tumor size more than 5 cm,tumor protruding to the broad ligament,and tumor adjacent to the isthmus.Surgical repair is the major treatment.

Objective To develop a HIS architecture based on.NET in C/S environment,so that the different functional modules of the HIS can be easily loaded into the architecture to improve the efficiency of HIS development and reduce development costs.Methods The proposed HIS architecture underwent hierarchical structure design,and was composed of boundary,logic,data access and physical layers.The user input data through the boundary layer,responded to the user request through the logic layer,and reacted to the request from the logic layer through the data access layer to realize database access.The boundary,logic and data access layers transferred data through the physical layer which was used as the data carrier.C# language of Visual Studio 2008 was applied to the development of the architecture program.Results The system could conveniently load each function module in HIS of the hospital,which greatly facilitated the developer to control the function of the program.Conclusion The system meets the requirements of medical staff and management to the software,improves the efficiency of HIS system development,and reduces the cost of system development.

Objective To evaluate the effect of intrathecal administration of ?-conopeptide SO3 on inducible nitric oxide synthase(iNOS)expression of spinal cord and the ligated sciatic nerve in a rat model with chronic constriction injury(CCI).Methods 40 male SD rats were randomly divided into 4 groups of 10 animals each.Rats in the N group served as controls;in group C 4 loose ligatures were placed around the right sciatic nerve for 14 days;in group CN,normal saline 1?l/h was injected intrathecally slowly for 7 days seven days after the ligation;in group CS,?-conopeptide SO3 30ng/h was administered intrathecally slowly for 7 days seven days after the ligature.Local expression of iNOS was assayed in samples taken from injured nerves(between and distal to the CCI site)and the spinal cord using Western blotting analysis,with GAPDH as an internal reference.Results A 130 kDa band,corresponding to iNOS protein was detected in the middle and distal sections of the injured nerves and the spinal cord.The iNOS immunoreactivity was inhibited by continuous intrathecal injection of ?-conopeptide SO3.There was no difference in the expression of iNOS between group CN and group C.Conclusion The expression of iNOS in the spinal cord and injured nerves of CCI rats was enhanced.Intrathecal injection of ?-conopeptide SO3 can inhibit the expression of iNOS.The data suggested that N-type calcium channel blocker took part in the expression of iNOS.

Objective To study the correlation between the mental health of family members of patients with schizophrenia and their coping style. Methods From December, 2014 to January, 2015, a total of 312 family members of patients with schizophrenia in 5 blocks were included. They were surveyed with self-made questionnaire, Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS) and Simplified Coping Style Questionnaire. The results were compared with the national normal model, and the correlation between SDS, SAS and the coping style was also analyzed. Results Compared with the normal model, the SDS (t=34.39, P<0.001), SAS (t=73.09, P<0.001) scores were higher in schizophrenia families, and they used positive coping style (n=128, 41%) less (t=-16.70, P<0.001), and more often used negative coping style (n=184, 59%) (t=-66.24, P<0.001). The SDS (r=-0.14, P<0.05), SAS (r=-0.15, P=0.01) scores were negatively correlated with positive coping style, the SAS score was positively correlated with negative coping style (r=0.27, P<0.001). Multivariate Lo-gistic regression analysis showed that women were prone to be anxiety and depressed compared with men (P<0.05); the divorcees were prone to be depressed compared with thoses not divorced. Education level and average monthly household income were factors influencing their coping style (P<0.05). Conclusion The mental health of family members of patients with schizophrenia is not optimistic, the female family members are more likely to be depressed and anxious than males. People with low education level and poor economic conditions more often use negative coping style, which need to be focused on, and to take appropriate and effective intervention.

Objective: To assess the predictive value of coronary lfow reserve (CFR) for diagnosing coronary stenosis by transthoracic Doppler echocardiography (TTDE) in patients with hypertension.
Methods: A total of 132 patients scheduled for elective coronary angiography (CAG) due to chest pain were enrolled. The patients were divided into 2 groups: Hypertension group,n=95 and Non-hypertension group,n=37. The CRF of left anterior descending coronary artery (LAD) was measured by ATP stress TTDE at 2 days before CAG in all patients and the results were compared between 2 groups. ROC curve was conducted to assess CFR value in diagnosing LAD stenosis which was deifned by LAD luminal diameter stenosis ≥ 70% in relevant patients.
Results: The condition of LAD stenosis was similar between 2 groups (42.1% vs. 35.1%),P>0.05. The CFR value in Hypertension group was lower than that in Non-hypertension group (2.39 ± 0.86) vs. (2.87 ± 1.12),P<0.05. The ROC curve for diagnosing LAD stenosis in all patients were at 0.884 (95% CI 0.83-0.94,P<0.0001), in Hypertension group at 0.874 (95% CI 0.81-0.94,P<0.0001) and in Non-hypertension group at 0.915 (95% CI 0.82-0.98,P<0.0001). With the cut-off point of CFR ≤ 2.2, it had the diagnostic sensitivity, speciifcity and accuracy in all patients were at 80.3%, 83.5% and 80.3%; in Hypertension group were at 77.5%, 80.0% and 78.9%, in Non-hypertension group were at 69.2, 91.7% and 83.8% respectively.
Conclusion: The patients of hypertension combining chest pain had decreased CFR which implied the dysfunction of their microcirculation. CFR had the better diagnostic value for predicting the signiifcant LAD stenosis in such patients.