Coincidence exists in the value selection,main form of human communication and imbalance between teacher-student relationship and doctor-patient relationship.Therefore,teacher-student relationship today will directhy have an impact on the future of doctor-patient relationship.Teachers should cultivate medical students'equality consciousness and communicating ability between doctors and patients by establishing equal relationship and good communication between teachers and stdents.

Objective To investigate the effect of carvedilol combined with spironolactone in the treatment of elderly patients with chronic heart failure clinical efficacy and to provide reference for clinical treatment of formulation. Methods 104 elderly patients with chronic heart failure were randomly divided into observation group and control group,52 cases were randomly divided into observation group and control group.Control group intervention in accord-ance with the conventional treatment of chronic heart failure program,the observation group in the conventional scheme based on,combined with oral carvedilol and spironolactone therapy.6 months after treatment,clinical efficacy was compared between the two groups.The results of echocardiography before and after treatment in two groups were compared.The adverse reactions in the treatment process were compared.Results The effective rate in the observation group was 59.62%,the total effective rate was 96.15%,which were significantly higher than those of the control group (χ2 =4.10,9.82,all P <0.05);After treatment,LVEDD and LVESD of the two groups were significantly lower than those before treatment[(51.89 ±7.06)mm,(41.39 ±6.85)mm,(60.71 ±7.43)mm,(51.02 ±7.95)mm], LVEF[(52.31 ±9.02)% and (41.64 ±7.73)]were significantly higher than that before treatment,there were statistifically significant differences between the two groups(t =4.92,5.10,5.45,2.87,2.98,3.03,all P <0.05);After treatment,LVEDD[(51.89 ±7.06 )mm],LVESD [(41.39 ±6.85 )mm]of the observation group were significantly lower than those of the control group,and LVEF(52.31 ±9.02)% were significantly higher than that of the control group,there were statistifically significant differences between the two groups (t =3.02,2.98,2.97,all P <0.05);There was no significant difference in the incidence of adverse reactions between the two groups(P >0.05).Conclusion Carvedilol combined with spironolactone can significantly improve the clinical effect of the treatment of elderly patients with chronic heart failure,effectively improve the left ventricular remodeling in patients with,improve myocardial contractility in patients and has good security.

Objective To clone and express the extracellular portion of mouse Fcγreceptor Ⅱ-b ( FcγRⅡb) and to analyze the functions of the expressed proteins in a mouse model of systemic lupus ery-thematosus ( SLE) .Methods The gene fragment encoding FcγRⅡb was amplified by PCR, and then in-serted into the prokaryotic expression vector pET-32a(+) to construct the recombinant expression plasmid pET-FcγRⅡb.The expression plasmid was identified with restriction enzymes and then sent to the Shanghai Bio-Engineering Co.LTD for further sequencing analysis.The transformed Escherichia coli ( E.coli) BL21 ( DE3) strains carrying the recombinant expression plasmid pET-FcγRⅡb were induced by isopropylβ-D-1-thiogalactoside ( IPTG) .The expressed fusion proteins were analyzed by Western blot assay and purified with purification kits.The immune complex ( IC)-binding ability of FcγRⅡb was measured by ELISA.MRL/lpr mice with SLE in both the prevention (12 weeks old, n=40) and the treatment groups (19 weeks old, n=40) were randomly divided into four groups including 60 μl (4.8 μg) treatment group, 120 μl (9.6 μg) treatment group, 180μl (14.4μg) treatment group and PBS treatment group with 10 mouse in each group. The MRL/lpr mice with SLE were injected with the fusion protein through tail vein once a week for four con-secutive weeks.Serum samples were collected from each mouse after one week of observation.The levels of FcγRⅡb in soluble form in mice form both the prevention and treatment groups as well as the levels of anti-double stranded DNA antibodies were detected by ELISA.Results The gene encoding FcγRⅡb was ampli-fied and the recombinant expression plasmid pET-FcγRⅡb was successfully constructed.The recombinant proteins were expressed in the prokaryotic expression system, and then successfully purified.The recombi-nant proteins could bind to IC.Compared with the corresponding PBS control group, the levels of FcγRⅡb in soluble form were increased in mice from both prevention and treatment groups after treating with various concentrations of the recombinant protein (P<0.05).Significant differences in the levels of FcγRⅡb were found among mice of the same age after treating with different concentrations of the recombinant protein ( P<0.05).Compared with the corresponding PBS control group, the levels of anti-double stranded DNA anti-bodies were decreased in mice from both prevention and treatment groups after treating with various concen-trations of the recombinant protein (P<0.05).The levels of anti-double stranded DNA antibodies were grad-ually decreased along with the increasing dosage of protein (P<0.05).Conclusion The extracellular por-tion of murine FcγRⅡb in soluble form was successfully expressed.The recombinant proteins played a cer-tain role in the prevention and treatment of SLE in a mouse model.

12)is good after nonoperative treatment above 2 years.

Objective To evaluate the role and safety of continuous vano-venous hemofiltration(CVVH) in treating critical patients. Methods We summarized 109 cases of critical patients treated by CVVH in our ICU from 2002 to 2006. Results The therapy time ranged from 18 to 72 hours. Of all patients, there were 13 cases of hypotension, 5 cases of filter occlusion,2 cases of bleeding and 3 cases of local or blood infection. Conclusion CVVH can be appli-Gated in critical patients with good safety and efficiency. High-quality management plays an important role in the carry--out of CVVH.

Objective To study the right ventricular function of patients with pulmonary thromboembolism by using color Doppler ultrasound.Methods 31 patients with acute pulmonary thromboembolism,compared with 31 vohnteers,were enrolled in this study.The right ventricular anterior wall movement,right ventricular end diastolic volume,right ventricular ejection fraction,and myocardial performance index were observed by echocardiography.Resuits The right atrium diameter,right ventricles diameter,right ventrieular end diastolic volume and pulmonary artery inner diameter in study group were much larger than that in control group (P<0.01),and the right ventricular anterior wall movement and right ventrieular ejection fraction decreased in study group (P<0.01).Tricuspidal annular E peak velocity tended to be decreased,isovolumie relaxation time and isovolumic contraction time were prolonged and myocardial performance index was increased (P<0.01).Right ventricular myocardial performance index showed significant correlation with right ventrieular ejection fraction (r=0.78,P<0.01),isovolumic relaxation time and isovolumic contraction time(rl=0.88,r2=0.57,P<0.01).Conclusion The right ventricular function in patients with pulmonary thromboembelism is decreased and myocardial performance index is a sensitive index which can be used to reflect right ventricular function in pulmonary thromboembolism.

BACKGROUND: It has been proved that interleukin-18 (IL-18) involves in the development of acute cerebral infarction (ACI) and is positively correlated with the time of brain stroke onset, erythrocyte sedimentation rate (ESR), as well as neurological deficit and low-density value of brain CT.OBJECTIVE: To investigate the dynamic changes of serum IL-18 in the course of ACI.DESIGN: Verification analysis with patients as subjects and healthy volunteers as controls.SETTING: Department of neurology of a municipal hospital.PARTICIPANTS: Totally 46 inpatients (29 males and 17 females) with ACI were randomly selected from the Department of Neurology of People's Hospital, Maoming City, between December 2002 and January 2004.Meanwhile, 40 healthy controls (27 males and 13 females) were recruited from those who came to the hospital for routine physical examination. All the participants signed informed consent.METHODS: Fasting peripheral vein blood of 2 mL was collected from the patients on the 1st, 7rh, 14th and 21st days of ACI onset, and from healthy controls on the day of routine examination. The blood samples were centrifuged at 3 000 r/minute for 15 minutes at 4 ℃, and then the supernatant was collected for detecting IL-18 level by ELISA.MAIN OUTCOME MEASURES: The serum IL-18 level of patients on the 1st, 7th 14th and 21st days of ACI onset and that of healthy controls on the day of routine examination.RFSULTS: Totally 46 patients and 40 healthy controls were enrolled in this study and all data were statistically analyzed. The level of serum IL-18 was significantly higher in the patients with ACI than in normal controls on the 1st and 7th days of onset [(178±41) ng/L, (104±34) ng/L, (65±14) ng/L, P ＜ 0.01],but was similar on the 14th and 21st days [(88±36) ng/L, (72±33) ng/L,(65±14) ng/L, P＞ 0.05]. The level of serum IL-18 in ACI patients was significantly higher on the 1st day than on the 7th, 14th and 21 st days of the onset (P ＜ 0.05-0.01); moreover, it was also significantly higher on the 7th day than on the 21st day of the onset (P ＜ 0.05).CONCLUSION: The level of IL-18 increases obviously on the 1st day of ACI onset, and gradually decreases with the extended course of disease and time of treatment.

Objective To investigate the efficiency of chitosan hemostatic dressing combined radial artery hemostasis device in patients after transradial coronary intervention.Method Six hundred consecutive patients after transradial coronary intervention were selected and randomly divided into the experimental group and the control group according to the hospital number,there were 300 cases in each group.Single pneumatic tourniquet was used in the control group,while the chitosan hemostatic dressing combined with pneumatic tourniquet was used in the experimental group.Hemostasis consumption time,incidence of bleeding,ecchymosis and radial arterial occlusion were compared between two groups.Results There was no significant difference in the incidence of skin ecchymosis between two groups,P ＞ 0.05.The hemostasis consumption time and the incidence of bleeding,early radial arterial occlusion and chronic radial arterial occlusion were (127.6± 33.0) min,7.0％(21/300),5.7％(17/300),4.0％(12/300) in the experimental group and (181.6± 32.2) min,20.0％(60/300),11.7％(35/300),9.0％(27/300) in the control group,t or x2 values were 20.258,21.708,6.822,6.170 respectively,and there were significant differences,P＜0.01 or ＜0.05.Conclusion In patients after transradial coronary intervention,the application of chitosan hemostatic dressing combined with pneumatic tourniquet is safer and more effective than using pneumatic tourniquet alone.

Objective To discuss the feasibility of constructing the system of traditional Chinese medicine nursing diagnosis.Methods Based on the theoretical analysis and status quo analysis,the feasibility of constructing the system of TCM nursing diagnosis was discussed,and the achievements and problems waiting for settlement were also narrated.Resuts It has the foundation of constructing the system of TCM nursing diagnosis,but some problems still need to be solved.Conclusions It is feasible for building TCM nursing diagnosis system,and the TCM nursing diagnosis system does not conflict with NANDA-I.

Objective To evaluate the value of spiral CT in analyzing correlation of growth pattern with pathology and prognosis in gastric stromal tumor(GST).Methods CT findings and pathological data including immunohistochemical staining sections of 43 patients with GST were reviewed and all patients were followed.The correlation between growth pattern,pathology and prognosis was studied.Results Of the 43 GST,there were benign in 9 and malignant in 34.the benign or malignant GST closely correlated with the growth pattern.Of the 17 intra-and extra-luminal growth patients,16 cases were malignant and 5 cases recurred in 3 years.Conclusion The GSTs that appear intra-and extra-luminal gowth hint the poor prognosis.