Clinical tutors' personality manifesting during the process of clinical practice and daily communication with medical interns has a series of influences on medical ethics formation of medical interns,including influences of direction,demonstration,contraction,and halo effect.Thus,clinical tutors should pay attention to cultivating a decent moral personality,and hospitals should value the proper combination of moral evaluation and supervision for medical staff in order to achieve the unity of heteronomous morality and self discipline,and effectively promote the formation of decent morality and personality of clinical tutors.

Objective To observe the effect of nerve growth factor(NGF) on Caspase-3 expression in hippocampus of epileptic rats induced by kainic acid(KA) and explore the protective effect and mechanisms of NGF on the epileptic neurocytes.Methods Sixty healthy rats aged 21 to 30 days were randomly divided into 3 groups,each of which included 20 rats.Rats in group A were treated with 9 g?L-1 sodium,rats in group B were treated with KA,rats in group C were treated with KA and NGF.Concentration of KA was 2 g?L-1 diluted by 9 g?L-1 sodium;KA was injected into rats in group B and group C,intraperitoneally.Then state of seizure was recorded,and EEG and pathological section were performed.Five rats in each group were sacrificed by perfusion with paraform respectively at 6 hour,on the 1st day,on the 3rd day after injection of KA.Specimen was sampled and made into frozen section.Expression of Caspase-3 in hippocampus of epileptic rats was analyzed by immunohistochemistry.And microscope image measuring and analysis instrument was used to analyze image of expression.Results Symptoms of seizure appeared 30 min after injection of KA.Seizure was proved by detection of EEG and pathological section.Expressions of Caspase-3 detected by immunohistochemistry in group C decreased at every time spot were higher than those in group B,and the defferences between 2 groups had statistically significant(Pa

Objective To detect serum bone specific alkaline phosphatase(BAP) and osteocalcin(OC) in children with idiopathic short stature(ISS),and explore the status of osteoblast.Methods Thirty-six cases of ISS in this study were divided into two groups(preaddescence group and adolescence group),50 healthy children as control group.The height,weight and body mass index in every group were measured.Left hand and wrist were measured with CHN way for bone age.Serum BAP and OC were measured by enzyme linked immunosorbent assay(ELISA).Results BAP and OC in ISS group of preadolescence were(79.90?25.96) U/L,(60.96?18.46)?g/L,and(152.17?35.36)U/L,(76.16?28.03)?g/L in normal children.In the ISS group of adolescence BAP and OC were(108.33?35.20)U/L,(63.82?24.81)?g/L,and(156.30?35.29)U/L,(104.92?28.26)?g/L in normal group.There was significant difference between ISS and control group in both age in the levels of BAP and OC(Pa

Objective To evaluate the effect of arsenic trioxide (As2 O3 ) on the proliferation of human renal carcinoma cell line 786-O ,and to explore the changes of the PI3K-Akt signaling pathway .Methods Human renal cancer cells 786-O was cultured in 96-well plates ,and divided into the control group (n= 45 holes) and the experimental group (n= 45 holes) .After stimulation by 1 μM As2 O3 and saline ,the cells in 15 holes were collected at 0 ,12 ,and 24 h .BrdU assay was performed to quantify DNA synthesis to evaluate the cells proliferation ,the quantitative PCR was used to measure PI3K and Akt relative mRNA expression ,and Western blot was used to quantify the relative expression levels of of intracellular PI 3K and Akt .Results After 12 ,24 h of As2 O3 stimula-tion ,the amount of DNA synthesis in the observation group was gradually lower than that of the DNA synthesis at 0 h(P<0 .05) and significantly lower than that of the control group at 12 h and 24 h(P<0 .05) .At 0 ,12 ,24 h ,the relative expression level of in-tracellular PI3K and Akt mRNA and protein in the observation group had no significant difference (P>0 .05) ,and the relative ex-pression levels of PI3K and Akt mRNA and protein in the control group were increased as the proliferation was gradually increased . Conclusion As2 O3 inhibits human renal carcinoma cell line 786-O proliferation through inhibiting the PI3K-Akt transduction path-way ,and has potential clinical value for the treatment of kidney cancer .

Objective To evaluate the expression of MMP-2 and MMP-9 and their relation with tumor invasion and metastasis in transitional cell carcinoma of bladder (TCCB). Methods Immunohistochemistry of EliVision were respectively used to determine the MMP-2 and MMP-9 expression in tumor tissues of 46 patients with TCCB and 14 cases of control group which were screened quantitatively (3-5 cm of surrounding tumor) between August 2006 and August 2008. Results Expression of MMP-2 and MMP-9 in TCCB are obviously higher than the normal control group (P <0.01), expressions of MMP-2 and MMP-9 in level Ⅱ,Ⅲ are obviously higher than in level Ⅰ (P <0.01), but there was no significant relationship between high stage or level Ⅲ and low stage or level Ⅱ (P >0.05). Conclusion The positive expressions of MMP-2 and MMP-9 in tumor tissues correlated with the malignant degree, invasion and metastasis of TCCB, MMP-2, MMP-9 could be useful indicators for the assessment of prognosis of TCCB.

Objective To explore the sleep problem and its related factors,and to provide evidence for improving sleep quality of patients with ankylosing spondylitis (AS). Methods Pittsburgh sleeping quality index (PSQI),self-rating depression scale (SDS),self-rating anxiety scale (SAS) and a self-designed questionnaire were applied to survey 318 patients with AS.Data were analyzed by the SPSS 17.0 software.The relationship between the various relevant factors were revealed by t-test,x2 test,Wilcoxon rank-sum test and Pearson correlation analysis.Results The mean total score of PSQI was 6.6±3.6, and 35.4％ of AS outpatients showed poor sleep quality.The difference of PSQI scores and detection rate of poor sleep quality between male and female were not statistically significant.There were significant difference of early morning stiffness(Z=-3.077,P=0.002),BASFI(Z=-4.766,P=0.000),BASDAI(Z=-6.880,P=0.000),nocturnal pain VAS(VAS)(Z=-6.502,P=0.000),total back pain VAS(Z=-6.675,P=0.000),ESR(Z=-2.370,P=0.018),CRP(Z=-2.063,P=0.039) between the poor sleep and the good sleep patients (P＜0.05).The PSQI score was positively correlated with age (r=0.165,P=0.003) but not gender and disease duration (r=0.078,P=0.165; r=0.094,P=0.097).PSQI score difference were also observed between patients with negative mood and patients without negative mood (t=-7.613,P=0.000; t=-7.287,P=0.000).Conclusion High incidence of sleep disorder exists among AS outpatients,and it is closely related with age,anxiety,depression and activity of AS.Attention should be paid to AS patients with sleep problems.

Objective:To explore the perioperative dynamic changes of cellular immune function and its clinical significance in patients with chest surgery.Methods:The numbers of CD3、CD4、CD4/CD8、CD8 T lymphocyte and nature killer(NK) cells in peripheral blood were examined in 45 patients with chest surgery before operation and 1、3、5 and 7 days after operation by flow cytometry.45 patients were devided randomly into groups.The perioperative changes of T lymphocyte subsets and NK cells were compared among mediastinal disease,pulmonary operation,esophagus and gastric cardia surgery.Results:CD4/CD8 decreased 1 day after surgery and CD4 decreased at the 3rd postoperative day in patients with chest surgery.In patients with mediastinal disease,CD4/CD8 decreased 1 day after surgery and CD4 decreased at the 3rd postoperative day.In patients with pulmonary operation,CD8 decreased at the 1st day and 7th day after surgery.NK cells decreased at the 5th postoperative day CD3 increased at the 5th day after surgery.CD4/CD8 increased at the 7th day after operation.In patients with esophagus and gastric cardia surgery,CD4/CD8 decreased 1 day after operation,CD3 and CD4 increased at the 7th postoperative day.All differences are statistically significant( P

Purpose:To observe the efficacy of capecitabi ne in the treatment of relapsed breast cancer. Methods:21 patients with relapsed breast cancer were treated. C apecitabine was administered twice a day at the dose of 2 500 mg/(m 2?d) f or two weeks. 21 days was one cycle. Patients could be evaluated after at least 2 cycles treatment. Results:20 patients could be evaluated. There were no complete response but 6 partial response, 8 stable disease and 6 progressive disease in t he group. The response rate was 30.0%. The common toxic effects were hand-foot syndrome (61.1%), nausea and vomiting(66.7%), leucopenia (42.9%) and skin pigm entation (23.8%). Conclusions:Capecitabine is effective for the relapsed breast c ancer patients who have been treated with anthracycline and taxanes. The toxic e ffects are mild and the tolerance is well. Capecitabine can be used as the secon d line regimen for relapsed breast cancer.

Objective To understand the quality of construction and sanitation of double_urn_and_single_funel(DUSF)latrines widely popularized in He'nan province and its current problems.Methods The qualities of contruction and sanitary management of 1269 DUSF latrines were investigated in countryside of Zhengzhou.Results The total qualified rate of the construction quality was 86.9% for 1269 observed DUSF latrines.The constituent ratios of latrines with good,moderate and bad sanitary management were 43.4%,33.4% and 23.2% respectively.The percentages of the latrines with auxiliary facilities such as flax brushes,tolet paper collectors and water storage tanks were 66.5%,67.3%and 39.4% respectively.Conclusion The quality of construction of DUSF latrines in countryside of Zhengzhou was qualified on the whole.But the sanitary management and maintenance of DUSF latrines should be improved further.

Objective To compare the effects of general anesthesia versus combined epidural?general anesthesia on postoperative complications in the patients undergoing thoracic surgery. Methods Two hundred twenty?one patients of both sexes, aged 18-80 yr, weighing 36-100 kg, of American Society of Anesthesiologists physical status Ⅰ?Ⅲ, scheduled for elective thoracic surgery, were randomly divided into either combined epidural?general anesthesia group ( group GE, n=112) or general anesthesia group ( group GA, n=109) . The patients were further allocated to high?risk population and low?risk population. Anesthesia was induced with target?controlled infusion of remifentanil and iv injection of propofol, sufentanil and rocuronium. A double?lumen endotracheal tube was placed, and the patients were mechanically ventilated. Partial pressure of end?tidal CO2 was maintained at 30-40 mmHg. Anesthesia was maintained with inhalation of 1% sevoflurane, target?controlled infusion of remifentanil, iv infusion of propofol, and intermittent iv boluses of sufentanil. 2% lidocaine 4 ml∕h was infused epidurally in group GE, and normal saline 4 ml∕h was given in group GA. Bispectral index value was maintained at 40-60 during surgery. Patient?controlled epidural analgesia ( PCEA ) was performed after surgery. PCEA solution contained
0.125% ropivacaine and sufentanil 0.5μg∕ml ( in 250 ml of normal saline) . The PCEA pump was set up to deliver a 2 ml bolus dose with a 20?min lockout interval and background infusion at 4 ml∕h, and visual analogue scale ( VAS) score was maintained less than 4. When VAS score ≥ 5, sufentanil 5 μg was injected intravenously as the rescue analgesic. The requirement for rescue analgesics after surgery, length of hospital stay after surgery, complications during postsurgical hospital stay ( cardiovascular events, cardiac insufficiency, acute coronary syndrome, pulmonary infection, stroke, transient cerebral ischemic attack) , and death within 30 days after surgery were recorded. Results Compared with group GE, the incidence of postsurgical cardiovascular events and atrial fibrillation was significantly decreased in group GA ( P<0.05) . In the high?risk population, compared with group GE, the length of hospital stay after surgery was significantly shortened, and the incidence of postsurgical atrial fibrillation was decreased in group GA ( P<0.05) . In the low?risk population, compared with group GE, the length of hospital stay after surgery was significantly shortened (P<0.05), and no significant change was found in the incidence of postsurgical complications, requirement for rescue analgesics after surgery, and fatality rate in group GA (P>0.05). Conclusion Compared with combined epidural?general anesthesia, general anesthesia alone provides lower occurrence of postsurgical complications for the patients undergoing thoracic surgery, and offers advantage for the high?risk patients having underlying diseases before surgery.