Wenchuan earthquate brought great misfortune to people,but this disaster has evoken human beings' moral power greatly.Love is the source of moral power,altruism is basic point of moral power and charity is performence of moral power.In this paper,we discuss moral powers' meanings and founctions in three aspects: great devotion of love,altruistic sacrifice and all kinds of charity without the boundary of counties and field.

This paper discussed the development of hospice care in our country form five respects , detailed e-laborated our country the main manifestations of lacking hospice medical service policy : relevant policies render fragments;relevant policy interoperability is not strong;Relevant policy lack of financial support;the lack of pub-licity related policy .On this basis , put forward the hospice career development needs of related policies , inclu-ding:set up complete medical security system;establish perfect hospice service classification management mecha-nism;establish and perfect the government funds allocated for hospice care medical services .

Doctor′s license for multi-sited service is an important part of hierarchical diagnosis.Aiming at the requirements and management in Guangdong medical reform, this essay clarified the situation and restriction factors when Doctor′s license for multi-sited service was carried out and gave some suggestions under the current conditions.

The hospitalpice enterprise has developed vigorously in China ever since 1980s.However,influenced by the long history and traditional Chinese culture,there are some ethical dilemmas in the issues of choice of death and palliative treatment.Choice of death and palliative treatment for the dying patients have been restricted by the traditional Chinese philosophy of death,traditional principles of filial piety,and the absence of support from euthanasia legislation.It is suggested that during the introduction of hospitalpice into china,the traditional Chinese value be respected.Meanwhile,people's cognition of hospitalpice should also be shifted to decrease the constraint of traditional ideas.The whole social power should be united and professional regulation construction should also be strengthened.Besides,it is also important to improve training for related professionals,promote the process of hospitalpice legislation as well as go abide by the current laws in order to achieve a high-quality hospitalpice.

Serum adiponectin levels in type 1 diabetic patients are higher than those in the normal population.We reviewed the influencing factors of serum adiponectin levels in type 1 diabetic patients,the relationship between adiponectin and adverse type 1 diabetic clinical features,complications,concurrent condition,and all-cause mortality,as well as potential mechanisms and research directions.

The tralning system for orthopedic surgeon in Britaln is mature and complete. After completing education in medical college, medical students receive a 2-year base tralning (FY1, FY2), which focus on learning and consolidating basic medical knowledge and clinical skill, followed by a 6-year specialist tralning, which subdivides into tralning of ankle and foot, hand, should and elbow, hip, knee, spine, and pediatric surgery, provided by several district hospital (Peripheral hospitals). Students are required to return to teaching center for review, ward inspection, case discussion at regular inter-vals. Compared with the specialist tralning system based on the hospital staffs in chi-na, the role ofsocial workersin British during the period of tralning makes better mobility of tralnee among medical institutions and medical treatments, which makes the tralning more comprehensive and professional. In addition, there is no consistent system for examination and admittance of specialist, and awareness of specialist tralning among medical institutions and doctors is weak. Therefore, it should be done to form a single tralning system and unify the tralning specification and assessment standard.

Objective To investigate the curative effect of laparoscopic or laparoscopically-assisted repair of gastrointestinal perforation. Methods Eighteen patients with gastroduodenal perforation underwent laparoscopic full-thickness repair with greater omentum covering. One patient with intestinal perforation underwent double-layer suture.Three patients with intestinal perforation were treated with mini-incisional repair or partial enterectomy.One patient with perforation of the sigmoid colon received laparoscopically-assisted loop sigmoidostomy.Results Laparoscopic repair was successfully accomplished in 18 patients,while laparoscopically-assisted repair was carried out in 3 patients with intestinal perforation and 1 patient with perforation of the sigmoid colon.The operation time was 35～80 min(mean,50 min).No complications occurred.Follow-up observations in 23 patients for 6～24 months(mean,18 months) revealed no recurrence of peptic ulcer in 18 patients with gastroduodenal perforation within 6～8 months and no intestinal obstruction. Conclusions Laparoscopic operations for gastrointestinal perforation is micro-invasive and effective.

With more details of end-of-life-care such as moral principle and standard management,the development condition of end-of-life-care in China is compendiously introduced, and "1,3,9——PSD"service mode of end-of-life-care is also put forward in this artical.

Objective To investigate the clinical characteristics and treatment of external auditory canal chol‐esteatoma (EACC) .Methods The clinical data of 38 cases(39 ears)with external auditory canal cholesteatoma from August 2006 to December 2014 were retrospectively analyzed .Results All the cases of EACC in this study had the external ear canal full of impacted squamous material or granulation tissue .The Holt and CT imaging examinations disclosed that 10 ears were phase I ,lesions were confined to the external auditory with no bone destruction .There were 23 ears were phase II ,the lesions were located in external auditory meatus with destruction of bone ,but with no involvement of the middle ear .There were 6 ears were phase III ,showing the lesions with disrupt external audi‐tory meatus and involvement of the middle ear ( mastoid and/or tympanic sinus) .Hearing impairment and aural fullness were the most common symptoms .The phase I cases were treated by removing cholesteatomas from the ex‐ternal auditory canal .Canaloplasty and/or tympanoplasty were performed in phase II cases .The phase III cases were successfully managed by modified radical mastoidectomy and/or tympanoplasty .There were 30 ears of tympan‐ic membrane were perfect and invaginate .There were 4 ears of ossicular chain were disrupted with one ear of facial nerve exposed .All surgeries were performed at once .No recurrence except in one patient was found during the fol‐low -up period .Conclusion The clinical stages can help identify the primary lesions and determine the choice of the best surgical approach .

Objective To investigate the effect of Notch signaling during bone marrow mesenchymal stem cells (BMSC) differentiating into islet in vitro.Methods The specific inhibitor of γ-secretase DAPT was used to inhibit the Notch signaling pathway.Mter induction,DTZ staining,indirect immunofluorescence staining,RT-PCR and Westenn blotting were used to detect the expression of insulin,glucagon,Pdx-1 and Ngn3.Results (1) Identification of BMSCs:Indirect immunofluorescence staining showed that BMSCs could express CD59 and CD90,which both were makrers of mesenchymal stem cells.Besides,BMSCs could express nerve culluar markers such as NSE,GFAP,suggesting multi-directional differentiation.(2) The result of MTT showed DAPT could inhibit the cell proliferation in a time-dependent manner and a dose-dependent mannar.Besides,DAPT could inhibit the expression of target gene of Notch signal pathway in a time-dependent manner and a dosedependent mannar.After treated by 1,5,20 μmol DAPT,the expression of Hes1 had reached to 92.06％,71.40％ and 46.89％ of controls respectively,suggesting efficiency of inhibition on Notch reached 7.94％,28.6％ and 53.11％ respectively (all P＜ 0.05).(3) Indirect immunofluorescence staining showed the expression of pancreas-specific markers such as insulin and glucagon were much higher in DAPT treated BMSCs than that in controls,which was confirmed by RT-PCR and Western blotting analyses.The proportion of insulin-producing cells differentiated from DAPT treated BMSCs was (74.03 ± 3.96)％,which was higher than that from controls[(36.49 ± 3.24)％,P＜ 0.05].(4)Furthermore,RT-PCR and Western blotting analysis showed that the expressions of Pdx-1 and Ngn3 were earlier than that of insulin and glucagon,and the expressions of Pdx-1 and Ngn3 were higher in DAPT treated BMSCs than that in controls.Conclusions Notch signaling pathway plays a role in the differentiation of BMSCs into islet in vitro.Pharmacological interference with Notch signaling pathway may provide a novel method to obtain islet for therapeutic use.