The article teased the concept of medical futility and analyzed the issues when implement the medical futility policy.It introduced the medical futility policy by the examples of New York Public Health Code Article 29-B:Orders Not to Resuscitate and relevant regulations in Taiwan and presented some reflections on medical futility.The authors suggested that it should cope with the common and troubled cases of medical futility,establish ethics committee,and make the medical futility policy at the stage of tense doctor-patient communication.

Endometriosis is a common gynecologic disorder defined by the presence,growth,and invasion of endometrial tissue outside the uterine cavity.Although many hypotheses have been proposed,the etiology of the disease remains an enigma.Recent studies have suggested that factors within the peritoneal fluid contribute to endometriotic implant invasion,neovascularization,and proliferation.Chemokines,especially ENA-78,similar to IL-8,are postulated to play an essential role in the local inflammatory reactions seen in endometriosis.

Objective To evaluate the effect of different health education methods on inhospital pa-tients in sports medicine department and establish the most appropriate health education method. Meth-ods Sixty patients in the sports medicine department of a certain class-3 and grade-1 hospital were inves-tigated by questionnaires in the 10 aspects (such as the acceptability,comprehension,practicablity,vividness,instruction,etc) of 7 different health education methods.The quantitative score of O to 10 grade was adopted.Results The scores of 7 different health education methods were statistically different.The highest score was DVD which was followed by special explanation.The difference of the seven different health education methods was demonstrated in the following aspects such as mutual communication,vividness and memory holding.While the difference in practicability and instruction was not statistically different. Conclusions The health education methods were various and each had its characteristic,so they should be combined.The more satisfying health education effect will be obtained by carrying out health education with DVD as the major style complemented with special explanation,group explanation and multimedia teaching style.

trypsin. The EWPHs with papain for 3h displayed the strongest radical scavenging activity. The values of hydroxyl radical and superoxide free radical scavenging activity were 65.63% and 38.40% respectively. Conclusion EWPHs exhibited free radical scavenging activity and the activity of scavenging hydroxyl radical were stronger than superoxide radical.

Objective To study the clinical features of invasive pulmonary aspergillosis (IPA) with chronic obstructive pulmonary diseases (COPD),so as to provide evidence for early diagnosis and treatment.Methods A retrospective analysis was made upon clinical data,diagnosis,treatment and prognosis of 53 patients with IPA and COPD admitted between January 2005 and February 2011 collected in a respiratory unit of the Second Xiangya Hospital Affiliated Central South University.Results There were 53 cases of diagnosed as IPA with COPD,with history of using broad-spectrum antibiotics.And there were 43 cases using steroids more than 2 weeks,51 with obvious breathlessness,and 20 with fever.Early stage didn't present characteristical changes on CT scan.However,after disease progression,32 cases had maculas shadows and nonspecific consolidations in bilateral lung,14 with solitary or multiple nodules,4 with solitary or multiple air crescent sign,and 2 with halo sign.Four patients of COPD with IPA underwent bronchoscopy examination.In fungi pathogeny,sputum positive rate and galactomannan positive rate were 56.6％ and 52.8％,respectively.A total of 53 cases received antifungal treatment.Among 37 cases which underwent mechanical ventilation,24 received noninvasive ventilation and 13 received invasive ventilation.There were 33 cases which were improved and cured,and 20 cases which had no relief after half-a-month treatment or withdrew treatment.Among them,13 cases died because of multiple-organ failure (5/15) or acute renal failure (8/15).Conclusions Early suspected diagnosis,timely examination in allusion to IPA,actively searching for etiological and imaging evidences,early established diagnosis and antifungal treatment would improve prognosis of patients with COPD combined IPA who have history of high doses of cortieosteroids,obvious breathlessness and non-response to antibiotics.

Objective To study the application of debridement with arthroscopy in acetabular dysplasia with osteoarthritis. Methods Thirty-two cases in 48 hips acetabular dysplasia with osteoarthritis debrided under the arthroscopy. In this group, male 9 and female 23, the mean age was 38.1 years old (range, 28-52 years old), the left side for 9, right side for 7 and bilateralis for 16. In the 48 hips, X-ray showed that comparatively large acetabular draw with normal position of femoral head in 21 cases (28 hips), large acetabular draw with femoral head lateral shift slightly but did not exceed 1/3 of femoral head in 11 cases (20 hips).MRI demonstrated that intraarticular fluid in 28 hips, subcartilage anormal signal of acetabular and femoral head at weight loading region in 10 hips, signal interruption of glenoid lip of hip in 10 hips. The procdure which included to remove of osteophyma, loose body and hyperplasia synovial membrane, degenerated cartilage on the stress areas of the hip joint, wear and tear of glenoid lip. Results The perianal skin in 2 patients suffered dysesthesia because of the over traction during operation. They recovered 7 days postoperation. Dysesthesias twenty-eight patients (36 hips) were follow-up with an average of 23 months (range, 6 months-3.5 years). After debridement and lavage, the patients released from pain, restored function and the range of the motion. According to VAS evaluation system for pain, the preoperative score was 5-9, with an average of 6.8; the postoperative score was 4-6, with an average of 2. According to Harris hip joint score evaluation system, preoperative score was 58.8?6.15, postoperative score was 89.6?11.3. The excellent in 20, good in 4, fair in 3 and poor in 1. The excellent and good result was up to 85.7%. Conclusion Selectivity debridement and lavage were effective methods for osteoarthritis hip joint acetabular dysplasia. It can delay the developing of course of disease; improve clinical symptom and elevate quality of life.

ObjectiveTo investigate the difference in cell apoptosis between keratoacanthoma and squamous cell carcinoma.Methods Ninety specimens were obtained from the lesions of 30 patients with regressing keratoacanthoma (rKA) and 30 patients with well-differentiated squamous cell carcinoma (wdSCC) as well as from the normal skin of 30 human controls.Immunohistochemistry was carried out to measure the expressions of B-cell leukemia/lymphoma 2(Bcl-2),cysteine-aspartic acid protease(Caspase)-3,second mitochondria-derived activator of caspase/direct inhibitor of apoptosis-binding protein with low pl (Smac/DIABLO) and inhibitor of apoptosis protein Livin.ResultsThe Bcl-2 protein expression was significantly lower in rKA specimens than in normal control specimens(t =3.1572,P ＜ 0.05).A lower expression of Caspase-3 protein was observed in rKA specimens compared with wdSCC specimens (t =2.1364,P ＜ 0.05).The expression of Smac/DIABLO protein was significantly increased in normal control specimens than in rKA and wdSCC specimens(t =7.6141,9.5666,respectively,both P ＜ 0.05).Livin was absent in normal skin,but highly expressed in rKA and wdSCC specimens,and the difference was significant between the normal skin and lesional (rKA and wdSCC) specimens ( t =4.7913,12.7737,respectively,both P ＜ 0.05).The expression of Livin protein was significantly reduced in rKA specimens than in wdSCC specimens(t =7.9824,P ＜ 0.05).Conclusions Cell apoptosis plays a certain role in the natural regression process of KA.The detection of apoptosis-regulating proteins Caspase-3 and Livin are beneficial for the differentiation between rKA and wdSCC.

Objective To explore the impact and mechanism of miR-200 b on intestinal epithelial tight junction. Methods The negative-lentivirus and human-miR-200 b-lentivirus were employed to infect the Caco-2 cell thus establishing two stable cell lines which were then stimulated by 10 ng/mL human tumor necrosis factor-α(TNF-α) to establish the model of the intestinal epithelial injury. Those Caco-2 cells were divided into NC, NC+TNF-α, 200b, and 200b+TNF-αgroups.The tight junction permeability was detected by transepithelial electrical resistance (TEER) and Fluorescein isothiocyanate-labeled dextran (FITC-dextran). The protein alterations myosin light chain kinase (MLCK)/phosphorylated myosin light chain (P-MLC) pathways were measured by Western blot analysis. Results Compared to NC group, NC+TNF-αgroup had lower TEER, higher FITC-dextran, and up-regulated expressions of MLCK and P-MLC proteins (P

Objective To investigate the level of the peripheral blood percentage of neutrophils(Neu% ) and C reactive protein (CRP) in the early diagnosis of burn infection .Methods A total of 84 burn infection patients were collected from August 2013 to May 2014 ,28 cases with minor burns ,28 cases with moderate burns and 28 cases with severe burns .According to test results of wound infection ,they were divided into infected group with 64 cases and control group with 20 patients .Two milliliter peripheral blood samples were collected and used to measure the WBC ,CRP ,and Neu% .Results In the 84 patients ,66 cases with elevated CRP(78 .6% ) ,43 cases with elevated WBC(51 .2% ) and 57 cases with Neu% (67 .9% ) .The WBC levels in the infected group and control group had no significant different(P>0 .05) ,but there were significant differences on the levels of Neu% and CRP(P<0 .05) .WBC of mild ,moderate and severe burn patients had no significant differences(P>0 .05) ,but there were significant differ-ences on the levels of Neu% and CRP(P<0 .05) .Conclusion Neu% ,CRP might reflect the presence or absence of infection in burn patients ,and also increased with the burn degree .The combined detection of CRP and Neu% is more sensitive than the com-bined detection of CRP and WBC .

Objective To discuss the curative effect of arthroscopiclly assisted radiofrequency tenotomy of the sternocleidomastoid muscle for the treatment of congenital muscular torticollis in teenagers. Methods A total of 12 patients (right, 4 patients; left, 8 patients) were enrolled in the study. A 3-mm skin incision was made at the site 5 cm below the sternoclavicular joint. A dissector was inserted through the incision to perform blunt dissection subcutaneously until the attachment points of the sternocleidomastoid muscle. After a subcutaneous operative space 3 cm ? 3 cm in size was created, a 30? wide-angle arthroscope was placed. Another incision was located at the site 5 cm below the mid-clavicle for placing the bipolar radiofrequency probes (Arthrocare 2000). Under the assistance of arthroscopy, the sternocleidomastoid muscle was severed from the attachment at the both sides. Results The operation time was 15~30 min (mean, 20 min). No intraoperative hemorrhage or vascular and nervous injuries were observed. Follow-up for 5~10 months (mean, 7 months) in the 12 patients found normal appearance and no recurrence or diplopia. Conclusions Arthroscopiclly assisted radiofrequncy therapy for congenital muscular torticollis is characterized by simplicity of manipulation, micro-invasion, and satisfactory curative effect.