BACKGROUND:Analgesia in different ways can be selected for the elderly in hip and knee arthroplasty. Considering the actual situation of the elderly patients, choice of anesthesia should be reasonable in order to achieve fast acting, long lasting time and good analgesic effect. OBJECTIVE:To explore the analgesic effect of ropivacaine of lumbar epidural anesthesia on elderly knee arthroplasty. METHODS:A total of 78 elderly patients aged 80-96 years, who were treated with hip and knee arthroplasty in the Shenyang Orthopaedic Hospital from September 2011 to September 2014, were enrol ed in this study. They were equal y and randomly assigned to control group and observation group, and separately administered continuous epidural anesthesia and lumbar epidural anesthesia with ropivacaine. The excel ent and good rate, onset time, anesthetic induction, frequency of use of Duffing mixture, and adverse reactions were compared between the two groups. RESULTS AND CONCLUSION:The excel ent and good rate of analgesic effect was higher in the observation group (97%) than in the control group (87%) (P<0.05). Onset time was significantly shorter, the dose of anesthetic was significantly less, frequency of use of Duffing mixture was significantly less in the observation group than in the control group (P<0.05). The difference was not significant in adverse reactions between the two groups (P>0.05). Above results indicated that lumbar epidural anesthesia of ropivacaine obtained good analgesic effects during elderly knee arthroplasty.

Medical science is the science which closely combines scientific knowledge with humanistic spirit. Becausemodern science and technology have been more and more applied in medical research and practice, the medical sciencehas been developed rapidly. But medical science calls us to concern more about medical humanistic spirit, so how wecombine medical scientific knowledge with humanistic spirit is a very important topic in our medical university education.[

The lack of organs has been an crucial limiting factor for Chinese organ transplantation,thus it is in urgent need to effectively increase the number of donor organs.This article holds that,besides through publicity and education to promote unpaid voluntary organ donation,some incentive mechanisms are also required to serve as useful complements.Therefore,organs' origin can be expanded to a certain extent,and the intense supply and demand in organ transplantation can also be eased.Unifying organ transplantation practice in China,this paper explains the necessity of organ donation incentive mechanisms from both theoretical and practical significances,reveals the main elements of the incentive mechanisms,and explores the realization means.

Background and purpose:Glutamine is the major fuel for the enterocyte and major energy origin of intestinal mucosal cell which prevent gastrointestinal mucosal cell from atrophying.Although there were a lot of studies of how to protect the gastrointestinal mucosal in various stress,such as trauma,burn and complex operation,but the impact of how the glutamine affected the gastrointestinal mucosa in the period of chemotheraphy was rarely reported.Our aim was to investigate the protective effects of glutamine for the morphological and functional damage of gastrointestinal mucosa induced by introperitoneally fluorouracil(5-FU) in rats in order to find the ways to prevent the intestinal mucosa from damage in the period of chemotherapy.Methods:Forty Wistar rats were randomly divided into four groups:A:Blank control group,B:5-FU group,C:5-FU + Glycin group,D:5-FU + Glutamine group.The rats in group C were given Glycin,group D glutamine(0.35 g/kg each).Group B,group C and group D received 5-FU(100 mg/kg) injection intraperitoneally on the fourth day respectively to make the model of gastrointestinal barrier injury.The content of endotoxin in peripheral blood was measured in all groups after the rats were killed on the seventh day.The mesenteric lymph nodes(MLN) and liver were harvested for comparison of bacterial translocation incidence among the four groups.Ileum tissue was taken for pathologic examination including comparison of mucosal thickness,villus height and width and morphology change of ileum of each group.Results:The test showed that the weight and the height,the width,the thickness of the villus intestinal mucosa of group D were more than those of groupB and group C.The content of endotoxin in peripheral blood and the positive cases of bacterial translocation in MLN and liver of group D were less than group B and group C.The weight and the height,the width and the thickness of the villus intestinal mucosa of group A were more than those of group B,group C,and group D.The content of endotoxin in peripheral blood and the positive cases of bacterial translocation of MLN and liver of group A were less than group B,group C and group D.Conclusion:There were damage to the rat's gastrointestinal mucosa during the giving of 5-FU intraperitoneally.Glutamine could protect rat's gastrointestinal mucosa from damage during the giving of 5-FU intraperitoneally.Glycin could not protect rat's gastrointestinal mucosa against from damage during the giving of 5-FU intraperitoneally.

The scenario simulation teaching method created a novel teaching mode for medical ethics and explored the new methods to enhance the teaching level.Through 6-year practice teaching,the authors made a comprehensive summary,refined the process,and resolved the existing problems.Several experiences gained in the process.The form of scenario simulation is novel,which is loved by the students.It is helpful to achieve the teaching goal that class should be led by students,cultivate medical students' humanistic quality,and make teaching benefits teachers as well as students.

This paper analyzed the main cause of the alienation of doctor-patient trust,the poor complaint channels of medical dispute,the lack of credibility for medical and judicial authentication,citizens' consciousness and other medical violence.Aiming at medical violence,we should popularize the concept of law firstly.Secondly,we should revise and perfect the act of medical violence,and promote the institutionalization of handling medical disputes.Then,we should strengthen the construction of physicianprofessionalism and perfect the medical identification.Third,we should strengthen the construction of mediation mechanism and import medical liability insurance appropriately.

At present,there are the following problems in the country doctors' professionalism education,the lack of country doctors' understanding of physician professionalism,the impact of the market economy and the neg-lect of the current physician professionalism education.On the basis of this,this paper suggested to improve the so-cial status and treatment of country doctors,to strengthen the education and training of professionalism-related subjects,to embody the humanistic idea and criterion in the rich specialized course teaching,and to promote the implementation of country doctors' professionalism education and training.

Chinese Physician Declaration and Medical Professionalism in the New Millennium-Physician De-claration in the United States and European countries are two significant documents that promote and cultivate phy-sicians′professionalism. Researches showed that the two declarations were basically the same in the background and guiding ideology. However, influenced by the historical tradition, cultural characteristics, medical and health system, medical science technological development, and social psychological factors, there exists difference in terms of perceive and practice. The differences manifest in the comprehension and grasping, ethnical theory basis, the nature and the degree of standard abilityand practice guarantee of physicians′professionalism. Therefore, study on the differences between the two declarations is beneficial to the construction of physicians′professionalism in our country.

Objective To explore the prognostic value of APACHE Ⅱscore in patients with Severe acute organophosphorus poi-soning .Methods 42 patients with Severe acute organophosphorus poisoning ,in which 34 cases survived ,8 cases dead ,were select-ed .The APACHE Ⅱscores of patients in first 24 h of admission were collected ,and receiver operating characteristic curves (ROC curve) were drawn .Results APACHE Ⅱ score of the 42 patients with Severe acute organophosphorus poisoning was 18 ~30 (20 .11 ± 6 .32) ,in which the survival group was(16 .10 ± 3 .12) ,the dead group was(28 .01 ± 4 .46) (P<0 .01) .With the increase of APACHE Ⅱ score ,the fatality rate gradually increased .The total area under the ROC curves of APACHE Ⅱ score for death judgment was 0 .922 ,APACHE Ⅱ score of 21 .2 was the best diagnostic point ,the sensitivity was 95% ,and specificity was 89% . Conclusion The APACHE Ⅱscore could predict severity of patients with Severe acute organophosphorus poisoning ,and APACHEⅡscore ≥21 .2 could be used as the prognosis for death of the patients .

Objective To explore the feasibility and application skills of transabdominal preperitoneal prosthesis (TAPP) with cross-encircling arms of mesh.Methods From Septemer 2009 to February 2012,46 cases were given TAPP with cross-encircling arms of mesh.The clinical data and surgery videos were retrospectively analyzed.Results All of the 46 cases with 53 inguinal hernias were successful in TAPP.The mean operative time of unilateral hernia was (57.74 ± 11.89) min,the mean operative time of 7 cases with biliateral hernia was (83.86 ±20.42) min and the longest time was 125 min.There were 6 cases with the contralateral hidden hernia,2 cases with hematoma,1 case with paresthesias of skin,no realpse.Conclusion The mesh with cross-encircling arms can be exactly fixed by spermatic cord,ductus deferens or round ligament of uterus,without stitching and stappling.