This article analyzed the difficulty and insufficiency in the practice of present medical ethics education and its absence in occupational career planning,the significance of medical ethics education in the occupational career planning,and explores approaches to promoting the practice of medical ethics education in occupational career planning.

Objective To evaluate the technique and clinical effect of retroperitoneoscopic adrenalectomy for pheochromocytoma.Methods A total of 78 patients received roperitoneoscopic adrenalectomy for pheochromocytoma from March 2006 to June 2008.Retroperitoneal space was enlarged routinely with patient in lateral decubitus position.After adequate retroperitoneal space was created,three relatively bloodless planes were orderly entered for exposure and separation of the adrenal gland and tumor.The first dissection plane was between the psoas and posterior Gerota's fascia.The subsequent dissections were proceeded in the plane between anterior Gerota's fascia and perirenal fat.The third dissection plane was between the adrenal gland and upper pole of kidney.The tumor and parts of adrenal glands were then excised.Results A1l operations were successful.The mean operative time and estimated blood loss were 145?53min and 100?49 ml,with no blood transfusion,and no conversion to open surgery.The mean postoperative analgesic(pethidine) consumption was 57?38mg.Time for oral intake of food and ambulation after operation were 1.6?0.5d and 1.5?0.3d,respectively.The mean postoperative hospital stay was 5.8?1.9d.No major intraoperative complications occurred.Conspicuous fluctuation of blood pressure(≥50mmHg) was observed in 49 patients during operation.56 patients were followed up,and no recurrence or metastasis of the tumor was found during a follow-up period of 12.3?8.7 months in average(range from 2 to 26 months).Conclusions With adequate preparations,retroperitoneoscopic adrenalectomy for pheochromocytoma(≤6cm) is a safe and effective procedure in the hand of an exparienced surgeon since it gives a clear operative field,adequate space for manipulation,distinct anatomic landmark and minimal agitation.

Objective To investigate the effect of somatostatin on pancreatic blood flow and pancreatic function on the patients with acute pancreatitis.Methods 120 patients with acute pancreatitis from March 2015 to March 2017 were collected, and were randomly divided into the observation group and the control group.The control group were given routine treatment, at the basis of this, the observation group were given somatostatin.octreotide 0.6 mg was dripped into intravenous continuously, and was reducted to 0.3 mg, continuous treatment for 7 d.The changes of blood flow and the curative effect of pancreas were compared between the two groups before and after treatment.Results The total effective rate was 96.67%(58/60)in the treatment group and 80.00%(48/60)in the control group.The total effective rate in the observation group was significantly higher than that in the control group, the difference was statistically significant (P<0.05).There was no significant difference in blood flow(BF), blood volume(BV)and capillary surface permeability(PS)between the two groups before treatment.1 and 7 days after treatment, BF, BV in the observation group were higher than those in the control group, the levels of PS were significantly lower than that in the control group, the differences were statistically significant(P<0.05).Before treatment, the differences of(CP), insulin(INS), glucagon(GLU), serum lipase(LIP), amylase(AMY)and trypsinogen-2(TPS)were measured in the two groups were not statistically significant.1 and 7 days after treatment, CP and INS in the observation group were significantly higher than those in the control group, and GLU, LIP, AMY and TPS-2 were significantly lower than those in the control group, the differences between the two groups was statistically significant (P<0.05).Conclusion It has a protective effect on pancreatic blood flow and function which somatostatin was used in the treatment of the patients with acute pancreatitis, it can improve the overall state of pancreas, and has significant therapeutic effect.

Objective To study the value of laparoscopic cholecystectomy (LC) for treating gallbladder benign diseases in aged patients. Methods Laparoscopy cholecystectomy (3-port or 4-port) was performed in 2335 senile patients with gallbladder benign diseases from December 1992 to May 2005. Results Five patients were found as having the Mirizzi syndrome and were given a subtotal cholecystectomy. In 18 patients with a frozen Callot’s triangle, the anterior wall of the gallbladder was resected and the mucous membrane on the posterior wall was electrocauterized. LC was completed smoothly in the remaining 2312 patients. No conversions to open surgery were needed. The operation time was 8~55 min (mean, 19 min), and the intraoperative blood loss was 1~ 50 ml (mean, 8 ml). An abdominal drainage tube was placed in 213 patients, including double-cannula lavage in 56 patients. The length of hospital stay was 4~16 d (mean, 6 d). Follow-up examinations for 10 days ~13 years in 1859 patients showed no biliary stenosis, gallbladder pouch, or residual stones. Conclusions Laparoscopic cholecystectomy is safe and feasible in aged patients, being the first choice of operative method. Proper perioperative management, careful prevention co-morbidities, and control of operation time as short as possible are important for senile patients.

BACKGROUND: A fibrinolytic enzyme (FLE) was purified from the venom of Agkistrodon blomhoffi brevicaudus by ion-exchange chromatography;meanwhile, it can dissolve thrombotic anti-thrombus drugs during onset of myocardial infarction and apoplexy.OBJECTIVE: To investigate the purification of FLE from the venom of Agkistrodon blomhoffi brevicaudus and research some biochemical and pharmacological characterizations.DESIGN: Controlled observational study.SETTING: Snake Venom Research Institute, Guangxi Medical University.MATERIALS: The experiment was carried out in Snake Venom Research Institute of Guangxi Medical University from July 2003 to June 2005.Kunming mice, weighing 18-25 g, of mean body mass of (20±2) g, aged 3-4 months were provided by Experimental Animal Center of Guangxi Medical University. Agkistrodon blomhoffi brevicaudus was supplied by Snake Venom Research Institute of Guangxi Medical University.METHODS: FLE was purified with DEAE Sepharose CL-6B ion exchang columns and HiPrep Sephacryl S 100; purity and relative molecular mass were measured with high-effective chromatograph of liquid and polyacrylamidedel electrophoresis (PAGE); isoelectric point was measured with isoelectric focusing electrophoresis; and then, components and partially pharmacological characteristics were also measured.MAIN OUTCOME MEASURES: Relative molecular mass, conformation of isoelectric point and amino acid, effect of inhibitor on FLE, hemorrhagic activity, and anticoagulant effect of FLE.RESULTS: All 30 rats and 12 rabbits were involved in the final analysis.Relative molecular mass was 59 100 and isoelectric point was 4.98. SDSPAGE acted as a zone in vitro. High-effective chromatograph of liquid showed a simple peak of FLE. This group belonged to metallo proteinases.Analysis of components of amino acid suggested that it contained a lot of acidity amino acids, had mild hemorrhagic toxicity and strongly thrombolytic effect.CONCLUSION: A simple acidity metallo proteinases, which is characterized by mild hemorrhagic toxicity and strong anti-coagulation, can be purified from the venom of Agkistrodon blomhoffi brevicaudus.

Objective To explore the value of follow-up of serum TSH stimulating thyroglobulin (Tg) test and 131I whole body scan(WBS) in patients with differentiated thyroid cancer(DTC) who were treated by 131I.Methods By SPSS software,Kappa test was performed between results of serum Tg,TgAb test and WBS for diagnosis of persistent/recurrent DTC.Results Consistency test of TSH stimulating Tg,TgAb and 131I WBS for diagnostic persistent/recurrent or metastasis of DTC:kappa value =0.587,SE =0.076,P ＜ 0.01.Although the results showed that two measurements appeared definite consistency,it is dissatisfactory.Conclusion Serum TSH stimulating Tg test and 131I whole body scan(WBS) are important follow-up tools for patients with DTC.Because of Tg interfering it is necessary to performed TgAb test simultaneously,when Tg test was performed.Especially 131I WBS do is not absent because false negative would be able to appeared in single serum TSH stimulating Tg and TgAb test.

Objective To construct a eukaryotic expression vector of decorin(DCN),and observe its expression in CHO cells,in order to provide a basis for further study on the anti-tumor effect of DCN. Methods DCN cDNA was amplified by PCR.The human full-length DCN cDNA ligated into pBluescript was used as template.The fragment was ligated to the expression vector pCDNA3 previously digested with XbaⅠ and EcoR Ⅰ.The ligation mixture was transformed into competent E.coli JM109 cells.Transformants containing inserts were confirmed by restrictive digestion and DNA sequencing.The expression vector was transfected into CHO cells using lipofectamine,and transfected cells were cultivated in DMEM containing G418 (800 mg?L-1) for about 2 months.Immunohistochemistry method was used to detect the expression of DCN protein in stably transfected cells.Results The PCR product was about 1 000 bp.The recombinant expression vector was identified by restrictive digestion and DNA sequencing. DCN protein was detectable in stablely transfected cells.Conclusion The recombinant eukaryotic expression vector pCDNA-DEC is constructed successfully and stablely transfected CHO cells are established.

Objective To introduce the technique and evaluate the clinical effect of retroperito-neoscopic anatomical radical nephrectomy. Methods One hundred and sixty-eight patients under-went retroperitoneoscopic anatomical radical nephrectomies. The average tumor size was 4.7 cm (ran-ging from 2.0-6.9 era) in diameter. There were 87 tumors in the left kidney and 81 tumors in right kidney. Ninety-two eases were in cli.nieal stage T1a. N0 M0 and 76 in T1b N0 M0. Retroperitoneal space was created routinely at lateral decubitus position. Four relatively bloodless planes were orderly entered for exposure and separation of the kidney outside Gerota's fascia. The first dissection plane was be-tween the psoas and posterior Gerota's fascia. The renal pedicle was found in this plane. The following dissections proceeded in the plane between posterior Gerota's fascia and fusion fascia. The third dissec-tion plane was between adrenal gland and the upper pole of kidney or between the adrenal gland and di-aphragma. The fourth dissection plane was in the bottom of Gerota's fascia. Results All operations were successfully completed. The mean operative time was 138:J:46 min and estimated blood loss was 90±30 ml. The average day of resuming oral intake was 1.3 d and time of ambulation was 1.2 d. The mean postoperative hospital stay was 5.8 d. Peritoneum injuries happened in 14 patients. Omalgia oc-curred in 18 patients and disappeared 2 d after operation. One hundred and twenty-three patients were followed up, they all survived during the average follow-up of 8 months (ranging from 6-18 months);, .Conclusions Retroperitoneoscopie anatomical radical nephrectomy is a safe and effective procedure. It can decrease operation time, blood loss and complication rate remarkably. It is a good option for patients needing radical nephrectomy.

Objective To investigate the MRI findings of perihip heterotopic ossification (HO) in the early, mid and late stages. Meth-ods The MRI of 44 inpatients with HO from February, 2011 to September, 2013 were reviewed, in which 20 cases (28 joints) were in early stage, 18 cases (24 joints) in mid stage and 6 cases (8 joints) in late stage. For the enhanced T1WI, 9 cases (11 joints) were in early stage, 6 cases (7 joints) in mid stage, and 3 cases (4 joints) in late stage. Theχ2 trend test was used to evaluate the MRI signal change with the HO maturity. Results With the maturity of hip HO, the signal intensity of T2WI reduced (χ2=16.773, P<0.001), fat signal on T1WI increased, the enhancement reduced (χ2=16.048, P=0.007). Conclusion The MRI findings of perihip HO are characteristic in MRI in all the stages. MRI is useful for the diagnosis of perihip HO, especially for the early HO.

BACKGROUND:Vascularuzed fibular graft is one of the effective methods for repair of large segmental bone defects in the extremities OBJECTIVE:To explore the clinical effects of vascularized fibular graft for repairing large segmental bone defects in the extremities. METHODS:Twenty-eight non-malignant patients who received vascularized fibular graft for repairing large segmental bone defects in the extremities and were folowed up for more than 20 months were enroled. After lesion removal, vascularized fibula bone graft was used to repair the bone defects. If cases combined with soft tissue defects, fibula flap or anterolateral thigh flap was adopted. RESULTS AND CONCLUSION: Al patients were folowed up for 20 months to 6 years. The grafted bones were healed with the surrounding bone at 3-8 months after fibula bone grafting. The grafted bone was enlarged near to the diameter of recipient bone at 10-22 months after grafting. Based on the Enneking system, the average score of large segmental tibia bone defects was 24.2 points with 81% limb function recovered and 94.1% patient satisfaction; the average score of large segmental femur bone defects was 26.3 points with 87.7% limb function recovered and 100% patient satisfaction; the average score of large segmental bone defects of the distal radius and ulna was 21.75 points with 72.5% limb function recovered and 100% patient satisfaction. These findings reveal that vascularized fibular graft for repairing large segmental bone defects in extremities can effectively promote bone healing and reduce disability, infection, amputation rate; moreover, patients are satisfied with the postoperative recovery of limb function.