The crux of medical moral education into training the medical moral concept of medical students. From psycholgical aspect,this paper analyzes the levels and structures of medical concept,and suggests its corresponding training method.

Objective To investigate the therapeutic effects of citalopram on alleviating painful symptoms in type 2 diabetes mellitus(DM) patients with complication of painful peripheral neuropathy.Methods Thirty-eight type 2 DM patients with painful peripheral neuropathy were randomly divided into control group(eighteen patients) and treatment group(twenty patients).The diabetes control(including fasting blood glucose) and general health state(including body mass index,liver function,renal function) of patients were recorded.Patients in control group were given conventional drugs(including hypoglycemic drugs,anodyne,neurotrophy drugs,antiplatelet drugs),and those in treatment group received conventional drugs plus antidepressant drugs(citalopram,20mg,q.i.d.for 14 days).Hamilton Depression Rating Scale for Depression(HAMD-17) was used to assess the depressive symptoms,and numeric pain intensity scale(NPIS) was used to assess the pain intensity on baseline and the 1st,7th and 14th day.At the same time,the levels of analgesic agents were recorded.Results On the 7th and 14th day,the HAMD-17 scores in treatment group(22.14?8.92,18.69?9.4) were significantly lowered compared with that in control group(26.81?9.79,25.71?9.92),P

Objective To evaluate the left ventricle geometry shape and left heart regional function in mitral insufficiency (MI) by quantitative tissue velocity imaging (QTVI) and the left ventricle systolic and diastolic geometry spbericity index. Methods Thirty normal subjects and 62 MI patients underwent QTVI and color Doppler imaging (CDFI) were enrolled in this study in order to measure the left ven-tricular geometry shape and left ventrieular regional function along LV apical long-axis view. Off-line LV regional velocity images along LV apical long-axis view were synchronously obtained. Peak tissue velocities of LV regional muscular tissue during systole(Vs),systolic acceler-ation(a), early diastole(Ve), LA contraction(Va)were synchronously measured as the index of left ventricular regional systolic and dias-tolic function. The left ventricle geometry shape index were reflected from the systolic and diastolic geometry sphericity index (SIs and Sid) and the left ventrieular ejection fraction (LVEF) and the peak D and peak a (PVd/PVa) of pulmonary veins flowing spectrum reflected the global left ventricular function index. The Vs, Ve, Va, a, PVd/PVd ratio, LVEF, SIs, SId were recorded and their correlation between normal subjects and patients with MI were compared. Result Vs, Ve,Va,a,PVd/ PVa ratio,SIs,SId in patients with MI were significantly re-duced. There was positive relation between Sis and a(r=0.602)and Ve/Va and SId(r=0.635). Conclusion There was negative rela-tion between regional cardiac function and LV spberieity, the higher cardiac function was accompanied with the lower SI.

Objective: To investigate the effects of Ginkgo biloba extract 50 (GBE50) preconditioning on contents of inflammation-related cytokines in rats with myocardial ischemia-reperfusion. Methods: Fifty-eight SD rats were divided into sham-operated group, untreated group, Salviae miltiorrhizae (SM) injection group and low-, medium- and high-dose GBE50 groups. After intragastric administration for 7 d, the left anterior descending (LAD) coronary artery was occluded for 30 min followed by 60-min reperfusion to induce ischemia-reperfuion injury. Myocardium histopathologic change was observed by HE staining under a light microscope; myeloperoxidase (MPO) activity in myocardium was measured by colorimetric detection; tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and IL-8 were detected by radioimmunoassay; IL-4 and IL-10 were tested by enzyme-linked immunosorbent assay (ELISA). Results: Compared with untreated group, rats in medium-dose GBE50 group had lower inflammatory reaction and MPO activity (P<0.01). GBE50 also decreased the content of IL-6 (P<0.05, P<0.01) and increased the content of IL-4 in myocardium (P<0.05, P<0.01) as compared with the untreated group. The content of TNF-alpha in myocardium in the medium-dose GBE50 group was lower and IL-10 was higher than those in the untreated group, but without significant differences. Conclusion: GBE50 can decrease the content of IL-6 and increase the content of IL-4 in myocardium after ischemia-reperfusion injury. It suggests that GBE50 can regulate the inflammatory reaction after ischemia-reperfusion injury via inhibiting inflammatory cytokines and promoting anti-inflammatory cytokines.

The X-ray computed tomography (CT) appearance of 4 cases with pulmonary cryptococcosis (PC) diagnosed by pathological examination in our hospital was retrospectively analyzed. The appearances of PC on CT were various: solitary lesion in 1 case, multiple lesions in single lobe in 2, and multiple lesions in multiple lobes in 1. There were total 52 lesions in 4 cases; the diameter of nodules or masses was 3 - 75 mm. Cavitations were found in 1 case; lesions appeared obviously enhanced and one lesion showed central necrosis. Two cases underwent pulmonary lobectomy; and 2 cases received core cutting needle biopsies, after antifungal therapy for 3 months to 1 year the lesions showed being absorbed. In summary, the CT appearance of PC is non-specific with various modes and forms. PC should be considered when multiple nodules or masses scattered in subpleural zone, accompanied with ground-glass opacity and obviously enhanced. The examination of pathogen and pathology at the beginning is crucial for improving diagnostic accuracy.

The periods of the medical students' clinical practice is an important transition from medical theory to medical practice.According to the medical interns' expectations,such as the clinical tutor' level,hardware of the department,daily medical process and our department' s experiences,we grope for much better teaching methods that can meet medical interns' expectations and evaluate the new teaching methods.The basic clinical skills of medical students and the teaching level of gastrointestinal surgery department have been effectively improved.

Objective To investigate effect of rotational and shortening osteotomy at the conjoined mass in the treatment of congenital radioulnar synostosis.Methods Fourteen cases of radioulnar synostosis in 13 patients were treated by rotational and shortening osteotomy at the conjoined mass of radius and ulna.There were 10 males and 3 females,aged from 2 to 7 years (average,3.5 years).The pronation deformity of the forearm ranged from 50° to 90° (average,82.1°).The affected limbs could not perform some activities of daily living such as eating by holding a bowl,cleaning genitals and buttocks,turning on the global door knob,turning a key in a keyhole,and accepting objects in the palm.The operation was done through Boyd approach,and the proximal interosseous membrane of forearm was identified and released.The conjoined mass of radius and ulna was cut and shortened about 0.5 cm,then the distal part of forearm was rotated to neutral position or 10° to 20° of supination.Finally two parts of osteotomy were closed and fixed by crossing Kirschner wires which were removed 8 to 16 weeks after operation when reunion had been achieved.Results The average correction of pronation deformity of the forearm was 90.7°.No ischemic contracture of the forearm and incision infection occurred.And bone union was achieved in all patients.The parents and children were satisfied with improvement of deformity and function of the affected limbs.All patients were followed up for 14 to 88 months (average,35.7 months),and there was no loss of correction.Conclusion Rotational and shortening osteotomy at the conjoined mass of radius and ulna is an effective method for treating congenital radioulnar synostosis,which can significantly improve deformity and function of the affected limbs,and decrease risk of ischemic contracture of the forearm after operation.

AIM: To establish the quality standard of Puqinxiaoyan Tablets (Radix Scutellariae, Herba Taraxaci, Herba Corydalis Bungeanae, etc.). METHODS: TLC was used for identification of Herba Taraxaci, Herba Corydalis Bungeanae; HPLC was used for the determination of baicalin. RESULTS: The TLC identification was highly specific and the spots clear and concentrated. The linear range of baicalin was from 0.060～ 0.660?g, r = 0.99991, The recovery of the loading was 97.29%, RSD was 2.13%, respectively. The content of baicalin wasn't less than than 9.0mg per tablet. This method was easy to operate with accurate result, high sensitivity and good reproducibility. CONCLUSION: These methods are able to effectively control the quality of Puqinxiaoyan Tablets.

Objective To investigate the relationship of radiation dose with the volume and late toxicity of the sternocleidomastoid muscle ( SM) in patients with nasopharyngeal carcinoma. Methods SM was divided into upper part and lower part based on the lower edge of cricoid cartilage. Patients were divided into three groups according to the prescribed dose for clinical target volume at the lower neck ( CTV2 ) ( 0, 54,60 Gy) . The dosimetric parameters included Dmean , V66 , and V60 for the upper, lower, and whole SM. SM was delineated and the volume was calculated on computed tomography images in the treatment planning system before and at 6, 12, and 18 months after treatment. The anteroposterior and transversal diameters of SM at C3?C4 , C4?C5 , C5?C6 , and C6?C7 levels were measured and recorded. Late toxicity of neck skin and SM was evaluated according to the Common Terminology Criteria for Adverse Events V4 .0 criteria. Between?group comparison was made by t?test or Kruskal?Wallis non?parametric test. Between?group comparison of the sample rate was made by one?way analysis of variance. The correlation analysis was made by Spearman correlation. Results There were significant difference in SM volume between the three time points after treatment ( P=0. 000) . At 12 or 18 months after treatment, the volume of SM wasignificantly reduced ( P=0. 000,0. 000);the reduction in SM volume was significantly correlated with V66 of the SM and the upper SM ( P=0. 015,0. 020) . At 18 months after treatment, SM fibrosis was significantly correlated with V60 of the upper SM ( P=0. 030);the fibrosis of neck skin was significantly correlated with the Dmean and V60 of the upper SM ( P=0. 029,0. 005) . Conclusions In order to prevent the incidence of the fibrosis of neck skin and SM, the dose homogeneity should be as high as possible, while the number of hot spots should be as small as possible.

OBJECTIVE To understand the relationship between the detection rate of Pseudomonas aeruginosa in Children′s Hospital wards from Jan 2008 to Sep 2008 and disinfection and isolation in the department and investigate the change in antimierobial resistance of P.aeruginosa to provide basis for reasonable use of antibiotics in clinical practice.METHODS The clinically isolated P.aeruginosa strains were collected,cultured and identified by paper diffusing method.The results were evaluated according to the relevant documents of NCCLS of USA.RESULTS The resistant rates of P.aeruginosa to Ampicillin,Ampicillin/Sulbactam,ceftriaxone,cefazolin and SMI were higher than 98%.Their resistant rate to Levofloxacin and IMP was the lowest(about 2% or so).CONCLUSIONS Effective disinfection and isolation of P.aeruginosa should be performed.Selection of antimicrobial drugs should be according to the results of drug susceptibility,reduce the rate of bacterial resistance.