The physicians and nurses in the intensive care unit often discuss about withdrawing or withholding life-support therapy of critical ill patients with them or their family members.In this article,we expatiate on the importance,approach,agendas and medical ethical issues of the communication about end-of-life care between clinicians and families.

Objective To explore the occurrence of diaphragmatic muscle fatigue(DMF) in children with pneumonia and its relationship with respiratory failure.Methods One hundred and twenty-six cases of pneumonia(pneumonia group) and 60 healthy children(healthy control group) were selected,and 2K-V1 type intelligence electric impedance respirograph was used to measure diaphragmatic function of the children in both groups to find if the ribcage-abdomen motion was synchronic and to calculate M levels.The abdomen impedance values as X-axis were calculated,which were regarded,and the chest impedance values as Y-axis were calcaulated,which described two-dimensional chart of ribcage-abdomen motion curve and the ? angle which was between connection of maximum X value to the smallest X value and the X-axis were calculated.According to the changes of chest-abdominal curve in one-dimensional chart and the changes of M value and ? angle,the degree of the diaphragmatic muscle fatigue was judged.Results There were 98 cases of DMF in the 126 children with pneumonia,and 68 cases of which were type Ⅰ DMF,and 30 cases were type Ⅱ DMF.One-dimensional chart showed contradictory chest-abdominal respiratory motional curve,and two-dimensional chart moved in a clockwise direction.M value was(46.1?8.4)%,? angle was(136.7?12.0) degrees in children with type Ⅰ DMF;One-dimensional chart showed that the peak value of chest-abdominal respiratory motional curve dislocates,and two-dimensional chart moved in a counter-clockwise direction.M value was(17.2 ? 3.2)%,? angle was(48.2 ? 9.5) degrees in children with type Ⅱ DMF;the control group had M value(4.3 ? 1.0)%,? angle was(31.7 ? 5.2) degree.There were significant differences in M value and ? angle between type Ⅰ DMF children,type Ⅱ DMF children and healthy children(Pa

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Combined Modality Therapy ; Exercise Therapy ; Female ; Humans ; Lumbar Vertebrae ; injuries ; Male ; Middle Aged ; Spinal Diseases ; therapy ; Sprains and Strains ; therapy ; Young Adult

The pathogenesis of heart failure is a complex progression and associated with abnormal regulation of many signaling pathways. As a cofactor of hemoglobin, myoglobin, oxidative respiratory chain, DNA synthase and other important proteins, iron plays an indispensable role in myocardial energy metabolism. Recently, a large number of studies have shown that heart failure is related to the disorder of iron metabolism. Both iron deficiency and iron overload can lead to the development of a variety of cardiomyopathy, and even progress to heart failure. Iron metabolism could be a key target for the diagnosis, prevention and treatment of heart failure. Here, we review the basic process of iron metabolism and its mechanism in heart failure, expecting to provide new clues and evidence for the treatment of heart failure.

Integrative Medicine ; education

In recent years, the cases of prenatal paternity testing gradually increased in forensic practice. The traditional prenatal paternity analysis can be performed only after invasive sampling of chorionic villi or amniotic fluid, which can result in a risk of miscarriage. The existence of circulating cell-free fetal nucleic acid in maternal plasma has brought new opportunities for the noninvasive prenatal paternity testing. In this paper, the research situation and application prospect of circulating cell-free fetal nucleic acid in maternal plasma in prenatal paternity testing are reviewed.

Objective To diagnose the first imported case of Plasmodium ovale infection by laboratory detection. Meth?ods The epidemiological data and blood samples of the case were collected,and the samples were detected by the microscopic examination,rapid diagnostic test(RDT)and nested PCR. Results The patient was a construction worker backing from Con?go,Africa. He experienced the symptoms of irregular fever and weakness one month after returning in Lingyang Town,Junxian County. The results of RDT only suggested no?Plasmodium falciparum infection. Under the microscope,it was seen that the in?fected RBC were obviously disfigured and in irregular shape,the ring forms were thick and big,and also thick granulas in big trophozoite stage and schizont stage were found. The results of PCR showed that the size of amplified product was about 800 bp, which was conformed to that of P. ovale. Conclusion Though microscopic examination is the golden standard for malaria diag?nosis,as P. ovale is difficult to be identified under microscope,the microscopic method combined with PCR test can be used for definite diagnosis.

Prostate cancer is a common malignancy that affects men's health in the Western countries. Single nucleotide polymorphisms (SNPs), as the third generation of genetic markers, can influence the development, progression, and prognosis of prostate cancer. The same SNP may be related differently with prostate cancer among different races. This paper describes the relationship between SNPs and prostate cancer according to their related genes. SNPs can predict the risk of prostate cancer as well as the possible adverse reactions in its treatment, but at present they do have some limitations.
Humans ; Male ; Polymorphism, Single Nucleotide ; Prostatic Neoplasms ; genetics

Head and Neck Neoplasms ; surgery ; Humans ; Robotics

?AIM:To investigate the causes and characteristics of retinal detachment after vitrectomy.?METHODS: Retrospective analysis of patients in our hospital in recent 4a who underwent primary, standard, three -port pars plana vitrectomy ( PPV ) . Retinal detachment occurred in 24 eyes ( 23 cases ) , 24-67 years old, average 49.0±12.0 years old.There were male in 17 cases, female in 6 cases, 6 right eyes, 18 left eyes.?RESULTS:Eighteen (75%) eyes without any symptoms were found during a routine check, 6 eyes ( 25%) with decreased visual acuity or in front of shadow.It took 1-223d from PPV to retinal detachment, average 40.7 ± 54.2d, of which retinal detachment occurred in 10 (42%) eyes within 1wk, 14 (58%) eyes within 1mo.The direct cause of retinal detachment was new retinal break ( a total of 27 holes ) in 19 eyes, proliferative vitreoretinopathy ( PVR) in 4 eyes, 1 eyes with primary hole not closed.All retinal detachment were ultimately completely reset.?CONCLUSION: The occurrence of new retinal breaks is the main cause of retinal detachment after vitrectomy, attention should be paid to the early postoperative peripheral retinal examination;after a timely surgery, the retina can be reset.