Medicine occupation market is an inevitably trend. During the course of this, medical ethics has not only morality value, but only economy connotation. Medical ethics is a very important medical resource. It can bring about economy and transform medicine capital through participating distribution and revolvation. Medicine occupation should be think highly of medicine confidence ethics' developing. It is medicine confidence ethics that is medical ethics new topic. It is going under market economy. At last, in our opinion, four basic criterions of medicine confidence ethics is no lies, no deceit, fulfilling promises of medical quality and propagating humanism.

Objective To study the method for determination of pentachlorophenol(PCP) in water by headspace solid phase microextraction(SPME) gas chromatography. Methods Pentachlorophenol in water samples was extracted using optimized SPME technology, separated by SE30 chromatographic column and the content of pentachlorophenol in water was determined by electron capture detector (ECD) under the conditions: adjusting water samples to pH 2.0, to maintain an agitating equilibrium concentrations at 60 ℃ for 40 min, headspace absorption for 10 min using extraction head holding polyacrylic ester-coated microfiber (0.83 ?m in thickness), desorption at 280 ℃ for 3 min. Results The detection limit of the method was 0.13 ?g/L. The correlation coefficient r=0.999 was noticed in range of pentachlorophenol concentrations 0-12 ?g/L. When adding standard material of pentachlorophenol at concentrations of 1 ?g/L, 6 ?g/L, 10 ?g/L, the recovery rates were 88.9%-105.0%, 88.9%-102.8% and 98.0%-99.5% respectively and the RSD were 4.9%-8.4%, 3.1%-8.5% and 4.0%-5.4%(n=6)respectively. Conclusion The method was simple, sensitive, stable and without solvent pollution, which was an ideal method for determination of pentachlorophenol in water.

Objective To investigate the efficacy and safety of dexmedetomidine on prevention of emergence agitation in adult patients during recovery period after abdomen surgery.Methods 1 20 ASA I -II patients scheduled for elective abdominal surgery under general anesthesia were randomly divided into three groups:dexmedetomidine group (group A),midazolam group (group B)and the saline control group (group C),40 cases in each group.40min before the end of surgery,dexmedetomidine 0.6μg/kg was continued intravenous infusion 1 0min in group A,midazo-lam 30μg/kg and 1 mL physiological saline were respectively intravenously injected in group B and group C.The post-operative recovery room (PACU)of restlessness,sedation,blood pressure,SpO2 and extubation time were observed. Results In of midazolam group,the time of anesthesia recovery[(1 8.2 ±1 .9)min],extubation[(32.1 ±3.9)min] and PACU staying[(48.7 ±3.1 )min]were significantly longer compared with the dexmedetomidine group[(1 3.1 ± 2.4)min,(26.5 ±2.2)min and (39.8 ±3.4)min,P =0.023,0.040 and 0.003]and the saline group[(1 2.6 ± 2.3)min,(24.8 ±2.9)min and (38.6 ±4.3)min,P =0.01 7,P =0.023 and P =0.001〗.The postoperative seda-tion scores of dexmedetomidine [(2.3 ±0.2 )points,P =0.025 ]and midazolam group [(2.4 ±0.1 )points,P =0.020]were significantly higher than the saline control group[(1 .1 ±0.5)points].The postoperative agitation score of dexmedetomidine (1 .3 ±0.5)points was lower than midazolam group [(2.5 ±0.5)points,P =0.01 1 ]and the saline control group[(2.4 ±0.6)points,P =0.020].HR and MAP of three groups at 2 min before extubation were observed,in the immediate extubation and at 5 min after extubation,the HR of dexmedetomidine group[(62.7 ± 4.1 )times/min,(67.3 ±3.4)times/min and (63.2 ±4.3)times/min]was significantly delayer than midazolam group [(72.3 ±3.4)times/min,(84.9 ±5.3)times/min and (82.1 ±3.1 )times/min],(P =0.002,P =0.001 and P =0.001 )and the saline control group [(73.6 ±2.9 )times/min,(85.3 ±4.7 )times/min and (83.3 ± 4.5)times/min],(P =0.001 ,P =0.023 and P =0.038)at the three time.In the immediate extubation,the MAP of patients in dexmedetomidine group[(87.3 ±4.2)mmHg)]was lower than midazolam group[(93.1 ±4.3)mmHg, P =0.001 ]and the saline control group[(95.6 ±5.8)mmHg,P =0.001 ].At 5 min after extubation,the MAP of patients in both of dexmedetomidine[(84.5 ±3.1 )mmHg)]and midazolam[(85.1 ±2.9)mmHg]group were lower than that in the saline control group[(92.3 ±4.6)mmHg,P =0.023 and P =0.038〗.Conclusion Dexmedetomi-dine could be one of the ideal drug to relieve emergence agitation in adult patients during recovery period after abdo-men surgery and the curative effect is better than midazolam.

Objective To evaluate the effect of hydrogen-rich saline on the regulatory T cells (Tregs ) in the peripheral blood during global cerebral ischemia-reperfusion (I/R ) in rats .Methods Seventy-seven male Sprague-Dawley rats ,aged 2-3 months ,weighing 260-300 g ,were randomly divided into 3 groups using a random number table:sham operation group (group S , n=11) ,group I/R (n=33) ,and hydrogen-rich saline group (group H , n=33 ) .Global cerebral I/R was produced by 4-vessel occlusion method .The bilateral carotid arteries were blocked for 15 min followed by reperfusion in I/R and H groups .In group H ,0.6 mmol/L hydrogen-rich saline 5 ml/kg was injected intraperitoneally at 0 and 6 h of reperfusion ,while the equal volume of normal saline was injected instead in the other two groups .Before ischemia (T0 ) in group S and at 6 ,24 and 72 h of reperfusion (T1-3 ) in I/R and H groups ,7 rats were chosen ,the blood samples from the peripheral vein were collected for determination of the number of Tregs . Then the animals were sacrificed and the spleen was removed for measurement of transforming growth factor-β1 (TGF-β1) content .The left 4 rats of each group were sacrificed at T0 and T1-3 and the brains were obtained for examination of the pyramidal cell morphology in the hippocampal CA 1 region and for determination of the number of pyramidal cells in brain tissues .Results Compared with group S , the number of pyramidal cells in the hippocampal CA1 region ,the number of Tregs in the peripheral blood and content of TGF-β1 in the spleen were significantly decreased at T1-3 in group I/R ( P<0.05) .Compared with group I/R ,the number of pyramidal cells in the hippocampal CA 1 region and the number of Tregs in the peripheral blood at T2-3 ,and the content of TGF-β1 in the spleen at T1-3 were significantly increased ( P<0.05) ,and the pathological changes of pyramidal cells were attenuated in group H .Conclusion The mechanism by which hydrogen-rich saline attenuates global cerebral I/R injury may be related to the increased number of Tregs in peripheral blood and promoted secretion of TGF-β1 in rats .

Objective To investigate the effects of alcohol extract of Kunmu decoction on proliferation and apoptosis of rheumatoid arthritis fibroblast-like synoviocytes (RA-FLS). Methods Synovial tissues were obtained from patients with active RA received joint replacement or arthroscopy. The surface antigen and the amount of apoptotic cells were determined by flow cytometry. The inhibitive effect was detected by MTT assay. Results The CD90+surface antigen of synoviocytes was (94.78 ± 0.98)%. The inhibitive effect on the proliferation in all treatment groups were in a time-and dose-dependent manner. The apoptosis rate was increased in a dose-dependent manner among all dosage alcohol extract groups. Conclusion Kunmu decoction might inhibit proliferation and induce apoptosis of RA-FLS.

Objective To prepare quercetin ( QT )-loaded polylactic-co-glycolic acid-D-α-tocopheryl polyethylene glycol 1000 succinate ( PLGA-TPGS) nanoparticles ( QPTN) and QT-loaded polylactic-co-glycolic acid ( PLGA) nanoparticles ( QPN) by using QT as model drug and PLGA-TPGS or PLGA as carrier materials, and to investigate the quality of the two nanoparticles. Methods QPTN and QPN were prepared by using the ultrasonic emulsification-solvent evaporation method, and their surface morphology,size and surface charge were detected by using a transmission electron microscope ( TEM) and a Nano ZS90 light scattering and laser Doppler anemometry, respectively. Drug loading ( DL) , entrapment efficiency ( EE) and in vitro drug release of QT in the two nanoparticles were determined by using a reverse phase-high performance liquid chromatography (RP-HPLC) on Hypersil C18 column (4.6 mm×250 mm, 5 μm) with methanol and 0.03% phosphoric acid (3︰2) as mobile phase, and the detective wavelength was 370 nm. Results TEM images exhibited that two nanoparticles were all spherical and regular. The average sizes of QPTN and QPN were (155.4±2.7) nm and (363.8±3.2) nm, while DL and EE of QPTN were approximately (21.6±2.8)%, (93.7±2.9)% (n=6), and DL and EE of QPN were approximately (15.0±1.5)%, (64.6± 1.6)% (n=6), respectively. Both of nanoparticles exhibited sustained release, and the cumulative QT release of QPTN and QPN reached (85.8±2.8)% and (68.6±1.4)% (n=6) at day 30, respectively, with a significant difference between them (P<0.05) . Conclusion QPTN gets smaller size, higher DL and EE, and exhibits sustained release, and the in vitro cumulative QT release is faster and more complete than QPN relatively.

Objective:To investigate the effectiveness of case-based learning (CBL) combined with online teaching in standardized residency training of rheumatology and immunology.Methods:A total of 78 individuals who participated in standardized residency training in Department of Rheumatology and Immunology in our hospital from June 2019 to August 2020 were included and divided into observation group and control group. The individuals in the control group received traditional teaching, and those in the observation group received CBL combined with online teaching. The physicians receiving standardized residency training were evaluated by theoretical examination, clinical operation skill assessment, and instructor rating, and the degree of satisfaction with teaching, degree of satisfaction with teaching methods, and classroom learning atmosphere were also evaluated.Results:The observation group had a theoretical examination score of (94.10±2.01) and a clinical operation skill assessment score of (90.44±1.57), which were significantly higher than those of the control group ( P<0.05), and the observation group had a significantly better instructor rating (89.36±1.33) than the control group ( P<0.05). Compared with the control group, the observation group had significantly higher degree of satisfaction with teaching (3.79±0.41), degree of satisfaction with teaching methods (3.92±0.27), and evaluation of classroom learning atmosphere (3.90±0.31) ( P<0.05). Conclusion:CBL combined with online teaching can help to improve learning efficiency, stimulate the enthusiasm for learning, expand clinical thinking, promote the growth of teaching and learning, and form a virtuous cycle among trainees receiving standardized residency training, which holds promise for further exploration.

Objective:To evaluate the association between thrombus composition and mechanical recanalization,operation procedure and clinical outcome.Methods:One hundred and ninety-two consecutive stroke patients with large-vessel occlusion treated by mechanical thrombectomy using a stent retriever and (or) aspiration catheter in the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University between January 2018 and January 2020 were collected. The retrieved thrombi were quantitatively analyzed for red blood cells, white blood cells, platelets, and fibrin. The patients were divided into two groups, a erythrocyte-rich group and a fibrin-rich group based on the predominant composition in the clot. The clinical prognosis, CT value of thrombus, procedure time,number of recanalization maneuvers, and degree of vascular recanalization were compared between the two groups.Results:The retrieved clot from 138 patients with acute ischemic stroke from internal carotid artery occlusion ( n=56), middle cerebral artery occlusion ( n=62), intracranial segment of vertebral artery or basilar artery occlusion( n=20) were histologically analyzed. Erythrocyte-rich clots were present in 59 cases, while fibrin-rich clots were present in 79 cases. Cardioembolic thrombi had higher proportions of fibrin/platelets [77.2%(61/79)], less erythrocytes than noncardioembolic thrombi [45.8%(27/59), χ2=8.115, P=0.004]. Patients with erythrocyte-rich thrombi had a smaller number of recanalization maneuvers [2 (1, 2) vs 3 (2, 4), Z=-7.613, P<0.001], shorter procedure time [45 (30, 60) min vs 80 (60, 90) min, Z=-6.944, P<0.001], higher thrombus CT value [42 (32, 53) vs 36 (31, 41), Z=-2.003, P=0.045], good clinical prognosis (the ratio of modified Rankin Scale score ≤2, 62.7% (37/59) vs 39.2% (31/79), χ2=7.444, P=0.006). There was no significant difference in the location of vascular occlusion between the two groups. Conclusion:For patients whose thrombotic components are mainly red blood cells, the cause of stroke may be non cardiogenic cerebral embolism, the CT value of embolus is relatively high, the embolus is easy to remove, and the clinical prognosis is relatively good.

Objective:To investigate the relations of thrombotic components with cause of stroke, procedure of mechanical thrombectomy, degrees of vascular recanalization and clinical prognoses in patients with large vessel occlusive cerebral infarction.Methods:One hundred and thirty-eight patients with large vessel occlusive cerebral infarction accepted mechanical thrombectomy using stent retriever and/or aspiration catheter in our hospital from January 2018 to January 2020 were chosen. These patients were divided into two groups, a erythrocyte-rich group and a fibrin-rich group, based on the predominant composition in the clots. The baseline clinical data, procedure time, number of recanalization maneuvers, degrees of vascular recanalization and clinical prognoses were compared between the two groups. The relations of infiltration degrees of erythrocytes and fibrin in embolus with procedure time were investigated.Results:The components of thrombus clots were mainly erythrocytes, fibrin, leukocytes, and platelets; erythrocyte-rich clots were presented in 59 patients, and fibrin-rich clots were presented in 79 patients. There was no significant difference in age, gender, preoperative NIHSS scores, proportions of hypertension, proportion of diabetes and proportion of vascular recanalization between the two groups ( P>0.05). As compared with patients from erythrocyterich group, patients in the fibrin-rich group had significantly higher proportion of cardioembolic thrombus (22.8% vs. 77.2%), statically larger number of recanalization maneuvers (2 [1, 2] times vs. 3 [2, 4] times), significantly longer procedure times (45 [30, 60] min vs. 80 [60, 90] min), and significantly lower proportion of patients with modifed Rankin scale (mRS) scores≤2 90 d after surgery (62.7% vs. 39.2%, P<0.05). Procedure time was negatively correlated with erythrocyte infiltration ( r= -0.562, P=0.005) and positively correlated with fibrin infiltration ( r=0.567, P=0.010). Conclusions:Different components of thrombus suggest the etiology of stroke may be different. Thrombus removal is relatively easy in patients with erythrocyte-rich clots, and the clinical prognosis is relatively good.

Objective To validate and discuss the time response correction formula for four types of dosimeters (6150AD6 + 6150AD-b,FH40G + FHZ672E-10,451P ionization chamber and AT1123).Methods The ambient dose equivalent rates shown by survey meters were recorded separately when X-ray emission time was 500,200,100 and 50 ms.The corrected values were obtained by the formula of circuit having a capacitance C and asistance R in series.Results Therewas no correlation between the value measured by AT1123 dosimeter and the time of irradiation.The values by other three kinds of dosimeters obviously varied with the time of irradiation.Conclusions It is not required to make the time response correction for the measured value of ATl123 dosemeter,whereas the values measured by the other three dosimeters could be corrected by the time response correction formula.