With the development of modern medicine,to see a doctor is no longer a simple process of diagnosis or taking drugs.Human have deeply recognized medical science and health from a simple biomedical model to a social,psychological and biomedical model.On the one hand,people seek help from medical science.On the other hand,people fear that malpractice could occur.It has been in a love-hate mentality for people to seek medical and legal relief.In the new era,physician-patient relationship needs to be recognized again from medical staff,patients and legal angles.The combination of medicine and law is the requirement of development of the times.No matter how strong the law is,and no matter how much we hope the legislation is from strength to strength,moderation is still the virtues of the law.Medical perspective is still required in the examination of medical activity.

To evaluate the inhibitory effect of recombinant adenoviruses p16 (Ad p16) combined with Ad p53 on human cholangiocarcinoma cell line QBC939 in vitro. Expression of p16 was low and p53 was negative in QBC939 cells. High level of p16 and p53 expressions were observed in QBC939 cell line transfected with Ad p16 and Ad p53. The growth rates of the Ad p16 infected combined with Ad p53 infected QBC939 cells were inhibited, which was higher than those of the Ad p53 or close to Ad p16 transfection. Colony formation in Ad p16 with Ad p53 transfected cells greatly decreased versus Ad p16 transfected or Ad p53 transfected cells. The Ad p16, Ad p53 and Ad p16 with Ad p53 transfected cells manifested apoptosis and G 1 arrest, which were confirmed by the flow cytometry. The suppression effects mediated by expression of the exogenous p16 with p53 in tumor cell resulted mainly from apoptosis and G 1 arrest, which is higher than exogenous p16 or p53.

Myocardial infarction and ischemic stroke share many common risk factors.Their pathophysiological processes are also similar and the 2 diseases often occur at the same time.Coronary artery disease is one of the important causes of embolic stroke in the elderly population.However,there are a few reported stroke events available after myocardial infarction.This article reviews ischenic stroke following acute myocardial infarction.

[Summary] Limb numbness is a common symptom of diabetic peripheral neuropathy(DPN),which is similar to lumbar vertebra disease and spinal cord tumor compression syndrome. Diabetes mellitus (DM) combined with lumbar spondylosis and spinal cord tumor compression is rarely occurred and is difficult to distinguish from DPN . Here we reported a case of DM combined with spinal neurilemoma that was misdiagnosed as DPN for half a year.

BACKGROUND: Tissue-engineered spinal cord has brought new treatment ideas for spinal cord repair.OBJECTIVE: To construct the tissue-engineered spinal cord by chitosan alginate scaffold and adipose-derived mesenchymal stem cells (ADMSCs), and to investigate its repairing effects on acute spinal cord injury in rats.METHODS: The spinal cord hemisection model was established in 48 Sprague-Dawley rats and then, rat models were randomly divided into four groups: model group, scaffold group, ADMSCs group and tissue-engineered spinal cord group,followed by direct suturing of the dura mater, implantation of chitosan alginate scaffold, implantation of ADMSCs, and implantation of tissue-engineered spinal cord, respectively. The limb motor function of rats was evaluated based on the Basso-Beattie-Bresnahan score at 1, 3, 7 weeks after transplantation. Immunofluorescence staining and hematoxylin-eosin staining of the spinal cord specimens were performed at 7 weeks after transplantation.RESULTS AND CONCLUSION: (1) Motor function of the hind limb: At 3 and 7 weeks after transplantation, the Basso-Beattie-Bresnahan score was highest in the tissue-engineered spinal cord followed, followed by the ADMSCs and scaffold groups, and lowest in the model group (P < 0.05). (2) Immunofluorescence and hematoxylin-eosin staining: in the model group, the spinal cord injury area was infiltrated with a large number of fibroblasts and inflammatory cells. In the scaffold group, there was no scar formation; neuron-specific enolase-positive cells, glial fibrillary acidic protein-positive cells and a few neurofilament protein 200-positive cells were found in the junctional area. In the ADMSCs group, the spinal cord injury area was filled with scar tissue, and a large number of glial fibrillary acidic protein-positive cells were found. In the tissue-engineered spinal cord group, there was no scar tissue, and there were a large number of neuron-specific enolase-positive cells, a small amount of CM-Dil-labeled ADMSCs and more glial fibrillary acidic protein-positive cells. Neurofilament protein 200 positive cells were connected to each other at the junction. These findings indicate that the tissue-engineered spinal cord constructed by chitosan alginate scaffold and ADMSCs can promote spinal cord repair after acute spinal cord injury.

OBJECTIVE:To prepare the norcantharidin (NCTD) nano-micelle and study its antitumor effect. METHODS:NCTD nano-micelle was self-formed in water using Triblock copolymers distearyl phosphatidylethanolamine-polyethylene glycol-ma-leimide;its shape was observed,the drug-loading rate,entrapment efficiency,particle size,Zeta potential were investigated. MTT was used to investigate the cell survival rate of human lung cancer A549 cells in negative control group (Phosphate buffer solu-tion),carrier group (blank nano-micelle),positive control group (NCTD APIs,5-320 μg/mL) and NCTD nano-micelle group (NCTD,5-320 μg/mL) after acting different time (24,48,72 h). Tumor nude mice were randomly divided into blank control group,NCTD injection group(1 mg/kg),NCTD low-dose,high-dose groups(0.5,1 mg/kg),6 in each group. All mice were in-travenously injected relevant medicines in tail,once a day,for 8 weeks. Tumor size was measured every week,and tumor quality was detected after the second day of finishing administration. RESULTS:NCTD nano-micelle was round,drug-loading rate was (2.82±0.05)%,entrapment efficiency was(83.67±1.78)%,particle size was(138.6±45.8)nm,Zeta potential was -(12.75± 0.34)mV(n=6). Cell survival rate of A549 cells in carrier group had no obvious changes,and was obviously decreased in posi-tive control group and NCTD nano-micelle group,which was positively correlated with concentration and time. And the decrease degree of cell survival rate in NCTD nano-micelle group was stronger than positive control group(P<0.01). Compared with blank control group,the tumor quality of mice in 3 administration groups was reduced (P<0.05),the reduction degree in NCTD na-no-micelle high-dose group was stronger than NCTD nano-micelle injection group (P<0.05). CONCLUSIONS:NCTD nano-mi-celle is successfully prepared,which has good in vitro and in vitro anti-tumor effect on A549 cells.

Objective To observe the effects of compound lidocaine cream on patients with tracheotomy during recovery from general anesthesia.Methods Fifty-four patients scheduled for radical oral cancer resection and tracheotomy under general anesthesia were randomly allocated into two groups:control group (group C,27 patients) and compound lidocaine cream group (group L,27 patients).Compound lidocaine cream was uniformly smeared on the airway segment of tracheotomy tube in group L,and no drug was coated on tracheotomy tube in group C.Hemodynamic parameters before induction (To),at the end of surgery(T1),at the moment of awake(T2) and 1 min after awake(T3),respiration recovery time,awake time,time spent in the postanesthetic care unit (PACU),coughing,and agitation after surgery were monitored.Results There were no difference in the operation time,sevoflurane inhale time,respiration recovery time and awake time between two groups (P ＞ 0.05).The time spent in the PACU in group L was less than that in group C [(27.3 ± 6.9)min vs.(34.9 ± 6.6) min] (P ＜ 0.05).The HR and MAP of T3 in group C were significantly higher than those ofT0 [(113.5 ± 18.0) bpm vs.(82.2 ± 13.1) bpm,(112.7 ± 15.7) mmHg (1 mmHg =0.133 kPa) vs.(87.5 ± 12.7) mmHg] (P ＜ 0.01).The HR and MAP of T3 in group L were lower than those in group C [(92.6 ± 12.8) bpm vs.(113.5 ± 18.0) bpm,(98.3 ± 13.5) mmHg vs.(112.7 ± 15.7) mmHg] (P ＜ 0.01 or P ＜ 0.05).Degree of coughing in group L was lower than that in group C (Z =-2.409,P ＜ 0.05).Degree of agitation in group L was lower than that in group C (Z =-2.013,P ＜ 0.05).Conclusion Topical anesthesia of tracheal mucosa using compound lidocaine cream can effectively alleviate hemodynamics fluctuations,coughing and agitation after tracheotomy during recovery for general anesthesia.

Objective To analyse peritoneal dialysis(PD) in 30 infants and children with acute renal insufficiency after complex congenital heart disease surgery,sum up the clinical experience of PD therapy infants and children with acute renal insufficiency after complex congenital heart disease surgery.Methods The clinical records of 30 infants and children during January 2010 to June 2012 were analysed retrospectively,with 23 male and 7 female,aged from 7 days to 18 months[average (8.28 ± 5.17) months],weight 2.5-14 kg[average (5.15 ± 3.89) kg].The reasons for PD:7 cases because of oliguria (urine ＜ 1 ml · h-1 · kg-1,duration ＞ 4 h) and the other 23 cases because of anuria.Results One case with total anomalous pulmonary venous connection(TAPVC) died of left heart failure,1 case with transposition of the great arteries died of multiple organ failure,and the other 28 cases were all cured,cure rate 93.33％.Conclusion PD is easy,safe and low-cost,has definite curative effect in infants and children with acute renal insufficiency after complex congenital heart disease surgery,worth to popularize.

Background:Personality characters will influence the future career planning and development of medical students.Therefore,it will be important in the field of medical education to survey their personalities.Study design:The personality questionnaire was developed according to the Big-Five characters.The content validity and consistent reliability were assessed.A total of 124 undergraduate medical students participated in this 44-item self-evaluation about their personalities.Results:The inter-item consistency reliabilities of the 44-items of Big-Five personality questionnaire were analyzed and discordant items were deleted(Crobach's Alpha from 0.484~0.782 before selection to 0.67~0.82 after selection).The content validity of this five dimensions ranged from 0.8 to 0.9(P

Objective To analyze the effectiveness of doctor-patient communication course on improvement of doctor-patient communication ability.Methods Totally 360 eight-year program medical students of clinical medicine from Shanghai Jiaotong University School of Medicine were chosen as the research object and were divided into educational group(n＝l80) and control group(n＝180).Students in educational group study doctor-patient communication course while those in control group do not.SEGUE Framework was used to conduct exploratory research between educational group and control group.Accuracy of questionnaire database was examined by Excel software and logical test.KoImogorov-Smimov(K-S test) was applied to analyze the scores and (x ± s) was used to express the data through SPSS 16.0 statistical software.Comparison between group differences are statistically significant(P＜0.05).Results Overall score was higher in educational group than in control group.Concerning of communication initiation,infomation collection and understanding of patients,scores of educational group were significantly higher than those of control group(P=0.001,P=0.002 and P=0.007,respec-tively).Furthermnore,KoInogorov-Smimov(K-S test) and (x ± s) statistical results showed that scores of detailed items were higher in educational group than in control group as well.Conclusions Doctor-patient communication course is of great importance to help medical students practice physician-patient communication based on related knowledge learning,but course content setting remains to be further improved.