This article discusses the causes and base of clinical teaching theory and practice of Medical Ethics,and how to play it into practice and the effect.As proved by practice,clinical teaching plays an active role in fostering medical students' ethical awareness will,improving ethical determinating ability and bringing up medical moral emotion.Clinical teaching theory and practice of Medical Ethics,both in teaching design and teaching notion,adapts to the transformation of medical model,and emphasizes on the teaching thought of "teachers as center,students as main body".

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare disorder of hematopoietic stem cells due to acquisition of somatic mutations.Somatic mutations in phosphatidylinositol glycan class A (PIGA) account for intravascular hemolysis and other PNH manifestations,but the pathophysiology of clonal expansion of PNH cells cannot be elucidated clearly.PNH is closely related to aplastic anemia and myelodysplastic syndromes.Today,the gold standard for PNH is flow cytometry to detect the absence or severe deficiency of glycosylphosphatidylinositol (GPI)-anchored proteins on white and red blood cells.However,PNH diagnosed by phenotype is a group of heterogeneous disease in pathogenesis.Eculizumab,a first-in-class monoclonal antibody that inhibits terminal complement,is highly effective in stopping intravascular hemolysis and improving quality of life.Further research on the pathogenesis of PNH would be helpful to understand the underlying reasons for PNH phenotype cells in different patients,improve differential diagnosis and more targeted and specific therapy.Research progress in recent years will be reviewed in this article.

Objective To investigate the correlation between the inflammatory-nutritional index (INI) and recurrence and prognosis in patients with gastric cancer. Methods A total of 78 cases patients of gastric cancer with recurrence and 64 cases without recurrence were enrolled. INI was calculated by the ratio of serum albumin and C-reactive protein. The value of INI predicting recurrence was analyzed using receiver operating characteristic curve (ROC). According to this value, the Kaplan-Meier curves and Cox regression analysis were used to evaluate the effect of INI on prognosis. Results Compared with the control group, the recurrence group showed smaller INI, larger tumors, lower degree of differentiation, deeper invasion and higher TNM stage, the differences were statistically significant (all P < 0.01); The INI significantly predicted the recurrence of gastric cancer, with a sensitivity of 62.5%, specificity of 79.5% and critical value of 0.36 (P < 0.01); Additionally, The pathological features were worse in the low INI group than the high INI group , the differences were statistically significant (P < 0.01); The INI significantly predicted the prognosis of gastric cancer, with a sensitivity of 65.9%, specificity of 66.8% and the critical value of 0.34 (P < 0.01); Obviously, the survival rate was lower in the low INI group than the high INI group (48.8% vs 25.0%, P < 0.01). Furthermore, INI was an independent risk factor for prognosis of gastric cancer (OR = 1.78, 95% CI: 1.34 ~ 2.59, P < 0.01). Conclusion The INI is closely related to the characteristics of gastric cancer, it is an effective marker to predict recurrence and prognosis of gastric cancer.

Objective To explore the effect of modified electroconvulsive therapy (MECT) on working memory in schizophrenia patients.Methods 2-back test paradigm was set to measure the performances of working memory.A total of 30 cases of schizophrenia were recruited and measured with accurate rate and reaction time on this tasks before and after treatment with MECT.Differences were analyzed between patients through MECT treatment and 30 patients through drug treatment.Results Repeated measure ment analysis of variance on the accurate rate ((66.70±9.82) ％,(67.61±6.83) ％,(80.72± 12.08) ％) and reaction time((1415.69± 258.51) ms,(1328.65±236.08) ms,(1094.45± 259.44) ms) of 2-back test were significant among three times of MECT (F=19.163,P＜0.001 ; F=13.084,P＜0.001).Schizophrenia patient's performance of error rate and reaction time of 2-back test were higher at the end of 2 weeks after treatment((80.72± 12.08)％;(1094.45± 259.44)ms) than before MECT treatment ((66.70±9.82) ％ ; (1415.69±258.51) ms).The difference between them were significant(t =-4.369,P＜0.001 ; t=5.596,P＜0.001).Schizophrenia patients performance of error rate and reaction time of 2-back test were higher at the end of 2 weeks after treatment((80.72± 12.08)％;(1094.45±259.44) ms) than at the end of 1 day after treatment((67.61±6.83)％;(1328.65±236.08) ms).The difference between them were significant(t=-5.416,P＜0.000; t=3.824,P=0.001).Schizophrenia patients performance of error rate of 2-back test were higher at the end of 2 weeks after treatment than drug treatment group ((73.67±10.41) ％),and the difference between them were significant(t=2.424,P=0.018).Conclusion Working memory functions in schizophrenia patients may be improved in varying degrees with MECT.

Objective To study the relationship between white blood cell(WBC) count and cardiac events in acute ST-elevation myocardial infarction(STEMI) patients treated with reperfusion in the early stage. Methods Two hundred and thirty-five patients with acute STEMI were divided into two groups:percutaneous coronary intervention group (PCI group, 97 patients) and thrombosis therapy group (138 patients). WBC count and cardiac events of the two groups before and after treatment (3 h and the second day and the third day) were recorded and compared. Results The level of WBC count had no changes in two groups before and after treatment in first 3 h (P>0.05) , while the level of WBC count was significantly decreased, and the level of WBC count was significantly lower in PCI group than that in thrombosis therapy group (P<0.05). The rate of no cardiac events and two cardiac events in two groups has no significant differences (P > 0.05). The rate of one cardiac events in PCI group was significantly higher than that in thrombosis therapy group (P<0.05). The rate of three cardiac events in PCI group was significantly lower than that in thrombosis therapy group (P<0.05). WBC count had a positive correlation with cardiac events rate (r = 0.231, P < 0.05). Conclusions Primary percutaneous coronary intervention decreases WBC count and cardiac events rate. In patients with acute myocardial infarction, level of WBC count has positive relationship with cardiac events.

BACKGROUND: Cervical orthosis is one of the non-surgical therapeutic methods for the remedy of cervical deformities. The introduction of cervical orthosis into the clinical remedy of cervical deformities resulted by burn can maximally restore the cervical function of the patients.OBJECTIVE: To analyse the clinical applicative mode and the effects of moulded cervical orthosis (MCO) on cervical burn.DESIGN: A before-and-after verification study by employing pateitns as subjects.SETTING: Prosthetics and orthotic department in a provincial artificial limb center.PARTICIPANTS: Totally 19 cases including 13 males and 6 females after skin-transplantation due to serious burn in head, neck and chest admitted by the outpatient department of prosthetics center between January and September 2003.METHODS: Nineteen patients with cervical burn wore MCO. Return visits were made afterwards for the evaluation of the treatment effects of MCO.MAIN OUTCOME MEASURES: Resutls of therapeutic effectiveness evaluation.RESULTS: All nineteen patients with cervical deformities due to burn reached the effects of correcting cervical flexion and restoring cervical functions through wearing orthosis. The cervical functions restored entirely in seven cases, almost restored in eight cases and improved in four cases.CONCLUSION: MCO can be clinically used on cervical deformities resulted by burn and provide good effects on remedy and rehabilitation.

BACKGROUND: Decoy receptor 1 (DcR1), which acts as decoy receptors, is resistant to apoptosis induction by related apoptosis inducing ligand (TRAIL). OBJECTIVE: To investigate the expression of the DcR1 (TRAIL-R3) protein in human herniated and normal lumbar intervertebral discs (IVD). METHODS: The expression and distribution of DcR1 proteins were assessed by using immunohistochemistry in 20 herniated lumbar IVD and 8 normal lumbar IVD tissues samples following discoidectomy from January to September 2010. RESULTS AND CONCLUSION: Percentage of nucleus pulposus and anulus fibrous cells with DCR1 expression was obviously more in the herniated group than in normal IVD group. The current results indicate that the expression of DCR1 rises after herniation.

Objective To analyze the survival rate and hospitalization information for 81 2 cases of very low birth weight (VLBW)and extremely low birth weight (ELBW)infants.Methods The retrospective study was con-ducted in a single center,Department of Neonatology,Hubei Women and Children Hospital,from January 2009 to De-cember 201 4,where the data of 81 2 infants with birth weight(BW)less than 1 500 g was analyzed in regard to perinatal condition,treatment and complications of these in relation to prognosis.Results (1 )A total of 621 cases(76.5%) had favorable prognosis.(2)There was a significant difference in the favorable prognosis rate between different BW groups (χ2 =28.87,P <0.05)and different gestational age(GA)groups (χ2 =1 4.77,P <0.05).The favorable prog-nosis rate for the male infants(χ2 =4.69,P <0.05),puerpera age between 1 7 -25 and 36 -46 years old (χ2 =1 1 .1 9, P <0.05),usage of prenatal hormones(χ2 =8.02,P <0.05),the infants without intrauterine infection (χ2 =8.61 ,P <0.05),the mother without gestational hypertension (χ2 =7.20,P <0.05)and gestational diabetes mellitus(χ2 =1 9.2, P <0.05)were different compared to the control groups.(3)Infants with peripherally inserted central catheter (PICC) (χ2 =33.31 ,P <0.05)and recovery birth weight within 1 0 days(χ2 =29.65,P <0.05)had higher favorable prognosis rate compared to the control groups,which had significant differences.(4)Infants with intraventricular haemorrhage (IVH)(χ2 =1 3.1 6,P <0.05),respiratory distress syndrome (RDS)(χ2 =7.59,P <0.05),necrotizing enterocolitis (NEC)(χ2 =1 3.02,P <0.05)and serious asphyxia (χ2 =6.05,P <0.05)had lower favorable prognosis rates than those did not,with significant differences.(5)Logistic analysis:the lower BW,smaller GA,earlier birth,unused PICC, serious asphyxia,IVH,RDS were risk factors for poor prognosis(all P <0.05).Conclusions The favorable prognosis rate of VLBW and ELBW infants has improved gradually,and is closely related to GA,BW,maternal age,perinatal care,prevention complication,treatment of disease and social factors etc.

Objective To study the levels of interleukin-6 (IL-6) and C-reactive protein(CRP) in umbilical cord serum of the newborns with premature rupture of membrane(PROM)and to explore the value of IL-6 and CRP in the diagnosis of early onset neonatal sepsis (EONS).Method A total of 187 term newborns with PROM ＞ 12 h who were born normal vaginally in our Hospital from April 2015 to December 2015 were enrolled in this study as the PROM group and another 50 term infants without PROM and infection as the control group.The levels of IL-6 and CRP in umbilical cord serum were quantified by ELISA,the results of which were compared between groups.Receiver operating characteristics (ROC) curves were drawn to find out the cut-off value of IL-6 and CRP for the diagnosis of EONS.Result The levels of IL-6 and CRP in umbilical cord serum in the PROM group were significantly higher than those in the control group [IL-6 20.3 (9.5,35.8) pg/ml vs.9.3 (6.9,27.5) pg/ml,CRP 0.42 (0.25,0.78) mg/L vs.0.33 (0.18,0.45) mg/L,P ＜ 0.05].The levels of IL-6 and CRP in the newborns whose mother had chorioamnionitis were significantly higher than those in the newborns whose mother was without chorioamnionitis [IL-6 62.5 (35.2,92.7) pg/ml vs.10.8 (9.3,33.4) pg/ml,CRP 0.86 (0.44,1.95) mg/L vs.0.35 (0.20,0.62) mg/L,P ＜0.05].The levels of IL-6 and CRP in the infants with PROM≥18 h was significantly higher than those in the infants with PROM ＜ 18 h [IL-6 32.1 (9.9,42.2) pg/ml vs.10.7 (9.2,32.6) pg/ml,CRP 0.44(0.29,0.86) mg/L vs.0.35 (0.23,0.61) mg/L,P ＜ 0.05].The levels of IL-6 and CRP in the neonates with EONS was significantly higher than those in the neonates without EONS [IL-6 92.0 (58.3,161.0) pg/ml vs.20.0(9.4,35.2)pg/ml,CRP 1.94(0.47,2.73) mg/L vs.0.38(0.24,0.67) mg/L,P ＜ 0.05].ROC curve analysis showed that the cut-off value of IL-6 and CRP for the diagnosis of EONS were 81.lpg/ml (sensitivity 76.5％,specificity 90.6％) and 1.88mg/L (sensitivity 64.7％,specificity 89.4％).With the combination of IL-6 and CRP levels,the sensitivity was 88.2％ and the specificity was 84.1％ for the diagnosis of EONS.Conclusion To measure the IL-6 and CRP levels in umbilical cord serum is helpful for the early diagnosis of EONS,and the combined detection of the 2 items may improve the sensitivity of diagnosis.

Objective To introduce improved techniques for one-stage operation of penile lengthening and thickening. Methods 8 cases were operated by this kind of procedure which comprised bilateral longitudinal incision of the corpora cavernosa and enlargement of the tunica albuginea using sapheneous grafts. Results All the cases gained satisfactory results without serious complications such as infection, fistula, and hemorrhage. All the cases who have married resumed regular and satisfactory sexual activities after one month without any functional limitation . The penile corpus circumferential measurements after operation immediately and at 12-month follow-up revealed increases of 1-2 cm. Conclusions The introduced technique for one-stage plastic procedure of penis lengthening and thickening indicates for treating micropenis and dysmorphophobia in terms of aesthetics or sexual function need . The new technique is a reliable method for penile augmentation with good configuration, satisfactory function and few complications.