This paper firstly introduces the perspectives of medical ethics moral imagination, then illustrates the specific connotation of the medical students moral imagination:moral sensitivity, perspective transformation, situat-ed cognition and beyond and moral reflection and evaluation ability, finally analyzes the narrative method based class to cultivate the medical students moral imagination, the narrative is to cultivate the medical students moral i-magination again the main teaching method.

Objective To explore clinical features of severe preeclampsia patients with adverse outcome, and the risk factors of adverse outcomes. Methods From Jan. 2008 to Dec. 2009 149 severepreeclampsia impatients who occurred adverse outcome enrolled as case,and 278 severe preeclampsia impatientswithout adverse outcome at the same period enrolled as control. The clinical features between the two groups were compared and the risk factors were investigated. Results No significant differences were found between the two groups in maternal age,times of previous prenancies. The gestation ages at the onset of preeclampsia and at delivery in the cases were less than controls(P ＜ 0. 05). There was significant difference in irregular antenatal checks between the two groups(x2 = 8. 515, P ＜ 0. 05). Proterinuria and the level of oedema in cases were higher than controls( P ＜ 0. 05). Fetal growth restriction (FGR) occurred more frequently in the cases (P ＜0. 05). Indirect bilirubin, total bilirubin, glutamic oxalacetic transaminase, glutamic pyruvic transaminase, uric acid, creatinine, white blood cell, thrombin time, D-dimeride of cases were higher than those of controls(Ps ＜0. 05). Albumin, platelet and profibrin of cases were lower than those of controls(Ps ＜ 0. 05 ＝. Multivariate logistic analysis showed that the gestation ages at the onset of preeclampsia, regular antenatal checks were significantly associated with adverse outcome(OR = 0. 899, P ＜ 0. 001; OR = 0. 600, P = 0. 022, respectively ＝Indirect bilirubin and D-dimeride were significantly associated with preeclampsia complications(OR = 1. 533,P =0. 010; OR = 1.001, P = 0. 003, respectively). Mean arterial pressure and creatinine were significantly associated with eyeground changes(respectively OR = 1. 030,P = 0. 048; OR = 1. 025, P = 0. 022, respectively).Regular antenatal checks was associated with dead fetus(OR = 0. 317, P = 0. 046). No significant differenceswere found between the two group in uterine-incision delivery(P ＞ 0. 05). Incidence rate of low birth weight infants and postpartum hemorrhage of cases were higher than controls and Apgar score was lower in cases than controls( all P ＜0. 05＝. Conclusion The gestation ages at the onset of preeclampsia,regular antenatal checks,fetal distress were risk factors for preeclampsia adverse outcome. Patients with.high indirect bilirubin and Ddimeride are more likely to suffer adverse pregnancy outcomes.

Objective To improve the early diagnosis and prognosis factor of pancreatic carcinoma by summarizing and analyzing the clinical data. Methods The clinical data of 90 patients with pancreatic carcinoma of our hospital from 1989 to 2005 were analyzed retrospectively. Results The symptoms of pancreatic carcinoma were very complicated,the most common manifestations were bellyache,jaundice and weight loss. Main physical signs in these patients included abdominal tenderness,abdominal mass,hepatomegalia,gallbladder enlargement. Jaundice was the outstanding manifestation of pancreatic head cancer. Among all patients,16 cases accepted sugical resection(17.8%),and the 1-year,3-year,5-year survival rate were 22. 2%,11.1% and 2. 2% respectively. Our data showed that the most important prognostic factors which influenced life span were the surgical procedures,tumor size and location,histological differentiation,TNM stage. Conclusions Clinical manifestations of pancreatic carcinoma are related to TNM stage,tumor size and location,histology type,complication disease. Clinical symptoms only provide clue for diagnosis of pancreatic carcinoma. Laboratory and imaging examination will provide objective evidence for further diagnosis and prognosis in pancreatic carcinoma.

AIM To investigate the activation of p38 protein kinase in alveolar macrophages(AMs) stimulated with lipopolysaccharide(LPS) and the effects of dexamethasone(DEX) and N acetylcysteine(NAC) on the process. METHODS AMs isolated and purified from normal rats were divided into four groups:Control group, LPS stimulated group ,DEX group and NAC group. The activation of p38 protein kinase in nuclear protein extract from the AMs and the concentration of TNF ? and IL 8 in supernatant were measured by Western blot and radioimmunoassay, respectively. RESULTS The activation of p38 protein kinase and the concentration of TNF ?, and IL 8 in LPS stimulated group were significantly higher than those in control group( P

Objective To investigate mobilization of the bone-marrow-derived stem cell (BMSC) into peripheral blood by granulocyte-colony stimulating factor (G-CSF) to accelerate the renal regeneration.Methods Six-week-old transgenic C57BL/6J mice labeled with green fluorescent protein (GFP) as bone marrow donors and C57BL/6 mice without fluorescence label as recipients ( n =20 ) of bone marrow transplantation were used.All recipients received lethal dose of 8.5 Gy total body γ-ray irradiation with 137 Cs before bone marrow transplantation,and the transplantation of bone marrow mononuclear cells 2 × 105 by retrobulbar injection was done two hours later after irradiation. Bone marrow reconstruction after transplantation was proved by flow cytometry five weeks after transplantation.Six weeks after the bone marrow reconstruction completed,left renal pedicles of all mice were cross-clasped for 30 minutes followed by reperfusion to establish the animal model of ischemia-reperfusion injury.Mice were divided into two groups:( 1 ) Saline control group ( n =10),saline 0.2 ml/day was injected subcutaneously into chimeric mice from 3 days before to 4 days after operation ; (2) G-CSF mobilization group (n =10),chimeric mice were injected subcutanously with recombinant human G-CSF,200μg/kg/day,once a day from three days before surgery for a week.On the 1st day after mobilization,the percentage of stem cell in non-erythroid cells of peripheral blood was detected by using flow cytometry.One week after ischemia,the homing of BMSC to kidney was identified by flow cytometory.Renal tissue sections were stained with Hemotoxylin and Eosin staining method for pathological study,and the degree of renal tubular injury was analyzed by semiquantitative method of Vyacheslav.Four weeks after ischemia,the differences in degree of renal regeneration between the two groups by analysis the numbers of vascular endothelial cells in the kidney.Results After G-CSF mobilization,the percentage of stem cells with Sca-1 +,c-Kit +,CD29 and CD34 + antigen in peripheral blood in G-CSF mobilization group were higher than those in control group.One week after ischemia,mice of mobilization group showed higher percentage of Sca-1 +,c-Kit + and CD34 + bone marrow derived stem cells in tbe kidney compared to control group (P ＜0.05).One week after ischemia,the tubular epithelial damage score of mobilization group was lower significantly than that of the control group (P ＜ 0.05 ) studied by Hemotoxylin and Eosin staining. Four weeks after ischemia,mice of G-CSF mobilization group showed more CD31 positive cells in the kidney compared to control group (P ＜ 0.05 ).Conclusions G-CSF can effectively mediate the mobilization of bone marrow derived stem cells to peripheral blood and homing to kidney.G-CSF mobilization can accelerate renal regeneration and alleviate the degree of renal histopathological changes after ischemia.

Objective:To explore the effective way of cultivating the operating room nurses′humanistic quality by using the morning shift and to improve operating room nurses′comprehensive quality .Methods:The operating room nurses were divided into five specialist groups according to the nurses′levels, helping each group to determine the training topic of humanistic quality training , via taking a variety of training methods to promote operating room nurses′humanistic quality by making good use of the morning shift time .Results: Through taking a variety of training methods to promote the operating room nurses′humanistic quality by making good use of the morning shift time, the operating room nurses′humanistic care ability , theoretical knowledge , professional skills were improved significantly(P<0.05),and the operating rooms doctors, surgical patients′satisfaction of operating room nurses′service were improved ( P<0 .05 ) .Conclusion:Making good use of the morning shift time to improve the nurses′humanistic quality , at the same time , the nursing service quality and patients satisfaction were also improved .

Objective To evaluate the signal changes of the skull base after salvage surgury via endoscopic transnasal approach for local recurrent nasopharyngeal carcinoma.Methods Twenty patients with nasopharyngeal carcinoma after radiation failure underwent nasophargeryngectomy via an endoscopic transnasal approach were selected from April 2006 to December 2011,including 16 males and 4 females with 31 to 67 years old.Each patient had previously received irradiation and experienced recurrence after 8 to 83 months of completed irradiation.All patients underwent MRI no more than 2 weeks before the salvage surgery and were subjected to repeat MRI scans 2 weeks,3 months,6 months later and semi-annually thereafter,with the follow-up time of 6 to 45 months(median 18 months).A two-sided Chi-square test was used to compare the signal changes and the tendency of changes on all presurgical and postsurgical MR images.Results The MRI signal changes were detected at 92 sites of skull-base between 2 weeks and 3 months after the surgery,which was hypointense on T1 WI with moderate to marked contrast enhancement.In the follow-up period,the signal abnormalities at 36 sites of skull base had resolved or restored to the normal,and 34 sites remained stable,while in 22 sites,the MR signal changes became more obvious.The skull base bones adjacent to the region of the resection were more likely to show signal changes than nonadjacent areas (72 vs.20,x2 =33.128,P ＜0.01).The signal changes were more common on the ipsilateral skull base to the recurrent tumor in contrast to the contralateral skull base (68 vs 24,x2 =21.182,P ＜ 0.01).Conclusions The skull base signal changes after salvage surgury via endoscopic transnasal approach for local recurrent nasopharyngeal carcinoma,and it occurs in specific location.Most of sites tend to resolve or be stable at the follow up.

Objective: To investigate the association between inflammatory cytokines and ventricular remodeling after acute myocardial infarction (AMI) in rats, and the effects of simvastain on inflammatory cytokines and ventricular remodeling after AMI thereof. Methods: After AMI was produced in female SD rats, the animals were divided into control group,simvastain group and sham-operated group. After transthoracic echocardiography, TNF-α, IL-6 and P Ⅲ NP of the serum and cardiac muscle were measured by radioimmunology technology. The comparative heart weight and infarct sizes were calculated.Results: Compared with the control group, the LVDd and LVDs decreased significantly (P ＜ 0.05), LVEF,LVFS and posterior wall thicking increased significantly (P ＜ 0.05) in simvastain group. The values of TNF-α, IL-6 and P Ⅲ NP increased significantly in simvastain and control group compared with those of sham-operated group(P ＜ 0.05 or P ＜ 0.01 ). The values ot TNF-α, IL-6 and pⅢ NP decreased significantly in simvastain group compared with those of the control group (P ＜ 0.05). The comparative heart weight and infarct size decreased significantly in simvastain group compared with those of the control group (P ＜ 0.05). Conclusion: Simvastain can ameliorate the ventricular remodeling and improve cardiac performance after AMI by restraining the overexpression of inflammatory cytokines.

ObjectiveA new style of artificial vessel scaffold was designed making the use of property of organoselenium catalyzing the releasing of Nitric oxide (NO). MethodsSelenium-containing catalyst organoselenium immobilized polyethyleneimine (SePEI) as polycation and polyglutamic acid (PGA) as polyanion were alternately coated onto the surface of polycaprolactone (PCL) nanofiber scaffolds obtained by electrospinning to form the blood vessel scaffold. Self-assembly was characterized by UV and atomic absorption qualitatively and quantitatively. Catalytic generation of NO from the NO donors- RSNOs was tested under the existence of reducing agent RSH. Biological properties were also evaluated. Results The NO release was relatively stable with no significant burst appeared, and still could be detected after 80 hours of catalyzing. The material was proved to show little cytotoxicity, and displayed significant effect in inhibiting of platelet aggregation through biological testing. Conclusion The new style of artificial vessel scaffold has good effect on improving the biological properties of materials.

BACKGROUND:Embryonic stem cel s have the capacity of multi-differentiation potential, and have been utilized for the therapy of acute liver injury. However, the migration and proliferation of embryonic stem cel s after transplantation remains not wel characterized.
OBJECTIVE:To track the transplanted embryonic stem cel s in repairing acute liver injury by bioluminescence imaging technology.
METHODS:Murine embryonic stem cel s (D3) were transducted with a construct composed of firefly luciferase, monomeric red fluorescence protein and herpes simplex virus truncated thymidine kinase triple fusion reporter genes by lentivirus system. Stable D3 embryonic stem cel s integrating three report genes were screened. The undifferentiated embryonic stem cel s or differentiated embryonic stem cel s from the 6-day-old embryoid body were transplanted into acute liver injury model of SV129 mouse through spleen, and the transplanted cel s were monitored by bioluminescence imaging technology.
RESULTS AND CONCLUSION:Reverse transcription PCR results showed that the expression level of Oct-4 and Nanog was not affected in embryonic stem cel s transducted with triple fusion reporter gene compared with wild-type embryonic stem cel s. The migration process of transplanted cel s was visualized by bioluminescence imaging technology. Teratomas were found in both triple fusion-embryonic stem cel s treatment group and triple fusion-embryoid body cel s treatment group at liver, and the teratoma formation could be suppressed by ganciclovir administration because ganciclovir can react with herpes simplex virus truncated thymidine kinase and trigger cel necrosis process. Histological analysis showed that teratomas comprised tissues from al three germ layers. These results demonstrate that triple gene fusion does not affect differentiation potential of embryonic stem cel s and it is risky to utilize embryonic stem cel s for cel therapy, because it affects repair of liver injury. The therapy strategy requires further improvement and real-time visualizing of embryonic stem cel s in vivo is absolutely necessary.