The head injury patients is very common in clinic and it is complicated to cure them.Furthermore,many ethical questions are involved during the treatment,which are discussed in the article.The aim is to be helpful to protect both patients'and medical staff's right,reduce medical disputes and form a good relationship between doctors and patients from the view of ethics.Accordingly,the patients of head injury will acquire better treatment.

Objective To investigate the association between the level of advanced oxidation protein products (AOPP) in serum and the dialysate glucose exposure dose in patients undergoing non-diabetic maintenance peritoneal dialysis (PD). Methods In this cross-sectional study, the levels of serum AOPP were measured in 192 non-diabetic PD patients. Based on the exposure dose of dialysate glucose , PD patients were assigned into the high-dose exposure and low-dose exposure groups. Serum C-reactive protein levels were also measured and the rates of cardio-vascular disease (CVD) were recorded in both groups. Results The levels of serum AOPP were higher in the high-dose exposure group, as compared with the low-dose exposure group [(78.7 ± 15.6) mmol/L vs. (71.7 ± 14.8) mmol/L, P = 0.003]. The serum C-reactive protein levels [4.6 (3.0-11.4) mg/L vs. 3.0 (2.2-5.3) mg/L, P < 0.001] and the rates of CVD (53.6% vs. 35.8%, P = 0.014) were also higher in the high-dose exposure group. After multivariate adjustment ,the level of serum AOPP was independently associated with dialysate glucose exposure dose (β = 0.157, P = 0.031) and duration of PD (β = 0.164, P =0.043). Conclusion The serum AOPP levels are associated with the dialysate glucose exposure doses in non-diabetic PD patients. Minimizing the glucose load might reduce the risk of developing CVD.

Objective To investigate the relationships between the level of heat shock protein (HSPs) 70 and severity of sepsis in order to find its effects on the status of sepsis and the prognosis of the patients. Methods In total, 120 patients diagnosed to be suffering from sepsis from the emergency department were selected as studying subjects. According to SAPS Ⅱ score, all of these patients were divided into mild, moderate and severe groups (n =40 in each group) , and at the same time, 40 healthy volunteers were studied as controls. The levels of intracellular HSPs70 in peripheral blood neutrophil cells in the mild, moderate and severe groups were determined by using flow cytometry, while serum levels of procalcitonin (PCT) and C-reactive protein ( CRP) were measured as well. Results ① The levels of heat shock proteins HSPs70 in neutrophil cells and PCT in patients with sepsis escalated gradually with the increase in SAPS Ⅱ score, and there were significant different among the mild, moderate, and severe sepsis groups(P<0.05). ② In all septic patients, the death happened only in the severe group. Compared other markers in the survivals , the level of heat shock protein HSPs70 was significantly higher in fatal patients. ③ In curve plot analysis in the patients with sepsis done by the curve of receiver operating characteristic (ROC) , the area of HSPs70 in neutrophil cells under the curve was significantly larger as compared with that of PCT and CRP. Conclusions Heat shock protein HSPs70 has a certain clinical value in determining the severity of disease and prognosis of patients suffering from sepsis.

Objective To study the changes in interleukin-32 (IL-32) in rats with Klebsiella bacillus pneumonia and approach its significance. Methods Seventy-two Sprague-Dawley(SD)rats were divide into control group,model group and experimental group by the method of random digits table,then the experimental group was subdivided into 4 hours and 1,3 and 5 days experimental subgroups(each n=6). The rat model of Klebsiella bacillus pneumonia was established by injection of 0.3 mL Klebsiella bacterial suspension into the trachea. Before the establishment of the model in the experimental group,IL-32 inhibitory agent,protease activated receptor-2(PAR2) was injected into the abdominal cavity. After model establishment,at different time points,blood was collected via tail vein to observe the changes in serum levels of IL-32,tumor necrosis factor-α(TNF-α),IL-6 and IL-8 in all the groups. The lungs were removed and stained with hematoxylin-eosin(HE)method to investigate the histopathological changes of the lung tissues under the light microscope. Results Compared to the control group, with the prolongation of time the levels of IL-32,TNF-α,IL-8 and IL-6 were increased gradually in the model group,and reached their peaks at 3 days〔IL-32(ng/L):84.40±28.24 vs. 18.57±3.86,t=5.544,P=0.002;TNF-α(ng/L):79.27±14.64 vs. 17.82±3.86, t=9.994, P=0.000;IL-8(ng/L):55.85±10.90 vs. 16.66±3.76,t=8.544, P=0.000;IL-6(ng/L):56.65±2.57 vs. 28.48±2.11,t=19.693,P=0.000〕;PAR2 could inhibit above indexes significantly,there was statistical difference at 3 days compared with the model group〔IL-32(ng/L):54.13±6.68 vs. 84.40±28.24,t=2.560,P=0.046;TNF-α(ng/L):49.12±3.56 vs. 79.27±14.64,t=4.901,P=0.003;IL-8 (ng/L):22.95±2.52 vs. 55.85±10.90,t=7.204,P=0.000;IL-6(ng/L):36.49±2.63 vs. 56.65±2.57,t=13.443, P=0.000〕. Under the light microscope,the inflammatory changes in the lung tissue in experimental group were milder than those in the model group. Conclusion As a pro-inflammatory cytokine,IL-32 can induce the production of TNF-α,IL-6 and IL-8,and the inhibition of IL-32 production may play a role in suppression of the development of Klebsiella bacillus pneumonia.

Five general practitioners were trained for application of the enhancing CalgaryCambridge guide in consultation.The consultation time in 50 patients were recorded before and after training and the satisfaction degree of patients was investigated by questionnaire survey.Results showed that the length of consultation time after training was longer than that before training (490 s vs 277 s,P ＜ 0.05) and also longer than that of specialists (490 s vs 268 s,P ＜0.05).The overall satisfaction rate of patients was increased after training (72％ vs 88％,P ＜0.05).The results indicate that training of Calgary-Cambridge guide for doctor-patient communication can improve the communication skills of general practitioners.

Objective To evaluate the efficacy and safety of single intra-articular etanercept injection in patients with rheumatoid arthritis (RA) and spondyloarthropathy (SpA) who had knee arthritis.Methods This was a randomized, single-blind, parallel, controlled clinical trial. The subjects were the RA or SpA patients with the knee arthritis without deformity, moderate or severe bone erosion and obvious joint space narrowing in radiography in the target knees, who had taken at least 6-week therapy with routine dosage of disease modifying anti-rheumatic drugs (DMARDs) before the study. The subjects were randomized in 2:1 ratio to receive either single intra-articular 25 mg etanercept injection or 2 ml compound betamethasone to the target knees joint after their synovial fluid being drawn away at baseline. They were followed up four weeks after injection. The primary end-point was the 4-week change in the modified Hospital for Special Surgery (HSS) knee score for the target knee. Results Forty-seven subjects in the experimental group and twenty-three subjects in the controlled group were included in the trial. The modified HSS knee score for the experimental group was baseline mean 65.6 ± 14.0, follow-up 84.3 ±11.1 (P ＜0.0001 ), the controlled group baseline mean 68.2 ± 11.4, follow-up 79.4 ± 15.5(P =0.0015). A mean (34.9 ±38.9)% improvement on the modified HSS knee score was achieved in the experimental group, while ( 17.9 ±24.5)% improvement on the modified HSS knee score was achieved in the controlled group (P =0.0467). Adverse events were observed in eight patients (19.0% ) in the experimental group and eight patients (44.4%) in the controlled group. No serious adverse event had been observed. Conclusions Single intra-articular 25 mg etanercept injection had a better efficacy than 2 ml compound betamethasone. It was an effective and safe therapeutic option for SpA and RA patients who had knee arthritis without obvious change in radiography.

Objective An ideal small bowel transplantation model is the prerequisite and guarantee of small bowel transplan-tation-related researches.The aim of this study is to establish a pig model of orthotopic segmental small bowel transplantation by modifi-cation of blood vessel reconstruction and surgical techniques. Methods Twenty healthy pigs were equally assigned as donors and re-cipients.The superior mesenteric vessels were freed and the distal ileum harvested as grafts.After irrigation and preservation, the small bowel was transplanted by end-to-end anastomosis of the superior mesenteric arteries and veins, and then the small bowel was re-constructed simultaneously to restore intestinal continuity, with the proximal part of the graft brought out as a stoma for the purpose of graft monitoring. Results Transplantation was successfully performed in 9 of the 10 cases, with a success rate of 90%.The donor operations averaged 100 min, recipient operations 172 min, warm ischemia 1.3 min, cold ischemia 96 min, and vascular anastomosis 27.6 min.No postoperative anastomosis fistula occurred in any of the cases. Conclusion The pig model of orthotopic segmental small bowel transplantation is ideal for small bowel transplantation-related researches.

Objective To investigate the effects of propofol on brain injury induced by intestinal ischemia-reperfusion (I/R) in rats.Methods Forty-eight adult male Sprague-Dawley rats,weighing 250-300 g,were randomly allocated to one of 3 groups (n =16 each) using a random number table:sham operation group (group Sham),I/R group,and propofol group (group P).Intestinal I/R was produced by occlusion of the superior mesenteric artery for 90 min followed by reperfusion.In group P,propofol 50 mg/kg was injected intraperitoneally at 30 min before reperfusion,and the equal volume of fat emulsion was given in the other two groups.Blood samples were collected at 24 h of reperfusion for determination of serum tumor necrosis factor-alpha (TNF-α) and interleukin-1beta (IL-1β) concentrations.The cerebral cortex and hippocampus were isolated for measurement of TNF-α and IL-1β mRNA expression (by real-time reverse transcriptase-polymerase chain reaction) and myeloperoxidase (MPO) activity (using colorimetric method).Morris water maze test was carried out at 1,3 and 5 days of reperfusion.Results Compared with group Sham,the serum TNF-α and IL-1β concentrations were significantly increased,the expression of TNF-o and IL-1β mRNA in the cerebral cortex and hippocampus was up-regulated,the MPO activity was increased,and the escape latency was prolonged,and the frequency of crossing the original platform was decreased during reperfusion in group I/R (P＜0.05).In group I/R,the concentrations of serum TNF-αand IL-1β were significantly decreased,thc cxpression of TNF-α and IL-1β mRNA in the cerebral cortex and hippocampus was down-regulated,and the escape latency was shortened,and the frequency of crossing the original platform was increased during reperfusion (P＜0.05),and no significant change was found in MPO activity in group P (P＞0.05).Conclusion Propofol reduces brain injury induced by intestinal I/R through inhibiting systemic and local inflammatory responses in rats.

Objective To explore the change of function and expression of hematopoietic lineage cell specific protein-1 (HS1) and phosphorylated HS1 (p-HIS) and factors devoting to HS1 phosphorylation in platelet with sepsis.Methods Plasma with rich platelet was collected from 150 sepsis patients and 50 healthy subjects, and comparison of platelets adhesion and aggregation were detected by micro-pore method and platelet aggregation instrument.Meanwhile the ATP concentrations of washed platelet of two groups were detected by the kit to compare release reaction.And then total HS1 (t-HIS) and p-HS1 of platelet from two groups were compared by using western blot.Afterwards the specific inhibitors of Src and Syk were used to verify the HS1 activation regulated by Src and Syk in LPS-induced cell model.Results The significant differences were present between healthy subjects and sepsis patients in platelet counts, platelet distribution width (PDW) and mean platelet volume (MPV) (P ＜ 0.01).The data showed the sepsis patients had greater ability than healthy subjects in adhesion, aggregation and release reaction.Meanwhile the platelets of sepsis patients had higher concentration of t-HS1 and p-HS1 than healthy subjects, and the specific inhibitors of Src and Syk , PP2 and piceatannol, inhibited the increase in p-HS1 in LPS-induced cell model.Conclusions Function of platelet is closely related to HS1 in sepsis and it will be a target for sepsis therapy.