The nature of medical science,especially the highly socialized characteristic of modern healthcare service determines that a larger ratio of medical ethics should be included in the new healthcare reform,with the construction of a new medical ethics taken as support and guidance.An overall view of medical ethics is crucial in the construction of medical ethics under the context of current Chinese healthcare reform,that is,the construction of medical ethics should be performed in an ultra-wide field.Medical ethics should take a complete participation in each and every field of healthcare reform,but not merely focuses on the particular field of medical professionals and the construction of a harmonious physician-patient relationship.In the systematic construction of new medical ethics,the current key issue lies in the reconstruction of a socialist medical ethics and related regulations,both for theoretical and practical reasons.The reconstruction is far more than releasing a couple of policies.Merely in a theoretical perspective,seven major issues are to be resolved during the reconstruction process.

BACKGROUND:Electroacupuncture has promoting effects on the functional recovery of the injured spinal cord, can decrease pain, and elevate postoperative effect after acute spinal cord contusion.OBJECTIVE:To observe the effect of electroacupuncture on apoptosis in the injured site after spinal cord contusion, and analyze its neuroprotective effects on neurological function in rats with spinal cord contusion. METHODS:A total of 66 adult female Sprague-Dawley rats were randomly divided into: sham surgery group (n=20), spinal cord contusion group (n=20), electroacupuncture stimulation group (n=20) because six rats were excluded due to modeling failure and death. Before model establishment, at 1, 3 days, 1, 2, 3 and 4 weeks after model establishment, motor functions were evaluated by BBB score and the inclined plate test. At 3 days after model establishment, apoptosis of nerve cels could be detected in the site of injury in each experimental group using TUNEL assay. mRNA and protein expression of bax, bcl-2 and caspase-3 was detected surrounding the injury site using RT-PCR and western blot assay. Morphological changes in the site of injury could be observed using hematoxylin-eosin staining. The regeneration of nerve fibers was observed using HRP tracing. RESULTS AND CONCLUSION:(1) Motor function score was significantly increased at various time points in the 2nd week of treatment in the electroacupuncture stimulation group than in the spinal cord contusion group (P< 0.05). (2) Apoptotic index was significantly lower in the electroacupuncture stimulation group than in the spinal cord contusion group at 3 days after model establishment (P < 0.05). (3) mRNA and protein expression of bax and caspase-3 was significantly lower in the electroacupuncture stimulation group than in the spinal cord contusion group at 72 hours (P < 0.05); bcl-2 gene and protein expression was significantly higher (P < 0.05). (4) The number of HRP-positive nerve fibers was highest in the sham surgery group, folowed by electroacupuncture stimulation group, and lowest in the spinal cord contusion group at 4 weeks (P < 0.05). Results indicated that electroacupuncture plays a protective role on the spinal cord contusion by reducing apoptosis of nerve cels at the site of injury.

BACKGROUND:Neural stem cel transplantation alone has achieved unsatisfactory outcomes in the repair of damaged spinal cord tissues. To promote the survival, proliferation and neuronal differentiation of transplanted cels in vivo, it is necessary to further improve the micro-environment of spinal cord injury.
OBJECTIVE:To investigate the effect of neural stem cel transplantation plus electroacupuncture on the hindlimb function and electrophysiological changes of rats with spinal cord injury.
METHODS: Animal models of spinal cord injury were made in 72 Sprague-Dawley rats and randomized into four groups: control group with injection of culture mediumvia the tail vein; neural stem cel group with injection of neural stem cel suspensionvia the tail vein; electroacupuncture group given 1-week electroacupuncture atDu meridian and body points starting from 6 hours after modeling; combined group given injection of neural stem cel suspension via the tail vein+1-week electroacupuncture atDu meridian and body points starting from 6 hours after modeling. Motor functional recovery in rats was assessed by Basso-Beattie-Bresnahan score and inclined plane test before and at 1, 3 days and 1-4 weeks after modeling. At 4 weeks after modeling, hematoxylin-eosin staining was performed for pathological observation; fluorescence microscope was used to observe the survival and distribution of CM-Dil-labeled neural stem cels; horseradish peroxidase tracer was used to observe nerve fiber regeneration; rat neurophysiological recovery was assessed by determining motor evoked potentials and somatosensory evoked potentials.
RESULTS AND CONCLUSION:At 2-4 weeks after modeling, the hindlimb function was better in the combined group than the neural stem cel group and electroacupuncture group; while it was better in the neural stem cel group and electroacupuncture group than the control group. At 4 weeks after modeling, there were few nerve axon-like structures and smal voids in the spinal cord of the neural stem cel group and electroacupuncture group; however, in the combined group, there were more nerve axon-like structures and no void in the spinal cord. At 4 weeks after modeling, the number of nerve fibers positive for CD-Dil and horseradish peroxidase was ranked as folows: combined group > neural stem cel group and electroacupuncture group > control group, and there were significant differences between groups (P < 0.05). The latencies of motor and somatosensory evoked potentials were significantly lower in the combined group than the neural stem cel group and electroaucpuncture group folowed by the control group (P < 0.05), whereas the amplitudes of motor and somatosensory evoked potentials were significantly higher in the combined group than the neural stem cel group and electroacupuncture group folowed by the control group (P < 0.05). In conclusion, these findings indicate that neural stem cel transplantation combined with electroacupuncture can promote synaptic regeneration and improve the motor and electrophysiological functions of rats.

In this paper, a biodynamic model of human upper-body in the seated posture is developed. Based on d'Alembert's principle, the non-linear biodynamic equation of the modelling is derivated. Furthermore, the function of frequency and amplitude of modelling is obtained by employing the KB method in the non-linear theory. The response of realistic human parameters and the external stimulus on the modelling is simulated by MATLAB. The results show that the modelling presents a plenty of non-linear characteristics. The parameters identified and the stable areas to keep the stabilization of upper-body in the seated posture are discussed. These data can be used to explain and estimate the mechanism for the maintenance of stable trunk posture due to the mechanical shocks transmitted through the vehicle seat.
Automobile Driving ; Biomechanical Phenomena ; Humans ; Low Back Pain ; etiology ; Models, Biological ; Nonlinear Dynamics ; Posture ; physiology ; Spine ; physiology ; Vibration

Objective Retrospectively study of the effects of interferon-α therapy on height and weight of children with chronic hepatitis B (CHB).Methods Total of 116 hospitalized cases of CHB children in Adolescent Liver Centre, 302 Military Hospital of China from January 2010 to December 2011 were respectively studied.Heights and weights of all the subjects at baseline, 24 weeks, 48 weeks, 72 weeks and 96 weeks of treatment, and 24 weeks, 48 weeks and 96 weeks of follow-up were measured.The weight Z score (WAZ), height Z score (HAZ) and body mass index (BMI) Z score of subjects with hepatic fibrosis (S) <3 and S≥3 were compared.The differences of HAZ and WAZ between baseline and treatment or follow-up in groups of subjects aged 1-6 years and 6-16 years were also compared.T test or rank sum test was used for comparison between groups.Results Among the study of all 116 patients studied, median baseline values of HAZ, WAZ and BMI Z score were 0.76, 0.38 and-0.04, respectively.For patients with hepatic fibrosis S<3, the median HAZ and WAZ were 0.83 and 0.32, respectively.For patients with hepatic fibrosis S≥3, the median HAZ and WAZ were 0.52 and 0.15, respectively.The differences were not statistically significant (both P>0.05).At 48 weeks of treatment, the median HAZ was 0.50, and the median WAZ was 0.20;after a follow-up period of 24 weeks, the median HAZ was-0.32, and the median WAZ was-0.18;after a follow-up period of 48 weeks, the median HAZ was 0.09 and the median WAZ was 0.06.All the above median values of HAZ and WAZ were significantly different from those at baseline (all P<0.05).The difference of HAZ at baseline and 96 weeks of treatment in group aged 6-16 years was significantly different from that in group aged 1-6 years (-0.74±0.69 vs-0.53±0.35, t=1.85, P<0.05).Also, the difference of WAZ at baseline and 96 weeks of treatment in group aged 6-16 years was significantly different from that in group aged 1-6 years (-0.69±0.41 vs-0.17±0.75, t=3.74, P<0.05).The difference of HAZ at baseline and 96 weeks after treatment in group aged 6-16 years was significantly different from that in groups aged 1-6 years (-1.12±0.81 vs-0.05±0.69, t=2.06, P=0.022).Conclusions Interferon-α treatment for children with chronic hepatitis B does have influence on their height and weight, which restores to some degree after the treatment finished.Physicians should pay more attention to the influence of interferon-α treatment on height and weight in children aged 6-16 years.

OBJECTIVETo explore the pathological and clinical characteristics of children with liver diseases by retrospective study on clinical and liver biopsy pathological data of children with liver diseases.

METHODThis retrospective analysis was performed at Beijing No. 302 Hospital among 3 932 children with liver diseases who visited the hospital from January 2001 to December 2012. The kinds of diseases were compared with the results of 1983-2000.

RESULT(1) Liver biopsy was successful in 99.72% (3 932/3 943) of cases of 2001-2012 group, complications occurred in 31 children only. (2) Of the 3 932 cases, 2 647 (67.32%) had hepatitis , non-hepatotropic viral hepatitis and non viral liver disease were seen in 365 cases (9.28%), and 920 cases (23.4%), respectively. Among 2 647 cases with viral hepatitis, 2 115 were hepatitis B (79.90%), 521 hepatitis C (19.69%), 7 were hepatitis A (0.26%) and 4 hepatitis E (0.15%), respectively. (3) In 2001-2012 group, the degrees of inflammatory activity (>G2) of liver were seen in 9.57% (202/2 111) patients with hepatitis B, while 23.57% (132/560) in 1983-2000 group. There was significant difference between the two groups (χ(2)=80.36, P=0.00 ). (4) Significant difference was observed in the rate of non viral liver disease between 2001-2012 group (23.40%, 920/3 932) and 1983-2000 group (9.61%, 98/1 020) (χ(2)=93.46, P=0.00). In 2001-2012 group, including 46 kinds of diseases, which were significantly higher than those of 1983-2000 group (18 kinds). In 2000-2012, the main causes of diseases were liver degeneration (18.26%, 168/920), drug-induced liver injury (13.59%, 125/920), fatty liver (8.80%, 81/920) and liver glycogen accumulation disease (8.70%, 80/920). While in 1983-2000 group, the main causes were liver degeneration (20.41%, 20/98), fatty liver (16.33%, 16/98), glycogen storage disease (10.20%, 10/98) and myopathy (9.18%, 9/98).

CONCLUSIONLiver biopsy in children is safe and feasible. Hepatitis B virus was ranked first in children with liver diseases in 2001-2012 group. The kinds of non viral hepatic disorders had changed and extended.

Adolescent ; Biopsy, Needle ; Child ; Child, Preschool ; Female ; Hepatitis B ; pathology ; Hepatitis, Viral, Human ; pathology ; Hepatolenticular Degeneration ; epidemiology ; pathology ; Humans ; Infant ; Liver ; pathology ; Liver Diseases ; pathology ; Liver Function Tests ; Male ; Retrospective Studies

ObjectiveTo investigate the liver disease phenotypes and clinical features of patients with different genotypes of Wilson’s disease （WD）. MethodsA retrospective analysis was performed for 163 patients with WD who were diagnosed and underwent genetic testing in The Fifth Medical Center of Chinese PLA General Hospital from August 2008 to June 2023， and clinical manifestations， laboratory examination， pathological examination， imaging examination， and ATP7B genetic testing results were collected. According to ATP7B gene mutation， the patients were divided into groups as follows： R778L mutation group and non-R778L mutation group； P992L mutation group and non-P992L mutation group； truncation mutation group and non-truncation mutation group. Liver disease phenotypes and clinical features were analyzed for the patients with c.2333G>T/p.R778L mutation （R778L mutation）， c.2975C>T/p.P992L mutation （P992L mutation）， and truncation mutation of the ATP7B gene. The Mann-Whitney U test or the Kruskal-Wallis H test was used for comparison of continuous data between groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. ResultsThe 163 patients with WD had varying severities of liver disease phenotypes， among whom 121 （74.23%） were diagnosed with chronic liver disease， 36 （22.09%） were diagnosed with decompensated cirrhosis， and 6 （3.68%） were diagnosed with fulminant WD， and in addition， there were 5 patients （2 with chronic liver disease and 3 with decompensated cirrhosis） with neurological abnormalities. For the 163 patients with WD， R778L mutation （with an allele frequency of 28.2%） was the most common mutation in the ATP7B gene， followed by P992L mutation （with an allele frequency of 12.6%）， and truncation mutation showed an allele frequency of 11.0%. There was no significant difference in the distribution of the three mutations across different liver disease phenotypes （P>0.05）. The R778L mutation group had a significantly lower level of ceruloplasmin （CP） than the non-R778L mutation group ［0.04 （0.02‍ ‍—‍ ‍0.08） g/L vs 0.08 （0.03‍ ‍—‍ ‍0.13） g/L， Z=-2.889， P=0.004］. Compared with the non-P992L mutation group， the P992L mutation group had significantly higher levels of alanine aminotransferase ［135.0 （80.5‍ ‍—‍ ‍237.0） U/L vs 80.5 （36.0‍ ‍—‍ ‍173.3） U/L， Z=2.684， P=0.007］ and aspartate aminotransferase ［121.4 （77.0‍ ‍—‍ ‍195.0） U/L vs 84.0 （39.0‍ ‍—‍ ‍123.3） U/L， Z=3.388， P<0.001］. Compared with the non-truncation mutation group， the truncation mutation group had significantly lower levels of CP ［0.03 （0.02‍ ‍—‍ ‍0.08） g/L vs 0.06 （0.03‍ ‍—‍ ‍0.11） g/L， Z=-3.136， P=0.002］ and serum copper ［3.20 （2.15‍ ‍—‍ ‍5.00） mg/L vs 4.20 （2.60‍ ‍—‍ ‍7.50） mg/L， Z=-2.296， P=0.025］. ConclusionR778L mutation， P992L mutation and truncation mutation are not associated with liver disease phenotype in WD patients； however， R778L mutation is associated with a lower level of CP， P992L mutation is associated with higher levels of ALT and AST， and truncation mutation is associated with lower levels of CP and serum copper.

Objective: To investigate the curative effect of antiviral therapy and related factors influencing the curative affect in children with immune-tolerant phase chronic hepatitis B. Methods: From May 2014 to April 2015, 46 children with chronic hepatitis B, aged 1 to 16 years with immune-tolerant phase were enrolled as the treatment group. All cases in the treated group either received interferon alpha (3-5 MIU/m², once daily) in lamivudine combination (if HBV DNA decreased < 2 log₁₀) or repeatedly received interferon-alpha alone (if HBV DNA decreased >2 log₁₀) for 12 weeks. Interferon was discontinued at 72 weeks and followed-up period was continued with lamivudine for 24 weeks. At the same time, data of 23 cases of untreated children with immune-tolerant phase chronic hepatitis B were collected as the control group. The treatment group and the control group were divided into two age groups: 1-7 years old and 7-15 years old. Data measurements were compared using t-test, analysis of variance and single factor analysis methods, and the count data were analyzed by χ ² test. Multiple logistic regression analysis was used to analyze the effects of different factors on response. Results: (1) There were 22 cases aged 1-7 years in the treatment group (47.8%) and 12 cases aged 1-7 years in the control group (52.2%). The cases of mother-to-child transmission (MTCT) in treatment and control group were 34 (73.9%) and 17 (73.9%), while children with normal baseline ALT in the treatment and control group were 18 (39.1%) and 10 (43.5%). (2) At the end of follow-up, 15 cases in the treatment group (32.6%) had HBeAg serological conversion. Among them, nine (19.6%) cases had HBsAg clearance or HB-Ag seroconversion with anti-HBs, and one (2.2%) case had HBsAg clearance, but both HBeAg and anti-HBe were positive. In the control group, one case had HBV DNA lower than the lower limit of detection level, and one case had HBeAg seroconversion without HBsAg clearance. (3) At the end of follow-up, the seroconversion rates of HBeAg in patients aged 1 to 7 years and patients aged 7 to 15 years were 45.5% and 20.8%, respectively (P = 0.078) and the clearance rates of HBsAg were 36.4% and 8.3% (P = 0.023). The serum conversion rates of normal and abnormal baseline alanine aminotransferase levels were 5.6% and 50.0% (P = 0.005), and the clearance rates of HBsAg were 5.6% and 32.1% (P = 0.077), respectively. There was no statistically significant difference in gender, mother-to-child transmission, HBV DNA genotyping and baseline HBsAg level in antiviral efficacy among children (P > 0.05). (4) HBsAg and HBeAg clearance occurred in 100% of patients at the end of follow-up who had HBsAg < 3 000 IU/ml at 24 weeks of treatment. (5) Multivariate logistic regression analysis showed that serum HBeAg conversion rate had relation with non-MTCT transmission and abnormal baseline alanine aminotransferase. Furthermore, HBsAg clearance rate was associated with the age of children. Conclusion Sequential combination of interferon and lamivudine with a prolonged course can improve the HBV DNA negative conversion rate, HBeAg seroconversion rate, HBsAg loss rate and mild ALT abnormalities at baseline in children under the age of 7 years with immune-tolerant phase chronic hepatitis B.