Informed consent is one of the basic rights of patients.Nowadays it is very difficult to implement sufficiently in health care practice.The article analyzes the relative factors affecting the enforcement of the right of informed consent.from the point of law and ethic as well as psychology.

Purpose　To study the effects of trihexyphenidyl (THP) on levels of monoamine neurotransmitters in the cerebral cortex after subarachnoid hemorrhage (SAH).　Methods　SAH model of rats were used,the levels of norepinephrine (NE),dopamine(DA),5-hydroxytrypatamine (5?HT) and hydroxyindoleacetic acid (5?HIAA) were measured by flurospectrophotometry.　Results　There was an extensive increase in levels of NE (P<0.01),5?HT (P<0.01) and 5?HIAA (P<0.01) in the cerebral cortex after SAH,DA had a tendency to increase without significance.The increase in levels of NE (P<0.01),5?HT (P<0.01) and 5?HIAA (P<0.05) in the cerebral cortex after SAH could be effectively inhibited by THP.　Conclusions　There will be a remarkable increase in levels of NE,5HT and 5HIAA in the cerebral cortex after SAH,THP could significantly ameliorate the metabolic disorder of NE and 5HT after SAH

Objective To evaluate the role of poly (ADP-ribose) polymerase 1 (PARP1) in spinal cord in a rat model of neuropathic pain.Methods One hundred and eighty male Wistar rats weighing 180-220 g were randomly divided into 4 groups( n =45 each): sham operation group(group S),neuropathic pain group (group NP),siRNA negative control group (group NS) and PARP1-siRNA group (group PS).Neuropathic pain was produced by L5 spinal nerve ligation (SNL).Viral of PARP1-siRNA or viral of siRNA negative control was injected intrathecally after SNL in groups PS or NS.Mechanical pain threshold was determined at 3,7 and 14 d after SNL.Then the rats were sacrificed and L5 lumbar spinal tissues were removed for determination of coexpression of PARP1 with glial fibrillary acidic protein (GFAP) (by immunohistochemistry double stain),protein expression of PARP1 and GFAP (by Western blot),and mRNA expression of PARP1 and GFAP (by RT-PCR).Results Compared with group S,mechanical pain threshold was significantly decreased and the protein and mRNA expression of GFAP and PARP1 up-regulated in groups NP,NS and PS( P ＜ 0.05).Compared with groups NP and NS,mechanical pain threshold was significantly increased and the protein and mRNA expression of GFAP and PARP1 down-regulated in group PS (P ＜ 0.05).There was no significant difference in above indexes between groups NP and NS(P ＞0.05 ).PARR1 was expressed in the astrocytes in the spinal cord.Conclusion PARP1 is involved in the formation and maintainance of neuropathic pain in rats via activating astrocytes.

Objective To explore the related factors of local reccurrence to rectal cancer after Dixon operation. Methods 100 patients with rectal cancer were used Dixon treatment. Then the tumor cells in the intestine and peritoneal fluid were qualitatively and quantitatively analyzed by flow cytometry during operation. The patients were followed up 2 years to understand the local recurrence. Results In 100 patients,8 cases were found in local recurrence after 2 years. 6 cases of recurrence were in the anastomotic site. Conclusion The local recurrence was related to Dukes stage,tumor distance from the anus,much margin of tumor length,tumor differentiation,intestine and abdominal shed close tumor cells,and it was worthy of attention.

Objective To explore impact of nursing intervention on the adverse reaction of patient con-trol epidural analgesia (PCEA) after abdominal operation. Methods 258 patients underwent PCEA after ab-dominal operation were selected from 2006 to 2007. The clinical data of 126 patients without nursing interven-tion were analyzed as the control group admitted to our hospital from January to December, 2006 and compared with those of 132 patients receiving nursing intervention as the experimental group from January to December, 2007. The control group was managed by the anesthetists and nurses only conducted routine nursing instruction, while the experimental group was given systematic and normative nursing intervention besides routine nursing instructions, including psychological intervention, behavioral intervention, close observation, of discovery of ad-verse reaction in time and giving early disposal. The incidence of adverse reaction of PCEA of the two groups such as urinary retention, nausea and vomiting, abdominal distension, skin indentation, catheter shedding, skin itching, numbness of lower limbs, respiratory depression was observed. Results Compared with the control group,the incidence of adverse reactions of PCEA in the experimental group such as urinary retention,nansea and vomiting, abdominal distension,skin indentation,catheter shedding was significantly lower. Conclusions The implementation of nursing intervention can reduce the adverse reaction of PCEA after abdominal operation, alle-viate the suffering of patients, and promote functional recovery and the body rehabilitation.

Objective To explore a simple and safe method for preservation of the sputum aspirator nozzle. Methods Using self-controlled method, the traditional method was to place the nozzle in the glass bottle of disinfectant liquid, the modified method was to fix a sputum tube to a suitable location of the sputum aspirator or bedside with the joint free, after sputum aspiration,the nozzle was connected to the joint. One patient used the same sputum aspirator. The two methods of preservation were alternated every 24 hours. The slippage times of the nozzle were compared, and samples from glass nozzle and joints of disinfectant liquid bottles/spu-tuna tube joints were underwent bacterial culture. Results Significant difference existed in slippage times of the nozzle, the positive rate of bacteria colony in the.glass nozzle and disinfectant liquid bottles/sputum tube joints between the two methods. Conclusions Using sputum aspiration tubes to fix the nozzle of aputum aspi-rator is better than the traditional method of putting the nozzle into the glass bottle of disinfectant liquid,this method proves to be easy, safe,portable and economical and is worthy of clinical application.

OBJECTIVE:To evaluate the economic effectiveness of different pharmacotherapeutic schemes for peptic ulcer and chronic gastritis with infection of Helicobacteria pylori(Hp) METHODS:To perform cost-effectiveness analysis of three ther_apeutic schemes for Hp infection RESULTS:The cost-effectiveness ratios of three therapeutic schemes were 8 71,10 12 and 13 99 CONCLUSION:Scheme A(omeprazole+amoxicillin+clarithomycin) is the best one

Objective To evaluate the effectiveness of biofeedback for anxiety patients by carrying out a Meta-analysis.Methods We searched CNKI,VIP,CBM(1989 to 2013) to identify relevant randomized-control trials applying biofeedback for anxiety patients.We used Review Management (RevMan) 5.0 software (provided by the Cochrane collaboration) to conduct Meta-analysis.Results We included 11 studies.Meta-analysis for the biofeedback group vs.the control group showed that biofeedback was significantly superior to control (SMD=-3.00,95％CI:-4.40～-1.61); Meta-analysis for the biofeedback plus drug group vs.drug group showed that biofeedback plus drug was significantly superior to drug (SMD=-1.33,95％CI:-1.82～-0.85).Conclusions We found evidence that biofeedback (applying alone or combined with drugs) is effective in improving anxiety symptom.But all the studies had methodological limitations,our conclusion needs further studies with strict design,high quality and consistent assessment tools to be expounded and proven.

Objective To discuss the management and selection of donor and recipient veins in the transfer of vascularied autogeneous submandibular gland (SMG).Methods The SMGs of 48 patients with severe keratoconjunctivitis were transfered to the temporal region by microsurgery from June,2002 to June,2013.The secreted saliva was used as the substitute of tear.Donor and accepting-site vessels,vessels crisis and managements,survival of grafts were retrospectively analysed.Results Transplantation succeeded in 45 patients and failed in 3.For donor veins,39 were facial veins,12 were venae comitantes of facial artery,1 was vein near the duct.For revipient veins,41 were superficial temporary veins,6 were deep temporary veins and 5 were veins in the upper neck.For revipient artery,except superficial temporary artery,deep temporary artery was also a good selection.After surgery,2/5 venous crisis cases were rescued by reanastomosising veins.TC99m examination suggested that the 49 TSMGs were survived,and the ducts were unobstructed.Follow up lasted for 6 months to 10 years,the symptoms of photophobia and anemophobia were alleviated,the symptoms of corneal xerosis disappeared.Good clinical efficacy was obtained after transplantion.Conclusion During SMGs transplantion,facial veins,venae comitantes of facial artery or vein near the duct can be used for donor vein.For recipient veins,except the superficial temporary veins as major,deep temporary veins or veins in the upper neck is also a secection.Correct selection and microsurgical management of donor and revipient veins are keys to successful SMGs transplantion.