During the process of teaching in clinical practice, there objectively exist the contradiction between the obligation of teaching and the invasion of the right to informed consent, and the contradiction between the growth of medical students and the invasion of patients' right to privacy. Health reforms, such as the regulation of "patient selecting doctor", bring some side effects to the teaching in clinical practice. In order to maintain the right to informed consent and privacy, to benefit the teaching in clinical practice, to develop the doctor-patient relationship, and to decrease medical disputes, the art to deal with the doctor-patient relationship must be explored. The laws and regulations of the teaching in clinical practice and of the right of doctors and patients must be developed too.

Objective To explore the treatment of children with hernia,and the advantage of transabdominal extraperitoneal hernia sac exclusion was analyzed.Methods A total of 102 patients in our hospital from January 2005 to January 2015 were randomly divided into 2 groups,55 cases who treated by the surgery of transabdominal extraperitoneal hernia sac exclusion were treatment group,47 cases who treated by the surgery of high ligation of the hernia sac throug the inguinal incision were control group.The operative time,length of hospital stay, length of incision,postoperative pain and hospitalization costs between two groups were compared.Results The effect of the treatment group was superior to the control group on operative time,length of incision and postoperative pain,the difference was significant(P <0.05).Con-clusion There are some advantages of more simplified operation,shorter time of the surgery,less complication,lower recurrence rate and more reliable curative effect in the treatment of transabdominal extraperitoneal hernia sac exclusion for children with hernia,which is worthy of clinical promotion.

Objective To discuss the feasibility of moving average method (X‐B method) in the quality control of coagulation function measurement .Methods Fluctuation average value tendency of prothrombin time (PT ) ,activated partial thromboplastin time (APTT) ,thrombin time (TT) and fibrinogen (FIB) of clinical specimen ,detected by using Stago Compact analyzes ,were ana‐lyzed ,and compared cryochemic plasma method .Results Average value of PT ,APTT ,TT and FIB changed in small ranges .Tend‐ency of quality control chart of X‐B method and cryochemic plasma method were basically consistent .Conclusion X‐B method ,u‐sing plasma of patients ,could be used for the quality control of PT ,APTT ,TT and FIB examination and for the monitoring of the stability of analyzers .

ObjectiveTo evaluate the efficacy of preemptive analgesia with parecoxib for acute postoperative pain after pulmenary lobectomy.MethodsSixty ASA Ⅱ or Ⅲ patients of both sexes aged 20-64 yr weighing 50-80 kg undergoing elective pulmonary lobectomy were randomly divided into 3 groups ( n =20 each): control group (group C); group A (parecoxib 40 mg was injected iv at 20 min before surgery) and group B (parecoxib 40 mg was injected iv when skin was sutured).Patient controlled intravenous analgesia (PCIA) with sufentanil and ramosetron (continuous background dose 2 ml/h,bolus dose 0.5 ml,lockout time 15 min) was used after surgery.When VAS score ＞ 3,iv bolus of tramadol 1-2 mg/kg was injected as rescue medicine.Agitation condition was observed after operation.The number of successfully delivered doses and the number of attempt were recorded.The consumption sufentanil and the number of rescue medicine were recorded during 24 h after surgery.ResultsThe incidence of postoperation agitation,number of successfully delivered doses and number of attempt,consumption sufentanil and number of rescue medicine were significantly lower in groups A and B than in group C.The consumption sufentanil and number of rescue medicine were significantly lower in group A than in group B ( P ＜0.05).ConclusionParecoxib can use for preemptive analgesia in patients after thoracic surgery,reduce the complication during anesthesia recovery and the opioid analgesics consupmtion.

Objective To investigate the effect of astragalus polysaccharide,a component of an aqueous extract of Astragalus Membranaceus roots,on differentiation and maturation of dendritic cells in vitro. Methods 30 BALB/c mice were randomly divided into three groups,normal control group,100,200 mg/kg APS intraperitoneal injection groups. After one week,weight the mouse spleen,account the splenetic index. Collect the mouse bone marrow cell,induced and cultured with rmGM-CSF and rmIL-4. With inverted microscope to investigate the morphous of DC cell. The phenotypes of DC were detected by flow cytometry and the expression of the GM-CSF protein in serum was tested by ELISA. Results Astragalus polysaccharide injection had obvious effects on the spleen weight of mice. The degree of CD11c and MHC-Ⅱ expression in 100 mg/kg and 200 mg/kg groups on flow cytometry were advanced significantly compared with that in normal control group,but the degree of CD80 and CD86 was not increased. And the expression of the GM-CSF protein in serum in 100 mg/kg group and 200 mg/kg group were both not increased significantly compared with nomal control group. Conclusion The intraperitoneal injection of astragalus polysaccharide could stimulate the proliferation of the pre DC in bone marrow. The angtigen presentation of DC might be enhanced,but this effects was not positive correlation with concentration of GM-CSF.

Objective To investigate the anatomical character and clinical application value of external malleolus periosteum bone flap pedicled with facia and external malleolus anterior artery. Methods Applied anatomy was studied with 10 adult corpse specimen after artery perfusion,observed the origin.trackway,and measured the external diameter and major vessel's length of external malleolus anterior artery,observed the composition of external malleolus artery net,and completed the performance in clinic in 10 patients and followed up for 6 months～6 years. Resultes The bone flap had abundant blood-supply,its pedicle was long enough for transfer,little injury to donor,the surgical procedure was easy to manipulate,and was used in clinic to treat talus fracture in 9 cases (fresh 5 and old 4) and old tibia fracture in 1 case,10 cases were involved with satisfactory outcome. Conclusion External malleolus periosteum bone flap pedicled with fascia and external malleolus anterior artery is a good new donor for the patients with fracture of talus or lower tibia,especially ununited case or osteonecrosis.

Objective To introduce a better and quicker technique of transperitoneal laparoscopic ureterolithotomy. Methods 42 cases of ureterolithiasis (23 males and 19 females;mean age of 42.4 years,range from 16 to 63 years) were included.Of them 26 cases had calculi on the left side and 16 cases,on the right side.All the cases underwent laparoscopy through 3-port technique. Results The operations were successful in all of 42 cases.The mean operative time was 43 min (range,33 to 56 min).Blood loss was 20 to 50 ml.The postoperative hospital stay was 3 to 5 days.None experienced urinary leakage.During the follow-up of 12～18 months no ureteral stricture was found.The renal functions were improved. Conclusions Our experience indicates that appropriate trocar location,exactly checking of calculi,good D-J tube drainage and skillful intra-abdomenal suturing are the keys to perform laparoscopic ureterolithotomy quickly.

Objective To describe the new technique of transperitoneal laparoscopic dismembered pyeloplasty and to evaluate its clinical effect. Methods Of the 18 cases of ureteropelvic junction (UPJ) obstruction who underwent transperitoneal laparoscopic dismembered pyeloplasty,8 cases had severe hydronephrosis;7,intermediate;3,mild. Results Operations were all successful in 18 cases with the operating time being 100 to 210 min (mean,142 min) and the blood loss,40 to 200 ml.All the pores of puncture healed at phase 1;mean hospitalization was 7.4 d.Only 1 case had postoperative urine leakage.Follow-up of 3 to 12 months showed there was no stricture at UPJ and hydronephrosis was remitted (intermediate hydrops in 4 cases,mild in 7 and resolution in 7).The renal functions were improved. Conclusions Laparoscopic dismembered pyeloplasty is an effective and minimally invasive approach and can be used as an alternative to open surgery for UPJ obstruction.

0.05), but BIS was markedly lower in group Ⅲ than that in group Ⅰ (P