The medical humanistic spirit is an ethical concept which takes people-oriented,life-loving,and a sustainable development of human physical and mental health as its ideal value.However,since the modern society is filled with technological doctrines,utilitarianism and market-oriented behaviors,making the humanistic spirit in medical education weakened,resulting in unethical action of healthcare services,disordered healthcare services,and the imbalance between physicians and patients.This paper studies the question of modern medicine brought about by the loss of humanistic spirit,discusses the "humanistic" feature of new healthcare reform,and bring forward a medical personnel training mode which stresses humanistic spirit.

To study the effectiveness of gene therapy for acoustic trauma induced by intensive noise, the replication defective adenovirus that carries human neurotrophin 3 cDNA(Ad NT3) was inoculated into the guinea pig cochlea 3 days after exposure. ABR and CAP were recorded after 14 days and 2 months, respectively. No difference was found 14 days after exposure. At the end of two months, the Ad NT3 treated animals showed less ABR threshold shift, lower CAP threshold and shorter CAP N1 latency by 100dBSPL click. The result suggested that Ad NT3 could be used to express the neurotrophins within the cochlea and reduce noise induced hearing loss in vivo .

Objective To Know the present situation of diabetes′ self-management ,explore its influencing factors and provide theoretical evidences for conducting diabetic health education and improving patients′ level of self-management .Methods Using random sampling method ,we took 483 cases of diabetic patients concluded inpatient and outpatient from a first class hospital and two community hospitals who meet the inclusion criteria from March 2011 to April 2013 in Chongqing city .All patient were investi-gated with diabetes self-management questionnaire scale .Results 500 questionnaires ,received 483 valid questionnaires ,and the ef-fective rate of recovery is 96 .6% .Among 483 cases of diabetic patients in the investigation ,78 .7% of patients understood diabetes knowledge from medical staffs .In the aspect of following the treatment plan :drug plan had the best executive power with 59% ;the average score of diabetes knowledge was (41 .747 ± 10 .23) ,score index was 51 .5% ;82 .2% of patients did ,not understand their value of glycated hemoglobin ,44 .5% of patients did not understand the two-hour postprandial blood glucose ;The average score of diabetes′self-care behaviors was(3 .59 ± 1 .249) ,score index was 51 .29% ,different score index accompany with different self-man-agement levels .Educational level ,retirees ,diet control ,blood glucose monitoring ,the understanding of diabetes knowledge were pro-tective factors for receiving health education .Conclusion Patients grasp diabetic knowledge are poorly in average ,the present situa-tion of patients′self-management is not optimistic ,it is better to increase the health education of diabetes′ self-management ,and make great efforts to improve diabetes′self-management skills .

BACKGROUND:Calcium phosphate cements (CPCs) possess the bio-degradation and osteoconduction, and its final hydration product, hydroxyapatite, is the main inorganic constituent of bones. However, its poor mechanical property makes it unable to be used for repairing weight-bearing bone defects. OBJECTIVE:To develop a kind of bioactive bone cements with decent biomechanical property and biocompatibility. METHODS:6%silk fibroin aqueous solutions containing different concentrations of N-acetylcysteine (0, 10 and 25 mmol/L) were prepared. Each cement sample was prepared by mixing the curing liquid andα-tricalcium phosphate powder with the ratio of 0.4 mL:1 g;α-tricalcium phosphate powder mixed with ddH2O as control group. The compressive strength, setting time of the cements were measured. The crystal components of the cements were characterized using X-ray diffraction and the microstructure was observed using scanning electron microscope. MC3T3-E1 cel s were seeded onto the material in each group, and cel morphology was observed under scanning electron microscope at 24 hours. MC3T3-E1 cel s were cultured in the extract of each material, cel proliferation was detected at 1, 3, 5 and 7 days, and the lactate dehydrogenase level was detected at 1 and 3 days. RESULTS AND CONCLUSION:X-ray diffraction and scanning electron microscope showed that the final hydration products ofα-tricalcium phosphate in al specimens were hydroxyapatite. When the concentration of N-acetylcysteine was 25 mmol/L, the compressive strength of the material reached (49.39±1.68) MPa, with the initial setting time of (21.77±1.07) minutes and the final setting time of (31.88±1.69) minutes. There was no significant difference in cel morphology among cements. These results suggest that the cement containing N-acetylcysteine exhibites good biocompatibility and high mechanical strength.

BACKGROUND:Calcium phosphate bone cement has been applied to clinical surgery because of its good biocompatibility and osteoconduction. However poor mechanical properties and lack of osteoinductivity limit its wide application.
OBJECTIVE:To develop calcium phosphate cement incorporated with N-acetylcysteine (NAC) loaded silk fibroin microspheres (SFM), which is a kind of new injectable bone graft material with slow-release function, and evaluate its physical and chemical properties and cel compatibility.
METHODS: Empty SFMs were prepared with emulsion solvent evaporation to absorb NAC solution of different concentrations by NAC-SFM and the concentration of NAC at the maximum drug loading ratio was determined. Then, NAC-SFM was loaded into calcium phosphate bone cement to test the drug release propertiesin vitro. MC3T3-E1 osteoblasts were cultured on the surface of NAC-SFM calcium phosphate bone cement and cel attachment and growth were observed by scanning electron microscope. Additionaly, MC3T3-E1 cels were cultured with three kinds of bone cement extracts (calcium phosphate cement, SFM-calcium phosphate cement, NAC-SFM-calcium phosphate cement, as wel as cultured in theα-minimum essential medium containing a volume fraction of 10% fetal bovine serum and 1% penicilin-streptomycin double antibody as the control. MTS assay was used to evaluate cel proliferation.
RESULTS AND CONCLUSION:Microspheres in the composite bone cement presented with smooth surface, same size, diffused distribution and no obvious destroy. Thus, the SFM could remain stable in the reaction process of the composite bone cement. The double slow release system which contained silk fibroin microspheres and calcium phosphate bone cement showed a significant decrease in the cumulative release percentage of NAC within the first 24 hours compared with the control group (P < 0.05). In the next 28 days, the release speed of NAC was significantly lower in the NAC-SFM-calcium phosphate cement group than the calcium phosphate cement group (P< 0.05). In addition, different extracts had no significant cytotoxicity to the growth of MC3TC-E1 cels. Thus, the NAC-SFM-calcium phosphate cement has good cytocompatibility, which provide a new insight into the development of bone repair biomaterials.

Objective To explore the correlation between the expression of protease activated receptors-2 (PAR-2) and intestinal mucosal barrier injury of acute necrotizing pancreatitis (ANP) in rats.Methods The ANP rat model was created.The expression of PAR-2 in rat's intestinal mucosa of sham-operated group and ANP group at six,12 and 24 hours after model established was detected by immunohistochemistry (IHC),reverse transcription-polymerase chain reaction (RT-PCR) and Western blot.The difference between groups was analyzed by one way analysis of variance.Results The results of IHC indicated that PAR-2 expression in rat's intestinal mucosa of sham-operated group was weak.The number of PAR-2 expression positive cells and immunostaining intensity increased significantly after ANP model established.The IHC score was 4.88±0.33,5.87±0.32 and 11.17±0.27 at six,12 and 24 hours after model established respectively.Compared with those of shamoperated group (2.86 ± 0.31),the differences were statistically significant (F=747.08,P＜0.01).The expression of PAR-2 at mRNA and protein level in intestinal mucosa of sham-operated group was very low.As time extended after ANP model established,both expression increased gradually.The PAR-2 mRNA was 0.56±0.03,0.69±0.03,1.05±0.05,and the protein was 0.28±0.02,0.35±0.03,0.69±0.04 at six,12 and 24 hours after model established respectively.Compared with shamoperated group,the differences were statistically significant at each time point (F=785.69,1177.82,both P＜0.01).Conclusions PAR-2 is activated in the inflammatory progress of ANP,and may play an important role in the pathogenesis and development of intestinal mucosa barrier injury in ANP.

Objective To evaluate the efficacy of early continuous high-volume-hemofiltration in the treatment of patients with severe acute pancreatitis (SAP).Methods Based on the method of prospective,randomized and controlled clinical trial,60 patients with SAP between January 2005 and July 2011 from the First Affiliated Hospital of Nanchang University were divided into control group and hemofiltration group.The hemofiltration group was treated with early continuous high-volume-hemofiltration and not in the control group.The changes of vital signs,clinical symptoms and laboratory indicators were compared between the two groups before and after the treatment.Results After hemofiltration,the clinical symptoms such as abdominal pain,fever,tachycardia and respiratory distress in hemofiltration group were significantly remitted compared to those in the control group (P ＜0.05).The APACHE Ⅱ score (13.3 ± 1.0 vs 14.1 ± 1.2) and the level of TBil[(20.4±11.3) μmol/L vs (28.1 ±10.9) μmol/L],creatinine[(178.7 ±71.8)μmol/L vs (215.6 ± 51.3) μmol/L],blood urea nitrogen[(10.1 ± 5.6) mmol/L vs (13.2 ± 3.8) mmol/L] and ALT[(51.3 ± 13.2) U/L vs (62.5 ±14.3) U/L] were decreased compared to those in the control group (all P values ＜0.05).The level of PaO2/FiO2(197.3 ±32.4 vs 178.3 ±31.7) was increased (P ＜ 0.05).After hemofiltration,heart rate was decreased gradually (P ＜ 0.05) in the hemofiltration group than in the control group.Mean artery pressure (mAP) increased gradually (P ＜ 0.05) in the hemofiltration group than in the control group.Conclusion Early continuous high-volume-hemofiltration has significant effects on the treatment of SAP including the improvement of clinic symptoms,the blockade of development from systemic inflammatory response syndrome (SIRS) to multiple organ dysfuction syndrome(MODS),improvement of organ function and prevention from the complications.It may become one of the important therapies for SAP.

Objective To study the effect of cisplatin on the hepatocellular carcinoma HepG2 cells by Atomic Force Microscopy (AFM), then analysis the changes of ultrastructural in HepG2 cells during apoptosis induced by cisplatin at nanoscale level. Methods HepG2 cells were treated with cisplatin for 24h and 48h. The ultrastructural change of cell surface was detected by AFM , the inhibitory rate and apoptotic rate of cell were examined by MTT and fow cytometry. Results AFM images showed that with the prolongation of cisplatin-inducing, the deformation change of HepG2 cells varying degree. The cells appeared larger pore size of cell membrane, the value of cell membrane particle sizes, Rp-v, Ra, Rq and Meant Ht were significant increased. The inhibitory rate and apoptotic rate were significant increased. Conclusions Cisplatin induced shrinkage in cell morphology, pore formation and roughness increasing in cell membrane, thereby inducing apoptosis in HepG2 cells.

Objective To study the potency of transdifferentiated renal tubular epithelial cells for acquiring the tissue stem cells during renal fibrosis.Methods The in vitro cellular model of renal tubular epithelial cells(NRK-52E)transdifferentiation under the inflammatory environment of the local renin-angiotensin (AngⅡ)system was established.The expression and change situation of the embryonic kidney developmental gene Pax2 and the tissue stem cell surface marker CD133 were observed.Results Local high concentration of AngⅡcould stimulate the NRK-52E cells to express Pax2 and CD133 molecule,its effect demonstrated the dose-and time-dependent relation.Conclusion The inflammatory damage leads to the transdifferentiated renal tubular epithelial cells po-tency to acquire the tissue stem cell.

Objective: To investigate the clinical value of peripheral blood neutrophil to lymphocyte ratio ( NLR) in patients with acute respiratory distress syndrome, and to compare the role of NLR and procalcitonin ( PCT) in the prognosis of patients with acute respiratory distress syndrome. Methods: From October 2015 to December 2017, 79 cases of ARDS patients were selected as case group, and 79 health examination persons were also selected as control group. According to the situation of death in 28 days of the ARDS patients were divided into survival group ( 38 cases) and death group ( 41 cases). The peripheral blood white blood cell count ( WBC), neutrophils count ( NC), lymphocyte count ( LC) and serum PCT level were detected, and calculate NLR. The clinical value of NLR and PCT in patients with acute respiratory distress syndrome ( NLR) were evaluated by receiver operating characteristic curve ( ROC) and the area under the curve ( AUC). The Kaplan-Merier method was used to analyze survival rate of patients with ARDS. Results: The levels of WBC, NC, NLR and PCT in ARDS patients were significantly higher than those of the control group ( P＜ 0. 05), while the level of LC was significantly lower than that of the control group ( P＜0. 05). The level of NLR and PCT in the survival group were significantly lower than those in the death group ( P＜0. 05). The AUC of NLR and PCT for evaluating the prognosis of ARDS patients were 0. 786 and0. 689 respectively. With Kaplan-Meier analysis of survival curves, ARDS patients whose NLR ≥13. 80 and PCT ≥ 4. 01 μg/L had lower 28 day survival rate as compared with those with NLR＜13. 80 and PCT＜4. 01 μg/L ( P＜0. 001). Conclusion: The NLR and PCT could be used as biomarkers for evaluating the prognosis of ARDS patients, but the effect of NLR is better than that of PCT.