Universal health has been highly valued by the public and the government,and medical science and technology have been much improved.However,these are accompanied by a complex situation of doctor-patient relationship.We discuss here that humanism be fostered in medical education and clinical practice.A harmonious doctor-patients relationship can be maintained only when patientcentered medical service is applied and humanistic care is integrated but not overly dependent on technology and seeing patient as mere cases.

Objective To investigate the expression of serum interleukin-2(IL-2),tumor necrosis factor-α(TNF-α)in the pa-tients with pulmonary tuberculosis and diabetes,and prelininary explore its clinical significance.Methods Experiment were divided into control group(health check-up outpatient,n=10),pulmonary tuberculosis group(n=20),diabetes group(n=20),tuberculosis combine diabetes group(n=20),tuberculosis combine diabetes group was divided into improved group,diabetes group and deterio-rated group after 2 months with therapy according to disease outcome,ELISA assay was used to measured the level of serum IL-2 and TNF-α.Results Before treatment:serum IL-2 levels of pulmonary tuberculosis group,diabetes group and pulmonary tuberculo-sis combine diabetes group were reduced (P<0.05),and the pulmonary tuberculosis group was lower than the pulmonary tubercu-losis group and diabetes group (P<0.05);serum TNF-αlevels of pulmonary tuberculosis combine diabetes group,pulmonary tu-berculosis group and diabetes group increased (P<0.05),and that of pulmonary tuberculosis combine diabetes group was higher than that of diabetes group (P<0.05).After treatment:the level of serum IL-2 increased and TNF-αsignificantly decreased in pul-monary tuberculosis combine diabetes improved group (P<0.05),the deterioration group had no change(P>0.05).Conclusion IL-2 and TNF-αplay a role in the immune pathogenesis of tuberculosis combine diabetes,which dynamic changes can reflect the progression and outcome of pulmonary tuberculosis combine diabetes.

Humans ; Otolaryngology ; Printing, Three-Dimensional

OBJECTIVE:To provide policy recommendations for optimizing medicines distribution system reform in China.METHODS:Literature review and field investigation were used to mapping the medicines distribution system. Problems and influ-ential factors were analyzed and policy recommendations for optimizing the medicines distribution system reform were put forward. RESULTS & CONCLUSIONS:Medicines distribution system has been undergoing a rapid development and transformation under the overall health system reform. Most medicines distributors are still with small scale,low concentration,high cost,low profitabil-ity,lack of core competence, development of new form facing challenges. A large number of drug distributors still follow the tradi-tional business model,know little about modern drug supply chain management,and not understand their appropriate roles under the new social and economic development. Medical E-commerce face both opportunities and challenges in the process of develop-ing. Drug distribution industry needs vertical and horizontal integration, speeds up the socialization of the third party logistics and the healthy development of the medical electricity supplier, improves and perfects the drug distribution supervision system which is suitable for the healthy development of new form.

ve To determine the most approprite hypoxic concentration and duration for prenatal hypoxic adaptation animal experiment by exposing pregnant rats to the hypoxic air of different oxygen concentration.Methods Full-term pregnant rats( gestation time 22 days) were placed in an airtight cabin specially designed for hypoxic adaptation experiment. The rats were divided into 7 groups. The Q2 concentration in the airtight cabin was decreased from 21% (group Ⅰ as control) to 18% (group Ⅱ), 17% (group Ⅲ), 16% (group Ⅳ), 15% (group Ⅴ), 14% (group Ⅵ) and 13% (group Ⅶ) respectively. The animals were exposed to short duration of hypoxic air twice with a break of 5min breathing fresh air. The duration of the first hypoxic episode lasted 10 min (group Ⅰ ) , 5 min (group Ⅱ), 7.5min (group Ⅲ), 9.83 min (group Ⅳ), 11.5 min (group Ⅴ), 13.17 min (group Ⅵ) and 14 min (group Ⅶ) respectively. The second hypoxic episode lasted 10min, 9.33 min, 11 min, 15.17 min, 13.33 min, 17 min and 18 min respectively. Ten newborn rats (1 day after birth) randomly selected from each group were placed in a 100ml airtight bottle and the duration from the start to the time when the newborn rat stopped breathing was recorded as hypoxia surviving time. Another 10 newborn rats randomly selected from each group were decapitated and brain was removed for light and electron microscopic examination to determine the degree of neuronal damages. Results In group Ⅰ-Ⅴ the newborn rats were normal (pink skin color and good extremity movement) . In group VI 10/55 (18%) newborn rats were cyanotic with diminished extremity movement, the others were normal. In group VIII 11/52(21% ) newborn rats died, 14/ 52(27%) were cyanotic with diminished extremity movement. Neuronal damages could be seen in cyanoticnewborn rats including decreased number, swelling, apoptosis of neurons and expanded mitochondria. The hypoxia surviving time was significantly longer in group Ⅳ, Ⅴ and Ⅵ than that in control group. Conclusions Hypoxic air containing 15% O2 is appropriate for animal experiment of prenatal hypoxic adaptation. It is better to divide prenatal hypoxia into two episodes lasting 11.5 min and 13.33 min with a break of 5 min between them when animals breathe fresh air.

Objective To investigate the mechanism involved in the brain protection afforded by prenatal hypoxic adaptation by determining the quantitative variation in bcl-2 and bax mRNA expression.Methods Twenty-four Wistar pregnant (22d pregnant) rat were randomly divided into two groups: group I (hypoxia group) and group *** ( control group) . In group Ⅰ the pregnant rats were placed in an airtight cabin specially designed for hypoxic adaptation. When O2 % in the cabin decreased to 15%, the animals were taken out breathing fresh air for 5min and then placed back in the cabin and underwent another episode of hypoxia. In group Ⅱ the animals were placed in the cabin which was not tightly closed and underwent no hypoxia. 7 fetal or newborn rats were taken at 1st, 3rd, 24th, 48th, 72nd, 120th, and 168th h after prenatal hypoxic adaptation from each group and their brains removed for determination of bcl-2 mRNA and bax mRNA. Results In control group the expression of bcl-2 and bax were observed in the brain tissue of normal fetal or newborn rats from the 22nd day in the uterus to the 7th day postpartum during which there were no significant changes in bcl-2 gene expression while bax gene expression gradually decreased with time ( the decrease was of no statistical significance) . In hypoxia group bax gene expression decreased at 8th h after hypoxic adaptation and reached the bottom at 24th h which persisted until 120th h; while bcl-2 gene expression started increasing at 24th h after hypoxic adaptation and persisted until 72nd h. The bcl-2/bax ratio also started increasing at 8th h after hypoxic adaptation and peaked at 24th h and persisted until 72nd h. Conclusions In the brain tissue of fetal and newborn rats which have undergone prenatal hypoxic adaptation, bcl-2 gene expression is elevated, bax gene expression decreases and bcl-2/bax ratio increases. These changes are time -dependent.

Objective To make cephalometric analysis on the morphology of mandibular angle and its relationship with adjoining craniomaxillofacial structures in adults, and to discuss the application of the results in preoperative analysis and operation design. Methods Cephalometric analysis was made on the following parameters in 30 adults (15 men and 15 women) for frontal and lateral cephalometric radiograms: the distance between the mandibular angles (Go Go) and between the malar points (Zy Zy), and the mandible mental angels (Zy Go Me) on an anteroposterior cephalometric radiograph; the gonial angle (Ar Go Me), mandibular plane sella nasion angle (MP SN) and ramus plane sella nasion angle (RP SN). Results Go Go in male was (130?6) mm, female (116?6) mm; Zy Zy in male was (156?5) mm, female (146?5) mm; Zy Go Me in male was (117?5)?, female (119?5)?; Ar Go Me in male was (117?5)?, female (119?5)?; MP SN in male was (27?5)?, female (29?5)?; RP SN in male was (94?5)?, female (93?5)?. Conclusion The morphology of mandibular angle should be envisioned in three directions. The results of evaluation can be served as the reference of preoperative analysis and surgery design.

Objective To analyze the surveillance data from 2003 to 2007 for Hubei province,investigate the epidemic characteristics of human rabies in these years,so as to provide scientific basis for its control and prevention.Methods Rabies data collected from the National Disease Surveillance Reporting System from 2003 to 2007 in Hubei province and 134 Rabies cases investigated in 2007 were analyzed in detail.Results The results showed that the trend of the number of rabies reported cases in Hubei province was obviously increased from 2003 to 2007.The involved counties and districts of the epidemic situation were widely expanded accordingly.Each month had Rabies case,but a lot of cases were dominated in August to November for every year.Most of the cases were farmers and students.The sex ratio of male to female was 2.38∶1.The age of the cases were mainly ranged from 5 to 15 and from 40 to 70 years old.Investigation of 134 cases indicated that the median of the incubative period was 66 days;94.78% of cases were injured by the dog;only 15.67% of injured cases were treated by the medical institution;the vaccinate ratio was 14.93%;the proportion of patients who received wound treatment,vaccinate and passive immunization were 5.80% of all the grade-Ⅲ-exposed patients.Conclusions The epidemic situation of Rabies was serious from 2003 to 2007 for Hubei province.The main reasons of the increase of rabies cases in Hubei province are absence of the effective management of the dog,the lack knowledge of rabies prevention,low rate of vaccine and passive immunization after exposure,and the lack of the standardized management for some of the low level medical institutions.

Objective To explore the role of multi-media teaching in the ENT physician training. Methods 32 further-study professionals were randomly divided into 2 groups. The control group received traditional teaching methods(n = 16), and the experimental group received the multi-media teaching method (n = 16). After the training, all trainees would take the theory test and skill assessment Results The basic theory and clinical skill scores of the experimental group are better than the control group at the end of the training. Conclusion Multi-media teaching method is very suitable for ENT refresher training.

Objective To introduce a method of dorsal augmentation rhinoplasty using autogenous septal cartilage. Methods Autogenous septal cartilage was obtained through a standard septoplasty approach. Graft was cut into single oval, or divided into two or three parts, then the cartilage was sutured by means of a mattress suture; or graft was made into an inverted V frame, depending on size and shape of dorsal depression, and finally graft was inserted for augmentation of dorsum. Results Since May 1989 to Dec. 2001, this technique was performed in 43 patients, 6 men and 37 women, with a range of 17-35 years and a mean age of 24 years. Follow-up ranged from 6 months to 5 years. The authors asserted the sustained satisfactory outcomes. Conclusion Autogenous septal graft is technically simple and relatively free of complication. Long-term evaluations show no absorption of grafts and preservation of desired shape.