This article deals with the relationships between doctors and patients in the ethical and legal perspective.It emphasizes that doctors should envisage,solve and settle new problems even conflicts with patients.Meanwhile,it points out that in China's tradition of ethical standard,the harmony between doctors and patients could not copy the legal system of the West.Adoption of ethics and laws as well as social responsibilities could result in good relationships between doctors and patients which could improve the service of hospitals.

Objective To investigate the effect of continuous positive airway pressure(CPAP) on nocturnal polyuria in patients with obstructive sleep apnea syndrome(OSAS). Methods The number of nocturia, the nocturia output, the osmotic pressure of nocturia and the nocturia excretion of Na＋ . Plasma levels of atrial natriuretic peptide (ANP) in night were measured in 8 patients. After treatment with CPAP, the patients were recorded or measured by those index again. Results The number of nocturia ， The nocturia output， The osmotic pressure of Na＋ ,and the plasma leels of NAP in night decreased significantly after tretment with CPAP.The osmotic pressure of nocturia rose significantly.The reduction of ANP corrected with the reduciton of the nocturia output,addition of the osmotic pressure of nocturia and the reduction of the nocturia exeretion of Na＋ .Conclusion CPAP can reduce the number of nocturia, the nocturia output and the nocturia excretion of Na＋ , increase the osmotic pressure of nocturia. The changes probably relate with the reduction of plasma level of ANP.

To introduction the biological function of vascular endothelial growth factor and to explore the role of vascular endothelial growth factor(VEGF)and in the pathogenesis of endotoxin,ischemia-reperfusion,hyperoxia,ventilator-induced lung injury(ALI)/acute respiratory distress(ARDS).

Objective To differentiate the sequences of Cyt b gene Agkistrodon from its adulterants sold in the market in order to provide molecular evidence for identification of Agkistrodon. Methods Cyt b gene was used to sequence and analyze Agkistrodon and its adulterants sold in the market. Results There was a mixed phenomenon in Agkistrodon species. The differences of Cyt b gene sequence between Agkistrodon and its adulterants sold in the market are significant: the difference rates among the species of Agkistrodon are 0%—0.91%, the difference rates between Agkistrodon and its adulterants are 18.57%—23.78%. Conclusion The characteristics of Cyt b gene sequence can be used as a better molecular marker for authenticating Agkistrodon from its adulterants.

Objective To explore the nutritional condition of primary liver cancer inpatients by means of nutrition risk screening 2002 (NRS2002) and mini nutritional assessment,and compare their feasibility.Methods A total of 80 cases of liver cancer patients hospitalized in Tianjin Third Central Hospital from August 2012 to March 2013 were collected.We investigated the incidence of malnutrition with the scales of NRS2002 and MNA.Comparative analysis of the relationship between the two methods and the traditional single index,liver function was conducted in order to find the more appropriate one for nutritional evaluation.Results NRS2002 got a 33.7％ nutrition risk incidence and MNA showed a 45.0％ risk rate.NRS2002 showed better correlation with traditional individual indicators than MNA.Conclusions Compared with MNA,NRS2002 is more reliable for nutritional assessment in primary liver cancer inpatients.

Aspirin is a primary and secondary preventive medication for ischemic cerebrovascular diseases .Artery thrombotic events are still possible to occur after taking aspirin for a long time,and this indicates aspirin resistance(AR).At present, there is still lack of gold standard for the diagnosis of AR. It is usually interpreted as the loss of the biological effect of aspirin's antiplatelet aggregation and the role of preventing cerebral thrombosis events. Once AR occurs, other safe and effective altematives to antiplatelet agents should he used timely. This article reviews the concept, epidemiology, mechanisms, laboratory methods for detection and clinical intervention of AR.

Objective　To study the effects of deliberated hypotension combined with acute simple hemodilution on blood loss,postoperative hemoglubin of the patients undergoing spinal side(back) protrude correction(SSP).Methods　Twenty four ASA grade Ⅰ to Ⅱ patients undergoing elective SSP were randomly divided into two groups:control group(n＝12) and hypotensive group(n＝12).The all patients received with general anesthesia.In the hypotensive group:acute simple hemodilution was accomplished with infusion of lactated Ringer's solution and Gelofusine of as three times as blood loss.Deliberated hypotensin was induced and maintained with 0.01% sodium nitroprusside 2～6μg/kg/min iv.Intraoperative blood loss,blood transfused volume during operation and postoperative hemoglobin were recorded and compared between both groups.Results　 Blood loss was about 51% lower in the deliberated hypotensive group than that in the control group at the end operation.The average volume of transfused blood during operation was(1200±140)ml in control group,blood transfusion was(400±128)ml in the hypotensive groups.Conclusion Deliberated hypotension combined with acute simple hemodilution can significantly decrease the intraoperative blood loss and the SSP operation can be better tolerated for the indicated patients.

This paper reports on the comparative susceptibility of A. dirus (Hainan strain) and A. stephensi (Hor strain) to the B strain of P. cynomolgi in paired feeding experi-ments. In the most susceptible infective period, the infection rate in midgut and salivary gland of the two species was over 90 %, the difference is not statistically significant.In relatively infective period, three experiments were performed, the infection rate in midgut of A. dirus was 24.4-60.4% with an average of 46.5% (53/114), and that of A. stephensi was 11.5-21.1% with an average of 14.2% (16/113). Statistically, experiment I showed no significant difference, the difference in experiment n was highly significant (P

Objective To analyse the effects of OPG (osteoprotegerin, OPG) at different concentrations on activity of osteoclasts (osteoclasts, OC) , and the relationship between them in physiological activity and function.Methods The bone marrow cells of six weeks old female mice were collected and cultured in vitro on the basis of adding different levels of OPG(10, 20, 50, 100 μg/L).The relationship between OPG and OC were analysed by tartrate resistant acid phosphatase ( TRAP) staining, F-actin cytoskeleton staining and bone resorption pits.Results OC showed adherent growth within 1h cultured, and there were no large multicore OC.Cultured for 5 days, the smaller monocytes gradually began to fusion with each other to form multinucleated cells and showed distinctive characteristics.After three days OPG treatment, the number of multicore cells gradually reduced with OPG concentration increaseing in experimental group, and showing a negative correlation between them(r=-0.516,P<0.05).And there were only a small amount of multinucleated cells at OPG concentration of 50 μg/L.At 20,50 μg/L of OPG concentration, OC number significantly decreased compared with control group (P<0.05), and when the concentration of OPG was 100μg/L, OC number showed significant reduction (P<0 01).the experimental group OPG bone resorption lacunae area, density and decrease the degree were positively correlated with concentration of OPG (r=0.459;r=0.426;r=0.389,P<0.05), and the area had a significant difference when two groups compared.Conclusion The inhibitive effects of OPG on OC function and activation increase with concentration increasing.

Objective To explore the feasibility of a novel technique of anvil placement in combined use of laparoscopic and thoracoscopic Ivor Lewis esophagectomy. Methods From June 2011 to October 2012, we performed a novel technique of minimally invasive Ivor Lewis esophagogastrectomy in 20 patients with midthoracic esophageal cancer.The anvil was placed to connection with the esophageal stump under thoracoscopic vision, and an apical pleural stomach esophagus anastomosis was performed by using normal stapling. Results The mean operation time lasted for 200 minutes (150-300 minutes) with a mean blood loss of 180 ml (150-250 ml) without blood transfusion.The mean number of lymph nodes resected was 18 (12-44).No additional incision was required. There were no complications at post-operation and no anastomic leakage.The patient’s hospital stay lasted a mean of 10 days (8-12 days) .Follow-up reviews were conducted for 6 months and no recurrence was found in all the 20 patients. Conclusion Laparoscopic and thoracoscopic Ivor Lewis esophagectomy with novel technique of anvil placement for the treatment of esophageal carcinoma ensures the feasibility and safety.