Diagnostics Teaching is the important transition period from the completion of basic medical knowledge to clinic practice.In the period,we should not only pay attention to medical knowledge and clinic techniques,but also emphasize humane spirit education,which is the basic principle of medical science,the intrinsic request of medical mode and especially the urgent request of relieving confliction between doctors and patients and of reconstructing harmonious society.At present,the present situation of humane spirit education of the interns is not ideal.This article tries to analyze the associated reason and discusses the countermeasures.

The Free-floating Flexible Dual-arm Space Robot is a highly nonlinear and coupled dynamics system. In this paper, the dynamic model is derived of a Free-floating Flexible Dual-arm Space Robot holding a rigid payload. Furthermore, according to the singular perturbation method, the system is separated into a slow subsystem representing rigid body motion of the robot and a fast subsystem representing the flexible link dynamics. For the slow subsystem, based on the second method of Lyapunov, using simple quantitative bounds on the model uncertainties, a robust tracking controller design is used during the trajectory tracking phase. The optimal control method is designed in the fast subsystem to guarantee the exponential stability. With the combination of the two above, the system can track the expected trajectory accurately, even though with uncertainty in model parameters, and its flexible vibration gets suppressed, too. Finally, some simulation tests have been conducted to verify the effectiveness of the proposed methods.

It is a consensus to place stent after cutting bile duct in the hepatobiliary surgery in the past.However,as the development of bile physiological research and surgical technique,especially the raise of medical concepts of rapid recovery,the negative effects which are caused by the placement of stent have been taken seriously gradually.Up to now,whether the stent should be placed after the bile duct is cut has no definite answer yet.

ObjectiveTo observe the infection of continuous aspiration of subglottic secretion(CASS) for patients with ventilator associated pneumonia (VAP).MethodsOne hundred and fifty VAPpatients under mechanical ventilation whose basical information were recorded were divided into two groupsby random digits table method:control group(70 cases) and CASS group(80 cases).Conventional VAPprevention was taken in control group and CASS group,while CASS therapy was added to CASS group.ResultsSex,age,acute physiology and chronic health evaluation Ⅱ score,recent antibiotics usage,airpressure,time in ICU,hospital stay and mortality rate of two groups had no statistical significance(P ＞0.05 ).The time of ventilator treatment of CASS group was obviously shorter than that of control group [ (5.2 ±1.4) d vs.(7.8 ± 1.2) d,P =0.02 ],and VAP incidence was lower than that of control group [ 22.5％ (18/80)vs.32.9％(23/70),P =0.04 ].ConclusionCASS could reduce the incidence of VAP and short the time ofventilator treatment.

Objective To investigate the significance of H.pylori infection on upper gastrointestinal rebleeding in patients with long-term (≥ three months) aspirin and clopidogrel combination therapy.Methods From September 2007 to September 2011,at Yijishan Hospital of Wannan Medical College 78 patients with upper gastrointestinal bleeding and receiving long-term (≥ three months) aspirin and clopidogrel combined therapy were selected and treated with esomeprazole.The results of rapid urease test and gastric mucosal biopsy Giemsa staining of selected patients indicated 55 patients were H.pylori positive (positive group) and the other 23 cases were in negative group.The patients of positive group were randomly divided into intervention group (28 cases) and control group (22 cases) by the random allocation table method.The patients of intervention group received H.pylori eradiation treatment and the situation of H.pylori eradication was checked by 14C breath test.After treatment all patients were followed up for six months and clinical symptoms and the situation of rebleeding were observed.Categorical variables were expressed as percentage,intentional analysis and in accordance with protocol analysis were performed separately and analyzed by chi-square test.Results One patient in negative group with gastric cancer withdraw from the study.Two patients in intervention group lost.And one patient in control group lost.H.pylori of intervention group was all eradiated.In accordance with protocol analysis,the rebleeding rates of intervention group and control group were 7.69％ (2/26) and 34.62％ (9/26),respectively,and the difference was statistically significant (x2 =5.650,P=0.017).There was no significant difference between negative group (18.18％,4/22) and intervention group and no significant difference between negative group and control group (both P ＞ 0.05).In intentional analysis,the rebleeding rates of intervention group and control group were 7.14％ (2/28) and 33.33％ (9/27),respectively,and the difference was statistically significant (x2 =5.893,P =0.015).There was no significant difference between negative group (17.39 ％,4/23) and intervention group and no significant difference between negative group and control group (both P ＞ 0.05).Conclusion Eradication of H.pylori can reduce the rate of upper gastrointestinal rebleeding in patients with long-term aspirin and clopidogrel combination therapy.

Radiotherapy is the main treatment method of early lung cancer not undergoing surgery for medical reasons and advanced non-resectable lung cancer. The local regional control of lung cancer requires high-dose irradiation, but this treatment is restricted by normal tissue tolerance. The measurement and control of errors are crucial for safe implementation of lung cancer precision radiotherapy. Lung tumor radiotherapy error sources, the methods to control these errors, and the error development trend are discussed in this review.

Objective To explore the effect and significance of propofol combined with a small dose of butorphanol in anesthesia abortion surgury.Methods Retrospective analysis of 2145 cases of the propofol combined with a small dose of butorphanol on the anesthesia abortion surgery of the anesthesia effect,side effects,anesthesia,surgery time,recovery time,discharge time,cost,etc.Results The excellent rate of narcotic analgesia was 99.9％,the satisfaction rate of the patients was 100％,4.5％ incidence of adverse events,mainly body movements and allergies.The average amount of anesthetic propofol was ( 95 ± 15) mg,the butorphanol was 0.6mg;the operative time was (5.4 ±1.6) min,the patients alert in ( 1.8 ± 0.6) min,and discharged from the hospital 0.5 to 1 hour after the surgery.Conclusion The propofol combined with a small dose of butorphanol used in anesthesia abortion surgery has good curative effects,safety,low incidence of side effects,cheap price.

OBJECTIVE:To observe the efficacy and safety of aspirin combined with Dieda huayu powder in the prevention of deep vain thrombus (DVT) after great saphenous varicose vein surgery. METHODS:280 patients with great saphenous vein sur-gery were randomlt divided into control group and observation group. control group was given Aspirin enteric-coated tablet 100 mg breakfast in the next day of surgery,once a day;observation group was additionally given Diedahuayu powder 2 g to fumigate feet and non-operation place on ill leg in the next day of surgery. 7 d was a treatment course. The incidence of prothrombin time(PT), activated partial thromboplastin time(APTT),fibrinogen(Fg),platelet count and the incidence of DVT and adverse reactions af-ter surgery before and after surgery in 2 groups were observed. RESULTS:The incidence of DVT in observation group was signifi-cantly lower than control group,the difference was statistically significant(P<0.05). After surgery,the PT,APTT and Fg in 2 groups were significantly higher than before,and observation group was higher than control group,platelet count was significantly lower than before,and observation group was lower than control group,the differences were statistically significant(P<0.05);there was no significant difference in the incidence of adverse reactions between 2 groups(P>0.05). CONCLUSIONS:Aspirin combined with Dieda huayu powder can more effectively prevent the DVT after great saphenous varicose vein surgery than only as-pirin,inhibit coagulation,with similar safety.

Objective Study of self expandable stent assisted coiling for treatment of intracranial saccular aneurysm effect.Methods Select 2011 April 2013 April in our hospital by self expandable stent assisted coil in the treatment of in-tracranial saccular aneurysms of the 27 patients as the research object , after the occurrence of complications in patients with statistics.And by using the digital subtraction angiography (DSA) under full of carotid and cerebral angiography in patients with tumor total occlusion rates are examined and of patients were the therapeutic effect of three years of follow -up were ob-served.Results The incidence of postoperative complications was low , and the patients were followed up after the tumor to-tal occlusion rate was significantly better than the examination results , and the difference was significant ( P<0.05 ) , with statistical significance .Conclusion The Peng type stent assisted coiling for treatment of intracranial saccular aneurysms has significant effect , safe and reliable .

Objective To explore the effects and mechanisms of nesfatin-1 injection in the central nucleus of the amygdale(CeA) on exploratory behavior in rats.Methods Fifty rats were divided into 5 groups randomly : nesfatin-1 low dose group, nesfatin-1 high dose group, SHU9119 group, SHU9119+nesfatin-1 low dose group and control group.Drugs were administrated via CeA to examine behavioral changes of rats by elevated plus maze model test and nesfatin-1 mRNA expression in CeA of anxiety rats (10 rats).Results Compared with the control group,anxiety behaviors of rats in nesfatin-1 low dose group and nesfatin-1 high dose group were improved remarkably,showing that the open arm entries were significantly reduced (OE, t=4.16-12.87, P＜0.01), open arm entry proportion was decreased remarkably (OE％, t=2.39-4.39, P＜0.01-0.05), and time proportion in open arm was decreased significantly (OT％, t=5.43-20.55, P＜0.01),which presented dose dependent.Compared with the control group, anxiety degree of rats in nesfatin-1 low dose group and nesfatin-1 high dose group significantly enhanced, showing that the rats head dipping reduced obviously (HD, t=6.97-16.73, P＜0.01) ,while rearing was increased significantly (RE, t=6.60-13.25, P＜0.01) ,which was presented dose dependent.Melanocortin receptor antagonist SHU9119 can partly eliminate nesfatin-1 induce-anxiety (t =2.11-3.08, P＜ 0.01-0.05).Real-time PCR results showed that nesfatin-1 mRNA expression of anxiety model rats was significantly increased (t =3.40-5.58, P＜0.05).Conclusion Amygdala nesfatin-1 can increase anxiety and fear of rats,which may be associated with melanocortin systems.