This text expounds the standpoint that the doctor's double agent identity must bring the morals risk through the analysis of it in medical insurance, and the financial input to the medical organization of our country is so insufficient as to make this problems more serious, so we must take precautions against the doctor's morals risk from solving the unbalanced information, reforming the management system and increasing the financial input.

OBJECTIVE:To study the pharmacodynamics of Compound xiangqi granules in vitiligo model guinea pigs. METH-ODS:The vitiligo guinea pigs model was established by chemical decolorization with hydrogen peroxide. Then guinea pigs were randomly divided into 5 groups after modeling,including model control group (water),vitiligo capsules group [positive control, 50 mg/(kg·d)] and Compound xiangqi granules low-dose,medium-dose and high-dose groups [25,100,and 400 mg/(kg·d)]. They were given related medicines intragastrically once a day for 40 days. The distribution of skin melanin and the number of black hair follicle were observed,and cholinesterase (ChE) activity,malondialdehyde (MDA) content of plasma and hemorheology in-dexes were detected. Blank control group had also been established. RESULTS:Compared with blank control group,the distribu-tion of skin melanin,the number of black hair follicle and ChE activity decreased in model control group,while plasma viscosity, whole blood viscosity and hematocrit increased significantly,and erythrocyte sedimentation rate decreased significantly;there was statistical significance(P<0.05 or P<0.01). Compared with model control group,except erythrocyte sedimentation rate and hema-tocrit of low-dose group,above indicators of positive control group and Compound xiangqi granules low-dose,medium-dose and high-dose groups were all improved;there was statistical significance(P<0.05 or P<0.01),showing good effectiveness-dose rela-tionship. CONCLUSIONS:Compound xiangqi granules improve relative indicators of experimental vitiligo model guinea pigs effec-tively.

ObjectiveTo compare the outcomes and safety of 23G and 20G vitrectomy for treatment of infectious endophthalmitis.MethodsThis was a retrospective case study.Sixty-seven eyes of 67 eyes suffering from infectious endophthalmitis with a history of trauma or intraocular operation history were enrolled in this study.They were diagnosed by the examinations of best corrected visual acuity,intraocular pressures,slit lamp microscope,indirect ophthalmoscopy,B-scan ultrasound and CT.There were 49 males (49 eyes) and 18 females (18 eyes).The patients aged from 18 to 72 years with a mean age of (43±13)years.There were 60 patients (60 eyes) with a history of trauma,7 patients (7 eyes) with intraocular operation history.The patients were enrolled into 20G vitrectomy group (35 patients,35 eyes) before December,2009 and 23G vitrectomy group (32 patients,32 eyes) after January,2010 when 23G vitrectomy system was imported in this hospital.Vitreous purulence was taken in all patients at the beginning of the surgery for bacteria and fungal culture and drug sensitivity test. A standard vitrectomy with artificial posterior vitreous detachment followed by internal limiting membrane peeling,and (or) intraocular laser photocoagulation,cryocoagulation,fluid-air exchange with intraocular silicone oil or gas tamponade were performed in all eases.Broad-spectrum antibiotics and glucocorticoids were used systematically for one week after surgery,but glucocorticoids were not used for fungal infections.The follow-up was ranged from two to nine months with a mean of (7 ± 1) months.The surgical time,inflammation situation,visual acuity,intraocular pressure, retinal reattachment rare,iatrogenic retinal hole rate, bulbar conjunctiva scar formation rate,reoperation rate and eye retention situation before and after surgery were comparatively analyzed.ResultsThe mean surgical times were (126 ± 12) and (89 ± 12) minutes in 20G and 23G group,which was significantly different (t=3.125,P＜0.05).The major surgery complications were ora serrata dialysis and other iatrogenic retinal breaks,and were occurred in 34 eyes,including 30 eyes (85.71％) in 20G group and 4 eyes (12.50％) in 23G group (x2 =35.85,P＜0.05).These 4 eyes in 23G group received foreign body removal surgery previously.The inflammation was controlled in 65 eyes (97.01％) including 34 eyes (97.14％) and 31 eyes (96.88％) in 20G and 23G group respectively,which was not significantly different (x2=0.004,P＞0.05).At last follow-up,There was no statistical difference of visual acuity between the two groups (t=3.12,P＞0.05).Fourteen eyes underwent silicone oil tamponade including 13eyes (37.14％) and 1 eye (3.13％) in 20G and 23G group respectively,which was significantly different (x2=11.703,P＜0.05).Nine eyes underwent reoperation (13.43％),including 8 eyes (22.86％) and 1eye (3.13％) in 20G and 23G group respectively,which was significantly different (x2=5.597,P＜0.05).The 8 re-operated eyes in 20G group included 1 eye of recurrent endophthalmitis and 7 eyes with retinal detachment,the 1 re-operated eye in 23G group was of recurrent endophthalmitis.There was significantly different (x2=7.147,P＜0.05) for the rate of retinal detachment between the 2 groups.There were 40eyes with bulbar conjunctiva scar including 35 eyes (100.00％) and five eyes (15.63％) in 20G and 23G group.Conclusion 23G vitrectomy is an effective treatment for infectious endophthalmitis with shorter surgery time,lower reoperation rate,lower retinal reattachment rate and fewer bulbar conjunctiva scar.

Objective To investigate the relationship in clinical features of invasive pituitary adenoma patients and their aggressive,matrix metalloproteinase 9 (MMP-9),vascular endothelial growth factor (VEGF) expression and tumor invasiveness of pituitary adenomas.Methods 96 patients with pituitary adenoma were selected,46 cases of invasive pituitary adenomas,50 cases of non-invasive pituitary adenomas,MMP-9,VEGF expression were detected by immunohistochemical assay,their expression levels were analyzed with tumor invasiveness correlation.Results MMP-9,VEGF expression in invasive pituitary adenomas strongly positive rates were 54.35％,52.17％,the total positive rates were 89.13％,95.65％,which were significantly higher than the non-invasive pituitary adenomas MMP-9,VEGF strong positive expression rate of 16.00％,20.00％,the total positive rates were 44.00％,56.00％ (x2 =15.618,9.416,21.631,20.090,all P ＜ 0.05);MMP-9,VEGF for invasive pituitary volume under positive circumstances,the maximum diameter was significantly higher than non-invasive of the group (t =4.32,3.67,2.49,2.54,all P ＜ 0.05),and MMP-9,VEGF were under negative circumstances invasive and non-invasive pituitary adenoma group,the difference was not statistically significant(t =1.56,1.47,0.53,0.21,all P ＞ 0.05);By correlation analysis,invasive pituitary adenoma MMP-9 expression was positively correlated with VEGF levels (r =0.734,P ＜ 0.01).Conclusion Invasive pituitary adenomas of MMP-9 and VEGF expression increased,MMP-9 and VEGF can be used as auxiliary judge biological indicators of invasive pituitary adenomas.

Objective To investigate the influence of dexmedetomidine on hemodynamic,cerebral state index(CSI) and awakening quality in elderly patients after total hip replacement.Methods Sixty cases of elderly patients undergoing total hip replacement surgery who ASA classification Ⅰ-Ⅱ,were divided into observation group and control group by random number table with 30 cases each.After establishing patients with upper limb venous access,the patients in observation group received load 0.4 μ g/ (kg· h) dexmedetomidine given by micro 10 min intravenous infusion pump,and the maintenance dose was 0.3 μ g/ (kg· h),while those in control group with pump equivalent in 0.9％ sodium chloride.Systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR),CSI were recorded into the operating room (T0),beginning of pump drugs (T1),beginning of pump drugs 10 min(T2),beginning of skin incision (T3),beginning of skin incision 30 min (T4),extubation (T5),after extubation 30 min (T6).And recovery time,extubation time and observer's assessment of alterness/sedation (OAMS) score after surgery 30 min were recorded.Results The SBP,DBP,HR in two groups began to decrease at T2 and began to increase at T5,the difference was significant at T2-T5 and T0(P＜ 0.05).And the SBP,DBP,HR in observation group at T5 and T6 were lower than those in control group,the differences were significant (P ＜ 0.05).The CSI in observation group was began to decrease at T2 and began to increase at T5,the difference was significant at T2-T5 and T0 (P ＜ 0.05).And the CSI in observation group at T2-T6 compared with control group in the same period,the difference was statistically significant (70.34 ±4.99 vs.92.76 ±4.63,40.73 ± 3.79 vs.70.49 ± 3.51,40.93 ± 3.67 vs.71.82 ± 3.37,91.92 ± 5.28 vs.76.01 ± 4.90,92.49 ± 5.32 vs.80.53 ± 4.89,P ＜ 0.05).The recovery time and extubation time in observation group were lower than those in control group [(14.22 ± 1.11) min vs.(19.56 ± 1.05) min,(13.82 ± 0.94) min vs.(21.61 ± 0.88) min],and the OAA/S score was higher than that in control group [(4.29 ± 0.27) scores vs.(2.87 ± 0.24) scores],the difference was significant (P＜0.05).Conclusions The dexmedetomidine can reduce the impact on hemodynamics in elderly patients after total hip replacement,and can reduce CSI,deepen the depth of anesthesia,reduce the extubation time and recovery time.It is an ideal method of anesthesia for elderly patients after total hip replacement.

OBJECTIVE By using the VITEK32 and Microscan AS-4 microbiology identification system to identify the external quality control(QC) strains of microbes,to find out the difference and the coincidence degree with quality assessment result of the two systems. METHODS Thirty nine various strains of QC bacteria were isolated and cultured according to operation rule,and were identified by VITEK-32 and Microscan AS-4 and compared within them. RESULTS The coincidence rate of VITEK-32 and Microscan AS-4 to identify directly their species was 76.9% and 69.5% for 39 strains of QC bacteria,It was 89.7% and 76.9% after the serum or further tests,and the coincidence rate was 90.9% and 81.8% in 22 strains of Gram negatives,and 88.2% and 58.8% in 17 strains of Gram positives. CONCLUSIONS The detectable rate and coincidence rate of VITEK-32 are superior to those of Microscan AS-4,especially in the identification of Enterococcus and Streptococcus,the accuracy of Gram negatives is good,and of Gram positives is short,both them could not identify Salmonella and Shigella to their species.

Objective To explore the clinical effect of Xiyanping injection combined with bifidobacterium in the treatment of infantile virus diarrhea.Methods 80 cases of infantile virus diarrhea were selected,they were randomly divided into control group and research group according to the digital table,40 cases in each group.The control group received intravenous drip ribavirin treatment,the research group received treatment of intravenous drip Xiyanping injection combined with bifidobacterium at the same time.The symptoms disappear time(time of diarrhoea,antifebrile time),length of hospital stay and clinical curative effect were observed and compared between the two groups.Results The indicator of symptoms disappear time (time of diarrhoea,antifebrile time) and length of hospital stay of the research group were (2.19 ±0.43)d,(1.75 ±0.36)d,(4.13 ±0.85)d,respectively,which were shorter than those of the control group [(4.89 ± 0.61) d,(3.68 ± 0.52) d,(7.91 ± 1.13) d],the differences were statistically significant(t =22.89,19.30,16.90,all P ＜ 0.01).The total effective rate of the research group was 97.5％,which was significantly higher than 72.5％ of the control group (x2 =24.5,P ＜ 0.01).Conclusion Xiyanping injection combined with bifidobacterium in the treatment of infantile virus diarrhea has significantly shorter antidiarrheal time,antifebrile time,length of hospital stay than ribavirin,the clinical curative effect is distinct,which is worthy of clinical popularization and application.

4 cases of simple blunt trauma to the heart,with laceration of cardiac valve in 2 cases,perforation of valve in 1 and rupture of chordae tendineae in 1,were reported.The immediate symptoms were chest pain and sensation of oppression,palpitation,dizziness or syncope.The most threatening episode,however,was acute heart failure,which occurred 3-6 months after the injury.3 cases in this series required emergent operation due to acute heart failure.2 patients made an uneventful recovery following valve replacement,and 1 patient died of ventricular fibrillation during operation.Autopsy confirmed the diagnosis of Marfan's syndrome.A brief discussion on blunt trauma of the heart was made with analysis of the mechanism involved,and the literature was reviewed.Preliminary experience in diagnosis and management of this series of patients was presented.

As the medical health service is closely related to health of general public,making harmonious hospital inevitably becomes an important link in constructing a harmonious society.The mutual trust is the most fundamental and active factor in physician-patient relationship.Therefore,construction of a harmonious hospital in the new situation should embark from the hospital connotation construction in great details to reconstruct a harmonious medical relation with mutual trust between doctors and patients.