Narrative medicine adds new elements for the development of medical humanistic education .It pro-vides a new perspective to re -examine the doctor -patient relationship .From medical humanities and narrative and narrative ability is medical students overall development reality needs two aspects analyzes the narrative ability training medical students is a new requirement , medical humanities education narrative medical practice signifi-cance is not only reflected in promoting the medical work of humanity , but also in the training process for medical students through the narrating ability .

ObjectiveTo investigate environmental factors of the relapse of alcohol dependence.MethodsOne hundred and seventeen in-patients with alcohol dependence were assessed with a home-designed questionnaire,Family Environment Scale Chinese Version (FES-CV),Clinic Institute Alcohol Withdrawal Syndrome Scale Chinese Version(CIWA-Ar) and the Scale of Personality Change Post-Traumatic Brain Injury(SPCPTBI).One hundred and five patients reassessed with alcohol dependence syndrome diagnostic criteria 1 year after hospitalization.t -test,chi-square and logistic regression were used for analysis.Results 57 of 105 were relapse and 48 of them were not relapse.The results showed that relapse group had a higher divorce or separated or remarried rate (21/36) than the no-relapse one (7/41 ) ( chi-square =6.60,P =0.010) ; a less number of years of education (5.2 ± 1.8 vs 7.2 ± 1.7,t =5.64,P =0.000) ; a bigger daily drinking ( (512 ± 186) ml vs (396 ± 109) ml,t =3.93,P =0.000) ; a higher drinking frequency in relapse group ( (2.6 ± 0.9 ) vs ( 1.8 ± 0.6) times,t =5.38,P=0.000) ;a higher rates in personality change(47/57 vs 15/48 ),brain damages (27/57 vs 13/48 ) and mood disorders (35/57 vs 17/48 ),They also showed that relapse group had more problems on intimate degree (5.66 ±1.40 vs 6.20 ± 1.20),emotional expression (4.59 ± 1.54 vs 5.41 ± 1.26,independence (3.61 ± 1.29 vs 4.64± 1.49),organization (4.26 ± 1.56 vs 5.22 ± 1.18 ),and self-controlling (4.21 ± 1.43 vs 5.12 ± 1.12 ),the differences were significant (P＜0.05) ;a higher contradiction score(4.35 ± 1.73 vs 3.64 ± 1.22,t =2.42,P =0.017).Logistic regression analysis showed that the number of daily drinking,intelligent damaged,emotional problems,arid dependence were the risk factors for the alcoholic relapse ( OR =7.44,3.99,3.92,2.96) ;Self-controlling was the protective factors for the alcoholic relapse ( OR =0.19).ConclusionProblem marital status,less education,and heavy drinking,and the number of drinking times,personality change,intellectual impairment and mood change,and poor family environment were the risk factors for the relapse of alcohol dependence.

Objective To investigate the clinical features of and gene mutations in a Chinese Han pedigree with piebaldism. Methods Clinical data were collected with informed consent from a pedigree with piebaldism, processed and documented. A clinical genetic analysis was conducted and pedigree chart was drawn. Genomic DNA was extracted from the peripheral blood of 14 patients and 40 unaffected individuals in the family as well as 50 unrelated human controls, and subjected to the amplification of 21 exons and flanking sequences of the KIT gene by PCR. Sequence analysis was performed by Mutation SurveyorTM. Results There were 73 members in the family, and of them, 14 were diagnosed with piebaldism according to typical clinical features. Piebaldism was inherited in an autosomal dominant pattern in this family. A heterozygous 4-base insertion mutation 1900insATGA in exon 13 of KIT gene was identified in all the 14 affected family members, which resulted in a frame-shift mutation at codon 634 and produced a premature translation termination codon. This mutation was undetected in either the unaffected family members or unrelated controls. Up to the time of this writing, this mutation had not been previously reported. Conclusion The novel mutation 1900insATGA in the KIT gene may be the cause of clinical phenotype of piebaldism in the family.

ADAM Proteins ; blood ; immunology ; ADAMTS13 Protein ; Adult ; Female ; Humans ; Male ; Middle Aged ; Plasma Exchange ; Purpura, Thrombotic Thrombocytopenic ; blood ; pathology ; therapy

Objective To study the changes of serum CORT,SOD and LPO in large-acreage cerebral insarction(LCI) and hyperthermia patients,and observe the effect of head hypothermia on them.Methods All cases of LCI were divided into head hypothermia treatment group(group A,n=49),warm water bath and glacial saline enema treatment group(group B,n=43),and health group(control group,group C,n=30).With the methods of radioimmunoassay,hydroxylamine oxidation and thirddialdehyde,the serum CORT,SOD and LPO level in the two groups were measured on the 2nd day after hospitalization and on the 2nd day,the 3rd day and the 4th day after hyperthermia.In addition,the life quality scores of the two groups were compared.Results The serum CORT,LPO of group A and group B were higher on the 2nd day after hospitaiization than the group C(P0.05),while the SOD were lower(P

To report a boy with reflex seizures induced by micturition.He suffered from seizures during micturition for four yesrs.The clinical symptoms consisted of head backwards,limbs dithering,sometimes accompanying tumble.During the episodes of the seizure,his consciousness did not lose.Few seizures showed only eyes up-staring for several seconds.The livelong process of micturition was often interrupted by seizures for several times.When he finished or stoped micturition,the seizures did not occur again.His seizures could not be induced by free of micturition or other stimulative factors.The interictal EEGs showed that background asymmetry manifested as the lower amplitude and irregular rhythm in the left hemisphere,sharp or sharp and waves in right hemisphere,especially mid and back temporal.There also had sharp,spike,and spike and waves in many regions of double spheres in interictal EEGs.The other assistant check-ups were normal.while this disease was infrenquncy,it would be worthy to regard.

Objective To explore the correlation between caring behavior and critical thinking of nursing students in clinical practice. Methods Totally 203 nursing students in clinical practice were investigated with Critical Thinking Disposition Inventory- Chinese Version (CTDI- CV) and Caring Behavior Scale (CBS). Results The structural model obtained a good fit. Critical thinking and caring behavior were positively correlated with each other(β=0.46,P<0.01). Conclusions Nursing students′caring behavior could improve their critical thinking. With the cultivation of critical thinking of nursing students, nursing educators should pay attention to improving their caring behavior.

Objective To explore the influence of all-trans retinoic acid(ATRA) on in-vitro proliferation of human lung adeno-carcinoma cell line A549 and to preliminarily study its mechanism .Methods The human lung adenocarcinoma cell line A549 was taken as the experimental group .The cells in the experimental group and the control group were detected by using 3-(4 ,5-dimethyl-thiazol-2-yl)-2 ,5-diphenyltetrazolium bromide(MTT) assay for calculating the cell growth inhibition rate ;the microstructure of the cultured cells was observed by the transmission electron microscope technique ;the expression of cyclooxygenase-2(COX-2) in the cell supernate was detected by the enzyme linked immunosorbent assay .Results The different concentrations of ATRA for treating A549 cells could produce the inhibiting effect on A 549 cells to some different degrees ,furthermore ,after 72 h ,the expression of COX-2 in cytoplasma among the various concentrations groups was significantly decreased ,which was positively correlated with the concentration ,the difference showing statistical significance (P< 0 .05);at the same time ,by detecting TRAIL expression level in the experimental group(1 × 10-5 mol/L ,1 × 10-4 mol/) ,the expression of TRAIL in the A549 cell supernate after ATRA treatment was increased .Conclusion ATRA has the significant anti-tumor effect on the lung adenocarcinoma cell line A549 with the concen-tration-time dependence;ATRA in lung cancer tissue may play its anti-tumor effect by inducing apoptosis ,which can provide the theoretical basis for the treatment of lung cancer .

Objective To investigate the prognostic significance of serum cystatin C in multiple myeloma (MM).Methods 160 cases of newly diagnosed MM patients with average age of 61.38 years old.Determine the levels of serum cystatin C,serum creatinine,β 2-microglobulin,lactate dehydrogenase and hemoglobin before the treatment; median follow-up of 38 months,observe the relationship between serum cystatin C with overall survival (OS) and event-free survival (EFS).Results Median serum cystatin C level in 160 MM patients was higher than that in the 80 healthy controls [(0.96 ± 0.32) mg/L vs (0.71 ± 0.16) mg/L,P ＜ 0.000].All the patients in ISS stage were divided into 3 stages.Median serum cystatin C levels significantly increased in higher ISS stages [stage Ⅰ (0.70±0.13) mg/L,stage Ⅱ (0.87±0.16) mg/L,stage Ⅲ(1.23±0.33) mg/L (P ＜ 0.05)],serum cystatin C level was positively correlated with levels of serum creatinine (r =0.669,P ＜ 0.000),β2-microglobulin (r =0.672,P ＜ 0.000).lactate dehydrogenase (r =0.521,P ＜ 0.000),and negatively correlated with hemoglobin levels (r =-0.436,P ＜ 0.000).Using ROC analysis,patients with serum cystatin C levels ＞ 0.95 mg/L had significantly shorter EFS and OS patients with serum cystatin C levels ≤0.95 mg/L (median EFS:30 vs 57 months,P ＜ 0.05; median OS:43 vs 68 months,P ＜ 0.05).Conclusion Serum cystain C is not only a sensitive marker of kidney damage,but also reflects tumor burden and delivers prognostic information in MM.