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 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 observe the effect of evidence-based nursing on improvement of preoperative fears and perioperative quality of life in patients undergoing general surgery. Methods 160 cases of general surgery patients in our hospital from September 2009 to September 2010 were chosen as the research object.The 160 cases were divided into the control group and the observation group with 80 cases in each group.The control group was taken with perioperative routine care.The observation group was given evidence-based nursing.The preoperative fear score (FAVS),perioperative quality of life (QOL)score and treatment compliance for the two groups were compared. Results The fear scores for the two groups of patients before treatment were compared.The score in the observation group was significantly lower than the control group,the difference was significant.The scores of preoperative and postnperative quality of life for the two groups were compared.The patients of the observation group were significantly higher than the patients of the control group,the difference between the two groups was significant.The treatment compliance of the observation group was better than that of the control group. Conclusions The evidence- based nursing model can improve preoperative fears and perioperative quality of Wife of patients undergoing general surgery,improve patients' treatment compliance,and promote the success of operation and recovery of patients.It is worthy of clinical application.

Objective To investigate optimal extraction process of Piper puberulum ( Benth.) Maxim.and qualitative analyze the chemical component of the extracts.Methods Method of solvent heating reflux was used for extraction.On the basis of single factor experiment, L9 (34 ) orthogonal experiment was designed with the variants of extraction frequency, time, material-liquid ratio, and immersion time.Extraction rate as index, extraction processes were optimized to achieve best extraction.The extracts, including total extract, water elution, and ethanol elution, were physiochemically analysed to achieve an initial qualitative result.Results The optimal extraction process was: extractions 3 times for 2 hours, with an 1︰30 material -liquid ratio and 2 hours of immersion, Initial qualitative analyzed the total extracts containing amino acids, polypeptides, proteins, alkaloids, steroids or triterpenes, flavones, saponins, polysaccharides, reducing sugars or glucosides, cumarins, terpene lactones, phenols, and tannins.The water elution containing: amino acids, polypeptides, proteins, saponins, polysaccharides, reducing sugars or glucosides, cumarins, and terpene lactones.The ethanol elution containing: amino acids, polypeptides, proteins, alkaloids, steroids or triterpenes, flavones, polysaccharides, reducing sugars or glucosides, phenols, and tanins.Conclusion The experiments show that optimal extraction process can achieve high extraction yield, stable and practical.

Objective To investigate the situation of admission nursing evaluation on elderly patients of geriatrics departments in several Shanghai comprehensive hospitals, and the results will be the base for designing elderly patient′s comprehensive admission nursing evaluation form. Methods 41 nurse managers of geriatrics department in Shanghai comprehensive hospitals were selected as research object. Self-designed questionnaire included general data, elderly patient admission nursing evaluation content and the importance of each item. Results The effective recovery rate was 97.56%(40/41). 98%(39/40) hospitals considered that elderly patients need to have a comprehensive assessment according to the elderly characteristics, only 18%(7/40) hospitals used the special nursing evaluation form for elderly patients. The score of importance of five dimensions were as follows: geriatric syndromes or problems scored (4.64 ± 0.38), physical function assessment scored (4.60 ± 0.46), physiological function assessment scored (4.53 ± 0.45), mental and psychological assessment scored (4.10 ± 0.57) and social assessment scored (4.07±0.52). The score of importance of 29 items were as follows:fall assessment scored (4.90±0.30), pressure ulcer assessment scored (4.85 ± 0.36), activities of daily living scored (4.75 ± 0.44), urinary incontinence assessment scored (4.70 ± 0.52), pain assessment scored (4.70 ± 0.46). Conclusions It is of great significance to carry on the comprehensive admission nursing evaluation for the elderly patients, which needs to be valued and strengthened.

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.