The article teased the concept of medical futility and analyzed the issues when implement the medical futility policy.It introduced the medical futility policy by the examples of New York Public Health Code Article 29-B:Orders Not to Resuscitate and relevant regulations in Taiwan and presented some reflections on medical futility.The authors suggested that it should cope with the common and troubled cases of medical futility,establish ethics committee,and make the medical futility policy at the stage of tense doctor-patient communication.

Objective To determine co-author contribution for a biomedical scientific paper describing collaborative research by an analytical process model.Methods The important features of contribution were identified,categorized and organized into a logical hierarchy consisting of the main dimensions and sub-dimensions.A face-to-face survey was conducted to obtain data about their relative importance from co-authors.Analytical hierarchy process methodology was used to determine the relative important weights from main dimensions and sub-dimensions along with the consistency.Results Among the 5 main dimensions,all authors considered problem statement as the most important with a weight of 0.4355,and considered research design and data analysis taking the 2nd and 3rd positions.Among the 10 sub-dimensions,hypothesis construction,method development,result interpretation,and critical revision of manuscript were considered the most important contributions.Conclusion Analytical hierarchy process effectively supportto establish the co-authors' priorties for a biomedical scientific paper.

Edong Healthcare Group is cited as an example to introduce the founding background, and summarize its successful practices and outcomes in corporate governance, internal operation management mechanism, and optimized resources deployment within the group.Win-win mechanism is proposed as the key to a successful grouping reform, and further experiment with the hierarchical medical system is recommended for deeper reform in building groups of public hospitals.

Objective To assess the clinical value of multi-slice CT(MSCT)in showing the ear lesions.Methods MSCT high resolution scan images of 52 ears of 11 normal adult and 15 patients with hearing loss were reconstructed,by bone plus with 0.625 mm collimation,9.6 cm small field of vision(FOV)and 0.3 mm reconstruction interval before volume rendering(VR)and multiplanar reformation(MPR)were performed.Results VR,MIP and MPR images of 40 normal ears clearly showed the complicated anatomic structures.VR,MIP and MPR images of twelve abnormal ears displayed 3 ears of malformations of crus longum incudis,1 ear of destructed semicircular canals,2 ears of malleus dysplasia,2 ears of fusion of incudostapedial joint,2 ears of bony atresia of external auditory complicated with auditory ossicles dysplasia,and 2 ears of crus stapedis dysplasia.MPR is easier to manipulate than VR that has three dimensional effect butis difficult to handle.Conclusion HRCT images,combined with post-processing technique of VR,MIP and MPR,can clearly show the anatomic structures and lesions of middle and inner ears.

We measured IgG and IgM ACA levels by a modified enzyme一linked immunosorbent as-say(ELISA) in 122 patients with brain infarction and 86 healthy controls. Significant difference in positiveIgG and IgM ACAs was found between the patients with infarction(50.8%)and the control group(11.6%).The relation between positive ACAs and brain infarction was studied. The pathogenetic mecha-nism remains unclear.

Objective: To explore the effects of hydrogen sulfide (H 2S) on hypoxic pulmonary vascular smooth muscle cell (VSMC) apoptosis in rats. Methods: Twenty four Wistar rats were divided into 3 groups: control group ( n =8), hypoxia group ( n =8), and hypoxia +NaHS group ( n =8). The plasma level of H 2S was determined by methylene blue spectrophotometric method. VSMC apoptosis was measured by terminal deoxynucleotidyl transferase biotin nick end labeling (TUNEL). The protein expressions of Bcl 2, Fas and caspase 3 in pulmonary arteries were detected by immunohistochemical technique. Results: Compared with rats in the control group, the plasma level of H 2S decreased by 36% in rats of hypoxic group . The apoptotic rate per area in VSMCs detected with TUNEL was significantly decreased by 52.9% in rats of hypoxic group . The expressing integral score of Bcl 2 of VSMCs was increased by 123.9%,while Fas protein expression of VSMCs was decreased by 45% and caspase 3 protein expression of VSMCs was not significantly changed in rats of hypoxia group. But compared with rats in the hypoxia group, the plasma level of H 2S increased by 65% in rats of hypoxia+NaHS group. The apoptotic rate in VSMCs of TUNEL was significantly increased by 62.5% in rats of hypoxia+NaHS group. The Bcl 2 protein expression of VSMCs was decreased by 36.4% in rats of hypoxia+NaHS group. The expressing integral scores of Fas and caspase 3 were significantly higher in rats of hypoxia+NaHS group than in those of hypoxia group. Conclusion: Hypoxia decreased the pulmonary artery smooth muscle cell apoptosis. H 2S inhibited Bcl 2 protein expression of VSMCs and activated Fas and caspase-3 protein expressions of VSMCs, and therefore promoted the pulmonary artery smooth muscle cell apoptosis.

Objective To discuss the relationship between prognosis and different surgical procedures for gallbladder cancer in different stages. Methods The clinical data of 107 patients with gallbladder cancer from January 2001 to May 2007 were retrospectively analyzed. The surgical procedure was chosen according to different stages. Results Eighty-one of the 107 patients (75.6%) were followed up with the median time of 5 years. Of the 10 patients with stage Ⅰ gallbladder cancer who had underwent simple cholecystectomy, 9 survived. Of the 8 patients with stage Ⅱ gallbladder cancer, 3 received palliative cholecystectomy and the median survival time was 12 months, which was significantly shorter than 24 months of the remaining 5 patients who received radical operation (X2= 5.698, P <0.05). Of the 42 patients with stage Ⅲ gallbladder cancer, 18 received radical operation, and the median survival time was 24 months, which was not significantly different from 18 months of the 5 patients who received extended radical operation (X2=0.238, P>0.05). The remaining 19 patients received palliative operation, and the median survival time was 6 months, which was significantly shorter than those of patients received radical operation or extended radical operation (X2=5.772, 6.318, P <0.05). There were 47 patients with stage Ⅳ gallbladder cancer. Seventeen patients received extended radical operation and 30 received palliative operation, and no significant difference upon the median survival time was observed among different surgical procedures (X2=0.001,0.694, P>0.05). The complication recurrence after the extended radical operation was significantly higher than palliative operation (X2=6.039, P<0.05). Conclusions For patients with stage Ⅰ gallbladder cancer, simple cholecystectomy is preferred. Radical operation is good for patients with stage Ⅱ gallbladder cancer. The choose of radical operation or extended radical operation for patients with stage Ⅲ gallbladder cancer should be based on the condition of invasion. Palliative operation could be used to patients with stage Ⅳ gallbladder cancer.

Objective To compare the efficacy of thrombus aspiration catheter combined with intracoronary tirofiban and nitroglycerol injection through the aspiration catheter versus the guiding catheter during primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods Thirty-four patients with STEMI undergoing primary PCI and receiving thrombus aspiration catheter combined with intracoronary tirofiban and nitroglyeerol injection through the aspiration catheter were enrolled as the aspiration group (n =34),and those who had similar coronary angiography results and basic characteristics but receiving thrombus aspiration catheter combined with intracoronary tirofiban and nitroglycerol injection through the guiding catheter were served as the guiding group ( n =33 ).The outcomes of the two groups were observed and compared.Results There was no significant change of blood pressure between before and after injection in the aspiration group ( P ＞ 0.05 ),but the change of blood pressure was significant after injection compared with before injection in the guiding group ( P ＜ 0.01 ).The cTn-I,BNP,peak-value of CK-MB,peak-time of CK-MB,TIMI grade 3 flow,slow-reflow in IRA after PCI in the aspiration group were superior to those in the guiding group ( t =3.92,P ＜ 0.01 ;t =4.70,P ＜ 0.01 ; t =3.39,P ＜ 0.01 ; t =7.17,P ＜0.01 ; x2 =3.877,P ＜ 0.05 ; x2 =3.876,P ＜ 0.05 ).LVEF,LVEDd and LVESd after 1 month in the aspiration group were superior to those in the guiding group (t =5.99,P ＜ 0.01 ;t =4.53,P ＜ 0.01 ;t =8.12,P ＜ 0.01 ),but no significant differences of LVEF,LVEDd,LVESd were found after 1 week resolution of sum of ST-segment elevation and the MACE rates after PCI were found between the two group ( P ＞ 0.05 ).Conclusion Application of thrombus aspiration catheter combined with intracoronary tirofiban injection through the aspiration catheter is more effective than through the guiding catheter in patients with Acute ST-segment elevation myocardial infarction,which could decrease slow-reflow phenomenon and improve re-perfusion and left ventricular function with better clinical outcomes.