Globalization is an irresistible trend today. Because of its quality and characteristics ,globalization play important ?profound and double roles in Chinese medical ethics: The criterion of valuation is diversification; Traditional medical ethies is desalting;Medical science is sticking out humanity sense; Technical advancement brings new moral question.This article suggested we should pay attention to amalgamation of eastern and western moral,introduce valuation's build and consideration, strengthen education on humanistic character,regard educatee as main body,follow its arrangement and rule.

9).Renal pathology revealed 3 patients with class Ⅳ, 1 patient with class Ⅱ. Image results showed diffuse pulmonary infiltration lesions. Bronchial lavage fluid was hemorrhage. Three patients recovered after treatment with corticosteroid and intravenous cyclophosphamide therapy. Conclusions Diffuse alveolar hemorrhage is rare serious complications of lupus nephritis. Aggressive immunosuppressive therapy should be started early for a favorable outcome.

It's very important to carry on medical students' ideological and political education.This text expatiates personality 、occupation personality、medical occupation personality,and points out that modeling medical students' occupation personality is the stand to start a new phase of ideological and political education.The author discusses the approaches to modeling medical students' occupation personality from the practice of Chinese medical education,following the principle of personality education.

Objective: To explore clinical characteristics and severity of coronary lesions in young and aged patients with acute myocardial infarction (AMI).Methods: A total of 60 young AMI patients and 60 aged AMI patients hospitalized in our hospital from Oct 2014 to Apr 2016 were randomly selected as youth group and aged group respectively.General data, clinical characteristics, coronary lesion severity and incidence of adverse events during hospitalization were analyzed and compared between two groups.Results: Compared with aged group, there were significant rise in percentages of male (75.0% vs.100.0%), smoking (43.33% vs.76.67%), family history of CHD (18.33% vs.46.67%) and obesity (30.00% vs.53.33%);and significant reductions in percentages of hypertension (63.33% vs.33.33%) and type 2 diabetes mellitus (50.00% vs.13.33%), P<0.05 or <0.01;significant rise in percentages of clear causes (30.0% vs.60.0%), typical chest pain (58.33% vs.86.67%) and STEMI (43.33% vs.76.67%), significant reductions in percentages of old myocardial infarction history (13.33% vs.0), atypical chest pain and NSTEMI, P<0.01 all;significant rise in percentages of single-vessel disease (18.33% vs.63.33%),medium stenosis (16.67% vs.40.00%), and significant reductions in percentages of multi-vessel disease (61.67% vs.20.00%) and severe stenosis (45.00% vs.20.00%) in youth group, P<0.01 all.Compared with aged group, there was significant reduction in incidence rate of major adverse cardiovascular events (88.33% vs.13.33%) in youth group during hospitalization, P=0.001.Conclusion: Compared with aged patients,the symptoms and ECG manifestations are more typical, vascular lesion range is limited, and complications are few in young AMI patients.

Objective To investigate the prostecdtive efficacy of one-stage bone grafting in man-aging chronic osteomyelitis after debridement.Methods From March 1999 to May 2003, 79 patients with chronic osteomyelitis including 28 patients with nonunion underwent one-stage autogenous bone graft-ing, allografts or mixed bone grafting after debridement in Nanjing General Hospital of Nanjing Military Command.All patients were followed up for a mean period of 77 months (60-111 months).Results Six patients (8%) , including two with autogenous bone grafting, three with allografts and one with mixed bone grafting, were confirmed with recurrence of infection, with no statistical difference among three methods of bone grafting.Of 28 patients with nonunion, 23 patients with autogenous bone grafting and two with allografting obtained union, the other three patients with mixed bone grafting obtained union in two patients but resulted in recurrence of infection with nonunion in one, with cure rate of 96% (27/28).Conclusions One-stage bone grafting after debridement for infection and bone union can reach cure rate of over 90%.The recurrence of infection mostly occurs within the first year after operation, with stable long-term curative effect.

BACKGROUND: Intra-articular injection is a classic strategy for the treatment of early osteoarthritis (OA). However, the local delivery of traditional therapeutic agents has limited benefits for alleviating OA. Exosomes, an important type of extracellular nanovesicle, show great potential for suppressing cartilage destruction in OA to replace drugs and stem cellbased administration. METHODS: In this study, we developed a thermosensitive, injectable hydrogel by in situ crosslinking of Pluronic F-127 and hyaluronic acid, which can be used as a slow-release carrier to durably retain primary chondrocyte-derived exosomes at damaged cartilage sites to effectively magnify their reparative effect. RESULTS: It was found that the hydrogel can sustainedly release exosomes, positively regulate chondrocytes on the proliferation, migration and differentiation, as well as efficiently induce polarization of M1 to M2 macrophages. Intraarticular injection of this exosomes-incorporated hydrogel significantly prevented cartilage destruction by promoting cartilage matrix formation. This strategy also displayed a regenerative immune phenotype characterized by a higher infiltration of CD163+ regenerative M2 macrophages over CD86+ M1 macrophages in synovial and chondral tissue, with a concomitant reduction in pro-inflammatory cytokines (TNF-a, IL-1b, and IL-6) and increase in anti-inflammatory cytokine (IL-10) in synovial fluid. CONCLUSION Our results demonstrated that local sustained-release primary chondrocyte-derived exosomes may relieve OA by promoting the phenotypic transformation of macrophages from M1 to M2, which suggesting a great potential for the application in OA.

Objective:To explore the value of panoramic teaching in clinical practice teaching of department of respiratory medicine.Methods:A total of 35 clinical interns who had a 3-week rotation in the department of respiratory medicine from October 2019 to June 2020 were selected, and they were divided into a control group ( n=17) and a study group ( n=18) according to the order of admission. The control group used traditional teaching, and the research group used panoramic teaching. After the teaching, the teaching effect was evaluated through theoretical knowledge assessment, practical assessment and questionnaire survey. SPSS 19.0 was used for t test. Results:There was no statistically significant difference between the two groups of interns in theoretical assessment [(89.62±4.05) points vs. (90.84±4.12) points, t=-0.891, P=0.379]. The results of practice assessment (case analysis, physical examination of the department, medical history inquiry and skills manipulation) of the study group were significantly higher than those of the control group ( P<0.05). The interns in study group were better than those in control group in such aspects as learning interest, self-learning ability, self-study ability, doctor-patient communication language expression ability, literature review ability, clinical thinking ability, comprehensive analysis ability, knowledge development ability, system diagnosis ability, teamwork ability and teaching satisfaction ( P<0.05). Conclusion:Panoramic teaching can effectively improve the ability of interns to master the clinical diagnosis and treatment of respiratory medicine, improve the teaching effect, and improve the learning ability and clinical competence of interns in the future.

Objective:To retrieve, evaluate, and summarize the best evidence for the prevention and management of nipple pain or injury in breastfeeding puerperae, providing evidence-based basis for clinical practice of breastfeeding.Methods:According to the "6S" evidence pyramid model, clinical decisions, guidelines, expert consensus, evidence summaries, and systematic reviews on the prevention and management of nipple pain or injury in breastfeeding puerperae were systematically searched. The search period was from database establishment to March 10, 2023. The research team members independently evaluated the quality of the included article based on the corresponding quality evaluation standards, and combined professional judgment to extract and summarize evidence for the final included article.Results:A total of 15 articles were included, including two clinical decisions, 7 guidelines, and 6 systematic reviews. Finally, 19 best pieces of evidence were summarized, including four themes, namely, assessment of nipple pain or injury, prevention of nipple pain or injury, management of nipple pain or injury, and health education.Conclusions:Obstetrical nurses and midwives should provide standardized nursing for breastfeeding puerperae based on specific clinical scenarios, reduce the incidence of nipple pain or injury in breastfeeding puerperae, and promote puerperae to adhere to breastfeeding.