This article selected several typical clinical cases, analyzed many factors affect the doctor-patient relationship of ethical issues and new technology of differentiating the ethical dilemma for clinical application, and put forward some suggestions for the reference of medical staff , hospital ethics committees and health policy makers.

Objective:To explore the resource of rice bran by comparing antioxidative activities and growth promotion of Bacillus bifidus between supernatant of formented rice bran(RBF) by Bacillus natto and water extract of rice bran(RBW) . Method:The reducing capacity the?OH and ??O 2 scavenging capacity and the inhibitory effect to oxidize lard were determined in vitro. The growth promotion for Bacillus bifidus by photodensity with simulated condition was investigated in vivo. Results:RBF and RBW had antioxidant activity in vitro. The IC50 of scavenging?OH and ??O 250 of RBF was 3.55 mg/ml and 23.5 mg/ml,0.3 and 10 folds higher than that of RBW respectively. In inhibiting oxidation of lard,RBF had a little higher antioxidative activities than RBW,near VE. RBF and RBW could promot growth of Bacillus bifidus by 65.2% and 17.8% respectively. By enzymatic digestion,the promotive rate of RBF was still 51.6%. Conclusion:RBF had higher antioxidant activity and growth promotion to Bacillus bifidus.

Purpose To study the clinicopathologic features,immunophenotypes,diagnosis and differential diagnosis of epithelioid hemangioendothelioma (EHE).Methods Histopathology,clinical features and immunophenotypes of 12 cases of EHE which diagnosed by resection and core needle biopsy were analyzed retrospectively.These patients were followed-up.Results There were 9 males and 3 females,aged from 30 to 69 years,with an average age of 43.5 years.Among 12 EHEs,there were 8 cases in liver,3 cases in bone,and 1 case in lung.Histopathologically,the tumor cells were round and oval epithelioid arranged in single,nests,and cords.Tumor cells had abundant eosinophilic cytoplasm that contained vacuoles and erythrocyte in the tumor cytoplasm.The stroma showed myxoid change.Sparse calcification could be seen in some EHEs.Immunophenotype,tumor cells showed strong positive for CD34,CD31 and factor Ⅷ related antigen (FⅧRAg).Most EHEs are alive with tumor.1 case recurred in 6 months after surgery.1 patient died at 100 months postoperation.3 cases were lost follow-up.Conclusion EHE is a very rare low-grade malignant vascular neoplasm especially for arising from solid organ.Precise diagnosis must depend on surgical histopathology and molecular biology test of WWTR1-CAMTA1 fusion gene.

Objective To discuss the application and effect evaluation of the standard operation procedure ( SOP ) teaching method during applying surgical practice teaching in local medical college . Method 123 undergraduate students from Grade 2011 clinical medical major in Medical College of Shaoguan University were selected as objects of study. The students were divided into test (odd) group and control (even) group by draw. The two groups were taught by the same teachers, while the SOP method was applied to the test group (n=62) and the traditional surgical clinical teaching method was applied to the control group (n=61). Meanwhile, we used a combined method of the formative assessment and final assess-ment to compare and analyze the teaching feedback. After their graduate internship, we compared their autonomous study capability, clinical evaluation thought, normativity of the operation and capability in their intern positions as well as the degree of satisfaction of the test of two groups by doing a survey among them. All these were analyzed by SPSS 18.0 software, and t test was used to compare two groups' measurement in-formation and count data with chi-square. Results The comprehensive evaluation scores of the test group were significantly higher than the control group, in which the margin was of statistical value [(79.394 ± 8.049) vs. (71.703±10.462), t=39.632, P=0.000]. The percentage of excellence of the test group was signif-icantly higher than the control group, in which the margin was of statistical value (59.68% vs. 39.35%, χ2=5.082, P=0.024). The percentage of failure of the test group was lower than the group taught by the tradi-tional method, in which the margin was of statistical value (3.22%vs. 16.39%, χ2=4.652, P=0.031). Its for-mative assessment result on the evaluation of the experimental teaching process and summative assessment scores were higher than the control group, and the difference was statistically significant [formative scores points: (46.018 ±5.749) vs. (42.771 ±6.459), t=19.445, P=0.000; summative scores: (33.659 ±3.437) vs. (29.063±4.366), t=36.249, P=0.000]. As far as their clinical graduate internship adaptation capabilities were concerned, students from the test group had more satisfaction on the teaching feedback over 4 perspectives than the other group, in which the margin was of statistical value. Experimental groups' satisfaction showed that: 93.55% of students thought the standard operation procedure (SOP) teaching method was beneficial to improving their clinical practice skills, 91.94%thought that it improved their surgical clinical work ability to adapt, 85.48% thought it helped to cultivate their surgical clinical thinking and innovation ability. Conclusions The SOP teaching method in surgical practice teaching helps to enhance students' clinical operation and adaptation capability and promote the teaching quality.

Objective To explore the significance of serum cytokine interferon-gamma (IFN-γ) ,interleukin-4(IL ) ,transforming growth factor-beta 1 (TGF-β1) ,interleukin-9 (IL-9) ,interleukin-17 (IL-17) in detection of youth first-episode depression .Methods Ninety cases of youth first-episode depression as the experimental group were equally divided into 3 groups according to different disease courses(<6 months ,6 months to 2 years ,>2 years)and other 30 normal persons served as the control group .The levels of serum cytokines were measured by ELISA .The level of each cytokine and Hamilton Depression Scale (HAMD) score were per-formed the Spearman correlation analysis .Results The IL-9 level in the 6 months to 2 years group and > 2 years group was high-er than that in the control group (P< 0 .05);the IFN-γlevel was negatively correlated with psychic anxiety (P<0 .05);the IL-9 level was positively correlated with the somatic anxiety and systemic symptoms (P<0 .05);the IL-17 level was positively correla-ted with the depressive mood and suicide (P<0 .05);the IFN-γlevel was positively correlated with difficulty falling asleep ,early a-wakening ,work and interest in the 6 months to 2 years group ,while positively correlated with somatic anxiety (P<0 .05);the IFN-γ level was positively correlated with depressive mood and block in the >2 years group(P<0 .05);the IL-4 level was positively correlated with the depressive mood (P<0 .05) .Conclusion Different cytokines play different roles in youth first-episode depres-sion ,cytokines may involve in the occurrence and development of depression .

Objective To investigate the relationship between serum C-reactive protein(CRP) level ,CRP gene C+1444T poly-morphism and the risk with Acute myocardial infarction (AMI) in Chinese Han population in Sunan region .Methods The CRP gene C+1444T polymorphism was genotyped by Polymerase reaction restriction-fragment length polymorphism (PCR-RFLP) and the serum CRP level was measured by enzyme linked immunosorbent assay (ELISA) between 227 patients with AMI(AMI group) and 161 control subjects .Results No differences were found in genotype distribution between AMI group and controls (CC 82 .38% ,CT 17 .62% ,TT 0% vs 86 .96% ,13 .04% ,0% )(P>0 .05) .The serum CRP level in AMI group was significantly higher than controls(P< 0 .01) .There was no differences in the serum level between any genotypes of the CRP gene C + 1444T (P<0 .05) .Conclusion The CRP gene C+1444T polymorphism is not associate with increased risk of AMI ,and it have no effect with the serum level in Chinese Han population in Sunan region .

ObjectiveTo explore the correlation between the prevalence of benign prostatic hyperplasia(BPH) and metabolic syndrome (MS)in the army elderly.Methods Totally 1 230 veterans (aged 70 years and over) from 26 military sanatorium in Shijiazhuang city were studied.The prevalence of BPH and MS was calculated.ResultsThe prevalence of BPH among the elderly was 77.0％.There was a trend of increase in the prevalence of BPH with increasing age (x2 = 50.4,P＜0.01).The prevalence of MS among the male elderly was 19.6％.MS was a risk factor for BPH(x2 =24.2,P＜0.0001).ConclusionsMS may be one of risk factors for the prevalence of BPH.

Objective To investigate the association between the phosphodiesterase 4D(PDE4D) gene rs153031 polymorphism and the susceptibility of unstable angina pectoris(UAP) in Chinese Han population of Changwu region .Methods The PDE4D gene rs153031 polymorphism was genotyped by Taqman probe in 172 UAP patients(UAP group) ,as well as in gender-and-age-matched 220 subjects without coronary heart disease(CHD)(control group) .Results In this crowd ,there was PDE4D gene rs153031 poly-morphism in patients with UAP and in subjects without CHD .Compared with control group ,frequencies of GG ,GA ,AA genotypes and G allele of rs153031 in UAP group showed no statistical differences (P> 0 .05) .Conclusion In Chinese Han population of Changwu region ,PDE4D gene rs153031 polymorphism shows no association with the susceptibility of UAP .

@@

Objective To evaluate the applied value of multislice CT (MSCT) in the selection of living donor kidneys and excision methods.Methods Ninety living renal donors underwent MSCT assessment.The nonenhanced,arterial,venous and excretory phase examinations were performed.Using maximum intensity projection and volume rendering techniques for vascular imaging,two blinded radiologists independently analyzed and evaluated all MSCT images.According to the CT reconstructive images,radiologists and physicians selected the left renal or the right renal donors,and chose laparoscopic or open live donor nephrectomy.Results On the 90 cases of donors,78 donors underwent nephrectomy in the left kidney.Seventy-one left kidney donors having no significant variation received the routine laparoscopic live donor nephrectomy.Seven left kidney donors on both sides had relatively obvious anatomical variations such as accessory renal artery,multi-branch renal vein and renal vein in the back of the abdominal aorta,and they were subjected to the left kidney open donor nephre.ctomy.Other 12 donors having significant variation in the left kidney were given nephrectomy in the right kidney,and all of them received hand-assisted laparoscopic live donor nephrectomy.All intraoperative records of urine collection system and renal vascular anatomy were consistent with the preoperative evaluation of MSCT,and the accuracy was 100 ％.Two imaging experts in the evaluation of renal artery,renal vein and urine collection system showed good consistency.Nephrectomy was successfully performed on 90 cases of donors,and.postoperative recipients had no renal vein thrombosis and other vascular complications.Conclusion MSCT can provide accurate and valuable information for the selection of living donor kidneys and excision methods as a “one-stop” technique for the preoperative evaluation of living renal donors.