The validity of moral education is the emphases and difficulty that current research and academic studies focus on.Taken the concept of validity as the basic point,this article analyzes the deep-seated reason why the medical ethics education loses its validity and discusses the rules to realize the validity of the medical ethics education from the aspects that the medical ethics education should return to real life,adapt to psychology laws and penetrate through the clinical stage.

Objective To investigate the features and diagnostic value of MRI in prenatal and postpartum for placenta accreta. Methods 18 cases of placenta accreta confirmed by surgical pathologically and clinical were retrospectively analyzed,including 10 ca-ses of prenatal and postpartum 8 cases,observed the signal feature and diagnostic value of MRI images.Results In the 10 cases of prenatal patients with placenta accreta,MRI manifestations of 9 cases of placenta prevail,totally or partly covering cervical,10 cases of partial placenta and uterine muscle gap disappeared,boundaries are not clear,2 cases of uterine wall bars low signal-image inter-rupted,bulging outward placenta,increased sub placental vascular wag detected in 8 patients;8 cases of postpartum patients with pla-centa accrete,MRI show 4 examples which were mixed signals within the uterine cavity,with the junctional zone boundaries were not clear,the junctional zone was discontinuous interruption in 7 cases,8 cases of muscular layer appear oval,high and low,patchy mixed signals in shadow,4 cases in the palace district,5 cases of invading the shallow layer,3 cases of infection and deep muscle layers. Conclusion MRI technique is of great value for diagnosis of placenta accreta.

Objective To explore the value of MRI in differentiation diagnosis of benign ovarian mucin-ous cystadenoma ( MC) and borderline mucous cystadenoma ( BMC).Methods MRI data of 23 cases of benign MC and 14 cases of BMC, confirmed by surgery and pathology, were retrospectively analyzed, including tumor lo-cation, shape, size, loculation, signal intensity of cyst fluid, cyst wall, cyst septum and nodules, and they were compared with pathological results.Results Single loculus benign cystadenoma nodules showed isointensity T2 WI signal, low T1 WI signal, and low DWI signal.Single loculus borderline cystadenoma nodules showed high T2 WI signal, low T1 WI signal, and high DWI signal.Signs such as honeycomb loculi of multilocular cystadeno-ma, cyst fluid of high T1 WI signal, cyst fluid of low T2 W1 signal, cyst wall and irregularly thickened cyst septum ( >3 mm) were more seen in BMC (7/11, 6/11 and 7/11) than in MC (5/18, 4/18 and 5/18);5 cases were with cyst sediments (MC=4, BMC=1), showing moderate T2WI signals, and high T1WI signals.Broken fish-ing net gathering was only restricted to MC (5/18) with characteristics.Benign multilocular cystadenoma nodules showed low DWI signal,and borderline multilocular cystadenoma nodules showed high DWI signal.Conclusion MRI can well display pathological characteristics of ovarian MC, which has practical value for the differentiation and diagnosis of MC and BMC and can provide the reference for clinical surgery.

Objective To investigate the effect of plasma erythropoietin ( EPO) concentration on left ventricular systolic function and its relationship with acute mountain sickness ( AMS ) .Methods A total of 289 healthy young men were recruited in this study and divided into five groups:plain control group (Ⅰ) with 55 subjects;acute high altitude exposure group(Ⅱ) with 74 subjects(3700 m exposure for 24 h); the group of acute exposure after acclimatization (Ⅲ) with 68 subjects(4400 m exposure for 24 h after 1 week acclimatization at 3700 m); high altitude migrate group (Ⅳ) with 19 subjects ( migration to 3700 m for more than 1 year ); and the group of exposure after migration (Ⅴ) with 73 subjects (4400 m exposure for 50 d after more than one year migration to 3700 m).Lake Louise Self-assessment Scoring System ( LLSS) was used to assess AMS .Plasma concentrations of EPO and echocardiography were also determined .Results EPO was significantly increased after acute high altitude exposure .There was no significant difference in EPO between groupⅡand Ⅲ(P>0.05), but significantly higher than in group Ⅰ (P<0.05).No significant difference was found between group Ⅳ,Ⅴ and Ⅰ (P>0.05).In group Ⅱ, positive correlation was found between EPO concentration and stroke volume (SV) as well as left ventricular diastolic diameter (LVDD) (R=0.278 and 0.236,respectively,P<0.05), while negative correlation was expressed between EPO concentration and the AMS score (R=-0.249,P<0.05).In other groups,there was no relationship between EPO concentration and the index of left ventricular function .Conclusion EPO may work on AMS through left ventricular systolic function enhancement after acute high altitude exposure .

Objective To study the dosimetric peculiarity of 3D intracavitary brachytherapy in the application of endometrial carcinoma comparing with traditional 2D plans. Method 39 3D brachytherapy treatment plans of 11 patients with endometrial carcinoma were retrospectively analyzed with re?planning 2D treatment plan, the dose volume histogram ( DVH) parameters such as the target dose volume parameters V150 and D90 , the 2?cc doses to organs such as bladder, small intestine, rectum and sigmoid and the total reference air kerma TRAK were analyzed. The differences between the two groups are compared by paired samples T test. Results For target with V<60 cm3 ,there is no statistically significant difference between 2D and 3D plans,the D90 is (551?17±90?33) cGy and (574?15±117?18) cGy,respectively (P=0?390). As the increase of target volume,the D90 came to be significantly different ( P=0?001) , high dose region V150 for 3D and 2D plans is (51?05±21?61) cm3 and (53?41±11?71) cm3, respectively (P=0?482). With the target volume larger than 60 cm3 ,compare to 2D plans, the 3D plan can increase the target coverage as well as OAR dose except for small intestine ( P=0?128) . In addition, with different plan mode,the BMI did not affect the crisis organ dose such as rectum, small intestine, bladder and sigmoid, the P value is 0?239, 0?198,0?744 and 0?834,respectively. Conclusions For endometrial carcinoma,compared with traditional two?dimensional plans,the 3D brachytherapy treatment plans can significantly improve the target coverage and avoiding overdose of organs, clinical curative effect and side effect still needs further observation.

OBJECTIVESince glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common hereditary hemolytic erythrocyte enzyme deficiency, most cases have single nucleotide mutations in the coding region, and current test methods for gene mutation have some missed detections, this study aimed to investigate the feasibility of RT-PCR sequencing in the detection of gene mutation in G6PD deficiency.

METHODSAccording to the G6PD/6GPD ratio, 195 children with anemia of unknown cause or who underwent physical examination between August 2013 and July 2014 were classified into G6PD-deficiency group with 130 children (G6PD/6GPD ratio <1.00) and control group with 65 children (G6PD/6GPD ratio≥1.00). The primer design and PCR amplification conditions were optimized, and RT-PCR sequencing was used to analyze the complete coding sequence and verify the genomic DNA sequence in the two groups.

RESULTSIn the G6PD-deficiency group, the detection rate of gene mutation was 100% and 13 missense mutations were detected, including one new mutation. In the control group, no missense mutation was detected in 28 boys; 13 heterozygous missense mutations, 1 homozygous same-sense mutation (C1191T) which had not been reported in China and abroad, and 14 single nucleotide polymorphisms of C1311T were detected in 37 girls. The control group showed a high rate of missed detection of G6PD deficiency (carriers) in the specimens from girls (35%, 13/37).

CONCLUSIONSRT-PCR sequencing has a high detection rate of G6PD gene mutation and a certain value in clinical diagnosis of G6PD deficiency.

Adolescent ; Child ; Child, Preschool ; Female ; Glucosephosphate Dehydrogenase ; genetics ; Glucosephosphate Dehydrogenase Deficiency ; diagnosis ; genetics ; Humans ; Infant ; Male ; Mutation ; Reverse Transcriptase Polymerase Chain Reaction ; methods ; Sequence Analysis, DNA

Objective To evaluate the influence of different clinic pathways on the time from first medical contact to balloon (FMC2B) and the time from door to balloon (D2B) for emergency patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention as well as the prognosis. Methods 183 consecutive patients were divided into emergency easy access group and normal access group. The two groups were compared in terms of the FMC2B time, D2B time and outcomes during hospitalization and follow-up. Results Compared with the normal access group, the FMC2B time in the emergency easy access group was significantly shorter (100.3 min vs. 145.6 min, P < 0.05) and so it was with the D2B time (77.1 min vs. 115.4 min, P<0.05). Meanwhile, in-hospital mortality was significantly lower (5.0%vs. 15.7%, P<0.05). The follow-ups showed the rates of re-hospitalization related to heart diseases, and the mortality rate of cardiovascular disease were significantly lower in the emergency easy access group. Conclusion The optimized emergency easy access could reduce the FMC2B time and D2B time and improve the prognosis of patients with STEMI.

Objective To investigate the virtual wedge (VW) dosimetric parameters with the ionization chamber array Matrixxenvlution.Methods Using Matrixxenvlution and solid water to measure and calculate Siemens accelerator's VW angle and VW factors of different fields and compare the wedge field dose distribution to that of treatment planning system (TPS) by gamma analysis,summarized the measurement results of 50 times.Results The γ pass rate (3 mm/ 3％) of 15° and 30° VW in both direction were (91.47 ± 1.76)％,(92.99 ± 1.54)％ and (93.27 ± 1.24)％,(93.27 ± 1.68)％,respectively,with the increase of filed size and the VW angle,but for 20 cm ×20 cm field and VW 60°,the result was not very good.The largest angle deviation ＜ 2° except small field size and wedge angle,VW factors were approximately equal to 1,the maximum deviation was no more than 0.05,plan dose distribution and the measured dose distribution have good consistency except large field with large wedge angle.Conclusions Matrixxenvlution used in the measurement of VW dosimetric parameters which can obtain all parameters for angle calculation and dose plane analysis with only once positioning,and become more rapid,convenient,economical and practical one of quality assurance tools for VW dose verification.

Objective To compare the efficacy and safety of two kinds of homemade sirolimus-eluting stents (Firebird and Excel) for treatment of acute ST segment elevation myocardial infarction (STEMI) in patients who underwent percutaneous coronary intervention (PCI). Methods The 249 consecutive patients with STEMI who underwent PCI were randomly divided into two groups: Excel group (n=136) and Firebird group (n=113). They were followed up for 6-24 months, and coronary angiography was reviewed average 12 months later. The primary endpoints were major adverse cardiac events, including death, reinfarction and target vessel revascularization. The second endpoints included late luminal loss and restenosis 12 months after treatment. Results There were no significant differences in baseline data, coronary arterial lesion before operation, and immediateness condition after PCI between the two groups (all P＞0.05). Within follow-up, there were 2 (1.47%) death cases and 1 (0.88%) death case, 1 (0.74%) and 1 (0.88%) nonfatal myocardial infarction case, 2 (1.47%) and 2 (1.77%) target vessel revascularization cases in the two groups respectively (all P＞0.05). There were no significant differences in late luminal loss of in-stent and in-segment, the rates of in-stent restenosis, in-segment restenosis and stent thrombosis, the in-stent minimal lumen diameter and in-segment minimal lumen diameter between the two groups (all P＞0.05). Conclusions The two kinds of homemade sirolimus-eluting stents may have similar efficacy and safety in patients with STEMI treated with primary PCI.

Objective To probe the feasibility of susceptibility weighted imaging (SWI) for evaluation of renal blood oxygenation level of healthy volunteers after water loading.Methods SWI of 11 healthy volunteers,acquired before (group 1) and after water loading (group 2),were assessed retrospectively by two radiologists with more than 10 years abdominal work experience independently.In those images of the same section plane derived from two groups,the phase values in cortex ((φ)cor) and medulla ((φ)med),difference between the same vein and surrounding tissue on phase map (△(φ)) were measured using SPIN software package,and the oxygen extraction fraction changes (△OEF) was calculated.The (φ)cor,(φ)med and △(φ) between two groups were compared by paired t test.And the intraclass correlation coefficient (ICC)was used to evaluate the consistency between two radiologists.Results For the radiologist 1,the (φ)cor,(φ)med and △(φ) were (0.046 ±0.019),(-0.014 ±0.003) and (1.3 ±0.4) rad in group 1,and were (0.047 ±0.014),(-0.012 ±0.005) and (1.1 ±0.4) rad in group 2 respectively,and no significant change was found in (φ)cor and (φ)med after water loading (t =-0.589 and-0.206,P ＞ 0.05 in all),except of in △(φ) (t =2.400,P ＜ 0.01).For the radiologist 2,the (φ)cor,(φ)med and △△(φ) were (0.049 ± 0.011),(-0.012 ± 0.004)and (1.5 ±0.4) rad in Group 1,and were (0.046 ±0.017),(-0.011 ±0.003) and (1.3 ±0.2) rad in group 2 respectively,there was no significant change in (φ)cor and (φ)med after water loading (t =0.590 and -0.974,P ＞ 0.05 in all),except of in △(φ) (t =2.760,P ＜ 0.05).Between two radiologists,the ICC of (φ)cor,(φ)med and △(φ) were 0.623,0.472 and 0.328 in group 1 and 0.599,0.442 and 0.445 in group 2 respectively.△OEF decreased about (-4.2 ± 2.3) c％ and (-4.3 ± 2.8) c％ measured by two radiologists respectively,and the consistency is good between two radiologists (ICC =0.784).Conclusion SWI provides a novel method to assess indirectly the oxygenation level of kidney,△OEF is an indicator with suitable reliability.