The defense for paternalism is based on that family members' decisions are usually beneficial for patients' best interests.However,this premise remains to be demonstrated.The moral theory of maintaining family members' interests challenged the ethical principle of respecting patients' autonomy,which believed that treatment decisions should be discussed by the whole family members.However,the principle of autonomy does not always dissever the relationship between individual and family members.It resorted East Asia family autonomy of Chinese traditional culture and emphasized on the value of objective goodness and family dependence.However,patients often do not play a proper role in families' decision-making.Besides,the Confucian bioethics also needs to provide more sufficient argumentation to deal with the relationship between subjective goodness and objective goodness.The unconditional acquiescence of family members' domination in decision-making is worthy reflecting in the current medical environment.

The ambiguous diagnosis,the public's insufficient understanding of AMR and improper use of antibiotics in agriculture are the main reasons for accelerating antibiotic resistamce(AMR).At present,the main coping strategies are limited to technical means while lacking ethical consideration.The related ethical issues are,mainly,tensions of personal health interests and public health interests,the conflicts between agricultural development and human health benefits,the distributive justice,inter-generational justice.Understandings and addressing these issues rely on value judgments based on the moral theories.And then it will form an effective and reasonable antibiotic management solution which will help to deal with AMR fundamentally.

Objective:To investigate the function of CD 59 in LAT induced T lymphocytes'proliferation and activation.Methods:Transfected LAT-GFP recombinant lentiviral vectors into Jurkat cells and established a fusion-protein stable express cell line ( Jurkat-GFP ).Junket-GFP cells were transfected with pSUPER-siCD59 plasmids by electroporetion or stimulated by anti-CD59 antibody.The cellular locations of CD 59 and LAT were observed under fluorescence microscope with the immunofluorescence cytochem -istry.The cells proliferation were measured by MTT assay.Furthermore,Western blot was used to detect the total and phosphorylation levels of several down-stream proteins after T cell activated .Results: Jurkat-GFP cells successfully transfected with pSUPER-siCD59 plasmids showed lower fluorescence staining.CD59 and LAT distributed uniformly on the cell surface before stimulated with anti-CD59 antibody and formed clusters once upon stimulation.Jurkat-GFP cells stimulated with anti-CD59 antibody showed a higher level of pro-liferation and protein phosphorylation ,compared with the others.Conclusion:CD59 contributed to LAT induced signaling transduction of T lymphocytes ,and stimulated CD59 molecule partly promoted T cell activation.

Objective To investigate the relationship of low level of high-density lipoprotein cholesterol to contrast induced-acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI) in patients with coronary heart disease.Methods A total of 1500 consecutive patients,who underwent PCI from January 2009 to May 2011,were enrolled in this study.There was no limit on age or sex,and all patients were self-identified as Han ethnic group.Patients were excluded from this study,however,if they had a history of malignant tumor,urinary tract infection,nephrectomy operation,chronic peritoneal or hemodialysis,or if they had been exposed to contrast media within the past 14 days.CI-AKI was defined as an absolute increase in serum creatinine ≥44.2 μmol/L or a relative ≥25％ increase in serum creatinine within 72 hours after procedure.Low level of HDL-C was defined as ＜ 1.04 mmol/L.Monofactorial and multivariate analysis was performed to identify risk factors for CI-AKI and low level of HDL-C in these patients.Results Among the 1500 patients with coronary heart disease,CI-AKI occurred in 246 patients after PCI and the overall incidence of CI-AKI was 16.4％.The patients with low level of HDL-C had a higher incidence of CI-AKI than those without it (21.5％ vs.13.3％ in total,P ＜0.01),no matter that they had suffered from chronic kidney disease (39.8％ vs.26.5％,P ＜ 0.05) or not (17.7％ vs.9.7％,P ＜ 0.01).By multivariate analysis,low level of HDL-C was identified as an independent risk factor for CI-AKI and smoke,great BMI as well as anemia were considered as prediction factors for low level of HDL-C.Conclusion The patients with low level of HDL-C have a higher incidence of CI-AKI after PCI.Low level of HDL-C is one of risk factors for CI-AKI after PCI in patients either with chronic kidney disease or not.Great BMI,smoking as well as anemia are independent predictors for low HDL-C level in these patients.

Objective To investigate the effects of crude Fomes officinalis polysaccharide ( FOPS ) and its purified constituent ( FOPS-a) on mitogen-activated protein kinases ( MAPK) signaling pathway and se-cretion of tumor necrosis factor-α (TNF-α) in RAW264. 7 macrophages. Methods RAW264. 7 macrophages were treated with FOPS and FOPS-a respectively at different concentrations (50, 100, 200 μg/ml) for 24 h. RT-qPCR and Western blot methods were respectively used to detect the expression at mRNA level and the phos-phorylated proteins of p38, c-Jun NH2-terminal kinase ( JNK ) and extracellular signal-regulated kinase ( ERK) . Changes in the phosphorylation of these proteins and TNF-α secretion were respectively detected by Western blot and ELISA after treating the macrophages with MAPK-specific inhibitors ( PD98059, SP600125, SB203580). Results Compared with the blank control group, different concentrations of FOPS and FOPS-a could significantly increase the expression at mRNA level and the phosphorylation of p38 and ERK (P<0. 05). Three inhibitors of MAPK could markedly decrease the phosphorylation of ERK1/2 and p38 and TNF-αsecretion that were induced by FOPS and FOPS-a (P<0. 05). Conclusions FOPS and FOPS-a might have immunomodu-latory effects on RAW264. 7 macrophages through activating ERK1/2 and p38 MAPK signal transduction pathways.

To observe the layout and evolution of the traditional Chinese medicine (TCM) medical industry, classify the industry by region and conduct a preliminary study on its professional advantages, competitiveness and possible cause by using the theory of location quotient in regional economics, in order to provide suggestions for the layout of the TCM medical industry.
Drug Industry ; Medicine, Chinese Traditional

Objective To evaluate the effect of extremity ischemia preconditioning on lung protection in patients undergoing pulmonary lobectomy,and to further explore its possible mecha-nisms.Methods Forty patients (male 26 and female 14,BMI 20-28 kg/m2,ASA Ⅰ or Ⅱ,aged 45-64 years old)scheduled for elective pulmonary lobectomy via a thoracoscope,were randomly divided into two groups:extremity ischemic preconditioning group (group P)had the left leg roots tied with a tourniquet,lower extremity blood flow aerated blocked for 5 min,then deflated to restore blood flow for 5 min,the cycle was repeated three times;control group (group C)had the left lower extremity tied but not charged for 30 min.All the patients underwent intravenous-inhaled composite anesthesia. Arterial and venous blood samples were taken after admission to the operating room,at 6 h,12 h and 24 h after operation.The alveolar-arterial oxygen pressure difference (PA-aO2),respiratory index(RI) and oxygenation index (OI)were calculated.The level of TLR4 was measured.The pulmonary com-plications within 48 h after operation were recorded.The adverse reactions of the left lower extremity of the group P were recorded.Results Compared with the admission to the operating room,the ex-pression of TLR4 was significantly increased in the two groups at 6 h,12 h and 24 h after operation, but the expression of the group P was significantly lower than that of group C (P<0.05).Compared with the admission to the operating room,PA-aO2and RI were significantly increased,and OI was sig-nificantly decreased in the two groups at 6 h,12 h and 24 h after operation (P<0.05).Compared with group C,PA-aO2and RI were significantly decreased,and OI was significantly increased in group P (P<0.05).There was no statistically significant difference in the incidence of pneumonia and ate-lectasis in the two groups after operation,and no respiratory failure was observed in both groups.The left lower extremity of the group P had no adverse reactions,such as rupture of skin,thromboembo-lism,and nerve injury.Conclusion Extremity ischemic preconditioning has protective effect on pul-monary function in the patients undergoing pulmonary lobectomy,which may be related to down-reg-ulation of TLR4 expression in monocytes of blood and inhibition of the systemic inflammatory re-sponse.

Objective To explore the clinical characteristics and outcomes of obstetric patients in intensive care unit(ICU).Retrospective study over a period of four years and 232 cases were included.Methods Records were reviewed for clinical characteristics,maternal and neonatal outcomes.All patients were divided into obstetric related disease group and non-obstetric related disease group.Results The patients who had regular antienated examination only accounted for 34.5％.Seven patients died.Hypertensive disorders,heart disease and hemorrhage are the main cases of admission.Among the 232 obstetric patients,there are 131 cases(56.5％) in the obstetric group,101 cases(43.5％) in the non-obstetrical group.The average age of the patients in obstetric related disease group were lower than those in non-obstetric related disease group (P ＜ 0.001).The postpartum hemorrahge within 24 hours,the rates of hystereyomy and the rates of hemorrhagic shock in obstetric related disease group were all higher than those in non-obstetric related disease group (P ＜ 0.001).Conclusion The establishment of specialized obstetric ICU and physicians with obstetric and ICU knowledge to manage such patients will be a future development trend.

Objective To explore the interaction of angiotensin converting enzyme (ACE) insertion/deletion(I/D) polymorphism(rs1799752)with diabetic kidney disease (DKD) development as well as its interaction with smoking and obesity in Chinese type 2 diabetic mellitus (T2DM) using the improved experiment method. Methods From June 2016 to March 2018, 300 T2DM patients with DKD [DKD(+)] and 300 T2DM patients without DKD[DKD(-)] were selected from China-Japan Friendship Hospital. The improved Triple Primer Method that combined PCR with capillary electrophoresis was established in this study to detect the ACE genotype. The relevant clinical data as well as the frequencies of genotype and allele of ACE gene I/D polymorphism between two groups were statistically analyzed. Patients were further grouped based on smoking status and obesity for multivariate regression. Results Frequency of the DD genotype and D allele were significantly higher in DKD(+) group than in DKD(-) group [DD genotype:15.0％ (45 cases) vs 7.3％(22 cases),χ2=10.8, P=0.004;D allele:36.5％(219 cases) vs 28.0％(168 cases),χ2=9.92, P=0.02]. Multivariate logistic regression analysis found that D allele of rs1799752 was associated with a significantly higher risk of DKD in both recessive model(OR=1.45, 95％CI:1.06-2.00, P=0.022 after adjustments) and additive model(OR=1.41, 95％CI:1.04-1.90, P=0.025 after adjustments). In the smoker group and the obese group, D allele showed significant relationship with DKD incidence (P<0.05 after adjustments) in both recessive model and dominant model. No such relationships were observed in non-smoker group and non-obese group (P>0.05). Conclusions I/D polymorphism of ACE gene is associated with the incidence of DKD in T2DM patients. DD genotype of the ACE gene is the risk factor for T2DM patients with DKD. D allele may increase DKD incidence in the presence of smoking and obesity.

Objective To explore the effect of different treatment methods on prognosis in elderly patients with lower extremity arterial occlusive disease.Methods A total of 352 elderly patients with lower extremity arterial occlusive disease admitted in our hospital from May 2020 to May 2022 were enrolled,and according to their willingness and characteristics of lower extremity le-sions,they were divided into balloon dilation group(142 patients),stent implantation group(145 patients)and conservative treatment group(65 patients).All patients were followed up for 13-24 months.The incidences of major adverse cardiovascular events(MACE),including all-cause death,acute myocardial infarction,acute ischemic stroke,and major adverse lower limb events(MALE),including lower extremity pain at rest,ulcers or skin defects,gangrene,reocclusion,and amputation were observed and recorded.The clinical data and prognosis were compared and ana-lyzed of the three groups.Kaplan-Meier survival curves were drawn.Results The incidence of all-cause mortality was significantly lower in the stent implantation group than the conservative treatment group(9.7％vs 23.1％,P＜0.01).The incidence of MALE was obviously lower in the stent implantation group and the balloon dilatation group than the conservative treatment group(4.8％and 9.2％vs 24.6％,P＜0.01).Conclusion Endovascular therapy can reduce the risk of all-cause death and MALE occurrence in elderly patients with lower extremity arterial occlusive disease who are suitable for interventional therapy.