Objective To investigate the effects of different head positions during operation on wake-up time and quality among ankylosing spondylitis (AS) patients with thoracolumbar kyphosis following pedicle subtraction osteotomy (PSO).Methods Sixty patients were included in this study.All of them,treated with intravenous anesthesia,took the bow-prone position.The patients were randomly divided into two groups:the experiment group where the head was elevated by 10° and the control group where the head was not elevated.The two groups were compared in respect of wake-up time and quality of wake-up test.Results The wake-up time in the experiment group was significantly shorter as compared to that of the control group (1 3.7±2.0 min vs.24.2±2.7min,P＜0.05).The wake-up quality was better as well.Conclusion Elevation of the head by 10° can shorten wake-up time and improve the quality of wake-up test during the procedure of PSO for AS patients with thoracolumbar kyphosis.

Objective To study the chemical components from the pericarps of Juglans mandshurica with anti-tumor activity.Methods It showed that pericarps of J.mandshurica had a good performance in treating cancer and low toxicity from CHCl3 and EtOAc portions by a lot of pharmacological experiments and modern clinical application in the past.Compounds were isolated by chromatography on silica gel columns and AB-8 macroporous resin.On the basis of spectral evidences including 1D-NMR and 2D-NMR,the structures of these compounds were determined.Results These compounds from CHCl3 portion were identified as 20(S)-protopanaxadiol-3-one(1),dammara-20,24-dien-3?-ol(2),galeon(3),juglanin A(4),2?,3?,23-trihydroxy olean-12-en-28-oic acid(5),2?,3?,23-trihydroxy urs-12-en-28-oic acid(6),oleanolic acid(7),ursolic acid(8).Conclusion Compound 1 is a new natural product.Compounds 2 and 5-8 are isolated firstly from the plants of Juglans L.which are due to pentacyclic triterpane.Compound 3 is isolated from the pericarps of J.mandshurica for the first time.

To explore the value of acoustic radiation force impulse (ARFI) technique in the differential diagnosis of benign and malignant hepatic neoplasms.Retrospective analysis of touch tissue quantification (VTQ) and general ultrasonic examination of interesting region were performed for hepatocellular carcinoma (HCC),hepatic hemangioma,focal nodular hyperplasia (FNH) and controls.Significant differences existed between HCC and hepatic hemangioma,hepatic FNH and controls (all P ＜0.01).No significant difference existed between primary and metastatic HCC (P ＞ 0.05).There was no significant difference between hepatic hemangioma,FNH and controls (all P ＞ 0.05).With a cut-off VTQ value of 1.95 m/s,the sensitivity and accuracy rate in the differentiation of benign and malignant hepatic neoplasms was 90％ and 83％ respectively.The sensitivity and accuracy rate in general ultrasound examination of hepatic neoplasms was 88％ and 70％ respectively.Significant differences existed in accuracy rate between two methods (P ＜ 0.01).It was confirmed that ARFI could reflect the stiffness of liver neoplasm noninvasively.Compared with general ultrasonography,ARFI is better at differentiating benign and malignant hepatic neoplasms.

Forensic science is a cross discipline,involving both the subjects of natural sciences and the humanities & social sciences.It needs not only the application of forensic techniques and other theoretical results of natural sciences,but also be bounded by moral and ethical guidance.This paper discusses ethical issues involved in the teaching of forensic medicine in medical colleges,exploring the relationship between the teaching of forensic medicine and ethics,so as to promote the development of forensic science education.

There existed animal ethical issues in the process of functional experiment including poor breeding environment before animal experiment, insufficient prepare before class, not standard experimental operation, less attention paid to the study of anesthesia, disposal on animals after the experiment. Based on the analysis of these issues and combined with the thought of respect for animals′rights and attention to animal welfare, the authors put forward suggestions from the aspects including the schools′active attention and support, curriculum, standardizing the experimental design and operation steps, improving the animal experiment teachers′ethical consciousness, cul-tivating the students′experimental animal ethical consciousness. In addition, this paper put forward the thinking of further strengthening education:the domestic medical colleges generally need to strengthen medical ethics educa-tion, and should adopt various forms to cultivate medical students′medical ethics quality of treasuring life.

ObjectiveTo collect and analyze patients' evaluation of basic medical services in Tianjin community health service institutions and to suggest improvements.MethodsA total of 15 community health service centers and 15 community health service stations in six urban districts of Tianjin were selected by stratified sampling and 300 randomly intercepted patients were surveyed by questionnaire.ResultsApproximately half ( 157/300, 52. 3％ ) the patients selected community health service institution as their first choice to seek medical attention. The most important reason for this, with 89.2％ patients responding yes, was that the community health service institution was close to home and very convenient.One quarter (79/300, 25.3％ ) of the patients regularly consulted the same doctor and 17.7％ (53/300)seldom went to see a doctor. The proportion of patients expressing a high degree of satisfaction to service standards and health professionals was 78. 7％, of which satisfaction with physicians' explanation about the patients' illness ranked highest at 83. 7％ (251/300). Patients' confidence level of doctors' diagnosis,physical examination, and auxiliary examination was 92. 0％. Moreover, most (87. 0％ ) patients reported that doctors communicate well with them; 85.0％ (255/300) patients received health instruction from doctors during visits, and 82. 0％ patients reported that doctors pay attention to protecting patients' privacy.The overall satisfaction of patients to environmental facilities and process management of community health service institutions was 73.6％. On the other hand, patient satisfaction with medicine types, service price,instrumentation and equipment, and environment were all lower than the average satisfaction. Conclusions Patients were basically satisfied with medical service in community health service institutions. Three main problem areas were identified: patients' use of community health services is deficient, medical service ability is partially lacking, and the service feature of general practitioners (GPs) is not obvious. Improvements of basic medical service ability in the community, cultivation of GPs, and basic medicine regulation are advocated.

Objective To observe the changes of intraocular pressure(IOP)in surgical treatment of Arnold-Chiari malformation.Methods The IOP of 20 patients who underwent surgical treatment of ArnoldChiari malformation were detected by Tono-Pen tonometer at 5 min utes after general anesthesia(T0),5 minutes after prone position(T1),30 minutes after prone position(T2),60 minutes after prone position(T3),prone position before the end of operation(T4),5 minutes after recovery prostration position(Ts)and 30 minutes after prostration position(T6),mean aortic pressure(MAP),heart rate(HR)and partial pressure of carbon dioxide in end tidal(PETCO2)were recorded at the same time.With the prone position,head was fixed bead-holder with skull pin.Results There was no statistical difference in MAP,HR,PEtCO2 at each time point(P＞ 0.05).The IOP significantly increased at T1[(20.9 ±2.5)mm Hg(1 mm Hg =0.133 kPa)],T2[(17.7 ± 1.7)mm Hg],T3[(23.9 ±2.4)mm Hg],T4[(26.3 ± 1.0)mm Hg]compared with IOP at T0 [(9.5 ± 1.5)mm Hg](P ＜ 0.05),there were significant differences between T2 and T3,T3 and T4(P ＜ 0.05).Recovery prostration position,the IOP decreased gradually,IOP at T5[(18.6 ± 1.8)mm Hg]was significantly lower than that at T4(P ＜ 0.05),but T5 was still higher than T0(P ＜ 0.05).The IOP at T6[(10.3 ± 1.7)mm Hg]was no difference compared with T0.Inserting of skull pin might be increase IOP for a moment,the IOP at T; was significantly higher than that at T2(P ＜ 0.05).Conclusion IOP gradually increases as the patients prone position changes in surgical treatment of Arnold-Chiari malformation,and inserting of skull pin maybe increase IOP for a moment.

Objective To study the effects of steaming Orange Magnoliavine Fruit with vinegar on the lignan metabolism in rats.Methods The rats were fed with same amount of extracts:Orange Magnoliavine Fruit before and after steaming processing with vinegar. Then plasma samples were collected at different times and determined contents of schisantherin A and deoxyschizandrin by HPLC to draw drug concentration in blood-time curve. The pharmacokinetic parameters were calculated with DAS2.0 analysis software.Results Pharmacokinetic model of schisantherin A and deoxyschizandrin in rats accorded with one compartment model. Plasma concentration in rats under the condition of Orange Magnoliavine Fruit samples before and after steaming processing with vinegar was:Tmax of schisantherin A was determined with (4.250±1.523), (5.750±1.784)h respectively, Cmax with (2.197±0.995), (2.815±0.842)μg/mL respectively, T1/2 with (2.654±0.377), (3.504±0.856)h respectively. Tmax of deoxyschizandrin was determined with (3.250±1.836), (4.250±1.471)h respectively, Cmax with (1.922±0.773), (2.307±0.602)μg/mL, T1/2 with (2.111±1.185), (3.242±2.126)h. Orange Magnoliavine Fruit before and after steaming processing with vinegar exhibited differences in pharmacokinetic parameters in rats.Conclusion The pharmacokinetic parameters of schisantherin A and deoxyschizandrin showed that the steaming processing with vinegar on Orange Magnoliavine Fruit can slow down lignan metabolism in vivo.

A total of 526 team members from 28 community health service (CHS) centers in 5 pilot cities were surveyed by a questionnaire.All CHS centers developed team service.And 275 service teams were established and the coverage rate of area resident committee was 100％.The teaming modes were mainly divided into four kinds:medical-nursing-prevention classic combination,big team professional expansion,small team medical combination and non-health technology extensive participation.The team services showed multiple advantages of professionism,energy and time complementing.We should strengthen team construction,improve perfect team service mode and policy support and create a good environment for CHS development.

Objective To propose a modified graph cut algorithm under the elliptical shape constraint to segment the ultrasonogram of cervical lymph nodes. Methods Since cervical lymph nodes were usually oval-shaped, the prior of the elliptical shape information, which was expressed as a distance function, was used to constrain the cut cost of the graph cut algorithm. The initially segmented contour was fitted with an ellipse to get the constraint. Then a certain segmentation was obtained by minimizing the cut cost function constrained with the elliptical prior. This procedure was iterated until it to be convergent. Results Under the same user input, this algorithm successfully segmented nodes on the low contrast ultrasonograms, while the traditional graph cut approach failed. For 20 ultrasonograms, with the average minimum Euclidean distance (AMINDIST) measure and the Hausdorff distance measure, these two distances between contours manually delineated by the radiologist and those segmented by this algorithm were far less than the distances resulted from the traditional graph cut algorithm. Conclusion It is indicated that utilizing the elliptical shape constraint prior can obviously improve the graph cut algorithm for segmenting cervical nodes on ultrasonograms.