Under the background of resident standardization training pilot in Zhejiang province , this paper put forward the scheme of resident doctors standardization training and teacher training for the first time .This paper an-alyzed the necessity of medical ethics education in teacher training and standardization training and the requirements of teacher training in ethical education and ways for ethical education .Carrying out medical ethics education not only improves teachers'medical ethics knowledge , but also let them master the medical ethics teaching methods and skills.

Objective To investigate the clinical application of mutations drug-resistant tuberculosis (MDR-TB) by polymerase chain reaction(PCR)-oligonucleotide probes. Methods 80 cases of MDR-TB were divided into observed group 40 cases and conventional group 40 cases, the resistant gene and the type of mutation were determined by polymerase chain reaction (PCR)-oligonucleotide probes. Results 78 isolates of 4 kinds of resistance genes (KatG,inhA,rpoB,embB) ,the mutation rates were 90.9% ,84.8% ,51.98% and 58.1% ;the gene of rpoB sensitivi-ty of 98.0% and specificity of 100% ,positive predictive value of 82.61% ,the rate of according with traditional drug susceptibility testing were 62.50% by polymerase chain reaction (PCR)-oligonucleotide probes;the serisitivity of the KatG gene mutation is of 50.56% ,specificity of 75% ,positive predictive value of 68.75% ,the rate of according with traditional drug susceptibility testing were 46.43% by polymerase chain reaction (PCR)-oligonucleotide probes;the observed group in focus significant absorption, absorption, invariability, deterioration were 32.5% ,62.5% ,5.0%, 0% ,higher than the conventional group(25.0% ,50.0% ,20.0% ,5.0% ) (χ2=3.98,χ2=3.92, P<0.05;χ2=6.78,χ2=6.80,P<0.01) ;observed group in 3 months after treatment,6 months,9 months sputum the conversion negative rate in observed group (65.0%, 77.5%, 85.0% ) higher than the conventional group (37.5%, 50.0%, 60.0%) (χ2=3.86,χ2=3.85,χ2=3.89,P both<0.05). Conclusion An analysis available 3 kind of MDR-TB, 4 kind gene by PCR-oligonucleotide;the observed group in curative effect is better than the conventional group in pa-tients with MDR-TB.

Objective　To study the effects of transforming growth factor-β1 (TGF-β1) and transforming growth factor-α (TGF-α) on the growth and invasive potentials in human bladder tumor cells.　Methods　The effects of TGF-β1 and TGF-α on the growth of EJ cell line and the effects on MMPs and TIMP-2 were studied by means of MTT,Western Blot and RT-PCR methods.　Results　(1)TGF-β1 and TGF-α tended to inhibit the growth of EJ cells but statistically nonsigficant.(2)Higher levles of MMP-9 mRNA but lower levels of MMP-2,TIMP-2,MT1-MMP mRNA were found in EJ cells following the treatment with TGF-β1.The same was true for the expression of MMP-2,TIMP-2 mRNA in TGF-α groups.However,MMP-9 mRNA was not found in both TGF-α groups and the control groups. (3)TGF-β1 (0.1,1.0 ng/ml) enhanced MMP-2 protein but not the TIMP-2 protein,while TGF-β1 (5.0,10.0 ng/ml)decreased TIMP-2 protein but not on MMP-2.In TGF-α groups,when the concentration was 1.0,5.0,10.0ng/ml,TIMP-2 protein expression was decreased but MMP-2 did not.When the concentration reached 100.0 ng/ml,it increased MMP-2 protein level,not the TIMP-2 protein.　Conclusions　TGF-β1 and TGFα do not inhibit the proliferation of EJ cells whereas the enhanced-invasiveness and metastasis may be associated with regulating the expression of MMPs and TIMP-2.

Objective To investigate the association between global registry of acute coronary events (GRACE) score,N-terminal pro brain natriuretic peptide (NT-proBNP) and heart function in patients with acute coronary syndromes(ACS).Methods One hundred and seventy-four ACS patients and 60 healthy persons were enrolled our study.Of ACS patients,96 cases were with unstable angina pectoris(UP) and 78 cases with acute myocardial infarction (AMI).The level of NT-proBNP,left ventricular ejection fraction (LVEF) and GRACE score were measured.Results The NT-pro BPN of patients with UP or AMI were 87.00(38.25,245.75) ng/L and 686.00 (169.00,1 852.75) ng/L,and GRACE score were (87.51 ± 17.69) and (134.74 ± 23.56),which were higher than that in the control group (31.50 (13.00,54.75) ng/L,(81.10 ± 15.75)).LVEF in patients with AMI (57.72 ± 9.04) ％,lower than that of the control group ((64.45 ± 6.31) ％),and there were statistically significant difference among the three groups (Z =44.111,P ＜ 0.001 ; F =172.366,18.176,P ＜0.01).There was positive correlation between serum NT-pro BNP levels and GRACE score(r =0.451,P ＜ 0.001),and negative correlation was seen between serum NT-pro BNP and LVEF (r =-0.294,P ＜ 0.001)Conclusion NT-pro BNP level increases and LVEP decreases in patients with ACS and they are related to GRACE score as well as associated with the degree of risk in patients with ACS.

Objective To explore the feasibility and significance of hand-assisted laparoscopic splenectomy (HALS) for ruptured spleen. Methods We conducted HALS in 18 cases of ruptured spleen between January 2002 and January 2003. According to the Buntain classification of CT-graded splenic injury, 7 cases were classified as “type Ⅱ” and 11 cases, “type Ⅲ”. Ruptured spleen was complicated by other organ injuries in 12 cases. Results The operation was completed successfully in 16 cases, the operation time being 75～115 min (mean, 92.5 min). A conversion to open surgery was made in 2 cases, which were suspected of having injuries of other major vessels. Postoperative time to normal activities was 20～30 days in 6 cases of simple ruptured spleen and 30～100 days in 10 cases of ruptured spleen complicating other injuries. Conclusions HASL is feasible for “type Ⅱ or Ⅲ” ruptured spleen without severe complicating injuries.

Objective To explore the feasibility and the selection of laparoscopic cholecystectomy(LC) for the treatment of acute gallstone pancreatitis(AGP) without jaundice.Methods Laparoscopic cholecystectomy had been performed in 95 patients with AGP accompanying no jaundice from July 1996 to July 2004 in this hospital.All of the patients had a history of conservative treatment.Selective LC was performed in 79 patients after their symptoms were relieved,while emergent LC was required in 16 patients because of failure of response to conservative treatment.Results All the operations were successfully completed.The operation time was 40~328 min(mean,103 min),and the intraoperative blood loss was 0~210 ml(mean,35 ml). Intraoperative cholangiography was carried out in all the 95 patients and succeeded in 92.Thirteen patients were found having lower common bile duct stones and then were cured with endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic spincterotomy(EST).No conversion to open operation was required.No postoperative biliary hemorrhage or leakage occurred.No fatal case was seen.Pathological examinations following operation revealed multiple small or sand-like stones in the gallbladder.Follow-up in 39 patients for 1 months ~ 5 years found no recurrence of pancreatitis or cholelithiasis.Conclusions Laparoscopic cholecystectomy should be performed as early as possible in the treatment of AGP without jaundice.Use of intraoperative cholangiography and postoperative EST should be emphasized in proper cases.

Objective To study the effects of transforming growth factor ?1 (TGF ?1) and transforming growth factor ? (TGF ?) on the growth and invasive potentials in human bladder tumor cells. Methods The effects of TGF ?1 and TGF ? on the growth of EJ cell line and the effects on MMPs and TIMP 2 were studied by means of MTT,Western Blot and RT PCR methods. Results (1)TGF ?1 and TGF ? tended to inhibit the growth of EJ cells but statistically nonsigficant.(2)Higher levles of MMP 9 mRNA but lower levels of MMP 2,TIMP 2,MT1 MMP mRNA were found in EJ cells following the treatment with TGF ?1.The same was true for the expression of MMP 2,TIMP 2 mRNA in TGF ? groups.However,MMP 9 mRNA was not found in both TGF ? groups and the control groups. (3)TGF ?1 ( 0.1 , 1.0 ng/ml) enhanced MMP 2 protein but not the TIMP 2 protein,while TGF ?1 ( 5.0 , 10.0 ng/ml)decreased TIMP 2 protein but not on MMP 2.In TGF ? groups,when the concentration was 1.0 , 5.0 , 10.0 ng/ml,TIMP 2 protein expression was decreased but MMP 2 did not.When the concentration reached 100.0 ng/ml,it increased MMP 2 protein level,not the TIMP 2 protein. Conclusions TGF ?1 and TGF? do not inhibit the proliferation of EJ cells whereas the enhanced invasiveness and metastasis may be associated with regulating the expression of MMPs and TIMP 2.

Objective To explore the feasibility and clinical efficacy of hand assisted laparoscopic splenectomy (HALS) for ruptured spleen. Methods From January 2002 to October 2002, HALS was performed in 12 cases, among whom were 8 cases combined with other viceral trauma. Results HALS was accomplished successfully in 10 cases and laparotomy in 2. In 10 cases, the operation time of HALS averaged 102.5 minutes. The mean post operative hospitalization was 5.8 days in 4 cases with only spleen trauma and 15.5 days in 6 combined with other viceral trauma. Conclusions HALS is a feasible, effective and safe surgical procedure for the cases with Buntain CT scalingⅡ or Ⅲ spleen trauma with no severe combined trauma.

Objective To explore the application of mini-laparoscopy in the diagnosis and management of nonpalpable undescended testis in children.Methods 38 cases of impalpabal testes(46 testicular) had been operated by mini-laparoscopy in children with cryptorchidism.Results 38 children with nonpalpable undescended testis (46 testicular) had been operated by mini-laparoscope.Results After laparoscopic exploration,inguinal probe and postoperative pathology,it had been confirmed that 2 testicular were absent,34 testicular were found in high inguinal location,10 testicular were located in intraperitoneal cavity.In addition to the absent testicular,the rest had been performed with mini-laparoscope:one period descent fixation 41 testes,Fowler-Stephens (F-S) installment orchiopexy three testes.Follow-up with side testicular atrophy 2,including one period orchiopexy a testis,F-S installment fixation a testicular; Testicular rebound 1,who had been operated with one phase of testicular descent fixtion.Conclusion For inguinal failed to find the testicular,children with cryptorchidism should be done by laparoscopy because of its positioning accuracy,and most children can do a period drop fixed,but for those really intraperitoneal more exalted person,stage surgery should be needed.Its overall treatment effect is satisfactory and is worth popularizing.

Objective To investigate the risk factors of worsening renal function (WRF) in patients with chronic heart failure ( CHF) and WRF influence on prognosis. Methods A case-control study were undertaken to analyze independent risk factor statistically related to incidence of WRF, and to assess the influence of WRF on prognosis. Results The independent predictors of WRF were creatinine level at admission (OR 2.248,95% CI 1.088-4.647, P = 0.029) and NYHA class on admission ( OR 2.485, 95% CI 1.3854. 459, P = 0.002). The mortality of patient with WRF was obviously higher than that of control group during hospitalization( OR 3. 824,95% CI 2. 452-5. 637 ,P ＜0.015). Conclusions WRF is a common complication among patients hospitalized for CHF, and is obviously associated with mortality during hospitalization. Higher creatinine level and weak heart function are independent risk factors for incidence of WRF of patients with CHF.