High-risk procedures in general surgery usually carry high risks and uncertainties,and patients may face significant changes in their living and health conditions,which can easily lead to doctor-patient disputes.This paper summarized the obstacles to implementing joint decision-making of doctors and patients in high-risk procedures in general surgery,as well as explored the best way to incorporate joint decision-making into clinical practice.In the decision-making process,general surgeons and patients need to work together to overcome ethical dilemmas such as lack of communication and decision-making abilities,inadequate informed consent and cognitive abilities,as well as institutional and cultural issues.To help patients choose the most suitable treatment method and truly make decisions about high-risk procedures,it is recommended that China strengthen communication skills training for general surgeons,develop and utilize decision-making support tools,and simultaneously supported multiple parties,to provide a good incubation soil for the implementation of joint decision-making of doctors and patients in general surgery.

Colorectal cancer(CRC)is one of the common malignant tumors,and its incidence rate and mortality rate in China are rising.As a high-incidence malignant tumor,in the process of screening,diagnosis,and treatment,CRC not only has universal ethical issues similar to other diseases,but also has its unique ethical problems,including the accessibility of CRC screening and medical insurance reimbursement,privacy exposure and the materialization of doctor-patient relationship during consultation and physical examination,the balance between"killing"and"nurturing"of cancer cells in excessive diagnosis and treatment,as well as the physiological and psychological issues of patients caused by enterostomy.This paper summarized and analyzed the special ethical issues in the diagnosis and treatment of CRC,and proposed corresponding countermeasures and suggestions.

OBJECTIVE: To observe the clinical efficacy of moxibustion and acupuncture at acupoints of the governor vessel combined with repeated transcranial magnetic stimulation (rTMS) in the treatment of post-stroke fatigue (PSF). METHODS: A total of 78 patients with PSF were randomized into an observation group (39 cases, 1 case dropped out) and a control group (39 cases, 1 case dropped out). The patients in both groups received conventional medical basic treatment. In the control group, rTMS was adopted, 20 min each time. On the basis of the treatment in the control group, therapy of moxibustion and acupuncture at acupoints of the governor vessel was delivered in the observation group, Baihui (GV 20), Dazhui (GV 14), Shenting (GV 24), Fengfu (GV 16), Zhiyang (GV 9), Mingmen (GV 4) and Yaoyangguan (GV 3) were selected, Baihui (GV 20) was treated with moxibustion, Dazhui (GV 14) was treated with collateral-pricking, other acupoints were treated with conventional acupuncture, moxibustion and acupuncture were sustained for 30 min. The treatment in both groups was given once a day for continuous two weeks. Before and after treatment, the scores of fatigue severity scale (FSS), Pittsburgh sleep quality index (PSQI) and Fugl-Meyer motor function assessment (FMA) were observed, and the serum levels of C-reactive protein (CRP), interleukin (IL)-1β and IL-6 were detected in both groups. RESULTS: After treatment, in the two groups, the FSS and PSQI scores, as well as the serum levels of CRP, IL-1βand IL-6 were decreased compared with those before treatment (P<0.05), while FMA scores were increased compared with those before treatment (P<0.05). After treatment, in the observation group, FSS and PSQI scores, as well as the serum levels of CRP, IL-1β and IL-6 were lower than those in the control group (P<0.05), while FMA score was higher than that in the control group (P<0.05). The serum levels of CRP, IL-1β and IL-6 were positively correlated with FSS score in the observation group (P<0.01). CONCLUSION Moxibustion and acupuncture at acupoints of the governor vessel combined with rTMS can effectively alleviate the fatigue, improve the sleep quality and limb function in PSF patients, its mechanism on alleviating fatigue may be related to the down-regulation of serum inflammatory factors.
Humans ; Acupuncture Points ; Male ; Moxibustion ; Female ; Middle Aged ; Aged ; Fatigue/physiopathology* ; Stroke/complications* ; Transcranial Magnetic Stimulation ; Acupuncture Therapy ; Treatment Outcome ; Combined Modality Therapy ; Adult ; Interleukin-6/blood* ; C-Reactive Protein/metabolism*

Due to the particularity of mental diseases, doctor-patient relationship in psychiatric medicine is a subject that needs to be paid attention to. This paper focused on the discussion of the model of doctor-patient relationship in psychiatric medicine from the perspective of constructing a harmonious doctor-patient relationship. Based on the Szasz & Hollender’s Model of Doctor-patient Relationship and combined with the characteristics of psychiatric medicine, this paper discussed the applicable doctor-patient relationship models, namely, the shared participation model, the guidance-cooperation model, the active-passive model, and the protective-constraint model. The specific application of the shared participation model, the guidance-cooperation model, and the active-passive model in the psychiatric medicine context were introduced in detail, and the reasons and characteristics of the protective-constraint model added on the basis of Szasz & Hollender’s Model of Doctor-patient Relationship were elaborated. Meanwhile, the realization paths of the protective-constraint model in clinical practice were further explored, which included evaluating the behavioral capacity and consciousness state of patients with mental disorders, obtaining informed consent, and standardizing the use of intervention rights and withdrawal mechanisms. The discussion of this model will promote the improvement of doctor-patient relationship and the development of psychiatric medicine.

The integrity and transparency of cornea plays a key role in vision. Limbal Stem Cells (LSCs) are precursors of cornea, which are responsible for self-renewal and replenishing corneal epithelium. Though it is successful to cell replacement therapy for impairing ocular surface by Limbal Stem Cell Transplantation (LSCT), the mechanism of renew is unclear after LSCT. To real time follow-up the migration and differentiation of corneal transplanted epithelial cells after transplanting, we transfected venus (a fluorescent protein gene) into goat LSCs, selected with G418 and established a stable transfected cell line, named GLSC-V. These cells showed green fluorescence, and which could maintain for at least 3 months. GLSC-V also were positive for anti-P63 and anti-Integrinbeta1 antibody by immunofluorescent staining. We founded neither GLSC-V nor GLSCs expressed keratin3 (k3) and keratinl2 (k12). However, GLSC-V had higher levels in expression of p63, pcna and venus compared with GLSCs. Further, we cultivated the cells on denude amniotic membrane to construct tissue engineered fluorescent corneal epithelial sheets. Histology and HE staining showed that the constructed fluorescent corneal epithelial sheets consisted of 5-6 layers of epithelium. Only the lowest basal cells of fluorescent corneal epithelial sheets expressed P63 analyzed by immunofluorescence, but not superficial epithelial cells. These results showed that our constructed fluorescent corneal epithelial sheets were similar to the normal corneal epithelium in structure and morphology. This demonstrated that they could be transplanted for patents with corneal impair, also may provide a foundation for the study on the mechanisms of corneal epithelial cell regeneration after LSCT.
Animals ; Cell Culture Techniques ; methods ; Cell Line ; cytology ; Epithelium, Corneal ; cytology ; metabolism ; Fluorescent Antibody Technique, Indirect ; Goats ; Limbus Corneae ; cytology ; Stem Cell Transplantation ; Stem Cells ; cytology