With the widespread promotion of patient-centered care models,narrative medicine,as a medical practice that emphasizes patients'personal stories and experiences,has garnered increasing attention in the medical field.Through a systematic literature review and field observations,this paper analyzed the ethical challenges faced by narrative medicine in reconstructing doctor-patient relationships,which mainly include information asymmetry and uneven distribution of medical resources,insufficient informed consent and privacy protection of patients,and difficulties in ensuring the authenticity and completeness of narrative content.In response,this paper proposed strategies such as enhancing patients'understanding of their rights and narrative medicine,promoting continuous ethical evaluations of narrative medicine practices,and exploring interdisciplinary collaborations to foster harmonious doctor-patient relationships.It also emphasized the importance of establishing multidisciplinary cooperation mechanisms and strengthening ethical training for medical personnel,as well as the necessity of ensuring information security through technological means,aiming to promote harmonious doctor-patient relationships,better realize the ethical practices of narrative medicine,optimize doctor-patient relationships,and improve the quality of medical services.

With the widespread promotion of patient-centered care models,narrative medicine,as a medical practice that emphasizes patients'personal stories and experiences,has garnered increasing attention in the medical field.Through a systematic literature review and field observations,this paper analyzed the ethical challenges faced by narrative medicine in reconstructing doctor-patient relationships,which mainly include information asymmetry and uneven distribution of medical resources,insufficient informed consent and privacy protection of patients,and difficulties in ensuring the authenticity and completeness of narrative content.In response,this paper proposed strategies such as enhancing patients'understanding of their rights and narrative medicine,promoting continuous ethical evaluations of narrative medicine practices,and exploring interdisciplinary collaborations to foster harmonious doctor-patient relationships.It also emphasized the importance of establishing multidisciplinary cooperation mechanisms and strengthening ethical training for medical personnel,as well as the necessity of ensuring information security through technological means,aiming to promote harmonious doctor-patient relationships,better realize the ethical practices of narrative medicine,optimize doctor-patient relationships,and improve the quality of medical services.

Objective To observe the dynamic changes of Notch1 protein expression in the subventricular zone (SVZ) after traumatic cerebral injury (TBI) in rats,and to explore the correlation between Notch signaling pathway and neural stem cells (NSCs) proliferation after TBI.Methods Ninety-six SD rats were randomly divided into sham-operated group (only opening the scalp and shall window,n=16),control group (without any treatment,n=16) and experimental group (establishing medium-sized TBI models with Feeney's free fall method,n=64);rats in the experimental group were divided into 4 sub groups according to the execution times (one,three,7 and 14 d after TBI,n=16).Immunofluorescence staining was performed to detect the Notchl/nestin labeled cell expressions in SVZ of rats,and Notch1 protein expression was detected by Western blotting.Results Immunofluorescence results showed that the Notch1/nestin double staining positive cells in the right SVZ brain tissues of the experimental group on the first day of TBI had peak level,which was 2-3 times of the control group;and then,it gradually declined and basically returned to normal on 144 day of TBI;the differences between the 4 subgroups were statistically different (P＜0.05).The positive cell counts in the subgroups of first,third,and 74 d after TBI were statistically different as compared with those in the control group and sham operated group (P＜0.05).Western blotting results indicated that there was no significant difference in the Notch1 protein expression between control group and sham operated group;Notch1 protein expression in SVZ of the experimental group had peak level on the first day of TBI,gradual decline was noted after that,and normal level was noted on the 14th d of TBI.Conclusion TBI can activate the Notch1 protein expression,which induces the opening of Notch signaling pathway so as to affect the regulation of NSCs proliferation.

Objective To investigate the clinical characteristics of multisystem impairment of Sj(o)gren's syndrome (SS) to make quick and accurate diagnose and treatment to decrease the rate of misdiagnosis and mistreatment.Methods A case of thrombotic thrombocytopenic purpura with SS was reported and the related literatures were reviewed.The clinical manifestations,laboratory examinations,diagnostic criteria and therapy of thrombotic thrombocytopenic purpura with SS were analyzed.Results Purpura haemorrhagica,hemolytic anemia,central nervous systemic symptoms,kidney impairment and fever were the representative clinical manifestations of thrombotic thrombocytopenic purpura with SS.Plasmapheresis was the most effective therapy with the background treatment with glucocorticosteroid and immunosuppressive agents.Conclusion Thrombotic thrombocytopenic purpura with SS presents a complicated clinical manifestations,so misdiagnosis and mistreatment is very frequent.More attention should be paid to this specific situation because the disease is rare and has high mortality rate.

Objective To evaluate the radioprotective effect of vanillin derivative VND3207 on DNA damage induced by different LET ionizing radiation.Methods The plasmid DNA in liquid was irradiated by 60Co γ-rays, proton or 7Li heavy ion with or without VND3207.The conformation changes of plasmid DNA were assessed by agarose gel electrophoresis and the quantification was done using gel imaging system.Results The DNA damage induced by proton and 7Li heavy ion was much more serious as compared with that by 60Co γ-rays, and the vanillin derivative VND3207 could efficiently decrease the DNA damage induced by all three types of irradiation sources, which was expressed as a significantly reduced ratio of open circular form (OC) of plasmid DNA.The radioprotective effect of VND3207 increased with the increasing of drug concentration.The protective efficiencies of 200 μmol/L VND3207 were 85.3% (t =3.70,P =0.033), 73.3% (t = 10.58, P =0.017)and 80.4% (t =8.57,P =0.008)on DNA damage induction by 50 Gy of γ-rays, proton and 7Li heavy ion, respectively.It seemed that the radioprotection of VND3207 was more effective on DNA damage induced by high LET heavy ion than that by proton.Conclusions VND3207 has a protective effect against the genotoxicity of different LET ionizing radiation, especially for γ-rays and 7 Li heavy ion.