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The cultivation of medical ethics includes two aspects, namely, the education of professional ethics in the doctor-patient communication and the cultivation of personal virtues. The morality of doctors is not only a pure personal morality, but mostly based on the professional ethics of "maintaining the connection with the others" in the doctor-patient relationship. In fact, doctors need to deal with and respond to the interaction of doctor-patient communication in medical service activities, and construct professional ethics and personal virtues within an appropriate "degree" range in correct behavior ways, that is, the virtue and ability of doctors’ practical wisdom. In reality, medical recipients of medical skills (patients and their relatives) not only decline but also lack of active dialogue and interaction power with medical professionals. There is a considerable lack of professional medical knowledge and patients have high medical expectations. Starting from the doctor’s professional ethics, it is necessary to not only abide by the medical scientific guidelines and professional ethics, but also take into account patients’ wishes and expectations, use practical wisdom to balance the measurement of medical benefits and risk, and make correct and appropriate scheme suitable for medical cases, with a view to achieving good medical effect. Patients’ good wishes for medical treatment are limited by the development degree of medical science and technology. A stable and mature doctor-patient relationship needs to be oriented towards fulfilling others, everything except oneself, and oneself. It is necessary to stick to the professional ethics of doctors as professionals, vigorously advocate professional ethics in performing their duties for the sake of obligations, and improve the doctors’ personal practical wisdom and virtue ability. Exploring the practice of medical wisdom from the perspective of medical treatment, grasping the wisdom of medical practice through the coordinated development of medical personal morality and professional ethics to explore the reflection and expression of doctors’ private ethics and professional ethics in promoting the construction of "the art of benevolence".
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Objective:To investigate the present situation of unintended pregnancy within two years postpartum and its influencing factors in China.Methods:Participants who delivered a live birth at 60 hospitals in 15 provinces in the eastern, central and western regions of China during July 2015 to June 2016 were interviewed by using structured questionnaire. Information on occurrence of unintended pregnancy within 2 years after delivery, postpartum contraceptive use, sexual resumption, breastfeeding, and women′s socio-demographic characteristics, and so on, were collected. Life-table analysis, cluster log-rank tests and a 2-level Cox regression model were used for data analysis.Results:A total of 18 045 postpartum women were investigated. The cumulative 1- and 2-year unintended pregnancy rates after delivery were 5.3% (95% CI: 4.5%－6.1%) and 13.1% (95% CI: 11.3%－14.8%), respectively. Cox regression model analysis showed that the risk of unintended pregnancy within 2 years postpartum were increased in younger women, ethnic minorities, women with abortion history, and those who had a vaginal delivery with short lactation time and late postpartum contraceptive initiation (all P<0.01). The risk of postpartum unintended pregnancy was not associated with geographic regions and hospitals where women gave a birth (all P>0.05). Conclusions:In China, the risk of unintended pregnancy within 2 years after delivery is relatively high. Service institutions and service providers should improve the quality of postpartum family planning services, promote the use of high effect contraceptive methods, and educate women to use a method at the time of their sexual resumption or even before.
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Objective To analyze the efficacy of entecavir (ETV) combined with Peg IFNα-2b in chronic hepatitis B ( CHB) patients with low levels HBsAg following initial ETV treatment.Methods Sixty-nine CHB outpatients achieving serum HBsAg ＜2 000 IU/mL and HBV DNA＜100 IU/mL following initial ETV treatment in Pujiang People's Hospital and the First Affiliated Hospital of Zhejiang University School of Medicine from January 2014 to January 2016 were enrolled.Patients were randomly assigned in two groups: 39 patients in combination group received ETV (0.5 mg/d ) and Peg IFNα-2b (1.5 μg· kg－1· week －1, hypodermic injection), and 30 patients in ETV group received ETV (0.5 mg/d) alone.Serum HBsAg quantification, negative conversion rate of HBsAg and HBeAg , and levels of aminotransferase (ALT) were measured at baseline , 12th, 24th, 48th, 72th and 96th week after treatment.Results The levels of HBsAg in the combination group decreased gradually with the prolongation of therapy , which were lower than those in ETV group 24 week after treatment (Z＝－2.566,P＜0.05),and at 48th, 72th and 96th week (Z＝－3.499,－3.825 and －3.864,P＜0.01).Clearance of HBsAg appeared in the combination group at 24th week,the clearance rates were 7.70%(3/39) and 28.20%(11/39) at 24th and 96th week, respectively;while the clearance of HBsAg occurred in ETV group at 96th week, the clearance rate was only 3.30%(1/30).The negative conversion rates of HBsAg in combination group were higher than those in ETV group at 48th,72th and 96th week (P＜0.05 or＜0.01).In the combination group, there were 11 cases of clinical cure , 11 cases of clinical efficacy and 17 cases of clinical effectiveness , while there were 1, 1 and 28 cases in ETV group,respectively.The treatment effect of the combination group was better than that of ETV group(χ2＝18.496,P＜0.01).Serological conversion rates of HBeAg were 30.00%(6/20) and 65.00%(13/20) in combination group at 12th and 96th week, while those were 11.11%(2/18) and 22.22%(4/18) in ETV group at 48th and 96th week.There were significant differences in the HBeAg serological conversion rates at 12th, 24th, 72th and 96th week between two groups (P＜0.05 or ＜0.01). The levels of ALT in combination group increased at 12th and 24th week, which had significant difference compared with ETV group (Z＝－1.236 and －2.658,P＜0.05), and the ALT levels gradually declined 48 week after treatment in combination group and there were no statistical differences between two groups at other time points.The ETV combined with Peg IFNα-2b and low baseline HBeAg levels were associated with the clearance rate of HBsAg (both P＜0.01).Conclusions CHB patients with low HBsAg levels following initial ETV monotherapy can achieve high negative conversion rate of HBeAg and HBsAg with the combination treatment of ETV and Peg IFN α-2b.
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Objective To investigate the clinical application significance of flow cytofluroometric(FCM ) antibiotic susceptibility test for A .baumannii in vitro .Methods The sensitivity to Ampicillin/Sulbactam ,Levofloxacin ,Meropenem ,Cefotaxime of an Esch‐erichia coli standard strain and 66 isolates of A .baumannii were tested with FCM by using propidium iodide as a fluorescent probe . The survival rates of the bacteria in the culture after treatment with different dosages of the antibiotics were determined according to the fluorescence strength .The MIC value of the antibiotics against the 66 strains were judged with FCM ,compared with microdi‐lution and VITEK methods .Results The antibiotic resistant strains number of sultamicillin ,levofloxacin ,meropenem and cefo‐taxime sodium were 35 ,30 ,13 and 38 respectively in flow cytofluorometric antibiotic sensitivity test(FCST) of 66 strains of A .bau‐mannii .There was no significant difference(P>0 .05) compared with the antibiotic susceptibility results by the methods of VITEK instrument and microdilution by measuring with χ2 test respectively .Conclusion The established method of FCST for A .baumannii is suitable for dectecting bacterial drug‐sensitivity ,which is more rapid ,accurate and objective .
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BACKGROUND:In recent years,artificial cervical disc replacement surgery as a new method for the treatment of cervical disease has gradualy been accepted and understood,but relevant complications have gradualy attracted attention.OBJECTIVE:To investigate the clinical outcomes of artificial cervical disc replacement in the treatment of cervical disease and the range of motion of the replacement segment.METHODS: A total of 25 patients with artificial cervical disc replacement in the treatment of cervical spondylosis,who were treated in the Department of Orthopedics,Air Force General Hospital of Chinese PLA from August 2006 to April 2012,were enroled in this study,including 15 males and 10 females,aged 31-76 years,averagely 51.04 years.There were 6 cases of double segments and 19 cases of single segment.They were folowed up for 24 to 93 months.Clinical results were assessed using the Japanese Orthopaedic Association score,cervical dysfunction index and pain visual analog scale scores.Imaging was used to observe range of motion,cervical curvature,heterotopic ossification,and degeneration of adjacent segments.RESULTS AND CONCLUSION:Neurological function in al patients was improved to different degrees.One case suffered from mild heterotopic ossification,but no clinical symptoms were found.No significant difference in range of motion of surgical segment,and range of motion of upper and lower adjacent segments was detected between pre-replacement and final folow-up results (P＞0.05).No significant difference in range of motion of C2-C7 was found between pre-replacement and final folow-up results (P＞0.05).Japanese Orthopaedic Association score,cervical dysfunction index and pain visual analog scale scores were significantly improved during final folow-up compared with pre-replacement (P＜0.05).These results indicated that artificial cervical disc replacement in the treatment of cervical disease can achieve better clinical efficacy,can keep the range of motion of replacement segment and avoid the accelerated degeneration of adjacent segments.
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Objective To evaluate the clinical efficacy of Clostridium butyricum tablets in treatment of diarrhea in patients with hepatitis B-related liver cirrhosis.Methods Eighty-seven patients with hepatitis B-related liver cirrhosis and diarrhea were collected from Pujiang People' s Hospital in Zhejiang province during January 2011 and May 2013.According to random number table,patients were divided into Clostridium butyricum treated group (n =44) and control group (n =43).Both groups were given antiviral,liver support,jaundice-relieving and fluid infusion treatments,while patients in Clostridium butyricum group were given Clostridium butyricum tablets (2 tables per time,3 tables per day for 4 weeks) additionally.Diarrhea remission time,improvements in liver function and the complications were observed.Differences in measurement data were compared with t test,and enumeration data were compared with x2 test or rank-sum test.Results The total effective rate in Clostridium butyricum group was 95.45％ (42/44),while that in control group was 74.4％ (32/43) (Z =2.82,P ＜ 0.05).After 4 weeks of treatment,the improvements of alanine aminotransferase (ALT),aspartate transaminase (AST),total bilirubin (TBil),albumin (Alb) and Child-Pugh (CTP) score in Clostridium butyricum group were more marked than those in control group (t =2.13,2.57,4.83,5.93 and 3.30,P ＜ 0.01).Hepatic encephalopathy occurred in 2 patients in control group and none in Clostridium buayricum group.Conclusion Clostridium butyricum has significant curative effect on diarrhea in patients with hepatitis B-related liver cirrhosis,and it can also improve liver function and reduce the incidence of hepatic encephalopathy.
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Objective To evaluate the immune effect of combined immunization for newborns of pregnant women with HBeAg-negative chronic hepatitis B.Methods Three hundred and seventy-five cases of children given birth by 326 cases of HBeAg-negative HBV-infected pregnant women were enrolled in this study.The usage of hepatitis B immunoglobulin (HBIG) during pregnancy,mode of delivery,the child's immunization measures after the birth and feeding patterns were recorded,and compared the HBV markers.Results All of 375 cases of children were given HBIG after delivery for 12 h,352 (93.9％) cases of children were given the first time of hepatitis B vaccines(HepB) after delivery for 24 h,and 23 (6.1％) cases of children were delayed because of all kinds of neonatal disease,but they were given vaccination after delivery for 7-42 d.Two hundred and thirty-six cases of cord blood were detected for HBV markers,39 (16.5％) cases were HBsAg positive,197 (83.5％) cases were HBsAg negative.The positive rate of anti-HBs and the meta-concentration of anti-HBs in the child with HBsAg positive and HBsAg negative of cord blood had no significant difference (P ＞ 0.05).The positive rate of anti-HBs of children whose mothers used HBIG or not during pregnancy were 63.5％ (47/74),59.8％(180/301).The positive rate of anti-HBs in cesarean section group and the nature delivery group were 65.2％ (103/158),57.1％ (124/217).The positive rate of anti-HBs in breast feeding,mixed feeding and artificial feeding group were 62.0％ (119/192),58.9％ (63/107),59.2％(45/76).There was no significant difference(P ＞ 0.05).Conclusions After normal HBIG combined HepB,different mode of delivery,feeding,third trimester whether given HBIG have no effect on the newborns of pregnant women with HBeAg-negative chronic hepatitis B.
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Objective To further research the urinary monitoring of the maternal thyroid functional status ,the levels of urine thyroid hormones were analyzed during pregnancy .Methods This study recruited 30 cases of healthy pregnant women at 9-12 ges-tational weeks .Their random urine specimens were collected every four weeks until delivery .The concentrations of urine thyrotro-pin(uTSH) ,urine free triiodothyronine(uFT3) and urine free tetraiodothyronine(uFT4) were detected by electrochemical lumines-cence immunoassay(ECLIA) .The urine retinol binding protein(uRBP) was detected by enzyme immunoassay (EIA) .After correc-ted by uRBP ,the statistical analysis was done to analyze the variation of the ratio of uTSH and uRBP (uTSH/uRBP) ,the ratio of uFT3 and uRBP(uFT3/uRBP)and the ratio of uFT4 and uRBP(uFT4/uRBP)during pregnancy .Results The median levels of u-rine thyroid hormone parameters were obtained from the healthy pregnant women every four weeks and were compared among dif-ferent stages .The difference of uFT3/uRBP and uFT4/uRBP was statistically significant (F= 6 .222 ,P< 0 .05 ;F= 5 .078 ,P<0 .05) ,and the levels of them varied linearity during pregnancy (F=27 .480 ,P<0 .05 ;F=23 .959 ,P<0 .05) .The difference of uT-SH/uRBP had no statistical significance(F=2 .731 ,P=0 .054) .Conclusion After corrected by uRBP ,the levels of uFT3 and uFT4 of healthy pregnant women decreased linearity among different gestational stages ,and the levels of uTSH had no noticeable change .
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10.3969/j.issn.2095-4344.2013.26.005
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@#ObjectiveTo investigate the clinical efficacy of the fixation of elderly fracture of proximal humerus with locking compression plate(LCP) by mini-incision approach from lateral shoulder.Methods31 elderly patients suffered from elderly fracture of proximal humerus were treated with locking compression plate(LCP) by mini-incision approach from lateral shoulder, male 13 cases, female 18 cases; aged from 56 to 72, average 62-8 years old; fractures according to Neer classification: type Ⅱ(8 cases), type Ⅲ (19 cases), type Ⅳ (4 cases). Cause of injuries: traffic accident (9 cases), falling (20 cases), other injuries(2 cases).ResultsThe patients were followed up 6 to 36 months, an average of about 24 months. Fracture healing time was 2-2 ～ 6-4 months, on average 3-7 months; No wound infection occurred. Post-operative functional score (Neer score) revealed: excellent(18 cases), good (11 cases), fair (2 cases), the ratio of excellent(18 cases), good (11 cases) was 93-5%. ConclusionFixation of elderly fracture of proximal humerus with locking compression plate(LCP) by minimally invasive approach from lateral shoulder is a safe, reliable and minimally invasive procedure with good reduction and stable fixation. Early post-operative functional exercise may be permitted for preventing shoulder joint adhesion.
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Objective To determine the effect of Vibrio vulnificus cytolysin (VVC) inducing ap-optosis in human umbilical vein endothelial cell(HUVEC) and its possible mechanism. Methods The en-tire vvhA gene that encoding VVC from V. vulnificus strain GTC333 was amplified by PCR and sequenced af-ter T-A cloning. E. coli BL21DE3pET-42a-vvhA, a prokaryotic expression system of the vvhA gene, was then con-structed. Ni-NTA affinity chromatography was applied to purify the target recombinant protein rVVC, and SDS-PAGE plus Bio-Rad Agarose Image Analyzor were used to measure the output of rVVC and to determine the purity of rVVC extract. The activity of rVVC dissolving rabbit erythrocytes was detected by hemolysis test. DPNH chromotometry and TphBNa chromotometry were performed to examine the contents of LDH and K+ in the supernatants of rVVC-treated HUVEC cultures, respectively. The effect of rVVC inducing apepto-sis of HUVEC was detected by flow cytometry, rVVC was labeled with FITC and the location of FITC-labe-ling rVVC in HUVEC was observed by laser canfocal microscopy. Results The cloned whA gene had 96.09% and 98.26% similarities of nucleotide and amino acid sequences compared to the corresponding se-quences in GenBank. rVVC, with a dosage of 1 μg/ml, could dissolve rabbit erythrocytes (P<0.01). 10 μg/ml rVVC was able to promote the increases of K+ content (P<0.01) but no change of LDH content could be found in the cell supernatants. HUVEC was apoptotic after the cell was treated with 1～100 μg/ml of rVVC for 2 h. In the 5～240 min duration of co-incubation of FITC-labeling rVVC and HUVEC, the rV-VC gradually moved from surface to inner side of the membrane and then entered the cytoplasms. When FITC-labeling rVVC treated HUVEC for 30 min, most of the rVVC was found to be intracellular location. Conclusion rVVC has cytolytic activity. VVC has an ability to enter HUVEC and causes injury of HUVEC via inducing apoptosis, which may be the major pathogenic mechanism of VVC.