Nowadays doctor-patient conflicts have benn a focus problem,which the important reason is "trust crisis"between doctors and patients.Doctor-patient trust is the guarantee of medical profession.It is the key to build binding mechanism of sincerity and trust in hospitals,promote humanistic accomplishment and medical ethics accomplishment of medical professinal.

Objective: To explore the effects of acupuncture on nutritional status in patients in a persistent vegetative state. Methods: A prospective randomized controlled trial was designed. A total of 66 patients in a persistent vegetative state were randomized into a control group and an observation group, with 33 cases in each group. The control group was given conventional treatment plus enteral nutrition support. The observation group was treated with additional Tiao Shen Jian Pi acupuncture therapy (acupuncture for spirit-regulating and spleen-invigorating) based on the same interventions in the control group. Both groups were treated for 8 weeks. The levels of total protein (TP), prealbumin (PA), albumin (Alb), and hemoglobin (Hb) were measured before and after treatment. The upper arm circumference and skinfold thickness of triceps brachii were measured. And the intestinal flora and fecal short-chain fatty acids contents were determined.Results: After treatment, the levels of TP, PA, Alb, and Hb in the control group were decreased (P<0.05), while in the observation group, compared with those before treatment, the levels of TP, PA, Alb, and Hb had no statistical differences (P>0.05), and the levels were all higher than those in the control group (P<0.05). The upper arm circumference and skinfold thickness of triceps brachii in both groups decreased (P<0.05), and the values of these two items in the observation group were higher than those in the control group (P<0.05). In the control group, the contents of Bifidobacterium and Lactobacillus in feces decreased (P<0.05), and the content of Enterococcus increased (P<0.05). In the observation group, the contents of Bifidobacterium and Lactobacillus in feces increased (P<0.05), and the content of Enterococcus decreased (P<0.05). The differences between the two groups were statistically significant (P<0.05). In the control group, the total content of fecal short-chain fatty acids and the contents of acetic acid and butyric acid in feces decreased (P<0.05). In the observation group, the total content of fecal short-chain fatty acids and the contents of acetic acid and butyric acid in feces increased (P<0.05) and were all higher than those in the control group (P<0.05). Conclusion: Acupuncture can improve nutrition-related blood indicators in patients in a persistent vegetative state and delay the decrease of upper arm circumference and skinfold thickness of triceps brachii, which may be related to the regulation of intestinal flora and fecal short-chain fatty acids contents.

Objective: To observe the clinical efficacy of warm needling moxibustion plus lumbar traction for lumbar disc herniation (LDH) and its effect on Oswestry disability index (ODI) score, present pain intensity (PPI) score, and the degree of straight leg raising.Methods: A total of 146 patients with LDH were randomized into a combination group and a control group by the random number table method, with 73 cases in each group. The control group was treated with lumbar traction, and the combination group was treated with lumbar traction plus warm needling moxibustion. The curative efficacy of the two groups was compared. Also, the lumbar function, pain, straight leg raising degree, and inflammatory factor levels before and after treatment were compared. Results: The total effective rate of the combination group was 93.2％, which was higher than 78.1％ of the control group (P<0.05). After treatment, the lumbar ODI score, the PPI scores of lumbar pain and lower-limb pain, tumor necrosis factor (TNF)-α and interleukin (IL)-6 levels, and straight leg raising test score in both groups were significantly decreased (P<0.05). The Japanese Orthopaedic Association (JOA) score significantly increased (P<0.05). The improvements of the above items in the combination group were all superior to those in the control group (P<0.05). Conclusion: Warm needling moxibustion plus lumbar traction in the treatment of LDH can improve lumbar function, relieve pain, and reduce inflammatory response of the body.

Objective: To explore the effects of acupuncture combined with Brunnstrom staging on upper-limb motor function, cerebral arterial blood flow velocity, and brain function remodeling after stroke. Methods: A total of 77 patients after stroke were selected between January 2017 and December 2019 to perform a prospective study. All cases were divided into an observation group and a control group by the random number table method. Both groups were treated with conventional symptomatic treatment for stroke and functional exercise according to the Brunnstrom staging. The observation group was treated with additional acupuncture treatment based on the Brunnstrom staging therapy. The therapeutic efficacy was evaluated after six-week treatment. The traditional Chinese medicine (TCM) symptom scores of dizziness, headache, limb numbness, and language disorders before and after the treatment in the two groups were compared. According to the Fugl-Meyer motor function assessment (FMA), the upper-limb motor function before and after the treatment was compared. And the average systolic blood flow velocity of the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) in the two groups before and after the treatment were compared. According to the modified Edinburgh-Scandinavia stroke scale (MESSS), the nerve function before and after the treatment was compared. Results: The total effective rate of the observation group was 94.9％, significantly higher than 79.0％ of the control group (P<0.05). After the treatment, the TCM symptom scores of dizziness, headache, limb numbness, and language disorders in both groups decreased, and the scores in the observation group were all significantly lower than those in the control group (P<0.05). The FMA score of upper limbs in both groups increased, and the score in the observation group was significantly higher than that in the control group (P<0.05). The average systolic blood flow velocities of the ACA, MCA and PCA in both groups increased, and were significantly higher in the observation group than in the control group (P<0.05). The MESSS score in both groups decreased, and the score in the observation group was significantly lower than that in the control group (P<0.05). Conclusion: Acupuncture combined with Brunnstrom staging is effective for patients after stroke. It can effectively improve the upper-limb motor function and cerebral artery blood flow velocity, promote brain function remodeling, and restore nerve function.

Objective: To observe the clinical efficacy of Tuina (Chinese therapeutic massage) plus Shen Ling Bai Zhu San for pediatric diarrhea due to spleen deficiency.Methods: A total of 105 children with diarrhea due to spleen deficiency were selected and randomized into two groups by the random number table method. Fifty-two cases in the control group were treated with oral Shen Ling Bai Zhu San, and 53 cases in the observation group were treated with additional Tuina treatment. The clinical efficacy was evaluated after treatment, and the changes of traditional Chinese medicine (TCM) symptom scores were observed. Results: During the trial, there were three dropouts in the observation group, and two in the control group. After the treatment, the total effective rate was 100.0％ in the observation group, and 90.0％ in the control group. The difference between the two groups was statistically significant (P<0.05). The scores of primary and secondary symptoms, and the total scores of TCM symptoms in both groups were significantly lower than those before treatment (P<0.05). And the scores of primary and secondary symptoms, and the total score of TCM symptoms in the observation group after treatment were lower than those in the control group (P<0.05). There were no obvious adverse reactions in either group during the treatment. Conclusion: Tuina plus Shen Ling Bai Zhu San has a better therapeutic effect in treating pediatric diarrhea due to spleen deficiency than Shen Ling Bai Zhu San alone.

Objective To study the influence of blood glucose, blood lipids and other cerebral infarction risk factors in the mean platelet volume (MPV). Methods A total of 562 patients with cerebral infarction and type 2 diabetes mellitus (DM) and 216 cerebral infarction patients without DM (non-DM) were included in this study. The platelet parameter of peripheral blood and other laboratory indexes were detected including platelet count (PLT), MPV, platelet distribution width (PDW), plateletcrit (PCT), fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL-C), low density lipoprotein (LDL-C) and very low density lipoprotein (VLDL-C), urea nitrogen (BUN), creatinine (Cr), uric acid (UA), high-sensitivity C-reactive protein (hs-CRP) and homocysteine (HCY). The patients were scored by the National Institute of Health stroke scale (NIHSS) after hospitalization. The MPV changes in patients with cerebral infarction were observed, and different influences of blood glucose, blood lipids to MPV were analysed. Results Values of FBG, HbA1c, TC, TG, LDL-C, BUN, UA, HCY, hs-CRP, and NIHSS were significantly higher in DM group than those of non-DM group. The score of NIHSS was significantly higher in DM group than that of non-DM group. The level of HDL-C was significantly lower in DM group than that of non-DM grou. The MPV was significantly higher in DM group than that of non-DM group [(9.60 ± 1.35) fL vs. (9.27 ± 1.01) fL, P<0.05). There was a positive correlation between MPV and FBG, HbA1c, hs-CRP, WBC, VLDL-C and NIHSS, r=0.438, 0.410, 0.336, 0.164, 0.321 and 0.249 (P<0.05). Multiple regression analysis showed that FBG, VLDL-C, HbA1c, hs-CRP and NIHSS were the independent influential factors of MPV (P<0.05). Conclusion The influencing factors of MPV should be controlled in patients with cerebral infarction combined with type 2 diabetes mellitus, reducing the activation of platelet, and delaying the progress of cerebral infarction.

Objective:To investigate the methods and nutritional effects of endoscopic jejunal ac cess for enteral feeding.Methods:106 cases placed jejunum feeding tube were randomly divided into the observation group and the control group,54 cases in the observation group and 52 cases in the control group.43 patients underwent nasogastric enteral nutrition were as the nasogastric tube group.The traditional endoscopic jejunal access method was used in control group,and the modified endoscopic jejunal access method was used in observation group.The operation time,the success rate of indwelling,complications and nutritional indexes were compared among these three groups.Results:The operative time of the observation group and nasogastric tube group was significantly shorter than that of the control group (P ＜ 0.05).The success rate of indwelling was significantly lower in the control group (P ＜ 0.05).There was no significant difference in the incidence of postoperative complications among these three groups (P ＞ 0.05).After intubation and nutritional treatment in all the groups,hemoglobin,plasma albumin and serum albumin levels were significantly improved (P ＜ 0.05).There were no significant differences in nutritional indexes between the observation group and the control group (P ＞ 0.05).The levels of hemoglobin,plasma albumin and plasma prealbumin in nasogastric tube group were significantly lower than those in the observation group and the control group (P ＜ 0.05).Conclusion:Modified endoscopic jejunal access for enteral feeding can effectively shorten the intubation operation time and improve success rate and nutritional indexes.

The neutron activation analysis of a stable isotope (58Fe)was used successfully in the study of iron absorption from different diets in children suffering from iron deficient anemia. The method was correct and convenient, and uninjured to human body. The principle, procedure and the control of errors were also discussed. The iron absorbability of the balance diet,soy protein diet and soy protein diet plus vitamin-C were (group average?SD) 12.0? 3.6%, 10.7?4.7%, and 18,1?3.6% respectively. According to the results and the animal experiments which were reported in another paper, we agreed that soy protein unfavor or reduce the bioavailability of iron from diet, which was made by International Nutritional Anemia Consultative Group (INACG) and others, but it is still a disputing question. The data of iron absorbability from diets in children suffering from iron deficient anemia and the method of neutron activation analysis of a stable isotope (58Fe) have not be seen up to now in China. This paper will be valuable for studing, preventing and treating iron deficient anemia in our country.

In order to clarify the disputing view-points in some publications, that the soy products are whether unfavourable or not to the bioavailability of diet iron, we estimated the relative bioavailability of the iron from soy flour by hemoglobin regeneration method in rats suffered from iron deficiency anemia. In this experiment the ferrous sulfate was used as a standard, wheat flour as a vehicle, and the pig blood powder as a reference substance. The iron content in the regeneration diet fed to rats of each group was 32 ppm in total, and among it 24ppm was originated from (1) soy flour, (2) soy flour plus wheat flour (half and half), (3) pig blood powder, (4) pig blood powder plus wheat flour (half and half), and (5) ferrous sulfate respectively.The experimental results showed that during the 5-week regeneration period the regenerated hemoglobin level of the rats of corresponding groups were (1) 6.6?1.6→9.4?1.7, (2) 7.0?0.9→10.4 ?1.5, (3) 6.4?1.6→ 11.4?1.4, (4) 6.1?0.6-11.1?1.9, and (5) 5.3?1.2-12.8 1.0, thereby the percentage of iron relative bioavailability of five groups were (1)45.4, (2)65.0, (3)74.0, (4)72.0, (5)100.0 respectively. The iron from soy flour showed a lowest bioavailability aalong the different diet sources in our exper-iment, and therefore the iron from soy products was unfavourable to prevent and treat the iron deficiency anemia. We also made some discussions and suggestions in this paper.

Objective To assess the changes in normal-appearing white matter fiber tracts of the brainstem in patients with relapsing-remitting multiple sclerosis (RRMS) quantitatively with diffusion tensor imaging (DTI). Methods Fifty patients with RRMS were recruited, and twenty five healthy volunteers with the same gender and age were selected as controls. Conventional magnetic resonance imaging and DTI was performed. Quantitative indexes as fractional anisotropy (FA) and mean diffusivity (MD) values in the brainstem fiber tracts, including corticopontine tract/corticospinal tract (cpt/cst), superior cerebellar peduncle (scp), middle cerebellar peduncle (mcp), inferior cerebellar peduncle (icp), and medial lemniscus (ml) were measured and analyzed. Results In comparison with controls, decreasing FA values in cpt/cst (L:P=0.030; R:P=0.020), icp (L:P=0.030; R:P=0.037), scp (L:P=0.036; R:P=0.041) and ml (L:P=0.014; R:P=0.035), as well as increasing MD values in cpt/cst (L:P=0.004; R:P=0.046), icp (L:P=0.047; R:P=0.011), scp (L:P=0.021; R:P=0.011) and ml (L:P=0.002; R:P=0.044) were found in patients with RRMS. No significant difference of FA and MD values was found in mcp between patients with RRMS and controls (P＞0.05). None of the MD or FA values in fiber tracts of the brainstem in patients with RRMS was correlated with brain parenchymal fraction (BPF) or T2 lesion volume. Conclusion The relevant abnormalities which were found in normal-appearing white matter fiber tracts of the brainstem in RRMS patients by DTI scanning suggested pathological changes. It is presumed that the changes may be due to demyelination caused by hiding lesions.