Doctor-patient relationship is essentially a kind of trust relationship.From the perspective of economics,the trust between people is based on the cooperative behavior with the intersection of interest.Although the stag hunt game shows that the attitudes of bounded rational individuals on cooperationissues tend to be cautious and suspicious,the practice attribute of doctor-patient interaction enables the two sides to generate socialized cooperation emotion.In reality,the doctor's too much consideration on personal interests,the patients' previous negative medical experience,the particularity of medical market and other issues will hinder the cooperation of doctor-patient and it needs to be solvedtargeted.

Through expounding the definition of effective consent and ineffective consent, this article pointed out that the doctors must identify the ineffective consent cases such as fictive consent that misread the patients′in-tention, presumed consent that extend the patients′intention excessively,imaginative consent that transfer possible consent in the future into actual consent, and the consent that the patients′personality is on nonidentity. It also put forward the problems of achieving effective consent as following:judgement of individual active ability, the consent in the unbalanced doctor-patient relationship, and the consent that kidnapped by sociology.

OBJECTIVETo explore the distribution features of Chinese medical syndromes of rheumatoid arthritis (RA) by literature retrieval.

METHODSPertinent articles on treating RA by syndrome differentiation were retrieved from China National Knowledge Infrastructure Databases (CNKI), VIP Chinese Biomedical Journal Database, Guizhou Digital Library, and Duxiu Chinese Academic Periodicals full papers database from January 2000 to December 2011.

RESULTSA total of 33 documents were recruited covering 4 233 cases. Damp-heat blocking collaterals syndrome occupied the top in the occurrence frequency (20 times, 60.61%), followed by deficiency of Gan and Shen syndrome (18 times, 54.55%), intermingled phlegm and blood-stasis syndrome (17 times, 51.52%), wind-cold-damp impediment syndrome (15 times, 45.45%), cold-damp blocking collaterals syndrome (14 times, 42.42%), wind-damp-heat impediment and deficiency of qi and blood syndrome (10 times, 30.30%), and intermingled cold and heat syndrome (9 times, 27.27%). According to the case number of patients, it was sequenced as damp-heat blocking collaterals syndrome syndrome (768 cases, 18.14%), wind-damp-heat impediment syndrome(666 cases, 15.73%), wind-cold-damp impediment syndrome(584 cases, 13.80%), cold-damp blocking collaterals syndrome syndrome (517 cases, 12.21%), intermingled cold and heat syndrome (415 cases, 9.80%), intermingled phlegm and blood-stasis syndrome (364 cases, 8.60%), deficiency of Gan and Shen syndrome (235 cases, 5.55%),asthenia of healthy energy due to lingering arthralgia syndrome (223 cases, 5.27%). The case numbers of remaining syndromes did not exceed 5%.

CONCLUSIONDamp-heat blocking collaterals syndrome was the main syndrome in RA patients, followed by wind-cold-damp impediment syndrome,wind-damp-heat impediment syndrome,cold-damp blocking collaterals syndrome,intermingled phlegm and blood-stasis syndrome, and deficiency of Gan and Shen syndrome.

Arthritis, Rheumatoid ; classification ; diagnosis ; Humans ; Medicine, Chinese Traditional ; Yang Deficiency ; classification ; diagnosis ; Yin Deficiency ; classification ; diagnosis

ObjectiveTo investigate the association between serum level of osteopotin(OPN) and disease activity of rheumatoid arthritis (RA) patients, and explore the importance of OPN in the pathogenesis of interstitial lung disease (ILD) in RA. MethodsSixty-five RA patients and 20 healthy controls were pros-pectively enrolled. RA patients were divided into active group(n=43) and inactive group(n=22), and ILD groups (n=24) and non-ILD group (n=41). Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of OPN in patients with RA and healthy controls, and the relationship between OPN and other clinical and laboratory findings were analyzed.Results① Serum OPN tended to be significantly higher in RA patients (median, 18.0 ng/ml) than in the healthy controls (median, 14.3 ng/ml), P<0.01; ②The serum level of OPN in RA patients showed a significant positive correlation with the course of disease, numbers of tender joints , ESR and CRP, but no positive relationship was found in number of swollen joints; ③ The serum level of OPN was significantly higher in RA-ILD patients(median, 20.0 ng/ml) than that in non-lLD (median, 17.0 ng/ml, P<0.05). And there was remarkable negative correlation between the concentration of serum OPN and the value of PaO2, but no association was found with pulmonary function %VC and %DLCO. ④ Compared with the non-ILD group, the ILD group had more active disease in terms of tender joint counts and swollen joint counts, ESR, CRP(P<0.01) and the serum titer of RF-IgM,(P<0.05). ConclusionOPN plays a role in the pathogenesis of RA and is related to the disease activity. It may serve as an active disease inflammatory marker of RA . OPN may be involved in the pathogenesis of RA related ILD and is associated with the severity of pulmonary damage.

Objective To study the expression of hepatocyte growth factor (HGF) in placenta from normal pregnancy and pregnancy induced hypertension (PIH) and the effect of HGF on angiogenesis in placenta. Methods Immunohistochemistry was used to determine the location and intensity of HGF staining in placenta from 20 cases of normal pregnancy and 58 cases of mild,moderate and severe PIH groups. HE staining was used in order to count the number of the vessles. Results HGF mostly were expressed in villous core mesenchymal cells,less in decidual cells . Intensity of HGF immnostaining in villous mesenchymal cells was significantly reduced in the severe PIH group compared with the normal group(H=7.395,P=0.003),while there were no statistical differences between the mild,moderate PIH group and the normal group (H=0.869,P=0.351,H=0.017,P=0.896) .The count of vessels reduced in severe PIH (F=10.676,P=0.008). There was positive correlation between the expression of HGF and the count of vessels in villous(r=0.246,P=0 030). Conclusion These results suggested that HGF is secreted mainly by villous core mesenchymal cells in human placenta and the reduction of HGF in PIH may be responsible for the impaired vascularization in PIH.

Objective To evaluate the safety and effectiveness of the Hem-o-lok in retroperitoneal laparoscopic nephrectomy.Methods A total of 178 patients underwent retroperitoneal laparoscopic nephrectomy from November 2003 to November 2006.The operation was performed through 3 lumbar ports.The renal artery and veins were blocked with the Hem-o-lok and then severed.The ureter was cut at the site near the iliac blood vessel.For living donor nephrectomy,the kidney was taken out and infused with 4℃ kidney preserving fluid immediately.Results The operation was successfully completed in all the 178 cases and there was no conversion to open surgery.No Hem-o-lok ligating clips became dislodged.The mean operation time was 100 min(60-200 min),and the mean blood loss was 95 ml(20-200 ml).Complications included renal vein injury in 1 patient and pancreatic tail injury in 1 patient.The mean length of postoperative hospital stay was 5 days(4-8 days).Pathological results showed renal clear cell carcinoma in 65 patients,renal cystadenocarcinoma in 3 patients,renal leiomyosarcoma in 1 patient,renal lymphoma in 1 patient,renal oncocytoma in 2 patients,renal hamartoma in 2 patients,ureteral transitional cell carcinoma in 12 patients,ureteral squamous cell carcinoma in 2 patients,renal pelvis transitional cell carcinoma in 31 patients,renal pelvis xanthogranuloma in 1 patient,renal tuberculosis in 4 patients,accessory kidney in 1 patient,renal calculus in 4 patients,nephrohydrosis in 4 patients,and renal abscess in 1 patient.A total of 136 patients were followed for 1-36 months(mean,25 months),involving 64 patients followed for

OBJECTIVE:To investigate osteogenic and chondrogenic differentiation of adipose-derived stem cells following a short time induction with bone morphogenetic protein 2(BMP-2) or BMP-7.METHODS:The subcutaneous adipose tissue was obtained from adult New Zealand rabbits under aseptic condition,and cultured in vitro with collagenase digestion.All cells were divided into 3 groups:in the BMP-2 group,cells were cultured with medium containing 0.1 g/L vitamin C,10 mmol/L?-sodium glycerophosphate and 10?g/L BMP-2 for 10 minutes,followed by 4-14 days inoculation with density of 18?104 cells per pore.In the BMP-7 group,cells were cultured with BMP-7 with the same methods as BMP-2 group.The cells were cultured with simple culture medium in the control group.RESULTS:Compared to the control group,the number of adipose-derived stem cells,protein level and ALalkaline phosphatase(ALP) activity of BMP-2 and BMP-7 groups was up-regulated 1.78-1.79,1.15-1.95,and 32-40 times,respectively.At days 4 after a 15 minutes induction,the runx-2 gene expression,osteopontin gene,and biglycan gene were increased 1.9,2.2 and 1.3-1.7 folds than that of the control group.Meantime,only the biglycan gene expression was increased 1.3-1.7 folds in the BMP-7 group,the runx-2 gene expression,osteopontin gene was not changed.At day 14 after a 15 minutes induction,there was no alter of runx-2,osteopontin,biglycan,as well as aggrecan gene expression in the BMP-2 group;while down-regulated runx-2,osteopontin,biglycan 1.8,5.0 and 1.7 folds,with increased aggrecan gene in the BMP-7 group.CONCLUSION:Following a short time induction,BMP-2 can stimulate runx-2 and osteogenic expression at 4 days after re-culture,whereas BMP-7 down-regulate genes expression at days 14,yet down-regulate aggrecan mRNA expression.

Objective To evaluate the value of ultrasound-guided mammotome in the diagnosis and therapy of breast tumor.Methods From May 2006 to February 2009,a total of 205 cases diagnosed with breast tumor by physical examination or ultrasonography underwent ultrasound-guided mammotome in our department.In the patients,142 cases had single tumor and 63 cases showed multiple tumors.Among the 205 cases,impalpable lesions were detected by ultrasonography in 58 patients.Mammotome biopsy system with 11 G/8 G needles were used in the operation.After the surgery,pathological examination was carried out,and short-and medium-term follow-up results of the patients were analyzed.Results In the 205 cases,totally 356 tumors were detected.The size of the tumors ranged from 0.3 to 3.5 cm in diameter.The operation time of the patients was 10.2 min in average(1-50 min).After the surgery,22 patients showed bruise in the surgical area,and 19 patients developed hematoma(three of them received puncture of the hematoma).Post-operative pathological examination showed fibroadenoma in 98 cases,breast hyperplasia in 246 cases(154 of them were complicated with fibroadenoma),7 had intraductal papilloma,4 were diagnosed with breast cyst,and 1 showed tubular adenoma.Follow-up was achieved in 132 patients for 2 to 36 months,during the period,residual tumor was detected in 4 patients(3.0%).All the patients were satisfied with the cosmetic results of the surgery.Conclusions Ultrasound-guided mammotome is a minimally invasive procedure that can safely and reliably diagnose and remove breast tumor,particularly multiple tumors and impalpable lesions.The cosmetic results of the operation are satisfying.

Objective To study effect of general anesthesia combined with epidural anesthesia on analgesia and microcirculation in patients undergoing total hysterectomy. Methods 92 patients of total hysterectomy who received therapy were selected, according to random number table,those patients were divided into the observation group (n=42) and the control group (n=48),the observation group received general anesthesia combined with epidural anesthesia, the control group were only given general anesthesia.The operation condition, hemodynamics and stress response before anesthesia(T0), at tracheal intubation(T1), after pneumoperitoneum 10min(T2), after surgery(T3), at extubation(T4) were compared,and postoperative pain (VAS) score was compared. Results There was no significant difference in operation time and fluid volume between the two groups. In the control group,the levels of mean arterial pressure (MAP), heart rate (HR) at the time of T1, T2, T3 were significantly increased(P<0.05), the levels of MAP and HR at the time of T1,T2,T3 in the observation group were lower than the control group(P<0.05). The cortisol (Cor), epinephrine (E), norepinephrine (NE) at the time of T1,T2,T3,T4 in the observation group were lower than the control group(P<0.05). Two groups of patients in the postoperative 12h, 6h, the VAS scores in the resting state and cough state were higher than the postoperative 1h(P<0.05),but the scores in the observation group were lower than the control group(P<0.05). Conclusion General anesthesia combined with epidural anesthesia is well for total hysterectomy,which can maintain hemodynamic stability during surgery, relieve stress reaction, alleviate postoperative pain, it is worthy of application and promotion.

Objective To evaluate the clinical effect of immediate implant restoration in lower posterior teeth . Methods 31 XIVE implants were placed in lower posterior teeth of 31 patients.The temporary fixed resin crowns were fabricated immediately and final restorations were finished in 3~4 months.The control group used nonsub-merged implants and were restored with final crowns in 3~4 months.The tracking survey was taken from 12 to 24 months after final restoration .The patient satisfaction , papilla index score ( PIS ) and implant survival rate were eval-uated between the two groups .Results PIS of patients with immediate restoration reached (2.35 ±0.70) in aver-age compared(1.84 ±0.74) in control group.The patient satisfaction reached (91.5 ±7.5) with immediate resto-ration, compared with VAS score in average of(85.8 ±8.1) in control group.All implants in both groups achieved osseointegration and received 100% survival rate .Conclusion With proper technique in surgical and restoration procedure , immediate restoration after implant insertion in posterior madible has similar clinical success compared with delayed restoration .