The co-existence of physician-patient disharmony and the high rate of cesarean section suggest that there must be some internal relationship between the two medical phenomena.The physician-patient disharmony not only increases the rate of non-indicative cesarean section,but also leads to artificial expansion of the cesarean section indicators.Building up a harmonious physician-patient relationship is an important safeguard to reduce the rate of cesarean section and protect the benefits of mothers and infants.

Objective To investigate the immunoreactivity of platelet-derived growth factor-A (PDGF-A) and its receptor at human and mouse neuromuscular junctions and to explore their regulatory effects on neuromuscular junctions. Methods Specific polyclonal antibodies were used to detect PDGF-A and PDGF a-receptor expression. Double immunohistochemistry for platelet-derived growth factor and the acetylcholine receptor was performed on normal human muscle biopsy specimens. Double fluorescence labeling was applied to detect immunoreactivity for PDGF-A, its receptor and acetylcholine receptors. Results PDGF-A and its receptor was closely co-localized with acetylcholine receptors at human and mouse neuromuscular junctions. Conclusion PDGF-A and its receptor concentrated at human and mouse neuromuscular junctions. PDGF might be involved in the interaction between the presynaptic and postsynaptic components, PDGF-A and its receptor might play regulatory role in signaling at neuromuscular junctions in normal muscle.

Objective To investigate the effect of ERK in apoptosis of neuron induced by endotoxemia,provide the theory basis for the early intervention. Methods Wistar rats aged 10 day were randomly divided into two groups:LPS group and NS group. Neuron apoptosis at 6、12、72 h after abdomen injection were detected by TUNEL method, the expressions of ERK were measured by immunohistochemial method.Results ( 1 ) apoptosis cell appeared at 6 hour in LPS group, but the apoptosis index showed no difference from NS group( P ＞ 0. 05 ). The apoptosis cell obvious increased at 12 hour, peaked at 72 hour( P ＜ 0. 05 ,P ＜0. 01 ). (2) As compared with NS group, the expression of ERK increased at 6 h ( P ＜ 0. 01 ), obviously decreased at 12 h(P ＜0. 01 ) ,and reversed to the level of NS group at 72 h(P ＞0. 05). Conclusion LPS can induce the neuron apoptosis in young rats, the ERK is activated and could play role in apoptosis.

Objective To explore the diffusion-weighted magnetic resonance imaging (DWI) and apparent dispersion coefficient(ADC) value in cerebral infarction diagnosis and judgment of cerebral infarction outcome and staging of the value.Methods According to different stages,26 patients were divided into 3 phases,phase Ⅰ (6 ～72 h) had 11 cases,phase Ⅱ (4 ～ 10 d) had 12 cases,phase Ⅲ (10 d later) had 9 cases,of which 3 cases were reviewed,3 cases were recurrence of cerebral infarction.Each patient's MRI included T1 weighted imaging,T2 weighted imaging,DWI and ADC sequence scan image reconstruction,the ADC map obtained one regions of interest (ROI),and the mean ADC value of ROI were calculated,the average ADC value of the corresponding contralateral area were also calculated by the same method,and then the mean relative ADC value were calculated.Results DWI image of all cases showed high signal,11 cases showed high signal and 1 case showed low signal in phase Ⅱ.In phase Ⅲ,1 case showed normal signal and 1 case showed high signal,2 cases showed mixed signal,1 case were reduced,and the rest were all low signal.Compared with the contralateral corresponding region,the average ADC values were reduced in phase Ⅰ.The infarction average ADC values were 0.434 × 10 3mm2/s,0.653 × 10-3mm2/s,1.600 × 10-3mm2/s in phase Ⅰ,Ⅱ,Ⅲ respectively,and the average ADC values of contralateral corresponding region were 0.938 × 10-3 mm2/s,0.814 × 10-3 mm2/s,0.757 × 10-3 mm2/s respectively; the mean relative ADC values were (51.5 ±16.8)％,(79.2 ±30.0)％,(210.9 ±45.1)％ in phase Ⅰ,Ⅱ,Ⅲ respectively (P ＜ 0.05).Conclusion ADC value of cerebral lesions area and relative ADC value of the variation in time provides an objective basis for the diagnosis of DWI,contributes to timely and accurately determine the age of cerebral lesions and pathophysiology of the changes.

Objective To investigate the serum cystatin C(Cys C)levles in different age and sex health physical examination people,and to analyze the correlation between different ages,different genders and Cys C levles. Methods 648 healthy subjects checked with physical examination were selected.611 patients with normal renal function were selected.The serum Cys C and Cr concentrations were determined and statistically analyzed according to different age or gender groups.The serum Cys C and Cr concentrations of other 37 patients with abnormal renal func-tion were detected and compared with normal renal function people in the same ages.Results There were no signifi-cant differences in serum CysC levels between men and women in different ages and normal renal function people(t =2.449,P =0.092;t =0.176,P =0.872;t =2.030,P =0.135;t =2.376,P =0.098;t =1.549,P =0.219;t =1.732,P =0.182;t =1.095,P =0.353;t =1.732,P =0.182;t =2.449,P =0.092;t =2.611;P =0.080).There were significant differences in serum Cys C level between men,women and combined with normal renal function(F =5.662,5.615,7.253,all P <0.05).Taken the linear correlation analysis by age with serum Cys C level among men, women and combined with normal renal function groups,the results showed that had positive correlation(r =0.525, 0.511,0.522,all P <0.05 ).Renal function of different genders in the health physical examination people over 50 years of age appeared serum Cys C positive persons,and the positive rate of each gender group increased alone with the increase of age(F =7.324,7.341,7.452,all P <0.05).The Cys C,Cr content and positive rate of renal function in health physical examination people were significantly lower than abnormal renal function people (t =31.080, 15.472;χ2 =17.043,34.105;all P <0.05).Conclusion There is an evident positive correlation in health physical examination people between serum Cys C level and the ages,and are increased alone with increase of age,which is increasing evidently alone with increase of age,while has no correlation with gender.

Objective To investigate the effect of vascular inner diameter and artery flow velocity on the flow of internal arteriovenous fistula. Methods Sixty-two patients received the operation of internal fistula were enrolled. According to the inner diameter (Group A: d ≤ 1.5 mm, Group B: 1.5 mm < d ≤ 2.0 mm, Group C: 2.0 mm < d ≤ 3.0 mm, Group D: d > 3.0 mm), the patients were divided into four groups in terms of artery flow velocity (Group a: v ≤ 20 cm/s, Group b:20 cm/s < v≤50 cm/s, Group c:50 cm/s < v ≤ 100 cm/s, Group d:v > 100 cm/s), the differences of fistula and dialysis flow for two months were analyzed among various groups. Results Compared with Group B/b, patients in Group A/a had higher risk of operation failure, with lowered inner fistula flow and dialysis flow. In terms of inner venous diameter , there were significant differences between Group B and C. Conclusions It is not recommended to carry out the inner vascular fistula operation. Followed with the thickening and increasing of inner artery diameter and artery flow , the inner fistula flow and the dialysis flow increase. The inner venous diameter has no significant impact on the inner fistula flow.

Objective To identify the relationship among serum 25-hydroxyvitamin D[25(OH)D] level, chronic inflammation state and malnutrition in maintenance hemodialysis (MHD) patients. Methods The serum 25 (OH)D level of 119 patients on MHD was detected. All the patients were divided into three groups according to the serum 25(OH)D level. Vitamin D deficiency: 25(OH)D ≤ 15 ng/mL, vitamin D insufficiency: 15 ng/mL <25(OH)D ≤ 30 ng/mL, vitamin D normal: 25(OH)D > 30 ng/mL. Inflammatory factor and nutritive index were compared among the three groups. Result The average of serum 25 (OH)D level was 3.4~45.3 ng/mL (22.5~14.8 ng/mL), and the prevalence of 25 (OH)D deficiency and insufficiency was 88.2%. Significant differences existed in age, inflammatory factor (IL-6, TNF-α, CRP) and nutritive index (Alb, PA, SGA) between 25(OH)D deficiency, insufficiency groups and normal group (P<0.05). Conclusion The serum 25(OH)D level is possibly related to the malnutrition in MHD patients. It may inhibit chronic inflammation state , in which it can promote state of nutrition of MHD patients.

OBJECTIVE To evaluate risk factors of the death among lung cancer patients with nosocomial pneumonia.METHODS A total of 312 lung cancer patients with nosocomial pneumonia in our hospital were retrospectively analyzed.RESULTS Eighty-seven patients died and remaining 225 patients were cured finally.Risk factors by multivariate analysis were more than 62 years old(OR 1.75,95%CI 1.06-2.98),metastatic disease(OR 9.24,95%CI 5.21-16.17),bacteria/fungi infection(OR 2.31,95%CI 1.15-4.67),and lower serum albumin concentration(OR 1.87,95%CI 1.08-3.13).CONCLUSIONS Older,metastatic diseases,double infections and lower serum albumin concentration are the risk factors correlated with the mortality among lung cancer patients with nosocomial pneumonia.

Objective To study the factors influencing the recurrence of aggressive fibromatosis(AF) patients.Methods Analyze clinical features and find out factors affecting AF recurrence with univariate and multivariate analysis. Results One hundred and three AF patients were analyzed. Diameter of all the masses was (7.84?5.62)cm. 98.2% of all patients received surgery and radical resection rate is 79.4%. First recurrent time after surgery of male and female is (1563?377) and (2117?3704) days for male and female cases respectively,it's (2723?461),(657?262),(2090?499),(812?220) and (721?234) days for that of abdomen wall、head and neck(H & N),deep mass,joints and chest wall. Recurrent time is (2232?271) and (1347?267) days for those with or without surgery history patients. Univariate analysis showed that gender,tumor site and surgery history of tumor site are prognostic factors of tumor recurrence. Multivariate analysis suggest that only surgery history of tumor site is an independant prognostic factors of AF recurrence after surgery. Conclusion Gender,tumor location and surgery history of tumor site can be valuable to predict postsurgery recurrence of AF.

Objective To compare the noxious stimulations induced by insertion of Proseai laryngeal mask airway(PLMA)and classic laryngeal mask airway(CLMA)in children.Methods Forty-seven ASA Ⅰ or Ⅱ children,aged 3-12 yr and undergoing surgery under general anesthesia,were randomly divided into 2 groups:PLMA group(group P,n =23)and CLMA group(group C,n =24).General anesthesia was induced with target-controlled infusion(TCI)of propofol.When the effect-site concentration of propofol was equal to the plasma concentration predetermined.PLMA or CLMA insertion was attempted.The target plasma concentration of propofol was predetermined according to Dixon's up-down method,with 0.2 μg/ml as a step size.The initial target plasma concentration of propofol was 6 μg/ml and 4.4 μg/ml for groups P and C,respectively.The preedetermined target plasma concentration of propofol and the satisfaction of insertion conditions for each child were recorded.Results The 50％ effective concentration(EC50)of propofol to achieve satisfied condition of PLMA and CLMA insertion were 5.87(95％ CI,5.62-6.11)and 4.53(95％ C1,4.38-4.69)μg/nl,respectively,and the difference was significant(P ＜ 0.01).Conclusion The noxious stimulation induced by insertion of PLMA in children aged 3-12 years is stronger than that of CLMA.