The patient-physician relationship can be understood from the two aspects of patients′ trust and patients′ satisfaction.Compared with patients′ satisfaction,dimensions and attributes of patients′ trust indicate to better match with the measuring capacity of patients.Thus,the evaluation of the quality of medical services based on patients′ trust is justified theoretically.The existing literatures assert that the research on patients′ trust could help understand patient-physician relationship and eventually improve the quality of medical services.The conceptual model in this paper entails the concept,dimensions and attributes of patients′ trust.Also,this paper points out its effect on the measurement of the quality of medical services through the comparison of patients′ trust and patients′ satisfaction.

The study of quality control of Chinese medicine has always been the hot and the difficulty spot of the development of traditional Chinese medicine (TCM), which is also one of the key problems restricting the modernization and internationalization of Chinese medicine. Multivariate statistical analysis is an analytical method which is suitable for the analysis of characteristics of TCM. It has been used widely in the study of quality control of TCM. Multivariate Statistical analysis was used for multivariate indicators and variables that appeared in the study of quality control and had certain correlation between each other, to find out the hidden law or the relationship between the data can be found,.which could apply to serve the decision-making and realize the effective quality evaluation of TCM. In this paper, the application of multivariate statistical analysis in the quality control of Chinese medicine was summarized, which could provided the basis for its further study.
Medicine, Chinese Traditional ; standards ; Multivariate Analysis ; Quality Control

ObjectiveTo evaluate the influence of different hemoperfusion (HP) intensity on 7-day and 28-day mortality for patients with paraquat (PQ) poisoning, and examine the factors that may affect the decision of the clinicians to prescribe a high intensity HP.Methods A retrospective cohort study was conducted. The patients admitted to the department of critical care medicine of Anhui Provincial Hospital Affiliated to Anhui Medical University with the diagnosis of PQ poisoning from August 2012 to August 2014, fulfilling the following criteria were enrolled in the study: older than 18 years, interval from ingestion PQ to hospital admission shorter than 12 hours, and receiving HP treatment within 24 hours, and expecting surviving time exceeding 24 hours after admission, and data of the patients available for at least 28 days after admission. Depending on the intensity of HP, patients were assigned to either lower intensity HP group (LHP, defined as receiving HP for less than 4 hours, 2 columns) or higher intensity HP group (HHP, defined as receiving HP longer than 6 hours, 3 columns). Patients' data were retrieved from hospital's electronic database after hospital admission, and the results at 7th day and 28th day were recorded. Multiple logistic regression model was used to determine factors with which the clinician decided to choose the intensity of HP for the patients, and Cox regression model was used to evaluate 7-day and 28-day mortality.Results Data of 60 patients was finally available for this study. LHP group consisted of 28 patients, with a 7-day mortality of 53.6%(15 patients) and 28-day mortality of 64.3% (28 patients); 32 patients were assigned to HHP group with 7-day mortality of 43.8% (14 patients) and 28-day mortality of 62.5% (20 patients). Twenty-eight patients constituted as the HHP group, with higher PQ concentration in plasma, higher incidence of respiratory alkalosis and acute kidney injury (AKI), and higher level of lactate (Lac) compared with LHP group. However, a lower 7-day mortality was observed in the HHP group. Multiple logistic regression model indicated that at admission, interval from ingestion PQ to hospital admission longer than 4 hours [odds ratio (OR) = 1.461, 95% confidence interval (95%CI) = 1.132-1.435,P< 0.001], younger than 50 years old (40-49 years old:OR = 1.397, 95%CI = 1.251-1.703,P = 0.002;< 40 years old:OR = 1.701, 95%CI = 1.253-1.836,P< 0.001), PQ plasma concentration≥ 2 mg/L (OR = 3.140, 95%CI = 1.511-3.091,P< 0.001), white blood cell (WBC)> 10×109/L (OR = 1.222, 95%CI = 1.032-1.275, P = 0.018), Lac> 2.0 mmol/L (OR = 2.392, 95%CI = 2.090-2.734,P< 0.001), AKI on admission (stage 2:OR = 2.350, 95%CI = 2.160-3.910,P< 0.001; stage 3:OR = 2.821, 95%CI = 1.932-3.651,P< 0.001), accompanying hypoxia (OR = 2.420, 95%CI = 2.131-2.662,P = 0.003) were more likely to receive higher intensity of HP. Furthermore when compared with patients survived for 28 days, patients who were older, with higher levels of PQ concentration at admission or after 4 hours of HP, accompanied by AKI, increased serum creatinine (SCr), WBC, Lac, and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score, lower arterial partial pressure of carbon dioxide (PaCO2) and lower pH value were more likely to die. After adjusted for con-variables in COX regression model, HHP was associated with lower 7-day mortality after admission [hazard ratio (HR) = 0.843, 95%CI = 0.732-0.971, P = 0.032], but devoid of lowering effect on 28-day mortality rate (HR = 0.930, 95%CI = 0.632-1.411,P = 0.423). In addition, age> 50 years old (HR = 1.282, 95%CI = 1.050-1.530,P = 0.043), PQ concentration increased by 1 mg/L (HR = 2.521, 95%CI = 2.371-3.825,P = 0.012), AKI on admission (HR = 3.850, 95%CI = 2.071-5.391,P< 0.001), WBC>10×109/L (HR = 1.932, 95%CI = 1.782-2.171,P = 0.006), Lac> 2.0 mmol/L (HR = 2.981, 95%CI =2.210-3.792,P = 0.002), and PaCO2< 35 mmHg (HR = 1.772, 95%CI = 1.483-2.516,P = 0.008; 1 mmHg =0.133 kPa) were independent risk factors for 28-day mortality.Conclusions Though HHP was helpful in lowering mortality rate in patients with PQ poisoning within 7 days, it did not influence on 28-day mortality. Clinicians' decisions on HP intensity need further investigation, and more perfect clinical evaluation system is required for reasonable use of expensive medical resources such as HP.

Objective To evaluate indwelling intrapulmonary artery catheter thromolysis for acute pulmonary embolism.Methods From June 2011 to June 2013 56 cases of acute pulmonary embolism were diagnosed by multi-row spiral CT and admitted at the Department of Vascular Surgery.The average age was (56 ± 11) years.Inferior vena cava filter was implanted and pulmonary angiography,catheter thrombectomy,indwelling pulmonary intraarterial thrombolytic therapy was performed.Postoperatively low molecular weight heparin and warfarin was given,dosage adjusted by prothrombin international normalized ratio at 2-3.Results Mean pulmonary arterial pressure (mPAP) decreased from (43 ± 7) mmHg to (22 ± 6) mmHg (P ＜ 0.05),arterial partial pressure of oxygen (PO2) rose from (49 ± 8) mmHg to (83 ± 9) mmHg (P ＜ 0.05).Clinical symptoms significantly relieved in 51 out of the 56 cases (91％).45 patients were followed up for an average of (15 ± 4) months,with one recurrence.There was no filter migration,vena cava thrombosis,chronic obstructive pulmonary disease and other complications.Conclusions Emergency pulmonary artery indwelling catheter thrombolysis is safe and effective therapy for acute pulmonary thromboembolism.

Objective Pulmonary embolism is a common cardiovascular emergency with the characteristics of high incidence,high mortality.This study compared pulmonary artery catheter thrombolysis with peripheral intravenous thrombolysis for acute pulmonary embolism in the mid-term clinical efficacy.Methods From June 2011 to September 2015,68 patients were given pulmonary artery interventional therapy,54 cases received peripheral intravenous thrombolysis;discharged patients were followed up for 3-12 months to evaluate the curative rate,effective rate,recurrence rate and the incidence of complications.Results Follow up rate was 79.5％.The cure rate of the treatment group was higher than that of the control group (47.3 ％ vs 23.8 ％,P ＜ 0.05);The significant effective rate of the treatment group was higher than that of the control group (81.8％ vs 52.4％,P ＜ 0.05);The incidence of Chronic pulmonary hypertension (1.8％) was lower than that of the control group (16.7％);There was no significant difference in improvement rate,recurrence rate and mortality.Conclusion The medium-term efficacy of pulmonary artery catheter directed thrombolysis is superior to that of peripheral intravenous thrombolysis;it can effectively reduce the incidence of chronic thromboembolic pulmonary hypertension.

Objective To explore the clinical value of sequential endoscopic therapy(SET) in treating severe acute cholangitis (SAC) in the eldly patients. Methods 38 eldly SAC patients were divided into 2 groups:emergency operation group and SET group. The efficacies in the emergency and stable periods were compared between the two groups. SET consisted endoscopic nasobilliary drainge (ENBD)first; after the disease was controlled, endoscopic sphincterotomy (EST) and stone removing by a basket with netting on top were done, and followed by laparoscopic cholecystectomy (LC) in patients with cholelithiasis in the stable period. Results Compared with the emergency operation group, the mortality of SET group reduced from 21.1%to 5.3%,the rate of complications from 57.9% to 15.8%, the preoperative preparation time was shortened from 12.4 hours to 7.6 hours, postoperative recovery time from 6.5 days to 3.5 days,and the period of total treatment from 45 days to 23 days. Conclusions SET is an ideal alternative for eldly SAC patients,it has minimum injury, effectiveness and shorter treatment course.

Objective To develop an intelligent assist order system for parenteral nutrition and embed it into hospital information system,so as to facilitate rational prescription of parenteral nutrition.Methods Comprehensive database,knowledge base and control system of parenteral nutrition orders were set up based on production rule.An intelligent assist order system for parenteral nutrition was designed and developed.Individual energy demand of patients were calculated automatically and compared with doctors' orders of parenteral nutrition.Cation concentration was calculated automatically and controlled for the stability of all-in-one parenteral nutrition admixture.Results This system achieved successful and fast calculation of individual energy demand,over-standard warning of total energy,the ratios of carbohydrates to lipids and non-protein calories to nitrogen,ion concentration,and liquid volume.It also controlled the cation concentration,thus avoiding demulsification.Conclusions The intelligent assist order system for parenteral nutrition can solve the problems of energy calculation and ensure the stability of all-in-one parenteral nutrition admixture.As a result,it can improve the utilization of parenteral nutrition in hospital.

Recently,a fast developing new technology for gene modification named as CRISPR-Cas9 which based on CRISPR-Cas9 system composed of clustered regulatory interspaced short palindromic repeat(CRISPR) and Cas9 nuclease(CRISPR associated system 9,Cas9)has been developed. CRISPR-Cas9 system is a kind of immune mechanism widely found in bacteria and archaea. This mechanism can help bacteria and archaea against exogenous DNA by the approach of specifically breaking DNA. Later,this mechanism was found to be useful for gene modification and gene deletion. At present,this technology has been applied to gene modification and therapy. Many studies have shown that the technology,compared with other genetic technology,has higher efficiency and accuracy,and it has promoted genetic engineering progress. Summarized here is the principle and application advance of CRISPR-Cas9.

Objective To prospectively observe the changes of amplitude-integrated electroencephalogram(aEEG) in neonates with hypoxic-ischemic encephalopathy (HIE).Methods Thirty-five HIE neonates with gestational age of 37 ～ 41 weeks were chosen as HIE group,and all of them were hospitalized in neonatal intensive care unit of Bethune International Peace Hospital from Aug 2011 to Jan 2012.At the same time,40 healthy term neonates were chosen as control group.aEEG monitoring was done within 24 ～ 48 hours after birth with cerebral function monitor (CF3000) and each recording last at least 8 hours.The continuity,sleep-wake cycle,voltage of every aEEG tracing were analyzed.Results (1) The maximal voltage of aEEG tracing in control group was 30 μV,while that in HIE group was 16 μV.The minimal voltage of aEEG tracing in control group was 13 μV,while that in HIE group was 7 μV.The aEEG tracing amplitude both in highest and lowest in HIE group were significantly lower than those in the control group.There were significant differences between them (P ＜ 0.05).(2) There was significant difference of sleep-wake cycling between HIE group and control group[20％ (7/35) vs 100％ (40/40),x2 =51.064,P ＜ 0.05].While there was also significant difference of the continuity of the amplitude between HIE group and control group[31％ (11/35)vs 100％ (40/40),x2 =40.336,P ＜0.05].Conclusion aEEG has some specific changes in neonates with HIE,possiblility it can be used for earlier predicting the occurrence of brain damage after asphyxia and provides good evidence for the early diagnosis and treatment of HIE.

Objective To compare the effects of equivalent dose sufentanil,remifentanil or fentanyl on hemodynamic and cardiac output in the elderly patients during induction of general anesthesia.Methods Ninety elderly patients(ASA Ⅰ ～ Ⅱ) undergoing elective abdominal surgery under general anesthesia were randomly divided into sufentanil group(group S),remifentanil group(group R) and fentanyl group(group F),30 patients in each group.Patients in group S,group R and group F received sufentanil 0.2μg/kg,remifentanil 2μg/kg and fentanyl 2μg/kg Ⅳ,respectively,using an blind method before intubation.SBP,DBP,MAP,HR,CO,CI and SVR were recorded before of anesthesia (T0),immediately after induction (T1),1,3 minutes after tracheal intubation (T2,T3).Changes of SBP and HR during observation were also recorded.Results The MAP and HR in three groups at T1 were significantly lower than those at T0 and decreased significantly in group R than those in group F and S(P ＜0.05).The MAP and HR in group F significantly increased at T1 than T0.The MAP and HR in group R were significantly decreased after tracheal intubation.Compared with the baseline,the MAP and HR in group S at T1,T2,remained unchanged.In group R,there were two patients whose HR were under 50 bpm.In group F,the MAP at T1,T2 were significantly higher than those at T.In group S,there were no significant changes in CO,CI,SVR which were all within normal range (P ＞ 0.05).Conclusion Both sufentanil and remifentanil effectively inhibit the stress response during induction of general anesthesia.At the same time,sufentanil has better hemodynamic stability.