Doctor-patient communication could assist in medical diagnosing , strengthening the confidence of patients and relieving psychological pressure of the medical staff , so that it plays an indispensable role in the process of building a harmonious doctor -patient relationship .Improve the system of doctor -patient communica-tion, set up the third-party supervition of mediation system , convert the mode of thinking with a positive attitude , improve communication skills , correct use communication methods , strengthen the humanistic care and knowledge popularization .Therefore , under the medical model of people-oriented, it should shorten the distance between the doctors and the patients with heart and soul and gradually establish a new harmonious doctor -patient relation-ship with mutual respect , mutual trust , equal communication and cooperation .

Objective To study the adsorption ability of the chitosan and the chitosan film to Cd2+. Methods Under the given condition,different time and different temperature and different beginning concentration of Cd2+, the adsorption rate and capability of the chitosan and the chitosan film were studied. Results The chitosan (or chitosan film) could adsorb Cd2+ quickly at first,however,an hour later,the adsorption rate declined slowly. Adsorption rate increased as the temperature increases. There was significant connection between the beginning concentration of Cd2+ and the adsorption rate and capability of the chitosan(or chitosan film). The adsorption rate of the chitosan (or chitosan film) even reached above 80% when the beginning concentration of Cd2+ was no more than 20 mg/L, whereas the adsorption rate and capability of the chitosan (or chitosan film) declined slowly when enhanced the beginning concentration of Cd2+. The adsorption rate and capability of the chitosan (or chitosan film) obtained a maximum only when the beginning concentration of Cd2+ was about 10 mg/L. The adsorptive ability of the chitosan film to Cd2+ was stronger than that of chitosan under the same condition. Conclusion The biosorption of the chitosan (or chitosan film) to Cd2+ fits the Langmuir equation and the adsorbability to Cd2+ of the chitosan film is stronger compared with chitosanb.

Objective To observe the changes of the depressive behavior and amygdaloid nucleus nerve growth factor(NGF)expression in estro?gen?deprived female rats and explore the possible mechanism and targets of estradiol in depression treatment. Methods A total of 30 adult SD fe?male rats were randomly assigned to 3 groups:sham operation group(SHAM,n=10);ovariectomized group(OVX,n=10)and ovariectomized rats treated with estradiol group(OVX+E,n=10). The behavior changes were observed by tail suspension test(TST)and sucrose preference test (SPT) after 8?week estradiol treatment. Subsequently ,immunohistochemical staining detect NGF expression in amygdaloid nucleus. Results Compared with the SHAM group rats,sucrose preference ratio significantly decreased in SPT(P<0.01),immobile time prolonged in TST(P<0.01),serum estradiol level and amygdaloid NGF expression significantly decreased(all P<0.01). 8?week estradiol treatment ameliorated depres?sion?like behavior and increased serum E2 level and NGF expression in amygdaloid nucleus in OVX+E group rats when compared with the OVX group(all P<0.01). Conclusion Estradiol treatment can improve the depressive behavior of ovariectomized rats ,which may be related to the in?crease of serum estradiol level and the expression of NGF in amygdaloid nucleus.

Objective To investigate the changes in tumor necrosis factor-α(TNF-α) and plasminogen activator inhibitor(PAI) in the presence of obstructive sleep apnea syndrome(OSAS) in patients with type 2 diabetes mellitus,and to investigate if that 2 inflammatory factors is associated with hypoxemia during sleep.Methods Fiftyfour patients with type 2 diabetes mellitus hospitalized for glycemic control were subgrouped into 27 patients with OSAS (group O) and 27 patients without OSAS (group N).26 people without diabetes and OSAS were selected from a health check-up program to serve as control group (group C).Serum TNF-α and PAI levels were measured by commercial ELISA kits.Apnea hypopnea index (AHI),the lowest pulse oxygen saturation (LSpO2) at night were detected by portable sleep monitor.The relativity regarding TNF-α,PAI,homeostasis model assessment for insulin resistance (HOMA-IR),fasting blood glucose(FBG),AHI,LSpO2,and age was discussed.TNF-α and PAI were regard as dependent variables,and FBG,HOMA-IR,AHI,LSpO2,and age as independent variables in multivariate stepwise linear analysis.Results The levels of HOMA-IR,TNF-α,PAI in group O [2.69 ± 1.53,(1.97 ±0.13) ng/ml,and (2.27 ± 0.85) ng/ml] were higher than the those in other 2 groups,and those in group N [1.70 ± 0.88,(1.09 ±0.29) ng/ml,and (1.59 ± 0.13) ng/ml] were higher than group C [1.15 ± 0.67,(0.73 ± 0.19) ng/ml,and (0.89 ±0.25) ng/ml].The levels of FBG in the 2 diabetic groups were higher than those in group C.The level of AHI in group O was higher than that in group N and group C,while LSpO2 in group O was lower than that in group N and group C.Spearman univariate analysis showed that TNF-α and PAl both were associated positively with HOMA-IR,FBG,and AHI,while negatively with LSpO2.Multivariate stepwise linear analysis denoted that TNF-α was independently associated with AHI,FBG,while PAI was independently associated with AHI and HOMA-IR.Conclusions Patients with diabetes and OSAS manifest raised level of chronic inflammatory activity,and therefore,OSAS might be implicated in the pathogenesis of chronic complication of patients with type 2 diabetes.

Objective To explore the feasibility of amide proton transfer (APT) MR imaging for the detection of basal ganglia abnormalities in patients with Parkinson' s disease (PD).Methods Twentyseven patients with PD and twenty-three age-matched normal control subjects underwent cerebral APT and structural MR imaging.The magnetic resonance ratio asymmetry (MTRasym) values at 3.5 ppm of bilateral globus pallidus,putamen and caudate were measured on APT images.MTRasym (3.5 ppm) values of cerebral structures between PD patients and control subjects were compared with independent-samples t test.Paired-samples t test was used to compare the difference of MTRasym (3.5 ppm) between the side of onset and contralateral side in patients with PD.The difference of MTRasym (3.5 ppm) among normal controls,early-stage PD,and advanced-stage PD patients was assessed with one-way analysis of variance.Results Compared to normal controls,MTRasym(3.5 ppm) values of globus pallidus,putamen and caudate were significantly increased in PD patients ((0.89 ±0.12)％ vs (0.57 ±0.16)％,(1.05 ± 0.11)％ vs (0.82 ± 0.15)％,(1.15 ±0.13)％ vs (0.78 ±0.19)％; t =3.311,2.562,3.277 respectively,all P values ＜ 0.05).Significant differences in MTRasym (3.5 ppm) values of these cerebral structures were observed among normal controls,early-stage PD and advanced-stage PD patients.And MTRasym (3.5 ppm) values in globus pallidus,putamen and caudate were significantly higher in early-stage PD patients than normal controls.In PD patients,even not statistically significant,MTRasym (3.5 ppm)values of sides of onset were slightly lower than contralateral sides.Conclusions APT MR imaging can sensitively identify the difference of MTRasym (3.5 ppm) in the basal ganglia between PD patients and normal controls.APT might be a useful tool to evaluate abnormal metabolite in basal ganglia of PD patients.

Objective To explore the clinical features of transbronchial tuberculous mediastinal lymph-adenitis and value of bronchoscopic interventional therapy. Methods The clinical data of 50 patients who had been diagnosed as tuberculous mediastinal lymphadenitis and had received bronchoscopic interventional therapy in our hospital during the period from January 2008 to January 2013 were retrospectively analyzed. The bronchoscopic change , improvement in symptoms , and time to sputum smear and culture conversion were used to assess the therapeutic effect. The patients were followed up for six months. Results The mean age of the patients was (35 ± 15) years and the male to female ratio was 1:1.2. The lesions occurred mostly at the right middle lobe in 24% (12/50) of the patients. The total effectiveness rate was up to 98% (49/50) after chemotherapy and bronchoscopic interventional therapy. The major complication associated with interventional therapy was hemoptysis (8%, 4/50). After follow-up of 6 months , 49 patients with active lesions were stable , with smooth bronchial mucosa and no obvious obstruction by granulation and caseous necrosis tissues. Conclusions The relavent clinical symptoms of transbronchial tuberculous mediastinal lymphadenitis is mainly caused by tuberculosis inflammation which destroys and blocks the airway. The fiber bronchoscopic therapy with forceps clip and drug infusion has a definite effect and fewer complications.

Objective To explore the feasibility of amide proton transfer (APT) MR imaging to detect cerebral abnormality of the substantia nigra and red nucleus in patients with Parkinson disease (PD). Methods Twenty-seven patients with PD and twenty-three age-matched healthy control subjects were recruited in this study. According to Hoehn&Yahr stages, PD group was divided into two subgroups:early-stage(n=14) and advanced-stage(n=13). PD with right limb onset were seen in 14 patients, and PD with left limb onset in 13 patients. All the PD patients and healthy controls underwent brain APT MR imaging. The magnetic resonance ratio asymmetry (MTRasym) values at 3.5 ppm of bilateral substantia nigra and red nucleus were measured on APT images. MTRasym(3.5 ppm)values of substantia nigra and red nucleus between PD patients and control subjects were compared with independent-samples t test. The difference of MTRasym(3.5 ppm)among normal controls, early-stage PD, and advanced-stage PD patients was assessed with one-way analysis of variance. Paired-samples t test was used to compare the difference of MTRasym (3.5 ppm) in substantia nigra and red nucleus between the side of onset and contralateral side in PD patients. Results Compared to normal controls, MTRasym(3.5 ppm) values of substantia nigra significantly decreased in PD patients[(0.96±0.35)%vs. (1.20±0.39)%respectively, t=-2.093 P=0.039]. No significant differences in MTRasym (3.5 ppm) values of red nucleus were observed between normal controls and PD patients[(0.97 ± 0.36)% vs. (1.09 ± 0.38)% respectively, t=-1.148, P=0.254]. Significant differences in MTRasym(3.5ppm) values of these cerebral structures were observed among normal controls, early-stage PD and advanced-stage PD [substantia nigra(1.20±0.30)%,(1.09±0.32)%and(0.81±0.37)%respectively, F=3.954, P=0.022;red nucleus(1.09±0.28)%,(1.21±0.35)%and(0.71±0.33)%respectively, F=7.563, P=0.001]. MTRasym(3.5 ppm) in substantia nigra showed a consistently decreasing tendency from normal controls to early-stage PD, to advanced-stage PD. MTRasym(3.5 ppm) values of sides of onset and contralateral sides of substantia nigra and red nucleus in PD patients had no significant statistically difference (substantia nigra(0.93 ± 0.33)% vs.(0.99 ± 0.30)%, t=-0.660, P=0.515; red nucleus(1.01 ± 0.36)% vs.(0.93 ± 0.29)%, t=0.545, P=0.590). Conclusions APT MR imaging can show sensitively the difference of MTRasym (3.5 ppm) in substantia nigra and red nucleus between early PD patients and normal controls, Thus, APT is a useful tool to diagnose PD and monitor the disease progression.

Objective To explore the risk factors for patients with massive hemoptysis in tuberculosis and to provide a strategy for clinical treatment for tuberculosis massive hemoptysis (TMH). Methods Chi-square test and multivariate logistics analysis were applied to analyze the medical data of 241 cases of TMH. Results Chi-squared test showed that eleven factors were found to be significantly correlated with TMH. Longer disease course (≥3 months), lung lesions range ≥ 3 lung fields, pulmonary tuberculosis cavity, a higher smoking index (≥400 cigarettes per year) and clinical treatment were risk factors for TMH. Patients aged 45 years or older accompanied with bronchiectasia, pulmonary fungal infection, diabetes or hepatopathy had higher probabilities of developing massive hemoptysis. Multivariate analysis showed lung lesions range over 3 lung fields (OR = 2.447,P = 0.015), pulmonary tuberculosis cavity (OR = 2.486, P = 0.004), bronchial asthma (OR =3.192,P = 0.002), pulmonary fungal infection (OR = 3.896, P = 0.005) and hepatopathy (OR = 3.101, P =0.006) were final risk factors for TMH. Conclusion Multiple factors contributed to patients with massive hemoptysis in tuberculosis. Lung lesions range over 3 lung fields, pulmonary tuberculous cavities, bronchial asthma, lung fungal infection and hepatopathy might be the independent risk factors for TMH.

Magnetic resonance imaging ( MRI ) findings were studied in 19 patients with non-dementia Parkinson′s disease ( PD) Hoehn-Yahr Stage 1 and 1.5 and 38 healthy subjects.The width and area of pars compacta of substantia nigra ( SNc) , substantia nigra ( SN) and midbrain were measured.The width and area ratios of SNc to SN were calculated.Compared with controls, the widths of right SNc was narrower, bilateral ratios of SNc to SN width were decreased in PD group.As to the area of substantia nigra, there was no significant difference between PD and controls.The width of left SN and the ratio of right SNc to SN width was negatively correlation with age of patients.The ratio of left SNc to SN width, the area of bilateral SNc and left SN, as well as the ratio of right SNc to SN area had negative correlation with the disease duration;however, there was no correlation with gender, Hoehn-Yahr Stage, the Unified Parkinson disease rating scale score, mini mental state scale, education years, levodopa equivalent daily dose, Hamilton Depression Scale or Hamilton Anxiety Scale in PD group.The results indicate that there are bilateral structural changes of SN in unilateral PD patients, which may be more significant with increasing disease duration.The measurement of SNc width and SN area can be used as an objective indicator for diagnosis and disease progression monitoring of PD.

Objective To discuss the clinical values of two-dimensional and three-dimensional diagnoses of nontraumatic esophageal hiatal hernia (HH) in middle-aged and elderly people. Methods Thirty-two cases underwent two-dimensional and three-dimensional ultrasonic examination with fasting and water iflling methods in half-sitting, standing, supine and supine right anterior oblique positions. The ifndings were compared with X-ray barium meal examination, endoscopy and operation. Results There were 27 cases sliding HH, 3 cases paraesophageal HH and 2 cases short HH. Traditional two-dimensional manifestations were as follows:widening of hiatal diaphragmatic muscles (1.6±0.4 cm) and echoes of gastric mucosa in superior hernial sac and inside hernial sac. Real-time three-dimensional surface image formations were as follows: along the long axis of diaphragmatic hiatus, superior phrenic sac was showed as mushroom-shaped or pond-shaped and the neck of hernial sac was showed as irregular tunnel-shaped or ditch-shaped;looking upward from the fundus of stomach, superior phrenic hiatus was showed as caved-shaped or louver-shaped;looking downward from mediastinal surface of lung, uperior phrenic hiatus was showed as piercer-shaped. Conclusions Two-dimensional abdominal ultrasound can diagnose nontraumatic HH in middle-aged and elderly people conveniently and accurately. Real-time three-dimensional abdominal ultrasound can display the range, size, and shape clearly. Compared with the former, the latter can provide more information for diagnosis and help ultrsound doctors and clinical doctors to understand and master the anatomical and morphopathological features of this disease.