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.

Background Integrated transepithelial photorefractive keratectomy (TransPRK) is a new kind of surface ablation and has a fast reepithelialization and uncorrective visual acuity (UCVA) recovery as well as slighter postoperative pain,and epipolis laser in situ keratomileusis (Epi-LASIK) has been recognized to be an effective method for myopia.But there have been few studies to evaluate the dynamic change of the corneal biomechanical properties and posterior corneal elevation after TransPRK.Objective This study was to assess and compare the effectiveness and safety between TransPRK and Epi-LASIK for myopia with thin cornea.MethodsThis study was approved by Ethic Committee of Jinan Mingshui Eye Hospital,and written informed consent was obtained from each patient.In this prospective non-randomized controlled study,93 right eyes of 93 myopic patients with the central corneal thickness 460 to 500 μm were included in Jinan Mingshui Eye Hospital from June to December 2013 under the informed consent.The eyes were divided into TransPRK group for 46 eyes and Epi-LASIK group for 47 eyes.UCVA,manifest refraction,haze,corneal biomechanical properties,posterior corneal elevation,Qvalue and corneal high order wavefront aberration were analyzed before and 1 week,1 month,3 months and 6 months after operation,respectively,and the examination results were compared between the two groups.Results There was no statistically significant difference in the eyes of postoperative UCVA and manifest refraction between the TransPRK group and the Epi-LASIK group at various time points (all at P＞0.05).Six months after surgery,the percentage of eyes with UCVA of 1.0 or better was 93.9％,and 90.9％ eyes exhibited the targeted refraction in ± 1.00 D in the TransPRK group.Corneal haze was most obvious 1 month after surgery in both groups,with the incidence of 32.6％ (15/46) in the TransPRK group and 17.4％ (8/47) in the Epi-LASIK group,but no significant difference was found in the eye numbers with haze between the two groups (x2 =2.841,P =0.092).No significant differences were seen in the corneal hysteresis(CH) values and corneal resistance factor(CRF) values between the two groups (CH:Fgroup =0.000,P =0.999;CRF:Fgroup =0.110,P =0.741),however,the postoperative CH values and CRF values were significantly declined in comparison with preoperative ones,with significant differences among various time points (CH:Ftime =103.658,P =0.000;CRF:Ftime =132.008,P =0.000),while there were no remarkable differences between any two time points in postoperation (all at P＞0.05).Posterior corneal surface height shifted rearward 1 week,1 month,3 months and 6 months after surgery,showing remarkable differences in comparison with before surgery in both groups (Ftime =12.868,P =0.001),but no significant differences between the two groups (Fgroup =1.923,P=0.169).No significant differences were found in Q-value between the two groups (Fgroup =0.191,P=0.663).Root mean square (RMS) and spherical aberration values elevated in postoperation compared with preoperation,with significant differences between them(all at P＜0.01),but the comparison between intergroup was insignificant (RMS:Fgroup =0.299,P =0.586;Spherical aberration:Fgroup =1.290,P =0.259).Conclusions TransPRK for myopia with thin cornea is safe and stably effective like Epi-LASIK.TransPRK affects corneal biomecbanical properties early after surgery but the effect gradually lessens over time.The posterior corneal elevation shows a tiny backward displacement,while posterior corneal asphericity has no change.

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 .

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 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 explore the relationship of life events and internet use in junior high school students.Methods:123 7th grade students were asked to complete the Chinese Adolescent Life Events Checklist,Internet Service Preference Questionnaire for Adolescence and Adolescent Pathological Internet Use Scale.Results:Students' life events scores were lower than the norm significantly;Junior high school students' life events positively correlate with pathological internet use,as well as with salience,tolerance,compulsion symptoms,social comfort,and negative outcomes subscales;Internet service preference closely correlates with pathological internet use;Subjective stress,social preference of internet can predict pathological internet use significantly.Conclusion:Pathological internet use is closely related to life events and social service.

Objective To analyze the imaging characteristics of pulmonary sclerosing hemangioma(PSH) and to improve the accurate rate of its diagnosis before surgery.Methods Imaging findings in 11 cases pathologically proved sclerosing hemangiomas were retrospectively analyzed in comparison with pathology.Results The imaging findings of PSH mostly were solitary masses with homogeneous density,and with smooth margin in 10 cases and irregular margin in 1 case;1 case with slight calcification and 1 case with air-meniscus sign were found.7 cases were homogeneous enhancement and 4 were heterogeneous enhancement on contrast-enhanced scan.The high and low attenuation areas on CT corresponded with angiomatous and cystic areas respecitvely on pathology.Conclusion Chest roentgenogram and unenhanced CT scan of PSH are not of remarkable characteristics,contrast-enhanced CT scan plays an important role in diagnosis and differential diagnosis of PSH.