Doctors ought to belong to a social stratum with fairly high incomes. The high input and long cycle that is essential to becoming a high-caliber doctor constitute the high costs of the medical profession; high technology, high responsibility and high sacrifices constitute the high risks of the medical profession; the contrast between the input of high intelligence, high academic degree, and high expertise and the output of low economic income tends to warp the minds of doctors. The inversion of the burden of proof in medical lawsuits has practically put doctors on the weak side. Their rights and interests as well as their practice circumstances have been disregarded. For the sake of the development of the health cause, it is imperative to respect the labor of doctors and to provide them with sound survival circumstances.

The curriculum system of Proteomics was analyzed based on the teaching practice,the characteristics of ability training and gradation teaching were summarized and the prospect of curriculum optimization was proposed.These measures were conceived to enrich the course content and teaching methods for Proteomics course.

Objective To investigate the impact of pelvic muscle training (PFMT) on the quality of life (QOL) and incidence of postoperative complications in stress urinary incontinence (SUI) patients after tension-free vaginal tape surgery (TVT). In order to provide evidence for clinical nurses taking measures to promote rehabilitation of postoperative patients. Methods A total of 101 female SUI patients who underwent TVT surgery were included in this study. 50 patients in the trial group received pelvic muscle training guidance by one-to-one for 3months while 51 patients in the control group were instructed to the routine discharge guidance. All patients were asked to finish the Incontinence-specific Quality of Life questionnaire (I-QOL) at the day before surgery and 3 months after the surgery, respectively. And incidence of postoperative complications were evaluated at 3 months after the surgery. Results A total of 94 participants completed all questionnaires, including 48 patients of the trial group and 46 patients of the control group. The postoperative score of I-QOL in the trial group were higher than that of control group (94.32 vs. 90.34, Z=3.863, P<0.01). Further analysis found that avoidance and limiting behaviors domain score (90.63 vs.87.50, Z=3.227, P<0.01) and psychosocial impacts domain score (97.22 vs. 90.28, Z=4.186, P<0.01) in the trial group were higher than that of control group. The incidence of postoperative urgency urinary incontinence was significantly difference between the two groups (χ2=4.953,P=0.026), the proportion were 16.67% (8/48) in the trial group and 36.96% (17/46) in the control group, respectively. According to the results, the patients′overall quality of life of the trial group was better than that of control group after surgery. Conclusions Postoperative SUI patients′implementation of pelvic muscle training can significantly increase their quality of life and can decrease the incidence of urgency urinary incontinence.

Objective To study the effects of high albumin, high glucose and low bovine serum on the phenotypic transformation of renal tubular epithelial cells. Methods The normal human kidney proximal tubular eel] line (HKC) was cultured for 30 days in the presence of high albumin (1.5 g/L), high glucose(25 mmol/L) and low bovine serum(2% ) . Morphological changes were observed by electronic microscopy. Immunohistochemistry stain was used to examine the expression of cytokeratin, vimentin, a-SMA, collagen Ⅰ and TGF-pl protein. Western blot was applied to further detect the process of collagen I protein expression, and in situ hybridization was used to examined the expression of collagen Ⅰ gene. Results Renal tubular epithelial cells cultured in high albumin, high glucose and low bovine serum showed obvious morphologic changes, including elongated shape, decrease of microvilli and mitochondria, and increase of rough endoplasmic reticulum under electronic microscopy. Immunohistochemistry stain revealed the reduction of cytokeratin, and enhancement of vimentin, ?-SMA, TGF-?1 and collagen Ⅰ. Western blot demonstrated that the expression of collagen Ⅰincreased in a time-dependent manner, and in situ hybridization showed that collagen type Ⅰ mRNA increased as well. Conclusion High albumin, high glucose and low bovine serum induce phenotypic transformation of renal tubular epithelial cells into mesanchymal cells.

Abstract: Objective　To investigate the fundus arteriosclerosis and its influencing factors in HIV/AIDS patients after long-term highly active antiretroviral therapy (HAART). Methods　The clinical basic data and fundus examination data of 203 HIV/AIDS patients before and after HAART in the Fourth People 's Hospital of Nanning from January 2020 to June 2022 were collected to evaluate the occurrence of fundus arteriosclerosis and analyze its influencing factors. Results　Of the 203 HIV/AIDS patients, 159 patients developed fundus arteriosclerosis, with an incidence of 78.33%, including 33 patients with grade Ⅰ(20.75%), 87 patients with grade Ⅱ (54.72%), 28 patients with grade Ⅲ(17.61%), and 11 patients (6.92%) with Grade Ⅳ. Before HAART, there was no significant difference in CD4+T lymphocyte count, CD8+T lymphocyte count, viral load, white blood cell count, platelet count, hemoglobin, serum creatinine, blood urea nitrogen, triacylglycerol, total cholesterol, fasting blood glucose, alanine aminotransferase, aspartate aminotransferase and serum total bilirubin between the atherosclerosis group and normal group (P>0.05). After 6 months of HAART, CD8+T lymphocyte count, triacylglycerol and fasting blood glucose in atherosclerosis group were significantly higher than those in normal group (P<0.05). In the stratified comparison of CD4+ and CD8+ lymphocyte counts after 6 months of HAART, the proportion of patients with CD4+ lymphocyte count (CD4+)<200 (cells/μL) in the atherosclerosis group was significantly higher than that in the normal group; the proportion of patients with CD4+ lymphocyte count (CD4+)≥500 (cells/μL) was significantly lower than that in the normal group; the proportion of patients with CD8+ lymphocyte count CD8+≥ 800/μL was significantly higher than that in the normal group (all P<0.05). Binary logistic regression analysis showed that opportunistic infection, HIV course, CD4+T, CD8+T lymphocyte count after HAART and triglyceride were independent risk factors for ocular fundus atherosclerosis in HIV/AIDS patients (all P<0.05). Conclusions　The incidence of ocular fundus arteriosclerosis is high in HIV/AIDS patients. More than 4 years of HIV course, combined opportunistic infection, Low CD4+T lymphocyte count after 6 months of HAART, high CD8+T lymphocyte count and high triglyceride level are independent risk factors for ocular fundus arteriosclerosis in HIV/AIDS patients. Fundus screening should be performed before and after HAART in such population, HAART program should be formulated for the risk of cardiovascular disease, and risk management of cardiovascular disease should be strengthened during treatment to improve patient outcomes.

Hepatocellular carcinoma is one of the most common malignancies in the worldwide.Selected patients with hepatocellular carcinoma are candidates for curative resection,but nevertheless there is a high risk of tumor recurrence.Microvascular invasion (MVI) is an aggressive biological behavior and has repeatedly been identified as a risk factor for prognosis after curative treatment,meanwhile,it is now becoming increasingly concerned.It would be of great significance to distinguish MVI in an early stage and choose an appropriate treatment timely to get a definite improvement for the long-term survival in patients with hepatocellular carcinoma after curative treatment.This review focuses on some certain issues of MVI.

Objective To analyze the characteristics of gastroesophageal junction(GEJ) in gastroesophageal reflux disease (GERD) using high resolution manometry (HRM),and the features in different GERD subtypes,reflux esophagitis (RE) and non-erosive gastrooesophageal reflux disease (NERD).Methods Sixty GERD patients were divided into two subtypes,RE (n =33) and NERD(n =27),based on the results of endoscopy.All patients received HRM,and were divided into three subtypes,type Ⅰ,type Ⅱ and type Ⅲ according to the GEJ pressure morphology.HRM results among different subtypes were investigated.Results In 60 GERD patients,the GEJ was divided into three subtypes,including 26 cases of type Ⅰ (RE =14,NERD =12),29 cases of type Ⅱ (RE =14,NERD =15) and 5 cases of type Ⅲ (RE =5).The characteristics of GEJ morphologic subtypes were analyzed.The total length of lower esophageal sphincter(LES) of three GEJ subtypes(type Ⅰ,type Ⅱ and type Ⅲ) were (3.35 ± 0.56) cm,(3.29 ± 0.87) cm and(2.43 ± 0.22)cm,respectively.The LES intra-abdominal length of three GEJ subtypes were(2.41 ± 0.68) cm,(3.07 ± 4.59) cm and (0.00 ± 0.00) cm,respectively.The LES rest pressure of three GEJ subtypes were (22.00 ± 8.00) mmHg,(16.46 ± 8.60) mmHg and (11.07 ± 5.80) mmHg,respectively.The total length of LES were significantly different among three subtypes (P ＜ 0.05).The LES rest pressure were not significantly different among three subtypes (P ＞ 0.05).Among type Ⅰ and type Ⅱ patients,there were no significant difference in LES-CD distance,total length of LES,LES intra-abdominal length and LES rest pressure between RE group and NERD group.Conclusion HRM can clearly distinguish the GEJ subtypes.To some extent,esophageal motility characteristics of the patients with different subtypes GEJ is various.However,it still needs further studies with larger sample size to confirm.

Objective To investigate the role of p38 MAPK in the trypsin-induced injury in human esophageal epithelial cells.Methods Primary cultured human esophageal epithelial cells were stimulated with trypsin (20,40,and 80 μg/ml) for4 hours,phosphorylation of p38 MAPK was evaluated by Western blotting.Primary cultured human esophageal epithelial cells were stimulated with trypsin (40 μg/ml) and treated with p38 MAPK inhibitor (SB203580,1 and 10 μmol/L) simultaneously.Four hours later,the cells were collected for analysis.Results Western blotting results revealed that stimulation with trypsin enhanced phosphorylation of p38 MAPK,indicating that trypsin activated p38 MAPK in esophageal epithelial cells.SB203580 treatment suppressed trypsin-induced expression of pro-inflammatory cytokines including interleukin-8 (IL-8),cyclooxygenase 2 (COX2),and tumor necrosis factor alpha (TNFcα).Finally,SB203580 treatment suppressed trypsin-induced upregulation of protein expression of inducible nitric oxide synthase (iNOS),and subsequently reduced nitric oxide (NO) levels.Conclusions The regulation of p38 MAPK was involved in the trypsin-induced injury in esophageal epithelial cells.

The incidence of menopausal anxiety and depression is increasing. It can induce and aggravate a variety of somatic symptoms. Despite of the good effects of psychotropic drugs on the disease, patients' compliance is poor. Therefore, it is necessary to find a drug which is practical, effective, and easy for patients to take.

Objective To summarize the key points of nursing care to pregnant women with acute cholecystitis and gallstones. Methods The clinical data of twenty three pregnant women with acute cholecystitis and gallstones during August 2007 to January 2012 were reviewed and analyzed retrospectively,including 19 cases for conservative treatment,3 cases for surgical treatment,1 case for abortion.Results All patients were cured and discharged with hospital stay for 7 to 21 days,averaged(12.7±4.7)days. Conclusion For pregnant women with acute cholecystitis and gallstones,efforts should be focused on dynamic monitoring of vital signs and fetal conditions,psychological care and diet care in order to ensure the safety of the mathers and infants.