At present,the satisfaction of free medical care of undergraduate is declining,and the doctor-patient relationship is becoming tense.By investigating and interviewing the three representative universities in Beijing,we conclude three reasons including the supplier of medical service,the receiver and doctor-patient communication.By adhering to the medical treatment concept of"Patient-Oriented",the paper puts forword serveral measures including incresing input and improving system and so on to achieve the harmonious development of doctor-patient relationship of undergraduate.

[Abts ract] Ven tilato r-associated pneumonia ( VAP) is one fo the most common nosocomila infec-tions of mechanically ventilated children in PICU.VAP not only contributes to prolong ed hospital and PICU lengt h of stay,but asl o icn reaseds medical cost,mortality and mo rbility in critiac lly ill children.It′s an urgent task to prevent VA P in pediatrici ntensive care medicine.The aimo f the articel was to intor duce the epidemi-ology,risk factors,prevention strategya nd practice in children.The article reviewed guidelines of strategies to prevent VAP in pediatric patients.

Objective To observe the changes of plasminogen activator inhibitor-1(PAI-1)mRNA expression in experimental lung iniury and to evaluate the effect of inhaled nitric oxide(NO)on PAI-1 mRNA expression.Methods In this study,acute lung injury rat model was established by lipopolysaccharide(LPS)-induced endotoxemia followed by a second LPS attack via intratracheal injection.Eighty-nine SD male rats aged 4～5 week were randomly assigned to three groups:saline control(C-A)group,LPS-A group attacked by LPS,LPS-NO group treated by nitric oxide.Realtime PCR was used to study the expression of PAI-1 mRNA in the lung.Histopathological lung injury score was evaluated.Results In LPS group,the histopathological lung injury score values were significantly higher than that of C-A group at 2 h[(3.10±0.38)vs(1.12±0.84)](P＜0.05)and the score values after 2 h were higher than that of LPS group at 2 h(P＜0.05).PAI-1 mRNA in lung increased gradually in LPS groups at 2 h,4 h,8 h,16 h,24 h(P＜0.05)and decreased at 48 h(P＞0.05).The PAI-1 mRNA decreased in LPS-NO groups at 4h(P＜0.05).Conclusion The study above demonstrates that PAI-1 mRNA expression is early elevated in rats with endotoxin-induced acute lung injury.Decreased PAI-1 mRNA expression is associated with the efficacy of inhaled nitric oxide.

Objective To explore the effects of inhaled nitric oxide(NO) on expression of plasminogen activator inhibitor-1 (PAI-1) mRNA and protein in the early-stage of experimental acute lung injury (ALI) in a rat model.And to investigate the relationship between endogenous NO system including inducible nitric oxide synthase (iNOS)and intrapulmonary NO production and expressions of PAI-1 in ALI.Methods In the study,endotoxemia followed by the second attack due to intratracheal injection of lipopolysaccharide (LPS) in rats caused ALI.Male SD rats aged 4-5 weeks (clean conventional rats,180-200 g) were randomly assigned to 2 groups:saline control (C) group,LPS-treated (LPS) group,and the 2 groups were randomly allocated to subgroups exposed to air (A) or 20 × 10-6 NO.They were sacrificed for 24 h.Expressions of PAI-1 mRNA of the lung tissue were evaluated by real-time polymerise chain reaction; PAI-1 proteins were determined by immunohistochemistry.NO production in the lung tissues and pulmonary iNOS activity were measured.Meanwhile,histopathological lung injury scores were evaluated and modified martius acid fuchsin brilliant blue(MSB) stains was performed to evaluate fibrin of the lung tissues.Results At 24 h time point with intervention of iNO,PAI-1 mRNA and protein levels in LPS-NO subgroup were decreased compared with those in LPS-A subgroup (4.94 ± 0.52 vs 5.56 ± 0.27 ; 1.31 ± 0.40 vs 1.69 ± 0.16,all P ＜ 0.05).Meanwhile,iNOS activity and NO productions in LPS-NO subgroup were lower than those of LPS-A subgroup [(0.84 ± 0.36) U/mg prot vs (2.30 ± 0.25) U/mg prot ; (1.90 ± 0.84) μmol/g prot vs (3.38 ± 0.73) μmol/g prot,all P ＜ 0.05].iNOS activity had significant correlation with expression of PAI-1 mRNA and protein in lung tissue (r =0.481,P =0.005 ; r =0.667,P =0.000) ; NO production had significant correlation with expression of PAI-1 mRNA and protein in lung tissue(r =0.532,P =0.002; r =0.784,P =0.000).At 24 h time point,the histopathologic lung injury scores in LPS-NO subgroup were decreased in contrast to LPS-A subgroup (4.28 ±0.94 vs 6.12 ± 1.51,P ＜ 0.05).Fibrin deposition evaluated by modified MSB stains in LPS subgroups was found in alveolar space,lumen of blood vessel and mesenchymal ;LPS subgroup with NO appeared a decreasing trend in contrast to LPS subgroup with air.Conclusions Inhaled nitric oxide of 20 × 10 6 can suppress elevated expression of PAI-1 in ALI induced by endotoxin.This inhaled NO can improve the imba-lance of plasminogen activation system and alleviate lung injury.Meanwhile,inhaled NO down-regulates intrapulmonary iNOS activity as well as endogenous NO productions in rats with 2 hits of LPS induced ALI.These changes also have a close correlation with down-regulation of PAI-1 mRNA and protein.Thus,regulation of endogenous NO system on the expression of PAI-1 will be the future direction of new therapies for ALI.

Objective To probe the application of umbilical vein catheterization among the verylow-birth-weight or the low-birth-weight children.Methods In this retrospective study,the clinical condition of the very-low-birth-weight or the low-birth-weight infants in neonatal intensive care unit who had umbilical vein catheterization from June 2011 to January 2013 was concluded.Results Sixty-three cases were successfully catheterized,of which 41 cases were catheterized in inferior vena cava(65.1％).The retention time was 4 to 21 days,with an average of 12.9 days.Eleven cases suffered unplanned extubation of the indwelling catheters,and eight of them were located in the umbilical vein.There were statistically significant differences of unplanned extubation rates among different location of the catheters (x2 =8.38,P ＜ 0.01).All cases were intubated within 36 hours after birth,and the intubation time was not positively correlated to the success rate of catheterization in the inferior vena cava (x2 =0.223,P ＞ 0.1).Suspected catheter-related infections occurred in 5 cases and the infection rate was 6.2/1000 per intravascular catheter day.After extubation,bacterial cultures of the tips of the catheters and blood were arranged.The results suggest that the bacterial culture of the catheter tip was positive in only 1 case(1.6％),and yeast-like fungus was positive in 1 case (1.6％),while the retention time and incidence of catheter-related infection had no significant corelation(x2 =0.075,P ＞ 0.95).Conclusion Umbilical vein catheterization could be used at the early stage in preterm (very) low-birth-weight infants.

Epidemic influenza (flu) is a disease threatening the life of people for a long history.A precise forecast for the flu outbreak can warn and help health care providers to take measures to reduce the influences and harms in advance.At present,with the development of information technology,there have accumulated tremendous data of flu trends and climate information.With a history of 90 years researches about the forecast of flu trends,researchers have put forward different types of forecasting methods,and each of them has merits and demerits.Among these methods,those ones considering the key climate factors have higher precisions.Considering various methods at present,the prediction accuracy can be improved mainly from two aspects:on one hand,the forecast accuracy can be improved by effectively integrate the advantages of different models ; On the other hand,the prediction must take into account of the specific climate of an area,pathogens and the mode of transmission characteristics in order to determine the most relevant climate factors or other highly related factors with which to design a more reasonable and accurate prediction method.

Objective To summarize the clinical features of brucellosis and investigate the experience of diagnosis and treatment of the disease .Methods Data from epidemic reports and clinical characteristics from 172 ca-ses of patients with brucellosis were retrospectively analyzed .Results 130 out of 172 cases of were diagnosed as bru-cellosisaise.Of the misdiagnosed 42 cases,13 cases were misdiagnosed as lumbar spine ,10 cases as upper respiratory tract infection 8 cases as pancytopenia,5 cases as orchitis epididymitis,2 cases as hepatitis,1 case as prostatitis, 1 case as cervical disease ,1 case as myocarditis ,1 case as rheumatoid arthritis .And after treatment ,142 cases recov-ered completely,16 cases improved.The total efficiency was 100.0%.2 cases without standard treatment recurred ,an interval of 3 to 15 months.Conclusion So the clinical manifestation of brucellosis is lack of specificity that misdiag-nosis rate is high;The manipulation combined with standard antibiotic therapy may have certain effects on early -stage brucellosis .

Objective To investigate platelet counts and acute obstructive suppurative cholangitis correlation analysis and possible influential factors.Methods Data of 117 patients from October 2012 to October 2015 treated in our hospital,of whom 57 with acute obstructive suppurative cholangitis and 60 with common acute cholangitis were analyzed retrospectively to explore whether there was a correlation between thrombocytopenia (100 × 109/L) and AOSC,then experimental and control groups were established according to thrombocytopenia in the AOSC patients.The patient's age,sex,previous biliary surgery,white blood cells(WBC) count after admission within 6h,the percentage of neutrophils (NEU％),calcitonin (PCT) were retrospectively analyzed to further explore the influence factors of thrombocytopenia in AOSC patients.Results By comparison with the common acute cholangitis group,thrombocytopenia in AOSC group had obvious difference (P =0.01).In experimental group,NEU％,PCT had statistical difference compared with those in control group (P ＜ 0.05),and the patient's age,sex,previous biliary surgery,white blood cells(WBC) after admission within 6h count had no statistical significance.The logistic multivariate regression analysis showed that,NEU％,PCT were the independent predictors.Conclusion Correlated with AOSC,thrombocytopenia can be valued as indicators of the severity of acute cholangitis.In AOSC patients,NEU％,PCT were independent predictors of thrombocytopenia.

Objective To investigate the changes of serum adiponectin (APN) levels in patients with essential hypertension (EH) and the correlation with carotid artery intima-media thickness (IMT).Methods Sixty patients with EH(EH group) and 30 healthy people (control group) were studied,the EH patients were divided into 3 subgroups with 20 cases each according to the standard of China guideline for hypertension prevention and control (2005).The serum APN level was detected by double antibody sandwich ABC enzyme-linked immunosorbent assay,the blood lipids levels [total cholesterol (TC),triglyeride (TG),low density lipoprotein-cholesterol (LDL-C) and highdensity lipoprotein-cholesterol (HDL-C)]were detected by automatic biochemical analyzer,and the carotid artery IMT was detected by color Doppler ultrasonography.Results The serum APN levels and carotid artery IMT in EH group and 1,2,3 subgroup were significant differences compared with those in control group [(3.94 ± 1.28),(5.25 ± 1.69),(4.01 ±1.27),(2.56 ± 0.87) mg/L vs.(7.63 ± 2.50) mg/L; (1.30 ± 0.42),(0.94 ± 0.30),(1.32 ± 0.44),(1.65 ±0.51)mm vs.(0.69 ± 0.22) mm,P ＜ 0.05].The comparison between two subgroups,along with elevated blood pressure levels,APN levels gradually decreased,and carotid artery IMT gradually increased (P ＜0.05).The serum TC,TG,LDL-C and HDL-C levels in EH group and 1,2,3 subgroup were significant differences compared with those in control group [TC:(6.53 ± 2.09),(5.14 ± 1.66),(6.59 ± 2.20),(7.86 ±2.42) mmol/L vs.(4.17 ± 1.32) mmool/L;TG:(2.15 ± 0.69),(1.72 ± 0.55),(2.07 ± 0.69),(2.65 ± 0.82)mmol/L vs.(1.38 ±0.44) mmol/L;LDL-C:(3.78 ± 1.21),(3.12 ± 1.01),(3.74 ± 1.25),(4.48 ± 1.38)mmol/L vs.(2.46 ±0.78) mmol/L;HDL-C:(0.96 ±0.31),(1.39 ±0.45),(0.85 ±0.28),(0.64 ±0.20)mmol/L vs.(1.69 ± 0.54) mmol/L,P ＜ 0.05].The comparison between two subgroups,along with elevated blood pressure levels,TC,TG and LDL-C levels gradually increased,and HDL-C gradually decreased (P ＜0.05).There was negative correlation between the serum APN level and carotid artery IMT (r =-0.435,P＜0.01),and there was correlation between the serum APN level and blood lipids levels (TC,TG,LDL-C and HDL-C) (P ＜ 0.01).Conclusions The APN plays an important role in the occurrence and development of EH,it is closely related to the carotid artery IMT thickening and lipid metabolism disorders.Increasing the lipid-lowering drugs may improve the efficacy of antihypertensive therapy in patients with resistant EH.