It is crucial for the medical staff to build up mutual trust with patients by their credible attitude and behavior.As core competitiveness of the hospital,the fame of credibility is important to the development of building a harmonious hospital.Only by constructing the hospital's credibility system,integrating the principle of commitment to credibility into the hospital culture,making medical staff work according to this principle,and guiding the harmonious development of a hospital by the credibility culture,can make the hospital management achieve the ultimate goal and reach a satisfying state.

Objective:To explore the clinical value on application of laparoscopic ultrasonography (Lap US) in the adnexal operation. Methods:Eleven patients including 7 cases of tubal pregnancy, 3 cases of teratoma of ovary and 1 case of endometrial cyst of ovary were examined by LapUS, then operated with laparoscopy.Results:The results showed that the modality presented is a big progress over the traditional operative management for adnexal diseas. Conclusions:It is a good approach for micro-surgery in the adnexal operation by laparoscopy.

OBJECTVE:To investigate the clinical effect and safety of pregabalin combined with gabapentin in the treatment of central pain after cerebral infarction.METHODS:One hundred and fifty patients with central pain after cerebral infarction in our hospital from Jan.2010 to Dec.2015 in our department were randomly divided into group A,B,C,with 50 cases in each group.Group A was given Pregabalin capsule 75 mg,bid combined with Gabapentin capsule 0.1 g,tid;group B was given Pregabalin capsule 75 mg,bid;group C was given Gabapentin capsule 0.1 g,tid;3 groups were treated for 4 weeks.VAS score,NRS score,PSQI and SF-36 score were observed among 3 groups before and after treatment to evaluate clinical efficacies of 3 groups;the occurrence of ADR were recorded in 3 groups.RESULTS:The clinical total response rate of group A,B,C were separately 94.00％,74.00％,70.00％.The clinical total response rate of group A was significantly better than that of group B and C,with statistical significance (P＜0.05).After treatment,VAS score of group A,B,C were separately(3.87 ± 0.74),(5.10 ± 1.26),(5.03 ± 1.23);NRS score were separately (3.91 ± 0.88),(5.29 ± 1.25),(5.37 ± 1.30);VAS score and NRS score of group A were signifi cantly lower than group B,C and before treatment,with statistical significance (P＜0.05);PSQI score of group A,B,C were separately(4.03 ± 0.85),(5.92 ± 1.16),(5.83 ± 1.11);SF-36 score were separately (372.84 ± 73.25),(348.07 ± 60.54),(345.67 ± 59.72);PSQI score and SF-36 score of group A were significantly better than group B,C and before treatment,with statistical sig nificance (P＜0.05).There was no statistical significance in the incidence of ADR among 3 groups (P＞0.05).CONCLUSIONS:Compared with pregabalin and gabapentin alone,pregabalin combined with gabapentin in the treatment of central pain after cerebral infarction can efficiently relieve the perceived pain,improve sleep quality and daily life quality and not increase the risk of ADR;therefore,drug combination plan is recommended for patient with central pain after cerebral infarction,especially with poor effect of two single drug.

Objective: To analyze the information of patients with acute myocardial infarction (AMI) in a single center during last 6 years, and to distinguish the clinical differences of patients between TakoSTubo cardiomyopathy (TTC) and ST-segment elevation myocardial infarction (STEMI). Methods: A total of 1042 consecutive patients with primarily diagnosed acute anterior ST-segment elevation (STEMI) admitted in our hospital from 2008-01 to 2014-04 were retrospectively enrolled. The relevant patients were studied in 2 groups:TTC group, the patients with coronary angiography (CAG) and the contrast study of left ventricle corrected TTC diagnosis, n=10, and STEMI group, the patients received CAG within 6 hours of on set with conifrmed left anterior descending singlevessel disease at the same period of time as TTC patients,n=32. The basic clinical characteristics, levels of blood lipids, MI related biomarkers, the incidence rate of pathological Q wave, QTc interval and negative T wave in 12-lead ECG were compared between 2 groups. Results: The percentage of corrected TTC diagnosis in patients with primarily diagnosed STEMI was 1.06%. The female gender in TTC group and STEMI group was 100% vs 9%,P<0.01, TTC group had more patients with stress history before on set than that in STEMI group (70% vs 22%,P=0.02), lower levels of MI related biomarkers as CK (486 ± 249) U/L vs (716 ± 132) U/L, CK-MB (13.5 ± 17.1) mg/L vs (47.5 ± 21.9) mg/L, cTnI (22.8 ± 16.3) ng/mL vs (56.4 ± 24.0) ng/mL, allP<0.01. The age of morbidity, the ratios of hypertension, diabetes mellitus and blood lipids were similar between 2 groups. The frequency of abnormal Q-wave in ECG was similar between 2 groups, while the QTc interval was different in TTC group and STEMI group (630 ± 117) ms vs (540 ± 62) ms,P=0.001, the negative T waves in ECG leads II, III, aVF, aVR and V6 were as (100.00% vs 3.13%), (60.00% vs 6.25%), (90.00% vs 3.13%), (100.00% vs 21.88%), (100.00% vs 46.88%), allP<0.05. Conclusion: TTC patients with the main presentation as ST-segment elevation are usually having emotional or physical stress before on set, with obviously prolonged QTc interval and more frequency of negative T waves in ECG.

Objective To study on the difference of plasma renin activity ( PRA),angiotensin Ⅱ (Ang Ⅱ ),and aldosterone levels in patients with essential hypertension (EH) or primary aldosteronism (PA) or pheochromocytoma (PHEO),and to analyze the sensitivity and specificity on the diagnosis of PA among patients with hypertension with aldosterone/PRA ratio (ARR).Methods The plasma aldosterone,Ang Ⅱ and PRA concentrations in supine and upright positions were measured by radioimmunoassay from 413 patients including idiopathic hyperaldosteronism (IHA,n =111 ),aldosterone-producing adenoma (APA,n=l18),PHEO (n=98) and EH (n=86).ARR was calculated.Results Plasma aldosterone concentrations in both of supine and upright positions in PHEO group [ 374 (294,465 ) pmol/L and 629 (449,997) pmol/L] and PA group [471 (346,632) pmol/L and 673(499,825) pmol/L] were higher than those in EH group [ 277 (224,332) pmol/L and 427 (341,501 ) pmol/L ] (P ＜ 0.01 ).They were also higher in APA group [576 (416,731 ) pmol/L and 726 (554,906 )pmol/L ] than those in IHA group [399(313,504) pmol/L and 609(485,776)pmol/L ] (P ＜0.01).Ang Ⅱ levels in both positions were lower in PA group [43.2(26.4,74.4) ng/L and 60.1(38.5,103.6) ng/L] than in EH group [56.7 (43.3,78.9) ng/L and 84.3(61.3,108.4) ng/L] or PHEO group [54.3(29.9,101.5) ng/L and 102.8 (49.9,167.0) ng/L] (all P values ＜ 0.01 ),and there was no difference between IHA and APA group (P ＞ 0.05 ).The PRA level in both positions of each group were PHEO group [ 0.3 (0.2,1.0) μg ·L-1 · h-1 and 1.4(0.6,3.4) μg · L-1 · h-1] ＞EH group [0.2(0.1,0.4)μg · L-1 · h-1 and 0.6(0.4,1.0)μg· L-1 ·h-1] (P＜0.01) ＞PAgroup [0.1(0.1,0.1)μg· L-1 · h-1 and 0.2(0.1,0.3)μg·L-1 · h-1] (P＜0.01),and APA group [0.1(0.1,0.1)μg · L-1 · h-1 and0.1(0.1,0.3)μg · L-1 ·h - 1 ] ＜ IHA group [ 0.1 ( 0.1,0.2 ) μg · L - 1 · h - 1 and 0.2 (0.1,0.3 ) μg · L-1 · h - 1 ] ( supine P ＜0.01 ; upright P ＜ 0.05 ).APA was divided into 2 types with renin-Ang Ⅱ -responsive APA ( n =26) and unresponsive APA (n =92).The plasma aldosterone concentration was lower in supine position but higher in upright position in renin-Ang Ⅱ-responsive APA than in unresponsive APA patients.ARR in upright was higher in PA group ( P ＜ 0.01 ) but lower in PHEO group ( P ＜ 0.05 ) compared with EH.ARR was higher in APA than in IHA (P ＜0.01 ).The sensitivity and specificity of ARR as 40 (aldosterone unit:ng/dl;PRA unit:μg · L-1 · h-1; its value should multiply 27.7 when transferred to pmol/L,simili) were 93％ and 76％,respectively.Conclusion The levels of PRA,Ang Ⅱ and aldosterone from patients with EH,PA and PHEO are significant different.ARR as 40 in upright position could be used for PA screening cutoff point.

Objective To explore the application value of transperineal three-dimensional ultrasound combined with SWE in evalu-ating the effect of delivery mode on the morphology and function of levator ANI muscle in primipara,and to provide a new method for early diagnosis of pelvic floor dysfunction(PFD).Methods A total of 92 primiparas who were re-examined 6-8 weeks after delivery in our hospital were selected as postpartum group,and divided into vaginal delivery group(n=45)and cesarean section group(n=47)accord-ing to their delivery mode,and healthy women without childbirth at the same period were selected as control group(n=43).Transperineal three-dimensional ultrasound combined with SWE was used to examine the differences in the morphological parameters and elastic param-eters of levator anal hiatus in different states among all groups.Results The hiatus area of levator anal muscle(LHA)at rest,maximum anal retraction and maximum Valsalva in the vaginal delivery group was greater than that in the cesarean section group and control group,and the cesarean section group was greater than the control group,the differences were statistically significant(P＜0.01).Compared with control group and cesarean section group,the elastic parameters of vaginal delivery group at rest and maximum anal retraction were de-creased,the difference was statistically significant(P＜0.01).There was no significant difference in elastic parameters between the cesar-ean section group and the control group(P＞0.05).The difference between maximum Valsalva state and resting state LHA(Δ A')was negatively correlated with the difference before and after contraction of bilateral PR Young's modulus(ΔE)(left r=-0.444,P=0.008;Right r=0.488,P=0.002).Conclusion Three-dimensional perineal ultrasonography combined with SWE can quantitatively evaluate the morphology and function of levator ANI muscle,and provide evidence for the early diagnosis of PFD.

Fibroblast growth factor 23 (FGF23) is a bone-derived hormone that plays a central role in the regulation of calcium, phosphorus and active vitamin D levels. Recent studies have shown that high FGF23 is associated with cardiocerebrovascular diseases. This article reviews the correlation between FGF23 and cerebrovascular diseases.

Objective To investigate the effect of supportive nursing intervention on treatment adherence of patients with schizophrenia and caregivers′anxiety.Methods A total of 72 schizophrenia patients and their caregivers were randomly divided into observation group and control group,with 36 patients in each group.Two group both received routine therapy and nursing care,meanwhile the observation group received an extra 3 months supportive nursing intervention.Medication adherence scale was used to evaluate treatment adherence of patients;self-rating anxiety scale (SAS)was used to evaluate mental health of caregivers,and nursing satisfaction scale was used to evaluate the satisfaction of nursing care.Results After 3 months intervention,treatment compliance (12 cases fully compliance, 18 cases partially compliance,6 cases noncompliance)and nursing care compliance (11 cases fully compliance,15 cases partially compliance, 10 cases noncompliance)of the observation group were obviously higher than those of the control group(χ2 =13.461,17.537;P <0.01 ).After intervention,SAS scores of the observed caregivers(37.51 ±5.93)were lower than that before intervention(43.11 ±4.98)and that of the control group(42.08 ±5.64)(t =4.283, 4.040;P <0.01 ).In the observation group,nursing care satisfaction of caregivers was markedly improved, including 29 cases (82.6%)satisfied,with 5 cases(14.2%)somewhat satisfied,1 case(2.9%)unsatisfied;while in the control group,15 cases (41.7%)satisfied,11 cases (30.6%)somewhat satisfied,9 cases (25%) unsatisfied,and the difference was statistically significant(χ2 =13.105,P <0.01).Conclusions Supportive nursing intervention can significantly improve the treatment and nursing adherence of schizophrenia patients, alleviate caregivers′anxiety,and promote their satisfaction of nursing care.

OBJECTIVETo explore the clinical characteristics, and the effect of paroxysmal nocturnal hemoglobinuria (PNH) clone size and its evolution on response and survival in aplastic anemia (AA) patients.

METHODSThe clinical data of 90 AA cases with PNH clones from 316 AA patients between January 2011 and September 2014 were retrospectively reviewed, their clinical characteristics were analyzed, and the influence of PNH clone evolution and size on response and survival were explored.

RESULTS① Of 316 patients, 90 cases (28.5%) with PNH clones. Of 83 cases with long-term follow-up data available, the complete (CR) and partial response (PR) rates were 43.4% and 33.7% respectively, with the overall responsive rate of 77.1%. The 3-year and 5-year overall survival (OS)rates were 79.4% and 76.1% respectively. ② After immunosuppressive therapy (IST), the PNH clone changed from negative to positive in 24 cases, persistently positive PNH clones were observed in 22 cases, disappeared in 10 cases. There were no significant differences in terms of overall responsive rates, survival rates, absolute reticulocyte value, TBIL, IBIL and LDH among the three groups (P >0.05). Ten cases became AA-PNH after a median time of 15.6 months, no significant differences were found in overall responsive and survival rates between the 10 cases and the other 46 cases who were monitored for PNH clones (P values were 0.896, 0.688, respectively). ③ According to univariate analysis, age≥55, infection, VSAA, ANC <0.5 × 10(9)/L and absolute reticulocyte value <0.012 × 10(12)/L had significant influence on survival (P values were 0.026, 0.000, 0.001, 0.000 and 0.010, respectively). Cox regression model analysis identified that age, infection and ANC were independent prognostic factors affecting survival (P values were 0.050, 0.012 and 0.050, respectively). The PNH clone size had no significant influence on response and survival based on univariate and Cox analyses.

CONCLUSIONThe PNH clone size and its evolution had no significant influence on response and survival.

Anemia, Aplastic ; complications ; pathology ; Clone Cells ; Hemoglobinuria, Paroxysmal ; complications ; pathology ; Humans ; Immunosuppression ; Reticulocytes ; Retrospective Studies

Objective To study the effect of enhancer of rudimentary homolog (ERH) gene on migration and invasion in human bladder cancer T24 and 5637 cells.Methods After knocking out the ERH gene of human bladder cancer T24 and 5637 cells,Wound healing assay,Transwell cell migration assay and Transwell cell invasion assay were used to verify the migration and invasion function.Cell migration related protein was detected by Western blot.Nude mouse tail vein transfer assay was used to study the metastasis ability of bladder cancer cells in vivo.Results (1) The Wound healing assay showed that there were significant differences in the migration cell counts of human bladder cancer 5637 and T24 (P ＜ 0.05).(2) There were significant differences in migration and invasion cell counts of Transwell assay (P ＜0.05).(3) Western blot showed that the expression of E-Cadherin in human bladder cancer 5637 cells and T24 cells was significantly increased (P ＜ 0.05) after knocking out ERH gene,while the expression of Fibronectin,Twist,Vimentin and Snail2 protein were significantly decreased (P ＜ 0.05).(4) Nude mouse tail vein transfer assay showed that lung metastases were significantly reduced in the ERH knockout group compared with the normal ERH group.Conclusions Both in vitro and in vivo experiments suggest that ERH knockout affects the migration and invasion of human bladder cancer T24 and 5637 cells.