Doctors'language can help the patients and hurt them as well just like their bis-toury.Warm words give the patients confidence,hope and energy to beat their disease.When doctors communicate with the patients,their words are not only the important tool but also a kind of art.This article displays five artistic characters of doctors'words such as morality,etiquette,emotion,preciseness and secrecy.

Objective:To preliminarily study the characteristics of ventricular synchronicity in patients of idiopathic pulmonary arterial hypertension (IPAH) with different heart function.
Methods:Our research included in 2 groups:IPAH group, n=40 patients intermittently collected in our hospital from 2010-10 to 2014-12 and Control group, n=23 normal subjects from the same period of time. Tissue Doppler echocardiography was conducted to compare interventricular systolic and diastolic time to peak (Ts and Te), their differences (Te-Ts) and (Te-Ts) of left ventricle (LV), right ventricle (RV), interventricular septum (IVS) between 2 groups.
Results:Ts and Te of RV were longer than Ts and Te of LV and IVS in both groups, P<0.05. Compared with Control group, by heart function reducing, IPAH group showed different Ts and Te of LV and IVS, P<0.05 and Ts was gradually prolonged, Te was gradually shorter;while Te of RV became longer firs tand then became shorter thereafter. In IPAH group, the patients with heart function grade IV had the longer Ts of LV and IVS than those with heart functionII, III;the patients with heart function IV had the shorter Te of LV, RV and IVS than those with heart function II, III, all P<0.05. In IPAH group with different heart function, Te between RV-IVS and RV-LV were different from Control group, all P<0.05;Te between LV-IVS in heart function IV patients had the largest difference from Control group, P<0.05. Compared with Control group, IPAH group had gradually decreased Te-Ts of LV and IVS by heart function reducing asgrade II>III>IV, all differences had statistic meaning.
Conclusion:IPAH patients with different right heart function may have interventricular systolic and diastolic de-synchronicity;by reduced heart function, interventricular Te-Ts could be specifically shortened.

Objective To evaluate the effectiveness of Percu Twist (PT) tracheostomy comparing with that of operative tracheostomy(OT)in intensive care unit(ICU). Methods Related data were retrieved from CBM,CNKI,Wanfang Data,VIP,PubMed,EMBASE,CENTRAL,and Web of Science from the time of their establishment to May 15th 2014,and the data of randomized controlled trials(RCTs)concerning PT and OT were selected. The risk of bias assessment and data extraction were performed by two independent reviewers. Meta analysis was conducted using RevMan 5.2 software. Results A total of 12 RCTs were identified,and 893 patients in ICU were involved. The results of Meta-analysis showed that PT could significantly shorten the operation time〔mean difference (MD)=-15.11,95% confidence interval(95%CI)=-17.14 to -13.07,P<0.000 01〕,reduce the volume of blood loss(MD=-17.59,95%CI=-21.90 to-13.28,P<0.000 01),reduce the size of incision(MD=-2.20, 95%CI=-2.57 to -1.82,P<0.000 01),shor ten the time of healing(MD=-3.60,95%CI=-4.15 to -3.05, P<0.000 01),and reduce complications such as infection of the wound〔odds ratio(OR)=0.20,95%CI=0.10-0.44,P<0.000 1〕and cutaneous emphysema/mediastinal emphysema(OR=0.22,95%CI=0.10-0.47,P<0.000 1)compared with OT group. The funnel plot suggested that publication bias might be found among 12 researches. Conclusions PT was shown to be more effective than OT in ICU with lower incidence of complications. As number of RCT cases is still small with unsatis factory quality,further clinical use is warranted for a better assessment.

Objective To compare two different dumping cooking methods (boiling vs.frying) in their effect on postprandial glucose level in diabetic patients using continuous glucose monitoring (CGM).Methods 10 type 2 diabetes mellitus (T2DM) in-patients in the Department of Endocrinology of Peking Union Medical College Hospital between February and May 2011 were enrolled,whose fasting and preprandial glucose levels were controlled with a insulin pump.On day 2 and day 4 in the study period,the patients were given fried dumplings and boiled dumplings for lunch respectively,with the same nutrient contents.The starch digestibility of these two kinds of dumplings were compared using in vitro resistant starch digestion,measuring the concentrations of rapidly digestible starch,slowly digestible starch,and resistant starch.CGM was used to record blood glucose changes,in order to evaluate glycemic effect of these two dumpling cooking methods on postprandial glucose levels at 9 time points (0,15,30,60,90,120,150,180,and 240 minutes),peak blood glucose,and area under the curve (AUC) in 4 time periods (0-60,63-120,123-180,and 183-240 minutes).Results The percentage of rapidly digestible starch was remarkably lower in fried dumplings than in boiled dumplings (30.8％ vs.77.0％),but the content of slowly digestible starch in fried dumplings was higher than that in boiled ones (63.7％ vs.20.7％),and the content of resistant starch in both dumplings were similarly low (1.9％ and 2.3％).The average time to the peak glucose value was shorter in fried dumplings compared with boiled dumplings [(93 ± 53) minutes vs.(156 ± 61) minutes,P =0.02],but the average glucose levels at all the 9 time points and the AUC in all the 4 time periods were not significantly different (all P ＞ 0.05).Conclusions Compared with fried dumplings,boiled dumplings show faster starch digestion,but long time to the peak postprandial glucose level.Fried dumplings may raise the glucose level faster than boiled dumplings do in T2DM patients.

Objective To evaluate the reliability of mannitol for fluid responsiveness test in the patients undergoing intracranial surgery.Methods Sixty-two ASA physical status Ⅰ or Ⅱ patients,aged 18-64 yr,with body mass index of 18-25 kg/m2,scheduled for elective intracranial surgery,were enrolled in the study.The patients were mechanically ventilated after induction of anesthesia.The radial artery and central vein were cannulated,and FloTracTM/VigileoTM system was connected for stroke volume variation monitoring.Before infusion of mannitol,effective circulating blood volume was confirmed according to stroke volume variation.20％ mannitol 250 ml was infused over 20 min starting from onset of craniotomy.The fluid responsiveness test was recorded at the end of mannitol infusion.Results The sensitivity of fluid responsiveness test was 43％,and the specificity of fluid responsiveness test was 44％.Conclusion Mannitol can not be used for fluid responsiveness test in the patients undergoing intracranial surgery.

The DNA structures could be altered or even damaged by exogeous or endogenous factors during cell proliferation. Failure of effective and timely repair will lead to cell cycle arrest or apoptosis. By taking the advantage of the quick proliferation of cancer cells, DNA damage induction, cell cycle arrest and apoptosis promotion have become important strategies for ant-cancer chemotherapy. Previous reports showed that an array of natural compounds inhibit cancer cell proliferation by inducing DNA damage, which have therapeutic potentials for anti-cancer drug research and development.
Animals ; Biological Products ; pharmacology ; therapeutic use ; DNA Damage ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Neoplasms ; drug therapy

Objective To investigate the effect of intensive lipid-lowering therapy on the imbalance between inflammatory and anti-inflammatory responses in patients with acute coronary syndrome (ACS).Methods Observed serum levels of hs-CRP and IL-IO in 82 patients with ACS, 17 patients with stable angina, and 22 controls. Forty-one patients with ACS were randomized to take either atorvastatin 10 mg/d (standard lipid-lowering therapy) or atorvastatin 40 mg/d (intensive lipid-lowering therapy) for one month in addition to their routine anti-anginal treatment. Serum levels of hs-CRP, blood lipids, IL-10 were investigat-ed.IL-10 was measured by ELISA. Results The level of hs-CRP in patients with ACS [(11.10 ± 14.30)mg/L] was higher than that in patients with stable angina [(2.47 ± 2.72) mg/L]and controls [(2.34 ± 4.22)mg/L] (P all < 0.05 ). The level of IL- 10 was lower in ACS patients [( 3.94 ± 1.91 ) ng/L] compared with those who had stable angina [(6.31 ± 4.26) ng/L] and controls [(7.76 ± 2.82) ng/L], Pan <0.05. The level of hs-CRP in patients with ACS was decreased and IL-10 was increased after one month treatment with atorvastatin (P < 0.05).The effect of atorvastatin 40 mg/d was more effective than that of atorvastatin 10 mg/d.Conclusions Patients with ACS have higher level of hs-CRP and lower level of IL-10 than those with sta-ble angina. This finding suggests that imbalance of inflammatory and anti-inflammatory responses is related with aggravation of atherosclerotic disease. Intensive lipid-lowering therapy is more effective than standard lipid-lowering therapy on ameliorating the imbalance.

Objective To investigate the correlation between the human telomerase gene (hTERC) and the generation and progression of cervical cancer.Methods A total of 173 patients with abnormal results of cervical biopsy by colposcopy were selected,meanwhile the 40 normal cases were selected as control group.The expression of hTERC gene was detected by fluorescence in situ hybridization (FISH),and the relationship between the HPV infection and the positive rate of hTERC was analyzed.Results The positive rate of hTERC in the control group was 7.50％,which was respectively 15.79％,46.15％,68.63％,and 91.11％ in the CIN Ⅰ group,CIN Ⅱ group,CIN Ⅲ group,and cervical cancer group.The positive rate of the hTERC was significantly increased during the progression of cervical exfoliative cell lesions (P ＜ 0.05).The precancerous lesion and cancer rate in patients with high-risk HPV infection and positive hTERC was 100％,significantly higher than that of patients with high-risk HPV infection as well as positive hTERC and also non high-risk HPV infected patients (P ＜ 0.05).Conclusion hTERC gene amplification is involved in the development of cervical cancer,and increase with cervical lesions rising,and the positive expression of hTERC gene is valuable to the early diagnosis of cervical cancer.

Objective To investigate clinical features and risk factors for recurrent syncope in children with orthostatic intolerance.Methods Patients with orthostatic intolerance and syncope admitted in the Second Hospital of Lanzhou University from January 2014 to June 2015 were retrospectively analyzed by using t test,Chi -square test,and Fisher′s exact probability method.According to frequency of syncope,all cases were divided into 2 groups,the occasio-nal syncope group and the recurrent syncope group.All risk factors including age,gender,body mass index(BMI),in-ducement,the history of motion sickness,family history,syncope -related injuries,performance of head -up tilt table test,and outcomes of head -up tilt table test were studied statistically and compared within 2 different groups.Results A total of 83 cases were enrolled in this study.Among these children,33 cases(39.76%)were assigned as occasio-nal syncope group,in which 17 cases were male and 16 cases were female and the age ranged from 6 to 18 years with the average age of (9.70 ±2.87)years;50 cases(60.24%)were assigned as recurrent syncope group,in which 27 ca-ses were male and 23 cases were female and the age ranged from 6 to 18 years with the average age of (11.24 ±2.83) years.Of all the investigated risk factors,the BMI and the history of motion sickness were significantly different between 2 groups[(18.84 ±3.49)kg/m2 vs (18.16 ±3.68)kg/m2 ,t =4.82,P =0.001;39.39%(13 /33 cases)vs 70.00%(35 /50 cases),χ2 =7.64,P =0.006].No significant difference was found in age distribution(6 -9 years,10 -14 years,15 -18 years)between 2 groups(P =0.428).There were no significant differences in gender (male /female), family history,or syncope -related injuries between 2 groups[17 /16 cases vs 27 /23 cases;3.03%(1 /33 cases)vs 10.00%(5 /50 cases);15.15%(5 /33 cases)vs 20.00%(10 /50 cases),all P >0.05].And no significant difference was found in inducement (prolonged standing,body posture change,emotional stress/emotional stimuli,muggy environ-ment,movement)between 2 groups [78.79% (23 /33 cases)vs 72.00% (36 /50 cases);9.09% (3 /33 cases)vs 14.00%(7 /50 cases);3.03%(1 /33 cases)vs 6.00%(3 /50 cases);12.12% (4 /33 cases)vs 10.00% (5 /50 cases);3.03%(1 /33 cases)and 12.00%(6 /50 cases),all P >0.05].And performances of head -up tilt table test (blurred vision/blacked out,nausea/vomiting,sweating,dizzy/headache,palpation,anhelation /chest tightness,hot, weak)between 2 groups showed no significant differences[18.18%(6 /33 cases)vs 12.00%(6 /50 cases);36.36%(12 /33 cases)vs 50.00%(25 /50 cases);24.24%(8 /33 cases)vs 26.00%(13 /50 cases);51.52%(17 /33 cases) vs 58.00%(29 /50 cases);6.06%(2 /33 cases)vs 16.00%(8 /50 cases);27.27%(9 /33 cases)vs 22.00%(11 /33 cases);33.33%(11 /33 cases)vs 32.00%(16 /50 cases);12.12%(4 /33 cases)vs 16.00%(8 /50 cases),all P >0.05].Also there were no significant differences in outcomes of head -up tilt table test between 2 groups(P =0.589). Conclusions The risk factors for recurrent syncope in children with orthostatic intolerance were low BMI and the his-tory of motion sickness for such children,and more positive and effective clinical intervention can improve the living quality of children with orthostatic intolerance to some extent.

Objective To investigate the clinicopathologic characteristics and prognosis of medullary breast carcinoma.Methods We conducted a retrospective analysis on clinical and pathologic data of 166 patients with medullary breast cancer.Results All the patients were female with a median age of 52 years old.The proportion of patients with stage Ⅰ,Ⅱ and Ⅲ disease was 16.9％,68.1％,15.0％,respectively.The Luminal,HER-2 overexpressing and triple-negative subtypes constituted 31.3％,8.4％,and 60.3％,respectively.There was significant difference in regional lymph node status of medullary breast cancer patients with different molecular types (x2 =18.248,P =0.003),but not in tumor size,TNM stage,histological grade,and expression of Ki67 (all P ＞ 0.05).Multivariate survival analysis indicated that TNM stage was an independent predictor in the prognosis of medullary breast cancer (HR =5.664,P =0.001).All the patients were followed up from 15 months to 145 months with a median follow-up time of 108 months.The 5-year survival rate was 91.5％ and the 10-year survival rate was 87.2％.Conclusions The prognosis of medullary breast cancer is favorable.Personalized treatment according to the TNM stage and histopathologic characteristics achieve a favorable prognosis.