Doctor-patient relationship has attracted increasing attention.In the light of modern model to study the related theory,a preliminary study of the ancient Chinese doctor-patient relationship model has been done.The doctor-patient relationship in ancient society is the same complex and multi-level.Therefore,doctor-patient model could not be lumped together.According to the social status of patients and the extent of their demand for medical services,and the social status of doctors and their medical technique,the doctor-patient relationship could be divided into three typies-equality type,authority type,and principal and subordinate type.With a view of doctor-patient relationship of traditional Chinese medicine,there draws an acquisition value of the current complex patient relationship.

Objective To explore true thoughts and experience about student-based nursing teaching rounds among vocational college nursing students in Pediatric during the initial stage of clinical practice.Methods Interview was conducted on 27 nursing students of seven focus groups with semi-structured interview.The data was transcribed based on the tape and were analyzed by Giorgi analysis.Results Nursing students held positive attitude to this mode.Three themes were extracted:stimulating nursing students' learning potential,enhancing the comprehensive ability of nursing students; some students had difficulties in case selection,disease analysis and physical examination; suggesting that detailed rounds guideline should be issued to students first,and teaching rounds should be held every two weeks.Conclusions We should strengthen training of the ability of nursing assessment in pediatrics for nursing students,play the role of facilitator and advocate self-directed learning methods.

Objective To explore the association between the polymorphism rs671 site of the acetaldehyde dehydrogenase 2 (ALDH2) gene and H-type hypertension in the elderly in Han nationality in Qingdao.Methods Totally 406 patients aged 60-90 years with primary hypertension were randomly selected in the study.Serum levels of homocysteine(Hcy),folate and vitamin B12 were determined and all patients were divided into H-type hypertension group and non H-type hypertension group.Gene chip technology was used to analyze the ALDH2 (rs671) polymorphism,and the association between ALDH2 gene and H type hypertension was evaluated.Results Of all hypertensive participants,82.0％ (333/406) were in H-type hypertension,87.4％ (221/253) in male and 73.2％ (112/153) in female.The GA/AA genotype and A allele frequency were higher in H-type hypertension group than in non H-type hypertension group [37.2 ％ (124/333) vs.16.4 ％ (12/73) and 21.3％(71/333) vs.9.6％(7/73),P=0.001and 0.021].Serum Hcyleveland the prevalence of H type hypertension were higher in GA/AA genotype group than in GG genotype group(both P＜ 0.05).Logistic regression analysis showed that GA/AA genotype,gender (male),drinking,folate deficiency and increased systolic pressure were the risk factors for H-type hypertension (OR=3.17,2.14,2.37,0.75,1.03,respectively,all P＜ 0.05).Conclusions The genetic variation of ALDH2(rs671) may increase Hcy level by decreasing the levels of folate and vitamin B12.GA/AA genotype is a risk factor for H-type hypertension,and it contributes to H-type hypertension together with gender,drinking history,folate levels and systolic pressure.

Objective To know about the post-traumatic stress disorders (PTSD) of women with termination of pregnancy for fetal anomalies (TOPFA),and investigate the relationship of PTSD and the big five personality traits.Methods The general questionnaire,the Impact of Event Scale-Revised (IES-R) and the Big Five Questionnaire were administered to the women with TOPFA in hospital from February 2014 to February 2015.Results The total score of IES-R of 84 cases was 26.20 ± 16.38.The scores of 49 cases(58.3％) were more than 19 and that of 20 cases (23.8％) more than 35.Women who had the first pregnancy had higher level of arousal symptoms,12.84±7.41 vs.9.65±5.53 (t =2.25,P ＜ 0.05).Women whose scores were above 19 had lower adaptation,sociality,altruism and conscience compared with those scored ≤ 19,14.96±3.29,16.84±3.00,18.55±3.49,17.57±2.99 vs.13.57±2.82,18.31±2.65,20.03±2.32,18.86±2.21,t=2.02-2.33,P ＜ 0.05.The IES-R score had no linear correlation with that of the big five personalities,and intrusion subscale had linear correlation with the adaptation.Avoidance symptoms had low positive relationship with sociality in women whose IES-R were above 19,r =0.23,P ＜ 0.05.In populations whose IES-R scored above 19,avoidance subscale had positive weak correlation with sociality,r=0.31,P ＜0.05.Conclusions The women with TOPFA had high level of PTSD before termination.Women with sever posttraumatic stress symptoms had lower sociality and altruism.Moreover,of the women who had sever posttraumatic stress symptoms,one with higher sociality always had higher avoidance symptoms.

Objective To investigate the distribution and drug resistance of pathogens in intensive care unit (ICU) so as to provide scientific basis for antibiotic adoption and the prevention and control of nosocomial infections. Methods The various specimens collected from the patients admitted into ICU in the First People's Hospital of Shunde Affiliated to the South Medical University from January 2007 to December 2014 were used to isolate the pathogens that might cause nosocomial infections and retrospectively analyze their clinical distribution and drug resistance. Kirby-Bauer paper diffusion and minimal inhibitory concentration (MIC) methods were applied to test the drug sensitivity, and according to National Committee for Clinical Laboratory Standards/Clinical and Laboratory Standards Institute (NCCLS/CLSI) standard, the results were identified.Results The sputum was the major specimen source in ICU, accounting for 68.8%, followed by urine (12.4%) and blood (6.8%). All together 557 pathogens in ICU causing nosocomial infections were isolated of which there were 377 gram-negative (G-) bacilli (67.7%), 103 gram-positive (G+) cocci (18.5%), and 77 fungi (13.8%). Among G- bacilli, the top three wereAcinetobacter baumannii (34.5%), Klebsiella pneumonia (17.8%), andPseudomonas aeruginosa (13.0%). Beside carbapenem, the drug resistance rates of Acinetobacterbaumannii to other antibiotics were more than 40%. The main G+ coccus causing nosocomial infection wasSaphylococcus aureus (36.9%) in ICU. The drug resistance rates ofSaphylococcus aureus to penicillin, gentamicin and erythromycin were higher than 50%. In 77 fungus strains,Candida albicans was ranked the first, accounting for 41.6%.Conclusion The main infection site in ICU is primarily respiratory tract, the G- bacilli are the predominate pathogens, and the drug resistance to antibiotics found in this report is serious, so clinically, the antibiotics should be properly used to avoid the occurrence of pathogenic strain with drug tolerance.

Objective To investigate the association between sarcopenia and nutritional status among inpatients aged 80 years and over.Methods A total of 120 patients aged ≥80 years admitted into geriatrics department of a third-grade first-class hospital in Shandong province who met inclusion and exclusion criteria were enrolled from March 2017 to March 2018 in this cross-sectional study.According to diagnostic criteria of Asian Working Group for Sarcopenia,patients were divided into the sarcopenia group and the non-sarcopenia group.General clinical data were collected.Nutritional assessment was validated by using Mini Nutritional Assessment(MNA)and the determined nutritional indexes of serum levels of hemoglobin and albumin.Univariate and multivariate analysis were used to analyze the association between sarcopenia and nutritional status.Results Of 120 inpatients aged ≥ 80,28 cases(23.3％)had sarcopenia,including 20 men(71.4％)and 8 women(28.6％).The incidences of sarcomenia were 1.4％ (1 case)in patients with normal nutritional status and 100％ (6 cases)in patients with malnutrition.Compared with the non-sarcopenia group,the sarcopenia group had lower levels of body mass index,serum hemoglobin,serum albumin and MNA scores[(20.0 ± 2.2) kg/m2 vs.(25.4±3.0)kg/m2,(34.5±3.4)g/L vs.(38.6±3.5)g/L,(114.4± 14.0)g/L vs.(127.3± 14.8) g/L,(8.8 ± 1.9) score vs.(12.7 ± 1.4) score,P ＜ 0.05].After adjustment for all covariates,multivariate Logistic regression analysis showed that MNA score was an independent risk factor for sarcopenia(OR =0.118,95％CI:0.026-0.530).Conclusions The incidence of sarcopenia is high in hospitalized patients aged 80 years and older.MNA score is an independent risk factor for sarcopenia.

Objective To investigate the impact of sarcopenia on muscle strength and exercise capacity in elderly patients with chronic heart failure (CHF).Methods One hundred and sixteen inpatient aged ≥65 years with CHF were enrolled in the study.General clinical characteristics were collected with questionnaire;the appendicular skeletal muscle mass (ASM) was assessed with body composition analyzer;the arm muscle strength was measured and a 6m-walk test was performed.The sarcopenia was evaluated according to the Asian Working Group for Sarcopenia (AWGS) criteria.Simple regression analysis and logistic regression were used to analyze the correlation between sarcopenia and decreased muscle strength,exercise capacity in elderly CHF patients.Results Among 116 elderly CHF patients,sarcopenia was confirmed in 42 patients(36.2％).Patients with sarcopenia had poorer cardiac function and lower muscle strength,ASM and 6m-walking speed than patients without sarcopenia did(allP＜0.05).Simple regression analysis showed positive correlation between ASM and muscle strength in both groups.Logistic regression analysis showed that after adjustment for confounders,ASM reduction was an independent risk factor for reducedexercisecapacity(OR=0.158,95％CI:0.055-0.455,P＜0.05).Conclusion Sarcopenia is a common complication in elderly patients with CHF and may lead to decreased muscle strength and exercise capacity.

Objective:To investigate the protective effect of hyperbaric oxygen therapy(HBOT)on myocardial fibrosis and oxidative stress induced by D-galactose(D-gal)in senescent model mice and its possible mechanism.Methods:Three-month-old male Kunming mice(n=27)were randomized into control, D-gal, and D-gal + HBOT groups.The control group received subcutaneous sterilized saline(5 ml · kg -1· d -1)for 8 weeks; the remaining 2 groups received subcutaneous D-gal(200 mg · kg -1· d -1)for 8 weeks. The D-gal + HBOT group underwent HBOT intervention at week 7~8.At the end of the experiment, the histopathological changes were analyzed by hematoxylin-eosin(HE)staining, and the fibrosis changes were analyzed by Masson staining and Sirius red staining.Oxidative stress kit was used to detect catalase(CAT), total superoxide dismutase(T-SOD)activity and malon-di-aldehyde(MDA)content in serum of mice.Western blotting was used to detect the expression levels of the aging-related proteins p53 and p16 in mouse heart tissue, the heart-function-related proteins atrial natriuretic peptide(ANP)and brain natriuretic peptide(BNP), and the oxidative stress-related protein superoxide dismutase 1(SOD1), superoxide dismutase 2(SOD2)and catalase(CAT). Results:Cardiac morphologic staining indicated that as compared with the control group, mice of D-gal group exhibited features of senescence and the increased fibrosis area, and senescence and fibrosis were obviously improved after HBOT intervention as compared with the D-gal group.The findings of the oxidative stress kit measurement indicated that as compared with the control group, the D-gal group had markedly decreased activities of CAT and T-SOD, significantly increased MDA content in the serum.After HBOT treatment, as compared with d-gal group, serum CAT and T-SOD activities were increased, while MDA content was decreased( F=126.85, 32.89, 157.50, all P<0.05).Furthermore, as compared with the control group, the D-gal group had obviously increased contents of p53, p16, ANP and BNP, while the content of CAT, SOD1 and SOD2 were obviously decreased.After HBOT intervention, as compared with the D-gal group, the contents of p53, p16, ANP、BNP were reduced, while the content of CAT, SOD1 and SOD2 were increased( F=36.37, 14.81, 23.28, 58.41, 12.79, 80.08, 6.63, all P<0.05). Conclusions:HBOT intervention could protects against cardiac injury in aging mice, which may be related to attenuating myocardial fibrosis, inducing the expression of antioxidant enzymes, and reducing oxidative stress.

Objective To explore the transformation of three-dimensional curve,and to observe effect of three-dimensional remodeling surgery in order to find an ideal method to achieve upper eyelid rejuvenation.Methods Retrospective analysis was conducted after surgical correction for three-dimensional reconstruction in 48 patients with upper eyelid that were female,aged 58 to 76 years;all of them had simultaneous surgery of both eyes.Using double eyelid crease incision to remove loose and redundant skin,we transplanted the herniated fat of the medial orbital septum to the deep surface of the orbicularis oculi muscle in the distinct bony structure of the extra-supraorbital margin,folded and lifted orbital septum fascia;at the same time lifted eyebrow through eyebrow incision,transplanted and filled dermis and muscle fascia flap to remodel the transverse S-shaped stereo curve of the coronal plane of the upper eyelid.Results A lot of 41 cases were followed up more than 6 months from 48 patients,except that one patient had a second surgery due to double eyelid asymmetry after one year,eyelid rejuvenation in 40 patients were improveed.Effect of 33 cases was satisfactory.Satisfaction rate was 80.49％.Less satisfaction were 6 cases,accounting for 14.63％.No satisfaction was 1 case,ac counting for 2.44 ％.Conclusions The surgery can reshape the concavity inside,the full crown outside of upper eyelid by the skin removing,fat shifting,leather fat muscle flap filling,and restore the upper eyelid to three-dimensional full round young shape.It is an ideal surgical method for eye anti-aging treatment.

Objective:To explore a new method for correcting the senile blepharochalasis and depression of the upper eyelid.Methods:Fourteen female patients with blepharochalasis and depression of upper eyelid were treated with subcutaneous tissue flap filling during eyebrow lifting. The under-eyebrow incision was used to remove the loose skin and lift the eyebrow, and a subcutaneous tissue flap was made to fill up the upper eyelid depression.Results:All the incisions were healed in one stage without complications such as infection and subcutaneous hematoma. 12 patients were followed up for more than 6 months. In the 3rd month after operation, 1 patient had obvious scar under the eyebrow, 1 patient had skin traction wrinkles at the eyebrow. After 6 months, the incision scar was not obvious in all patients, the appearance of eyebrow ptosis was eliminated, the upper eyelid was smooth and flat, and no absorption and further depression of the upper filler were observed; the effect was satisfactory.Conclusions:The eyebrow lifting combined with the subcutaneous tissue flap filling to correct the senile upper eyelid chalasis and depression is significantly effective with less trauma and complications, and it is worthy to be promoted.