Doctor-patient trust is the core and foundation of harmonious doctor-patient relationship, because our country is at the stage of social transformation and deepening medical reform, various problems make the doctor-patient relationship unoptimistic, and there appeared crisis of confidence between doctors and patients. This arti-cle analyzes the current situation of doctor -patient trust in our country, based on the clarification of doctor -patient trust. It also comb the researches focused on doctor-patient trust evaluation on the basis of domestic and foreign literature. It is expected to provide a reference to the future evaluation of doctor-patient trust, to improve the level of trust between doctors and patients, and to build a harmonious doctor-patient relationship.

Objective To construct the recombinant expression vector carrying human glucocorticoid receptor ?(hGR?) cDNA to provide experiences for cloning of large DNA fragments and offer experimental materials for studying the function and medchanism of hGR? by antisense nucleic acid technique. Methods hGR? cDNA was amplified from an expressional phage library of human white cells by L-PCR, and cloned into pGEM-Teasy vector. Subsequently, the hGR? cDNA fragment digested from the recombinant T vector was sub-cloned into retroviral vector pLXSN in sense and antisense orientations, respectively through an improved ligasing protocol. Results Restriction endonuclease analysis and sequencing showed that cloning and sub-cloning of hGR? were successful. Conclusion Retroviral recombinant vectors carrying sense-and antisense-hGR? cDNA were successfully constructed.

Objective To explore the role of Extracellular signal-regulated kinase(ERK)signal transduction pathway in the mechanism of liver fibrosis via investigating the expression of ERK1 in fibrotic liver tissue of human.Methods SABC immunohistochemistry was used to detect the expression of ERK1 in 32 liver fibrosis and 12 normal liver tissues from Jan.2001 to Dec.2003.Results The expression of ERK1 in liver fibrotic tissues were found chiefly in hepatic stellate cells(HSC),and it presented with significantly progressive tendency for the expression of ERK1 in normal and liver fibrosis cirrhosis tissues(P

The development of protein chip technique in clinical diagnosis of lung-related diseases are reviewed to provide the references for the application of technique in other diseases.The SELDI technique is a high throughput research method in proteomics with superiorities of automation,rapidness,sensitivity and specificity.It has widely potential application in clinical diagnosis of lung-related diseases.Its principle,classification,application,analysis and advantage are introduced.The protein chip technique improves positive ratio and specificity of lung-related diseases diagnosis.

Among many factors affecting dental caries, bacteria are its initiating factor. From the perspective of ecological plaque hypothesis, the application of modern molecular biology methods enable scholars to deeply explore the relationship between the microbial population distribution, biodiversity, microbial community changes of dental plaque biofilm and the occurrence of dental caries in children. The decrease in microflora diversity is closely related to the occurrence of dental caries, which can be detected as early as 6 months before the occurrence of dental caries, providing an important basis for caries monitoring and caries risk assessment. Differential bacteria such as Lactobacillus and Veillonella may be used as biomarkers of caries in children to judge the risk of caries in children. However, current studies have shown that the dominant bacteria in the microbial community structure vary in different processes of caries occurrence and development, that the interaction between different flora is still not clear, and that the specific cariogenic mechanism of the oral plaque microbial community in the process of caries occurrence and development has not been clarified. Further research is still needed to explore the changes in plaque microbial diversity and composition during the development of dental caries and to screen specific dental caries biomarkers. This paper also summarizes the related research findings.

Objective:To investigate the effects of miRNA-143-3p on the proliferation, migration and invasion of keloid fibroblasts (KFB) and the possible mechanism.Methods:KFB and normal skin fibroblasts (NFB) were isolated and cultured. The expression of miRNA-143-3p and integrin β5 (ITGB5) at mRNA level in KFB and NFB were detected by RT-qPCR. Western blot was performed to measure the expression of ITGB5 at protein level. After overexpressing miRNA-143-3p or suppressing ITGB5 expression in KFB cells, MTT assay, Transwell assay, RT-qPCR and Western blot were used to detect the effects on the proliferation, migration and invasion of KFB and the expression of related proteins. Dual-luciferase reporter gene assay was used to validate the targeting relationship between miRNA-143-3p and ITGB5.Results:Compared with NFB, KFB showed down-regulated miRNA-143-3p expression and up-regulated expression of ITGB5 at both mRNA and protein levels. The proliferation, migration and invasion of KFB were inhibited after overexpressing miRNA-143-3p or suppressing ITGB5 expression. Moreover, miRNA-143-3p could negatively regulate ITGB5 expression and overexpression of ITGB5 reversed the effects of miRNA-143-3p overexpression on KFB proliferation, migration and invasion.Conclusions:This study suggested that miRNA-143-3p could inhibit the proliferation, migration and invasion of KFB through down-regulating ITGB5 expression.

Objective To summarize the clinical manifestations,diagnosis and treatment of perinatal tuberculosis.Methods We retrospectively analyzed the clinical data of six infants with perinatal tuberculosis treated in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2000 to December 2016.Results (1) The six patients were at the age of 27 to 60 days at the onset,while the mean ages of full-term and preterm infants were (31 ± 4) and (55± 6) days,respectively.Three mothers were diagnosed with active tuberculosis (two of which were diagnosed after parturition).(2) Three infants were admitted to the hospital with fever including two having respiratory diseases,one with external auditory canal secretions and deviated mouth,and two with secretions in the external auditory canal and masses in the head and neck.One was diagnosed as hepatosplenic tuberculosis,three as miliary tuberculosis (one was complicated by tuberculous meningitis and one with tuberculous meningitis and cervical lymph node tuberculosis),one with left cervical and temporal tuberculosis,and one with miliary tuberculosis complicated with left temporal,external auditory canal and cervical lymph node tuberculosis.(3) Two cases were positive for purified protein derivative skin test and two were positive for tuberculosis infection T cell spot test.Five cases were negative in anti-tuberculosis antibody test.Typical miliary shadows in the lungs of three infants were shown on chest X-ray.Two cases received auriculotemporal CT/MRI,indicating space-occupying lesions and destruction in the middle ear and mastoid process.Cranial MRI findings indicated one case had tuberculous meningitis.Diagnosis of three cases were confirmed by biopsy or after operation.(4) All six patients survived.Four cases recovered after combined treatment of isoniazid,rifampicin and pyrazinamide and two were transferred to a specialized hospital for further treatment.(5) All six patients were fully recovered in follow-ups at 2-3 years after discharge with normal development comparing with healthy children of the same age.Conclusions Perinatal tuberculosis,with nonspecific clinical manifestations,has a low incidence of infection but a high mortality rate.Suspected cases require full consideration including clinical symptoms,dynamic observation of laboratory findings and imaging features,and pathological examination when necessary.Maternal history of tuberculosis should be consulted and timely treatment is mandatory to improve the outcomes.

Objective:To compare the effects of glenosphere offset positions on the impingement-free range of motion (ROM) in reverse total shoulder arthroplasty (RTSA).Methods:Shoulder joint models were reconstructed using shoulder CT scans of 6 patients with primary osteoarthritis. RTSA was performed virtually according to standard surgical procedures, and shoulder movements were simulated. Reverse shoulder models were constructed with 2 lateral offsets (0 and 4 mm) and 6 positional offsets (center, inferior, posterior, anterior, anterior-inferior, and posterior-inferior). The impingement-free ROM and impingement sites for abduction-adduction, flexion-extension, total rotation (sum of internal and external rotation), and total ROM (sum of ROM in all movement modes) were evaluated.Results:All the 12 combinations of different glenosphere offsets achieved 50% of the original shoulder ROM in all movements. In the abduction-adduction motion with 0 and 4 mm lateral offsets, the anterior-inferior offset provided the largest ROM (94.4°±8.7° and 105.3°±6.9°, respectively), but there was no significant difference between the positions ( P>0.05). In the flexion-extension motion with 0 and 4 mm lateral offsets, the posterior-inferior offset showed the largest ROM (194.1°±6.9° and 196.9°±9.7°, respectively), but there was no significant difference between the positions ( P>0.05). In the total rotation motion with 0 and 4 mm lateral offsets, the anterior-inferior offset had the largest ROM (141.5°±5.9° and 160.6°±8.5°, respectively), showing significant advantages over the center, anterior, and posterior offsets ( P<0.05), but insignificant advantages over the inferior and posterior-inferior offsets ( P>0.05). In total ROM, the anterior-inferior offset provided the largest ROM. When the lateral offset was 0 mm, the anterior-inferior offset provided a ROM of 421.8°±16.4°, showing significant advantages over the center and posterior offsets ( P<0.05). Compared with the lateral glenosphere offset of 0 mm, the lateral glenosphere offset of 4 mm significantly improved total shoulder ROM (122.8°±10.6° versus 145.8°±4.8°) and total ROM (390.9°±11.6° versus 428.4°±19.8°) ( P<0.05). Conclusions:The anterior-inferior, inferior, and posterior-inferior glenosphere offsets can improve ROM in all movement patterns. The position and lateral offset of the glenosphere significantly affect the total rotation and total ROM of the shoulder joint. Specifically, the anterior-inferior and inferior offsets show significant advantages over the center position in total rotation and total ROM of the shoulder joint.

Objective:To investigate the clinical effects of superior gluteal artery perforator " buddy flap" in repairing pressure ulcer in sacrococcygeal region.Methods:From January 2017 to December 2018, 13 patients (8 males and 5 females) aged 24-79 years with stage 4 pressure ulcers in sacrococcygeal region were admitted to the First Affiliated Hospital of Zhengzhou University, with wound area from 5 cm×4 cm to 12 cm×10 cm. After thorough debridement and vacuum sealing drainage, the superior gluteal artery perforator " buddy flap" was designed to repair the pressure ulcer in sacrococcygeal region. The pressure ulcer was repaired by the main flap with area from 7.0 cm×5.0 cm to 18.0 cm×12.0 cm; the main flap′s donor area was covered by the auxiliary flap with area from 5.0 cm×3.0 cm to 11.0 cm×7.0 cm; the auxiliary flap′s donor area was covered by the connecting flap between the main flap and the auxiliary flap. The remaining wound without covering was directly closed by suturing. The postoperative flap survival and complications were observed. The appearance and function of flaps and the recurrence of pressure ulcer were followed up.Results:The flaps of 12 patients survived after operation without complications of infection, fat liquefaction, or poor flap survival. A small area of superficial necrotic skin at the distal end of flap was observed in one case, which was healed after dressing change. All the patients were followed up for 6 months without recurrence of pressure ulcer, and the operation area was naturally full in appearance, which was pressure and wear resistant.Conclusions:Superior gluteal artery perforator " buddy flap" is an effective method for the treatment of pressure ulcer in sacrococcygeal region. The effect of tension-free repair of the pressure ulcer and main flap donor area can be achieved in one operation. The operation is simple, the curative effect is accurate, and it has certain clinical value.

Objective : To explore from the perspective of microorganisms the changes in plaque microbial community of children with severe early childhood caries (S-ECC) before and 3 months after dental treatment. Meanwhile to show the effect of treatment on the maintenance of long- term caries-free state. Methods: S-ECC children completed dental treatment under general anesthesia. We collected plaque from caries-free dental surfaces before treatment (caries, C) and at the postoperative follow-up review time points of 7 days (C-7D), 1 month (C-1 M), and 3 months (C-3 M). We included caries-free children (caries free, CF) as the control group to analyze the dynamic modification process of the plaque microbial community in the short-term pre- and postdental treatment. Results: Species clustering analysis showed that the compositions of the microbial communities of the S-ECC and CF groups were highly similar. The α diversity index was not statistically significant (P>0.05). From the analysis of the relative abundance, Leptotrichia spp. and Aggregatibacter spp. decreased after treatment compared with before treatment (P<0.05). Streptococcus sanguinis in the C-7D group increased compared with that in the C group and gradually decreased within 3 months. Veillonella spp., Actinomyces spp., Allprevotella spp., Capnocytophaga spp., and Streptococcus mutans differed between the C and CF groups (P<0.05), Streptococcus mutans did not differ significantly between the C-7D and C-1 M groups and the CF group after treatment, while C-3 M showed an increase compared with the CF group (P<0.01). Conclusion The rapid change in the structure of the flora of children with S-ECC after treatment. The plaque microbial community structure in a caries-free state gradually starts to be established 1-3 months after treatment. There is a "core microbiota" in the oral plaque community that jointly maintains microecological stability. Veillonella spp., Allprevotella spp. and Streptococcus mutans have potential as possible microbial markers.