The rapid development of medical science and technology, which has greatly promoted the development of medicine and the improvement of diagnosis and treatment, has also brought about various negative impacts in clinical practice on the doctor-patient relationship. The paper attempts to analyze these impacts from such perspectives as medical treatment, society, ethics, and law and proposes some corresponding countermeasures in perspective of the present reality: (1)rationally controlling medical expenses; (2) effectively stepping up communication; (3)appropriately handling difficult ethical problems; (4) amplifying necessary health rules and regulations. The goal is to create a win-win situation for both progress in medical science and technology and improvement of the doctor-patient relationship.

Objective The objective of this study was to observe effects of miR-409-5p on the proliferation and migration of HepG2 cells.Methods HepG2 cells were transfected with miR-409-5p mimics and verified by Real-Time quantitative PCR.After high expression of miR-409-5p,MTT and wound healing assays were used to detect the proliferation and migration ability of HepG2 cells.Results The cell viability of HepG2 cells transfected with miR-409-5p mimics was significantly decreased in comparison with the control group and showed a dose-and time-dependent manner(P<0.05).The migration ability of cells overexpressing miR-409-5p mimics was significantly lower than that in the NC group(P<0.05).There was significant difference between the two groups at treatments for 24 h and 48 h.Conclusion Up-regulated miR-409-5p can inhibit the proliferation and migration of HepG2 cells.

Objective To summarize the perioperative experience of nursing the middle-aged and elderly patients of lumbar spinal stenosis and degenerative lumbar scoliosis treated with posterior or transforaminal lumbar interbody fusion. Methods Posterior or transforaminal lumbar interbody fusion was performed in 69 middle-aged and elderly patients with lumbar spinal stenosis and degenerative lumbar scoliosis. Nursing measures included evaluation and treatment of complications, preoperative guidance for surgical body position, and postoperative close monitoring, treatment of complications and functional exercises. Results The operation on all the 69 patients was smooth, with surgical time ranged from 3 to 7 hours and bleeding volume between 300~750 mL. Postoperatively, 9 patients suffered from CSF leaks, 3 ones had a screw loose by imageology, 2 did from pneumonia, 2 did from DVT, and 3 did from depression. After clinical management and nursing, all the patients were cured and discharged. Conclusions Meticulous clinical treatment and nursing of preoperative complications and instructions on body position are the foundation for successful surgeries. Postoperatively, close monitoring, management of the complications and the instruction on functional exercises are guarantees for the successful surgeries.

Objective To investigate the changes of Claudin-3 and Claudin-11,two key components of blood-testis barrier (BTB) on male infertility induced by γ-ray irradiation.Methods Fortytwo KunMing male mice (20-25 g) were divided into one control group,three γ-ray irradiation groups and three estrodiol (E2) intervention groups randomly:Group A,sham controlled; the lower abnominal and scrotal area of the mice in Group B,C,D were irradiated with single dose of 2,6 or 10 Gy 60Co γ-ray after anaesthetizd; 17β-estradiol intervention were initiated in Group E,F,G after 6 Gy γ-ray irradiation via hypodermic injection for 4w at the dose of 1,2,4 μg/d,respectively.Mice were sacrificed 2 w after the last E2 administration.The tubule differentiation index (TDI) was counted in testis sections.InhibinβB,Claudin-3 and Claudin-11 transcription levels were assayed with semiquantitative real time PCR.Claudin-11 protein levels in testis were generated by western blot.Results Compared with sham control group,TDI in three γ-ray irradiation groups were markedly reduced (68.5 ± 6.4,35.0± 6.1,16.3 ± 5.7 vs 100.0,all P＜0.05).InhibinββB mRNA expression level in testis of gourp D was markedly decreased (0.5±0.2 vs 1.0±0.1,P＜0.05).Claudin-3 mRNA levels of group C and D were up-regulated to 2.17 and 3.49 times,respectively.Claudin-11 protein levels were significantly increased to 2.18 and 2.23 times.Compared with group C,TDI in three E2 intervention groups were improved,which were obvious in group F and G (61.7±7.2,55.8±11.9 vs 35.0±6.1,P＜0.05).The InhibinβB mRNA levels were increased,though there were no significant differences (all P ＞0.05).Claudin-3 mRNA levels in group F and G were down-regulated (1.3± 0.2,1.6±0.3 vs.2.2 ± 0.2,all P＜0.05).In group F significantly reduced mRNA level and protein level of Claudin-11 were observed (mRNA:1.2±0.2 vs.1.8±0.2,P＜0.05; Protein:1.5±0.5 vs.2.2±0.3,P＜0.05).It was negatively correlated TDI with mRNA expression levels of Claudin-3 and Claudin-11 in the irradiated testis (rs =-0.884,P＜0.05; rs=-0.758,P ＜0.05,respectively).Conelusions Irradiation could elevated the expression of claudin-3 and claudin-11.

Objective To detect the relationship between tumor markers (TM) and prognosis of NSCLC.Methods The level of TM of 178 NSCLC cases,which all accord with the standard of advanced NSCLC come from Guang'an Men Hospital of China Academy of TCM from 2006 October to 2009 March.Was divided into 5 groups:group 1 (0～3 months)、group 2 (4～6 months)、group 3 (7～9 months)、group 4 ( 10～ 12 months)、group 5 ( ＞ 12 months) according to time to progression (TTP).Studied the correlation between TM,TTP and one year survival retrospectively.Results The serum level of Ca125 in TTP 1～5 group was:(227.9± 73.3)U/ml,(83.4± 127.6)U/ml,(74.8 ± 174.5)U/ml,(53.15 ± 26.3)U/ml,(24.69± 8.78)U/ml respectively which indicated that the higher the serum level of Ca125 was,the more quickly the progress of disease would be(P=0.02); The serum level of Cyfra211 [(9.8±9.4)ng/ml,(10± 6.9) ng/ml,(41.55±9.3) ng/ml,(11.98 ± 9.9) ng/ml,(4.1 ± 0.5) ng/ml) ],CEA [ (88.4± 227) ng/ml,(75.8 ± 272) ng/ml,(57.4 ±153)ng/ml,(35.4±52.5)ng/ml,(17.1± 15.4)ng/ml] and Ca153 [(42.6±52.3)ng/ml,(47.6±147.0) ng/ml,(57.4± 153)ng/ml,(19.4± 12.7)ng/ml,(33.7± 14.6)ng/ml] was associated with prognosis,the higher level they were the lower possibility of one-year survival would be (P=0.041 ).Conclusion Ca 125、Cyfra211、CEA and Ca153 had certain value for prognostic judgment and it was of great significance that measuring rational serum tumor markers on judging prognosis of NSCLC.

Objective:To analyze the incidence trend, current status and survival period of young patients with lung cancer aged from 15 to 44 years in Shanghai between 2002 to 2005. Methods:All the data were collected from the database of registration and ma-nagement system of diagnosed cancer cases in Shanghai city organized by Shanghai Municipal Center for Disease Control & Prevention. The incidence trend was analyzed by using APC(annual percent change)model. The survival period and median survival time were calculated by using SPSS 12.0 software and life table method. The univariate and multivariate analyses were analyzed by using Kaplan-Meier and COX regression model, respectively.Results:A total of 972 young patients with lung cancer who aged from 15 to 44 years were diagnosed in Shanghai between 2002 and 2005, accounting for 3.09% of the whole percentage of adenocarcinoma in young patients was higher than that in whole lung cancer population at the same period, while the TNM stage was not significantly different between male and female young patients. Multivariate analysis demonstrated that gender, pathological classification and TNM stage were independent prognostic factors for young patients with lung cancer. Conclusion:The lung cancer had different characteristics in young patients compared with that in whole lung cancer population in Shanghai city. It was necessary to further investigate the biologic behavior of lung cancer in young patients.

Objective To investigate the relationship between duration of hypertension and cognitive function in adult hypertension patients.Methods A total of 224 subjects with normal blood pressure were enrolled in group A,and 1 296 patients with poorly controlled hypertension were further divided by the duration of hypertension into group B (≤5 years),group C (6-10 years),group D (11-20years) and group E (＞ 20 years).Face-to-face surveys were conducted in all the subjects by trained physicians using Mini-Mental-State-Examination (MMSE) and Clock-Drawing-Test (CDT).The incidences of cognitive impairment were compared among the five groups and the relationship between duration of hypertension and cognitive function were analyzed by SPSS 18.0 software.Results (1) Compared with the normotensive group,the hypertensive group performed worse in the scores of MMSE,CDTs,the memory type cognitive function and the non-memory type cognitive function (MMSE:Z =-2.585,P =0.010;C DTs:Z =-3.689,P ＜ 0.001 ; memory type cognitive function:Z =-2.718,P =0.007 ; non-memory type cognitive function:Z =-1.994,P =0.046).(2) The incidences of cognitive impairment in the five groups were 3.6％ (8/224),6.6％ (26/393),16.6％ (72/433),19.7％ (55/279) and 33.5％(64/191),respectively.(3) Compared with the group A,the cognitive function was significantly worse in the group E (MMSE:Z =61.314,P ＜ 0.001 ; CDTs:Z =44.642,P ＜ 0.001 ; memory type cognitive function:Z =35.703,P ＜ 0.001 ; non-memory type cognitive function:Z =54.440,P ＜ 0.001).Conclusions Hypertension is a risk factor for the cognitive dysfunction.The incidence of cognitive dysfunction and the severity are positively associated with the duration of hypertension.In those with hypertension over 20 years,the cognitive dysfunction occurs much more obviously.

Objective To analyze clinical pathologic characteristics of patients with primary biliary cirrhosis autoimmune hepatitis overlap syndrome (PBC AIH OS),the incidence of extrahepatic autoimmune disease,malignant tumor and the abdominal lymph node enlargement.Methods From January 2000 to January 2012,the clinical data of 49 patients with PBC AIH OS were retrospectively analyzed,which included general information,clinical manifestations,biochemical parameters,immunological parameters,liver histopathological features,the incidence of extrahepatic autoimmune disease and malignant tumor,imaging findings and the efficacy.Results Among 49 PBC-AIH OS patients,the percentage of patients between 51 and 60 years old was 59.2％ (29/49),and the mean age of onset was (57.2±8.9) years old.Female was 83.7％ (41/49).The percentage of jaundice and pruritus in the main symptoms of initial visit was 42.9％ (21/49).The serum level of alanine aminotransferase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),γ-glutamyl transpeptadase (GGT) and total bilirubin (TBil) of 49 patients all increased.Among 31 patients who accepted IgA,IgG and IgM level test,the level of IgM increased in 58.1％ (18/31) of patients,and the level of IgG increased in 61.3％ (19/31) of patients.Ninety-eight percent of patients were antinuclear antibody (ANA) positive,6.1 ％ (3/49) were anti-smooth muscle antibody (SMA) positive,89.8％ (44/49) of patients were anti mitochondrial antibody (AMA) and or AMA-M2 positive.All patients had interface hepatitis.Forty-nine percent (24/49) of patients had both histological features of autoimmune hepatitis (AIH) and primary biliray cirrhosis (PBC).After being treated with ursodeoxycholic acid (UDCA) and immunosuppressant,the percentage of remission,incomplete response and failure was 65.3％ (32/49),26.5％ (13/49) and 8.2％ (4/49),respectively.After remission,five of six patients with medicine withdrawal relapsed.Among 49 patients,40.8％ (20/49) with extrahepatic autoimmune disease and the percentage of Sjogren's syndrome,autoimmune thyroid disease,interstitial pneumonia,systemic lupus erythematosus,psoriasis,sarcoidosis and membranous nephropathy was 16.3％ (8/49),12.2％ (6/49),4.1％ (2/49),2.0％ (1/49),2.0％ (1/49),2.0％ (1/49) and 2.0％ (1/49),respectively.Among 49 patients,14.3％ (7/49) with malignant tumor and the percentage of endometrial cancer,breast cancer,thyroid cancer and lymphoma was 4.1％ (2/49),4.1％ (2/49),4.1％ (2/49) and 2.0％ (1/ 49).Among 49 patients,abdominal ultrasound showed abnormality in 93.9％ (46/49) of patients.Abdominal lymph nodes enlargement was found in 91.8％ (45/49) of patients.Conclusions Autoimmune disease and malignant tumor should be screened when patients with PBC-AIH OS were assessed.Abdominal lymph nodes enlargement found by imaging examination may have guiding significance to the diagnosis.

Objective To explore the effect of electroacupuncture intervention on tumor growth and PCNA expression in HepG2 nude mice.Methods Thirty-two nude mice were randomized to electroacupuncture, electrostimulation, model and blank control groups, 8 mice each. A nude mouse model of subcutaneous tumor was made with HepG2. The electroacupuncture group received electroacupuncture at points Zusanli and Sanyinjiao on bilateral lower limbs and the electrostimulation group, direct electrical stimulation of the same points. The tumor volume, the tumor/weight ratio and the tumor growth inhibition rate were observed. PCNA expression in the tumor tissue was determined.Results There was no statistically significant pre-/post-intervention difference in the tumor volume in the electroacupuncture, electrostimulation and model groups (P>0.05). There was no statistically significant post-intervention difference in the tumor volume between the electroacupuncture or electrostimulation group and the model group (P>0.05), but tumor growth tended to slow in the electroacupuncture group. There was no statistically significant pre-/post-intervention difference in the nude mouse weight in every group (P>0.05). There was a statistically significant post-intervention difference in the tumor/weight ratio between the electroacupuncture group and the electrostimulation or model group (P<0.05), but no statistically significant post-intervention difference in the tumor/weight ratio between the electrostimulation and model groups (P>0.05). There was a statistically significantpost-intervention difference in the tumor growth inhibition rate between the electroacupuncture and electrostimulation groups (P<0.05). There was a statistically significant post-intervention difference in the PCNA expression level between the electroacupuncture or electrostimulation group and the model group (P<0.05), no statistically significant post-intervention difference in the PCNA expression level between the electroacupuncture and electrostimulation groups (P>0.05).Conclusion Electroacupuncture can delay HepG2 tumor growth to a certain extent.

Objective To study the process of foam fractionation of polyphyllin in semi-batch mode. Methods Taking enrichment ratio, recovery rate of polyphyllin, and purity ratio as the performance criteria and using single examining method to examine the operational parameters, i.e. operation mode, air flow rate, initial feed concentration, solution pH value, initial feed height and temperature on separation performance. The optimal conditions of the process were obtained finally. Results The separation performance is good when gas flow rate is 400 mL/min, initial feed concentration (polyphyllins content) is 0.3 mg/mL, pH value is 7, feed height is 30 cm, and feed temperature is 40 ℃. The enrichment ratio is 25.7, recovery ratio is 42.1%, and the foam liquids purity of total polyphyllin is 41.4%, which is 4.5 times higher than that in feed purity. Conclusion Foam fractionation technique could be applied to separate polyphyllin.