Objective To investigate the effects of dexmedetomidine pretreatment on lung injury for patients after liver surgery. Meth-ods Sixty patients who had liver surgery in our hospital from August 2009 to February 2014 were equally divided into the treatment group and the control group, with 30 patients in each group. Both of the two groups were given one-lung ventilation anesthesia. Patients in the treatment group were given continuous intravenous infusion of dexmedetomidine after induction of anesthesia while paitents in the control group were not. In the time of before induction of anesthesia (T0), closed chest (T1), immediately after surgery (T2), all patients were given the gas analysis, expression of inflammatory cytokines and lung function testing and analysis. Results The diastolic blood pressure and heart rate at time points of T0, T1 and T2 in the two groups showed no significant difference (P> 0. 05). And the expression of TNF-αand SP-D at time points of T1 and T2 in the two groups were significantly higher than those at T0 (P<0. 05);while the expression of TNF-αand SP-D in the treatment group were significantly lower than those in the control group at time points of T1 and T2 (P<0. 05). The plateau air-way pressure and airway resistance in the treatment group at T2 and T3 were significantly lower than that at T1 (P<0. 05), and there were statistically significant differences compared with the control group (P<0. 05). Conclusion The dexmedetomidine pretreatment for the liver surgery patients can inhibit the inflammatory response, while improve lung airway plateau pressure and airway resistance. It has no significant effect for blood, so it can play a protective role for lung function.

Objective To investigate the characteristics of intestinal flora in infants with different feeding patterns.Methods Sixty-two cases of health infants(30-120 d)were divided into 4 groups according to their feeding patterns:breast feeding,imported powder milk feeding,domestic powder milk feeding and mixed feeding.Samples of their fresh feces in each group were collected and divided into sections equally:the bifidobacteria were isolated in anaerobic box and the number was counted for one section;for the other section,total DNA of intestinal flora was extracted and enterobacterial repetitive intergenic consensus (ERIC) fingerprints were amplified with the method of ERIC-PCR.After that,the specific bands observed in different groups were cloned and sequenced and alignmented.Results The colonies of bifidobacteria were more in breast feeding and mixed feeding groups[(9.10 ± 1.33) cfu/g;(8.62 ± 1.35) cfu/g]than those in domestic powder milk feeding and imported powder milk feeding groups[(7.62 ± 1.22) cfu/g;(7.32 ± 0.80) cfu/g,t =3.23,P ＜ 0.05];while there was no significant difference between breast feeding and mixed feeding groups,and between 2 powder milk feeding groups.Two specific bands were found from the ERIC fingerprints (A:1 100 bp mainly in breast feeding,domestic powder milk feeding and mixed feeding groups;B:1 000 bp mainly in imported powder milk feeding group).Sequencing and analysis of Basic Local Alignment Search Tool showed that homologous bacteria of A and B fragments were bifidobacterium longum.The encoding protein of A fragments might be related to the enzymes of carbohydrate metabolism,and B fragments were related to the enzymes of protein metabolism.Conclusions The colonies of bifidobacteria in intestinal tract are more in breast feeding and mixed feeding infants than those in formula feeding groups.The distribution of intestinal flora in domestic powder milk feeding infants is more similar to that of the breast feeding infants.

Objective To investigate the effects of post-propofol anesthesia on cognitive function and hippocampus proteome expressions in aged rats.Methods Thirty healthy male Wistar rats aged 20 months were randomly divided into control group(n =15) and propofol group(n =15).The control group was injected with normal saline of 6 ml/kg intraperitoneally and propofol was injected intraperitoneally with propofol 60 mg/kg.The rats in both groups underwent Step-down Test to assess cognitive function at the first day and at the seventh day after the termination of drug administration.Five rats were decapitated randomly each time after the two step-down tests and their hippocampi were removed for two-dimensional gel electrophoresis and mass spectrometric analysis.Results In the step-down test,aged rats in the propofol group showed significantly learning impairment and decreased memory abilities at the 1st day after propofol anesthesia as compared with those in the control group.In learning phase of the 1st day,the latency of the propofol group is (29.5 ± 7.6)s as compared with(19.7 ± 7.0)s of the control group,while the error time is 3.6±1.2 vs.1.6 ±0.8 in the propofol group vs the control group,and the total time of electric shock is(65.2 t 10.6)s vs.(42.7 ± 10.3)s in the propofol group vs the control group(all P＜0.01).The latency of the memory phase in the propofol group is also decreased as compared with that in the control group(31.4±14.3)s vs.(111.2± 23.7) s,(P＜0.01).On the 7th day after anesthesia,there was no significant difference between the two groups.There were 17 differentially expressed proteins on the 1st day after propofol anesthesia,6 of them were up-regulated and 11 proteins were down-regulated (P ＜ 0.05).On the 7th day,there were 10 differentially expressed proteins,and the expression of 5 proteins was down-regulated (P ＜ 0.01).Conclusions Aging rats receiving propofol anesthesia show cognitive function decline,but do not show a long-term decline.The mechanism may be related to the different expressions of hippocampal proteins.

Objective To investigate the diagnosis and treatment of sequential diffuse large B-cell lymphoma (DLBCL) after peripheral T-cell lymphoma (PTCL).Methods A case with sequential DLBCL after PTCL was reported,and the characteristics and responses of this case were analyzed.The previous literature was reviewed in order to explain the mechanism and prognosis of such type of disease.Results This patient was diagnosed as PTCL not otherwise specified (PTCL-NOS) definitely,but after a period of treatment,DLBCL was developed as a second tumor.The characteristics and onset interval were just similar to those described in the literature,in which the mechanisms were mentioned as common effects of tumor cell,microenviroment and therapies.This patient got effects through the initial treatment,but considering the poor outcome by former researchers,the prognosis needed to be closely followed up.Conclusion Sequential development of EBV-unrelated DLBCL after PTCL-NOS is very rare,and the mechanism,therapy and prognosis need further investigation.

Objective To investigate the incidence of serum monoclonal immunoglobulins (McIg) in B-cell chronic lymphoproliferative disorders (B-CLPD) and the clinical significance of McIg in B-CLPD and its possible sources.Methods A total of 1 147 patients with B-CLPD treated from May 2006 to May 2015 were enrolled into this retrospective study.The incidence of McIg and the relationship between McIg and prognostic factors in patients with B-CLPD were analyzed.Results Out of 1 147 B-CLPD patients,there were 164 patients with lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia (LPL/WM),and among them,McIg was detected in 140 cases (85.4 ％).In the remaining 983 patients with B-CLPD,monoclonal Ig was detected in 50 (5.1％) patients.Most of McIg in 2 groups were IgM paraprotein.The levels of IgM paraprotein of the LPL/WM group,non-LPL./WM group and McIg-negative patients were (48.88±33.42) g/L,(27.9±15.23) g/L and (2.75±1.21) g/L,respectively,the difference was statistical significance (P=0.000);the level of IgM paraprotein in LPL/WM group was significantly higher than that in non-LPL/WM group (P=0.000).The level of paraprotein decreased significantly when the patients got complete response after therapy (P=0.001,0.048,respectively).The incidence of serum McIg was higher in the group with complex karyotype (P =0.016) andwith high level of β2-microglobulin (β2-MG) (P =0.001).In the 47 non-LPL/WM patients with positive McIg,serum McIg in 38 (80.9 ％) patients were expressed in a pattern consistent with the distribution of tumor cells (P ＜ 0.005).Most of the light chain subtype of the McIg were consistent with the light chain subtype of the membrane immunoglobulin on the tumor cells.Conclusions Some non-LPL/WM B-CLPD patients also have serum McIg,and it could have certain relevance with the prognosis of B-CLPD.Moreover,the McIg may be secreted by tumor cells or those derived from the same progenitor cells with tumor cells.

Objective This paper explored the effect of the early clinical exposure in im-proving medical students' cognitive aspects of the doctor-patient relationship. Methods (1)From 280 undergraduate students of Grade 2010 who participated in early clinical exposure of Xi'an Jiaotong University College of Medicine and 280 undergraduate students of Grade 2011 who did not participate in the early clinical exposure, we selected 140 students respectively to conduct a simple random sam-pling survey. The results were analyzed by SPSS after using Microsoft Excellsoftware for entry. Statis-tical methods selected χ2-test/Fisher exact test(P<0.05). (2)We had an interview to students,teachers leading the project, instructor,experts engaging in the study of the doctor-patient relationship by using focus group discussion and in-depth interview, and then using thematic analysis to analyze the data. (3)The main aspects of questionnaires and interviews were: details, activity participation/interest, general cognitive on the doctor-patient relationship, passion for profession, choice of career, the effect in improving medical students' cognitive aspects of the doctor-patient relationship and the suggestions and comments. Results The effective questionnaires collected from Grade 2010 were 134, and124 from Grade 2011.The participation rate of the undergraduates of Grade 2010(participating group) was 94.0%(126/134), while the interest rate of undergraduates of Grade 2011 (control group) was only 76.6%(95/124). Participating group had a better cognitive understanding of doctor-patient relationship than control group(P=0.0192). The activities had significant effects on choice of career(P=0.0002), and no effect on passion for profession(P=0.7372). There was statistically significant difference on their views of employment(P=0.0002). The key words for the interview were: not enough preparation before activity, not reasonable timing, teachers leading the project, stimulation of professional pride. Conclusions Early clinical exposure activities can be effective in improving medical students' awareness of the current doctor-patient relationship. Still we have some shortages in the activity, some more exploration and amelioration should be made in late stage.

Objective To evaluate the reliability and validity of the Chinese version of the uterine fibroid symptom and health-related quality of life (UFS-QOL) in patients with uterine fibroid. Methods The original English UFS-QOL was translated into Chinese and linguistically validated following the cross-cultural adaptation of health-related quality of life measures. Patients recruited randomly from Peking Union Medical College Hospital from June 2013 to December 2016 were scheduled for two visits with 2 weeks apart, and they were surveyed through the Chinese version of UFS-QOL and short-form 12-item health survey (SF-12). The reliability and validity of the Chinese version of UFS-QOL were evaluated. Results A total of 190 uterine fibroid patients who met the criteria participated this study. The Chinese version of UFS-QOL had a high internal consistency (Cronbach′s α, uterine fibroid symptom severity scale:0.912, health-related quality of life scale: 0.976) and high test-retest reliability (intraclass correlation coefficient, 0.572 - 0.951, P<0.01). The symptom severity scores and SF-12 scores were negatively correlated (r=-0.813, P<0.01); the health-related quality of life scores and SF-12 scores were positively correlated (r=0.620, P<0.01). The factor analysis showed good construct validity. Conclusion Psychometric testing supports the reliability and validity of the Chinese version of UFS-QOL as an disease-specific measure of health-related quality of life.

Objective To observe the effects of 1,25-dihydroxyvitamin D3 on the expressions of transforming growth factor-β1(TGF-β1), fibronectin(FN),and vascular endothelial growth factor(VEGF) in rats with diabetic nephropathy(DN), and to elucidate the protective mechanism played by 1,25-dihydroxyvitamin D3. Methods DN models were estabolished by injecting streptozotoein ( STZ ) into male SD rats, which were divided into TGF-β1 overexpression group, TGF-β1 overexpression plus vitamin D3 group, TGF-β1 low-expression group, TGF-β1 low-expression plus vitamin D3 group, TGF-β1 normal-expression group, and TGF-β1 normal-expression plus vitamin D3 group. After 1,25-dihydroxyvitamin D3 treatment for 37 days, renal function and blood biochemical parameters were evaluated. The morphology and fibrosis of kidney tissues were observed. The expressions of TGF-β1, FN, and VEGF in kidney cortex were measured by immunohistochemistry, realtime PCR, and Western blotting. Results The levels of cholesterol, triglyceride, creatinine,plasma glucose, HbA1C , and 24 h urinary protein were lower in vitamin D3treated groups than those in corresponding control groups(P<0. 05). The degree of renal fibrosis was raised with the increased level of TGF-β1. Vitamin D3 treatment decreased the fibrosis in diabetic kidney. There were significant differences in the mRNA and protein expressions of TGF-β1 in three control groups(P<0. 05). With the increased levels of TGF-β1, the expressions of FN and VEGF were increased. The expressions of TGF-β1, FN, and VEGF were lowered by vitamin D3compared with the corresponding control groups(P<0. 05). Conclusion 1,25-dihydroxy-vitamin D3 may protect the renal tissure in diabetic rats via inhibiting the expressions of TGF-β1, FN, and VEGF in the kidney.

The study found that the physician-patient trust crisis results from overreliance on technology trust instead of interpersonal trust and institutional trust. The alleged “Paternalistic government innovation”in healthcare service has caused wastes of healthcare resources and gap below public expectancy due to its incompetence in resolving social problems,further eroding institutional legality and intensifying such crisis.This research aimed to identify government accountabilities in building such trust from three aspects.

Objective To investigate the impact of automatic tube voltage selection ( ATVS) and sinogram-affirmed iterative reconstruction ( SAFIRE) on image quality and radiation dose in the arterial phase (AP) and portal venous phase (PVP) abdominal dual-source CT imaging.Methods Abdomen contrast-enhanced computed tomography ( CECTs ) in 70 patients were scanned with dual-source CT.Patients were divided into study group and control group based on the scanning date.In the first 35 patients ( study group) , ATVS mode was applied; in the second 35 patients ( control group ) , the conventional fixed at 120 kVp mode was used.The imaging of the study group was reconstructed with FBP ( protocol A ) or SAFIRE ( protocol B ) respectively; the imaging of the control group was reconstructed with FBP ( protocol C).Image quality scores of the 3 protocols were assessed and compared with Rank-sum test.Analysis of variance was used to compare mean signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and image noise among the 3 protocols.Two sample t tests were used to compare the radiation dose difference.Results The effective radiation dose in the study group ( 3.9 ±0.4 ) mSv was much lower than that in the control group (4.9 ±0.4) mSv, dropped by 20.41% (t =2.315, P=0.021).The subjective rating scores in protocol A, B, C in arterial were (3.65 ±0.08), (4.41 ±0.10) and (3.79 ±0.10) point, while the subjective rating scores in venous phase were (3.57 ±0.08), (4.41 ±0.10) and (3.95 ±0.11) point.The differences were statistically significant (Z value were 27.587 and 27.436, P<0.01).The image noise of protocol A , B, C in dual-phase were ( 11.96 ±0.33 ) , ( 8.45 ±0.26 ) , ( 10.38 ±0.26 ) HU and (12.79 ±0.39),(9.14 ±0.36), (11.13 ±0.18) HU.The differences were statistically significant (F value were 39.235 and 29.846, P<0.01).Compared to protocol A and C, SNR and CNR in protocol B were much higher (P<0.01).No statistically significant differences were shown between protocol A and C in SNR and CNR ( P>0.05).Conclusion Use of ATVS and SAFIRE could reduce the radiation dose and provide better quality images compared with conventional abdominal CECT and FBP .