Relations between doctor and patient are basic and important human relation in medical practice.Because of some reasons,the relations appear tense status in our country,moreover the market economy flourishingly develops,as the result of medical organizations suffering more and more existent pressure.It is an important subject faced for people,especially for medical worker,to righly think the existed defects,and set up the mutual action between doctor and patient.

Objective To explore the application value of layered suture technique in laparoscopic common bile duct exploration with primary suture. Methods A total of 216 patients received laparoscopic common bile duct exploration with primary suture in our hospital from March 2007 to March 2013.Of these cases, layered suture technique was utilized in 89 patients and single-layer suture was used in 127 patients.The operation time, postoperative hospital stay, and postoperative complications were compared between the two groups. Results Two groups of patients were operated smoothly, with no conversions to laparotomy.Postoperative recovery was smooth.The operative time was not significantly different between the two groups of patients (t=-0.931, P=0.353). The postoperative hospital stay and incidence of postoperative bile leakage were significantly lower in layered suture group than those in single-layer suture group [(5.9 ±1.7) d vs.(7.7 ±1.8) d,t =7.400, P=0.000;3.4%(3/89) vs.20.5%(26/127), χ2 =13.167, P=0.000].In the single-layer suture group, the incidence of postoperative bile leakage was significantly higher in patients complicated with acute cholangitis [45.4%(10/22) vs.15.2%(16/105),χ2 =8.429, P=0.004], whereas in the layered suture group, the incidence of postoperative bile leakage was insignificantly different among patients with and without acute cholangitis [7.1%(1/14) vs.2.7%(2/75),χ2 =0.002, P=0.964]. Conclusion Application of layered suture technique in laparoscopic common bile duct exploration with primary suture is feasible and safe, with advantages of less bile leakage and shorter hospital stay.

Drugs, Chinese Herbal ; adverse effects ; Humans ; Nephritis ; chemically induced ; prevention & control

Objective To summarize the clinical and electroencephalography(EEG) characteristics of benign epilepsy with centro-temporal spikes (BECTS) in children.Methods The clinical manifestations,EEG findings,response to drug treatment and prognosis of 35 children with BECTS from Jul.2003 to Dec.2008 in the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.Results In the 35 cases,the age of onset was 2.5 to 14.0 years old,and the peak age of onset was 6-10 years old(62.9%).Twenty-two cases mainly presented partial seizures:hemifacial convulsions,sialorrhea,sounds,limb tonic-clonic seizures,and secondary generalized seizures.Thirteen cases were only describled generalized tonic-clonic seizures.Seizures were closely related to sleep and almost occurred shortly after falling asleep or before waking up.There were 26 cases who displayed convulsion during sleeping,including noon break.The EEG features showed numerous or single spikes on one side or both sides in the central and temporal areas under the background of normal activity in interictal period.The release frequency of abnormal wave was significantly increased after falling asleep,so the EEG monitoring during sleep could improve the positive rate of BECTS.Monotherapy with low-dose anti-epileptic drug could obtain good efficacy.Twenty-five cases stopped seizures within 3 months after therapy.Thirty-three cases hadn't get seizure since drug therapy at the age of 16 years old.So far,12 cases had been stopped medicine.Conclusions BECTS mostly begins at school-aged children,which displays partial seizures or secondary generalized seizures.The seizures are closely related to sleep.EEG monitoring during sleep which shows numerous or single spikes on the centrotemporal area has crucial diagnostic value to BECTS.There is a positive response to monotherapy with low-dose anti-epileptic drug and generally the prognosis is good.

Objective:To find out the key demand and connection point of health quality education for students of different stages by analysis of their health quality characteristics and the main contribution path, and then explore strategies to improve health quality. Methods:The stratified random cluster sampling method was carried out to select the sample population in Hangzhou. The variance analysis, curve fitting and multivariate linear regression analysis were used to analyze health quality characteristics and the main contribution path. Results:The health quality of pri-mary school students was best;the difference in quality between college students and junior high school students was not statistically significant ( P>0. 05 );and high school students had the worst health quality. The high school stage is the weakest link of health quality education. The order of the health education path and the means for improving the health quality of college, high school, and primary school students differ. With the improvement of students’ lev-el, the students that require physical quality promotion gradually decreases; the moral quality demand remains sta-ble;and the psychological quality and social adaptation ability present the tendency of a gradual increase. Conclu-sion:Student health quality shows a tendency to decreases with the rise of learning phase. The education departments should foster health consciousness and habits for students, form a healthy lifestyle behavior and ways of thinking for high school students, shape healthy personalities to improve health literacy and social adaptation abilities for college student, which is the key strategy for promoting the health quality of all-round development of the students and a-chieve the primary education goal of “health education”.

Objective To study the expression and significance of miR-26a in intrahepatic cholangiocarcinoma.Methods The expression of miR-26a in 46 intrahepatic cholangiocarcinoma(ICC) tissues and peritumoral tissues was detected by quantitative real time polymerase chain reaction (qRT PCR).The intrahepatic eholangiocarcinoma cell line HCCC-9810 and RBE were transfected with miR 26a mimics and miR 26a inhibitors,respectively,by lipofectamine 2000.The growth curves were constructed by the CCK 8 method.The migration and invasion ability was demonstrated by wound healing and transwell assay.The cell cycle was analyzed by flow cytometry.The potential mechanism was illustrated by Western blotting.Results For the 46 ICC tissues and peritumoral tissues,miR 26a levels were significantly higher in the tumor tissues than in the peritumoral tissues (P＜0.05).Vascular invasion,TNM Ⅲ～Ⅳ stage and lymph node metastasis were significantly associated with high miR 26a expression levels (P＜0.05),but gender,age,tumor amounts,tumor encapsulation,tumor diameter and tumor differentiation showed no significant association (P＞0.05).Enhanced cell proliferation,migration and invasion ability,accelerated G0/G1 phase to S phase transition,activated AKT by PTEN suppression were observed in HCCC-9810 cells with up regulation of miR-26a.Conversely,cell proliferation,migration and invasion ability was inhibited,G0/G1 phase was blocked and AKT was restrained by PTEN increase wkh down regulation of miR-26a in RBE cells.PTEN mRNA in versely correlated with the miR-26a level (r=-0.8272,P＜0.01).Patients with a high miR-26a expression had significantly poorer overall survival (P＜0.05).A high miR 26a exprcssion,multiple tumors and lymph node metastasis were independent prognostic factors of overall survival (P＜0.01).Conclusion Overexpression of miR-26a in intrahepatic cholangiocarcinoma correlated with clinicopath ological features and overall survival,and it potentially promoted tumor proliferation and metastasis through the PTEN/AKT pathway.

Medicine, Chinese Traditional

Objective To develop a highly sensitive and accurate time-resolved immunofluorometric assay (TR-IFMA) for measurement of Dickkopf-1(DKK-1),as a novel serologic biomarker for lung cancer. Methods The study constructed a two-manoclonal-antibody "sandwich"-type assay and the sensitivity, within run CV and between run CV and accuracy were evaluated. Serum DKK-1 concentrations were measured by TR-IFMA in 120 healthy controls, in 72 benign lung disease patients, and in 212 lung cancer patients before surgery. The association between serum DKK-1 levels and clinicopathological features were evaluated. Results A standard curve for DKK-1 TR-IFMA had been developed with good sensitivity (0.08 μg/L). Both within run CV and between run CV were less than 6.5%. Accuracy studies, parallelism and precision data were determined and all found to be satisfactory. The validity of DKK-1 assay was confirmed by the good correlation between the results obtained by TR-IFMA and commercial ELISA (r=0.972, P=0.01). The serum levels of DKK-1 were higher in lung cancer patients 31.93(79.47-18.03) μg/L than in benign lung diseases 15.25(18.41-11.49) μg/L and in healthy controls 13. 90( 16. 91-11.02) μg/L DKK-1 levels were significant associated with the presence of distant metastases, as well as lymph node metastases and TNM stage, but not with patients' age, gender and tumor histology. At the cutoff of 22.63 μg/L, the diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the TR-IFMA for lung carcinoma were 68.4%, 92.2%, 82.1% ,90.6% and 72.5%. Diagnostic sensitivity and accuracy were higher for small cell carcinoma than for non-small cell carcinoma (70.7% vs 69.5% and 85.6% vs 80.7%, respectively). Conclusions A highly sensitive and reliable TR-IFMA for DKK-1 has been developed. The determination of serum DKK-1 levels may be useful for diagnosis and tumor staging of lung cancer.

Objective To explore the efficacy of intervention combined with traditional Chinese medicine for the treatment of early femoral head necrosis. Methods 62 cases of early femoral head necrosis were treated with interventional and traditional Chinese medicine, all patients were assessed for clinical efficacy before treatment and 6 months after treatment. The clinical hip function, pain index evaluation and rating of the femoral head venography were recorded. Results 41 cases were cured, 18 cases improved,no improvement in 3 cases,the total effective rate was 95. 2%. Clinical hip function after treatment compared with before treatment increased by 32.5%,there was a statistically significant difference (P＜0.01); compared with before treatment, significantly reduced pain (P＜0. 01). After treatment, Ⅲ and Ⅳ were significantly increased number of cases, respectively, compared with the preoperative increase of 146.2% and 160.0%,femoral venography ratings before and after treatment had significant difference(P＜0.01). Conclusion Intervention combined with traditional Chinese medicine treatment could significantly improve the early femoral head necrosis.

Objective To investigate the expression and significance of E-selectin in lung tissue of rat of acute necrotizing pancreatitis (ANP)-induced lung injury.Methods Rats were randomly divided into control and ANP groups.ANP model was induced by retrograde injection of sodium taurocholate into the biliary and pancreatic duct.The rats were sacrificed at 3,6,12 and 24 h.Serum amylase,albumin,Ca2+ and lung wet/dry (W/D) weight ratio were determined,and pancreas and lung tissues underwent routine pathological examination and histopathological scores were evaluated.The expression of E-selectin mRNA and protein in lung tissue of rat was measured by real-time fluorescence quantitative RT-PCR and immunohistochemistry.Results In ANP group at 6h,the serum level of amylase,histopathological scores of pancreas and lung tissues,lung W/D weight ratio were (3978 ± 476) U/L,8.22 ± 0.63,( 12.31 ± 1.58,5.21 ± 0.20,which were significantly higher than those in control group [ (843 ± 90)U/L,0.22 ± 0.36,0.13 ± 0.34,4.46 ±0.17,P ＜ 0.05 or ＜ 0.01 ],the serum level of albumin was (12.9 ± 1.0)g/L,which was significantly lower than that in control group [ ( 15.6 ± 0.7 ) g/L,P ＜ 0.01 ],the serum level of Ca2 + at 12 h was ( 2.33 ±0.15) mmoL/L,which was significantly lower than that in control group [(2.57 ± 0.23)mmoL/L,P ＜ 0.01 ].E-selectin was located in the cell membrane and cytoplasm of vascular endothelial cells.Expression of E-seleetin mRuNA and protein in the lung tissue at 6h was significantly higher than those in control group (3.51 ±0.45 vs 0.95 ± 0.16,0.174 ± 0.019 vs 0.060 ± 006,P ＜ 0.01 ).Conclusions Pulmonary expression of E-selectin of vascular endothelial cell is significantly up-regulated in a time dependant manner when ANPinduced ALI occurs; and it is involved in leukocyte mural and extravasation,and can promote lung injury.