Objective To explore the relationship among aggression of patients,doctor-patient trust and perceived social support,and to provide a new prospective of improving doctor-patient relationship.Methods Data of Chinese buss-perry aggression scale,wake forest physician trust scale and perceived social support were collected from a sample of 338 patients in Guangzhou and analyzed with structural equation modeling.Results ①Median (interquartile range) of aggression,doctor-patient trust and perceived social support were 54(18),32(8) and 62(15) respectively.②Total score of aggression(Z=-2.37,P=0.02) and the dimension score of physical-aggression(Z=-4.07,P＜0.01) between different gender were statistically significant,and the scores of male were higher than female.③According to relevant result,aggression of patients was significantly negatively correlated with both doctor-patient trust (r=-0.13,P＜0.05)and perceived social support(r=-0.14,P＜0.01).Doctor-patient trust was significantly positively correlated with perceived social support(r=0.36,P＜0.01) ④Perceived social support fully mediate the relationship between aggression of patients and doctor-patient trust(GFI =0.989,NFI =0.989,IFI =0.998,CFI =0.998,RMSEA =0.026,x2/df=1.229).Conclusion Perceived social support is a protective factor of aggression of patients.Improving the perceived social support of patients can promote the doctor-patient trust.

Purpose:To detect the expression of a novel i nh ibitor gene of apoptosis,survivin,in gastric cancer and in gastric carcinoma MGC -803 cell line,also to analyze its correlation with the expression of COX-2. Methods:In 93 stomach carcinoma tissues and 20 normal gastric tissues , the expression o f survivin and COX-2 were examined by using the streptavidin-biotin peroxidase (SP) method. Results:In contrast to negative expression in normal gastric mucosa,survivin was express ed in 66 of 93(71%) cases of gastric cancer samples,Overexpression of survivin i n gastric carcinoma MGC-803 cell line was also found,There was a relationship b etween survivin gene expression and degrees of differentiation,lymph node metast ases and TNM stages.The expression of survivin was positively correlated with th at of COX-2(liner index of Pearson=0.227 P

Objective To study the clinical changes of von Willebrand factor( vWF) and interleukin-8 (IL-8) in patients with severe pulmonary contusion. Methods Sixty-three patients with severe pulmonary contusion were divided into three different classifications for the sake of comparison in different respects, namely (1) severe pulmonary contusion with ARDS group and severe pulmonary contusion without ARDS group, (2) survival group and non-survival group, and (3) ISS score <20 group and ISS scored 20 group. In addition, the normal control group was set up. The levels of plasma vWF and serum IL-8 were respectively detected by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA) within 24 hours of injury and 1,3,5 and 7days after injury. The regularity of their changes was observed and the correlation factors were analyzed from the data. Results Compared with normal controls, the concentrations of plasma vWF and serum IL-8 were significantly increased in patients with severe pulmonary contusion in all intervals of detection. The concentrations of plasma vWF escalated gradually in severe pulmonary contusion with ARDS, and reached significantly higher levels in 5 days and 7 days after injury compared with those without ARDS group (P <0. 05). The increase in concentrations of serum IL-8 peaked in 5day after injury, and then declined. The levels of serum IL-8 were higher in patients with severe pulmonary contusion with ARDS group than those in this kind of patients without ARDS group. The levels of plasma vWF and serum IL-8 were higher in non - survival group than those in survival group (P < 0.05). The increase in levels of plasma vWF and serum IL-8 peaked and then declined in 5 days in ISS score 3:20 group, whereas it peaked and declined in 3 days after injury in ISS score < 20 group. The level of plasma vWF was positively correlated with platelets and negatively correlated with oxygenation index. The levels of serum IL-8 was positively correlated with white blood cell count and ISS score, and negatively correlated with oxygenation index. Conclusions The levels of plasma vWF and serum IL-8 were increased in patients with severe pulmonary contusion, reflecting the severity of pulmonary injury. The levels of plasma vWF and serum IL-8 were the sensitive markers for evaluating the severity of pulmonary injury and the prognosis of ARDS caused by severe pulmonary contusion.

Objective To study the clinical values of dynamic changes of yon Willebrand factor (vWF) and ADAMTS13 (a disintegrin and metalloprotease with thrombospondin repeats-13 ) in aneurysmal subarachnoid hemorrhage. Methods Twenty-nine patients with aneurysmal subarachnoid hemorrhage admitted to Department of Neurosurgery from April 2010 through April 2011 were enrolled for retrospective study.They could be categorized into 3 sets of grouping:delayed cerebral ischemia group ( DCI group) and non-delayed cerebral ischemia group ( no DCI group ),cerebral vasospasm group ( CVS group ) and no vasospasm group (no CVS group),and good prognosis group and poor prognosis group,and another 20 healthy subjects as control group.All patients were examined with CT,DSA,or/and CTA to identify the intracranial subarachnoid hemorrhage resulted from aneurysm rupture.The exclusion criteria included:(1)the time from onset to admission was longer than 72 hours or patient was in imminent danger of death; (2)patients had surgery,interventiona] or conservative treatment outside the hospital; (3) patients were under the treatment of antiplatelet medicine such as aspirin,clopidogrel,or other anticoagulants such as warfarin,etc ; (4) patients had blood diseases,impaired kidney or liver function,pregnant,or with recent infections.Venous blood were taken one day,4 days and 10 days after SAH to determine plasma concentrations of ADAMTS13 and vWF by using enzyme-linked immunosorbent assay (ELISA). Transcranial Doppler ultrasonography (TCD) was used to measure mean blood flow velocity of middle cerebral artery (VMCA).Glasgow outcome scale (GOS) score was measured before discharge. Data were analyzed by using SPSS version 13.0 software. Results The levels of vWF were significantly higher in DCI group,CVS group and poor prognosis group compared with those in the control group 1 day,4 days and 10 days after SAH.There were differences in vWF between DCI group and no DCI group 1 day and 4 days after SAH ( P ＜ 0.05 ).There were significantly differences in vWF between CVS group and no CVS group,and between good prognosis group and poor prognosis group 4 days and 10 days after SAH ( P ＜ 0.01 ).In DCI group and poor prognosis group,the level of plasma ADAMTS13 was significantly lower 1 day after SAH than that in the normal control group (P ＜0.01) and in the no DCI group (P ＜0.O1 ); and there were no differences in ADAMTS13 between CVS group and no CVS group.Conclusions In the early stage,the increase in plasma vWF and decrease in ADAMTS13 activity are associated with DCI,and the decrease in ADAMTS13 activity can be used to predict the outcome.

Objective To evaluate the overall effectiveness of microsurgery for elderly pituitary adenomas,and to select the optimal surgical approaches for this type of tumor. Methods Microsurgical operation was performed on 190 patients with elderly pituitary ademomas,and these patients were retrospectively analysed. The 190 cases were divided into transsphenoidal group and transcranial group with a comparison analysis of respective removal percentage,postoperative complication and follow-up. Results In the transsphenoidal group with 158 cases,total removal were performed in 112 cases (71.0%),subtotal removal in 30 cases,partial removal in 16 cases. In the transcranial group with 32 cases,total removal were performed in 8 cases (25.0%),subtotal removal in 16 cases,partial removal in 8 cases. Conclusions Transsphenoidal approach was characterized by shorter hospitalization period,less therapeutic charges and better postoperative quality of life and it should be of choice for the treatment of the elderly pituitary adenomas.

Objective To screen the peripheral blood circRNA differently expressed in patients with rheumatoid arthritis (RA) and to explore the pathogenetic role of peripheral blood cicRNA in RA by analyzing the data with bioinformatics.Methods The study was performed in 3 RA cases and 3 healthy controls,using circRNA microarrays to screen the circRNA in peripheral blood of patients with RA.The data were normalized and analyzed by R soft package,screening by fold change and P value and searching the differently expressed circRNAs between the two samples by t test.Bioinformatics was performed to analyze the differently expressed circRNAs.Results The results from circRNA microarrays revealed that 36 circRNAs were significantly al-tered in RA patients (P ＜0.05) compared with the control group.Among them,22 were significantly up-regulated,and the other 14 were down-regulated.The GO analysis of the genes involved in the circRNA showed that these genes participated in the progress of biological regulation,cell differentiation,and metabolism.We predicted the target miRNA of all the differently expressed circRNAs,among the results there was a miRNA (hsa-miR-125a-3p) targeted by a circRNA(hsa_circ_0005397) experimentally confirmed by other studies.The relationships among circRNA-miRNA-Gene were predicted by Cytoscape software.Conclusion There are many differently expressed cireRNAs in peripheral blood of patients with RA,and the circRNAs maybe involved in the regulatory mechanisms of Rheumatoid Arthritis.

One hundred and six men aged >60 years were assigned to Group A (60 to 69 years old, n=33), Group B (70 to 79 years old, n=38) or Group C ( >80 years old, n =35), respectively. Serum testosterone, broadband ultrasound attenuation (BUA), speed of sound (SOS) , and stiffness (STI) were determined. Our results showed that as age increased, serum testosterone, BUA, SOS and STI decreased; serum testosterone was positively correlated with BUA ( r=0.62, P<0.05 ) and SOS ( r=0.54, P<0.05 ). We thus suggest that serum testosterone in elderly men might be closely related with bone mineral density.

Objective EGFR targeted therapy mediated by adeno-associated virus is a promising way to treat pancreatic cancer.This study aimed to assess the feasibility and activity of combining rAAV-anti EGFR,gemcitabine,and radiation in pancreatic cancer cells.Methods Aspc-1 human pancreatic carcinoma cells were divided into several groups,in vitro and in vivo,which were respectively exposed to gemcitabine alone,radiation alone,rAAV-anti EGFR alone,the combination of rAAV-anti EGFR with gemcitabine,the combination of rAAV-anti EGFR with radiation,and the combination of all three agents.The pancreatic cancer tumor growth and apoptotic rate were measured.Results The apoptotic rate was higher in cells treated with a single or combination of agents compared to the negative control (P＜0.05).The combination of rAAV-EGFR,gemcitabine,and radiation produced the highest induction of apoptosis compared to a single agent alone (P ＜ 0.05).Treatment with rAAV-anti EGFR greatly inhibited growth in the tumor xenografts (P＜0.05),and a synergistic effect of rAAV-anti EGFR,gemcitabine,and radiation was found.The number of tissue cancer cells that expressed cleaved caspase-3 after treatment with rAAV EGFR was more than that of the control group (P＜0.05).The combined treatment of rAAV-anti EGFR,gemcitabine,and radiation induced the highest numbers of cells expressing cleaved caspase-3 compared to that with a single agent alone (P＜0.05).Conclusions The rAAV-anti EGFR therapy in combination with chemotherapy and radiation therapy demonstrated a greater efficacy over therapy with a single agent alone.rAAV-anti EGFR increased the efficacy of gemcitabine and radiation in the treatment of pancreatic cancer cells.

Objective:To examine the correlations of microRNA-34c(miR-34c) expression in the peripheral blood with the onset of diabetic foot ulcer(DFU)and diabetic foot osteomyelitis(DFO)in patients with type 2 diabetes mellitus(T2DM).Methods:Sixty newly-diagnosed T2DM patients without DFU(T2DM group), 112 T2DM patients with DFU(DFU group), and 60 healthy controls with normal glucose tolerance(NC group)were included. The 112 T2DM patients with DFU were further divided into DFO( n=64)and NDFO( n=48)groups. The levels of miR-34c were determined by quantitative real-time PCR, while clinical features and risk factors of DFU and DFO were explored. Results:A significant increase in the expression level of miR-34c in peripheral blood was observed in T2DM group compared with NC group[2.99(1.45-6.22) vs 1.01(0.89-1.52), P<0.05], and a markedly increased miR-34c expression level was noted in DFU group compared with T2DM group [9.65(6.15-18.63) vs 2.99(1.45-6.22), P<0.01]. Additionally, the expression level of miR-34c in peripheral blood significantly increased in DFO group compared to NDFO group [13.46(8.89-19.11) vs 6.02(5.93-14.72), P<0.01]. Moreover, there was a positive correlation between the expression level of miR-34c in peripheral blood and the amputation rate in patients in DFU group( P=0.030), and a negative correlation in the expression level of miR-34c( P=0.025)with healing rate of DFU after eight weeks. The multivariate logistic regression analysis confirmed that a high expression of miR-34c was an independent risk factor for DFU and DFO( OR=3.52, 4.13; both P<0.01). Conclusion:An increased expression of miR-34c in peripheral blood of T2DM patients might be closely related to the occurrence, development, and prognosis of DFU and DFO.

Objectives To detect the expression of serum high mobility group box-1 (HMGB1) and explore its changes in rats with acute necrotizing pancreatitis (ANP).Methods Intraperitoneal injection of 20％ L-arginine in the dosage of 250 mg/100 g twice every 1 hour was used to establish ANP rat model.Intraperitoneal injection of normal saline solution in equal volume was performed in control rats.Rats were sacrificed at 6 h,18 h,24 h,36 h,48 h,72 h and 96 h after injection.Blood samples were collected to detect serum amylase and HMGB1 level.Pancreatic tissue was collected for pathological examination.Realtime PCR was applied to detect the mRNA expression of HMGB1 in pancreatic tissue.Werstem blot was used to determine HMGB1 protein expression in pancreatic tissue.Results Serum amylase level began to increase at 6 h after modeling,reached the peak at 18 h [(5 070 ± 603) U/L] and returned to normal level after 48 h.Serum amylase activity at 6 h and 18 h in ANP group was much higher than that in control group (1 844 ± 181)U/L(P＜0.05).The expression of HMGB1 began to increase at 6 h,reached to the peak at 36 h [(288.5 ±42.1)μg/L],and then decreased gradually.HMGB1 expressions at each time point in ANP group were significantly higher than those in control group (31.6 ± 10.1) μg/L],and the differences were statistically significant (all P ＜ 0.05).Pathological scores in pancreatic tissues in ANP group were higher than those in control group 0.38 ± 0.52,and the differences were statistically significant (P ＜ 0.05).HMGB1 mRNA expressions at t 6 h,18 h,24 h,36 h,48 h,72 h and 96 h in ANP group were 1.23 ±0.25,2.60 ± 0.46,3.23 ± 0.34,4.77 ± 0.66,2.88 ± 0.56,2.05 ± 0.20,1.33 ± 0.28,which were significantly higher than those in control group 0.44 ± 0.09,and the relative expression of HMGB1 in ANP group at 36 h was significantly higher than those at other time points (all P ＜ 0.05).HMGB1 protein expression in pancreatic tissue in ANP group at 6 h,18 h,36 h,72 h were 1.14 ±0.02,1.15 ±0.01,1.22 ±0.01,1.22 ±0.04,which obviously higher than those in control group(1.0),and HMGB1 expression in ANP group at 36 h was higher than those at other time points (all P ＜ 0.05).Conclusions HMGB1 may participate in systematic inflammation as one of the late inflammatory mediators during ANP.