It was undoubted that doctor-patient relationship was becoming more and more worse,and this condition lead the doctors,patients,governments feel ve ry awkward.Every related side would be Faliures.Nowadays,the tensional doctor patient relationsh i p is a result of improper value choice and institutional arrangement in the back ground of market economy and high technology development.Building a harmonious doctor patient relationship and become double win is a key issue to affect medical service.It needs government,hospital,doctor and patient to work together.Therefore,we should promote the harmony of doctor-patient relationship in the respects of value choice and institutional arrangement.The action of benefiting others at the medical market includes benefiting for others unselfish and benefiting for others for self under the condition of market economy.Seeking patients' interests even at the expense of the professionals' own interests is the most essential moral criterion and professional obligation.

INTRODUCTION: In recent years, () has emerged as the predominant cause of pyogenic liver abscess in Asia. - as the causative microorganism in other visceral organ abscesses-is less described. In this study, we seeked to describe the clinical characteristics of visceral organ abscesses in our institution and evaluated the prescription practices of physicians with regard to antibiotic therapy. MATERIALS AND METHODS: A retrospective analysis of patients with culture positive (blood or abscess aspirate) visceral organ abscesses from May 2014 to April 2016 requiring hospitalisation in Changi General Hospital was conducted. RESULTS: A total of 140 adult patients with visceral organ abscesses were identified. The commonest site of involvement was the liver (77.9%), followed by genitourinary tract (20.7%). Diabetic patients were more likely to have liver abscesses, genitourinary abscesses, abscesses in 2 or more organs, genitourinary disease with abscess formation outside of the genitourinary tract, and endovascular infection. Patients with extended spectrum beta-lactamase producing , were more likely to have an obstructive lesion related to the site of the abscess. Overall mortality rate was 7.1%. Amongst survivors, the mean total duration of parenteral antimicrobial therapy was 2.5 weeks before switching to oral antimicrobial agents. CONCLUSION Genitourinary tract is the commonest extra-hepatic site for visceral organ abscess in infections. Parenteral to oral switch of antimicrobial agents appears to be a safe and effective treatment option.
Abscess ; classification ; microbiology ; mortality ; therapy ; Anti-Bacterial Agents ; therapeutic use ; Diabetes Mellitus ; epidemiology ; Female ; Humans ; Klebsiella pneumoniae ; isolation & purification ; Liver ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Survival Analysis ; Urogenital System ; pathology ; Viscera ; pathology

Objective:To analyze the protective effects of adoptively transferring different patrilineal lymphocytes and their Exosomes ( Exo) on fetation of mice with pregnancy loss comparatively.Methods: The peripheral blood mononuclear cells ( PBMC) from healthy men and the splenocytes from BALB/c and DBA/2 male mice were induced in vitro ,and their Exo were isolated through sucrose gradient ultra-centrifugation combined with ultrafiltration.The mice of CBA/J (♀) mated with BALB/c (♂) were enrolled as control group of normal pregnancy ,and the CBA/J (♀) mated with DBA/2 (♂) as URSA of pregnancy loss experimental animal model.The mice in URSA group were randomly divided into each group with treatment through adoptively transferring , which were injected intravenously or subcutaneously with splenocytes or splenocytes -derived Exo from mated DBA/2,unmated DBA/2 or unrelated BALB/c,also PBMC-derived Exo from men,respectively.And then,the placenta volumes,rates of fetal absorption and pregnancy loss were calculated to observe the fetation of embryos.Results:Compared with the group of normal pregnancy ,the placenta volumes from URSA group decreased greatly ,and rates of fetal absorption and pregnancy loss elevated greatly ( all P<0.000 5 ).After transferring different sources of cells and their Exo through different injection ,the placenta volumes resumed to the level of normal pregnancy ,and the rates of fetal absorption and pregnancy loss decreased significantly ( all P<0.000 5 ).No differences were observed after treatment through injecting intravenously or subcutaneously ( all P>0.05 ).After transferring the Exo derived from either male mice or healthy men,the level of decreased fetal absorption rates were more than that in cellular-therapy groups ( all P<0.05 ).After transferring the Exo derived from men ,the level of decreased pregnancy loss rates were more than that in cellular -therapy groups and mice splenocytes-derived Exo group ( all P<0.05 ).Conclusion:Adoptively transferring patrilineal T lymphocytes and their Exo can greatly improve the fetation.Exo should become a non-cellular bio-remedy,which is expected to replace traditional immunotherapy of adoptively transferring lymphocytes.

Objective To investigate the effect of different enteral nutrition (EN) preparations on nutritional status and glucose metabolism in elderly heart failure (HF) patients. Methods Eighty-two elderly HF patients were consecutively admitted to Taizhou Enze Medical Center Group Enze Hospital from January 2017 to March 2018, and they were randomly divided into a study group and a control group, each group with 41 cases. The basic treatments were the same in two groups, while the patients in study group were treated with TPF-D emulsion, and those of control group were treated with SP emulsion. Nutritional status [serum albumin (Alb), proalbumin (PA) and transferrin (TF)], glucose metabolism indexes (glucose, Betatrophin and insulin dose), cardiac function [N-terminal B-type pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF)], high-sensitivity C-reactive protein (hs-CRP) in serum were compared between two groups after treatment, and the incidences of adverse reactions (gastric retention, diarrhea, constipation, electrolyte abnormality, pulmonary infection, dysfunction of liver) were also observed in the two groups. Results In the aspect of nutrition, no statistical significant differences in indexes were found at each time point between the two groups during the therapeutic course (all P > 0.05). In terms of glucose metabolism, the blood glucose levels in the study group were significantly lower than those in the control group on day 5 and day 7 after treatment (mmol/L: 9.73±3.69 vs. 11.56±3.78 on day 5, 8.35±2.17 vs. 10.41±2.38 on day 7, both P < 0.05); the serum Betatrophin levels in the study group were also significantly lower than those in the control group on 5 days and 7 days (μg/L: 5 days was 1.36±0.49 vs. 1.89±0.74, 7 days was 1.31±0.47 vs. 1.62±0.59, both P < 0.05); the doses of insulin used in the study group were obviously lower than those in the control group on 3, 5 and 7 days (U: 3 days was 37.86±8.49 vs. 47.84±10.33, 5 days was 29.33±7.45 vs. 38.56±9.69, 7 days was 13.35±8.56 vs. 28.49±9.77, all P < 0.05). In terms of cardiac function, the study group showed significant lower NT-proBNP levels on 3, 5 and 7 days (μg/L: 3 days was 5.8±0.8 vs. 6.2±1.0, 5 days was 3.7±0.7 vs. 4.4±0.9, 7 days was 1.9±0.5 vs. 3.1±0.7, all P <0.05]; significant higher level of LVEF in study group on 7 days (0.50±0.02 vs. 0.48±0.03, P < 0.05) and significant lower hs-CRP levels in study group on 5 days and 7 days (μg/L: 5 days was 27.12±10.58 vs. 34.41±12.69, 7 days was 15.33±9.87 vs. 22.71±11.45, both P < 0.05). In addition, compared with the control group, the incidence of gastric retention [17.07% (7/41) vs. 36.59% (15/41)], so of diarrhea [14.63% (6/41) vs. 34.15% (14/41)] and of electrolyte abnormalities [14.63% (6/41) vs. 39.02% (16/41)] were significantly lower in study group than those in the control group (all P <0.05). Conclusion Compared with SP, TPF-D not only can effectively improve the nutritional status, but also can superiorly control blood glucose, improve cardiac function and lower the incidence of adverse reactions in elderly HF patients.

Background::The calcineurin inhibitor (CNI)-based immune maintenance regimen that is commonly used after renal transplantation has greatly improved early graft survival after transplantation; however, the long-term prognosis of grafts has not been significantly improved. The nephrotoxicity of CNI drugs is one of the main risk factors for the poor long-term prognosis of grafts. Sirolimus (SRL) has been employed as an immunosuppressant in clinical practice for over 20 years and has been found to have no nephrotoxic effects on grafts. Presently, the regimen and timing of SRL application after renal transplantation vary, and clinical data are scarce. Multicenter prospective randomized controlled studies are particularly rare. This study aims to investigate the effects of early conversion to a low-dose CNI combined with SRL on the long-term prognosis of renal transplantation.Methods::Patients who receive four weeks of a standard regimen with CNI + mycophenolic acid (MPA) + glucocorticoid after renal transplantation in multiple transplant centers across China will be included in this study. At week 5, after the operation, patients in the experimental group will receive an additional administration of SRL, a reduction in the CNI drug doses, withdrawal of MPA medication, and maintenance of glucocorticoids. In addition, patients in the control group will receive the maintained standard of care. The patients’ vital signs, routine blood tests, routine urine tests, blood biochemistry, serum creatinine, BK virus (BKV)/cytomegalovirus (CMV), and trough concentrations of CNI drugs and SRL at the baseline and weeks 12, 24, 36, 48, 72, and 104 after conversion will be recorded. Patient survival, graft survival, and estimated glomerular filtration rate will be calculated, and concomitant medications and adverse events will also be recorded.Conclusion::The study data will be utilized to evaluate the efficacy and safety of early conversion to low-dose CNIs combined with SRL in renal transplant patients.Trial registration::Chinese Clinical Trial Registry, ChiCTR1800017277.

To conduct genetic analysis of pancreatic ductal adenocarcinoma tissues and analyze the correlation between targeted microRNA (miRNA) and pathways in pancreatic ductal adenocarcinoma.
 Methods: We collected 19 samples of peripheral venous blood serum from patients with pancreatic ductal adenocarcinoma in Hainan Provincial Hospital of Chinese Medicine, and also collected 21 blood serum samples as a control group of non-pancreatic ductal adenocarcinoma. We used the bioinformatics analysis of literature GCBI data platform for screening and analyzing the genetics of pancreatic ductal adenocarcinoma samples. Through GCBI data platform of hierarchy clustering analysis and the enrichment of gene function analysis, the relevant miRNA was screened as a research object in patients with pancreatic ductal adenocarcinoma. The miRNA was screened by literature analysis and pancreatic cancer gene analysis. Real-time PCR and Western blotting were carried out to study the relationship between the selected miRNA and TGF-β1 by overexpression and suppression of the gene in pancreatic ductal adenocarcinoma cells.
 Results: MiRNA-21 was screened as a gene associated with pancreatic ductal carcinoma via hierarchy clustering analysis and gene function analysis. MiRNA-21 was highly expressed in the pancreatic ductal carcinoma patients. Expressions of TGF-β1 were inhibired in miRNA-21 overexpressed PANC-1. While the expression of miRNA-21 was inhibited, TGF-β1 expression increased obviously.
 Conclusion: MiRNA-21 is highly expressed in patients with pancreatic ductal adenocarcinoma, can regulate the expression of TGF-β1, which may be a mechanism of miRNA-21 in pancreatic ductal adenocarcinoma.
Carcinoma, Pancreatic Ductal ; genetics ; Humans ; MicroRNAs ; genetics ; Pancreatic Neoplasms ; genetics ; Transforming Growth Factor beta1

Objective:To explore the medical costs and influencing factors of patients diagnosed with Brucellosis in Datong of Shanxi province.Methods:Information on demographics, medical visits, and costs of patients diagnosed with Brucellosis between January 1, 2017, and December 31, 2019, were collected. Health care utilization and medical costs were analyzed from different genders, age groups, underlying diseases, clinical stages, and comorbidities.Results:A total of 2 289 patients (1 715 outpatient and 574 inpatient cases) were included in the analysis. 72.0% (1 649/2 289) were male, with an average age of (49.6±15.5) years; age between 45-59 years was the dominant group (36.2%,829/2 289). The mean age of inpatients (51.4±16.0) was higher than that of outpatients (49.0±15.2)( Z=-4.01, P<0.001). The average number of outpatient visits per outpatient was (1.6±1.5) times. The duration of hospitalization was (14.6±9.9) and (20.8±11.4) days for patients with central nervous system complications and (16.6±9.5) days for vascular system complications. Of the inpatients, 51.0% (293/574) had underlying diseases, and 30.3% (174/574) had endocrine and metabolic diseases. 54.0% (310/574) of inpatients were diagnosed with acute Brucellosis, and 46.0% (264/574) were diagnosed with chronic Brucellosis. A total of 64.3% (369/574) of inpatients had complications, 30.3% (174/574) of digestive system complications, followed by skeletal system complications (29.1%, 167/574). Among outpatients, age significantly affected medical costs ( P<0.001). For inpatients, age and complications and treatment effect were influential factors ( P<0.05). Patients with the combined skeletal system and central nervous system complications had significantly higher medical costs ( P<0.001). Conclusions:The medical costs for outpatient cases of Brucellosis were moderate. However, the economic burden was higher for inpatients, especially those with skeletal and neurological complications. Early detection, diagnosis, and treatment of cases were essential to avoid chronic Brucellosis and its complications and reduce medical costs.

BACKGROUNDThe high blood homocysteine (Hcy) levels found in patients with hyperhomocysteinemia (HHcy) have been implicated in an increased risk of cardiovascular disease morbidity and mortality in end-stage renal disease (ESRD). This study investigated the association of HHcy with progression of IgA nephropathy.

METHODSWe analyzed 108 participants newly diagnosed with IgA nephropathy between August 2005 and August 2007 in the Department of Nephrology, Chinese People's Liberation Army General Hospital. The association between clinicopathological factors and the Hcy levels were analyzed by Logistic regression and those with ESRD risk were analyzed by Cox regression.

RESULTSPatients were aged (35.71 ± 10.73) years and included 45.71% women and 12.04% patients with HHcy. In multivariate Logistic regression analysis, HHcy was associated with arterial lesions (OR 2.60; 95% CI 1.55 ± 4.34; P < 0.001) even when age, body mass index, estimated glomerular filtration rate, mean arterial pressure, and initial proteinuria were taken into account. Mean follow-up was (67.37 ± 16.21) months. HHcy was also associated with worse ESRD-free survival (HR 4.71; 95% CI 1.45 to 15.31; P = 0.010).

CONCLUSIONHHcy is associated with the risk of intrarenal arterial lesions and may be useful for estimating the prognosis of IgA nephropathy.

Adult ; Body Mass Index ; Female ; Glomerular Filtration Rate ; physiology ; Glomerulonephritis, IGA ; etiology ; physiopathology ; Humans ; Hyperhomocysteinemia ; complications ; physiopathology ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies