Through analyzing the current situation of mediation of doctor-patient disputes,this paper cleared the connotation of mediation of doctor-patient disputes and explored diversified measures of mediating medical dis-putes.It included changing the concept of medical education actively and deepening the reform of medical system constantly,improving the level of hospital management actively and cracking down the occupational medical trouble and hospital scalper,taking litigation as backed mediation mechanism and playing the advantage role of people in mediation,taking initiative to communicate the mission knowledge and playing the role of media fully,and thus to reduce the occurrence of doctor-patient disputes from the source.

BACKGROUND: At present, there are some reports regarding the treatment of high-energy shockwave to chronic pain of muscle and born joint, however,the therapeutic effects and mechanism are still uncertain and need further discussion.OBJECTIVE: To explore the curative effects, mechanism and clinical application of high energy shockwave to bone joint myofascitis.DESIGN: Non-randomized case controlled study based on diagnosis SETTING: Rehabilitation Medicine Department of First Affiliated Hospital of Sun Yat-sen University.PARTICIPANTS: Totally 90 patients with chronic pain of muscle and bone joint treated in Rehabilitation Medicine Department of First Affiliated Hospital of Sun Yat-sen University from July 2001 to April 2002 were divided into treatment group and control group each with 45 cases by the order of visiting time. There were 17 males and 28 females in the treatment group with mean age of 54 years and 15 males and 30 females in the control group with mean age of 63 years.METHODS: Shockwave therapy was applied to the treatment group while routine physical treatment was conducted to the control group. Simple McGill pain questionnaire(MPQ) was used to evaluate the general reactions of patients to pain and assess the shoulder joint territory and clinical effects.therapeutic effects.RESULTS: There was significant difference on sensory, affective and pain score, visual analogous scale(VAS) and pain presentation inventory(PPI) before and after treatment in the treatment group( t =5.69, 5.67, 7.06, 8.37,6. 21, P ＜ 0.01 ). When compared with control group, there was significant difference on sensory, pain score, VAS between the treatment group and control group(t =4. 66, P ＜ 0.01; t =2.52,3.40, P ＜0.05).CONCLUSION: Extracorporeal high-energy shockwave has reliable effects on treating chronic pain caused by bone joint myofascitis, which is characterized by its effective, quick and safe features.

Humans ; von Hippel-Lindau Disease ; pathology

Objective To investigate the effects of heat-sensitive moxibustion combined with uncture and bloodletting on hemorheology and cerebral blood flow parameters of cedar spondylosis of ertebral artery type (CSA). Methods A total of 130 patients with CSA who met the inclusion criteria were andomly divided into 2 groups, 65 patients in each group. The observation group was treated with heat-sensitive oxibustion combined with blood-letting, and the control group was treated with conventional acupuncture. oth groups were treated for 14 days. The Transcranial Doppler was used to monitor the peak velocity of ystolic (Vs) of the intracranial vertebral artery and basilar artery, the peak velocity of diastolic (Vd) and the esistante index (RI). The whole blood viscosity (RBV), plasma specific viscosity (RPV), the hematocrit HCT) and the erythrocyte sedimentation rate (ESR) were detected and the clinical efficacy was evaluated.Results The total effective rate was 93.9% (61/65) in the observation group and 80.0% (52/65) in the control roup. The difference between the two groups was statistically significant (χ2=5.482, P=0.019). After treatment,the RBV, the RPV, HCT and ESR in the observation group were significantly lower than the control group. The Vs on the left side of the vertebral artery in the observation group was significantly higher than that in the control group (t=2.087, P=0.039), and the Vs and Vd in the right vertebral artery were significantly higher than the control group (t values were 3.505, 3.161, respectively, all Ps<0.01). The RI of the observation group was significantly lower than the control group (t=2.425, P=0.017). The Vs and Vd of the basilar artery in the observation group were significantly higher than the control group (t values were 2.716, 4.748, all Ps<0.01), and the RI was significantly lower than the control group (t=3.299, P=0.001). Conclusions Moxibustion combined with bloodletting can relieve the symptoms of CSA patients, improve the vertebrobasilar blood supply and improve clinical efficacy.

Objective To analyze the characteristics and correlated factors of attempted suicide among psychological aid hotline callers,and provide a reference for suicide prevention and intervention to the domestic psychological aid hotlines.Methods From September,2010 to August,2015,1 299 callers who had the database of attempted suicide among hotline callers were collected.During the calling,the callers were interviewed on their attempted suicides,depression and 10 correlated factors associated with caller's suicidal behaviors.Results Among 1 299 callers who received assessment of suicidal behavior relates factors,361 (27.8％) had evaluated of current suicidal ideation or behavior,223 (17.2％) had history of prior suicidal attempts.There was no significant difference in the incidence of suicide attempts among different gender,age and occupation.1 024 (78.8％) had symptoms of mental illness,794 (61.1％) had symptoms of anxiety,708 (54.5％) had symptoms of depression,864(66.5％) had concomitant two or more symptoms.Compared the caller's occurrence rate of suicidal attempter between single depression and concomitant other symptoms,the results found single depression and concomitant anxiety,concomitant obsession,concomitant panic and concomitant fear were statistically significant.Multiple logistic regression analysis showed that high depression emotion (β=O.389,OR=1.48,95％CI=1.08-2.02),the history of prior attempted suicide (3=0.487,OR=1.63,95％CI=1.19-2.22) and high hopelessness (β=0.618,OR=1.86,95％CI=1.32-2.60) were associated with the caller of ever attempted suicide behaviors.Conclusion Among the callers with attempted suicide,in order to improve the effectiveness of hotline prevention and invention,the psychological consultant should focus on the evaluation of concomitant mental symptoms,high depression emotion,history of prior attempted suicide and hopelessness.

Objective: To study the effect of orthodontic traction on the roots and periodontal soft and hard tissues of buried obstructed upper incisors. Methods: This study was reviewed and approved by the ethics committee, and informed consent was obtained from the patients. From January 2018 to December 2022, 40 patients who underwent orthodontic traction on impacted upper incisors were selected; those whose contralateral homonymous apical foramen was not developed were placed in group A (23 cases), and those whose contralateral homonymous apical foramen was developed were placed in group B (17 cases). Software was used to measure the root length of the impacted upper incisors in groups A and B on cone beam CT (CBCT) images before and after traction and compare the changes in alveolar bone (alveolar bone width, labral bone plate thickness, and horizontal height of alveolar bone) and keratinized gingival width between each impacted upper incisor and the corresponding contralateral tooth immediately and one year after traction Results: The root length of the impacted upper incisors increased after traction compared to before traction (P<0.05). The width of the alveolar bone at the completion of traction in group A was similar to that of the contralateral homonymous tooth (P>0.05), whereas the width of the alveolar bone at the completion of traction in group B did not reach that of the contralateral homonymous tooth, with a significant difference in width (P<0.05). Neither the labial bone plate height or width in group A or B reached that of the contralateral homonymous tooth after traction (P<0.05). The keratinized gingival width on the affected side was also significantly smaller than that on the contralateral side (P<0.05), but it was increased significantly in group A at the one-year follow-up visit (P<0.05). Conclusion Tooth traction is conducive to impacted upper incisor root growth, alveolar bone reconstruction and keratinized gingival growth but cannot produce complete symmetry with respect to the contralateral side.

Objective:To investigate the correlation between fasting plasma glucose (FPG) and new-onset carotid plaque through latent class trajectory models.Methods:A total of 953 observation objects came from the first affiliated hospital of Zhengzhou University in accordance with the inclusion criteria. According to the FPG values of the observed subjects during the annual physical examination from January 2017 to December 2019, the following four different FPG trajectories groups were determined by latent class trajectory modelling tools: the low-stable group, the medium stable group, the medium-high stable group, and the high stable group. Carotid plaque incidence in each group was followed up in 2020 to compare the differences of the cumulative incidences of the four groups. The Cox proportional risk regression model was used to analyze the correlation between different FPG trajectories and new-onset carotid plaque.Results:The incidence of carotid plaque increased with the increase of FPG trajectories by 11.13%, 19.70%, 23.44%, 23.81%, respectively, with significance ( P<0.001). After adjusting gender, age, BMI and other confounding factors with the cox proportional risk regression model, the risk of carotid plaque in the FPG medium stable group, medium and high stable group, high-stable group was still 1.895 (95% CI: 1.296-2.769), 2.273 (95% CI: 1.241-4.161), 2.527 (95% CI: 1.219-5.241) times of the low stable group (all P<0.05). Conclusion:The long-term high FPG levels are independent risk factors for the incidence of carotid plaque, and controlling FPG at a low level steadily can reduce the risk of carotid plaque.

Objective To investigate the incidence and risk factors of neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture. Methods Live born infants, including those diagnosed with neonatal asphyxia, were recruited from 16 different hospitals in Hubei Enshi Tujia and Miao Autonomous Prefecture from January to December of 2016. The 16 hospitals included four grade A tertiary hospitals (three general hospitals and one traditional Chinese medicine hospital) and 12 grade A secondary hospitals (eight general hospitals, one maternal and child health hospital and three traditional Chinese medicine hospitals). A retrospective investigation was conducted using questionnaire to analyze the basic information, perinatal risk factors and prognosis of those infants. Chi-square test was used for statistical analysis. Results Among 22 294 recruited live born infants, 733 (3.29%) were diagnosed with neonatal asphyxia on discharge, including 627 (85.54%) mild cases and 106 (14.46%) severe cases. And neonatal asphyxia resulted in deaths of 27 cases (3.68%). The risk factors for neonatal asphyxia included multiple pregnancy, pregnancy conceived with assisted reproductive technology, premature infant, low birth weight infant, fetal malposition, congenital malformation, male infant, born during transfer, mother of Tujia nationality, low educational level (primary school or lower), living in rural area, the number of antenatal visits ≤3, history of early threatened abortion, anemia in pregnancy, hypertensive disorders of pregnancy, chorioamnionitis, abnormal pregnancy history and abnormality of umbilical cord, amniotic fluid or placenta. Conclusions The incidence of neonatal asphyxia in Enshi area is obviously higher than the national average. The main risk factors for neonatal asphyxia in this area are related to maternal background and the living condition of the mother during pregnancy, delivery as well as the newborn at birth.

Objective:To investigate the mediation effect of triglyceride glucose index(TyG) on the relation between thyroid nodules and visceral fat area.Methods:A total of 9 324 individuals at the Health Management Center of the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2021 were selected, and the basic information, biochemical indicators, color ultrasound of thyroid were also collected. According to the cut-off value of visceral fat area(VFA) of 100 cm 2 and body mass index(BMI) of 24 kg/m 2, they were divided into four groups: VFA(-)BMI(-), VFA(-)BMI(+ ), VFA(+ )BMI(-), and VFA(+ )BMI(+ ). Chi-square test was used to compare the incidence rate among the four groups, and multivariate logistic regression analysis to indentify influencing factors. TyG and VFA were quartiled, and multivariate logistic regression analysis was used to explore the effects of TyG and VFA on thyroid nodules. The regression coefficient test was used to analyze whether TyG mediated the association between VFA and thyroid nodules. Results:Multivariate logistic regression analysis revealed that compared with VFA(-)BMI(-) group, the VFA(+ )BMI(-) group had the highest risk of thyroid nodules( OR=1.283, 95% CI 1.064-1.546, P=0.009), followed by VFA(+ )BMI(+ ) group( OR=1.245, 95% CI 1.028-1.508, P=0.025). When using TyG and VFA Q1 group as reference, the Q4 group showed an increased risk of thyroid nodule by 1.584 times(95% CI 1.208-2.077, P=0.001) and 1.573 times(95% CI 1.249-1.982, P<0.001), respectively. Mediation analysis indicated that VFA had a direct impact on the incidence rate of thyroid nodules( β=0.162, 95% CI 0.140-0.186, P<0.001). TyG partially mediated the effect of VFA on the incidence rate of thyroid nodules( β=0.103, 95% CI 0.087-0.121, P<0.001), accounting for 38.87% of the total effect. Conclusions:VFA is an independent risk factor for thyroid nodules regardless of BMI. Among individuals with visceral obesity but normal BMI, the incidence rate of thyroid nodules was the highest. In addition, TyG partially mediates the risk of thyroid nodules in patients with visceral obesity. The evaluation of visceral obesity might be of great significance in the early screening and prevention of thyroid nodules.

Objective:To explore the relationship between the long-term dynamic change in alanine aminotransferase(ALT) level and metabolic associated fatty liver disease(MAFLD).Methods:A retrospective study was conducted on 6 864 subjects who underwent four consecutive physical examinations from 2017 to 2020 in a cohort study of physical examination population in Henan Province. The relation between ALT level and the shift of MAFLD risk was analyzed using a multi-state Markov model, and the bidirectional relationship between ALT level and MAFLD was explored using a random intercept cross-lagged model.Results:Multi-state Markov model after adjusting for confounding factors showed that the risk of MAFLD in ALT Q2, Q3, Q4 group was gradually higher than that in Q1 group; Compared with health status, non-alcoholic fatty liver disease and MAFLD status gradually increased the risk of ALT shifting from normal to abnormal. The random intercept cross-lagged model after adjusting for confounding factors showed that there was a significant positive bidirectional relationship between MAFLD and ALT level. The cross-lag effect of MAFLD→ALT level was 0.083(95% CI 0.078-0.087), and the cross-lag effect of ALT→MAFLD was 0.044(95% CI 0.039-0.050). And with the extension of time, the cross-lag effect gradually decreased. Conclusions:There is a significant bidirectional relationship between the long-term dynamic change of ALT level and MAFLD. The occurrence of MAFLD is more likely to increase the risk of elevated ALT level, emphasizing the need for enhanced early prevention and treatment of MAFLD.