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.

Objective To investigate the effect of immunoglobulin G (IgG) in bullous pempbigoid (BP) blister fluid on the secretion of chemokines by human keratinocytes. Methods IgG was obtained from the blister fluid of patients with bullous pemphigoid and sera of normal human controls, then purified by sequential precipitation with caprylic acid and ammonium sulfate. The immunological activity of blister fluid was tested before and after the purification by BP180 ELISA kit. Keratinocytes were isolated from the foreskin tissue of yong adults, and subjected to primary culture. After 3 passages, the primary keratinocytes were harvested and subcultured in the presence of purified IgG of 0.5, 1, 2, 4 and 8 g/L, respectively, for 24 hours, or IgG of 4 g/L for 3, 6, 12, 24 hours, respectively, followed by the detection of levels of eotaxin, monocyte chemoattractant protein (MCP)-1 and interleukin (IL)-8 in the supemate of keratinocytes by ELISA. Results The valence of IgG remained unchanged after the purification with caprylic acid and ammonium sulfate. Compared with IgG from the sera of normal controls, that from bullous pemphigoid blister fluid sig- nificantly enhanced the secretion of IL-8 by keratinocytes in a time- and dose-dependent manner (both P < 0.01 ). Neither eotaxin nor MCP-1 was detected in the supemate of control IgG-treated, BP IgG-treated or untreated keratinocytes. Condusions The IgG in BP blister fluid has been proved to stimulate the secretion of IL-8 by cultured human keratinocytes, which may be involved in the pathogenesis of BP.

Objective To study the level of expression of RAR?/RXR?mRNA in skin lesions of patients with psoriasis vulgaris.Methods The skin biopsies were collected fro mskin lesions in 20cases of psoriasis vulgaris and 10normal controls.Expression o f RAR?/RXR?mRNA was detected by RT -PCR.Results Expression levels of RXR?mRNA were 0.19760?0.0933in epiderm ides from psoriatic lesions,which were markedly lower than those in normal controls(0.5867?0.0132)(P0.05).Conclusion The results indicate that decreased expression of RXR?mRNA might be related to the pathogen esis of psoriasis.

Objective To study level of the expression of RAR? mRNA in the skin lesions of patients with psoriasis vulgaris. Methods The biopsies were taken from skin lesions in 20 patients with psoriasis vulgaris and the skin of 10 normal controls, and levels of RAR? mRNA were investigated with RT-PCR. Results The level of RAR?mRNA was significanlly lower in the epidermis of patients with psoriasis vulgaris than that in the control(P

Objective To investigate the mRNA expression of Fc gamma RⅡA(FcγR ⅡA)on polymorphonuclear neutrophils(PMN)from patients with Beh(c)et's disease(BD).Methods Twenty-five patients with active BD and 20 healthy human controls were included in this study.Blood samples were obtained from all patients with active BD before treatment,from 15 patients with inactive BD after treatment and from healthy controls.PMN were isolated.The FcγR Ⅱ A mRNA expression on PMNs was detected by RT-PCR,and plasma myeloperoxidase (MPO)activity which represented neutrophil activation,was measured spectrophotometricaily.Results The relative expression level of FcγR Ⅱ A on PMN and plasma MPO aetivity were 1.80 1±0.829 and 32±5 U/L.respectively,in patients with active BD,0.820±0.625 and 27±4 U/L,respectively,in those with inactive BD,and 0.745 ±0.931 and 29±5 U/L,respectively,in normal controls;the differences were significant in the two parameters between the patients with active and inactive BD (both P＜0.01),while no statistical difference was observed between inactive patients and normal human controls(P＞0.05).There was a positive eorrelation between the expression level of FcγR Ⅱ A on PMN and plasma MPO activity in patients with BD(r=0.39,P＜0.0 1).Conclusions The mRNA expression of FcγR ⅡA on neutrophils is up-regulated in patients with active BD.It is likely that FcγR Ⅱ A is involved in the activation of neutrophils in BD.

Objective To explore the expression of neutrophil adhesion molecule CD11b,and plasma level of elastase in patients with anaphylactoid purpura during different clinical phases and their correlation with disease activity.Methods A total of 20 patients with anaphylactoid purpura were recruited into this study,along with 20 normal human controls.Two blood samples were collected from each patients at the first visit(active phase)and after 3～5 weeks of treatment(remission phase).The expression of CD11b was measured by flow cytometry in 12 patients and normal controls,and plasma levels of elastase by ELISA in 20 patients and normal controls.Results Increased CD11b expression and elastase level were noted in patients in active phase compared with those in patients in remission phase(3367.25±434.57 vs 2569.33±411.06.13.98±2.05 vs 4.29±0.80.both P＜0.01).No significant difference was found in CD11b expression between patients in remission phase and normal controls(P＞0.05).while the elastase level was higher in patients in remission phase than in normal controls(4.29±0.80 vs 3.67±0.54.P＜0.05).In active phase of anaphylactoid purpura,the expression of CD11b was positively correlated with the plasma level of elastase(r=0.73,P＜0.01),while no correlation was noticed between them in remission phase(r=0.20,P=0.54).Conclusion Peripheral neutrophils are activated in anaphylactoid purpura,which seems to be more obvious in active phase than in remission phase.

Objective To detect the mRNA and protein expressions of desmoglein 1 (DSG1) and DSG3 in different types of keratinocytes (KCs).Methods Two keratinocyte cell lines HaCaT and A431,as well as primary keratinocytes from human abdomenal skin served as the object of this study.Direct immunofluorescence assay was performed to observe and quantify the expressions of DSG1 and DSG3,and quantitative PCR (qPCR) to determine the mRNA expressions of DSG1 and DSG3,in these cells.Results Both DSG1 and DSG3 were expressed in all the three types of keratinocytes,and the fluorescence intensity of DSG1 and DSG3 in HaCaT cells was higher than that in primary keratinocytes but lower than that in A431 cells.Similarly,all the keratinocytes expressed DSG1 and DSG3 mRNA,with the relative expression levels of DSG1 and DSG3 mRNA in primary keratinocytes being 291.7％ and 237.4％ of those in HaCaT cells respectively (both P ＜ 0.01),and those in A431 cells being 0.1％ and 18.8％ of those in HaCaT cells respectively (both P ＜ 0.05).Conclusions HaCaT cells,A431 cells and primary keratinocytes all can be used for the study of DSG1 and DSG3,of which,A431 cells show the strongest expressions of DSG1 and DSG3,and primary keratinocytes display the highest expressions of DSG1 and DSG3 mRNAs.

Objective To elucidate the protein expression and gene expression status and the relationship between epidermal growth factor receptor (EGFR) protein expression and EGFR gene status.Methods Tissue microarray containing 72 cervical squamous cell carcinoma tissues was constructed,and EGFR protein expression and gene status were evaluated by immunohistochemical and fluorescence in situ hybridization (FISH) techniques.Results Protein expression of EGFR:69 of 72 cervical squamous cell carcinomas were observed.The results demonstrated it was significant association with invasion depth,lymphnode metastasis and lymph-vessel invasion (x2 =4.998,P ＜ 0.05 ; x2 =4.299,P ＜ 0.05 ; x2 =4.686,P ＜ 0.05) in cervical squamous cell carcinomas.For FISH assessing EGFR gene,64 of 72 carcinomas were observed; 7 of 64 cases showed EGFR gene amplification,and 25 disomy,23 trisomy and 9 polysomy were detected.There were high levels of protein expression in all the EGFR gene amplification cases,and there were significant association between EGFR protein expression and the gene copy number (x2 =13.564,P ＜ 0.05).Conclusions EGFR may participate in the occurrence,progression and metastasis of cervical squamous cell carcinoma.Overexpression of EGFR protein may result from gene amplification and gene copy number increases,which showed that EGFR gene expression status may be a more effective biological indicator of cervical squamous cell carcinoma targeted therapy.

Objective To investigate the relationship between disease severity and enzyme-linked immunosorbent assay (ELISA) index values of anti-desmoglein (Dsg) 1 and-Dsg3 antibodies in 56 patients with pemphigus,and to characterize fluctuations in anti-Dsg1 and-Dsg3 antibodies in different forms of pemphigus.Methods Fifty-six patients with pemphigus (including 36 cases of pemphigus vulgaris (PV) and 20 cases of pemphigus foliaceus (PF)) were enrolled in this study.Blood samples were obtained from these patients before treatment and at the following four time points:when the condition was relieved and the taper of glucocorticoids began,the dose of glucocorticoids was tapered to half of their initial dose,the maintenance treatment started,and when the duration of maintenance treatment reached two years.ELISA was performed to determine the levels of anti-Dsg1 and-Dsg3 antibodies in these serum samples.Spearman correlation analysis was carried out to assess the relationship between disease severity and ELISA index values,and independent sample's t test to compare the levels of anti-Dsg antibodies among these time points.Results The severity of pemphigus was correlated with anti-Dsg antibody ELISA index values.Both anti-Dsg1 and anti-Dsg3 ELISA index values were significantly reduced at the remission of pemphigus compared with those before treatment (all P ＜ 0.01).At the end of the two-year maintenance treatment,10 (50％) patients with PF and 7 (19.4％) patients with PV became negative for anti-Dsg1 ELISA,whereas only 1 (2.7％) patient with PV became negative for anti-Dsg3 ELISA.Conclusions Anti-Dsg antibody ELISA index value is correlated with disease severity in patients with pemphigus,which may serve as a useful marker for assessing disease severity and activity as well as evaluating therapeutic efficacy.

ObjectiveTo determine the death level， change trend and life loss of pancreatic cancer among residents in Yuyao， and to provide scientific reference for the prevention and control of pancreatic cancer. MethodsThe death monitoring data of registered residents in Yuyao from 2014 to 2021 were collected to calculate crude mortality rate（CMR）， standardized mortality rate （SMR）， potential years of life lost （PYLL）， average years of life lost （AYLL）， PYLL rate （PYLLR）， average annual percent change （AAPC） and other indicators. ResultsFrom 2014 to 2021， 860 cases of pancreatic cancer died in Yuyao， accounting for 6.25% of all malignant tumor deaths in the same period. The average annual mortality rate was 12.86/100 000， the age-standardized rate by Chinese standard population （ASRC） was 7.08/100 000， and the age-standardized rate by world Segi’s population （ASRW） was 5.17/100 1000. The CMR showed an upward trend in eight years （t=-5.076， P=0.002）. 493 men died of pancreatic cancer with an average annual mortality of 14.95/100 000， ASRC of 8.13/100 000， and ASRW was of 6.24/100 000. 367 women died of pancreatic cancer with an average annual mortality rate of 10.82/100 000， ASRC of 6.02/100 000， and ASRW of 4.14/100 000. The mortality rate of men was higher than that of women （χ²=22.191， P<0.001）. The minimum death age of pancreatic cancer is 27.52 years old， the maximum death age is 94.52 years old， and median age （Q₁， Q₂） of death was ［71.13（63.21， 78.87）］ years old. The death age of men ［69.61（62.30， 77.06）］ was less than that of women ［72.48（64.63， 81.09）］ （t=-3.820， P<0.001）. The mortality rate of pancreatic cancer showed an upward trend with age （χ²_trend=1 110.844， P<0.001）， and the 75 year old mortality rate （75.58/100 000） fell after reaching the peak. PYLL caused by death of pancreatic cancer in 8 years was 9 775.00 person years， AYLL was 14.33 person years， and PYLLR was1.53‰. ConclusionPancreatic cancer is an important cause of death for residents in Yuyao， which has a huge loss of life. It is necessary to formulate targeted prevention and control strategies， with the middle-aged and elderly as the key population， to reduce the incidence and death of pancreatic cancer.