In the light of sociological and psychological theories, the authors reflect from the perspectives of social politics, economy, culture, psychology and law on the current situation of the physician-patient relationship, the causes and lessonss. They argue that the current situation of the worsening physician-patient relationship is worrisome, its causes are multifarious, and channels for improvement ought to be as wide as possible. They hold that there is still a long way to go to improve the situation, efforts ought to be made by the whole society and humane medical services are indispensable.

ObjectiveTo investigate the influence of exhalation valve location as well as its type on carbon dioxide (CO2) rebreathing during noninvasive positive pressure ventilation (NPPV).Methods With a standardized NPPV experimental model system, the exhalation valve was respectively installed between the ventilator tube and mask (positionⅠ), or on the mask (positionⅡ). This study included four groups according to the position and type of exhalation valve, namely: single-arch exhalation valve was installed on the positionⅠ (A group), and positionⅡ (C group, the distal end of single-arch exhalation valve was blocked); plateau exhalation valve was installed on the positionⅠ (B group) and positionⅡ (D group, the distal end of plateau exhalation valve was blocked). Under standard experimental condition, the pressure of end-tidal carbon dioxide (PETCO2) was monitored in the trachea or the mask through adjusting the expiratory positive airway pressure (EPAP, EPAP was set at 5 cmH2O and 10 cmH2O, 1 cmH2O = 0.098 kPa) and tidal volume (VT, VT was set at 300, 400, 500 mL). Leakage of exhalation valve was monitored when single-arch exhalation and plateau exhalation valves were respectively placed in the positionⅠ through adjusting the inspiratory positive airway pressure (IPAP at 5, 10, 15, 20 cmH2O respectively). Results① Under standard experimental condition, when EPAP was 5 cmH2O, PETCO2 (mmHg, 1 mmHg = 0.133 kPa) in the trachea was 69.6±3.4, 61.4±2.7, 54.8±1.5, 49.8±1.3 in A, B, C, D groups respectively; and it was 24.8±1.9, 21.8±1.6, 2.8±0.8, 1.8±0.8 in the mask, respectively. When EPAP was 10 cmH2O, the PETCO2 in the trachea was 64.2±3.6, 57.2±3.7, 48.8±2.6, 41.8±2.6 in A, B, C, and D groups respectively; and it was 23.0±1.6, 20.2±1.6, 2.2±0.8, 1.2±0.8 in the mask, respectively. For the same exhalation valve type, exhalation valve being installed on positionⅡ could induce significantly lower PETCO2 in the trachea and mask than that being installed on positionⅠ (allP< 0.05). For the same expiratory valve position, plateau exhalation valve produced significantly lower PETCO2 than single-arch valve (allP< 0.05).② As the VT increased, the PETCO2 in the trachea of each group was reduced obviously. When VT was 500 mL, PETCO2 (mmHg) was significantly lower than VT, which were 300 mL and 400 mL (A group: 51.4±2.7 vs. 72.8±2.9, 69.6±3.4; B group: 44.8±2.4 vs. 65.4±2.1, 61.4±2.7;C group: 36.8±1.9 vs. 59.0±1.6, 54.8±1.5; D group: 28.8±1.9 vs. 52.6±2.0, 49.8±1.3; allP< 0.05).③ When exhalation valve type was placed in positionⅠ, the air leakage of single-arch exhalation valve was increased to (15.8±1.9), (20.2±1.9), (23.8±2.8), (28.0±1.6) L/min, and the plateau exhalation valve was essentially unchanged to (24.2±1.6), (23.8±1.6), (25.2±1.6), (25.2±1.6) L/min as the IPAP was increased from 5, 10, 15, to 20 cmH2O. Conclusions Exhalation valve fixing on mask is more appropriate for CO2 discharge than that fixed on tube-mask valve. Plateau exhalation valve as well as moderately increasing VT is beneficial for CO2 discharge and CO2 rebreathing prevention.

[Objective] To investigate the characteristics of PD-1/PD-L1 expressed on T cell and bladder cancer cell and clinical significance.[Methods] 64 patients with primary bladder cancer were into experiment group and 10 normal people were into control group.Peripheral bloods were used to test the PD-1 expressed on CD8+ T lymphocytes by flow cytometry.Immunohistochemistry staining was used to detect the PD-L1 expression in tumor and normal specimen.[Results] PD-1 expressed on CD8+T lymphocytes was (2.25 ± 0.60)％ in experiment group and (0.68 ± 0.17)％ in control group,respectively (P ＜ 0.001).And the PD-1 expression on T cell in invasive bladder cancer patient was significant higher than superficial bladder cancer patients [(3.04 ± 0.46)％ vs (0.68± 0.17)％,P ＜ 0.001].The expression of PD-L1 in experiment group was higher than control group,(26/64 vs 0/15,P ＜ 0.001).But there was no different between invasive and superficial bladder cancer patients,(41.3％ vs 38.8％,P ＞ 0.01).[Conclusions] Expression of negative stimulatory molecule PD-1 in CD8+T lymphocytes of peripheral blood is significantly correlated with bladder cancer advanced.Bladder cancer cell was strongly expressed PD-L1,and this expression is not related to cancer advanced.

Objective To investigate the effects of serum from patients receiving isoflurane and sevoflurane on the invasion and migration ability of human lung adenocarcinoma cell line A549. Methods Twenty ASAⅠorⅡ lung cancer patients aged 40 ~ 68 yr undergoing radical surgery were randomly divided into sevoflurane group (SEV group, n = 10) and isoflurane group (ISO group, n = 10). The concentration of sevoflurane or isoflurane maintained 1.5 MAC during anesthesia. Ten healthy volunteers were selected as control group. Serum was separated from blood sample taken at the end of surgery. A549 cells were randomly divided into sevoflurane group (group SEV, n = 10), isoflurane group (group ISO, n = 10) and control group (group C, n = 10). Cells of SEV group and ISO group were treated with 10% serum as respect to anesthetics for 24 hours. Cells of group C were treated with serum of control group. The invasion ability of cells was evaluated by Transwell assay. The migration ability of cells was determined by wound healing assay. The expressions of MMP-2 and MMP-9 in A549 cells were detected by ELISA. Results Compared with group C and ISO group,the number of invasive cells in group SEV was reduced significantly (P < 0.05). The levels of MMP-2 and MMP-9 in group SEV were significantly decreased compared with those of group C and ISO group (P<0.05). Conclusion The serum of patients receiving sevoflurane anesthesia can attenuate the metastatic ability of A549 cells through inhibiting the expression of MMP-2 and MMP-9.

OBJECTIVE:To optimize the formulation of Budesonide sustained-release tablet. METHODS:Using the cumula-tive releases in 2,4,8 h as investigation indexes,central composite design-response surface method was used to optimize the amount of hydroxypropylcellulose L(HPC-L),amount of soybean phosphatides,and filler(fixed total 200 mg)lactose- micro-crystalline cellulose mass ratio in the formulation of Budesonide sustained-release tablet,and the verification test was conducted. The release behaviors of prepared sustained-release tablet and original preparation in pH 7.2,7.0,6.8 phosphate buffer were com-pared. RESULTS:The optimal formulation was as follow as budesonide of 9 mg,HPC-L of 46.49 mg,soybean phosphatides of 9.23 mg,filler lactose-microcrystalline cellulose mass ratio of 1:2.9;the cumulative releases in 2,4,8 h were 21.9%,50.1%, 99.5%,the relative errors with predicted values (22.0%,50.0%,98.5%) were 0.45%,0.20%,1.02%(n=3),respectively. Compared with cumulative release of original preparation,the f2 was higher than 50. CONCLUSIONS:Budesonide sustained-re-lease tablet is successfully prepared,which shows similar release behavior to original preparations.

Objective To establish a flow cytometry-based assay for the detection of monocyte-me-diated antibody-dependent cell-mediated cytotoxicity ( ADCC ) .Methods P815 cells double stained with PKH26 and carboxyfluorescein succinimidyl ester ( CFSE ) were used as target cells and coated with P 815 specific antibodies to form antigen-antibody complexes .The peripheral blood mononuclear cells were isolated as effector cells and co-cultured with the antigen-antibody complexes .The CD3-CD14+PKH26+CFSE-cell population were gated by flow cytometry .Optimized effector/target cell ratio and incubation time for killing assay were identified .Monocyte-mediated ADCC in 23 patients with chronic HCV infection and 22 healthy subjects were analyzed .Results The monocyte-mediated ADCC could be evaluated through analyzing the CD3-CD14+PKH26+CFSE-cells with flow cytometry .The optimized effector/target cell ratio was 10 ∶1 and the optimized time for incubation was 4 h.Monocyte-mediated ADCC was inhibited in patients with chronic HCV infection as compared with healthy subjects (P=0.009).Conclusion A flow cytometry-based assay for the detection of monocyte-mediated ADCC was established , which could be used as a fast , sensitive and safety method for the evaluation of monocyte-mediated ADCC during viral infections and the research and de-velopment of drugs .

Objective To investigate the effect of Saussurea involucrata Injection(SII)on counteracting adjuvant-induced arthritis and its immunoregulation function,thus to supply the pharmacological evidences for the clinical treatment of arthritis.Methods Adjuvant arthritis was induced by plantar injection of Freundi' s complete adjuvant.MTT method was used to detect T and B lymphocytes proliferation,and sheep red blood cell immunization was used for hemolysin determination.Results(1)Rats right posterior metatarsus which was injected adjuvant was swollen from the second day to the 22nd day(the primary injury),and left posterior metatarsus not receiving adjuvant injection was swollen from the sixth day to the 20 th day(the secondary lesion).The differences of swelling degree were significant between SII group and NS group.(2)Consecutive intramuscular injection of SII 0.2,0.4,0.8 mL? kg-1? d-1 for 22 days suppressed the primary injury and the secondary lesion of adjuvant arthritis in rats,relieved swelling significantly from the sixth day(P

Objective To investigate the effects of an electromagnetic field on the extra-cellularly regulated kinase(ERK)signalling pathway and to determine the impact of electromagnetic activation on osteogenic proliferation and differentiation in rat bone marrow mesenchymal stem cells.Methods Rat bone marrow mesenchymal stem cells were isolated and cultured in vitro.The third-passage cells were divided into 4 groups(Control,PD98059,EMF and EMF+PD98059).Western blotting Was used to detect the activation of the ERK signal pathway after exposure to an electromagnetic field.MTT assay Was used to determine the activation of proliferation in the celb in the different groups.The cells' alkaline phosphatase activities were also detected. Results (1)The ERK signal pathway in these rat bone marrow mesenchymal stem cells was activated after exposure to a 15 Hz.1 mT,sine wave form electromagnetic field for 5 min.Activation remained high for at least 1 h.PD98059 can effectively block the activation of the ERK signal pathway.(2)Cell proliferation was promoted after exposure to the electromagnetic field,and this effect could be significantly inhibited by PD98059.(3)Alkaline phosphatase was significantly elevated in these bone marrow mesenchymal stem cells after exposure to the electromagnetic field.The activation in the EMF+PD98059 group Was slightly greater than in the EMF group.Conclusion Electromagnetic fields of 15 Hz and 1 mT can activate the ERK signal pathway and alter proliferation and osteogenic differentiation in the bone marrow mesenchymal stem cells of rats.

Objective:To investigate the effect of transforming growth factor (TGF- β) signal in muscle fiber itself during inflammation/immunity response on intramuscular inflammation. Methods:Sixteen wild C57BL/6 mice (wild group) and sixteen mice with skeletal muscle-specific deficiency of T βRⅡ (knock-out group) between 4-8 weeks of age were selected for this study. Acute muscle injury in mice was induced by injection of myotoxin cardiotoxin (CTX) into gastrocnemius. The differences in intramuscular inflammation were compared between the wild and knock-out groups on 0, 4, 7 and 10 d after CTX injection by observing exudation of mononuclear phagocytes, macrophages, M1 type macrophages, CD4 +T cells and helpers T cells (Th1, 2&17). Two newborn C57BL/6 wild mice and 2 SM TGF- βr2-/- knock-out mice were selected to culture primary myoblasts in vitro which were divided into 2 groups: an interferon group subjected to interferon simulation and a control group subjected to addition of an equal amount of solvent. The differences in expression of IL-6, IL-10, MCP-1, MIP-1α, H-2K b, H2-Ea, Toll-like receptor (TLR)3 and TLR7 were compared between the interferon and control groups, as well as between the wild and knock-out groups. Results:On 4&7 d after CTX injection, the ratios of mononuclear/macrophage (75.73%±3.62%, 45.27%± 2.32%), macrophages (38.67%±2.76%, 24.87%±2.19%), M1 macrophages (43.21%±0.11%, 30.43%±2.19%), CD4 +T cells (20.13%±1.62%, 5.67%±0.32%) in the muscle tissue from the knock-out mice were significantly higher than those from the wild mice (58.52%±2.43%, 29.21%±2.45%; 20.63%±2.32%, 16.23%±1.25%; 24.98%±0.35%, 14.23%±1.69%; 10.70%±0.43%, 2.50%±0.45%), with a majority of Th1&Th17 ( P<0.05). In vitro results showed that the levels of IL-6, MCP-1, MIP-1α, H-2K b, H2-Ea and TLR3 were significantly upregulated in the interferon group compared with the control group and that such upregulation in the nock-out mice was more significant than in the wild mice ( P<0.05). Conclusions:Endogenous TGF- β signal activation plays a role in the functional recovery after muscle trauma, because it is involved in the regulation of immune behavior of muscle fibers, thus affecting intramuscular inflammation and muscle regeneration.

Objective:To construct a DNA vaccine co-expressing the HBV compound multi-epitope antigen gene, the hIL-12 and the anti-HBV siRNA genes, and to express this DNA vaccine in HepG2 cells. Methods:The HBV multi-epitope antigen gene was designed and synthesized before it was fused with enhanced green fluorescent protein(EGFP) gene, and cloned into the multi-clone site(MCS) of the eukaryotic expression vector pVAX1. The expressinig units of hIL-12 and siRNA were cloned into the BspH I and Mlu I site of pVAX1 respectively. Then the recombinant plasmid pVAX1-siHBV-HB-EGFP-hIL12 was transiently transfected HepG2 cells. The expression of HBV compound multi-epitope gene was observed through EGFP report gene. The expression of hIL-12 was analyzed by ELISA and the effects of anti-HBV siRNA was confirmed with rtPCR . Results: The analysis of enzyme digestion and sequencing both demonstrated that the trible-expressing HBV DNA vaccine has been constructed successfully. The green fluorescent image was detected in the transfected cells which could confirm the expression of the multi-epitope antigen gene. The amount of hIL-12 secretion was 1289pg/ml in supernatant at 48h after transfection and 1712pg/ml at 72h after transfection. The mRNA amount of HBV S gene, which was the siRNA target, had been obviously knockdown. Conclusion: The DNA vaccine co-expressing the HBV compound multi-epitope antigen gene, the hIL-12 and the siRNA genes was constructed and transiently expressed in HepG2 cells, and siRNA had shown us a good anti-HBV effect. It laid a foundation of further study on anti-HBV effect of the new DNA vaccine.