The doctor-patient relationship has become increasingly tense. The requirement of the society for physicians, especially surgeons is higher. Apart from fine professional skills, surgeons must learn some other skills, such as communication, the ability of self-decompression, and the awareness of public relationship to deal with inculpation from the media and society. The medical record is more and more important nowadays, surgeons should pay enough attention to it. The public misunderstanding of the medical profession will surely harm both doctors and patients in the end.
Adaptation, Psychological ; Attitude of Health Personnel ; Communication ; Digestive System Surgical Procedures ; Humans ; Physician-Patient Relations ; Physicians

Adenocarcinoma ; diagnosis ; surgery ; Esophageal Neoplasms ; diagnosis ; surgery ; Esophagogastric Junction ; Humans ; Stomach Neoplasms ; diagnosis ; surgery

Humans ; Stomach Neoplasms ; diagnosis ; therapy

Humans ; Stomach Neoplasms ; surgery

Objective To observe the effect of interleukin-1β(IL-1β) on expression of Matrix Metalloproteinases 13 (MMP-13) in rat chondrocytes and its regulation of miR-27b. Methods Chondrocytes were extracted from 7 Wistar male rats. Expression of MMP-13 were examined by Western blot at 0 h, 24 h, 48 h after IL-1βstimulation. Differential miRNAs expression profiles were examined by miRNAs microarray. The most obviously down-regulated miRNAs were confirmed by quantitative Real-time PCR. Targeted regulation relationship between miR-27b and MMP-13 was set up by Luciferase re?porter gene experiments. Results Expression of MMP-13 in rat chondrocytes was increased at a timely dependent manner upon IL-1βstimulation(P<0.05);Microarray revealed 36 miRNAs whose expression changed, among which 6(miR-27b, miR-31, miR-26a, miR-26b, miR-23, miR-204)were especially obvious. Real-time PCR confirmed that miR-27b was the one whose expression level were most down-regulated. Transient co-transfection of miR-27b mimics with luciferase expres?sion plasmids resulted in significant repression of luciferase activity in rat chondrocytes (P < 0.05). Conclusion IL-1βstimulation result in down-regulation of miR-27b and up-regulation of MMP-13 expression. MiR-27b and MMP-13 show targeted regulation relationship.

Liver cancer remains difficult to treat, owing to a paucity of drugs that target critical dependencies; broad-spectrum kinase inhibitors such as sorafenib provide only a modest benefit to patients with hepatocellular carcinoma. The induction of senescence may represent a strategy for the treatment of cancer, especially when combined with a second drug that selectively eliminates senescent cancer cells (senolysis). Here, using a kinome-focused genetic screen, we show that pharmacological inhibition of the DNA-replication kinase CDC7 induces senescence selectively in liver cancer cells with mutations in TP53. A follow-up chemical screen identified the antidepressant sertraline as an agent that kills hepatocellular carcinoma cells that have been rendered senescent by inhibition of CDC7. Sertraline suppressed mTOR signalling, and selective drugs that target this pathway were highly effective in causing the apoptotic cell death of hepatocellular carcinoma cells treated with a CDC7 inhibitor. The feedback reactivation of mTOR signalling after its inhibition is blocked in cells that have been treated with a CDC7 inhibitor, which leads to the sustained inhibition of mTOR and cell death. Using multiple in vivo mouse models of liver cancer, we show that treatment with combined inhibition of CDC7 and mTOR results in a marked reduction of tumour growth. Our data indicate that exploiting an induced vulnerability could be an effective treatment for liver cancer.

we have designed a program-controlled high-fi amplifier for EMG.Its gain can be controlled by computer.The program-contralled circuit is implemented with numerical control resistor.The amplifier can be used in automatically measuring EMG signals over 100?v.The circuit is characterized by easy de- sign,simple programing and convenient control.

ObjectiveTo investigate the efficacy of low-molecular-weight heparin (LMWH)combined with warfarin in advanced lung cancer patients with acute non-massive pulmonary embolism (PE) and the effect on dyspnea symptom.MethodsFifteen (stage Ⅲ B-Ⅳ ) lung cancer patients with PE from July 2008 to June 2010 were enrolled.All the patients were diagnosed as acute non-massive PE according to spiral computed tomography pulmonary angiography (SCTPA).Enoxaparin (1 mg/kg) was injected with subcutaneous injection twice a day for 7-14 days.Oral warfarin was added once a day 48 h after enoxaparin injection and the dosage was adjusted according to international normalized ratio (INR) level(maintain 2.0-3.0).The medical research council (MRC) grade,results of arterial blood gas analysis and adverse reactions were observed.ResultsSix patients were accompanied with deep venous thrombosis (DVT)according to vascular Doppler ultrasound,2 patients were died at the 6th day and 11th day due to multiple organ dysfunction syndrome.Six patients were cured.5 patients were good,2 patients were improved.The median survial time was 9.2 months.Thirteen patients' MRC grade was decreased trom (3.1 ± 0.5 ) grades to ( 1.9 ± 0.8 ),( 1.5 ± 0.5 ),(0.6 ± 0.6) grades,arterial oxygen pressure (PaO2) was raised from (60.5 ± 7.2)mm Hg (1 mm Hg=0.133 kPa) to (76.1 ±9.7),(81.6±9.2),(86.2±7.5) mm Hg,plasma D-dimer was decreased from (9.44 ± 5.29 ) mg/L to (4.33 ± 3.34 ),(0.88 ± 0.32 ),( 0.41 ± 0.1 7 ) mg/L and alveolar-arterial oxygen tension gradient [ P( A-a)O2 ] was increased from ( 38.5 ± 6.7 )mm Hg to ( 35.5 ± 5.1 ),(29.3 ± 3.2),(24.1 ± 4.1 ) mm Hg after 4,7,14 days of the treatment.There were significant differences in PaO2,MRC grade,plasma D-dimer before and after 4,7,14 days of the treatment(P ＜ 0.05),there was significant difference in P ( A-a)O2 before and after 7,14 days of the treatment (P＜ 0.05).There was no patient with big hemorrhage and thromboembolism during anticoagulant therapy.ConclusionsFor advanced lung cancer patients,the combination therapy with LMWH and warfarin for acute non-massive PE appears to be safe and effective on improving dyspnea symptom and hypoxemia.Adverse reaction is seldom.

Through analysis of the anatomic and physiological characteristics and the pathophysiological changes of 84 obstructive sleep apnea syndrome (OSAS) patients,the risks and key points of nursing care during general anesthesia were summarized,such as careful assessment of the patient situation,preparations of first aid materials and drugs,close observation and cooperation with the procedure of anesthesia,timely detecting and dealing with the abnormal changes during anesthesia.

Objective To evaluate the effects of proportional assist ventilation (PAV) and pressure support ventilation (PSV) on ventilate parameters of patients with chronic obstructive pulmonary disease (COPD) combined with respiratory failure.Methods Fifteen intubated stable patients recovering from acute exacerbation of COPD combined with respiratory failure were randomized to receive PAV or PSV support 60 min and then crossed over to alternative mode.Respiratory mechanics including respiratory systemelastic resistance and airway resistance were monitored by least square fitting (LSF) methed.During PAV support.the ratio of volume assist (VA) and flow assist (FA) level wag 80%.The ventilate parameters and arterialblood gas at different ventilate condition was observed.Results Compared with low level PSV (PS 10 cm H2O,1 cm H2O=0.098 kPa,PS10),tidal volume in high level PSV (PS 15 cm H2O,PS15) and PAV was significantly increased [(443±12)ml vs(532±34)ml,(464±23)ml,P<0.05].There was no difference in respiratory rate and peak inspiratory pressure between PAV and PS10.Airway occlusion pressure and time product of triggering was d()reased from (5.70±0.25)cm H2O to (4.53±0.25)cm H2O and (0.42±0.04) cm H2O to (0.32±0.03)cm H2O(P<0.05),PaO2/FiO2 ratio and PaCO2 was also significantly improved after PAV supported compared with PS10,and similar with PS15.The rapid shallow breath index at PAV was similar with PS10.Condusion As a positive feedback system,PAV seems more efficacious than low level of PSV in decreasing the work of breathing during the inspiratory phase,resulting in fewer patient-ventilator asynchronism,and it may be beneficial for weaning.