The patient-physician relationship can be understood from the two aspects of patients′ trust and patients′ satisfaction.Compared with patients′ satisfaction,dimensions and attributes of patients′ trust indicate to better match with the measuring capacity of patients.Thus,the evaluation of the quality of medical services based on patients′ trust is justified theoretically.The existing literatures assert that the research on patients′ trust could help understand patient-physician relationship and eventually improve the quality of medical services.The conceptual model in this paper entails the concept,dimensions and attributes of patients′ trust.Also,this paper points out its effect on the measurement of the quality of medical services through the comparison of patients′ trust and patients′ satisfaction.

Objective To evaluate the potential high risk factors of femoral head necrosis after femoral neck surgery in adult patients. Methods From January 2009 to October 2014,390 patients with femoral neck fractures in our hospital were treated with multiple hollow compression screws. All patients were followed up for 12 to 60 months. Then retrospectively analyzed the incidence rates of femoral head nec-rosis and the clinical data about age,gender,fracture side,Garden index,fracture shift condition,internal medicine complications,whether to do lower limb preoperative traction,restoration method,postoperative load time and whether take out hollow compression screw internal fixa-tion,so as to explore the higher risk factors for femoral head necrosis. Results Among the 390 cases,352 cases got followed up. There were 45 cases of them ended with nonunionand 49 cases ended with femoral head necrosis. The univariate regression analysis results showed that the age,fracture shift condition,internal medicine complications,postoperative load time and Garden index,whether take out internal fixation were risk factors for femoral head necrosis (P<0. 05). The multi-factor results showed that aged from 40 to 60 years old,transfered fracture, seriously complications,time of loading less than 3 mouths,Ⅲ and Ⅳ Garden index,take out internal fixation were the high risk factors for femoral head necrosis (P<0. 05). Conclusion Patients who aged from 40 to 60 years old and having transfered fracture,seriously complica-tion,early weight bearing,high Garden index and internal fixation take-out would increase the risk of femoral head necrosis.

Objective The expression of TGF-β1 and IL-10 in the grafts of inbred mice with rejection of heart transplantation were studied and the interaction of them in the rejection of heart transplantation in inbred mice investigated.Methods Allografts were divided into 2 groups:control group (n =70),cyclosporin A-treated group (CsA group,n =70).Hearts from inbred BABL/c mice were transplanted into a cervical location in the other recipients and the survival time of the allografts was observed.The local expression of TGF-β1 and IL-10 was detected at day 1,3,7,11,14,21 by reverse transcription polymerase chain reaction(RT-PCT) respectively.Results The survival time of the allografts was (20.3 ± 1.7) days in control group,and(32.2 t 3.4) days in CsA group (P ＜ 0.01).The levels of the two cytokines expression were up-regulated in CsA group.The up-regulation of TGF-β1 was closely correlated with the survival of the grafts.Conclusion The expression and production of the two cytokines is up-regulated probably cause of administ ration of cyclosporin A,and favorite to the heart graft survival,and action of these two cytokines are probably interrelated.

Objective To explore the relationship between the cognitive disorders in the first episode of schizophrenia and P300 components.Methods P300 components were measured by using an auditory oddball paradigm with a Denmark KeyPoint Evoked Potentials instrument in 60 cases of schizophrenia and 3 cases of schizophreniform disorder,whose psychopathological status was assessed with the Positive and Negative Syndrome Scale(PANSS).Forty healthy subjects were used as control.Results The principal component analysis of the PANSS items revealed five factors:cognitive disorder,negative symptoms,depressive disorder,hostility/excitement and delusion/hallucination.The patients had lower amplitude of P300 at Fz,Cz,Pz,T3 and T4 than the normal controls(P

Objective To compare the severity of periopemtive myocardial injury caused by live donorliver transplantation (LDLT) performed under sevoflurane and pmpofol combined anesthesia in adult patients. Methods Forty ASA Ⅱ-Ⅳ patients(liver function Child-Pugh grade B or C)aged 40-67 yr weighing 47-95 kgundergoing right lobe LDLT were randomly divided into 2 groups(n=20 each):sevoflurane combined anesthesiagroup (group S) and propofol combined anesthesia group(group P).Anesthesia was maintained with 1.6%-3.0% sevoflurane in group S or PCI of pmpofol(Cp 2-4μg/ml)in group P combined with sufentanil infusion at 0.5- 1.0 μg·kg-1·h-1 and intermittent iv boluses of cisatracurium in both groups.MAP,HR,CVP,MPAP,PCWP, CO and mixed venous O2 saturation(S(v)O2)were recorded before skin incision at 5 and 30 min of anhepatic phaseand 5 and 30 min of ncohepatic phase and the end of operation:Blood samples were taken from central vein beforeskin incision(T0,baseline)at 30 min of anhepatic phase(T1),30 min of neohepatic phase(T2),the end ofsurgery (T3) and 24,48,72 h after operation (T4,5,6) for determination of serum concentrations of cardiactroponin I (cTnI) and creatine kinase MB(CK-MB).Postoperative adverse effects were recorded.Results Thetwo groups were comparable with respect to 8ex ratio(M/F),age,body weight,duration of operation,duration ofanhepatic phase,blood loss,dopamine and nitroglycerin consumption.There was no significant difference in MAP, HR,CVP,MPAP,PCWP,CO and S(v)O2 between the two groups.The serum concentrations of cTnI and CK-MB were significantly increased at T2-5 as compared with the baseline value at T0 in both groups. There was no significant difference in serum concentrations of cTnI and CK-MB and in the incidence of myocardial ischemia and arrythmia between the two groups. Conclusion Sevoflurane and propofol combined anesthesia have similar effects on myocardial injury caused by LDLT in adult patients.

Objective To discuss the degenerative factors, the spinal segment distribution, and the mechanism in hyperextension injury of cervical spine. Method Eighty-nine patients with hyperextension injury of cervical spine were retrospectively analyzed by observing the degenerativelesion, the spinal cord segment with high signal in T2WI, and the location of facial trauma. Results Fifty-eight cases showed the disc hemiation which was the most common lesion, followed by 8 cases showing the calcification of the posterior longitudinal ligament. Besides, 7 cases presented the developmental stenosis of spinal canal, and also, 6 cases showed disc hemiation combined with the yellow ligament hypertrophy. The intervertebral level of the spinal cord with high signal in T2WI were distributed as follows:4 cases were at C2/3, of which onesuffered the forehead trauma; 12 cases were at C3/ 4, of which 10 had the forehead trauma, and one had the zygomatic trauma; 12 cases were at C4/5, of which 5 had the forehead trauma, one had both the zygomatic and the forehead trauma, and one had both the forehead and with the lower jaw trauma; 11 cases were at CS/6,of which 3 had the forehead trauma, 3 had the zygomatic trauma, and 2 had the lower jaw trauma. The location of the spinal cord with single high signal in T2WI did not correspond with the intervertebral disc level in 4 cases. For 10 cases the high signal in T2WI was found at two discontinuous segments. For 2 cases the 1 high signal in T2WI was found at over two segments. For 6 cases the high signal in T2WI was found at over three segments. Conclusions Disc hemiation is the most common underlyding factor in cervical hyperextension injury. The spinal level with high signal in T2WI was correlative to the impacted facial site. The shear force at the inflection point with or without the anterior-posterior compression force accounted for the cervical hyperextension injury.

Objective To quantify the validity and reliability of the Hong Kong version of the functional test for the Hemiplegic Upper Extremity (FTHUE-HK).Methods Forty-two stroke patients were studied.Patients were assessed twice within one week using the FTHUE-HK,the upper extremity component of Fugl-Meyer movement assessment (FMA) and the modified Barthel index (MBI).The test-retest reliability and inter-rater reliability of the FTHUE-HK were thus quantified.The FTHUE-HK's validity was evaluated according to the correlation between the FTHUE-HK,FMA and MBI results.Results Significant correlations between the three assessments were demonstrated(P≤0.01).The intra-and inter-class correlation coefficients were 0.983 and 0.985 respectively.Conclusion The FTHUE-HK is a simple and useful assessment of the upper extremity function of stroke patients with good validity and reliability.

OBJECTIVE: To investigate the possibility and anatomy landmark of the frontal beak approach of endoscopic frontal sinusotomy to the frontal sinus lesions. METHOD: (1)Twenty cases of frozen cadaveric head underwent spiral computed tomography scans. Then data were transferred into the Mimics image workstation to reorganize CT images in the coronal, sagittal, and axial planes. The anatomic parameters related to surgical approach points were measured, such as the distance between vertical plate of the middle turbinate and lamina papyracea and the thickness of the frontal beak. (2) 3D visual model of the frontal cell and the drainage way of the frontal sinus was produced with the application of Sinuses Trachea I software. (3)The endoscopic frontal sinus surgery were performed on 20 cases of subjects (objects)to find out the anatomy landmarks of the frontal beak approach, measure the parameters such as the distance between middle turbinate and lamina papyracea, and evaluate the potential surgical complications during operation. RESULT: (1)The frontal beak is a white bony arcs located at the attachment point of middle turbinate front inserted to the skull base. Its position was relatively constant, before frontal sinus above. (2)The distance between the middle turbinate vertical plate and lamina papyracea was (7. 61 ± 1. 34) mm. The thickness of the frontal beak in surgical approach was (3. 27 ± 0. 91) mm. (3) 3D visual structure of the frontal sinus and its ventilation pathway: the shape of unilateral frontal sinus looked like the cone, which was transited by the drainage pathway of the frontal sinus. The front part of the frontal sinus ostium is surrounded by the frontal beak. The upper part the frontal beak connected to the floor of the frontal sinus. (4) Frontal beak can be used as an landmark of frontal beak approach in the endoscopic frontal sinus surgery. But the lateral view of frontal sinus still was limited in the operation. CONCLUSION The endoscopic frontal sinus surgery with the approach of the frontal beak is easy to operate and learn. In this area between the double "L", the operation is safe.
Anatomic Landmarks ; Endoscopy ; methods ; Frontal Sinus ; surgery ; Humans ; Skull Base ; Software ; Tomography, Spiral Computed ; Tomography, X-Ray Computed ; Turbinates ; anatomy & histology

Abstract: Objective To investigate the clinical features and risk factors for severe tsutsugamushi disease, so as to provide reference for diagnosis and differentiation of severe tsutsugamushi disease as soon as possible. Methods The clinical data of 178 cases of inpatients with tsutsugamushi disease admitted to the Guangzhou Eighth People's Hospital, Guangzhou Medical University from January 2016 to September 2021 were collected and analyzed according to their gender, age, underlying diseases, clinical characteristics at admission, laboratory examination results within 24 hours of admission and epidemiological history. The patients were divided into the severe group and the non-severe group according to the diagnostic criteria. The data of clinical characteristics, laboratory examination and prognosis of the two groups were compared. Multivariate logistic regression analysis was performed on the variables with statistical significance and the receiver operating characteristic curve (ROC) was drawn. Results A total of 178 patients were included in this study, with 37 in the severe group and 141 in the non-severe group. Compared with the non-severe group, the age of the severe group was older, the underlying diseases were more, the incidence of dyspnea and the levels of white blood cell, total bilirubin, aspartate aminotransferase, lactate dehydrogenase, cystatin C, uric acid and serum creatinine were significantly increased, the levels of platelet and albumin were significantly decreased (all P<0.05). The dyspnea [odds ratio (OR value)=8.93, 95% confidence interval (CI): 1.200-66.424; P=0.032], total bilirubin (OR=1.091, 95%CI: 1.028-1.159; P=0.004) and serum creatinine (OR=1.052, 95%CI: 1.004-1.102; P=0.033) were independent risk factors for severe tsutsugamushi disease. The area under ROC curve of total bilirubin and serum creatinine were 0.777 and 0.764, respectively (both P<0.01), indicating high predictive value for severe tsutsugamushi disease. The optimal cut-off value for total bilirubin was 23.01 µmol/L, with a sensitivity of 54.10% and a specificity of 90.60%; the optimal cut-off value for creatinine was 126.45 µmol/L, with a sensitivity of 43.20% and a specificity of 100.00%. The case fatality rate of severe tsutsugamushi disease was 2.70%. Conclusions The patients with severe tsutsugamushi disease are older, and have more underlying diseases. Dyspnea, increased total bilirubin and elevated serum creatinine are independent risk factors for severe tsutsugamushi disease, which can help in the early identification of severe tsutsugamushi disease early.

BACKGROUND: Recently the prevalence rate of mass in mammary gland increases significantly than before. To use which kind of technology is not only related with the post-operation recurrence, but also related with the reconstruction of their confidence. Therefore, how to reduce the trauma physically and psychologically in patients to the maximal degree has become the chief factor to choose technology by surgeons.OBJECTIVE: To observe the effects of transverse rectus abdominis musculocutaneous (TRAM) flap, latissimus dorsi musculocutaneous flap with breast prothesis, local flap and simple breast prothesis after skin-sparing mastectomy with immediate breast reconstruction.DESIGN: Case analysis.SETTING: Department of Plastic Surgery, Shenzhen People's Hospital,Second Clinical Medical College of Jinan University.PARTICIPANTS: A total of 15 ductal carcinoma in situ (DCIS) and huge breast benign tumor patients were enrolled into Shenzhen People's Hospital between October 1997 and May 2004, aged from 20 to 46 years. They all got disease in single breast, and 8 of them had preoperative diagnosis of DCIS, T1N0M0 and 7 of them had huge breast benign tumor. Operation program was informed to the patients before operation so as to gain their agreement.METHODS: Skin-sparing mastectomy was performed with circular shape incision at areola and using TRAM flap, latissimus dorsi musculocutaneous flap with breast prothesis, local flap and simple breast prothesis to fill breast. Slight skin of musculo-cutaneous flap could compensate the nipple and areola when performing reconstruction. At the reoperation, nipple was made at the transferred flap.MAIN OUTCOME MEASURES: To observe the patients with or without recurrence or transfer after operation and local healing of wound.RESULTS: With the cooperation of general surgeons the operation was done in 15 cases and 14 cases of them were followed up for more than 1 year. The reconstructed breasts were with good symmetry with the opposite one, normal skin sensation, natural shape and inconspicuous scar.CONCLUSION: This is an excellent alternative method for mastectomy and breast reconstruction based on the avoidance of recurrence of breast cancer in severe operation.