Patient′s expectation has been defined as the anticipation that given events were likely to occur during, or as an outcome of, health care. What people expect from their health care are potentially important in predicting patient satisfaction and dissatisfaction with their care, treatment and health outcomes. There was widespread recognition of the importance of evaluating services from consumer perspectives. In this article, domestic and foreign research in recent years, expectations status, significance and various influencing factors in relation to the expectations in processes of health care were summarized. Consumer evaluations of their health care are now an established component of quality assessment, planners need to understand the expectations underlying patients′views in order to interpret their feedback. Thus leading to improve patient satisfaction and the social evaluation of medical units.

Objective To investigate the kinetics processes of TLR2 and TLR4 in CD14~+ monocyte of patients during and after cardiac surgery with cardiopulmonary bypass(CPB) and the effects of dexamethasone(DXM) on the regulation of TLR2 and 4 in CD14~+ monocyte. Methods Twenty patients undergoing elective atrial/ventricular septal defect correction were randomized to received 1 mg/kg dexamethasone or placebo before induction of anesthesia. The CD14~+ monocyte surface TLR2 and TLR4 and the intracellular HSP70 were stained and analyzed by flow cytometry, and plasma level of TNF-?, IL-6, IL-10, NO and MDA were measured at following times: before the dexamethasone or placebo were administer(T1), before starting CPB(T2), immediately after aortic declamping(T3), 30min after aortic declamping(T4), 5h after skin closure(T5) and 24h after skin closure(T6). Results Both the HSP70~+ TLR2~+ monocytes and HSP70~+-TLR4~+ monocytes,the plasma concentration of TNF-?, IL-6, NO and IL-10 were upregulated after introduction (P

OBJECTIVETo observe the therapeutic effect of a drug pair of Radix Astragali and Rehmanniae Radix combined with glucocorticoid (GC) in treating lupus nephritis (LN) patients and its influence on some experimental indices.

METHODSTotally 52 LN patients were randomly assigned to the treatment group (treated by routine Western medicine and a drug pair of Radix Astragali and Rehmanniae Radix, 25 cases) and the control group (treated by Western medicine, mainly by GC and cyclophosphamide, 27 cases). All patients received 6-month therapy. The GC dosage, the withdrawal and reduction dosage of GC, clinical efficacy, systemic lupus erythematosus disease activity index (SLEDAI) score, adverse reactions, and laboratory indicators were recorded.

RESULTS(1) All patients got relieved to some degree with the dosage of GC reduced. The total withdrawal and reduction dosage of GC was slightly higher in the treatment group than in the control group [(50.23 +/- 12.43) mg vs (48.76 +/- 13.61) mg, P > 0.05]. Besides, the prednisone dosage in the treatment group was lower than that in the control group, but without statistical difference (P > 0.05). The ratio of patients in need of adding prednisone for aggravating disease was 24.0%, significantly lower than that in the control group (44.44%, P < 0.05). (2) There was no statistical difference in the SLEDAI score, inflammatory indicators, liver and renal functions, blood electrolytes, blood glucose, blood and urine routines between the two groups (P > 0.05). The 24-h urinary protein count was (1.06 +/- 0.22) g/L in the treatment group, obviously lower than that in the control group (1.43 +/- 0.55 g/L, P < 0.05). (3) There was no statistical difference in the incidence rate of infection, gastrointestinal hemorrhage, psychoneuroses, Cushing's syndrome, cardiovascular anomalies, and femoral head necrosis between the two groups (P > 0.05). But the incidence of adverse reactions such as insomnia, tidal fever, spontaneous sweat, and obesity was less in the treatment group than in the control group (P < 0.05).

CONCLUSIONSUsing a drug pair of Radix Astragali and Rehmanniae Radix combined with GC in treating LN could withdraw the dosage of GC and relieve symptoms it induced. It was advantageous in reducing the dosage of GC and stabilizing patients' conditions.

Adolescent ; Adult ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Glucocorticoids ; therapeutic use ; Humans ; Lupus Nephritis ; drug therapy ; Treatment Outcome ; Young Adult

Objective To observe the therapeutic effect of Radix Astragali,Radix Rehmanniae combined with glucocorticoid(GC) in treating patients with systemic lupus erythematosus(SLE) and its influence on some experimental indexes.Methods 72 cases of SLE were randomly recruited into the integrated traditional Chinese and western medicine treated group (treated group) and the western medicine treated group (control group).The control group was treated with prednisone and cyclophosphamide,while the treated group was treated with Radix Astragali and Radix Rehmanniae on the basis of the control group.Both groups had been treated for 6 months as a therapy course.The use of prednisone dosage were recorded and its influence on indexes of clinical and laboratory value were observed.Results 27 SLE patients in the treated group and 34 in the control group were completely observed.The dosages of prednisone in both groups were decreased gradually after the state of disease had been relieved.The predrisone dosage in the treated group was lower than that in the control group in the therapy course(15.41 ±7.65)mg vs (17.25±8.83)mg,but without significant difference (t=0.85,P＞0.05).The total decreased prednisone dosage in the treated group (50.12±12.53 mg) was slightly higher than that in control group(48.96± 13.71) mg (t=0.34,P＞0.05).The ratio of cases who had to add prednisone for aggravating disease in treated group(15.92％) was less than that in the control group (38.24％),the difference was significant (x2=3.24,P＜0.05).The incidence rate of cushing syndrome,infection,diseases of digestive,cardiovascular anomalies in the treated group was slightly less than the control group (x2=0.42,0.98,0.01,0.03respectivly,P＞0.05),but the number of insomnia and hot flush were significantly larger in the control group than the treatment group (x2=4.24,5.93,P＜0.05).No difference about the SLEDAI,ESR,CRP,Blood Complement3,Blood imune globinG was found between the two groups (t=2.16,1.04,1.18,0.26,1.61 respectively,P＞0.05),and 24 hours urinary protein count decreased significantly in the treated group (1.06 ± 0.12) g/L,compared with control group (1.42 ± 0.54) g/L,(t =3.78,P ＜ 0.05 ).Conclusion Radix Astragal,Radix Rehmanniae combined with conventional treatment of western medicine could withdraw corticosteroid smoothly,relieve symptoms and alleviate some side-effects of western medicine.

Background and purpose: With the increase of aging population, elderly patients (age ≥70 years) with esophageal squamous cell carcinoma occurred more and more. However, few studies have focused on elderly esophageal squamous cell carcinoma patients. This study aimed to assess the outcomes and prognostic factors for elderly patients with esophageal squamous cell carcinoma treated after deifnitive chemoradiotherapy. Methods:We retrospectively analyzed 53 patients (age≥70 years) with esophageal squamous cell carcinoma and treated with deifnitive radiotherapy with or without chemotherapy from Fudan University Shanghai Cancer Center from Mar. 2009 to Dec. 2011. Results:Median age was 74 years. Twenty-nine patients underwent radiotherapy, 24 patients underwent radiochemotherapy. 1-, 2-, 3-, and 5- year survival was 62%, 44%, 33% and 19% respectively. Grade 2 and above acute radiation-induced esophageal toxicity and radiation pneumonitis occur rate was 6% and 9% respectively. No treatment-related deaths occurred and no patients experienced any grade 4 and above toxicities. Multivariate analysis identiifed treatment modality, tumor site and smoking history as independent prognostic factors for overall survival. Conclusion:Radiotherapy may be an acceptable treatment option for elderly patients with esophageal squamous cell carcinoma. In appropriately selected patients, concurrent chemotherapy could bring a better overall survival.

Objective To compare the efficacy of internal fixation with non-operative treatment of traumatic flail chest combined with sternal fracture.Methods A retrospective review was made on 102 patients with traumatic flail chest combined with sternal fracture treated from January 2007 to January 2014.There were 71 patients in operation group and 31 patients in non-operation group.Operation group was allocated to pure titanium rib plating (Group Ⅰ,22 cases),porous titanium screw fixation (Group Ⅱ,20 cases),and nickel-titanium memory alloy sternal rib plating (Group Ⅲ,29 cases).Rib traction was performed in non-operation group.Clinical results and incidence of complications were compared between the two groups.Results At 24 and 72 hours,operation group was superior over non-operation group with regard to HR [(100.4 ± 9.5) times/min vs (105.2 ± 10.1) times/min,(92.1 ± 9.9) times/min vs (102.1 ± 9.2) times/min],MAP [(97.7 ± 14.5) mmHg vs (91.0 ± 13.3) mmHg,(112.5 ± 15.2) mmHg vs (93.1 ± 13.8)mmHg] and CVP [(7.8 ±3.7)cmH2O vs (9.4 ±3.8)cmH2O,(6.2 ±2.9)cmH2O vs (9.1 ±3.2) cmH2 O] (P ＜ 0.05).Duration in ICU [(5.1 ± 0.8) days vs (9.3 ± 1.1) days],ventilation time [(4.5 ±1.0)days vs (8.2 ± 1.4)days],hospitalization time [(14.6 ±3.5)days vs (23.3 ±4.4)days] and incidence of complications were significantly lower in operation group than in non-operation group (P ＜ 0.05).Two months after discharge,tidal volume (VT) [(0.52 ±0.04)L vs (0.40 ±0.03)L],inspiratory capacity (IC)[(1.99 ±0.45)L vs (1.22 ±±0.33)L],forced vital capacity (FVC) [(3.52 ±0.51)L vs (2.44 ±0.42)L],total lung capacity (TLC) [(5.41 ±0.82)L vs (3.72 ±0.56)L] and forced expiratory volume in one second (FEV1) [(2.80 ± 0.43) L vs (1.95 ± 0.50) L] showed significantly better results in operation group than in non-operation group (P ＜ 0.05).Operation time,intraoperative bleeding and daily drainage volume were (38.8 ±9.2)min,(43.5 ±7.6)ml and (10.9 ± 1.1)ml in Group Ⅱ versus (62.5 ± 10.1)min,(100.0 ± 10.5) ml and (26.8 ±3.1)ml in Group Ⅰ and (49.3 ±9.6)min,(61.4 ±8.3)min and (19.8 ±1.6)ml in Group Ⅲ (P ＜ 0.01).Conclusion For traumatic flail chest combined with sternal fracture,the internal fixation should be done as early as possible so as to reduce incidence of complications.Relatively,porous titanium screw fixation has better clinical outcome.

Background and purpose:Postoperative sore throat (POST) is one of the common complaints of patients after radical thyroidectomy. Tracheal intubation is the main cause of POST. This study compared the effect of intubation with visual endoscopy and general laryngoscope on POST in patients undergoing radical thyroidectomy. Methods:One hundred patients (18-60 years, ASAⅠ-Ⅱ) undergoing elective radical thyroidectomy were randomized into two groups:patients in group A (n=50) were intubated with visual endoscope while patients in group B (n=50) were intubated with general laryngoscope. Endotracheal tube cuffs pressure was maintained at 20mmHg in all patients. Visual analogue scale (VAS) and Bruggrmann comfort scale (BCS) were recorded at the time points of 1, 6 and 24 h after extubation. Results:Compared with group B, the incidence of POST in group A was signifcantly reduced (42%vs 64%, P=0.027). The VAS of group A was lower than that of group B (3.05±1.56 vs 4.25±1.30, 3.05±1.56 vs 4.01±1.98, 2.72±1.77 vs 3.31±1.12) (P<0.05). The BCS of group A was higher than that of group B (0.99±0.46 vs 0.69±0.30, 1.95±0.47 vs 1.51±0.58, 2.82±0.87 vs 2.31±0.72) (P<0.05). Conclusion:Using visual endoscopic intubation can reduce the incidence of the POST in patients undergoing radical thyroidectomy.

Objective To investigate the influence of a multifaceted stroke telehome-care (THC) on extremities function, activities of daily living (ADL) and quality of life in stroke patients with hemiplegia. Methods A total of 52 stroke survivors in department of neurology were randomized to the THC intervention or usual care. The patients in the control group received conventional care, while those in the intervention group were additionally given a THC program over 3 months. The THC intervention includes motor imagery and adaptive strategies. Data collection was undertaken using the Fugl-Meyer Motor Assessment Scale (FMA), the Barthel Index (BI), the Stroke Impact Scale (SIS) at baseline, 3 months, and 6 months. Results At baseline, the scores of FMA, BI, and SIS in the intervention group were 53.62 ± 23.52, 54.04 ± 17.44, 179.96 ± 28.51, and while the scores of the control group were 50.96 ± 19.52, 49.46 ± 15.09, 169.23 ± 28.48. There were no pre-existing differences on any scale between the two groups (t=0.443, 1.012, 1.358, P > 0.05). At 3 months, the scores of FMA, BI, SIS in the control group were 53.54 ± 17.45, 50.77 ± 14.47, 76.19 ± 27.78, and were significantly lower than 78.38 ± 12.54, 74.62 ± 11.22, 228.54±22.63 in the THC group (t=5.895, 6.641, 7.449,P<0.01). At 6 months, the scores of FMA, BI, SIS in the control group were 57.88±17.89, 59.08±13.85, 183.92±26.56, and were significantly lower than 90.58 ± 9.60, 86.54 ± 9.88, 252.19 ± 20.10 in the THC group (t=8.211, 8.233, 10.451, P < 0.01). Conclusions A telehome-care program that provide distance training and education of disabled persons resulted in greater improvements in physical functioning, ADL and quality of life.

Objective To investigate the status of anxiety,depression and self-efficacy, social support among patients with severe burns and analyze their correlation. Methods Eighty-four patients with severe burns were selected by convenience sampling. They were evaluated by Hospital Anxiety and Depression scale (HADS), General Self-efficacy Scale (GSES) and Social Support Assessment Scale (SSAS) and the correlation of two scales was analyzed. Results The anxiety score was 6.62 ± 3.98, depression score was 7.63 ± 4.36, self-efficacy score was 20.94 ± 4.96 and the social support score was 41.40±6.47;Self-efficacy was negatively correlated with the anxiety (r=-0.356, P<0.05) and depression (r=-0.362, P<0.05). Social support was also negatively correlated with the anxiety (r=-0.305, P<0.05) and depression (r=-0.320, P<0.05). Conclusions There is a medium level of anxiety and depression among patients with severe burns. Psychological interventions via increasing the self- efficacy are suggested for the patients with severe burns in the future.

Objective To analyze the CT and MR manifestations and the diagnosis of primary malignant melanoma in the nasal cavity and paranasal sinuses.Methods CT,MR features and clinical data of 1 6 cases of malignant melanoma in the nasal cavity and paranasal sinuses,which were confirmed by biopsy or surgical pathology and immunohistochemistry were analysed retrospectivelly. CT routine and enhanced scan were performed in all patients,MR routine and enhanced scan were performed in 9 cases.Results CT findings of 1 6 patients were unilateral,in which 8 cases were located in the nasal cavity,4 cases in the paranasal sinuses,and 4 cases were both in the nasal cavity and paranasal sinuses.All lesions were irregular shape with soft tissue densityand without calcification and cystic degeneration and demonstrated invasiveness to the surrounding tissue.Lesions were nonuniformly moderate to severe en-hancement.Among 9 patients with MR examination,lesions were mainly unilateral in which 4 cases were in the nasal cavity,3 cases in the paranasal sinuses,2 cases both in the nasal cavity and paranasal sinuses.Lesions were irregular in 9 cases,in which 1 case had typical high signal on T1 WI,low signal on T2 WI,while 3 cases equal signal on T1 WI,equal or slightly higher signal on T2 WI and 5 cases mixed signal.On MR enhanced scan,unevenly slight-medium enhancement were showed in the lesion and surrounding tissues. Conclusion Primary malignant melanoma of the nasal cavity and paranasal sinuses is lack of specificity on CT imaging.Typical ma-lignant melanoma,a type of rare to finding,has certain characteristics on MR,non-pigment type and mixed type are more common. CT combined with MRI can better show the site of the tumor,and the relation with surrounding tissues and adjacent bones.