Firstly the paper expounds the fact that letting patients pick their doctors goes with the tide of social development: ①the connotation of medical quality determines the necessity of patients involvement; ②evaluation of medical quality has extended from self appraisal to social assessment; and ③the mechanism of letting patients pick their doctors conforms to the medical quality requirements of the times. Then the paper discusses the positive impact of letting patients pick their doctors on medical quality, including the choice of doctors by outpatients and the impossibility of doing so in medico technical and emergency departments or by inpatients. The paper also gives an account of the measures taken for safeguarding medical quality when adopting the practice of letting patients pick their doctors. Lastly the paper explains the boosting role of the practice and the difference between letting patients pick their doctors and letting them name particular surgeons for their operations.

Objective To investigate the changes of gastrin(GAS) and somatostatin(SS) in diabetic gastroparesis (DGP). Methods Totally 103 patients were divided into normal control group (n =17),simple gastroparesis(GP) group (n =30),simple diabetes mellitus(DM) group (n =23) and diabetes mellitus complicated with gastroparesis (DGP) group (n =33). Radioimmunity and RT-PCR were performed to detect the serum GAS and SS levels and the mRNA expression in the gastric mucosa tissue of 4 groups. Results There were significant differences in the serum levels and protein expression of GAS and SS between simple gastroparesis group,simple diabetes mellitus group, DGP group and the normal control group(P< 0.05). The differences between DGP group and normal control group was the most significant (P< 0.01), the differences between DGP group and the simple gastroparesis group or simple diabetes mellitus group were significant (P< 0.05). Contusion The increase of GAS and decrease of SS may play an important role in the occurrence and development of DGP.

OBJECTIVETo determine the exact location of the opening of the ejaculatory duct in men and provide some basic anatomical evidence for seminal vesiculoscopy and the treatment of ejaculatory duct obstruction.

METHODSWe performed ureterocystoscopy for 21 male patients aged 26 - 47 years with hematuria (n = 12), hematospermia (n = 2), glandular cystitis (n = 6), and anejaculation after radical resection of rectal carcinoma (n = 1), and meanwhile, with the consent of the patients, massaged the prostate and ejaculatory duct and observed the outlet of the expelled fluid. Under the microscope, we described the fluid samples with sperm as the expulsion from the ejaculatory duct.

RESULTSUreterocystoscopy showed that the exact anatomical sites of the expulsion of prostatic fluid and semen in the patients were the side and lower side of the prostatic utricle opening above the verumontanum and the ventral side of the verumontanum. Quantities of sperm were found in the expulsion fluid of 13 of the patients, and no expulsion, including semen, was seen from the prostatic utricle opening.

CONCLUSIONAnatomically, the ejaculatory duct openings of males are located at the two sides of the verumontanum adjacent to the opening of the prostatic utricle, rather than in the prostatic utricle above the verumontanum.

Adult ; Cystoscopes ; Ejaculation ; physiology ; Ejaculatory Ducts ; anatomy & histology ; physiology ; Endoscopy ; instrumentation ; methods ; Hematuria ; Hemospermia ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Prostate ; anatomy & histology ; physiology ; Rectal Neoplasms ; surgery ; Semen ; secretion ; Spermatozoa

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.

OBJECTIVETo develop a new method for REZ-1 cochlear implant electrode array insertion.

METHODSREZ-1 cochlear implant electrode array was implanted in 22 human temporal bone specimens. Cochlear diameters were measured from spiral CT scan before implantation. Cochlear views were taken before and after pullback technique. Modiolus-electrode distances were measured and compared. The diameters of sixty normal cochleae were measured.

RESULTSIn 3 cases, 27 electrode rings were inserted into the cochlea, while in others, all 28 electrode rings were inserted into the cochlea. After pullback of the electrode array, No. 12 to No. 19 electrode rings were closer to the modiolus in 17 cases (paired t test, P<0.01). The cochlear diameters in the 17 cases were smaller than 9.50 mm, while in the other 5 cases, the cochlear diameters were at least 9.60 mm. The cochlear diameters in the 17 cases were 9.11 (0.57) mm, while the cochlear diameters in the 5 cases were 9.78 (0.28) mm (Mann-Whitney test, P<0.001). The diameters of normal cochleae were (9.04 +/- 0.45) mm, with 90% larger than 9.50 mm.

CONCLUSIONSIn cases whose cochlear diameter is smaller than 9.50 mm, pullback technique can help some electrode rings be closer to the modiolus. Measurement of the cochlear diameter can help the surgeon to have a better choice in the selection of REZ-1 cochlear implantation methods.

Cochlea ; diagnostic imaging ; Cochlear Implantation ; methods ; Cochlear Implants ; Electrodes, Implanted ; Equipment Design ; Humans ; Radiography

DNA, Viral ; blood ; Hepatitis B virus ; genetics ; Hepatitis B, Chronic ; virology ; Humans ; Nucleic Acid Conformation ; RNA, Viral ; genetics ; Viral Envelope Proteins ; genetics

OBJECTIVE Liver cancer is one of the most common causes of cancer related deaths worldwide, specially, in China. Hinesol, extracted from Atractylodeslance a(Thunb.) DC. has been proved that has anti-cancer effect in leukemia in vitro and in vivo.However,it has been not well under-stood in liver cancer cells.METHODS Cell proliferation,apoptosis,cell cycle and invasion were performed to investigate the anti-liver cancer effect of hinesol in SMMC-7721 and LM3 by MTT assay,flow cytometry and scratch assay.Western blot was used to research the potential mechanism.RESULTS We revealed that hinesol suppresses cell proliferation and invasion,prompts population of G1 phase,induces apop-tosis in dose-dependent manner in SMMC-7721 and LM3 cells.Western blot data showed that hinesol could inhibits the expression of cyclin-D1, Bcl-2 and Bax, and inhibited phosphorylation of MEK and ERK, down-regulated the expressions of NF-κB p65 and phosphor-p65 in nucleus. The results indicated that hinesol reduces cell proliferation via arresting cell cycle at G1 phase and induces apoptosis.Further-more,western blot showed that hinesol inhibited phosphorylation of MEK and ERK,down-regulated the expressions of NF-κB p65 and phosphor-p65 in nucleus.CONCLUSION Our results demonstrate that hinesolreduces cell proliferation via arresting cell cycle at G1 phase and induces apoptosis, it has potent anti-cancer effect against liver cancer cells via down-regulation of MEK/ERK and NF-κB pathway,and indicate that hinesol is a potential liver cancer drug for further research.

Objective: : To explore the clinical efficacy and safety of microvascular decompression (MVD) combined with internal neurolysis (IN) in the treatment of recurrent trigeminal neuralgia (TN) after MVD. Methods: : Sixty-four patients with recurrent TN admitted to the hospital from January 2014 to December 2017 were divided into two groups according to the surgical method. Twenty-nine patients, admitted from January 2014 to December 2015, were treated with MVD alone, whereas 35 admitted from January 2016 to December 2017 were treated with MVD+IN. The postoperative efficacy, complications, and pain recurrence rate of the two groups were analyzed. Results: : The efficacy of the MVD+IN and MVD groups were 88.6% and 86.2%, and the cure rates were 77.1% and 65.5% respectively. There was no statistically significant difference between the two groups (p>0.05). The cure rate (83.3%) of patients in the MVD+IN group, who were only found thickened arachnoid adhesions during the operation that could not be fully released, was significantly higher than that of the MVD group (30.0%) (p<0.05), while the efficacy (91.7% vs. 70%) of the two groups was not statistically different (p>0.05). For patients whose arachnoid adhesions were completely released, there had no significant difference (p>0.05) in the efficacy (87% vs. 94.7%) and recurrence rate (5.0% vs. 11.1%). The incidence of postoperative facial numbness (88.6%) in the MVD+IN group was higher than that in the MVD group (10.3%) (p<0.01). The long-term incidence of facial numbness was not statistically significant (p>0.05). In the 18–36 months follow-up, the recurrence rate of patients in the MVD+IN group (9.7%) and in the MVD group (16%) were not statistically different (p>0.05). Conclusion : A retrospective comparison of patients with recurrent TN showed that both MVD and MVD combined with IN can effectively treat recurrent TN. Compared with MVD alone, MVD combined with IN can effectively improve the pain cure rate of patients with recurrent TN who have only severe arachnoid adhesions. The combination does not increase the incidence of long-term facial numbness and other complications.

OBJECTIVETo summarize the experience in the treatment of erectile dysfunction (ED) with no successful intercourse at the baseline with tadalafil.

METHODSWe retrospectively analyzed 21 cases of ED with no successful intercourse at the baseline treated with tadalafil on alternate days combined with sex guidance.

RESULTSAfter 4 weeks of tadalafil treatment, 19 of the patients achieved successful sexual intercourse, and the IIEF-5 score was remarkably improved as compared with pre-medication (3.24 +/- 1.55 vs 18.95 +/- 3.02, P<0.0001). Mild adverse reactions were observed in 6 cases, including 2 cases of mild headache and 4 cases of facial blush.

CONCLUSIONTadalafil on alternate days combined with sex guidance can significantly improve ED with no successful intercourse at the baseline.

Adult ; Carbolines ; administration & dosage ; therapeutic use ; Coitus ; Erectile Dysfunction ; drug therapy ; physiopathology ; Humans ; Male ; Retrospective Studies ; Tadalafil ; Treatment Outcome ; Young Adult

BACKGROUNDStroke is the most common neurological disease in China, and antiplatelet treatment is important for primary and secondary prevention. This study aimed to describe the current status of antiplatelet treatment before, immediately after, and 1 month after ischemic stroke in the Qingdao area of China, and to determine the factors and potential barriers influencing use.

METHODSA total of 1114 patients with acute ischemic stroke were enrolled from 11 hospitals in the Qingdao area. Patient demographic data, clinical data, and treatment before and after the stroke were recorded. Univariate analysis (two sample t-test or Mann-Whitney U test, and chi-square test) and multivariate Logistic regression analysis were used to determine the frequency of antiplatelet treatment, and factors associated with treatment, at three time points: before the stroke, in hospital after the stroke, and at 1-month follow-up.

RESULTSThe frequency of antiplatelet treatment was 6.4% before the stroke, 91.5% in hospital, and 77.2% at 1 month. Aspirin pretreatment was independently associated with higher education level, higher income level, history of hyperlipidemia, and history of cerebral vascular disease. Antiplatelet treatment in hospital was independently associated with treatment in an urban hospital, National Institutes of Health Stroke Scale at onset, and statin use in hospital. Antiplatelet treatment at 1-month follow-up was independently associated with higher income level, diagnosis of transient ischemic attack, antiplatelet treatment in hospital, large artery atherosclerosis according to the Trial of Org 10172 in Acute Stroke Treatment classification, and statin use at follow-up. Modified Rankin Scale ≥ 4 at 1-month follow-up and history of coronary heart disease were negatively associated with antiplatelet treatment at follow-up.

CONCLUSIONSThis study documents the current status of antiplatelet treatment in primary and early secondary prevention of ischemic stroke in China. Further education of clinicians and the public about stroke prevention is important.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Platelet Aggregation Inhibitors ; therapeutic use ; Prospective Studies ; Stroke ; drug therapy ; Young Adult