To explore the effect of doctor-patient relationship perception on work performance among medical staff in public hospitals and its mechanism. The convenient sampling method was used to select 380 medical staff working in four public tertiary hospitals in Sichuan Province, Zhejiang Province, and Fujian Province from August 2022 to October 2022 as the research objects, and the General Information Questionnaire, Doctor-Patient Relationship Scale, General Self-Efficacy Scale, Perceived Organizational Support Scale, Work Performance Questionnaire were used. This paper showed that the doctor-patient relationship perception of medical staff was negatively correlated with self-efficacy (r=-0.392, P<0.01) and work performance (r=-0.286, P<0.01), self-efficacy was positively correlated with perceived organizational support (r=0.538, P<0.01) and work performance (r=0.507, P<0.01), perceived organizational support was positively correlated with work performance (r=0.510, P<0.01). Self-efficacy played a partial mediating role between doctor-patient relationship perception and work performance, and its effect value was -0.241, accounting for 64.78% of the total effect. Perceived organizational support weakened the negative predictive effect of doctor-patient relationship perception on self-efficacy, which moderates the first half path of the mediating model that doctor-patient relationship perception affects work performance through self-efficacy. It indicated that the doctor-patient relationship perceived by medical staff in public hospitals is poor. Measures should be taken from the aspects of policy support, hospital and society levels to alleviate the doctor-patient relationship, play the mediating role of self-efficacy and the moderating role of organizational support, minimize the negative impact of doctor-patient relationship on the work performance among medical staff, and improve the work performance of medical staff, so as to improve the overall quality of medical services.

Type 1 diabetes mellitus(T1DM)is a disease that seriously harms children′s health.It often occurs in childhood and is a major public health problem all over the world.T1DM can cause damage to multiple systems including nervous, circulatory, urinary systems, etc.The etiology, prevention and treatment of T1DM have become a research hotspot.With the deepening of researches, the influence of T1DM on cognitive function in children has attracted increasing attention.T1DM can damage the brain structure, neurological development and cognitive function of children, influencing intelligence, attention, memory, executive function, etc.This paper reviews the recent researches between T1DM and cognitive function of children, so as to improve the awareness of pediatricians.

Objective To investigate the diagnostic value of enzyme-linked immunosorbent assay combined with bronchoalveolar lavage fluid tuberculosis Xpert detection in smear negative pulmonary tuberculosis. Methods From August 2015 to August 2016 ,68 cases of smear negative pulmonary tuberculosis ,admitted in the hospital ,were enrolled in the study.Enzyme-linked immunosorbent assay and bronchoalveolar lavage fluid tuberculosis Xpert detection were used in the study.The results of enzyme-linked immunosorbent assay and tuberculosi sXpert detection were compared with sputum culture results ,and their diagnostic values for smear negative pulmonary tuberculosis were analyzed.Results The clinical manifestations of pulmonary tuberculosis were mainly nocturnal sweating ,fever ,cough and expectoration.The results of X-ray and CT examinations showed that the lesions were mostly patchy or in cloudy opacity.The diagnostic accuracy of the combined ex-amination for different types of pulmonary tuberculosis was significantly higher than single detection of en-zyme-linked immunosorbent assay or tuberculosis Xpert detection ,and the difference was statistically signifi-cant (P＜ 0.05).The sensitivity of enzyme-linked immunosorbent assay was 88.46%,the specificity was 69.05%,and the accuracy was 76.47%;the sensitivity of tuberculosis Xpert detection was 80.77%,the speci-ficity was 52.38%,and the accuracy was 63.23%;the sensitivity of the combined detection was 92.30%,the specificity was 78.57%,and the accuracy was 83.82%;the sensitivity ,the specificity and the accuracy of the combined detection for diagnosis of smear negative pulmonary tuberculosis were significantly increased ,and the difference was statistically significant (P＜0.05).Conclusion The enzyme-linked immunosorbent assay combined with bronchoalveolar lavage fluid tuberculosis Xpert detection has important value in the diagnosis of smear negative pulmonary tuberculosis.It is a simple ,rapid and effective method of examination.

Objective To explore the effects of miRNA-204 targeted LC3B expression on Ang Ⅱ induced cardiomyocytes hypertrophy.Methods The primary neonatal rat cardiomyocytes served as the research objects and divided into the control group,AngⅡ group,combination-treated group 1 (cardiomyocytes were given Ang Ⅱ stimulation,meanwhile infected by negative control lentivirus vector),combination-treated group 2 (cardiomyocytes were given Ang Ⅱ stimulation,meanwhile infected by lentivirus carrying miRNA-204 overexpression vector) according to different treatments.About 48 h to 72 h after intervention treatment,the cardiomyocyte hypertrophy change was detected by confocal microscopy,the expression of miRNA-204 was analyzed by real time PCR,the protein expression of LC3B was measured by Western blot and targeted gene of miRNA-204 was demonstrated by dual-luciferase reporter assay system.Results Compared with the control group,the cardiomyocyte relative surface area in the Ang Ⅱ group was significantly enlarged,the protein expression of LC3B was significantly increased,the expression of miRNA-204 was upregulated,the differences were statistically significant (P＜0.05).Whereas comparing the combination-treated group 1 with combination-treated group 2,the protein expression of LC3B in the latter was down-regulated and the cell area was reduced (P＜0.05).The further luciferase activity report gene experiment results suggested that miRNA-204 was able to bind to LC3B 3'-UTR and decreased the luciferase activities (P＜0.05),but not to bind its mutated fragment for inactivating luciferase activity(P＞0.05).Conclusion miRNA-204 is able to inhibit Ang Ⅱ induced cardiomyocytes hypertrophy,its action is realized by targeting the expression of LC3B.

Objective To explore the effect and mechanism of renal denervation combined with Losartan on cardiac hypertrophy in spontaneous hypertensive rats. Methods Spontaneous hypertensive rats with cardiac hypertrophy underwent renal denervation combined with following 4 weeks drug treatments. Transthoracic two-dimensional guided M-mode echocardiography was performed. The expression of hypertrophy-related gene was detected. Left ventricularmass index was calculated and histological sectionsstained with hematoxylin and eosin (HE). Results The characteristics of cardiac hypertrophy was observed in left ventricular tissues with HE staining in12 weeks old spontaneous hypertensive rats.The thickness was increased in those ventricular (IVSs, IVSd, LVPWs and LVPWd). After4 weeks after treatment, histological improvements were observed in both RDN and R+L groups compared with sham group. The improvement was more obvious in R+L group. Similar results were observed in histological sections, ventricular thicknesses (IVSs, IVSd, LVPWs and LVPWd), related-hypertrophy genes (ANP and β-MHC) expression, left ventricular mass idex (LVMI) and the protein expression of inflammatory cytokines (TNF-α and IL-6). Conculsion Renal denervation therapy can improve hypertensive-induced cardiac hypertrophy in spontaneous hypertensive rats. The effect was more significant when combined with Losartan. The mechanism might be involved in inhibiting inflammatory cytokines.

Objective To explore the effects of miR-34a and the alteration of AMPK/mTOR signal pathway on angiotensin (Ang)Ⅱ-stimulated cardiomyocytes hypertrophy. Methods Neonatal rat cardiomyocytes were cultrued in vitro and were divided into 3 groups:negative control for lentivirus carrying miR-34a group (NC), AngⅡplus lentivirus carrying negative control group (AngⅡ+NC) and AngⅡplus lentivirus carrying miR-34a group (AngⅡ+miR-34a). The relative cell area was detected by confocal microscopy. The expression of miR-34a and hypertrophy-related genes (ANP and β-MHC) were analyzed by real time PCR. The AMPK/mTOR signal pathway was measured by Western blot assay. Results Compared to NC group, the relative cell area was increased in AngⅡ+NC group (P<0.05). But compared with AngⅡ+NC group, the relative cell area was decreased in AngII+miR-34a group (P<0.05). Moreover, compared with NC group, the expression of miR-34a was decreased, and the expression of hyperthophy-related genes(ANP and β-MHC) was up-regulated in AngⅡ+NC group. However, the expression of miR-34a was decreased, and the expression of hyperthophy-related genes (ANP and β-MHC) was down-regulated (P<0.05). Finally, compared to NC group, the ratio of phosphop-AMPK/AMPK was significantly induced in AngII + NC group, but the ratio of phosphop-mTOR/mTOR was significantly decreased (P<0.05). However, compared to AngⅡ+NC group, the ratio of phosphop-AMPK/AMPK was significantly decreased in AngII + miR-34a group, but the ratio of phosphop-mTOR/mTOR was significantly increased (P<0.05). Conclusion miR-34a is able to inhibit myocardial hypertrophy of neonatal rat cardiomyocytes, and its mechanism is partly carried out by the alteration of the signal pathway of AMPK/mTOR.

Objective To explore the effect of chitosan on vascular smooth muscle cells inhibited proliferation from rabbit arteriovenous fistula and its mechanisms.Methods Established rabbit fistula model on carotid arteryinternal jugular vein.After 1 month cultured VSMCs with primary culture by tissue-pieces inoculation.Cultured VSMCs were divided into three groups:①normal control group.②FBS-treated group:cell were treated with 5％,10％,20％ for 48 h,respectively; established the model of rabbit VSMCs proliferation.③chitosan-treated group:VSMCs cultured with 20％ FBS were exposed to different doses of chitosan(10,100,500,1000,2000μg/ml) for 48 h.And VSMCs were treated for different time (0,12,24,48 h) with Chitosan 1000 μg/ml.Expression levels of PCNA and TLR4/ NF-κB were detected by Western blotting.RT-PCR were applied to measure the mRNA expression of PCNA and TLR4.The protein levels of TLR4 and NF-κB were detected by immunofluorescence.Results Compared with low concentration serum group,FBS-treated VSMCs exhibited a increase in mRNA and protein expression of PCNA and TLR4.FBS-induced protein expression of PCNA and TLR4/NF-κB were reduced by chitosan.Also mRNA expression of PCNA and TLR4 were reduced.They were dependent on concentration and time.In rabbit VSMCs TLR4 was mainly expressed in the cytoplasm and NF-κB expressed mainly in the nucleus.Compared with normal control group,TLR4 and NF-κB protein expression were significantly decreased by chitosan.Conclusion High concentration serum induced VSMCs proliferation.Chitosan can inhibit the proliferation of rabbit VSMCs.It is speculated that the mechanism may be related to the expression of TLR4 receptor activation,reducing expression of downstream factor MyD88 and NF-κB.It is suggest that chitosan can become potential new drugs of arteriovenous fistula prevention of intimal hyperplasia.