The doctor-patient fiduciary relationship confronts multiple legal dilemmas， such as the asynchrony between patients’ trust along with the granting of their body control rights and doctors’ fulfillment of diagnostic and treatment obligations， the difficulty in exhaustively specifying the content and performance standards of doctors’ diagnostic and treatment obligations in advance， the potential diminishment of medical service value due to excessive restrictions or interference with doctors’ autonomous decision-making， and the mismatch between the costs of patients supervising doctors and the benefits obtained. These dilemmas stem from the fact that the doctor-patient relationship constitutes a special fiduciary relationship based on trust， characterized by the transfer of fiduciary object， aimed at altruism， and marked by unequal status. To resolve the legal dilemmas in the doctor-patient fiduciary relationship， a shift from the “static trust” paradigm to the “dynamic fiduciary” paradigm is necessary. Guided by the concept of the doctor-patient community， a normative system for the doctor-patient fiduciary relationship should be constructed and refined， thereby fostering a fiduciary spirit， clarifying fiduciary obligations， implementing interest balancing， safeguarding patients’ rights and interests， enhancing remedies for breaches of trust， and strengthening supervision of doctors.

Objective To explore the therapeutic effect of dual microcatheter technology on patients with intracranial wide necked aneurysms and its impact on their neurological function.Method This article adopts a prospective randomized controlled study,collect clinical data of 55 patients with intracranial wide neck aneurysms from the First People's Hospital of Suzhou City from March 2017 to March 2022.According to different treatment methods,divided treatment group 28 cases and control group 27 cases.The control group patients received stent assisted therapy,while the treatment group patients received dual microcatheter intervention therapy.Compare efficacy and complications two groups;changes in NIHSS score and ADL score before and 6 months after surgery;Postoperative prognosis at 6 months.Result The total effective rate of the treatment group was 100.00％,while the total effective rate of the control group was 96.30％;two groups of patients with intracranial wide necked aneurysms treatment efficacy no significant difference(P＞0.05).The treatment group complications in patients with intracranial wide necked aneurysms(7.14％)less control group(33.33％)(P＜0.05).The two groups NIHSS score of patients with intracranial wide necked aneurysms lower before surgery at 6 months after surgery,while the ADL score higher before surgery(P＜0.05);the treatment group NIHSS score of patients with intracranial wide necked aneurysms(8.76±0.87)score lower control group(9.82±0.96)score after 6 months of treatment,while the ADL score(57.82±5.43)score higher control group(64.52±5.16)score(P＜0.05).There was no significant difference in mRS Scores between the two groups(P＞0.05).Conclusion The dual microcatheter technology has a good therapeutic effect on IWNA patients,can reduce the occurrence of complications,improve patient neurological function.

Objective To explore the clinical efficacy and prognostic factors of YL-1 type hard channel trepanation and drainage combined with stereotactic treatment for hypertensive intracerebral hemorrhage.Methods A retrospective study was conducted on 110 patients with hypertensive intracerebral hemorrhage at the Cerebrovascular Disease Center of the First People's Hospital of Suzhou from August 2019 to October 2022.The observation group(55 cases)received YL-1 type hard channel drilling and drainage combined with stereotactic treatment,while the control group(55 cases)received simple YL-1 type hard channel drilling and drainage.The perioperative indicators,neurological damage,and prognosis of the two groups of patients were compared;Using multiple Logistic regression analysis to identify the prognostic factors affecting patients.Results The perioperative indicators,neurological damage,and prognosis of the observation group were better than those of the control group(P＜0.05);The admission NIHSS score(OR=2.504,P＜0.05),simple minimally invasive drilling and drainage(OR=1.881,P＜0.05),disease duration＞24 hours(OR=2.782,P＜0.001),and ventricular rupture(OR=2.252,P＜0.05)are risk factors for poor prognosis in patients.Conclusion The prolongation of the patient's disease course,ventricular rupture,and severe neurological damage are associated with poor prognosis.Combining stereotactic minimally invasive surgery has a positive significance for improving the prognosis of patients with cerebral hemorrhage.

ObjectiveTo explore the effect of Buzhong Yiqitang on the immune imbalance of helper T cell 17 （Th17）/regulatory T cell （Treg） and Notch1 signaling pathway in mice with autoimmune thyroiditis （AIT）. MethodA total of 60 8-week-old NOD.H-2^h4 mice were randomly divided into the normal group， model group， western medicine group （selenium yeast tablet， 32.5 mg·kg^-1）， and low-dose （4.78 g·kg^-1·d^-1）， middle-dose （9.56 g·kg^-1·d^-1）， and high-dose （19 g·kg^-1·d^-1） Buzhong Yiqitang groups， with 10 mice in each group. The normal group was fed with distilled water， and the other groups were fed with water containing 0.05% sodium iodide for eight weeks. After the animal model of AIT was formed spontaneously， the mice were killed under anesthesia after intragastric administration for eight weeks. Serum anti-thyroglobulin antibodies （TGAb）， thyroid-stimulating hormone （TSH）， free triiodothyronine （FT3）， and free thyroid hormone （FT4） were detected by enzyme-linked immunosorbent assay （ELISA）， and thyroid tissue changes were observed by hematoxylin-eosin （HE） staining. The mRNA and protein expressions of retinoid-related orphan receptor-γt （RORγt）， interleukin （IL）-17， forkhead box P3 （FoxP3）， IL-10， Notch1， and hair division-related enhancer 1 （Hes1） in thyroid tissue were detected by Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot， respectively. ResultCompared with the normal group， the thyroid structure of the model group was severely damaged， and lymphocytes were infiltrated obviously. The levels of serum TGAb， FT3， and FT4 contents were significantly increased， and TSH content was significantly decreased （P<0.01）. The mRNA and protein expression levels of RORγt， IL-17， Notch1， and Hes1 were significantly increased， while those of FoxP3 and IL10 were significantly decreased in the model group （P<0.01）. Compared with the model group， thyroid structural damage and lymphocyte infiltration were improved in the treatment groups， and serum TGAb， FT3， and FT4 contents were significantly decreased. TSH content was increased， and mRNA and protein expression levels of RORγt， IL-17， Notch1， and Hes1 were decreased. mRNA and protein expression levels of FoxP3 and IL-10 were increased to different degrees （P<0.05， P<0.01）， and the middle-dose Buzhong Yiqitang group had the most significant intervention effect. ConclusionBuzhong Yiqitang can alleviate the thyroid structural damage in AIT mice， and its mechanism may be related to improving the abnormal differentiation of Th17/Treg immune cells and inhibiting the activation of the Notch1 signaling pathway.

Objective:Extracorporeal carbon dioxide removal(ECCO 2R) is a technique that aims to decarboxylate the blood and thus to correct hypercapnia and respiratory acidosis in acute respiratory failure, but is rarely used in children.We successfully completed the ECCO 2R treatment for a pediatric case with adenovirus pneumonia, severe acute respiratory distress syndrome(ARDS) and hypercapnia in PICU, which provided clinical references for the use of ECCO 2R in acute respiratory failure for children. Methods:A patient with adenovirus pneumonia and severe ARDS was successfully treated with ECCO 2R-continuous renal replacement therapy(CRRT)combined system after weaning from extracorporeal membrane oxygenation(ECMO). We reported the treatment process, ECCO 2R treatment effect and side effects, so as to provide clinical reference for ECCO 2R treatment of children with ARDS. Results:One-year and four-month-old boy was treated with mechanical ventilation and venous-arterial ECMO due to adenovirus pneumonia and severe ARDS.After ECMO treatment for 25 days, he developed severe hypercapnia after weaning from ECMO.ECCO 2R was initiated.The pH value increased by 11.2%(from 7.222 to 7.303) 1 hour after ECCO 2R treatment, partial pressure of blood carbon dioxide(PCO 2)decreased by 29.1%(from 72.6 mmHg to 51.5 mmHg, 1 mmHg=0.133 kPa) and the average airway pressure of high-frequency ventilation decreased by 5 cmH 2O(from 20 cmH 2O to 15 cmH 2O, 1 cmH 2O=0.098 kPa) after 6 hours of ECCO 2R.The CO 2 removal rate of ECCO 2R system was 29.1 mL/min.It was stopped because of ECCO 2R-membrane clotting after 72 h. There was no increase of PCO 2.Extubation was successfully after undergoing invasive mechanical ventilation for 39 days and with noninvasive ventilation for 5 days.The boy was hospitalized in PICU for 54 days, improved and discharged from the hospital.Followed up for 2 years after discharge, the growth and development were good, but the strenuous exercise endurance was still poor. Conclusion:ECCO 2R is effective in improving gas exchange, reducing PCO 2 and lowering ventilator pressure in children with ARDS and hypercapnia, which allow more protective ventilation.ECCO 2R provide transitional treatment for ECMO weaning and provide meaningful clinical reference for the use of ECCO 2R as part of respiratory support in children with respiratory failure.

【Objective】 To study the annual financial expenditure in blood stations with different scales, and to establish the regression equation between blood collection units and total expenditure. 【Methods】 The annual total expenditure, the per capita cost of serving population, as well as the collection units of whole blood and apheresis platelet of 24 blood stations were collected. The financial expenditure required for collecting 10 000U blood was calculated.The statistical analysis was carried out with SPSS statistical software. 【Results】 From 2017 to 2020, the total annual financial expenditure of 24 blood stations showed an upward trend. The total expenditure among blood stations was different. The per capita cost of servicing population in the areas where the 24 blood stations were located had been increasing year by year. The 24 blood stations were divided into two grades according to the blood collection volume as 50 000 U, and the relationship equation between the blood collection volume and the annual total expenditure had been established. After testing, each equation was effective(P<0.05); There was no difference in the financial expenditure required for collecting 10 000U blood among blood stations with different scales. 【Conclusion】 From 2017 to 2020, the blood stations with an annual collection volume more than 50 000 U demonstrated a higher financial expenditure and the per capita cost of serving population than those <50 000 U. The blood collection volume of blood stations is significantly correlated with the annual total expenditure and the per capita cost of serving population.

Objective: To explore the association between dietary pattern which benefit for normal kidney function and the risk of cognitive decline or impairment in the elderly. Methods: In 2015, subjects aged 60 and over from four counties in the Nutrition and Chronic Disease Family Cohort project, were followed up in 2017. Cognitive function was repeatedly assessed, using the Mini Mental State Evaluation (MMSE) scale. Dietary pattern that benefit for normal kidney function was extracted, using the reduced rank regression method and followed by logistic regression models to explore the associations between scores that showing the kidney function on dietary patterns and the risk of cognitive deterioration and impairment in two years among those who were with normal cognition in 2015. Results: Dietary pattern that benefit for normal kidney function, was characterized by high consumption of cereal, vegetables, legume and fruits but with less meat and soy products. Comparing with the group with lowest score quartile on this dietary pattern, the risk of cognitive deterioration in the highest quartile group was significantly low (P<0.01) in two years, with an odds ratio as 0.57 (95%CI: 0.37-0.85). Linear trend was also obviously visible (P=0.007) in this group. The ones at the highest quartile group among the normal cognition ones in 2015, the risk of cognitive impairment also significantly reduced (P<0.05) in two years time, with an odds ratio as 0.52 (95%CI: 0.29-0.93). Also, linear trend could obviously be seen (P=0.01). Conclusion Dietary pattern that benefit for normal kidney function was both inversely associated with cognitive deterioration and impairment, in two years.

Objective: This study was to analyze the association of lipid parameters with insulin resistance of Chinese elderly population in different glycemic status. Methods: Data were from China National Chronic Diseases and Nutrition Survey (2015). A total of 15 535 participants aged 60 and above who had completed survey questionnaire, physical examination, fasting blood biochemistry and insulin measurements were included in this study. According to the American Diabetes Association (2010) criteria, the participants were divided into normal glucose regulation, pre-diabetes, newly-diagnosed diabetes and previously-diagnosed diabetes. Multivariable logistic regression was preformed to assess the effects of lipid parameters on insulin resistance in different glycemic among the elderly population. Results: The proportion of normal glucose regulation, pre-diabetes, newly-diagnosed diabetes and previously-diagnosed diabetes was 50.46% (n=7 839), 22.19% (n=3 448), 12.46% (n=1 937) and 14.88% (n=2 311), respectively. The risk of insulin resistance increased with the elevated per quartile of triglycerides (TG) (OR=1.48,95%CI: 1.35-1.62), non-high-density lipoprotein cholesterol (Non-HDL)/HDL-C (OR=1.23, 95%CI: 1.12-1.35) and TG/HDL-C (OR=1.50, 95%CI: 1.36-1.65) and decreased with the elevated per quartile of HDL-C (OR=0.83, 95%CI: 0.76-0.90) after multivariate adjustment among normal glucose regulation participants. As for pre-diabetes participants, the risk of insulin resistance increased with the elevated per quartile of TG (OR=1.26, 95%CI: 1.14-1.39) and TG/HDL-C (OR=1.38, 95%CI: 1.24-1.54) and decreased with the elevated per quartile of HDL-C (OR=0.79, 95%CI: 0.71-0.87). The risk of insulin resistance increased with the elevated per quartiles of TG/HDL-C (OR=1.29, 95%CI: 1.12-1.48) among newly-diagnosed diabetes. As for previously-diagnosed diabetes, the risk of insulin resistance increased with the elevated per quartile of TG, Non-HDL/HDL-C and TG/HDL-C with adjusted OR(95%CI) about 1.28 (1.16-1.41), 1.37(1.21-1.55) and 1.51 (1.33-1.72) repsectivley and decreased with the elevated per quartile of HDL-C (OR=0.77, 95%CI: 0.67-0.87). Conclusion The relationship between lipid parameters and insulin resistance presented diversely in different glycemic status. The elderly with normal glucose regulation and previously-diagnosed diabetes should pay close attention to the change of TG/HDL-C, TG, HDL-C and Non-HDL/HDL-C. As for prediabetes participants, the TG/HDL-C, TG and HDL-C level change should be focused.

Objective To explore the relationship between temperature and change of serum electrolytes (potassium, natrium, chlorine,and calcium) in patients with spinal cord injury. Methods 321 patients with spinal cord injury (SCI) following fever were regarded as observation group, while 313 SCI patients in normal temperature as control group. The level of serum electrolytes (potassium, natrium, chlorine, and calcium) in both groups was analyzed. Results There was no significant difference in the level of serum potassium (P>0.05), but was in the serum natrium, chlorine, and calcium (P<0.05) between 2 groups. The level of serum potassium didn't correlated with their temperature, and the level of serum natrium, chlorine, and calcium correlated with the temperature negatively. Conclusion The level of serum natrium, chlorine, and calcium may decrease in SCI patients following fever while the level of serum natrium is unchanged.