Return to the Essence of Doctor-patient Relationship / 中国医学伦理学

Doctor-patient relationship plays a crucial role in regulating medical behavior and medical ethics. The essence of doctor-patient relationship is the true practice of life created by mutual kindness and harmony, which expressed by love, sympathy, comfort and cooperation. From the perspective of economy, ethics, law, science and technology, this paper deeply analyzed the reasons and consequences of doctor-patient relationship’s deviation from the essence, and believed that effectively strengthening communication, actively enhancing empathy, and sincerely providing care are conducive to returning to the essence of the doctor-patient relationship and easing the tense situation of the doctor-patient relationship.

Epidemiological characteristics of 17 imported patients infected with SARS-CoV-2 Omicron variant / 中南大学学报(医学版)

OBJECTIVES@#With the continuous generation of new variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pressure of epidemic prevention and control continues to increase in China. Omicron with stronger infectiousness, immune escape ability and repeated infection ability spread to many countries and regions around the world in a short period of time. China has also successively reported cases of imported Omicron infections. This study aims to understand the epidemiological characteristics of Omicron variant via analyzing the epidemiological characteristics of imported patients with Omicron in Hunan Province, and to provide reference for preventing and controlling the imported epidemics.@*METHODS@#The clinical data of imported patients with coronavirus disease 2019 admitted to Hunan Province from December 16 to December 31, 2021 were retrospectively collected. The epidemiological information, general information, clinical classification, clinical symptoms, vaccination status, and lung CT were analyzed. Nasopharyngeal swabs and blood samples were collected. Virus nucleic acid was detected by magnetic beads method using SARS-CoV-2 detection kit. Ct values of ORF1ab gene and N gene were compared between asymptomatic infected patients and confirmed patients. The specific IgM and IgG antibodies were detected by chemiluminescence assay using SARS-CoV-2 IgM test kit and SARS-CoV-2 IgG test kit, respectively. Ct values of IgM and IgG antibodies were compared between asymptomatic infected patients and confirmed patients.@*RESULTS@#Seventeen patients with Omicron variant infection were treated in Hunan, including 15 confirmed patients (5 common type and 10 mild type) and 2 asymptomatic infection patients. The 17 patients were all Chinese, they were generally young, and 16 were male. There were 9 patients with diseases. Of them 3 patients had respiratory diseases. All 17 patients had completed the whole process of vaccination, but only one person received a booster shot of SARS-CoV-2 vaccine. The clinical manifestations of the patients were mild, mainly including dry/painful/itchy throat, cough, and fatigue. The total protein and creatine in the asymptomatic infection and confirmed cases infected with Omicron variant were all within the normal range, but other biochemical indicators were abnormal. There were the significant differences in C-reactive protein and fibrinogen between asymptomatic infection and confirmed patients (both P<0.05). There were more patients with elevated C-reactive protein in confirmed patients than without confirmed ones. The detection rate of specific IgM and IgG antibodies on admission was 100%, and there was no significant difference in the specific antibody levels between asymptomatic infection and confirmed patients (P>0.05). There were no significant differences in Ct values of ORF1ab gene and N gene (21.35 and 18.39 vs 19.22 and 15.67) between the asymptomatic infection and the confirmed patients (both P>0.05). Only 3 patients had abnormal lung CT, showing a small amount of patchy and cord-like shadows. One of them had no abnormality on admission but had pulmonary lesions and migratory phenomenon after admission.@*CONCLUSIONS@#The patients with Omicron variant tend to be young people and have milder clinical symptoms, but the viral load is high and the infectiveness is strong. Therefore, the timely identification and effective isolation and control for asymptomatic infections and confirmed patients with mild symptoms are extremely important. In terms of epidemic prevention and control, the government still needs to strengthen the risk control of overseas input, adhere to normalized epidemic prevention and control measures, to effectively control the source of infection, cut off the route of transmission, and protect vulnerable people.

Clinical characteristics of Graves / 中南大学学报(医学版)

OBJECTIVES@#A variety of causes can lead to cholestasis, however, cholestasis caused by Graves' disease is usually overlooked clinically. Here we analyze the clinical characteristics of Graves' disease associated cholestasis so as to have a better understanding for the disease.@*METHODS@#We retrospectively collected 13 inpatients' data who suffered from the Graves' disease associated cholestasis in the Department of Infectious Disease of Xiangya Hospital from January 2000 to December 2018. The characteristics of the patients' age, gender, liver function, thyroid function, coagulation function, the special cardiac examination, treatment, and follow-up data were analyzed.@*RESULTS@#Thirteen patients, including 10 males and 3 females with the age range from 33 to 55 (median 43) years old presented cholestasis, pruritus, and hypermetabolic symptoms. The levels of total bilirubin (TBIL), direct bilirubin (DBIL), glutamic-pyruvic transferase, glutamic-oxaloacetic transferase, alkaline phosphosphatase, and gamma glutamyl transpeptidase were 170.4-976.7 (median 388.8) µmol/L, 93.2-418.1 (median 199.2) µmol/L, 25.1-182.1 (median 106.4) U/L, 38.2-265.7 (median 59.7) U/L, 105.3-332.0 (median 184.5) U/L, and 20.7-345.1 (median 47.6) U/L, respectively. The levels of free triiodothyronine (FT@*CONCLUSIONS@#Graves' disease can cause cholestasis, with the low incidence. The symptoms of cholestasis can be improved or even eradicated with the cure of the Graves' disease. The cholestasis may be idiopathic. For patients with cholestasis and hyperthyroidism, Graves' disease should be considered for differential diagnosis.

Predictive role of clinical features in patients with coronavirus disease 2019 for severe disease / 中南大学学报(医学版)

OBJECTIVES@#Since the outbreak of coronavirus disease 2019 (COVID-19), it has spread rapidly in China and many other countries. The rapid increase in the number of cases has caused widespread panic among people and has become the main public health problem in the world. Severe patients often have difficult breathing and/or hypoxemia after 1 week of onset. A few critically ill patients may not only rapidly develop into acute respiratory distress syndrome, but also may cause coagulopathy, as well as multiple organs failure (such as heart, liver and kidney) or even death. This article is to analyze the predictive role of clinical features in patients with COVID-19 for severe disease, so as to help doctor monitor the severity-related features, restrain the disease progress, and provide a reference for improvement of medical treatment.@*METHODS@#The clinical data of 208 patients with COVID-19 who were isolated and treated in Changsha Public Health Treatment Center from January 17, 2020 to March 14, 2020 were collected. All patients were the mild and ordinary adult patients on admission, including 105 males and 103 females from 19 to 84 (median age 44) years old. According to the "Program for the diagnosis and treatment of novel coronavirus (COVID-19) infected pneumonia (Trial version 7)" issued by the General Office of National Health Committee and Office of State Administration of Traditional Chinese Medicine as the diagnostic and typing criteria. According to progression from mild to severe disease during hospitalization, the patients were divided into a mild group (=183) and a severe transformation group (=25). The clinical features such as age, underlying disease, blood routine, coagulation function, blood biochemistry, oxygenation index, and so on were analyzed. Among them, laboratory tests included white blood cell (WBC), lymphocytes (LYM), neutrophil (NEU), hemoglobin (Hb), platelet (PLT), prothrombin time (PT), plasma fibrinogen (Fib), activated partial prothrombin time (APTT), thrombin time (TT), -dimer, total bilirubin (TBIL), albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), serum creatinine (Cr), creatine kinase (CK), creatine kinase isoenzyme-MB (CK-MB), lactate dehydrogenase (LDH), C-reactive protein (CRP), and oxygen partial pressure in arterial blood. Partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen (PaO/FiO) was calculated. The variables with statistical significance were analyzed by logistic regression analysis.@*RESULTS@#Patients in the severe transformation group had more combined underlying diseases than those in the mild group (<0.05). From the perspective of disease distribution, patients in the severe transformation group had more combined hypertension (<0.05). In the severe transformation group, PT was significantly longer, the levels of Fib, ALT, AST, CK, LDH, and CRP were significantly higher than those in the mild group (<0.05 or <0.001), while LYM, ALB, and PaO/FiO were significantly lower than those in the mild group (<0.05 or <0.001). Logistic regression analysis was performed on clinical features with statistically significant differences. Combined with hypertension, LYM, PT, Fib, ALB, ALT, AST, CK, LDH, and CRP as independent variables, and having severe disease or not was the dependent variable. The results show that combined hypertension, decreased LYM, longer PT, and increased CK level were independent risk factors that affected the severity of COVID-19 (<0.05).@*CONCLUSIONS@#The patients with mild COVID-19 who are apt to develop severe diseases may be related to combined hypertension, decreased LYM, and longer PT, and increased CK level. For the mild patients with these clinical features, early intervention may effectively prevent the progression to severe diseases.

Discussion on repair and maintenance management mode of hospital medical equipment under new situation / 医疗卫生装备

Objective To establish a set of feasible and complete repair and maintenance management mode in the medical equipment department of the hospital.Methods A team like the third-party outsourcing service company was established by improving talent echelon and management mode in the department and drawing lessons form the company, which could undertake the business from medium-or small-scale hospital or community health center when it became mature.Results The improved management mode in the medical engineering department enhanced department cohesiveness, academic impact and hospital director′s emphasis. Conclusion A set of repair and maintenance management mode is of great significance for the development of medical engineering department in the hospital.

Expression of nitric oxide and γ -aminobutyric acid in the retina of two kinds of amblyopia cats / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To study the role of nitric oxide ( NO ) and γ-aminobutyric acid ( GABA) in the formation of amblyopia by establishing 2 different types of amblyopic models.METHODS:A total of 18 aged 3-week kittens were randomly divided into monocular deprivation, strabismus and normal groups. All types of amblyopia were developed in the experimental eyes that were detected by P-VEP 12wk later. The cats were killed and the immunocytochemistry staining method were applied to observe under the light microscope the changes of distribution and positive cells areas of NO and GABA across the amblyopic retinal, compared to that from the normal cats of identical age. RESULTS: The P-VEP showed that the amplitude of wave P1 was lower (P CONCLUSION:The NO and GABA play an important role in the formation of amblyopia in the level of retinal.

Clinical observation on epidemic hemorrhagic conjunctivitis by optical coherence tomography / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe thickness and morphological changes of bulbar conjunctiva pre- and post epidemic hemorrhagic conjunctivitis ( EHC ) therapy by optical coherence tomography ( OCT) . METHODS: Observed morphological changes and measured the bulbar conjunctiva thicknesses of 29 cases (36 eyes) of incipient (1-2d) EHC patients, who were received and treated by department of ophthalmology, the Putuo Affiliated Hospital of Shanghai University of Traditional Chinese Medicine from May 2013 to December 2013, by OCT. Then measured the thickness again on 7, 14d after the therapy. RESULTS: Among 29 patients (36 eyes), 7d after the EHC therapy, in 27 cured eyes, the full-thickness ( before 344. 00±59. 91μm, after 230. 19±22. 16μm, t=11. 75, PCONCLUSION: The OCT is able to measure the thickness of bulbar conjunctiva in EHC patients. An significant increase was found in full, epithelial and stromal thickness of EHC patients' bulbar conjunctiva. With recovery from the disease, subepithelial fluid, interlaminar fluid and edema of the bulbar conjunctival stroma faded away firstly, which provide references for clinical therapies of the EHC.

Association of adiponectin gene polymorphism with obesity in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the distribution characteristics of adiponectin gene +45 single nucleotide polymorphisms (SNP) in Chinese children, and to determine the role of adiponectin gene +45 polymorphisms in the pathogenesis of childhood obesity.</p><p><b>METHODS</b>A total of 147 Chinese obese and 118 healthy children were randomly selected and enrolled to identify adiponectin gene SNP+45 polymorphism by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay. Plasma adiponectin levels were determined using ELISA. Waist circumference (WC), waist to hip ratio (WHR), percentage of body fat (%BF), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), serum triglycerides (TG), total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), plasma fasting insulin (FINS), and homeostasis model assessment of insulin resistance (HOMA-IR) were measured.</p><p><b>RESULTS</b>The allelic frequency of adiponectin gene SNP+45 in children with obesity and healthy controls were 40.5% and 25.4%, respectively. There were significant differences in the distribution of genotypes and the allelic frequency between the two groups (P<0.05). The plasma adiponectin levels were significantly higher, in contrast, %BF, HOMA-IR, TC and LDL-C levels were significantly lower in obese children with TT genotype than those in obese children with TG or GG genotype.</p><p><b>CONCLUSIONS</b>The adiponectin gene SNP+45 polymorphism may be associated with pathogenesis of obesity in children. T→G variance may be associated an increased risk of childhood obesity and result in a decreased level of adiponectin.</p>

Association of PTP1B gene polymorphism with obesity in Chinese children / 中南大学学报(医学版)

Objective To investigate the distribution characteristics of protein tyrosine phosphatase 1B (PTP1B) gene IVS6+G82A and Pro303Pro polymorphisms in Chinese children and determine the effect of PTP1B gene IVS6+G82A and Pro303Pro polymorphisms on the pathogenesis of childhood obesity. Methods A total of 147 Chinese obese and 118 healthy children were randomly selected and enrolled to identify IVS6+G82A and Pro303Pro genotypes by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) assay. Waist circumference (WC), waist to hip ratio (WHR), percentage of body fat (%BF),systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), serum triglycerides (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), plasma fasting insulin (FINS), homeostasis model assessment for insulin resistance (HOMA-IR), and plasma leptin were examined. Results The allele frequencies of IVS6+G82A and Pro303Pro were 59.5% and 19.4% in obese children, and 53.4% and 11.0% in healthy children, respectively. There were significant differences in allele frequencies of Pro303Pro polymorphism between the obese and the control group. Pro303Pro polymorphism was associated with body mass index, WC, TG, and LDL C in the obese subjects. There was not di fference in the genotype distributions or allele frequencies of IVS6+G82A polymorphism between the obese and the control group. Further analysis showed no association between the genotypes of IVS6+G82A and clinical characteristics in the obese subjects. The linkage disequilibrium analysis for IVS6+G82A and Pro303Pro (D′: 0.441, r2: 0.027) was weak.Conclusion PTP1B gene Pro303Pro polymorphism might be associated with the pathogenesis of obesity in children and could affect the lipid metabolism in Chinese obese children.

Genotype identifications of ESBLs and AmpC β-Iactamase of a Enterococcus gallinarum isolated from chloebia gouidiae / 中国兽医学报

The genotypes of extended spectrum β-laetamases(ESBLs) and AmpC β-lactamases produced by Enterococcus gallinarum isolated from chloebia gouldiae were determined to elucidate the evolution mechanism of the resistant genes.The minimum inhibitory concentrations (MICs) of 18 antibacterial drugs against the Enterococcus gallinarum were detected with two dilution method,and the ESBLs and AmpC β-lactamases from the bacterium were amplified by PCR using the primers of TEM,SHV,CTX-M,ACC,CIT,DHA,EBC,FOX and MOX,respectively.The PCR products were cloned and then the cloned fragments were sequenced to identify their genotypes and subtypes.The bacterium was proved to be a ESBL-producing and AmpC β-lactamase-producing bacterium,showing severe resistant to the other drugs,except the third and forth cephalosporins,carbopenems and fosfomycin.Compared with that of AJ847364 (TEM-116),the sequence of the TEM-type was characterized by two nucleotide mutations (512T→A and 695A→C),which led to two mutations of amino acids(17111e→Lys and 232Lys→Thr),showing that the detected TEM-type was a new genotype,the sequence of the AmpC β-lactamase was similar to that of EF078894 (ACT-like type)with a 97% homology.The genotype of ESBLs of Enterococcus gallinarum was a new TEM-type derived from the TEM-type ESBLs of klebstella pneumoniae isolated from the same avian.The genotype of AmpC lactamase was ACT-type,which probably concerned with β-1actam antibiotics used.

Plasma levels of adiponectin and tumor necrosis factor-alpha in children with obesity / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To examine plasma adiponectin (ADPN) and tumor necrosis factor-alpha (TNF-alpha) levels and their correlation in children with obesity in order to investigate the roles of both in the development of childhood obesity.</p><p><b>METHODS</b>One hundred and forty-seven children with obesity and 118 normal children who were randomly sampled from five primary schools from the Kaifu District in Changsha were enrolled. Physical shape indexes, including height, weight, waist circumference, hip circumference, and waist to hip ratio (WHR) were measured. Body mass index (BMI) was calculated. Blood pressure was measured. Percentage of body fat (%BF) was measured with dual energy X-ray absorptiometry. Plasmal levels of ADPN and TNF-alpha were detected using ABC-ELISA. Blood concentrations of triglycerides (TG), total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C) were measured by automatic biochemistry analyzer. Fasting blood glucose level was measured by glucose oxidase method. Fasting blood insulin level was assayed by radioimmunity. Homeostasis model assessment for insulin resistance (HOMA-IR) was performed.</p><p><b>RESULTS</b>Plasma ADPN levels in obese children significantly decreased compared with those in normal children (8.12+/-2.54 mg/L vs 12.22+/-4.68 mg/L; p<0.05), and had a negative correlation with plasma TNF-alpha levels, BMI, WHR and HOMA-IR (p<0.01), and with %BF, fasting insulin, systolic blood pressure and TG (p<0.05). Plasma TNF-alpha levels in obese children significantly increased compared to normal children (171.38+/-34.33 ng/L vs 91.07+/-21.60 ng/L; p<0.01) and positively correlated with BMI, WHR, %BF, fasting insulin, HOMA-IR, TG and systolic blood pressure (p<0.01), and negatively with HDL (p<0.05). Multiple stepwise regression analysis showed that ADPN, BMI and TNF-alpha were main influential factors for %BF (R2=0.926, p<0.01). There was a significant interaction between ADPN and TNF-alpha (p<0.05).</p><p><b>CONCLUSIONS</b>Plasma ADPN levels decreased and plasma TNF-alpha levels increased in children with obesity and both were main influential factors for %BF in children. There was an interaction between ADPN and TNF-alpha, suggesting that they both participate in the development of childhood obesity.</p>

Serum leptin level and its association with bone mineral density in obese children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate serum leptin level and its relationship with bone mineral density in obese children from Changsha City.</p><p><b>METHODS</b>One hundred and nineteen obese children and 103 normal children aged 7 to 12 years from five primary schools of Changsha City were enrolled. Obesity was assessed based on the body mass index (BMI). Dual energy X-ray absorptiometry (DEXA) was used to determine bone mineral density (BMD) and body composition. Serum leptin level was measured using enzyme-linked immunosorbent assay (ELISA).</p><p><b>RESULTS</b>The obesity group had higher height, weight, BMI, waist circumference and waist to hip ratio (WHR) compared with the normal group (p<0.01). BMD, bone mineral content (BMC), lean mass (LM), fat mass (FM), percentage of body fat (%BF) and leptin concentration in the obesity group were significantly higher than those in the normal group (p<0.01). Serum leptin level was positively correlated with BMD, BMC, LM and FM (r=0.528-0.903, p<0.01). Multiple stepwise regression analysis indicated that BMI and %BF were independent influencing factors for serum leptin level.</p><p><b>CONCLUSIONS</b>Obese children have higher serum leptin level. Serum leptin concentration is significantly correlated with BMD and body composition. BMI and %BF are independent influencing factors for serum leptin level in children.</p>

Obesity and its influencing factors in primary school students from Kaifu District of Changsha City / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the prevalence of obesity and the influencing factors for obesity in primary school students from Kaifu District of Changsha City.</p><p><b>METHODS</b>A total of 4 140 students aged 7 to 12 years sampled randomly from Kaifu District of Changsha City were enrolled. Obesity was identified based on the body mass index (BMI). The influencing factors for obesity were investigated by non-logistic regression analysis.</p><p><b>RESULTS</b>The prevalence of overweight and obesity were 9.76% and 7.39% respectively, and the prevalence of obesity in boys and girls were 9.37% and 5.13% respectively (P<0.05). The obese children had significantly higher BMI, waist circumference (WC), waist to hip ratio(WHR), percentage of body fat (%BF), systolic blood pressure, and serum triglyceride (TG) and low density lipoprotein-cholesterol (LDL-C) levels but significantly lower serum high density lipoprotein-cholesterol (HDL-C) level compared with the children with normal weight. BMI, %BF, WC and WHR were all positively correlated to serum levels of TG and LDL-C in obese children. Binge overeating, increased television viewing time, fast speed of eating and increased consumption of fried foods are all risk factors for the development of obesity. Preference for physical activity and sufficient physical activity were protective factors for obesity.</p><p><b>CONCLUSIONS</b>The prevalence of obesity of primary school students from Kaifu District of Changsha City is high in China. The development of childhood obesity is associated with poor eating behaviors, less physical activity and increased television viewing time. The control of childhood obesity may be beneficial to early prevention of some adult chronic diseases.</p>