From the perspective of law-and-economics, this paper analyzed the characteristics between medical workplace and other workplace in terms of public safety liability, risk identifiability and preventability. Then it went on to explore the costs structure incurred by medical violence, namely personal costs of victims, public safety cost, risk prevention cost and service supply cost. A law-and-economics optimal penalty model is then developed based on the benchmark of crime of violence free of social cost, and by incorporating the social cost of medical violence. And it is found that an upward deflection of the crime cost curve sharply drives up the optimal penalty corresponding to various levels of violence, and lowers the threshold violence constituting criminal offence, thus balancing the social costs borne by the public for medical violence.

Traditional mindset in anti-medical violence legislation tends to divert the responsibility to prevent medical violence to the party of the lowest costs, a design of obvious loopholes in reducing medical violence occurrence. By combining the legal liability and penalty adjustment to counter medical violence crimes, the US, Australia and South Korea are trying to match the private cost of victims and its social cost with the punishment of crime law. In this sense, China should highlight the nature of public safety of medical service, zero tolerance report and optimal punishment to medical violence crimes. This approach can take place of the existing incentive mechanism featuring violent conflicts, being conducive to building a safe and harmonious doctor-patient relationship.

Depression is a common mental disease,characterized by a high suicide rate and social burden.Integrated traditional Chinese medicine (TCM) and western medicine will be a major mean of clinical treatment in the future.In the clinical research,integrated TCM and western medicine is recommended by improving curative effects and reducing adverse reactions.Research on action mechanism will be the main direction in ahead.The application of neuroimaging,genomics,neurochemistry and metabonomics can explore and expound the mechanism of depression treatment by integrated TCM and western medicine.This paper summarized both clinical and basic research on depression treated by integrated TCM and western medicine in recent years,which may contribute to the development of integrated TCM and western medicine in mental diseases.

Objective To evaluate the lipid-lowering effect of 10 mg policosanol versus an equal dose of atorvastatinin patients with dyslipidemia.Method Databases such as VIP,Wanfang,CNKI,Cochrance Library,PubMed,Web of Science and EMBASE were searched for random control trials(RCT) and controlled clinical trials (CCT) of 10 mg policosanol versus an equal dose of atorvastatinin their lipid-lowering effects.The quality was assessed by Cochrance Handbook 5.1.0 or Newcastle-Ottawa scale (NOS).The study related data were analyzed statistically with RevMan 5.2 software.4 RCTs were selected.257 patients were included in the trials.130 cases were in 10 mg policosanol group and 127 cases belonged to 10 mg atorvastatin group.Results Results of Meta-analysis show that TC[SMD=0.84,95%CI(0.41,1.27),P=0.000 1] and LDL-C[SMD=0.68,95%CI(0.28,1.09),P=0.001] were reduced more effectively in 10 mg atorvastatin group than in 10 mg policosanol group.HDL-C[SMD=0.27,95%CI(0.02,0.51),P=0.03] was elevated more in 10 mg policosanol group than 10 mg atorvastatin group.Both groups showed no statistic difference(P=0.42) in TG [SMD=0.10,95% CI:(-0.41,0.35),P=0.42].Conclusion The lipid-lowering efficacy of 10 mg atorvastatin is better than equal dose of policosanolin patients with dyslipidemia.Dose increase of policosanol should be considered to ensure the efficacy when policosanol was used tore place atorvastatin therapy.This study had some shortcomings, such as limited study numbers and small sample size.The reliability of this study should be verified from high-quality,multi-center RCTS with large samples.

Objective To observe the impact of individualized diet intervention on diet therapy compliance of patients with diabetes mellitus. Methods All of 180 patients with diabetes mellitus were randomly divided into the intervention group and the control group. The intervention group was treated with conventional treatment and care. While in the control group,the individualized nutrition intervention therapy was used together with conventional treatment and care. After six months,the differences of diet therapy compliance and metabolism indexes between the two groups were com-pared and analyzed. Results Compared with the control group, there was higher compliance of diet therapy in the in tervention group (P<0.01). The levels of glycemia, triglyceride, cholesterol, LDL-C and HbAlc in the intervention group were better than the control group,there was significant difference(P<0.01). Conclusion Individualized nutrition intervention therapy could improve the diet therapy compliance of patients with diabetes mellitus, and could also im-prove indexes of glucose and lipid metabolism.

[Objective]We select the cases of the famous doctor RUAN Huaiqing in Zhejiang, hoping to provide reference for the modern clinical treatment of depression.[Methods]In view of the collation and study of ancient famous medical records,this article analyzes the cases about depression syndrome in Ruan Shi Yi An,including the gynecologic and miscellaneous diseases medical cases,and evaluates the treatment experience of them at the same time. [Results]RUAN Huaiqing considers the location of this disease belonging to the three viscera of heart, liver and spleen. For the most part, he uses Yueju Wan,Guipi Tang and Xiaoyao San as a treatment, and pays more attention to emotional adjustment.[Conclusion] RUAN Shi Yi An can reflect the clinical experience of RUAN Huaiqing,and he inherited the academic viewpoints and experience of diagnosis and treatment of the former. The discussion and treatment experience of RUAN Huaiqing about depression syndrome, is worthy learning and being applied to clinic.

Objective:To explore the expectations of different groups, including the vice president in charge of hospital infection, hospital infection management professionals, nursing managers, and department directors, on the core competence of head nurses in hospital infection prevention and control.Methods:Using the phenomenological research method, purposive sampling method was used to conduct in-depth semi-structured interviews with 25 interviewees from 5 tertiary general hospitals in Hangzhou City, Zhejiang Province, including vice presidents in charge of hospital infection, hospital infection management professionals, nursing managers, department directors, clinical staff and logistics supervisors. A total of 25 interviewers conducted in-depth semi-structured interviews, and the collected data were analyzed by Colaizzi′s 7-step analysis method.Results:Four themes were extracted, including the expectation of the head nurse′s infection control target management ability, the expectation of the head nurse′s infection control professional knowledge ability, the expectation of the head nurse′s infection control clinical practice ability, and the expectation of the head nurse′s infection control influence.Conclusions:In the sensory control management of the department, head nurses should have strong infection control target management ability, continue to learn and update the infection control knowledge and concepts, improve the clinical infection control practice ability, properly authorize, reasonably motivate and improve the infection control management. Team execution ability, create a good atmosphere of department sense control, and promote the development of infection control work.

Objective In critically ill elderly patients with "heat fecaloma with watery discharge", deficiency syndrome occupies its eighty to ninety percent, while "heat accumulation" occupies its ten to twenty percent; in fact, it is "dry feces accumulation stagnation and manure water side stream". Factors of Qi deficiency, blood deficiency, Yin deficiency, Yang deficiency, etc. are the main causes of dry stool accumulating in the intestine and manure water flows to side stream. The therapeutic principles of this disease should be removing stasis by purgation, in the mean time supplementing Qi and moistening intestine, or moisturizing dryness by nourishing blood, or supplementing Yin and increasing fluids, or warming yang for relaxing bowels in order to solve the root causes of the disease. The mechanism of heat fecaloma with watery discharge in critically ill elderly patients is different from that of general patients; clinically it is necessary to interrogate the disease history in detail, synthesize the four diagnostic methods, and differentiate manifestations from root cause, deficiency from sthenia, mildness from severity and amelioration from urgency. Casually using attack should be avoided, and aiming to treat its root cause is the proper therapeutic method.

Objective To observe the clinical effect of Levosimendan for treatment of patients with refractory heart failure in order to provide a reference for doctors treating this disease. Methods One hundred and eighty patients with refractory heart failure were admitted to Tongde Hospital of Zhejiang Province from February 2014 to December 2017, and they were divided into two groups by random number table method: a western medicine routine treatment group (western control group) and a Levosimendan group, each group 90 cases. The patients in western control group were given conventional anti-cardiac failure drugs ; and those in Levosimendan group were treated with the therapies as above group, and additionally Levosimendan continuous intravenous infusion for 24 hours was given. The clinical efficacy of the two groups was evaluated after 3 days of treatment. After treatment, the differences of ejection fraction (EF), stroke volume (SV), end-systolic volume (ESV), end-diastolic volume (EDV) and the levels of N-terminal brain natriuretic peptide precursor (NT-proBNP) and cardiac troponin I (cTnI) were compared between the two groups. Results After treatment, the EF and SV levels were significantly increased, while the ESV, EDV, NT-proBNP and cTnI levels were decreased obviously compared with those before treatment in the two groups (all P <0.05); the changes of the levels of EF, SV and NT-proBNP and cTnI of Levosimendan group were more significant than those of the western control group [EF: 0.49±0.06 vs. 0.44±0.06, SV (mL): 86.54±17.63 vs. 81.48±18.46, NT-proBNP (μg/L): 5.50±1.28 vs. 6.64±1.54, cTnI (μg/L): 0.08±0.01 vs. 0.14±0.13, all P < 0.05], while there were no significant differences of the levels of ESV and EDV between the two groups [ESV (mL): 111.56±32.53 vs. 128.76±32.13, EDV (mL): 187.95±39.28 vs. 185.06±41.23, both P > 0.05]. The total effective rate of the Levosimendan group was obviously higher than that of the western control group [97.78% (88/90) vs. 78.89% (71/90), P < 0.05]. Conclusion Levosimendan can effectively improve the hemodynamics in patients with refractory heart failure, the elevation of patients' heart function, and the short-term therapeutic effect is very remarkable.

Objectives To develop Z-scores reference ranges for kidney in normal fetuses from the measurements of gestational age (GA),biparietal diameter (BPD) or femur length (FL) using two-dimension ultrasound.Methods A retrospective cross-sectional study of 403 singleton normal fetuses was performed.The gestation age range was from 18 to 40 weeks.Fetal biologic parameters included GA and BPD and FL based on menstrual age.Left kidney length and left kidney width of normal fetus were measured.Normal Z-score ranges were developed for leftkidney length or left kidney width using GA,BPD and FL as independent variables.Results Linear regression model was the best description of the data in each case and correlation between left kidney length or left kidney width and independent variables were excellent (r=0.8761,0.8818,0.8797,0.8604,0.8723,0.8643).All P values were less than 0.01.The equations were as follows,Y=0.094 22 + 0.1088X,Y=0.132 57 + 0.4349X,Y=0.6664 + 0.491 05X,Y=0.060 58X-0.051 98,Y=0.262 19X-0.197 55,Y=0.294 02X + 0.136 19.Heteroscedasticity of standard deviation (s) with increasing independent variables also could be modeled with a simple linear (r=0.925,0.934,0.915,0.908,0.914,0.922),All P values were less than 0.01.The equations were as follows,Y=0.025 + 0.005 58X,Y=0.097 09 + 0.010 45X,Y=0.046 17 + 0.025 65X,Y=0.001 13 + 0.002 24X,Y=0.003 67 + 0.011 55X,Y=0.005 07 + 0.015 89X.Then we got Z-scores based on the equation,Z-score=(actual measurement data of left kidney length or left kidney width-predictive data of left kidney length or left kidney width) predictive s.Conclusions Normal reference ranges and Z-scores for fetal left kidney length and left kidney width had been provided.These normative data may be useful tools for assessment of fetal kidney length and kidney width,especially had potential applications in malformations of fetal kidney.