The special nature of medical care determines the high riskiness of the medical profession that is lacking in other professions. In view of the high-techness and high riskiness of the medical profession, it is only proper to start thinking about setting up corresponding mechanisms for guarding against and dissolving the risks so as to safeguard the legitimate rights of the doctors. Guarding against and dissolving risks of the medical profession fall into a systematic framework of regulations and legal arrangements that are composed of mechanisms for dispersing risks of the medical profession, mechanisms for sharing medical liabilities and systems of medical care and social security.

BACKGROUND:Neural stem cel (NSC) transplantation is a common method for various ischemicencephalopathies, but inability to survive in the transplantation region limits its further use in clinical practice. OBJECTIVE:To explore the effect of vascular endothelial progenitor cel s (VEPCs) on the proliferation and apoptosis of co-cultured NSCs as wel as vascular remodeling in rats with ischemia reperfusion injury. METHODS:125 Sprague-Dawley rats were randomly divided into five groups, 25 rats in each group, including sham operation, ischemia, NSCs, co-culture, and VEPCs groups. Rat models of ischemia reperfusion injury were made in al groups except for the sham operation group, fol owed by corresponding interventions. The proliferation and apoptosis of neural stem cel s were detected, and vascular remolding in the ischemic region was observed in each group. RESULTS AND CONCLUSION:At different time points after transplantation, BrdU positive cel s were not observed in VEPCs, ischemia and sham operation groups;the number of BrdU positive cel s in the co-culture group was significantly higher than that in the NSCs group (P<0.05);BrdU+/Caspase-3+cel were observed in both co-culture and NSCs groups, and the apoptosis rate of the co-culture group was significantly lower than that in the NSCs group (P<0.05);there were new blood vessels in al the groups except for the sham operation group, and the number of new bone vessels was highest in the co-culture group. To conclude, our experimental results show that VEPCs promotes the proliferation of co-cultured NSCs, inhibits cel apoptosis and and promote angiogenesis in the ischemic penumbra of rats with ischemia reperfusion injury.

AIM: To approach the relationship between the expression of intercellular adhesion (ICAM-1 mRNA) and acute lung injury (ALI) as well as the mechanisms of rhubarb in the prevention and treatment of the lung injury. METHODS: ALI animal model was performed by Lipopolysaccharide (LPS). The rats were divided into 4 groups: LPS group, control group, rhubarb+LPS group and dexamethasone+LPS group. Histopathological examination and biological markers were measured for the lung specimens. Molecular hybridization method was used to determine the expression of ICAM-1 mRNA. RESULTS: The ICAM-1 mRNA expression in the lung tissues of LPS group significantly increased compared with control group ( P

Objective: To investigate the effects of Shengmai drink(生脉饮) on nitric oxide(NO) and inducible nitric oxide synthase(iNOS) in rats with acute lung injury(ALI) induced by lipopolysaccharide(LPS).Methods: The male Wistar rats were randomly divided into four groups: control group,ALI group,Shengmai drink group and dexamethasone group.LPS was injected into the sublingual vein of rats to prepare ALI models.Macroscopic and histopathological examinations were performed and biological indexes including lung wet weight/dry weight,the ratio of neutrophils and protein content in the bronchoalveolar lavage fluid((BALF),) pulmonary vascular permeability and pulmonary alveolar permeability index were detected.(Meanwhile),the activities of serum NO and lung tissue homogenate iNOS were measured.Results: Lung histopathological examination showed the injury and cellular infiltration in the pulmonary stroma and alveoli were more prominent in the ALI group than that in the control group.Lung wet weight/dry weight,the(ratio) of neutrophils and protein content in BALF,pulmonary alveolar(permeability) index,pulmonary vascular(permeability) were significantly increased,NO and iNOS were also markedly elevated in the ALI group((P

Objective To investigate the role of underlying diseases in predicting the length of stay for observation in emergency department of internal medicine by the Charlson weighted index of comorbidities (WIC).Methods A single-center retrospective analysis of clinical data of 2 836 patients admitted in emergency observation room of the Beijing Chaoyang Hospital from January 1 to June 30 in 2013 was carried out.The patients were divided into two groups according to the length of observation time:Group A (time of observation ≥72 h,n =1908) and Group B (time of observation ＜ 72 h,n =928).The data of the length of observation time were recorded,and the WIC and the APACHE Ⅱ score were calculated.Logistic regression analysis was used to determine the independent predictors for 72-hour observation.Receiver operating characteristics (ROC) curve was used to evaluate the value of WIC in predicting 72-hour observation.Results Of 2836 patients,1176 (41.5％) suffered from respiratory disease,709 (25.0％) had cardiovascular and cerebrovascular diseases,423 (14.9％) were contracted digestive system disease,251 (8.8％) had renal and endocrinology system diseases and 277 (9.8％) had diseases arisen from physicochemical factor and miscellaneous causes.Compared with patients in Group B,the average age,the number of elderly patients residing in apartment exclusively for elderly,the WIC and the APACHE Ⅱ score were higher in patients in Group A.The one-variable and multi-variable Logistic regression analyses showed that age,the WIC score,the APACHE Ⅱ score and residing in apartment for elderly people were related with 72-hour observation in emergency observation room.The area under the ROC curve in predicting 72-hour observation was 0.701 for the WIC score,0.788 for APACHE Ⅱ score and 0.853 for their combination.Conclusions The WIC scoring system can be a good predicting method for 72-hour observation in patients in emergency observation room.

Purpose To investigate the effect of sensitivity on image quality and radiation dosage of digital chest radiography. Materials and Methods A total of 300 healthy people undergoing chest X-ray examination were randomly enrolled and divided into two groups according to body weight (150 people with normal weight and 150 overweight), which were further randomly divided into three subgroups (S200 subgroup with low-sensitivity, S400 subgroup with mid-sensitivity, S800 subgroup with high sensitivity, each subgroup contained 50 people). With other parameters unchanged, digital chest photography with different sensitivities was performed to each subgroup (S200, S400 and S800, respectively), and then uploaded the data to PACS and recorded mAs value and dose area product (DAP) value for each time. Then the image quality was assessed by three doctors in terms of mAs value, DAP, image quality score and noise score. Results In all subgroups of normal weight, differences on mAs and DAP were significant (F=1443.191-1829.895, P<0.05) whilst differences on image quality score and noise score were not significant (F=0.686-2.516, P>0.05). In all overweight subgroups, differences in mAs, DAP, image quality score and noise score were significant (F=163.358-290.656, P<0.05). According to one-factor analysis of variance, mAs value was S200>S400>S800 (F=0.626-3.210, P<0.05), DAP value was S200>S400>S800 (F=0.416-1.416, P<0.05), there was no difference in image quality score and noise score (F=0.001-0.100, P>0.05). In overweight group, there was no difference between subgroups of S200 and S400 (F=0.120-0.145, P>0.05); whilst differences between subgroups of S200 and S800 were significant, the same appeared in subgroups of S400 and S800 (F=1.655-2.360, P<0.05). Conclusion Radiation dose can be effectively controlled by regulating sensitivity with image quality unaffected. It is advisable to choose high-sensitivity photography for patients with normal weight and low or mid-sensitivity photography for overweight patients.

To investigate the effectiveness of thymosin a1 on patients with severe community-acquired pneumonia (SCAP). Methods Thirty-five patients with SCAP were randomly divided into two groups, group A with regular treatment as control and group B with both thymosin a1 and regular treatment. Venous blood specimens were collected from them before treatment (baseline) and seven days after treatment for laboratory testing, including serum concentrations of c-reactive protein (CRP) and albumen (ALB), serum activities of aspartate aminotransferase (AST) and aniline aminotransferase ( ALT), and percentage of T-lymphocyte subsets CD3+ , CD+ and CD8+ by indirect immunofluorescence. Meanwhile, their symptoms, signs and chest X-ray were observed. Length of mechanical ventilation and stay at emergency intensive care units (EICU) of the patients were recorded. Results Percentages of CD3+ and CD4+ , and ratio of CD+ to CD8 + increased significantly and percentage of CD8+ reduced significantly in group B seven days after treatment, as compared to those before treatment [ (46.3 ± 5.3) % vs. (29.9 ± 2.1 ) %, (44.5 ± 5.2) % vs. (28. 7 ± 2. 8 ) %, and 1.8 ± 0. 4 vs. 0. 9 ± 0. 1, respectively, P < 0.05, and (24.6 ± 2.9) % vs. (31.4 ± 3.7) %, P < 0. 05 ]. But, no significant improvements in those indicators were found in group A after treatment. There were significant differences in percentages of CD3+ , CID4+ and CD8 + , and ratio of CD4+ to CD8+ between group B and group A after trestmenL Serum concentration of ClIP reduced in both groups after treatment, as compared to that before treatment, but reduced more significantly in group B than that in group A. Serum concentration of ALB increased slightly in both groups after treatment, more in group B than that in group A, as compared to that before treatment. However, no significant difference in occurrence of ventilator-associated pneumonia ( VAP ) was found between the two groups (44.4% vs. 17.7%, P > 0.05 ) . Length of mechanical ventilation and stay at EICU were significantly shorter in group B than those in group A [ ( 8.4 ± 2.7 ) d vs. ( 5.1 ± 1.6 ) d, P < 0.05 ; and ( 16.1±2.9) d vs. ( 11.7 ± 2. 3 ) d, P < 0.01 ], and overall cure rates improved significantly in group B than that in group A (76.5% vs. 44.4%, P < 0.05 ), but no difference in case-fatality ratio was found between the two groups (33.3% vs. 23.5%, P >0.05).Conclusions Immune status of patients with SCAP could be improved by thymosin a1, with a shorter length of mechanical ventilation and stay at EICU, to promote their recovery.

Objective To in ve stigate the effects of advanced glycation end products (AGEs) on matrix metallop roteinase-2 (MMP-2) activity and its mRNA expression in renal cortex of rats. Methods Diabetic model of rats was induced by s treptozotocin. AGEs were prepared by incubation of rat serum protein with 0.5 mo l/L glucose. AGEs was administered intravenously to normal rats (AGEs group), an d native rat serum protein was given as negative control (negative group) and no rmal rats without treatment were as control (control group). AGEs content in ren al cortex and serum was quantified by ELISA, MMP-2 and TIMP-2 mRNA expressions were examined by RT-PCR and MMP-2 activity was measured by zymography. Results AGEs content increased significantly, MMP-2 mRNA expression descended and TIMP-2 mRNA expression ascended in renal cortex o f diabetic rats (all P

ObjectiveTo study the role of catecholamine in genesis of myocardium injury after organophosphorus poisoning (OP) in order to elucidate the underlying mechanisms of OP-induced cardiotoxicity.Methods Of 92 patients with severe acute dichlorvos poisoning,41 were consecutively enrolled for study and followed up for three months. The levels of serum creatine kinase isoenzyme myocardium (CK-MB),cardiac troponin Ⅰ (cTnI),acetylcholinesterase (AChE),acetylcholine (Ach),epinephrine and norepinephrine were assayed on the 1st,3rd and 5th days after admission and on the day of discharge.Electrocardiography was recorded every day after admission.ResultsOf them,37 (90.2％ )patients survived and four ( 9.8％ ) patients died during treatment.Sinus tachycardia was found in 37 (90.2％ ) patients and ST-T changes in 33 (80.4％ ) patients.CK-MB and cTnI levels peaked 3 days after admission,and then decreased to normal levels.Serum Ach,epinephrine and norepinephrine peaked on the 1st day after admission and then decreased.ConclusionsSevere acute dichlorvos poisoning is associated with myocardial dysfunction likely caused by increase in catecholamine levels.

Objective To evaluate the predictive value of Wells score combined with D-dimer in the diagnosis of acute pulmonary embolism.Methods A total of 540 patients with suspected pulmonary embolism admitted from 2008 to 2011 were enrolled for study.The diagnosis of pulmonary embolism (PE) was confirmed by using computed tomography pulmonary angiography (CTPA).These patients were divided into two groups:PE group and non-PE group.Comparative analysis was carried out in demographics,underlying diseases,chief complaints,physical signs,venous thrombosis risk factors,laboratory findings and Wells scores between the two groups.Results Of 502 patients selected into this study,there were 246 in PE group and 256 in Non-PE group.The incidence rates of history of recent surgery or bed-ridden,recent fracture of pelvis or lower limb,symptoms of hemoptysis,transient disturbance of consciousness,signs of unilateral lower limb swelling,hypoxia and hypocapnia of arterial blood gas analysis,elevated levels of D dimer,high Wells score in PE group were significantly higher than those in non-PE group (P ＜ 0.05).And there were no statistical difference in other variables found between the two groups.The areas under the ROC curve of Wells score,D-dimer and the combination of the two were 0.775 (95％ CI:0.719-0.831),0.802 (95 ％ CI:0.751-0.853) and 0.899 (95 ％ CI:0.834-0.964),respectively.And the area under the ROC curve of the combination of the two was greater than that of separated application (P ＜ 0.05).When the cut-off value of Wells score was 5 and D-dimer was 1 724 μg/L,the weighted maximum sensitivity and specificity were reached,and these cut-off values were higher than above determined values,the reliability of the diagnosis of PE was obviously increased,and those were lower than these cut-off values,the reliability of excluding PE was also increased.Conclusions Wells score combined with D-dimer showed a higher value in predicting acute pulmonary embolismthan than their separated application.