Medical liability insurance is a latecomer in China,and faced with many challenges ever since.This paper picked medical liability insurance in Nanjing as an empirical study example,as the author analyzed the insurance,underwriting and premiums of medical liability insurance,as well as the insurance programs and claim settlements from 2008 to 2012.In addition to noting problems found in medical liability insurance in Nanjing,the author proposed the roadmap for China' s medical liability insurance,with reference to experiences of overseas medical liability insurance industry.

Objective To investigate the expression ot XAF1 protein in pancreauc cancer,and its relationship with clinicopathological parameters and prognosis.Methods The tissue microarray was composed of 89 pancreatic cancer and 21 normal pancreatic tissues,and immunohistochemistry was used to examine the expression of XAF1 protein.The correlation between XAF1 expression and clinicopathological parameters was analyzed.The 89 patients were followed,and the survival was shown in Kaplan Meier curve.Cox proportional hazards regression was used to identify risk factors for the survival of pancreatic cancer patients.Results The negative expression rate of XAF1 was 44.9％ (40/89),and it was 9.5％ (2/21) in normal tissue,and the difference between the two groups was statistically significant (P ＜0.05).The expression of XAF1 was negatively associated with tumor staging (P ＜ 0.05),but it was not associated with age,gender,lymph node metastasis,distant metastasis,pathological grading,surgical margins,vascular and neural invasion.Patients with negative expression of XAF1 had much shorter survival than patients with positive expression.Univariate analysis showed that negative expression of XAF1,pathological grading,lymph node metastasis,distant metastasis was associated with the survival (P ＜ 0.05),and the multivariate analysis indicated that negative expression of XAF1 was an independent prognostic factor for survival of pancreatic cancer.Conclusions XAF1 may be involved in the development and growth of pancreatic cancer,and it is related with patient's prognosis.

Objective:To participate in the anti-infection regimen adjustment and perform pharmaceutical care for one pneumonia patient after lung transplantation by clinical pharmacist to provide experience for individualized medication. Methods:Clinical pharma-cist adjusted the treatment plan and doses of immunosuppressive agents according to the patient' s conditions. Results: The infection was effectively controlled through optimizing the treatment plan. Conclusion:Pharmaceutical care for patients after lung transplantation performed by clinical pharmacists is helpful to both the recovery of patients and future appropriate drug use.

Objective: In order to validate the effectiveness of methods of defining poverty caused by illness which are based on catastrophic health expenditure and impoverishment health expenditure, originated from relative costs theory.Results: This paper uses empirical approach to explore the definition methods by comparing the original methods with modified methods and defined population with the actual situation of poverty alleviation.Results: Study results show that the catastrophic health expenditures incurred ratio is about 20% and shows the aggregation of both low-income and high-income groups.The impoverishment health expenditure incurred ratio is about 12% and they mainly are families at the edge of poverty line.This study found that 70% of the families defined based on our method did not receive medical assistance in reality.Conclusion: Therefore, the definition methods based on relative costs theory are of great value in Chinese medical assistance systems for defining poverty caused by illness.Grouping based on household ability to pay could improve the methods' operability and effectiveness.

Neck shoulder pain or lumbocrural pain caused by intervertebral disc degeneration (IDD) could seriously affect the qualities life of patients. Current treatments mainly focus on alleviating pain and the symptoms of nerve compression, which could not radically stop the process of intervertebral disc degeneration, but conversely lead to high recurrence rate. In recent years, scholars have turned to study the biological treatment for repair and rebuild the intervertebral disc by biological molecular therapy, gene therapy, cell therapy and tissue engineering to solve the problem of intervertebral disc degeneration, while most of the above methods are still in animal experiments or in vitro experiments and the clinical application is still a long way to go.
Animals ; Biological Therapy ; Genetic Therapy ; Humans ; Intervertebral Disc ; metabolism ; Intervertebral Disc Degeneration ; genetics ; metabolism ; therapy

Objective To evaluate the engraftment state after allogeneic peripheral blood stem cell transplantation(Allo-PBSCT)in 2 exposed patients in Shandong “10?21” radiation accident.Methods The dynamic cytogenetic analysis was performed by chromosome aberration(CA)analysis,R-band karyotyping analysis and micronucleus(MN)assay of peripheral blood and/or bone marrow samples of 2 patients(A and B).Results The results showed that the transplantation was successful(complete chimerism),and the engraftment state was stable.No difference was observed between the results of cytogenetic analysis from peripheral blood samples and bone marrow samples.These results were in fairly good accordance with those results by short tandem repeats-polymerase chain reaction(STR-PCR)and clinical manifestations.Conclusions The results suggested that the dynamic observations of dicentric and ring aberrations and MN can be used as an indication to estimate the engraftment state after Allo-PBSCT,but only for the patient with acute radiation sickness.Moreover,the cytogenetic analysis performed on bone marrow samples is better than that on peripheral blood samples when the lymphocytes were reduced sharply in peripheral blood.

Objective A biological dose estimation by cytokinesis-block micronucleus(CBMN)assay was performed on 2 patients exposed to accidental radiation.Method Micronucleus assay and dose estimation by CBMN in peripheral blood and bone marrow were performed in 2 patients(A and B)suffering from radiation sickness.Results No binucleated lymphocytes were observed in peripheral blood of 2 patients.The results of bone marrow examination showed that only one binucleated cell was discovered in patient A.The rough estimation of radiation dose of A was above 20Gy according to the degree of reduction of binucleated cell in our previous study.The micronucleus frequency was 2.42 per cell and the dose estimation was 8.7(8.0-9.4)Gy for patient B.These results were approximately in accordance with that of dose estimations by physical method,chromosome aberration analysis,ESR method,and clinical manifestations.Conclusion MN assay is simple,quick and accurate.It is a reliable biodosimetry in addition to chromosome aberration analysis.

Objective To discuss the effectiveness of heart operation through subaxillary minithoracotomy.Methods Subaxillary minithoracotomy heart operation was carried out in 378 cases between March 1995 and October 2004.The operation was performed under beating heart and without the occlusion of the ascending aorta in 81 cases of atrial septal defect, 32 cases of ventricular septal defect,and 16 cases of other diseases.The operation was completed under low temperature and extracorporeal circulation in other 249 cases.Results The operation was accomplished smoothly in all the cases.The operation time was 167?2.0 min,and the extracorporeal circulation time was 28.1?16.6 min.Postoperatively,1 patient with double-chamber anormaly of the right ventricle was given a tracheotomy because of an acute laryngeal edema,1 patient with tetralogy of Fallot died of low cardiac output syndrome,1 patient had a cerebral embolism,2 patients experienced an incision fat liquefaction,and the remaining patients recovered uneventfully.A follow-up for 2 months ~ 10 years(mean,5.1 years) in 366 patients revealed a full range of physical activities.One case of ventricular septal defect with residual shunt and 1 case of cerebral embolism were fully recovered.Conclusions Subaxillary minithoracotomy open heart operation has advantages of minimal invasion,quick recovery,simplicity of performance,and good cosmetic results.

Objective:To construct BimS lentivirus RNA interference(RNAi) vector and to study its infection efficiency by using RNAi technique.Methods:Three interference targets were designed according to the BimS sequence.The single chain primer was annealed into double-stranded oligo sequences,and then connected with vector linearized with Age Ⅰ and EcoR Ⅰ enzyme.The recombinant plasmid was packaged,and the infection efficiency was observed by infecting ACC-2 cells.Results:After amplification,a 337 bp band was appeared in the electrophoresis results of positive clones.Sequence of inserted fragments were identical with the result of DNA sequencing.Restructuring lentivirus was packed in 293T cells,the virus titer was 2 × 108 TU/ml,MOI =20,and the transfection efficiency was 85％.The BmS mRNA relative expression of pFU-GV-BmS-1,pFU-GV-BMS-2 and control group was 0.743 ±0.025,0.466 ±0.023 and 1.266 ±0.042 respectively(between each 2 groups,P ＜0.05).Conclusion:BimS lentivirus virus RNA interference vectors can be constructed,and can efficiently infect ACC-2 cells.

OBJECTIVE To strengthen the cleaning and disinfection management for endoscope to fulfil the specification.METHODS The management of cleaning and disinfection of the endoscopes were to be improved by methods of education,inspection,condition improvement and perfect institution.RESULTS The endoscopes which were disinfected were all reached the standards.CONCLUSIONS It is important to strengthen the cleaning and disinfection management for endoscopes.