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 investigate the association of insulin dose with clinical factors of type 2 diabetes. Methods We reviewed the data of 214 type 2 diabetic patients who received insulin regimens.We compared the insulin dose and period at the targeted blood glucose levels among 6 groups according to different type of oral hypoglycemic agents. Results There existed statistically significant correlations of the glucose-targeted insulin dose with course,FPG,BMI,combination therapy with oral hypoglycemic agent(P<0.1,test level P=0.1).Merely metformin failure group took less insulin than the group admitted due to combination therapy failure (P=0.016, 0.53(0.35～0.62)U/kg and 0.63(0.51～0.75)U/kg respectively).The longest targeted period existed in the later. Relationship between the targeted bedtime insulin NPH dose and FPG level can be demonstrated by equation Y=0.255X+7.8. Conclusions The targeted insulin dose is influenced by synthetic factors. Patients admitted due to combination oral hypoglycemic drug failure have the maximal targeted insulin dose and the longest titration period. The final bedtime insulinNPH dose can be predicted by FPG level.

Objective To summarize the surgical treatment of heart disease in patients aged 70 years and over. Methods From May 1995 to July 2000, 23 patients aged 70 years and over underwent cardiac operation at our department. Thirteen cases underwent isolated coronary bypass grafting, 5 had isolated valve operations , 3 had combined valve operation and coronary bypass grafting, 1 had excision of left atrial myxomas, 1 had combined pericardiectomy and coronary bypass grafting .Results Postoperative complications occurred in 5 cases (21.7%). The hospital mortality rate was 4.3% (1 case) . All of the 22 cases survived showed improvements in cardiac function and quality of life during a follow up of 1 month to 5 years.Conclusions Cardiac operations can be performed in patient saged 70 yeas and over with a satisfactory outcome,earlier referral and intervention is mandatory to improve results in this patients.

Objective:To study the function and mechanism of miR-30a in rat cerebral ischemia-reperfusion (I/R) injury.Methods:The middle cerebral artery occlusion (MCAO) model was established by intravascular suture method, and the expression of miR-30a in brain tissue was detected by real-time quantitative polymerase chain reaction (qRT-PCR). After intracerebroventricular injection of miR-30a lentivirus, the infarct area was detected by 2, 3, 5-triphenyltetrazole chloride (TTC) staining, the neurological deficit was detected by Bederson method, and the concentration of neurotrophin-3 (3-NT) and nitric oxide (NO) in brain tissue was detected by enzyme-linked immunosorbent assay (ELISA). The protein levels of kelch like ECH associated protein 1 (Keap1), NF-E2-related factor 2 (Nrf-2) and hemeoxygenase-1 (HO-1) in brain tissue were detected by Western blot. Double luciferase reporter assay was used to detect the targeting relationship between miR-30a and Keap1.Results:Compared with sham operation group, the expression of miR-30a was down-regulated in a time-dependent manner after I/R. The overexpression of miR-30a can reduce the area of cerebral infarction tissue at the pathological level, the degree of neurological impairment at the functional level, the 3-NT, NO and Keap1 at the molecular level, and enhance the expression of Nrf2 and HO-1. The dual luciferase reporter assay also showed that miR-30a could bind to Keap1 mRNA.Conclusions:The expression of miR-30a was down-regulated in MCAO rat brain tissue, and miR-30a could attenuate cerebral I/R injury in rats by targeting Keap1.

Objective: To study the potential of growth and mineralization of cultured osteoblasts on the indium tin oxide conductive(ITO) glass disk coated with polypyrrole film (Ppy) . Methods: Osteoblasts were seeded onto ITO glass or ITO glass coated with polypyrrole film of implant materials. The cells were stained by HE and Von Kossa, observed by light microscope and scanning electron microscope (SEM) on day 3, 7, 14 and 28 after seeding respectively. Results: The osteoblast cells attached well to both ITO surfaces and Ppy films, mineralized nodules was observed on Ppy film. Conclusion: The polypyrrole films have good bone biocompatibility and it can be used as the biomaterials for dental implant.

Objective: To study the relationship between the patient satisfaction with complete denture and the pain perception threshold (PPT) of alveolar ridge mucosa. Methods: Forty-five edentulous patients with complete denture were investigated with the questionnaire of patient satisfaction, PPT of alveolar ridge mucosa in the patients was measured with a pressure algometer. Results: No difference was found in the PPT of alveolar ridge mucosa between the left and the right side. The PPT was found to be higher in maxillary site than in mandibular side(P