Identifying the similarity and differences of malpractice,medical negligence and medical error has realistic meaning to deal with medical disputes efficiently.They are all subjective negligence and belong to the category of medical behavior.This paper mainly discussed the criteria and civil liability of their differences.

OBJECTIVE To investigate the value of rigid bronchoscope combined with fiber bronchoscope application in children with airway obstruction.METHODS Retrospective analysis of 176 cases children with airway obstruction from January 1, 2006 to January1, 2016, all patients were diagnosised and treated in our hospital. RESULTS All children were acceptted rigid bronchoscopy combined with fiber bronchoscope under general anesthesia, then received the different thrapy according to the different causes. 104 patients with airway foreign body were all obtained satisfactory effect, 2 cases of children with bronchial foreign body(cap) inspection, failed to remove and contact thoracic surgery doctors to remove the foreign body by thoracotomy. 10 plastic bronchitis patients improved after treatment or cured. 7 cases of bronchial tuberculosis were cured after treatment. 4 patients with airway tumor after minimally invasive surgery, obtained good effect, 2 cases were turned to the other cancer hospital. 2 cases of patients with tracheal stenosis, the symptom is reduced after expansion. Bronchial granulation, tracheomalacia, bronchial softening, bronchial atresia patients improved after treatment. This group of all patients with pneumonia were cured after symptomatic treatment.CONCLUSION Rigid bronchoscopy and fiber bronchoscope are both useful for diagnosis and treatment of children with airway obstruction, both have its advantages and disadvantages, combined application can improve the accuracy of disease diagnosis and timely intervention on the patients.

Objective To compare the value of pacemaker implantation using the subclavian vein (SCV) puncture and thecephalic vein(CV) cutdown approach.Methods One hundred and forty-six patients were randomized into SCV group (98 patients) and CV group (48 patients).We observed the success rate,surgery duration,fluoroscopy time and complications of the two groups.Results The SCV group had significantly higher success rate,shorter duration of surgery and fluoroscopy than the CV group (success rate:100％ (98/98) vs.89％ (43/48),x2 =10.5,P ＜ 0.05 ; duration of surgery:(118 ± 35) min vs.(256 ± 75)min,t =12.12,P ＜0.01 ; duration of fluoroscopy:(15 ±5) min vs.(35 ± 10) min,t =13.08,P ＜0.01).Both groups had one case who developed compilations which were pocket hematoma and wire electrode dislocation respectively.The rate of complications was not significantly different between the two groups (P ＞ 0.05).Conclusion The SCV approach should be considered a preferable access in pacemaker implantation.

This thesis analyzed the inevitability of medical negligence according to the nature of medical behavior,particularity of medical profession and psychological factors of medical staff.How to control the occurrence of medical errors is an important social problem which is the whole community has been looking forward to solve.This thesis proposed methods to reduce medical negligence from the aspects of service concept,medical education and healthy psychology.

Objective To investigate the clinical effect and safety of spleen-preserving surgery by microwave tissue coagulation (MTC) therapy.Methods Retrospectively analyzed the clinical data of 45 cases undergoing spleen retaining surgery by MTC therapy (observation group) and comparative study was used on another 45 cases experiencing splenectomy (comparative group),clinical effect and complications were compared.All cases were patients from Jan.2010 to Jun.2013.Results All cases were cured.Hospitalization of observation group is obviously shorter than that of comparative group(P =0.007).The rate of complication in observation group(4.44％) is lower than that in comparative group (20.00％),but the time and amount of bleeding in operation of observation group is much more than that of comparative group.Conclusion MTC can effectively guarantee patients safety,shorten hospital stay,and be worthy of popularization.

BACKGROUND:The treatment difficulties of thoracolumbar angular kyphosis surgery are:low correction rate, hard to rebuild sagittal plane, easily induce neurological complications, postoperative loss of balance, high incidence of pseudarthrosis and postoperative loss of correction degree.
OBJECTIVE:To explore the safety and efficacy of modified posterior vertebral column resection osteotomy and bilateral pedicle screw combined with echelon tight closure spinal cord technique and implant fixation for severe spinal angular kyphosis.
METHODS:A total of 87 severe spinal angular kyphosis patients, 36 males and 51 females, who were treated in the Department of Orthopedics, the 306 Hospital of Chinese PLA from January 2006 to December 2013, were enrol ed in this study. They underwent posterior vertebral column resection, bilateral pedicle screw combined with echelon tight closure spinal cord, and implant fixation. Kyphosis, spinal sagittal imbalance, offset rate towards trunk side, operation time and intraoperative blood loss were observed before and after treatment.
RESULTS AND CONCLUSION:The preoperative average kyphosis was 90.1° (31°-138°). The postoperative average kyphosis was 27.9° (15°-57°). The improvement rate was 76%. The improvement rate of trunk sagittal offset was 76%. Intraoperative blood loss was 800-3 000 mL, and average blood loss was 2 300 mL. The operation time was 5-7 hours, averagely 5.9 hours. Before treatment, two patients affected neurologic symptoms in double lower extremity, and their Frankel classification was grade C and became grade E after treatment. Al patients were fol owed up for 9-57 months. Bony fusion was achieved in al patients. No complications of spinal cord injury appeared, and no orthopedic angle missing occurred. These results indicate that during posterior vertebral column resection for treating severe angular stiffness of the thoracic kyphosis, blood vessels could be maintained greatly. Blood vessel injury-induced ischemic changes in spinal cord and ischemic reperfusion injury could be avoided. To reduce hemorrhage and to keep effective blood volume in patients with low body mass are effective for early recovery after treatment. Bilateral pedicle screw combined with echelon tight closure spinal cord technique greatly protected spinal cord cells against injury. We should pay attention to the protection and loose of nerve root to avoid postoperative nerve root irritation. Sufficient bone fusion ensures kyphosis correction, avoids spine lateral offset, and plays a key role in spinal function and postoperative orthopedic effect.

Pulse recognition is an important part of the objectification and intelligence of TCM.This non-invasive and fast diagnostic method has great clinical value,however,data imbalance and cumbersome feature extraction are still challenging problems.The feature vectors were extracted from the one-dimensional pulse signal obtained after the Butterworth bandpass filter using the tsfresh library.And 9 columns of medical auxiliary features selected by exploratory data analysis were added.The feature filtering is performed jointly to derive 21 columns of feature vectors,which are used as input to the weighted soft voting fusion model.The data imbalance problem is solved by Borderline SMOTE algorithm.Construct a weighted soft-voting fusion model based on four types of machine learning:XGBoost,RF,LGBM,and GBDT.Eventually,the models will output specific pulse categories and demonstrate the performance by evaluating the metrics accuracy,precision,recall and F1 score.The experimental results show that the screened 21 feature vectors for a total of six types of pulse signal test sets achieve an accuracy of 90.04%in the five-fold cross-validation and take only 65.9466 seconds.It can provide a more accurate and intelligent auxiliary reference for pulse signal recognition,with lower operational complexity and higher accuracy compared to commonly used pulse recognition methods.The shorter training time also makes it more clinically useful in the recognition of multiple pulse signals.

Objective To explore the effect of PDCA [plan (P), design (D), check (C), act (A)] cycle on primary cardiopulmonary resuscitation (CPR) training for medical assistants in hospitals. Methods PDCA cycle was used to enhance continuous quality improvement (CQI) of team members to carry out brain storming to find out the root causes of the training difficulty, and directing to the 3 main root causes: lack of emergency rescue consciousness, without systematic training system and improper education procedure, it was proposed to arrange 3 great strategies: emergency rescue knowledge training, design of systematic training system and proper arrangement of training process. The changes of medical assistants' subjective willingness to perform the first aid, the accurate rates of answering questions on CPR location, frequency, depth, ratio of compression to breathing and awareness degree of CPR before and after training were observed. Results After training, the medical assistants' subjective willingness to perform the first aid was higher than that before training [91.7% (121/132) vs. 2.3% (3/132), P＜0.05]. The accurate answer rates on questions concerning CPR basic knowledge, such as location, frequency, depth and compression-breathing ratio had been greatly improved after training compared with those before training [location: 65.2% (86/132) vs. 4.5% (6/132), frequency: 40.2% (53/132) vs. 0 (0/132), depth: 90.2% (119/132) vs. 0 (0/132), compression-breathing ratio: 84.8% (112/132) vs. 1.5% (2/132 ), all P＜0.05]. After training, the percentage of medical assistants having very familiar awareness degree of CPR was significantly higher than that before training [65.2% (86/132) vs. 3.0% (4/132), P＜0.05]. Conclusion Via CPR training PDCA cycle, not only the efficiency of CPR training management is greatly improved, but also the training effect of participants is significantly elevated.

OBJECTIVE: To explore the characteristics of post-operative pain following coblation tonsillectomy and/or adenoidectomy in children with sleep-disordered breathing (SDB) and explore the correlation between the first day post-operative pain scores and age and operating time. METHOD: 1) A total of 113 SDB children scheduled to undergo coblation tonsillectomy and/or adenoidectomy were recruited. 113 children were divided into two groups according to the method of operation, children who underwent coblation tonsillectomy and adenoidectomy were enrolled in study group one and children who underwent coblation adenoidectomy only were in study group two. Be sides, children of study group one with a history of chronic tonsillitis were in chronic tonsillitis group, children without a history of chronic tonsillitis were in non-chronic tonsillitis group. 2) The parents scored pain in their children on a VAS (anchored by "no pain" at 0 and "worst pain" at 10) in the morning, before using any analgesics and having breakfast, over the first 3 and the seventh post-operative days. 3) Post-operative pain scores were compared between both the study group one and two and chronic tonsillitis group and non-chronic tonsillitis group. Futhermore, the correlation between the first day post-operative pain scores and age and operating time were also analysed. RESULT: 1) The difference of post-operative pain scores over the first 3 and the seventh post-operative days were significant between the study group one and group two (P<0.05). 2) Non-chronic tonsillitis group were significantly less painful than chronic tonsillitis group on day 1, day 2 and day 7 (z=-2.004, -2.059, -2.334, P<0.05). But there was no significant difference in pain levels on day 3 (P>0.05). 3) The first day post-operative pain scores was correlated with age (r=0.273, P<0.01) and operating time (r=0.423, P<0.01). CONCLUSION The first day post-operative pain scores was correlated with age and operating time. Children with a history of chronic tonsillitis were more painful than children without the history.
Adenoidectomy ; adverse effects ; methods ; Child ; Child, Preschool ; Female ; Humans ; Hypothermia, Induced ; Male ; Pain Measurement ; Pain, Postoperative ; etiology ; Sleep Apnea Syndromes ; surgery ; Tonsillectomy ; adverse effects ; methods

Objective To explore the effects from the synergy of substrate stiffness and hypoxia on epithelial mesenchymal transition (EMT) of colon cancer cells SW480 by simulating the microenvironment of human colon cancer tissues. Methods Polyvinyl alcohol gels with different stiffness ( 4. 5, 20, 40 kPa) were prepared to simulate the stiffness of each part of colon cancer tissues. The morphological change of cells on substrate with different stiffness was detected under simulated hypoxia ( CoCl2 ) environment. The expression of hypoxia inducible factor (HIF-1α), and EMT markers E-cadherin, Vimentin, Snail 1 were detected by Western blot. The mRNA expression of E-cadherin, Vimentin, Snail 1, matrix metalloproteinase-2 ( MMP-2), and MMP-9 was detected by quantitative real-time PCR ( qRT-PCR). Results Under simulated hypoxia environment, with the increase of substrate stiffness, the SW480 cells spreading area increased, and transformed from round shape into irregular polygon. The EMT of SW480 could be enhanced through up-regulating expression of Vimentin, Snail 1, MMP-2, MMP-9, and down-regulating expression of E-cadherin. Conclusions This study is important for exploring the synergistic effect of substrate stiffness and hypoxia on the EMT of colon cancer cells as well as the molecular mechanism.