The crime of accident of medical treatment is the new crime added to the Criminal law of 1997.Since it appeared in the Criminal law of 1997,there have been many debates about it.One of them is how to comprehend the "serious hurt".I think the prescript itself lacks pertinence and we should make the GBH as the standard of judging the "serious hurt".

Asthma is a common disease in children. Adherence to inhaled glucocorticoid therapy directly affects the outcome of asthma. The article mainly reviews the adherence status, assessment method, patient barriers to non-adherence and intervention strategy,so as to provide references for clinical practices and scientific research of nursing staff.

BACKGROUND:Neural stem cells(NSCs)are characterized by widely resources,convenient harvesting,easy culture and prone to import and express exogenous genes,which can be served as carriers of gene therapy for neural system disease.OBJECTIVE:To review the application of NSCs in spinal cord injury.METHODS:Databases of PubMed(http://www.ncbi.nlm.nih.gov/PubMed)and Wanfang(http://www.wanfangdata.com.cn)were searched by the correspondence author using key words of "neural stem cells,spinal cord injury,cellular transplantation" both in English and Chinese to retrieve papers concerning isolation,identification,differentiation of NSCs as well as its application in repairing spinal cord injury.A total of 82 documents were initial obtained by computer,after repetitive studies were excluded,23 papers were included in the final analysis.RESULTS AND CONCLUSION:The NSCs transplantation has been widely used in animal experiments.Currently,the applications of NSCs in repairing spinal cord injury are concentrated on the following aspects:Firstly,cellular replacement therapy,namely,direct transplanting NSCs or activating in vivo NSCs to differentiate into neurons and glial cells,and then integrating transplanted cells with the existed neural cellular structure to cure the disease.Secondly,NSCs were utilized as gene carriers,which carrying target gene to body and reach the aims of cellular replacement and gene therapy.Thirdly,autologous NSCs were induced differentiation for self neural repair via studying growth factors and cytokines.

Objective In order to research the operative method for preservation of healthy lung in the middle lobe carcinoma.Methods From June,1994 to August,1999,16 cases lobectomy of middle lobe cancer were performed.12 of 16 cases were received middle lobectomy with bronchial wedge-shaped resection,6 of which were followed by partial pulmonary artery resection,2 of which,with pulmonary artery sleeve resection,3 of 16 were cured by the middle lobe sleeve lobectomy,one of which was done with combined partial pulmonary artery resection.One of 16 received both middle and lower lobectomy,simultaneously,completed upper pulmonary vein and lower pulmonary vein reconstruction.Results 16 cases operation were all successful.The survival rate in 1 and 3 years were 88% and 50%,respectively.Conclusion Bronchovascular resection and reconstruction applied to treat the middle lobe cancer not only could maximal remove the focal lesion,but also reserve the healthy lung fully,and expanded the surgical indication.

Objective To analyze the factors contributing to local recurrence following body gamma knife radiotherapy in patients with non-small cell lung cancer(NSCLC),and to explore a standard therapeutic scheme under the circumstance.Methods 332 patients with NSCLC received body gamma knife therapy and subsequent regular follow-up.Dose per fraction and total dosage used were dependent on disease condition,tumor location,tumor features and tumor size,etc.On the basis of patients' conditions and adverse effects,biological effective dose(BED) was 56-90Gy calculated with LQ model.Univariate analyses were performed including sex,age,Karnofsky performance score,clinical stage,pathological type,tumor differentiation degree,tumor size,tumor location,target volume delineation,dose per fraction,BED and chemotherapy scheme,etc.with X2 or t test.By selecting significant clinical factors in univariate analysis,multivariate analyses were performed with COX regression model.Results Of the 332 patients,local recurrence occurred in 22 cases during regular follow-up period,with average recurrence time of 10 months,and the local recurrence rate was 6.63%.The results of multivariate analysis showed that low BED,low Karnofsky score,old age,too small delineation for target volume range and central type of lung cancer were the factors related to local recurrence.Conclusions Low BED in body gamma knife radiotherapy is the significant factor of local recurrence for patients with NSCLC.BED in body gamma knife radiotherapy should be more than 80Gy for NSCLC patients who receive the radical treatment.

Objective To evaluate the therapeutic effects and complications of whole body gamma knife conformal radiotherapy for patients with non-small cell lung cancer(NSCLC).Methods 169 patients with NSCLC received whole body gamma knife conformal radiotherapy.Total dose,fractions,and radiation time were determined based on disease course,tumor location,tumor features and tumor volume,etc.Small target volume(tumor size less than 3cm in diameter) received 5-10Gy each time,40-50Gy in 4-10 fractions;moderate target volume(tumor size 3cm-5cm in diameter) received 4-8Gy each time,48-56Gy in 4-16 fractions;and big target volume(tumor size more than 5cm in diameter) received 3-4Gy per time,40Gy in 10-14 fractions and followed by 10-30Gy using reduced fields.Results Of 269 tumors in 169 patients,complete response(CR) rate,partial response(PR) rate,and rate of no change(NC) were 41.6%(112/269),44.6%(120/269) and 13.8%(37/269),respectively.Overall response rate(CR+PR) was 86.2%(232/269),with 1-year local control rate of 92.3%.1-year and 2-year survival rate was 75.1% and 46.2%,respectively,with median survival time of 19 months.The incidence of Grade 1,2 and Grade 3 radiation pneumonia was 15.4% and 3.1%,respectively.Conclusions With minor adverse effects,whole body gamma knife conformal radiotherapy may have short-term therapeutic effects for NSCLC patients with amelioration of disease symptoms,obvious elevation of tumor local control rate,a raise of the survival rate,and improvement of life quality.

Objective To investigate the effect of propofol on ketamine-induced cognitive dysfunction and neuronal apoptosis in hippocampus in aged rats. Methods Thirty-two male SD rats aged 18-24 months weighing 380-470 g were randomly divided into 4 groups ( n = 8 each) :control group (group C);propofol group (group P);ketamine group (group K) and propofol + ketamine group (group PK). Propofol 30 mg·kg-1·h-1 or/and ketamine 40 mg· kg-1·h-1 were infused for 2 h once a day for 7 consecutive days. After the last day of drug administration cognitive function was assessed using Morris water maze (escape latency and the number of animals' swimming across the platform). The animals were sncrificed after water naze test and their hippocampi were removed for determination of neuronal apoptosis (by TUNEL) and caspase-3 expression (by immuno-histochemistry) in hippocampal CA1 region. Results There was no significant difference in escape latency and the number of the animals,swimming across the platform, the neuronal apoptotic rate (the number of apoptotic neurons/the number of total neurons) and caspase-3 expression between group C and P. In group K and PK the escape latency was prolonged,the number of animals' swimming across the platform was decreased, neuronal apoptotic rate increased and the caspase-3 expression up-regulated as compared with group C. The ketamine-induced changes were significantly attenuated by coadministration of propofol in group PK. Conclusion Coadministration of propofol can ameliorate ketamine-induced cognitive dysfunction and hippocampal neuronal apoptosis.

Objective To investigate the prevalence of the genotypes of extended spectrum ? lactamses (ESBLs) in klebsiella pneumoniae and eschrichia coli, which were isolated in Hangzhou City from 2000 to 2001. Methods Total of 198 isolates of E. coil and K. pneumoniae were isolated from five hospitals in Hangzhou. ESBLs-producing isolates were detected by inhibitor-potentiated disc diffusion test, Agar dilution method was used to determine the minimum inhibitory concentrations (MIC) of cefotaxime and ceftazidime.ESBLs genes were analysed by isoelectric focusing (IEF) assay and PCR initially,genotypes were determined by sequencing. Results 51 isolates (25.76%) from 198 E. coil and K. pneumoniae strains were obtained. In ESBLs producers, the ESBLs types of SHV, TEM, CTX-M were 17.65%,84.31% and 80.39% respectively. genotypes were: SHV 11,12;TEM 1;CTX M 3and CTX M 3 like, CTX M 13,14. respectively. Conclusions CTX M type were the major genotypes of ESBLs in klebsiella pneumoniae and eschrichia coli isolated in Hangzhou city.

Objective To observe levels of the serum albumin and their association with prognosis in children with hand-foot-and-mouth disease (HFMD) . Methods A total of 122 HFMD children admitted from 2011 to 2013 were selected and divided into three groups:common group (n=57), severe group (n=52) and critical group (n=13). Serum albumin levels, blood glucose levels, peripheral blood white cell counts of the children in the three groups were compared within 24 hours of admis-sion. Moreover, the incidence of hypoalbuminemia and mortality of the children were analyzed in each group. Results In critical group, serum albumin levels were signiifcantly decreased while blood glucose levels and peripheral blood white cell counts were signiifcantly increased than those in the severe group and common group, and the differences were all statistically signiifcant (all P<0.05). There were no signiifcant differences in serum albumin levels, blood glucose levels and peripheral blood white cell counts between severe group and common group (all P>0.05). There was no hypoalbuminemia and death in severe group and common group. The percentage of hypoalbuminemia and mortality of children in critical group were higher than those in the other two groups (all P<0.01). Conclusions The mortality was extremely high in children with critical HFMD. The decrease of serum albumin levels was a high risk factor for death in children with critical HFMD. Early and dynamic monitoring serum albu-min levels may be helpful in evaluation of disease condition and prognosis of HFMD.

Objective To investigate the clinical efficacy of intravitreal injection of Lucentis combined with pan retinal photocoagulation and trabeculectomy for neovascular glaucoma(NVG). Methods Seventeen eyes of 15 patients with NVG were treated by 0.5 mg Lucentis intravitreal injection first. Trabeculectomy was performed 7 days later and Pan retinal photocoagulation 2 weeks later. Iris,anterior chamber angle neovascularization,intraocu?lar pressure ,and visual acuity were observed in the following 6 months. Results Iris and anterior chamber angle neovascularization were completely regressed 7 days after the injection in 17 eyes. Six months after photocoagulation, 6 eyes had different degrees of improvement in visual acuity,10 eyes no change in visual acuity and 1 eye decreased from anterior index to immediate manual. There was significant difference in pre?treatment IOP and postoperative IOP( t = 12.75 ,10.26 ,9.73 ,10.77 ,P < 0.01 ). No serious complications were observed after intravitreal injec?tion and trabeculectomy. Conclusions Intravitreal injection of Lucentis could significantly accelerate the regres?sion of iris and anterior chamber angle neovascularization ,which could improve the successful rate of trabeculecto?my and pan retinal photocoagulation. Intravitreal injection of Lucentis combined with trabeculectomy and panretinal photocoagulation is safe and effective for NVG.