The defensive medical treatment can be classified both into the field of medical sciences, as well as the ethical and legal circle. This article, starting from the concept and historical changes of the defensive medical treatment, deeply discusses, in combination with the basic principles in medical ethics and jurisprudence, the reason why the defensive medical treatment originated and evolutes. Furthermore, some suggestions and solutions, based on relevant medical legislations, the enhancement of physicians' professional ethical standards and the establishment of the hospital's internal supervision mechanism, are put forward for the legislative bodies, the medical service providers and governments on how to reduce the defensive medical treatment. In achieving this goal, of course, we can not ignore the positive role of the general public.

While the basic concept of saving life and decreasing disability h as not changed in the management of polytrauma, the timing and strategies of tre atment have been gradually modified. Damage control is one of the new strategies , and its application in orthopedic traumatology is known as damage control orth opedics. Damage control orthopedics involves formalized three stages in the mana gement of fractures of long bones and pelvis. Stage 1 consists of temporary fixa tion of the unstable fractures and hemostasis. Stage 2 comprises resuscitation, warming, oxygen delivery and administration of coagulation factors to the patien t in the intensive care unit. In Stage 3 definitive fixation is done for the fra cture. Indications of damage control orthopedics: for patients with polytrauma w hose conditions are unstable or in extremis the damage control strategy is recom mended. For the borderline patients early total care may be applied, but the sur gery should be performed with great caution. It has to be converted to the damag e control strategy if conditions of the patient deteriorate during the operation . Since damage control orthopedics is an evolving practice, further work is need ed to enhance its effectiveness and to reduce the incidence of ARDS and MOF.

OBJECTIVE: To summarize and analyze the characters, pathogenesis and influencing factors of various tremors, so as to provide evidence for the identification, prevention and treatment of various tremors in clinic.DATA SOURCES: A computer-based online search of Medline database was undertaken to identify articles about tremor published in English between January 1998 and May 2005 with the keyword of "tremor". Meanwhile, Chinese relevant articles published between January 1998 and May 2005 were searched with computer in Chinese full-text journal net by using the keyword of "tremor" in Chinese. STUDY SELECTION: The data were primarily checked. Inclusive criteria: ① articles about the classification, etiological factors and influencing factors of tremor; ② retrospective investigation on specific events. Exclusive criteria: repetitive studies.DATA EXTRACTION: Totally 48 articles were collected, and 31 repetitive studies were excluded. Of the other 17 ones accorded with the inclusive criteria, 9 were the investigations about tremor, and 8 were the specific cases of tremor.DATA SYNTHESIS: Tremor is classified mainly according to its manifestations and the etiological factors of basic disease. Mechanical tremor,reflexion of central nervous system and central oscillator are the pathogenesis of tremor. According to the manifestations, tremor canbe classified into static tremor, kinetic tremor, essential tremor, postural tremor, unfixed tremor. According to the different etiological factors, tremor can be classified into enhanced physiological tremor, essential tremor syndrome (classical essential tremor, orthostatic tremor, task-specific tremor, undetermined tremor), dystonic tremor, cerebellar tremor, Holmes tremor, peripheral neuropathic tremor, drug-induced and toxic tremor and psychogenic tremor,and different treatments should be adopted according to different etiological factors in clinic.CONCLUSION: Tremor has similar manifestations, but the pathogenesis are different, so different treatments should be adopted according to different etiological factors in clinic.

Objective To investigate the effects of fruit potassium supplement on hypokalemia at in the perioperative period of percutanous coronary intervention(PCI)? Methods Ninety cronary herat disease patients with hypokalemia undergoing PCI during July to December 2011 involved the study? Since admission,the patients were administered with oranges and bananas each 500 g daily until the third day after PCI,on the basis of oral administration of potassium? Serum potassium was assessed in all patients at time points of the day at PCI,the first day and third day after PCI? Results The time range for the patients to take potassium supplement by eating fruits was 12-45 hours,averaged(28?84 ± 11?70)hours? The serum potassium levels on days 1 and 3 were significantly higher than that on the day for the admission(P < 0?05 for both)and even maintained at the normal level? Conclusion The oral complement of potassium by eating bananas and oranges can help patients to correct and prevent hypokalemia during the perioperative period of PCI?

Modern Chinese Orthopaedic traumatology has stemmed from the orthopaed ics of Traditional Chinese Medicine(TMC)and western orthopaedics.On the one hand,with a long history and its unique system of theory and treatment,TMC orthopaedics h as made a great con-tribution to the development of modern Chinese orthopaedic traumatology.On the other hand,the introduction and development of western medicine have dramatically pro moted the development of modern Chinese orthopaedic traumatology.Modern Chinese surgeons of orthopaedic trauma have accomplished numerous successful f irst cases in the world since 1950s an d have thus expanded their professional influence.At pr esent,the Chinese orthopaedic trau ma community has grown much stronger and established its ow n academic associations and journals.More and more de-partments of orthopaedic traumatology have been successively establis hed as an independent en-tity in large and middle-sized hospi tals in China.So far,the Chinese orthopaedic trauma com-munity,on the whole,has reached the international level,but there are q uite a lot to be improved in the aspect of treatment.To end the backwardness,in the future Chinese orthopaedic trauma community should make great efforts in education of orthopedists on comp rehensive knowledge,establishment of formal profession al training system,national standardization of orthopaedic procedures in clinical diagnosis an d treatment,active membership of re lative international aca-demic associations and increasing p rofessional exchanges with international counterparts,as well as in research and development of operative techniques and fixators.All these will be the main strategies and developmental trends in the future for Chinese orthopaed ic traumatology. [

Objective To analyze the effects of position shift and dose adjustment on the pass rate of IMRT dose verification to facilitate to obtain rapidly high-pass-rate IMRT dose verification report.Methods At first,the dose unit of measuring dose map image and planning Dose Profile was unified.Secondly,the planning Dose Profile was moved at lateral and cephal-ocaudal directions respectively in contrast mode so as to determine the position error with the maximum pass rate.Thirdly,the highest pass rate point of dose verification was found in the range of dose adjustment.Fourthly,the plan report with the highest pass rate of dose verification was found out by adjusting position error and dose coefficient.Results The highest pass rate was obtained in case the displacement was-3 mm at lateral direction or +3 mm at cephal-ocaudal direction;high pass rate was got when dose adjustment coefficient was 1.02;high pass rate was achieved in case the displacement was-3 mm at lateral direction,+2 mm at cephal-ocaudal direction and the dose adjustment coefficient was 1.02,which was significantly different from those with other combined values (P＜0.05).Conclusion The dose verification technique is convenient and quick when used to obtain a high-pass-rate dose verification report.

Objective :To study the effects of NO precursor, L-arginine(L-Arg) and constitutive nitric oxide synthase(cNOS) inhibitor, L-nitroarginine(L-NNA)) on the expression of cNOS in facial nerve and surrounding tissues in traumatic facial paralysis rats. Methods:Facial paralysis was surgicaly created by impact in 57 SD rats. The rats were divided into 3 groups with 18 in each group, another 3 rats were used for morphological study. L-Arg at 40 mg/kg or L-NNA at 50 mg/kg were intraperitoneally injected into rats 2 times a day, from 4 days before untill 14 days after surgery(group L-Arg and group L-NNA). In control group(NS) same volume of normal saline was given to the rats after creation of facial paralysis. The facial nerve and surrounding tissue samples were obtained at different time. Immunohistochemical ABC method was used to examine cNOS and inducible NOS (iNOS) expression in facial nerve and surrounding tissues. Results:cNOS immunoreactivity was observed in traumatic facial nerve in L-Arg group 7 days after trauma and in the adjacent muscle in the 3 groups from 6 h to 3 d after trauma. iNOS was found in the paralyzed nerves from 1 d to 7 d after trauma in the 3 groups, and in the adjacent tissues from 6 h to 3 d after trauma in the 3 groups. Conclusions:L-Arg may stimulate constitutive NOS expression in facial nerve and probably promote the nerve regeneration.

OBJECTIVE:To standardize hospital purchasing management for medicinal material. METHODS:The separation of the four powers,including plan,purchase,supply,and payment,was practiced on the basis of centralized purchasing medicinal material in our hospital. SWOT method was used to analyze the strengths,weaknesses,opportunities and threats of the model;im-provement measures were formulated;finally the effects of the model were evaluated. RESULTS:This model played an active role in the professional advantage of purchasing management,made up for the lack of management system and manpower shortage dis-advantage;adapted to policies to seize the opportunities for improvement,reduced the threat of standard deletion and purchasing cost,and promoted reasonable consumption of medicinal materials. And then the purchasing cost of our hospital was reduced after system procedure improvement,fine management of medicinal material and professional level improvement,medicine ratio fell from 42% in 2010 to 37% in 2014;logistics support became stable and standard,and the level of medicinal material supply was improved. CONCLUSIONS:The purchasing model for medicinal material under separation of the four powers provides the refer-ence for the correct course of the standardized,normalized and modernized hospital purchasing management.

Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) combined with eye-acupuncture on cognitive dysfunction on cognitive dysfunction in patients with traumatic brain injury. Methods From May, 2014 to June, 2016, 90 trau-matic brain injury patients with cognitive impairment were randomly divided into eye-acupuncture group (n=30), rTMS group (n=30) and combination group (n=30), who accepted eye-acupuncture, rTMS and combination of eye-acupuncture and rTMS, repectively, for eight weeks. They were assessed with Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) before and after treatment. Results There was no significant difference in scores of LOTCA among three groups before treatment (F<0.523, P>0.05). The scores of LOTCA were the best in the combination group after treatment (F>3.789, P<0.05). Conclusion The combination of eye-acupuncture and rTMS is more effective in improving cognitive function after traumatic brain injury than either alone.

Objective To observe the effects of aerosolized prostaglandin E1 (PGE1 )via right lung before one-lung ventilation (OLV ) on shunt rate (Qs/Qt ) and oxygenation in patients undergoing surgery for oesophageal cancer.Methods Sixty patients scheduled for elective trans-left-thoracic esophagectomy for esophageal cancer were randomly and single-blindly located into two groups.Patients in each group received different therapy before OLV,namely inhaling PGE1 0.2μg/kg via right lung in group P and inhaling normal saline in group C.The PaO 2 and hemodynamic indicators of two groups were recorded at these points:before OLV(T1 ),OLV 10 min (T2 ),OLV 1 5 min (T3 ),OLV 30 min (T4 ),OLV 60 min (T5 ),OLV 120 min (T6 ),.Results PaO 2 in both groups were declined straightly since OLV and fell to the lowest point at T4 in group C.PaO 2 in group P at T2-T4 were significantly higher than that in group C (P <0.05),and the lowest point of which was recorded at T5 .Qs/Qt in group P was significantly lower than that in group C at T2-T4 (P <0.05).There were no significant differences in hemodynamics indicators between the two groups. Conclusion Inhalation of 0.2 μg/kg PGE1 before OLV via one lung can reduce pulmonary shunt and improve PaO 2 in thoracic surgery patients.