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.

Objective To understand the clinical features of primary Sjgren′s syndrome (pSS) in both sex,thus to improve the level of diagnosis and treatment.Methods Clinical data of 77 cases of pSS were collected and analyzed.Results No significant difference was found between male and female in mean age of onset and average disease duration at the time of diagnosis.Patients with dry mouth/eye as a complaint for seeing a doctor accounted for only less than a half;whereas,hyper ? globulinemia existed in more than 90% of the patients.The onset symptom in male was more different from female.Dry mouth/eye,arthralgia,pulmonary manifestations,renal tubular acidosis,and dermatic manifestations were the frequent presentations.Dry mouth/eye presented latter,uncommon,and milder in male than in female.However,no difference was found between male and female in the incidence of salivary gland involvement.Pulmonary symptoms presented earlier,and the incidence of pulmonary fibrosis was higher in male than in female.Whereas,the pulmonary symptom occurred earlier in male patients,and the incidence of pulmonary interstitial fibrosis was higher in male than in female.The incidence of positive RF and anti SSA/SSB antibody was significantly lower in male than in female.Conclusion Primary Sjgren′s syndrome is one of the systemic immune diseases.It′s clinical manifestations were diverse.Less than a half of patients see a doctor because of dry mouth/eye.There are many differences between male and female patients in clinical presentations;and the incidence of positive auto antibodies is lower in male patients than in female.

BACKGROUND:There are many animal models used for studying discogenic pain, but percutaneous puncture annulus is rarely reported. Minimal y invasive approach to establish a discogenic pain model in Spraque-Dawley rats could reduce the interference factors of surgical trauma.
OBJECTIVE:To establish a Spraque-Dawley rat model of discogenic pain by percutaneous puncture annulus, with easy operations, high stability and obtaining large-scale productions, and to confirm the model by the results of behavior, MRI and molecular biology.
METHODS:Eighty-eight male Sprague-Dawley rats, of specific pathogen free level, were randomly divided into three groups, model group (n=44), control group (n=10) and sham group (n=34). In the model group, the annulus was percutaneously punctured under X-ray guidance;while rats in the sham group were punctured at the paravertebral tissue, rather than the annulus.
RESULTS AND CONCLUSION:The 50%mechanical withdrawal threshold of both hind paws in model group were reduced compared with control group and sham group. In the model group, the L 5/6 intervertebral disc degeneration was apparently visible, and the degree of degeneration was aggravated along the time. In the model group, the expression of calcitonin gene-related peptide in dorsal root ganglion of rats began to increase at 3 days post-operation and reached the peak at 21 days post-operation, then remained at high levels until the 35th day post-operation. The expression of tumor necrosis factor-αin dorsal root ganglion of rats increased at 3 days post-operation and reached the peak at 14 days post-operation, then remained at a higher level until the 35th day post-operation. The experiment result verifies that the discogenic pain model of Spraque-Dawley rats induced by percutaneous puncture annulus has the advantages of good stability and less trauma. The model can be used to study discogenic pain.

BACKGROUND: The data of epidemiological survey on rheumatic diseases such as ankylosing spondylitis (AS) are very rare in China, especially in Shenzhen. The comprehensive understanding of epidemiological situation of AS in Shenzhen can be used to draw up treatment plans by Shenzhen Health Bureau and some other health organizations.OBJECTIVE: To investigate the epidemiological features of AS.DESIGN: Randomized complete collection and cross-sectional investigation.SETTING: Shenzhen Rheumatism Institute of Guangdong Medical College. PARTICIPANTS: From December 2001 to April 2004, totally 6 684 adults aged over 16 years were selected from three regions (one region of river and lakes, one local mountain region and one inhabitant region) of Shenzhen. Among them, 5 922 adults (2 659 males and 3 263 female) were actually investigated and the investigative rate was 88.6%. Males were accounted for 44.9% and females were 55.1%, and the ratio was 1:1.23.METHODS: Step 1 and 2, the investigated individuals were questioned and their answers were recorded by the investigators. The questionnaire proceeded one by one for every individual and proceeded at homes. Step 3,the individuals with positive findings at steps 1 and 2 were examined by rheumatologic doctors. Step 4, individuals with suspected AS were subjected to human leukocyte antigen B27 (HLA-B27) assays, radiographies including plain pelvic films, plain lumbar-vertebral films and if necessary, radiographies at other areas of spinal column as well as peripheral joints.MAIN OUTCOME MEASURES: Frequencies of rheumatic complaints,prevalence rate of AS, positive frequencies of hum an HLA-B27, and comparisons with relevant data abroad.RESULTS: ① General frequency of rheumatism was 21.6%, and the highest complaint was at knee joint, then at waist, shoulder, neck and hand. In female, the frequencies of complaints at every joint mentioned above were higher than those in male (P ＜ 0.05). A total of 13 patients (4.7%) had to discontinue their work because of rheumatic diseases. ②Prevalence rate of AS was accounted for 0.37%, and the ratio between male and female was 4.5: 1. The onset of AS began at middle age in majority patients. ③ Positive frequency of HLA-B27 was 5.0%. ④ Rate of misdiagnosis, the rate of early diagnosis and the rate of long-term irrational drug-usage were 64%, 27% and 73%, respectively.CONCLUSION: In Shenzhen, the prevalence rate of AS (0.37%) is ranked higher than that in Beijing (0.26%), Shantou (0.26%), America(0.20%) and the whites of Greece (0.24%). The differences among them may be connected with the fact that in Shenzhen the young people occupy a large proportion of population.

Objective To evaluate the safety and efficacy of endoscopic radial incision (ERI) for benign stricture of upper digestive system. Methods Patients with benign esophageal or gastric stricture (including anastomotic stricture, stricture after ESD and caustic stricture) were enrolled in this study. The stage of stricture, length of the lesion and the thickness of the scar were recorded. ERI (maybe associated with balloon dilatation) were performed. Post-opera-tive symptoms, complications and follow-up were also recorded. Results 7 patients were enrolled and all received ERI, and 4 additional balloon dilatation were done. Dysphagia in all patients relieved. 1 case with hemorrhage oc-curred and relieved with conservative treatment. Majority of the patients got long-term remission after 1~2 times of ERI. Conclusion ERI is safe and effective for benign stricture of upper digestive system. It may prolong the dyspha-gia-free period, worth clinical promotion.

Objective To identify regular roots for medical disputes by case studies for providing evidences for hospital management..Methods 200 cases of medical malpractice were selected consecutively and categorized according to the causes,dispute focus and expert opinions.Results The main factor to trigger medical disputes is dissatisfaction of the outcome,accounting for 50.5％.48.15％ of the disputes,however,result from dissatisfaction of the therapy process which constitutes a medical malpractice.Neglect or defects in treatment,surgical operation,information notice and medical papers were highly common causes.Conclusion Medical disputes result from a variety of causes,so are the roots of medical malpractice.Medical institutions are recommended to enhance medical quality management,make sufficient doctor-patient communication,and make high quality documentation of key medical activities,in an effort to minimize medical disputes and medical malpractice.

BACKGROUND:Previous studies have documented that,the increase of anti-cardiolipin(aCL) antibody titer has an obvious positive relaltionship with the vascular thrombosis,thrombocytopenia and repeated abortion in the patients with systemic lupus erythematosus and antiphospholipid syndrome,but there is little information on the aCL antibodies in lupus nephritis(LN).OBJECTIVE:To ascertain the preyalence and significance of aCL antibodies in Chinese patients with LN.DESIGN:Prospective follow-up study of one sample.SETTING:Department of Rheumatology in Xiangmihu Branch of Shenzhen Fourth People's Hospital,Shenzhen Institute of Rheumatology in Guangdong Medical College.PARTlCIPANTS:The study was performed in 97 LN Patients consecutively recruited in the Department of Rheumatology in Xiangmihu Branch of Shenzhen Fourth People's Hospital between March 2001 and October 2003.All the included patients met the revised criteria of American College of Rheumatology for the diagnosis and classification of LN.And they all knew the fact saying yes.METHODS:The clinical data and auxiliary examination result were recorded when hospitalizalion.The aCL antibodies were measured by the enzyme-linked immunosorbent assay,and Were considered as positive if over 100 U/mL.High-dose oral administration of prednisonc combined with cyclophosphamide intravenous pulse therapy were applied for inducing release.The curative effect was remained by using azathioprine and prednisone at a decreasing dose.Meanwhile the complications such as hypertension,hyperlipemia and arthralgia were prevented by drugs.All the patients had routine visits at six-month intervals for a total of 3 years,Clinical and seroIogic manifestations of Patients with LN were tested and recorded regularly.MAIN OUTCOME MEASURES:Gender,age,systemic lupus erythematosus disease activity index,clinical manifestations,vascular thrombosis,pregnancy outcome and renal function.RESULTS:All the 97 LN Patients were included in the study.and 83 of them entered the result analysis while the other 14 cases were lost.The overall prevalence of aCL antibodies in 97 subjects was 39%(38 cases).Hypertension,thrombocytopenia and Raynaud's phenomenon were more frequent in LN Patients with aCL antibodies.The aCL IgG antibody-positive Patients showed a greater risk for the occurrence of vascular thrombosis;Pregnancy morbidity of miscarriages,premature birth,fetal death and the probabmty of developing irreversible renal function deterioration occurred at a greater frequency in aCL antibody-positive patients.CoNCLUSIoN:The prevalence of aCL antibodies in LN Patients is 39%.A higher incidence of hypertension.thrombocytopenia and Raynaud's phenomenon is found in patients with aCL antibodies.Detection of aCL antibodies in Patients with LN may be usefol to predict the development of vascular thrombosis,pregnancy morbidity and irreversible chronic renal function deterioration.

Objective To observe the effect of low level infrasound on neuropathic pain and explore its underlying mechanism. Methods Rats were divided into experimental and control groups after their L5 spinal nerves had been ligated to create a neuropathic pain model. The experimental group was subjected to 40 to 80 dB infra sound. The control group received no infrasound treatment. Paw withdrawal latency in response to heat radiation was measured and the average gray scale of the microglia in a slice of the L5 spinal cord was compared. Results The experimental group expressed significantly lengthened paw withdrawal latency on the 12th and 14th day. The average gray scale showed significantly weakened activation of spinal microglia in the 2nd week of infrasound treatment compared with the control group. Conclusion Low level infrasound can ameliorate neuropathic pain to a certain extent,which might be related with inhibition of spinal microglia.

Objective According to the clinical and gene mutation characteristics of ACADVL-related very long chain acyl-CoA dehydrogenase deficiency(VLCADD),the types that contribute to the gene mutation of ACADVL were summarized.Methods By analyzing clinical,laboratory and genetic data of 1 case with ACADVL-related very long chain acyl-CoA dehydrogenase deficiency diagnosed from Department of Pediatrics,the Affiliated Hospital of Inner Mongolia Medical University in August 2016,based on the agreement signed by both the litde patient's parents and the hospital,plus the high-throughput sequencing analysis and PCR sequencing test for the 2 generation genes,some presented mutation sites were analyzed and concluded,in addition to taking "ACADVL" as key words to search the databases from CNKI,Wanfang(updated in 2016) as well as PubMed and related documents from On-line Mendal Inheritant databases of Man (OMIM) and HGMD.Results Through physical examination,VLCADD was diagnosed.After being given Levocamitine and the diet likemedium-chain fatty acid food for a week,the metabolism returned to normal.Tracking him for 3 months,his hepatitis obviously rebounded,within the reach of 3 cm under the right rib and 1 cm under the xiphoid.The exome sequencing study (trios) was identified the novel heterozygous mutation according to the statistics below A CAD VL (N M_000018.3) Exon7:c.608 C ＞ T;p.(Pro203 Leu) (heterozygous) and A CAD VL (NM _000018.3) Exon18:c.1748C ＞ T;p.(Ser583Leu) (heterozygous) in ACADVL.Relevant literature reported suggest these two mutations from both the parents are pathogenic genes,which can account for the reason why the boy got ill.However,these two mutations had not been reported in ACADVL-related VLCADD so far.Up to now,73 types of mutations from documents index were related to the VLCADD,but the clinical case included 75 kinds of gene mutations.Conclusions The apparent symptoms of the boy with the gene mutation were reflected in abnormal heart rates,hepatomegaly and hypoglycemia.VLCADD was diagnosed through genetic testing,and systematic treatment can partly control the development of the disease.In conclusion,the findings (exon 7 and 18) show that according to the genetic tests,disease-causing genes from both parents are new mutations of ACADVL and they are pathogenic.

AIM: To investigate the effective dose of esketamine for prevention on propofol injection pain in painless abortion. METHODS: From November 2021 to December 2021, thirty patients undergoing painless abortion, aged 20 to 40 years old, ASA physical status or Ⅱ, BMI 19-26 kg/m