In recent years,medical disputes in China are on the rise and it has been one of the social hot issues.Reasons for the medical disputes can be the disadvantages of present medical system or imperfection of medical laws and regulations,or irresponsibility of medical workers or poor medical skills.In response to these reasons,reforming the existing medical system,perfecting the law system in the field of health,strengthening the construction of medical workers'morality,upgrading medical skills and so on,should be adopted to reduce the occurrence of the medical disputes to the greatest extent.Meanwhile,a variety of solution systems related to medical disputes should be established to findact out proper resolutions to the medical disputes occurred.

Objective To observe the effect of 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) on S.epidermidis planktonic cells,and to determine the optimal concentration and incubation time of ALA.Methods Some S.epidermidis planktonic cells were divided into 3 groups to be incubated with ALA at 50 mmol/L for different durations (3,5,8,12,16,18,20 and 24 hours) at 37 ℃ in dark room (group 1 ),with ALA at various concentrations ( 10,20,30,40 and 50 mmol/L) for 16 hours at 37 °C in dark room (group 2),and with fresh trypticase soya broth (TSB) solution for 24 hours at 37 ℃ in dark room (group 3),respectively.Confocal laser scanning microscopy (CLSM) was used to measure the fluorescence intensity of protoporphyrin Ⅸ (PpⅨ) in bacterial suspensions at different time points.Additionally,some S.epidermidis planktonic cells in group 1 were irradiated with red light at 30,50,70,90 and 100 J/cm2 after incubation with ALA at 50 mmol/L for 16 hours,some in group 2 were irradiated with red light at 100 J/cm2 after incubation with ALA for 16 hours,those cells in group 3 received no irradiation (blank control group),and some S.epidermidis planktonic cells receiving only irradiation and no pretreatment with ALA served as the laser control group; subsequently,the bacterial suspension was inoculated onto trypticase soy agar (TSA) followed by the calculation of colony forming units (CFUs) of S.epidermidis.Results Brick red fluorescence was observed by CLSM in S.epidermidis planktonic cells in group 1 and 2,but not in those in group 3,and the fluorescence intensity was enhanced with the increase in incubation time and concentration of ALA.In detail,the fluorescence intensity was significantly higher in planktonic S.epidermidis cells after 16-,18-,20- and 24-hour incubation than in those after 3-,5-,8- and 12-hour incubation with ALA at 50 mmol/L (all P ＜ 0.05),and higher in those incubated with ALA at 50 mmol/L than in those with ALA lower than 50 mmol/L (all P ＜ 0.05).After irradiation,the number of surviving S.epidermidis planktonic cells declined with the increase in ALA concentration and red light doses,statistically lower in the group 1 and 2 than in the blank control group (both P ＜ 0.05),but similar between the blank control and laser control group (P ＞ 0.05).The growth of planktonic cells was inhibited after incubation with ALA at 50 mmol/L and irradiation with red light at 100 J/cm2.Conclusions ALA-PDT shows a marked inhibitive effect on S.epidermidis planktonic cells,with the optimal working concentration of ALA being 50 mmol/L,incubation time 16 hours,and dose of red light 100 J/cm2.

Objective To investigate the effect and safety of photodynamic therapy (PDT) with topical aminolevulinic acid (ALA) in moderate to severe acne. Methods Seventy patients with moderate to severe acne were randomly divided into two groups, one group was treated with topical ALA-PDT for 1-3 sessions with an interval of 2 weeks, the other group received oral isotretinoin 10 mg twice a day for 6 weeks. Patients were evaluated for efficacy on week 2, 4 and 6 after the initial treatment. A 3-month follow up was performed to monitor adverse events following the end treatment. Results The total effective rate was 97.1% in ALA-PDT group after 1-3 sessions of treatment, 80.0% in the control group on week 6, and the difference was significant between the two groups (P<0.05). Acne lesions tended to recur more slightly with a longer remission period in ALA-PDT group than in the control group. A temporary and local pigmentation was observed in some patients treated with ALA-PDT, but no scar was noticed. Conclusion Topical ALA-PDT is a simple and effective treatment option for moderate to severe acne with mild side effects.

Objective To observe the clinical efficacy of acupoint sticking with Chan Wu gel in managing cancer pain.Method A hundred patients were randomized into a treatment group of 50 cases and a control group of 50 cases. The treatment group was intervened by thethree-step analgesic ladder plus acupoint sticking with Chan Wu gel; the control group was by the three-step analgesic ladder alone. The decrease of the pain degree, action and lasting time of analgesia, and adverse reactions in the two groups were observed.Result The treatment group was superior to the control group in comparing the release of pain, action and lasting time of analgesia; the occurrence rate of adverse reactions in the treatment group was obviously lower than that in the control group(P<0.05).Conclusion The conventional three-step analgesic ladder plus acupoint sticking with Chan Wu gel is effective in mitigating cancer pain, and it can reduce the dose of the three-step analgesics and the adverse reactions.

Objective:To observe the clinical effect of electroacupuncture (EA) plus pricking-cupping bloodletting therapy for herpes zoster.
Methods:A total of 43 patients with herpes zoster were randomly divided into two groups, 23 cases in the treatment group and 20 cases in the control group. The treatment group was given EA plus pricking-cupping bloodletting therapy. The control group was given oral administration of Aciclovir Tablets, Diclofenac Sodium Dual Release Enteric-coated Capsules, Methylcobalamin Dispersible Tablets, and V itamin B12.
Results: The total effective rate was 87.0% in the treatment group and 70.0% in the control group, with a statistical significance in difference of the total effective rate between the two groups (P<0.01).
Conclusion:The clinical effect is better in the treatment of herpes zoster by EA plus pricking-cupping bloodletting therapy than by medications.

Objective To evaluate the efficacy of light-emitting diode (LED) irradiation at 530 nm,630 nm and 850 nm in the treatment of photoaged skin.Methods A total of 14 adults with photoaged extensor forearm were recruited in this study.Three areas were selected at the extensor forearm in each of these subjects and received LED irradiation at 530 nm,630 nm and 850 nm,respectively,thrice a week for 12 sessions.Dermoscopy was used to visualize these areas before and after the irradiation,the Corueometer CM 825 to measure stratum corneum (SC) hydration,Tewameter TM 300 to determine transepidermal water loss (TEWL),and CM-2600d spectrophotometer to measure L* value and melanin index (MI).Tissue specimens were obtained from these areas irradiated with LED at 530 nm (n =5),630 nm (n =5) and 850 nm (n =4) separately before and 6 weeks after the initial irradiation,and subjected to histopathological examination.Results Both skin texture and pigmentation were improved in 10 and 7 testees after 12 sessions of LED irradiation at 630 nm and 850 nm,respectively,but the skin texture became rougher and pigmentation was increased in 7 testees after LED irradiation at 530 nm.After LED irradiation at 630 nm and 850 nm,the testees experienced an obvious increase in SC hydration ((37.9 ± 7.7) au and (34.5 ± 7.1) au at 6 weeks after the initial irradiation vs.(33.1 ± 6.1) au and (32.0 ± 7.0) au before irradiation,both P ＜ 0.05),but a significant decrease in TEWL value ((9.8-± 2.5) and (10.9 ± 2.5) g·m-2·h-1 at 6 weeks after the initial irradiation vs.(14.0 ± 1.8) and (14.2 ± 2.6) g·m-2·h-1 before irradiation),with no significant changes in L* value or MI (both P ＞ 0.05).No evident alteration was observed in SC hydration or TEWL value (both P ＞ 0.05),while the L* value significantly decreased (P ＜ 0.05) and MI increased (P ＜ 0.05) after LED irradiation at 530 nm.Histopathological examination showed photo-induced denaturation of collagen fibers and elastic fibers in the dermis of these subjects before irradiation,as well as nascent collagen fibers and elastic fibers in a more dense and regular arrangement after irradiation at the three wavelengths.Conclusions LED irradiation at both 630 nm and 850 nm can improve the appearance and barrier function of,and stimulate the proliferation and rearrangement of collagen fibers and elastic fibers in,photoaged skin,while LED irradiation at 530 nm increases skin pigmentation.

Objective To analysis the cause of injury of traumatic optic neuropathy and explore the main factors affecting the prognosis of visual acuity. Methods We retrospectively collected clinical data of 104 cases (108) of traumat-ic optic neuropathy from January 2007 to December 2012 in the Renhe Hospital of Three Gorges University. We then ex-amined the cause of injury and analyzed risk factors for poor prognosis of visual acuity in traumatic optic neuropathy us-ing multivariate Logistic regression analysis. Results The mean age of patients was 33.6 ± 12.8 years and 95 cases (91.3%) were males. The injury was mainly caused by non-motor vehicle and motor vehicle accidents (84 cases, 80.8%). Most of the patients came to the hospital within 3 days after the injury (81 cases, 77.9%). Overall efficacy rate of treat-ment was 45.4%(49/108). The effective rate was 29.9%(20/67) for visual acuity without light perception and 70.7%(29/41) for visual acuity with light perception, respectively. Logistic regression analysis showed that the time to treatment≥24h, orbital hemorrhage or orbital fracture, ethmoid or sphenoid sinus bleeding and no light perception vision were an in-dependent prognostic factors. Conclusion Time to treatment time and severity of injury are the independent risk factors for poor visual prognosis of traumatic optic neuropathy whereas controlling these risk factors has important clinical signifi-cance to the treatment and prognosis of traumatic optic neuropathy.

Objective To explore the effects of aminolevulinic acid-based photodynamic therapy (ALA-PDT) on the proliferation and apoptosis of HaCaT cells stably expressing human papillomavirus type 16 E7 protein (HaCaT/HPVl6 E7 cells).Methods Cultured HaCaT/HPV16 E7 cells were divided into several groups: blank control group receiving no treatment, ALA group treated with ALA alone, irradiation group irradiated with 630-nm red laser (30 mW/cm2,12 J/cm2), ALA-PDT groups pretreated with ALA for 5 hours followed by 630-nm red laser radiation at 4, 8, 12 J/cm2 respectively.CCK8 assay was performed to determine the survival rate of cells at 24 hours after PDT, and flow cytometetry and confocal microscopy were conducted to detect cell apoptosis and observe cell morphology respectively at 3 hours.Results At 24 hours, the survival rate of cells was 68.98％ ± 1.03％, 46.03％ ± 2.96％ and 23.57％ ± 3.83％ in the 4-,8-and 12-J/cm2 ALA-PDT groups respectively, significantly lower than that in the blank control group, ALA group and irradiation group (99.15％ ± 0.64％, 98.13％ ± 0.83％ and 96.85％ ± 1.37％ respectively, all P ＜ 0.05).With the increase in radiation dose, cell apoptosis was accelerated with obvious morphological changes and shrinkage of cells in the ALA-PDT groups.Conclusion ALA-PDT can inhibit the proliferation, and promote the apoptosis of HPV-infected HaCaT cells in a dose-dependent manner within a certain range of radiation dose.

Objective To investigate the efficacy and safety of 5-aminolaevulinic acid-photodynamic therapy (ALA-PDT) in cervical condyloma acuminatum. Methods Forty-five patients with cervical condyloma acuminatum topically applied 10% ALA thermal gel followed by PDT. The treatment was repeated 14 days later if the lesion was not completely removed. Totally, 1 - 4 treatment sessions were given. Thirty-five patients with cervical condyloma acuminatum who received CO2 laser treatment served as the control. All patients were followed up for 12 weeks. Results Complete remission was achieved in 97.8% (44/45) of patients with cervical condyloma acuminatum treated by ALA-PDT, and among the 44 cured patients, 3 were treated by 1 cycle of ALA-PDT, 6 by 2 cycles, 20 by 3 cycles, and 15 by 4 cycles. The lesions of condyloma acuminatum were removed after 1 session of CO2 laser treatment in 30 patients, and after repeated treatments in 5 patients, with the complete remission rate being 100% (35/35). The overall recurrence rate calculated for the whole followup period in patients treated with ALA-PDT was significantly lower than that in patients treated with CO2 laser [6.8% (3/44) vs 31.4% (11/35), x2 = 6.497, P ＜ 0.05]. However, no significant difference in complete remission rate was found between the two groups (P ＞ 0.05). Almost all the patients in ALA-PDT group presented with pain of bythus during illumination, but no severe side effects or scar formation was observed. In patients treated with CO2 laser, adverse reactions mainly included bleeding, erosion, shallow ulcer and even scar formation. Conclusions Topical ALA-PDT is effective and safe for the treatment and reduction in recurrence of condyloma acuminatum, and may serve as a therapeutic option for cervical condyloma acuminatum.

Objective To investigate the optimal concentration and incubation time of 5-aminole-vulinic acid (ALA) in photodynamic therapy of acne vulgaris. Methods Thirty patients with facial acne vulgaris were equally divided into two groups. In group 1, ALA (10%)cream was applied to acne lesions and protoporphyrin Ⅸ (PpⅨ) fluorescence was examined visually and spectroscopically at 1, 2, 3, 4 and 5 hours. In group 2, ALA cream of 3%, 5% and 10% was applied to lesions in the right cheek, left cheek, and forehead, respectively, of the same patient and incubated for 3 hours followed by photodynamie diagnosis and quantification of fluorescence intensity; clinical outcome and side effects were analyzed. Results Strong brick red PpⅨ fluorescence was observed in inflammatory papules, pustules, and cysts alter applica-tion of 10% ALA cream and irradiation with excitation light. The relative intensity of Ppix fluorescence was 1.3, 4.3, 5.1 and 5.8 in comedones, inflammatory papules, pustules and cysts, respectively, and it increased with the severity of lesions. A higher intensity of PpⅨ fluorescence was noted in patients with longer incu-bation period (3, 4 or 5 hours) compared with those with shorter incubation period (1 or 2 hours), and the difference was significant (P < 0.05). However, there was no significant difference in PpⅨ fluorescence intensity among lesions receiving ALA of different concentrations (P > 0.05). The overall clearance rate was 73% (11/15) after two courses of ALA-photodynamic therapy (PDT) in group 2. Side effects mainly included mild to moderate erythema, swelling and little exudation (occasionally). A transient pigmentation was observed in 2 patients. Neither ulceration nor scarring was noted. Conclusions ALA-PDT is suitable for the manage-ment of acne vulgaris mainly characterized by inflammatory papules, pustules and cysts. The results strongly suggest that 3% and 3 hours are the optimal concentration and incubation time of ALA in PDT of acne vulgaris.