Commercialization of the doctors sector and lawyers sector, and that of medical services, sharp rise of medical disputes and its impact on healthcare services have grown into major challenges for the healthcare system in the United States where litigation is the legal way out of medical disputes at large.Anglo-American law system depends heavily on precedence as the criteria and the majority of such disputes trials are held in state courts, there is also a complete system of laws and decrees on medical disputes on the federation level.In an effort to handle medical disputes that are rising sharply in a piling-up amount, American lawyers, social organizations of arbitration and medicine, and many state courts are seeking alternative dispute resolution as a better way out for medical dispute mediation and resolution.Given the gaps between China and USA in social systems, legal systems, ,economic development, cultural background, healthcare systems and heahhcare security systems, these experiences will prove their value of reference for medical disputes resolution in China.

OBJECTIVE:To investigate the analgesia effect of low-dose ketamine combined with sufentanil after radical sur-gery of esophageal cancer. METHODS:Totally 153 patients of pre-implementation esophageal cancer surgery were randomly divid-ed into group A,B and C. After induction of anesthesia in patients in each group,patients in group A administered sufentanil 2 μg/kg;group B were treated with sufentanil 2.5 μg/kg;group C were treated with sufentanil 2 μg/kg + ketamine 85 μg/(kg·h). Visual analog(VAS)score and Ramsay score before and after anesthesia 4,8,16,24 and 48 h,analgesia pump pressing times and inci-dence of adverse reactions in each group were observed. RESULTS:Ramsay score in 4,8 and 16 h in each group were significant-ly higher than before anesthesia,the differences were statistically significant(P<0.05),however,compared with before,there was no significant difference in the Ramsay score in 48 h among each group(P<0.05);VAS scores in each group(except for group C in 48 h) at each time point were significantly higher than before,group C

OBJECTIVE:To improve the quality standard of Shexiang qutong liniment. METHODS:TLC was used for qualita-tive identification of Resina draconis and Rehmannia. The determination of total solids and ether-soluble extracts in the preparation was detected. GC was used for the content determination of muscone:the column was Thermo-TG-WAXMS capillary column by programmed temperature,the detector was FID detector,the detector temperature was 250 ℃,inlet temperature was 200 ℃,carri-er gas was high purity nitrogen at a flow rate of 1.0 ml/min,split ratio was 5:1,and the injection volume was 1 μl. RESULTS:The TLC pots of R.draconis and Rehmannia were clear with good separation. The total solids in preparations were not less than 0.6%,and extracts were not less than 3.0%. The linear range of muscone concentration was 15.21-243.36 μg/ml(r=0.9998);RS-Ds of precision,stability and reproducibility tests were lower than 2%;recovery was 97.70%-99.63%(RSD=0.78%,n=6). CON-CLUSIONS:The established method can be used for the quality control of Shexiang qutong liniment.

Uveitis is a kind of refractory blinding eye diseases.Noninfectious uveitis is an important part of uveitis,which is thought to be an autoimmune disease,and systemic immunosuppressive therapy is usually required to prevent visual loss.As a selective T-cell inhibitor,cyclosporine A is one of the most widely used immunosuppressants,and has obvious therapeutic effect on many kinds of uveitis.Cyclosporine A combined with glucocorticoid,other immunosuppressants or biological agents can improve the therapeutic effect and reduce the side effects.Recently,the inhibitory effect on glucocorticoid-resistant Th17 cells and topical application of cyclosporine A,show its advantage and potential in the treatment of noninfectious uveitis.

Objective To explore the clinical efficacy of the combination of the vaginal and high frequency electric wave loop(LEEP) in the treatment of cervical precancerous lesions.Methods The clinical data of 76 cases with cervical precancerous lesions confirmed by postoperative pathological examination were collected,Pathologic biopsy was conducted under colposcope.For patients with operative indication, LEEP operation was carried out under colposcope and analyzed vaginal microscopic pathological biopsy diagnosis accurate rate.The operation time,bleeding volume and treatment were observed.Results Satisfactory colposcopy and biopsy results difference had statistical significance;colposcopy with biopsy diagnosis accurate rate was 90.79%.The average operation time was (6.42±1.21)min.The mean operative bleeding was (10.45±2.31)mL.Postoperative 3 months, TCT negative rate was 95.83%(92/96).After 6 months of TCT negative rate was 100.00%(76/76).Conclusion LEEP combined with vaginal cytology in the treatment of cervical precancerous lesions has less invasion,less bleeding,shorter hospitalization time,and can effectively remove the lesion site,it is worthy of recommending.

Objective To investigate the perinatal outcomes of isolated single umbilical artery (ISUA) in full-term birth. Methods We performed a retrospective study of 82 252 pregnant women (aged<35 years;singleton; full-term live birth; no known chromosomal/structural anomalies) who delivered between January 1, 2011 and January 1, 2012 in 39 hospitals in 14 cities in China. There were 273 cases with ISUA as study group and 1 092 cases with a three-vessel cord selected in a 1∶4 ratio as control group. Perinatal outcomes including delivery modes (vaginal delivery or emergency cesarean section for fetal reasons), birth weight and height, placental weight, umbilical cord length, Apgar scores at 1 min, and rate of neonatal asphyxia were analyzed retrospectively. Data were analyzed using the Chi-square test, two independent samples t-test or rank sum test. Results The incidence of ISUA was 0.3%(273/82 252). There was no difference between the two groups with regard to maternal age, parity, gravidity, smoking status, gestational age at birth, or rate of complications during pregnancy (gestational diabetes mellitus or pregnancy-induced hypertension) (all P>0.05). The birth weight in ISUA group and control group was (3 259±463) and (3 344±411) g (t=3.689), birth hight was (48.6±2.7) and (49.7±1.9) cm (t=8.368), placental weight was (508±72) and (543±153) g (t=3.114), umbilical cord length was (52.6±8.1) and (53.7±7.5) cm (t=1.983), and Apgar scores at 1 min were 9.0 (8.0-10.0) and 10.0 (9.0-10.0) (Z=11.831), respectively; the values in the ISUA group were lower than those in control group (all P < 0.05). No significant differences were observed in the rate of vaginal delivery and emergeny cesarean section for fetal reasons between the ISUA group and control group [52.8%(144/273) and 49.9%(545/1 092),χ2=0.704;19.4%(25/273) and 15.7% (86/1 092), χ2=1.162; both P>0.05]. Conclusions ISUA does not increase emergency cesarean delivery rates for the fetal reasons, but the fetal growth and development may fall behind those with a three-vessel umbilical cord. Monitoring during pregnancy and delivery should be intensified for fetuses with ISUA.

Abdominal aortic aneurysm (AAA) is a common fatal aortic disease.The rupture of AAA is the procession affected by multiple factors.Besides physiological,pathological and biochemical changes,morphological and biomechanical alteration can also influence this procession.The progress of rupture risk evaluation through morphological and biomechanical characteristics of AAA were reviewed in this article.

ObjectiveTo compare of the thickness of left ventricular wall of Ang Ⅱ induced cardiac hypertrophy model in both TR3 konock-out C57BL/6 mice (TR3-/- mice) and wild type C57BL/6 mice (TR3+/+ mice) by high frequency ultrasound,combined with experimental research to discuss if TR3 take part in the process of cardiac hypertrophy.Methods26 TR3 -/- mice and 33 TR3 +/+ mice were randomized to 2 groups respectively:TR3+/+ + AngⅡ group (27 mice),TR3+/+ + PBS group(6 mice),TR3-/- + Ang Ⅱ group(20 mice),TR3-/- + PBS group(6 mice).Micro-pumps with AngⅡ or PBS were placed into the subcutaneous tissue of mice to construct hypertension model in 4 weeks.Interventricular septum enddiastolic thickness (IVSd) and left ventricular posterior wall end-diastolic thickness (LVPWd) were measured by echocardiography 2 days before operation and every week after operation until 4 weeks.Then,mice were killed and mice cardiomyocytes were isolated and detected in lab (HE dyeing test,Western blotting).Results①Echocardiography:before operation,IVSd and LVPWd was not statistically different between TR3+/+ group and TR3-/- group( P ＞0.05).1 - 2 weeks after operation,IVSd and LVPWd had peaked in both TR3-/- + Ang Ⅱ group and TR3 +/+ + Ang Ⅱ group,IVSd and LVPWd in TR3 +/+ + Ang Ⅱgroup were significantly thicker than control group (TR3 +/+ + PBS group) ( P ＜0.05),IVSd and LVPWd in TR3-/-+ AngⅡ group were slightly thicker than control group (TR3-/- + PBS group) ( P ＜0.05).Compared with TR3-/- + Ang Ⅱ group,IVSd and LVPWd in TR3+/+ + Ang Ⅱ group were markedly increased( P ＜0.05).After 4 weeks operation,IVSd and LVPWd of all 4 groups were not statistically different than that in the 2nd week.②HE dyeing test:The cell size of cardiomyocytes in TR3+/+ mice increased significantly after Ang Ⅱ treatment,while TR3-/- mice did not.③ Western blotting:Ang Ⅱ promoted TR3 expressions in TR3 +/+ mice( P ＜0.05).ConclusionsTR3 do take part in the process of Ang Ⅱ induced cardiac hypertrophy in mice and it is a key factor in this process.

Laboratory animal science has become a main support for the development of life science and has occupied an importance place in higher medical education.The paper analyzed the characteristics and problems of laboratory animal science and proposed the ideas of applying conformational memory teaching in laboratory animal science teaching from there aspects:teaching method,teaching frame and teaching effect.These measures established the foundation for the cultivation of applied talents with comprehensive competence.

Objective Discussion of diagnosing insulinoma.Methods Retrospective analysis based on 45 cases of insulinoma patients that are collected by General Surgery Department in the First Affiliated Hospital of Zhengzhou University from June 2008 to October 2014.Results Forty-five cases of patients with insulinoma including 41 cases (91.11％) of functional insulinoma and 4 cases (8.89％) of non-functional insulinoma.Apply selective arteriography,preoperative ultrasound,intraoperative ultrasound and CT to diagnosis.Forty-five cases of patients with insulinoma,in which 18 cases with laparoscopic simple tumor resection,6 cases with laparoscopic splenectomy and tail of the pancreas resection;45 cases of insulinoma with laprotomy,in which 8 cases with pancreaticoduodenectomy,12 cases which the tumors were located in the neck,neck-line of the pancreas with local excision of the pancreas and pancreatic tail-jejunal Roux-en-Y anastomosis,one cases of laparotomy found no placeholder.Conclusions Surgery removal is currently the most successful way to eliminate insulinoma.And localization diagnosis can determine the outcome of the surgery.Co-operation of surgery removal and localization diagnosis can be the optimal approach to diagnose certain insulinoma.