The special nature of medical care determines the high riskiness of the medical profession that is lacking in other professions. In view of the high-techness and high riskiness of the medical profession, it is only proper to start thinking about setting up corresponding mechanisms for guarding against and dissolving the risks so as to safeguard the legitimate rights of the doctors. Guarding against and dissolving risks of the medical profession fall into a systematic framework of regulations and legal arrangements that are composed of mechanisms for dispersing risks of the medical profession, mechanisms for sharing medical liabilities and systems of medical care and social security.

Objective To investigate the number of osteoclast (OC) precursor in the peripheral blood of patients with ankylosing spondylitis (AS) and its relationship with serum receptor activator of nuclear factor KB-ligand (RANKL) and Osteoprotegerin (OPG) concentration as well as the disease activity. Methods The peripheral blood mononuclear cells from 8 cases of AS patients and 5 healthy controls were cultured in the medium containing macrophage colony-stimulating factor (M-CSF) (25 ng/ml) and RANKL (40 ng/ml). After being cultured for 14 days, cytochemistry was applied to detect tartrate-resistant acid phosphatase (TRAP) expression and the cells with TRAP expression and ≥3 nuclei were counted and defined as OC. Bone resorption assay was used to demonstrate OC function. ELISA was used to measure serum RANKL and OPG concentration in 23 cases of AS and 17 healthy controls. The relationship was analyzed in AS patients between the number of OC precursors and serum RANKL and OPG concentration as well as the disease activity. The indicators of disease activity were Bath ankylosing spondylitis disease activity index (BASDAI), Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). T test, t' test and Spearman correlation were selec-ted. Results ① Significantly higher OC production was observed in the peripheral blood of AS patients than that of healthy control group. The OC number per ten fields was 10.9±3.4 and 6.2±1.3 respectively (P<0.05); ② There was significant difference between AS patients and healthy controls in serum concentration of OPG and RANKL and the ratio of RANKL/OPG. OPG was significantly higher in AS patients [(157±49) pg/ml] than in healthy controls [(105±20) pg/ml] (P<0.05). RANKL was significantly higher in AS patients [(5.4± 3.8) pg/ml] than in healthy controls [(1.6±0.8) pg/ml] (P<0.05). The ratio of RANKL/OPG was significantly higher in AS patients (0.037±0.026) than in healthy controls (0.016±0.008) (P<0.01 );③Significantly positive correlation was observed between the OC number and the serum concentration of RANKL (r=0.692, P=0.009), the ratio of RANKL/OPG (r=0.813, P=0.001);④ In AS patients, serum concentration of OPG was found to have significantly negative correlation with BASDAI (r=-0.444, P=0.044). Serum RANKL concentration was found to have significantly positive correlation with BASDAI (r=0.543, P=0.011). The ratio of RANKL/OPG was found to have significantly positive correlation with BASDAI (r=0.672, P=0.001). Conclusion ① More OC precursors exist in the peripheral blood of AS patients. These cells may differentiate into osteoclasts, which might play a role in joints destructions in AS;② The mechanism of high OC production is likely to be due to high RANKL concentration which is caused by inflammatory reaction.

AIM: To construct the shuttle plasmid vector for thymidine kinase (tk) and EGFP fusion protein gene driven by IGF - Ⅱ P3 promoter, and investigate the specific killing effect of the HSV - tk/GCV system on hepatocellular carcinoma(HCC) cells in vitro. METHODS: Recombinant shuttle plasmid vector was constructed by techniques of genetic recombination and screening, and identified by restriction digestion and sequencing analysis. Then the recombinant shuttle plasmid was transfected into HepG2 and HeLa cells by techniques of lipofectamine transfection and its expression was detected by fluorescence microscope and RT -PCR. Cell killing after ganciclovir(GCV) application was determined by MTT. RESULTS: Identification of pDC316 -tkEGFP- P3 by enzyme digestion and sequencing analysis showed that the length, inserted location and direction of the target genes which were inserted into the recombinant were correct. It was found that enhanced green fluorescence protein could only be seen in HepG2 cells, but not in HeLa cells. The results of RT -PCR showed that only two bands could be seen in the samples of pDC316 -tkEGFP- P3 transfected HepG2 cells. The MTT test showed the selective cytotoxicity of GCV to the transfected HepG2 cells. CONCLUSION: The shuttle plasmid vector carrying the tkEGFP fusion protein gene driven by IGF - Ⅱ P3 promoter has been constructed successfully and its specific expression in HepG2 cells provided a sound basis for targeted gene therapy for HCC.

Objective To compare the successful ratio, efficacy and complications between ultrasound-guided and X-ray-guided endoscopic biliary drainage (EBD). Methods EBD was performed in 62 patients under ultrasound guidance and 54 patients under X-ray guidance. Serum bilirubin, the bile duct diameter and the changes of clinical symptoms were compared before and after the procedure. Results Tube placement was successfully achieved in 54 of 62 patients under ultrasound guidance and 51 of 54 patients under X-ray guidance. The serum direct bilirubin and the common bile duct diameter in patients with ultrasound guidance before and one week after procedure were (205.41±115.27) μmol/L vs. (106.47±82.16) μmol/L and (12.6±7.1) mm vs. (8.5±3.1) mm, respectively, with significant difference (all P values<0.05). Whereas they were (211.14±106.25) μmol/L vs. (110.89±59.47) μmol/L and (13.1±7.0) mm vs. (8.8± 3.2) mm, respectively, in patients with X-ray guidance (P<0.05). No complications such as abdominal pain, fever and elevated amylase were found in patients with ultrasound guidance, while 3 patients (5.9%) with X-ray guidence had above complications. Conclusions X-ray is a most effective method in guidance of EBD. However, ultrasound guidence, which may avoid unfavorable factors such as X-ray radiation and allergic contrast agent, has some advantages including real-time display, mobile convenience and emergency bedside application. It can instead of X-ray in performance of endoscopic nasobiliary drainage and endoscopic retrograde biliary drainage in patients with bile duct stone and mild narrow ducl caused by tumors.

Objective To analyze the structure of microbial community in the bile of patients with obstructive jaundice.Methods From October 2010 to October 2013,117 patients with obstructive jaundice were selected.The results of bile microbial regular culture and anaerobic bacteria culture were both negative.A total of 10 mL bile of each case was aspired and DNA of bile microbial community was isolated.16S rDNA of bile microbial was amplified and underwent terminal restriction fragment length polymorphism (T-RFLP) analysis.Clone libraries were constructed and conducted sequencing and system analysis.Chi-square test was performed for data analysis.Results Among the 117 patients,16S rDNA of 50 cases was positive,and the total positive rate was 42.7 ％.The positive rate of bile bacterial 16S rDNA in stone and tumor cased obstruction was 97.3％ (36/37) and 17.5％ (14/80),and the difference was statistically significant (x2=65.828,P＜0.01).There was no statistically significant difference in the positive rate of bile bacterial 16S rDNA among hilar obstruction,above hilar obstruction and below hilar obstruction,which ware 43.3％ (13/30) and 42.5％(37/87),respectively (P＞0.05).Bile microbial community of obstruction coused by stone was mainly Enterobacteriaceae (Escherichia,Salmonella,Klebsiella,Proteus),Streptococcus (Streptococcus),digestive coccaceae (digestive bacteria genus,peptostreptococcus),Micrococcus branch (Staphylococcus),Propionibacterium (Propionibacterium) and Neisseriabacteria (Acinetobacter).Bile microbial community of obstruction caused by tumor was mainly Enterobacteriaceae (Clay Beth spp,Escherichia,Salnonellatyphi) and Micrococcus branch (Staphylococcus).Conclusion The condition and variety of bile microbial community of patients with obstructive jaundice could be effectively evaluated by 16S rDNA fragment through T RFLP analysis.

OBJECTIVE:To establish the method to identify the polysaccharide element in Holothuria atra Jeager by spectroscopy.METHODS:The purity of polysaccharide in Holothuria atra Jeager was determined by electrophoretic method;the infrared absorption spectrum,ultraviolet absorption spectrum,carbon spectra and hydrogen spectra of NMR were identified in structure by infrared spectrophotometry,ultraviolet spectrophotometry and NMR spectrometry respectively.RESULTS:The gel band after electrophoresis took blue color and the results of spectrum determination accountable for each other.CONCLUSION:Uniformly constituent of polysaccharose was found in the Holothuria atra Jeager,which was an acidic polysaccharose with vitriolic esterfunction,without glucopeptide;?-configuration,?-glucopyranose was found and the intramolecular hydrogen bond was formed by hydroxide radical.

AIM: To investigate the genetic and epigenetic alterations of p14~ ARF gene and mutation status of p53 gene in human primary colorectal carcinomas and to analyze the relationship between the two gene changes and the role of abrogation of the p14~ ARF -p53 pathway in colorectal carcinogenesis. METHODS: The homozygous deletions, mutations, methylation of 5′ CpG islands, mRNA expression of p14~ ARF gene and mutations of p53 gene were assessed by PCR, direct sequencing, methylation-specific PCR, and RT-PCR in the tumorous and matched adjacent normal colorectal tissues from 56 patients with colorectal carcinoma. RESULTS: ① p14~ ARF alterations were detected in 27% (15/56) of colorectal carcinoma tissues studied, of which 1 case showed homozygous deletion, 14 cases showed 5′ CpG island methylation, and no mutation was found in any tumor. ②15 colorectal carcinomas with p14~ ARF alterations indicated lack of (13 cases) or at low level of expression (2 cases) of p14~ ARF mRNA, while expression of the p14~ ARF transcript was detected in the remaining 41 colorectal carcinomas and any matched adjacent normal colorectal tissues. ③ The mutations of p53 gene were detected in 48% (27/56) of colorectal carcinomas investigated. ④ Of these 56 cases, 12 had p14~ ARF alterations alone, 24 had p53 mutations alone, 3 had both p53 mutations and p14~ ARF methylation, and 17 had neither. 70% (39/56) of the samples had either or both abnormalities of the two genes, and p14~ ARF hypermethylation was related to wildtype p53 (P

OBJECTIVE: To investigate the change of the resistance of common pathogenic bacteria isolated in the First Clinical Hospital of Jilin University during the past 5 years to quinolones.METHODS: Disk diffusion test was used to study the susceptibility test,with the results evaluated based on US Clinical and Laboratory Standards Institute(CLSI).WHONET-5 software was used to analyze the drug resistance data.RESULTS: During 2003～2007,the detection rates of extended spectrum beta-lactamases(ESBLs)-producing Escherichia coli and Klebsiella.spp were 43.6%～60.1% and 51.0%～65.1%,respectively;the detection rates of methicillin-resistant Staphylococcus aureus(MRSA) and methicillin-resistant coagulase negative Staphylococcus(MRSCN) were 50.8%～83.3% and 80.0%～81.5%,respectively;the resistance of common pathogenic bacteria to quinolones showed an increasing tendency,much as in MRSA,MRSCN,feces enterococci,Enterococcus faecalis,and Escherichia coli.CONCLUSION: Monitoring of the resistance of common pathogenic bacteria to quinolones should be strengthened.The change of the antimicrobial resistance should be investigated in order to direct rational drug use in the clinic and prevent the propagation of drug-resistant strains.

A large series of lens were collected from normal and senile cataractous human eyes, and were investigated according to the theories of oxyradical and lipid peroxide (LPO). The findings showed that the activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase in the senile cataractous lens were very significantly lower than those in the normal ones, while the content of malondialdehyde (MDA) in the lens of senile cataractous eyes was very significantly higher than that of normal eyes. The results suggest that the oxyradical and LPO might be one of the direct causes leading to senile cataract formation.

Objective To explore the efficacy of intervention combined with traditional Chinese medicine for the treatment of early femoral head necrosis. Methods 62 cases of early femoral head necrosis were treated with interventional and traditional Chinese medicine, all patients were assessed for clinical efficacy before treatment and 6 months after treatment. The clinical hip function, pain index evaluation and rating of the femoral head venography were recorded. Results 41 cases were cured, 18 cases improved,no improvement in 3 cases,the total effective rate was 95. 2%. Clinical hip function after treatment compared with before treatment increased by 32.5%,there was a statistically significant difference (P＜0.01); compared with before treatment, significantly reduced pain (P＜0. 01). After treatment, Ⅲ and Ⅳ were significantly increased number of cases, respectively, compared with the preoperative increase of 146.2% and 160.0%,femoral venography ratings before and after treatment had significant difference(P＜0.01). Conclusion Intervention combined with traditional Chinese medicine treatment could significantly improve the early femoral head necrosis.