By analyzing repeated judicial expertise cases of illegal practice,we find it a serious threat to patients' health and safety,and more deep-seated reasons for illegal medical practice of medicine are discovered as follows.Investigators and expertise staff have to face legal,ethical,social and other factors when judging the relationship between illegal medical practice and adverse consequences(patient injury or death),which are quite worth exploration in depth to clear up the complicated relationships.

OBJECTIVE:To observe clinical efficacy of epinephrine combined with vasopressin and naloxone for cardiopulmonary resuscitation(CPR)and to investigate its mechanism. METHODS:64 patients with sudden cardiac and respiratory arrest were randomly divided into control group(epinephrine group),treatment group Ⅰ(epinephrine+vasopressin group)and treatment group Ⅱ(vasopressin+epinephrine+naloxone group). Spontaneous circulation,breathing recovery time,restoration of spontaneous circulation and respiration rate,24 h survival rate and discharge survival rate were observed and compared among different groups. RESULTS:As compared with control group,spontaneous circulation,breathing recovery time 24 h survival rate and discharge survival rate in treatment group Ⅰ and Ⅱwere increased significantly(P

Objective To investigate the expression of nuclear factor-κB (NF-κB) and p53 up-regulated modulator of apoptosis (PUMA) in acute lung injury (ALI) induced by severe acute pancreatitis (SAP), and the therapeutic role of proline dithiocarbamate (PDTC). Method SD rats weighed 200～ 250 g were randomly(random number) divided into sham operation group (A group, n = 18), ALI group (B group, n = 18) and PDTC treatment group (C group, n = 18). The model of SAP was eastablished by injecting 1 mL/kg of sodium tauarocholate into the pancreatic capsule of the rats in B group and C group. The model rats in C group were treated with PDTC one hour after modeling. Six rats of each group were sacrificed 6 h,12 h, and 24 hours after modeling. The histopathological changes in lung and pancreas were observed. The levels of NF-κB p65 and PUMA in lung were detected by using Western blotting, and the expressions of bcl-2, bax and caspase-3 mRNA in the lung were detected by using RT-PCR. The lung tissue was taken for examination under transmission electron microscope. TUNEL was used for detection of apoptotic alveolar epithelial cells. Results Six to 24 hours after modeling, the pathological scores in lung of ALI group were significantly higher than those of control group and PDTC group after sodium taurocholate injection ( P ＜ 0.05). The levels of NF-κB p65 and PUMA, and the expressions of bax and caspase3 mRNA in ALI group at different intervals were higher than those in control group and PDTC group ( P ＜ 0.05),whereas the expression of bcl-2 mRNA in ALI group was lower than that in control group and PDTC group ( P ＜0.05). The NF-κB p65 was correlated closely and positively with PUMA ( r= 0.987, P ＜ 0.01). Higher activity of caspase-3 acrtive units was seen in ALI group than that in control group and PDTC group ( P ＜ 0.05). The microvilli disappeared in ALI group 24 hours later. The apoptosis index in ALI group was higher than that in control group and PDTC group ( P ＜ 0.05). Conclusions The apoptosis of alveolar epithelial cells of rats in ALI group is caused by PUMA activated by NF-κB. PDTC treatment can inhibit apoptosis of alveolar epithelial cells of rats in ALI group by inhibiting the activation of NF-κB.

Objective To investigate the predictive value of T,B,and NK lymphocyte subsets jointly detected in poor prognosis in patients with sepsis.Methods Totally 101 patients with sepsis were enrolled for prospective study.The percentages of lymphocyte sub-populations in peripheral blood were detected within 48 h after admission.The outcomes of patients during hospitalization were observed by follow-up study.The predictive value of lymphocyte sub-populations jointly detected in death risk was assessed.Results The percentages of CD3,CD3 +/CD4 + in patients with septic shock were lower than those in patients with mild/moderate sepsis and severe sepsis.The percentages of CD3+/CD8+,CD3-/CD19 +,CD4 +/CD8 + in patients with severe sepsis and septic shock were lower than those in patients with mild/moderate sepsis.The percentage of CD (16 +56) + in severe sepsis and septic shock was higher than that in mild/moderate sepsis group (P ＜ 0.05).The total number of monocytes in the deaths was higher than that in survivals.The percentages of CD3,CD3-/CD19 +,CD3 +/CD4 +,CD4 +/CD8 + were lower in deaths than those in survivals (P ＜ 0.05).The CD3-/CD19 +,CD3 +/CD8 and CD4 + / CD8 + were protective factors against sepsis with their OR values of 0.235,0.006 and 0.108,respectively.The ROC curve of lymphocyte subsets jointly detected,APACHE]] score and SOFA score to predict the risk of death were 0.993,0.877 and 0.848,respectively.The misjudgment rate of discriminating disease severity function of lymphocyte subgroups jointly detected was 19.8％,and that of outcomes was 4％.Conclusion The percentages of lymphocyte sub-populations in patients with sepsis is abnormal,and therefore,the lymphocyte subgroups jointly detected has value in the judgment of disease severity and prognosis in patients with sepsis.

24 patients with chronic hepatitis B were treated with interleukin-2 activated human peripheral blood lymphocytes (IAPBL). 23 patients served as control. The results showed that HBeAg disappeared in 54.2% of IAPBL group, in comparison with 17.4% of the controls (P

Objective To analyze the relationship between the posterior circulation cerebral infarction and posterior embryonic cerebral artery,and to explore the possibility of posterior embryonic cerebral artery to be predictive indicator for the occurrence and development of the posterior circulation infarction.Methods A total of 2341 posterior circulation cerebral infarction patients in our hospital were recruited,and its location was confirmed in infarction circulation blood supply range and existence condition of posterior embryonic cerebral artery was explored by head MRI and DWI.The correlation between posterior embryonic cerebral artery and posterior circulation cerebral infarction,arteriosclerosis.Results Among the 2341 patients,there were 1012(41.63％) patients with posterior circulation infarction,including 314 cases with left posterior circulation infarction,295 cases with right posterior circulation infarction,403 cases with bilateral posterior circulation infarction.There were 578 (23.78％) patients with embryonic posterior cerebral artery,including 179 cases with left posterior cerebral artery,257 cases with right posterior cerebral artery,and 142 cases with bilateral posterior cerebral artery.There were 1193 (49.1％) patients with cerebral arteriosclerosis.The incidences of cerebral arteriosclerosis and posterior circulation cerebral infarction showed significant difference in the embryo posterior cerebral artery and non-embryo posterior cerebral artery patients (P ＜ 0.05),but no significant difference in posterior embryonic cerebral artery patients with different locations (P ＞ 0.05).Conclusion Embryonic posterior cerebral artery has a significant correlation with posterior circulation cerebral infarction,and can significantly increase the incidence of posterior circulation cerebral infarction.

Objective To analyze the relationship between the posterior circulation cerebral infarction and posterior embryonic cerebral artery,and to explore the possibility of posterior embryonic cerebral artery to be predictive indicator for the occurrence and development of the posterior circulation infarction.Methods A total of 2341 posterior circulation cerebral infarction patients in our hospital were recruited,and its location was confirmed in infarction circulation blood supply range and existence condition of posterior embryonic cerebral artery was explored by head MRI and DWI.The correlation between posterior embryonic cerebral artery and posterior circulation cerebral infarction,arteriosclerosis.Results Among the 2341 patients,there were 1012(41.63％) patients with posterior circulation infarction,including 314 cases with left posterior circulation infarction,295 cases with right posterior circulation infarction,403 cases with bilateral posterior circulation infarction.There were 578 (23.78％) patients with embryonic posterior cerebral artery,including 179 cases with left posterior cerebral artery,257 cases with right posterior cerebral artery,and 142 cases with bilateral posterior cerebral artery.There were 1193 (49.1％) patients with cerebral arteriosclerosis.The incidences of cerebral arteriosclerosis and posterior circulation cerebral infarction showed significant difference in the embryo posterior cerebral artery and non-embryo posterior cerebral artery patients (P ＜ 0.05),but no significant difference in posterior embryonic cerebral artery patients with different locations (P ＞ 0.05).Conclusion Embryonic posterior cerebral artery has a significant correlation with posterior circulation cerebral infarction,and can significantly increase the incidence of posterior circulation cerebral infarction.

Objective:To investigate the effectiveness of an enhanced CT automatic recognition system based on Faster R-CNN for pancreatic cancer and its clinical value.Methods:In this study, 4 024 enhanced CT imaging sequences of 315 patients with pancreatic cancer from January 2013 to May 2016 at the Affiliated Hospital of Qingdao University were collected retrospectively, and 2 614 imaging sequences were input into the faster R-CNN system as training dataset to create an automatic image recognition model, which was then validated by reading 1 410 enhanced CT images of 135 cases of pancreatic cancer.In order to identify its effectiveness, 3 750 CT images of 150 patients with pancreatic lesions were read and a followed-up was carried out.The accuracy and recall rate in detecting nodules were recorded and regression curves were generated.In addition, the accuracy, sensitivity and specificity of Faster R-CNN diagnosis were analyzed, the ROC curves were generated and the area under the curves were calculated.Results:Based on the enhanced CT images of 135 cases, the area under the ROC curve was 0.927 calculated by Faster R-CNN. The accuracy, specificity and sensitivity were 0.902, 0.913 and 0.801 respectively.After the data of 150 patients with pancreatic cancer were verified, 893 CT images showed positive and 2 857 negative.Ninety-eight patients with pancreatic cancer were diagnosed by Faster R-CNN.After the follow-up, it was found that 53 cases were post-operatively proved to be pancreatic ductal carcinoma, 21 cases of pancreatic cystadenocarcinoma, 12 cases of pancreatic cystadenoma, 5 cases of pancreatic cyst, and 7 cases were untreated.During 5 to 17 months after operation, 6 patients died of abdominal tumor infiltration, liver and lung metastasis.Of the 52 patients who were diagnosed negative by Faster R-CNN, 9 were post-operatively proved to be pancreatic ductal carcinoma.Conclusion:Faster R-CNN system has clinical value in helping imaging physicians to diagnose pancreatic cancer.

Objective:To investigate the effectiveness of an enhanced CT automatic recognition system based on Faster R-CNN for pancreatic cancer and its clinical value.Methods:In this study, 4 024 enhanced CT imaging sequences of 315 patients with pancreatic cancer from January 2013 to May 2016 at the Affiliated Hospital of Qingdao University were collected retrospectively, and 2 614 imaging sequences were input into the faster R-CNN system as training dataset to create an automatic image recognition model, which was then validated by reading 1 410 enhanced CT images of 135 cases of pancreatic cancer.In order to identify its effectiveness, 3 750 CT images of 150 patients with pancreatic lesions were read and a followed-up was carried out.The accuracy and recall rate in detecting nodules were recorded and regression curves were generated.In addition, the accuracy, sensitivity and specificity of Faster R-CNN diagnosis were analyzed, the ROC curves were generated and the area under the curves were calculated.Results:Based on the enhanced CT images of 135 cases, the area under the ROC curve was 0.927 calculated by Faster R-CNN. The accuracy, specificity and sensitivity were 0.902, 0.913 and 0.801 respectively.After the data of 150 patients with pancreatic cancer were verified, 893 CT images showed positive and 2 857 negative.Ninety-eight patients with pancreatic cancer were diagnosed by Faster R-CNN.After the follow-up, it was found that 53 cases were post-operatively proved to be pancreatic ductal carcinoma, 21 cases of pancreatic cystadenocarcinoma, 12 cases of pancreatic cystadenoma, 5 cases of pancreatic cyst, and 7 cases were untreated.During 5 to 17 months after operation, 6 patients died of abdominal tumor infiltration, liver and lung metastasis.Of the 52 patients who were diagnosed negative by Faster R-CNN, 9 were post-operatively proved to be pancreatic ductal carcinoma.Conclusion:Faster R-CNN system has clinical value in helping imaging physicians to diagnose pancreatic cancer.

Objective To understand the comparability of the detection results of four items (ALT ,AST , GGT ,ALP) of liver enzymology in 11 clinical laboratories in Xinjiang Production and Construction Corps (XPCC) and offer reference for improving mutual recognition of the results .Methods Eleven clinical labora-tories of XPCC organized the result comparability tests of 4 items of liver enzymology twice in 2017 ,and the samples with 5 batches were completed in each comparability test .One set of detection system in each labora-tory was used as comparability system according to comparability scheme .The detection results were analyzed through Robust Z Score and the evaluation criterion was :|Z|≤2 "satisfied";2< |Z|<3"warning";|Z|≥3 "not satisfied".Results The detection results of all 10 batch samples in 4 clinical laboratories showed |Z|≤2 in 2 comparability tests .In the first comparability test ,the detection results of 5 batch samples for 4 items were |Z|≤2 in 5 laboratories .In the second comparability test ,the detection results of 5 batch samples for 4 i-tems were |Z|≤2 in 8 laboratories ,but the ALT results of 5 batch samples in 1 laboratory showed positive deviation(Z≥3)and the GGT results of 5 batch samples in the other laboratory showed negative deviation (Z≤ -3) .Conclusion The 11 clinical laboratories in XPCC should continuously improve quality management system and make sure that the mutual recognition of the detection results of 4 items of liver enzymology is effective .