After the Statute on Disposing Medical Accident was put in practice,doctors in China are faced with tremendous stress that never faced before.Doctors begin to evade risks with defensive medicine under the stress.There are two types of defensive medicine,one is positive defensive medicine,which will induce to excessive medical treatment for evading risks,another is negative defensive medicine which will lead to nonfeasance in the presence of intensive patients or dangerous diagnosis and treat procedure.Defensive medicine results in inefficiency of medical service and influences patients' safety.How to lessen doctors' defensive medicine will be an important social problem.

Objective To describe the clinical features and genetic susceptibility of the familial myasthenia gravis (FMG) patients. Methods The clinical data of 47 FMG patients and 2953 sporadic myasthenia gravis (SMG) patients from 1977 to 2003 were analyzed retrospectively, and 15 FMG patients, 36 SMG patients and 47 healthy controls were investigated for human leukocyte antigen (HLA)-DQA1 genotyping by polymerase chain reaction-sequence specific primers. Results FMG was an autoimmune disorder disease and immunosuppressive therapy was as highly effective in FMG as in SMG. In all patients, 11(23.4%) cases improved significantly, 14(29.8%) cases relieved with only 5 mg prednidone, and 20(42.6%) cases relieved completely. Most FMG occurred in siblings and familial members within 2 generations, and no sexual difference was found. These suggested it should be atypical Mendel’s rules. Onset and clinical features of patients within the same family often had little difference. As compared with the SMG patients, the frequence of DQA1 *0301 allele was higher in FMG patients, especially in the ocular form, and the differences had statistical significance(40.0% vs 19.4%, P

Objective To investigate the correlation between Kupffer cells and the synthesis of platelet activating factor(PAF)in experimental hepatic cirrhosis,and to elucidate the effects of endothelin(ET)on portal hypertension.Methods Thirty SD rats were randomly assigned to two groups:control group and CCl4-induced hepatic cirrhotic group.Kupffer cells,isolated from the livers of animals in both groups,were cultured for 24h.ET-1-induced PAF synthesis,and mRNA expression of PAF,ET-1 receptor and preproendothelin-1 in Kupffer cells were determined by rapid 3H-PAF scintillation proximity assay,saturation binding technique and semi-quantitative reverse transcriptase polymerase chain reaction(RT-PCR),respectively.Results Cell-associated PAF synthesis and release increased about 1.48 folds and two-folds,respectively,by cirrhotic Kupffer cells as compared to the control(1.02 ? 0.06 vs 0.69 ? 0.07 pg /mg DNA in Kupffer cells and 1.42? 0.14 vs 0.66 ? 0.04 pg/mg DNA in medium).Endothelin-1 enhanced Kupffer cells to stimulate PAF synthesis in a concentration-dependent manner,and for cirrhotic Kupffer cells,the effect was more significant than control.Cirrhotic Kupffer cells also had increased densities of functional receptors for both PAF and ET-1(exclusively ETB),but did not change the affinity of these receptors.No mRNA transcripts for the ETA receptor or preproET-1 were detected.Conclusion Kupffer cell is the main source of PAF in the cirrhotic rats.ET-1 stimulates PAF synthesis in activated Kupffer cells via ETB receptor.Since both ET-1 and PAF individually cause portal hypertension,Kupffer cells may play a role in portal hypertension associated with liver cirrhosis.

Objective To develop a gas chromatography-mass spectrometric method(GC/MS) for simultaneous determination of environmental estrogens including 4-nonylphenol,bishphenol A,diethylstilbestrol and 17?-ethinylestradiol and endogenic estrogens including 17?-estradiol,17?-estradiol,estriol and estrone in mutton. Methods Mutton samples were extracted using a mixture of acetonitrile-ethyl acetate(3∶2,V/V) and cleaned up by florisil cartridge. Derived with pentafluoropropionic anhydride(PFPA) ,the derivatives were determined by GC-MS. Results The linear range of determination was 0.2-5.0 ?g/kg. The intraday relative standard deviations of the peak area were 1.25%—5.85% and the detection limits ranged from 0.024 to 1.40 ?g/kg,and the rates of recovery ranged from 71.5%—111.0% except for 17?-ethinylestradiol( 55.4%) . Conclusion This method is simple,rapid,accurate and applicable to the determination of trace environmental estrogens in mutton

Objective:To explore the clinical efficacy of rotating-lifting oblique Ban-pulling tuina manipulation plus acupuncture in treating cervical vertigo (CV).Methods:Seventy-three CV patients were divided into two groups by block randomization, 50 cases in each group. The observation group was intervened by rotating-lifting oblique Ban-pulling tuina manipulation plus acupuncture, while the control group was by the same acupuncture treatment alone. The tuina treatment was given once every other day and the acupuncture treatment was given once every day. The symptom score was observed before and after 20-day treatment, and the therapeutic efficacies were compared between the two groups.Results:During the intervention, 14 subjects in the observation group and 13 subjects in the control group dropped out. Finally, 36 cases in the observation group and 37 cases in the control group were involved into the data analysis. After 20-day treatment, the symptom scores were significantly increased in both groups (P<0.05), and the symptom score in the observation group was significantly higher than that in the control group (P<0.05). The total effective rate was 91.7% in the observation group versus 83.8% in the control group, and the difference was statistically insignificant (P>0.05). The recovery and markedly effective rate was 69.4% in the observation group versus 32.4% in the control group, and the difference was statistically significant (P<0.05).Conclusion:Rotating-lifting oblique Ban-pulling tuina manipulation plus acupuncture can significantly improve the clinical symptoms of CV patients, and its clinical efficacy is superior to that of acupuncture alone.

Objective To investigate the infection of human cytomegalovirus (HCMV) in patients with atherosclerosis and explore its clinical significance.Methods A total of 134 patients with atherosclerosis (observation group) including 102 patients with coronary heart disease (CHD) and 32 patients with non-CHD from December 2009 to April 2012 were enrolled in this study.The 102 patients with CHD were divided into HCMV infection group (86 cases) and non-HCMV infection group (16 cases).Another 40 healthy person were selected as control group.The carotid intima-media thickness (IMT) was assessed by ultrasonography.The serum HCMV-IgM was measured by enzyme-linked immunosorbent assay.Results The infection rate of HCMV in observation group was 77.6％ (104/134),which was higher than that of 37.5％(15/40) in control group(P ＜ 0.05).The infection rate of HCMV in CHD patients and non-CHD patients was 84.3％(86/102) and 56.2％(18/32),and there was significant difference (P ＜ 0.05).The carotid IMT in HCMV infected atherosclerosis patients was (1.31 + 0.28) mm,which was higher than that of (1.14 ± 0.21)mm in non-HCMV infected atherosclerosis patients (P ＜ 0.05).The incidence of myocardial infarction and multi-vessel lesion in HCMV infection group was higher than that in non-HCMV infection group [39.5％(34/86) vs.25.0％(4/16) and 43.0％(37/86) vs.18.8％(3/16)](P＜ 0.05).The incidence of stable angina pectoris and single-vessel lesion in HCMV infection group was lower than that in non-HCMV infection group [26.7％(23/86) vs.43.8％(7/16) and 22.1％(19/86) vs.56.2％(9/16)](P＜0.05).Conclusion The high-infection rate of HCMV is found in atherosclerosis patients,and it maybe have a close relationship with the occurrence and development of atherosclerosis.

Based on health economics principle and the present situation,the academic paper mostly analyzed various relevant market and government factors to changes in supply and demand of acup-mox services,and thereby could be used for reference to reforms about health economics policy in acup-mox field.

Objective To evaluate the ability of diffusion tensor imaging (DTI )and DTT to differentiate the central prostate cancer(PCa )from benign prostate hyperplasia (BPH ).Methods 16 CG-PCa cases and 30 BPH cases proven by Histopathologi-cally had been performed MRI and DTI.ADC values and FA values of CG-PCa and BPH were respectively measured,comparing whether there is any discrepancies between two groups.For DTT maps,two observers record the score using a four-point scale and compare the differences between two groups of lesions about fibers continuity and density.Results ADC values and FA values in BPH-PCa were:(1 357±163)×10-6-(1 058±196)×10-6 mm2/s,and (356±116)×10-3- (407±132)×10-3 respectively. ADC value between the two groups was statistically significant difference (P< 0.05).While FA values was not(P>0.05).Interob-server agreement regarding the scale was good (k =0.723).The two viewers'DTT map score of CG cancer were 2.9±0.9;2.8± 1.0,the BPH were 1.8±0.7;1.7±0.8.The DTT map score between the two groups for two viewers were all statistically signifi-cant difference (P< 0.05).Conclusion ADC values can significantly differentiate CG-PCa from BPH,FA values cannot.DTT maps can describe prostate more institute,providing a certain value in distinguish PCa from BPH.

OBJECTIVE:To optimize the formulation of Cilnidipine sustained-release tablet,and study its drug-release mecha-nism. METHODS:Solvent method was adopted to prepare the cilnidipine solid dispersion,then Cilnidipine sustained-release tablet was prepared by using hypromellose K4M(HPMC K4M)as release material. Using comprehensive scores of cumulative release de-gree in 2,6,12 h as indexes,single factor method and Box-Behnken response surface method were used to screen the amounts of HPMC K4M and ethyl cellulose (EC),lactose-microcrystalline cellulose (MCC) ratio in formulation of Cilnidipine sustained-re-lease tablet,and verification test was conducted. The drug-release mechanism of Cilnidipine sustained-release tablet was investigat-ed by model fitting way. RESULTS:The optimal formulation was as follow as 25％ of cilnidipine solid dispersion,30％ of HPMC K4M,10％ of EC,lactose-MCC ratio of 1:1(m/m). The adhesive was 5％ PVPP ethanol solution and the lubricant was 0.5％magnesium stearate. The cumulative release degrees of prepared sustained-release tablet in 2,6,12 h were(21.4±3.3)％,(62.9± 2.8)％,(85.4±0.5)％(n=3),relative error of which to predicted value 25％,60％,90％were 14.4％,4.8％and 5.1％. Release curve showed the highest fitting degree with the first-order release model,conforming to non-Fick diffusion. CONCLUSIONS:Cil-nidipine sustained-release tablet with sustained-release effect is successfully prepared by optimized formulation.

OBJECTIVE To explore the incidence of the nosocomial infection in patients with mental diseases,analyze the correlative factors and then reduce the incidence.METHODS By using the retrospective method,the inpatient cases in Department of Psychotherapy from Jan 2000 to Dec 2005 were surveyed and statistically analyzed.RESULTS There were 307 cases of nosocomial infection from 4175 inpatients with mental diseases.The infection rate was 7.35%.The total rate had been dropped year by year.The major sites of the infection were the upper respiratory tract,the gastrointestinal tract and the lower respiratory tract.CONCLUSIONS The incidence of the nosocomial infection is related with fallowing factors:the characteristic of patients,the crowded wards,the changing seasons and the side-effect of drug.