The paper reviews the background and current situation of medical disputes and puts forward the concept of the reaction chain of medical disputes in view of their high occurrence rate and the difficulty in handling them. It discusses the framework, chief content, basic principles and major features of the reaction chain of medical disputes and argues that as a commonly used tool for handling medical disputes, the reaction chain renders it possible to check from the angje of the interests of the patients whether each party involved in the dispute has fulfilled its duties. Intended to improve the professional ethics of the physicians and the quality of medical care and calling on the patients to rebuild their confidence in the physicians, the reaction chain indicates that it is necessary to scientifically analyze the entire process and various influencing factors of medical disputes and bring into play the advantages of integration so as to successfully resolve medical disputes.

Objective:To investigate the infusion methods of postoperative enteral nutrition in patients with gastric cancer.Methods:86 patients with gastric cancer received radical operationin our hospital from January 2014 and December 2015 were enrolled for the study and randomly divided into continuous infusion group and periodic infusion group,each group with 43 cases.Patients in continuous infusion group were given postoperative continuous enteral nutrition for 24 h in one day,while cases in periodic infusion group were given postoperative continuous enteral nutrition for 15-17 h in one day.Results of enteral nutrition,physical indicators including upper arm skinfold,diameter of midpoint of upper arm and grip strength,nutritional indexes including total protein (TP),hemoglobin (Hb),albumin (AIb),prealbumin (PA) and transferrin(TF),immune indicators including immunoglobulin G(IgG),immunoglobulin M (IgM),immunoglobulin A (IgA),CD4+,CD8+ and CD4+/CD8+were compared between two groups before and after operation.Results:Intolerance of enteral nutrition occurred in 1 case(2.3％) of continuous infusion group and 3 cases(7.0％) of periodic infusiongroup,and there was no significant difference between them (P＞0.05).Time of transition to full enteral nutrition and taking off the tube to self-feeding incontinuous infusion group were significantly smaller than that in periodic infusion group (P＜0.05).There were no significant difference in baseline data,physical indicators,nutritional indexes and immune indicators between them before operation (P＞0.05).PA level at 5 d,10 d after operation in continuous infusion group were significantly higher than that in periodic infusion group (P＜0.05),and there were no significant difference in physical indicators,other nutritional indexes and immune indicators between them after operation(P＞0.05).Conclusion:Compared with periodic infusion,continuous infusion method could shorten the time of transition to full enteral nutrition and taking off the tube to self-feeding in patients after radical operation of gastric cancer,and had more significant effect of improvement of nutritional status,worthy of clinical popularization and application.

Objective: To evaluate the effect and safety of continuous veno-venous hemofiltration(CVVH) in the treatment of multiple organ failure(MOF) in senile patients.Methods: Sixteen patients with multiple organ failure,aged over 80 years,were divided into a survival group,who lived more than 20 days,and a non-survival group,less than 20 days after CVVH,and observed for such clinical indexes as of renal function,K+and blood gas analysis,APACHEⅡ scores and complications.Results: After CVVH,eleven of the patients survived for over 20 days,with 1 case up to 3 years.CVVH effected a significant improvement in BUN,Scr,K+and blood gas as well as a marked reduction in complications.APACHE Ⅱ scores decreased significantly after CVVH in the survival group though not in the non-survival group,as compared with those before CVVH,which were significantly lower in the former than in the latter.Conclusion: CVVH is a safe,effective and well-tolerated method for the treatment of MOF in senile patients.Patients with higher APACHEⅡscores have a poor prognosis.

Aim: To establish an HPLC method for the determination of 3-methyl-7, 8-dihydroxy-isochroman-4-one in the peel of Musa sapientum. Methods: A column of Shimadzu ODS-C_(18) column (250 mm × 4. 6 mm,5 μm), and a mobile phase of acetonitrile-water-phosphoric acid(9:91:0. 1) were adopted. A detect wavelength of 283 nm, a flow rate of 1 mL/min, and a column temperature of 35 ℃ were set. Results: The content of 3-methyl-7,8-dihydroxy-isochroman-4-one in the peel of Musa sapientum was 0.029 5%-0.036 7%. Calibration curve was linear over the range 1. 09-13. 08 μg. The average recovery was 100. 0%. The assay variability value was 0. 64 %(n=9). Conclusion: The method can be used for the quality control of Musa sapientum.

Objective:To investigate the causes, characteristics and treatment of maxillofacial trauma in children. Methods: A retrospective analysis of 470 consecutive maxillofacial records of the patients not older than 14 years was conducted. Data regarding age, gender, cause, anatomic site and treatment were reviewed. Results:Most of the patients were mals(335 cases, 71.3% ), with a male and female ratio of approximately 2. 5;1 of the injuries, 28. 5% were due to accidental falls, 17.0% traffic accidents and 10.0% sharp implementt cutting. Injuries of soft tissue often occurred on gingiva, cheek, lip and chin. Mandibuir fratures were the most common (55.1% ) of all bone fractures. Conservative therapy, such as closed reduction surgery, maxillomandibular fixation, was usually performed. Conclusion: ①Boys are more tendent to be victims of maxillofacial trauma than girls. ②Falls are the first cause of child victims. ③Gingiva, chin, lip, check and mandible are the most commonly injuried sites.

Objective To compare the effect of different ways of water supply and whether or not drain water from waterlines for overnight on bacterial counts in dental unit waterlines(DUWLs).Methods In the first phase,6 sets of DUWLs were randomly divided into 2 groups (external storage tank water supply group and municipal water sup-ply group);in the second phase,6 sets of DUWLs were all changed to use external storage tank and randomly di-vided into 2 groups (draining water for overnight group and without draining water for overnight group),bacterial count before and within one week of disinfection between two groups at two phases were compared respectively. Results In the first phase,handpiece water of DUWLs was most seriously contaminated by bacteria,the average colony count was 4117 CFU/mL,qualified rate was 15.38%.Before disinfection,no significant difference in bacte-rial count were found among each groups (all P>0.05),bacterial count of DUWLs of all groups severely exceeded the standard(all >3000 CFU/mL).Comparison of bacterial count in DUWLs from different water supply routes after disinfection was not significantly different on day 1(P>0.05),but were significantly different at day 2-7(all P<0.05).On the second day after disinfection,municipal water supply group began to exceed bacteria standard;on the third day after disinfection,external storage tank group began to exceed bacteria standard.Bacterial count in DUWLs after disinfection between draining water for overnight group and without draining water for overnight group was no significantly different on day 1(P>0.05),but were significantly different on day 2-7(all P<0.05). On the fourth day of disinfection,bacterial count of without draining water for overnight group exceeded standard.On day 7 of disinfection,bacterial count in draining water for overnight group exceeded>100 CFU/mL.Conclusion Use of external storage tank,daily change of sterile distilled water,and daily emptying water for overnight can effectively reduce bacterial count in DUWLs.

Objective To investigate the associations between the polymorphisms in CD40‐1C/T polymorphism(rs1883832) and Graves′disease by Meta‐analysis .Methods We searched Pubmed ,CBM ,VIP ,CNKI ,Cochrane library and Wanfang ,covering and selecting literatures according to criterions .Statistical analysis was performed by using Revman5 .2 and Stata12 .0 .Results A total of 18 eligible literatures were included(5 198 cases and 4 417 controls) ,The pooling results suggested that significant differ‐ence in allele C/T frequency and genotype frequency were observed between patients with and control subjects (P<0 .05);the indi‐viduals of genotype CC and(or) CT have significantly increased Graves′disease risk(CC vs .TT :OR=1 .60 ,95% CI=1 .28-2 .00 , P<0 .01;CC vs .CT :OR=1 .25 ,95% CI=1 .14 -1 .37 ,P<0 .01 ;CC vs .CT+ TT :OR=1 .34 ,95% CI=1 .17 -1 .52 ,P<0 .01 ;CC+CT vs .TT :OR= 1 .36 ,95% CI= 1 .13 -1 .64 ,P< 0 .01) .From subgroup analysis ,we identified that the research subjects difference showed between thyroid anti‐body(Ab ± ) and thyroid anti‐body (Ab -) in control group ,which might be the cause of heterogeneity ,but the pooling results in sensitivity analysis were stable and no significant publication bias were found .No significant difference in allele and genotype frequency of CD40 SNP were observed between Graves′disease with ophthalmopathy group and Graves′disease without ophthalmopathy group ,Graves′disease with family history group and Graves′disease without family histo‐ry group(all P>0 .05) .Conclusion This Meta analysis indicated that the polymorphisms in the CD40 gene(rs1883832) was related with Graves′disease ,but had nothing to do with family history and Graves′disease with ophthalmopathy .

ObjectiveTo investigate the therapeutic effect of mefformin on type 2 diabetes mellitus (T2DM) complicated with non-alcoholic fatty liver disease (NAFLD).MethodsThe model rats of T2DM complicated with NAFLD were established by feeding high-glucose and high-fat diet, and injection of low dose streptozotocin.The model rats were randomly divided into 2 groups, model group (n = 16) and metformin group (n = 16).Twenty normal rats were set for normal control group.Intragastric administration lasted for 12 weeks.At the end of 16th week (after treated 8 weeks) and 20th week (after treated 12weeks), the levels of serum alanine aminotransferase (ALT), aspartate aminotransferase(AST), fasting blood glucose (FBG),fasting insulin (FINs), triglyceride (TG), total cholesterol (TC) and free fatty acid (FFA) in each group were determined and the level of insulin sensitivity index (ISI) was determined.Meanwhile, pathological changes of liver, the expression of uncoupling protein-2 (UCP-2) mRNA and UCP-2 protein of liver tissues in each group were detected.ResultsThe levels of serum ALT, AST, FBG,FINs, serum TG , TC and FFA were significantly higher and ISI was significantly lower and the expression of UCP-2 protein significantly increased in model group, compared with control group (all P ＜ 0.01).The expression of UCP-2 mRNA at 16th and 20th week in model group were significantly higher than that in control group [(1.789 +0.301) vs (0.245 ±0.087), t =11.02, P ＜0.01 and (1.989 +0.207) vs (0.262+ 0.058), t = 17.93, P ＜ 0.01, respectively].Fatty degeneration of liver tissues was significantly exacerbated in model group.After treatment for 8 weeks and 12 weeks with mefformin, the levels of serum ALT,AST, FBG, serum TG, TC and FFA significantly decreased, ISI significantly increased, fatty degeneration of liver tissues was significantly improved, and the expression of UCP-2 protein significantly decreased,compared with model rats (P ＜ 0.01 or P ＜ 0.05).The expression of UCP-2 mRNA at 16th and 20th week in metformin group were significantly lower than that in model group [(0.665 + 0.088) vs (1.789 ±0.301), t = 7.81, P ＜ 0.01 and (0.610 ± 0.1 02) vs (1.989 ± 0.207), t = 9.98, P ＜ 0.01, respectivelv].ConclusionsMetformin has therapeutic effect on T2DM complicated with NAFLD.

Objective To establish a long-term surviving model of ventilator induced lung injury ( VILI) in piglets with large tidal volume ventilation. Methods A total of 21 piglets were randomly( random number) divided into trial experiment group (group A,n =9), injury group ( group B,n =6) and control group ( group C, n = 6). Each piglet was intubated orotracheally and intravascular cannulae were inserted both into carotid artery and external jugular vein. The tidal volume in 60 - 80 ml/kg was given to rats of group A and 50 ml/kg to rats of group B, and free breath to rats of group C. Vital signs, pneumatic mechanics, blood-gas analysis and hemodynamics were monitored every hour ( group A and group B from just after the model established 0 h, group C from 0 ～6 h). The t test or ANOVA test was used for statistical analysis. Left lung tissue was sent to biopsy after experiment. Results About 6 hours after mechanical ventilation with large tidal volume, PaO2/FiO2 lower significantly both in A and B group in comparison with control group (P ＜0.05 ) and histological changes hit the ALl criteria. Piglets ventilated with 50 ml/kg of tidal volume could survive for long-term. Conclusions The model of VILI in piglets made with 50 ml/kg of tidal volume ventilation was established successfully and survived for long-term.

Objective To observe the effect of liraglutide, an analogue of glucagon like peptide-1 (GLP-1), on the expression of PDX-1 gene in the islet beta cells of type 2 diabetes rats. Methods Sixty male SD rats were divided into 3 groups:normal control group, diabetic model group and GLP-1 group. Normal control group was given normal diet and diabetic model group and GLP-1 group were given high fat diet. After the eighth weekend, the high fat diet group was intraperitoneally injected with streptozotocin (STZ) 30 mg/(kg·bw), and the GLP-1 group was subcutaneously injected with liraglutide 200μg/kg with 2 times per day for 8 weeks. The other groups were treated with normal saline by subcutaneous injection. Real-time fluorescent quantitative reverse transcription polymerase chain reaction (Real-Time RT-PCR) was used to detect the expression of PDX-1 gene in rat pancreatic islet cells. Results The expressions of PDX-1 mRNA in the GLP-1 group and untreated group were significantly lower (P <0.001) than that in the normal control group, but significantly higher than that after GLP-1treatment (P < 0.001). Conclusion GLP-1 can upregulate the expression of PDX-1 gene in the islet beta cells of type 2 diabetes rats.