Through analyzing the current situation of mediation of doctor-patient disputes,this paper cleared the connotation of mediation of doctor-patient disputes and explored diversified measures of mediating medical dis-putes.It included changing the concept of medical education actively and deepening the reform of medical system constantly,improving the level of hospital management actively and cracking down the occupational medical trouble and hospital scalper,taking litigation as backed mediation mechanism and playing the advantage role of people in mediation,taking initiative to communicate the mission knowledge and playing the role of media fully,and thus to reduce the occurrence of doctor-patient disputes from the source.

Objective To analyze the effect of 10 mg,20 mg simvastatin on vascular endothelial function in elderly patients with coronary heart disease. Methods 96 cases withcoronary heart disease admitted in the First people's Hospital of Xiaoshan District from Janary 2009 to December 2010 were selected and divided into three groups,each had 32 cases. Control group were given expanding coronary artery,blood,anticoagulation therapy.Observation group 1 and observation group 2 were separately taking 10 mg,20 mg simvastatin on the basis of control group. Endothelium-dependent vasodilation (FMD)functional,non-endothelium-dependent vasodilation (NMD)functions,nitric oxide (NO),and endothelin (ET)in three groups before and after treatment were detected and compared. Results Before treatment,the differences of FMD,NMD,NO,ET in three groups were not significant. After treatment,FMD were increased in all three groups,but the difference between two observation group was not statistically significant.NO was also increased in all three groups,but value in two observation group was higher than control group. NMD were unchanged in all three groups.Compared with before treatment,ET in two observation groups after treatment were decreased significantly (P<0.05 ). Conclusion simvastatin can effectively rectify the metabolic imbalances of vascular endothelial cells in patients with coronary heart disease and promote the improvement of FMD,but there is no significant difference between 10 mg~20 mg dose.

Objective To compare the long-term efficacy between laparoscopic liver resection and open liver resection to treat small hepatocellular carcinoma.Methods The clinical data of 52 patients with small hepatocellular carcinoma treated from August 2011 to November 2012 were reviewed.Twenty patients underwent laparoscopic liver resection (the laparoscopic group),while the remaining 32 patients underwent open liver resection (the laparotomy group).The preoperative,postoperative and overall survival data between the two groups were compared.Results The data between the two groups before surgery were comparable (all P ＞ 0.05).The differences in tumor size and pathologic type between the two groups did not reach statistical significance (t =1.087,x2 =0.738,all P ＞ 0.05).However,the length of hospital stay in the laparoscopic group was significantly shorter than in the laparotomy group (t =3.363,P ＜ 0.05).Post-procedural complications occurred in no patients in the laparoscopic group,but in 8 patients in the laparotomy group (x2 =5.909,P ＜ 0.05).The cumulative survival rates in the two groups were not statistically signifi cant (P ＞ 0.05),but the recurrence-free survival of the laparoscopic group was significantly longer than the laparotomy group (P ＜ 0.05).The postoperative 1-year disease-free survival was not significantly different (P ＞ 0.05),though the 3-and 5-year recurrence-free survival rates were significantly different (all P ＜ 0.05).Conclusion The long-term overall survival rate of laparoscopic treatment for small liver cancer was similar to open operation,but the recurrence free survival rate was greatly improved.

BACKGROUND:Hyperuricemia is a common metabolic disease,and the main clinical manifestation of patients with hyperuricemia is the formation of uric acid crystals leading to gout.Previous studies have only reported that uric acid crystals lead to intervertebral disc degeneration,but there are fewer studies on the correlation between hyperuricemia and intervertebral disc degeneration. OBJECTIVE:To retrospectively analyze the characteristics of intervertebral disc degeneration in patients with hyperuricemia and the correlation between serum uric acid level and intervertebral disc degeneration. METHODS:A retrospective analysis was performed in all patients diagnosed with intervertebral disc degeneration admitted at the Department of Orthopedics,the Affiliated Hospital of Southwest Medical University from January 2021 to December 2022.There were 97 hyperuricemia patients in the hyperuricemia group and 194 non-hyperuricemia patients in the control group according to sex and age in a ratio of 1:2.Blood uric acid test results were collected,and Pfirrmann scoring was performed for the degree of disc degeneration in patients based on the whole spinal MRI images.The difference in the degree of disc degeneration between the two groups was compared,and the correlation between the serum uric acid level and the degree of intervertebral disc degeneration was analyzed. RESULTS AND CONCLUSION:The Pfirrmann score in the hyperuricemia group was higher than that in the control group,and the total number of disc degeneration in the hyperuricemia group was also significantly higher than that in the control group(P<0.05).Spearman correlation analysis showed that the degree of disc degeneration in male patients was positively correlated with serum uric acid level at many spinal segments in the hyperuricemia group(C3/4:r=0.317,C4/5:r=0.333,C5/6:r=0.309,L2/3:r=0.443,P<0.05);the degree of disc degeneration in female patients was also positively correlated with serum uric acid level(C3/4:r=0.354,C4/5:r=0.388,C6/7:r=0.312,T7/8:r=0.282,T9/10:r=0.305,T11/12:r=0.277,L4/5:r=0.319,L5-S1:r=0.367,P<0.05).In the control group,there was no significant correlation between the degree of disc degeneration and serum uric acid level in male and female patients(P>0.05).To conclude,in patients with hyperuricemia,the higher serum uric acid level indicates the more serious intervertebral disc degeneration.Therefore,hyperuricemia is one of the risk factors for intervertebral disc degeneration.