This paper investigates 240 cases of medical disputes and interviews involved patients with questionnaires,explores patients′ behaviors,attitudes,and complaints in medical disputes,and analyzes the reasons and motivations for those behaviors and attitudes,in order to provide reference for reduce medical disputes and improve physician-patient relationship.

Objective To generally analyze the current situations and advancement of the study on immunotherapy for colorectal cancer. Methods The pertinent published papers about the current situation and research advancement of the immunotherapy of colorectal cancer were retrospectively investigated. And also the immunogenicity and the varying principles of immunoresistance, the functional targets, the practicality, and some other characteristics of different immunotherapy for colorectal cancer were reviewed. Results The main treatments and the research focuses in the immunotherapy of colorectal cancer are initiative nonspecific immunotherapy, adoptive immunotherapy, monoclonal antibody immunotherapy, initiative specific immunotherapy, and targeted therapy. They work by fighting against the cancer itself, cutting off the tumor’s nutrition supply, activating the immune system specifically or breaking the immune tolerance and so on. Though there are still many problems unsolved, immunotherapy has a promising clinical prospect. Conclusion As a beneficial complement for surgery, chemotherapy and radiotherapy, immunotherapy plays an important auxiliary role in the combined therapy for colorectal cancer.

Objective To explore humidifying effects for artificial airway of mechanically ventilated patients by heat/moisture exchanger(HME) combined closed endotracheal suctioning(CS).Methods A total of 114 patients who had mechanical ventilation for at least 48h were randomly divided into two groups with 59 cases in experimental grooup and 55 cases in control group.HME combined CS were used in the experimental group,heated humidifier combined open endotracheal suctioning were used in the control group.The effect of humidification, the reserved time of artificial airway,the time on mechanical ventilation, the time of stay in ICU, the incidence of ventilator-associated pneumonia(VAP) and the mortality rate between the two groups were compared.Results Significant differences were found in the effect of humidification between the experimental group and the control group,more cases found insufficiency of humidification or excessive humidification and airway spasm in the control group, however,less time on mechanical ventilation and stay in ICU in the experimental group.The incidence of VAP in the control group was significantly higher than that in the experimental group.There were no significant differences existed in the reserved time of artificial airway and the mortality rate between the two groups.There were no accident of humidification occurred in the experimental group,while 8 cases complicated with choking with water in the control group.Condusion HME combined CS,used in mechanically ventilated patients ,could help to improve the effects of airway humidification and reduce the incidence of VAP,also shorten the duration of mechanical ventilation.

Objective To observe recombinant plasmids were constructed with the macrophage colony-stimulating factor ( GM-SCF) , interleukin -21 (IL-21) and retinoic acid early transcription factor-1 (Rae-1), and observe the inhibitory effects in subcutaneous liver cancer model in mice with the recombinant plasmids.Methods The recombinant plasmids of GM-SCF, IL-21 and Rae-1 were constructed with RT-PCR method, mouse model was constructed, the model mice were randomly divided into six groups including control, IRES/GFP, IRES/IL21, IRES/GM-SCF, IRES/GM-SCF-IL21 and IRES/combination with 10 mice included in each group, each groups (15 mice) were treated with the corresponding gene therapy.The survival rate were observed after 60 days.The blood levels of interferon -γ(IFN-γ) and interleukin -2 (IL-2) were detected in each group.Results The pGM-CSF-GFP-IRES-Rae-1-IL-21 has been successfully constructed.All mice had demised 14 and 16 days after treatment in the control and IRES/GFP groups, respectively.There were 2, 1, 11 mice remaining after 60 days of treatment in the IRES/GM-SCF, IRES/IL21 and IRES/GM-SCF-IL21 groups respectively.The survival rate of mice at 60 days of treatment was 73.33%, 13.33%, and 6.67% for groups IRES/GM-SCF-IL21, IRES/GM-SCF and IRES/IL21, respectively.The survival rate of the mice was significantly higher in IRES/GM-SCF-IL21 than the other groups.The levels of IL-2 and INF-γof mice 1-6 days after treatment gradually increased in the IRES/combination groups, including IRES/GM-SCF-IL21, IRES/GM-SCF and IRES/IL21.They were highest in the IRES/combination group and lowest (P<0.01) in the IRES/GM-SCF and IRES/IL21 groups, with the IRES/GM-SCF-IL21 group showing intermediate levels.By 6-10 days after treatment, IL-2 and INF-γlevels had stably increased in the IRES/combination groups, but had gradually decreased in the IRES/GM-SCF-IL21, IRES/GM-SCF and IRES/IL21 groups.At the end of treatment, IL-2 and INF-γlevels were significantly (P<0.01) higher in the IRES/GM-SCF-IL21 than were found in either the IRES/GM-SCF group or IRES/IL21 group, which were also significantly (P<0.01) higher than either the IRES/GFP or control groups.The levels of IL-2 and INF-γwere highest in the IRES/combination group ( P<0.01) and not significantly different among the IRES/GM-SCF, IRES/IL21, IRES/GFP, and control groups.Conclusion The inhibitory effects in subcutaneous liver cancer model in mice were obvious significantly, and its mechanism maybe be related to the activation of the body's immune.

AIM: To establish an identification method of Fritillaria based on near-infrared diffuse reflectance spectroscopy(NIRDRS). METHODS: Seven certified Fritillaria,i.e.,F.przewalskii Matim,F.cirrhosa D.Don,F.unibraacteate Hsiaaoet.K.C.Hsia,F.thunbergii Mig,F.pallidiflora,F.ussuriensis Matin and F.kupehensis Hsiaet K.C.Hsia,and three fake "Fritillaria",i.e.,F.thunbergii Varchekiugensis Hsiaet K.C.Hsia,Tulipa edulis and Iphigeniaindica were dried,grinded and sieved before their NIRDRS spectra were detected.Cluster analysis,convolution transform-visualization-similarity analysis were further employed to(identify) the NIRDRS of the ten herbal medicines. RESULTS: The zero-order NIRDRS spectra of the ten herbal medicines were too similar to be identified respectively.The cluster analysis helped differentiate the three fake "Fritillaria" from seven certified Fritillaria,but the identification between the certified Fritillaria remained dissatisfactory.The convolution transform-visualization-similarity analysis magnified and then quantified the minute differences between the certified Fritillaria,which significantly improved their identification. CONCLUSION: NIRDRS is a direct,non-destructive analytical method of solid samples.Coupled with information treatment techniques,DIRDRS provides a new identification method of crude traditional Chinese medicines.

BACKGROUND:Cervical decompression and fusion internal fixation wil accelerate adjacent segment disc degeneration, and it is not clear whether single segment instaibility can increase the adjacent segment disc degeneration. OBJECTIVE:To study the changes of morphology, proteoglycan and col agen type Ⅱ in the adjacent intervertebral disc of the cervical instability models. METHODS:Sixteen New Zealand white rabbits were divided into two groups randomly, with eight rabbits in the control group and eight rabbits in the model group. The animal cervical instability models were made by destroyed partly annulus fibrosus and absorbed C 5/6 nucleus pulposus through anterior cervical puncture. After 12 weeks, the animal models were tested by X-ray film. Al rabbits were sacrificed and 10 mg nucleus pulposus of the intervertebral discs of C 4/5 cut from sagittal plane were harvested and stored under 0 ℃. The content of proteoglycan in nucleus pulposus was tested with phloroglucinol method. Then, the paraffin sections of intervertebral disc tissues were taken for hematoxylin-eosin staining and SABC immunohistochemical staining. RESULTS AND CONCLUSION:The notochord cells of C4/5 intervertebral discs in the experimental group was decreased, and being replaced by fibroblast-like cells. Round chondrocytes could be seen occasional y and intervertebral discs annulus fibrosus became rough and arranged disorderly, the hyaline degeneration and pigmentation were observed as wel as the fibrochondrocytes, and there was a gap between inner and outer annulus fibrosus. The content of proteoglycan was decreased in the nucleus pulposus, and there was significant difference between two groups. The col agen type Ⅱ in the degenerative disc nucleus pulposus and annulus fibrosus of the experimental group was lower than that of the control group. Cervical instability can lead to adjacent intervertebral disc degeneration with the morphological changes and decreased content of proteoglycan and col agen type Ⅱ.

Objective: To establish capillary zone electrophoresis method for determination of sildenafil citrate (Viagra) content in its troche. Methods： Using tetrandrine as internal standard(IS), the electrophoretic separation was achieved with 25 mmol/L borate (pH=7.89) running buffer. And a voltage of 14 kV was applied to the 40 cm×75 μm(i.d) capillary. The analytes were introduced into capillary by siphon (1 s) and determined with on-column monitoring at 214 nm. Results：The determination could be completed within 4 min and the minimum concentration of detection was 5 μg/ml.The analytical results of sildenafil citrate samples demonstrated a good linear relationship within the range of 24-480 μg/ml.The relative standard deviations (RSD) of intra-day was less than 1.58% and that of inter-day was less than 2.46%.The present recoveries were between 95%-105％. Conclusion：The CZE method is accurate, simple, rapid and reliable, so it can be applied to the determination of sildenafil citrate content.

Objective To discuss the clinical value of percutaneous vertebroplasty (PVP) in treating severe vertebral compression fracture. Methods During the period from June 2012 to March 2013, PVP was carried out in 30 patients with severe vertebral compression fracture (30 diseased vertebrae in total). The clinical data were respectively analyzed. According to the shape of compressed vertebra , the fractures were divided into three types: wedge-shaped, double concave and oblong-shaped. For wedge-shaped fracture, PVP was performed via the pedicle access of the healthy side. For double concave type , unilateral pedicle access was used, while for oblong-shaped type unilateral or bilateral access was adopted to conduct PVP according to the distribution of the injected PMMA. The therapeutic results were evaluated by using VAS and pain degree classification standard of WHO. The preoperative and postoperative vertebral height was estimated on the lateral projection. All patients were followed up for six months at out-patient clinic or by telephone. Results The success rate of puncturing was 100%. The preoperative mean VAS was 6.9 ± 0.9. The postoperative VAS at one day, one, 3 and 6 months after the procedure was 5.0 ± 0.9, 3.5 ± 0.7, 2.5 ± 0.8 and 1.6 ± 0.7 respectively. Based on WHO pain degree classification standard, complete remission (CR) was obtained in 25 cases, partial remission (PR) in 3 cases, and invalid in 2 cases. The effective rate (CR +PR) was 93.33%. The mean preoperative height of the compressed vertebrae was (5.77 ± 1.09) mm and the mean postoperative height of the compressed vertebrae was (14.33 ± 2.03) mm. Conclusion For the treatment of severe vertebral compression fractures, percutaneous vertebroplasty is clinically feasible with reliable short-term effect.

With the expansion of herbal medicine (HM) market, the issue on how to apply up-to-date analytical tools on qualitative analysis of HMs to assure their quality, safety and efficacy has been arousing great attention. Due to its inherent characteristics of accurate mass measurements and multiple stages analysis, the integrated strategy of liquid chromatography (LC) coupled with time-of-flight mass spectrometry (TOF-MS) and ion trap mass spectrometry (IT-MS) is well-suited to be performed as qualitative analysis tool in this field. The purpose of this review is to provide an overview on the potential of this integrated strategy, including the review of general features of LC-IT-MS and LC-TOF-MS, the advantages of their combination, the common procedures for structure elucidation, the potential of LC-hybrid-IT-TOF/MS and also the summary and discussion of the applications of the integrated strategy for HM qualitative analysis (2006-2011). The advantages and future developments of LC coupled with IT and TOF-MS are highlighted.