The paper analyzes the potential drawbacks of the current medical liability insurance from the perspectives of hospitals, insurance companies and patients. It puts forward suggestions for the sustainable development of medical liability insurance, viz. involvement of insurance brokers in coordinately solving the issue of application for medical liability insurance, involvement of loss assessors in solving medical disputes, adoption of compulsory medical liability insurance in due time, and further expansion of the scope and categories of insurance.

The force of hospital culture is a kind of flexible spiritual productivity.First,it can improve in a comprehensive way the quality of a team and the ideological level of all the employees,make the cultural content permeate the various layers within the organizational framework,and ensure that the employees fulfill quality and quantity requirements in completing their tasks.Second,it can impel people to have a sense of identification,mission and pride concerning the hospital's overall objectives,increase the initiative of both individuals and the organization,and result in the exercise of self-control and self-management on the basis of mechanisms and ideology.Third,it can create a life-learning environment for the employees,raise their awareness of and capability for innovation and the hospital's mechanisms for innovation,and bring about enduring spiritual support to the core values of the hospital.Finally,it can make patients associate the hospital with a unique image of service,create a unique culture of service,and increase patients' trust in the hospital.

Excessive and fast rise of medical expenses in China recent years has worsened the financial burden of both the government and individuals alike,making it a hotspot issue countrywide.To alleviate the difficulties of "accessibility to medical services" and "poverty or repoverty resulting from sickness" faced by the Chinese people at large,we built a multi-factor analysis model to identify key factors contributing to such a fast rise of medical expenses based on an analysis of the medical expenses in Shandong Province.In addition,we discussed the causes for GDP and headcount of medical staff in relation to the rise of medical expenses,and the strategies to curb expenses.

MicroRNA-375 (miR-375) is closely related to the development of cancer,such as liver cancer,gastric cancer,pancreatic cancer,endometrial cancer,esophageal cancer,non-small cell lung cancer,etc.The mainly tumor pathogenesis related miR-375 includes that miR-375 is combined with specific target genes,can degrade mRNA or inhibit protein translation in the transcriptional level,and plays antitumor effect of inhibition of cell proliferation,promoting cell apoptosis and inhibiting the invasion and metastasis.miR-375 is expected to be a new target for cancer therapy,which may become an important biomarker for the diagnosis,treatment and prognosis of cancer.

Objective To investigate the association between the neck circumference and central obesity in the elderly.Methods The neck circumference(NC),height,weight,waist circumference (WC) and hip circumference(HC) of 2820 subjects aged over 60 years were detected from some communities in Nanchang.All subjects were divided into different groups,according to the two different obesity indicators of WC and BMI.The relationship between NC and obesity was analyzed.A multiple linear regression analysis was conducted using the Enter method.An R()C curve analysis was employed to judge the tangent point of NC in central obesity.Results The height,weight and BMI were reduced along with age (all P＜0.05),and the waist hip ratio(WHR) was increased along with age(P＜0.01) in the elderly.The NC was decreased along with age in males(P＜0.01),and the WC was increased along with age in females(Pt＜0.01).The NC was longer in males than in females [(36.5±3.0) cm vs.(32.6±2.4) cm,P＜0.01].The NC was increased along with body weight,WC and BMI in the elderly:with each 1 kg increase in body weight,the NC was increased by 0.079 cm in males and 0.139 cm in females;with each 1cm increase in WC,the NC increased by 0.073 cm in males and 0.040 cm in females;with each 1 kg/m2 increase in BMI,the NC increased by 0.121 cm in males and 0.065 cm in females;with 1 year increase in age,the NC was decreased by 0.033 cm in males(all P＜0.05).when obesity was diagnosed according to both BMI and NC,the NC was longer in the obesity group than in the control group,(P ＜ 0.01).The area under receiver operating characteristic(ROC) curve of NC for diagnosing central obesity showed that the area was 0.802 and 0.743 in males and females,and the optimal cut-off value of NC was 36.85 cm and 31.75 cm in males and females,respectively.Conclusions NC is increased along with the increases of body weight,WC and BMI in the elderly.NC is significantly associated with central obesity.NC is more predictive of the central obesity when the value ＞36.85 cm in males and ＞31.75 cm in females.

Objective To summarize the method and effects of extracorporeal membrane oxygenation (EC-MO) for eight patients with sever heart or(and) lung diseases,and to get some reliable advises by analysis of retro-spoctive indications,timing and result in ECMO therapy. Methods Eight patients,aging from 26 to 82 and weighted from 57-87 kg were observed. Vein-artery ECMO was used in all patients,with the flow in 40-70 ml/(kg·min) and the activated clotting time(ACT) kept at 160-200 s. Results The time of ECMO support varied from 9.5 h to 84.1 h;Among the eight patients,one didn't weaned from ECMO and died,two who were weaned died 38 h ,6 h af-ter ECMO;five patients weanned succsesefully from ECMO and discharged. Conclusions ECMO do well in treat-ment of severe cardiopulmonary failure, resuscitation and support post cardiosurgery,and the indication and timing performance are important to the final result.

AIM: To investigate the effect of a Chinese medicime, Dan-Shao-Hua-Xian capsule, on liver fibrosis induced by CCl_4 by observation of apoptosis and cell cycle variation in the liver cells. METHODS: Animal models were produced through eight-week treatment of the rats with CCl_4, alcohol and diet of high fat/low proteins, and then administration of Dan-Shao-Hua-Xian to the rats (1 g/kg) via stomach-tube-pouring for eight weeks was performed. Liver index, serum hyaluronic acid (HA) and glutamate pyruvate transaminase (ALT) were measured and hydroxyproline (Hyp) content in urine were determined. The extent of the liver fibrosis was observed under light microscope and apoptosis and cell cycle were also examined by cytometry between the two groups. RESULTS: Compared to the liver fibrosis group, the liver index, serum HA, ALT in the treatment group decreased, the development of liver fibrosis delayed, the urine Hyp and the number of apoptosed cells and the ratio of G_0/G_1 cells increased, as well as the S phase cells decreased, yet unable to return to normal. All those changes detected were statistically significant. CONCLUSIONS: The Dan-Shao-Hua-Xian is effective in treating the CCl_4-induced liver fibrosis in rats partly by virtue of inhibition of the growth of hepatic stellate cells and induction of apoptosis.

Objective To discuss the association of allele polymorphisms SNP-rs1799724(C>T)in the TNF-αand SNP-rs11559013(G>A)in the ALCAM with HCV chronic infection in Han population in Yunnan province. Methods 434 HCV chronic infectious patients and 444 healthy individuals of Han Chinese population in Yunnan province were recruited. Two single nucleotide polymorphisms(SNPs)in the SNP-rs1799724(C>T) of TNF-αgene and SNP-rs11559013(G>A)of ALCAM gene were determined by real-time TaqMan polymerase chain reaction. We evaluated the associations of the two SNPs with HCV chronic infection. Results The distributions of allele and genotype of SNP-rs1799724(C>T)in the TNF-αand SNP-rs11559013(G>A)in the ALCAM between hepatitis C virus(HCV)chronic infectious patients and the healthy controls were not statistically significant(P > 0.05). Conclusion SNP-rs1799724(C>T)in the TNF-αand SNP-rs11559013(G>A) in the ALCAM have no association with HCV chronic infection in the Han population in Yunnan province.

OBJECTIVETo assess the association of single nucleotide polymorphisms (SNPs) of the low molecular weight polypeptide (LMP) gene with chronic hepatitis C virus (HCV) infection among ethnic Han population from Yunnan.

METHODSA total of 427 patients with chronic HCV infection and 412 healthy controls were recruited. SNPs rs1351383, rs17587 and rs2127675 from the promoter region of the LMP2 gene and rs2071543 from the promoter region of the LPM7 gene were genotyped using a TaqMan probe. The haplotypes were constructed. Frequencies of various alleles, genotypes and haplotypes of the selected SNPs were calculated, and their association with chronic HCV infection was analyzed.

RESULTSThe frequencies of rs1351383 and rs2127675 alleles of the LMP2 gene, as well as the A-G-A and C-G-G haplotypes of the rs1351383/rs17587/rs2127675 loci, had differed significantly between the two groups (P<0.05).

CONCLUSIONThe C allele of the rs1351383 locus and G allele of the rs2217675 locus of the LMP2 gene may be susceptible factors for chronic HCV infection among ethnic Han people from Yunnan. The A-G-A haplotype of the rs1351383/rs17587/rs2127675 loci may confer a protective effect, while the C-G-G haplotype may be a susceptible factor for chronic HCV infection in this population.

Adult ; Alleles ; Asian Continental Ancestry Group ; genetics ; China ; Female ; Gene Frequency ; genetics ; Genetic Predisposition to Disease ; genetics ; Haplotypes ; genetics ; Hepatitis C ; genetics ; Humans ; Male ; Peptides ; genetics ; Polymorphism, Single Nucleotide ; genetics

Objective To investigate the correlations of serum prealbumin and albumin with the shortterm outcome in patients with acute cerebral infarction in different age groups.Methods Patients with acute ischemic stroke admitted to hospital with 48 h were prospectively enrolled in the study.The modified Rankin Scale was used to assess the functional outcomes at 14 d after onset,0-2 was defined as a good outcome.According to the age of the patients,they were divided into either a young and middle-aged group (＜ 60 years) or an elderly group (≥60 years).The demography,baseline clinical data and laboratory findings of the patients were compared in the overall patients and the different age groups between the good outcome group and the poor outcome group.Multivariate logistic regression analysis was used to determine the independent influencing factors of short-term outcomes.Results A total of 622 patients with acute ischemic stroke were enrolled,including 402 (64.6％) males and 220 (35.4％) females;206 (33.1％) were in the young and middle-aged group,and 416 (66.9％) were in the elderly group;310 (49.8％) had good outcomes and 312 (50.2％) had poor outcomes.There were significant differences in the proportions of patients in male,old people,hyperlipidemia,diabetes mellitus,history of previous stroke or transient ischemic attack (TIA),as well as age,body mass index,levels of prealbumin,albumin,triglyceride,high-density lipoprotein cholesterol low-density lipoprotein cholesterol total bilirubin,direct bilirubin,indirect bilirubin,urea nitrogen,and uric acid between the good outcome group and the poor outcome group (all P ＜0.05).Multivariate logistic regression analysis showed that the female (odds ratio [OR] 1.522,95％ confidence interval [CI] 1.023-2.266;P =0.038),diabetes (OR 1.789,95％ CI 1.171-2.735;P =0.007) and higher low-density lipoprotein cholesterol (OR 1.251,95％ CI 1.017-1.539;P =0.034),total bilirubin (OR 1.054,95％ CI 1.029-1.081;P＜0.001),urea nitrogen (OR 1.245,95％ CI 1.100-1.409;P=0.001),and baseline National Institutes of Health Stroke Scale (NIHSS) score (OR 2.854,95％ CI 1.027-3.628;P =0.019) were the independent risk factors for poor outcomes,and higher prealbumin (OR 0.798 95％ CI 0.633-0.979;P =0.034) and albumin (OR 0.741,95％ CI 0.693-0.988;P =0.020) were the independent predictors of good outcomes.In the young and middle-aged patients,there were significant differences in the proportions of patients with small artery occlusion as well as age,triglyceride,and high-density lipoprotein cholesterol levels between the good outcome group and the poor outcome group (all P ＜0.05);multivariate logistic regression analysis showed that diabetes (OR 2.343 95％ CI 1.127-4.871;P=0.023) and higher baseline NIHSS scores (OR 2.041,95％ CI 1.304-4.125;P =0.027) were the independent risk factors for poor outcome,and higher high-density lipoprotein cholesterol (OR 0.742 95％ CI 0.639-0.937;P =0.044)was an independent predictor for good outcome.In the elderly patients,there were significant differences in the proportions of patients in male,previous stroke or TIA,and cardiogenic embolism,as well as prealbumin,low-density lipoprotein cholesterol,total bilirubin,direct bilirubin,indirect bilirubin,and uric acid levels between the good outcome group and the poor outcome group (all P ＜ 0.05);multivariate logistic regression the analysis showed that diabetes (OR 2.797,95％ CI 1.153-4.756;P =0.039),higher baseline NIHSS score (OR 2.586,95％ CI 1.033-3.435;P =0.035) and higher low-density lipoprotein cholesterol (OR 1.304,95％ CI 1.027-1.656;P =0.029) were the independent risk factors for poor outcome,and higher prealbumin was an independent predictor for good outcome (OR 0.795,95％ CI 0.691-0.998;P =0.002).Conclusions Prealbumin and albumin are the independent predictors for short-term good outcome in patients with acute ischemic stroke.The protective effect of serum prealbumin is more obvious in the elderly population (≥60 years).