Objective To find out the tendency of medical accident arbitration in 5 hospitals of Shanghai and the causes. Methods Cases involving medical accident arbitration that occurred in the 15 years running from 1985 to 1999 in 5 third tier hospitals of Shanghai were collected and a retrospective correlation analysis was conducted. Then 45 of the cases were selected by random sampling and a detailed analysis was made. Results ①During the 15 years the number of cases involving medical accident arbitration by class 1 commissions was 295, with the average number per year in the latter five years rising 51% as compared with the first ten years. ②There was no significant correlation between the number of cases involving arbitration and the number of cases judged to be accidents. ③There was no correlation, either, between the total volume of emergency outpatient service, which amounted to 68, 6 million visits, and the number of cases involving medical accident arbitration. ④The sample survey showed that the operating room and the emergency room were sections where medical accidents occurred most frequently. Conclusion In the past 15 years, the number of cases involving medical accident arbitration has been on the rise, yet there is no correlation between the rise and the number of cases judged to be accidents or the volume of medical service. The causes for the rise include both iatrogenic and non iatrogenic ones. The paper puts forward 6 countermeasures.

Objective: To prepare an adenovirus, Ad-CD, expressing bacterial cytosine deaminase(CD),and use it for tumor suicide gene therapy. Methods: We constructed a recomb ined adenoviral vector carrying CD or LacZ. 293 packaging cell was trans fected by the newly-constructed plasmid and generated the infectious virus. The n the adenovirus was used to infect C26 cell in vitro. Results: The growth of Ad-CD-infected cell was obviously surpressed after admini stration of 5-FC. Conclusion: CD gene carried by adenoviral vec tor is effective for tumor cell suicide gene therapy in vitro.

Objective To investigate the effects of supreme laryngeal mask airway (SLMA) and endotracheal intubation on the elderly hypertensive patients treated with knee arthroplasty. Methods Forty cases of elderly hypertensive patients ASA Ⅰ-Ⅲ treated with knee arthroplasty in our hospital were selected and randomly divided into laryngeal mask airway group (group LMA)and endotracheal intubation (group TT),20 cases for each group.The same protocol for induction and maintenance of general anesthesia was used.After the patients entering,the changes of SpO2 and ECG were performed continuous noninvasive monitoring and SBP,DBP and HR were performed con-tinuous invasive monitoring.SBP,DBP and HR of two groups were recorded at different time points:before anesthesia induction (T0 ,based value),at intubation immediate (T1 ),5 mins after intubation (T2 )and 1 5 mins after intubation (T3 ).At the same time,the content of cortisol (Cor),atrial natri-uretic peptide (ANP)and the concentration of epinephrine (E)and norepinephrine (NE)were meas-ured at the corresponding time points above.Results Compared with T0 ,SBP and DBP at T1-T3 in group LMA were decreased(P <0.05 or P <0.01);SBP and DBP at T1 in group TT were increased while decreased at T2 ,T3 ,HR at T1 were increased(P < 0.05 or P < 0.01 ).Compared with group LMA,SBP and DBP at T1-T3 and HR at T1 ,T2 in group TT were increased (P <0.05 or P <0.01). Compared with T0 and group LMA,the content of E,NE and Cor at T1-T3 increased(P <0.05 or P <0.01).The level of ANP in both groups at T1-T3 were higher than those at T0 ,and group TT were higher than group LMA(P <0.01).Conclusion Compared to endotracheal intubation,SLAM can ef-fectively reduce the stress reaction of elderly hypertensive patients treated with general anesthesia in knee arthroplasty.

Objective To investigate the effect of caspases-3 on doxepin-induced apoptosis in rat neurons.Methods The PC12 cells seeded in culture plates were randomly divided into 4 groups (n =10 each) using a random number table:normal control group (group C);doxepin group (group D);caspase-3 inhibitor Z-DEVD-FMK group (group Z);doxepin + Z-DEVD-FMK group (group DZ).In group C,the cells were continuously incubated for 24 h.In group D,doxepin was added with the final concentration of 120 μmol/L,and the cells were continuously incubated for 24 h.In group Z,Z-DEVD-FMK was added with the final concentration of 10 μmol/L,and the cells were continuously incubated for 24 h.In group DZ,doxepin and Z-DEVD-FMK with the final concentrations of 120 and 10 μmol/L,respectively,were added,and the cells were continuously incubated for 24 h.After 24 h of incubation,the cell viability was detected by methyl thiazolyl tetrazolium assay,the cell morphology was observed under inverted microscope,and the neuronal apoptosis was measured by flow cytometry.Apoptosis rate was calculated.Results Compared with group C,the cell viability was significantly decreased,and apoptosis rate was increased in D and DZ groups (P＜0.01),and no significant change was found in the parameters mentioned above in group Z (P ＞ 0.05).Compared with group D,the cell viability was significantly increased,and apoptosis rate was decreased in group DZ (P＜ 0.01).The morphological changes were significantly mitigated in group DZ as compared with group D.Conclusion Caspases-3 may mediate doxepin-induced apoptosis in rat neurons.

Objective To explore the optimum sentinel lymph node (SLN) mapping method in gastric cancer. Methods The clinical data of 59 patients who were confirmed with gastric cancer at Guangzhou General Hospital of Guangzhou Military Command from January 2004 to August 2008 were retrospectively analysed. Patent blue V dye was used in 20 patients (group A), technetium-99m sulfur colloid was used in 20 patients (group B),and a combination of patent blue V dye and technetium-99m sulfur colloid were used in 19 patients (group C).The number of SLNs detected, and accuracy and false-negative rate of SLNs in diagnosing regional lymph node metastasis were analysed by t test and chi-square test. Results The numbers of SLNs detected in groups A, B and C were 38 (1.9 per case), 31 (1.6 per case) and 56 (2.9 per case), respectively. In group C, 46 SLNs were screened out by patent blue V dye and technetium-99m sulfur colloid simultaneously, six SLNs were only detected by patent blue V dye and four only by technetium-99m sulfur colloid. There was a significant difference in the number of SLNs detected among the three groups (t = 4.35, P ＜ 0. 05 ). The number of SLNs detected in group C was significantly greater than that in groups A and B (t = 4. 21, 3. 54, P ＜ 0.05 ). The accuracy and false-negative rate of SLNs in diagnosing regional lymph node metastasis were 95% (19/20) and 5% (1/20) in group A, 90% (18/20) and 10% (2/20) in group B, and 100% (19/19) and 0 in group C. The accuracy was significantly higher (x2 = 163.01, P ＜ 0.05) and the false-negative rate was significantly lower in group C compared with those in groups A and B (x2 = 170. 14, P ＜ 0. 05). Conclusion A combination of dye and radioactive tracer is a favorable method for detecting SLNs in gastric cancer.

Objective To evaluate the effect of doxepin on the expression of p38 mitogen-activated protein kinase (p38 MAPK) in the spinal cord of rats with neuropathic pain (NP).Methods Sixty clean-grade male Wistar rats in which intrathecal catheters were successfully implanted,weighing 200-250 g,were divided into 3 groups (n =20 each) by a random number table method:sham operation group (S group),NP group and doxepin group (D group).NP was induced by chronic constriction injury (CCI) to sciatic nerve.Doxepin 20 mmol/L (10 μl) was intrathecally injected at 3,7,14 and 21 days after CCI (T1-4) in group D.The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 1 day before CCI (T0) and at T1-4.The rats were sacrificed after measurement of pain threshold at T4,and L4-6 segments of the spinal cord were removed for determination of the expression of p38MAPK protein by Western blot.Results Compared with S group,MWT was significantly decreased and TWL was shortened at T2-4,and the expression of p38MAPK protein was up-regulated in NP and D groups (P＜0.05).Compared with NP group,MWT was significantly increased and TWL was prolonged at T2-4,and the expression of p38MAPK protein was down-regulated in D group (P＜0.05).Conclusion The mechanism by which doxepin mitigates NP is related to down-regulating p38MAPK expression in the spinal cord of rats.

Objective:To investigate how medical staff recognize and understand the nursing quality evaluation in robot-assisted arthroplasty so as to provide reference and evidence for construction of a nursing quality evaluation system for robot-assisted arthroplasty.Methods:The descriptive phenomenological research method was used for this qualitative research. From May to October, 2021, 6 doctors and 9 nurses from Operating Room, Laoshan Campus, Hospital Affiliated to Qingdao University were interviewed in a semi-structured way about the nursing quality evaluation for robot-assisted arthroplasty. The data were sorted out by Nvivo12.0 qualitative analysis software, and the interview data were analyzed while the themes and topics refined according to the Colaizzi seven-step analysis of phenomenological data.Results:Three themes were extracted. ① The first theme was related to the quality evaluation of nursing structure, including 2 topics: nursing staff allocation and nursing quality management in operating room. ② The second theme was related to the quality evaluation of nursing process, including 4 topics: environment and facilities, nosocomial infection control, management of patients' operative safety, and specialized operative nursing. ③ The third theme was related to the quality evaluation of nursing outcomes, including 3 topics: satisfaction for operating room nursing, incidence of adverse events and patients' benefits.Conclusion:The themes and topics for nursing quality evaluation in robot-assisted arthroplasty extracted from the perspective of medical staff can provide reference for construction of a reasonable, scientific, efficient and comprehensive nursing quality evaluation index system.

OBJECTIVE：To provide reference for constructing and improving the pharmacovigilance signal management sys - tem in China by comparing signal management system among the European Union （EU），the United States （U. S. ）and Japan. METHODS：Literature analysis method was used to systematically compare the similarities and differences on definitions ，sources， detection methods and management process of pharmacovigilance signals among EU ，U. S. and Japan. Some suggestions were put forward for pharmacovigilance management in China. RESULTS & CONCLUSIONS ：Regulatory authorities of the EU ，U. S. and Japan did not have a uniform definition on signals ；EU drug administration adopted the definition of the eighth working group of Council for International Organizations of Medical Sciences ，FDA adopted its own definition ，while the Japanese regulatory agency had no clear definition. Currently ，post-marketing surveillance still relied mainly on spontaneous reporting systems ；EU，U. S. and Japan had carried out the signal detection based on the spontaneous reporting system ；EU mainly adopted the proportional reporting ratio method ，U. S. mainly adopts the multiple gamma Poisson Shrinker ，and Japan mainly adopted the reporting ratio method. EU had special guidelines for signal management process ，while the U. S. and Japan did not. It is recommended to accelerate the deve- lopment of the legal and regulatory framework on pharmacovigilance in China ，draw up guidelines on pharmacovigilance practices ， strengthen the active ADR surveillance and promote the application of data mining techniques in signal detection field ，for accelerat - ing the standardization and internationalization of China ’s pharmacovigilance work.

ObjectiveTo observe the effect of comprehensive intervention on the incidence of lactation galactostasis in communities from the perspective of preventive medicine， so as to prevent the occurrence of the mammary ducts obstruction disease. MethodsA total of 400 women in the early stage of pregnancy were selected from four communities. Those in two communities were set up as the intervention group. Comprehensive intervention for the prevention and treatment of mammary ducts obstruction disease during pregnancy and "Six-step recanalization manual therapy" practical guidance were conducted on the intervention group. The pregnant women from the other two communities were the control group， who received no intervention or guidance training. The two groups were followed up at 1 month， 3 months and 5 months postpartum， and the occurrence of mammary ducts obstruction disease was investigated and interventions were carried out. ResultsThe incidence of galactostasis in the intervention group was 26.0%， 10.6% and 5.1%， respectively at 1， 3 and 5 months after delivery， and the incidence of galactostasis in the control group was 38.0%， 22.2% and 8.3%， respectively. The incidence of galactostasis at 1 month and3 months after delivery was statistically different （P<0.05）， while the incidence of galactostasis 5 months after delivery was not statistically different （P>0.05）. The protection rates of comprehensive intervention on galactostasis were 31.58%， 52.25% and 38.55%， respectively. ConclusionPublicity and education work of prevention and control of the mammary ducts obstruction disease and "Six-step recanalization manual therapy" practical guidance can effectively reduce the occurrence of plugged mammary ducts， and therefore should be promoted.

OBJECTIVESTo compare the prognostic value of three lymph node(N) staging systems, including the number of metastatic lymph nodes(pN), the metastatic lymph node ratio (Nr) and the log odds of positive lymph nodes (LODDS), in gastric cancer patients after radical resection.

METHODSClinical and pathological data of 1 796 patients who underwent gastric cancer radical resection with complete follow-up information from January 2000 to December 2010 at Sun Yat-sen University Cancer Center were retrospectively analyzed. For each patient, N stages were classified according to three lymph node staging systems (pN, Nr, and LODDS). The relationship between each N staging was examined. Survival was analyzed using the Cox's proportional hazard model, and discrimination of staging system was determined using the change value of Chi squared statistic (▹χ) from the log-likelihood test. A larger ▹χvalue indicates a better discriminatory ability. The homogeneity of 5-year overall survival across each pN stage within each Nr and LODDS stage was compared by using the log-rank test. The subgroup analysis was performed to evaluate whether each of the competing system was affected by the number of lymph nodes retrieved.

RESULTSThe mean number of lymph node examined and positive nodes in the entire cohort was 21.1±12.1 and 7.9±8.2,respectively. The median overall survival of all the patients was 45 months (95% CI: 42.6 to 47.4 months), and the 5-year survival rate was 55.0%(95% CI: 52.6% to 57.4%). The ▹χof Nr system was 198.546, which was higher than that of pN(191.255) and LODDS(196.557) system. Except for the pN3b stage, significant heterogeneity was found among patients of different Nr subcategories in 5-year overall survival rate (all P<0.05) within each pN stage. While there was no significant difference in overall survival when any of the Nr stages was stratified by pN stages(all P>0.05). Significant difference in survival among patients of different LODDS subcategories was also seen within each pN stage. But for the LODDS system, the survival rate was similar among patients of different pN subcategories (all P>0.05) apart from the LODDS3 stage. The hazard ratios of patients with insufficient lymph nodes examined (≤15) were higher than those with sufficient nodes examined (>15) when the pN classification was used (all P<0.05), whereas similar results were not found if the Nr or LODDS classification was applied.

CONCLUSIONCompared with the pN staging system, both the Nr and LODDS staging system, especially the former, have a higher degree of discrimination ability and robustness to predict the prognosis in patients with gastric cancer after radical resection.

Aged ; Female ; Gastrectomy ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery ; Survival Rate