Nonalcoholic fatty liver disease (NAFLD)and gallstone disease (GD)are considered the manifestations of metabolic syndrome in the liver and gallbladder.NAFLD and GD are closely related to insulin resistance (IR),obesity,dyslipidemia,abnormal glucose metabo-lism,and so on.Worldwide studies,which have been reviewed,show that both NAFLD and GD have the common risk factors,such as IR, obesity,dyslipidemia,abnormal glucose metabolism,and middle-aged and elderly women.NAFLD is the risk factor for GD.GD,closely related to nonalcoholic steatohepatitis and liver fibrosis,accelerates the progression of NAFLD.Thus,it is considered that the prevention and treatment of NAFLD can reduce the incidence of GD,and the progression of NAFLD can be delayed by the prevention and treatment of GD.

With the development of medicine and health,the experts who have a good command of medicine and law are in great social need,so the major of medical law was introduced.This article,based on the experience and construction of medical law major in Kunming Medical College,put forward that the major of medical law must establish the cultivation goals curriculum system and projects of internship.It emphasizes the approaches to improving the students' knowledge of Arts and comprehensive abilities.

Objective To discuss the necessity and methods of combined reconstruction of the injured posterior cruciate ligament(PCL)and posterolateral complex(PLC)of the knee. Methods From January 2001 to December 2006,28 patients with injury of both PCL(≥Ⅱ°b)and PLC(＞Ⅱ°)of the knee were treated operatively in our department.Eight patients received arthroscopic PCL reconstruction with single bundle of 5-6 strands of hamstring and conservative treatment of PLC during January 2001 to December 2003.Twenty Datients received arthroscopic PCL reconstruction followed by open operative repair of PLC with median 1/3 femoral biceps tendon and gracilis during January 2002 to December 2006. Results All the patients were followed up for 6 to 24 months postoperatively (mean,15 months).By Lysholm scoring,3 cases obtained good results and 5 poor in the first group,while 19 excellent and 1 good in the second group.The mean Lysholm scores were 47.1±8.2 and 86.7±7.2 respectively(P＜0.05).According to IKDC scale,3 patients(37.5%)in the first group and 19 patients (95.0%)in the second group were graded normal or nearlv normal(t=19.277,P＜0.05). Conclusion Arthroseopic PCL reconstruction with single bundle of 5-6 strands of hamstring plus PLC reconstruction with 1/3 femoral biceps tendon and gracilis is more reliable to restore the stability of the knee than PCL reconstruction only.

Objective To summarize the experience of nursing cancer patients with Wernicke encephalopathy (WE) after gastrointestinal surgery. Method The clinical data of 6 patients with WE after gastrointestinal surgery in our hospital from January 2005 to June 2015 were retrospectively analyzed to summarize the nursing strategies. Results All the 6 patients showed mental changes of different types, 5 patients developed with ocular manifestations and one patient with ataxia. Only one patient showed the classic triad of the disease at clinical presentation. All the 6 patients had characteristic manifestations on cranial MRI and received thiamine (vitamin B1) at diagnosis. Four patients were completely recovered and 2 were partially recovered. Conclusion Timely sufficient thiamine supplementation during the perioperative period is the key to prevent and treat WE in the patients with gastrointestinal cancer. Careful observation of the patients′ mental state and the effective nursing for the special classic triad of the disease are critical for a better prognosis.

Objective To explore the mechanism of the reversibility of chronic cyclosporine (CsA) nephrotoxicity in rats after long-term drug withdrawal. Methods Chronic CsA nephrotoxicity was induced in Sprague-Dawley rats by administering CsA(15 mg . kg-1. d-1) for 5 weeks,and then the effect of drug withdraw for 5 and 10 weeks was observed. Body weight,systolic blood pressure,and renal function were monitored. In addition,renal histopathology(arteriolopathy,ED-1-positive cells,and tubulointerstitial fibrosis) and expression of osteopontin(OPN) and transforming growth factor(TGF) -?1 mRNA was examined. Results Compared with the control rats,CsA-treated rats showed loss of body weight,deterioration in renal function and development of typical histopathology. All of these above parameters were significantly reversed,meanwhile,the upregulation of OPN and TGF-?1 mRNA expression decreased significantly at 5th and 10th week after CsA withdrawal. Of note,the decreased OPN and TGF-?1 mRNA expression was positively correlated with the reduction in the tubulointerstitial fibrosis score. Conclusion The established chronic CsA nephrotoxicity is reversible after long-term CsA discontinuation,and the mechanism may be associated with the down-regulation of OPN and TGF-?1 mRNA expression.

Objective To discuss the medical treatment responsibility caused by unpredictable harm.Method In medical treatment,the court usually applies the "Equitable Responsibility" principle to settle the medical conflicts caused by unpredictable harm,this poses certain limitations.Result The fact that hospitals being liable for compensation or reparation ignores the mutual risk-sharing responsibility of hospitals and patients.Conclusion To establish the system of medical accident insurance is one of the best measure to solve the medical conflicts caused by unpredictable harm.

Animals ; Cell Adhesion Molecules ; drug effects ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; E-Selectin ; drug effects ; Humans ; Intercellular Adhesion Molecule-1 ; drug effects ; Phytotherapy

Objective To investigate the effects of desflurane and/or nitric oxide (NO) on the lung injury induced by ischemia-reperfusion ( I/R) during cardiopulmonary bypass (CPB) in children with pulmonary hypertension secondary to congenital heart disease (CHD) .Methods Forty children with CHD and pulmonary hypertension (24 male, 16 female) aged 0.6-3.7 yrs weighing 7.1-11.9 kg undergoing cardiac surgery under CPB were randomly divided into 4 groups ( n = 10 each): group control; group DES; group NO and group DES + NO. The patients were premedicated with oral midazolam 0.5 mg?kg-1. Anesthesia was induced and maintained with fentanyl and vecuronium. Radial artery was cannulated for MAP monitoring and blood sampling. Pulmonary catheter was placed under direct vision after chest was opened. The patients received inhalation of desflurane (1-1.3 MAC) (group DES)/NO (10-20 ppm) (group NO) /DES + NO (group DES + NO) immediately after pulmonary catheterization until the start of CPB. MAP, PAP, peak airway pressure (Ppeak) and compliance of respiratory system (Crs) were recorded at 5 min after induction (T0 ), 5 min before CPB (T1 ), 5 min after start of CPB (T2) and at the end of surgery (T3) . Blood samples were taken at T0 and T3 for determination of methemoglobin (Met-Hb), soluble intercellular adhesion molecule-1 (sICAM-1), XOD and MDA.Results The four groups were comparable with respect to age, M/F ratio, body weight, duration of CPB and type of operation performed. MAP was significantly decreased after inhalation of desflurane alone or desflurane + NO before CPB ( at T1) as compared to the baseline value at T0; while PAP was significantly decreased after inhalation of NO alone or NO+ desflurane before CPB (at T1) as compared to the baseline value. Ppeak was significantly lower while Crs was significantly higher at end of surgery (T3) in group NO and NO + desflurane than in control group. Blood sICAM-1 and MDA concentrations and XOD activity were significantly lower at the end of surgery (T3 ) in group DES, NO and DES + NO than in control group. Met-Hb was significantly increased at the end of surgery (T2) as compared to the baseline (T0) in group NO and DES + NO but was still within normal range. Conclusion Inhalation of desflurane and/or NO can ameliorate the lung injury during CPB in children with pulmonary hypertension secondary to CHD, in addition to inhibit the pulmonary hypertension.

Objective To evaluate the perfectibility of colposcopy directed biopsy for the diagnosis of cervical intraepithelial(CIN)through cervial conization by loop electrosurgical excision procedure(LEEP).Methods Biopsy by colposcopy and biopsy after LEEP were analyzed retrospectively in 108 cases of cervical intraepithelial neoplasia to study the related factors of affecting the coincidence rate.Results Comparison of pathological hanges following both LEEP and colposcopy showed that 69 cases were the same,24 upgrade,and 15 downgrade.Conclusion LEEP is a kind of effective and perfect method for the specific diagnosis and treatment of CIN.Colposcopically directed biopsy has its limitations.

Case management is a flexible, systematic, holistic new care model which can integrate the episodic therapy of cancer patients. Case management applied the process of assess, plan, implementation, evaluation and feedback to the process of case management, conduct the path management from diagnosis to follow-up. This paper introduces the job descriptions and competence of case managers, the development of cancer case management domestic and overseas; so as to offer reference for the domestic implementation of cancer case management. Consequently realize the comprehensive rehabilitation of physical, psychological, social and spiritual function for cancer patients.