The crime of accident of medical treatment is the new crime added to the Criminal law of 1997.Since it appeared in the Criminal law of 1997,there have been many debates about it.One of them is how to comprehend the "serious hurt".I think the prescript itself lacks pertinence and we should make the GBH as the standard of judging the "serious hurt".

BACKGROUND:Neural stem cells(NSCs)are characterized by widely resources,convenient harvesting,easy culture and prone to import and express exogenous genes,which can be served as carriers of gene therapy for neural system disease.OBJECTIVE:To review the application of NSCs in spinal cord injury.METHODS:Databases of PubMed(http://www.ncbi.nlm.nih.gov/PubMed)and Wanfang(http://www.wanfangdata.com.cn)were searched by the correspondence author using key words of "neural stem cells,spinal cord injury,cellular transplantation" both in English and Chinese to retrieve papers concerning isolation,identification,differentiation of NSCs as well as its application in repairing spinal cord injury.A total of 82 documents were initial obtained by computer,after repetitive studies were excluded,23 papers were included in the final analysis.RESULTS AND CONCLUSION:The NSCs transplantation has been widely used in animal experiments.Currently,the applications of NSCs in repairing spinal cord injury are concentrated on the following aspects:Firstly,cellular replacement therapy,namely,direct transplanting NSCs or activating in vivo NSCs to differentiate into neurons and glial cells,and then integrating transplanted cells with the existed neural cellular structure to cure the disease.Secondly,NSCs were utilized as gene carriers,which carrying target gene to body and reach the aims of cellular replacement and gene therapy.Thirdly,autologous NSCs were induced differentiation for self neural repair via studying growth factors and cytokines.

Objective To analyze the factors contributing to local recurrence following body gamma knife radiotherapy in patients with non-small cell lung cancer(NSCLC),and to explore a standard therapeutic scheme under the circumstance.Methods 332 patients with NSCLC received body gamma knife therapy and subsequent regular follow-up.Dose per fraction and total dosage used were dependent on disease condition,tumor location,tumor features and tumor size,etc.On the basis of patients' conditions and adverse effects,biological effective dose(BED) was 56-90Gy calculated with LQ model.Univariate analyses were performed including sex,age,Karnofsky performance score,clinical stage,pathological type,tumor differentiation degree,tumor size,tumor location,target volume delineation,dose per fraction,BED and chemotherapy scheme,etc.with X2 or t test.By selecting significant clinical factors in univariate analysis,multivariate analyses were performed with COX regression model.Results Of the 332 patients,local recurrence occurred in 22 cases during regular follow-up period,with average recurrence time of 10 months,and the local recurrence rate was 6.63%.The results of multivariate analysis showed that low BED,low Karnofsky score,old age,too small delineation for target volume range and central type of lung cancer were the factors related to local recurrence.Conclusions Low BED in body gamma knife radiotherapy is the significant factor of local recurrence for patients with NSCLC.BED in body gamma knife radiotherapy should be more than 80Gy for NSCLC patients who receive the radical treatment.

Objective To evaluate the therapeutic effects and complications of whole body gamma knife conformal radiotherapy for patients with non-small cell lung cancer(NSCLC).Methods 169 patients with NSCLC received whole body gamma knife conformal radiotherapy.Total dose,fractions,and radiation time were determined based on disease course,tumor location,tumor features and tumor volume,etc.Small target volume(tumor size less than 3cm in diameter) received 5-10Gy each time,40-50Gy in 4-10 fractions;moderate target volume(tumor size 3cm-5cm in diameter) received 4-8Gy each time,48-56Gy in 4-16 fractions;and big target volume(tumor size more than 5cm in diameter) received 3-4Gy per time,40Gy in 10-14 fractions and followed by 10-30Gy using reduced fields.Results Of 269 tumors in 169 patients,complete response(CR) rate,partial response(PR) rate,and rate of no change(NC) were 41.6%(112/269),44.6%(120/269) and 13.8%(37/269),respectively.Overall response rate(CR+PR) was 86.2%(232/269),with 1-year local control rate of 92.3%.1-year and 2-year survival rate was 75.1% and 46.2%,respectively,with median survival time of 19 months.The incidence of Grade 1,2 and Grade 3 radiation pneumonia was 15.4% and 3.1%,respectively.Conclusions With minor adverse effects,whole body gamma knife conformal radiotherapy may have short-term therapeutic effects for NSCLC patients with amelioration of disease symptoms,obvious elevation of tumor local control rate,a raise of the survival rate,and improvement of life quality.

Asthma is a common disease in children. Adherence to inhaled glucocorticoid therapy directly affects the outcome of asthma. The article mainly reviews the adherence status, assessment method, patient barriers to non-adherence and intervention strategy,so as to provide references for clinical practices and scientific research of nursing staff.

Objective In order to research the operative method for preservation of healthy lung in the middle lobe carcinoma.Methods From June,1994 to August,1999,16 cases lobectomy of middle lobe cancer were performed.12 of 16 cases were received middle lobectomy with bronchial wedge-shaped resection,6 of which were followed by partial pulmonary artery resection,2 of which,with pulmonary artery sleeve resection,3 of 16 were cured by the middle lobe sleeve lobectomy,one of which was done with combined partial pulmonary artery resection.One of 16 received both middle and lower lobectomy,simultaneously,completed upper pulmonary vein and lower pulmonary vein reconstruction.Results 16 cases operation were all successful.The survival rate in 1 and 3 years were 88% and 50%,respectively.Conclusion Bronchovascular resection and reconstruction applied to treat the middle lobe cancer not only could maximal remove the focal lesion,but also reserve the healthy lung fully,and expanded the surgical indication.

Objective To investigate the effect of propofol on ketamine-induced cognitive dysfunction and neuronal apoptosis in hippocampus in aged rats. Methods Thirty-two male SD rats aged 18-24 months weighing 380-470 g were randomly divided into 4 groups ( n = 8 each) :control group (group C);propofol group (group P);ketamine group (group K) and propofol + ketamine group (group PK). Propofol 30 mg·kg-1·h-1 or/and ketamine 40 mg· kg-1·h-1 were infused for 2 h once a day for 7 consecutive days. After the last day of drug administration cognitive function was assessed using Morris water maze (escape latency and the number of animals' swimming across the platform). The animals were sncrificed after water naze test and their hippocampi were removed for determination of neuronal apoptosis (by TUNEL) and caspase-3 expression (by immuno-histochemistry) in hippocampal CA1 region. Results There was no significant difference in escape latency and the number of the animals,swimming across the platform, the neuronal apoptotic rate (the number of apoptotic neurons/the number of total neurons) and caspase-3 expression between group C and P. In group K and PK the escape latency was prolonged,the number of animals' swimming across the platform was decreased, neuronal apoptotic rate increased and the caspase-3 expression up-regulated as compared with group C. The ketamine-induced changes were significantly attenuated by coadministration of propofol in group PK. Conclusion Coadministration of propofol can ameliorate ketamine-induced cognitive dysfunction and hippocampal neuronal apoptosis.

Objective To analyze the mutations in keratin 1 (KRT1), KRT9 and KRT10 genes in a Chinese family with epidermolytic palmoplantar keratoderma (EPPK). Methods Clinical data were collected from a family with EPPK. Genomic DNA was extracted from the peripheral blood of 12 family members, including 6 patients and 6 unaffected members, as well as from 50 unrelated normal human controls. PCR was performed to amplify all the exons and flanking sequences of KRT1, KRT9 and KRT10 genes followed by DNA sequencing.Results A missense mutation C.1436T > C was found in the highly conserved helix termination motif of KRT1 gene of all the patients, resulting in a substitution of isoleucine by threonine at position 479 of the KRT1 protein. No mutation was found in the unaffected members or unrelated controls. Conclusions The missense mutation C.1436T > C in K.RT1 gene is likely to be the main cause of the phenotype of EPPK in this family.This is the first report of a pedigree with KRT1 gene mutation-induced EPPK in China.

Objective To study the correlation between serum adiponectin along with insulin resistanee and vascular dilation function in patients with different rates of glucose metabolism.Method A total of 83 patients aged 50-65 years,including 17 with normal glucose tolerance(NGT),22 with impaired fasting glucose (IFG),23 with impaired glucose tolerance(IGT)and 21 with diabetes(DM)were enrolled. Serum adiponectin was measured,and homeostasis model assessment for insulin resistance index (HOMA-IR)and B cell function index were used to evaluate the function of insulin secretion before and during oral glucose tolerance test(OGTr).The brachial artery responses to flow-mediated endothelium-dependent vascular dilation(EDVD)and nitroglycerin-mediated vascular dilation (EIVD) were evaluated by using the vascular ultrasound with high resolution.Results The serum adiponectin and EDVD decreased that the degrees of reduction from slightness to greatness were in turn from NGT,IFG,IGT to DM,whereas,the insulin resistance index (HOMA-IR) increased just in reverse order.Adiponectin was negatively associated with HOMA-IR(r=-0.353,P<0.01)but positively associated with EDVD and EIVD(rl=0.391,r2=0.375,P<0.01),and was not associated with HOMA-B.On the other hand,EDVD was not associated with HOMA-IR(P>0.05).In a multiple regression analysis with a stepwise manner to predict adiponectin concentration and EDVD.HOMA-IR was supposed to predict adiponectin concentration.Meanwhile APN but not HOMA-IR was used to predict EDVD(P<0.05).Condusions The decrease in serum adiponectin,endothelial dysfunction and insulin resistance can be observed in the early stage of impaired glucose metabolism. Serum adiponectin concentration appears to be associated with vascular function and insulin resistance.The association between serum adiponectin concentration and vascular function seems to be independence from its link with insulin resistance index.

Objective To observe the effect of lipopolysaccharide (LPS)-mediated infection during pregnancy on the expression of mineralocorticoid receptor (MR) and density of dendritic spines in CA1 region of the dorsal hippocampus of rat offspring,so as to explore the mechanisms for learning and memory injury of rat offspring which were infected during prenatal period,then to provide scientific experimental evidence for the prevention of prenatal infection-induced delayed neuropsychiatric sequelae which contributed to learning and memory dysfunction.Methods Ten-week-old female Sprague-Dawley rats (n =30) were matched with male rats (1 ∶ 1).Pregnant rats were randomly divided into a control group (n =10) and an experimental group (n =20).The pregnant rats in experimental group were treated with LPS (66 μg/kg,intraperitoneally),and the pregnant rats in control group were intraperitoneally injected with same volume of saline on gestational day 10.On postnatal day 48,Morris water maze was used to estimate the ability of learning and memory;the brain tissues of offspring were taken and paraffin sections were stained with hematoxylin eosin (HE) for histological observation of CA1 region of the dorsal hippocampus;frozen sections were treated with indirect immunofluorescence to observe the expression of MR in CA1 region of the dorsal hippocampus;Golgi-Cox method was used to observe the density of dendritic spines of CA1 region.Results In Morris water maze test,from the third day the time of escape latency in experimental group [the 3rd day:(42.603 ± 9.837) s;the 4th day:(30.222 ± 9.789) s;the 5th day:(28.808 ± 12.526) s] was significantly higher than that of the control group [the 3rd day:(28.078±14.088) s;the 4th day:(20.692±13.099) s;the 5th day:(14.632 ±11.624) s] (the 3rd day:t =-3.274,P＜0.01;the 4th day:t =-2.257,P ＜0.05;the 5th day:t =-3.213,P＜0.01);the swimming time in the target quadrant [(14.660 ± 7.337) times] and the number of crossing platform [(0.933 ± 0.704) times] in experi mental group were significantly decreased compared with those of the control group [time:(23.820 ± 6.321) s;num bers:(2.000 ± 0.756) times] (t =3.663,4.000,all P ＜ 0.01).Hematoxylin eosin staining showed that the nerve cells of the hippocampus in the control group distributed in order,nucleuses were round or oval,nucleoli were obvious,and chromatins were homogeneous;but the cells in the experimental group distributed in disorder and pathological changes were detected,such as cellular swelling,necrosis and obvious nuclear pyknosis.By immunofluorescence staining,the average optical density (AOD) of MR in CA1 region decreased significantly in the experimental group (0.067 ± 0.017) compared with that of the control group (0.083 ± 0.009) (t =2.644,P ＜ 0.05).In Golgi-Cox method,the density of dendritic spines in experimental group [(7.705 ± 0.791)/10 μm] was below that of the control group [(9.655 ± 1.391)/10 μm] (t =3.852,P ＜ 0.01).Conclusions LPS-mediated infection during pregnancy might lead to hippocampus-dependent learning and memory dysfunction which might be associated with the reduced expression of MR and the low density of dendritic spines in CA1 region of the dorsal hippocampus.