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.

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 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.

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 analyze the influence of mode of delivery on post-neonatal gut microbiota using polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) technology.Methods From April to August in 2013,thirty healthy urban full-term neonates in Nanjing City were enrolled in the study,including fifteen exclusive breastfed ones (seven born of caesarean section and eight born vaginally) and fifteen mixed feeding ones (eight born of cesarean section and seven born vaginally).Stool specimens were collected on the 28th day after birth and bacterial genomic DNA was extracted and examined by PCR on 16S rDNA V3 variable region.Bacterial community profiles were obtained by DGGE.Diversity and similarity differences of the gut microbial community structures were analyzed.Two independent sample t test or Chi-square tests were used for stastistical analysis.Results (1)Diversity analysis showed that among exclusive breastfeeding infants,the Strip number and Shannon-Weaver Diversity Index of gut microbiota in infants born abdominally were significantly lower than those born vaginally [9.71 ±4.27 vs 15.12±4.19,2.13±0.39 vs 2.61±0.32,both P＜0.05],but the Simpson index of gut microbiota was significantly higher [0.13 ± 0.04 vs 0.08± 0.03,P＜0.05],and no significant difference was shown in Pielou Index (P＞0.05).In the mixed feeding group,the Strip number and Shannon-Weaver Diversity Index of gut microbiota in infants born abdominally were significantly lower than those born vaginally [10.88±3.23 vs 16.29±5.38,2.26±0.37 vs 2.66±0.31,both P＜0.05],the Simpson index was higher,but together with the Pielou Index,neither showed significant difference (both P＞0.05).(2) Similarity analysis found that gut microbiota from neonates born of same mode of delivery mostly gathered together and had much more similar structures.Conclusions In the post-neonatal period,the species and numbers of gut microbiota in infants born abdominally are all behind of those born vaginally.The predominant microbiota in babies born of cesarean section are more prominent,and gut microbiota in vaginal delivered babies are more uniformly distributed.

Objective: To establish an HPLC-fluorescence detection method for the determination of thioguanosine-monophosphate (TGMP), thioguanosine-diphosphate (TGDP) and thioguanosine-triphosphate (TGTP) in red blood cells (RBC), as well as quantify the individual thioguanine nucleotides metabolites in kidney transplant recipients with azathioprine (AZA) therapy.Methods: The individual thioguanosine phosphates were extracted from RBC by dichloromethane and subsequently oxidized by potassium permanganate.The separation was achieved on a Nucleosil C18 column (150 mm×4.6 mm,5 μm) with an ion pairing reagent and detected by a fluorescence detector (excitation at 315 nm, emission at 390 nm).The mobile phase consisted of 20 mmol·L-1 potassium phosphate buffer (pH was adjusted to 6.8 by 5 mmol·L-1 tetrabutylammonium hydrogensulfate)-acetonitril (80:20) with the flow rate of 1.0 ml·min-1.Results: TGMP, TGDP and TGTP were quantified from RBC within the range of 50-500, 50-1000 and 100-5 000 pmol·ml-1, respectively.The limit of quantification (LOQ) was 50, 50 and 100 pmol·ml-1 RBC for TGMP, TGDP and TGTP, respectively.The intra-and inter-day RSDs were below 7.0% with the method recovery between 95.0% and 103.6%.The mean extraction recovery was above 90%.The assay was applied in the blood samples of 30 kidney transplant recipients with AZA therapy, and the results indicated that TGTP was the predominant phosphate metabolite in RBC.Conclusion: The method is simple, rapid, sensitive and specific, and it can quantitatively determine the individual thioguanosine phosphates in RBC of kidney transplant recipients with AZA therapy.