Commercialization of the doctors sector and lawyers sector, and that of medical services, sharp rise of medical disputes and its impact on healthcare services have grown into major challenges for the healthcare system in the United States where litigation is the legal way out of medical disputes at large.Anglo-American law system depends heavily on precedence as the criteria and the majority of such disputes trials are held in state courts, there is also a complete system of laws and decrees on medical disputes on the federation level.In an effort to handle medical disputes that are rising sharply in a piling-up amount, American lawyers, social organizations of arbitration and medicine, and many state courts are seeking alternative dispute resolution as a better way out for medical dispute mediation and resolution.Given the gaps between China and USA in social systems, legal systems, ,economic development, cultural background, healthcare systems and heahhcare security systems, these experiences will prove their value of reference for medical disputes resolution in China.

Objective To evaluate the efficiency of the management of medical equipment. Methods Ergonomics was applied to analyze the influence of Man-Machine-Environment System. Results Based on the actual cases, the improved procedure for equipment quality was realized and the management of purchase items were evaluated in quantification. Conclusion The efficiency of the management of medical equipment can be evaluated by using this method.

Objective: To realize cycle management early warning function of measuring instruments. Methods: The software will visit the existing access log files of measuring instruments for the next test date. They are compared with the system date. Software will alarm when measurement instruments test cycle is about to expire. Results: By setting the parameters, the software can easily access the measuring equipment log files. It can effectively implement early warning function. Conclusion:Visual Basic6.0 achieved the development of this software conveniently, took up less system resources, powerful, effectively preventing the verification of measuring instruments and missed period expired to happen.

Objective:To explore the relation of the expression among C-erbB-2,p16 and nm23-H 1 protein in tissues of nasopharyngeal carcinoma(NPC)and its clinical significance.Methods:SP TMimmunohistochemical technique was used to detect the positive expression rate of C-erbB-2,p16 and nm23-H 1 protein in NPC tissues.Rusults:①The positive rates of C-erbB-2,p16 and nm23-H 1 in low differentiated squamous cell carcinoma were 58.75%,47.5% and 35%,while in undifferentiated squamous cell carcinoma, they were 86.67%,31.11% and 60% respectively. ②Their expression rate were significantly correlated with the clinical staging(P

Objective To introduce a new bilateral triceps brachii approach for the treatment of intercondylar fractures of the humerus, and explore the possibility for the operation without injuring the mechanism of extension of the elbow. Methods With fresh cadaver specimens, the triceps brachii was stripped off from the distal end of the humerus, the muscle belly was elevated and retracted bilaterally, then the height was recorded, and the exposure of the distal humerus was observed, especially to the trochlear region when the elbow were flexed at 15? , 30? , 45? , 60? , 80? respectively. Results Through the cadaver specimen observation and the clinical application, the reduction and fixation of the intercondylar fractures of humerus should be performed when the elbow is flexed at 45?－ 60?， at 15?－ 30? flexion, fracture over the supracondylar can be treated and finally at 80? flexion, the reduction of the trochlear region can be examined. Conclusion This bilateral approach through the triceps brachii is suitable for the treatment both of the intercondylar and epicondylar fractures.

Objective To discuss methods of pedicle screw fixation for thoracolumbar burst fractures among middle and old aged patients with different degree of osteoporosis, and to improve the clinical result by individualized treatment according to fracture characteristics. Methods There were totally 25 patients, 17 males, and 8 females. These patients with a mean age of 52 years (range, 43-63 years), had suffered from thoracolumbar burst fractures consisted of 1 T11 fracture, 6 T12 fractures, 8 L1 fractures, 7 L2 fractures, 3 L3 fractures. According to Jikeis osteoporosis grading system, 5 patients were of early stage, 7 of stage Ⅰ, 13 of stageⅡ. Posterior stabilization with the short-segment pedicle screw system were given to all the patients, among which 6 RF, 8 AF, 5 USS, 6 Socon were performed. Fifteen patients received anterolateral decompression, and ten patients accepted no decompression at all. Some measures were taken in order to enhance the fixation stiffness for pedicle screw system, such as increasing the screws diameter, using the vertebral body reducer to reduce the depressed vertebral body and so on. To enhance vertebral body strength after fracture union, transpedicular bone graft was also performed. Results All the patients achieved fracture union during the follow-up with a mean period of 28 months (range, 9-48 months). All of the fractures were reduced satisfactorily, SI (sagittal index) was improved from 53% to 89% after operation. No fracture of screws or rods occurred, also no screw loosened. No reduction loss was found. Conclusion In order to decrease failure rate of pedicle screw fixation for thoracolumbar fractures among middle and old aged patients, osteoporosis of vertebral body should never be neglected and, of course, treatment should be given with individualized fixation.

Objective The olecranon is likely to become shorter following the treatment of its comminuted fractures, which will lead to the compromise of the function of elbow joint. So through the cadaver experiment, introduce the method of making different thickness and direction in osteotomy so as to intimate the shape change of the olecranon after the comminuted fractures, and explore its effect on the flexion-extension function of the elbow joint. Methods Through three cadaver(six arms), osteotomy at 25 mm below the olecranon process was made horizontally and fixed with two screws temporarily, furthermore, the bone fragment of 1 mm, 3 mm and 5 mm in length was resected in order, then specimens were divided into two groups: In the first group, osteotomy was made up to 7 mm and 8 mm continually, and the changes of the range of the elbow joint movement were measured; in the second group, the additional wedge osteotomy of 5 mm and 7 mm was performed respectively, then the outcomes between the two groups were compared. Results If the osteotomized bone was within 3 mm, shortening internal fixation was satisfactory for the reconstruction of the elbow joint function. However, in cases of osteotomized bone of 5 mm, the extension function would be limited as the loss of the trochlear notch is too much. In order to keep the normal range motion of the elbow, the dorsal cortex distal to osteotomy should be scarified about 3 mm for the wedge osteotomy. When the shortage attained to 7 mm, the elbow instability would occur, even if advanced wedge osteotomy was accomplished. Conclusion In cases of the comminuted olecranon fractures, if the osteotomy is made within 3 mm, the shortening fixation is appropriate; if it has not exceeded 5 mm, the fracture should be treated with advanced wedge osteotomy tilting back to keep the radian of the trochlea; and if it has reached 7 mm, bone grafting is necessary for recovering of the flexion-extension of the elbow joint.

Objective To investigate articulation characteristics and rehabilitation training methods of abnor-mal supradental of patients with dysarthria after lingual frenectomy.Methods A total of 107 patients with dysar-thria after lingual frenectomy were studied for articulation characteristics.Then 32 patients with dysarthria were re-cruited from those 107 patients for further research of the training methods.Results The articulation disorders of/z/and/s/were replaced by/d/when/z/and/s/were combined with/a/,/o/,/e/,/u/or the vowels whose head vowels were them,/z/and/s/were replaced by/j/and/x/when they were combined with/i/.The proportion of these disorders were 32.71%,26.17%,30.84% and 40.19%,respectively.The articulation disorders of/c/was re-placed by/d/or/t/when/c/was combined with/a/,/o/,/e/,/u/or the vowels whose head vowels were them. The proportions were 5.61% and 25.23%,respectively.When/c/was replaced by/q/and/j/.When/c/was com-bined with/i/,the proportions respectively were 42.06% and 14.02%.Then/z/,/c/,/s/were totally replaced to/zh/,/ch/and ,/sh/or lateralization.The proportions of these disorders were 14.02%,15.89%,13.08% and 10.28%,9.35%,11.21%,respectively.After the speech training,the patients made less mistakes about supradental consonant,the number changed from 34.53±6.08 to 7.97±2.52.The differences were statistically significant(t=30.035,P<0.001).Conclusion The main articulation disorders were replacement and lateralization.The training methods that this research has established are significantly effective,and is worth receiving further study and possi-ble clinical application.

OBJECTIVE:To establish a method for the simultaneous determination of chlorogenic acid,hesperidin and baicalin in Shubiaoling granule. METHODS:HPLC was performed on the column of SAGA Tri-Sal C18 with mobile phase of acetonitrile-0.5%phosphoric acid(gradient elution)at a flow rate of 1.0 ml/min,detection wavelength was 320 nm,column temperature was 30℃,in-jection volume was 10μl. RESULTS:The linear range was 2.463-240.5μg/ml for chlorogenic acid(r=0.999 9),6.577-642.3μg/ml for hesperidin(r=0.999 8)and 1.708-166.8 μg/ml for baicalin(r=0.999 8);RSDs of precision,stability and reproducibility tests were no more than 1.8%;recoveries were 97.02%-102.40%(RSD=1.9%,n=6),96.55%-100.20%(RSD=1.6%,n=6) and 97.51%-100.70%(RSD=1.2%,n=6),respectively. CONCLUSIONS:The method is simple,accurate with high sensitivity and good reprosucibility,and can be used for the simultaneous determination of chlorogenic acid,hesperidin and baicalin in Shubiaoling granule.

Peroxisome proliferators -activated receptors γ(PPARγ)agonist is a kind of drugs that is widely used in the treatment of type 2 diabetes,also shows effects on hypertensive disease,regulating blood lipid metabolism, anti -atherosclerosis and inhibiting inflammatory response.In recent years,good effects of PPARγagonist have been found on different animal models of asthma,and production of proinflammatory cytokines can significantly be reduced. Airway remodeling can be reduced,and airway hyper responsiveness can be inhibited by PPARγagonist that provide theoretical basis on new drugs for asthma.The mechanism of bronchial asthma cured by PPARγagonists are reviewed briefly.