Based on the realistic circumstances at home and successful experiences from abroad,this paper holds the idea to introduce medical liability insurance into medical market to relieve the currently tense physician-patient conflict and analyzes the role and function of medical liability insurance.Meanwhile,some problems and countermeasures are also explained in the functioning process of medical liability insurance.

A fair,just,and credible mediation institution is required to ensure the effective implementation of medical liability insurance,relieve physician-patient conflicts,and protect the legal rights of medical institutions,patients and insurance corporations as well.Medical disputes mediation institution,as the arbitrator of physician-patient conflicts,clarifies the rights and obligations on all parties,including doctors,patients,and the insurance corporations as well,safeguards the legal rights of all parties,standardizes and simplifies the settlement procedure of medical disputes,and provides an effective approach to relieving the conflicts between doctors and patients.

Objective Primitive neuroectodermal tumor (PNET) is a rare malignant small round cell tumor .This paper aimed to study the clinical and pathological features of primary pulmonary primitive neuroectodermal tumor . Methods We collected 2 cases of primary pulmonary PNET to review the clinical and pathological features .Immunohistochemical staining was used to detect immune mark-ers, and fluorescence in situ hybridization (FISH) was applied to detect EWS translocation. Results 2 patients were aged 33 years and 17 years.Microscopically, the tumor cell was composed of single small round cells in diffusion or in distribution of sheets or beams , with scant cytoplasm , oval or spindle-shaped nucleus , high mitotic count .Irregular tumor necrosis scattered in the tumor along with visi-ble rosette structure.Immunohistochemical study showed that the tumor cells were positive for CD 99, FLI-1 and Syn, while CKpan, EMA, Desmin, CgA, TTF1, CD34 were negative.EWS/FLI1 translocations were detected positive in both the cases .2 patients died 7 months and 32 months after operation , respectively . Conclusion Primary pulmonary PNET is rare , so the selection of appropriate im-mune markers (CD99, FLI-1, Syn) and FISH for the detection of EWS translocation helps to improve the accuracy of diagnosis .

Computer tomography scanning was performed in 16 patients with mandibular angle hypertrophy before and after surgery. The imaging data of patients were recorded in three-dimensional reconstruction software (Mimics 10.0), and found the most appropriate surgery plan through simulating different surgical procedures. The geometry character indexes of the face were compared between before and after surgery, and then the results were analyzed. We got intuitive, accurate three-dimensional reconstruction graphs, simulation of surgery procedures, and calculation of difference in the geometry character index of face in all cases. The bone width of mandibular angle shortened (7.69?.89) mm; the soft tissue width of mandibular angle shortened (5.13?.19) mm; the both gonial angle increased (5.68?.43)?and (5.91?.66)? respectively. Applied to actual surgery procedure,the operation time shortened and precision of operation was improved. Results demonstrated that Computer three-dimensional reconstruction and computer simulation techniques is beneficial to reveal the variational regularity of bone and soft tissue, which is a good aided method in stimulation of surgery and choice of surgery plan.

AIM: To study the effect of vascular endothelial growth factor(VEGF) on hematopoietic differentiation from mouse embryonic stem cells(ESC) in vitro.METHODS: ES-D3 was allowed to grow on mouse fetal fibroblast feeder layer,and then was developed into embryoid bodies(EB).EB cells were transferred into medium supplemented with different concentration of VEGF and VEGF+SCF for 1 week.Six groups,including.VEGF 5 ?g/L,VEGF 10 ?g/L,VEGF 20 ?g/L, VEGF 5 ?g/L+SCF,VEGF 10 ?g/L+SCF and VEGF 20 ?g/L+SCF,were designed.The group of spontaneous differentiation without cytokine(s) was used as control.Hematopoietic transcription factor GATA-2 and early hematopoietic differentiation genes(c-kit and ?-H1) were detected by RT-PCR.The content of CD34~+ cells in each group were measured by flow cytometry.The cells derived from ESC were incubated in semisolid methycellulose cultures.The numbers of total colony-forming units in culture(CFU-C) were counted by reverse microscope.RESULTS: ES-D3 grew and formed EB at day 4.VEGF had a stimulatory effect as a single factor on the expression of genes associated with early hematopoietic differentiation(GATA-2,c-kit and ?-H1),the generation of CD34~+ cells and CFU-C in EB.The effects of VEGF+SCF were the most potent in the experimental groups according to the percent of CD34~+ cells and the numbers of hematopoietic colonies.The most highest inducing efficacy was achieved in VEGF 20 ?g/L or VEGF 10 ?g/L combined with SCF.CONCLUSION: VEGF promotes the differentiation of ESC into hematopoietic cells in vitro.The strongest effect was achieved when VEGF was combined with SCF.

Objective:To explore the efficiency of a new scoring system of gastric cancer screening for early gastric cancer in health examination population.Methods:The risk score of gastric cancer was assessed based on the new scoring system in health examination population. A notice for further gastroscopy was sent to the medium-risk and high-risk people. Gastroscopy was performed on those who agreed to undergo the examination.Results:From January to April 2019, a total of 5 357 people in health system visited the Physical Examination Center of Shanghai Songjiang Clinical Medical College of Nanjing Medical University for health examination. Seven hundred and forty people were classified as medium- and high-risk groups by the new screening system, 576 in medium-risk group, and 164 in high-risk group. Among them, 131 cases (17.70%) came for further gastroscopy, of whom 91 (69.47%) were in the medium-risk group and 40 (30.53%) in the high-risk group. After gastroscopy, 4 cases of gastric cancer and 1 case of esophageal cancer were detected, and both were early cancer. In the medium-risk group, 2 cases (2/91, 2.20%) of early gastric cancer and 1 case (1/91, 1.10%) of early esophageal cancer were found. In the high-risk group, 2 cases (2/40, 5.00%)of early gastric cancer were found. The tumor detection rate of high-risk group (5.00%) was higher than that of medium-risk group (3.30%), but there was no significant difference ( P>0.05). Conclusion:Risk stratification with the new scoring system of gastric cancer screening can improve the detection rate of early gastric cancer.

Background and purpose: The protein tyrosine kinase-7 (PTK7) gene may be related to the occurrence and progression of many tumors. This study was aimed to explore the expression of PTK7 in ovarian serous tumors and its relationship with clinical stage, histological grade, metastasis and prognosis indicators linkages, and analyze the diagnostic and prognostic value of PTK7 in ovarian serous tumors. Methods:Expressions of PTK7 in 3 ovarian cell lines (HO8910, SKOV3, A2780), 14 cases of normal fallopian tube epithelium, 6 cases of benign serous ovarian tumors, 51 cases of borderline serous ovarian tumors and in 97 cases of ovarian serous carcinoma were detected by immunohistochemical EliVision two-step method. Statistical analysis of the relationship between the expression of PTK7 and the pathological indicators was performed byχ2 test, Fisher exact test and Kaplan-Meier method. Results:PTK7 was negatively expressed in HO8910 and A2780, but weakly positively expressed in SKOV3. The positive rates of PTK7 in normal fallopian tube epithelium, benign serous ovarian tumors, borderline serous ovarian tumors and serous ovarian cancer were 92.86%(13/14), 83.33%(5/6), 45.10%(23/51), and 28.87%(28/97), respectively. The expression of PTK7 had no difference between normal fallopian tube epithelium and benign serous tumors, benign serous tumors and serous borderline tumors (P=0.521, P=0.102). The PTK7 expression showed signiifcant differences in serous ovarian carcinoma compared with those in normal epithelium, benign serous tumors and borderline serous tumors (P=0.000, P=0.012, P=0.048). Expression of PTK7 in borderline serous ovarian tumors was signiifcantly with clinical stage, metastasis (lymph node and/or peritoneum metastasis) (P=0.038, P=0.038), rather than its location, age (P=0.088, P=0.896). Expression of PTK7 in ovarian serous carcinoma had a signiifcant relation with its clinical stage, WHO grade, MDACC grade (P=0.011, P=0.004, P=0.000), rather than its location, metastasis, tumor diameter and age (P=0.326, P=0.524, P=0.588, P=0.584). The survival rate of PTK7 positive group in ovarian serous carcinoma was signiifcantly higher than that in the negative control group (P=0.017). Conclusion:The expressions of PTK7 in normal ovarian epithelium, benign serous ovarian tumors, borderline serous ovarian tumors and epithelial serous carcinoma show a gradual downward trend. The expression of PTK7 in ovarian serous tumors has a positive correlation with late clinical stage, high histological grade and poor prognosis. PTK7 can be a new indicator of clinical diagnosis and prognosis in ovarian serous tumors.

PURPOSE: Breast cancer (BC) is one of the most common malignancies globally, and millions of women worldwide are diagnosed with BC every year. Up to 70% of BC patients are estrogen receptor (ER)-positive. Numerous studies have shown that tamoxifen has a significant therapeutic effect on both primary and metastatic ER-positive BC patients. Although tamoxifen is currently one of the most successful therapeutic agents for BC, a significant proportion of patients will eventually become resistant to tamoxifen, leading to tumor recurrence and metastasis. Knowledge about the development of tamoxifen resistance in BC patients is still limited. METHODS: We applied a loss-and-gain method to study the biological functional role of cell division cycle associated 8 (CDCA8) in tamoxifen resistance in BC cells. RESULTS: We found that CDCA8 was significantly elevated in tamoxifen-resistant BC cells. Knockdown of CDCA8 expression significantly inhibited the proliferation of tamoxifen-resistant BC cells and reduced their resistance to tamoxifen. In contrast, overexpression of CDCA8 promoted the growth of tamoxifen-sensitive BC cells and induced their resistance to tamoxifen. CONCLUSION: In this study, we reported that CDCA8 is a key regulator of tamoxifen resistance in BC, suggesting that CDCA8 may serve as a potential therapeutic target for BC treatment.
Apoptosis ; Breast Neoplasms ; Breast ; Cell Cycle ; Cell Division ; Estrogens ; Female ; Humans ; Methods ; Neoplasm Metastasis ; Recurrence ; Tamoxifen

OBJECTIVEBody plethysmography is a typical method to measure functional residual capacity (FRC) and airway resistance (Raw). The aim of the study was to test the feasibility of measuring lung function with the body plethysmography in young children with acute lower respiratory tract infection (ALRI) by evaluating changes and prognosis of lung function for infants with ALRI with or without wheezing via body plethysmograph.

METHODPulmonary function tests (PFTs) were performed by using body plethysmography in 444 children with ALRI, aged 1-36 months, to assess their tidal breathing parameters such as ratio of time to peak tidal expiratory flow to total expiratory time (TPTEF/TE), ratio of volume to peak tidal expiratory flow to total expiratory volume (VPTEF/VE), plethysmographic functional residual capacity (FRCP), FRCP per kilogram (FRCP/kg), specific effective airway resistance (sReff), effective airway resistance (Reff), Reff per kilogram (Reff/kg), etc. According to whether there was wheezing or not, children who had ALRI with wheezing were classified as Group-W, or without wheezing as Group-N. Changes or correlations of tidal breathing parameters and plethysmographic parameters were compared.One hundred and three contemporaneous healthy controls aged 1-36 months underwent the same tests for comparison. And 36 wheezing children accepted PFTs at follow-up in recovery phase.

RESULTMean values of TPTEF/TE in Group-W,Group-N and the Control respectively were (20.5 ± 6.7)%,(22.8 ± 6.5)%,(34.6 ± 5.0)% (F = 110.500, P < 0.001), while VPTEF/VE respectively were (23.0 ± 6.3)%,(25.2 ± 6.8)%,(34.5 ± 4.2)% (F = 107.800, P < 0.001). Compared to the Control,Group-W and Group-N had significantly higher values of FRCP (226 vs. 176 vs. 172 ml, χ(2) = 64.870, P < 0.001), FRCP/kg(24.40 vs.17.80 vs.17.60 ml/kg,χ(2) = 68.890, P < 0.001), sReff(1.00 vs. 0.52 vs. 0.46 kPa·s,χ(2) = 75.240, P < 0.001), Reff (3.90 vs.2.74 vs.2.20 kPa·s/L, χ(2) = 36.480, P < 0.001) and Reff/kg [0.42 vs. 0.29 vs.0.22 kPa·s/(L·kg), χ(2) = 29.460, P < 0.001]. Although 25 (12.8%) wheezing children with ALRI had normal values of tidal breathing parameters, they already had increased FRCP, FRCP /kg, sReff, Reff and Reff/kg (t = 2.221, 1.997, 2.502, 2.587, 2.539, all P < 0.05). Values of FRCP and Reff in infants caught ALRI were inversely correlated to that of TPTEF/TE and VPTEF/VE (P < 0.05); 36 children with wheezing who accepted PFTs at follow-up had shown significant decline in the specific parameters of plethysmography such as FRCP, FRCP/kg, sReff, Reff and Reff/kg (Z = -1.999, -2.195, -2.038, -1.823, -2.054, all P < 0.05), while no improvement in the main parameters of tidal breathing such as TPTEF/TE.

CONCLUSIONMeasuring lung function with the body plethysmography in young children with ALRI is feasible. FRC and Raw, as special lung function testing parameters of body plethysmography, were sensitive indicators reflecting impairment of lung function in infants with ALRI (especially for children caught ALRI with wheezing) and shows significant correlation with parameters from lung function testing via tidal breathing. Therefore plethysmography is worthy of clinical promotion.

Airway Resistance ; physiology ; Case-Control Studies ; Child, Preschool ; Female ; Functional Residual Capacity ; physiology ; Humans ; Infant ; Lung ; physiopathology ; Male ; Plethysmography, Whole Body ; Respiratory Function Tests ; Respiratory Sounds ; diagnosis ; physiopathology ; Respiratory Tract Diseases ; diagnosis ; physiopathology ; Tidal Volume

Objective To evaluated the effectiveness and safety ofLianhua Jizhi Tablets for acute trachitis and bronchitis with syndrome of phlegm-heat obstructing.Methods A randomized double-blind, placebo-controlled and multi-center clinical trial design was selected. Totally 240 cases were randomly divided into experimental group and control group, 120 cases in each group, of which 237 cases were included in the analysis of FAS. Experimental group was givenLianhua Jizhi Tablets, while control group was given placebo, 12 tablets/day, 7 days for a course. Curative effect of acute trachitis and bronchitis, TCM syndrome and disappearance of cough, cough and sputum symptom scores and area under the curve (AUC) were observed. The safety was evaluated. Results The cure rates of disease in experimental group and control group were 66.67% (78/117) and 29.17% (35/120), respectively;cure rates of TCM syndrome in experimental group and the control group were 68.38% (80/117) and 27.50% (33/120), respectively;there was statistically significant difference in area under the curve of cough and sputum symptom score between the two groups (P<0.01). Disappearance rates (cure) of daytime cough in experimental group and control group were 52.99% (62/117) and 13.33% (16/120), respectively;disappearance rates (cure) of nocturnal cough in experimental group and control group were 76.52% (88/115) and 31.90% (37/116), respectively;there were no side effects in experimental group.ConclusionLianhua Jizhi Tablets can significantly relieve clinic symptoms in the treatment of acute trachitis and bronchitis, and have good clinical efficacy and safety.