As an element of tort liability,negligence is the main form of fault in medical tort.The essence of negligence is disobeying "the duty of care".So,understanding "the duty of care" correctly is very important in the judgement of medical tort.

Objective To investigate the effects of benazepril on plasma copeptin and N terminal brain natriuretic peptide (NT-proBNP) in the patients with chronic heart failure (CHF) in order to explore the mechanism of benazepril on ventricular remodeling.Methods Two hundred and thirty-eight patients with CHF were randomized into control group (n =118) and therapy group (n =120).Patients in control group were received regular treatment including medicine of treating cardiotonic diuretic and vasodilator for 6 months,while in therapy group were given benazepril beside regular treatment.The levels of copeptin,NT-proBNP were measured before and after treatment.The left ventricular ejection fraction (LVEF),left ventricular end systolic diameter(LVESD) and left ventricular end diastole diameter(LVEDD) were recorded and compared before and after treatment.Results In treatment group,the levels of copeptin and NT-pro BNP,LVEF,LVEDD,LVESD were (4.9 ± 1.3) pmol/L and (327.8 ± 226.8) ng/L,(33.5 ± 6.2) ％,(47.6 ± 8.9) mm,(60.2 ± 7.1) mm before treatment,different from that after treatment ((17.8 ± 7.9) pmol/L,t =7.331,P =0.008 ; (1 779.6±838.3) pg/mL,t =10.236,P =0.002; (50.5 ±5.2)％,t =3.336,P=0.009;(32.9 ±5.7) mm,t =2.767,P =0.010 ; (43.2 ± 5.6) rmm,t =2.882,P =0.009).After treatment the levels of copeptin,NT-proBNP,LVEF,LVESD and LVEDD in treatment were lower than that of control group(control group:copeptin:(10.5 ± 2.4) nmol/L; NT-proBNP:(1076.6 ± 486.6) pg/L; LVEF:(36.6 ± 5.6) ％ ; LVESD:(45.9 ± 6.8)mm; LVEDD:(57.5 ± 5.4) mm),and there was significant difference between groups (P =0.049,0.010,0.035,0.038,0.048 respectively).Conclusion Benazepril treatment could decrease the level of plasma copeptin and NT-proBNP in CHF patients,inhibit neuroendocrine and the ventricular remodeling,and then improve the heart function.

Objective To compare adaptive support ventilation (ASV) and pressure-controlled assist/control ventilation (PCMV) and evaluate the clinical effects of ASV. Methods 12 cases of acute respiratory failure patients induced by all causes were selected in the study. All patients with breathing independently underwent endotracheal intubation. The patterns of mechanical ventilation was PCMV-ASV-PCMV. the two settings of PCMV were uniformity. With ASV mode mechanical ventilation,we adjusted the percentage of minute ventilation (MV%) and ideal body weight (IBW) of patients,so as to reach the same minute ventilation volume of PCMV. We compared the blood gas,respiratory mechanics,work of breathing(WOB),airway occlusion pressure (P0.05). Compared with the first of PCMV,various indicators and blood gas of ASV had no significant difference,work of breathing (WOB),airway occlusion pressure (P=0.1) and inspiratory pressure time product (PTP) were significantly lower (P0.05). Conclusion ASV can get similar goals with conventional ventilation,and reduce patient′s effort and the central respiratory drive.

Objective To study the prognosis of polymyositis(PM) and dermatomyositis(DM) patients and its influence factors.Methods Sixty DM and 30 PM patients diagnosed according to the diagnostic criteria of Bohan and Peter in our hospital during 2000-2008 were used as study subjects.The patients were followed up till their death or to August 2009.Gender,age of disease onset,disease course,serum creatine kinase,interstitial lung disease,heart involvement,connective tissue disease(CTD),malignancies,and treatment with corticosteroids,immunoglobulin and immunosuppressive agents were assessed as predictive factors for the prognosis of patients.Characteristics of muscular biopsy from 20 cases were analyzed.Results The median age of the 90 patients(29 males and 61 females) was 51 years(range 6-74 years).The male and female ratio was 1∶2.The most commonly involved muscles were the proximal muscles of limbs(83.3%),followed by neck muscles(25.6%),laryngea pharyngeal muscles(12.2%) and masticatory muscles(2.2%).Among the 42 patients(46.7%)with lung disease,interstitial lung disease and hear involvement were found in 29(32.2%)and 13(14.4%)patients,respectively.Of the 13 patients complicated by connective tissue disease,DM and PM accompanying connective tissue disease were diagnosed in 9 and 4,respectively,and DM and PM accompanying malignancies were observed in 2 patients.Muscular or skin biopsy was performed for 23 patients,which showed typical inflammatory infiltration in 13,dermatomyositis in 3,and no significant lesion in 2 patients,respectively.Of the 18 patients who died during the follow-up,5(16.67%) and 13(21.67%) died of PM and DM,respectively.Seventy-two patients survived.Their 1-,5-,and 9-year survival rate was 90%,84.4%,and 80%,respectively.The complete and partial remission rate was 22.2% and 36.7%,respectively,with a relapse rate of 20%.Advanced age of disease onset(P=0.003 8),interstitial lung disease(P=0.011 3) and malignancies(P=0.004 9) were main causes of death.Malignancy(RR=6.34,P=0.001 2)was the factor for poor prognosis and long-term treatment with hormones and immunosuppressive agents is the protective factor for PM and DM.Conclusion Complete and partial remission can be achieved in 58.9% patients with DM and PM.Advanced age of disease onset,interstitial lung disease and malignancy are the factors for poor prognosis of such patients.Long-term treatment with corticosteroids and immunosuppressive agents are the protective factors.

Objectives To study if there exists the ununi formity of drug resistance of mycobacterium tuberculosis (M.TB) isolated from MDR-TB patients .Methods One MDR-TB patient was chosen for this study a nd his sputum was cultured.The suspension of the culture was filtered through 8 0?m -pore-size membrane filter and single M.TB suspension was obtained.The single M.TB suspension was cultured on Lowsenstein Jensen (L-J) medium.24 of col onies were obtained and they were cultured respectively again to get pure strain s.The drug sensitivity test was carried out for these 24 pure strains of M.TB wi th Chinese standard method.H 37 Rv was taken as control.Results 1 strain (4 2%) was found to be susceptive to INH,22 strains ( 91 6%) resistant to low concentration INH (H 1 ),1 strain (4 2%) resistant to high concentration INH (H 10 ).2 strains (8 3%) were found t o be susceptive to RFP,2 strains (8 3%) resistant to low concentration RFP(R 50 ),20 strains (83 4%) resistant to high concentration RFP(R 250 ).We f ound 1 strain (4 2%) susceptive to SM,23 strains (95 8%) resistant to high concentr ation SM(S 100 ).All were susceptive to EMB.Conclusions The ununiformity of drug resistance exists among the M.TB isolated from the MDR-TB patients.Sensitive and resistant strains exist together,low and high concentration-drug-resistant strains coexi st in the same situation.The majority of M.TB is drug-resistant and only a few are still sensitive to low concentration- drug- resistant.

Objective To discuss the relationship between the expression of programmed death-1 (PD-1) in liver with traditional Chinese medicine (TCM) syndromes and pathological diagnosis in chronic hepatitis B.Methods 156 CHB patients treated in our hospital of infectious diseases department were recruited as an observation group. Based on the principle of informed voluntary and approved by the ethics committee, liver biopsy was adopted to make clear liver tissue pathology. According to TCM classification criteria, CHB patients were divided into five groups: a blood stasis group, a damp heat resistance group, a liver and spleen deficiency group, a liver and kidney yin deficiency group, and a spleen and kidney yang deficiency group. In the same period, 12 healthy persons were recruited as a control group. The PD-1 expression was detected with immunohistochemical SP method, and the correlation between expression of PD-1 in liver tissue and TCM syndrome type and liver pathology was analyzed.Results Different degrees of positive cell expression were found in the liver tissue. With the liver inflammation and fibrosis severity, the number of PD-1 positive cells also increased. The PD-1 expression levels varied with mild, moderate, and severe CHB patients (0.24 ± 0.03, 0.36 ± 0.05 vs. 0.43 ± 0.05) , which were statistically significant (P<0.05) . PD-1 expression levels also varied among different TCM type CHB patients, of which, PD-1 expression of blood stasis type was the highest (0.35 ± 0.04), while the liver and spleen deficiency type was the lowest (0.23 ± 0.03).Conclusion The expression levels of PD-1 has a certain correlation with the patients illness, chronic mechanism, and TCM syndromes. CHB patients can be treated by controlling the expression of PD-1.

In order to observe clinical therapeutic effect of Shen Ma Yi Zhi Capsule on senile vascular dementia (VD), 68 cases of VD were randomly divided into the treatment group treated with Shen Ma Yi Zhi Capsule and the control group treated with Western medicine Trigogine, and double blind and double simulation methods were adopted for administration of drugs. Results indicated that Shen Ma Yi Zhi Capsule could obviously improve clinical symptoms, increase cumulative score of intelligence rating scale, improve memory and gnosia function, restore nervous function improve daily living capability, indexes of blood rheology and cerebral function. The treatment group in improvement of symptoms was superior to the control group. It is suggested that Shen Ma Yi Zhi Capsule has definite therapeutic effect for senile VD, with no adverse effect.

Occupational Diseases ; prevention & control ; Occupational Health Services ; Public Health

ObjectiveTo investigate the effects and problems of problem-based learning ( PBL ) teaching methods that are adopted in the laboratory medicine practice teaching. MethodsOne hundred and four undergraduate students of 5-year system of laboratory medicine were selected to use the PBL teaching methods during the laboratory medicine practice. ResultsIt showed that the PBL teaching methods obtained good probation effect. But teachers and students are required to make greater efforts in PBL teaching mode than in traditional mode, and the teaching methods was also needed to be consummated.ConclusionsUsing the problem-based teaching methods the comprehensive ability of the student is enhanced. Therefore it deserves to be generalized during laboratory medicine practice teaching.

BackgroundOptic nerve injury lead to apoptosis of retinal ganglion cells ( RGCs ), and its mechanism of apoptosis is endoplasmic reticulum stress (ERS). So, decreasing of ERS may protect the injury of RGCs. ObjectiveThe present study was to investigate the mechanisms of endoplasmic reticulum stress(ERS) and the protective effects of human umbilical cord blood stem cells on partial optic nerve crush injury. MethodsThe optical nerves were crushed with a 40 g clip by holding for 60 seconds to establish the partial optical nerve injury model in the left eyes of 102 SPF SD rats,and 10 μl of mRNA and 10 μl of nerve growth factor were injected into the vitreous immediately after the establishment of the model. The morphological changes of retinal ganglion cells(RGCs) were examined under the light microscope after 3,7,14,21 and 28 days and the RGCs number was calculated. The apoptosis rates of RGCs were detected by the TUNEL technique after 3, 12,24,45,72 hours and 1 week. The expression levels of GRP78 mRNA and CHOP mRNA were detected by reverse transcription polymerase chain reation (RT-PCR). This procedure followed the Regulations for the Administration of Affair Concerning Experimental Animals by Hunan Provincial Science and Technology Committee.Results The number of RGCs was significantly decreased with the prolongation of time of optical nerve injury in the model injury group,whereas the number of RGCs in the human cord blood cells group was reduced at a slower rate( Ftime =20. 100,P =0. 007 ). At various time points after the injection of human cord blood cells, the survival of RGCs was evidently increased in comparison with the model group(P＜0. 01 ). The apoptosis rate of RGCs was considerably elevated with injury time prolongation both in the model group and human cord blood cells group,but no apoptosis was seen from 3-24 hours after operation,and only a small amount of apoptotic cells were found in the human cord blood cells group from 48 hours through 1 week than in the model group(P＜0. 01 ). In the human cord blood cells group,GRP78 mRNA level was significantly higher and the CHOP mRNA level was significantly lower than those in the injury group at identical time points(P＜0. 01 ). ConclusionsIn the rat optic nerve partial crush model,ERS induces the apoptosis of RGCs. Human umbilical cord blood stem cells can protect RGCs from ERS injury by inhibiting apoptosis.