The special nature of medical care determines the high riskiness of the medical profession that is lacking in other professions. In view of the high-techness and high riskiness of the medical profession, it is only proper to start thinking about setting up corresponding mechanisms for guarding against and dissolving the risks so as to safeguard the legitimate rights of the doctors. Guarding against and dissolving risks of the medical profession fall into a systematic framework of regulations and legal arrangements that are composed of mechanisms for dispersing risks of the medical profession, mechanisms for sharing medical liabilities and systems of medical care and social security.

Objective:To study the effectiveness of Loop electrosurgical excision procedure (LEEP) in the diagnosis and management of cervical intraepithelial neoplasia(CIN). Methods: 155 patients with CIN were diagnosed by cervical biopsy under colposcopy. All cases were treated with LEEP and the operative time, bleeding volume, cervical biopsy results before and after LEEP were evaluated, and the effects and cervical regeneration were followed up. Results: The mean operative time of LEEP was 6. 8 minutes. The mean bleeding volume was 9.6m1. Pathological diagnosis of CINI CIN Ⅱ CIN Ⅲ after LEEP were positively correlated to directed biopsy by colposcopy. The correlation coefficient was 0.785 ( P < 0.01). The cure rate of LEEP was 98.6%. Among the 151 cases, 134 (88. 7%) were satisfactory cervical regeneration. Conclusions: LEEP is one of the effective and safe methods for the diagnosis and treatment of CIN.

Objective To evaluate the accuracy of different methods in detecting free amino acids in plasma.Method 40 blood samples from healthy volunteers were analyzed by an automatic amino acid analyzer ( Li+system) and the results compared with previous reports using other analyzers.Results The results ob-tained by this analyzer for major amino acids [asparagine (Asn), glutamic acid (Glu), glutamine (Gln), valine (Val), tyrosine (Tyr), phenylalanine (Phe), ornithine (Orn), arginine (Arg)] were similar with those previously reported using other amino acid analyzers ( all P>0.05 ) and liquid chromatography tandem-mass spectrometry (LC-MS/MS) (all P>0.05).Except for Glu and Tyr, the results for major amino acids showed large deviation compared to the results from high performance liquid chromatography ( HPLC) ( all P<0.05).Conclusion The amino acid analyzer (Li+) and LC-MS/MS (iTRAQ kit) could accurately detect free amino acids in plasma.

BACKGROUND:In recent years, minimal y invasive percutaneous plate fixation has been a selectable method to repair fracture of lower limbs, especial y complex fracture of lower limbs. Its advantages are to reduce the damage to soft tissues, and do not destroy bone nutrient supply vessels. However, there is no unified criterion to select which method in the repair of distal tibial fractures. OBJECTIVE:To observe clinical effects of minimal y invasive percutaneous plate fixation versus open reduction and plate fixation in the repair of distal tibial fractures. METHODS:A total of 60 cases of distal tibial fractures treated with minimal y invasive percutaneous plate osteosynthesis (n=35) and open reduction and plate fixation (n=25) were selected. The time of surgery was identified by evaluating soft tissue. We should pay attention to the protection of soft tissue in surgery and reasonable fixation method should be selected. After fixation, we guided patients to do active early functional exercise. They were fol owed up and regularly received X-ray reexamination. Operation time, weight loading time, healing time and functional recovery were observed and the clinical therapeutic effects of the two methods were compared. RESULTS AND CONCLUSION:Al patients were fol owed-up after surgery. They were fol owed up for 3 to 15 months. No significant difference in healing time of type A fracture was detected between minimal y invasive percutaneous plate fixation and open reduction and plate fixation. The healing time of types B and C fracture was better in minimal y invasive percutaneous plate fixation group than in open reduction and plate fixation group. These results indicated that minimal y invasive percutaneous plate fixation in repair of tibial fractures, especial y distal complex tibial fractures, is an effective method. The healing rate of fracture was high, but postoperative complications were less.

[ Objective ] To investigate the mechanism of Jianxin Pinglu Pill (JPP) in counteracting arrhythmia. [Methods] Ninety rats were randomized into 3 groups: model (normal saline), high-dose JPP (1.6 g/kg) and low-dose JPP (0.8g/kg) . The treatment lasted 7 days. Rat models with myocardial ischemia /repermsion were established by blocking left coronary artery. Ⅱ lead of electrocardiogram was recorded, connexin 43 (Cx 43) was detected by immunohistochemical assay. The effect of JPP on incidence of arrhythmia, death rate and the expression of connexin 43 in the myocardium was observed. [Results] JPP could decrease the incidence of arrhythmia and death rate obviously and enhance the expression of connexin 43 in myocardium. [ Conclusion ] JPP can counteract the damage of myocardial ischemia /reperfusion to enhance Cx 43 expression, and this is one of its possible mechanism.

Objective To explore the efficacy of intervention combined with traditional Chinese medicine for the treatment of early femoral head necrosis. Methods 62 cases of early femoral head necrosis were treated with interventional and traditional Chinese medicine, all patients were assessed for clinical efficacy before treatment and 6 months after treatment. The clinical hip function, pain index evaluation and rating of the femoral head venography were recorded. Results 41 cases were cured, 18 cases improved,no improvement in 3 cases,the total effective rate was 95. 2%. Clinical hip function after treatment compared with before treatment increased by 32.5%,there was a statistically significant difference (P＜0.01); compared with before treatment, significantly reduced pain (P＜0. 01). After treatment, Ⅲ and Ⅳ were significantly increased number of cases, respectively, compared with the preoperative increase of 146.2% and 160.0%,femoral venography ratings before and after treatment had significant difference(P＜0.01). Conclusion Intervention combined with traditional Chinese medicine treatment could significantly improve the early femoral head necrosis.

BACKGROUND: miRNA plays a critical regulatory role in the development and plasticity of spinal cord, and pathological changes after spinal cord injury. OBJECTIVE: To study the effect of miR-136-5p on the A20 expression in mouse astrocytes stimulated by interleukin-17 (IL-17). METHODS: C57BL/6 mouse astrocytes were cultured in vitro, identified by immunofluorescence staining, and then stimulated by 100 μg/L IL-17 for 0, 3, 6, 12 and 24 hours, respectively. The relative mRNA expression levels of IL-6 and tumor necrosis factor-α were detected by RT-PCR to determine the optimal stimulation time of IL-17. The mouse astrocytes were respectively stimulated by 10, 20, 50, 100 and 200 μg/L IL-7 for 6 hours, and similarly, the relative mRNA expression levels of IL-6 and tumor necrosis factor-α were detected to determine the optimal concentration of IL-17. At 6 hours after IL-17 (50 μg/L) stimulation, the mRNA expression levels of miR-136-5p and A20 in mouse astrocytes were detected by RT- PCR, and the protein expression level of A20 was detected by western blot assay. In addition, the lentiviral expression vector (miR-136-5p-inhibition) was constructed and transfected into the mouse astrocytes that were also stimulated by IL-7 to detect the expression levels of miR-136-5p, A20 mRNA and A20 protein. RESULTS AND CONCLUSION: Compared with the blank control group, the expression level of miR-136-5p in the miR-136-5p-inhibition group was significantly decreased after 6-hour IL-17 stimulation (P < 0.05). The expression levels of A20 mRNA and protein in each group were significantly decreased after 6-hour IL-17 (50 μg/L) stimulation (P < 0.05). The expression levels of A20 mRNA and protein in the miR-136-5p-inhibition group were significantly higher than those in the blank control group (P < 0.05), while there were no significant differences in the expression level of A20 protein between blank control and negative groups (P > 0.05). To conclude, miR-136-5p makes certain effect on the expression of A20 protein in astrocytes after IL-17 stimulation.

Objective To investigate the effect of super-selective intracoronary administration on acute myocardial in farction patients.Methods A total of 240 patients with ST-segment elevation myocardial infarction who received emergency percutaneous coronary intervention in our department from March 2012 to January 2014 were selected and divided into the intravenous drug administration group (n=77),the conventional intracoronary drug administration group (n=81) and the super-selective intracoronary drug administration group (n=82).Parameters,including the Thrombolysis in Myocardial Infarction (TIMI) classification,ST segment resolution after operation,peak values of creatine kinase MB (CK-MB) and troponin-I (cTn-I),left ventricular ejection fraction,left ventricular end-diastolic diameter (LVEDD),major adverse cardiovascular events and bleeding events,were compared between the groups.Results There were no significant differences in TIMI flow grade between the three groups (x2 =0.14,P=0.529).The percentage of patients with complete ST segment resolution after operation was higher in the super-selective intracoronary drug administration group than in the intravenous drug administration and conventional intracoronary drug administration groups (74.4％ vs.62.3％,61.7％,x2 =8.24,P＜0.05).Peak values of CK-MB and cTn-I were lower in the super-selective intracoronary drug administration group than in the other groups (P＜0.05).There were no significant differences in left ventricular ejection fraction and LVEDD between the three groups after operation,but left ventricular ejection fraction and the incidence of angina pectoris significantly improved in the super-selective intracoronary drug administration group than in the other groups after a three month follow-up (P＜0.05).There were no significant differences in target lesion revascularization,nonfatal myocardial infarction and druginduced thrombocytopenia between the three groups (P ＞ 0.05).Conclusions Super-selective intracoronary drug administration can significantly enhance cardiac function and alleviate angina pectoris in patients with acute myocardial infarction,and should be a recommended method.

BACKGROUND: Bone marrow-derived mononuclear cells (BM-MNCs) hold the potential of differentiating into osteoclasts. Polygonatum sibiricum polysaccharide (PSP) may inhibit the differentiation of BM-MNCs into osteoclasts and it is expected to become a new drug for the treatment of osteoporosis. OBJECTIVE: To investigate the effect of PSP on the differentiation of mouse BM-MNCs into osteoclasts induced by receptor activator of nuclear factor kappa-B ligand (RANKL) and bone resorption in vivo. METHODS: Mouse bone marrow-derived macrophages cultured in vitro, the effect of macrophage colony stimulating factor and PSP (5, 10, 20, 40, 80,160, 320, 640, 1280, 2560 mg/L) on the proliferation of mouse BM-MNCs was detected by cell counting kit-8 assay to determine the PSP concentration range; the mouse BMMs were cultured and induced in DMEM medium containing macrophage colony stimulating factor, RANKL and 5, 10, 20, 40, 80,160, 320, 640 mg/L PSP, respectively; those cultured without PSP served as control group. The morphological changes of cells were observed under an inverted microscope.; the number of osteoclasts was detected by tartrate-resistant acid phosphatase staining; the mRNA expression levels of osteoclast-related genes including tartrate-resistant acid phosphatase, matrix metalloproteinase-9, cathepsin K, and nuclear factor of activated T cells c1 were evaluated by quantitative real-time PCR. A mouse model of calvarial osteolysis induced by lipopolysaccharide was established to receive PSP intervention, and then micro CT scanning, three-dimensional reconstruction and relevants software were used for quantitative analysis of bone volume/volume percentage, trabecular number, trabecular bone spacing and thickness. The number of osteoclasts was identified by tartrate-resistant acid phosphatase staining and quantitative analysis of bone resorption area was conducted. RESULTS AND CONCLUSION: Compared with the control group, the concentration of PSP below 640 mg/L showed no significant effect on the proliferation of BMMs (P > 0.05). Different concentrations of PSP (40-640 mg/L) significantly reduced the number of osteoclasts, osteoclast differentiation and maturation, and the mRNA expression levels of tartrate-resistant acid phosphatase, matrix metalloproteinase-9, cathepsin K, and nuclear factor of activated T cells c1 TRAP, MMP-9, CtsK and NFATc1 (P < 0.05). Compared with lipopolysaccharide, PSP could effectively alleviate the lipopolysaccharide-induced calvarial osteolysis, and the bone volume/volume percentage, trabecular number, and trabecular bone spacing were significantly decreased (P < 0.05); additionally, the number of osteoclasts and the area of bone resorption were decreased significantly (P < 0.01). To conclude, PSP can inhibit the differentiation and maturation of mouse BMMs to osteoclasts and alleviate lipopolysaccharide-induced calvarial osteolysis.

ObjectiveTo evaluate the early cellular immune responses to three kinds of hepatitis B surface antigen (HBsAg) in the immunized mice.MethodsAt day 4,the levels of IFN-γand IL-2 secreted by CD4+ and CD8+T cells which selected from splenic mononuclear cells (MNC) of the vaccinated mice were detected by enzyme-linked immunospot methods (ELISPOT) after stimulation in vitro with HBsAg MHC class Ⅰ peptide S28-39 of HBsAg or recombinant hepatitis B surface antigen(rHBsAg).ResultsAfter selected by MACs,the purity of CD3+/CD4+ and CD3+/CD8+T cell was more than 90％.The positive rate of IFN-γsecreted by CD4+T cells induced by HBsAg derived from Hansenula polymorpha(rHP) was higher than that of HBsAg derived from CHO cell (rCHO).Levels of IFN-γ secreted by CD8+T cells and IL-2 secreted by CD4+T cells induced by rHP antigen were significantly higher than those of rCHO( P＜0.05 ).Meanwhile,levels of IFN-γsecreted by CD4+T cells and CD8+T cells induced by rHP were also significantly higher than those of plasma HBsAg(pHB) (P＜0.05).ConclusionAt day 4,the cellular immune responses induced by HBsAg could be detected.But the immune responses induced by the three kinds of HBsAg are different in levels.According to early cellular immune response intensity,the rHP HBsAg are superior to the rCHO and pHB,in accordance with the high protection rate interrupting the mother-infant transmission immunized by rHP vaccine in clinical trial.It provides scientific basis for necessity of timely birth dose of HB vaccine and kind of HB vaccine for high risk newborn infants vaccinated.