After the Statute on Disposing Medical Accident was put in practice,doctors in China are faced with tremendous stress that never faced before.Doctors begin to evade risks with defensive medicine under the stress.There are two types of defensive medicine,one is positive defensive medicine,which will induce to excessive medical treatment for evading risks,another is negative defensive medicine which will lead to nonfeasance in the presence of intensive patients or dangerous diagnosis and treat procedure.Defensive medicine results in inefficiency of medical service and influences patients' safety.How to lessen doctors' defensive medicine will be an important social problem.

Objective To describe the clinical features and genetic susceptibility of the familial myasthenia gravis (FMG) patients. Methods The clinical data of 47 FMG patients and 2953 sporadic myasthenia gravis (SMG) patients from 1977 to 2003 were analyzed retrospectively, and 15 FMG patients, 36 SMG patients and 47 healthy controls were investigated for human leukocyte antigen (HLA)-DQA1 genotyping by polymerase chain reaction-sequence specific primers. Results FMG was an autoimmune disorder disease and immunosuppressive therapy was as highly effective in FMG as in SMG. In all patients, 11(23.4%) cases improved significantly, 14(29.8%) cases relieved with only 5 mg prednidone, and 20(42.6%) cases relieved completely. Most FMG occurred in siblings and familial members within 2 generations, and no sexual difference was found. These suggested it should be atypical Mendel’s rules. Onset and clinical features of patients within the same family often had little difference. As compared with the SMG patients, the frequence of DQA1 *0301 allele was higher in FMG patients, especially in the ocular form, and the differences had statistical significance(40.0% vs 19.4%, P

Objective To study the changes in PAF and its receptor in Kupffer cells in experimental cirrhosis and to evaluate the role of activated Kupffer cells in portal hypertension. Methods Kupffer cells, isolated from the livers of control and CCl_4-induced cirrhotic rats, were cultured in serum-free medium overnight. PAF synthesis and release by Kupffer cells were determined 24 h later by rapid ~3H-PAF scintillation proximity assay, and the expression of PAF receptor in Kupffer cells by saturation binding technique and semi-quantitative reverse transcriptase polymerase chain reaction (RT-PCR). By immunohistochemisty, the distribution of PAF in Kupffer cells was surveyed. Results Cell-associated PAF synthesis and release was increased about 1.48 fold and 2 fold, respectively, by Kupffer cells in cirrhotic liver as compared with the control (P0.05). Consistent with the receptor binding capacity, the mRNA expression of PAF receptor increased significantly in the Kupffer cells of cirrhotic liver (P

Objective To investigate the correlation between Kupffer cells and the synthesis of platelet activating factor(PAF)in experimental hepatic cirrhosis,and to elucidate the effects of endothelin(ET)on portal hypertension.Methods Thirty SD rats were randomly assigned to two groups:control group and CCl4-induced hepatic cirrhotic group.Kupffer cells,isolated from the livers of animals in both groups,were cultured for 24h.ET-1-induced PAF synthesis,and mRNA expression of PAF,ET-1 receptor and preproendothelin-1 in Kupffer cells were determined by rapid 3H-PAF scintillation proximity assay,saturation binding technique and semi-quantitative reverse transcriptase polymerase chain reaction(RT-PCR),respectively.Results Cell-associated PAF synthesis and release increased about 1.48 folds and two-folds,respectively,by cirrhotic Kupffer cells as compared to the control(1.02 ? 0.06 vs 0.69 ? 0.07 pg /mg DNA in Kupffer cells and 1.42? 0.14 vs 0.66 ? 0.04 pg/mg DNA in medium).Endothelin-1 enhanced Kupffer cells to stimulate PAF synthesis in a concentration-dependent manner,and for cirrhotic Kupffer cells,the effect was more significant than control.Cirrhotic Kupffer cells also had increased densities of functional receptors for both PAF and ET-1(exclusively ETB),but did not change the affinity of these receptors.No mRNA transcripts for the ETA receptor or preproET-1 were detected.Conclusion Kupffer cell is the main source of PAF in the cirrhotic rats.ET-1 stimulates PAF synthesis in activated Kupffer cells via ETB receptor.Since both ET-1 and PAF individually cause portal hypertension,Kupffer cells may play a role in portal hypertension associated with liver cirrhosis.

OBJECTIVE To explore the incidence of the nosocomial infection in patients with mental diseases,analyze the correlative factors and then reduce the incidence.METHODS By using the retrospective method,the inpatient cases in Department of Psychotherapy from Jan 2000 to Dec 2005 were surveyed and statistically analyzed.RESULTS There were 307 cases of nosocomial infection from 4175 inpatients with mental diseases.The infection rate was 7.35%.The total rate had been dropped year by year.The major sites of the infection were the upper respiratory tract,the gastrointestinal tract and the lower respiratory tract.CONCLUSIONS The incidence of the nosocomial infection is related with fallowing factors:the characteristic of patients,the crowded wards,the changing seasons and the side-effect of drug.

Objective To evaluate the ability of diffusion tensor imaging (DTI )and DTT to differentiate the central prostate cancer(PCa )from benign prostate hyperplasia (BPH ).Methods 16 CG-PCa cases and 30 BPH cases proven by Histopathologi-cally had been performed MRI and DTI.ADC values and FA values of CG-PCa and BPH were respectively measured,comparing whether there is any discrepancies between two groups.For DTT maps,two observers record the score using a four-point scale and compare the differences between two groups of lesions about fibers continuity and density.Results ADC values and FA values in BPH-PCa were:(1 357±163)×10-6-(1 058±196)×10-6 mm2/s,and (356±116)×10-3- (407±132)×10-3 respectively. ADC value between the two groups was statistically significant difference (P< 0.05).While FA values was not(P>0.05).Interob-server agreement regarding the scale was good (k =0.723).The two viewers'DTT map score of CG cancer were 2.9±0.9;2.8± 1.0,the BPH were 1.8±0.7;1.7±0.8.The DTT map score between the two groups for two viewers were all statistically signifi-cant difference (P< 0.05).Conclusion ADC values can significantly differentiate CG-PCa from BPH,FA values cannot.DTT maps can describe prostate more institute,providing a certain value in distinguish PCa from BPH.

Objective To investigate the infection of human cytomegalovirus (HCMV) in patients with atherosclerosis and explore its clinical significance.Methods A total of 134 patients with atherosclerosis (observation group) including 102 patients with coronary heart disease (CHD) and 32 patients with non-CHD from December 2009 to April 2012 were enrolled in this study.The 102 patients with CHD were divided into HCMV infection group (86 cases) and non-HCMV infection group (16 cases).Another 40 healthy person were selected as control group.The carotid intima-media thickness (IMT) was assessed by ultrasonography.The serum HCMV-IgM was measured by enzyme-linked immunosorbent assay.Results The infection rate of HCMV in observation group was 77.6％ (104/134),which was higher than that of 37.5％(15/40) in control group(P ＜ 0.05).The infection rate of HCMV in CHD patients and non-CHD patients was 84.3％(86/102) and 56.2％(18/32),and there was significant difference (P ＜ 0.05).The carotid IMT in HCMV infected atherosclerosis patients was (1.31 + 0.28) mm,which was higher than that of (1.14 ± 0.21)mm in non-HCMV infected atherosclerosis patients (P ＜ 0.05).The incidence of myocardial infarction and multi-vessel lesion in HCMV infection group was higher than that in non-HCMV infection group [39.5％(34/86) vs.25.0％(4/16) and 43.0％(37/86) vs.18.8％(3/16)](P＜ 0.05).The incidence of stable angina pectoris and single-vessel lesion in HCMV infection group was lower than that in non-HCMV infection group [26.7％(23/86) vs.43.8％(7/16) and 22.1％(19/86) vs.56.2％(9/16)](P＜0.05).Conclusion The high-infection rate of HCMV is found in atherosclerosis patients,and it maybe have a close relationship with the occurrence and development of atherosclerosis.

Resveratrol(RES)is a kind of antitoxin material produced by plant angainst fungi,it has many biological activites, which can restrain a variety of microorganisms.RES was reviewed in this paper with a variety of inhibition microbial func-tions in recent years,and summarized the antibacterial mechanisms of interfering with cell wall protein synthesis,cell mem-brane damage and RsbA mediating antibacterial factor formation.

Based on health economics principle and the present situation,the academic paper mostly analyzed various relevant market and government factors to changes in supply and demand of acup-mox services,and thereby could be used for reference to reforms about health economics policy in acup-mox field.

Objective To observe the therapeutic effect of rude Rhubarb combined with Danshen root treating Cholestatic hepatitis E. Methods 60 cases of cholestatic hepatitis E were randomly recurited into a treatment group and a control group, with 30 cases in each group. The control group was administrated with liver protection therapy, symptomatic treatment and supportive care. Based on therapies of the control group, the treatment group was taken with Rhubarb 3 g orally, twice daily, and intravenously dropped with Danshen root injection 20ml, once daily. Results The total effective rate of the treatment group and the control group was 93.3% and 66.7% respectively, showing significant differance(P<0.01 ). The value of TBil and DBil in the treatment group was statistically improved compared with the control group (P<0.01) . besides the hospitalized time of the treatment group was 46±9 days and hospitalization expense was 6630±1032 RMB, demonstrating a significant difference compared with the control group. Conclusion Rude Rhubarb combined with Danshen root can treat Cholestatic hepatitis E by improving the symptoms and reducing serum bilirubin level. Besides this method also shortens therapeutic time and reduces hospitalization costs.