Doctors must carry out informed consent in medical treatment.However,to ensure patients' rights and interests mostly,this obligation needs exempted in some special cases.This article studies the insufficiency in the existing regulation on doctors' obligations exemption.It also lists some constructive suggestions based on the existing theory to solve this problem.

OBJECTIVE To investigate the degree of risk of viral prevalence of HBV,HCV and HIV through blood transfusion in Beijing Hospital in China,and to assess the need of a national Haemovigilance System. METHODS Retrospectively,7883 blood bank specimens (collected from 2004 to 2007) were re-examined using 8 indicators (including 5-item Hepatitis B,anti-HCV,anti-HIV and Syphilis) for the prevalence of most common viral infection. RESULTS From the blood bank specimens,the prevalence of HBsAg was 0.88% (69),the anti-HBc positive blood,only the anti-HBc was found in 2.65% of the specimens,while both the anti-HBc and the anti-HBe were found in 2.09% of the specimens. The prevalence of anti-HCV was 0.09% (7). CONCLUSIONS We need to establish the national Haemovigilance System to strengthen the monitoring of the above HbsAg,HBcAb and HCV indicators to prevent the transfusion-transmitted infection. Only in this way can the public confidence in blood safety be improved.

Objective To explore whether Helq deletion affect the pluripotency of stem cells. Methods Helq knockout embryonic stem cells were obtained by CRISPR?Cas9 gene editing technique. Results The results of immunoflu?orescence analysis showed that the expression of Oct4 and Nanog had no obvious difference to that of the control cells. The Helq-/ - embryonic stem cells could produce viable pups by tetraploid complementation, indicating that their pluripotency was not affected. Meanwhile, we found that day 2 epiblast?like cells also were obtained through differentiation of the Helq-/ - embryonic stem cells in vitro. Immunostaining and real?time PCR analysis showed that the gene expression of Helq-/ - epiblast cells were similar to the wild type cells. Conclusions Taken together, it is proved that the genomic in?stability caused by Helq deletion does not affect the pluripotency of pluripotent stem cells.

Objective To study the morphological changes of external eyes before and after epicanthoplasty combined with blepharoplasty and to explore a simple and efficient method to correct epicanthus. Methods A total of 120 eyes in 60 patients were operated on with the inverted L-sharp epicanthoplasty combined with double-eyelid blepharoplasty and the follow-up began 2 months after the surgery. The height and physiognomic length of the eyelid and the length and angle of the eyelash were measured and compared with preoperative meansurements, as well as the distance of the inner canthus. The ratios between the inner-canthus distance and the physiognomic eyelid breadth and the diameter of eyebrow and eye were also described. Results The contours of the eyelid fissure and the double-eyelid were natural and the surgical scare was seen unconspicuous 3 months after the operation. Changes in the palpebral fissure , the angel and length of the exposed eyelash were all significantly different by paired-sample t test (P < 0.01). The vertical and horizontal lines through the entocanthion and the vertical line through the gnomic ectocanthion combined with the horizontal line through the brow ridge formed a square structure. Conclusions This inverted L-shape epicanthoplasty combined with blepharoplasty may be effective in reconstructing the contours of the entocanthions as well as the shape of the double eyelids. It can also achieve better cosmetic effects in the proportional relation between the eyes and eyebrows. Therefore, it deserves clinical promotion.

Objective To analyze the schistosomiasis epidemic of 4 national pilots in Dongting Lake regions during 5 years period, and provide references for control strategy and policy making. Methods Four longitudinal monitoring pilots were set up in Dongting Lake regions from 2000 to 2004, and the field work in pilots was carried out based on “National Scheme on Schistosomiasis Epidemic Monitoring”. Results During the monitoring period, the infection rate of Schistosoma japonicum kept at 4% in Dongjia, 5% in Xinshang and over 12% in Quanxing, but in Changjiang, the rate was 8.92% in the first year of monitoring period, and stayed at 4% in the next 4 years. For all pilots, 20-49 age group had the highest infection rate, with the rate in male being higher than that in female and centering on the fishermen, farmers and students in occupation. There was the occurrence of acute and new advanced cases. The infection rate in domestic animals was fluctuated at 20%. There was extensive distribution of infected snails on marshlands outside embankments. Conclusion Schistosomiasis is seriously endemic in Dongting Lake regions, and intensive control measures are necessary.

Starting from the practices of grade protection assessment on the information system of Peking Union Medical College Hos -pital, the paper introduces the information system grade and assessment contents and processes , discusses common problems found in specific work and risk analysis approaches so as to provide a reference for work related to information security .

ObjectiveTo compare the efficacy of laparoscopic and open left lobectomy.MethodsThe clinical data of 92 patients who received left lobectomy at the First Affiliated Hospital of Harbin Medical University from May 2010 to June 2011 were retrospectively analyzed.Of the 92 patients,42 received laparoscopic left lobectomy (laparoscopic group ) and 50 received open left lobectomy (open group ). The advantages and disadvantages between laparoscopic and open left lobectomy were compared. All data were analyzed using the t test,chi-square test or by calculating the Fisher exact probability.ResultsTwenty-nine patients received left lateral lobectomy and 13 patients received left hemihepatectomy in the laparoscopic group. One patient was converted to the open group becaused of the injury of the middle hepatic vein.Thirty-three patients nnderwent left lateral lobectomy and 17 underwent left hemihepatectomy in the open group.The tumor-free resection margin of the laparoscopic group was ( 1.6 ± 0.6 ) cm,which was significantly longer than ( 1.2 ± 0.4 ) cm of the open group (t=3.81,P＜0.05).The volume of operative blood loss of the laparoscopic group was (158 ±89)ml,which was significantly smaller than (292 ± 172)ml of the open group (t =4.56,P ＜ 0.05 ).The time of postoperative pain control,time to bowel function recovery and duration of hospital stay were ( 1.2 ± 0.3 )days,(23 ± 4)hours,( 7.5 ± 2.8 ) days in the laparoscopic group,which were significantly shorter than ( 2.0 ± 1.1 ) days,(4.9 ± 7 ) hours,( 11.3 ± 4.2 ) days in the open group,respectively ( t =4.57,21.31,5.00,P ＜ 0.05 ).The levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) at postoperative day 1 were increased,while the increase of AST and ALT in the open group were greater than that in the laparoscopic group (t =6.73,5.03,P ＜0.05).The postoperative prothrombin time in the open group was significantly longer than that before operation (t =2.32,P ＜ 0.05 ).The incidence of postoperative complications and total hospital costs were 7％ (3/41) and (2.5 ±0.7) ×104 yuan in the laparoscopic group,which were lower than 8％ (4/50) and (2.6 ±0.6) × 104 yuan in the open group,but no significant difference was observed (t =0.74,P ＞0.05).One patient in the open group died of multi-organ dysfunction syndrome caused by acute hepatic failure.ConclusionLaparoscopic left lobectomy is safe and effective,and it has the advantages of small trauma,quick recovery of patients and significant overall efficacy when compared with open left lobectomy.

Objective To observe the clinical effect of Guizhi Fuling pill in the treatment of interstitial tubal pregnancy.Methods80 cases with interstitial tubal pregnancy in Hangzhou obstetrics and gynecology hospital from August 2015 to December.2016 were randomly divided into the observation group and the control group, 40 cases in each group.The control group were given methotrexate and mifepristone, at this basis, the observation group were given Guizhi Fuling pill.The effect was analyzed in the two groups.Results①β-HCG negative time in the observation group were significantly shorter than that in the control group(P<0.05).②Adverse reactions rate in the observation group was significantly lower than that in the control group(P<0.05).ConclusionIt can shorten the treatment time, reduce the adverse reaction which Guizhi Fuling pill was used in the adjuvant treatment of interstitial tubal pregnancy.

OBJECTIVETo investigate the clinical application of the vacuum-sealing drainage (VSD) in the prevention of lymph leakage after inguinal lymphadenectomy.

METHODSFrom September 2003 to September 2013, 60 cases who underwent inguinal lymph nodes dissection received VSD (n = 30), or traditional pressure dressing and drainage( control group, n = 30) after operation. The flap blood supply, healing process and incidence rate of lymph leakage were observed.

RESULTSTwenty-eight cases in VSD group were effective. Eleven cases were cured, ten cases were effective, and nine cases were invalid in control group. The cure rate, effective rate and healing period were significantly different between the two groups (P < 0.01).

CONCLUSIONSThe incidence of lymph leakage after inguinal lymphadenectomy can markedly decrease with VSD application. VSD could be an ideal preventive method for post-operative lymph leakage.

Adult ; Aged ; Female ; Groin ; surgery ; Humans ; Lymph Node Excision ; Lymph Nodes ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; Postoperative Complications ; prevention & control ; Surgical Flaps ; Young Adult

Objective To evaluate the diagnostic value of the SPM-based interhemispheric asymmetry analysis (SIAA) of 18F-FDG PET brain imaging in localization of temporal lobe epileptic foci.Methods A total of 73 patients (42 males,31 females,average age: (27.10±9.78) years) diagnosed as temporal lobe epilepsy (TLE) and 30 healthy volunteers (17 males,13 females,average age: (33.79±5.46) years) from March 2012 to July 2015 were enrolled in this retrospective study.18F-FDG PET brain imaging was performed on all subjects to localize temporal lobe epileptic foci.The results of 18F-FDG-PET were analyzed by SIAA,visual analysis and asymmetry index (AI) analysis.The accuracy of the three methods was evaluated according to the postoperative pathological results and curative effect.χ2 test and partition of χ2 test were used to analyze the data.Results The accuracies of localization with SIAA,visual analysis and AI analysis were 87.67％(64/73),75.34％(55/73) and 69.86％(51/73),respectively (χ2=6.993,P<0.05).The accuracy of SIAA was higher than that of visual analysis and AI analysis (χ2 values: 5.818 and 8.481,both P<0.017),while there was no significant difference between AI analysis and visual analysis (χ2=0.500,P>0.017).Conclusion The SIAA of 18F-FDG PET brain imaging may be a more objective and accurate method in localization of TLE foci.