Since the tort law came into implementation,the establishment of a unified identification mechanism of medical malpractice has become inevitable for the application of the law.Integration of medical malpractice identification into judicial expertise can ease the social confidence crisis,and realize the natural advantage of the justice,making the expertise fair and open.Therefore it is necessary to examine the fusion and improvement of the model from both static and dynamic aspects.Correspondingly,the system design to optimize the main body of identification,identification contents,application of evidence,and external oversight of identification,has become the key to establishing the identification mechanism of medical malpractice.

The quality of thinking of TCM syndrome differentiation is the imagery thinking, which is dominanted by Concrete thinking and supplemented by logical thinking. Syndrome is a kind of cognition about condition of the whole life from the aspect of system function, i.e. xiang of life. Tongue demonstration, pulse tracings and so on, they are the epitome of the whole life condition and syndrome, not just the symptom. Every prescription has the only xiang, so does every Chinese traditional medicine. The thought process of determination of treatment based on differentiation of symptoms and signs and principle-method-recipe-medicines is the process of diagnosis xiang based on xiang, treating xiang based on xiang. In exopathic disease, there is disease at fi rst, then the symptoms, and then the corresponding xiang, and the syndrome differentiation can be carried. So, syndrome differentiation bases on disease and the main symptomes. In internal damage diseases, the xiang and syndromes appear before the disease and symptoms. Therefore the thought of TCM syndrome differentiation ought to adopt the imagery thinking, which is dominanted by Concrete thinking and supplemented by logic thinking, and differentiating syndrome based on xiang and symptoms.

Objective:To explore the application value of central venous indwelling catheter guided by ultrasound in temporary hemodialysis patients.Methods:Seven hundred and eight cases of hemodialysis patients were choosed as the respondents who were divided into control group(n=386) and ultrasound group(n=322), sex ratio, average age, disease distribution, platelet count(Plt), prothrombin time(PT), systolic blood pressure (SBP), neck circumference was no statistical difference in two groups. In control group, indwelling catheter of the right internal jugular vein were implemented in the triangle area formed by sternocleidomastoid clavicular head, sternum, clavicle by using surface anatomic mapping. In ultrasound group, position, the diameter and blood flow filling situation of the right internal jugular vein by using ultrasound scan, the veins were punctured and indwelled catheter under the guided by ultrasound. The success rates and times of indwelling catheter, as well as complications were compared between two groups.Results: One-time success rate of indwelling catheter guided by ultrasound group was obviously higher than that of control group, the rates were statistically significant difference (x2=118.82,P<0.01), and the indwelling time was significantly shorter than that of control group, The difference was statistically significant (t=7.03,P<0.01). The puncture comfort score of ultrasound group was significantly higher than that of control group, The difference was statistically significant (t=6.29,P<0.01). The complication rate of ultrasound group was lower than that of control group, the difference was statistically significant (x2=28.24,P<0.01).Conclusion: Ultrasound help to understand the position, diameter and blood flow filling situation of the right internal jugular vein, improve the success rate of indwelling catheter and reduce the occurrence of complications.

Objective:To observe the effect of high-flux polyethersulfone dialysis membrane to inflammatory mediators and nutritional status in patients with maintenance hemodialysis, and to explore its mechanism.Methods: Ninety six patients with low-flux maintainance hemodialysis were recruited after changing to a high-flux hemodialysis. Hs-CRP, IL-1, IL-6,ALB, Hb,β2-MG were tested before treatment, 6 months and 12 months after treatment, at the same time single chamber urea clearance index (spKt/V) was recorded. Results:①The compare results among high-flux polysulfone membrane dialysis treatment for 6 months and after 12 months, and before treatment, hs-CRP andβ2-MG significantly decreased (F=6.53,P<0.05), spKt/V was significantly higher(F=4.35, P<0.05), and IL-6 significantly decreased at 12 months after treatment, compared with before treatment, the difference was statistically significant (F=7.21,P<0.05).②There was significantly negative correlation between hs-CRP and ALB (r=-0.463,r=-0.396,r=-0.402;P<0.05). Inflammatory mediators may participate in the occurrence and development of its hypoalbuminemia in MHD patients, and elevated hs-CRP levels may be a risk factor for hypoalbuminemia. Conclusion:High-flux polysulfone membrane hemodialysis can effectively reduce micro-inflammatory state MHD patients and improve their nutritional status, improve the quality of life and long-term survival.

Through various mechanisms, malignant tumors can cause thrombosis, which in turn facilirates the growth and metastasis of tumors. Platelets interact with tumor cells to form tumor thrombosis and assist the metastasis of malignant tumors by mechanisms such as protecting tumor cells from immune surveillance and facilitating tumor cell growth and adhesion to vascular endothelial cells.

It has been suggested that aspirin may have anti-tumor effect based on animal experiments and epidemiological investigation, however, it remains controversial whether aspirin has certain effects on prostatic cancer, bladder cancer, ovarian cancer and pancreatic cancer whereas it has been well documented that long-term regular use of aspirin can significantly reduce risks of colorectal cancer, esophageal cancer and gastric cancer.

Objective To explore the influence of environment early in life on learning and memory abilities and neuroglobin (Ngb) expression. MethodsForty-five newborn,male,Sprague-Dawley rats were randomly divided into an EE (enriched environment) group,an EI (isolated environment) group and a normal control group,with 15 rats in each group.The EE and EI group rats lived in those environments for their first 28 days of life.The step-down test was used to measure the rats'learning and memory abilities on the 29th day.Ngb expression was examined using immunohistochemical methods. ResultsThe step-down test showed learning and memory scores for the EE group rats of (9.67±0.49) and (9.80±0.56) respectively,significantly higher than those of the control group,(8.67±0.72) and (8.93±1.10).The learning and memory abilities of the EI group were the lowest among the three groups,with scores of only (7.07±1.98) and (7.67±0.98 ),respectively.The latency of the first electric shock was (166.33±36.08)s in the EE group and significantly shorter than that in the control group (108.93±73.26) s.The EI group showed the longest average latency (44.93±45.03)s.Average Ngb expression as reflected by the integrated optical density in the EE group was (224.56±89.09) in the frontal cortex and (127.70 ± 28.16)in the hippocampus,a significant increase over expression in the control group.The Ngb expressions of the EI group were the lowest among the 3 groups-(88.78 ± 18.84) and ( 63.42 ± 16.41 ) in the frontal cortex and hippocampus respectively. ConclusionsEarly exposure to an enriched environment can increase Ngb expression and improve learning and memory ability,but early isolation will reduce Ngb expression and learning and memory function.

Objective To translate the English version of Nursing Activities Scale (NAS) into Chinese,and to test the reliability and validity of the Chinese version of NAS.Methods A total of 520 nurses were tested by the Chinese version of NAS.SPSS17.0 and AMOS 17.0 were used to test the reliability and validity.Results The correlations between the items and total scale ranged from 0.232 to 0.732 (P＜0.01).Four factors were extracted by exploratory factor analysis and they could explain 52.251％ of the total variance.The confirmatory factor analysis revealed a good model fit,and the fit indices were x2/df =1.145,GFI =0.962,AGFI =0.933,RMR =0.028,RMSEA =0.017,NFI =0.957,CFI =0.994.Conclusion Chinese version of NAS is reliable and valid,and can be used to assess the level of professional nursing practice.

Objective To understand the psychological experience of primary caregivers of patients with cancer-related pain,care to focus on caregivers psychological health, improve life quality and ability to cope with pain. Methods A qualitative, descriptive, semi-structured research were used in this study. Nineteen primary caregivers of cancer patients with cancer-related pain were in-depth interviewed. Colaizzi′s analytical method was adopted to analyze the data, which were then organized into themes and subthemes. Results The primary caregivers confronting cancer-related pain experienced a series of negative psychological changes, worry, fear, anxiety, vexation, sadness, helplessness and powerlessness, their physical and mental health, life were also affected .The primary caregivers were lack of pain related knowledge and pain management skills generally. Conclusion Medical staff should pay high attention to the psychology status of primary caregivers, to provide support, health education and skill training of pain coping strategies, which then might help relieve cancer patients′pain and in turn improve their quality of life.

ObjectiveTo investigate the status of job burnout of clinical nurses,and to analyze its relationship with self-efficacy and the environmental factors.MethodsMaslach Burnout Inventory,General Self-Efficacy Scale,Nursing Work Index-Revised and Nurses'Job Stressor Scale were used to investigate 239 clinical nurses from 2 tertiary first-class hospitals of Lianyungang City.Correlation and regression analysis were used to analyze the relationship between all the dimensions of nurse burnout,self-efficacy,professional nursing practice environment and job stressor.ResultsThe scores of emotional exhaustion and depersonalization were ( 23.95 ± 11.11 ) and (7.90 ± 6.58 ) respectively,indicating medium level of burnout.The score of decreased personal accomplishment was reverse coded,and the score was ( 27.51 ± 10.96),indicating a high level of burnout.Both work environment and self-efficacy were related to job burnout (P ＜ 0.05 or P ＜ 0.01 ).Environment played bigger roles in influencing emotional exhaustion and depersonalization,and self-efficacy influenced personal accomplishment more significantly.ConclusionMore attention should be paid to the improvement of nurses' self-efficacy and work environment in order ot reduce nurses'job burnout.