Medical liability insurance is a latecomer in China,and faced with many challenges ever since.This paper picked medical liability insurance in Nanjing as an empirical study example,as the author analyzed the insurance,underwriting and premiums of medical liability insurance,as well as the insurance programs and claim settlements from 2008 to 2012.In addition to noting problems found in medical liability insurance in Nanjing,the author proposed the roadmap for China' s medical liability insurance,with reference to experiences of overseas medical liability insurance industry.

Objective To investigate the expression ot XAF1 protein in pancreauc cancer,and its relationship with clinicopathological parameters and prognosis.Methods The tissue microarray was composed of 89 pancreatic cancer and 21 normal pancreatic tissues,and immunohistochemistry was used to examine the expression of XAF1 protein.The correlation between XAF1 expression and clinicopathological parameters was analyzed.The 89 patients were followed,and the survival was shown in Kaplan Meier curve.Cox proportional hazards regression was used to identify risk factors for the survival of pancreatic cancer patients.Results The negative expression rate of XAF1 was 44.9％ (40/89),and it was 9.5％ (2/21) in normal tissue,and the difference between the two groups was statistically significant (P ＜0.05).The expression of XAF1 was negatively associated with tumor staging (P ＜ 0.05),but it was not associated with age,gender,lymph node metastasis,distant metastasis,pathological grading,surgical margins,vascular and neural invasion.Patients with negative expression of XAF1 had much shorter survival than patients with positive expression.Univariate analysis showed that negative expression of XAF1,pathological grading,lymph node metastasis,distant metastasis was associated with the survival (P ＜ 0.05),and the multivariate analysis indicated that negative expression of XAF1 was an independent prognostic factor for survival of pancreatic cancer.Conclusions XAF1 may be involved in the development and growth of pancreatic cancer,and it is related with patient's prognosis.

Objective:To participate in the anti-infection regimen adjustment and perform pharmaceutical care for one pneumonia patient after lung transplantation by clinical pharmacist to provide experience for individualized medication. Methods:Clinical pharma-cist adjusted the treatment plan and doses of immunosuppressive agents according to the patient' s conditions. Results: The infection was effectively controlled through optimizing the treatment plan. Conclusion:Pharmaceutical care for patients after lung transplantation performed by clinical pharmacists is helpful to both the recovery of patients and future appropriate drug use.

Objective: In order to validate the effectiveness of methods of defining poverty caused by illness which are based on catastrophic health expenditure and impoverishment health expenditure, originated from relative costs theory.Results: This paper uses empirical approach to explore the definition methods by comparing the original methods with modified methods and defined population with the actual situation of poverty alleviation.Results: Study results show that the catastrophic health expenditures incurred ratio is about 20% and shows the aggregation of both low-income and high-income groups.The impoverishment health expenditure incurred ratio is about 12% and they mainly are families at the edge of poverty line.This study found that 70% of the families defined based on our method did not receive medical assistance in reality.Conclusion: Therefore, the definition methods based on relative costs theory are of great value in Chinese medical assistance systems for defining poverty caused by illness.Grouping based on household ability to pay could improve the methods' operability and effectiveness.

Objective To study the relationship of apoptosis-related gene survivin with bcl-2, bax protein in endometriosis. Methods The expressions of survivin, bcl-2 and bax protein were detected by immunohistochemical method (SP) in ectopic endometrium from 40 cases, and compared with that in eutopic endometrium from 25 cases without endometriosis. Results The expression rate of survivin protein in endometriotic cells was much higher than that in normal endometrial cells. The survivin was not correlated with the phase of menstrual cycle , but positively correlated to bcl-2, negatively to bax. Conclusion Survivin may play an important role in pathogenesis of endometriosis. With survivin gene, apoptosis-related gene bcl-2 may have a synergic role and bax have an antagonistic role in the formation and progression of endometriosis.

Objective To evaluate the engraftment state after allogeneic peripheral blood stem cell transplantation(Allo-PBSCT)in 2 exposed patients in Shandong “10?21” radiation accident.Methods The dynamic cytogenetic analysis was performed by chromosome aberration(CA)analysis,R-band karyotyping analysis and micronucleus(MN)assay of peripheral blood and/or bone marrow samples of 2 patients(A and B).Results The results showed that the transplantation was successful(complete chimerism),and the engraftment state was stable.No difference was observed between the results of cytogenetic analysis from peripheral blood samples and bone marrow samples.These results were in fairly good accordance with those results by short tandem repeats-polymerase chain reaction(STR-PCR)and clinical manifestations.Conclusions The results suggested that the dynamic observations of dicentric and ring aberrations and MN can be used as an indication to estimate the engraftment state after Allo-PBSCT,but only for the patient with acute radiation sickness.Moreover,the cytogenetic analysis performed on bone marrow samples is better than that on peripheral blood samples when the lymphocytes were reduced sharply in peripheral blood.

Objective A biological dose estimation by cytokinesis-block micronucleus(CBMN)assay was performed on 2 patients exposed to accidental radiation.Method Micronucleus assay and dose estimation by CBMN in peripheral blood and bone marrow were performed in 2 patients(A and B)suffering from radiation sickness.Results No binucleated lymphocytes were observed in peripheral blood of 2 patients.The results of bone marrow examination showed that only one binucleated cell was discovered in patient A.The rough estimation of radiation dose of A was above 20Gy according to the degree of reduction of binucleated cell in our previous study.The micronucleus frequency was 2.42 per cell and the dose estimation was 8.7(8.0-9.4)Gy for patient B.These results were approximately in accordance with that of dose estimations by physical method,chromosome aberration analysis,ESR method,and clinical manifestations.Conclusion MN assay is simple,quick and accurate.It is a reliable biodosimetry in addition to chromosome aberration analysis.

We used retroviral vector pLXSN to construct recombinant retroviral vectors with the human apoptosis gene, interleukin-l? converting enzyme (ICE). The vectors were introduced into packaging cell line PA317 by electroporation method. The G418 resistant colonies were selected, and the supematants of the colonies were used to infect the human hepatocellular carcinoma cell line SMMC7721. G418 resistant colonies of SMMC7721 were named SMMC7721-MCE and SMMC7721-neo. The results of RT-PCR analysis showed that exogenous hICE gene had successfully integrated into the genome of SMMC7721-hICE cells. The proliferation rate and tumorigenicity of cells in nude mice were examined. Our data showed that the growth rate and the tumorigenicity of SMMC7721-hICE cells in nude mice were considerablely decreased comparing with parent SMMC7721 and SMMC7721-neo. These results suggested that the retroviral vector expressing hICE gene was successfully constructed and could suppress the growth ability and tumorigenicity of human hepatocellular carcinoma cells, which provided a basis for further investigation of hICE gene therapy.

Objective To summarize the surgical treatment of heart disease in patients aged 70 years and over. Methods From May 1995 to July 2000, 23 patients aged 70 years and over underwent cardiac operation at our department. Thirteen cases underwent isolated coronary bypass grafting, 5 had isolated valve operations , 3 had combined valve operation and coronary bypass grafting, 1 had excision of left atrial myxomas, 1 had combined pericardiectomy and coronary bypass grafting .Results Postoperative complications occurred in 5 cases (21.7%). The hospital mortality rate was 4.3% (1 case) . All of the 22 cases survived showed improvements in cardiac function and quality of life during a follow up of 1 month to 5 years.Conclusions Cardiac operations can be performed in patient saged 70 yeas and over with a satisfactory outcome,earlier referral and intervention is mandatory to improve results in this patients.

To evaluate engraftment state after allogeneic peripheral blood stem cell transplantation (ALLO PBSCT), 30 patients who received ALLO PBSCT were studied using cytogenetic analysis and short tandem repeats polymerase chain reaction (STR PCR). Twenty one of the 23 patients who received sex mismatched donor marrows showed complete chimerism (CC), one showed mixed chimerism (MC), and one showed completely recipient karyotype. In the 7 patients of chronic myelogenous leukemia (CML) who received sex matched donor marrows, except 2 patients, the rest showed completely disappearance of Ph positive cells. The results from these two detection methods completely coincided mutually. STR PCR and cytogenetic analysis can be supplementary to each other and their results can be pooled together.