ObjectiveTo understand the current situation of medical damage liability disputes involving breach of the duty to inform in China， analyze the factors influencing the types of medical staff’s breach of the duty to inform， and explore the notification problems of medical staff in clinical practice. On these foundations， suggestions were proposed to improve the performance of the duty to inform and reduce medical disputes. MethodsUsing public cases from the China Judgements Online as the data source， the relationship between risk points and types of breach of duty to inform was analyzed using the Chi-square test. Logistic regression analysis was performed to explore the influencing factors of the types of breach of the duty to inform， and qualitative research summarized the specific contents of breach of the duty to inform. ResultsThere were differences in the effects of factors， including whether the patient was hospitalized， whether surgery was performed， whether Intensive Care Unit （ICU） treatment was required， the level of the medical institution， and whether a consultation occurred， on the types of breach of the duty to inform （P<0.05）. Whether surgery was performed was an influencing factor for the types of breach of the duty to inform. Qualitative research showed that the contents of breach of duty to inform primarily involve risk， treatment plan， and deficiencies in disease notification. ConclusionStrengthening the performance of the medical staff’s duty to inform should mainly focus on the medical side， coordinating with multiple parties and taking measures to improve the performance of the duty to inform， to reduce unnecessary medical disputes.

With the rapid development of network technology， live surgery has become the new way of surgery teaching. However， the issue of patient privacy protection caused by live surgery has received widespread attention. Based on the evolutionary game theory， this paper constructed an evolutionary game model from the three-party perspectives of doctors， patients， and government and analyzed the game behaviors of the three parties in the process of live surgery. Matlab software was utilized to conduct dynamic simulation and numerical simulation analysis. It was found that the factors affecting the choice of doctors’ strategies included protection costs， the cost of privacy leakage， the benefits of protection， high-traffic benefits， and other aspects； the factors affecting the choice of patient strategies encompassed surgical costs， the risk of privacy leakage， additional benefits， and other aspects； the factors affecting the choice of government strategies embodied regulatory costs and the improvement of credibility. To realize a win-win situation among doctors， patients， and the government， the three parties need to work together to ensure that patient privacy is not violated and find a balance between expanding the influence of medical education and protecting patient privacy.

Objective To analyze the quality of 22 batches of Fritillariae thunbergii bulbus Formula Granules from 12 different manufacturers by using water-extraction reference substance of Fritillariae thunbergii bulbus(ZBM ERS ST)and water-extraction reference substance of Fritillariae hupehensis bulbus(HBBM ERS ST)as references.Methods Ethyl acetate-methanol-triethylamine-water(17∶1∶1∶0.5)was used as the developing solvent for high-performance thin-layer chromatography(HPTLC)fingerprint analysis.The high-performance liquid chromatography(HPLC)fingerprint analysis was performed on a Agilent Eclipse XDB-C18 column(4.6 mm×250 mm,5 μm)with the gradient mobile phase consisted of acetonitrile-0.03%diethylamine solution.The column temperature was set at 25℃and evaporative light-scattering detector was used.The determination was conducted according to standard test method for measurement of Fritillariae thunbergii bulbus Formula Granules(Guangdong PFKL00117).Results The results of HPTLC and HPLC analysis showed that there are significant differences among the 22 batches of Fritillariae thunbergii bulbus Formula Granules.There were 4 batches of Fritillariae thunbergii bulbus Formula Granules from 3 manufacturers among them showed fingerprint characteristics of Fritillariae hupehensis bulbus.The total amount of peimine and peiminine in the remaining 18 batches of Fritillariae thunbergii bulbus Formula Granules was 0.291-3.179 mg·g-1,which were quite different.Conclusion Currently,the quality of Fritillariae thunbergii bulbus Formula Granules on the market varies greatly.Standardized water-extract reference substance has better applicability for the analysis of the quality of Fritillariae thunbergii bulbus Formula Granules than the control medicinal materials.

【Objective:】 To explore the network structure characteristics and core items of meaning in life and coping styles among college students, and provide a basis for understanding their relationships and related interventions. 【Methods:】 A survey was conducted among college students using the Simplified Coping Style Questionnaire and Meaning in Life Questionnaire . The network analysis method was used to construct a network of college students’ meaning in life and coping styles, and R software was used for statistical analysis and visualization. 【Results:】 In the network of college students’ meaning in life and coping styles, "believing that time will change the status quo, and the only thing to do is to wait" and "trying to forget the whole thing" had the closest connection. "Learning from others to handle similar difficult situations" had the highest expected impact. "Seeking the meaning in life" and "pursuing hobbies and actively participating in cultural and sports activities" had the highest bridge expected influence. The average predictability value of all nodes was 0.775. 【Conclusions:】 Interventions aimed at "learning from others to handle similar difficult situations", "changing one’s own ideas and rediscovering what is important in life" and "changing some of the original practices or problems" may maximize the coping effect of college students. "Seeking the meaning in life" can furthest influence the coping styles, and "pursuing hobbies and actively participating in cultural and sports activities" can maximize the improvement of meaning in life.

Objective:To explore the clinical characteristics and risk factors of influenza virus complicated with gram-positive bacterial infection in children.Methods:The clinical data of children with influenza virus complicated with gram-positive bacterial infection hospitalized at Shenzhen Children′s Hospital affiliated to China Medical University from January 2013 to December 2019 (observation group) were retrospectively studied.During the same period, 110 hospitalized children with influenza virus infection without co-infection were selected as the control group.The clinical data of the children in two groups were analyzed.Logistic regression analysis was used to analyze the risk factors of influenza virus complicated with gram-positive bacterial infection.Results:There were 108 children in the observation group, including 68 boys and 40 girls, with the age of(2.6±1.8)years, and 100(92.6%) children under 5 years old.Incidence month distribution: 61 cases from January to March, 15 cases from April to June, 13 cases from July to September, and 19 cases from October to December.In the observation group, 73 cases were infected with influenza A virus, 35 cases were infected with influenza B virus, 94(87.0%)cases were complicated with Streptococcus pneumoniae infection, 11 cases with Group A Streptococcus infection and 8 cases with Staphylococcus aureus infection.And 15 (13.9%) cases had underlying diseases.None of the patients in the observation group received pneumococcal conjugate vaccine, and two cases received influenza vaccine within one year.There were 110 children in the control group, including 57 boys and 53 girls, with the age of (5.0±2.4)years old.There were 80 cases of influenza A virus infection and 30 cases of influenza B virus infection.Four cases had underlying diseases, six cases received 13-valent pneumococcal conjugate vaccine and 12 cases received influenza vaccine within one year.Compared with the control group, the children in the observation group were younger[(2.6±1.8)years vs.(5.0±2.4) years, χ2=-7.935, P<0.001], had more underlying diseases[13.9%(15/108)vs.3.6%(4/110), χ2=7.200, P=0.007], less proportion of influenza vaccine[1.9%(2/108)vs.10.9%(12/110), χ2=7.439, P=0.006], the hospitalization time was longer[6(5, 7)d vs.4(3, 5)d, Z=-7.278, P<0.001], and mone cases of first use of neuraminidase inhibitors(NAI) for more than 48 hours[75.9%(82/108)vs.14.5%(16/110), χ2=82.971, P<0.001]. In the observation group, there were 97 culture-positive specimens of Streptococcus pneumoniae, including 89 of sputum/bronchoalveolar lavage fluid, five of blood culture and three of cerebrospinal fluid.All Streptococcus pneumoniae were resistant to erythromycin and clindamycin; the resistance rates of non-meningitis Streptococcus pneumoniae to ceftriaxone, cefotaxime and penicillin were 7.7%, 5.5% and 1.1%, respectively, and all the strains were sensitive to vancomycin, linezolid and levofloxacin.All patients in the observation group were treated with NAI and antibiotics, 37 cases were treated with bronchoalveolar lavage, 27 cases were admitted to pediatric intensive care unit, 10 cases were treated by non-invasive continuous positive airway pressure ventilation, and 17 cases received mechanical ventilation; 6 cases died.Logistic regression analysis showed that underlying diseases, unvaccinated with influenza and (or) pneumococcal vaccine, and the first use of NAI>48 hours were risk factors for influenza virus complicated with gram-positive bacterial infection. Conclusion:Influenza virus complicated with gram-positive bacterial infection can aggravate the illness and even death of children.Early identification of gram-positive bacterial infection, timely treatment of NAI and antibiotics, and active control of complications could be helpful to improve the cure rate.Strengthening influenza and pneumococcal vaccine during flu season can help reduce infection.

Objective:To evaluate the efficacy and safety of SPOT (GI Supply, USA), a new carbon-based permanent marker approved by the Food and Drug Administration (FDA), in the endoscopic marking for gastrointestinal lesions.Methods:A total of 115 patients with gastrointestinal lesions who underwent endoscopic treatment or surgery in Beijing Friendship Hospital or Beijing Chao-Yang Hospital from April 2019 to November 2019 were enrolled in the study. SPOT was used to mark the lesions, and marking points were found during endoscopic treatment or surgery to calculate the effective marking rate by single-group target value method. Adverse events after marking were recorded, and the changes of blood routine test, liver and kidney functions before and after marking were compared.Results:The effective rate of endoscopic marking with SPOT was 99.13% (114/115). The longest marking time was 57 days. There was no puncture of intestinal wall or injection into abdominal cavity during the marking process. One patient developed mild fever after marking. The incidence of adverse events was 23.48% (27/115), which were all unrelated to the test equipment. There was no significant difference in blood routine tests or liver and kidney functions before and after marking ( P>0.05). Conclusion:SPOT produced by GI Supply can effectively mark gastrointestinal lesions without serious adverse events, which meets the requirements of clinical use.

Objective:To investigate the analysis of postoperative death in patients with Stanford B acute aortic dissection (AAD) by XGBoost model.Methods:A retrospective study was conducted on 226 patients with Stanford type B AAD diagnosed in Yunnan Wenshan People′s Hospital from February 2012 to June 2019, including 126 males and 100 females, with an average age of (61.24±4.25) years. According to the outcome of discharge, the patients were divided into survival group ( n=129) and death group ( n=97), in which those who automatically gave up treatment and left the hospital were regarded as the death group. If the patients were admitted to Yunnan Wenshan People′s Hospital for many times during the study period, only the clinical data diagnosed as Stanford B AAD for the first time were selected for the study. The clinical data and hematological indexes of the subjects were collected, and the XGBoost model was used to predict the rapid diagnosis of postoperative death in patients with Stanford B AAD, and compared with the traditional Logistic regression model. Results:In the XGBoost model, the influencing factors were ranked according to the degree of importance. The top 6 factors were hypertension, neutrophil-to-lymphocyte(NLR), C-reactive protein (CRP), white blood cell count(WBC), D-dimer and heart rate. Hypertension and NLR had the greatest influence on postoperative death in patients with Stanford B AAD. Using receiver operator charateristic curve to compare the prediction performance of the two models, it was found that the prediction efficiency of the XGBoost algorithm was significantly stronger than that of the Logistic regression model in the training set, while the two models were equivalent in the verification set. The prediction models constructed by the two methods eventually included independent variables such as hypertension, NLR, CRP, WBC, D-dimer, heart rate, systolic blood pressure, diastolic blood pressure, surgical treatment and so on.Conclusions:XGBoost model can be used to predict the postoperative death of patients with Stanford B AAD. Its diagnostic performance is better than Logistic regression model in training set and equivalent to the latter in verification set. Hypertension and NLR are the most important predictors of postoperative mortality in patients with Stanford B type AAD.

Objective:To explore the distribution characteristics of pathogens in adult patients with community-acquired pneumonia (CAP) and to provide basis for the diagnosis, treatment, prevention of CAP.Methods:1 446 inpatients with CAP were prospectively enrolled in a third-class hospital in Beijing in recent 5 years (from January 2015 to December 2019). Respiratory tract samples were collected for smear, culture, nucleic acid, antigen and antibody detection to identify the pathogen of CAP. Mann-Whitney U test was used for continuous variables and χ 2 test or Fisher′s exact test was used for categorical data for statistical analysis. Results:Among the 1 446 patients, 822 (56.85%) patients were infected with a single pathogen, 231 (15.98%) patients were infected with multiple pathogens, and 393 (27.18%) patients were not clear about the pathogen. Influenza virus is the first pathogen of CAP (20.95%, 303/1 446), mainly H1N1 (8.51%, 123/1 446), followed by mycoplasma pneumoniae (7.19%, 104/1 446), Mycobacterium tuberculosis (5.33%, 77/1 446) and Streptococcus pneumoniae (5.05%, 73/1 446). The outbreak of H1N1 occurred from December 2018 to February 2019, and the epidemic of mycoplasma pneumoniae pneumonia was monitored from August to November 2019. Patients under 65 years old had high detection rates of Mycoplasma pneumoniae (14.41% vs. 2.41%, χ2=74.712, P<0.001), Streptococcus pneumoniae (8.16% vs. 2.99%, χ2=18.156, P<0.001), rhinovirus (6.08% vs. 3.56%, χ2=5.025, P<0.025), Chlamydia pneumoniae (5.90% vs. 1.15%, χ2=26.542, P<0.001) and adenovirus (3.13% vs. 0.92%, χ2=9.547, P=0.002). The severe disease rate of CAP was 14.66% (212/1 446), and the average mortality rate was 3.66% (53/1 446). The severe illness rate and mortality rate of bacterial-viral co-infection were 28.97% (31/107) and 19.63% (21/107), respectively. Conclusions:Influenza virus is the primary pathogen of adult CAP. Outbreaks of Mycoplasma pneumoniae and H1N1 were detected in 2018 and 2019, respectively. The remission rate and mortality rate of virus-bacteria co-infection were significantly higher than those of single pathogen infection. Accurate etiological basis not only plays a role in clinical diagnosis and treatment, but also provides important data support for prevention and early warning.

Objective:To explore the distribution characteristics of pathogens in adult patients with community-acquired pneumonia (CAP) and to provide basis for the diagnosis, treatment, prevention of CAP.Methods:1 446 inpatients with CAP were prospectively enrolled in a third-class hospital in Beijing in recent 5 years (from January 2015 to December 2019). Respiratory tract samples were collected for smear, culture, nucleic acid, antigen and antibody detection to identify the pathogen of CAP. Mann-Whitney U test was used for continuous variables and χ 2 test or Fisher′s exact test was used for categorical data for statistical analysis. Results:Among the 1 446 patients, 822 (56.85%) patients were infected with a single pathogen, 231 (15.98%) patients were infected with multiple pathogens, and 393 (27.18%) patients were not clear about the pathogen. Influenza virus is the first pathogen of CAP (20.95%, 303/1 446), mainly H1N1 (8.51%, 123/1 446), followed by mycoplasma pneumoniae (7.19%, 104/1 446), Mycobacterium tuberculosis (5.33%, 77/1 446) and Streptococcus pneumoniae (5.05%, 73/1 446). The outbreak of H1N1 occurred from December 2018 to February 2019, and the epidemic of mycoplasma pneumoniae pneumonia was monitored from August to November 2019. Patients under 65 years old had high detection rates of Mycoplasma pneumoniae (14.41% vs. 2.41%, χ2=74.712, P<0.001), Streptococcus pneumoniae (8.16% vs. 2.99%, χ2=18.156, P<0.001), rhinovirus (6.08% vs. 3.56%, χ2=5.025, P<0.025), Chlamydia pneumoniae (5.90% vs. 1.15%, χ2=26.542, P<0.001) and adenovirus (3.13% vs. 0.92%, χ2=9.547, P=0.002). The severe disease rate of CAP was 14.66% (212/1 446), and the average mortality rate was 3.66% (53/1 446). The severe illness rate and mortality rate of bacterial-viral co-infection were 28.97% (31/107) and 19.63% (21/107), respectively. Conclusions:Influenza virus is the primary pathogen of adult CAP. Outbreaks of Mycoplasma pneumoniae and H1N1 were detected in 2018 and 2019, respectively. The remission rate and mortality rate of virus-bacteria co-infection were significantly higher than those of single pathogen infection. Accurate etiological basis not only plays a role in clinical diagnosis and treatment, but also provides important data support for prevention and early warning.

Objective:To analyze the MRI features of hepatic epithelioid hemangioendothelioma (HEHE).Methods:The data of patients with HEHE managed in the Wenzhou People's Hospital of Zhejiang Province and the First Affiliated Hospital of Wenzhou Medical University from April 2000 to April 2019 were retrospectively analyzed. Among the 26 patients with HEHE, there were 12 males and 14 females, aged from 23 to 65 years (average 44.4 years). The quantity, size, shape and type of the lesions were observed and the MRI features were analyzed.Results:Of the 382 nodules detected by MRI in the 26 patients, the size varied from 0.5cm to 12.0 cm, with 16 nodules being more than 5.0 cm in diameter (average of 2.2 cm). Four patients with a single nodular type presented with low signal on T 1 weighted imaging (T 1WI), high signal on T 2 weighted imaging (T 2WI), high signal on diffused weighted imaging (DWI), and high central signal and low peripheral annular signal on apparent diffusion coefficient (ADC). After enhancement, the lesions presented with annular centripetal enhancement or continuous annular enhancement. Fourteen patients with multiple nodules had a total of 147 lesions, presenting with low signal on T 1WI, high signal on T 2WI, high signal on DWI, and high central signal and low peripheral annular signal on ADC. After enhancement, the lesions presented with annular centripetal enhancement and continuous annular enhancement. There were 24 lesions in 6 patients who had a " double-ring sign" , 21 lesions in 7 patients who had a capsule " shriveled sign" , 16 lesions in 7 patients who had a " lollipop sign" and 18 lesions in 5 patients who had an " intravascular sign" . There were 231 lesions in 8 patients of the fusion type. The lesions showed low signal on T 1WI, high signal on T 2WI , high signal on DWI, and high central signal and low peripheral signal on ADC. After enhancement, the lesions presented with flocculent or annular centripetal enhancement. In 8 patients, 87 lesions had a " target sign" , 55 lesions had a " lollipop sign" and 42 lesions had a capsule " shriveled sign" , and 36 lesions in 5 patients had an " intravascular sign" . Conclusion:MRI signs of HEHE have certain characteristics, such as lesions being distributed near the capsule, and fusing with each other; a " target sign" on T 2WI; a capsule " shriveled sign " ; and a " double-ring sign" , a " lollipop sign" , an " intravascular sign" in the portal phase. These features are helpful in diagnosing HEHE.