Objective To analyze the medical malpractice technical appraisals accepted by a health administration department,and to provide suggestions for the work improvement of the health administration department and its affiliated medical institutions.Methods A total of 57 cases of technical appraisals for medical malpractice accepted from 2015 to 2023 were analyzed retrospectively.Yi fa hui's reasons for the failure of medical institutions were taken as the main classification basis of the medical fault.Results There were 51 cases of the first appraisal and 6 cases of the second appraisal.Among them,38 cases were completed,and the completion rate was 66.67%,involving 15 departments;17 cases were deemed medical accidents.The most frequent category was Grade 1 medical malpractice with minor liability borne by the healthcare provider,involving 8 types of faults.Conclusion The majority of appraisals accepted by a health administration department is the first appraisal,and the completion rate of appraisal needs to be improved.It is suggested that the health administration department should do well in the explanation and communication in the process of medical malpractice technical appraisal,and medical institutions should strengthen their supervision responsibility for clinical work.

ObjectiveThis study aims to investigate the mechanism in which Celastrus orbiculatus extract （COE） affects the proliferation and differentiation of gastric organoids and the expression of Lgr5 and thus reverses the precancerous lesions of gastric cancer （PLGC） by regulating the leucine-rich repeat containing G protein-coupled receptor 5 （Lgr5）/Wingless （Wnt）/β-catenin signaling pathway based on a gastric organoid injury model. MethodGastric organoids were established based on stem cells of the mouse gastric gland. Gastric organoid injury models were constructed by treating gastric organoids with N-methyl-N'-nitro-N-nitrosoguanidine （MNNG， 0.02 mg·L^-1）. Gastric organoid injury models were randomly divided into normal group， model group （0.02 mg·L^-1 MNNG）， low， medium， and high dose （5， 10， 20 mg·L^-1） groups of COE， and Wnt inhibitor Dickkopf-related protein 1 （DKK1） （0.5 mg·L^-1） group， and they were treated with respective agents for 24 h. The number and volume of gastric organoids under different drug concentrations were observed under a microscope. The viability of the gastric organoid injury models was detected by Methyl thiazolyl tetrazolium （MTT） assay. The morphology and pathology of gastric organoids were observed using Hematoxylin and Eosin （HE） staining. The expression levels of Lgr5， Mucin2 （MUC2）， Mucin5AC （MUC5AC）， Mucin6 （MUC6）， Wnt， and β-catenin in gastric organoids under different drug concentrations were detected by Western blot （WB）. ResultCompared with the normal group， the number， volume， and activity of gastric organoids in the model group were decreased （P<0.01）， while the expressions of Lgr5， MUC2， Wnt， and β-catenin were significantly increased （P<0.01）. The expressions of MUC5AC and MUC6 were significantly decreased （P<0.01）. Compared with the model group， the number and volume of gastric organoids in the low， medium， and high dose groups of COE were all improved （P<0.01）， and the vitality of gastric organoids was significantly enhanced （P<0.01）. The effect was the most significant at a COE concentration of 20 mg·L^-1 （P<0.01）. The expressions of Lgr5 and MUC2 in the medium and high dose groups of COE were significantly reduced （P<0.01）， while the expression of MUC5AC and MUC6 were significantly increased in the low， medium， and high dose groups of COE （P<0.05， P<0.01）. Compared with the model group， Wnt inhibitors could promote the expression of MUC5AC and MUC6 in gastric organoids （P<0.05， P<0.01） and reduce the expression of MUC2， Wnt， and β-catenin. In addition， the combined use of COE at high concentrations and Wnt inhibitors could further promote this trend （P<0.01）. ConclusionCOE inhibits the Wnt/β-catenin pathway by inhibiting the expression of Lgr5， MUC2， Wnt， and β-catenin and promoting the expression of MUC5AC and MUC6， thus promoting the proliferation and differentiation of gastric organoids and reversing the PLGC process.

Objective To investigate the application of personal health record(PHR)and chronic disease management platform established on the basis of patient portal system(PPS)in managing older adults with coronary heart disease and to examine the effect on patients'self-care ability,coping mode,and quality of life.Methods A total of 532 elderly patients with coronary heart disease were included in the study.All the participants enrolled were admitted to a tertiary-care hospital between January 2019 and June 2021.They were randomly assigned to the study group(269 cases)and the control group(263 cases).Patients in the control group were discharged with the routine discharge procedures and received the routine follow-up care.On the other hand,patients in the study group were discharged and followed up through the PHR and chronic disease management platform established on the basis of PPS.After 6 months,12 months,and 18 months of patient management,the Exercise of Self-Care Agency(ESCA)Scale,Medical Coping Modes Questionnaire(MCMQ)and Seattle Angina Questionnaire(SAQ)were used to evaluate the patients'self-care ability,coping mode,and quality of life,respectively.The patient management effects of the two groups were analyzed.Results Before the management programs started,there was no statistically significant difference in the scores for the scales between the two groups of patients.After 6 months,12 months,and 18 months of patient management,the ESCA scores of both groups were higher than those before patient management started(P＜0.05).Facing scores in the MCMQ of both groups were higher than those before patient management started(P＜0.05),while the scores for avoidance and yielding were lower than those before patient management started(P＜0.05).The SAQ scores of both groups were higher than those before patient management started(P＜0.05).After 6 months,12 months and 18 months of patient management,the ESCA scores of the study group were always higher compared with those of the control group(P＜0.05).The facing score of the study group was higher,while the scores for avoidance and yielding were lower compared with those of the control group(P＜0.05).The SAQ scores of the study group were higher compared with those of the control group(P＜0.05).The medication compliance rate in the study group(83.27%)was higher than that in the control group(69.96%)(P＜0.05).The incidence of adverse cardiovascular events in the study group(4.09%)was lower than that in the control group(10.27%)(P＜0.05).The average times of emergency treatment and readmission in the study group were lower compared with those of the control group(P＜0.05).The patient satisfaction score of the study group was higher compared with that of the control group(P＜0.05).Conclusion The PHR and chronic disease management platform established on the basis of PPS can increase the convenient access to medical care among elderly patients with coronary heart disease,which is conducive to improving their self-care ability,coping mode,and quality of life.In addition,the patient management effect is good.

Objective To discuss the effect and clinical value of serum sialic acid (SA) and lactadherin(MFG-E8) in the coronary atherosclerotic heart disease(CHD).Methods Selected 295 patients who visited to Wuhan University Renmin's Hospital cardiovascular medicine (from January to June, 2014), and then according to the results of coronary angiography divide the subjects into control group (n =78, the result of coronary angiography completely normal)and coronary heart disease group(n =217, the results of coronary angiography showed that one major coronary stenosis was more than 30％).Detected their serum level of lipid, SA, MFG-E8, hs-CRP index.At last, analyze the differences of SA and MFG-E8 between these groups, and the correlation with the severity of coronary stenosis (symbolize with Gensini score), use the binary logistic regression analysis to research the relationship among the serum level of SA, MFG-E8 and the risk of CHD.Results Compared with the control group, the patients with CHD have a higher level of serum SA and a lower level of MFG-E8 (U =4 402.5, 2 736.0 respectively,P ＜0.001);the AMI group has a higher level of serum SA than the StA and UA groups (U =1 329.0,957.5 respectively, P ＜0.001);the AMI group has a lower level of serum MFG-E8 than the StA groups (U =1517.0, P ＜ 0.001).The spearman correlation analysis showed that the serum SA has a positively correlation with the level of TG, hsCRP and Gensini score, and has a negatively correlated with the level of MFG-E8 (r =0.214, 0.462, 0.378,-0.322 respectively,P ＜0.01);the MFG-E8 has a negatively correlated with the level of TG, hsCRP and Gensini score (r =-0.18,-0.425,-0.564 respectively, P ＜0.01).Binary logistic regression analysis showed that there was a positive correlation between the serum SA and the risk of CHD (OD =4.782, 5.319, 4.179 3.832, 3.648 respectively, P ＜0.001), and the was a negative correlation between the serum MFG-E8 and the risk of CHD (OD =O.118, 0.112, 0.127, 0.135, 0.134 respectively, P ＜ 0.001).Conclusion With the serum SA rised and the MFG-E8 reduced, the risk of coronary heart disease was higher, combined detection these two indexes may be able to diagnose the CHD and assess the degree of stenosis and the risk of CHD.

Objective To evaluate the growth inhibition and apoptosis of human monocytic leukemia THP-1 cell line by using 5,8-dimethyl-2-β-hydroxyisovalerylshikonin (SK36) and explore its preliminary mechanism. Methods CCK colorimetric assay and cell counting was used to examine the growth inhibition of shikonin on THP-1 cells. The apoptosis of THP-1 cells was detected by Annexin V/PI double labeling. The activation of Caspase-3 apoptosis pathway was determined by FCM. The apoptosis and the necrosis of THP-1 cells were detected by the laser scanning confocal microscopy. Results When the THP-1 cells were treated with SK36 at 1.02 μg/ml for 24 h and 48 h, the growth inhibition was dose-dependent. The cell apoptotic rate of THP-1 cells treated with 1.02 μg/ml evaluated by FCM with Annexin V/PI double labeling staining were (40.61 ±2.13) % and (67.40±9.15) % at 24 h and 48 h after treatment, respectively, which were significantly higher than that of the control group [(16.97±0.61) %] ([ = 18.444, t = 9.528, P <0.01). SK36 could induce THP-1 cells apoptosis involving the activation of Caspase-3 (F= 323.61, P<0.01). Conclusion SK36 can induce human THP-1 cells to undergo apoptosis, and its primary mechanism was to activate the Caspase-3.

OBJECTIVE: To investigate the clinical experiences and access the auditory performance and speech intelligibility of cochlear implantees with inner ear malformations. METHOD: A retrospective study was performed on the surgical characteristics and the mapping characteristics after implantation of patients who received mult-channel cochlear implantation from 2000 to 2007 in Xijing Hospital. Matched with normal implanted, rank -sum test was performed to compare scores of categories of auditory performance (CAP) and speech intelligibility rating(SIR). RESULT: After the regular rehabilitation, the long term follow-up of the auditory performance and speech intelligibility were very positive. There was no significant difference between normal group and malformations group. CONCLUSION The cochlear implantation can be performed safely in patients with malformed inner ear. The results suggest that cochlear implantation could also provide long-term benefits to those malformed inner ear cases.
Child ; Child, Preschool ; Cochlea ; abnormalities ; surgery ; Cochlear Implantation ; rehabilitation ; Cochlear Implants ; Deafness ; rehabilitation ; surgery ; Ear, Inner ; abnormalities ; surgery ; Female ; Humans ; Infant ; Male ; Retrospective Studies ; Speech Perception ; Surveys and Questionnaires ; Treatment Outcome

Objective To investigate the related factors of speech intelligibility in the prelingually deafened children after cochlear implantation. Methods 47 prelingually deafened children who had received cochlear implantation and their families were investigated with questionnaires and analyzed with Fisher test. Results The age when cochlea implanted, the age when hearing aided, the time after the cochlear implantation and the time the cochlea opened were related with their speech intelligibility rating. Conclusion Suitable time for implantation, the hearing aid and making reasonable rehabilitation programme play a crucial role in the hearing rehabilitation of prelingually deafened children after cochlear implantation.