Objective To analyze the characteristics,causes,influencing factors of compensation,and appraisal features of second-instance medical malpractice cases involving cardiovascular diseases in Henan Province from 2017 to 2022,and to provide reference for forensic appraisal and judicial trial.Methods Cases were retrieved from China Judgments Online between 2017 and 2022.A total of 1,957 documents were reviewed,including 1,397 medical malpractice cases and 130 cardiovascular disease cases.Results The total compensation awarded in these second-instance cases was 27.04 million yuan,with a median of 158,600 yuan.Cases involving patient death accounted for 80.00％(104/130).Among 107 cases with first-instance appraisals,55.14％(59/107)raised objections,while 74.62％(97/130)of the second-instance trials upheld the original judgment.The most common degree of responsibility borne by medical institutions was secondary responsibility(41.54％,54/130).The top three medical faults were:inadequate observation and management of patient conditions(46.15％),omission of auxiliary examinations(37.50％),and insufficient notification(36.54％).In terms of violations-including medical record documentation,inappropriate treatment,misdiagnosis or missed diagnosis,out-of-scope practice,and improper medication use-the actual proportions in judgments(24/113,34/113,12/113,7/113,14/113)were all significantly lower than the patients' claims(all P＜0.05).Conclusion Cardiovascular medical malpractice cases in second-instance trials involve substantial compensation and a high proportion of death outcomes.Both medical institutions and patients should pay greater attention to first-instance trials.Appraisal organizations should proactively provide explanation and education regarding issues likely to raise patient doubts,thereby reducing unnecessary appeals.They should also avoid hasty revisions of appraisal opinions when faced with objections and instead focus on improving the quality and credibility of appraisals.In determining medical faults,emphasis should be placed on evaluating whether there was inadequate patient monitoring and management,omission of auxiliary examinations,and insufficient notification.

Objective To analyze the characteristics,causes,influencing factors of compensation,and appraisal features of second-instance medical malpractice cases involving cardiovascular diseases in Henan Province from 2017 to 2022,and to provide reference for forensic appraisal and judicial trial.Methods Cases were retrieved from China Judgments Online between 2017 and 2022.A total of 1,957 documents were reviewed,including 1,397 medical malpractice cases and 130 cardiovascular disease cases.Results The total compensation awarded in these second-instance cases was 27.04 million yuan,with a median of 158,600 yuan.Cases involving patient death accounted for 80.00％(104/130).Among 107 cases with first-instance appraisals,55.14％(59/107)raised objections,while 74.62％(97/130)of the second-instance trials upheld the original judgment.The most common degree of responsibility borne by medical institutions was secondary responsibility(41.54％,54/130).The top three medical faults were:inadequate observation and management of patient conditions(46.15％),omission of auxiliary examinations(37.50％),and insufficient notification(36.54％).In terms of violations-including medical record documentation,inappropriate treatment,misdiagnosis or missed diagnosis,out-of-scope practice,and improper medication use-the actual proportions in judgments(24/113,34/113,12/113,7/113,14/113)were all significantly lower than the patients' claims(all P＜0.05).Conclusion Cardiovascular medical malpractice cases in second-instance trials involve substantial compensation and a high proportion of death outcomes.Both medical institutions and patients should pay greater attention to first-instance trials.Appraisal organizations should proactively provide explanation and education regarding issues likely to raise patient doubts,thereby reducing unnecessary appeals.They should also avoid hasty revisions of appraisal opinions when faced with objections and instead focus on improving the quality and credibility of appraisals.In determining medical faults,emphasis should be placed on evaluating whether there was inadequate patient monitoring and management,omission of auxiliary examinations,and insufficient notification.

Perimenopausal syndrome （MPS）， a common endocrine system disease， is one of the diseases responding specifically to traditional Chinese medicine （TCM）. The China Association of Chinese Medicine organized experts in endocrinology， gynecology， and interdisciplinary fields of both Western and Chinese medicine to discuss the advantages and challenges of diagnosing and treating MPS with Western medicine， TCM， and integrative medicine. Experts at the conference believe that MPS is initiated by estrogen decline and rooted in deficiency， with the pathogenesis being imbalance between Yin and Yang in the kidney. The hormone replacement therapy in Western medicine for menopause can rapidly alleviate related symptoms by quickly restoring the estrogen level and timely detect and delay complications of menopause， whereas such a therapy has certain risks， necessitating close monitoring of adverse reactions. Moreover， the various contraindications and precautions limit the clinical application of the hormone replacement therapy. TCM has advantages in synergistically alleviating symptoms such as hot flashes， sweating， sleep disorders， and emotional abnormalities of MPS without causing obvious adverse reactions. However， its efficacy is slower than the hormone replacement therapy， and the TCM evidence for preventing and treating complications of menopause remains unclear. Three suggestions were proposed for the future development of both Western and TCM for ameliorating MPS. First， an integrated diagnosis and treatment system for MPS with both Western and Chinese medicine should be established. Second， high-quality evidence-based interventions for MPS should be developed with TCM alone or in combination with Western medicine. Third， efforts should be made to promote the new TCM drug development and the interdisciplinary cooperation for treating MPS.

Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.

Objective:To analyze the causes of postoperative stricture of biliary-enteric anastomotic for congenital choledochal cysts.Methods:These 28 patients underwent salvage operation on an average 15 years (0.2-25 years) after initial surgeries at the Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital from Jan 2014 to Jun 2018.Results:In 26 patients the biliary-enteric anastomotic stenosis was benign, and in 2 the stricture was caused by cancerration. In 26 cases the Roux-en-Y hepaticojejunostomy was redone,among them 8 cases underwent concurrent hepatectomy for a better exposure of the intrahepatic bile duct. In 2 cases the anastomotic stenosis was found to be caused by canceration with extensive intraabdominal metastasis ,an external drainage was adopted. There were no inhospital deaths, and no serious complications. The postoperative follow-up time was 6-67 months. Two cancerated patients died within half a year, and the remaining patients had no long-term complications.Conclusions:Biliary-enteric anastomotic stenosis is one of the serious complications in postoperative patients for congenital choledochal cysts. Hence a wide, tension free biliary-enteric anastomosis performed by a experienced hand is necessary.

Objective:To evaluate partial ventral hepatectomy in the treatment of patients with complicated iatrogenic high bile duct injury.Methods:The clinical data of 8 cases of complicated iatrogenic high bile duct injury treated with the assistance of hepatic ventral segmentectomy from Mar 2013 to May 2020 at Hunan Provincial People's Hospital was retrospectively analyzed.Results:Among the 8 patients, 5 patients underwent partial Ⅳb lobectomy, and 3 patients received partial Ⅳb and Ⅴ segmentectomy of the liver. All the operation was successful without death in hospital. One case developed subphrenic infection and seroperitoneum, which was healed by anti-infection treatment and abdominocentesis. The postoperative follow-up time was 5-90 months, and all of patients are doing well. There was no stenosis in intrahepatic bile duct by postoperative cholangiography or MRI.Conclusions:Quadrate lobe hepatectomy provides a wide view for the treatment of complicated iatrogenic high bile duct injury by fully opening the first porta hepatis and exposing the primary and secondary bile duct branch helping establish a wide patent tension free bile duct-jejunostomy.

Objective To investigate the efficacy and safety of programmed death receptor-1 (PD-1) inhibitor combined with transarterial chemoembolization (TACE) and anti-angiogenic drug tyrosine kinase inhibitor (TKI) versus TACE combined with TKI in the treatment of advanced hepatocellular carcinoma (HCC) and related influencing factors for prognosis. Methods An analysis was performed for all patients who received TACE+TKI+PD-1 inhibitor and some patients who received TACE+TKI in The First Affiliated Hospital of Air Force Medical University from June 2018 to July 2021. Related clinical data were collected, and propensity score matching (PSM) was used to balance the baseline characteristics between groups. The chi-square test was used for comparison of categorical data between two groups; the Wilcoxon rank-sum test was used for comparison of the number of TACE procedures between two groups; the Kaplan-Meier method was used to analyze overall survival (OS), and univariate and multivariate Cox regression models were used to analyze the influencing factors for prognosis. Results A total of 181 patients with advanced HCC were screened out, among whom 50 patients were treated with TACE+TKI+PD-1 inhibitor; after PSM, 40 patients treated with TACE+TKI+PD-1 inhibitor were enrolled as observation group and 40 patients treated with TACE+TKI were enrolled as control group. At the end of follow-up, the median follow-up time was 28.6 (95% confidence interval [ CI ]: 22.1-35.1) months, and the median OS was 15.9 (95% CI : 7.5-24.2) months in the observation group and 11.2 (95% CI : 5.0-17.5) months in the control group. The Cox regression analysis showed that the application of PD-1 inhibitor (hazard ratio [ HR ]=0.42, 95% CI : 0.23-0.80, P =0.008), the number of TACE procedures ( HR =0.67, 95% CI : 0.46-0.99, P =0.043), Child-Pugh class ( HR =2.40, 95% CI : 1.15-5.00, P =0.019), and vascular invasion ( HR =3.42, 95% CI : 1.11-9.42, P =0.031) were independent influencing factors for prognosis. The incidence rate of grade > 2 adverse events was 40% for both the observation group and the control group, and there was no significant difference between the two groups ( P =0.818). Conclusion Compared with TACE+TKI, TACE+TKI+PD-1 inhibitor can significantly prolong the OS of patients in advanced HCC, with relatively controllable adverse events.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

Objective:To compare the short-term clinical effects of absorbable cross nail, sheath compression nail and suspension fixation on the femoral side and sheath compression nail on the tibial side in anterior cruciate ligament reconstruction (ACLR) with autologous hamstring tendon.Methods:The clinical data of 373 patients with anterior cruciate ligament injuries treated with surgery in the First Hospital of Qinhuangdao Affiliated to Chengde Medical College from December 2008 to December 2018 were collected for a retrospective case-control study. There were 125 cases of absorbable cross nail (absorbable cross nail group), 112 cases of sheath compression nail (sheath compression nail group) and 136 cases of suspension fixation (suspension fixation group). The mean follow-up time was (13.96±1.42) months. The international knee documentation committee (IKDC) score and Lysholm score were used to score the patients, and the differences were statistically analyzed. The measurement data of normal distribution was represented by xˉ± s, and repeated measurement analysis of variance was used to compare the three groups in different time periods, and the operation time of the three groups of samples was compared by one-way analysis of variance. The counting data were compared by χ 2 test. Results:(1) There were no complications such as infection, adhesion, stiffness and neurovascular injury in the three groups at the last follow-up. (2) Comparison of preoperative and postoperative knee scores: Lysholm score: preoperative absorbable cross nail group (65.98±1.37), sheath compression nail group(66.13±2.13), suspension fixation group (65.76±1.55). Three months after operation, absorbable cross nail group (80.14±2.02), sheath compression nail group (79.70±1.98) and suspension fixation group (79.84±1.86). Twelve months after operation, there were (94.56±2.35) points in the absorbable cross nail group, (94.96±1.34) points in the sheath compression nail group and (94.40±3.15) points in the suspension fixation group.There was significant difference in the scores before and after operation in the same group ( Fintra-group=17 584.14, P<0.001), and there was no significant difference among the three groups ( Finter-group=2.65, P=0.072), There was no statistical significance in the trend of scores before and after operation in the three groups ( Finter-action=1.28, P=0.277). IKDC scores: Preoperative (62.02±1.43) in absorbable cross nail group, preoperative (61.95±0.82) in sheath compression nail group, preoperative (62.25±2.05) in the suspension fixation group. Three months after operation, absorbable cross nail group (77.99±2.18), sheath compression nail group (78.13±2.02) and suspension fixation group (77.97±2.24). Twelve months after operation, the absorbable cross nail group (92.68±3.21), the sheath compression nail group (93.25±2.04) and the suspension fixation group (92.96±3.11). There was significant difference in the scores before and after operation in the same group ( Fintra-group=18 338.15, P<0.001), and there was no significant difference among the three groups ( Finter-group=0.91, P=0.402), and there was no significant trend in the scores before and after operation in the three groups ( Finteraction=0.98, P=0.419). (3) Comparison of operation time: absorbable cross nail group (99.04±18.01) min, sheath compression nail group (112.88±19.79) min and suspension fixation group (83.81±16.69) min. there was significant difference among the three groups ( F=79.74, P<0.001). Further comparison between the three groups, the time of suspension fixation group was the shortest than the other two groups (all P<0.001). Conclusion:There is no significant difference in the short-term efficacy of ACLR with autologous hamstring tendon among the three groups, and there were no complications such as infection, adhesion, stiffness and neurovascular injury in the last follow-up. In terms of operation time, the suspension fixation group has the shortest time and is simple and easy to operate.

Objective:To understand the distribution and drug resistance of pathogens isolated from acquired immunodeficiency syndrome (AIDS) inpatients in Beijing area in recent years.Methods:The data on strain identification and antimicrobial susceptibility tests of clinical isolates of pathogens from AIDS inpatients in Beijing Ditan Hospital, Capital Medical University between January 2015 and December 2020 were collected and analyzed descriptively and retrospectively.Results:A total of 728 strains of pathogens were included in the analysis, mainly isolated from blood samples (292 strains, 40.1%), bronchial lavage fluid samples (116 strains, 15.9%), sputum samples (114 strains, 15.7%), urine samples (83 strains, 11.4%), bone marrow samples (26 strains, 3.6%), cerebrospinal fluid samples (24 strains, 3.3%), and pleural effusion samples (24 strains, 3.3%). Among the 728 pathogenic strains, 235 (32.3%) were Gram-negative bacilli, mainly including Pseudomonas aeruginosa, Escherichia coli, Salmonella spp., and Acinetobacter baumannii; 162 (22.3%) were Gram-positive cocci (22.3%), mainly including coagulase negative staphylococci and Staphylococcus aureus; 139 (19.1%) were mycobacteria, including Mycobacterium tuberculosis and nontuberculous mycobacteria; 108(14.8%) were fungi, mainly including Cryptococcus neoformans and Talaromyces marneffei; 84 (11.5%) were other pathogenic strains. According to the calculation of single strain, the top 5 pathogens were Mycobacterium tuberculosis, coagulase negative staphylococcus, nontuberculous mycobacteria, Pseudomonas aeruginosa, and Escherichia coli suceesively. In comparison with the distribution of pathogens isolated from AIDS patients in the same hospital in 2009-2014, the proportion of Gram-negative bacilli decreased (40.73% from 2009 to 2014), and the proportions of Gram-positive cocci, fungi, and Mycobacterium tuberculosis were similar (19.15%, 14.02%, and 9.27% respectively in 2009-2014), and the proportion of non tuberculosis mycobacteria increased significantly (it was not calculated separately and classified into 'others’ because of the relatively low proportion, and the proportion of others was 6.34% in 2009-2014) successively. Gram-negative bacilli were mostly isolated from respiratory samples (47.2%, 111/235), followed by urine samples (20.4%, 48/235); Gram-positive cocci were mostly isolated from blood samples (45.7%, 74/162), followed by bone marrow samples (13.0%, 21/162); mycobacteria were mainly isolated from blood samples (72.7%, 101/139), followed by respiratory samples (26.6%, 37/139); fungi were mainly isolated from blood samples (44.4%, 48/108), followed by respiratory samples (19.5%, 21/108) and cerebrospinal fluid samples (17.6%, 19/108). The results of antimicrobial susceptibility tests showed that the resistance rate of Gram-positive cocci decreased and the rate of the Gram-negative bacilli increased obviously in 2015-2020, compared to those in 2009-2014 in clinical isolates from AIDS patients in the same hospital respectively. Conclusion:In recent years, the proportion of Gram-negative bacilli decreases, the proportion of nontuberculous mycobacteria increases significantly, and the drug resistance rate of most Gram-negative bacilli increases significantly in clinical isolates from AIDS inpatients in Beijing.