目的 从法医学角度探讨儿科医疗纠纷案件特点及成因。 方法 对四川华西法医学鉴定中心2002 年1月－2011年12月受理的184例儿童死亡并进行尸检的儿科医疗纠纷案件的法医学鉴定资料进行回顾性研究。 结果 儿科医疗纠纷呈逐年升高趋势，年龄以新生儿为主，死因以呼吸系统疾病为主；临床-尸检符合率低（55.23%），医疗过错率高（60.47%），且两者呈负相关。 结论 儿科医疗纠纷临床-尸检符合率比所有年龄段人群低，医疗过错率比所有年龄段人群高，且呈现出临床-尸检诊断符合率越低，医疗过错率越高的特征。
目的 以问卷调查形式了解患者对就医现状及医患关系的认知度，以期为医疗机构管理者完善医疗服务行为，构建和谐医患关系提供参考依据。 方法 2009年8月－11月，采用自制问卷对6所不同医院因伤/病住院治疗终结患者进行调查，并对调查结果进行统计分析。 结果 大多数被调查者认为目前“看病贵”，且收入水平对医疗服务的选择有影响；医患信任程度与医患沟通呈正相关；被调查者对医患纠纷的认知主要来自于媒体的报导，且认为媒体报导是公正的。 结论 医疗机构管理者应强化医护人员“以人为本”的理念，加强医患沟通，以防范服务性医患纠纷；政府应深化医药卫生体制改革，以解决“看病贵”问题；媒体应加大力度宣传普及医疗相关法律法规及知识，以引导人民群众尽可能正确客观看待医疗结果，摒除不切实际的医疗高期待。
Objective To systematically evaluate the preventative effect of probiotics for infantile eczema and atopic eczema. Methods Databases including PubMed, EMbase, MEDLINE (Ovid), CENTRAL, CBM and CNKI were searched from inception to February 2012, so as to collect the randomized controlled trials (RCTs) on probiotics in preventing infantile eczema and atopic eczema. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, evaluated quality and cross-checked. Then the meta-analysis was conducted using RevMan 5.0 software. Result A total of 15 RCTs involving 3 179 infants were included. The results of meta-analyses on 8 high quality RCTs showed that: the incidence of infantile eczema was lower in the probiotics group than the placebo group, with a significant difference (RD=–0.06, 95%CI –0.10 to –0.03, Plt;0.05). Probiotics had no preventative effect on infantile atopic eczema (RD=–0.02, 95%CI –0.08 to 0.03, Pgt;0.05), and had preventative effects on both high risk population (RD=–0.09, 95%CI –0.15 to –0.03, Plt;0.05) and general population (RD=–0.05, 95%CI –0.10 to 0.00, Plt;0.05) of infantile eczema. Conclusion Probiotics have certain preventative effects on infantile eczema. Due to the differences of probiotics in the aspects such as probiotic strain, dosage, treatment course, etc., its specific effects on infantile eczema and atopic eczema should be further tested.
Objective To investigate the protective effect of the antioxidant glutathione (GSH) on the steroid-induced imbalance between osteogenesis and adipogenesis in human bone marrow mesenchymal stem cells (BMSCs). Methods The BMSCs were isolated from the proximal femur bone marrow from 3 patients of femoral neck fracture and were separated, cultured, and purificated by density gradient centrifugation and adherent wall methodin vitro. The third generation BMSCs were divided into 5 groups: group A, BMSCs (1×105 cells/mL); group B, BMSCs (1×105 cells/mL)+10 μmol/L dexamethasone; group C, BMSCs (1×105 cells/mL)+10 μmol/L dexamethasone+5 μmol/L GSH; group D, BMSCs (1×105 cells/mL)+10 μmol/L dexamethasone+10 μmol/L GSH; group E, BMSCs (1×105 cells/mL)+10 μmol/L dexamethasone+50 μmol/L GSH. After cultured for 7 days, the reactive oxygen species expression was detected by flow cytometry; the superoxide dismutase (SOD) and Catalase mRNA expressions were determined by RT-PCR; the peroxisome proliferator-activated receptors γ (PPAR-γ), CCAAT/enhancer-binding family of proteins (C/EBP), Runx2, and alkaline phosphatase (ALP) mRNA expressions were evaluated by real-time fluorescence quantitative PCR. After cultured for 21 days, Oil red O staining was used to observe the adipogenesis differentiation of cells, and the expressions of related proteins were detected by Western blot. Results The reactive oxygen species expression in group B was obviously higher than in the other groups, in group C than in groups A, D, and E, and in groups D, E than in group A, all showing significant differences between groups (P<0.05); but there was no significant difference between groups D and E (P>0.05). The oil red O staining positive cells in group B were obviously more than the other groups, and groups C, D, E, and A decreased sequentially, the absorbance (A) values had significant differences between groups (P<0.05). RT-PCR detection showed that the relative expressions of SOD and Catalase mRNA in group B were significantly lower than those in the other groups, while in group C than in groups A, D, and E (P<0.05), but there was no significant difference among groups A, D, and E (P>0.05). Real-time fluorescence quantitative PCR detection showed that the relative expressions of PPAR-γ and C/EBP mRNA in group B were significantly higher than those in the other groups, while in group C than in groups A, D, and E, and in groups D, E than in group A (P<0.05); but there was no significant difference between groups D and E (P>0.05). The relative expressions of Runx2 and ALP mRNA in group B were significantly lower than those in the other groups, while in group C than in groups A, D, and E, and in groups D, E than in group A (P<0.05); but there was no significant difference between groups D and E (P>0.05). Western blot detection showed that the relative expression of PPAR-γ and C/EBP protein in group B was significantly higher than those in the other groups, and groups C, D, E, and A decreased sequentially, all showing significant differences between groups (P<0.05). The relative expression of Runx2 and ALP protein in group B was significantly lower than those in the other groups, and groups C, D, E, and A increased sequentially, all showing significant differences between groups (P<0.05). Conclusions GSH can inhibit the adipogenesis differentiation and enhance the osteogenic differentiation of human BMSCs by reducing the intracellular reactive oxygen species level; and in a certain range, the higher the concentration of GSH, the more obvious the effect is.
Transrectal contrast-enhanced ultrasound (CEUS) is an important examination for rectal tumors. The inhomogeneity of the CEUS images has important clinical significance. However, there is no objective method to evaluate this index. In this study, a method based on gray-level co-occurrence matrix (GLCM) is proposed to extract texture features of images and grade these images according the inhomogeneity. Specific processes include compressing the gray level of the image, calculating the texture statistics of gray level co-occurrence matrix, combining feature selection and principal component analysis (PCA) for dimensionality reduction, and training and validating quadratic discriminant analysis (QDA). After ten cross-validation, the overall accuracy rate of machine classification was 87.01%, and the accuracy of each level was as follows: Grade Ⅰ 52.94%, Grade Ⅱ 96.48% and Grade Ⅲ 92.35% respectively. The proposed method has high accuracy in judging grade Ⅱ and Ⅲ images, which can help to identify the grade of inhomogeneity of contrast-enhanced ultrasound images of rectal tumors, and may be used to assist clinical doctors in judging the grade of inhomogeneity of contrast-enhanced ultrasound of rectal tumors.