2014年 · 第94卷第18期

The recent phenomenon of violence against doctors in China has attracted the attention of the international medical community.Lancet^[1,2,3]AndBMJ^[4]All tracked and commented on. These articles believe that the violence against doctors in China has seriously violated the safety, rights and dignity of doctors' practice, and doctors feel great pressure and challenges in their practice. If such incidents cannot be well prevented, the medical industry will It will be difficult to attract outstanding and sufficient talents to join. While calling for "zero tolerance" for such violent incidents, the crux of China's current medical and health system is the deep-seated reason leading to these violent incidents. Therefore, the reform of medical and health policy aiming at promoting the trust between doctors and patients is a top priority. Understanding the international consensus, research progress and governance experience on violence in medical places can provide ideas and reference for formulating relevant health policies in China.

At present, pancreatic cancer is still a major problem in the treatment of malignant tumors, and surgical resection is the only hope for long-term survival of pancreatic cancer patients. However, the 5-year survival rate is only about 20%^[1]。 Studies have confirmed that the margin condition after surgical resection of pancreatic cancer is one of the most important factors to determine the prognosis of patients. However, more than 80% of patients have local recurrence within 1 year after surgery, which suggests that most of the current "radical" resection cannot achieve the purpose of radical cure^[1]。 On the other hand, true R0 resection (no microscopic tumor residue at all margins) can significantly improve disease-free survival and overall survival in patients with pancreatic cancer^[2]。 Therefore, scholars have made a series of improvements to standard pancreaticoduodenectomy with the aim of increasing the R0 resection rate in patients with pancreatic head cancer, thereby improving long-term survival.

In recent years, the frequency and malignancy of "violent medical injury cases" are on the rise. On February 25, 2014, a nurse in Nanjing Stomatological Hospital was attacked by a patient's family; On February 17th, 2014, the director of ENT Department of Qiqihar Beiman Special Steel Hospital was killed by a 19-year-old patient; In October 2013, patients in Wenling First People's Hospital attacked medical staff, causing one death and two injuries; In September 2013, a female stomatologist in Beijing Tongren Hospital was slashed by a patient; In November 2012, a patient in the Second Affiliated Hospital of Anhui Medical University killed a nurse and slashed four medical staff; In April 2012, the chief physician of ENT Department of Peking University People's Hospital was chased and stabbed by a patient, and the deputy director of emergency department of Beijing Aerospace General Hospital was stabbed by a patient on the same day; In March 2012, the doctor of the First Affiliated Hospital of Harbin was killed... On March 22, 2014,LancetAnother commentary article "Why is hospital violence so serious in China"^[1]Recently, the frequent medical violence in China has attracted the attention of the international medical community. Now, a preliminary analysis is made on the reasons for the frequent occurrence of violent medical injuries.

In recent years, with the rapid development of medical technology, the hardware environment of hospitals has improved obviously. However, the tension between doctors and patients in China has not been alleviated, and the incidence of medical disputes is increasing in some areas^[1]Violent medical injuries occur from time to time, especially within 10 days from October 17 to 27, 2013, there were 6 medical injuries of patients nationwide, and many medical staff were seriously injured or even killed. The reasons for the current tense doctor-patient environment include system level, hospital and doctor level, patient level, media level and so on^[2]。 No suffering can justify a patient's violence against a doctor, whether or not the perpetrator was punished in time, what should a doctor do in the current environment? Don't let kids study medicine? Choose to give up, wait passively, or be proactive and improve? Be honest with it? The author thinks that doctors should take the lead, start from themselves, and actively create a harmonious doctor-patient environment from the following aspects^[3]。

In recent years, cases of killing doctors have frequently appeared in newspapers, and the majority of medical staff generally feel dangerous and angry. Surprisingly, parts of the public were indifferent to the atrocities, and some even felt "happy". In response to this chaos, people can't help but ask: What is wrong with the doctor-patient relationship in China, and why exactly, this article adopts Milne's right theory^[1]From the perspective of basic rights protection, the case of killing doctors is analyzed, and it is found that the basic rights of patients' minimum requirements are not fully guaranteed, which is the fundamental reason for the tension between doctors and patients in China at this stage.

"The hardest part for a clinician is not the technology, but the ethics." That's one of my "quotes." Here I will reflect with readers through two true stories about the ethics of technology, money, doctors and patients.

Medical disputes have become one of the difficult and hot issues in social problems. Medical disputes are mainly resolved through consultation and reconciliation between doctors and patients, administrative mediation and civil litigation. From a practical point of view, these approaches can't solve disputes well, the relationship between doctors and patients is still tense, and the resolution of medical disputes is still a thorny problem. New Dispute Resolution Mechanism-People's Mediation Mechanism of Medical Disputes is to introduce the people's mediation system with Chinese characteristics into the settlement of medical disputes^[1]。 Starting with the results of questionnaire survey and related interview data of patients accepted by Beijing People's Mediation Committee for Medical Disputes (MAC) from October to December, 2012, this paper preliminarily discusses the problems existing in the operation of people's mediation mechanism for medical disputes in Beijing and possible improvement countermeasures.

Gastrointestinal motility disorder is one of the important pathophysiological mechanisms associated with gastrointestinal symptoms in functional gastrointestinal diseases and even organic diseases^[1,2]It is also a therapeutic entry point to eliminate or relieve gastrointestinal symptoms. However, the clinical thinking and strategy of targeting gastrointestinal motility disorders to treat functional gastrointestinal diseases have always encountered the embarrassing situation of unsatisfactory efficacy. The reasons for this situation are as follows: (1) The forms of gastrointestinal motility disorders are complex and diverse, and there is no correspondence between them and clinical symptoms^[3,4]； (2) The efficacy of gastrointestinal motility promoting drugs has not been completely defined, especially the understanding of individualized response to gastrointestinal motility of patients is still lacking^[5]； (3) The etiology of gastrointestinal motility disorders is complex, and the overall efficacy of gastrointestinal motility-promoting drugs is not ideal^[5,6]。 Therefore, therapeutic ideas other than gastrointestinal motility-promoting drugs deserve attention. Now we will elaborate on the above three aspects.

A cough lasting more than 8 weeks is called a chronic cough^[1]。 Chronic cough is one of the most common diseases in respiratory clinic, which can seriously interfere with patients' sleep and become an important reason for patients to seek treatment. Common causes of chronic cough that are easily overlooked include the coexistence of one or more of gastroesophageal reflux disease (GERD), upper airway cough syndrome (UACS), and cough variant asthma (CVA)^[2]Some patients still have no significant improvement in symptoms after treatment for the above diseases^[3]。 Recent studies suggest that sleep apnea hypopnea syndrome (SAHS) may be an important cause of unexplained cough, but this has not been included in the newly published guidelines for cough diagnosis and treatment^[4,5]。

Antibody-related autoimmune diseases refer to diseases that cause abnormal B lymphocyte function to produce autoantibodies and then mediate tissue damage for various reasons, including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), autoimmune hemolytic anemia (AIHA), idiopathic thrombocytopenia (ITP), etc. Studies have shown that B lymphocyte immune memory is closely related to the occurrence, development, recurrence and prognosis of such diseases. B lymphocyte immune memory is mainly mediated by memory B lymphocytes (Bm) and long-lived plasma cells.