国内外关于医疗纠纷处置的利益相关者比较研究*

Objective: We learn about the methods, process, effects of each stakeholder and the principles of the disposition of medical dispute home and abroad through stakeholder analysis. Methods: We investigate the methods, process and the principles of the disposition of medical dispute home and abroad by literature retrieval, key informant interview and depth interview. Results: The stakeholders of medical disputes mainly include patients and families, medical staff and hospitals, pharmaceutical companies, governments, laws, non-government organizations and media. They play different roles in medical disputes and have different effects. Over all, patients and families, medical staff and hospitals have the greatest effect and then laws, media, government, non-government organizations and pharmaceutical companies. Conclusion: Different stakeholders affect the disposition of medical disputes differently. It is crucial to establish harmonious relationship between patients and doctors and to build harmonious society by untangling the responsibility between all the stakeholders and dispose medical disputes quickly and effectively.目的  通过利益相关者分析了解目前国内外医疗纠纷的处置办法、处理流程、各利益相关者的影响和责任推定原则。方法  通过文献检索、知情人访谈和深入访谈法，调查国内外目前医患纠纷处置的方法、流程和责任界定并进行比较。结果  医疗纠纷所涉及的利益相关者主要包括患者及家属、医疗人员和医院、医药公司、政府、法律、非政府组织和媒体，他们对医疗纠纷处置具有不同的立场和影响，其中患者及家属和医疗人员及医院的影响最大，其次为法律和媒体、政府、非政府组织、医药公司。结论  各个利益相关者对医疗纠纷处置的影响程度不同，合理评判各个利益相关者在医疗纠纷中的责任，快速、有效地解决医疗纠纷，是构建和谐医患关系和和谐社会的关键之一

Dynamic changes in gut microbiota during pregnancy among Chinese women and influencing factors: A prospective cohort study

Gut microbiota (GM) dynamics during pregnancy vary among different populations and are affected by many factors, such as living environments and diet. This study aims to observe and evaluate the changes in the structure and function of the GM from the first to the third trimester of pregnancy in Chinese women, and to explore the main factors affecting the changes in intestinal microecology. Fifty-five Chinese pregnant women were recruited for this study and their fecal samples were collected during the first (P1), second (P2), and third trimesters (P3) of pregnancy. We exploited metagenomic sequencing to compare the composition and function of the GM in different pregnancy periods. Bioinformatic analysis revealed that there were differences in the composition of the GM among P1, P2, and P3, as indicated by the increase in α-diversity and β-diversity of the GM and the differences in the relative abundances of distinct bacterial phyla. Gestational diabetes mellitus (GDM) was the main factor (P < 0.05) that affected the changes in GM at various stages of pregnancy. There were also disparities in the structure of the GM between the GDM group and non-GDM group in the P1, P2, and P3. The GDM group exhibited increased abundances in Ruminococcus_gnavus, Akkermansia_muciniphila, Alistipes_shahii, Blautia_obeum, and Roseburia_intestinalis; while, the abundances of Bacteroides coprocola, Bacteroides plebeius, Erysipelatoclostridium ramosum, and Prevotella copri were increased in the non-GDM group. Three of the four species enriched in the non-GDM group manifestied significantly negative correlations with the insulin-signaling pathway and lipopolysaccharide biosynthesis (r ≤ −0.3, adjusted P < 0.05). In the GDM group, Bacteroides vulgatus and Ruminococcus gnavus were significantly and positively correlated with insulin signaling pathway and lipopolysaccharide biosynthesis (r ≤ −0.3, adjusted P < 0.05) among the species enriched from early pregnancy. Virtually all of the species enriched in P2 and P3 were positively correlated with steroid hormone biosynthesis. These results suggest a potential role for the GM in the development of GDM, enabling the potential prevention of GDM by targeting the GM

Combining CD4 count, CD8 count and CD4/CD8 ratio to predict risk of mortality among HIV-positive adults after therapy: a group-based multi-trajectory analysis

IntroductionPrevious studies have indicated different immunological recovery trajectories based on CD4 count or CD4/CD8 ratio. However, these immune indicators are interconnected, and relying solely on one indicator may lead to inaccurate estimates. Therefore, it is essential to develop a comprehensive trajectory model that integrates CD4 count, CD8 count and CD4/CD8 ratio.MethodsWe utilized a group-based multi-trajectory model to characterize the latent cluster of recovery based on measurements of CD4 count, CD8 count and CD4/CD8 ratio over a period of up to 96 months following ART initiation. Subsequently, we investigated the characteristics associated with trajectory groups, especially sex and age. Cox model and Kaplan-Meier survival curve were employed to assess differences in all-cause, AIDS-related and non-AIDS related mortality between trajectory groups.ResultsA total of 14,718 eligible individuals were followed for a median of 55 months. Longitudinal model identified four subgroups: group 1 (32.5%, low CD4 and CD4/CD8 inversion), group 2 (25.9%, high CD8 and CD4/CD8 inversion), group 3 (27.2%, slow recovery of CD4 and CD4/CD8 inversion) and group 4 (14.4%, rapid increase of CD4 and normal CD4/CD8). Immune recovery was slower in male than in female, and in elders than in youngers. Compared to group 2, group 1 (adjusted hazard ratio [aHR]=3.28; 95% CI 2.33-4.60) and group 3 (aHR=1.56; 95% CI 1.09-2.24) had increased risk of all-cause mortality after adjusting for other factors. Besides, group 1 (aHR=2.17) and group 3 (aHR=1.58) had higher risk of non-AIDS related mortality, and group 1 (aHR=5.92) had significantly increased risk of AIDS related mortality.ConclusionLongitudinal trajectory analysis of multiple immune indicators can be employed to guide targeted interventions among vulnerable populations in clinical practice

The Effects of Warming and Nitrogen Addition on Soil Nitrogen Cycling in a Temperate Grassland, Northeastern China

Both climate warming and atmospheric nitrogen (N) deposition are predicted to affect soil N cycling in terrestrial biomes over the next century. However, the interactive effects of warming and N deposition on soil N mineralization in temperate grasslands are poorly understood.A field manipulation experiment was conducted to examine the effects of warming and N addition on soil N cycling in a temperate grassland of northeastern China from 2007 to 2009. Soil samples were incubated at a constant temperature and moisture, from samples collected in the field. The results showed that both warming and N addition significantly stimulated soil net N mineralization rate and net nitrification rate. Combined warming and N addition caused an interactive effect on N mineralization, which could be explained by the relative shift of soil microbial community structure because of fungal biomass increase and strong plant uptake of added N due to warming. Irrespective of strong intra- and inter-annual variations in soil N mineralization, the responses of N mineralization to warming and N addition did not change during the three growing seasons, suggesting independence of warming and N responses of N mineralization from precipitation variations in the temperate grassland.Interactions between climate warming and N deposition on soil N cycling were significant. These findings will improve our understanding on the response of soil N cycling to the simultaneous climate change drivers in temperate grassland ecosystem

Distribution of organochlorine pesticides and polychlorinated biphenyls in Ny-Ålesund of the Arctic

Sediment, moss and animal-dropping samples were collected from Ny-Ålesund of the Arctic to investigate the distribution of organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) in the Arctic area. OCPs and PCBs were analyzed using the capillary gas chromatography (GC-ECD). Recoveries of three surrogates were at a range of 69.5～92.2% (mean: 78.8% ) , 75.1～112.1% (98.5%) and 67.7～95.1% (79.5%) , and the relative standard deviations were 6.7% , 8.0% and 11.3% , respectively. The major monomers of OCPs were hexachlorocyclohexanes (HCHs) and DDTs. Their concentrations were at a range of 0.86～4.50 ng/g (mean: 2.24 ng/g) and 0.22～1.09 ng/g (mean: 0.55 ng/g). The concentrations of PCBs were 0.20～3.25 ng/g (mean: 0.84 ng/g) and the major congeners were tetra-, penta-, and hexa-PCBs, which were up to 23.8%、26.7% and 32.3% of total PCB s, respectively. Based on the results of the ratio analysis and the principal component analysis, the atmospheric transport is believed be one of the major input ways of OCPs and PCB s in the Ny-Ålesund of the Arctic