Correlation Between Malpractice Litigation and Legislation Reform in Taiwan Over a 30-Year Period.

BACKGROUND: The annual medical litigation rate has increased yearly since 1987 in Taiwan. Policy makers keep going medical legislation reforms. The effectiveness of legislation reforms to reduce malpractice litigation risk is uncertain. OBJECTIVE: To determine whether medical legislation reform helps reduce the risk of medical litigation. DESIGN SETTING AND PARTICIPANTS: This retrospective study used national data obtained from Ministry of Health and Welfare in Taiwan. The period analyzed was from 1987 to 2018. The annual medical litigation rate was determined, types of medical negligence litigation were compared, medical appraisal results were summarized, and the importance of medical legislation was identified. INTERVENTIONS: After legislation reform vs before legislation reform. MEASUREMENTS: The main outcome showed trends in medical dispute assessments over time by adjusting for the general population (per 1, 000, 000 people). We established 2004 and 2012 as the 2 cut-points for further analysis of medical appraisal results due to legislation reform. RESULTS: With legislation reforms, the annual medical litigation rate decreased from 26.68 cases per million people in 2012 to 16.41 cases per million people in 2018. The annual medical litigation rate declined by approximately 38% from 2012 to 2018. Medical appraisal results were malpractice cases in 22.1% before Medical Care Act (2004 Reform) compared with 18.8% from 2004 to 2012 (odds ratio [OR], 0.82; 95% CI, 0.727-0.924; p=0.001), and 6.4% after mediation system introduced in 2012 (odds ratio [OR], 0.243; 95% CI, 0.205-0.288; p<0.001). CONCLUSION: Medical legislation reform has reduced the risk of malpractice litigation over time.

[Expression and Significance of Low-Density Lipoprotein-Related Receptors 5 and 6 in the Wnt/ß-Catenin Signaling Pathway in Childhood Acute Lymphoblastic Leukemia].

OBJECTIVE: To investigate the significance of low-density lipoprotein receptor-related protein 5 and 6 (LRP5/6) in the Wnt/ß-catenin signaling pathway in the pathogenesis and prognosis of childhood acute lymphoblastic leukemia (ALL). METHODS: A total of 43 children who were newly diagnosed and achieved complete remission after remission induction therapy were enrolled. The children before treatment were included in incipient group, and after treatment when achieved complete remission included in remission group. A total of 39 children with immune thrombocytopenia were enrolled in control group. Three milliliter bone marrow samples were collected from above-mentioned each group. QRT-PCR was used to determine the mRNA expression of LRP5 and LRP6 in blood mononuclear cells of bone marrow. Western blot was used to detect the protein expression of LRP5 and LRP6. According to the protein expression levels of LRP5 and LRP6, the children were divided into low-expression group and high-expression group, and the clinical biological characteristics were compared between these two groups. Survival analysis was performed by Kaplan-Meier method. RESULTS: Both mRNA and protein expression levels of LRP5 and 6 were upregulated in the incipient group compared with the control and remission group (P<0.05). The mRNA and protein expressions of LRP5 and LRP6 in the high-risk group were higher than those in the medium-risk group (P<0.05), it is the same as in the medium-risk group than the low-risk group (P<0.05). The mRNA and protein expressions of LRP5 and 6 positively correlated with risk degree in the incipient group (rLRP5 mRNA=0.84, P<0.05; rLRP6 mRNA=0.66, P<0.05; rLRP5 protein=0.82, P<0.05; rLRP6 protein=0.76, P<0.05). The white blood cell count and lactate dehydrogenase in LRP5 and LRP6 high expression group were significantly higher than those in low expression group (P<0.05), while there was no significant difference in other biological characteristics. Kaplan-meier survival analysis showed that in the 43 children 3-year overall survival rate and event-free survival rate was (91.7±4.7)% and (87.6±5.2)%, respectively. CONCLUSION: The high expression of LRP5/6 may be one of the pathogenesis of childhood ALL, and the degree of LRP5/6 increase may be related to the risk level.

[Expression and significance of dishevelled proteins in the Wnt pathway in childhood acute lymphoblastic leukemia].

OBJECTIVE: To study the significance of dishevelled (DVL) proteins in the Wnt signaling pathway in the pathogenesis and prognosis of childhood acute lymphoblastic leukemia (ALL). METHODS: A total of 33 children with new-onset ALL were enrolled as the case group. According to the degree of risk, they were divided into 3 groups: low-risk (n=14), intermediate-risk (n=5) and high-risk (n=14). A total of 29 children with immune thrombocytopenia were enrolled as the control group. At diagnosis and on day 33 of induction therapy, 2 mL bone marrow samples were collected from the case and control groups, and qRT-PCR was used to measure the mRNA expression of DVL1, DVL2 and DVL3 in blood cells of bone marrow. RESULTS: The mRNA expression of DVL1, DVL2 and DVL3 in the case group in the incipient stage was significantly higher than that in the remission stage and the control group (P<0.05). Compared with the control group, the case group had a significant increase in the mRNA expression of DVL2 in the remission stage (P<0.05). The mRNA expression of DVL2 was significantly higher than that of DVL1 and DVL3 in both remission and incipient stages (P<0.05). The high- and intermediate-risk groups had significantly higher mRNA expression of DVL1 and DVL2 than the low-risk group (P<0.05). The mRNA expression of DVL2 was significantly higher than that of DVL1 and DVL3 in the low-, intermediate- and high-risk groups (P<0.05). CONCLUSIONS: The change in the expression of DVL, especially DVL2, in the Wnt signal pathway has certain significance in the pathogenesis and prognosis of childhood ALL.

[Two Data Inversion Algorithms of Aerosol Horizontal Distributiol Detected by MPL and Error Analysis].

Atmospheric aerosols have important impacts on human health, the environment and the climate system. Micro Pulse Lidar (MPL) is a new effective tool for detecting atmosphere aerosol horizontal distribution. And the extinction coefficient inversion and error analysis are important aspects of data processing. In order to detect the horizontal distribution of atmospheric aerosol near the ground, slope and Fernald algorithms were both used to invert horizontal MPL data and then the results were compared. The error analysis showed that the error of the slope algorithm and Fernald algorithm were mainly from theoretical model and some assumptions respectively. Though there still some problems exist in those two horizontal extinction coefficient inversions, they can present the spatial and temporal distribution of aerosol particles accurately, and the correlations with the forward-scattering visibility sensor are both high with the value of 95%. Furthermore relatively speaking, Fernald algorithm is more suitable for the inversion of horizontal extinction coefficient.

Sex-related differences in outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis.

BACKGROUND: There were considerable discrepancies with regard to sex-related differences in complications and prognosis after transcatheter aortic valve implantation. METHODS AND RESULTS: The Cochrane library and PubMed online databases were searched. Articles reporting sex-specific post-transcatheter aortic valve implantation complications and mortality were identified. Two authors selected studies and extracted data independently. Random- and fixed-effects models were used depending on between-study heterogeneity. There were 27 articles, a total of 9118 patients, enrolled in our systematic review and meta-analysis, including 4176 men and 4942 women. Pooled analyses suggested considerable sex-related differences in complications and early as well as midterm outcomes after transcatheter aortic valve implantation. The difference in the risk for heart block requiring permanent pacemaker implantation was noted to be significant only in the subgroup of the CoreValve-dominating studies (pooled risk ratio [RR, men versus women], 1.29; 95% confidence interval [CI], 1.13-1.47). Although men had significantly lower risks for major/life-threatening bleeding (pooled RR, 0.81; 95% CI, 0.68-0.96) and major vascular complications (pooled RR, 0.49; 95% CI, 0.37-0.66), they had poorer prognosis. In fact, male sex was associated with significantly higher risks for deaths at both 30 days (RR, 1.37; 95% CI, 1.07-1.76) and 1 year (RR, 1.30; 95% CI, 1.14-1.49). CONCLUSIONS: Although men had lower risks for major/life-threatening bleeding and major vascular complications after transcatheter aortic valve implantation, they had less favorable short-term and midterm survival.

D-ring modified novel isosteviol derivatives: design, synthesis and cytotoxic activity evaluation.

A series of polyhydric, amino alcohol and tricyclic derivatives were facilely synthesized by D-ring modification of isosteviol. These compounds were screened for their cytotoxic activities against four human tumor cell lines in vitro. Among them, the 15-α-aminomethyl-16-ß-hydroxyl isosteviol 23 exhibits significant cytotoxicity superior to the positive control (cisplatin) against EC9706, PC-3 and HCT-116 cell lines.