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Malpractice or masterful practice?Navigating vicarious liability in healthcare

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World Journal of Clinical Cases 2025年第2期13卷 10-13页

作者： Satvik N Pai Naveen Jeyaraman Madhan Jeyaraman Swaminathan Ramasubramanian department of orthopaedics PES University Institute of Medical Sciences and ResearchBengaluru 560100KarnatakaIndia department of orthopaedics ACS Medical College and HospitalDr MGR Educational and Research InstituteChennai 600077Tamil NaduIndia department of orthopaedics Government Medical CollegeOmandurar Government EstateChennai 600002Tamil NaduIndia

In the intricate landscape of healthcare,vicarious liability looms large,shaping the responsibilities and actions of healthcare practitioners and administrators *** by a poignant scenario of a medication error,this article navigates the complexities of vicarious liability in *** explains the legal basis and ramifications of this theory,emphasizing its importance in fostering responsibility,protecting patient welfare,and easing access to *** paper explores the practical effects of vicarious responsibility on day-to-day operations,leadership practices,and decision-making processes via the eyes of senior consultants,junior doctors,and hospital *** comprehensive insights and real-world examples,it underscores the imperative of fostering a culture of accountability,communication,and quality care to navigate the intricate web of liabilities inherent in modern healthcare.

关键词： Vicarious liability Healthcare Responsibility Litigation Patient welfare

Beyond statistical significance:Embracing minimal clinically important difference for better patient care

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World Journal of Methodology 2025年第1期15卷 33-41页

作者： Naveen Jeyaraman Madhan Jeyaraman Swaminathan Ramasubramanian Sangeetha Balaji Sathish Muthu department of orthopaedics ACS Medical College and HospitalDr MGR Educational and Research InstituteChennai 600077Tamil NaduIndia department of Research Methods Orthopaedic Research GroupCoimbatore 641045Tamil NaduIndia department of orthopaedics Government Medical CollegeOmandurar Government EstateChennai 600002Tamil NaduIndia department of Biotechnology Faculty of EngineeringKarpagam Academy of Higher EducationCoimbatore 641021Tamil NaduIndia department of orthopaedics Government Medical CollegeKarur 639004Tamil NaduIndia

The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the patient's *** comprehensive review analyzes the evolution,applications,and challenges of MCID across medical specialties,emphasizing its necessity in ensuring that clinical outcomes not only demonstrate statistical significance but also offer genuine clinical utility that aligns with patient expectations and *** discuss the evolution of MCID since its inception in the 1980s,its current applications across various medical specialties,and the methodologies used in its calculation,highlighting both anchor-based and distribution-based ***,the paper delves into the challenges associated with the application of MCID,such as methodological variability and the interpretation difficulties that arise in clinical *** for the future include standardizing MCID calculation methods,enhancing patient involvement in setting MCID thresholds,and extending research to incorporate diverse global *** steps are critical to refining the role of MCID in patient-centered healthcare,addressing existing gaps in methodology and interpretation,and ensuring that medical interventions lead to significant,patient-perceived improvements.

关键词： Minimal clinically important difference Patient-centered care Clinical relevance Global health

Dose-dependent effects of lanthanum chloride on wear particle-induced aseptic inflammation in a murine air-pouch model

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Journal of Rare Earths 2013年第4期31卷 420-427页

作者：江川邹飏刘翔尚江荫子程明戴闽 department of orthopaedics the First Affiliated HospitalNanchang University

To investigate the effects of local injection of different doses of lanthanum chloride （LaCl3） on aseptic inflammation in mice stimulated by wear particles from artificial joints, the particles were prepared by vacuum ball mill in vitro and air-pouch models were performed with 45 male BALB/c mice that were randomly divided into blank control group, wear particle group and wear parti- cle ＋ LaCl3 （0.1, 0.9 and 8.1 μmol） group. All animals were sacrificed and tissue specimens were harvested 7 days after treatment. Hematoxylin and eosin （H＆E） staining, enzyme-linked immunosorbent assay （ELISA）, reverse transcription-polymerase chain reac- tion （RT-PCR） and western blot were applied to observe inflammatory reaction and detect the expression of pro-inflammatory cyto- kines （TNF-et, IL-1β） and nuclear factor-κB （NF-κB） in mRNA and protein levels in air-pouch membrances. The results showed that wear particles could stimulate aseptic inflammation in vivo effectively; 0.9 μmol LaCl3 could significantly inhibit wear parti- cle-induced gene and protein expression of pro-inflammatory cytokines and NF-Id3 （P〈0.05）; 0.1 and 8. 1 μmol LaCl3 did not exert an inflammation-inhibiting effect and even caused adverse effects at 8.1 μmol. In conclusion, LaC13 played a protective role against wear particle-induced aseptic inflammation dose-dependently, which was involved in NF-κB related signaling pathways.

关键词： lanthanum chloride wear particle aseptic inflammation pro-inflammatory cytokine nuclear factor-KB air-pouch model

Wear particle-mediated expressions of pro-inflammatory cytokines, NF-κB and RANK were impacted by lanthanum chloride in RAW264.7 cells

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Journal of Rare Earths 2013年第5期31卷 531-540页

作者：戴闽江川刘翔李哲程细高邹飏聂涛 department of orthopaedics The First Affiliated HospitalNanchang University department of orthopaedics The Second Affiliated HospitalNanchang University

To explore the impact of different concentrations of lanthanum chloride （LaC13） on critical components of wear particle-mediated signaling pathways in inflammation and osteoclastogenesis, RAW264.7 cells were naturally divided into eight groups and analyzed by CCK-8 assay, flow cytometry, ELISA, RT-PCR and western blot after treatments. The results showed that three concentrations of LaCI3 had no influence on viability of RAW264.7 cells and down-regulated receptor activator of nuclear factor rd3 （RANK） instead of macrophage colony-stimulating factor receptor （M-CSFR）. Additionally, 2.5 and 10 pmol/L LaC13 could signifi- cantly inhibit gene and protein levels of pro-inflammatory cytokines （tumor necrosis factor-or and interleukin-113, i.e., TNF-ct and IL-113） and NF-r,B/p65, but 100 pmol/L LaC13 did not exert an obvious inflammation-inhibiting effect, and even induced inflamma- tion. In conclusion, these findings demonstrated that LaC13 was able to suppress wear particle-induced inflammation and activation of NF-rd3 in a certain range of concentrations in vitro and mainly decrease the expression of RANK, but not M-CSFR, all of which were generally recognized to play a pivotal role in osteoclastogenesis.

关键词： lanthanum chloride wear particle osteoclastogenesis inflammation pro-inflammatory cytokine NF-kB RANK M-CSFR rare earths

A Green Biocompatible Fabrication of Highly Porous Functional Ceramics with High Strength and Controllable Pore Structures

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Journal of Materials Science & Technology 2016年第8期32卷 729-732页

作者： Changlu Xu Haoran Liu Huilin Yang Lei Yang Orthopaedic Institute and department of orthopaedics The First Affiliated Hospital Soochow University International Research Center for Translational orthopaedics (IRCTO) Soochow University

A green biocompatible foaming method utilizing natural coconut oil and cornstarch was developed to fabricate highly porous functional ceramics with controllable strengths and pore structures. The poros- ity of A1203 ceramics prepared via this method reached 79.6%-86.9% while these ceramics maintained high compressive strengths of 2.2-5.5 MPa. More importantly, porous A1203 ceramic with a pore size gra- dient was also readily fabricated by casting serial layers of foams that were set for different time periods. The potential applications of porous Al2O3 and HA ceramics fabricated by this green foaming method in- cluding scaffolds for oil cleaning and cell culture, respectively, were also demonstrated.

关键词： Porous ceramic Pore structure Bioceramics Hydroxyapatite Alumina

Effect of down-regulation of voltage-gated sodium channel Nav1.7 on activation of astrocytes and microglia in DRG in rats with cancer pain

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Asian Pacific Journal of Tropical Medicine 2015年第5期8卷 405-411页

作者： Jun Pan Xiang-Jin Lin Zhi-Heng Ling You-Zhi Cai department of orthopaedics the First Affiliated Hospital of Medical School of Zhejiang University

Objective:To evaluate the effect of down-regulation of Nav1.7 on the activation of astrocytes and microglia in DRG of rats with cancer pain,and explore the transmission of the nociceptive ***:Lentiviral vector harboring RNAi sequence targeting the Navl.7 gene was constructed,and Walker 256 breast cancer cell and morphine was injected to build the bone cancer pain model and morphine tolerance model in *** vector was *** in each model were divided into 4 groups:model group,PBS group,vehicle group and LV-Nav1.7 *** expression levels of GFAP and OX42 in dorsal root ganglia(DRG) were ***:After the animal model was built,the level of Navl.7,GFAP and OX42 was improved obviously with the time prolonged,which was statistically significant(P<0.05).The expression level of GFAP and OX42 in the DRG in the LV-Navl.7 group declined obviously compared to the model group,PBS group and vehicle group(P<0.05).Conclusions:Intrathecal injection of Navl.7 shRNA lentiviral vector can reduce the expression of Nav1.7and inhibit the activation of astrocytes and microglia in *** effort is also effective in morphine tolerance bone cancer pain model rats.

关键词： Nav1.7 Bone cancer pain Morphine tolerance

Valproic acid reduces autophagy and promotes functional recovery after spinal cord injury in rats

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Neuroscience Bulletin 2013年第4期29卷 484-492页

作者： Hai-Hu Hao Li Wang Zhi-Jian Guo Lang Bai Rui-Ping Zhang Wei-Bing Shuang Yi-Jia Jia Jie Wang Xiao-Yu Li Qiang Liu department of orthopaedics Dayi Hospital of Shanxi Medical University department of Physiology Shanxi Medical University department of orthopaedics Taiyuan City Centre Hospital department of Radiology First Hospital of Shanxi Medical University department of Urology First Hospital of Shanxi Medical University

Secondary damage is a critical determinant of the functional outcome in patients with spinal cord injury （SCI）, and involves multiple mechanisms of which the most important is the loss of nerve cells mediated by multiple factors. Autophagy can result in cell death, and plays a key role in the development of SCI. It has been recognized that valproic acid （VPA） is neuroprotective in certain experimental animal models, however, the levels of autophagic changes in the process of neuroprotection by VPA treatment following SCI are still unknown. In the present study, we determined the extent of autophagy after VPA treatment in a rat model of SCI. We found that both the mRNA and protein levels of Beclin-1 and LC3 were significantly increased at 1, 2, and 6 h after SCI and peaked at 2 h; however, Western blot showed that autophagy was markedly decreased by VPA treatment at 2 h post-injury. Besides, post-SCI treatment with VPA improved the Basso-Beattie-Bresnahan scale, increased the number of ventral horn motoneurons, and reduced myelin sheath damage compared with vehicle-treated animals at 42 days after SCI. Together, our results demonstrated the characteristics of autophagy expression following SCI, and foundthat VPA reduced autophagy and enhanced motor function.

关键词： spinal cord injury autophagy valproicacid: LC3:Beclin-1

Addition of tanshinone IIA to UW solution decreases skeletal muscle ischemia-reperfusion injury

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Acta Pharmacologica Sinica 2006年第8期27卷 991-999页

作者： Hong-gang WANG Zhi-yong LI Xiao-lin LIU~2 department of orthopaedics & Microsurgery,the first Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510080,China department of orthopaedics & Microsurgery the First Affiliated Hospital of Sun Yat-Sen University Guangzhou China

Aim:To investigate whether tanshinone ⅡA could improve the effect of UWsolution for skeletal muscle preservation and to determine the dose range oftanshinone ⅡA providing optimal protection during ischemia and ***:Ischemic rat limbs were perfused with UW solution or UW plus tanshinoneⅡA (UW+T,0.05,0.1,or 0.2 mg/mL) for 0.5h before reperfusion;controls (I/R)received no *** creatine phosphokinase (CPK),aspartate aminotrans-ferase (AST),and lactate dehydrogenase (LDH) were measured pre-ischemia andafter reperfusion (2-h,4-h,and 6-h).Muscle water content,superoxide dismutase(SOD),malondialdehyde (MDA),adenosine triphosphatase (ATPase) were as-sessed pre-reperfusion and after 6-h *** adhesion molecule-1(ICAM-1) and apoptosis were detected after 6-h *** bloodflow was monitored during reperfusion ***:UW and UW+T pre-vented luxury perfusion during reperfusion and inhibited ICAM-1 expression andapoptosis after 6-h *** CPK,AST,and LDH levels in UW ratswere significantly less than those in controls after 2-h reperfusion (no difference,4-h or 6-h reperfusion).After 4-h ischemia,there were significant differences inwater content,MDA,SOD,and ATPase between UW and controls,but no differ-ence after 6-h *** tests with UW+T rats were significantly differentfrom control results at corresponding *** tanshinone doses im-proved ***:UW plus tanshinone ⅡA increased protection againstI/R injury,suggesting that tanshinone ⅡA has clinical value.

关键词： UW solution tanshinone IIA ischemia-reperfusion skeletal muscle

Over-expression of Sox4 and β-catenin Is Associated with a Less Favorable Prognosis of Osteosarcoma

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2016年第2期36卷 193-199页

作者：鲍正齐张长春肖玉周周建生陶仪声柴大敏 department of orthopaedics the First Affiliated Hospital of Bengbu Medical College department of Pathology the First Affiliated Hospital of Bengbu Medical College

The purpose of this study was to examine the association of the expression of Sox4 and β-catenin with the prognosis of osteosarcoma. A total of 108 cases of conventional osteosarcoma were involved in this study and 28 cases of osteochondroma served as controls. The expression of Sox4 and β-catenin was detected by using immunohistochemical staining and Western blotting. The results showed that Sox4 and β-catenin were over-expressed in 67（62.03%） and 62（57.41%） of 108 osteosarcoma cases, while in only 3（10.71%） and 5（17.86%） of 28 controls, respectively（P〈0.05 for all）. The expression of Sox4 and β-catenin was associated with the distant metastasis, pathological grade and Enneking stage of patients with osteosarcoma（P〈0.05 for all）. The mean overall survival time and the 5-year-survival rate in osteosarcoma patients with Sox4 and β-catenin over-expressed were significantly reduced as compared with those in Sox4 and β-catenin low-expression group（P〈0.05 for all）. Cox multifactor regression analysis revealed that the distant metastasis, Enneking stage, and the expression of Sox4 and β-catenin were independent risk factors of patients with osteosarcoma（P〈0.05 for all）. The findings indicated that overexpression of Sox4 and β-catenin is associated with a poor prognosis of osteosarcoma.

关键词： osteosarcoma osteochondroma Sox4 β-catenin prognosis