The authors first describe the concept and connotation, origin and functions of clinical pathways and then give an account of the selection of disease groups or cases in clinical pathways and the formulation of means and procedures. They argue that in the implementation of clinical pathways, reform of the manner of hospital payment is the driving force, transformation of physicians idea of service is the key, and coordination and cooperation between various departments is the guarantee.

Rectal carcinoma is a common malignant tumor in China. Although it decreased greatly after the introduction of total mesorectal excision and preoperative radiotherapy, the local recurrence rate of rectal carcinoma after curative surgery is still up to 11.3%. Surgery is the most effective treatment for local recurrence of rectal carcinoma. If excised radically, the five-year survival of patients with rectal carcinoma could be more than 35%. Only a few patients will benefit from ex-tended radical surgery because of its extremely high postoperative morbidity and mortality. Strict selection of patients by mul-tiple preoperative examinations makes extended radical surgery more reasonable. For the unresectable advanced recurrent rectal carcinoma, multimodality palliative therapy could lead to symptom relief, elevated quality of life and prolonged surviv-al. We discuss the diagnosis and treatment of recurrent rectal carcinoma in this review.

Recurrent urinary tract infection (RUTI) is a common disease in China. Modern medicine usually treats it with antibiotics. However, the drug resistance and adverse reaction of antibiotics lower the therapeutic effects and the compliance of patients. Based on the overall concept of Chinese medicine and the relationship of pathogenic factors and vital qi, Professor Zhang Qi proposed the general principles of RUTI treatment according to its different phases and patterns. The principles are listed as follows, eliminating method was used in the treatment of excess pattern;invigorating method was used in the treatment of deficiency pattern; and promoting of body resistance and eliminating pathogenic factors method was used in the treatment of the deficiency-excess complex pattern. These principles have instructional significance for clinical application.

Objective To evaluate the effect of oral rehabilitation method combined with Shaker exercise on the swallowing function and the quality of life in the patients with dysphagia caused by cerebral infarction.Methods A total of 120 patients with swallowing disorder caused by cerebral infarction were randomly divided into conventional treatment group (n=30),oral rehabilitation method group (n=30),Shaker exercise group (n=30) and comprehensive therapy group (n=30).The patients in the conventional treatment group were treated with conventional treatment,while the patients in oral rehabilitation method group received oral rehabilitation method treatment in addition.The Shaker exercise group accepted Shaker exercise and conventional treatment,while the comprehensive therapy group accepted oral rehabilitation method in addition.All patients were assessed with video fluoroscopic swallowing study (VFSS) and swallowing-related quality of life (SWAL-QOL),before treatment and 4-week after treatment.Results Before treatment there was no significant difference among the four groups in VFSS and SWAL-QOL scores (P＞0.05).After 4-week treatment the swallowing function showed different degrees of improvement.The difference of VFSS score in the conventional treatment group was not statistically significant before treatment and 4-week after treatment (P=-0.38),but it was statistically significant among the other three groups (P＜0.01).After 4-week treatment there was significant difference among the four groups in VFSS score (P＜0.01),and the comprehensive therapy group curative effect was significantly better than that of the other groups.The total effective rate was 96.67％ in the comprehensive therapy group,26.67％ in the conventional treatment group,66.67％ in the oral rehabilitation method group,and 70.00％ in the Shaker exercise group.the SWAL-QOL score in the comprehensive therapy group was higher than that of the other three groups.The average SWAL-QOL score was 187.30±10.68 in the comprehensive therapy group,(140.10±16.62) in the conventional treatment group,(161.47 ±24.53) in the oral rehabilitation method group,and (163.97 ± 23.91) in the Shaker exercise group.Conclusion Application of oral rehabilitation method combined with Shaker exercise in the patients with swallowing disorder caused by cerebral infarction could effectively improve the degree of swallowing disorder and the quality of life.

Object To develop and utilize a folk-medicine of Yunnan Province, Lethariella cladonioides (Nyl.) Krog. Methods The constituents were extracted with 80% ethanol and isolated with silica gel column chromatography. The structures were identified by physicochemical properties and spectral analysis. Results Two unknown constituents were elucidated from the extract as 3-aldehyde-6-methyl-2, 4-dihydroxy-ethyl-benzoate (Ⅰ), and 4-methyl-2, 6-dihydroxy-benzaldehyde (Ⅱ). Conclusion They are both new constituents obtained firstly.

In recent years, IgA nephropathy and Henoch-Sch?nlein purpura nephritis attract more and more attention on their unclear pathogenesis, single diagnostic criteria, long duration and poor prognosis, etc. Research suggests that IgA nephropathy and purpura nephritis are IgA immune complex related diseases, and serum galactose-deficient is elevated in patients with these two dis-eases, which might become a noninvasive biomarker for the diagnosis, prognosis prediction and disease development monitoring for IgA nephropathy and purpura nephritis. Galactose-deficient IgA1 is reviewed for its discovery, structure, process, the possible patho-genic mechanism and its significance in details in this paper.

Objective To study the effect of erythropoietin (EPO) on neural function and brain cell apoptosis in rats after cardiopulmonary resuscitation.Methods Adult male SD rats were randomly divided into control group and EPO group with 24 in each group.A rat model of asphyxial cardiac arrest and cardiopulmonary resuscitation was established.The neurological functions were assessed using neurological deficit score (NDS) 12 h and 24 h after cardiopulmonary resuscitation.The expressions of the apoptosis-inducing factor (AIF) and caspase-3 mRNA in cerebral cortex tissue were detected using reverse transcription-polymerase chain reaction (RT-PCR) at 0 h,12 h,and 24 h,respectively.Results Compared with the DNS scores in the control group (12 h:(60.00± 3.38) ;24 h:(54.50±2.56),respectively),12 h and 24 h NDS scores were (70.50±4.04) and (65.88±2.64) in EPO group after cardiopulmonary resuscitation,and the difference was statistically different (P＜0.01).The AIF mRNA expression levels of 12 h (1.31±0.26) and 24 h (1.87±0.17) after cardiopulmonary resuscitation in EPO group were obviously lower than those in the control group (12 h:(1.88 ± 0.18),24h:(2.71 ± 0.24),respectively),and the differences were statistically different (P＜0.01).The Caspas-3 mRNA expression levels of 12 h (1.49± 0.15) and 24 h (1.56±0.10) after cardiopuhmonary resuscitation in EPO group were obviously lower than those in the control group (12 h:(1.68± 0.10),24h:(1.84 ± 0.16),respectively),and the differences were statistically significant (P＜0.01).Conclusion EPO can reduce AIF and caspase-3 mRNA transcription,reduce apoptosis in cortical neurons caused by the cerebral ischemia and reperfusion injury after cardiopulmonary resuscitation,and therefore improve brain function.

Objective To assess the effects of Mtwo for root canal therapy in the aged patients .Methods One hundred and fifty-two root canals in 64 teeth for root canal therapy (RCT) in aged patients(60~70years)were randomly divided into M groups and K groups.Mtwo machine with nickel titanium file was used in M group (32 teeth, 78 root canals), and stainless steel file in K group (32 teeth, 74 root canals).Root canal preparation time, root spread reaction, and canal filling effects were compared between two groups.Results The root canal preparation and filling in group M were better than in K group ( P <0.05).The time consumption of RCT in M group was shorter than in group K .Conclusions Mtwo shows good shaping ability and is safe for aged patients in root canal treatment with high efficiency .

Objective To explore the correlation between Helicobacter pylori (H.pylori) infection and colorectal cancer.Methods From January 2008 to January 2014,263 patients pathologically diagnosed as colorectal cancer were selected as colorectal cancer group,and at the same period 263 patients with normal colon mucosa under colonoscopy were set as control group.The rates of H.pylori infection,the rates of H.pylori infection in patients with different pathological types of colorectal cancer,the rates of H.pylori infection accompanied with atrophic gastritis and the rates of H.pylori infection accompanied with intestinal metaplasia of two groups were retrospectively analyzed.The difference of H.pylori infection between proximal colorectal cancer and distal colorectal cancer was compared.Chi-square test was performed for comparison and odds ratio (OR) value and 95％ confidence interval (CI) were calculated.Results Among 263 patients with colorectal cancer,the H.pylori infection rate of colorectal cancer group was 63.50％ (167/263),which was higher than that of control group (39.54％,104/263),and the difference was statistically significant (x2 =27.66,OR=2.66,95％ CI 1.85 to 3.83,P＜0.01).There was no statistical difference in rates of H.pylori infection among different pathological types of colorectal cancer (x2=0.15,P=0.93).The rate of H.pylori infection accompanied with atrophic gastritis in patients with colorectal cancer was 46.39％ (122/263) which was higher than that of control group (23.57％,62/263),and the difference was statistically significant (x2=28.53,OR=2.94,95％CI 1.98 to 4.36,P＜0.01).The rates of H.pylori infection accompanied with intestinal metaplasia in patients with colorectal cancer was 17.87％ (47/263) which was higher than that of control group (4.18％,11/263),and the difference was statistically significant (x2=23.56,OR=5.50,95％CI 2.76 to 10.95,P＜0.01).There was no significant difference in the rate of H.pylori infection between the proximal colorectal cancer and the distal colorectal cancer (x2 =1.48,P =0.22).Conclusion H.pylori infection,together with atrophic gastritis and intestinal metaplasia caused by it are correlated with colorectal cancer.

As an important component of functional genomics,epigenetics is a subdiscipline within genetics and refers to heritable changes in gene expression without any alteration in DNA sequence,including DNA methylation,histone modification,chromatin remodeling and microRNA (miRNA).Epigenetic regulation plays a crucial role on the development of B-cell lymphomas,as it has been reported that perturbation of epigenetic pattern and mutations in epigenetic mechanisms are frequent events in B-cell lymphomas.This review summarized the research progress on DNA methylation,histone modification and miRNA as well as their roles in the development,treatment and prognosis of B-cell lymphomas.