The paper covered the selection of clinical trial diseases in the clinical pathway experiment in the hospital in the recent two years.It also introduced such management measures as making clinical pathway texts,the rate of cases into clinical pathways,emphasis of variation management,and enhanced clinical pathway data analysis.A comparison between the groups before and after clinical pathway management,found that the clinical pathway can reduce the average days of stay and total patient costs by 3.4 days and 1519 yuan respectively.Both patients and hospitals benefit from clinical pathways.The paper also advocates continuous and dynamic management at various stages of clinical pathway management.

Objective To study on postpartum obsessive compulsive disorder at home and abroad,and to provide new idea of diagnosis,evaluation and treatment on postpartum obsessive compulsive disorder.Method A search using Medline,Embase,EBSCO,Cochrane Library,Web of Science (ISI),Pubmed databases and Google Scholar was carried out using the key words:obsessive compulsive disorder (and derivatives),perinatal,pregnancy,postnatal,postpartum,mothers (and derivatives),anxiety disorders and subtypes. These articles and their references were reviewed.Results Twenty-seven papers were incorporated,but no Chinese paper.The life prevalence of postpartum OCD was 2.3％-11.0％.The most common obsessions were aggressive,contamination and miscellaneous,and compulsion for washing/cleaning and checking.Cognitive behavioural therapy and SSRIs have been suggested as a fist-line treatment of postpartum OCD.Conclusion OCD is more prevalent in the postpartum period.The evidence that OCD in the postpartum period presents a distinctive clinical picture with specific symptomatology and course is more compelling.Collaborative,international,prospective studies that take into account the methodological and definitional issues raised in this review are necessary to provide clarification.

Neoadjuvant chemotherapy is widely used in the therapy of locally advanced breast cancer.In the recent studies,the expressions of ER,PR and C-erbB-2 in tumor may change in different scheme preand post-neoadjuvant chemotherapies for breast cancer.It is obviously changed in the neoadjuvant chemotherapy scheme of anthracyclines and paclitaxel/docetaxel,but hardly changed in anthracycline-based neoadjuvant chemotherapy scheme.

BACKGROUND: Neurasthenia is commonly believed attributing to the complex influence of psychological, social and biological factors.OBJECTIVE: To probe the correlation of neurasthenia with personality,life events and the positive rate of serum Epstein-Barr (EB) virus.DESIGN: Case-controlled observation and prospective paired analysis.SETTING: Mental Health Institute of Second Xiangya Hospital Affiliated to Central South University.PARTICIPANTS: From May to October 2000, patients with neurasthenia,selected from the Clinical Ward of Mental Health Institute of Second Xiangya Hospital Affiliated to Central South University for medical treatment,19 males and 11 females, with mean age of (27±8), the course of disease ranged from 0.5 to 20 years with the average of 4.0 years, enrolled in this study. According to 1:1 paired principle, 30 matched volenteers, their relatives, or students of Xiangya Hospital were randomly selected as controls.Two groups were matched in age, sex and education, patients with psychological and physical disease were excluded. All participants were given written informed consent.METHODS: The level of serum EB virus IgG and IgM of two groups were determined by using ELISA methods. Blood samples were colleted before and after treatment in experimental group, while blood samples were only collected once in control group. Patients in experimental group were given routine medication and integrative psychotherapy according to their state of illness, and Eysenck personality questionnaire (EPQ) were filled in before and after treatment (including four dimensionalities: neuroticism, psychoticism, extroversion/introvision and lie, amongst which higher scores for extroversion/introvision dimensionality represented extroversion and lower dimensionality represented introvision; higher scores of neuroticism dimensionality suggested anxiety and worry. Higher scores for psychoticism suggested solitude and inadaptability to the outer environment), life events scale (including the total score for life events, positive events value and negative events value), and symptom checklist 90 (SCL-90) (consists of 10 factors scored of 0-4, representing non-symptom to severer symptom) were used to assess the clinical symptom. EPQ and SCL-90 were adopted on patients at four months after treatment for self-comparison. EPQ and life events scale were taken on healthy controls, the scores compared with that of experimental group before treatment.for EPQ, the total scores for SCL-90 and positive rate of EB virus in patients with neurasthenia before and after treatment.RESULTS: Totally 27 patients were followed up at 4 months after treatment, and 3 cases lost due to long distance from hospital, thereby 27 cases in experimental group and 30 cases in control group were remained in the roticism in neurasthenia group was significantly higher than that of control group (57.59±10.79, 40.58±8.68, t=6.536, P ＜ 0.01), scores of extroversion/introvision were obviously lower than that of control group (46.31 ±10.79, 53.50±11.28, t=3.203, P ＜ 0.01). In neurasthenic group, scores for neuroticism was obviously decreased after treatment in contrast to before events scale: The total scores and negative scores in neurasthenia group was significantly higher than that of control group (19.73±17.25, 18.93 tal scores for SCL-90: The total scores for SCL-90 was obviously declined after treatment comparing to that of before treatment in neurasthenia of EB virus IgG and IgM: The positive rate in neurasthenia group was significantly higher than that of control group (76.67% vs 26.67% );and positive rate of serum EB virus were proved to be two important pathogenic factors for neurasthenic patients.CONCLUSION: Patients with neurasthenia possess susceptible personality, such as neuroticism and introvision, and commonly experienced negative life events before illness. Moreover the positive rate of EB virus in neurasthenic patients is higher, which might be associated with the higher glucocorticoidinduced EB virus activation under stress state.

10.3969/j.issn.1000-3606.2013.06.024

Objective To evaluate the efficacy and safety of oral ibuprofen for closure of patent ductus arteriosus (PDA) in preterm infants.Methods The related literatures till December 31st,2011 in Cochrane Library,PubMed,EMBASE,Ovid,Springer,China Academic Journal Full-text Database,Wanfang Database,VIP Database and China Biological Medical Literature Database were searched.The inclusion criteria were:(1) the subject of the research was preterm infants with birth weight less than 2500 g and/or gestational age less than 37 weeks; (2) randomized or semirandomized controlled trial; (3) the intervention group received oral ibuprofen,while the control group received oral placebos / intravenous indomethacin or ibuprofen; (4) the main outcome was the failure rate of PDA closure; (5) hemodynamic changes with PDA were detected by ultrasonography.Meta-analysis was performed by Review Manager 4.22 software.Results Eleven randomized controlled trials were included,among which,three were high quality reports.Meta-analysis showed lower failure rate of PDA closure in subjects received oral ibuprofen than in those received placebos orally (RR =0.22,95 ％ CI:0.14-0.35),while the number of infants required operative closure of PDA decreased significantly (RR =0.16,95％ CI:0.03-0.86).Further analysis showed the effect of oral ibuprofen was similar to intravenous indomethacin (RR =0.93,95 ％ CI:0.57-1.53),but better than intravenous ibuprofen (RR=0.42,95％CI:0.26-0.67).However,oral ibuprofen did not reduced the ratio of patients required operation compared with intravenous indomethacin or ibuprofen (RR=0.58,95％CI:0.24-1.41).The incidence of gastrointestinal hemorrhage was higher in oral ibuprofen group than that in placebos(RR=1.99,95％CI:1.13-3.50).The serum level of creatine was lower in oral ibuprofen group than in intravenous indomethacin or ibuprofen group (weighted average=-19.10,95％ CI:-25.12-12.31).Compared with intravenous indomethcin group,less necrotizing enterocolitis cases were identified in oral ibuprofen group,but no statistical significance was found (RR=0.57,95％ CI:0.30-1.09).No long-term outcome was reported in any selected literature.Conclusions Oral ibuprofen for PDA closure in preterm infants appears to be as effective as intravenous or indomethacin,and more effective than intraveous ibuproten.Oral ibuproten represents better safety.

Objective To investigate the dysfunction of gallbladder emptying in diabetic patients and its possible mechanism. Methods The postprandial gallbladder emptying function and the release of pancreatic polypeptide (PP), as well as the therapeutic effect of Cisapride on gallbladder contraction were observed in 50 diabetics without cholecystolithiasis and 15 normal controls. The distributions of nitric oxide synthase (NOS) and acetylcholinesterase (AChE) in the wall of surgical removal gallbladders of 7 diabetic patients with cholecystolithiasis were also studied by histochemistry method. Results (1) The function of gallbladder emptying was distinctly lower in diabetic patients with autonomic neuropathy (AN) than that of the healthy subjects and diabetic patients without AN (NAN). (2) The postprandial release of PP in AN group was significantly lower than those in NAN group and healthy subjects. (3) The gallbladder emptying function was improved after receiving Cisapride in patients with AN. (4) Both the amount and activity of NOS and AChE in the wall of gallbladders of diabetic patients were lower than that of the non-diabetic subjects. Conclusion The dysfunction of gallbladder emptying in diabetic patients is partly due to the impaired autonomic nerve. The administration of Cisapride will improve the gallbladder emptying function of diabetic patients with AN.

Objective To investigate the protective effect of sevoflurane on acute intracranial hemorrhage craniotomy patients. Methods 60 acute intracranial hemorrhage craniotomy surgery patients were randomly divid?ed into control and experimental group of 30 patients under general anesthesia to have craniotomy. The patients in control group was operated by propofol and remifentanil as a inhalation anesthesia ,while patients in experimental group received sevoflurane ,propofol and remifentanil as a mixed anesthesia. Then intracranial pressure ,serum C?reactive protein(CRP),serum S?100β,NSE,IL?6 and TNF?α levels of different time points were deternmined. Results Serum CRP in experimental group were significantly decreased than the control group(P<0.05)1 d af?ter operation. T0~T3 levels of serum S?100β,NSE,IL?6 and TNF?α in two groups were both increased(P <0.05),and the experimental group was significantly lower than the control group(P < 0.05). The intracranial pressure of control group was significantly higher than the experimental group(P < 0.05). Conclusion Sevoflu?rane has a brain protective role in inhibiting acute inflammation in intracranial hemorrhage craniotomy patients.

Objective To evaluate the effect of rediological intervention on thrombotic membranous obstructive Budd-Chiari syndrome(TMOB-CS) .Methods Seventeen cases of TMOB-CS were treated with mutliple stent inplantation to press the thrombus with PTA.Results The inferior vena cave(IVC) pressure declined from(29.4?3.13)cm H 2 O to (3.45?3.20)cm H 2 O after the multiple stent inplantation.There was no severe complication such as pulmonary thrombembolism occurrence in this series.All the patients had been followedup for 3 to 40 months and showed good results.Conclusion Multiple stent inplantation pressing the thrombus with PTA can be used to treat the patients with TMOB-CS.

Objective To explore the relationship between the post-thoracotomic wound infection and nutritional status.Methods The patients treated with thoracotomy were divided into the simple wound infection group(n=15) as the experimental group and the phase Ⅰ healed group (n=15) as the control group.On the fifth day after operation, the sero-albumin quantity and cumulative nitrogen balance were recorded respectively. The statistical data were given the test.Results Every average index of sero-albumin in the experimental group was lower than the control group. Among them, the total protein comparison had statistical significance (P0 05) and transferrin comparison had statistical difference (P