Objective: To assess the implementation effects of clinical pathways, compared with usual care, among patients with stroke. Methods:Two investigators independently searched PubMed, Embase, the Cochrane Library, Web of Science, Chinese Biomedical Literature Database and Wanfang Database for studies published before December 2014. Jadad methodological approach was applied to assess the quality of included studies and RevMan software (version 5.2.7) was used for meta-analysis. Results: A total of 11 RCTs involving 913 patients were included in this meta-analysis. The overall results showed that a shorter average length of stay [MD = -2.92; 95% CI (-4.06, -1.78); P < 0.001] and a lower inpatient expenditures [SMD = -1.64; 95% CI (-1.80, -1.48); P < 0.001] in clinical pathways group comparing with the usual care group. The higher score of patient satisfaction was also seen in clinical pathways group. Conclusion: clinical pathways may reduce the average length of stay, reduce the inpatient expenditures, increase patient satisfaction and improve the quality of care in stroke management.
Stroke

[Objective] Compare the outcomes of vacuum extractors and forceps in assisted vaginal delivery.[Methods] One hundred and sixty-four pregnant women with operative vaginal delivery who received prenatal examination and delivered in our hospital were enrolled.Eighty-two women with vacuum extractors were assigned into vacuum extractors group,another eighty-two women with low or outlet forceps were assigned into forceps group.Occiput transverse or posterior position women before operative vaginal delivery were assigned into abnormal fetal position group.Compare the maternal and neonatal outcomes of vacuum extractors and forceps in assisted vaginal delivery.[Results] The vaginal laceration rate of forceps group was significant higher than vacuum extractors group (56.1％ vs 24.2％,P ＜ 0.01),but neonatal subscalp hematoma and hyperbilirubinemia rate were lower than vacuum extractors group (P ＜ 0.05).The vaginal laceration rate of abnormal fetal position forceps group was also higher than abnormal fetal position vacuum extractors group (76.5％ vs 22.2％,P ＜ 0.05),but neonatal hyperbilirubinemia rate was lower than abnormal fetal position vacuum extractors group (P ＜ 0.05).The Interval time from decision to delivery,postpartum hemorrhage volume with 24 hours,leukocyte and neutrophil count after 24 hours,asphyxia of newborn rate,intracranial hemorrahge,subgaleal hemorrahge,referral rate and hypoxic-ischemic encephalopathy did not significantly differ between vacuum extractors group and forceps group (all P ＞ 0.05).[Conclusions] Vacuum extractors can reduce the incidence of vaginal laceration rate,especial for abnormal fetal position,but increase the incidence of neonatal subscalp hematoma and hyperbilirubinemia rate.

Objective:To develop an HPLC-DAD-ELSD method for the determination of nitidine chloride, 5-ethoxychelerythrine, bergeninum and ardisiacrispin A in Shangtong tinctures ( STD) . Methods: A Hypersil C18 column was used as the chromatographic column, the flow rate was 0. 8 ml·min-1 . For nitidine chloride and 5-ethoxychelerythrine, the mobile phase A consisted of acetoni-trile,the mobile phase B consisted of 0. 1% formic acid-triethylamine (pH 4. 5),and the DAD detection wavelength was at 273 nm. For bergeninum and ardisiacrispin A, the mobile phase consisted of methanol-water(25∶75), the temperature of drift tube was set at 95℃, and the gas flow (N2) was set at 2. 5 SLPM·min-1. Results:There was a good linear relationship between the concentration and peak area for nitidine chloride and 5-ethoxychelerythrine within the range of 0. 021-0. 426 μg (r=0. 999 5) and 0. 075-1. 494 μg (r=0. 999 8), respectively. The average recovery was 99. 22%(RSD=0. 64%) and 98. 61%(RSD=0. 46%), respectively. There was a good linear relationship between the concentration and peak area for bergeninum and ardisiacrispin A within the range of 0. 215-4. 304 μg(r=0. 999 3) and 0. 286-5. 728 μg(r=0. 999 7), respectively. The average recovery was 99. 15%(RSD=0. 77%) and 99. 25%(RSD=0. 56%) accordingly. Conclusion:The method is accurate, sensitive and reproducible, and can be used in the de-termination of nitidine chloride, 5-ethoxychelerythrine, bergeninum and ardisiacrispin A in STD.

OBJECTIVE:To establish a method for simultaneous determination of the contents of ligustroflavone,specnuezhe-nide,demethylwedelolactone and wedelolactone in Zibu ganshen pill. METHODS:Dual-wavelength HPLC was performed on the column of Elite C18 with mobile phase of acetonitrile-0.5%acetic acid(gradient elution)at flow rate of 0.9 ml/min,column temper-ature was 25 ℃,detection wavelengths were 224 nm(0-30 min) and 351 nm (30-50 min),and the injection volume was 20 μl. RESULTS:The linear range was 6.75-135.00μg/ml(r=0.999 5)for ligustroflavone,6.54-130.80μg/ml(r=0.999 8)for specnuezhe-nide,4.90-98.00μg/ml(r=0.999 4)for demethylwedelolactone and 6.42-128.40μg/ml(r=0.999 6)for wedelolactone;RSDs of pre-cision,stability and reproducibility tests were no more than 1.25%;average recoveries were 96.15%-99.96%(RSD<2%,n=6). CONCLUSIONS:The method is rapid,sensitive and accurate,and can be used for the contents determination of ligustroflavone, specnuezhenide,demethylwedelolactone and wedelolactone in Zibu ganshen pill.

Objective To analyse the significance of proto oncogene protein in oral squamous cell carcinoma and oral leukoplakia.Methods 40 patients who were diagnosed with oral leukoplakia (OLK),40 patients who were diagnosed with oral squamous cell carcinoma(OSCC),and at the same time, 40 healthy volunteers as control group were collected.the lesions and normal oral mucosa were taken as samples, left supernatant after grinding, MDM2 protein, p53 protein and Ki-67 protein were detected by ELISA in three groups,and analyse the correlation between three groups.Results Among three groups,MDM2, p53 expression:OSCC group>OLK group>control group (P<0.05).Ki-67 expression level among three groups, OSCC group>OLK group>control group (P<0.05).MDM2, p53, Ki-67 expression had a positive correlation in OSCC group and OLK group (P<0.05), but there was no obvious correlation in control group.Conclusion When oral leukoplakia developes into oral squamous cell carcinoma, MDM2, p53, Ki-67 shows high expression, and there is a positive correlation between MDM2, p53, Ki-67.

Objective: To assess the implementation effects of clinical pathways, compared with usual care, among patients with stroke. Methods:Two investigators independently searched PubMed, Embase, the Cochrane Library, Web of Science, Chinese Biomedical Literature Database and Wanfang Database for studies published before December 2014. Jadad methodological approach was applied to assess the quality of included studies and RevMan software (version 5.2.7) was used for meta-analysis. Results: A total of 11 RCTs involving 913 patients were included in this meta-analysis. The overall results showed that a shorter average length of stay [MD = -2.92; 95% CI (-4.06, -1.78); P < 0.001] and a lower inpatient expenditures [SMD = -1.64; 95% CI (-1.80, -1.48); P < 0.001] in clinical pathways group comparing with the usual care group. The higher score of patient satisfaction was also seen in clinical pathways group. Conclusion: clinical pathways may reduce the average length of stay, reduce the inpatient expenditures, increase patient satisfaction and improve the quality of care in stroke management.

Magnetic nano gene vector is one of the non-viral gene vectors, modified by functional group to bind cationic transfect reagents. Coupling magnetofection with the universal lipofection we developed a novel somatic cell transfection method as the so-called liposomal magnetofection (LMF). This approach is potential to provide somatic cell cloning with stable genetic cell lines to cultivate transgenic animals. In order to construct such liposomal magnetic gene vectors complexes system, we used nano magnetic gene vector to combine with liposomal cationic transfect reagents by molecular self-assembly. This vectors system successfully carried exogenous gene and then transfected animal somatic cells. Here, we conducted atomic force microscopy (AFM), zeta potential-diameter analysis and other characterization experiments to investegate the size distribution and morphology of magnetic nanoparticles, the way of the vectors to load and concentrate DNA molecules. Our data reveal that, the LMF of Pig Kidney cells exhibited higher transfection efficiency comparing with the transfection mediated by the commercial lipofectamine2000. Moreover, LMF method overcomes the constraint of transient expression mediated by lipofection. Meanwhile, MTT assay showed low cytotoxicity of LMF. Hence, LMF is a feasible, low cytotoxic and effective method of cell transfection.
Animals ; Cations ; Cell Line ; DNA ; Genetic Vectors ; Kidney ; cytology ; Liposomes ; Magnetics ; Nanoparticles ; Swine ; Transfection

Objective:To study the role of phospholipase A 2 in the pathomechanism of low back and leg pain. Methods:Phospholipase A 2 was injected into rats′ cavum epidurale, then the pathologic changes of cauda equina was viewed under light microscopy and electronic microscopy. The substance P(SP) in the dorsal root ganglia(DRG) and spinal cord was determined by immunohistochemistry. Results:After phospholipase A 2 injection, the nerve fibers of cauda equina displayed significant degeneration and demyelination. In L 4 to L 6 segment, the number and area of SP positive neurons in the DRG increased significantly. The relative density of positive nerve endings in the dorsal horn of spinal cord was also increased significantly. There were significant difference compared to the normal solution control group by statistic analysis. Conclusion:Phospholipase A 2 is a nocuous substance to cauda equina. It may play an important role in the pathomechanisms of low back and leg pain related to lumbar disc herniation.

Objective To evaluate the feasibility of transparent cap-fitted endoscopy in improving diagnostic yield of Barrett's esophagus(BE).Methods A total of 168 patients with endoscopieally suspected BE were randomly divided into cap group(n=60)and control group(n=108).A transparent cap-fitted endoscopy Was applied in cap group to take biopsy,while a routine one was used in control group,and 2 biopsies from suspected lesions were collected in each patient.BE was diagnosed in the presence of columnar epithelium and the diagnostic rate was compared between 2 groups.Results The diagnostic rates of BE were 83.3%(50/60)and 69.4%(75/108)in cap and control group,respectively(P＜0.05).Conclusion The lesions at cardia Call be exposed clearly with capped endoscopy,which facilitates localized biopsy and BE diagnosis.

Objective To establish a simple,rapid and sensitive nucleotide polymorphisms genotyping method in order to conduct the routine clinical detections under the simple laboratory condition by this method.Methods Based on the ligase-agarose gel electrophoresis,the oligonucleotide detection probes of mutational sites was designed.The detection underwent the detection probe connecting,purification and universal amplification,finally the mutation genotypes of detection sites were judged by the ap-peared bands in the agarose gel electrophoresis(AGE).With the 3 SNP sites EGFR,c.2573T>G(L858R),EGFR,c.2582T> A (L861Q)and EGFR,c.2155 G>T(G719C)in epidermal growth factor receptor(EGFR)gene as the detection objects,the plasmid template and plasma circulating DNA sample in lung cancer were performed the detection.Results The established method was easy to operate with higher specificity and sensitivity.After 20-30 cycles of PCR amplification,the genotype of detection sites was clearly estimated according to the amplification band.When detecting the mixed alleles in the heterogeneous sample,minimal 2.5%mutation alleles could be detected out.This method and the direct sequencing method could respectively detect 6 cases and 2 cases of heterozygotes mutation in the SNP site of L858R among 62 samples of lung cancer.Conclusion The established detection method for SNP genotyping is suitable to the routine mutation detection on the heterogeneous samples under the simple laboratory condi-tion.