ObjectiveTo evaluate the application effect of clinical pathways in hospitalized inguinal hernia patients by using the Meta- analysis. MethodsPublished randomized controlled trials (RCT)in hospitalized inguinal hernia patients were searched and screened in CNKI、VIP、CBMdisc and Wanfang datebase under present standards.The quality of the included studies were evaluated and statistically analyzed by RevMan5.0 software. ResultsTotally 16 literatures including 1649 cases were eligible to the criteria (816 in clinical nursing pathways group and 833 in the traditional health education group)altogether.The Meta-analysis showed there were significant difference between the clinical pathway group and the traditional health education group in grasp of health knowledge,rate of patients,satisfaction degree,length of hospital stay and hospitalization expenses. ConclusionsClinical pathways is superior compared with the traditional health education for hospitalized inguinal hernia patients.

BACKGROUND:Currently, transplantation of bone marrow mesenchymal stem cel s into the spinal cord is very limited to the recovery of animals fol owing spinal cord injury. Methylcobalamin is a common drug for the treatment of neurological diseases and injuries, but its effects on bone marrow mesenchymal stem cel s are unclear. OBJECTIVE:To study the feasibility of bone marrow mesenchymal stem cel s differentiating into neuron-like cel s induced by methylcobalamin in vitro and to observe the cel viability and proliferation of differentiated cel s. Methods:Rat bone marrow mesenchymal stem cel s were isolated, cultured and purified by density gradient centrifugation and adherent culture. The fourth to fifth generation of bone marrow mesenchymal stem cel s were treated for 24, 48 and 72 hours with different concentrations (25, 50 and 100 mg/L) of methylcobalamin. The morphological changes and cel growth were continuously observed under an inverted phase constract microscope. The viability of induced cel s was detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. The expressions of Nestin and neuron-specific enolase were identified by reverse transcription PCR and western blot. RESULTS AND CONCLUSION:Most of bone marrow mesenchymal stem cel s could differentiate into neuron-like cel s after induction with methylcobalamin. The expressions of Nestin and neuron-specific enolase were up-regulated after 48 hours of methylcobalamin treatment at different concentrations, especial y after treatment with 100 mg/L methylcobalamin. Similarly, the expressions of Nestin and neuron-specific enolase could be increased significantly after 100 mg/L methylcobalamin treatment for 24, 48 and 72 hours, especial y for 72 hours. It is indicated that methylcobalamin can induce bone marrow mesenchymal stem cel s differentiating into neuron-like cel s, and the optimal concentration of methylcobalamin is 100 mg/L.

Objective To analyze the level and change trends of cancer mortality in the media focused area,Yingcheng of Hubei Province,to further support the authenticity and reliability of the information from media report.Methods Use the data of the first national retrospective death survey and the third national retrospective sampling death survey to describe cancer mortality and change trends in Yingcheng of Hubei Province.Results Crude cancer mortality in Yingcheng was 148.26/100 000.In the past 30 years,cancer mortality significantly increased by 9.27 times.Among 100 000 people in the county,each year 43 cases of malignant tumor death occurred more than the national average level.A variety of malignant tumors' mortality change in the county is significantly different from those of the country,such as esophageal cancer,stomach cancer did not fall but rise;liver cancer,lung cancer,leukaemia and colorectal cancer increased 5.84 times,5.61 times,5.07 times and 17.91 times more than the national average,respectively.The excess mortality rate of stomach cancer,liver cancer,lung cancer and colorectal cancer were 15.32/100 000,16.78/100 000,8.32/100 000 and 3.98/100 000 respectively.Negative binomial distribution fitting results suggest that death of stomach cancer exists village aggregation.Conclusions The level of historical cancer mortality in Yingcheng was low,but increase quickly,presently it is on the national high-incidence level.It presents the phenomenon that a variety of malignant tumors is generally on high-incidence level and stomach cancer exists village aggregation.

Objective To explore the clinical features diagnosis and treatment of left main coronary artery (LM) disease. Methods According to the results of coronary angiography,significant stenosis was defined as ≥50% stenosis. Isolated LM group had 9 patients (4.62%),one-vessel stenosis LM group 15 patients (7.69%),two-vessel stenosis LM group 53 patients (27.18%) and three-vessel stenosis LM group 118 patients (60.51%). Results 195 cases (6.74%) of LM stenosis were found. The incidence rate was low. 164 patients (84.1%) had unstable angina,and 125 patients (64.1%) had myocardial infarction. Coronary artery bypass surgery was performed in 57 patients (29.2%) and the angina disappeared in most of them (84.2%). Five patients received unprotected LM stenosis and angina disappeared in all. Conclusion LM stenosis has sever symptoms. Coronary angiography is the only way for diagnosis and CABG the best treatment. Unprotected LM stenosis is valuable for some patients.

Objective To analyze the influence of multiple myeloma tumor-associated gene MYEOV2 on NIH/3T3 cells growth. Methods The recombinant plasmid, pcDNA3.1(+)/MYEOV2, was constructed and subsequently transfected into NIH/3T3 cells by liposome. The positive clones of the transfected NIH/3T3 cells were obtained by G418 selection. RT-PCR was used to detecte the expression of MYEOV2 gene in the cells. Fluorescence-activated cell sorting (FACS) and cell grow curve drawing were applied to analyze the influence of MYEOV2 gene on NIH/3T3 cells proliferation. Results The cell clones stably expressing MYEOV2 gene were obtained. FACS analysis showed that the percentage of S phase cell of pcDNA3.1(+)/MYEOV2-transfected cells, pcDNA3.1(+) -transfected cells and non-transfected cells was 30.9%, 20.1% and 16.1%, respectively, and the difference of sphase cell percentage between pcDNA3.1(+)/MYEOV2-transfected cells and the other two groups of cells was significant (P

Objective To investigate the clinical efficacy of one-stage posterior internal fixation with pedicle screw and anterior debridement of bone grafting through the extraperitoneal approach the medial edge of rectus abdominis in treating severe lumbosa-cral tuberculosis .Methods 17 cases with L4-S1 tuberculosis were treated by internal fixation with pedicle screw ,anterior debride-ment through the extraperitoneal approach the medial edge of rectus abdominis ,and application of allogenic bone from January 2008 to December 2011 .All patients performed X-ray ,CT and MRI examinations before surgery .L5-S1 were involved in 8 cases ,L4-5 were involved in 6 cases ,and L4-S1 were involved in 3 cases;unilateral psoas abscess was found in 6 cases ,while bilateral psoas ab-scess was found in 3 cases ;Among the 17 cases ,8 cases had intraspinal invasion ,and 5 cases were combined with neurological dys-functions ,however ,according to Frankel grade ,4 cases were grade D ,and 1 case was grade C .Regular anti-tuberculosis treatment was given for more than 2 weeks before surgery ,and regular supportive treatment and anti-tuberculosis treatment were given for 9-12 months after surgery .As for regular follow-up(3 ,6 ,9 ,and 12 months after surgery ,and every 6 months later on) ,patients had examinations including ESR and X-ray to evaluate the tuberculosis activity and the condition of bone graft fusion ;while accord-ing to Frankel grade of nerves function ,changes in nerve function before and after surgery were evaluated in patients ,and changes of lumbosacral angle were also comparatively studied before and after surgery .Results There were no great vessel injuries and no nerve injuries except one case who had intraoperative ureteral injury which was repaired in time .The 17 patients were all followed up for 10-36 months(18 months average) ,and all reached clinical healing without complications such as tuberculous peritonitis ,e-rectile dysfunction and retrograde ejaculation .During the follow-up period ,there were no tuberculosis recurrence ,no loosening of in-ternal fixation ,and no break of rod and nail ;the grafted bones were fused in all patients with an average time of 7 .5 months ;accord-ing to Frankel grade of nerves function ,only one patient was grade D ,while the other four cases recovered to grade E .The lumbosa-cral angle of patients was corrected from 23 .8° ± 4 .0°(19 .8°-27 .8°) before surgery to 29 .1° ± 3 .6°(25 .5°-32 .7°) after surgery , and the change was statistical significance(P<0 .05) .Conclusion The one-stage posterior internal fixation with pedicle screw and anterior debridement of bone grafting through the extraperitoneal approach inside of rectus abdominis is a safe and effective meth-od ,which can thoroughly remove the focus ,reconstruct the lumbosacral stability ,and prevent the loosening of bone grafting .

Objective To assess the significance and the relationship of BODE index score and inflammation factors in stable chronic obstructive pulmonary disease(COPD).Methods Sixty COPD patients in their stable condition were evaluated for BODE index score and the level of tumor necrosis factor-α(TNF-α),interleukin-8(IL-8) and C reactive protein (CRP) were determined.Results BODE index score in COPD patients was positively correlated with serum concentrations of TNF-α,IL-8 (r =0.455,P ＜ 0.01 ; r =0.303,P ＜0.05),but not with CRP (r =0.111,P =0.398).IL-8 and TNF-α were both significantly negatively correlated to body mass index(BMI),force exhale volume of the first second (FEV1) and 6 minute walking distance (6MWD) (r=-0.417,P ＜0.01;r=-0.538,P＜0.01;r =-0.419,P＜0.01 for IL-8;and r=-0.262,P＜0.05;r=-0.348,P＜0.01;r=-0.334,P＜0.01 for TNF-α).Conclusion The BODE index,as a simple multidimensional grading system for COPD,is closely related to system inflammation,which indicates that system inflammation may contribute to the systemic development of COPD.

OBJECTIVE: To observe the anti-inflammatory and analgesic effects of Yitieling Paste (YTLP). METHODS: YTLP and aspirin (as a control drug) were introduced to treat the edematous ears of mice induced by xylene and swollen toes of mice induced by carrageenin, and to relieve the pain in mice induced by heat and acetic acid. The swelling degree, pain threshold and body distortions were measured. RESULTS: The repression rates of the ear edema in groups of YTLP of high and low dosages and the aspirin group were 67.92%, 52.52% and 58.28%, respectively. The repression rate of the toe swelling in YTLP high dosage group was higher than that of the aspirin group, which was higher than that of the YTLP low dosage group. The results of analgesic effect of the three YTLP-treated groups showed that with the increase of dosage, the pain thresholds were higher and higher, and the body distortions were lower and lower. The pain thresholds of high and medium dosage YTLP groups were near to the aspirin group. CONCLUSION: YTLP possesses a strong anti-inflammatory and analgesic effect.

Objective To evaluate the effect of conventional or goal-directed fluid management on hemodynamics in patients undergoing orthopaedic arthroscopic shoulder surgery in beach chair po-sition.Methods Thirty healthy adult patients,male 1 7 cases,female 13 cases,aged 18-65 years, weight 49-68 kg,ASA Ⅰor Ⅱ,undergoing elective arthroscopic shoulder surgery,were enrolled.Pa-tients were randomly assigned to the group R(Routine group,n = 1 5 )and the group S(SVV/CI/MAP-directed,n =1 5).All patients received 10 ml/kg of hydroxyethyl starch rapidly in group R;while in group S,if SVV > 13%,patients would receive 3 ml/kg of hydroxyethyl starch in 5 min, then the changes of each index were observed;if SVV <13% and CI< 2.5 L·min-1 ·m-2 ,given dopamine 0.5~1 μg·kg-1 ·min-1 ,until CI>2.5 L·min-1 ·m-2 .At 5 min after anesthesia induc-tion,patients were placed in a 60° upright position.The hemodynamic changes were monitored by FloTrac/Vigileo system.Heart rate (HR),mean artery pressure(MAP),cardiac index(CI),stroke volume variation(SVV),stroke volume index (SVI),were recorded on pre-induction (T1 ),post-induc-tion (T2 ),immediately after in beach chair position (T3 ),5 min after in beach chair position(T4 ),30 min after in beach chair position(T5 ),and at the end of surgery(T6 ).The duration of surgery,crys-talloid requirements,colloid requirements,urinary output,the dose of vasoactive drugs and the inci-dence of hypotension were recorded.Results Compared with T1 ,MAP,CI and SVI at T3-T5 point (after in BCP to the end of the surgery)were higher in both group(P <0.05 ).Compared with T2 , SVV in group R at T3-T5 were significantly increased (P <0.05),while SVV in group S only at T3 was slightly increased (P <0.05).Compared with group R,MAP,CI and SVI at T3-T5 were signif-icantly higher respectively,while SVV were higher at T3-T5 in group R (P <0.05).Compared with group R,the colloid requirements and total requirements in group S were significantly increased(P <0.05).Compared with group R,the doses of dopamine and ephedrine,the urinary output,the inci-dence of hypotension in group S were significantly reduced(P <0.05).Conclusion SVV/CI/MAP-di-rected fluid management is safer,more effective and renders much more stable hemodynamic than the routine fluid management.

Background:C-MET is expressed in a variety of tumor,and its expression may help to predict the prognosis of patients with gastric cancer. Aims:To explore the association of C-MET protein expression with survival in patients with stage Ⅲ gastric cancer. Methods:A total of 178 consecutive initially treated patients with stage Ⅲ gastric cancer from April 2010 to April 2014 at Beijing Pinggu Hospital were enrolled in this study. The expression of C-MET protein was determined by immunohistochemistry. Kaplan-Meier method was used to analyze the survival in patients with high C-MET protein expression and low C-MET protein expression,COX proportional hazards model was used to analyze the influence of various factors on prognosis. Results:C-MET protein was low expressed in 139 patients(78. 1%),and high expressed in 39 patients(21. 9%). Median survival(25. 1 months vs. 45. 0 months),1-year survival rate(69. 2% vs. 91. 4%),2-year survival rate(41. 0% vs. 84. 0%)were significantly decreased in high C-MET protein expression group than in low C-MET protein expression group(P all <0. 05). C-MET protein expression,N staging,and age were the influencing factor for prognosis of gastric cancer(P all <0. 05),however,gender and tumor differentiation were not related with prognosis(P>0. 05). Conclusions:C-MET protein expression rate is 21. 9% in patients with stageⅢgastric cancer,C-MET expression is significantly associated with survival;1-year survival rate is lower in patients with high C-MET protein expression.