Objective To explore the effect of clinical pathway on the safety in patient with intracranial aneurysms during the perioperative period. Methods A total of 68 patients with intracranial aneurysms who had been hospitalized and treated from July to December 2012 were assigned to a study group and received clinical pathway. And then they were compared with 56 patients who had been treated from January to June (control group). The patients in control group received routine medical care. Then all the patients were evaluated in preoperative waiting duration, incidence of postoperative complications, health education compliance rate, and the Glasgow outcome scale (GOS) at discharge. Results Both the incidence rate of cerebral vasospasm and hydrocephalus and the health education compliance rate were improved in the study group (P<0.05), so was the GOS at discharge and 6 months after discharge (P<0.05). Conclusions The clinical pathway management plays a role in guarantee of the safety in patient during the perioperative phase and in the acceleration of postoperative rehabilitation.

In order to determine the cellular immunestate in patients with multiple myeloma, T-cellsubsets in peripheral blood from 25 cases withmultiple myeloma were measured with SPA-Ig di-rect rosette assay, the activity of interleukin-2 wasinvestigated by using mice thymocyte proliferationassay. The results showed that in multiple myelo-ma, OKT_3~+, OKT_4~+ cell decreased significantly.OKT_6~+ cell increased markedly and the OKT_4/OKT_8 ratio was reduced. The activity of IL-2 in pe-ripheral blood lymphocytes of the patients withmultiple myeloma increased sharply and there wasa significant difference between the active diseaseand the remission disease. The activity of IL-2 inthe remission disease was lower than that in theactive disease but higer than that of the controlgroup. In conclusion, this study indicated thatthere were imbalance of T-cell subsets and abnor-mality of IL-2 production in patients with multiplemyeloma. The data might suggest that there wasdisorder of the cellular immunity in the course ofthe disease.

Objective To explore the clinicopathological features of osteofibrous dysplasia (OFD). Methods All the clinicopathological information of 17 cases of OFD were reviewed,including sex,age,course and radiography or histopathology features. The expression of Cytokeratin(CK) was examined by SP. Results Age of the patients ranged from 2-15 years, and the course of the lesion ranged from 1 month to 7 years. The mean age and the mean course was 7.2 years and 2.1 years respectively. Male to female ratio was 1∶1.4. The lesions all occured in tibia, presentating with localized masses. Only one invloved with both tibia and fibula. Radiographs showed there were cystic lesions in the thickened anterior cortex of the tibia with light marginal sclerosis. Histopathology showed a zonal architecture. Abundant osteoblasts in the vicinity of the trabeculae. Only two cases were positive for CK(11.8%). 8 of 10(80%) patients recurred. Conclusion OFD is predominately involved with the tibia in children. The history is long. It has a characteristic histopathologic image and clinical progress. Its a independent entity, not the same of adamantinoma.

Acute rejection is one of the serious early postoperative complications after liver transplantation.Many studies have shown that acute rejection was mainly mediated by T cells,while humoral factors were responsible for chronic rejection.However,accumulating evidences have demonstrated that humoral immune factors also played an important role in early acute rejection and usually resulted in severe adverse events.Here we clarify the role of humoral immunity in liver transplant rejection,which may help guide the clinical management of such patients with humoral rejection after liver transplantation.

Pancreatic head carcinoma could easily invade the neighboring vessels due to its own biological features and anatomical location,which increases the technique difficulty and risk,leading to low resection rate.Recently,with the progress on the surgical techniques and perioperative management,and the emergence of neoadjuvant chemoradiation,vascular invasion is no longer the surgical contraindications and pancreaticoduodenectomy combined with vascular resection has saved many patients ' lives.However,the preoperative assessment,the timing of surgery,the vessel management during the surgery,and the prevention and treatment of the postoperative complications remain controversial.In order to achieve a clear understanding on the application of pancreaticoduodenostomy combined with vascular resection,here we review the recent publications and share the experiences on pancreaticoduodenectomy with portal and/or superior mesenteric vein resection from our center,which may help improve the safety and resection rate of pancreatic carcinoma and enhance the overall therapeutic efficacy of treating pancreatic cancer.

AIM: To evaluate the clinical efficacy and safety of Qili Qiangxin Capsule(Radix Astragali,Radix Aconiti lateralis praeparata,Radix et Rhizoma Salviae miltiorrhizae,Radix et Rhizoma Ginseng,Semen Lepidii,Semen Descurainiae,Flos Carthami,Pericarpium Citri reticulatae,Rhizoma Alismatis,Cortex Periplocae,Rhizoma Polygonati odorati,Ramulus Cinnamomi) with chronic heart failure(CHF).METHODS: Seven randomized controlled trials were reviewed.RESULTS: The meta-analysis indicated that the treatment group of Qili Qiangxin Capsule could decrease the cardiac functional grading of NYHA with 1.21 of the relative risk,and 95% confidence interval(CI) from 1.08 to 1.36;increase 6 minute walking distance with the weighted mean difference(WMD) was 37.39,and 95% confidence interval was from 22.58 to 52.20;raise left ventricular ejection fraction(WMD = 3.97[2.09,5.85]),decrease the left ventricular end-diastolic diameter(WMD = 2.81[1.41,4.22]),lower the level of B-type natriuretic peptide(WMD = 118.00[4.44,231.56]) and N-terminal pro-brain natriuretic peptide(WMD = 476.90[371.26,582.54]) in blood plasma and drop the score of Minnesota living with heart failure questionnaire(WMD =8.00[3.48,12.52]),but Qili Qiangxin Capsule for reduction in left ventricular end-diastolic volume,left ventricular end-systolic volume,heart rate and blood pressure also need to be confirmed.Besides,individual ca-ses occurred adverse reactions like dry cough,epigastric discomfort,gastric distention.However,It could be tolerated and hadn't significant statistical difference with comparison to control group.CONCLUSION: Qili Qiangxin Capsule is effective and safe for the patients of chronic heart failure in improving the heart function and living quality.

Objective To compare the dosimetric parameters between the use of Tandem and Ring (TR;Nucletron#090.617) or Tandem and Ovoid (TO;Nucletron#189.730) applicators during three-dimensional (3D) high-dose rate (HDR) brachytherapy (BT) for cervical cancer.Methods The records of 40 cervical cancer (ⅡB-ⅣA) patients treated with 3D-image-guided HDR-BT were reviewed.Of these 40 patients, 20 were treated with the TO applicator, and 20 with the TR applicator.The D100% and V150% of the clinical target volume (CTV) and the D2 cc of organs at risk (OAR)(the rectum, bladder, and small intestine) during 3D-HDR-BT using TO and TR were compared using the independent sample t-test.ResultsOverall metrics:CTV volume:66.04±13.86 cm3(TR) vs.65.67±15.08 cm3(TO)(P=0.052);CTV D100:3.71±0.34 Gy (TR) vs.3.37±0.49 Gy (TO)(P=0.016);CTV V150%:0.54±0.02(TR) vs.0.56±0.04(TO)(P=0.034);rectum D2 cc:3.38±0.30 Gy (TR) vs.2.95±0.80 Gy (TO)P=0.037);bladder D2 cc:4.33±0.39 Gy (TR) vs.2.93±1.27 Gy (TO)(P=0.00);and small ntestine D2 cc:3.04±1.02 Gy (TR) vs.3.41±0.57 Gy (TO)(P=0.171).Conclusions TR has better CTV coverage than TO during 3D HDR brachytherapy for cervical cancer.In addition, D2 cc of the rectum and bladder were both igher with TR than with TO, though there is no significant dosimetric difference in the small intestine between the two applicators.Therefore, tumor location, extent of invasion, and vaginal conditions should be considered when selecting the suitable pplicator for the treatment of cervical cancer.

Objective To design a wearable physiological monitoring system for acquiring and monitor-ing vital signs non-intrusively and concurrently.Methods All bio-sensors were embedded in an elastic shirt for detecting physiological parameters with wearable technology.A patented respiratory inductive plethysmography technology was used to measure respiratory function,two sensors were woven into the jerkin around the patient's chest and abdomen.A three-lead,single channel ECG measures heart rate,and a three-axis accelerometer records posture and activity level.An NTC thermometer embedded in the shirt measures the body temperature.Results An elastic jerkin with embedded sensors that collect and continuously monitor respiration,cardiac,temperature,posture and activity signals was fabricated.Conclusion This wearable physiological monitoring system can record multiple parameters non-intrusively and concurrently.It can act as an useful platform for further researches.

Objective To study the clinical characteristics which are related to malignancy in pancreatic intraductal papillary mucinous neoplasm (IPMN) with an aim to provide evidence for clinical practice.Methods Using PubMed,all pancreatic IPMN related articles with positive pathologic results before July 30th,2011 were studied.A pooled analysis was carried out on the morphological features of the disease.The analysis included gender,diameter of main pancreatic duct,diameter of cystic lesion,mural nodules and histological types (benign/malignant) of the neoplasm.Results 98 articles (including 1902 cases) were collected and analyzed.1025 cases were benign (53.89％) and 877 cases (46.11 ％) were malignant.Morphologically,there were a correlation between main pancreatic duct dilatation (≥5 mm),cystic lesion of large size (≥30 mm),presence of mural nodules and malignancy.The OR (95％ CI) were 5.591 (3.657-8.548),3.633 (2.626-5.027) and 4.983 (3.872-6.412) respectively.Conclusions A main pancreatic duct dilatation (≥5 mm),cystic lesions of large size (≥30 mm) and presence of mural nodules prompt the tumor to be malignant.In clinical work,the management of pancreatic IPMN should be made prudently based on comprehensive analysis of clinical features and the patient's status and intent.

Objective To investigate the effect of Tetramethylpyrazine (extracted from Chinese herbal medicine Ligusticum wallichii) employed in the early stage of severe brain injury on the restoration of brain function in coma patients monitored with digitized cerebral state monitor and clinical signs.Methods A total of 364 patients were referred to us from Emergency Department and Neurosurgery Department,Shenzhen People's Hospital from January 2006 through May 2012.The scores of patients'GlasgowPittsburgh coma scales were between 7-20 as brain injury happened within 24 h and survived more than two weeks.All patients were randomly (random number) divided into two groups:Tetramethylpyrazine group (n =186) and control group (n =178).The patients of control group received routine treatment,and the patients of Tetramethylpyrazine group were treated with Tetramethylpyrazine in addition to routine treatment in early stage.The patients of two groups were assessed with cerebral state indexes (CSI) and GlasgowPittsburgh coma scales before treatment and 3,7,14 days after treatment.Statistical comparisons between groups were analyzed by using repeated measure design analysis of variance.Results A repeated measures design analysis of variance indicated that the CSI and clinical signs (Glasgow-Pittsburgh coma scale) were improved significantly in Tetramethylpyrazine group than those in the control group at 3,7,14 days after treatment (P =0.024).Conclusions Tetramethylpyrazine can protect brain function and improve clinical signs in patients with severe brain injury in the early stage.