Objective To evaluate the influence of a clinical pathway on mean length of hospital stay of ischemic stroke patients. Methods The study performed retrospective cohort study of stroke patients which were hospitalized in the Guangdong provincial hospital of TCM corresponding to the periods immediately before and after the implementation of the clinical pathway. The outcome measure was mean length of hospital stay. Results Mean length of hospital stay was significantly shortened after implementing clinical pathway. Conclusions The implementation of the ischemic stroke clinical pathway can shorten mean length of hospital stay of ischemic stroke patients and improve the utilization of medical source.

Objective:To study the stress distribution of the mandibular premolar cervix during clenching and mastication. Methods:Models of anisotropic enamel of the mandibular first premolar and the opposite maxillary first premolar crown were establishied. The stress distributions in the cervical region of the mandibular premolar were investigated in different loading conditions: simulating working, nonworking and vertical micromotions. In each case, the stroke was applied to the maxillary first mandibular premolar in a stepping procedure using nonlinear contact analysis. Results:The stress in the cervical region under loading condition simulating vertical micromotion was lower than that under loading conditions simulating working and nonworking micromotions. The stress was mainly concentrated near the buccal or the lingual cervical enamelo-dentinal junction under loading conditions simulating lateral excursion. Conclusion:The stress distribution in the cervical region is closely related to the pattern of occlusal force including location and direction.

Objective To measure various parameters with tissue Doppler imaging, quantitatively score left ventricular wall motion, assess longitudinal wall motion in total and regional myocardium of myocardial infarction patients. Methods Tissue tracking was adopted for assessing left ventricular regional myocardium of 30 myocardial infarction patients (MI group) and 30 normal subjects (control group). After collecting dynamic images and analyzing information off-line, maximum displacement along long axis asynchronously in annular, basal, mid and apical segments of different walls were acquired, and left ventricular wall motion score indexes(TT score indexes) were calculated. Results Maximum displacement in different segments of left ventricular regional myocardium was lower in MI group than control group, especially in infarcted segments. TT score indexes were lower in MI group than control group( 6.23? 1.93 vs 9.71? 1.08, P

Objective To observe longitudinal motion characteristics of regional myocardium in left bundle branch block(LBBB) patients. Methods Left ventricular regional myocardium of 15 LBBB patients and 15 normal subjects were assessed by tissue Doppler imaging(TDI). Peak velocities(V_S,V_E,V_A) during isovolumic contraction, ejection, isovolumic relaxation, early relaxation, atrial systole phases and maximum time velocity integral(TVI_(max)), displacement(D_(max)) in mitral(tricuspidal) annulets of different walls were measured. Furthermore, the different parameters from the beginning of electrocardiogram QRS wave to the beginning of S wave(Q-Sb),to the tip of S wave(TTP), the acceleration time of IVC wave(IVA), the acceleration time of the E wave(Eac),the durations of different phases(IVC,S,IVR,D)and IVC/S and others were acquired. Results Peak velocities(V_S,V_E)and TVI_(max) in left ventricular septal, inferior, anterior, posterior walls were lower in LBBB group than control group; those parameters in different segments of left and right ventricular lateral myocardium were not significantly lower in LBBB group than control group. What is more, D_(max) of mitral annular sites in LBBB group were lower than control group. Q-Sb, TTP and IVC in left ventricular septal, inferior, anterior, posterior walls were longer in LBBB group than in control group; IVA lengthened, Eac and Edc shortened in left ventricular septal, inferior walls; IVR lengthened, diastole shortened, IVC/S increased in left ventricular septal, inferior, and posterior walls. Conclusions Abnormal left ventricular activation sequence during LBBB caused obvious impairment in total and regional systolic and diastolic function. And delayed contraction with different degrees were resulted from different walls of left ventricle with intraventricular dyssynchrony; but contraction in right ventricle was not significantly delayed, with interventricular dyssynchrony.

Objective To evaluate orthotopic splenectomy and pericardial devascularization for the treatment of portal hypertension.Methods The modified anterior approach splenectomy includes dissection of the peri-splenic vessels and ligments before division of short gastric vessels.During pericardial devascularization,the dessection panel was close to the esophagus and the stomach,leaving intact both the anterior and posterior vagus trunks.Results 63 patients underwent this modified operation.The free portal pressure decreased from (38 ±4) cmH2O to(28 ±4)cmH2O.The average blood loss was (530 ± 37)ml.There was no mortality,nor perioperative gastric paralysis and portal venous thrombosis.By 12-36 months follow-up,there was no pancreatic leakage,hepatic coma and recurrence of bleeding.Intrahepatic portal venous thromboses were detected in 4 cases at the sixth postoperative months.Conclusions This modified splenectomy plus selective pericardial devascularization carries less bleeding and is safe and effective for the treatment of portal hypertension.

Objective To explore the indication,technology and clinical significance of laparoscopic choledocholithotomy and primary suture in treatment of choledocholithiasis.Methods 78 patients with choledocholithiasis were divided into two groups receiving respectively laparoscopic choledocholithotomy and T-tube drainage treatment,and laparoscopic choledocholithotomy and primary suture after common bile duct exploration.The time of operation,postoperative hospital stay and complications were analyzed and compared.Results Bile leakage occurred in 2 cases in the primary suture group and 3 cases in the T-tube drainage group;No residual stones or biliary stricture was found in either groups.The time of operation,postoperative complications were not statistically different (P ＞ 0.05).The difference in postoperative hospital stay and GI function recovery time between the two groups was statistically significant (P ＜ 0.05).Conclusion In well selected cases,the primary suture of common bile duct after laparoscopic choledocholithotomy is feasible and safe.

Objective The study aimed to analyze the clinical features and the causes of hospital death among the 5720 acute myocardial infarction(AMI)patients from Cardiology Center,Beijing Chao-Yang Hospital during the last 8 years. Methods A total of 5720 AMI patients received treatment in the Cardiology Center from January 1st ,2002 to December 31th ,2009 were retrospectively reviewed. All patients were classified according to age into 3 groups of ≤45,46 -75,and ＞ 75 years old. The morbidity,cause of death ,whether they had the PCI therapy,mortality after PCI and the impact of gender on the cause of death were observed respectively. Results The morbidity rate of male was significantly higher than female in all three groups,and the study also found that the morbidity rate of female was significantly higher in the group of ＞ 75 years old,which however was still lower than that of male. The AMI patients were more likely to accept PCI therapy,which could significantly reduce the mortality rate. The top 3 causes of death included acute heart failure(AHF),cardiogenic shock(CGS)and AHF combined with CGS. In addition,AHF caused significantly more death in female and older(＞ 75 years old)patients. Conclusions The morbidity rate of AMI patients in Beijing Chao-Yang Hospital increased year by year. And PCI therapy could reduce the mortality rate of all groups. Revascularization treatment seems to be feasible and safe for the patients older than 75 years old.

Objective To investigate the ability of dental service in Yunnan province by analyzing the distribution of oral medical institutions,the distribution of oraloral medical staffs,the per capita outpatient costs,and the rate of visiting the doctor.Methods A general survey on oral medical institutions was finished by using questionnaires.Results There were 1045 dental institutions,416 of them were public dental institutions.305 were in Kunming.305 dental institutions were in Kunming,the number of dental institutions per square kilometer was 14.2,the dental manpower index wasl5,the rate of visiting the doctor was 14.19％,per capita outpatient costs were 139.9 Yuan,and the above indexes were ranked first in Kunming.Conclusions In Yunnan province,oral health resources distribution were imbalanced.Dental service ability was uneven,perfect oral disease diagnosis and treatment quality control systems needs to be established,including cultivating specialized nurses relieve the tense situation of oral health care resources,and implenting the four hand operation,so as to effectively improve the quality of medical services.

Objective To investigate the relationship between plasma homocysteine (Hcy) levels and TCM syndromes of dementia.Methods 250 cases were divided into a dementia group (120 cases) and non-dementia group (130 cases).120 cases in the dementia group include 36 Alzheimer dementia(AD) patients and 84 vascular dementia (VaD) patients.The plasma levels of Hcy were measured in all 250 cases.The relationship between Hcy levels,TCM syndromes and dementia was analyzed.Results The level of plasma Hcy was significantly higher in the dementia group (17.13 ± 9.01) nmol/ml than that in the non-dementia group (12.81 ± 7.94) nmol/ml,and it was highest in the VaD patients (P＜0.01).The mean of Hcy concentration in obstruction of phlem-turbid syndrome was higher(18.43±7.81)nmol/ml than syndromes [Tanyuzuluo (5.38 ± 8.91)nmol/ml,Shenxusuikui (16.44 ± 9.05)nmol/ml,Shenyinkuixu(16.19 ± 9.24)nmol/ml,Ganjinghuowang (15.92 ± 7.28)nmol/m1,Pishen-Yangxu(12.26 ± 5.17) nmol/ml (P ＜ 0.01)].Conclusion Increased plasma Hcy levels may be one of the risk factors leading to AD or VaD.

Objective To explore the effect of time tracking on speed of tissue-type plasminogen activator treatment in patients with acute ischemic stroke,and the correlation between door to needle time (DNT) and onset to door time (ODT).Methods Time tracking tables had been prospectively collected since October 2012.The data of intravenous thrombolytic candidates with acute ischemic stroke were retrospectively reviewed from June 2009 to September 2013.Baseline characteristics and the correlation between ODT and DNT were assessed respectively before and after the implementation of time tracking.Results Three hundred and forty-two cases were finally included.Before the implementation of time tracking,ODT was negatively correlated with DNT (r =-0.169,P =0.015) ; Patients with transient ischemic attack (TIA)/stoke history (β =-0.168,P =0.020) and ODT (β =-0.246,P =0.001)accounted for the length of DNT independently.Since the implementation of time tracking,the elderly accounted for more (19.4％ (25/129) vs 10.3％ (22/213) ; x2 =5.552,P =0.018),the baseline nervous impairment was NIHSS scores (milder 11.0 ± 6.3 vs 12.5 ± 6.7 ; t =2.065,P =0.040),the proportions of patients taking multi-modality imaging were larger (63.6％ (82/129) vs 51.6％ (110/213) ; x2 =4.638,P =0.031) and the DNT decreased significantly ((87.6 ± 33.2) min vs (108.4 ± 52.4) min;t =4.274,P =0.000),which was especially seen in patients arrived within 1 hour after onset ((90.3 ±21.0) min vs (132.5 ± 46.0) min; t =5.048,P =0.000),and the previous inversely correlated DNT and ODT (r=-0.169,P=0.015) became irrelevant (r=-0.013,P=0.885).Conclusion Implementation of time tracking reduces DNT,and clears up the effect of ODT on DNT.