The key to clinical paths administration lies in the optimization of the key processes and sectors in medical service, which will achieve an integration that is based on patients and span departments to cover all medical service sectors and processes. The clinical path practice was introduced into the hospital in 2005, and the clinical paths have been put into practice for over 20,000 cases/occasions by the end of 2009, scoring satisfactory social and economic outcomes as of now. For the purposes of speeding up the clinical path practice for expected outcomes in optimizing key medical service processes, we have got the following eight experiences and lessons: (1) Build shared demands; (2)Establish a powerful leadership; (3) Develop and promote visions; (4) Eliminate resistance and pool the forces; (5) Keep on the efforts and focus on details; (6) Reward involvements; (7) Recruit and develop key operators within the hospital; (8) Systemize and supervise the experiences of implementation.Promotion of clinical paths is a renovation in management with its inherent rules. Adoption of appropriate technical strategies and cultural strategies will upgrade the quality and acceptance of clinical path implementation.

Benign symmetric lipomatosis is a rare disease and may appear as a huge tumor in the neck. Four benign symmetric lipomatosis associated with gigantic painless mass or neck motion limitation were reported. Operative technique of one-time radical resection or stage resection was used to remove these tumors. One patient had a postoperative complication of incision effusion and infection, and three patients had no significant complication. At more than one-year follow-up, the motion and appearance of a patient's neck returned to normal, and no recurrence was observed. The etiology, clinical manifestations, diagnosis, and treatment of the disease were discussed.
Humans ; Lipomatosis, Multiple Symmetrical ; Neck ; Recurrence

Objective To investigate the application of MRI in evaluation of the traumatic temporomandibular joint (TMJ) injury induced by type Ⅵ condylar fracture. MethodsMRI was performed in TMJs in 18 patients with type Ⅵ condylar fractures at days 3-14 post-injury and the MRI findings were analyzed. ResultsMRI findings of 18 patients with traumatic TMJ injury with 19 sides of type Ⅵ condylar fractures showed 15 sides of TMJ disk displacement,nine sides of capsule tear,16 sides of retrodiscal tissue tear (double-plate area) and 19 sides of joint effusion change. Conclusions MRI is very important in the diagnosis and evaluation of traumatic TMJ injury,since it can clearly display the TMJ injuries in type Ⅵ condylar fractures.Therefore,the clinical application of MRI is beneficial for selection of the therapeutic schedules.

Objective To discuss the influence of percutaneous coronary intervention ( PCI) on the serum concentration of homocysteine (Hcy) and galectin-3 in patients with coronary heart disease (CHD).Methods From September 2016 to October 2017,70 patients in Ji＇nan Central Hospital were selected.According to the results of coronary angiography(CAG),they were divided into observation group with drug -eluted stents(n ＝47,including 25 cases with type A CHD and 22 cases with type B CHD) and control group without abnormal CAG (n＝23).Serial venous blood samples were obtained 1 day before PCI as well as 1 day and 7 days after PCI.Plasma concentrations of Hcy,BNP and galectin-3 were measured and compared.The postoperative patients with PCI were tracked for 1 year to observe the influence of serum Hcy and galectin -3 on the severity of CHD and the quality after PCI.Results The plasma Hcy levels of type A[(16.52 ±5.41)μmol/L]and type B[(19.32 ±6.35)μmol/L]after PCI were signifi-cantly higher than those of the type A [(11.66 ±3.25)μmol/L]and the type B[(15.87 ±5.20)μmol/L]before PCI (t＝2.375,P ＜0.05,t ＝2.97,P ＜0.01).Meanwhile,the plasma galectin -3 levels of type A [(0.86 ± 0.11)μg/L] and type B [(1.15 ±0.48) μg/L] after PCI were also higher than those of the type A [(0.32 ± 0.53)μg/L]and the type B[(0.46 ±0.19)μg/L]before PCI(t＝2.178,P＜0.05,t＝4.269,P＜0.01).Further-more,levels of the plasma Hcy and galectin -3 were positively associated with the severity of CHD.Conclusion The higher blood levels of serum Hcy,BNP and galectin-3 after PCI indicate that the balloon inflation and implantation of stent can affect the level of plasma Hcy,BNP and galectin-3.Therefore,the levels of serum Hcy and galectin -3 are helpful to diagnose CHD and evaluate the degree of CHD.

No abstract available.
Up-Regulation*

Objective To analyze the clinical efficacy of amlodipine atorvastatin calcium tablets in the treatment of hypertension with coronary heart disease .Methods 88 patients with hypertension and coronary heart disease were selected as observation subjects and were randomly divided into control group (44 cases) and treatment group (44 cases) using the digital table method .The control group was treated with atorvastatin ,while the treatment group was treated with amlodipine and atorvastatin calcium .The therapeutic effects of the two groups were compared .Results The total effective rate was 93.18％in the treatment group,which was significantly higher than 75.00％ in the control group (χ2 =5.44,P<0.05).The incidence rate of adverse reactions in the treatment group was 11.36％,compared with 6.82％in the control group,the difference was not statistically significant (χ2 =0.55,P>0.05).Conclusion For patients with hypertension and coronary heart disease ,taking amlodipine atorvastatin calcium treatment can effectively improve their blood pressure conditions .Its efficacy is better than that of atorvastatin ,which is safe and reliable .

BACKGROUND:The cervical pedicle screws provide ideal three-column stability for cervical vertebra, but there is stil no a standard with the choice of pedicle screw place methods in cervical vertebra. Here, we try to seek a simpler, safer and accurate pedicle screw place method.OBJECTIVE:To evaluate the accuracy and security of transpedicular screw placement assisted by rapid prototyping individual navigation template. METHODS:Eight cadaver cervical specimens (C3-6) were selected to take CT-scan and data were saved in DICOM format. Three-dimensional (3D) software MIMICS was used to establish the C3~6 3D model, and designed the best pedicle screw channel. According to the morphological feature of the posterior cervical spine elements, the reverse template was designed. Then, the best pedicle screw channels were fused into bilateral navigation template. The navigation template was manufactured by rapid prototyping, and saved in STL format. Rapid prototyping technology was used to print out the navigation template. Cervical pedicle screws were inserted with the assistance of navigation templates fitted with the posterior structure of the vertebral body. Postoperative X-ray and CT scan were used to evaluate the accuracy of screw placement. RESULTS AND CONCLUSION:(1) Total y 64 screws were inserted with the assistance of individual navigation templates. Of them, 62 screws were completely in the pedicle;1 screw perforated the medial cortex of pedicle;1 screw perforated the lateral cortex of pedicle. Accuracy of screw placement was 97%. (2) The individual navigation template with a high accuracy rate is a feasible and safe method for cervical pedicle screw placement, which has great prospects for clinical application.

Objective To investigate the surgical outcome of lumbar spinal canal stenosis. Methods Forward analysis of 160 cases of the patients with lumbar spinal canal stenosis getting operative treament was performed. 87 cases were male and 73 case were female. The average age was 51 years old (18 ～ 78years old). The average course of deseases was 5 years (1 month ～ 36years). All of the cases used lumbar spinal canal decompression combined with pedicle screws fixation and posterolateral bone graft. All cases had a follow - up of 3 months to 5 years (mean 34 months). Results The (COA) recovery rate among the tolal patients was cassified as exellent in 120 ca-ses , good in 31 cases , fair in 7 cases. The excellent and good rate was 94.4%. Conclusion The operative intervention was an effective method for patients with severe or progressive clinical lumbar spinal canal stenosis. The procedure in decompressed compretely through pos-terior approach and the instability of cerrical apinein had the satisfactory clinical outcome.

Objective To analyze the temperature modification effect on acute mortality due to particulate air pollution. Methods Daily non-accidental mortality, cardiovascular mortality, and respiratory mortality data were obtained from Jiang'an District Center for Disease Control and Prevention. Daily meteorological data on mean temperature and relative humidity were collected from China Meteorological Data Sharing Service System. The daily concentration of particulate matter was collected from Wuhan Environmental Monitoring center. By using the stratified time-series models, we analyzed effects of particulate air pollution on mortality under different temperature zone from 2002 to 2010, meanwhile comparing the difference of age, gender and educational level, in Wuhan city of China. Results High temperature (daily average temperature>33.4℃) obviously enhanced the effect of PM10 on mortality. With 10 μg/m3 increase in PM10 concentrations, non-accidental, cardiovascular, and respiratory mortality increased 2.95%(95%CI:1.68%-4.24%), 3.58%(95%CI:1.72%-5.49%), and 5.07%(95%CI:2.03%-9.51%) respectively. However, low temperature (daily average temperature <-0.21 ℃) enhanced PM10 effect on respiratory mortality with 3.31%(95%CI: 0.07%-6.64%)increase. At high temperature, PM10 had significantly stronger effect on non-accidental mortality of female aged over 65 and people with high educational level groups. With an increase of 10 μg/m3, daily non-accidental mortality increased 4.27% (95%CI:2.45%-6.12%), 3.38% (95%CI:1.93%-4.86%) and 3.47% (95%CI:1.79%-5.18%), respectively. Whereas people with low educational level were more susceptible to low temperature. A 10μg/m3 increase in PM10 was associated with 2.11%(95%CI:0.20%-4.04%)for non-accidental mortality. Conclusions Temperature factor can modify the association between the PM10 level and cause-specific mortality. Moreover, the differences were apparent after considering the age, gender and education groups.

Objective To analyze the temperature modification effect on acute mortality due to particulate air pollution. Methods Daily non-accidental mortality, cardiovascular mortality, and respiratory mortality data were obtained from Jiang'an District Center for Disease Control and Prevention. Daily meteorological data on mean temperature and relative humidity were collected from China Meteorological Data Sharing Service System. The daily concentration of particulate matter was collected from Wuhan Environmental Monitoring center. By using the stratified time-series models, we analyzed effects of particulate air pollution on mortality under different temperature zone from 2002 to 2010, meanwhile comparing the difference of age, gender and educational level, in Wuhan city of China. Results High temperature (daily average temperature>33.4℃) obviously enhanced the effect of PM10 on mortality. With 10 μg/m3 increase in PM10 concentrations, non-accidental, cardiovascular, and respiratory mortality increased 2.95%(95%CI:1.68%-4.24%), 3.58%(95%CI:1.72%-5.49%), and 5.07%(95%CI:2.03%-9.51%) respectively. However, low temperature (daily average temperature <-0.21 ℃) enhanced PM10 effect on respiratory mortality with 3.31%(95%CI: 0.07%-6.64%)increase. At high temperature, PM10 had significantly stronger effect on non-accidental mortality of female aged over 65 and people with high educational level groups. With an increase of 10 μg/m3, daily non-accidental mortality increased 4.27% (95%CI:2.45%-6.12%), 3.38% (95%CI:1.93%-4.86%) and 3.47% (95%CI:1.79%-5.18%), respectively. Whereas people with low educational level were more susceptible to low temperature. A 10μg/m3 increase in PM10 was associated with 2.11%(95%CI:0.20%-4.04%)for non-accidental mortality. Conclusions Temperature factor can modify the association between the PM10 level and cause-specific mortality. Moreover, the differences were apparent after considering the age, gender and education groups.