Objective To analyze the effect of clinical pathways on single disease management.Methods Clinical controlled trials on tumors of uterine,benign biliary tract diseases and benign thyroid neoplasm were collected and related literatures were screened according to the criteria of inclusion.The literature so collected underwent a Meta analysis.Results A total of 21 literatures were included.Meta analysis indicated that statistical difference existed in the total cost of hospitalization(WMD=1046.06,95％CI:- 1281.15 ～ - 810.96,P＜0.00001) and length of hospital stay (WMD=- 2.18,95％CI:-2.59～- 1.76,P＜0.00001)between non-clinical pathways group and clinical pathways group.Conclusion Implementation of clinical pathways can further reduce hospital costs and shorten hospital days of the single disease management.

Objective To study HBeAg change in patients infected hepatitis B virus(HBV) with pre-C signal enzyme cleavage site mutation. Methods Mutation in pre-C signal enzyme cleavage site was detected by PCR-RFLP. The PreC/C gene with mutation was amplified by PCR and was cloned to EB viral eukarotic expression vector. Then transfect the vector with wild type or mutant PreC/C gene to HepG2 cell. SEAP reporter system was used to monitor the efficiency of transfection. HBeAg and its precursor in the supernatant and HepG2 cell were detected by ELISA and Western blot. Results HBeAg was positive in the supernatant of wild type and negative control in T1862 vaniant by ELISA. In HepG2 cell transfected with wild type, three proteins were detected by Western blot, they were HBeAg(17 000) and two HBeAg precursor(22 000 and 25 000). And in HepG2 cell transfected T1862 vaniant, only two HBeAg precursor was detected. The precursor in cells transfected withT1862 vaniant were significantly stronger than cells transfected with wild type. Conclusion Mutation in pre-C signal enzyme cleavage site may affect the decoration of HBeAg, which may cause great of HBeAg precursor locating in cells and lead to HBeAg negative in serum of patients infected with HBV.

Objective To investigate the clinicopathological difference and prognosis of colorectal adenocarcinomas including mutinous, Signet-ring cell, papillary and tubular carcinomas. Methods Two thousand and eighty-nine patients with colorectal cancer underwent colorectal operation between August 1994 and April 2007. The clinicopathological characteristics of mucinous adenocarcinoma (n=144), signet-ring cell carcinoma (n=25), papillary and tubular carcinomas (n= 1837) were compared expect of other types of cancer (n = 83). The single factor and Logistic regression methods were used to analyze the clinicopathological parameters that influence the prognosis of colorectal cancer such as age, location of the tumor, staging, peritoneum and pathological typing. The survival rates of patients with above three types of adenocareinomas were analyzed. Results The mean age of onset was lowest in patients with mutinous adenocarcinomas [(54. 20 ± 16.25) years] compared with that in patients with signet-ring cell cancer [(40.43 ± 12.88)years] or papillary and tubular carcinomas [(58. 73 ±13.62)]. There were significant differences in gender, size and location of the tumor, TNM staging, peritoneal metastasis, lymph node involvement and adjacent organ invasion among three groups (all P values <0.05). The single factor and Logistic regression analysis revealed that both mucinous adenocarcinoma and signet-ring cell carcinoma were risk factors ot prognosis. The patients with mucinous adenocarcinoma or signet-ring cell tumor were poor in long-term overall survival in comparison with patients with papillary and tubular carcinoma (P<0. 001). Conclusions The colorectal mucinous and signet-ring cell adenocarcinomas are risk factors for prognosis of colorectal cancer, which imply the poor outcome.

Objective To explore clinical features,prognosis and study related cancer types in patients with familial gastric carcinoma. Methods Nine families of ICG-HGC and 3 families of suspected-ICG-HGC according with International Collaborative Group on Hereditary Gastric Cancer standard were collected and their pedigree trees were drawn.Clincial features and prognosis of ICG-HGC and suspected-ICG-HGC families were analyzed.and the related cancer types of ICG-HGC and suspected-ICG-HGC kindreds were investigated. Resuits The morbidity of ICG-HGC and suspected-ICG-HGC was 0.99%;The age of patients among the propositi of 12 kindreds were 29～65 years old with the mean age of 56 years old.Among 11 kindreds,there were 45 cases of cancers including 2 cases of multiple cancers.There were 30 foci of gastric cancer,most of which were located in lower and middle third of the stomach,with pathologic type of adenocarcinoma in poor to moderate differentiation.There were totally 15 extrastomach tumors including 7 colorectal cancers.Four cases of 11 kindreds had survived for 3 years including 1 case surviving for more than 10 years. Conclusion The familial gastric cancers in southern China have special characteristics such as poorly pathologic differentiation,advanced cancer stage,early age of onset,distal end of the stomach in location and high incidence of related tumors in colorectum.

Objective To evaluate the efficacy and safety of sunituib in Chinese patients with advanced imatinib-resistant/intolerant gastrointestinal stromal tumor (GIST). Methods From Mar 2008to Sep 2009, the clinicopathological data of patients treated with sunitinib were retrospectively analyzed.Initial 5 patients received 50 mg/day of sunitinib on a protocol of 4/2 ( 4 weeks on treatment, 2 weeks off treatment), 13 patients subsequently admitted were switched onto protocol of 37.5 mg/day continuous daily dosing treatment. Results Eighteen patients received sunitinib for more than 8 weeks following imatinib failure. Median progression-free survival was 44. 0 weeks (95% CI:22. 7 ～ 65. 3 weeks). Partial responses were observed in 1 patient, disease stable in 11, disease progression in 5 and assessment was not applicable in 1 patient. The most common adverse effects of sunitinib were hand-foot syndrome and leucopenia.Conclusions Sunitinib is effective in patients with imatinib resistant/intolerant advanced GIST and Chinese patients generally tolerate to 37. 5 mg/day continuous daily dosing of sunitinib. Adverse effects are manageable using dose interruption/reduction and/or standard medical treatments.

Objective To investigate the clinical application of fast track surgery in patients undergoing elective colorectal carcinoma surgery. Methods Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: fast-track group (35 cases) and conventional care group (35 cases). Results Sixty-two patients finished the study, 32 cases in fast-track group and 30 cases in conventional care group. The median and average time to the first passage of flatus (2±1 vs. 4±2, P<0.01), the first passage of stool (3.8±1.6 vs. 6.4±2.5, P=0.0007), resumption of normal diet [(4±2) vs. (8.2±2.2), P<0.01] and the length of postoperative stay (6±1 days vs. 11.7±3.8 days, P<0.01) were much shorter in the fast-track group than in the conventional care group. The preoperative incidence of thirst (2/32 vs. 23/30, P<0.01), hunger (5/32 vs. 20/30, P<0.01) and postoperative infectious complications (2/32 vs. 8/30, P=0.04) were much lower in the fast-track group than in the conventional care group. Conclusion Fast track surgery in patients undergoing elective colorectal resection was safe and effective.

A gel permeation chromatography ( GPC ) coupled with solid phase extraction and gas chromatography-mass spectrometric ( GPC-SPE-GC/MS ) method was developed to analyze seven kinds of organophosphate esters ( OPEs ) , including tri-n-butylphosphate, tri ( 2-chloroethyl ) phosphate, triphenyl phosphate, tris ( 2-butoxyethyl ) phosphate, tri-o-tolylphosphate, tri-m-tolylphosphate, and tri-p-tolylphosphate) in human serum. The recoveries of cleanup methods between GPC-silica/alumina column and H2 SO4-silica/sulfuric acid gel column were compared. The purification method with the GPC-silica/alumina column didn’t destroy the structure of organophosphate esters ( OPEs ) and could effectively remove some protein and lipid matrix influence in serum. The developed method was verified using the spiked blank and the spiked serum, the good recoveries and reproducibilities were achieved. The recoveries of all of OPEs in spiked blank (n=3) were all more than 75%. The recoveries of d12-TCEP and d15-TPhP in human serum samples (n=9) were 86. 3%±21. 6% and 103. 1%±16. 5%, respectively. In human serum samples (n=9), the detection ratios for TnBP, TCEP, TPhP, TBEP and m-TTP were more than 90% in all of the serum samples, p-TTP was only 30%, o-TTP was not detectable. The concentrations of TnBP, TCEP, TPhP, TBEP and m-TTP in serum were 3. 4-46. 5 ng/g lipid, 248. 6-958. 2 ng/g lipid, n. d. -4. 2 ng/g lipid, n. d. -49. 9 ng/g lipid and n. d.-23. 1 ng/g lipid, respectively.

Objective To summarise the clinicopathologic features and survival of gastric cancer at different tumor locations.Methods A total of 942 adult gastric cancer patients undergoing curative gastrectomy with lymphadenectomy were recruited from the First Affiliated Hospital,Sun Yat-sen University,and examined retrospectively.In all cases,patients' age,gender,pTNM stage and survival time were identified and recorded.Results There were 208 carcinoma cases at gastroesophageal junction (GEJ,22.1％),261 fundus/body cases (27.7％),445 antrum/pylorus cases (47.2％) and 28 whole stomach cases (3.0％).Compared with fundus/body and antrum/pylorus carcinoma,GEJ carcinomas were more often seen in males,among older patients,with larger tumor size and deeper infiltrated tumors,higher stage and worse 5-year disease-free survivals.Whole stomach carcinoma had predilection in female,younger patients,and at later stages and worst 5-year disease-free survival.Conclusions Gastric carcinomas differ greatly in biologic behavior and prognosis by anatomic locations.GEJ carcinoma has independent biologic features.Whole stomach carcinoma is of the highest malignancy and worst prognosis.

Objective To evaluate the clinical and radiological results of locking plate for treatment of proximal humerus frac‐tures and the efficacy of anatomical healing of tuberosities .Methods A total of 57 patients with proximal humerus fractures were treated with locking‐plate from July 2008 to March 2012 .A standardized radiological evaluation was conducted .Patients were divid‐ed into two groups :group A (anatomical healing of tuberosities) with 31 cases and group B (without anatomical healing of tuberosi‐ties) with 26 cases .Clinical assessment was performed using the Neer rating scale .Results Considering the entire sample ,the mean Neer score was 87 .96 ± 5 .06 points ,the excellent rate was 94 .74℅ .Comparing these parameters in the two groups ,group A was significant higher in the Neer scores and the range of movement than that of group B (P<0 .05) ,there was no statistic differences in the scores of pain and function (P>0 .05) .Conclusion the locing plate for treatment of complex proximal humerus fractures has a high subjective satisfaction rate .A good functional result depends on anatomical reestablishment of proximal humerus anatomy , particularly the healing of the greater tuberosity .

Objective Routine perioperative intravenous antimicrobial agents,was administered as surgical prophylaxis.However,whether balanced ultrafiltration during extracorporeal circulation can remove antimicrobial agent remains unclear.The concentrations of antimicrobial agent in plasma and ultrafiltrate samples were measured in this pseudo-extracorporeal circulation model.Methods Extracorporeal circulation consisted of cardiotomy reservoir (Ningbo Fly Medical Healthcare CO.,LTD.Ningbo,China),D902 Lilliput 2 membrane oxygenator (Sorin Group Asia Pte Ltd,Beijing,China) and Capiox (R) AF02 pediatric arterial line filter (Terumo Corporation,Beijing,China).HEMOCONCENTRATOR BC 20 plus (MAQUET Cardiopulmonary AG,Hirrlingen,Germany) was placed between arterial purge line and oxygenator venous reservoir.Fresh donor human whole blood was added into the circuit and mixed with Ringer's solution to obtain a final hematocrit of 24％-28 ％.After 30 minutes of extracorporeal circulation,zero-balanced ultrafiltration was initiated and arterial line pressure was maintained at approximately 100 mm Hg(1 mm Hg =0.133 kPa) with Hoffman clamp.The rate of ultrafiltration (12 ml/min) was controlled by ultrafiltrate outlet pressure.Identical volume of plasmaslyte A was dripped into the circuit to maintain stable hematocrit during 45 minutes of experiment.Plasma and ultrafiltrate samples were drawn every 5 minutes and concentrations of antimicrobial agent (including Cefmetasole and cefotiam) were measured with high performance liquid chromatography.Results All these two antimicrobial agents were detected in ultrafiltrate,demonstrating hemoconcentration may remove antimicrobial agent.The concentration of plasma antimicrobial agent decreased lineally with the increase of ultrafiltrate volume.At end of balanced ultrafiltration,the concentration of plasma cefotiam was (104.96 ± 44.36) μg/ml,which is about (44.38 ± 7.42) ％ of the initial concentration (238.95 ± 101.12) μg/ml; the concentration of plasma cefmetazole decreased linearly to (25.76 ± 14.78) μg/ml,which is about (49.69 ± 10.49) ％ of the initial concentration (51.49 ± 28.03) μg/ml.The total amount of cefotiam in ultrafiltrate is (27.16 ± 12.17)％ of the total dose administered,whereas cefmetasole in ultrafiltrate is (7.74 ±4.17)％.Conclusion Balanced ultrafiltration may remove antimicrobial agent from serum and has significant influence on plasma concentration of antimicrobial agent.The strategy of surgical prophylaxis should consider this unique technique during extracorporeal circulation.