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Peking University Third Hospital is one of the first hospitals for experiments in clinical pathway selected by the Ministry of Health,which keeps optimizing the clinical pathway management mechanism and function of information system in its 4-year practice.This article described the combination strategy of clinical pathway management and information system applications,in terms of reasonable design of the management plan,standardized clinical pathway,strengthened execution control and improvement of the quality control.The purpose is to balance the relationship between clinical pathway management norms and user-friendliness of the system,enhance rationality and feasibility,improve efficiency and provide high-quality service to ensure medical safety.

To investigate whether accelerated blood clearance (ABC) phenomenon could be induced after repeated injection of mitoxantrone thermosensitive liposomes, LC-MS/MS and enzyme linked immunosorbent assay (ELISA) were used to measure the concentration of mitoxantrone and the anti-polyethylene glycol (PEG) IgM levels in rat plasma, separately. The drug was rapidly cleared away after the second administration. The anti-PEG IgM was detected after the first dose which was neutralized quickly after the second dose. It is proved that repeated administration of mitoxantrone thermosensitive liposomes in rat caused the ABC phenomenon.

Blood-brain barrier (BBB) is a kind of important barrier system in the body. It can have a choice to prevent certain substances from entering the brain, in order to maintain the relative stability of internal environment of the central nervous system (CNS). However, it also became an important restriction factor for the treatment of CNS diseases. Traditional Chinese medicine (TCM) had good curative effects on several kinds of CNS diseases, which illustrated that effective composition of TCM can pass through or influence the function of BBB. This paper summarized the research progress of literatures on current pharmacological and clinical trials for the effect of TCM on BBB.

Breach rhythm was firstly described in 1979, and is considered as a rare benign variant of electroencephalogram. The etiology, electroencephalogram features and evaluation of breach rhythm, and so on, are discussed in this article.

The diagnostic reference level (DRL) for adults radiation dose in CT examination based on a large-scale national survey data is released in the form of national health industry standards (WS/T 637-2018) after more than ten years of exploration by radiologists, imaging technologists, radiation protection specialists and radiographers. Its principles and method are in line with international practices and the actual situation in China, which basically cover frequently-used CT examination items for adults. Compared with DRL in several other countries or organizations, radiation exposure to the patients as a whole is at a reasonably low level. The 50^th percentile (achievable dosimetry levels) and 25^th percentile (indicative level of unusually low dosimetry) are given as additional tools for radiation dose optimization guidance. In daily activities of radiological diagnosis, the radiation dose should be matched with image quality and clinical diagnostic tasks, and the frequency of unjustifiable high or low radiation dose should be reduced.

Objective To investigate the speech recognition in noise in patients with unilateral conductive or mixed hearing impaired using Sophonotron Alpha 2 softband.Methods A total of 12 patients (12 ears) with unilateral conductive or mixed hearing loss participated in the survey and fitted with Sophonotron Alpha 2.The aided hearing threshold test and speech recognition test in noise were evaluated in both unaided and aided conditions.Results The average aided hearing threshold using Sophonotron Alpha 2 softband was 35.0±10.8 dB HL,showing significant improvement compared to that of unaided(P＜0.05).The average signal-to noise ratio loss was 5.9± 6.1 dB using Sophonotron Alpha 2 softband in noise,showing a more significant benefit than that of the unaided (13.6±10.9 dB).Conclusion The Sophonotron Alpha 2 softband can significantly improve speech recognition in noise for the patients with unilateral conductive or mixed hearing loss.

Objective:To study the expression and significance of microparticles (MPs), platelets microparticles (PMPs), CD41a +CD62P +PMPs from peripheral blood of patients with ankylosing spondylitis. Methods:Plasma were collected from 47 ankylosing spondylitis (AS) patients and 15 healthy volunteers. The levels of MPs, PMPs, and CD41a +CD62P +PMPs in plasma of AS patients and healthy controls (HC) were detected by flow cytometry. The clinical parameters including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Bath ankylosing spondylitis disease activity index (BASDAI) were obtained. T test and Spearman linear correlation analysis were used for statistical analysis. Results:The levels of MPs, PMPs, CD41a + CD62P + PMPs in plasma from AS patients were higher than those in plasma from HC [(3 466±641)/μl vs (619±152)/μl, t=2.342, P=0.022; (3 059±628)/μl vs (320±143)/μl, t=2.298, P=0.025; (566±121)/μl vs (47±22)个/μl, t=2.295, P=0.025]. The levels of MPs in plasma of AS patients were positively correlated with BASDAI ( r=0.555, P=0.000 4); and the levels of PMPs in AS patients were positively correlated with BASDAI ( r=0.542, P=0.000 6) but the CD41a +CD62P +PMPs in AS patients were not correlated with BASDAI ( r=0.298, P=0.073 2). The levels of MPs in plasma from AS patients were not correlated with ESR, CRP ( r=-0.016, P=0.917; r=0.035, P=0.817); PMPs in plasma from AS patients were not correlated with ESR, CRP ( r=-0.001, P=0.996; r=0.065, P=0.671). CD41a +CD62P +PMPs in plasma of AS patients were not correlated with ESR, CRP ( r=-0.129, P=0.400; r=-0.410, P=0.789). Conclusion:There is increased expression of MPs, PMPs and CD41a +CD62P +PMPs in AS patients, which is related with disease activity. MPs, PMPs may be involved in the inflammatory response of AS.

Implantable bone-conduction devices are characterized by the fact that the vibration is transmitted through bone conduction. The technology and surgical techniques in the application of implantable bone-conduction devices have developed considerably in recent years, experiencing a transformation from percutaneous to transcutaneous implantation. This article reviewed current developments in the types, surgical indications, and complications, as well as compared between the various bone-conduction devices to provid references for clinical application.

【Objective】 To investigate the relationship of miRNA gene polymorphisms with blood pressure (BP) responses to the sodium and potassium diet intervention. 【Methods】 In 2004, we recruited 514 participants from 124 families in seven villages of Baoji, Shaanxi Province, China. All subjects were given a three-day normal diet, followed by a seven-day low-salt diet, a seven-day high-salt diet, and finally a seven-day high-salt and potassium supplementation. A total of 19 miRNA single nucleotide polymorphisms (SNPs) were selected for analysis. 【Results】 Throughout the sodium-potassium dietary intervention, the BP of the subjects fluctuated across all phases, showing a decrease during the low-salt period and an increase during the high-salt period, followed by a reduction in BP subsequent to potassium supplementation during the high-salt diet. MiR-210-3p SNP rs12364149 was significantly associated with systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) responses to low-salt diet. MiR-4638-3p SNP rs6601178 was significantly associated with SBP while miR-26b-3p SNP rs115254818 was significantly associated with MAP responses to low-salt intervention. In addition, miR-26b-3p SNP rs115254818 was significantly correlated with SBP, DBP and MAP responses to high-salt intervention. MiR-1307-5p SNPs rs11191676 and rs2292807 were associated with SBP and MAP responses to high-salt diet. MiR-4638-3p SNP rs6601178, miR-210-3p SNP rs12364149, miR-382-5p SNP rs4906032 and rs4143957 were significantly associated with SBP response to high-salt diet. In addition, miR-26b-3p SNP rs115254818 was significantly associated with SBP, DBP and MAP responses to potassium supplementation. MiR-1307-5p SNPs rs11191676, rs2292807, and miR-19a-3p SNP rs4284505 were significantly associated with SBP responses to high-salt and potassium supplementation. 【Conclusion】 miRNA gene polymorphisms are associated with BP response to sodium and potassium, suggesting that miRNA genes may be involved in the pathophysiological process of salt sensitivity and potassium sensitivity.