The paper covered the selection of clinical trial diseases in the clinical pathway experiment in the hospital in the recent two years.It also introduced such management measures as making clinical pathway texts,the rate of cases into clinical pathways,emphasis of variation management,and enhanced clinical pathway data analysis.A comparison between the groups before and after clinical pathway management,found that the clinical pathway can reduce the average days of stay and total patient costs by 3.4 days and 1519 yuan respectively.Both patients and hospitals benefit from clinical pathways.The paper also advocates continuous and dynamic management at various stages of clinical pathway management.

Objective To study on postpartum obsessive compulsive disorder at home and abroad,and to provide new idea of diagnosis,evaluation and treatment on postpartum obsessive compulsive disorder.Method A search using Medline,Embase,EBSCO,Cochrane Library,Web of Science (ISI),Pubmed databases and Google Scholar was carried out using the key words:obsessive compulsive disorder (and derivatives),perinatal,pregnancy,postnatal,postpartum,mothers (and derivatives),anxiety disorders and subtypes. These articles and their references were reviewed.Results Twenty-seven papers were incorporated,but no Chinese paper.The life prevalence of postpartum OCD was 2.3％-11.0％.The most common obsessions were aggressive,contamination and miscellaneous,and compulsion for washing/cleaning and checking.Cognitive behavioural therapy and SSRIs have been suggested as a fist-line treatment of postpartum OCD.Conclusion OCD is more prevalent in the postpartum period.The evidence that OCD in the postpartum period presents a distinctive clinical picture with specific symptomatology and course is more compelling.Collaborative,international,prospective studies that take into account the methodological and definitional issues raised in this review are necessary to provide clarification.

Neoadjuvant chemotherapy is widely used in the therapy of locally advanced breast cancer.In the recent studies,the expressions of ER,PR and C-erbB-2 in tumor may change in different scheme preand post-neoadjuvant chemotherapies for breast cancer.It is obviously changed in the neoadjuvant chemotherapy scheme of anthracyclines and paclitaxel/docetaxel,but hardly changed in anthracycline-based neoadjuvant chemotherapy scheme.

Objective To evaluate the efficacy and safety of oral ibuprofen for closure of patent ductus arteriosus (PDA) in preterm infants.Methods The related literatures till December 31st,2011 in Cochrane Library,PubMed,EMBASE,Ovid,Springer,China Academic Journal Full-text Database,Wanfang Database,VIP Database and China Biological Medical Literature Database were searched.The inclusion criteria were:(1) the subject of the research was preterm infants with birth weight less than 2500 g and/or gestational age less than 37 weeks; (2) randomized or semirandomized controlled trial; (3) the intervention group received oral ibuprofen,while the control group received oral placebos / intravenous indomethacin or ibuprofen; (4) the main outcome was the failure rate of PDA closure; (5) hemodynamic changes with PDA were detected by ultrasonography.Meta-analysis was performed by Review Manager 4.22 software.Results Eleven randomized controlled trials were included,among which,three were high quality reports.Meta-analysis showed lower failure rate of PDA closure in subjects received oral ibuprofen than in those received placebos orally (RR =0.22,95 ％ CI:0.14-0.35),while the number of infants required operative closure of PDA decreased significantly (RR =0.16,95％ CI:0.03-0.86).Further analysis showed the effect of oral ibuprofen was similar to intravenous indomethacin (RR =0.93,95 ％ CI:0.57-1.53),but better than intravenous ibuprofen (RR=0.42,95％CI:0.26-0.67).However,oral ibuprofen did not reduced the ratio of patients required operation compared with intravenous indomethacin or ibuprofen (RR=0.58,95％CI:0.24-1.41).The incidence of gastrointestinal hemorrhage was higher in oral ibuprofen group than that in placebos(RR=1.99,95％CI:1.13-3.50).The serum level of creatine was lower in oral ibuprofen group than in intravenous indomethacin or ibuprofen group (weighted average=-19.10,95％ CI:-25.12-12.31).Compared with intravenous indomethcin group,less necrotizing enterocolitis cases were identified in oral ibuprofen group,but no statistical significance was found (RR=0.57,95％ CI:0.30-1.09).No long-term outcome was reported in any selected literature.Conclusions Oral ibuprofen for PDA closure in preterm infants appears to be as effective as intravenous or indomethacin,and more effective than intraveous ibuproten.Oral ibuproten represents better safety.

[Objective]To evaluate the efficacy of nerve transfer for reconstructing the sensory function of the sole.[Method](1)Select saphenous nerve as donor nerve for the patients with the sensory loss beneath ankle level:dissect and cut off the saphenous nerve at the medialposterior aspect at upper-middle 1/3 of the leg and divide the gastrocnemius to expose the tibial nerve at the medialposterior aspect of the tibia, cut off partly nerve fibre of the tibial nerve and then end-to-end anastomose to the proximal end of the saphenous nerve. (2) Select sural nerve as donor nerve for the patients with sensory loss of sole only:dissect and cut off the sural nerve at the posterior aspect of the lateral malleolus, expose the tibial nerve at the posterior aspect of the medial malleolus and then cut off partly nerve fibre of the tibial nerve. The sural nerve was comdicted from the subcutaneous tunel at the anterior aspect of the Achilles's tendon to the posterior aspect of the medial malleolus and end-to-end anastomose to the partial nerve fibre of the tibial nerve. [Result]All the 9 cases were followed up from 1.5 to 2 years(mean 2 l months). The SCV(sensory conduction velocity) of the tibial nerve was ranged from 36.1 to 41.2 m/s, mean 38.3 m/s and the amplitude of wave (peak-to-peak amplitude) was a range from 7 to 15.3?V, mean 11.2 ?V by orthodromic electrophysiologic techniques. All 9 cases regained the sense of pain and touch of the sole.Three cases restored their sense of two point discrimination. All the patients expressed their satisfaction with their ability of walk and no muscles atrophy of the foot. The sensory loss in donor region was oberserved only lateral part of the foot beneath the lateral malleolus (sural nerve as donor nerve) and a small part of the anterior aspect of the ankle(saphenous nerve as donor nerve).[Conclusion]Nerve transfer can reconstruct the sensory function of the sole effectively.

BACKGROUND: Small conductance,Ca2+-activated potassium(SK)channel,presents in various cell types and plays a crucial role in action potential profile.However,coupling and modulation of calcium and associated molecules to SK2 channel remains unclear.OBJECTIVE: To construct the recombinants of pGBAT7 and target fragments of SK2 gene,so as to observe the coupling and regulation of SK2 channel gene to calcium and other molecules.METHODS: Three pairs of primers of the target fragments of SK2 gene were designed and synthesized based on the full-length sequences of SK2.After being identified,they were individually sub-cloned into the yeast expressive plasmid pGBKT7 to construct pGBKT7-SK2 vectors.The recombinant pGBKT7-SK2 vectors were transformed into yeast AH109 by electroporation,and their activation was tested.The recombinants were extracted from yeast AH109 and verified by electrophoresis and sequencing.RESULTS AND CONCLUSION: The target fragments of SK2 gene by PCR were 411,546 and 729 bp,respectively.Three sub-clones of pGBKT7-SK2 were successfully constructed.Electrophoresis and sequencing showed that the constructed sub-clones of pGBKT7-SK2 met the expected requirements.The recombinant pGBKT7-SK2 vectors transformed into the yeast could be activated.The successful construction of the sub-clones of SK2 gene provides an important material basis for further study in the SK2 channel and function-associated molecules.

Objective To investigate the protective effect of sevoflurane on acute intracranial hemorrhage craniotomy patients. Methods 60 acute intracranial hemorrhage craniotomy surgery patients were randomly divid?ed into control and experimental group of 30 patients under general anesthesia to have craniotomy. The patients in control group was operated by propofol and remifentanil as a inhalation anesthesia ,while patients in experimental group received sevoflurane ,propofol and remifentanil as a mixed anesthesia. Then intracranial pressure ,serum C?reactive protein(CRP),serum S?100β,NSE,IL?6 and TNF?α levels of different time points were deternmined. Results Serum CRP in experimental group were significantly decreased than the control group(P<0.05)1 d af?ter operation. T0~T3 levels of serum S?100β,NSE,IL?6 and TNF?α in two groups were both increased(P <0.05),and the experimental group was significantly lower than the control group(P < 0.05). The intracranial pressure of control group was significantly higher than the experimental group(P < 0.05). Conclusion Sevoflu?rane has a brain protective role in inhibiting acute inflammation in intracranial hemorrhage craniotomy patients.

Objective To evaluate the effect of rediological intervention on thrombotic membranous obstructive Budd-Chiari syndrome(TMOB-CS) .Methods Seventeen cases of TMOB-CS were treated with mutliple stent inplantation to press the thrombus with PTA.Results The inferior vena cave(IVC) pressure declined from(29.4?3.13)cm H 2 O to (3.45?3.20)cm H 2 O after the multiple stent inplantation.There was no severe complication such as pulmonary thrombembolism occurrence in this series.All the patients had been followedup for 3 to 40 months and showed good results.Conclusion Multiple stent inplantation pressing the thrombus with PTA can be used to treat the patients with TMOB-CS.

Objective To explore the relationship between the post-thoracotomic wound infection and nutritional status.Methods The patients treated with thoracotomy were divided into the simple wound infection group(n=15) as the experimental group and the phase Ⅰ healed group (n=15) as the control group.On the fifth day after operation, the sero-albumin quantity and cumulative nitrogen balance were recorded respectively. The statistical data were given the test.Results Every average index of sero-albumin in the experimental group was lower than the control group. Among them, the total protein comparison had statistical significance (P0 05) and transferrin comparison had statistical difference (P

Objective To explore the distribution of Acinetobacter baumannii and its drug resistance to 17 antimicro-bial agents to provide basis for clinical treatment.Methods The data of 689 strains of A.baumannii from Jan.2010 to Dec. 2012 were collected and reviewed for bacterial identification and drug sensitive test and then analyzed using WHONET 5.4. Results 689 strains of A.baumannii isolates were broadly distributed in sputum (75.5%), most primarily isolated from the ICU (36.9%).The antimicrobial susceptibility testing showed that the drug resistance rate of Ab was the highest to Bactrim (36.3%), followed by gentamicin (29.0%), and the lowest to cefperazone-sulbactam (8.0%).The drug resistance rate of Ab to cefperazone-sulbactam was the lowest (8.5%) in 2012.In the three years, the drug resistance rate of Ab to imipenem was the biggest rise (14.5%);while to gatifloxacin and levofloxacin declined.The drug resistance rate of Ab to gatifloxacin dropped by 13.1%, which was bigger than that to levofloxacin (9.5%).The drug resistance rates of Ab to the rest antimi-crobial agents fluctuated insignificantly, but were all in an increasing trend.Conclusion Acinetobacter baummannii mainly distribute in sputum of patients in the ICU and department of respiratory diseases, and its detection rate and drug resistance rate are increasing year by year.