Objective To investigate the influencing factors for prehospital delay in patients with acute myocardial infarction (AMI).Methods A total of 807 consecutive patients with AMI who presented to the emergency department of Beijing Anzhen Hospital were analyzed. The influence of several potential risk factors on the prehospital delay time (PDT) was evaluated by comparing patients admitted more than 2 hours after onset of chese pain with those admitted within 2 hours after onset. Results Among 807 patients, 402 came to the hospital within 2 hours while the others arrived at the hospital after 2 hours. The median PDT was 130 min. Among the potential variables, advanced age, history of diabetes mellitus, occurrence of symptom at night and use of emergency medical service significantly affected PDT by multivariate analysis. Conclusion Interventions aimed at reducing the prehospital delay in AMI should primarily focus on the awareness of the risk and help-seeking behavior of patients.

Objective To investigate the relationship between the genesis of hypertensive disorder complicating pregnancy and neurokinin B (NKB).Methods The serum NKB levels of 229 women including non-pregnant women (n = 62),normal pregnant women (n = 80) and pregnant women with preeclampsia (n=37) or gestational hypertension (n= 50) were examined by enzyme linked immunosorbent assay.The umbilical blood levels of NKB and the NKB mRNA expression in the pregnant women were also tested by fluorescent quantitative reverse transcription-polymerase chain reaction technique.ANOVA and paired t-test were applied.Results (1)The maternal plasma NKB levels of normal pregnant women,patients with gestational hypertension or preeclampsia were significantly higher than that of non-pregnant women,respectively [(28.2±6.6)μg/L,(31.5±5.2)μg/L,(70.5±8.9)μg/L vs(3.2±1.8)μg/L,P＜ 0.01].In preeclampsia,gestational hypertension and normal pregnancy group,the NKB level in umbilical blood [(121.4±9.3)μg/L,(60.5±7.2)μg/L,(40.8±6.3)μg/L] were significantly higher than that of maternal plasma(P＜0.01).(2) The maternal plasma NKB level in gestational hypertension group was higher than that in normal pregnancy group,while the difference had no statistical significance (P＞0.05).The maternal plasma NKB level in preeclampsia group was higher than that in gestational hypertension group and normal pregnancy group (P＜0.01).Forty-eight hours after delivery,the maternal plasma NKB levels significantly decreased in the normal pregnant,gestational hypertension and preeclampsia group [ (14.1±4.2) μg/L,(16.4±3.8) μg/L,(25.4±5.2) μg/L],compared to the values before delivery (P＜0.01).(3) The expression of NKB mRNA in placenta of preeclampsia group was significantly higher than that of gestational hypertension group and normal pregnancy group [(3.8±0.6) × 10-3 vs(1.7±0.4) × 10-3 and (1.6±0.3) × 10-3,P＜0.01].No statistical difference was found in the expression of NKB mRNA in placenta between gestational hypertension group and normal pregnancy group (P＞0.05).Conclusions Elevated NKB level in placenta and maternal or umbilical blood might play an important role in the development of hypertensive disorder complicating pregnancy.

Objective To explore the clinical manifestations, diagnosis, treatment and prognosis of secondary thyroid neoplasms. Methods To retrospectively analyse clinical manifestations,examinations and treatment of 83 cases of secondary thyroid cancer, which were retrieved from CNKI (1994-2008). Results In all cases, 39 were male, 39 were female and 5 were unknow, aged from 16 to 78 years old, median age was 52. The primary cancers included 31 esophageal carcinomas, 12 lung cancers, 8 laryngopharynx cancers, 7 clear cell renal carcinomas, 6 rectal carcinomas, 6 melanomas, 3 breast cancers, 3 rhabdomyosarcoma, 2 gatric cancers, 1 liver cancer, 1 cervical cancer, 1 nonchromaffin paraganglioma,1 ovary cancer, 1 lip squamous cell carcinomac. 64 patients had undergone chemotherapy or surgery or radiotherapy. The intervals between finding of primary carcinoma and secondary thyroid carcinoma ranged from 1 month to 26 years with a median time of 2.5 years. Patients died of widespread metastases from 1 month to 12 years following the diagnosis of secondary carcinoma in thyroid, with a median time of 32 months. Conclusions Metastasis in the thyroid gland is uncommon and may cause a diagnostic problem. Metastatic cancer to the thyroid should be considered when a patient with histoy of malignant tumor has a recent found thyroid lesions. With the combination of Surgery, chemotherapy and radiotherapy, the survival of patients can be significantly prolonged.

Objective To explore the effect of the improved abdominal rotation card method in insulin injection. Methods A total of 100 hospitalized diabetes patients were randomly divided into control group (n=50) and observational group (n=50) according to the random number method. In the control group, insulin was injected to the subcutaneous tissue of abdomen with traditional method annular rotating method. Insulin was injected using improved abdominal rotation card method in the observational group. Compare accuracy and mastery rate of injection site rotation between the two groups. Compare fasting blood glucose (FBG), postprandial 2H blood glucose (PBG), HbA1c, the incidence of hypoglycemia and endermic induration between the two groups after three months. Results The nurses in the observation group had higher accuracy rate of the injection site rotation compared to the control group [98.6%(690/700) vs. 38.6%(270/700),χ2=584.66, P<0.01]. Mastery rate of the injection site rotation for the patients in the observation group were significantly higher than the control group [70.0% (35/50) vs. 20.0% (10/50), χ2=25.74, P < 0.01]. The incidence of endermic induration were significantly lower in observation group compared to the control group [2.0% (1/50) vs.16.0% (8/50), χ2=5.98, P < 0.01]. The incidence of hypoglycemia were significantly lower in observation group compared to the control group [4.0%(2/50) vs. 16.0%(8/50),χ2=4.00, P<0.01]. Conclusions The new abdominal rotation method in insulin injection can be a safe and effective therapy in patients with type 2 diabetes.

OBJECTIVE:To investigate the characteristics of serious ADR in psychiatric hospital,and to provide reference for effective and safe use of drugs in the clinic. METHODS:114 cases of serious ADR in our hospital from 2004 to 2015 were ana-lyzed retrospectively in terms of general information,primary disease,route of administration,dosage form,drug types,organs or systems involved in ADR and clinical manifestations,top 5 ADR-inducing drugs and main clinical manifestations,etc. RESULTS:Of 114 serious ADR cases,the number of female was more than that of male(71/43). Patients aged 21-30 years old took up the greatest proprotion(35 cases,30.70%). The main involved primary disease was schizophrenia(54 cases,47.37%). Oral adminis-tration-induced ADR was most common(103 cases,90.35%). The main involved drugs were antipsychotics,occupying the great-est proportion(75 cases,65.79%). Digestive system involved was the most common(53 cases,42.74%), Olanzapine tablets had the highest incidence of serious ADR (23 cases,18.55%),the main clinical manifestation were both abnormal liver function. There were 8 cases of new serious ADR (7.02%). Most of the ADR can be cured after drug withdrawal or countermeasures,no death case was found. CONCLUSIONS:Psychiatric drugs can induce serious ADR as treat psychiatric disease,among which the in-cidence of ADR induced by Olanzapine tablets is the highest and mainly manifestes digestive system symptoms. It is suggested to strengthen serious ADR monitoring to promote the safe use of drugs.

Objective To study the effects of phycocyanin on the expressions of matrix metalloproteinase 2 and 9(MMP-2 and MMP-9) after focal cerebral ischemic reperfusion in rats.Methods A rat middle cerebral artery occlusion/reperfusion(MCAO/R) model was built up using the intraluminal filament method and treated by phycocyanin.The brain water content(BWC) was calculated with dry-wet method and the Evans blue(EB) of the brain was measured with the method of colorimetry.The expressions of MMP-2 and MMP-9 were determined by immunohistochemical assay.Results The BWC and EB of the brain increased after cerebral ischemic reperfusion and peaked at reperfusion 2d,and decreased after applying phycocyanin.In control group,the upregulation of MMP-2 began at ischemic reperfusion 24h,reached a maximum at 3～7d,then subsided gradually,but was still in high level at 14d.In phycocyanin group,the expressing time-phase pattern of MMP-2 was similar to and significantly lower than that in control group at same time.In control group,the upregulation of MMP-9 began at ischemic reperfusion 6h,increased at 12h and reached a maximum at 2d,then subsided gradually at 3d to sham group level at 14d.In the phycocyanin group,the expression of MMP-9 was significantly lower than that in control group,and the time-phase pattern of MMP-9 was similar to that in control group.Conclusions Phycocyanin might play an neuroprotective effect by down regulating the expressions of MMP-2 and MMP-9 to reduce brain edema after cerebral ischemic reperfusion.

Objective To study the best protecting dosage of phycocyanin on PC12 cells after anoxia/re-oxygen in vitro.Methods The anoxia/re-oxygen cell models were established with cultured PC12 cells and treated by phycocyanin.The absorbency of PC12 cells was determined by MTT method to observe the activity and number of PC12 cells after anoxia/re-oxygen.The fluorescent intensity in PC12 cells labeled by Rhodamine123 was measured with laser scanning confocal microscope to observe the mitochondrial membrane potential after anoxia/re-oxygen.Results After anoxia/re-oxygen,the absorbency and fluorescent intensity in PC12 cells were significantly lower than those in control group.After treatment with phycocyanin,the absorbency of PC12 cell in test groups was higher than that in model group,especially in 5?g?mL-1 subgroup,P

Objective Acute type B aortic dissection (ATBAD) is a life-threatening condition.Open surgical (OS) repair with a prosthetic graft has been a conventional treatment for ATBAD.Thoracic endovascular aortic repair (TEVAR),as a less invasive and potentially safer technique,has been used increasingly in recent decade.Evidence to support the use of TEVARin these patients is needed.This meta-analysis was to assess the efficacy of TEVAR versus conventional OS in patients with ATBAD.Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (last searched 2010,Issue 4),MEDLINE,EMBASE,CINAHL,Web of Science 、OpenSIGLE 、National Technical Information Service(NTIS) 、CNKI 、Chinese Biomedicine Database 、VIP、WanFang Data for clinical trials and additional sources for published and unpublished trials until 1/18/2011.Controlled trials in which patients with ATBAD were assigned to TEVAR or OS repair were included.The authors extracted independently the following information using a specifically designed data collection form for individual trial included:first author and the year of publication,study population,interventions used (TEVAR or OS repair) and outcomes (short-term mortality,short-term complications,long-term complications and long-term mortality rates).Data were extracted on the relevant methodological domains to minimize the bias in the analysis with use of the Cochrane methods for bias assessment and Grading of Recommendations Assessments Development and Evaluation (GRADE)methods.For each outcome,GRADE criteria and Cochrane Bias evaluation were used to evaluate the quality of the evidence with regard to inconsistency (heterogeneity),indirectness,imprecision,and other potential sources of bias,such as publication and reporting bias.Revman5.0 and GRAED profiler 3.2.2 software were used to analyze the data.Results Five trials (318 participants) were included in the analysis.The five studies were limited by lack of allocation concealment and blindness,and the studies were small.The evidence quality determined with the GRADE approach for 30-day mortality was poor and for other variables was very poor.As compared with ATBAD,TEVAR associated with a significantly reduced short-term mortality,M-H fixed odds ratio 0.19,95％ CI [0.09,0.39],P＜0.001.However,TEVAR could not improve the postoperative outcomes such as complications or long-term mortality,M-H random odds ratio 1.40,95％ CI[0.24,8.18].Conclusion TEVAR can be weakly recommended as an alternative for the treatment of ATBAD in selected cases and may not be used as a general option in place of surgery based on the current evidences.

Objective To find out present condition and differences in implementation of clinical pathways in hospitals of in China.Methods "Clinical pathway" was entered as a keyword to search in PubMed NCBI Chinese Science and Technology Periodical Database for related literatures in China from 1999 to 2009,analyzing the general implementations of clinical pathways in hospitals in different areas using the SPSS12.0 software.Results A total of 1051 relevant literatures were found.Through data analysis of these literature,differences of implementation of clinical pathways were found for 162 hospitals of different areas.It was found that the differences of total diseases among China's East,West and Central areas are significant statically.Diseases of implementation per hospital in the Central average 16.8,those in the East 8 types,while those for the West 4.4.Tertiary hospitals account for 70% as the main force of clinical pathway implementation,with diseases of implementation up to 13.7,while that under tertiary level down to 2.8.Conclusions Implementation of clinical pathways varies significantly among hospitals in different areas in China.In the process of implementing clinical pathway,appropriate management strategies should be developed according to actual situation in different hospitals in light of policies,hospital management and patient considerations.

Implementation of clinical pathways has a natural tie with payment modes of medical insurance,as various payment modes apply different impacts on clinical pathway.This article compared the strengths and weaknesses of various payment modes,and analyzed their impacts on clinical pathway.This way the authors provide references for decision makers of medical insurance policy.