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 explore the effects of maternal exposure to dibutyl phthalate ( DBP) ,an environmental estrogen on the proliferation and differentiation of neural stem cells ( NSCs) in the neural tube of neonatal rats. Methods A total of 40 male and 40 female SD rates at age of 4 to 5 months,were matched,and the morning when vaginal plugs were found was designated as E0. Then the 40 pregnant rats were randomly divided into 4 groups,3 DBP exposure groups ( 25,75,and 225 mg/kg) and control group. DBP at corresponding doses were dissolved in corn oil,and administrated by intragastrically injection once per day from E0 till delivery,while those of control group were given corn oil. Brain tissue of newborn rats was collected for primary culture of NSCs. Then the cell colony formation was counted to detect the NSCs proliferation. Then 10% fetal bovine serum ( FBS) was added into the culture medium to induce the NSCS to differentiate. Neu-N and GFAP immunofluorescence stainings were used to detect neurons and astrocytes,and their morphological changes were observed. Results The proliferation of NSCs was decreased significantly after DBP administration. Compared with the control group ( 40. 53 ? 4. 65) % ,the colony formation rate of middle-and high-dose DBP exposure groups was significantly reduced and in a dose-dependent manner ( 30. 96 ? 3. 80) % ,( 15. 35 ?5. 29) %,( 6. 58 ?1. 43) %,P

Objective To study the effect of ovarian estrogen on the expression of estrogen receptor beta (ER beta) of the basal forebrain of mice. Methods Ovariectomized (OVX) mice were used as animal model, and nickel ammonium sulfate intensified immunohistochemical SP technique was used to detect the changes of ER beta expression in the basal forebrain. Results The expression of ER beta in the basal forebrain of mice decreased dramatically, after OVX decreased to the lowest levels at 3 d after OVX, increased gradually, and recovered to normal level 20 d later. Conclusion Ovarain estrogen can regulate the expression of ER ? of the murine basal forebrain, indicating that estrogen, via ER ?, can regulate the nerous structure and function of the basal forebrain, which may be the mechanism of estrogen replacement therapy on Alzheimer′s brain.

Objective To study the expression of estrogen receptor beta (ER ?) in the hypothalamic paraventricular nucleus (PVN) of maternal mice during pregnancy and lactation. Methods Nickel ammonium sulfate intensified immunocytochemical method was employed to investigate the expression of ER ? in the postnatal developing PVN of female mice. Results ER ? immunopositive materials were predominantly localized in the magnocellular division of PVN, and sparse positive cells were found in the parvocellular division. Most of the positive materials were found in the whole cell nuclei, but no obvious cytoplasma or process immunopositive cells were detected. In the pregnant female brain, generally, the ER ? level was lower. The lowest levels of expression were found at mid pregnancy, and then peaked at peripartum (from gestational days 18 to postpartum day 1), followed by another decrease to normal adult level from postpartum day 4. Conclusion The above results suggest that during pregnancy and lactation, ER ? may be predominantly involved in the PVN regulation of parturitional process.

Objective: To compare the early and long-term outcomes between on-pump and off-pump coronary artery bypass grafting (CABG) in elder female patients.
Methods: A total of 763 female patients elder than 65 years of age received isolated CABG in our hospital from 1999-01 to 2008-12 were retrospectively studied. The patients were divided into 2 groups according to operational method: On-pump group,n=331 and Off-pump group,n=432. The mortality at 30 days post-operation, in-hospital clinical indexes and long term mortality with MACCE as all cause death, myocardial infarction (MI), stroke and repeated revascularization were compared between 2 groups.
Results: Compared with On-pump group, the patients in Off-pump group had the elder age (P<0.01), with the higher rate of cerebral vascular accident (P=0.023); less family history of coronary artery disease (P=0.012), angina (P<0.001) and emergent operation (P=0.015), less venous distal anastomoses (P<0.001) ; while higher incomplete revascularization (P<0.001). Logistic regression model comparison indicated that Off-pump group had the lower mortality at 30 days post-operation (P=0.038), less application of blood products (P<0.001), lower rate of >24h mechanical ventilation (P<0.001), less renal failure (P=0.022), pulmonary complications (P<0.001) and re-exploration for bleeding (P=0.021). The morbidity of all post-operative complications were similar between 2 groups (P=0.110). Cox regression model comparison showed that long-term all cause mortality (P=0.477) and occurrence of MACCE (P=0.265) were similar between the two groups.
Conclusion: Off-pump CABG would reduce the mortality at 30 days post-operation, have less application of blood products, shorter post-operative mechanical ventilation, less early post-operative renal failure, pulmonary complications and re-exploration for bleeding. While it could not reduce the long-term mortality and MACCE occurrence.

Objective To explore the value of glypican-3(GPC-3)mRNA and paternally expressed 10(PEG10)mRNA in peripheral blood in diagnosis of metastasis in hepatocellular carcinoma(HCC). Methods With SYBR Green I as fluorescence signal,real-time fluorescent quantitative reverse transcription-polymerase chain reaction was employed to detect the expression of GPC-3 mRNA and PEG10 mRNA in peripheral blood from patients with HCC with metastasis(n=8),HCC without metastasis(n=12)and hepatic cirrhosis(n=11),and receiver operator characteristics curve(ROC)and specific parameters were adopted to analyse their value in predictive and exclusive diagnosis. Results The expression of GPC-3 mRNA and PEG10 mRNA in HCC with metastasis was significantly higher than that in HCC without metastasis and in hepatic cirrhosis(P<0.05),while there was no significant difference in the expression of GPC-3 mRNA and PEG10 mRNA between HCC without metastasis and hepatic cirrhosis.In single test,the sensitivities in the differential diagnosis between HCC with metastasis and HCC without metastasis were 66.7%for GPC-3 mRNA and 72.2%for PEG10 mRNA,and the specificities were 91.7%and 91.7%.respectively.The areas under ROC were 0.748 for GPC-3 mRNA and 0.812 for PEG10 mRNA.With two markers in parallel test,the sensitivity,specificity,negative likelihood and diagnostic accuracy were 90.7%,84.O%,0.11 and 83.3%,respectively.In serial test,the sensitivity,specificity,positive likelihood and diagnostic accuracy were 60.5%,98.7%,45.5 and 73.3%,respectively. Conclusion Detection of GPC-3 mRNA and PEG10 mRNA in peripheral blood may help to predict blood metastasis and extrahepatic metastasis of HCC,and PEG10 mRNA works better than GPC-3 mRNA.The serial test of GPC-3 mRNA and PEG10 mRNA is helpful to the predictive diagnosis of peripheral blood metastasis of HCC.

Objective To observe the effects of Suhuang Zhike capsules(SZC) on the guinea pig model of cough variant asthma(CVA), and to explore its therapeutic mechanism. Methods Fifty guinea pigs were randomly divided into normal control group, model group, prednisone acetate tablets group, and high-and low-dose SZC groups. With reference to the related literatures, we set up the guinea pig model of CVA. The observation indexes included cough frequency, lung histopathology, the percentage of eosinophils in bronchoalveolar lavage fluid (BALF), and the serum levels of interleukin 4(IL-4), interferon gamma(IFN-γ), tumor necrosis factor alpha (TNF-α), and immunoglobumin E(IgE). Results Compared with the normal control group, the cough frequency of the model group was significantly increased(P<0.05); compared with the model group, the cough frequency of high-dose SZC group was reduced obviously(P < 0.05). Compared with the normal control group , the percentage of eosinophils in BALF of the model group was significantly increased(P < 0.05); the percentage of eosinophils of the three medication groups was lower than that of the model group (P<0.05). The pathological changes of lung tissue in the medication groups were relieved compared to the model group. Compared with the normal control group, the serum IL-4, TN F-α and IgE levels of the model group were increased significantly (P < 0 . 05); compared with the model group , the serum IL-4 and TN F-α levels of prednisone acetate tablets group were significantly decreased, and the serum TNF-α and IgE levels of high-dose SZC group were decreased significantly (P < 0.05). Conclusion SZC could reduce the serum, TNF-α and IgE levels , and relieve the cough symptom, airway inflammation and the lung tissue pathology in CVA guinea pig, so as to achieve the therapeutic effect on CVA.

Aim To investigate the changes of phosphodiesterase4(PDE4,type 4 cAMP-specific PDE) activity,TNF-? and neutrophil recruitment in experimental rat lung injury(ALI).Methods ALI in the rat was induced by lipopolysacdharide(LPS).PDE4 activity was measured with HPLC,and the level of TNF-? was detected with ELISA,neutrophil infiltration in bronchoalveolar lavage fluid(BALF) and lung tissues was detected by cell count and morphological analysis.Result Lung tissue PDE4 activity significantly increased as early as 1 h,peaked 6 h,and then markedly lowered at 24 h after intratracheal administration of LPS,while there was a same time-course change of total white cell and neutrophil in the BALF(r=0.83,P

Selective courses are different from compulsory courses in teaching objective,students' study demand,teaching content.Different teaching designs should be used according to different teaching objectives in selective courses for graduates.Targeted scientific thoughts and methodological training should be designed with respect to the fact that students will begin their experimental studies after the selective lessons.We analyzed the current status of selective course of neuroanatomy for graduates and proposed some solutions.

Objective To evaluate the effect of butorphanol combined with dexmedetomidine on postoperative hyperalgesia induced by remifentanil in patients.Methods One hundred and twenty patients,of ASA physical status Ⅰ or],aged 20-64 yr,weighing 45-88 kg,undergoing elective gynecological laparoscopic surgery,were randomly allocated into 4 groups (n =30 each) using a random number table:control group (group C),butorphanol group (group B),dexmedetomidine group (group D) and dexmedetomidine + butorphanol group (group B+D).In group D,dexmedetomidine 1.0 μg/kg was infused at 10 min before induction of anesthesia,followed by continuous infusion at 0.7 μg·kg 1·h-1 until the end of operation.In group C,the equal volume of normal saline was given instead before skin incision.In group B,butorphanol 20 μg/kg was injected immediately before skin incision.In group B+D,dexmedetomidine 0.5 μg/kg was infused at 10 min before induction of anesthesia,followed by continuous infusion at 0.5 μg· kg-1 · h-1 until the end of operation,and butorphanol 15 μg/kg was injected immediately before skin incision.Anesthesia is induced with iv midazolam 0.05 mg/kg,sufentanyl 0.2-0.3 μg/kg,rocuronium 0.7 mg/kg and propofol 2.0 mg/kg.After tracheal intubation,all the patients are mechanically ventilated,and PETCO2 was maintained at 35-45 mmHg.Anesthesia was maintained with iv infusion of remifentanil 0.3 μg · kg-1 · min 1 and propofol 4-6 mg·kg 1·h-1 and intermittent iv boluses of rocuronium 0.3 mg/kg.BIS value was maintained at 40-60.Patient-controlled intravenous analgesia (PCIA) with sufentanil was used after operation,and VAS score was maintained ≤ 3.At 30 and 60 min and 6,12,24 and 48 h after operation,the sufentanil consumption was recorded.The development of bradycardia and hypotension during operation and postoperative nausea and vomiting,dizziness and somnolence was recorded.Results Compared with group C,the sufentanil consumption and incidence of nausea and vomiting were significantly decreased in B,D and B+D groups,the incidence of dizziness and somnolence was increased in group B,and the incidence of bradycardia and hypotension was increased in group D.There was no significant difference in sufentanil consumption between B,D and B+D groups.The incidence of dizziness and somnolence was significantly lower in group B + D than in group B.The incidence of bradycardia,hypotension and somnolence was significantly lower in group B + D than in group D.Conclusion Butorphanol combined with dexmedetomidine provides better efficacy than either alone in reducing postoperative hyperalgesia induced by remifentanil in patients.