Objective To observe the influence of the clinical pathway management intervention on medical service behaviors.Methods The clinical cases data in a grade A class 3 hospital of Zhangjiakou City,Hebei Province during 2011-2013 were retrospectively analyzed.The influence of implementing the clinical pathway management on the diagnosis results,medical records writing quality,clinical medication,operation,hospitalization time,medical costs,assisted examination items selection were observed and analyzed.Results The admission and discharge diagnosis coincidence rate and preoperative and postoperative diagnostic coincidence rate of 3 diseases entities in the two groups were 100%,the difference had no statistical significance (P>0.05);the medical record grade-A rate in the implementing clinical pathway group was significantly higher than that in the non-implementing clinical pathway group,the medical record grade-B rate was significantly lower than that in the non-implementing clinical pathway group,the difference was statistically significant (P<0.05);the antibacterial drugs cost and drugs proportion in the implementing clinical pathway group were significantly lower than those in the non-implementing clinical pathway group,the medication proportion within the directory in the implementing clinical pathway group was significantly higher than that in the non-implementing clinical pathway group,the difference was statistically significant (P<0.05);the preoperative preparation time in the implementating clinical pathway group was less than that in the non-implementing clinical pathway group,the difference was statistically significant(P<0.05),the grade-A healing rate had no significant difference between the two groups (P>0.05);the average hospitalization time,total costs,drug costs,laboratory fee and examination fee in the implementing clinical pathway group were lower than those in the non-implementing clinical pathway group,the difference was statistically significant (P<0.05);the operation fee,healthy material fee and nursing fee had no statistically significant difference was statistically significant(P<0.05).Conclusion Implementing the clinical pathway can standardize the doctor′s diagnosis and treatment behaviors and makes the medical work to develop to be more favorable for patients.

OBJECTIVE:To observe the efficacy and safety of Shuxuetong injection in the treatment of acute cerebral infarc-tion (ACI). METHODS:110 patients with ACI were randomly divided into control group and observation group. Control group was given mannitol,aspirin,atorvastatin,antidiabetic drugs and other conventional treatment;observation group was additionally given Shuxuetong injection 6 ml adding into 0.9% Sodium chloride solution 250 ml by intravenous infusion,3 times a day. The ef-ficacy in 2 groups was evaluated after 15 d,and the National Institute of Health Stroke Scale(NIHSS)score,neuron specific eno-lase(NSE),high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-α)levels before and after treatment and the incidence of adverse reactions in 2 groups were recorded. RESULTS:After treatment,NIHSS score,NSE,hs-CRP and TNF-αin 2 groups were significantly lower than before,and observation group was lower than control group,the differences were statisti-cally significant(P<0.05);total effective rate in observation group was significantly higher than control group,the difference was statistically significant(P<0.05). There was no obvious adverse reactions in 2 groups during treatment. CONCLUSIONS:Based on the conventional treatment,Shuxuetong injection has good efficacy and safety in the treatment of ACI.

Objective To evaluate the efficacy of the treatment of hilar biliary malignant obstruc tion with multiple stent drainage.Methods One hundred and twenty-seven patients with malignant biliary hilar obstruction were enrolled.The obstructions at the common hepatic duct within less than 1 cm to the junction of the left and the right hepatic duct were found in 66 cases,at the proximal common hepatic duct and the left and the right hepatic ducts in 45 cases,at the right hepatic duct in 5 cases and at the both left and right hepatic duets in 11 cases.Sixty-six patients received stent placement through the right biliary ducts and the common bile duct by puncturing the right mid-axillary line.The other 37 patients received 2 stents placement (disposed"Y"style) through the left and the right hepatic duct punc turing routway.Seven patients received 2 stents placement (disposed"┌"style) through the right hepatic duct and the common bile duct with a stent placed between the left and the right hepatic duct.Three patients had right hepatic duct stent placed first,followed by right hepatic duct and common hepatic duct stent. Twelve patients had stents placed in the right hepatic duct with external drainage from the left hepatic duct. Two patients had multiple strictures at the right hepatic duct,who got multiple external drainages.The total serum bilirubin levels were measured pre-and post-operatively.Results One hundred and twenty-seven patients with bi[iary obstraction had internal stents placed for drainage.The average total bilirubin levels among 121 patients were (283.4?175.4 )?mol/L pre-operation and (63.2?11.8)?mol/L post-operation (P

Objective To perform an anatomical study of the structures around the diaphragmatic foramen and analyze the mechanism of cerebrospinal fluid leak and empty sella(ES).Methods With HE and Masson staining,the structures around the diaphragmatic foramen were observed microscopically on serial histological sections of 8 fetal specimens.The transsphenoidal approach was then simulated in 10 adult cadaver heads,and the structures around the diaphragnmatic foramen were observed under an operating microscope.Results The suprasellar arachnoid adhered tightly to the pia mater covering the upper part of the pituitary stalk,and folded into the sella through the diaphragmatic foramen.On the upper surface of the pituitary gland,the diaphragm adhered to the pia mater of the gland around the foramen,and their histological boundaries could not be distinctly identified on the serial sections.The suprasellar cistern terminated above the foramen due to the restriction by the arachnoid,pia mater and sellae diaphragma.Conclusion The close anatomic relationship between the sellae diaphragm,pia mater,and suprasellar arachnoid is critical to prevention of cerebrospinal fluid leak,and the breach of this anatomic relation,especially in the transsphenoidal approach for pituitary adenoma management that causes excessive traction of the tumor,results in separation or rupture of the arachnoid and pia mater,which can be an important factor contributing to cerebrospinal fluid leak.The separation of the sellae diaphragm,pia mater and the upper surface of the pituitary gland may also play an important role in the occurrence of ES.

OBJECTIVETo explore the relationship between the expression of caspase-3 in testicular germ cells of rats with experimental left varicocele (ELV) and apoptosis of germ cells.

METHODSTwenty-four male SD rats were randomly divided into three groups with eight animals each: sham-operation group (SOG), 30-day post-operation group (PG1) and 60-day psot-operation group (PG2). ELV model was established by the partial ligation of the left renal vein. To detect apoptosis of germ cells and expression of caspase-3, TUNEL assay and immunohistochemistry (SABC) were used respectively.

RESULTSThe number of caspase-3 positive germ cells per tubular cross section in left and right testes of rats in SOG, PG1, PG2 were 0.1175 +/- 0.0129, 0.2463 +/- 0.0421, 0.2938 +/- 0.0511 and 0.1650 +/- 0.0192, 0.2538 +/- 0.0219, 0.2775 +/- 0.0343, respectively. Compared with SOG, the expression of caspase-3 in bilateral testes of rats in PG1 and PG2 were increased, and the differences were statistically significant(P = 0.0115 and P = 0.0144).

CONCLUSIONExpression of caspase-3 protein increased in germ cells of rats with ELV, which may be one of the molecular mechanisms related to excessive testicular germ cell apoptosis.

Animals ; Apoptosis ; Caspase 3 ; biosynthesis ; Disease Models, Animal ; Germ Cells ; cytology ; metabolism ; Male ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Varicocele ; metabolism ; surgery

OBJECTIVETo analyze the effects about inclinations of the second and the third molars in patients treated with or without premolar extractions.

METHODSFifty-six adolescents were chosen and divided into the first premolar extraction and non-extraction groups, 30 and 26 patients respectively. The pre-treatment and post-treatment panoramic radiographs were made. Angles between long axis of the third molar and the occlusal plane (the second molar alike), and long axis of the second and the third molar were measured and evaluated.

RESULTSThe maxillary and mandibular third molar angulations were all improved after treatment in two groups. Compared with non-extraction group, the average changes of angle between long axis of the third molar and the occlusal plane increased significantly in maxilla and mandible (P < 0.05). Average changes of angles between long axis of the second and the third molar decreased and had statistically significant difference (P < 0.05). The change of angle between long axis of mandibular second molar and the occlusal plane had statistically significant difference (P < 0.05), but there was no statistically significant difference in maxillary second molar (P > 0.05).

CONCLUSIONThe first premolar extraction in orthodontic treatment could improve the third molar angulations and it would promote the eruption of the third molar.

Adolescent ; Bicuspid ; Dental Occlusion ; Female ; Humans ; Male ; Mandible ; Maxilla ; Molar ; Molar, Third ; Radiography, Panoramic ; Tooth Eruption ; Tooth Extraction

To block tumor cell adhesion, inhibit tumor metastasis and recurrence, the anti-adhesion peptide-trimeric beta peptide (DLYYLMDLSYSMKGGDLYYLMDLSYSMKGGDLYYLMDLSYSMK, beta3) was designed. The DNA fragment of beta3 was cloned into expression vector pET-His and the fusion protein His-beta3 was expressed in E. coli. BL21(DE3)plysS. After 1.5 hours' induction with IPTG, His-beta3 peptide was expressed significantly amounting to 10% of the insoluble proteins and 4% of the total proteins. 20mg of beta3 peptide was obtained from one litter culture medium after purification by using metal-chelating sepharose 6B FF. The purity of beta3 is 92.2% according to Gel-Pro analysis. The anti-adhesion effects of beta3 peptide, beta1 peptide (DLYYLMDLSYSMK) and GRGDS on the hepatocellular carcinoma cell line SMMC-7721 and the high metastasis hepatocellular carcinoma cell line HCCLM6 were studied. The result showed the beta3 blocked the adhesion of HCCLM6 cells and SMMC-7721 cells to fibronectin (FN) specifically. The inhibition effect was dose-dependent and time-dependent and the inhibition rate of beta3 was higher than three times concentration of beta1 and GRGDS. This suggested that pET-His-beta3/BL21(DE3)plysS was a suitable expression system for beta3, and the expressed beta3 specially inhibited the adhesion of cancer cells.
Amino Acid Sequence ; Antineoplastic Agents ; pharmacology ; Cell Adhesion ; drug effects ; Cloning, Molecular ; Escherichia coli ; genetics ; metabolism ; Molecular Sequence Data ; Peptide Fragments ; pharmacology ; Peptides ; genetics ; metabolism ; pharmacology ; Recombinant Proteins ; biosynthesis ; genetics ; Tumor Cells, Cultured

BACKGROUNDVaspin is a newly-identified adipocytokine related to obesity and insulin sensitivity. However, its pathophysiologic role in humans remains largely unknown. The aim of our study was to investigate the relationship between serum vaspin level and glucose metabolism or obesity in Chinese adults.

METHODSA total of 123 subjects, including 84 subjects with normal glucose tolerance (NGT) and 39 subjects with diabetes, were enrolled in this study. Anthropometric parameters, abdominal fat areas, plasma glucose concentration, serum insulin, lipids, and vaspin level were measured in each participant.

RESULTSSerum vaspin concentration was significantly higher in diabetic patients than that in NGT subjects (592 (438 - 695) pg/ml vs 380 (294 - 517) pg/ml, P = 0.020) in women. In all participants, age, fasting plasma glucose concentration (FPG), 2-hour post-load plasma glucose (PG2h), hemoglobin A1c (HbA1c) and high-density lipoprotein cholesterol (HDL-c) significantly increased from the lower tertile to the higher tertile of vaspin. Univariate linear regression analyses revealed that vaspin level was only positively correlated with age (beta = 0.340, P = 0.002) in NGT subjects. And vaspin was positively associated with FPG (beta = 0.365, P = 0.023), PG2h (beta = 0.526, P = 0.001), HbA1c (beta = 0.388, P = 0.016), and HDL-c (beta = 0.353, P = 0.027), while negatively with homeostasis model assessment of beta cell function (HOMA-beta) (beta = -0.361, P = 0.024) in diabetic patients. In stepwise multivariate regression analyses, age was independently associated with circulating vaspin in NGT subjects, whereas PG2h was an independent predictor of vaspin in diabetic patients. In addition, there was no significant difference of serum vaspin level between men and women. And no significant correlations between vaspin and body fat indexes were detected.

CONCLUSIONSSerum vaspin level is higher in diabetic patients than that in NGT subjects in women. Age predicts serum vaspin level in NGT subjects, while PG2h is independently associated with vaspin in diabetic patients.

Adult ; Aged ; Blood Glucose ; metabolism ; Diabetes Mellitus ; blood ; Female ; Humans ; Linear Models ; Male ; Middle Aged ; Postprandial Period ; Serpins ; blood

Objective To assay serum apelin level in obesity and newly-diagnosed type 2 diabetes mellitus (DM) patients and investigate the relationship between serum apelin level and body fat parameter,glucose and lipid metabolism and insulin resistance index,etc.Methods Sixty-two patients with type 2 DM and 72 subjects with normal glucose regulation (NGR) were selected and each group was divided into obese and non-obese subgroups according to body mass index (BMI)≥25 kg/m~2 or

Carcinoma, Hepatocellular ; pathology ; Humans ; Liver Neoplasms ; pathology ; Neoplasm Invasiveness ; Neoplasm Metastasis ; Peptide Fragments ; pharmacology ; Peptides ; pharmacology ; Tumor Cells, Cultured