Objective:To explore the result of application of the clinical nursing pathway on percutaneous coronary interventional patient.Methods:One hundred patients were divided into two groups randomly,each group has 50 cases.We used the clinical nursing pathway based on holistic nursing case in experimental group,and the control group used the holistic nursing care.Results:After use the method of the clinical nursing pathway in the hospital,the medical cost and the rates of the nursing errors were less than that in the comparing group while the patients were more satisfied.Conclusion:As a scientific mode,the clinical nursing pathway could improve the working efficiency,guarantee the nursing quality.

The paper,based on a review of the reform of state-owned enterprises,and of the duty positioning and supervision of state-owned assets management committee, described experiences of Shanghai Hospital Development Center (SHDC ) in learning from such reforms. Centering onappropriate separation of ownership and power of management and defining public hospitals as key player of state-owned assets,SDHD explored to build a state-owned assets investor system conforming to the institutional positioning,assets category and operating targets of such hospitals.This way a state-owned assets management mode is gradually set up,featuring to make regulations beforehand,to supervise in the course and to supervise afterwards.

Aged, 80 and over ; Echinocandins ; adverse effects ; therapeutic use ; Humans ; Lipopeptides ; Liver ; drug effects ; Liver Function Tests ; Mycoses ; drug therapy ; Retrospective Studies

Establishment and improvement of rules and regulations will benefit to the management of research institutions.A comprehensive,fair,reasonable,and workable rules and regulations are the basic guarantee for maintaining the orderly,steady,and sustainable development of the institutions.It is also help to fully mobilize the enthusiasm and creativity of all members of the institutes.In this paper,we use an example of a construction of rules and regulations in the military medical research Institutions,to analyze current information and posted suggestions on the rules and regulations formulation principles,making procedure,overall framework and main innovation for the future improvement and implementation of rules and regulations.

Background:Cholangiocarcinoma(CCA)is a fatal digestive system tumor arising from biliary epithelium. Claudin-4,a key constituent of intercellular tight junction,is aberrantly and widely expressed in various epithelial tumors,and is correlated with tumorigenesis and tumor progression. Aims:To investigate the expression of claudin-4 in CCA and its correlation with clinicopathological characteristics of the tumor and patient’s prognosis. Methods:Immunohistochemistry was used to determine the expression rate and intensity of claudin-4 in CCA tissue and matched paracancerous tissue of 77 CCA patients. Correlation of claudin-4 expression in CCA with its clinicopathological characteristics was analyzed,and survival analysis was conducted by using Kaplan-Meier method. Results:Claudin-4 was strongly expressed in CCA tissue and mildly or weakly expressed in matched paracancerous tissue;the immunohistochemical score was significantly higher in cancerous tissue than in paracancerous tissue(9. 22 ± 3. 62 vs. 7. 12 ± 4. 26,P < 0. 05). Claudin-4 expression was significantly correlated with tumor location and tumor differentiation( P all< 0. 05 );the high expression rate was significantly higher in poorly differentiated CCA than in well or moderately differentiated ones(76. 2% vs. 50. 0% ). The 31-month accumulate survival rates of claudin-4 low-expression group and high-expression group were 29. 8% and 21. 1% , respectively( P > 0. 05). Conclusions:Claudin-4 is highly expressed in CCA and negatively correlated with tumor differentiation. It might be a novel diagnostic biomarker and therapeutic target for CCA.

Objective To measure serum ghrelin level in elderly Chinese, and investigate the relationship of the serum ghrelin level with age, obesity and other metabolic disorders. Methods A total of 109 men aged over 60 years without history of smoking and alcohol consumption from health examination were enrolled in this study. Subjects were excluded if they had serious diabetic complications, coronary artery disease and hepatic or renal dysfunction. A cross sectional study was made on ghrelin level and the correlated metabolic disorders. Results Compared with ghrelin level in subjects with normal BMI [(823. 57±410.40) ng/L], the ghrelin level was significantly decreased in overweight and obese elderly male, [(442.42 ± 171.10) ng/L and (434.64 ± 177.65) ng/L respectively]. ghrelin was significantly lower in subjects with three or more metabolic disorders (420.84±165.91) ng/L than in those with less disorder. Single factor analysis showed ghrelin was inversely associated with BMI, TG and uric acid (r=-0.359,-0.243,-0.189), but it was not associated with age, blood pressure, fasting glucose and insulin levels. Multivariate analysis revealed only BMI significantly affected the level of ghrelin (β =-0.386). Conclusions BMI is closely associated with ghrelin in elderly male,ghrelin is significantly lower with increased number of metabolic disorders.

Objective To investigate the effect of PKG on the secretion of IL-6, IL-10, and TNF-αin THP-1 macrophage-derived foam cells. Methods THP-1 monocytes were induced to construct macrophages by treating with 160 nmol/L TPA. Then the macrophages were further treated with 50 mg/L ox-LDL to become foam cells. Four groups were set in this study, including the macrophage group, the foam cell group, the group of foam cell treated with PKG agonist 8-Br-cGMP, and the group of foam cell treated with PKG inhibitor KT-5823. The morphology of THP-1 cells, macrophages and foam cells were observed under microscope. The cellular lipid accumulation was detected by oil red ostaining. The secretion of IL-6, IL-10, and TNF-α into the supernatant was detected by ELISA assay. Results The foam cell was obtained after macrophage incubated with ox-LDL for 48 hours. The secretion of IL-6 and TNF-α increased significantly from the foam cells than that from the macrophages (P<0.05). After the THP-1 monocyte-derived macrophages were incubated with 8-Br-cGMP, the secretion of IL-6 in the supernatant decreased significantly ( P < 0 . 05 ) and IL-10 level in the supernatant increased significantly (P < 0.05). After the macrophages were incubated with KT-5823, the secretion of IL-10 decreased significantly (P<0.05), but the secretion of IL-6 was not significantly changed (P>0.05). After incubation with 8-Br-cGMP, the secretion of IL-6 and TNF-α from the macrophage-derived foam cells decreased significantly (P < 0.05), but IL-10 increased significantly (P<0.05). After the foam cells were treated with KT-5823, the secretion of IL-6 and TNF-αwere also decreased significantly (P<0.05), with no significant change of IL-10 secretion (P > 0.05). Conclusions PKG may enhance the expression of anti-inflammatory cytokine IL-10, and inhibit the expression of inflammatory cytokine IL-6 and TNF-α, contributing to prevent the development of inflammation. PKG might have a potential anti-atherosclerosis effect.

Objective To evaluate the preliminary clinical efficacy of bevacizumab for cerebral radiation necrosis (CRN). Methods Nineteen patients with CRN for whom the treatment with steroids and mannitol failed were retrospectively analyzed with a total of 22 lesions. Except for 5 lesions confirmed by pathological evidence, all lesions were confirmed by the following imaging evidence:1. computed tomography (CT)?or magnetic resonance imaging (MRI)?enhanced lesions showed loss of tension and were accompanied by substantial edema;2. CT?or MRI?enhanced lesions had a low perfusion pressure;3. magnetic resonance spectroscopy indicated that the enhanced areas had a decreased choline peak; 4. positron emission tomography showed that the fluorodeoxyglucose uptake was substantially reduced in the enhanced areas. All patients were given 5 mg/ kg bevacizumab at an interval of 14 days for 2?6 cycles. MRI examination was performed in each cycle before treatment, and the enhanced lesions on T1?weighted images ( T1 WI) and edema on T2?weighted images (T2 WI) were compared before and after treatment. The clinical symptoms, Karnofsky Performance Status ( KPS), and adverse reactions in all patients were evaluated. Comparison before and after treatment was performed by paired t test. Results All 19 patients completed the treatment successfully and there were no severe adverse reactions. The clinical symptoms of patients were substantially improved after the second cycle of treatment, and the KPS score increased by 26?? 8 on average. The visible volume of enhanced lesions on MRI T1 WI was significantly reduced by 54?? 8% after treatment (P= 0?? 000), while the visible volume of edema on MRI T2 WI was reduced by 80?? 7% after treatment (P= 0?? 000). The follow?up time ranged from 3 to 12 months with a mean value of 5?? 6 months. Eleven patients kept clinical improvement in CRN, four patients had recurrence, and four patients died from tumor progression. Conclusions Bevacizumab is preliminarily confirmed to substantially improve the clinical symptoms and quality of life in patients with CRN.

Objective To evaluate the efficacy of low-dose and long-term clarithromycin in treatment of chronic rhinosinusitis with positive bacterial biofilms.Methods Seventy-seven patients with chronic rhinosinusitis and positive bacterial biofilms underwent functional endoscopic sinusitis surgery between January 2008 and December 2009 in department of otolaryngology of Jinhua Central Hospital.Fortytwo patients were treated with clarithromycin 250 mg/d orally for at least 3 months (trial group).At the end of 3 months patients received endoscopic examination,for patients with mucosal epithelialization the clarithromycin therapy was stopped; for those with mucosal edema,granulation or polyoid formations the clarithromycin treatment was continued,but no longer than 5 months.Thirty-five patients in control group were not given clarithromycin.All patients were assessed by visual analogue scale (VAS) and nasal endoscopic examination (Lund-kennedy score) 6 months after surgery,the results were compared between two groups.Results Two patients in the trial group did not complete the protocol.VAS score and Lundkennedy score in trial group were 8.0 ± 0.8 and 3.6 ± 1.3 at 6 month after surgery respectively,while those in the control group were 7.3 ± 0.7 and 4.5 ± 1.7,and the differences were of statistical significance (t =5.311 and-3.187,P ＜ 0.01).Conclusion Low-dose and long-term oral administration of clarithromycin has positive impact on the prognosis of bacterial biofilms positive patients with chronic rhinosinusitis.

Objective To observe the bacterial biofilm in patients with chronic rhinosinusitis (CRS), and to investigate the possible relationship between biofilm and clinical factors. MethodsSixtynine patients with CRS ( study group), 15 patients with nasal septum deviation and 10 patients with nasal bone fracture (control group) were enrolled in the study. Mucosa specimens of uncinate process or ethmoid near the ostium of the maxillary sinus were obtained during endoscopic sinus surgery. The specimens were subjected to scanning electron microscopy. All patients were evaluated by questionnaire of chnical factors based on sino-nasal outcome test-20. SPSS 10. 0 was used for statistical analysis, and the relationship between bacterial biofilm and clinical factors was evaluated by Chi-square test. ResultsBacterial biofilms were found in 49 patients ( 71.0％ ) with CRS. A marked destruction of the epithelium and cilia was observed in all samples of study group. No bacterial biofilm was found in the control group, and scanning electron microscopy showed normal epithelium and cilia in those specimens. Chi-square test showed that bacterial biofilm was not associated with clinical factors (gender, staging, course, nasal obstruction, phlegm, nasal discharge with stinking smell, headache, bloody nasal discharge and olfactory degeneration) in CRS. ConclusionsBacterial biofilms and destruction of the epithelium and cilia can be obscrved in CRS patients, which may be involved in the pathogenesis of CRS, but the formation of bacterial biofilm is not correlated with the clinical factors in CRS.