This paper analyzes the explore the factors influencing the TCM clinical pathway using the fishbone dragram. We found that the main impacting factors of TCM clinical pathway were government policy factors, hospital management factors and personal factors. It was suggested to promote Chinese medicine clinical pathway pilot job, not only need to cooperate with the administrative departments of health and medical institutions, also need to strengthen the change of the idea of both doctors and patients.

Fast-track surgery is a new concept in general surgery nowadays.Fluid therapy,one part of fast-track surgery,is an important part,which go through with the whole perioperative process.Fluid therapy includes short time of fasting,no bowel preparation,appropriate postoperative fluid management,new monitoring technologies of hemodynamics,and so on.This new approach benefits preventing postoperative complications such as postoperative insulin resistance and cardiopulmonary failure.Still,this is a new concept which needs to be examed in clinical practices.In the future,the challenges lie within procedure-specific approaches,goaldirected therapy,the balance between the amount and composition of colloid vs crystalloid and the developments of the optimal techniques to monitor intra-and post-operative hemodynamics.

Objective To investigate the acaroid mite pollution in houses in Huaibei area,Anhui province and to prevent allergic diseases caused by acaroid mites. Methods The samples of acaroid mites were collected from the houses,hotels and undergraduate dormitories,then the acaroid mites were separated,classed and counted. Results Fifteen kinds of acaroid mites were detected from the samples,belonging to 5 families,11 genera. The analysis showed that average density of acaroid mites in the common houses ranked the first,32.5. The values of the species richness index R was 1.36,the species diversity index was 2.16,the species evenness index was 0.9. Conclution The density of acaroid mites in the common houses is higher in Huaibei area and the effective measure should be taken to control the acaroid mites.

Objective:To establish a nomogram model for predicting the risk of intracranial hemorrhage in patients with acute cerebral infarction after mechanical thrombectomy.Methods:The clinical data of 251 patients with acute cerebral infarction who underwent mechanical thrombectomy in Shengjing Hospital Affiliated to China Medical University from January 2017 to December 2019 were retrospectively analyzed. Logistic regression model was used to analyze the independent risk factors of intracranial hemorrhage after mechanical thrombectomy. A nomogram prediction model based on independent risk factors was established to verify the prediction and accuracy of the model.Results:The analysis results of logistic regression model were as follows: age ( OR=1.303, 95% CI:1.184-1.433), the time from infarction to re-canalization ( OR=4.306, 95% CI:2.497-7.425), preoperative NISS score ( OR=7.584, 95% CI:2.221-25.900), preoperative computer tomography (CT) low-density lesions ( OR=7.954, 95% CI:1.176-53.792) were independent risk factors for intracranial hemorrhage after mechanical thrombectomy in patients with acute cerebral infarction ( P<0.05). Based on the above 4 independent risk factors, a nomogram predictive model of intracranial hemorrhage risk after mechanical thrombectomy was established. The Bootstrap internal verification method proved that the model had good prediction accuracy, and the receiver operating characteristic (ROC) curve analysis testified that area under curve (AUC) area was 0.966. Conclusions:The risk nomogram prediction model has good accuracy, discrimination and good prediction ability, which can improve the diagnostic efficacy of intracranial hemorrhage after mechanical thrombectomy in patients with acute cerebral infarction.

Objective To investigate the technical charactenstics ot SYSMEX XS1000i 5-part differential automated hematological analyzer and its clinical applications.Methods 209 samples were analyzed with the analyzer of XS1000i and compared to the results from Beckman-Coulter LH750 analyzer.The main parameters from XS1000i,such as precision within-run,day to day precision and carryover contamination rates etc,were recorded respectively in 509 samples to compare the difference between the instrumental and optical examination.Results All variation coefficients of precision from XSI000i were within the manufacturer.The carryover contamination rates of WBC,RBC,Hb,HCT and PLT were 0.19%,0.93%,0,-0.88%,-0.76%,respectively.The parameters of XS1000i were correlated with the results of LH750 except basophil granulocyte.The correlation coefficients of WBC,RBC, HGB and PLT were 0.994 5,0.996 8,0.997 0 and 0.974 6 ,respectively.The sensitivity of warning flags in immature leukocytes was 100% and the specificity was 69.7%,the sensitivity of warning flags in atypical lymphocyte was 100% and the specificity was 66.7%.Especially in 3 leukocytopenia that was induced by chemotherapy in patients with leukemia who had only few immature cells existed in the peripheral blood,the parameters of XS1000i were positive,and correlated with the results of detection of minimal residual disease with flow cytometry.Conclusions The warning system of XSIO00i provides more valuable information for manual microscopic examination.If it is combined with flow cytometry,the advantages in detection of residual leukemic cell will be fully displayed.

BACKGROUND:Source of bone for autografting,allografting and xenografting is insufficient.Moreover,immunoreaction,infection and re-fracture occur sometimes.As artificial bone substitute.calcium sulfate and calcium phosphate ate widely used in clinic.OBJECTIVE:To compare the curative effect between calcium sulfate(Stirnulan pellets)and calcium phosphate(Bio-Lu bioceramics)as bone substitutions in traumatic fractures.DESIGN.TIME AND SETTING:Randomized controlled observation was performed at the Department of Orthopedics,Beijing Xiyuan Hospital.China Academy of Chinese Medical Science between October 2004 and October 2007.PARTICIPANTS:Fifry patients with bone trauma-induced bone defect who needed bone grafting were selected and randomly divided into two groups:calcium sulfate(n=24)and calcium phosphate(n=26).METHODS:Besides internal fixation(steel-wire,plate)and external fixation(plaster,external frisket),all Cases were filled with bone substitutes.The grafted bone mass was on basis of standards of grafting:generally 3-5mL for Barton fracture and calcaneus fracture.the maximum 10 mL.MAIN OUTCOME MEASURES:Bone substitute usage,resorption time.fracture status and bone callus.RESULTS:All fractures that were filled with bone substitutes were healed well.No abnormal reaction occurred in calcium sulfate group.Two cases with calcium phosphate exhibited effusion in local soft tissue and healed by changing dressing.During the follow-up of 6 months(range 4-12 months),the bone substitutes were absorbed completely.The absorptivity of Stimulan pellets was 80%within 2 mortths and 100%within 3 months.faster than Bio.iu bioceramics(70%within 4-6months:90%within 7-12 mortths).CONCLUSION:The advantages of calcium sulfate and phosphate as bone substitutes are safety.convenience,and few side effects with good filling effect and well fractures healing.Moreover,the calcium sulfate powder(Stimulan)exhibits stronger supporting for bone defect area after soliditication,and faster degradation than calcium phosphate

Objective To invetigate the effect and safety of sufentanil mixed levobupivacaine on postoperative analgesia in pediatric caudal block anesthesia.Method Sixty pediatric patients (2 ～ 6 years old) who were undergoing elective abdominal surgery,such as repair hernia of high ligation,were randomly divided into three groups with 20 cases each.after intravenous induction,0.25％ levobupivacaine was injected in sacrum tube in group Ⅰ,0.5 μg/ml sufentanil mixed 0.25％ levobupivacaine and 1.0 μg/ml sufentanil mixed 0.25％ levobupivacaine were injected in sacrum tube in group Ⅱ and group Ⅲ respectively.The analgesia effect,the analgesia time,recover time and adverse reaction were observed and recorded 2,4,8,12,16,24 hours after the surgery.Results The analgesia effect in group Ⅱ、Ⅲ were significantly better than the group Ⅰ when 4、8、12 hours after the operation(P ＜0.05),and the analgesia effect in groupⅢ were significantly better than the group Ⅱ when 8 hours after the operation (P ＜ 0.05).There were no significant differences in three groups when 2、16、24 hours after the operation(P ＞0.05),the analgesia time in group Ⅱ、Ⅲ were significantly longer than the group Ⅰ (P ＜ 0.05),and the analgesia time in group Ⅲ were significantly longer than the group Ⅱ (P ＜ 0.05).There were no differences in the recovery time of three groups (P ＞ 0.05).There were no adverse reactions in three groups.Conclusions 0.5 μg/ml and 1.0 μg/ml sufentanil mixed 0.25％ levobupivacaine may be used on postoperative analgesia in pediatric caudal block anesthesia safely and analgesia effect and time were more better and longer than 0.25％ levobupivacaine singly.The analgesia effect in group with 1.0μg/ml sufentanil mixed 0.25％ levobupivacaine was the best in three groups with the fewest side effects.

Objective To investigate the pathologic features of ganglioglioma/gangliocytoma.Methods 19 cases of gangliogliomas and gangliocytomas were studied by HE stain, immunohistochemistry and ultrastructural observation.Results (1) The tumor cells presented widespread, derangement distribution, and conglobation in some regions. (2) The tumor cells were similar with ganglion cell, showing multipolar in feature, and had large, irregular nucleoli. The nucleoli were clear. Some tumor cells were bi-nucleated. (3) Neurogliocytomas were Ⅱ～Ⅲ grades according to the standard published by WHO. (4) Immunoreactions showed GFAP (-), S-100 (+) and Synaptophyein (+) in neoplastic cells. (5) Ultrastructure observation showed cytolysosome, ribosome and rough endoplasmic reticulum in the cytoplasm of the neoplastic cells. Abundant mitochondria and dense neuroendocrine granules were also found in these cells.Conclusions Ganglioglioma/gangliocytoma is a rare tumor of central nervous system. Its diagnosis mainly depends on histopathology, special markers of immunohistochemistry and ultrastructural features. The property of neoplasma is related to the component of neurogliocytoma.

Liver fibrosis is characterized by an abnormal hepatic accumulation of extracellular matrix (ECM) that results from both increased deposition and reduced degradation of collagen fibres. Some studies show that transforming growth factor ?1(TGF-?1), alternatively activated macrophage (aaM) and interleukin 13(IL-13) play a key role in the evolution of fibrosis, of which TGF-?1 and IL-13 become research hotspots. TGF-?1 mainly activates hepatic stellate cells (HSC) through TGF-?1/Smad signal pathway, while IL-13 seems to play a rather crucial role through JAK-STAT6 signal pathway. aaM is an important source of TGF-?1 and activated with Il-13. This paper reviews the role of those signaling molecules in cellular signal transduction of hepatic fibrosis of schistosomiasis japonica, and provides some targets for future drug development.

Objective To study the levels of soluble endoglin (sEng) in peripheral blood and intervillous space blood of patients with preeclampsia, and analyse the correlation between levels of sEng and clinical performance. Methods Levels of sEng in peripheral blood and intervillous space blood of 22 patients with preeclampsia (preeclampsia group, 12 cases of severe preeclampsia and 10 cases of mild preeclampsia) were detected by ELISA, and the correlation between levels of sEng and blood pressure, 24 h urine protein and fetal birth weight was analysed. Twenty-two normal pregnant women were served as control group. Results The sEng levels in peripheral blood and intervillous space blood of preeclampsia group were significantly higher than those of control group [ (31.89 ± 8.80) ng/mL vs (5.24 ± 1.60) ng/mL, P < 0.01; ( 37.74 ± 7.12) ng/mL vs (6.63 ±1.76) ng/mL, P < 0.01]. In preeclampsia group, the sEng levels in peripheral blood and intervillous space blood of severe preeclampsia were significantly higher than those of mild preeclampsia (P <0.01). In preeclampsia group, the sEng level in peripheral blood was significantly correlated with that in intervillous space blood of preeclampsia group (r = 0.876, P < 0.01) , neither was significantly correlated with blood pressure (P > 0.05), both were significantly correlated with 24 h urine protein (r = 0.729, P < 0.01; r = 0.743, P < 0.01) , and both were significantly correlated with fetal birth weight (r = - 0.736, P < 0.01; r = - 0.707, P < 0.01). Conclusion Levels of sEng in peripheral blood and intervillous space blood of patients with preeclampsia are significantly higher than those of normal pregnant women, and the levels of sEng are significantly correlated with the clinical performance of preeclampsia.