Objective To analyze the role of Clinical Pathway in controlling hospitalization cost and to provide the basis for reasonable control of medical cost.Methods The data of patients undergoing unilateral and bilateral total hip replacement in 2005 and 2010 in Arthritis Clinical and Research Center of Peking University People's Hospital were retrospectively analyzed.There were 70 unilateral and 14 bilateral total hip replacement cases in 2005,whereas the number of those in 2010 was 173 and 46 respectively.All charges were assigned to 1 of 9 categories:hospital room,nursing,radiology and laboratory,prosthesis,blood transfusion,surgery,pharmacy,treatment,diagnosis.We compared the total costs and cost of each category between 2005 and 2010.Results There was no statistical significant difference between 2005 and 2010 in terms of age,gender distribution,pri mary disease and type of prosthesis.The total costs for unilateral and bilatcral total hip replacement was 40 852.72 yuan and 73 020.28 yuan in 2010,respectively.They were both significantly lower than those of 2005 (49 371.35 yuan and 80 962.61 yuan respectively).The charge for each category of total hip replacement in 2010 was 585.88,145.38,2 885.47,3 222.32,1 776.15,3 805.29,132.79,4 100.88,and 3 0953.75 yuan.Compared with 2005,each category of charge dropped in 2010,especially the cost of surgery,treatment,diagnosis and hospital room,which decreased by 35.11％,31.76％,31.40％ and 30.67％ respectively.The tendency of each category change in charge of unilateral and bilateral total hip replacement was similar to the overall costs.Conclusion The total costs for total hip replacement (unilateral and bilateral total hip replacement) in 2010 were lower than those of 2005,which might be the result of adopting Clinical Pathway since 2010.Nevertheless,the prosthesis cost accounted for a large proportion in both years.Therefore,controlling the prosthesis cost might be an effective way to reduce medical costs for total hip replacement.

Arrhythmias, Cardiac ; etiology ; Birth Weight ; Electrocardiography ; Female ; Humans ; Hypocalcemia ; complications ; Infant, Newborn ; Male

Objective: Through comparing the hospitalization costs of total knee replacement (TKR) in People’s Hospital of Peking University in 2005 and 2010, to investigate the changing status of hospitalization costs on this operation and the impact of clinical pathway ( CP ) on controlling the hospitalization costs during 5 years , and provide references for controlling medical treatment cost reasonably. Methods: The patients are grouped into undergoing unilateral and bilateral TKR. The total hospitalization cost and cost of each category during 5 years are compared, and SAS 9.2 statistic software is applied to deal the data. Results: Compared with 2005, the total cost for TKR in 2010 decreased. All the charging items decreased, except implant material increased, especially the cost of surgery, hospital room, nursing and pharmacy. Specific to one knee replacement group and both knees replacement, the changing trend of cost is coincident with the total cost. Conclusion: The total cost for TKR in 2010 was lower than that of 2005, which might be the result of adopting CP since 2010. Nevertheless, the implant material cost accounted large proportion of hospitalization cost in 2010, and it has obvious increasing trend compared to 2005. This result is related the increasing application of the new edition of Artificial knee joint prosthesis. Controlling implant material cost is the effective method of decreasing medical costs for TKR.

Objective To examine the effect of donepezil on cognitive function of Alzheimer's disease from a naturalistic observation in memory clinic.Methods From the subject pool in memory clinic,thirteen patients with mild to moderate Alzheimer's disease(meeting NINCDS-ADRDA criteria of probable AD)were enrolled in the naturalistic observation.Donepezil with dosage of 5 mg daily Was administered.Cognitive Ability Screening Instrument (CASI)Was used to assess the cognitive function,and was administered at baseline,3 and 6 months after treatment with donepezil.Resuits After 6-month treatment with donepezil,the change of score of verbal fluency from baseline Was significant[(4.3±3.1)vs(6.2±2.7),P＜0.05].There was a trend that constructional praxis was also improved after 6-month treatment(P=0.06).The change of scores of other cognitive domains remained the sanle(P＞0.05).Conclusion In the naturalistic observation at memory chnic,donepezil may improve verbal fluency of AD patients,and keep most cognitive function stable.

Aged ; Atropine ; Electrocardiography ; Female ; Heart Rate ; drug effects ; Humans ; Male ; Muscarinic Antagonists ; pharmacology ; therapeutic use ; Preoperative Care ; methods ; Quinuclidines ; pharmacology ; therapeutic use

Health Knowledge, Attitudes, Practice ; Humans ; Occupational Diseases ; prevention & control ; Rural Population ; Sampling Studies ; Surveys and Questionnaires ; Transients and Migrants

Objective To study the effects of metformin on proliferation and apoptosis of oral squamous cells so as to create a new path for the treatment of oral carcinoma.Methods CAL27 cells were treated with different dosage of metformin(5,10,20 mmol/L)for 24,48, and 72 hours.The number of apoptosis was detected by flow cytometry and TUNEL.The autophagic vacuole was detected by immunofluores-cence.The expression of hallmark of apoptosis and autophagy was detected by Western blot.Results Metformin could induce apoptosis in CAL27 cells.The CL-PARP and Bcl-2 expression significantly increased.In line with the apoptosis,metformin can trigger autophagy in CAL27 cells.The expression of LC3,Beclin-1 and GFP-LC3 positive autophagosomes were increased by metformin.Metformin inhibit the expression of STAT3 and mTOR signaling pathways at the same time might be the possible reasons of the autophagy.And inhibited autophagy could en-hance metformin induced Caspase-3 activity in CAL27 cells.Conclusion Inactivation of STAT3 and mTOR pathway contributes to metform-in-induced autophagy.Inhibited autophagy could enhance metformin induced apoptosis in oral squamous cell carcinoma.

Objective To evaluate the clinical value of microvascular anastomotic devices in free anterolateral thigh flap in the recon-struction of oral carcinoma defects.Methods From September 2013 to September 2014,52 patients with oral cancer were treated by func-tional neck cleaning,primary tumors resection,and free anterolateral thigh flap in the reconstruction.Of which 27 patients received free of femoral anterolateral flap to repair veins by using microsurgical line end to end anastomosis.And 25 pieces of microvascular anastomotic ad-vices were applied in 25 patients with oral carcinoma defects.The length of anastomosis time,flap survival rate,and complications were recor-ded.Results In 52 patients,microvascular anastomotic devices were applied in 25 veins with shorter anastomosis time,(6.3 ±1.9)min vs. (12.3 ±1.4)min,and the difference was significant(P =0.001).The flap survival rate and vascular anastomosis patency rate was 100%.No intra-and post-operative complications such as blood leak,stapling,excessive tension and tear,thrombosis in flap vein crisis associated with microvascular anastomotic devices were observed.Twenty-seven patients with 40 root vein received manual microsurgical anastomosis,2 of them showed vein crisis.Conclusion The microvascular anastomotic devices used in repairing the soft tissue defects by anterolateral thigh flap with venous anastomosis for patients of oral cancer after surgery has the advantage of higher quality,shorter time and less complications.

Objective This study is aimed to compare sinus tarsi approach and conventional extensile L shape approach in the management of Sanders type III calcaneal fractures. Methods A total of 36 cases of Sanders type III calcaneal fractures treated in our hospital between August 2011 to February 2014(35 patients, 27males, 8 females. Nineteen of them were performed a limited open reduction and internal fixation(ORIF) via the sinus tarsi approach(as minimal invasive group), while the other 17 cas?es were performed ORIF via conventional lateral extensile L shape approach(as conventional group). X?ray films were taken post?operatively to record the changes of B?hler angle and Gissane angle. The AOFAS ankle hind?foot scale, visual analogue scale and the MOS item short from health survey(SF?36) were adopted to assess the therapeutic effect. Results The average follow?up peri?od of minimal invasive group was 14.6 months. And conventional group were followed up for average period of 18.3 months. All the fractures in the series had a boney union at or before the final follow?up. The immediate correction and final correction of B?hler angle and Gissane angle were significantly increased in both minimal invasive group and conventional group, while there was sig?nificant difference between the two groups. The median AOFAS score ,VAS score and SF?36 score of the minimal invasive group were 84.74±8.14,1.68±0.95 and 89.36±4.69, while those in the conventional group were 82.06±10.95,1.94±1.43and 86.71±5.39. There was no significant statistically difference between the two groups. No wound problem happened in the minimal invasive group, 3 cases of subtalar joint stiffness were found, and 1 developed traumatic arthritis. Respectively, 2 cases in conventional group got hematoma and dehiscence for each, 8 cases of subtalar joint stiffness were found, and 2 cases developed traumatic arthri?tis finally. Conclusion Limited ORIF via a sinus tarsi incision have the familiar therapeutic effects to ORIF via a conventional extensile L shape incision in the management of type III calcaneal fractures. But the former has the advantage of lower incision complication rate and lower stiffness subtalar joint rate.

Objective To discuss the clinical character and the therapeutic strategy of the super-proximal bicondylartibial plateau fracture.Methods A review of 8 patients with an average age of 40.8 years old (range,28-56 years; 6 males,2 females) surgically treated from June 2007 to October 2012 was conducted.Conventional pre-operative three-dimensional CT scans were used to clarify the types of fractures and the locations of major displaced bone fragments.All patients received open reduction and internal fixation 7-14 days after injury for recovery of soft tissue.Anterolateral incision combined anteromedial incision was made on those with limited posterior column shift.Otherwise anterolateral incision combined posteromedial might be better for those with obvious displacement.Six of the patients were implanted autograft bone or allograft bone.The collateral ligaments could be repaired in one stage,but a routine repair of cruciate ligaments was not concerned,and an immobilization for six weeks with a plaster or a brace should be followed.Results All cases were followed-up for 12 to 26 months (median follow-up period,18.6 months).All the fractures in the series achieved bone union at or before the last follow-up,and the healing time ranged from 18 to 26 weeks (median healing period,21.5 weeks).The X-rays showed the smooth surface and good alignment of knee joint at the last follow-up.The median hospital for special surgery knee score (HSS) was 78.12 (range,56-90),with 3 excellent cases,3 good cases,1 fair cases and 1 poor case; the excellent and good rate was 75％ (6 of 8).The median Lysholm score was 81.37 (range,58-91),with 4 good cases,3 fair cases and 1 poor case; the excellent and good rate was 50％ (4 of 8).Conclusion Super-proximal bicondylartibial plateau fracture is a special fracture type accompanied with posterior dislocation of knee,which is predominantly presented as an anterior plateau fracture.And injuries of blood vessels and nerve are common.Conventional pre-operative three-dimensional CT scans,paying attention to the stability of the knee,restoring the alignment and joint surface and early analgesic exercises with brace might be commended in management of such plateau fracture.