Taking three Chinese databases (CNKI,WANFANG and VIP) as data sources,the paper retrieves documents about Clinical Pathway (CP) dated from 2000 to 2009 and dated from 2010 to 2015 as well as respectively performing the clustering analysis and strategic coordinate analysis of high-frequency keywords on dereplicated document set,summarizes the study hotspots of documents about CP in China.

Objective To study the differences in levels of plasma cytokine profiles including interleukin-6 (IL-6),interleukin-10 (IL-10),tumor necrosis factor-alpha (TNF-alpha) and C-reactive protein (CRP) between healthy controls and people with smoking and alcohol drinking behaviors at different ages,and to investigate the correlation of plasma cytokine profiles with age,smoking and alcohol drinking behaviors.Methods The concentrations of IL-6,IL-10,TNF-alpha and CRP in 350 healthy volunteers,60 cigarette smokers and 65 people with smoking and alcohol drinking behaviors were detected by ELISA.All subjects were grouped by age,gender,smoking and alcohol drinking behavior.The differences in the levels of plasma cytokine profiles among groups were analyzed by statistics software SPSS18.0.Results The concentrations of IL-6 and CRP in 25-39years,40-49 years,50-59 years and over 60 years groups were (1.1±0.7) ng/L,(1.5±0.1) ng/L,(1.7±0.2) ng/L,(2.1±0.1) ng/L and (3.1±1.0) mg/L,(4.4±±0.6) mg/L,(6.2±1.7) mg/L,(8.0±0.8) mg/L,respectively.The concentrations of IL-6 and CRP were significantly increased with age (F=1.60,7.50,P=0.012,0.043),while the concentrations of IL-10 and TNF-alpha were not correlated with age (F=4.20,4.80,P=0.178,0.421).There were no significant differences in the concentrations of IL-6,IL-10,TNF alpha and CRP between males and females (P＞0.05).The plasma CRP level was higher in smoking group than in control group [(6.8±0.6) mg/L vs.(3.1± 0.4) mg/L] and was highest in smoking-alcohol group [(9.5±0.5) mg/L vs.(6.8±0.6) mg/L,(3.1±0.4) mg/L,F=8.40,P=0.046].Compared with the control group,IL-6 level was increased and IL-10 level was decreased in smoking group and smoking-alcohol group.There were no significant differences in levels of IL-6,IL-10 and TNF-a among the three groups (F=2.90,4.30,4.80,P=0.089,0.672,1.231).Conclusions The plasma levels of IL-6 and CRP are significantly increased with age,but the plasma levels of IL-10 and TNF-a have no correlations with age.The plasma levels of IL-6,IL-10,TNF-a and CRP are not affected by gender.CRP level is significantly influenced by smoking and alcohol drinking behaviors,which should be taken into consideration to establish the reference values.

Objective To explore the prevalence and related factors of post-traumatic stress disorder (FTSD) among nurses who took part in rescue of 5.12 Wenchuan earthquake after two years.Methods The PTSD Checklist-Civilian Version (PCL-C) was used to diagnose PTSD among nurses from Mianzhu,one of the city where the earthquake happened.Results Totally 223 subjects finished the evaluation.The incidence rate of PTSD among the nurses was 1.7％(PCL-C＞50),and 8.2％ people had different degree of post-traumatic stress disorder.Comparing the three symptom clusters,hyper-arousal was the most prominent one.Different age,professional position,marriage,health condition significantly influenced the prevalence of PTSD.The risk factors of PTSD was bad health condition and being divorced or widowed.Conclusions The nurses still showed some symptoms of PTSD two years after the earthquake,individualized psychological intervention should be applied to them.

Objective To understand the incidence and the severity of hypertension in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and to analyze the impact of OSAHS on the circadian rhythm of blood pressure in patients with hypertension and to investigate the risk factors for the occurrence of hypertension from the aspects of nocturnal hypoxemia and sleep structure. Methods Polysomnography monitor was used for 7-hour sleep monitoring at night and 24-hour ambulatory blood pressure monitoring in 77 patients with OSAHS (severe, n = 33; moderate, n = 23; mild, n = 23). The sleep-related indicators and blood pressure at different times were analyzed, and they were compared to the patients with hypertension without OSAHS (n = 15) and normal controls (n = 15). Results (1) The body mass index (BMI) in the severe, moderate, and mild OSAHS groups was 29.1±2.8, 25.0±2.5, and 23.2±3.0 kg/m~2 respectively, and they were all significantly higher than 20.3±4.1 kg/m~2 in the control group (all P <0.05); sleep apnea-hypopnea index (AHI) was 56.2±14.7, 19.1± 4.4, and 11.2±4.3/h respectively, and they were significantly higher than 2.9±1.0/h in the control group (all P <0. 05); oxygen saturation index (ODI) was 62.5±20.4, 19.6±8.8, and 24.8±22.7/h respectively, and they were significantly higher than 2.7±2.0/h in the control group (all P <0.05); microarousal index (MI) was 47.5±20.9, 12.8±4.6, and 9.8±4.6/h respectively, arid they were significantly higher than 1.3±1.1/h in the control group (all P < 0.05); 24-hour mean systolic blood pressure was 133±14.5, 126±6.5, and 118± 9.9 mm Hg respectively, and the severe and moderate OSAHS groups were significantly higher than 117±9. 6 mm Hg (all P <0.05); 24-hour mean diastolic blood pressure was 92.8±9.6, 86.3±7.5, and 81.9±3.9 mm Hg respectively, and the severe and moderate OSAHS groups were significantly higher than 78.5±5.6 mm Hg in the control group (all P <0.05); and the lowest oxygen saturation was 65.5%±10.4%, 78.5%±5.1%, and 79.7%±9.6% respectively, and the severe and moderate OSAHS groups were significantly lower than 84.7% ±8.2% (P <0.05). (2) There was no significant difference in blood pressure before going to bed and waking up between the hypertension group and the control group. The blood pressure after waking up in the OSAHS combined with hypertension group was significantly higher than before going to bed (142.0±12.4/110.0±10.2 mm Hg vs. 127.4±9.8/84.2± 6.0 mm Hg, P <0.05). (3) ODI and MI in the OSAHS combined with hypertension group were 43.5±26.2/h and 31.6±21.2/h respectively, and they were significantly higher than 26.7± 13.2/h and 27.5±20.6/h in the non-hypertension OSAHS group (all P <0.05), and the non-rapid eye movement sleep period S3 +4 and the sleep efficiency of the former were 5.1%± 3.5% and 62.2±15.4% respectively, and they were all significantly lower than 8.8%± 5.2% and 69.92%±14.8% of the latter (P <0.05 and 0.01, respectively). (4) component ratio of non-dipper blood pressure curve was 56.1% in the OSAHS combined with hypertension group, and it was significantly higher than 13.1% in the control group and 16.7% in the simple hypertension group (all P <0.01 ). (5) Multivariate logistic regression analysis showed that ODI (OR = 1.29, 95% CI 1.57-1.07; P = 0.01 ), MI (OR = 0.925, 95% CI 0.874-0.980; P =0.008) and the time of period S3 +4 (OR = 1.087, 95% CI 1.034-1.142; P =0.001 ) were significantly correlated with hypertension alter adjusting for BMI, sex and age. Conclusions Systolic and diastolic blood pressures in the OSAHS group were significantly high-er than those in the normal control group, and the blood pressure increased with the aggravation of OSAHS. 1he circadian rhythm of blood pressure disappeared, and the blood pressure variabili-ty showed a non-dipper-shaped curve. The major risk factor for causing patients with OSAHS combined with hypertension was nocturnal hypoxemia and then severe sleep disorders and in-creased MI.

Objective:To compare the personal characteristics between the patients with paradoxical insomnia and the patients with primary insomnia or the normal sleepers.Methods:A case-control study with the proportion at 1∶1∶1 was carried out.The patients with paradoxical insomnia were diagnosed in Sleep Medicine Center of West China Hospital of Sichuan University between March 2013 and December 2013.A case of paradoxical insomnia was matched with two controls:a primary insomnia patient and a normal sleeper.A total of 63 matched cases were collected.A face-to-face survey was conducted by using the following scales:General Data Scale and Eysenck Personality Questionnaire (EPQ).Results:The average scores of psychoticism,extraversion,and neuroticism for paradoxical insomnia cases were (52.1±10.2),(49.6±9.8),and (56.0±12.0),respectively.In general,31.7% of paradoxical insomnia patients had psychoticism or psychoticism tendency in their personality,which were more obvious than those in primary insomnia patients (7.9%) (x2=l 1.228,p<0.0125) and normal sleepers (0) (X2=23.774,P<0.0125).Moreover,19.0% of paradoxical insomnia patients had extroversion or extroversion tendency in their personality,which were more significant than those in primary insomnia patients (3.2%) (Z=-4.047,P<0.0125) but less obvious than those in normal sleepers (60.3%) (Z=-4.754,P<0.0125).Also,46.0% of paradoxical insomnia patients had neuroticism or neuroticism tendency in their personality,which were more significant than those in normal sleepers (0) (x2=37.670,P<0.0125) but similar to those in primary insomnia patients (52.4%) (x2=0.508,P>0.0125).Conclusion:The personal characteristics for paradoxical insomnia patients did not reached obviously abnormal level.However,their psychoticism tendency,extroversion tendency and neuroticism tendency needed to be paid attention.

Objective To study the changes of the expression of growth associated protein -43(GAP 43) in cochlear nucleus and the inferior colliculus (IC) in rats after unilateral cochlear damage at different time points after surgery ,and explore the remodeling and repair process of synapse in brainstem auditory center of rats after auditory deprivation .Methods Thirty rats were randomly divided into six groups :the 3 ,7 ,15 ,30 ,60 days group (with u-nilateral cochlea damage) and the control group (without cochlea damage) with 5 rats in each group .The immuno-histochemical SP method was used to detect the expression of GAP -43 in cochlear nucleus and inferior colliculus at different time points after cochlea damaged in the control group .Results After the unilateral cochlear ear was dam-aged at 3 ,7 ,15 days ,GAP -43 in operation side cochlear nucleus were expressed and the expression level signifi-cantly increased compared with normal control group .After 30 days postoperatively ,GAP - 43 expression level decreased ,but it was still higher than normal control group .After 60 days postoperatively ,GAP - 43 expression level was slightly higher than that of normal control group .After 3 days postoperatively ,GAP - 43 expression level was higher than normal control group .After 7 ,15 days postoperatively ,expression levels were increased .After 30 , 60 days postoperatively ,the expressions gradually decreased ,but still higher than the normal control group .Conclusion After unilateral cochlea damaged ,GAP - 43 was expressed an obvious dynamic change process in cochlear nucleus and infe-rior colliculus .It may reflect the axonal regeneration and synaptic plasticity after hearing loss in brainstem auditory neurons .

Objective To explore the main anatomical factors for relapse in patients underwent radical mas-toidectomy and discuss the preventive measures .Methods A retrospective study was carried out 36 patients who had underwent radical mastoidectomy and 100 patients (100 ears) who had been cured underwent radical mastoidectomy during July 2011 toSeptember 2013 .The patients underwent axial and coronal temporal Computed Tomography (CT) .The incidence of low -lying middle cranial fossa ,high jugular bulb ,anterior locati(36 ears)on of sigmoid si-nus ,dehiscent tympani tegmen ,dehiscent of the facial nerve canal ,large sinus tympani ,low -lying horizontal facial nerve were recorded .Results The incidence of low -lying middle cranial fossa(36 .1% ) ,anterior location of sig-moid sinus(41 .7% ) ,dehiscent tegmen tympani (30 .6% ) ,dehiscent of the facial nerve canal (41 .7% ) ,large sinus tympani(25 .0% ) ,low -lying horizontal facial nerve(22 .2% ) were higher than those of in the normal group .There was no significant difference in high jugular bulb .Conclusion The main anatomical factors for relapse in patients un-derwent radical mastoidectomy were low -lying middle cranial fossa ,anterior location of sigmoid sinus ,dehiscent tegmen tympani ,dehiscent of the facial nerve canal ,large sinus tympani ,low -lying horizontal facial nerve .

BACKGROUND:Although vitamin C has an anti-oxidation role and can promote cell proliferation, there is a lack of research about the promoting effect of vitamin C on the proliferation of adipose-derived stem cells under high glucose conditions and the related molecular mechanisms.OBJECTIVE:To explore the promoting effect of vitamin C on the proliferation adipose-derived stem cells treated by the high glucose and the related molecular mechanisms.METHODS:Passage 3 human adipose-derived stem cells were cultured under high glucose conditions and then treated with different concentrations of vitamin C (0, 100, 150, 200, 250, 300 μmol/L). Cells cultured under low glucose conditions acted as controls. The expression levels of p-ERK and p-AKT proteins were detected by western blot. MTT method was used to choose the optimal concentration and time of vitamin C for all the subsequent tests. Human adipose-derived stem cells cultured under high glucose conditions were divided into four groups, and cells in blank control group had no treatment. Cells in the other three groups were treated with the optimal concentration of vitamin C (vitamin C group), LY294002+the optimal concentration of vitamin C (LY294002 group), or U0126+the optimal concentration of vitamin C (U0126 group) for 48 hours.EdU staining assay was used to detect the cell proliferation of human adipose-derived stem cells.RESULTS AND CONCLUSION:(1) Cell counting kit detection:We found that high glucose reduced the proliferation of human adipose-derived stem cells, and vitamin C promoted the proliferation of these cells. The best concentration of vitamin C was 200 μmol/L and the optimal effect time was 48 hours. (2) Western blot detection:Compared with the 0 μmol/L vitamin C group, the level of p-ERK in the 200 μmol/L vitamin C group was upregulated significantly (P < 0.01),while no significant expression change in p-AKT protein was found in control, 0 and 200 μmol/L vitamin C groups.(3) EdU test:the number of EdU positive cells was significantly higher in the vitamin C, LY294002, and control groups compared with the blank control group (P < 0.01). Moreover, compared with the vitamin C group, the EdU positive cells in the U0126 group were decreased significantly in number (P < 0.01). In conclusion, the ERK/MAPK signaling pathway is involved in the promotion effect of vitamin C on the proliferation of human adipose-derived stem cells under high glucose conditions.

Objective To study the expression of signal transducer and activator of transcription 3 (STAT3) and Suppressor of cytokine signaling 3(SOCS3) in the middle ear cholesteatoma epithelium ,and the possible roles of STAT3 and SOCS3 in middle ear cholesteatoma .Methods The immunohistochemical assay was used to detect ex-pression of STAT3 and SOCS3 protein in 30 cases of middle ear cholesteatoma epithelial tissue and 20 cases of nor-mal external auditory canal skin tissues as the control group .Results STAT3 immunoreactivity was detected in the nuclei and cytoplasm of epithelial cells .The expression rates of STAT3 in middle ear cholesteatoma epithelial tissue were 76 .7% and higher than in the normal epithelium (25 .0% ) .The differences between the two groups were sta-tistically significant (P<0 .05) .SOCS3 immunoreactivity was detected in the cytoplasm of epithelial cells .The ex-pression rates of SOCS3 in middle ear cholesteatoma epithelial tissue were 33 .3% and lower than in the normal epi-thelium (65 .0% ) .The differences were statistically significant (P<0 .05) .The expression of STAT3 and SOCS3 in the middle ear cholesteatoma had negative correlation (r= - 0 .476 ,P<0 .05) .Conclusion The abnormal ex-pression of STAT3 and SOCS3 in the middle ear cholesteatoma may be involved in hyper proliferation and anti -ap-optosis of cholesteatoma cell ,and play an important role in the formation and development of middle ear cholesteatoma .

Objective To investigate the clinical features and incidence of depression in patients with different lo-cations and pathological types of brain tumors. Methods Hamilton Depression Scale (HRSD) was used to assess the de-pression in 140 patients with brain tumor before and after operation. Results The preoperative mean depression rating score was 15.36 ± 6.52 and the prevalence rate of depression was 50 cases (35.7%) in 140 patients with brain tumor. The postoperative mean score of depression was 9.71 ± 5.55 and the prevalence rate of depression was 9 cases (6.4%) in 140 patients with brain tumor. The postoperative depression score and the prevalence rate was significantly decreased after op-eration (P<0.05)(χ2=36.10,P<0.05). The postoperative depression score in either benign or malignant brain tumors was significantly lower after than before operation(all P<0.05)The postoperative depression score in either the left or right or bilateral brain lesions were significantly decreased after than before operation(all P<0.05).Conclusion Pa-tients with brain tumors have different degrees of depression in perioperative. Depression may be associated with brain tu-mour pathological types and lesion sites in patients with brain tumors.