Objective: To assess the implementation effects of clinical pathways, compared with usual care, among patients with stroke. Methods:Two investigators independently searched PubMed, Embase, the Cochrane Library, Web of Science, Chinese Biomedical Literature Database and Wanfang Database for studies published before December 2014. Jadad methodological approach was applied to assess the quality of included studies and RevMan software (version 5.2.7) was used for meta-analysis. Results: A total of 11 RCTs involving 913 patients were included in this meta-analysis. The overall results showed that a shorter average length of stay [MD = -2.92; 95% CI (-4.06, -1.78); P < 0.001] and a lower inpatient expenditures [SMD = -1.64; 95% CI (-1.80, -1.48); P < 0.001] in clinical pathways group comparing with the usual care group. The higher score of patient satisfaction was also seen in clinical pathways group. Conclusion: clinical pathways may reduce the average length of stay, reduce the inpatient expenditures, increase patient satisfaction and improve the quality of care in stroke management.

Objective: To assess the implementation effects of clinical pathways, compared with usual care, among patients with stroke. Methods:Two investigators independently searched PubMed, Embase, the Cochrane Library, Web of Science, Chinese Biomedical Literature Database and Wanfang Database for studies published before December 2014. Jadad methodological approach was applied to assess the quality of included studies and RevMan software (version 5.2.7) was used for meta-analysis. Results: A total of 11 RCTs involving 913 patients were included in this meta-analysis. The overall results showed that a shorter average length of stay [MD = -2.92; 95% CI (-4.06, -1.78); P < 0.001] and a lower inpatient expenditures [SMD = -1.64; 95% CI (-1.80, -1.48); P < 0.001] in clinical pathways group comparing with the usual care group. The higher score of patient satisfaction was also seen in clinical pathways group. Conclusion: clinical pathways may reduce the average length of stay, reduce the inpatient expenditures, increase patient satisfaction and improve the quality of care in stroke management.
Stroke

ObjectiveTo explore the death causes and its related factors among psychotic inpatients.MethodsThe medical records of dead psychotic inpatients over recent ten years were investigated with self-designed scheme.ResultsAmong all the investigated cases, the percentage of schizophrenia was more than 50%, the death diagnosis due to somatopathy was over 80%, and more than 50% inpatients suffered from 2～3 kinds of somatopathy. Marital status, diagnosis, smoking and drinking had influenced to the live time of psychotic inpatients.ConclusionThe death of psychotic inpatients might be influenced by multiple causes, including social factors and clinical features which should be paid much attention to extend their live time.

Objective·To investigate effect and the possible molecular mechanism of JQ1,a specific inhibitor of bromodomain containing protein 4,on human hypertropic scar.Methods·Primary fibroblasts were isolated from human hypertrophic scars and treated with JQ-1 of different concentrations (0.1,0.5,1.0,2.0,2.5,and 12.5μmol/L) for 48 h.Then CCK-8 kit and wound healing assay were used to measure proliferation and migration of the fibroblasts.ELISA was adopted to detect the levels of collagen type Ⅰ (COL Ⅰ) and TGF-β1 after JQ-1 treatment for 24 h.Thirty-six nude mice were used for hypertrophic scar models.Human hypertrophic scars (1.0 cm× 1.0 cm×0.5 cm) were grafted subcutaneously at the backs of nude mice to establish scar animal models.After 4 weeks,the nude mice were averagely divided into two groups,i.e.JQ-1 group and DMSO group,which were respectively injected with 0.5 μmol/L JQ-1 and 0.1％ DMSO each mouse every day.COL Ⅰ / Ⅲ and α-smooth muscle actin (α-SMA) were examined by immunohistochemical method and sirius red staining.Results·Cell experiments showed that JQ-1 with the concentration of 0.5 μmol/L and above significantly inhibited proliferation of fibroblasts (P＜0.01).JQ-1 inhibited migration of fibroblast (P＜0.01).JQ-1 inhibited secretion of COL Ⅰ and TGF-β1 of fibroblasts (P＜0.01).Animal experiments showed that concentration and proportion of COL Ⅰ / Ⅲ in JQ-1 group decreased compared to DMSO group (P＜0.05).α-SMA protein expression in JQ-1 group also decreased (P＜0.05).Conclusion·JQ-1 can inhibit proliferation,migration,secretion of COL Ⅰ,and production of TGF-β1 of human sear fibroblasts in vitro;it can also inhibit secretion of COL Ⅰ /Ⅲ and fibroblast-myofibroblast differentiation in the human hypertrophic scars in nude mice.

Objective To investigate the effect of ovulation induction of letrozole and clomiphene on the treatment of polycystic ovary syndrome.Methods From February 2014 to February 2014 80 cases with polycystic ovary syndrome in Hangzhou maternity hospitalas the research object were divided into two groups: the control group and the observation group.The control group were treated with clomiphene;the observation group were treated with letrozole.The clinical effect in the two groups were compared.Results The total effective rate was 95.0% in the observation group, which was higher than 67.5% in the control group, the difference was statistically significant(P<0.05).The thickness of endometrium in the observation group was(9.10±1.32)mm and(5.38±0.61)mm in the control group at the HCG injection day, the difference between the two groups was statistically significant (P<0.05).Conclusion Letrozole can be used in the treatment of polycystic ovary syndrome, can get high quality treatment effect, worthy of promotion.

Uncoupling protein 2 (UCP2) is a proton transporter which presents in the mitochondrial inner membrane.Recently studies found that UCP2 plays important roles in regulation of reactive oxygen species production,maintenance of mitochondrial function,as well as inflammation and blood glucose control.These features have important relevance with the pathophysiologic mechanism of sepsis.

Objective To investigate the effects of Dihuangyinzi(DHYZ) on behaviors and RAGE/p38 pathway in APP/PS1 mice.MethodTwenty APP/PS1 dementia mice were randomly divided into model group(n=10) and Chinese medicine group(n=10).The blank group was C57 BL/6 J normal mouse(n=10).The mice in Chinese medicine group were intragastric administration with DHYZ (9.75 g·kg-1·d-1).The mice in model group and blank group were treated with distilled water.After 30 days,the abilities of learning and memory of mice were detected by Morris water maze.The expression of amyloid-beta1-42(Aβ1-42) in the hippocampus and cortex was detected by immunohistochemistry.Reactive oxygen species of brain tissue were detected by DCFH-DA Methods in the brain of APP/PS1 mice.Gene expression level of receptor for advanced glycation end products(RAGE) was measured by real-time polymerase chain reaction (RT-PCR) in the cortex and hippocampus of APP/PS1 mice.The expression of phospho-mitogen-activated protein kinases (p38) was analyzed with Western blot and immunofluorescence analysis in the cortex and hippocampus of APP/PS1 mice.Results Behavioral Results showed that DHYZ significantly increased the distance((23.088±7.083)cm) and residence time((1.961±1.230)s)of effective area in Morris water maze on the fifth day(P<0.05,P<0.01)and remarkably increased the number of effective area crossings((1.607±0.405) times) and plats((0.893±0.283) times) in Morris water maze on the fifth day(P<0.01,P<0.05).DHYZ also significantly reduced the intracelluar ROS level(122.611±7.630) in the brain(P<0.01),and DHYZ could depress the expression of RAGE(1.467±0.081,7.983±0.136) and phosphorylation of p38 (0.376±0.026,0.538±0.016)in the cortex and hippocampus of APP/PS1 mice(P<0.01,P<0.05).Conclusions The Results demonstrate that DHYZ can partly improve memory impairment of APP/PS1 mice by the inhibition of RAGE/p38 pathway.

Objective To investigate the relationship between carotid intima media thickness (IMT) and pulse pressure index (PPI) in elderly hypertensive patients.PPI was defined as 24 h mean pulse pressure(PP)/24 h mean SBP.Methods One hundred and three elderly hypertensive patients were categorized by PPI level:group A (PPI

Objective: To investigate the effect of ginsenoside-rg1 (G-Rg1) on rat’s cardiomyocytes H9c2 with its mechanism of signal pathwayin vitro.
Methods: H9c2 cells were cultured and treated in different conditions by following groups:①Blank control group,②Hypoxia alone group, the cells were treated for (2, 6, 12, 24, 48) hr respectively,③G-Rg1 group, the cells were treated by G-Rg1 at (5, 10, 50) μmol/L respectively,④YC-1 group, which is the speciifc inhibitor of hypoxia inducible factor-1α (HIF-1α),⑤YC-1 + G-Rg1 group,⑥Wortmannin group, which is the speciifc inhibitor for protein kinase B (Akt) phosphorylation and⑦Wortmannin + G-Rg1 group. Each experiment was conducted with 5 replicates. The effects of G-Rg1, hypoxia and YC-1 on cell activity and injury were studied; intracellular mRNA expressions of HIF-1α, glucose transporter-1 (GLUT-1) and heme oxygenase-1 (HO-1) were examined by RT-PCR; protein expressions of HIF-1α, GLUT-1, HO-1, activating transcription factor-6 (ATF-6), CCAAT/enhancer binding protein homologous protein (CHOP) and Akt with its signal pathway factors were measured by Western blot analysis.
Results: The time of hypoxia was negatively related to cell activity (r=-0.8580,P<0.05) and positively related to LDH overlfow rate (r=0.9201,P<0.05). G-Rg1 (10μmol/L) group showed increased cell activity than Hypoxia alone (24 hr) group (87.8% vs 62.6 %,P<0.05), while decreased LDH overlfow (25.0% vs 74.8%,P<0.05), and up-regulated mRNA expressions of HIF-1α, GLUT-1 and HO-1, P<0.05. YC-1+ G-Rg1 group had decreased cell activity than G-Rg1 group (68.0% vs 87.8%,P<0.05), while increased LDH overlfow (56.4% vs 25.0%,P<0.05). Meanwhile, YC-1 clashed the effect of G-Rg1 on protein expressions of HIF-1α, GLUT-1, HO-1, ATF-6 and CHOP,P<0.05; wortmannin clashed the effect of G-Rg1 on protein expressions of HIF-1α, CHOP,P<0.05 and suppressed the two phosphorylation sites for Akt activation,P<0.05.
Conclusion: G-Rg1 may protect rat’s H9c2 cellsin vitro by activating expressions of HIF-1α with its downstream factors and inhibiting endoplasmic reticulum stress, which might be related to the effect of G-Rg1 on Akt activation.

OBJECTIVETo provide reference for the safe needling depth of Dazhui (GV 14), Jianzhongshu (SI 15), Xuanshu (GV 5) and Mingmen (GV 4) in clinical acupuncture and moxibustion treatment.

METHODSThirty-two adult volunteers were divided into 3 groups, thin person group, moderate person group and fat person group according to Luo's indexes, and computer-aided tomography was used to measure the needling depth of Dazhui (GV 14), Jianzhongshu (SI 15), Xuanshu (GV 5) and Mingmen (GV 4).

RESULTSThe safe depths of perpendicular needling were different for persons of different somatotypes, for example the needling depth for Dazhui (GV 14) was (32.86 +/- 3.96) mm for the thin person group, (37.76 +/- 4.91) mm for the moderate person group, and (47.93 +/- 5.30) mm for the fat person group.