Objective to investigate the application of the whole course case tracking method in continuous improvement of nursing quality of out-patient operation unit. Methods Administration frames were established for this project,such as monitoring group and executive group. the medi-cal treatment procedure and patients′experience were followed by referees. the results were quantified for statistical analysis. the problems were rec-ognized by priorities and rectification was correspondingly performed. Afterward,another group of patients were traced to evaluate the results of the rectification. We focus on those items of lower scores and undertook rectifications accordingly. Particularly,we optimized signs in outpatient unit, made pamphlets to clarify the procedures,and were cautious to provide more easy-to-understand informs. Results By the second round evaluate, these scores were effectively improved. Especially,the item of“clear informed consent”was statistically significant(P = 0.003). Meanwhile,the team of outpatient operation unit became more cohesion,with enhanced service consciousness,and was initiative to improve the work. Conclusion the whole course case tracking method is feasible for short-range medical service evaluation such as outpatient surgery. the evaluation results clarify the direction for quality improvement,thus set the starting point of quality management aiming at continuously improvement of the patients′ experi-ence and quality of nursing service.

Objective To investigate the effect of combination of cervical manipulation with cervical conditioning exercise for the treatment of cervical spondylosis of neck type or nerve root type. Methods Seventy-two patients were randomly divided into a treatment group (37 patients) or a control group (35 patients) by using a random number table. Patients in the treatment group and in the control group were treated with combination of cervical manipulation or cervical manipulation only, respectively. At the end of treatment and 3 months, treatment effects were assessed by Neck Disability Index (NDI) and Visual Analog Scale (VAS). Results NDI scores in both of the treatment group and the control group after treatment were significantly lower han those before treatment (t=4.471 in the treatment group, t=3.599 in the control group, all P<0.05), and NDI score in the treatment group were significantly lower than that in the control group after treatment (t=-2.085,P<0.05). Follow-up at 3 months, NDI score in the treatment group was significantly lower than that in the control group (t=-4.549, P<0.05). Proportions of improved patients, as assessed by NDI items, including pain intensity, personal care, lifting, reading, headaches, concentration, work, sleeping, driving and recreation in the treatment group were significantly higher than those in the control groups (Z=-3.521,-3.331,-3.003,-3.001,-3.265,-3.198,-3.016,-3.000,-2.102,-2.971, respectively, all P<0.05). VAS scores in both of the treatment group and the control group after treatment were significantly lower than those before treatment (t=7.986 in the treatment group, t=6.507 in the control group, all P<0.05), and VAS score in the treatment group were significantly lower than that in the control group after treatment (t=-2.426,P<0.05). Follow-up at 3 months, the VAS score in the treatment group was significantly lower than that in the control group (t=-7.065, P<0.05). Proportions of improved patients in the treatment group was significantly higher than that in the control group (91.89% vs 74.29%; χ2=4.014, P=0.045). Conclusion Combination of cervical manipulation with cervical conditioning exercise may be superior to cervical manipulation only for the treatment of cervical spondylosis of neck type or nerve root type.

Objective Gastrointestinal stromal tumor( GIST) is a rare mesenchymal tumor from gastroin-testinal tract,and surgery remains the only curative treatment.In order to improve the outcome of surgical treat-ment,reduce the risk of surgery,and increase the quality of life,preoperative imatinib( IM) treatment for GIST is investigated.Methods We retrospectively studied the multidisciplinary team model treatments for 8 GIST cases receiving preoperative IM treatment.The cases were prescribed IM of 400 mg daily for 12 to 40 weeks and exten-sively followed until surgery was considered feasibleg.The clinical significance and safety profile were analyzed. Results Partial responsive rate was 62.5% in this study.There was no intolerable sever adverse effects by IM preoperative treatment.All the cases received R0 dissection,with no intraoperative tumor rupture.The postopera-tive recovery was satisfied.Conclusion IM preoperative treatment brings significant clinical benefit to large stomach GISTs and cardiac region GISTs.The preoperative treatment should be monitored carefully under a multi-disciplinary team.Preoperative IM treatment is an evocative treatment strategy for high risk GIST.

To enhance speech recognition, as well as Mandarin tone recognition in noice, we proposed a speech coding strategy called zero-crossing of fine structure in low frequency (LFFS) for cochlear implant based on low frequency non-uniform sampling (LFFS for short). In the range of frequency perceived boundary of human ear, we used zero-crossing time of the fine structure to generate the stimulus pulse sequences based on the frequency selection rule. Acoustic simulation results showed that although on quiet background the performance of LFFS was similar to continuous interleaved sampling (CIS), on the noise background the performance of LFFS in Chinese tones, words and sentences were significantly better than CIS. In addition to this, we also got better Mandarin recognition factors distribution by using the improved index distribution model. LFFS contains more tonal information which was able to effectively improve Mandarin recognition of the cochlear implant.
Acoustics ; Cochlear Implants ; Equipment Design ; Humans ; Language ; Noise ; Recognition (Psychology) ; Speech Perception

Objective To comprehensively evaluate the relationship between murine double minute 2 (MDM2) gene promoter SNP309 T＞G polymorphism and the susceptibility of gastrointestinal cancer.Methods The China National Knowledge Infrastructure (CNKI),WanFang database,SpringerLink database and PubMed were retrieved to get all case-control research literatures (2005-2012) on the relationship of MDM2 gene SNP309 T＞G and gastrointestinal cancer susceptibility.Meta-analysis with RevMan 4.2 was used to combine OR values of the relationship between SNP309 T＞G and gastrointestinal cancer susceptibility.A sensitivity analysis and tested publication bias were made with all selected literatures' data.Results A total of 17 domestic and foreign qualified papers were included in this study.Twenty case-control studies including 5 183 cases and 6 660 controls were identified for the present meta-analysis.A significant association was detected between the MDM2 SNP309 T＞G polymorphism and gastrointestinal cancer risk.The meta-aualysis showed that the combined odds ratio (OR) for GG genotype was 2.23 (95 ％ CI =1.73-2.89,P ＜ 0.01) compared with that for TG + TT genotypes.There was no statistical significance for the evaluation of publication bias.Conclusion The GG genotype of MDM2 SNP309 may increase gastrointestinal cancer risk in Asians.

Objective To investigate the relationship between pelvic asymmetry and Crowe classification of unilateral developmental dysplasia of the hip in adults. Methods According to the inclusion criteria, 100 cases of unilateral DDH in adults were collected, including 78 females and 22 males, with an average age of 56.3 years old (range, 21-79 years). In terms of Crowe classification, there were 30 cases of Crowe typeⅠ, 24 cases of Crowe typeⅡ, 23 cases of Crowe typeⅢ, and 23 cases of CroweⅣ. The normal?side and affected?side pelvic vertical height (the distance from the highest point of the ischial tuberosity to the iliac crest peak) were measured via the radiogram of anteroposterior pelvis. Furthermore, we compared the affected?side pelvic vertical height with the normal?side and analyzed the relationship between Crowe classification and the difference in pelvic verti?cal height. Results The average pelvic vertical height was 23.38±1.46 cm in the normal?side and 22.41±1.38 cm in the affected?side. The average D?value of pelvic vertical height between two sides is 0.98 ± 0.76 cm. From Crowe typeⅠto Ⅳ, the average heights of the normal?side were 22.89±1.09 cm, 23.23±2.07 cm, 23.75±1.16 cm, 23.79±1.22 cm, while those of the affected?side were 22.70 ± 0.98 cm, 22.41 ± 1.98 cm, 22.47 ± 1.12 cm and 21.92 ± 1.32 cm. The average D?values in each group were 0.19 ± 0.37 cm, 0.82±0.43 cm, 1.28±0.32 cm, 1.87±0.59 cm. The differences between the normal?side and the affected?side in each type were statistically significant. The average D?value increased significantly with Crowe type increased, and there was a positive correla?tion between the D?value of bilateral pelvic vertical height and the degree of hip dislocation. Conclusion The pelvic asymmetry does exist in adult patients with unilateral developmental dysplasia of the hip. Moreover, the asymmetry has positive correlation with the degree of hip dislocation.

Over recent years,pedicle screw fixation is widely used in spine surgery,which allows 3-dimensional fixation with a more rigidconstruct and permits a shorter fusion length.However,its fixationeffect is not so good for patients with severe osteoporosis.Cortical bone trajectory screw insertion has been advocated because it is reportedly less invasive,improvesscrew-bone purchase and reduces neurovascular injury.Based on the present evidence,the author evaluates the relative advantages of cortical bone channels.To this end,a search of relevant published studies reporting biomechanical,morphemetricor clinical outcomes after using of cortical bone trajectory screws in patients with spinal pathologies is reviewed.

Objective: To observe and evaluate the mechanism and clinical values of Total Knee Arthroplasty in treating the patients with severe knee osteoarthritis. Method: To review and analyse 74 patients with severe knee osteoarthritis who were treated in Suzhou Atliliated Hospital of Nanjing Medical College, including 34 male patients and 40 female patients with average aged (58.22±3.24)ranging from 47 to 75. All the patients received TKA. Compared the HSS score, WOMAC and content of TNF-α and IL-1β in knee synovial fluid 3 months before the operation, 3 months after the operation and 6 months after the operation. SPSS20.0 software was used for statistical analysis, and ANOVA or nonparametric test was used for comparison among groups of data. Results: HSS scores measured at 3 months after the operation[(58.30±6.33)vs (31.31±15.92)] and 6 months after the operation[(72.39±6.68)vs (31.31±15.92)] were better than those measured before the operation, which proved a statistical difference (P<0.05). WOMAC measured 3 months after the operation and 6 months after the operation were better than those measured before the operation[(31.068±6.771)vs (67.014±7.699); (24.216±5.224) vs (67.014±7.699), all P<0.05]. TNF-α in knee synovial fluid measured 3 months after the operation and 6 months after the operation were lower than those measured before the operation [(56.182±7.056)pg/ml vs(85.065±6.666)pg/ml; (30.387±4.194)pg/ml vs (85.065±6.666)pg/ml; all P<0.05]. IL-1β measured at 3 months after the operation and 6 months after the operation were lower than those measured before the operation [(21.411±4.751) pg/ml vs (60.305±6.932)pg/ml; (11.578±4.142) pg/ml vs (60.305±6.932) pg/ml; P<0.05]. Compared with the data at 3 months after the operation, the content of TNF-α [(30.387±4.194)pg/ml vs (56.182±7.056)pg/ml] and IL-1β[(11.578±4.142)pg/ml vs (21.411±4.751)pg/ml] were both lower, which proved a statistical difference (P<0.05). Conclusion TKA can imporve the joint functions and activities of the patients with severe knee osteoarthritis and lower the the inflammatory factor like TNF-α and IL-1β in knee synovial fluid to relief the pain of the patiences and accelerate the process of recovery.

The uniqueness of the location of large general hospitals in urban areas determines that the contradiction between space constraints and medical expansion has become a problem of management bottleneck.The situation that expert visits are too concentrated on a certain working day morning has been significantly improved by carrying out peak load shifting in the visiting arrangements and visiting units of large general hospitals through the Total Quality Management theory and continuous improvement of work mode,greatly alleviating public transportation congestion around the hospital.Through the internal construction of the quality of outpatient clinics,it can effectively improve the patients'sense of access to health care.

The uniqueness of the location of large general hospitals in urban areas determines that the contradiction between space constraints and medical expansion has become a problem of management bottleneck.The situation that expert visits are too concentrated on a certain working day morning has been significantly improved by carrying out peak load shifting in the visiting arrangements and visiting units of large general hospitals through the Total Quality Management theory and continuous improvement of work mode,greatly alleviating public transportation congestion around the hospital.Through the internal construction of the quality of outpatient clinics,it can effectively improve the patients'sense of access to health care.