Objective To explore the effect of clinical pathway on the safety in patient with intracranial aneurysms during the perioperative period. Methods A total of 68 patients with intracranial aneurysms who had been hospitalized and treated from July to December 2012 were assigned to a study group and received clinical pathway. And then they were compared with 56 patients who had been treated from January to June (control group). The patients in control group received routine medical care. Then all the patients were evaluated in preoperative waiting duration, incidence of postoperative complications, health education compliance rate, and the Glasgow outcome scale (GOS) at discharge. Results Both the incidence rate of cerebral vasospasm and hydrocephalus and the health education compliance rate were improved in the study group (P<0.05), so was the GOS at discharge and 6 months after discharge (P<0.05). Conclusions The clinical pathway management plays a role in guarantee of the safety in patient during the perioperative phase and in the acceleration of postoperative rehabilitation.

In order to determine the cellular immunestate in patients with multiple myeloma, T-cellsubsets in peripheral blood from 25 cases withmultiple myeloma were measured with SPA-Ig di-rect rosette assay, the activity of interleukin-2 wasinvestigated by using mice thymocyte proliferationassay. The results showed that in multiple myelo-ma, OKT_3~+, OKT_4~+ cell decreased significantly.OKT_6~+ cell increased markedly and the OKT_4/OKT_8 ratio was reduced. The activity of IL-2 in pe-ripheral blood lymphocytes of the patients withmultiple myeloma increased sharply and there wasa significant difference between the active diseaseand the remission disease. The activity of IL-2 inthe remission disease was lower than that in theactive disease but higer than that of the controlgroup. In conclusion, this study indicated thatthere were imbalance of T-cell subsets and abnor-mality of IL-2 production in patients with multiplemyeloma. The data might suggest that there wasdisorder of the cellular immunity in the course ofthe disease.

Objective To explore the clinicopathological features of osteofibrous dysplasia (OFD). Methods All the clinicopathological information of 17 cases of OFD were reviewed,including sex,age,course and radiography or histopathology features. The expression of Cytokeratin(CK) was examined by SP. Results Age of the patients ranged from 2-15 years, and the course of the lesion ranged from 1 month to 7 years. The mean age and the mean course was 7.2 years and 2.1 years respectively. Male to female ratio was 1∶1.4. The lesions all occured in tibia, presentating with localized masses. Only one invloved with both tibia and fibula. Radiographs showed there were cystic lesions in the thickened anterior cortex of the tibia with light marginal sclerosis. Histopathology showed a zonal architecture. Abundant osteoblasts in the vicinity of the trabeculae. Only two cases were positive for CK(11.8%). 8 of 10(80%) patients recurred. Conclusion OFD is predominately involved with the tibia in children. The history is long. It has a characteristic histopathologic image and clinical progress. Its a independent entity, not the same of adamantinoma.

Acute rejection is one of the serious early postoperative complications after liver transplantation.Many studies have shown that acute rejection was mainly mediated by T cells,while humoral factors were responsible for chronic rejection.However,accumulating evidences have demonstrated that humoral immune factors also played an important role in early acute rejection and usually resulted in severe adverse events.Here we clarify the role of humoral immunity in liver transplant rejection,which may help guide the clinical management of such patients with humoral rejection after liver transplantation.

Objective To design a wearable physiological monitoring system for acquiring and monitor-ing vital signs non-intrusively and concurrently.Methods All bio-sensors were embedded in an elastic shirt for detecting physiological parameters with wearable technology.A patented respiratory inductive plethysmography technology was used to measure respiratory function,two sensors were woven into the jerkin around the patient's chest and abdomen.A three-lead,single channel ECG measures heart rate,and a three-axis accelerometer records posture and activity level.An NTC thermometer embedded in the shirt measures the body temperature.Results An elastic jerkin with embedded sensors that collect and continuously monitor respiration,cardiac,temperature,posture and activity signals was fabricated.Conclusion This wearable physiological monitoring system can record multiple parameters non-intrusively and concurrently.It can act as an useful platform for further researches.

AIM: To evaluate the clinical efficacy and safety of Qili Qiangxin Capsule(Radix Astragali,Radix Aconiti lateralis praeparata,Radix et Rhizoma Salviae miltiorrhizae,Radix et Rhizoma Ginseng,Semen Lepidii,Semen Descurainiae,Flos Carthami,Pericarpium Citri reticulatae,Rhizoma Alismatis,Cortex Periplocae,Rhizoma Polygonati odorati,Ramulus Cinnamomi) with chronic heart failure(CHF).METHODS: Seven randomized controlled trials were reviewed.RESULTS: The meta-analysis indicated that the treatment group of Qili Qiangxin Capsule could decrease the cardiac functional grading of NYHA with 1.21 of the relative risk,and 95% confidence interval(CI) from 1.08 to 1.36;increase 6 minute walking distance with the weighted mean difference(WMD) was 37.39,and 95% confidence interval was from 22.58 to 52.20;raise left ventricular ejection fraction(WMD = 3.97[2.09,5.85]),decrease the left ventricular end-diastolic diameter(WMD = 2.81[1.41,4.22]),lower the level of B-type natriuretic peptide(WMD = 118.00[4.44,231.56]) and N-terminal pro-brain natriuretic peptide(WMD = 476.90[371.26,582.54]) in blood plasma and drop the score of Minnesota living with heart failure questionnaire(WMD =8.00[3.48,12.52]),but Qili Qiangxin Capsule for reduction in left ventricular end-diastolic volume,left ventricular end-systolic volume,heart rate and blood pressure also need to be confirmed.Besides,individual ca-ses occurred adverse reactions like dry cough,epigastric discomfort,gastric distention.However,It could be tolerated and hadn't significant statistical difference with comparison to control group.CONCLUSION: Qili Qiangxin Capsule is effective and safe for the patients of chronic heart failure in improving the heart function and living quality.

Objective To compare the dosimetric parameters between the use of Tandem and Ring (TR;Nucletron#090.617) or Tandem and Ovoid (TO;Nucletron#189.730) applicators during three-dimensional (3D) high-dose rate (HDR) brachytherapy (BT) for cervical cancer.Methods The records of 40 cervical cancer (ⅡB-ⅣA) patients treated with 3D-image-guided HDR-BT were reviewed.Of these 40 patients, 20 were treated with the TO applicator, and 20 with the TR applicator.The D100% and V150% of the clinical target volume (CTV) and the D2 cc of organs at risk (OAR)(the rectum, bladder, and small intestine) during 3D-HDR-BT using TO and TR were compared using the independent sample t-test.ResultsOverall metrics:CTV volume:66.04±13.86 cm3(TR) vs.65.67±15.08 cm3(TO)(P=0.052);CTV D100:3.71±0.34 Gy (TR) vs.3.37±0.49 Gy (TO)(P=0.016);CTV V150%:0.54±0.02(TR) vs.0.56±0.04(TO)(P=0.034);rectum D2 cc:3.38±0.30 Gy (TR) vs.2.95±0.80 Gy (TO)P=0.037);bladder D2 cc:4.33±0.39 Gy (TR) vs.2.93±1.27 Gy (TO)(P=0.00);and small ntestine D2 cc:3.04±1.02 Gy (TR) vs.3.41±0.57 Gy (TO)(P=0.171).Conclusions TR has better CTV coverage than TO during 3D HDR brachytherapy for cervical cancer.In addition, D2 cc of the rectum and bladder were both igher with TR than with TO, though there is no significant dosimetric difference in the small intestine between the two applicators.Therefore, tumor location, extent of invasion, and vaginal conditions should be considered when selecting the suitable pplicator for the treatment of cervical cancer.

Pancreatic head carcinoma could easily invade the neighboring vessels due to its own biological features and anatomical location,which increases the technique difficulty and risk,leading to low resection rate.Recently,with the progress on the surgical techniques and perioperative management,and the emergence of neoadjuvant chemoradiation,vascular invasion is no longer the surgical contraindications and pancreaticoduodenectomy combined with vascular resection has saved many patients ' lives.However,the preoperative assessment,the timing of surgery,the vessel management during the surgery,and the prevention and treatment of the postoperative complications remain controversial.In order to achieve a clear understanding on the application of pancreaticoduodenostomy combined with vascular resection,here we review the recent publications and share the experiences on pancreaticoduodenectomy with portal and/or superior mesenteric vein resection from our center,which may help improve the safety and resection rate of pancreatic carcinoma and enhance the overall therapeutic efficacy of treating pancreatic cancer.

Objective To optimize the cerebral ischemia-reperfusion process for acute ischemic stroke patients,so as to reduce the time of in-hospital delays.Methods A multi-disciplinary management team was established to design the flowchart of the cerebral ischemia-reperfusion process for acute ischemic stroke patients.By applying Healthcare Failure Mode and Effect(HFMEA) management mode,intervention was conducted and its effect was analyzed.Results After implementation of the HFMEA intervention,the door to needle time(DNT)was reduced from 88 (42,140) minutes to 45 (37,59) minutes(P＜0.001);the ratio of patients with the DNT＜60 minutes increased from 20％ to 87.7％(P＜0.001);the door to cerebral ischemia-reperfusion time was shortened from 207(169,227) minutes to 165(155,185) minutes (P＜O.05).There was no significant difference in the incidence and mortality of symptomatic cerebral hemorrhage between before and after intervention (P＞0.05).Conclusion Utilization of HFMEA to optimize the emergency cerebral ischemia-reperfusion process can effectively reduce the in-hospital delays of acute ischemic stroke patients.

Objective To evaluate the clinical value of laparoscopic cystogastrostomy for retrogastric pancreatic pseudocysts.Methods Five patients suffering from retrogastric pancreatic pseudocysts caused by severe acute biliary pancreatitis received conservative management for 2 ～ 6 months,and the sizes of pseudocysts were 8,10,12,14,15 cm.All the 5 patients received laparoscopic cystogastrostomy,and 4 ports methods was applied,through anterior gastric wall,the posterior gastric wall and pancreatic pseudocysts were incised by using harmonic scalpel,then cystogastrostomy was performed to drain the pseudocysts.Results Laparoscopic cystogastrostomy for retrogastric pancreatic pseudocysts was successful in all patients,theoperation time was 90,105,115,120,150 minutes.The blood loss was 100,150,150,200,300 ml.No intra-gastric bleeding occurred.After 1 month follow-up,all the pseudocysts disappeared,and there was no acute pancreatitis and local infection recurrence.Gastric leakage occurred 7 d after operation in one patient,and was healed after one month of conservative management.Conclusions Laparoscopic cystogastrostomy through gastric cavity for retrogastric pancreatic pseudocysts is simple and effective,mini-invasive,and it can be an alternative therapeutic method for pancreatic pseudocysts.