Objective To observe the influence of the clinical pathway management intervention on medical service behaviors.Methods The clinical cases data in a grade A class 3 hospital of Zhangjiakou City,Hebei Province during 2011-2013 were retrospectively analyzed.The influence of implementing the clinical pathway management on the diagnosis results,medical records writing quality,clinical medication,operation,hospitalization time,medical costs,assisted examination items selection were observed and analyzed.Results The admission and discharge diagnosis coincidence rate and preoperative and postoperative diagnostic coincidence rate of 3 diseases entities in the two groups were 100%,the difference had no statistical significance (P>0.05);the medical record grade-A rate in the implementing clinical pathway group was significantly higher than that in the non-implementing clinical pathway group,the medical record grade-B rate was significantly lower than that in the non-implementing clinical pathway group,the difference was statistically significant (P<0.05);the antibacterial drugs cost and drugs proportion in the implementing clinical pathway group were significantly lower than those in the non-implementing clinical pathway group,the medication proportion within the directory in the implementing clinical pathway group was significantly higher than that in the non-implementing clinical pathway group,the difference was statistically significant (P<0.05);the preoperative preparation time in the implementating clinical pathway group was less than that in the non-implementing clinical pathway group,the difference was statistically significant(P<0.05),the grade-A healing rate had no significant difference between the two groups (P>0.05);the average hospitalization time,total costs,drug costs,laboratory fee and examination fee in the implementing clinical pathway group were lower than those in the non-implementing clinical pathway group,the difference was statistically significant (P<0.05);the operation fee,healthy material fee and nursing fee had no statistically significant difference was statistically significant(P<0.05).Conclusion Implementing the clinical pathway can standardize the doctor′s diagnosis and treatment behaviors and makes the medical work to develop to be more favorable for patients.

Animals ; Dose-Response Relationship, Drug ; Male ; Mice ; Mice, Inbred Strains ; Nickel ; toxicity ; Oxidative Stress ; physiology ; Testis ; drug effects ; metabolism

OBJECTIVETo preliminarily investigate the mechanism of small interfering RNA (siRNA) induced apoptosis in glioma U251 cells by silencing basic fibroblast growth factor (bFGF).

METHODSU251 cells were divided into the normal control group, the mock group and experiment group, the mock and experiment group were transfected with mock vector (Ad-null) and the recombinant adenovirus carrying bFGF-siRNA (Ad-bFGF-siRNA) respectively at a multiplicity of infection (MOI) of 100. After 72 hours, the expression of related proteins was revealed by the method of Western blot. Mitochondrial transmembrane potential (ΔΨm) was measured with flow cytometry and confocal microscopy, Groups were compared using single factor analysis of variance (One-way ANOVA).

RESULTSAfter U251 cells were transfected with bFGF-siRNA, the results of Western blot showed that after 72 hours of transfection the bFGF protein in the experiment group decreased obviously, meanwhile Cytochrome C, Caspase-3 and Bax showed increased expression while in the Bcl-xl and Bcl-2 proteins decreased expression. The proportion of high mitochondrial membrane potential of cells by flow cytometry, the experimental group was 74.4% ± 4.7% decreased significantly compared with the control group 92.1% ± 2.5%, the mock group 90.9% ± 1.8% (F = 28.805, P < 0.05); laser scanning confocal microscopy results showed that the red fluorescence and green fluorescence ratio of the experimental group was 0.83 ± 0.12 decreased significantly compared with 1.36 ± 0.40 of the control group and 1.32 ± 0.35 of the mock group(F = 7.920, P < 0.05).

CONCLUSIONsiRNA targeting bFGF induced U251 cell apoptosis may be achieved through the mitochondrial pathway.

Adenoviridae ; genetics ; Apoptosis ; Cell Line, Tumor ; Fibroblast Growth Factor 2 ; genetics ; Glioma ; pathology ; Humans ; RNA Interference ; RNA, Small Interfering ; Transfection

Objective To investigate the clinical features of recurrent epileptic seizures and perioperative management principles and methods of neurosurgical patients with recurrent epileptic seizures.Methods The clinical data,reasons for aggravated seizures,seizure characteristics,and treatment methods and results of 9 patients with recurrent epileptic seizures were analyzed retrospectively.Results Of all the 9 patients,3 were combined with glioma,1 with arachnoid cyst,1 with cavernous hemangioma and 1 with encephalomalacia; epilepsy history was noted in 7 patients; frontal lobe epilepsy was noted in 7,and temporal lobe epilepsy in 2.The reasons for seizure aggravation included drug-decrement(n=3),recent-diagnosed brain tumor(n=2)and surgical operation during intracranial electrode implantation(n=1); and unknown reason was noted in the other 3.Epileptic seizure types included partial seizure and secondary generalized seizure; the frequency of seizure ranged from 3 minutes of interval to several hours of interval.Patients given multiple antiepileptic drugs,including oral and parenteral administration,received good seizure-control; and levetiracetam showed good curative effect during the treatment.Conclusion Recurrent seizures show drug refractory,and is hard to control.The AEDs having good curative effect in partial seizure should be combined used in these patients with higher dosage than conventional initial dose; intravenous and intramuscular administration can be used; the seizures should be controlled as soon as posible.Levetiracetam has good curative effect on patients with recurrent seizures for its fast oral-absorption,rapid onset of action and good antiepileptic effect.

OBJECTIVE To observe the clinical therapeutic effects of the formula capable of resolving turbidity, removing toxin, activating blood circulation and dredging collectrals in improving patients with vascular cognitive impairment of none dementia(VCIND) after stroke.MEHTODS 128 cases with VCIND after stroke were randomly divided into treatment group and control group, with 64 cases in each group.Patients in the treatment group were given compound Changpu Yizhi Decociton warmly both early in the morning and late in the afternoon, one bag per day.While those in the control group were treated with nimodipine, 30mg at a time, three times per day.Both groups received three-month treatment.TCM syndromes, cognitive ability, activity of daily living before and after treatment were evaluated and the levels of homocysteine and acetylcholinesterase were tested to detect the safety index and side effects.RESULTS There experienced an evident improvement of the treatment group in TCM syndrome curative effects and scores, together with obvious increases in the scores of mini-mental state examination(MMSE) and Activity of Daily Living (ADL), decreased scores in ADAS-cog and declined levels in homocysteine and acetylcholinesterase when compared to the control group.The difference was statistically significant(P<0.05).Neither evident abnormalities nor side effects were detected before and after treatment in the test.CONCLUSION Compound Changpu Yizhi Decoction can efficiently improve the TCM syndromes, cognitive function and daily living activity and reduce the levels of homocysteine and acetylcholinesterase of patients with VCIND after stroke.

Objective To evaluate the vitamin D status of residents in two cities of Zhejiang province.Methods 442 participants from Hangzhou and Ningbo were selected using multi-stage cluster random sampling method,then the blood samples were collected and the serum level of 25 -hydroxyl vitamin D [25 (OH)D]was detected by the method of radioimmunoassay to analyze the Vitamin D status.Results Median (25 th-75 th percentile)level of serum 25 (OH)D in subjects aged 6 -11,12 -17,18 -44,45 -59 and over 60 years were 53.19 (41.85 -64.89),48.76 (32.56 -60.52),59.91 (48.05 -72.79),68.67 (55.50 -78.07)and 70.97 (56.91 -84.65)nmol/L,respectively.The number of vitamin D deficiency [25(OH)D<25 nmol/L],insufficiency[25≤25(OH)D <50 nmol/L],normal [50≤25 (OH)D <75 nmol/L ],sufficiency [25 (OH )D ≥75 nmol/L ] were 2.95%,30.84%,44.22% and 22.00%, respectively.Conclusion The deficient and insufficient status of vitamin D is common among residents in two cities of Zhejiang province.Vitamin D nutrition situation should be improved.

OBJECTIVEStudying on the routes of vas deferens to provide anatomy basis for surgical operation, especially, reconstruction of long segment loss of vas deferens.

METHODSThe routes of vas deferens were observed and anatomic distances along epididymal, infrainguinal, inguinal, retroperitoneal and ampullar segments of vas deferens, the distances from external ring to extremity of vas deferens were measured respectively in 18 formalin fixed adult cadavers.

RESULTSThe vas deferens have a large curve from external ring to extremity in its route, draw it out from the external ring. Eliminating this curve will allow to shorten this segment of vas deferens for vasovasostomy by 6.1 - 12.9 (9.31 +/- 1.30) cm. The length of each segment of vas deferens, respectively, is epididymal: 3.2 - 5.6 (4.53 +/- 0.79) cm, infrainguinal: 4.5 - 9.5 (7.31 +/- 1.78) cm, inguinal: 4.4 - 7.5 (5.52 +/- 0.74) cm, retroperitoneal: 12.5 - 19.5 (16.75 +/- 1.87) cm and ampullar: 2.9 - 3.8 (3.63 +/- 0.23) cm. There was no significant differences in segment length and the distances from external ring to extremity of vas deferens between the right and left.

CONCLUSIONReconstruction of long segment loss of vas deferens can be performed by mobilization retroperitoneal vas deferens and draw it out from external ring. There were no significant differences in lengths of vas deferens and the distances from external ring to vassal extremity between the left and right in adults. The surgical operations of vas deferens are closely related each segment of vasa.

Adult ; Autopsy ; Humans ; Male ; Vas Deferens ; anatomy & histology

OBJECTIVETo explore a more optimal therapy for intractable insomnia.

METHODSSeven hundred cases of intractable insomnia that were in accordance with the criteria were randomly divided into an observation group (368 cases) and a control group (332 cases). The acupuncture prescription of regulating yin-yang and five viscera was applied in the observation group, where Dazhui (GV 14), Shenmai (BL 62), Guanyuan (CV 4), Zhaohai (KI 6), Geshu (BL 17), etc. were selected. The acupuncture prescription of tranquilizing mind was applied in the control group, where Baihui (GV 20), Sishencong (EX-HN 1), Anmian (Extra), Shenmen (HT 7), Sanyin jiao (SP 6) were selected. The treatment was given once a day, ten times of which made a session. After the treatment for 4 sessions, the clinical efficacy and Pittsburgh sleep quality index (PSQI) were compared between two groups.

RESULTSThe total effective rate was 92.6% (338/365) in the observation group, which was superior to 73.1% (242/331) in the control group (P < 0.05). The PSQI score was obviously decreased in two groups after the treatment (both P < 0.05), in which the decreasing in the observation group was superior to that in the control group (P < 0.05).

CONCLUSIONThe acupuncture prescription of regulating yin-yang and five viscera has better effect for intractable insomnia, which could be considered as a more optimal therapy.

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Sleep ; Sleep Initiation and Maintenance Disorders ; physiopathology ; therapy ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the feasibility of tracheal reconstruction with a prosthesis made of memory alloy coated with collagen sponge in mongrel dogs.

METHODThe basic skeleton of the prosthesis was knitted with Ni-Ti memory alloy wires. The tubular mesh was sealed with polyurethane membrane and then inner and external walls of the lumen were coated with collagen sponge. Cervical trachea segmental reconstruction was performed in 8 mongrel dogs with these prostheses. The efficacy of the implanted prostheses were periodically evaluated after operation using x-ray, tracheoscopy and specimen microscope examinations.

RESULTSOne dog died of prosthesis dislocation 10 days after operation, another was killed 45 days later because of anastomotic stenosis. 6 dogs survived more than 90 days and the longest one lived for 150 days. Its implanted prosthesis was completely incorporated with the recipient tissue, where re-epithelialization occluded on anastomotic sites. The tracheal lumen was patent.

CONCLUSIONThis memory alloy tracheal prosthesis has been proved useful for reconstruction of large, circumferential tracheal defects, although its long-term safety and efficiency need to be confirmed.

Alloys ; Animals ; Artificial Organs ; Collagen ; Dogs ; Prosthesis Design ; Trachea

Objective To observe the brain cerebrovascular function and blood flow changes in patients with brain diseases during hyperbaric oxygen therapy of different states to provide evidence for their clinical treatment.Methods Forty-nine patients with brain diseases,admitted to our hospital from November 2010 to May 2011,were chosen in our study; their rheoencephalography data captured during a complete hyperbaric oxygen therapy of 4 different states were collected and compared; these 4 states were:state Ⅰ,before pressure raising,which could also be the beginning of the therapy; state Ⅱ,before oxygen intake while pressure coming to a stable level; state Ⅲ,40 min after oxygen uptake; and state Ⅳ,while the pressure inside the chamber coming back to normal level.Results Carotid artery and vertebrobasilar system enjoyed likely changes.Parameters of rheoencephalography showing cerebral blood flow changes,including impedance,raising time,total retraction time and high turn ratio,did not show any differences among the four states (P＞0.05),those showing vascular tension and elasticity,including elasticity index,angle of increasing,top angle of peak value,filling time and amplitude,showed statistically significant difference between each 2 states (P＜0.05),and those showing cerebral vascular resistance,such as resistance index,rising time and high turn ratio,showed significant difference between each 2 states (P＜0.05).Conclusion The hyperbaric oxygen therapy has little effect on changing the brain blood flow; it mainly functions as controlling the impedance and extending the contraction of brain vascular.