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.

To detect chromosome translocation t(11;18) (q21;q21) and the nuclear expression of bcl-10 in gastrointestinal mucosa-associated lymphoid tissue (MALT) lymphoma in Chinese, a possible API2-MALT fusion transcript specific to t(11; 18) (q21; q21) in tumors from 42 cases of primary gastrointestinal lymphoma (29 cases of low grade MALT lymphoma, 13 cases of transformed MALT lymphoma) and 40 cases of diffuse large B cell lymphoma was examined by means of RT-PCR and proved by DNA-sequencing. Bcl-10 expression was examined by immunohistochemical method. The results showed that t(11;18) (q21;q21) was 14% positive in cases of low grade MALT lymphomas and 46% positive in transformed MALT lymphomas, but none in cases of DLBCL. Bcl-10 nuclear expression was seen 61% in low grade MALT and 69% in transformed MALT lymphoma. It was suggested that t(11;18) (q21;q21) was related to the prognosis and development of highly advanced MALT lymphoma but not relevant to DLBCL. Bcl-10 nuclear expressions were not significantly different between these two groups, which remains to be explained.
Adaptor Proteins, Signal Transducing ; B-Cell CLL-Lymphoma 10 Protein ; Carrier Proteins ; analysis ; Cell Nucleus ; chemistry ; Chromosomes, Human, Pair 11 ; Chromosomes, Human, Pair 18 ; Humans ; Immunohistochemistry ; Lymphoma, B-Cell, Marginal Zone ; chemistry ; genetics ; Translocation, Genetic

Objective To explore the efficacy and safety of autologous peripheral blood stem cell transplantation (APBSCT) in the treatment of systemic lupus erythematosus.Methods Nine patients with systemic lupus erythematosus were enrolled in this study.Patients were given cyclophosphamide and granu- locyte colony-stimulating factor(G-CSF)as the mobilization regimen.Urine was alkalinized and hydrolyzed to protect the function of the heart,liver and kidney of the patients.A CS3000 Plus blood cell separator was used to collect peripheral blood stem cells,which were preserved in liquid nitrogen.Two to five days before the administration of the stem cells,the patients were pretreated with intravenous injection of cyclophos- phamide (50 mg?kg~(-1)?day~1) for 4 consecutive days and antithymocyte globulin (ATG,2.5 mg?kg~(-1)?day~1) for 3 consecutive days.Granulocytes were recoverd by G-CSF stimulation.Then,the peripheral blood stem cells were reinfused.Therapeutic effect was evaluated by assessment of alteration of clinical manifestation (skin erythema),levels of proteinuria and antoantibodies,hematopoietic reconstitution and occurrence of transplantation related complications.Results After transplantation,all patients had been successfully en- grafted.The time for peripheral leucocyte count to reach 1.0?10~9/L was 7～15d;the time for platelets to reach 20?10~9/L was 0～21 d.The skin erythema resolved in all patients;proteinuria decreased to normal level and the autoantibodies became negative in most of the patients.Serum sickness-like response occurred in all patients,renal and heart failure in 1 patient,hemorrhagic cystitis in 3 patients,psychiatric disorders in 1 patient,candidal infection in 1 patient.Conclusion One-year follow up suggests that autologous stem cell transplantation is markedly effective and relatively safe for systemic lupus erythematosus.However,the duration of remission remains to be investigated in a long-term follow up study.

To improve the solubility and antitumor activity of ampelopsin, ampelopsin-loaded nanomicelles from the mixture of pluronic F127 and D-α-tocopheryl polyethylene glycol 1000 succinate (TPGS1000) were prepared by film-thin hydration method, in order to optimize the process conditions and physicochemical properties. The antitumor activities against MCF-7 cells between ampelopsin and nanomicelles were compared by MTT method, respectively. The results showed that the optimal nanomicelles were round with the nanometric size of (22.6±0.5) nm, encapsulation efficiency rate of (80.42±1.13)%, and drug-loading rate of (4.41±0.26)%. The solubility of ampelopsin in mixed nanomicelles significantly increased by 16 times. In different release media, the mixed nanomicelles could release more than 90% of drug in 8 h, and showed stronger cytotoxicity and inhibition against MCF-7 cells (P<0.01). The mixed nanomicelles can be used as new drug delivery system of ampelopsin.

Objective To study the localization of the foramen of Monro on magnetic resonance image (MRI) and its clinical significance.Methods Cranial MRI was observed for 30 normal healthy subjects to study their location,shape and size of the foramen of Monro,as compared to those in 22 patients with hydrocephalus and 14 cases with tumor around their foramen.Results The the foramen of Monro is located between the fornix and the anterior part of thalamus in the normal healthy subjects,with a transverse diameter of 2.8 mm and a vertical diameter of 2.1 mm in average on MRI.Y-shaped structure is formed between their bilateral the foramen of Monro and the 3rd cerebral ventricle.Very obvious changes in shape and size of the foramen of Monro can be observed in patients with hydrocephalus,which sometimes can integrated with the 3rd cerebral ventricle and lateral ventricle,forming a"rabbit-head sign".Meanwhile, imaging of the foramen of Monro varied in patients with tumor around the foramen,depending on its location and size.Conclusions The foramen of Monro has a relative constant position in the brain.Changes in its position,size and shape are important signs suggesting intracranial lesions.An individualized operation plan for a patient should be determined based on those changes.

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.

OBJECTIVE: To examine the self-reported scale of brief psychopathological symptoms (SBPS) to detect malingering in forensic psychiatric cases. METHODS: Two hundred and six cases with different types of psychiatric problems were tested by SBPS. All cases were separately evaluated by two experts. RESULTS: About 34.5% cases (71/206) were classified as malingering by the cut-off 13 scores of SBPS. Compared with expert's evaluation, SBPS showed a false negative rate of 19.8% and a false positive rate of 1.7%, respectively, with a total accuracy rate of 90.8%. Cases involved in compensations including working injury and traffic accidence showed the highest rate of malingering (51%). CONCLUSION SBPS is useful for detecting malingering psychopathological symptoms.
Adult ; Female ; Forensic Psychiatry ; Humans ; Lie Detection ; Male ; Malingering/psychology* ; Mental Disorders/psychology* ; Psychological Tests ; Reproducibility of Results ; Volition ; Young Adult

Objective To clinically study the antiviral effects of lamivudine and entecavir on patients with early-to-mid stage Hepatitis B related acute on chronic liver failure(HBV-ACLF).Methods A prospective,randomized,open and parallel controlled clinical trial was designed to observe the antiviral effects of nucleoside analogues on patients with early-to-mid stage HBV-ACLF.Three groups were set for controlled study,i.e.basic treatment group,lamivudine plus basic treatment group and entecavir plus basic treatment group.Results One month after treatment,the improvement rates of lamivudine group and entecavir group were 58.85% and 59.15% respectively,significantly hisher than that of basic treatment group which was 34.84%(X2=9.8323,P=0.043).By the end of six months,the cumulative survival rates of patients with the antiviral treatments,i.e.,lamivudine,entecavir,were 65.8%,60.1%,significantly higher than that(42%) without the antiviral treatment(P=0.045,P=0.04 respectively).The cumulative survival rate in patients with a MELD score <30 was higher than that with a MELD score over 30(X2= 3.920 P=0.048).For the patients with pretreatment HBV DNA≥107,the cumulative survival rate in patients with entecavir treatments group was higher than that of patients in basic treatment group(X2=5.014 P=0.025).According to the Ordinal Regression analysis,antiviral therapy by using either lamivudine or entecavia could significantly increase the improvement rate of patients with early-to-mid stage HBV-ACLF. But severe complications, including hepatorenal syndrome, electrolyte imbalance and hepatic encephalopathy,medical history of liver cirrhosis,and pretreatment HBV DNA≥107 had significant impacts on prognosis of this group patients.Conclusions Antiviral therapy by using either lamivudine or entecavia could significantly increase the survival rate of patients with early-to-mid stage HBV-ACLF.

OBJECTIVETo explore the prognostic value of hyperuricemia for adverse events in patients >40 years old receiving valve replacement surgery for rheumatic aortic valve disease.

METHDSConsecutive middle-aged and elderly patients receiving aortic valve replacement surgery for rheumatic aortic valve disease between March, 2009 and July, 2013 were recruited in this study. The patients were divided into hyperuricemic group and normouricemic group based on their serum levels of uric acid, and the clinical data and adverse events within 1 year after the surgery were compared between the 2 groups.

RESULTSA total of 632 consecutive patients were recruited, including 381 patients with hyperuricemia and 251 with normouricemia. The in-hospital mortality rate was significantly higher in hyperuricemic group than in normouricemic group (7.6% vs 2.0%, P=0.002). Serum uric acid levels were negatively correlated with eGFR (r=-0.421, P<0.001) and positively correlated with C-reactive protein level (r=0.093, P=0.025). Multivariate analysis showed that hyperuricemia was independently associated with the in-hospital mortality (OR=3.07, 95%CI: 1.13-8.37, P=0.028) and mortality at 1 year after the surgery (HR=3.14, 95%CI: 1.30-7.62, P=0.011) after adjusting for potential risk factors including age, NYHA III-IV and postoperative acute kidney injury (AKI). Kaplan-Meier analysis showed that the cumulative rate of 1-year mortality after surgery was significantly higher in patients with hyperuricemia (Log-rank=11.73, P=0.001).

CONCLUSIONHyperuricemia is a predictor of in-hospital and one-year mortality in middle-aged and elderly patients following aortic valve replacement surgery for rheumatic aortic valve disease.

BACKGROUNDThe prevalence of hepatitis B virus (HBV) infection is high among individuals infected with human immunodeficiency virus (HIV) in China. Both HIV and HBV can be treated with tenofovir disoproxil fumarate (TDF) and lamivudine (3TC), so we evaluated the safety and efficacy of combination antiretroviral therapy (ART) that included TDF, 3TC, and efavirenz (EFV) among ART-naive individuals who were co-infected with HIV and HBV.

METHODSOne hundred HIV/HBV co-infected ARV-naive individuals were started on the regimen of TDF, 3TC, and EFV, and the levels of plasma HBV DNA, HIV RNA, and biochemical evaluation related to the function of liver and kidney were analyzed.

RESULTSConcerning efficacy, this study found that by week 48, the vast majority co-infected participants receiving this ART regimen had undetectable HBV DNA levels (71%) and/or HIV RNA levels (90%). Concerning safety, this study found that the median estimated glomerular filtration rate of participants decreased from baseline (109 ml·min-1·1.73 m-2) to week 12 (104 ml·min-1·1.73 m-2) but was almost back to baseline at week 48 (111 ml·min-1·1.73 m-2).

CONCLUSIONThis combination ART regimen is safe and effective for patients with HIV/HBV co-infection.

TRIAL REGISTRATIONClinicalTrials.gov, NCT01751555; https://clinicaltrials.gov/ct2/show/NCT01751555.

Adult ; Alanine Transaminase ; metabolism ; Anti-HIV Agents ; therapeutic use ; Aspartate Aminotransferases ; metabolism ; Benzoxazines ; therapeutic use ; CD4-Positive T-Lymphocytes ; metabolism ; Coinfection ; drug therapy ; Female ; HIV Infections ; drug therapy ; Hepatitis B virus ; drug effects ; pathogenicity ; Humans ; Lamivudine ; therapeutic use ; Male ; Tenofovir ; therapeutic use