Objective To explore the application effect of quality control for medical records of clinical pathway .Methods The 127 clinical pathway patients with acute ST segment elevation myocardial infarction were randomly divided into two groups .69 patients with clinical pathway quality control were taken as test group , while 58 patients without clinical pathway quality control were taken as control group.The hospitalization duration, total hospitalization expenses and various events expenses were compared between these two groups.Results The average hospitalization duration in test group was (10.32 ±2.03) days, while that in control group was (12.10 ±2.96) days, with statistically significant differences between the groups (p<0.05).The average hospitalization ex-pense in the test group was (52,349.94 ±16,944.22) yuan, while that in control group was (59,522.81 ±22,783.01) yuan, with statistically significant differences between the groups (p<0.05).Among various events of hospitalization expense, the medicine cost and nursing fee in the test group were lower than those in control group, with statistically significant differences (p<0.05), and no statistically significant differences were found in the other items (p>0.05).Conclusion The quality control for medical records of clinical pathway can effectively control the hospitalization duration and hospitalization expense , standardizing the implementation of clinical pathway.

AIM:To explore the possible alteration of refraction and estimate the potential impact of visual quality, investigate the impact of intraocular structure between the simple operation and the combination of phacoemulsification and intraocular lens implantation, and observe the influence among various tamponade materials application.
METHODS: Ultrasound biomicroscopy ( UBM ) and intraocular len ( IOL ) Master were measured for simple vitrectomy patients ( the simple group, 37 eyes ) and vitrectomy combined with cataract surgery patients ( the combined group, 11 eyes ) . Several parameters were measured such as the anterior chamber depth ( ACD ) , angle opening distance ( AOD ) , trabecular iris angle (TIA), axial length (AL), et al . The simple group was further divided into three sub - groups by various tamponade materials in vitreous: silicone oil group, gas group and equilibrium liquid group. All patients were measured including ACD, AOD250, AOD500, TIA500, AL and corneal curvature (K1, K2) parameters preoperatively and 2wk postoperatively.
RESULTS: AOD250, AOD500, TIA500 and AL were decreased 0. 13±0. 21mm, 0. 16±0. 22mm, 8. 68o±9. 72o and 0. 18±0. 24mm ( all P<0. 05 ) respectively in the simple group postoperatively. ACD, AOD250, AOD500, TIA500 and AL in combined group increased 0. 95±0. 54mm, 0. 13±0. 12mm, 0. 22±0. 20mm, 11. 49o±11. 06o, and 0. 45±0.30mm ( all P < 0. 05 ) respectively after operation. Alteration of ACD, AOD250, AOD500, TIA500 and AL were different between simple group and combined group ( P<0. 05). Of data from various tamponade materials sub-groups, ACD, AOD250, AOD500 and TIA500 of the gas group reduced 0. 19±0. 17mm, 0. 14±0. 09mm, 0. 20±0. 12mm, and 12. 02o±6. 64o respectively after operation ( P<0. 05), the AOD250, AOD500, TIA500 and axial length of silicone oil group decreased 0. 19±0. 25mm, 0. 21±0. 26mm, 10. 44o±9. 67oand 0. 23±0. 19mm respectively after operation ( P < 0.05 ) , while equilibrium liquid group had no significant changed in all intraocular structure (P>0. 05). However, neither the corneal thickness nor curvature (K1, K2) were changed postoperatively (P>0. 05).
CONCLUSION:Alteration of anterior segment and axial length in combined group are different from that of the simple group, while the corneal thickness and corneal curvature ( K1, K2 ) are not obviously changed in all groups. Meanwhile, various tamponade materials can also cause different impact on intraocular structure and refraction. In brief, alterations of intraocular structure might cause discrepant refractive changes and potential influence of visual quality.

Objective To investigate the toxic effects of rotenone on dopamine transporter in the substantia nigra of the rat. Methods Rats (male) were divided into normal control group, vehicle control group and rotenone experimental group(1.0mg/kg and 1.5mg/kg). The animals were subcutaneously administrated with the vehicle or rotenone in different dosage once a day for 28 days. One day after last injection, the brain was dissected and the substantia nigra was harvested. Protein expressions of tyrosine hydroxylase and dopamine transporter were determined with the methods of immunohistochemistry and Western blot. The mRNA expressions of dopamine transporter and dopamine receptor were detected with RT-PCR respectively. The activity of Na+-K+-ATPase was assayed biochemically. Results In the experimental groups, both the immune positive neurons of tyrosine hydroxylase and the expression of its protein were significantly decreased in the substantia nigra of the rats after rotenone treatment. The number of dopamine transporter antibody-immune positive neurons were significantly increased in the rats exposed to rotenone. Furthermore, protein and mRNA expressions of dopamine transporter in the experimental group were also obviously up-regulated compared with the normal control group. A decreased activity of Na+-K+-ATPase was observed in the substantia nigra of rats in the rotenone experimental group. In addition, the mRNA expression of D2R was also increased in contrast with that in the control group. Conclusions Rotenone is toxic to dopamine neurons in the substantia nigra of rats. Dysfunction of dopamine transporter may be involved in the mechanism of rotenone toxicity to dopamine neurons.

Objective To study the toxic effects of rotenone on substantia nigra of rats. Methods Rotenone was given subcutaneously once a day during 28 days. Substantia nigra was dissected. Morphology of dopamine neuron, synapse and myelin sheath were observed. SOD and GSH-Px activity were assayed; MDA and GSH contents were measured. Results Autonomic activities of rats decreased, similar to Parkinson's Symptoms. Morphology of dopamine neuron changed, synapse structures were abnormal, synapse vesicals increased and myelin sheath degenerated. MDA content increased (P

AIM:To investigate the effect of case-based learning ( CBL) teaching combination with paper review method in the teaching of ophthalmology residents. ·METHODS:The study was conducted from 2015 to 2016. The residents in Department of Ophthalmology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital were included in the research. During the year of 2015, the traditional lecture-based learning ( LBL) method was applied (as a control group). During the year of 2016, the CBL teaching combination with paper review teaching method was applied (as an experimental group). At the end of the course, exams and questionnaires were conducted to evaluate the teaching effect of two different methods. The exams consisted of theoretical and operational assessment. The teaching satisfactions, learning interests, scientific research interests and clinical abilities were included in the questionnaires. The data was analyzed by SPSS 16. 0. ·RESULTS:The results of final exams indicated that the scores of the experimental group (88. 2±6. 5) were higher than the control group ( 75. 6 ± 6. 0 ). The difference showed statistically significant (t=6. 68, P<0. 05). The results of questionnaires indicated that students showed much more satisfied with CBL teaching combination with paper review teaching method ( 91%) than traditional teaching method (50%, x2 =8. 84, P<0. 05). Students in the experimental group improved learning interest ( x2 =6. 29, P<0. 05), increased research interest (x2=4. 54, P<0.05) and approved clinical ability (x2 =4. 25, P<0. 05). The comparison of two groups showed the statistically difference (P<0. 05). ·CONCLUSION: CBL teaching combination with paper review teaching method is beneficial to improve the teaching effect, and it is also beneficial to train residents'clinical skills and research abilities.

Objective To evaluate the clinical safety and efficacy of HIFU treatment of hepatic metastases from colorectal cancer.Methods 20 tumor lesions in 14 patients with hepatic metastases from colonectal cancer were treated with HIFU therapy.The vital signs,main organs'functions,examination of MRI and complications were observed.Results Vital signs of all the 14 patients were stable.The function of liver and kidney were normal and life quality were improved with elevation of Karnofsky in 5 patients.On MRI examination,the MRI signals of treating area of 20 tumor lesion in 14 patients decreased remarkably with disappearance of blood supply and a thin layer of edematous intensified zone was detected on the margin of lesion.6 patients were found to have cord-like burning scar on skin.Conclusion HIFU treatment is safe and effective in treatment of hepatic metastases from colorectal cancer.

AIM To study the antitumor activity of astragalosides(AST) and its mechanism of action. METHODS By using two experimental models of hepatoma(HepA) and Sarcoma 180 in mice, the rate of inhibition of tumor weight AST on the growth of HepA and S180 tumor cells were tested. The growth inhibition of AST on Hela cells was detected by MTT assay. The effect of AST on cell cycle and apoptosis was analyzed by flow cytometry and TUNEL. RESULTS AST inhibited the growth of tumor cells of HepA and S180 in mice. AST inhibited the growth of Hela cell in concentration dependent manner with IC 50 of 80 4 mg?L -1 . Flow cytomety analgsis showed that G 0/G 1 phase rate was increased but S phase rate was decreased. The apoptosis rate of Hela cells treated with AST( 80 and 160 mg?L -1 ) was significantly higher than that of control. CONCLUSION AST can inhibit the growth of tumor cells of HepA and S180 in mice and the growth of HeLa cells in vitro . Causing cell cycle arrest and apoptosis is probably one of the mechanisms of antitumor effect by AST.

Objective: To observe the effects of interferon-induced protein 204 (p204) over-expression on apoptosis, proliferation and migration of aortic vascular adventitial ifbroblast (VAFs) in experimental rats.
Methods: Our research included in 3 groups: Iif204-Lv group, in whichVAFs were infected by Iif204-recombined lentivirus, Con-Lv group, in which VAFs carried the empty vector without virus, Blank control group, in which VAFs were untreated. VAFs proliferation was examined by MTT method, cell apoptosis was measured by lfow cytometry and the migration was detected by scratching assay and transwell chamber method. The mRNA and protein expressions of p204, p53 and p21were evaluated by real-time q RT-PCR and Western blot analysis respectively.
Results: Compared with Con-Lv and Blank control groups, Iif204-Lv group had decreased VAFs proliferation (by OD value) at 48 hours: (0.53 ± 0.05) vs (0.66±0.03) and (0.63 ± 0.06), at 72 hours: (0.89 ± 0.06) vs (1.02 ± 0.06) and (1.01 ± 0.07); distance of cell migration (by pixel): (61.00 ± 1.83) vs (74.50 ± 6.25) and (75.50 ± 7.85); number of cell migration: (61.75 ± 10.69) vs (155.25 ± 10.21) and (153.75 ± 9.40), allP<0.05. VAFs apoptosis rates were similar among different groups. Compared with Con-Lv and Blank control groups, Ifi204-Lv group presented up-regulated mRNA expressions of p204 (3.45 ± 0.15) vs (2.09 ± 0.10) and (2.06 ± 0.09); p53 (3.41 ± 0.09) vs (2.06 ± 0.07) and (2.10 ± 0.06); p21 (3.01 ± 0.08) vs (2.05 ± 0.06) and (2.11 ± 0.08), allP<0.05.
Conclusion: p204 over-expression inhibits VAFs proliferation and migration which might be partly related to the activation of p53 and p21 expression in experimental rats.

Objective: To study the impact of interferon-inducible protein 16 (IFI16) inhibition on apoptosis of human aortic adventitial fibroblasts (HAAFs). Methods: Our research included 3 groups: ① IFI16-siRNA group, specific small interference RNAs (siRNAs) of IFI16 were transfected into HAAFs in vitro to make IFI16 gene silence, ②Con-siRNA group, non-specific siRNAs were transfected into HAAFs as negative control and ③Untreated HAAFs group, blank control. HAAFs cell cycle and apoptosis rate were examined by flow cytometry, IFI16 mRNA expression was measured by real time qRT-PCR, protein expressions of IFI16, p53, p21, Bax and Bcl-2 were detected by Western blot analysis. Results: Compared with Con-siRNA group and Untreated HAAFs group, IFI16-siRNA group showed decreased apoptosis rate of HAAFs (3.33±0.41) % vs (7.42±1.51) % and (6.49±1.10) %, P<0.05, reduced ratio of G0/G1 phase cells (56.64 ± 4.77 ) % vs (69.67±3.54) % and (68.29±4.14) %, P<0.05, while increased ratio of S phase cells (25.23±5.19)% vs (13.76±2.07) % and (14.04±3.00) %, P<0.05. Meanwhile, IFI16-siRNA group presented down-regulated IFI16 mRNA and protein expressions, decreased protein levels of p53, p21, Bax and increased protein level of Bcl-2, all P<0.05. Conclusion: Inhibited IFI16 expression could decrease HAAFs apoptosis, promote cell cycle transition from G1 to S phase which might be related to the suppression of p53/p21 signaling pathway and regulation of Bax/Bcl-2 expression.

Objective To investigate the influence of alprostadil on renal function,oxidative stress,and immune function in early diabetic nephropathy patients.Methods Eighty-six cases of early diabetic nephropathy patients in our hospital during April 2013 to January 2016 were chosen as research subjects,all patients were divided into observation (n =43) and control (n =43) groups according to random data form.Patients in observation group received alprostadil combined with pioglitazone treatment and those in control group received pioglitazone treatment only,both lasted for one month.Before treatment,one month after treatment,renal function indices were detected;serum oxidative stress indices were detected by automatic biochemical analyzer;T lymphocyte subsets in peripheral blood were measured by flow cytometry.Results Before treatment,there were no significant differences in renal function,oxidative stress,immune function between two groups (P ＞ 0.05).One month after treatment,peripheral blood renal function indices such as blood urea nitrogen (BUN),estimated glomerular filtration rate (eGFR),and cystatin C (CysC) levels were lower in observation group than in control group,the level of serum albumin (Alb) was higher in observation group than in control group,the difference was statistically significant (P ＜ 0.05);semm oxidation indices malondialdehyde (MDA),and advanced oxidation protein products (AOPP) were lower in observation group than in control group,human antioxidant indices such as superoxide dismutase (SOD),and total antioxidant capacity (T-AOC) were higher in observation group than in control group,the difference was statistically significant (P ＜ 0.05);peripheral blood CD3 +,CD4 + T lymphocytes and the ratio of CD4 +/CD8 + were higher in observation group than in control group,CD8 +T lymphocyte level was lower in observation group than in control group,the difference was statistically significant (P ＜ 0.05).Conclusions Alprostadil can optimize the renal function and immune function in early diabetic nephropathy patients,reduce the degree of oxidative stress.