Objective To explore the application of clinical pathway in the management of single disease cost. Methods Inpatients with breast cancer from June 2006 to June 2007 were divided into the test group and the control group according to different payment models.Patients in the test group had medical insurance while patients in the control group did not.The general data in the two groups had no statistical difference.The test group were given nursing intervention by clinical pathway while the control group received routine nursing measures. Results The mean inhospital days,mean days waiting for operations and mean inhospital expenses in the test group were shorter or lower than those in the control group (P ＜ 0.05).The mastering degree of health knowledge and the satisfaction degree of patients in the test group were higher than those in the control group (P ＜ 0.05). Conclusions The application of chnical pathway in the single disease cost patients with medical insurance could effectively control the medical expenses and guarantee the quality.So we consider that the application of clinical pathway in single disease cost is applicable.

OBJECTIVE: To investigate the liver protection mechanisms of MAPK signaling pathway of limb ischemia preconditioning in the late phase. METHODS: Thirty-six adult male New Zealand white rabbits, weighing 1.8-2.0 kg, were randomly divided equally into 3 groups: group C (sham operation), group L (liver ischemia-reperfusion 24 h after limb ischemia preconditioning), group IR (liver ischemia-reperfusion without limb ischemia preconditioning). Serum alanine transaminase (ALT) was measured during ischemia reperfusion. The tissue and cell injury of liver were examined by optical and electron microscopy. Activation of P38MAPK, P44/P42MAPK, and JNK in hepatic tissue was assessed by western blot after 30 min of reperfusion. RESULTS: Serum ALT and cell injury in the liver as examined by optical and electron microscopy was decreased in group L as compared with the group IR. Phosphorylation of P38MAPK, P44/ P42MAPK, and JNK were all increased significantly after 30 min of reperfusion. Phosphorylation of P38MAPK and JNK was reduced by limb ischemia pre-treatment. CONCLUSION Limb ischemia pre-treatment can induce the late phase of preconditioning in rabbit liver through the inhibition of the phosphorylation of P38MAPK and JNK.
Animals ; Extremities ; blood supply ; Ischemic Preconditioning ; methods ; Liver ; blood supply ; MAP Kinase Signaling System ; Male ; Phosphorylation ; Rabbits ; Reperfusion Injury ; prevention & control ; p38 Mitogen-Activated Protein Kinases ; chemistry ; physiology

Objective To observe the effect of propofol and etomidate for anesthesia induction on hemodynamics and adverse reactions during the perioperative period. Methods One hundred patients undergoing elective abdominal surgery were randomly divided into the propofol group (Group P) and etomidate group(Group E). For anesthesia induc-tion, successively injected midazolam-propofol-fentanyl-rocuronium in Group P, and the propofol was replaced by eto-midate in Group P. The circulation,stress and the adverse reactions before induction(T0), before intubation(T1), 3 min after intubation (T2), two groups were recorded. Results Compared with the P group, the T1 SBP, HR, T2 SBP, DBP, and HR were higer in E group; The incidence of injection pain was higher in Group P , but the incidence of muscle tremors was lower in Group P(P<0.05). Conclusion The etomidate is more suitable for the patients with hemodynamic instability. Both etomidate and propofol has no effect on blood sugar.

Objective? To explore the knowledge demand on disaster nursing of nurses so as to provide the countermeasure and suggestions for improving the knowledge on disaster nursing of nurses. Methods? From August to October 2016, a total of 510 nurses at a ClassⅢ Grade A hospital in Hangzhou City were investigated with the Disaster Nursing Training Needs Questionnaire for the nurses. The SPSS 21.0 was used to data analysis. A total of 510 questionnaires were sent out and 479 valid questionnaires were collected with 93.92% for the recovery rate. Results? A total of 479 nurses were with the high demand for the professional knowledge and management knowledge of disaster nursing along with 4 and above for the scores of all terms. In the demand of professional knowledge, the highest demand term was the self-protection knowledge (4.70±0.54). Among 9 training modes with multiple choices by 479 nurses, the highest demand for the training mode was theoretical teaching. Among different training modes, 36.7% to 54.9% of nurses selected theoretical teaching. There were statistical differences in the training contents demands among nurses with different departments (P＜ 0.05). Conclusions? Hospitals should strengthen training for the disaster nursing events capability of nurses. Different disaster nursing knowledge and skills should adopt suitable training modes. Nurses with no rescue experience need to attend more effective organizational management training in the disaster.

Objective:To investigate the clinical characteristics of the coronavirus disease 2019 (COVID-19) with liver injury and to provide evidence for clinical diagnosis and treatment.Methods:The clinical data of 107 cases of COVID-19 with liver injury admitted to Guangzhou Eighth People′s Hospital from January 20, 2020 to February 17, 2020 were retrospectively analyzed. SPSS 20 was used for statistical analysis. Comparison of data between the two groups was performed by Mann-Whitney U test, and P<0.05 was statistically significant. Results:The proportion of COVID-19 patients with liver injury was 38.5%. Among the 107 patients, 53 were males and 54 were females, with a median age of 57 years. Among the 52 cases with basic diseases, 20(38.5%) cases had chronic liver diseases(including fatty liver and viral hepatitis). Patients had clinical manifestations of fever (86.0%), cough (92.5%), nausea and vomiting (29.0%), and diarrhea (21.5%). All the indexes of liver function were abnormal in different degree, 31.8% of patients had the total bilirubin (TB) increased, while 60.7% and 63.6% of patients had alanine aminotransferase (ALT) and aspartate aminotransferase (AST) increased respectively. The serum albumin (ALB), prealbumin (PAB), cholinesterase (CHE), prothrombin activity (PTA) decreased in 86.9%, 88.8%, 17.8% and 7.5% of patients, respectively. The level of TB, ALT, AST was higher in patients with severe or critical disease than in patients with light or common disease( Z=-2.3089, P=0.037; Z=-2.611, P=0.009; Z=-3.298, P=0.001), while ALB, PAB, CHE, PTA decreased more significantly( Z=5.527, P=0.000; Z=-2.324, P=0.020; Z=-3.119, P=0.002). Compared with the patients without basic chronic liver disease, the transaminase of the patients with basic chronic liver disease increased more significantly ( Z=-2.218, P=0.027; Z=-1.982, P=0.047). The TB level of patients treated with LPV/r was significantly higher than that of patients without LPV/r ( Z=-3.079, P=0.002). Conclusions:Liver injury is one of the common complications of COVID-19. Patients in severe or critical condition and with basic chronic liver diseases have severe liver injury. We should pay more attention to the liver injury effect of drugs.

Objective: To determine possible relations between early adiposity rebound and adolescent development. Methods: Prospective children cohort from 2 kindergartens selected through clustering convenience sampling method in Anhui Province was established since Sep. 2010. Participants were classified as Cohort 1 (2010), Cohort 2 (2011) and Cohort 3 (2012) according to the recruiting year. Till Sep. 2015, a toal of 802 girls were included in this study, and received follow-up till primary school. During kindergarten period, physical examination was carried out every 3 months, 8 times in total. In primary school, physical examination was carried out annually; till Sep.2015, the cohort 1, 2, 3 took physical examination for 12, 11, 10 times, respectively. Information on household economic status and child physical activity was acquired through parents questionnaire survey, and breast development were assessed through visual inspection and palpation. Adiposity rebound was determined according to Rolland-Cachera's method for each girl. Differences between early adiposity rebound and normal adiposity rebound groups were compared by using t test and χ² test. Multivariate regression analysis was applied to explore the association between early adiposity rebound and breast development. Results: The average age of participants was (8.90±0.87) years old and the BMI was (17.48±2.70) kg/m². The average age at adiposity rebound was (6.16±0.90) years old and the BMI was (15.33±1.82) kg/m². Premature breast development was found significantly higher in girls in early adiposity rebound group (27.8%, 54/802) than it in normal adiposity rebound group (13.7%) (P<0.001). After current adiposity, age, household economic status, childhood physical activity adjusted, the OR of premature beast development in early adiposity rebound group was 2.41(95%CI: 1.41-4.12). Conclusion Early adiposity rebound increases the risk of premature puberty in girls.

Objective To clarify whether the use of dynamic coronary artery roadmap(DCR)technology in a low-dose mode with 7.5 frames per second during coronary intervention can further reduce the total radiation dose,fluoroscopy time,and contrast agent usage.Methods A total of 94 patients,who received coronary angiography at the Shanghai Tongji Hospital of China between July 2022 and December 2022,were enrolled in this study.The patients were randomly divided into DCR group(n=53)and control group(n=41).DCR technology was used in the DCR group to guide the performance of percutaneous coronary intervention(PCI),while low-dose mode coronary angiography was adopted in the control group.The total air kerma(AK),dose-area product(DAP),intraoperative fluoroscopy time,and contrast agent usage were compared between the two groups.Results In the DCR group AK was(597.9±222.8)mGy,which was significantly lower than(717.0±326.8)mGy in the control group(P=0.039);DAP was(33.2±13.3)Gycm2/s,which was also remarkably lower than(41.3±21.5)Gycm2/s in the control group(P=0.027).In the DCR group and the control group,the intraoperative fluoroscopy time was(9.8± 3.3)min and(12.1±4.3)min respectively(P＜0.01),and the contrast agent usage was(122.3±19.0)mL and(130.5± 28.5)mL respectively(P=0.116).Conclusion In a low-dose mode during coronary intervention,the use of DCR technology can further reduce radiation dose,fluoroscopy time,and contrast agent usage.(J Intervent Radiol,2024,33:236-239)

To observe the safety and impact on the short-term prognosis for patients of stroke volume variation (SVV) goal-directed fluid therapy (GDFT) in laparoscopic precision hepatectomy.
 Methods: A total of 120 patients (18-65 years old) undergoing laparoscopic precision hepatectomy were randomly divided into the fluid therapy group (group S) guided by SVV and the fluid therapy group (group C) guided by central venous pressure group (CVP), with 60 cases in each group. Mean arterial pressure (MAP) and heart rate (HR) were recorded at the following time: at home calm (T0), the operation started (T1), began to cut the liver (T2), the hepatectomy was acheived (T3), and in the end (T4). The lactic acid was measured at T0 to T4 and 1 day after surgery (T5). The amount of blood loss, urine output and fluid supplement, the incidence of intraoperative hypotension, and the use of neophryn were recorded. The recovery of liver function, Hb, and so on were also recorded.
 Results: Compared with the group C, the number of hypotension cases, the amount of blood loss and the amount of neophryn in the group S were decreased during the operation (P<0.05), while the lactic acid values in the group S were not significantly increased than those in the group C at T3 and T4 (P<0.05) and the elevation of AST, ALT, DBIL and TBIL in the group S was significantly decreased than those in the group C at 1 and 2 d after the operation (P<0.05). Hb and Hct in the group S were higher than those in the group C at 1 d after the surgery (P<0.05). Compared with the group C, the postoperative exhaust time and hospitalization time were shortened in the group S (P<0.05), and the infection rate and ICU admission rate were decreased in the group S (P<0.05).
 Conclusion: SVV-guided GDFT in laparoscopic precise hepatectomy is safe and effective. It reduces intraoperative blood loss and benefits the short-term prognosis of patients after operations. High SVV value (13%-17%) is adopted at the liver resection stage, and SVV value with 8%-12% at the end of trans-section may be used as one of intraoperative liquid therapy in laparoscopic precise hepatectomy.
Adolescent ; Adult ; Aged ; Central Venous Pressure ; Fluid Therapy ; Hepatectomy ; Humans ; Laparoscopy ; Middle Aged ; Stroke Volume ; Young Adult

Objective: To observe the effects of general anesthesia and intravertebral anesthesia on the patients' temperature, perfusion index(PI) and coagulation function. Methods: From January 2016 to December 2017, 60 patients in the First Hospital of Jiaxing undergoing elective line of great saphenous varicose veins surgery were selected.According to the random number table, the patients were divided into the general anesthesia group(group G, n=30) and intraspinal anesthesia group(group I, n=30). The general condition, operation time, the core temperature(tympanic membrane temperature) before anesthesia(T0), 10 min after anesthesia(T1), 20 min later(T2), 30 min later(T3), and the PI with no-infusion upper limb were recorded.The changes of coagulation function before anesthesia(T0) and after surgery(T4) were observed by extraction of the thrombus(TEG). Results: The core body temperature of T1, T2 and T3 was significantly decreased in both two groups(F_G=58.789, P=0.000, F_I=2.965, P=0.035), and the hypothermia of group G was greater than that of group I(t₁=-2.998, t₂=-5.985, t₃=-7.705; P<0.05). The PI of T1, T2 and T3 was significantly higher than T0 in both two groups(F_G=5.439, P=0.002, F_I=3.404 P=0.020), and the increase of group G was greater than that of group I(t₁=2.065, t₂=2.041, t₃=2.649; P<0.05). In group G, TEG examination was significantly prolonged(F=5.482, P=0.023), and no significant changes were observed in group I. Conclusion The hypothermia of the patients and the increase of PI increased significantly, and the R time index of TEG is prolonged, and the anesthesia in the spinal canal has no obvious effect on the coagulation function.