The paper described practices in QC management pathway of death cases of the hospital.These refer to intensive education,clarification of access standard,death cases quarterly readings and administrative investigation,strict supervision among others.Authors pointed out that QC pathway can improve quality of care significantly,yet QC pathway calls for fair accountability,systemic care for patient safety,and all-staff involvement in QC improvement.

OBJECTIVE:To systematically review the efficacy and safety of gemcitabine combined with docetaxel in the treat-ment of non-small cell lung cancer(NSCLC),and provide evidence-based reference for clinical treatment. METHODS:Retrieved from PubMed,Cochrane Library,Elsevier,CJFD,Wangfang Database and VIP,randomized controlled trials(RCT)about the ef-ficacy and safety of gemcitabine combined with docetaxel(test group)versus the 3rd generation chemotherapeutic agents combined with cisplatin(control group)in the treatment of NSCLC were collected. Meta-analysis was performed by using Rev Man 5.3 soft-ware after quality evaluation by modified Jadad scale. RESULTS:Totally 9 RCTs were included,involving 1 986 patients. Results of Meta-analysis showed,there were no significant differences in the total effective rate [RR=0.93,95%CI(0.83,1.05),P=0.27], 1-year survival rate [RR=0.97,95%CI(0.87,1.09),P=0.64],the incidences of liver dysfunction [RR=0.35,95%CI(0.06,2.18), P=0.26] and leukopenia [RR=0.80,95%CI(0.57,1.10),P=0.17] and decreased rate of hemoglobin [RR=0.65,95%CI(0.25, 1.69),P=0.38] in 2 groups;the incidences of liver dysfunction [RR=0.09,95%CI(0.02,0.38),P=0.001] and neurotoxicity in test group were significantly lower than control group,while the incidence of lung injury [RR=8.71,95%CI(2.04,37.12),P=0.003] was significantly higher than control group,the differences were statistically significant. CONCLUSIONS:Gemcitabine com-bined with docetaxel shows similar efficacy to the 3rd generation chemotherapeutic agents combined with cisplatin in the treatment of NSCLC,less effect on renal function and nerve while high on pulmonary toxicity.

Objective To analyze the short-term results of endovascular aortic repair (EVAR)for patients with acute type B aortic dissection and chronic renal insufficiency (CRI ).Methods Between February 2009 and December 2012,EVAR was performed in 30 patients with acute type B aortic dissection and CRI (CRI group).Consecutive 30 patients with acute type B aortic dissection whose renal function was normal during the same period was chosen as the control group (non-CRI group).All patients were within 14 days after onset,in which Marfan syndrome was excluded and diagnosis made by computed tomographic angiography (CTA) before the procedure.In 57 patients,EVAR was performed under looal anesthesia and associated procedures included insertion of a chimney stent in the left subclavian artery in 2 case and a bare metal stent in the renl artery in 2,In 3 patients,EVAR was done following right axillary artery-to-left axillary and left subclavian artery bypass with a Y-shaped graft under general anesthesia.Follow-up regimen included renal function and CTA at I month and 1 year postoperatively.Results Compared to the non-CRI group,patients in the CRI grup was significantly younger [ (44.7±13.2) years versus (53.7±16.2)years,P ＜0.05)and had a higher rate of perioperative complications (cerebrospinal ischemia,deterioration of renal dysfunction,and gastroenteral dysfunction) (16.7％ versus 3.3％,P ＜0.05 ),all of which resolved after surgical or medical treatment.One patient in CRI group was readmitted at 6 months for a redo EVAR to treat a new tear distal to the stent.At 1 month and I year postoperatively,no patients suffered from deterioration ofthe renal function,and their CTAs detected no apparent device deformation,alteration and endoleak,with remsrkable improvement in the blood supply of the aortic trie lumen and branches.Conchusion Satisfactory short-term results can be achieved with EVAR for patients with acute type B aortic dissection and CRI.At I month and 1 year postoperatively,no mortality or morbidity occumed such as endoleak,aortic rupture,neurologic and abdominal ischermia.

Objective The purpose of the study was to assess the distal aorta changes and prognosis after total arch replacement combined with stented elephant trunk implantation(Sun's procedure) for Marfan patients with Stanford type A aortic dissection involving the aortic arch.Methods Between February 2009 and February 2014,47 Marfan patients (38 males,9 females) with Stanford type A aortic dissection involving the aortic arch underwent Sun's procedure.Mean ages(32.43 ± 7.96) years(ranged from 19 to 50 years).According to whether the growth rate of the distal aortic diameter is more than 5 mm/year or not after the first year,the data it was divided into the improve group(29 cases) and the progressive group(18 cases).The residual false lumen thrombosis and the diameter of the distal aorta were evaluated by CT date.Results All patients were survived and discharged after Sun's procedure.The mean follow-up period was 1 years.The survival rate was 97.9％ (46/47) and 1 patients died.The total recover of the distal aorta was achieved in12 patients(25.5％) after procedure.The reoperation of total thoracoabdominal aortic replacement rate of the distal aorta was 8.5％ (4/47) and the reoperation interval was(9.88 ±2.84) month(6-12 month).Complete thrombus formation around the stented elephant trunk was observed in 85.1％ (40 of 47).The annual rate of growth of the distal aorta were:the descending aorta segment of stented elephant trunk (0.00 s3.41) mm,the diaphragm level(1.14 ±2.20)mm,the renal artery level(0.97 ±2.15)mm.Complete thrombus formation around the stented elephant trunk of theprogressive group was lower thanthe improvegroup(72.2％ vs 93.1％,P =0.089).The reoperation rate of total thoracoabdominal aortic replacement surgery of the progressive group was higher than the improve group(22.2％ vs 0,P =0.017).The incidence of aortic rupture risk of the progressive group was higher than the improve group (5.6％ vs 0,P =0.383).The diameter of the distal aorta after Sun's procedure of the progressive group was higher than the improve group after 1 year:the descending aorta segment of stented elephant trunk end(40.17 ±7.09) mm vs (27.86 ±6.77)mm(P ＜0.001),the diaphragm level(42.17 ±9.91)mm vs(27.48 ±7.14) mm(P ＜0.001),the renal artery level (38.22 ± 6.90) mm vs(24.00 ± 6.18) mm (P ＜ 0.001),the difference was statistically significant.Conclusion Using Sun's procedure for Marfan patients with Stanford type A aortic dissection involving the aortic arch would promote false lumen thrombosis of stented elephant trunk and aortic remodeling and delay the time interval of the reoperation.The Marfan patients in progressive group which the diameter of the distal aortic growth rate was more than 5mm/year,should be actively carry out rigorous monitoring of the distal aorta and prevention of aortic rupture risk events.

Objective To investigate the relationships between the clinical and subclinical REM sleep behavior disorder(sRBD)and the cognitive function in patients with PD. Methods We enrolled 53 patients with PD from the Second Affiliated Hospital of Nanchang University. The age ,gender and education level of each patient were recorded. Patients with dementia were excluded. The correlative scales were assessed by the form of face to face,including Montreal cognitive function score(MoCA),Unified Parkinson Disease Rating Scale(UPDRS), Parkinson Disease Sleep Scale (PDSS) and so on. The sleep quality was assessed by polysomnography(PSG), meanwhile PD patients were divided into the RBD group(PD-RBD),the subclinical RBD group(PD-sRBD)and the normal REM group(PD-REM)based on the polysomnography. The cognitive function was compared among the three groups. Results (1)MoCA score of PD patients in the RBD group was lower than that in the normal REM group(P = 0.032.(2)No significant difference was observed in the cognitive function between the sRBD group and the normal REM group.(3)Length of morbidity of PD patients with RBD was longer than that of PD patients with sRBD(P=0.021). Conclusions The presence of RBD may be an important relative factor for the develop-ment of cognitive dysfunction in PD patients. We haven′t detected that the subclinical RBD was associated with the cognitive dysfunction in patients with PD. It is not clear whether the subclinical RBD in PD patients develops to RBD in all patients,which needs further investigation.

As an important method to detect intracranial arterial stenosis or occlusive disease,transcranial Doppler(TCD)has been widely used in clinical practice because of its low price and easy operation.The scope of application of TCD includes,but is not limited to,the diagnosis and collateral evaluation of intracranial artery stenosis or occlusive disease,intraoperative monitoring of carotid endarterectomy,assessment of brain death,etc.,but the characteristics of TCD blood flow changes of some special structures of intracranial arteries need to be improved.This paper presented 3 cases with special intracranial artery structures,and comprehensively analyzes the blood flow spectrum on TCD based on medical images,in order to improve clinicians'exploration experience on similar cases and the level of cerebrovascular ultrasound.

Objective:To investigate the preoperative ascending aorta diameter in patients with acute type A aortic dissection in the Chinese population, compares and analyze the differences in preoperative blood biomarkers, and evaluate the impact of the preoperative ascending aorta diameter in this part of patients on the short-term prognosis of patients.Methods:A collection of 641 patients with acute type A aortic dissection who were enrolled in the " Acute Aortic Syndrome High-Risk Early Warning and Intervention Study" project from January 2018 to January 2020 were collected. Divide the patients into two groups (group Ⅰ<55 mm, group Ⅱ≥55 mm) according to the preventive intervention value of ascending aorta diameter recommended by the guideline for studying preoperative ascending aorta diameter difference in blood biomarkers and the influence of ascending aorta diameter on the short-term prognosis of patients. All patients had CT scans to assess the diameter of the ascending aorta before operation.Results:In this study, all patients with acute type A aortic dissection had a mean preoperative ascending aorta diameter of (46.9±9.7)mm. The preoperative ascending aorta diameter of all patients was less than 55 mm, accounted for 84.1%. Male patients were more likely to have aortic dissection than females; most patients' age was less than 60 years old. The preoperative blood inflammatory index counts were higher in the ascending aorta diameter ≥55 mm group. However, the long-term prognosis of patients with different ascending aorta diameters before surgery was not apparent in this study. The preoperative survival rate and short-term survival rate of patients with ascending aorta diameter <55 mm were higher than those of other groups, but the difference was not statistically significant.Conclusion:In patients with acute type A aortic dissection, the diameter of the ascending aorta is usually less than 55 mm. Moreover, the blood inflammatory index counts are high in the preoperative ascending aorta diameter ≥55 mm group. Meanwhile, patients with smaller ascending aorta diameter have better survival rate and short-term prognosis.

OBJECTIVETo explore the influence of tumor-associated macrophages(TAMs) on the ability of invasion and metastasis of gastric cancer cells, and its associated mechanism.

METHODSImmunohistochemistry was used to examine the expression of TAM in 10 samples of normal gastric mucosa and 15 samples of gastric cancer tissues from sample bank of Department of Pathology, Union Hospital. Phorbol 12-myristate 13-acetate(PMA) and macrophage colony stimulating factor (M-CSF) were used to make THP-1 monocytes differentiate into TAMs. AGS gastric cancer cells were divided into two groups: experiment group was cultured with RPMI/1640 condition medium containing 50% TAM and control group was cultured with RPMI/1640 complete medium. The ability of invasion and metastasis of gastric cancer cells was measured by Transwell assays. Real-time PCR and Western blot were applied to detect the expression of MMPs and its inhibitor TIMPs before and after stimulation of TAMs.

RESULTSImmunohistochemistry results showed that CD68(+) cell number in normal gastric mucosa tissue was significantly less than that in gastric cancer tissue [(11.3±0.8)/HP vs. (31.6±1.4)/HP, P<0.000 1]. When treated with PMA and M-CSF, THP-1 cells were differentiated into type M2 TAMs with high expression of specific markers CD68, CD163, CD204 and CD206. Transwell test revealed that the number of piercing cells in the experimental group was significantly more than that in control group [(36.8±1.1)/HP vs. (12.8±0.9)/HP, t=17.5, P=0.000). Compared to control group, the expression of MMP-2, MMP-9 mRNA in experimental group respectively increased by 1.61 and 1.87 folds(P=0.017 and P=0.009). Protein level of MMP-2, MMP-9 was up-regulated accordingly. The expression of TIMP-1 and TIMP-3 mRNA was not significantly different between two groups(P=0.120 and P=0.096).

CONCLUSIONSTAMs may promote the invasion and metastasis of gastric cancer cells through increasing expression of MMP-9 and MMP-2, which may be one of the mechanisms of gastric cancer development.

Cell Line, Tumor ; Humans ; Immunohistochemistry ; Macrophage Colony-Stimulating Factor ; Macrophages ; Matrix Metalloproteinase 9 ; Neoplasm Invasiveness ; Neoplasm Metastasis ; Real-Time Polymerase Chain Reaction ; Stomach Neoplasms ; Tissue Inhibitor of Metalloproteinase-1 ; Tissue Inhibitor of Metalloproteinase-3

Objective To retrospectively review our experience of correction of type Ⅰa endoleak after thoracic endovascular aortic repair(TEVAR). Methods From August 2009 to May 2016, 29 patients with type Ⅰa endoleak after TEVAR (25 males, 4 females at mean age of 56±10 years (range, 41–86 years) underwent treatment: open surgery in 15 patients (an open surgery group), hybrid aortic arch repair in 6 patients (a hybrid group) and cuff extension in 8 patients(a cuff group). A history of hypertension was noted in 25 patients, diabetes mellitus in 3 patients, coronary artery disease in 3 patients, lung infection in one patient, aortic root aneurysm in one patient and aberrant right subclavian artery in one patient. Results In the open surgery group, no death was observed. Continuous renal replacement therapy and re-intubation was done in one patient and drainage of pericardial effusion in one patient. No death was noted in the hybrid group and persistent type Ⅰa endoleak in one patient. In the cuff group, thrombosis of the left common artery was noted in one patient and bypass of the left axillary artery to the left axillary artery and the left common carotid artery was done. Unfortunately, he died of cerebral infarction and total in-hospital death rate was 3.4% (1/29). Bypass of the left axillary artery to the left axillary artery was done in one patient with left upper limb ischemia. There were 4 (14.2%) deaths during follow-up: 3 deaths in the open surgical group and one death in the cuff group. Endoleak was observed in one patient in the hybrid group and one in the cuff group. Conclusion The corresponding procedure, including open surgery, hybrid aortic arch repair or cuff extension, is scheduled to be done according to the characteristics of type Ⅰa endoleak. Satisfactory outcomes are achieved in patients with typeⅠa endoleak.

Objective    To evaluate the preoperative risk factors for acute Stanford type A aortic dissection (ASTAAD) patients in our country by collecting multi-center data. Methods    We consecutively enrolled 700 patients who underwent surgery for ASTAAD in the multi-center hospital database from January 2018 to January 2020. According to the ascending aorta size (AAS), the patients were divided into two groups: a group AAS≥55 mm and a group AAS< 55 mm. Univariate and multivariate logistic regression analyses were used to investigate the related preoperative risk factors for the onset of ASTAAD. Results    According to the exclusion criteria, a total of 621 patients were finally enrolled, including 453 males and 168 females with an average age of 48.24±11.51 years, and 509 (81.94%) patients had AAS< 55 mm. Univariate and multivariate statistical analyses showed that smoking, hypertension, preoperative cardiac troponin I, and left ventricular ejection fraction were related to the occurrence of ASTAAD. The mortality rate of the patient during hospitalization was 13.04% (81 patients). Conclusion    In clinical practice, various preoperative risk factors affect ASTAAD patients, which should be paid attention to. Comprehensive evaluation and an individualized analysis of patients and timely prevention and intervention improve patients' survival rate.