Objective To analyze the effect of clinical pathways on single disease management.Methods Clinical controlled trials on tumors of uterine,benign biliary tract diseases and benign thyroid neoplasm were collected and related literatures were screened according to the criteria of inclusion.The literature so collected underwent a Meta analysis.Results A total of 21 literatures were included.Meta analysis indicated that statistical difference existed in the total cost of hospitalization(WMD=1046.06,95％CI:- 1281.15 ～ - 810.96,P＜0.00001) and length of hospital stay (WMD=- 2.18,95％CI:-2.59～- 1.76,P＜0.00001)between non-clinical pathways group and clinical pathways group.Conclusion Implementation of clinical pathways can further reduce hospital costs and shorten hospital days of the single disease management.

Objective To study HBeAg change in patients infected hepatitis B virus(HBV) with pre-C signal enzyme cleavage site mutation. Methods Mutation in pre-C signal enzyme cleavage site was detected by PCR-RFLP. The PreC/C gene with mutation was amplified by PCR and was cloned to EB viral eukarotic expression vector. Then transfect the vector with wild type or mutant PreC/C gene to HepG2 cell. SEAP reporter system was used to monitor the efficiency of transfection. HBeAg and its precursor in the supernatant and HepG2 cell were detected by ELISA and Western blot. Results HBeAg was positive in the supernatant of wild type and negative control in T1862 vaniant by ELISA. In HepG2 cell transfected with wild type, three proteins were detected by Western blot, they were HBeAg(17 000) and two HBeAg precursor(22 000 and 25 000). And in HepG2 cell transfected T1862 vaniant, only two HBeAg precursor was detected. The precursor in cells transfected withT1862 vaniant were significantly stronger than cells transfected with wild type. Conclusion Mutation in pre-C signal enzyme cleavage site may affect the decoration of HBeAg, which may cause great of HBeAg precursor locating in cells and lead to HBeAg negative in serum of patients infected with HBV.

Objective To investigate the correlated factors of peritoneal dissemination and lympah node metastasis from gastric cancer, the prognosis of patients with peritoneal dissemination and N_2 lymph node metastasis, and the impact of palliative surgery on the prognosis. Methods Based on our database built from 1994, the clinicopathologic data and the outcomes of the follow-up were analyzed respectively. Results The clinicopathologic factors correlated with peritoneal dissemination included T_4, hepatic metastasis, the primary tumor involving the whole stomach, undifferentiated carcinoma, female sex and lymph node metastasis, while those correlated with lymph node metastasis included the primary tumor involving the whole stomach, Borrmann III, T_2, T_3 and T_4, hepatic metastasis and peritoneal dissemination (P

A gel permeation chromatography ( GPC ) coupled with solid phase extraction and gas chromatography-mass spectrometric ( GPC-SPE-GC/MS ) method was developed to analyze seven kinds of organophosphate esters ( OPEs ) , including tri-n-butylphosphate, tri ( 2-chloroethyl ) phosphate, triphenyl phosphate, tris ( 2-butoxyethyl ) phosphate, tri-o-tolylphosphate, tri-m-tolylphosphate, and tri-p-tolylphosphate) in human serum. The recoveries of cleanup methods between GPC-silica/alumina column and H2 SO4-silica/sulfuric acid gel column were compared. The purification method with the GPC-silica/alumina column didn’t destroy the structure of organophosphate esters ( OPEs ) and could effectively remove some protein and lipid matrix influence in serum. The developed method was verified using the spiked blank and the spiked serum, the good recoveries and reproducibilities were achieved. The recoveries of all of OPEs in spiked blank (n=3) were all more than 75%. The recoveries of d12-TCEP and d15-TPhP in human serum samples (n=9) were 86. 3%±21. 6% and 103. 1%±16. 5%, respectively. In human serum samples (n=9), the detection ratios for TnBP, TCEP, TPhP, TBEP and m-TTP were more than 90% in all of the serum samples, p-TTP was only 30%, o-TTP was not detectable. The concentrations of TnBP, TCEP, TPhP, TBEP and m-TTP in serum were 3. 4-46. 5 ng/g lipid, 248. 6-958. 2 ng/g lipid, n. d. -4. 2 ng/g lipid, n. d. -49. 9 ng/g lipid and n. d.-23. 1 ng/g lipid, respectively.

Objective To summarise the clinicopathologic features and survival of gastric cancer at different tumor locations.Methods A total of 942 adult gastric cancer patients undergoing curative gastrectomy with lymphadenectomy were recruited from the First Affiliated Hospital,Sun Yat-sen University,and examined retrospectively.In all cases,patients' age,gender,pTNM stage and survival time were identified and recorded.Results There were 208 carcinoma cases at gastroesophageal junction (GEJ,22.1％),261 fundus/body cases (27.7％),445 antrum/pylorus cases (47.2％) and 28 whole stomach cases (3.0％).Compared with fundus/body and antrum/pylorus carcinoma,GEJ carcinomas were more often seen in males,among older patients,with larger tumor size and deeper infiltrated tumors,higher stage and worse 5-year disease-free survivals.Whole stomach carcinoma had predilection in female,younger patients,and at later stages and worst 5-year disease-free survival.Conclusions Gastric carcinomas differ greatly in biologic behavior and prognosis by anatomic locations.GEJ carcinoma has independent biologic features.Whole stomach carcinoma is of the highest malignancy and worst prognosis.

Objective Routine perioperative intravenous antimicrobial agents,was administered as surgical prophylaxis.However,whether balanced ultrafiltration during extracorporeal circulation can remove antimicrobial agent remains unclear.The concentrations of antimicrobial agent in plasma and ultrafiltrate samples were measured in this pseudo-extracorporeal circulation model.Methods Extracorporeal circulation consisted of cardiotomy reservoir (Ningbo Fly Medical Healthcare CO.,LTD.Ningbo,China),D902 Lilliput 2 membrane oxygenator (Sorin Group Asia Pte Ltd,Beijing,China) and Capiox (R) AF02 pediatric arterial line filter (Terumo Corporation,Beijing,China).HEMOCONCENTRATOR BC 20 plus (MAQUET Cardiopulmonary AG,Hirrlingen,Germany) was placed between arterial purge line and oxygenator venous reservoir.Fresh donor human whole blood was added into the circuit and mixed with Ringer's solution to obtain a final hematocrit of 24％-28 ％.After 30 minutes of extracorporeal circulation,zero-balanced ultrafiltration was initiated and arterial line pressure was maintained at approximately 100 mm Hg(1 mm Hg =0.133 kPa) with Hoffman clamp.The rate of ultrafiltration (12 ml/min) was controlled by ultrafiltrate outlet pressure.Identical volume of plasmaslyte A was dripped into the circuit to maintain stable hematocrit during 45 minutes of experiment.Plasma and ultrafiltrate samples were drawn every 5 minutes and concentrations of antimicrobial agent (including Cefmetasole and cefotiam) were measured with high performance liquid chromatography.Results All these two antimicrobial agents were detected in ultrafiltrate,demonstrating hemoconcentration may remove antimicrobial agent.The concentration of plasma antimicrobial agent decreased lineally with the increase of ultrafiltrate volume.At end of balanced ultrafiltration,the concentration of plasma cefotiam was (104.96 ± 44.36) μg/ml,which is about (44.38 ± 7.42) ％ of the initial concentration (238.95 ± 101.12) μg/ml; the concentration of plasma cefmetazole decreased linearly to (25.76 ± 14.78) μg/ml,which is about (49.69 ± 10.49) ％ of the initial concentration (51.49 ± 28.03) μg/ml.The total amount of cefotiam in ultrafiltrate is (27.16 ± 12.17)％ of the total dose administered,whereas cefmetasole in ultrafiltrate is (7.74 ±4.17)％.Conclusion Balanced ultrafiltration may remove antimicrobial agent from serum and has significant influence on plasma concentration of antimicrobial agent.The strategy of surgical prophylaxis should consider this unique technique during extracorporeal circulation.

Objective To investigate the prognostic significance of extended resection for locally advanced colorectal carcinoma. Methods Clinical data of 960 cases of colorectal cancer hospitalized for surgery between Jan 1995 and Dec 2002 were reviewed, and complication rates, perioperative mortality, 5-year survival were calcualated, prognostic factors were analyzed using Cox regression model. Results Sixty-six patients with locally advanced colorectal carcinoma were treated with extended resection, accounting for 6.9% of the total cases. Surgical complication rate in this subgroup was 27.3% (18/66), relatively higher than that of conventional resection for colorectal carcinoma (?~2 =8.82, P=0.002). The perioperative mortality was zero. Pathology showed that carcinoma invasion into the adjacent organs resected en bloc was 31% (27/88), the 5-year survival rate was 62%. The tumor spreading into the adjacent organ (Wald=7.42,P=0.005) and lymph node status (Wald=4.55, P=0.035) were found to be the independent prognostic factors. Conclusions Extended resection for locally advanced colorectal carcinoma resulted in a favorable prognosis. Postoperative complication was relatively high, but still acceptable.

0. 05) ; whereas Herrmann Ⅲ ,Ⅳand T3 ,T4(depth of invasion) were more often seen in advanced signet cell carcinoma (P 0. 05 ). Conclusion Compared with other pathological types, patients with advanced signet ring cell carcinoma of the stomach are with comparable long term survival.

Objective To explore the correlation between COX-2 and Ki-67 expression and microvessel density in primary gastric cancer tissue and clinicopathological parameters and to investigate their effect on postoperative gastric cancer recurrence. Methods Forty-eight postoperative recurrent gastric cancer patients were enrolled in this study, their clinicopathologic characters of primary tumors were analyzed retrospectively and compared with 48 cases without recurrence. Expression of COX-2 and Ki-67 and microvessel density ( MVD) in gastric cancer tissue were detected by immunohistochemical method. Risk factors correlated with tumor recurrence were studied by univariate and multivariate analysis. Results Expression of COX-2, Ki-67 label index (LI) and MVD were correlated with each other, and they were all correlated with depth of invasion and TNM stages in gastric cancer tissue. Patients with pelvic metastatic lymph node, cancer invasion to serosa, of Borrmann III or IV, high COX-2 and MVD expression are on high risk of recurrence (P

Objective To investigate the correlation between clinicopathologic factors and peritoneal dissemination from gastric cancer, and the impact of palliative resection on the prognosis of patients with gastric cancer complicated by peritoneal dissemination. Methods Based on our database built in 1994, the clinicopathologic data and the result of follow-up of all gastric cancer patients were analyzed retrospectively using the software of SPSS. Results One hundred and five out of 792 (13. 3% ) patients with primary gastric cancer were found complicated with peritoneal dissemination. The clinicopathologic factors in patients with peritoneal dissemination were significantly correlated with primary tumor penetrating through serosa, lymph node metastasis, primary tumor involving whole stomach, undifferentiated carcinoma, Borrmann IV and female gender (P