Objective To evaluate the influence of a clinical pathway on mean length of hospital stay of ischemic stroke patients. Methods The study performed retrospective cohort study of stroke patients which were hospitalized in the Guangdong provincial hospital of TCM corresponding to the periods immediately before and after the implementation of the clinical pathway. The outcome measure was mean length of hospital stay. Results Mean length of hospital stay was significantly shortened after implementing clinical pathway. Conclusions The implementation of the ischemic stroke clinical pathway can shorten mean length of hospital stay of ischemic stroke patients and improve the utilization of medical source.

A novel chemiluminescence (CL) system combined with flow injection analysis for the determination of rutin is presented . It is based on the CL reaction of rutin and hexacyanoferrate*# in sodium hydroxide medium. The proposed method has a linear range of 1×10-4g/mL ～ 1×10-6 g/mL with a RSD of 3.7%(5×10-6g/mL,n=11) and a sample throughput of 60 h-1. The method was successfully applied to the determination of rutin in a pharmaceutical preparation.

Objective To introduce the Chinese version of short Falls Efficacy Scale International (short FES-I) and test its reliability and validity in patients with cerebral infarction. Methods The English version and the traditional Chinese version of short FES-I were ob-tained from the Prevention of Falls Network Europe, and the simplified Chinese version was developed after a further revision. A sample of 105 inpatients with cerebral infarction from December 2014 to May 2015 were recruited from 2 tertiary hospitals in Tianjin. They were in-vestigated with the simplified Chinese version of short FES-I, modified Falls Efficacy Scale (MFES), Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). At the same time, the laboratory indexes of the patients were collected. Results The Cronbach'sαcoefficient of short FES-I was 0.98 and the score of short FES-I was negatively correlated with MFES (r=-0.41, P<0.001). Short FES-I was correlated wtih GAD-7 score (r=0.52, P<0.001), PHQ-9 score (r=0.46, P<0.001) and the level of C reaction protein (r=0.21, P=0.032), but uncorrelated with other laboratory indexes (P>0.05). There was significant difference in the score of short FES-I be-tween the patients with or without falling. Conclusion Short FES-I is valid and internal consistant, and can be used as an assessment tool to screen fear of falling among patients with cerebral infarction.

Objective To evaluate the accuracy of auditory evoked potential index (AAI) in monitoring the anesthetic depth during isoflurane anesthesia.Methods Thirty ASA Ⅰ or Ⅱ patients aged 18-55 years and undergoing elective surgery under general anesthesia were enrolled in this study. The patients were unpremedicated. Anesthesia was induced with midazolam 0.05 mg/kg, fentanyl 3 μg/kg and propofol 1 mg/kg. Tracheal intubation was facilitated with recuronium 0.1 mg/kg. The patients were mechanically ventilated (VT:40 mm Hg. Anesthesia was maintained with isoflurane inhalation and intermittent intravenous boluses of vecuronium. Isoflurane was started with high-flow (FGF, 3 L/min) for 12 min followed by low-flow (LGF, 0.5 L/min). The inspired isoflurane concentration was set at 3%. The electrocardiogram (ECG), mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2), end-tidal isoflurane concentration and AAI were continuously monitored during anesthesia and recorded before induction of anesthesia (baseline, To ), immediately after induction (T1), immediately before isoflurane inhalation (T2), at 3 min(T3), 6 min (T4), 9 min (T5) and 12 min (T6) during high-flow wash-in and at the end-tidal isoflurane concentrations of 0.8 MAC (T7), 1.0 MAC (T8) and 1.3 MAC (T9) during low-flow inhalation of isoflurane, respectively.Results AAI decreased gradually while the end-tidal isoflurane concentration increased during high-flow wash-in. And AAI was negatively correlated with the end-tidal isoflurane concentrations ( r = -0.896, P ＜ 0.01 ) during low-flow inhalation of isoflurane anesthesia.

Objective To investigate the status and influencing factors of fear of falling (FOF) in patients with first ever cerebral infarction. Methods A sample of 105 inpatients with cerebral infarction were recruited from two tertiary hospitals in Tianjin (Tianjin Huanhu Hospital, the First Affiliated Hospital of Tianjin University of TCM) to complete this research. They were investigated with the simplified Chinese version of Falls Efficacy Scale International-short (FES-Is), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Barthel Index Rating Scale (BI) and Functional Ambulation Category Scale (FAC). Results The total score of FES-Is was 15.38±7.45. Multiple stepwise regression analysis showed that age, marital status, fall history, walking ability and anxiety were important factors of FOF. Conclusions Clinical staff should guide the patients with first cerebral infarction especially who had a history of falling to take active and effective measures to deal with their FOF, and pay more attention on patients who was elderly, without a spouse, assisted walking and anxiety, to release their FOF, prevent the falling and promote the functional recovery of patients.

ObjectiveTo design the scale of death attitude for Chinese nurses and evaluate its validity and reliability.MethodsThe scale draft was formed through the literature review,the formal scale was got via expert consultation and interview survey of 20 cases of small sample.120 clinical nurses were selected for investigation.Then item analysis,factor analysis,correlation analysis and reliability analysis were applied to establish the scale′s validity and reliability.ResultsThe nursing staff death attitude scale consisted of 25 items,the varimax rotation factor analysis of the scale identified seven principal factors and explained for 63.732％ variances.The correlation coefficient between each item and its domain was 0.498～0.808,the Cronbach′s α coefficient of five domains was 0.595～0.774,the Cronbach′s α and split-half coefficient for the whole scale were 0.824 and 0.868 respectively.ConclusionsThe scale has high reliability and validity,and it can be the effective test instrument for death attitude of nurses in China.

Objective To study the extracellular signal-regulated kinase 1/2(ERK1/2) expression of renal cells in epilepsy rats induced by kainic acid,and elucidate the mechanism of renal injury caused by epilepsy.Methods 70 male Wistar rats were randomly divided into two groups:epilepsy group and control group,35 rats in each group.Rat epilepsy model was prepared by injection of kainic acid into amygdala under three-dimensional positioning devices.At different time points(0,2,6,12 and 24 h) after epilepsy spasm,the renal tissue specimens were immediately prepared for immunohistochemistry.The ERK1/2 expression of rat renal cells was calculated and compared with control group.Results The ERK1/2 expression(gray value) of renal tubular epithelial cells in epilepsy rats began to increase gradually after epilepsy spasm.It reached peak at 6 h after epilepsy spasm.The ERK1/2 expression of renal tubular epithelial cells in epilepsy rats was significantly higher than at 0 h(P0.05).There were no major pathological changes in kidney of rats with epilepsy stained with HE.Conclusion ERK1/2 activation may have important role in the renal injury caused by epilepsy.Inhibition of the activation of ERK1/2 may lead to the renal protection.

Objective To determine counts of T lymphocyte sub-populations in malignant and tuberculous pleural effusion or ascites and evaluate its significance in difierential diagnosis.Methods T lymphocyte sub-populations in pleural effusion or ascites and peripheral blood were determined in 30 patients with tuberculosis and 31 patients with cancer by flow cytometry.Concentrations of cytokines Th1 and Th2,γ-interferon(IFN-γ),interleukin-12(IL-12)and IL-4 in pleural effusion or ascites were measured by enzyme-linked immunosorbent assay(ELISA).Results Compared to that in peripheral blood,percentage of CD3+ and CD4+ T-celI counts were all higher in both malignant and tuberculous pleural effusion or ascites [(73±6)%and(67±20)%vs.(51±19)%and(48±14)%,P＜0.05].Although CD3+T-cells count was higher in tuberculous pleural effusions or ascites,no difference in ratio of CD3+ and CD4+/CD3+ and CD8+ T-cell counts was found between malignant and tuberculous pleural effusions or ascites.However,ratios of IFN-γ and IL-12 to IL-4 were higher in tuberculous pleural effusion or ascites(54±24 and 82±19vs.8±6 and 19±10,t=10.34 and 16.28,respectively,P＜0.01).Conclusions CD3+ and CD4+ Tcells can be aggregated in both malignant and tuberculous pleural effusions or ascites,80 nature (tuberculosis or malignancy)of pleural effusion or ascites can not be differentiated by CD4+ and/or CD8+ T-cell counts only,and determination of cytokines Th1 and Th2 can help their differentiation.

BACKGROUND: Resveratrol is a naturally occurring phytoalexin present in grapes, peanut and some herbs. It has been demonstrated to produce a variety of biological actions, such as anticancer, antiinflammation. Accumulating line of evidence supported the view that resveratrol may exert protective effect on cardiovascular system. However, its protective mechanism is not completely understood.OBJECTIVE: To investigate the anti-ischemic effect and mechanism of resveratrol (Res) on acute myocardial infarction in rats.DESIGN: Randomly grouping paralleled control study.SETTING: Pharmacological Laboratory of Harbin Medical University, Biopharmaceutical Key Laboratory of Heilongjiang Province-Incubator of State Key Laboratory.MATERIALS: The experiment was carried out in Department of Pharmacology of Harbin Medical University from March 2005 to July 2005.Totally 80 male Wistar rats weighting 250-300 g were selected in this study. Among them, 60 rats after operation successful modeling were randomly grouped into 5 groups: sham operation group, blank control group,resveratrol 5 mg/kg, 15 mg/kg and 45 mg/kg groups with 12 in each group.METHODS: Acute myocardial infarction (AMI) model was induced by ligation of the anterior branch of the left coronary artery in rat, Sham operation group: The same suture was put through but not ligated. Resveratrol group: Rats were injected with 5, 15 and 45 resveratrol mg/kg provided by Hunan Huaguang Biological Products Company Limited (batch number: 20050221, purity ≥99%) and ligated after 10 minutes. Model group: The same volume saline was injected for 10 minutes and then rats were ligated. Observe and record ST segment of standard limb lead Ⅱ electrocardiogram (ECG)after 1, 5, 10, 15, 30 minutes after ligating the left anterior decendingcoronary artery. After 6-hour ischemia, the infarct size areas was identified with the myocardium by 2, 3, 5-triphenyltetrazolium chloride (TTC) stain; the activities of serum .creatine kinase (CK)and lactate dehydrogenase (LDH) were determined by spectrophotometric method; the apoptosis in cardiomyocyte was detected by d-UTP end labeling method mediated with tagged deoxynucleotide transferase in situ (TUNEL); apoptosis-related proteins of Bcl-2, Bax and Fas expression were measured with estreptomicina avidin peroxidase chain. Measurement data were compared with t test.MAIN OUTCOME MEATURES: ST increase; the activities of serum creatine kinase (CK) and lactate dehydrogenase (LDH); the infarct size areas and the apoptosis rate in cardiomyocyte; the. expression of apoptosis-related proteins of Bcl-2, Bax and Fas.RESULTS: All of the 60 rats entered the final analysis. ① ST segment raise in high dosage group was lower than that in model group 1, 5 and 10 minutes after ligation (P ＜ 0.05), and it was also lower than that in model 15 and 30 minutes after ligation (P ＜ 0.05). This effect was dose-dependent. ② Infarct size in each dosage group was smaller than that in model group (P ＜ 0.05). This effect was dose-dependent. ③ The activities of CK and LDH in different dosages of resveratrol groups were significantly lower than those in model group (P ＜ 0.05). This effect was dose-dependent. ④ Apoptosis index in model group was higher than different dosages of resveratrol groups (P ＜ 0.05); The expression levels of Bax and Fas proteins in model group were higher than those in high and middle dosages of resveratrol groups (P ＜ 0.05); The expression level of Bcl-2 protein was lower than that in high and middle dosges of resveratrol groups (P ＜ 0.05).These effects were dose-dependent.CONCLUSION: Resveratrol can protect acute myocardial ischemic injury induced by coronary artery of ligated rats, and the effect is dose-dependent.Effect of resveratrol on myocardial ischemia is related to adjusting expressions of Fas, Bcl-2 and Bax and inhibiting myocardial apoptosis.

Objective To compare the efficacy of different target concentrations of etomidate in combination with midazolam,fentanyl and rocuronium used to induce anesthesia for tracheal intubation.Methods Eighty ASA Ⅰ or Ⅱ and Mallampati Ⅰ or Ⅱ patients of both sexes,aged 25-50 yr,weighing 57-76 kg,scheduled for elective non-cardiac surgery under general anesthesia,were randomly allocated into 4 groups according to the target effect-site concentration of etomidate (n =20 each) ∶ 0.5 μg/ml group (group E0.5),0.7 μg/ml group (group E0.7),0.9μg/ml group (group E0.9) and 1.1 μg/ml group (group E1.1).The patients were unpremedicated.Anesthesia was induced with midazolam 0.05 mg/kg,fentanyl 3 μg/kg,rocuronium 0.6 mg/kg and etomidate given by target-controlled infusion.When the effect-site concentration of etomidate reached 0.5,0.7,0.9 or 1.1 μg/ml,endotracheal intubation was performed.Auditory evoked potential index was recorded before induction of anesthesia (baseline),immediately before intubation,during insertion of the laryngoscope,and at 1,3 and 5 min after intubation.Myoclonus,injection pain,the requirement for vasoactive agents and burst suppression (BS) were recorded during induction of anesthesia.Results Compared with group E0.5,the requirement for urapidil was significantly decreased in group E0.7,the requirement for esmolol and urapidil was significantly decreased and the incidence of BS was increased in group E0.9,the requirement for esmolol and urapidil was significantly decreased,and the requirement for atropine and ephedrine and incidence of BS were increased in group E1.1 (P ＜ 0.05).The incidence of BS was significantly higher in group E0.9,and the requirement for atropine and incidence of BS were significantly higher in group E1.1 than in group E0.7 (P ＜ 0.05).The incidence of BS was significantly higher in group E1.1 than in group E0.9 (P ＜ 0.05).There was no significant difference in auditory evoked potential index and incidences of myoclonus and injection pain among the four groups (P ＞ 0.05).Conclusion The optimum target concentration of etomidate is 0.7μg/ml when combined with midazolam,fentanyl and rocuronium used to induce anesthesia.