Objective To build the indicators system for clinical pathway management as required by clinical pathway control.Methods An indicators system was proposed by means of evidence-based review,focus group discussions,and ratings of the indicators' importance by doctors and nurses.A multidisciplinary panel of 60 experts from across the country were selected.A 3-round Delphi survey was made on the proposed indicators.The weights of the indicators were established by analytical hierarchy process (AHP).The response rate,Cronbach's α,and the authority coefficient of experts were used as a measure of reliability.Results The response rates of the 3 rounds were 85％,70％,and 94％; the experts authority coefficient was 0.80.The ccoefficient of variation falls with the rising number of consultations.The Kendall's W ranged from 0.40 to 0.83.Following the 3 rounds,consensus was achieved among experts as such a system comprising three first-level,9 second-level,and 36 third-level indicators.Conclusion The expert consultation has achieved reliable results.The established indicators system can serve as a useful instrument for standardized development of clinical pathways management and constant improvement.

OBJECTIVETo evaluate the effect of glycogen on calcium concentration of rabbit donor liver during ischemia-reperfusion period.

METHODSDonor group (n=21) was divided into 3 subgroups randomly: Group A (n=7): fasting for 24 hours before harvesting; Group B (n=7): normal laboratory chew; Group C (n=7): normal laboratory chew plus glucose supplement intravenously. Based on the self-created animal model for ischemia-reperfusion, the levels of glycogen content, ATP level, viability of Ca(2+)ATPase and plasmic free Ca(2+) concentration ([Ca(2+)]i) of liver tissue were measured.

RESULTSBefore cold preservation, there was a significant difference of glycogen content among the three groups at all time points except at the end of rewarming period. ATP level and Ca(2+)ATPase viability were significantly higher in group C than in other two groups. But the plasmic free Ca(2+) concentration was lower in groups with higher glycogen content.

CONCLUSIONSDonor liver with high glycogen content can provide relatively sufficient ATP, maintain better Ca(2+)ATPase viability and prevent plasmic free Ca(2+) concentration overloading. This maybe an important mechanism for glycogen to ameliorate ischemia-reperfusion injury to the donor livers.

Adenosine Triphosphate ; metabolism ; Animals ; Calcium ; metabolism ; Calcium-Transporting ATPases ; metabolism ; Cytosol ; chemistry ; Female ; Glycogen ; metabolism ; Liver Diseases ; enzymology ; metabolism ; Liver Transplantation ; physiology ; Male ; Models, Animal ; Rabbits ; Reperfusion Injury ; enzymology ; metabolism

Objective To investigate the administration of antibiotics in the treatment of infection of burns based on bacteriological surveillance from burn wound.Methods A retrospective analysis of bacterial culture and drug-sensitivity results from burn wound and subeschar tissues in 581 patients during 1999 to 2004 was carried out.Results Eight hundred and eighty-seven strains of bacteria were isolated from burn wound and subeschar tissues in 581 patients,among which 481 strains were gram negative(54.23%),and 406 strains were gram positive(45.77%).Among the bacteria of gram negative,the most majority was Pseudomonas and then was the Enterobacteriaceae.Among the bacteria of gram positive,Staphylcoccus aureus was the majority,and MRSA accounted for 71.48% in the Staphylcoccus aureus.The resistance of Pseudomonas to Netilmicin was decreased from 20.1% to 4.9%,and the resistance of Enterobacteriaceae to Imipenem was still in a low level.All bacteria of gram positive were sensitive to Vancomycin.Conclusion The majority of the bacteria of burn infection is gram negative.The isolated bacteria show multiple resistance to antibiotic.The analysis of bacteria from burn wound and resistance of bacteria to antibiotic is very important to experiential treatment of antibiotic for burn infection.

Objective To study the protective mechanism of adenosine on intestinal barrier function in acute hemorragic necrotizing pancreatitis (AHNP) pigs; Methods Twelve small pigs were equally devided into two groups randomly after the AHNP model sitted up: (1) AHNP controll group (group A) and adenosine treated group (group B). The intestinal blood flow, intestinal permeability, bacterial culture and endotoxin in portal blood were compared between the two groups in pre and post AHNP. Results (1)The intestinal blood flow was dramatically decreased in group A, and much higher in group B than that in group A at the 8 h, 24 hour and day 7 after ANHP model was setted up (P0.001,P

OBJECTIVE To study the characteristics and management of fungal infection in severely burn patients.METHODS The clinical data of 51 severely burn patients with fungal infection in our department from 2000 to 2004 were analyzed.RESULTS The infection rate in total 213 severely burn patients was 23.72%.Candidiasis was the most frequent type in fungal infection accounting for 93.98%.The risk factors for fungal infection were the(severity) of burn,tracheal intubations,body catheterizations,long-term use of broad-spectrum antibiotic and(hospitalization).CONCLUSIONS Development and the types of fungi in severely burn patients with fungal infection have their own characterizations and inducing factors.it is important to eluminate the susceptible factors and provide early diagnosis and treatment.

In this paper, the model system of proton transfer with the water molecule as an intermediate acceptor of Ser-195 was suggested and analysed by the CNDO/2 method. The acylation activation barrier of this system was shown to restrict the stage of synchronous transfer of the Ser-195 alcoholic proton and the water molecule proton hydrogen bound to His-57 N~(?_2)-atom to the water molecule oxygen atom and the N~(?_2)-atom, respectively. The substrate protonation in the case of the model system with the water molecule as the in ermediate acceptor was demonstrated to begin before the completion of the tetrahedral inermediate substance, only the protonated form of the tetrahedal intermediate being shown. A lypothesis of considering the role of this water molecule as a nuclephilic reagent in the leacylation stage is presented.

AIM: To explore the value of donor liver re-warm ischemia-reperfusion injury during orthotopic liver transplantation and its mechanism. METHODS: The effect of rabbit liver re-warm ischemia on its reperfused liver function and change of malondialdehyde(MDA) and superoxide dismutase(SOD) in the hepatic tissue were observed with rabbit liver preservation-reperfusion injury model . RESULTS: In every group of donor livers, which had experienced re-warm ischemia for 0, 15, 30 and 60 minutes respectively following 6-hours cold storage,the more prolonged re-warm ischemia was, the higher the contents of blood AST, ALT and AKP of receptor rabbits would be, and among all the groups there was significant difference in the contents of AST or ALT or AKP(P

In this paper, the quantitative relation between strain and geometirc parameter in cycloalkene, bicylo (n.l.O) alkane and bicyclo (n.m.1) alkane discussed. We found ten excellent linear correlative equations.

Using the semiempirical MNDO method,several systems simulating the active site of serine proteases have been studied.The stabilization energy was found depending strongly on the nucleophilicity of the attacking group.the decrease of the activation energy has been esti- mated at 9 kca/mole.It was shown that the substrate distortion did not vary with the form- ing of hydrogen bonds.

Transnasal endoscopical biliary catheterization was done successfully in 44 cases,23 cases with complete data were reported.These cases consisted of decompression and drainage of benign and malignant biliary obstruction (12 cases),dissolution and irrigation treatment of remnants of ascaris in the biliary tract (5 cases),dissolution of gallstone (2 cases),irrigation for biliary calculi (2 cases),hemos-tasis after endoscopic sphincterotomy (EST,1 case),and the examination and culture of the bile ( 1 case).The results were satisfactory without complication.Problems concerning EST was discussed,and endoscopic retrograde biliary drainage (ERBD) and percutaneous transhepatic biliary drainage (PTBD) were compared.