Objective:To study the influencing factors of doctors′ compliance intention towards clinical pathways at diagnosis-related groups(DRG) pilot hospitals, as a reference in advancing the development of critical pathways management and the transition of DRG payment methods from pilot exploration to actual payment.Methods:With purposive sampling method, an online questionnaire survey was conducted on doctors at 4 tertiary hospitals involved in the DRG pilot in Wuhan from December 2020 to February 2021. The questionnaire covered doctors′ basic personal information, identification degree of three dimensions based on the theory of planned behavior, as well as their past compliance behavior and compliance willingness of clinical pathways. The influence of different factors on doctors′ clinical path compliance intention was analyzed by Kruskal-Wallis test and Wilcoxon signed-rank test, and the ordered multi-class logistic regression analysis was used in multivariate analysis.Results:335 valid questionnaires were obtained, of which 205(61.2%) doctors had high willingness to follow clinical pathways. Such factors as degree of attention to peer doctors′ attitudes towards clinical pathways( OR=16.44), sufficient understanding of the documents( OR=14.91), the adaptation between information systems and clinical pathways( OR=12.54), sufficient learning resources( OR=9.42), and high enrollment rate of their patients in charge in the past six months( OR=5.77), could positively affect the doctors′ willingness to follow clinical pathways. The high enrollment completion rate of patients cared by doctors in the past six months( OR=0.09) and the high mutation rate caused by medical prescriptions( OR=0.00) negatively affected doctors′ compliance intention towards clinical pathway. Conclusions:Most doctors at DRG pilot hospitals had high willingness to comply with the clinical pathways. The main factors affecting their willingness to follow the clinical pathway include, previous relevant work experience, the attitude of peer doctors, and support resources. To increase doctors′ compliance willingness towards clinical pathway, it is necessary to speed up the DRG payment process, adopt a flexible management model, enhance the sense of participation of doctors, and ensure adequate support vesources.

Type A (AOSpine type) thoracolumbar fractures are the most common. There has long been controversy over their treatment, especially for type A3N0/1, those without neurological injury. Although the fixation with pedicle screws via the anterior and posterior approaches has been widely carried out in clinical practice, such problems as unsatisfactory reduction, kyphosis recurrence and postoperative disc degeneration have not been resolved. In recent years, various attempts have been made to improve the prognosis of type A3 thoracolumbar fractures. This paper reviews the progress in researches on treatment of type A3N0/1 thoracolumbar fractures.

Objective To observe the effects of interfering Twist expression on glycolysis in pancreatic cancer PANC1 cells and explore the potential mechanism.Methods Twist targeting siRNA (siTWIST) was designed and synthesized,and pancreatic cancer PANC1 cells were transfected with siTWIST using liposome,with nonspecific siRNA (siNC) transfected cells as negative control group and untransfected cells as blank control group.RT-PCR and Western blot were used to detect the expression levels of Twist mRNA and protein,and Akt and p-Akt protein expression in different groups;cell proliferation was detected by MTT;and glycolysis key enzyme (pyruvate kinase and hexokinase) activity and the content of lactic acid in the supernatant of culture fluid were detected.Results Twist mRNA level in control group,siRNA group and siTwist group expression was 1.00 ± 0.09,1.01 ± 0.08 and 0.36 ± 0.02;Twist protein level was 0.41 ± 0.05,0.42 ± 0.04 and 0.12 ± 0.06;the mRNA and protein expression in siTWIST group was obviously lower than those in control group and the difference was statistically significant (P ＜ 0.05).The cell survival rate was (100.02± 9.36)％,(100.01 ± 10.25)％ and (59.32± 7.26)％,which in siTWIST group was obviously lower than that in control group;pyruvate kinase activity was (0.73 ± 0.05)U/mg,(0.72 ± 0.08) U/mg and (0.43 ± 0.05) U/mg;the activities of hexokinase were (4.98 ± 0.48) U/mg,(4.96 ± 0.52) U/mg and (2.54 ± 0.21) U/mg;the content of lactic acid was (20.36 ± 2.61) mmol/L,(20.64 ± 3.05) mmol/L and (9.48 ± 1.09) mmol/L;the ratio of p-Akt/Akt was 0.65 ± 0.04,0.63 ± 0.07,and 0.25 ± 0.04,which in siTWIST group was obviously lower than that in control group.Conclusions Interference with Twist expression could inhibit the proliferation and glycolysis pathway in pancreatic cancer cells,and the mechanism may be related to the Akt signaling pathway.

Objective: To analyze the composition and the content of volatile components in Dipsaci Radix and its wine broiled products. Methods: Headspace solid phase microextraction (HS-SPME) combined with gas chromatography-mass spectrometry ( GC-MS) was used to analyze the volatile components in Dipsaci Radix and its wine broiled products. The area normalization method was used to calculate the relative content. Results: Totally 31 ingredients were identified, which mainly included phenols, olefins, alcohols and aldehydes. Totally 25 peaks were detected out from the volatile components in Dipsaci Radix, and among them, 22 components were identified, which accounted for 94. 74% of the total volatile components. The content of 5-allylguaiacol was the highest, which accounted for 28. 37% of the total volatile components. Totally 23 peaks were detected out from the volatile components in wine-pro-cessed Dipsaci Radix, and among them, 17 ingredients were identified, which accounted for 85. 92% of the total volatile components. The content of nonanal was the highest, which accounted for 9. 66% of the total volatile components. Conclusion: The composition and the content of volatile components in Dipsaci Radix and its wine broiled products are different. The experiment provides scientific reference for the further research and development of the volatile components in Dipsaci Radix and its wine broiled products.

Objective To explore the factors which could lead to a preoperative diagnosis and to guide the management of cholecystoduodenal fistula (CDF).Method The experience on the diagnosis and treatment of 22 patients with CDF were retrospectively studied.These patients came from 1242 patients who received biliary tract operation in our hospital from 2001 to 2012.Results 64％ (14 of 22 patients) had 3 out of 5 of the following symptoms/signs:(1) symptoms of recurrent chills and fever,with no or only mild jaundice; (2) significant atrophy or disappearance of gallbladder on computed tomography (CT) ; (3) CT revealed complex anatomy in right upper abdomen with dilated loops of bowel; (4) ultrasound or CT revealed pneumobilia or pneumo-gallbladder; (5) barium study or duodenal endoscopy revealed obvious deformation in duodenal bulb or abnormal opening.There was no perioperative death.Morbidities included biliary fistula which presented on postoperative day 6 and day 7 in 2 patients,respectively.The daily volume of bile drainage was about 500 ml,and the biliary fistula healed after a month of conservative treatment.In addition,there were 6 patients who had infected wound,8 patients with right pleural effusion,and 8 patients with residual calculi.There was no intestinal fistula or biliary stricture.Conclusions Careful preoperative history taking and CT/uhrasound studies significantly improved the diagnostic rate of CDF.Individualized treatment reduced complications and improved clinical results.

Objective To investigate the effects and possible mechanisms of platelet-activating factor (PAF) on the invasion of ovarian cancer cells and to provide a potential target for ovarian cancer therapy.Methods ( 1 ) Serous type ovarian cancer cell line OVCA429 with platelet-activating factor receptor (PAFR) positive and mucinous type cell line RMUG-L (PAFR negative) were treated with 100 nmol/L of the PAF,cell invasion ability was determined by transwell cell migration assay.(2) For determination of the optimal PAF concentration,ovarian cancer cell OVCA429 was treated by 0,0.1,1,10,100,and 1000 nmol/L of PAF for 10 minutes or 24 hour,respectively.To observe the different time point of protein changes,OVCA429 were treated by 100 nmol/L of PAF for 0,5 minutes,10 minutes,30 minutes,1 hour or 12 hours,respectively.The total proteins of treated cells were extracted according to standard protocol.The expression of p38 mitogen-activated protein kinase (p38 MAPK),phosphorylated p38 MAPK (p-p38 MAPK),transcription factor response element-binding protein (CREB),phosphorylated CREB (p-CREB) and matrix metalloproteinase-2 (MMP-2) were detected by western blot.(3) To verify the pathway involved in the PAF induction of the cancer cell invasion,we repeated the experiments by adding the inhibitors when treating cells with PAF.The inhibitors used were as follows,PAFR inhibitor-WEB2076 (50 μmol/L),pp38 MAPK inhibitor-SB203580 (10 μmol/L),CREB binding protein (CBP)-CREB interaction inhibitor217505(25 μ mol/L).All treated cells were divided into 6 groups:control group,PAF group,PAF + WEB2076 group,PAF + SB203580 group,PAF + 217505 group and PAF + SB203580 + 217505group.Results ( 1 ) By transwell assay,100 nmol/L of PAF could improve the invasion ability of OVCA429 cell significantly [ PAF:( 118 ± 23 ) cells vs.control:(36 ± 8 ) cells,P ＜ 0.0l ],while the same treatment had no effect on RMUG-L cells [PAF:(45 t 13) cells vs.control:(53 ±9) cells,P＞0.05].(2) Even a very low concentration of PAF (0.1 nmol/L) could increase the expression of p-CREB and MMP-2,while the most effective concentration of PAF was 100 nmol/L.The highest p-CREB protein expression was detected at 10 minutes after administration of 100 nmol/L PAF,as well as the expression of p-p38 MAPK protein.Even 12 hours after treatment the p-p38 MAPK protein could be detected,while there was no significant difference in the expression of CREB ( P ＞ 0.05 ).(3) As compared with PAF group,both in PAF + WEB2076 group and PAF + SB203580 group,the expressions of p-p38 MAPK,p-CREB and MMP-2 protein were decreased significantly; in PAF + 217505 group,although the expression of p-p38 MAPK and p-CREB protein was significantly higher than the control group,the expression of MMP-2 protein was significantly lower; in PAF + SB203580 + 217505 group,the expression of these three proteins were also significantly lower,but there was no significant difference as compared with that in the PAF + WEB2076 or PAF + SB203580 group.Conclusion PAF could induce MMP-2 expression and contributed to PAFR positive ovarian cancer cell invasion via activation of CREB by phosphorylating of p38 MAPK.

Objective To investigate the effect of salidroside on brain edema and neurological function in global cerebral ischemia-reperfusion injury in rats.Methods A total of 100 Sprague Dawley rats were randomly divided into sham operation,ischemia-reperfusion and salidroside 12,24 and 48 mg/kg groups (n =20 in each group),and than redivided into 6 h,24 h,72 h and 7 dsubgroups (n =5 in each subgroup).A rat model of global cerebral ischemia was established using the four-vessel occlusion method.Immediately after modeling,all groups were administered intragastrically for 7 days.The brain water content was quantitated by the wet-dry weight method.The neurological evaluation was performed using a neurological deficit score (NDS).Results After modeling both the ischemia-reperfusion group and all the salidroside groups had significant neurological deficit,and as time went by,it was improved gradually.Compared to the ischemia-reperfusion group at the corresponding time points,neurological deficit in all the salidroside groups was improved significantly (all P ＜ 0.05),and showing a dose-dependent trend.Compared to the salidroside 12 mg/kg and 24 mg/kg groups,neurological deficit in the salidroside 48 mg/kg group was improved significantly at 72 hours and 7 days (all P ＜ 0.05).The brain water contents began to increase at 6 hours after modeling in the the ischemia-reperfusion group and all the salidroside group.They reached the peak at 72 hours,and significantly higher than that in the sham operation group (all P ＜ 0.05).The brain water contents in all the salidroside group were significantly lower than those in the ischemiareperfusion group at 24 and 72 hours after modeling (all P ＜ 0.05) and showing a dosedependent trend.The brain water content in the salidroside 48 mg/kg group was close to that in the sham operation group at 7 days after modeling.Conclusions Salidroside may significantlydecrease brain edema and improve neurological function in global cerebral ischemia-reperfusion injury in rats,and it has a neuroprotective effect.

Objective　To investigate the effect of amniotic membrane on the proliferation of YAC-1 in vitro. Methods　The YAC-1 cells were cultured with amniotic membrane and their proliferation were observed by MTT automated colorimetry on the lst day， the 3rd day and the 7th day respectively.Results　Amniotic membrane could significantly enhance the proliferation of YAC-1 on the lst day, the 3rd day and the 7th day respectively after having been seeded (P＜0.01).Conclusion　Amniotic membrane can enhance the proliferation of tumor cells (YAC-1), which should be paid attention to during amniotic membrane transplantation for treating ocular surface lesion caused by epibulbar tumors. ［Rec Adv Ophthalmol 2000;20(5)∶317-318］

0.05). At the concentration of glutamate more than or equal to 6 mmol, the number of normal morphological cells in ISRN was significantly less than that of the control group ( P 0.05). At the concentration of glutamate more than or equal to 8 mmol, the number of normal morphological cells in RGCs layer and INL was significantly less than that of the control group ( P

Objective To evaluate the application of tendency-oriented perimetry (TOP) in detecting the visual function of glaucoma. Methods The traditional threshold perimetry (Normal/Normal strategy) and TOP (TOP/Normal strategy) carried out by Octopus 101 perimetry were used to examine the visual field of 20 normal subjects (20 eyes), 32 cases (32 eyes) of primary open-angle glaucoma (POAG), and 14 cases (14 eyes) of suspected POAG, respectively. The visual field outcomes, indices, point by point threshold variability and defective points of the two perimetries were compared and analysed. Results The negative rate of TOP was 90% in normal subjects. The positive rate of TOP was 75% in POAG , and 100% in middle and late stage of POAG. The visual field indices of two perimetries were positively correlated, with mean sensitivity (MS) of r=0.9335, mean defect (MD) of r=0.9189, and loss variance (LV) of r=0.9621. The point by point threshold variability and defective points of TOP were higher than those of traditional threshold perimetry, but the difference between the two perimetries was not significant (P=0.2019, P=0.4448). Conclusion The visual field indices of TOP and traditional threshold perimetry are positively correlated. The sensitivity and reproducibility of TOP are high in detecting the visual function of middle and late stage of POAG.