This paper discussed on the importance of management system of paperless electronic medical record and pointed out that we would encountered lots of problems during the construction of paperless electronic medical record management system including authenticity,legal effect,similarity,safety,mistakes and missing of medical records.This paper analyzed these problems and proposed corresponding countermeasures including developing safety management system,whole-process monitoring of medical record quality,enhancing archive management,developing backup and recovery mechanisms,improving secrecy and authorization system,promoting borrowing management,performing copy system,strengthening electronic signature management,implementing unique number management and enhancing overall quality of personnel

Objective To investigate prognostic factors for gastric cancer patients with liver cirrhosis.Methods The clinicopathological data of 52 gastric caner patients with liver cirrhosis operated on between March 1994 and March 2006 were analyzed retrospectively and the prognostic factors were evaluated.Significant factors were then entered into a Cox regression analysis.Results The postoperative 1-3- and 5- year survival rates for these 52 patients followed up were 78％,44％ and 33％.Univariate analysis revealed that age,Borrmann type,histology timue typing,tumor size,pTNM stage,Child-pugh grade,postoperative complications,ascites,and albumin level were statistical significance for survival rate (P ＜ 0.05 ).Multivariate analysis demonstrated that pTNM stage,Child-pugh grade,ascites were independent prognostic factors affecting prognosis( P ＜ 0.05 ).The risk of Child-pugh grade is 3.005,the risk of pTNM is 1.594.Conclusions Compared with pathological disease stage of the gastric cancer,liver function affects more on the prognosis of cirrhotic gastric cancer patients undergoing gastrectomy.In Child-pugh grade B or C cases,postoperative liver dysfunction was the main concern.While those of Child-pugh grade A should undergo standard D2 gastrectomy.

Objective To investigate the effects of nutritional support on the hypermetabolism of patients with digestive tract fistula complicated with severe abdominal infection. Methods Twenty-nine patients with digestive tract fistula complicated with severe abdominal infection were administered parenteral nutrition (PN) for 4 to 8 days, and then followed by enteral nutrition (EN) or EN + PN. The body weight, serum albumin, transferrin, prealbumin, fibronectin were monitored before and on the 10th and 28th day after nutritional support. Results The levels of serum prealbumin and fibronectin were increased significantly on the 10th day after nutritional support (t = 3.72, 3.52, P <0.01). The body weight, the levels of serum albumin, transferrin, prealbumin and fibronectin were significantly higher than those before nutritional support (t=3.97, 6.57, 7.09, 3.51, 3.58, P<0.01). Conclusion Nutritional support is effective in alleviating hypermetabolism of patients with digestive tract fistula complicated with severe abdominal infection.

Objective To investigate the biopathologic characteristics of transitional mucosa (TM) adjacent to rectal cancer and its relationship to the anastomotic recurrence after curative surgery of rectal cancer. Method The expression of p53,p21 ras and PCNA proteins was determined immunohistochemically in primary rectal adenocarcinomas (n=67), the proximal margins (n=67), the distal margins (n=67) and rectal mucosa 1～3?cm distant to the anastomosis in patients one year after radical resection (n=33), and two years after (n=31).Results The expression of TM, p21 ras and p53 proteins,and PCNA index in primary rectal adenocarcinomas was higher than that in two resection margins (P0.05). Positive TM was often found in the area of chronic inflammation. conclusion TM adjacent to the rectal cancer is a nonspecific, not cancer precursor event.

Objective To investigate the surgical techniques and clinical efficacy of laparoscopic intersphincteric resection (ISR) in the treatment of low rectal cancer.Methods A retrospective descriptive study was performed.The clinical data of 12 patients who underwent laparoscopic low rectal anterior resection combined with ISR at the First Affiliated Hospital of Dalian Medical University from May 2014 to October 2014 were collected.The patients underwent abdominal operation including total mesorectal excision (TME) + sphincter mobilization,then transanal intersphincteric resection,finally colinic anal-anal anastomosis.The operation time,volume of intraoperative blood loss,number of lymph node dissected,postoperative complications,time to anal exsufflation,duration of hospital stay,duration of postoperative hospital stay,pathological stage and follow-up were observed.The patients were followed up by outpatient examination and telephone interview at month 1,3 and 6 after operation up to April 18,2015.The follow-up included the prognosis of patients and the recovery of anal function.The function of defecation was evaluated by Wexner scoring system and Kirwan grading.Measurement data with normal distribution were presented as (x) ± s.Results All the 12 patients were completed laparoscopic surgery without conversion to open surgery.Eight patients underwent partial internal anal sphincter resection,and 4 underwent subtotal resection.Four patients in T3 stage underwent lateral lymph node dissection preserving the left colonic artery,hypogastric nerve and pelvic nerve.The operation time was (290 ± 35) minutes.The volume of intraoperative blood loss was (124 ± 80) mL.The number of lymph nodes dissected was 17 ± 8,and the number of positive lymph nodes was 0-4.The distance of the distal margin was (2.0 ± 0.5) crm,and the margin was negative.All the 12 patients were not complicated with infection,bleeding,anastomotic leakage,anastomotic stenosis and other complications.The time to postoperative anal exsufflation was (3 ± 1)days,duration of hospital stay was (20 ± 3) days,and duration of postoperative hospital stay was (12 ± 3) days.The results of TNM stage showed 3 cases of pT1 stage,5 cases of pT2 stage,4 cases of pT3 stage,10 cases of pN0 stage,1 case of pN1 stage,1 case of pN2 stage,8 cases of Ⅰ stage,2 cases of Ⅱ stage and 2 cases of Ⅲ stage.All the 12 patients were followed up for 6-11 months.The defection frequency and the Wexner score at month 1,3 and 6 after operation were 12 ±7,15 ±3,9 ±5 and 13 ±4,5 ±3,10 ±3,respectively.Of the 12 patients,the number of patients with satisfactory Kirwan score,flatus incontinence and loose stool was 1,3,8 at month 1 after operation,3,3,6 at month 3 after operation,10,2,0 at month 6 alter operation,respectively.Conclusion Laparoscopic ISR is effective in the treatment of low rectal cancer.

Analysis of medical project is the first step in the work of medical institutions to carry out medical project cost accounting. It introduces a case of a general hospital by analyzing the structure, department distribution, contact ratio of medical project to design the practical steps of medical project cost accounting.

Reduced surgery for early gastric cancer has been actively performed because it can offer complete cure and a good postoperative quality of life.Pylorus-and vagus-preserving gastrectomy (PPG) is one form of function-preserving surgery.Laparoscopic surgery has been widely applied for the treatment of gastric cancer due to its advantages including low invasiveness,minimal bowel paralysis,earlier postoperative healing and nerve and gastric function preservation.Therefore,laparoscopic pylorus-and vagus-preserving gastrectomy (LAPPG) for the treatment of early gastric cancer is welcomed by surgeons.From May 2004 to April 2013,12 patients with early gastric cancer received LAPPG in the First Affiliated Hospital of Dalian Medical University.All the patients were followed up for 3-74 months.One patient died of gastric cancer liver metastasis at postoperative month 22.The 5-year cumulative survival rate was 86％.LAPPG preserves nerve function and limits surgical injury,it is one of the ideal surgical methods for the treatment of early gastric cancer.

Objective To construct an expression vector pGEX-2T/N, and to express the fusion protein consisting of N protein of SARS-CoV in E. coli.Methods The N region gene of SARS-CoV was obtained by RT-PCR. The expression vector PGEX-2T/N was constructed by DNA recombination. The recombinant plasmid was transformed into E. coli BL21(DE3). The expression of the fusion protein was determined by Western blot with anti-SARS-CoV antibody positive blood sera. Results The N region gene of SARS-CoV was obtained. The fusion protein GST-N was soluble. Western blot analysis showed that the reaction of GST-N to anti-SARS-CoV sera was positive. Conclusion The pGEX-2T/N has been constructed and expressed in the form of fusion protein GST-N successfully, and the result lays the foundation for further study of SARS-CoV N protein.

Objective To observe the effectiveness of liver-soothing and spleen-strengthening traditional Chinese medicine combined with intra-arterial infusion of chemical medicine for advanced primary hepatocellular cancer patients.Methods One hundred and twenty primary hepatocellular cancer patients were randomly assigned to treatment group(60 patients) and control group(60 patients).The treatment group was treated by traditional Chinese medicine combined with intra-arterial infusion of chemical medicine,while only intra-arterial chemical medicine was applied to the control group.The intra-arterial chemical medicine was applied every four weeks.Each group received at least two courses of treatment.Aspects such as treatment effectiveness,quality of life,immune function and the condition of blood coagulation were observed.Results Clinical stable rate of the treatment group was 80.8%,higher than the control group obviously(P

Acupuncture Points ; Acupuncture Therapy ; Fasciitis, Plantar ; therapy ; Female ; Humans ; Middle Aged