Service quality in the outpatient department reflects the overall capacity of a hospital.It has become the focus of hospital administrators' attention how to improve service quality by following the patients-centered policy,renewing service ideas and innovating the service mode in order to satisfy patients' needs to the best extent.The authors aim to summarize the experience in and explore the effective ways of improving service quality in the outpatient department.

Objective To investigate the effects of dexmedetomidine combined with sevoflurane on elderly patients with postoperative recovery quality.Methods Selected 60 cases of abdominal rectal cancer resection for elderly patients,which were ASA I or II,were randomly divided into two groups by a random number table method, while each groupincluded 30 cases:the control group( group N) and the dexmedetomidine group( group D) .Before the induction of anesthesia,group D vein was injected with micro pump ( more than 10 min) of dexmedetomidine 1μg/kg ( which was formulated with physiological saline as 4μg/mL) ,and then was given to maintain the dexmedetomidine 0.5μg/h and N group was injected with micro pump of the same volume of normal saline.The two groups of anesthesia were same,by which the static inhalation of composite general anesthesia.Observation were recorded before induction of anesthesia(T0),given dexmedetomidine(TI),after intubation 1 min(T1),5 min(T2),drawing tube immediately (T3),extubation after 5min(T4),30min(T5)the time of HR,BP,SpO2,BIS;propofol and remifentanil dosage,opera-tive time,operation time,a nesthesia time,recovery time,drawing tube time,extubation after Ramsay Sedation score, pain score,patient satisfaction and adverse reactions were recorded.Results In T3 period,the changes of HR (82 ± 14)times/min,SBP (130 ±8)mmHg,DBP (85 ±13)mmHg in group N were more obvious than (70 ±12)timse/min, SBP (121 ±7)mmHg,DBP (79 ±9)mmHg in group D,the difference between the two groups had statistical signifi-cance(t=6.28,4.63,2.08,all P<0.05).In T5 period,the levels of blood glucose (5.3 ±1.1)mmol/L and cortisol (402 ±78) nmol/L and ( 0.260 ±0.044 ) ng/L in group D were significantly lower than ( 5.9 ±1.2 ) mmol/L, (550 ±92)nmol/L,IL-6 (0.300 ±0.066)ng/L in group N(t=2.02,6.72,2.76,all P<0.05).However,the composite of dexmedetomidine group D patients with respiratory recovery time(7.5 ±2.3)min,calling the eyes open time(7.8 ±2.5) min,pull out the time of endotracheal tube (14.2 ±3.3) min compared with groups N of patients with respiratory recovery time (7.8 ±2.5)min,calling the eyes (14.8 ±3.2)min,pull out the time of endotracheal tube (13.9 ±3.1)min,showed no statistical significance (t=0.88,0.44,0.36,all P>0.05).In group N,postoper-ative restlessness in 8 cases,nausea and vomiting in 10 cases,chills in 9 cases,which were significantly higher than 2 cases,2 cases,2 cases in group D(χ2 =4.32,6.67,5.45,all P<0.05).At the same time,the satisfaction score of patient in group D (3.0 ±0.3)point,which was significant higher than (2.7 ±0.5)points in group N (t=1.88,P<0.05).Conclusion Dexmedetomidine detomidine composite sevoflurane anesthesia can improve the postoperative re-covery quality of elderly patients with rectal cancer radical surgery.

Clinical data of 53 patients (69 knees), who were treated at the Division of Joint Surgery, Department of Orthopaedics, Changzheng Hospital from January 1998 to December 2006, were retrospectively analyzed. These patients suffered from wound-healing complications following total knee arthroplasty. Wound skin problems included skin flare, disruption of wound, local hematoma, skin necrosis and deep infection. Local wound care was performed in 58 knees, debridement and secondary closure in 6 kness, and primary management of the soft tissue defect was achieved with local muscle flaps in 3 knees, with the fasciocutaneous flap in 1 knee, and with fasciocutaneous flap and skin grafting in 1 knee. Mean follow-up was 1.9 years. All wound was healed well. It is indicated that corresponding management should be used for treating wound-healing complications following total knee arthroplasty.

Objective To observe the clinical manifestation and the mode of RET proto-oncogene mutation in a pedigree of mutiple endocrine neoplasia type 2A (MEN2A). Methods Genomic DNA was extracted from the peripheral blood lymphocytes in 18 family members including 3 patients, then PCR was performed to amplify seven exons of the RET proto-oncogene, i. e. exon 8,10,11,13-16. The PCR products were directly sequenced to identify the RET mutation and then sequenced after subcloning to identify their heterozygosity. Results The male proband suffered from pheochromocytoma and medullary thyroid carcinoma since the age of 30; while his sibling sister was ill with pheochromocytoma, and his brother with medullary thyroid carcinoma. A novel heterozygous mutation, 1893-1895delCGA, was detected in exon 11 of the RET proto-oncogene in the 3 patients and the other 2 family members. Conclusion A novel heterozygous mutation of RET proto-oncogene, 1893-1895delCGA, seems to be the disease-causing mutation in the studied MEN2A family.

Objective To study the expressions of DD3 mRNA and PSA mRNA in the prostate tissues and its diagnostic value in prostate cancer (PCa). Methods DD3 mRNA and PSA mRNA were detected by real-time fluorescent quantitative reverse transcription polymerase chain reaction ( FQ-RT-PCR) based on Taqman technique in the tissues of 21 cases of PCa and 39 cases of BPH. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of DD3 mRNA, PSA mRNA and DD3 mRNA/PSA mRNA. Results The expressions of DD3 mRNA and PSA mRNA, and DD3 mRNA/ PSA mRNA were significantly higher in PCa tissues than those in BPH tissues ( P 0.05 for all). The AUC-ROC of DD3 mRNA,PSA mRNA and DD3 mRNA/PSA mRNA were 0. 937 (95% CI,0. 879 -0. 995) , 0.755(95% CI,0.629 -0.880) and 0.839 (95%CI,0.738 -0.940),respectively. The sensitivity for DD3 mRNA,PSA mRNA and DD3 mRNA/PSA mRNA was 90. 5% ,81. 0% and 81. 0% , respectively, and the specificity was 85.0% ,62.0% and 66.7% at cutoff value of 1.4?105 copies/mg tissue,3.0?107 copies/ mg tissue and 5. 0?10-3,respectively. The sensitivity and specificity of simultaneous detection for DD3 mRNA and PSA mRNA were 100% and 85.0%. Conclusions Both DD3 mRNA and PSA mRNA expressions were significantly higher in PCa tissues than those in BPH tissues; and the quantitative detection of DD3 mRNA is more helpful for the diagnosis. The simultaneous detection of DD3 mRNA and PSA mRNA can improve the sensitivity in the diagnosis of PCa.

Objective:To analyze the value of serum ceruloplasmin (CP) levels in predicting the outcome of patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF).Methods:The clinical data of 1 751 patients with HBV-ACLF treated in the Third Affiliated Hospital of Sun Yat-sen University from January 2010 to March 2018 were retrospectively analyzed. According to 30-day outcomes, 1 220 survival patients were classified into group A; 465 fatal patients and 46 patients receiving liver transplantation were classified into group B (total 531 cases). Risk factors associated with 30-day survival were estimated using Cox proportional hazards regression. ROC curve analysis was performed to evaluate the predictive value of CP on the 30-day outcome of patients with HBV-ACLF.Results:Multivariate analysis indicated that CP, albumin and alpha fetoprotein were independent protective factors for 30-day survival of HBV-ACLF patients ( P<0.05 or <0.01), while age, white blood cell count, AST, total bilirubin, INR, serum creatinine, HBV DNA, hepatorenal syndrome and hepatic encephalopathy were independent risk factors ( P<0.01). The area under the ROC curve (AUC) of CP was 0.570 (95% CI 0.540-0.599, P<0.01); while AUC of MELD score was 0.783 (95% CI 0.759-0.807, P<0.01) and MELD-Na score was 0.774 (95% CI 0.750-0.798, P<0.01). Compared with MELD score and MELD-Na score, the value of CP in predicting the 30-day prognosis of HBV-ACLF patients was lower ( P<0.01). The cut-off value of CP for predicting 30-day outcome of HBV-ACLF patients was 0.173 g/L, with the sensitivity of 69.4%, and the specificity of 41.6%. According to the cut-off value, the patients were divided into low CP level group (level of CP<0.173 g/L) and high CP level group (level of CP≥0.173 g/L); the 30-day cumulative survival rate of low CP level group was lower than that of high CP level group ( χ2=17.75, P<0.01). Conclusions:Serum CP level can predict the 30-day outcome of HBV-ACLF patients to a certain extent.

Objective:To summarize the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) infected with Delta variant, so as to provide further references for clinical diagnosis and treatment.Methods:A real-world study was conducted to analyze the characteristics of 166 COVID-19 patients infected with Delta variant at Guangzhou Eighth People’s Hospital, Guangzhou Medical University.Results:The study enrolled 5 asymptomatic cases, 123 non-severe cases (mild and moderate type), and 38 severe cases (severe and critical type). Among these patients, 69 (41.6%) were male and 97 (58.4%) were female, with a mean age of 47.0±23.5 years. Thirty-nine cases (23.5%) had received 1 or 2 doses of inactivated vaccine. The incidence of severe COVID-19 cases was 7.7% in 2-doses vaccinated patients, which was lower than that of 11.5% in 1-dose and 26.8% in unvaccinated patients. The proportion of severe cases in 2 dose-vaccinated patients was 7.7%, which was lower than that of 11.5% in 1-dose vaccinated patients and 26.8% in unvaccinated patients, but the difference was not significant ( P>0.05). The most common clinical symptom was fever (134 cases, 83.2%), and 39.1% of cases presented with high-grade fever (≥39 °C); other symptoms were cough, sputum, fatigue, and xerostomia. The proportion of fever in severe cases was significantly higher than that of non-severe cases (97.4% vs. 76.4%, P<0.01). Similarly, the proportion of severe cases with high peak temperature (≥39 ℃) () was also higher than that of non-severe cases (65.8% vs. 30.9%, P<0.01). The median minimal Cycle threshold (Ct) values of viral nucleic acid N gene and ORFlab gene were 20.3 and 21.5, respectively, and the minimum Ct values were 11.9 and 13.5, respectively. Within 48 h of admission, 9.0% of cases presented with decreased white blood cell counts, and 52.4% with decreased lymphocyte counts. The proportions of increased C-reactive protein, serum amyloid A, interleukin 6, and interleukin 10 were 32.5%, 57.4%, 65.3%, and 35.7%, respectively. The proportions of elevated C-reactive protein, serum amyloid A and interleukin-6 in severe cases were significantly higher than those in non-severe cases ( P<0.01). Logistic regression analysis showed that older age and higher peak temperature were associated with a higher likelihood of severe cases ( OR>3, 95% CI: 2-7, P<0.01). In terms of treatment, traditional Chinese medicine (TCM) was used in 97.6% of non-severe cases and 100% in severe cases. Other treatments included respiratory and nutritional support, immunotherapy (such as neutralizing antibodies and plasma of recovered patients). The median times from admission to progression to severe cases, of fever clearance, and of nucleic acid conversion were 5 days, 6 days and 19 days, respectively. No deaths were reported within 28 days. Conclusions:The symptoms of Delta variant infection in Guangzhou are characterized by a high proportion of fever, high peak temperature, long duration of fever, high viral load, a long time to nucleic acid conversion, and a high incidence of severe cases. The severe cases exhibit a higher percentage of elderly patients, a longer duration of fever and have a higher fever rate and a higher hyperthermia rate than non-severe cases. Age and hyperthermia are independent risk factors for progression to severe disease. The combination of TCM and Western medicine can control the progression of the disease effectively.