Bases on the changing idea and management policy,the out-patient service process rebuilding focuses on the patient,makes use of the information technology,imports the theory of operation process reforming,reconsiders and redesigns the operation process of the out-patient department,and improves the medical quality and service.The digitizing procedure in out-patient service is the important base of process rebuilding.In the paper,we try to discuss how to improve the digitizing procedure in out-patient service and rebuild the service process.

Objective To investigate the practical value of transcatheter hepatic arterial chemoembolization (TACE) in the treatment of spontaneously ruptured hepatocellular carcinoma. Methods Using Seldinger technique,we treated 14 patients with ruptured hepatocellular carcinoma by TACE, in which a suspension of gelatin sponge, iodide oil and chemotherapeutic agents was used as embolus. Results Of 12 patients with active bleeding, successful hemostasis was achieved in 10 patients, with an effective rate of 83 3% (10/12), and 2 patients died from hemorrhagic shock within 48 hours, with an in-hospital mortality of 14 3% (2/14). One patient succumbed to hepatic failure two months after the TACE, and 1 patient received a radical operation two months after the TACE. Follow-up in 10 patients revealed that 8 patients underwent TACE for 1 ～ 4 times (mean survival time, 7 8 months) and 5 patients existed for more than 1 year (35 7%, 5/14). Conclusions TACE is effective in the management of spontaneously ruptured hepatocellular carcinoma.

In order to implement the computerization of consumables management in hospital, the consumables management system is developed. The paper introduces the main functions, including treasury management, inventory management, bar,ode utilization, nurse station function intagration, financial reconciliation and management function. It points out that using this system could greatly re-duce the workload and enhance the efficiency.

The authors hold that factors affecting the quality of hospital network data include ideologies of relevant personnel, state of the administrative organization, quality of the staff, standardization level of data, level of the software used, interdepartmental cooperation, feedback of test data, and mechanism of supervisory control. Only by taking corresponding measures can the quality of network data be constantly improved.

Objective To investigate the number, distribution and metastatic rule of lymph nodes in the mesorectum of rectal cancer specimen after processing the recta] cancer specimen with modified fat clearance technique. Methods Sixty patients with mid-low rectal cancer who had been admitted to Peking University School of Ontology from 2003 to 2008 were assigned to test group. All the 60 patients who denied neo-adjuvant therapy were treated with total mesorectal excision, and the rectums resected were processed with the modified fat clearance technique. Rectums from another 50 patients with mid-low rectal cancer in control group were fixed in formalin solution for 24 hours. The mesorectum was divided into anterior, posterior, left and right quadrants, and each quadrant was further divided into upper, middle and lower parts. The numbers of lymph nodes harvested and metastatic rate of lymph nodes between the 2 groups were analyzed by t test and chi-square test. Results (1) The numbers of lymph nodes harvested in the test and control groups were 1436 and 525, with statistical difference between the 2 groups (t =- 12. 153, P <0.05). The number of small lymph nodes(diameter≤5 mm) harvested in test group was 985. (2) The numbers of lymph nodes harvested in the anterior, posterior and bilateral mesorectum were 125,696 and 615, respectively. The numbers of lymph nodes harvested in the upper, middle and lower part of the mesorectum were 395,534 and 507, respectively. The metastatic rate of lymph nodes in the upper part of the mesorectum was 18.5% (37/200), which was significantly lower than in the middle [43.5% (87/200)] and lower [38.0% (76/200)] part of the mesoreetum (X2= 9. 414, 6.406, P < 0.05). Two hundred metastatic lymph nodes in 33 patients were harvested, 48.0% (96/200) of which with a diameter of ≤ 5 mm. Twenty percent patients had their TNM stage changed after the retrieval of metastatic small lymph nodes. Conclusions Modified fat clearance technique significandy improves the retrieval of lymph nodes, and more small lymph nodes retrieved can increase the accuracy of staging. Rectal cancer cells have strong tendency to disseminate to the distal mesorectum. Adequate excision of the distal mesorectum is key in controlling the local recurrence.

Objective:To investigate the role of transforming growth factor β1 (TGFβ1) in the development of Helicobacter pylori ( H. pylori)-associated non-metaplastic atrophic gastritis. Methods:The expressions of TGFβ1, CD68 and smooth muscle actin(SMA) were detected immunohistochemically in 10 patients with mild non-atrophic gastritis, 30 patients with mild non-metaplastic atrophic gastritis, and 32 patients with severe non-metaplastic atrophic gastritis having H. pylori infecion. Meanwhile, three cases of mild non-atrophic gastritis and 4 cases of severe non-metaplastic atrophic gastritis were observed with electron microscope. Results: The count of TGFβ1 positive cells per high-power field (HPF) in severenon-metaplastic atrophic gastritis group (53±22 ) was significantly higher than that in mild non-atrophic gastritis group(22±/HPF) and mild non-atrophic gastritis group(0-3/HPF, P＜0.01). The count of CD68 positive cells in severe non-metaplastic atrophic gastritis group (23±7/HPF) was significantly higher than that in mild non-atrophic gastritis group (13±/HPF) and mild non-atrophic gastritis group (0-3/HPF, P＜0. 01). Correlation analysis showed that the expressions of TGFβ1 and CD68 had a moderate correlation in each group ( r = 0. 634, P＜ 0. 01; r = 0. 699, P＜ 0. 01). Compared with mild non-atrophic gastritis, SMA-positive myofibroblasts and smooth muscle cells in the lamina propria increased in mild and severe non-metaplastic atrophic gastritis. Ultrastructurally, the proliferation of fibroblasts in gastric lamina propria was observed in mild non-atrophic gastritis, while the proliferation of fibroblasts and presence of myofibroblasts could be observed in mild non-metaplastic atrophic gastritis, and there was a parallel phenomenon between myofibroblasts and fibroblasts, as well as smooth muscle cells.Conclusion: Our findings indicate that TGFβ1 expression increases with severity of H. pylori-associated non-metaplastic atrophic gastritis, suggesting that TGFβ1 might play an important role in the development of non-metaplastic atrophic gastritis.

ObjectiveTo compare the clinical effect of posterior circumferential fusion with versus without intertransverse process fusion on lumbar instability in aged patients. MethodsThe elderly with lumbar instability were treated with the posterior instrumented circumferential fusion technique in 80 cases. Among 58 patients followed up for at least 2 years, 28 cases (group A)underwent posterior circumferential fusion with intertransverse process, while 30 cases (group B)without intertransverse process. X-ray examination was used before and 1, 3, 6, 12 and 24 months after operation to evaluate the fusion condition of the bone graft, and visul analogue scale (VAS) and Oswestry disability index (ODI) questionnaire were applied to assess the pain of center back and leg,and the conventional activity.ResultsThe operation time and blood loss were more in group A[(185.3±56.6) min and (376.3±92.9) m1] than in group B [(146.4±46.3) min and (234.3±64.5)ml (t=12.37, 37.49, P＜0.01)]. All the 58 cases were followed for at least 2 years. The 27 cases (96.4％) of group A and 28 cases (93.3％) of group B got bone fusion (x2 =0.004, P＞0.05).There were marked differences in the VAS of center back at 1 and 3 months after operation between the 2 groups (t=3.178, 2.158, both P＜0.05), while no difference at the other 3 time point. VAS about the leg pain and the ODI showed no differences between group A and B after operation (all P＞0.05). ConclusionsFor the lumbar instability in the elderly, the posterior circumferential fusion with or without intertransverse process fusion can achieve a similar high rate of fusion and satisfactory clinical results,andtheposteriorcircumferentialfusionwithoutintertranaverseprocess is recommended for less trauma.

Objective To investigate cranial decompression under temporal muscle in very-low position with large bone flap combined with mild hypothermia for severe cranial trauma.Methods 88 severe brain injury patients (GCS ≤ 8 ) were randomly divided into two groups,mild hypothermia group( n =48) and non-mild hypothermia group ( n =40),both presented with cranial decompression under temporal muscle in very-low position with large bone flap.Data of patients,GCS increment,rate of brain cistern display,rate of pupil shrink and therapeutic effect were ananlyzed.Results The treatment group showed better effect compared with the oontrol group(P＜0.05).Condusion The therapy of cranial decompression under teniporal muscle in very-low position with large bone flap combined with mild hypothennia showed the advantage of depressing intracranial pressure,reducing crerebral edema and improving the therapeutic effect of severe brain injury patients.

Objective To evaluate the correlation between spiral CT ( SCT ) features and expression of cyclooxygenase-2 , nm23 in esophageal carcinoma.Methods Spiral CT scans were preformed in 44 patients with esophageal carcinoma before operation, and the results were compared with that of operation and pathology. Immunohistochemical streptavidin peroxidase conjugate method was used to analyze the expression of Cox-2 and nm23 in esophageal carcinoma. Statistical analysis was performed with SPSS 12.0 software. Results (1) The accuracy of spiral CT scan in judging adjacent- infiltration and lymph node metastasis in 44 patients was 88.6%(39 of 44) and 90.9% (40 of 44) respectively,there was significant coincidence with operation and pathology(P

Objective To analyze and investigate the correlation between the CYP2C19 gene polymorphism and clopidogrel cura-tive effect in the patients with coronary heart disease (CHD) to provide valuable reference information for the future clinical work. Methods A total of 128 cases of CHD undergoing PCI in our hospital from January 2015 to January 2016 were selected as the re-search subjects.All of them were treated with clopidogrel ,the loading dose was 300mg ,and the maintenance dose was 75mg.The subjects were divided into the clopidogrel resistance group and response group.The drug-metabolizing CYP2C19 genotype was com-pared between the two groups and the effect of CYP2C19 genotype on the clopidogrel response was observed.Results Among the subjects ,27 cases were clopidogrel resistance.A total of 16 cases of CYP2C19 slow metabolic gene carriers were detected.There was statistically significant difference between the patients with chronic metabolic genotype VASP-PRI with fast metabolic geno-type and intermediate metabolic genotype(P<0.05).The incidence rate of adverse end point events had statistical difference be-tween the clopidogrel resistance group and clopidogrel response group(P<0.05).Conclusion In the risk factors of clopidogrel re-sistance ,slow metabolism CYP2C19 genotype and clopidogrel resistance will increase the risk of clinical adverse endpoint events oc-currence ,clinic should give adequate attention.