Drug management system of No.1 Military Medial Project is an important component of hospital information management system. This paper introduces four pieces of application experience of drug management system and presents seven suggestions about it.

Objective To analyze the clinical characteristics of single renal transplantation from infant kidney donation after death (DCD) and summarize the nursing measures for nursing the infants. Method The clinical data of 36 cases of single kidney transplantation from 18 infant donors from January 2014 to June 2016 in our centre were reviewed and summarize the nursing experience. Results Pulmonary infection occurred in 3 cases, incision infection occurred in 2 cases and graft vascular complication occurred in 2 cases. Urinary fistula occurred in 2 cases, ureteral obstruction occurred in 1 case, delayed graft function (DGF) occurred in 16. Postoperative follow-ups for 1 to 20 months showed all the grafted kidneys survived and 34 of them were well recovery in view of renal function of grafted kidney and the rest two had the grafted kidneys resected because of arterial and venous thrombus in them. Conclusions The renal transplantation from infant DCD is difficult. The nurses should handle postoperative care to the patients, paying attention to the complications. On the other hand, intra-and post-operative monitoring of blood pressure, control of input and output and early observation of complications and treatment is of value for the improvement of survival rate of grafted kidneys, reduction of complication incidence and propelled recovery of the patients.

〔Abstract〕 The paper introduces the characteristics, methods and achivements of regional health informatization construction of Luoy-ang health information security project, overviews the construction ideas of regional informatization, providing basis for future development and references for similar projects implementation.

Objective To analyze the outcomes and the prognostic factors of allogeneic peripheral blood stem cell transplantation (allo-PBSCT) for acute lymphoblastic leukemia (ALL).Method From Feb.2002 to Feb.2014,a total of 95 patients with ALL were treated with alloPBSCT in our hospital.Of these,73 cases obtained the first CR (CR1),11 cases obtained late CR,7 patients were in relapse and 3 patients suffered from primarily refractory disease (PRD) before transplant.The median age was 26 (4-57) years.Conditioning regimens including total body irradiation (TBI)/ etoposide/semustine/cyclophosphamide or busulfan/semustine/cyclophosphamide were used.Matched sibling transplantation was performed on 68 patients,and matched unrelated donor transplantation was performed on 27 patients.Combination of CsA,MTX and low-dose,short-course mycophenolate mofetil was used for graft-versus-host disease (GVHD) prophylaxis.The average fellow-up was 57 months.Result Hematopoietic reconstitution was achieved in all 95 patients.Five-year estimate of overall survival (OS) was 54.3％,disease free survival (DFS) was 51.2％,relapse rate (RR) was 30.2％ and transplant-related mortality (TRM) was 24.0％.The 5 year OS and DFS were significantly longer in patients with CR1 than in late CR and relapse/PRD patients before allo-PBSCT (P＜0.001).There was no significant difference in OS between the two different conditioning regimens.Multivariate analyses revealed that Ⅱ-Ⅳ aGVHD and cGVHD were correlated with higher TRM,CR1 before allo-PBSCT and TBI were associated with a lower RR,and non Ⅱ-Ⅳ aGVHD and CR1 before allo-PBSCT were favorable factors which were associated with OS and DFS.In the patients with DFS≥1 year after allo-PBSCT,DFS and OS were shorter in patients with cGVHD (P =0.008).Conclusion Allo-PBSCT in adult ALL patients should be performed in CR1.Severe acute and chronic GVHD are not associated with improved survival.

Objective To study and correlate serum bilirubin and regulatory T cell (Treg) levels in patients with bile duct stone.Methods Flow-cytometry and Enzyme-linked immunosorbent assay (Elisa) were used to study the peripheral blood expression level of Tregs and the bilirubin level in 27 patients with bile duct stones and jaundice.The changes in the expression level of Tregs and the bilirubin level were studied and correlated before and after treatment.Results After treatment,both the peripheral blood bilirubin level,the Tregs expression level and the cell cytokines decreased significantly.The total bilirubin level decreased from (102.8 ± 33.1) mmol/L to (15.3 ± 5.7) mmol/L (P ＜ 0.05),the direct bilirubin level decreased from (38.1 ± 12.8) mmol/L to (5.0 ± 1.6) mmol/L (P ＜0.05);the percentages of CD4+ CD25 +Foxp3 + T cells in CD4+ T decreased from (4.2 ± 2.0) ％ to (2.4 ± 1.0) ％ (P ＜ 0.05).Before treatment,the levels of IL-10 and TGF-β were 171.4 ± 13.7 and 2016 ±657 pg/ml but after treatment,the two cytokines decreased to 92.1 ± 7.4 and 1 686 ± 168 pg/ml,respectively (P ＜ 0.05).Conclusions Patients with bile duct stones and jaundice presented with high expressions of bilirubin and Tregs level.These expressions returned to normal after effective treatment.The Tregs expression level was positively correlated with the bilirubin level.

Objective To investigate the expressions of regulatory T cell (Treg) and interleukin-35 (IL-35) in patients with cholangiocarcinoma and to explore their clinical significance.Methods Flow-cytometry,PCR,Enzyme-linked immunosorbent assay (Elisa) and immunohistochemistry were used to detect the levels of Treg and IL-35 in peripheral blood and cholangiocarcinoma tissues in 42 patients with cholangiocarcinoma.Healthy volunteers were used as a control group.Result The percentage of Treg cells to CD4 + T cells in patients with cholangiocarcinoma was (5.6 ± 1.7) ％,while that in the normal control group was (2.9 ± 0.8) ％.There was a significant difference between the two groups (P ＜ 0.05).The plasma levels of IL-35 in patients with cholangiocarcinoma was (198.4 ± 81.4) pg/ml,while that in the normal control group was (33.7 ± 18.0) pg/ml.Again,a significant difference was observed between the two groups (P ＜ 0.05).In peripheral blood mononuclear cell,the IL-35 mRNA level was positively correlated with the plasma IL-35 level (p35,R =0.795,P ＜0.05;EBI3,R =0.812,P ＜ 0.05).Immunohistochemical studies showed that FOXP3 + tumor cells and Treg cells increased significantly in tumor tissues.Conclusion Overexpressions of Treg and IL-35 in peripheral blood and tumor tissues of patients with cholangiocarcinoma suggested that they may play important roles in the development of cholangiocarcinoma.

Objective To explore the clinical value of dual-phase 99Tcm-MIBI scintigraphy in the localization and diagnosis of secondary hyperparathyroidism (SHPT).Methods A total of 20 patients (8 males,12 females; average age 49.6 years) with uremic SHPT who underwent parathyroidectomy from 2010 to 2013 were retrospectively analyzed.All patients underwent 99Tcm-MIBI SPECT/CT and 19 underwent color Doppler ultrasonography (CDUS).Post-excisional histopathology was considered as the gold standard.The diagnostic efficacies of 99Tcm-MIBI and CDUS for SHPT were calculated.The correlation between T/NT ratio in delayed imaging and the volume of excised parathyroid and the intact PTH (iPTH) were analyzed.x2 test,Pearson or Spearson correlation analysis were used to analyze the data.Results The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of 99Tcm-MIBI SPECT/CT and CDUS in the diagnosis of SHPT were 66.67％ (44/66),100％(14/14),100％ (44/44),38.89％(14/ 36),72.50％ (58/80) and 78.19％(43/55),52.38％(11/21),81.13％(43/53),47.83(11/23),71.05％ (54/76),respectively.There were significant differences in specificity and positive predictive value (x2 =9.33,9.26,both P＜0.05),but no significant differences in the sensitivity,negative predictive value and accuracy (x2 =1.97,0.04,0.46,all P＞0.05).T/NT ratio correlated with serum iPTH and parathyroid volume (r=0.638,rs =0.571,both P＜0.05).Conclusions The specificity of 99Tcm-MIBI SPECT/CT is superior to CDUS in the diagnosis of SHPT.Dual-phase 99Tcm-MIBI SPECT/CT could locate the hyperfunctional parathyroid gland and provide the basis for surgical treatment.

Objective To investigate the changes in plasma very long chain fatty acids (VLCFAs),and to explore its relationship with obesity-related index in obese children.Methods One hundred and sixty-six obese children aged 7 to 12 years old were investigated and 148 health children matched with age and sex were selected as control group.Their height,weight,and waist circumference (WC) were measured.The percentage of body fat (PBF) was tested by dual-energy X-ray absorptiometry.Fasting blood triglycerides (TG),total cholesterol (TC),high density lipoprotein-cholesterol (HDL-C),low density lipoprotein-cholesterol (LDL-C) levels,fasting plasma glucose,and fasting insulin (FINS) were determined.The body mass index (BMI),BMI-Z score,waist to height ratio (WHtR),and homeostasis model assessment for insulin resistance (HOMA-IR) were calculated.The plasma VLCFAs were analyzed by gas chromatography-mass spectrometry.Results (1) Compared with normal control children,body weight,BMI,BMI-Z score,WC,WHtR,PBF,TG,TC,LDL-C,FINS,and HOMA-IR in obese children were increased (all P ＜ 0.05),and the level of HDL-C was decreased (P ＜ 0.05).(2) The plasma levels of docosamonoenoic acid (C22 ∶ 1 n-9) and arachidonic acid (C20 ∶ 4n-6) were decreased while the levels of arachicacid (C20 ∶ 0) and eicosapentaenoic acid (C20 ∶ 5n-3) increased in obese children compared to non-obese children.(3) The linear correlation analysis showed that PBF was positively correlated with C20 ∶ 0 and C20 ∶ 5n-3,and negatively correlated with C20 ∶ 4n-6.WHtR was negatively correlated with C22 ∶ 1 n-9 and positively correlated with C20 ∶ 0 (4) The multiple stepwise regression analysis showed that C20 ∶ 0 was the main factor for PBF,and C22 ∶ 1 n-9 and C20 ∶ 0 were the main factors for WHtR.Conclusion The metabolic abnormality of plasma very long chain fatty acids exists in obese children.The changes in C20 ∶ 0,C22 ∶ 1 n-9,and C20 ∶ 5n-3 may be associated with obesity in children.

Objective To assess the patient enablement level in a general hospital and its related factors,to investigate the relationship of patient enablement with patient's overall satisfaction and doctor's empathy levels.Methods Patients attending the Family Medicine Clinic of HKU-Shenzhen Hospital in September 2014 and met the inclusion criteria were asked to complete a questionnaire survey which included general characteristics,overall satisfaction;the Patient Enablement Instrument (PEI) and the Consultation and Relational Empathy Measure Scale (CARE) after the consultation.Results Total 2 326 questionnaires were issued and 1 818 were retrieved,of which 1 478 were qualified questionnaires.The qualified rate of PEI was 81.3％ and the qualified rate of patient overall satisfaction was 96.28％.The positive rate of patient enablement was 97.70％ (1 444/1 478),and the mean score of PEI was 8.21 ±3.33.Multivariate linear regression analysis showed that the PEI scores were not influenced by gender and education level of the patients,gender of the consulting doctors and initial/follow up consultation.The PEI scores were influenced by the age of the patients,the types of clinic (general practice/chronic practice clinic) and the reasons for consulting (P ＜ 0.05).There were correlations between PEI score and overall satisfaction of patients (r =0.383,P ＜ 0.001),patient's recommendation of the clinic (r =0.595,P ＜ 0.001) and CARE scores (r =0.546,P ＜ 0.001).Conclusion The results show that the PEI scores of patients visiting family medicine clinic of this hospital are higher than those reported in other studies.The PEI score may be influenced by the age of the patients,the types of clinic and the reasons for consulting.Positive correlations between patient enablement and the overall satisfaction,patient's recommendation and doctor empathy were observed.

Objective To assess the empathy level of general practitioners (GPs) in the outpatient clinics of a general hospital,and to investigate the related factors.Methods Patients attending the Family Medicine Clinic of HKU-Shenzhen Hospital in September 2014 and met the inclusion criteria were asked to complete the questionnaire which included general characteristics,overall satisfaction and the Measure-Consultation and Relational Empathy Measure (CARE) Scale after the consultation.Results Of the 1 818 questionnaires retrieved,1 690 CARE scales were completed (intact rate was 92.96%).The overall satisfaction rate was 95.92% (1 621/1 690).And 97.28% (1 644/1 690) of the patients would recommend family medicine service to their friends or relatives.The total score of CARE scale was (45.47±6.26),and the scores of 4 CARE components were (4.63 ± 0.59),(4.43 ± 0.81),(4.54 ± 0.69) and (4.55 ± 0.66),which showed significant difference (P<0.01).The multivariate linear regression analysis showed that the mean CARE scores were not influenced by gender and education levels of the patients,gender of the consulting doctors,initial/follow up consultation,and the location of the consultation.The mean CARE scores were influenced by age of patients and the reasons for consulting (P<0.05).There was a moderate correlation of the CARE scores with the overall satisfaction of patients (r=0.613,P<0.001) and patient's recommendation of the clinic (r=0.466,P<0.001).Conclusion Doctors who were evaluated in this study have a higher empathy level than results from other countries.There is positive correlation between doctor's empathy level and patient's overall satisfaction.The result of doctor's empathy level may be influenced by patient's age and the reasons for consulting.