The paper analyzed the development and main problems of medical records management in hospitals,and proposed a number of measures based on the ongoing healthcare reform for medical records management in the hospitals.These include targeted management; innovative management model to enhance service; enhanced information security for better protection of patient privacy and hospital's intangible assets; modern management theories and technologies for resolving remaining problems in medical records management; scientific building of medical records quality control system.On such basis,the paper discussed the development trend and strategy of hospital medical records management.

Monoclonal gammopathy of undetermined significances (MGUS) is a premalignant clonal disorder occurring in 4.2 ％ of adults ＞50 years old,and is associated with a 1％ risk every year of progression to multiple myeloma (MM),light-chain amyloidosis and related conditions.Differential diagnosis of asymptomatic and symptomatic monoclonal gammopathies is the determinant for starting therapy.Most patients with MGUS need frequent assessment and follow-up.A few patients with MGUS might progress into smoldering MM and symptomatic MM,or develop into light chain diseases such as AL amyloidosis and light chain deposition disease caused by M-protein,who should be followed with effective therapy.The above were in detail reviewed in the 54th American Society of Hematology (ASH) annual meetina.

BACKGROUND: The reaction of osteoblasts is important role in the reconstruction of osteocytes, and the mechanism of bone remodeling can be known from the cytological level through analyzing the mechanical reaction of osteoblasts under different loading.OBJECTIVE: To analyze the effects of low frequency vibration on the proliferation and differentiation as well as the matrix excretion of cultured human osteoblasts.DESIGN: A comparative observation.SETTING: Department of Orthopaedics, Nanfang Hospital of Southern Medical University.MATERIALS: The experiment was carried out in the laboratory of Nanfang Hospital from January to December in 2002. Human osteoblasts were isolated from the iliac cancellous bone of adults.METHODS: The osteoblasts were cultured for 48 hours, and then treated with low frequency vibration of 0.1, 0.2, 0.5, 2 and 5 Hz. The proliferation of the osteoblasts was detected with flow cytometry, and the activity of alkaline phosphatase (ALP) and content of osteocalcin were assayed by spectrophotometric methods and radioimmunoassay respectively.MAIN OUTCOME MEASURES: ① Effects of low frequency vibration on the ALP activity and osteocalcin excretion of osteoblasts; ② Effects of low frequency vibration on the proliferation of osteoblasts detected with flow cytometry.RESULTS: ① 0.2 and 0.5 Hz vibrations could markedly increase the ALP activity of osteoblast (P ＜ 0.01), but that of 5 Hz obviously decreased the ALP activity (P ＜ 0.01). 0.1 and 2 Hz vibrations had no obvious effects on the ALP activity of osteoblasts. ② 0.2 and 0.5 Hz vibration could significantly increase number of osteoblasts at S phase from 10.4% to 12.45% and 16.12%, and the proliferative index increased from 20.14% to 26.21% and 28.75%; 0.1 and 2 Hz vibration has not obvious effects in osteoblast proliferation index; 5 Hz vibration obviously decreased the proliferative index value to 13.22% (P ＜ 0.05). 0.1 and 2 Hz vibrations had no obvious effects on the proliferative index of osteoblasts (P ＞ 0.05). ③ 0.2 and 0.5 Hz vibrations could obviously increase the amount of osteocalcin excretion to 1.87 μg/L and 2.47 μg/L(P ＜ 0.05), but 2 and 5 Hz vibrations decrease the amount of osteocalcin excretion (P ＜ 0.05), and that of 0.1 Hz had no obvious effect on amount of osteocalcin excretion (P ＞ 0.05).CONCLUSION: Low frequency vibrations of 0.2-0.5 Hz could accelerate the proliferation and differentiation as well as the excretions of active materials of osteoblasts, and it plays an instructive role for low frequency vibration to treat fracture.

Objective To establish a method for the determination of berberine hydrochloride in Huanglian Jiangtang Pill. Methods The sample was extracted with hydrochloric acid-methanol(1 ∶ 100). The chromatographic conditions were as follows:Diamonsil C18 chromatographic column(250 mm? 4.6 mm,5 ? m)with a mobile phase of acetonitrile-0.05 mol/L potassium dihydrogen phosphate(28 ∶ 72),the detection wavelength at 350 nm and the flow rate being 1.0 mL? min-1. Results A good linearity was obtained from 0.244 ? g to 2.928 ? g of berberine hydrochloride in Huanglian Jiangtang Pill(r=0.999 9,n=7).The average recovery was 99.07 % and RSD=1.30 %(n=6). Conclusion This method is simple,sensitive,specific and accurate for determination of berberine hydrochloride in Huanglian Jiangtang Pill.

Objective To explore the clinical significance of immunocyte subsets before and after immunosuppressive therapy in the peripheral blood of patients with immune thrombocytopenic purpura (ITP).MethodsThe percentages of immunocyte subsets in the peripheral blood of 35 patients with ITP and 20 healthy controls were detected by flow cytometry,including CD3+,CD4+,CD8+,CD56+,CD19+ lymphocytes and CD4+/CD8+.Results The percentages of CD3+ T lymphocyte (61.58 ± 6.45 ) %,CD4+ T lymphocyte (28.38 ±4.89)% and the ratio of CD4+/CD8+ 0.99 0.22 in patients with ITP were lower than those in healthy controls[( 67.85 ± 4.68 ) %,( 38.00 ± 3.37 ) %,1.54 ± 0.13,all P ＜ 0.05].After immunosuppressive therapy,the percentages of CD3+ T lymphocyte ( 69.41 ± 5.03 ) %,CD4+ T lymphocyte (38.17 ±3.18)% and the ratio of CD4+/CD8+ 1.60 ±0.15 recovered to control levels.The percentages of CD8+ T lymphocyte (29.20 ±4.50)% and CD19+B lymphocyte ( 17.74 ±4.14)% were higher than those in healthy controls[( 24.82 ± 2.93 ) % and ( 12.09 ± 3.51 ) %,all P ＜ 0.05].After the immunosuppressive therapy,the percentages of CD8+ T lymphocyte ( 24.06 ± 3.02 ) % and CD19+ B lymphocyte ( 10.90 ± 3.55 ) %recovered to control levels.There were no significant difference of the percentage of CD56+ lymphocyte among ITP patients ( 15.80 ± 2.85 )%,ITP patients after immunosuppressive therapy ( 15.16 ± 2.77 )% and healthy controls ( 16.36 ± 2.75 ) %.ConclusionThe aberrant immunocyte subsets are involved in the pathogenesis of ITP,and detection of immunocyte subsets might be helpful for the diagnosis and determination of therapeutic outcome of ITP.

Adolescent ; Adult ; Carotid Artery, Internal ; surgery ; Carotid Body Tumor ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Methods ; Middle Aged ; Time Factors

Objective To evaluate the therapeutic effects and pathologic changes of VX2 liver tumor in rabbits treated with CT-guided percutaneous ethanol injection (PEI) with different concentration. Methods Thirty-two New Zealand rabbits with VX2 liver tumor were randomly divided into 4 groups (each n=8), i.e. anhydrous ethanol, 75% ethanol, 50% ethanol and control group (administrated physiological saline). Tumor size, imaging and pothologic changes were observed 7 d, 14 d, 21 d and 60 d after PEI. Results The volume was (4.68±5.05) cm~3 in anhydrous ethanol group, (6.33±6.59) cm~3 in 75% ethanol group, (17.54±5.06) cm~3 in 50% ethanol group and (16.87±5.27) cm~3 in control group 21 d after PEI. Tumor size in control group was larger than that in 75% ethanol group (t=6.32, P＜0.05) and anhydrous ethanol group (t=6.74, P＜0.05), in 50% ethanol group was larger than that in 75% ethanol group (t=4.99, P＜0.05) and anhydrous ethanol group (t=12.77, P＜0.05). No difference of tumor size was found between 50% ethanol group and control group, nor between 75% ethanol group and anhydrous ethanol group. ALT and AST both increased in all groups 1 d after PEI and returned to normal 7 d later except anhydrous ethanol group. ALT and AST in anhydrous ethanol group were higher than those in other groups (t=4.10, 4.49, 3.06, 5.79, 5.91, 4.11, all P＜0.05), and no difference of ALT and AST was detected between other groups. Area of coagulation necrosis enlarged with the increase of ethanol concentration. Conclusion Anhydrous ethanol and 75% ethanol both have obvious inhibition function to the rabbit VX2 tumor, while 75% ethanol has little damage to the liver function and is suitable for PEI.

Objective To analyze the changes and clinical significance of C-reactive protein (CRP)、hemoglobin (Hb) and erythrocyte sedimentation rate (ESR) in different disease stage of multiple myeloma according the international staging system. Method Thirty untreated MM patients with complete clinical records were included in the stndy. The multiple myeloma patients were classified into three groups according to international staging system (ISS).Thirty megaloblastic anemia patients of similar age 、sex、hemoglobin level as the observation group.Resulets The levels of CRP (24.17±9.87 mg/L)、Hb (71.72±13.27 g/L) and ESR (105.94±27.73 mm/h) of stage Ⅲ patients were statistically different with stage Ⅰ ( CRP 8.54±1.97 mg/L; Hb 91.00±9.92g/L; ESR 73.57±20.53mm/h)、Ⅱ patients ( CRP 14.89±5.51 mg/L; Hb 91.29±8.32g/L; ESR 67.00± 15.56 mm/h) separately (P＜0.05).The levels of CRP (19.40±10.17 mg/L) and ESR (91.90±29.70 mm/h) in the MM patients were significantly higher than that in the observation group Ⅰ ( CRP 7.52±1.57mg/L; ESR 20.20±8.04mm/h) (P＜0.05 respectively).CRP and ESR level in MM patients positively correlated with myeloma cell proportion and β2-microglobulin level (P＜0.05), while Hb level negatively correlated with myeloma cell proportion and β2-microglobulin level (P＜0.05),Conclusion The levels of C-reactive protein、hemoglobin and erythrocyte sedimentation rate are closely associated with the development of multiple myeloma. C-reactive protein and hemoglobin are relatively sensitive response to disease than erythrocyte sedimentation rate. There is a clear clinical implication in detecting the patient' s condition for progress and the prognosis.

Objective To explore the clinical significance of a series of cytokines and peripheral blood immunocyte subsets before and after immunosuppressive therapy in patients with immune thrombocytopenia (ITP).Methods The percentages of immunocyte subsets in the peripheral blood of 20 patients with ITP and 20 healthy controls were detected by flow cytometry,including CD3+,CD4+,CD8+,CD4+/CD8+,CD1~.ELISA was applied to detect the level of serum TNFα,IL-2,IL-6,IL-4,IL-10,IL-11,IL-17,IL-27,transforming growth factor β (TGFβ),thrombopoietin (TPO) of 20 patients with ITP and 20 healthy controls.Results The percentage of CD3+ T lymphocyte,CD4+ T lymphocyte and the ratio of CD4+ / CD8+ T lymphocyte in patients with ITP were lower than those in healthy controls [(62.66 ± 6.58) ％ vs (69.93 ± 4.81) ％,(29.46 ± 5.02) ％ vs (39.08 ± 3.50) ％,0.97 ± 0.35 vs 1.56 ± 0.26,all P ＜ 0.05].After immunosuppressive therapy,the percentage of CD3+ T lymphocyte,CD4+ T lymphocyte and the ratio of CD4+/CD8+ T lymphocyte [(71.49 ±5.16)％,(39.25 ±3.21)％ and 1.56 ±0.28] recovered to the same levels in healthy controls.The percentage of CD8+ T lymphocyte and CD19+ B lymphocyte in patients with ITP were higher than those in the healthy controls [(30.28 ±4.63)％ vs (25.90±3.06)％,(18.92 ± 4.27)％ vs (13.17 ± 3.64)％,all P ＜ 0.05].After treatment of immunosuppressive therapy,the percentage of CD8+ T lymphocyte and CD19+ B lymphocyte [(25.16 ± 3.45) ％ and (11.98 ± 3.68) ％] recovered to the similar levels in healthy controls.The serum levels of IL-4,IL-6,IL-11,IL-17 and TPO in patients with ITP were significantly higher than those in healthy controls.While TGFβ level was significantly decreased.There was no significant difference of IL-27 between ITP patients and healthy controls.After the treatment of immunosuppressive therapy,IL-4,IL-6,IL-11,IL-17,TPO and TGFβ were down-regulated while IL-27 was up-regulated.There was no significant difference of IFNγ,TNFα,IL-2 and IL-10 among ITP patients before or after immunosuppressive therapy and healthy controls.Conclusions The present study suggests that the aberrant immunocyte subsets and cytokines are involved in the pathogenesis of ITP.Hyper-function of Th2 and Th17,dysfunction of Treg cells,up-regulation of IL-27,IL-11,TPO and other factors may contribute to the pathogenesis of ITP.

BACKGROUND:It is controversial to treat sacroiliac joint fracture.Some scholars advocated expectant treatment,and some others advocated surgery therapy.Pelvic stability was responsible for the scheme selection.Sacroiliac joint fracture-dislocation destroys pelvic stability,which easily induces instability and bone nonunion,resulting in sacroiliac joint pain,unequal size of lower limbs,sitting pain and dysfunction.Thus,prognosis of mental implant is significantly better than expectant treatment in treatment of unstable pelvic fracture.OBJECTIVE:To summarize the treatment of unstable pelvic fractures and their clinical application using various internal and external fixation of metal implants.METHODS:The computer-based research was done in Pubmed database (http://www.ncbi.nlm.nih.gov/PubMed) and Wanfang database (http://www.wanfangdata.com.cn) for articles published from January 1991 to December 2009 with the key words of "Pelvic fractures,instability,surgical treatment" by the first author.A total of 115 articles were retrieved,and those concerning characteristics and clinical application of implants in the treatment of unstable pelvic fracture.Articles addressing old and repetitive contents were excluded.Literatures of the same fields published in recent years or in authorized journals were selected.Finally,30 articles were included.RESULTS AND CONCLUSION:Sacroiliac joint fracture-dislocation is a severe,high-energy trauma,has been paid great attention in the therapy,particularly in unstable sacroiliac joint fracture-dislocation.A stable type of fracture and dislocation of the sacroiliac joint received a conservative treatment of unstable sacroiliac joint fracture-dislocation appropriate line of external fixation,internal fixation for reconstruction of pelvic stability and internal fixation treatment varied,but the therapeutic effect of internal fixation needs to be improved.What are bio-mechanical characteristics of various internal fixation methods,and how the timing of weight-bearing activities following various internal fixations require further basic and clinical studies.An unstable sacroiliac joint fracture-dislocation fixation has many ways,including the anterior and posterior fixed-fixed.Minim ally invasive therapy such as posterior CT guided sacroiliac joint lag screw is the developmental trend.