OBJECTIVE:To discuss the way to improve the service quality of outpatient pharmacy.METHODS:The pharmaceutical work in the outpatient pharmacy was optimized applying the theory of system engineering.RESULTS:The working efficiency and service quality of outpatient pharmacy were improved significantly.CONCLUSIONS:The theory of system engineering lay a focus on the optimal holistic effect of the system.Excellent results were achieved on the same objective conditions,when the stable quality of drugs,intensive scientific management,coordinating the exterior and interior relationships and reasonable usage of workers were considered as the elements of the system.

The vehicle-mouted medical PSA oxygen generation system for driver on plateau is developed independently,according to the environment characteristics of high altitude and low air pressure on the Qinghai-Tibet Plateau,aiming at the actual vehicles support work of plateau troops,through two years' research and experiment again and again.By system workflow design,tests under various conditions,and applicability analysis,especially,the tests conducted on the simulation plateau artificial environment and the vehicle loading tests under five typical environments of Qinghai-Tibet Route at different altitudes,the system is proved to be reliable,satisfied and can meet the requirements of national standard for medical oxygen.

Objective To study the methods and benefits of exposure of recurrent laryngeal nerve(RLN) in thyroid surgery Methods In this study, 2148 patients admitted in our hospital from July 1993 to July 2003 were divided randomly into two groups: RLN exposure group (936 cases) and RLN non exposure group (1212 cases) RLN was dissected around the inferior thyroid artery, thyroid cartilage, and cervical vagus Results Two cases (0 21%) suffered from RLN injury in exposure group and 5 cases (0 41%) suffered from RLN injury in non exposure group ( P

Objective To compare the therapeutic results between low-molecular-weight heparin therapy and combined therapy of low-molecular-weight heparin and Shuxuetong for deep venous thrombosis (DVT) after lower extremity fracture.Methods Forty-two patients with DVT from 1,037 patients with lower extremity fracture treated from December 2010 through November 2012 were included in the study.There were 31 males and 11 females,aged from 26 to 82 years (mean,63 years).The patients were assigned to administration of 4,250 IU low-molecular-weight heparin subcutaneously,twice daily (Group A,n =19)and 4,250 IU low-molecular-weight heparin subcutaneously,twice daily plus shuxuetong to 6 ml intravenously,once daily (Group B,n =23) according to the random number table.A period of treatment was a week.Color Doppler sonography was performed to detect DVT.Results Longest course of treatment was 3 weeks.In Group A,the results were recanalization in 2 patients with mean time of 2.50 weeks,significantly effective in 3 patients with mean time of 2.67 weeks,effective in 7 patients with mean time of 3 weeks,and invalid or worse in 7 patients with mean time of 3 weeks.Whereas in Group B,the results were recanalization in 7 patients with mean time of 1.86 weeks,significantly effective in 12 patients with mean time of 1.83 weeks,effective in 3 patients with mean time of 3 weeks,and invalid or worse in 1 patient with mean time of 3 weeks (P ＜ 0.05).Conclusion Low-molecular-weight heparin plus Shuxuetong is effective in treatment of DVT after lower extremity fracture and hence can be as an option in clinical application.

Objective To compare the image quality of diffusion-weighted MR neurography (DW-MRN) of the tibial nerve and the common peroneal nerve prospectively using different motion probing gradients (MPGs).Methods A total of 21 healthy volunteers underwent DW-MRN at the knee (unilateral imaging) on a 3.0 T magnetic resonance system with unidirectional MPGs.The protocol included anteriorposterior unidirectional,right-left unidirectional,three-directional and six-directional MPGs.The apparent SNR and CNR of tibial nerve and common peroneal nerve were calculated.Three-dimensional MIP images of the nerves were evaluated blindly by two radiologists using a four-point grading scale on basis of entirety depiction and the signal intensity.Significance was determined by using Friedman and paired Wilcoxon tests.Results The SNR of tibial nerves on DW-MRN with anterior-posterior,right-left,three directional and six directional MPGs were 4.17 (2.70-5.65),4.35 (0.47-4.69),3.46 (2.27-4.62) and 3.30 (2.06-4.43),respectively.CNR were 0.61 (0.46-0.70),0.63 (0.36-0.73),0.55 (0.39-0.64) and 0.53(0.35-0.63),respectively.The scores of tibial nerve image quality were 4.0 (2.0-4.0),4.0 (3.0-4.0),2.5 (2.0-3.5),2.0 (1.0-2.5),respectively.Interobserver agreement was good and the Kappa value was 0.69 (P ＜ 0.05).The SNR of the common peroneal nerves on DW-MRN with anteriorposterior,right-left,three directional and six directional MPGs were 3.05 (2.30-4.20),3.05 (2.26-4.34),2.72 (1.84-13.80) and 2.68 (1.87-3.67),respectively.CNR were 0.51 (0.39-0.62),0.51 (0.39-0.63),0.46(0.30-0.86) and 0.46(0.30-0.57),respectively.The scores of the common peroneal nerve image quality were 3.5 (2.0-4.0),4.0 (2.0-4.0),2.0 (1.0-3.0) and 2.0 (1.0-2.5),respectively.Interobserver agreement was good and the Kappa value was 0.70(P ＜0.05).For SNR,CNR and nerve image quality of the tibial nerves and the common peroneal nerves,there were significant differences among different MPGs (x2 =215.01,215.01,60.49 and 182.82,182.82,60.22,respectively,P ＜ 0.05).SNR,CNR and nerve image quality of the tibial nerves and the common peroneal nerves on DW-MRN with unidirectional MPGs were better than those with three-directional and sixdirectional MPGs (Z =-6.90-4.03,P ＜ 0.05).The SNR and CNR of the tibial nerves on DW-MRN with right-left direction were better than those with anterior-posterior unidirectional MPGs (Z =-3.53,-3.41,P ＜ 0.05),but there was no significant difference of image quality between right-left and anteriorposterior directional MPGs (Z =-0.58,P ＞ 0.05).DW-MRN of the tibial nerves with three-directional MPGs was better than that with six-directional MPGs (Z =-3.00,-2.80,-3.92,P ＜ 0.05).There were no significant differences between right-left and anterior-posterior unidirectional MPGs,or between three-directional and six-directional MPGs of common peroneal nerves (Z =-1.94--0.31,P ＞ 0.05).Conclusions DW-MRN has capability to provide three-dimensional visualization of the tibial and common peroneal nerves,and the image quality with unidirectional MPGs is better than that with three or six directional MPGs.

ObjectiveTo compare the efficacy of laparoscopic and open left lobectomy.MethodsThe clinical data of 92 patients who received left lobectomy at the First Affiliated Hospital of Harbin Medical University from May 2010 to June 2011 were retrospectively analyzed.Of the 92 patients,42 received laparoscopic left lobectomy (laparoscopic group ) and 50 received open left lobectomy (open group ). The advantages and disadvantages between laparoscopic and open left lobectomy were compared. All data were analyzed using the t test,chi-square test or by calculating the Fisher exact probability.ResultsTwenty-nine patients received left lateral lobectomy and 13 patients received left hemihepatectomy in the laparoscopic group. One patient was converted to the open group becaused of the injury of the middle hepatic vein.Thirty-three patients nnderwent left lateral lobectomy and 17 underwent left hemihepatectomy in the open group.The tumor-free resection margin of the laparoscopic group was ( 1.6 ± 0.6 ) cm,which was significantly longer than ( 1.2 ± 0.4 ) cm of the open group (t=3.81,P＜0.05).The volume of operative blood loss of the laparoscopic group was (158 ±89)ml,which was significantly smaller than (292 ± 172)ml of the open group (t =4.56,P ＜ 0.05 ).The time of postoperative pain control,time to bowel function recovery and duration of hospital stay were ( 1.2 ± 0.3 )days,(23 ± 4)hours,( 7.5 ± 2.8 ) days in the laparoscopic group,which were significantly shorter than ( 2.0 ± 1.1 ) days,(4.9 ± 7 ) hours,( 11.3 ± 4.2 ) days in the open group,respectively ( t =4.57,21.31,5.00,P ＜ 0.05 ).The levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) at postoperative day 1 were increased,while the increase of AST and ALT in the open group were greater than that in the laparoscopic group (t =6.73,5.03,P ＜0.05).The postoperative prothrombin time in the open group was significantly longer than that before operation (t =2.32,P ＜ 0.05 ).The incidence of postoperative complications and total hospital costs were 7％ (3/41) and (2.5 ±0.7) ×104 yuan in the laparoscopic group,which were lower than 8％ (4/50) and (2.6 ±0.6) × 104 yuan in the open group,but no significant difference was observed (t =0.74,P ＞0.05).One patient in the open group died of multi-organ dysfunction syndrome caused by acute hepatic failure.ConclusionLaparoscopic left lobectomy is safe and effective,and it has the advantages of small trauma,quick recovery of patients and significant overall efficacy when compared with open left lobectomy.

Objective To explore the clinical efficacy of rectangle advancement flaps used in the reconstruction of skin defects around the Achilles tendon in children.Methods From May 2014 to June 2015,7 children with skin defects around the Achilles tendon were admitted to our trauma center.The areas of skin defect ranged from 3.4 cm × 2.7 cm to 5.5 cm × 4.0 cm.The integrity of Achilles tendon was preserved in 6 cases but the tendon insertion was partly disrupted in one case.The skin defects were reconstructed with self-designed rectangle advancement flaps after debridement.In the one case with the Achilles tendon partly disrupted,the contaminated tendon ends were excised before wound closure.The injured ankles were immobilized in plantar flexion with one 1.5 mm K-wire and plaster splint to decrease the postoperative tension of the flap.Results All the flaps survived completely by primary intention but local infection occurred in 2 wounds which was cured by second intention of dressing change.The follow-up periods ranged from 8 to 12 months (average,11.5 months).The scar around the flap was remarkable in 2 cases,but the flaps in the other cases appeared normal in terms of color and texture.The ankle function was satisfactorily normal in all the cases.Conclusion Our self-designed rectangle advancement flaps provide a simple,safe and reliable way to repair skin defects around the Achilles tendon in children.

ObjectiveTo compare the efficacy and safety of sequential intravenous moxifloxacin treatment against cefoperazone/sulbactam in patients with acute biliary tract infection. MethodsA prospective, randomized, non-blind, multi-centric study was performed to compare the efficacy and safety of moxifloxacin 400 mg Ⅳ once daily to cefoperazone-sulbactam (2 g q12 hours) and metronidazole 250 ml once daily to treat patients, from March- December 2009 in 13 hospitals, with acute biliary tract infection.The primary efficacy variable was clinical cure rate after the end of a 5 - 14 day treatment period,bacteriologic outcomes and adverse reaction effects were also determined.ResultsA total of 319 subjects were enrolled, 282 of whom were eligible for protocol efficacy analyses ( 138 moxifloxacin, 144 comparator).Demographic and baseline medical characteristics were similar between the 2 groups. Clinical success rates were 86.2％ for moxifloxacin and 84. 7％ for the comparator(P =0. 7192). Pathogens (55 moxifloxacin, 61 comparator) were isolated from bile or blood cultures and the predominant strains were E. coli, Klebsiella species and Enterococcus species. Bacterial eradication rates were 85.4％ ( 37 of 55 ) with moxifloxacin versus 82. 0％ (50 of 61 ) in the comparator group ( x2 = 0. 2568, P = 0. 6123 ). Both treatments were safe and well tolerated. ConclusionsE. coli, Klebsiella species and Enterococcus species were the most common bacteria isolated from bile or blood from patients with acute biliary tract infection. Moxifloxacin monotherapy has high clinical and bacteriological efficacies and safety for the treatment of acute biliary tract infection.

Objective To investigate the enhanced CT features of papillary renal cell carcinoma (PRCC)and its subtypes (PRCC-Ⅰ, PRCC-Ⅱ)and chromophobe renal cell carcinoma(CRCC).Methods The CT features of 30 tumors with pathologically proved PRCC and CRCC were analyzed retrospectively,including location,size,enhanced types,calcification and necrosis etc.The differences in the CT features among PRCC and its subtypes and CRCC were evaluated.Results 1 2 cases of PRCC with single lesion (7 in the right kidney and 5 in the left)were shown;1 case was multifocal PRCC with 1 lesion in the right kidney and 2 lesions in the left.1 5 cases of CRCC were single lesion(9 in the right kidney and 6 in the left).The medium tumor maximum size of CRCC was larger than that of PRCC,and the PRCC-Ⅰ tumors tended to be smaller than PRCC-Ⅱ ones.53% of the PRCC had heterogeneous enhancement,and all calcification and necrosis were found in PRCC-Ⅱ lesions.Of all the CRCC,27% had uniform enhancement,20% had calcification and 40% had necrosis or central scar.There was no significant difference between PRCC and its subtypes and CRCC in location, maximum size,heterogeneity,calcification,necrosis and central scar.The degree of enhancement of CRCC(89.53 HU)was significantly greater than that of PRCC(66.60 HU),PRCC-Ⅰ(71.75 HU)and PRCC-Ⅱ(64.73 HU)in the cortical phase(P<0.05).The enhancement peak in the nephrographic phase was CRCC,PRCC-Ⅰ,PRCC and PRCC-Ⅱ from high to low in turn,which were all higher than that in cortical phase.In the excretory phase,the enhancement of all lesions was declined.Conclusion Contrast-enhanced CT is of certain value in the differential diagnosis among PRCC and its subtypes and CRCC.The enhancement degree of CRCC in the cortical phase is significantly greater than that of PRCC and its subtypes.The enhancement peak of PRCC and its subtypes and CRCC appears in the nephrographic phase.

OBJECTIVE: To investigate the role and clinical value of the serum level of hepatocyte growth factor (HGF) and vascular endothelial growth factor(VEGF) in laryngeal squamous cell cancer and the relationship between HGF, VEGF and clinicopathological factors. METHOD: We measured serum HGF and VEGF level in 54 laryngeal squamous cell cancer patients using ELISA to demonstrate the variation of HGF, VEGF level before operation and at day 1, 3, 7, 14 post-surgery. The concentration of the serum HGF, VEGF content in 35 normal healthy people and in 30 vocal cords polyps patients were measured by the quantitative sandwich enzyme linked immunoassay technique. RESULT: (1) The level of serum HGF and VEGF in the patients with laryngeal squamous cell cancer was significantly higher than that of normal healthy people and vocal cord polyps patients (P < 0.01). (2) The level of serum HGF, VEGF in the patients with laryngeal squamous cell cancer was related to clinical stage, differentiation situation, lymph nodes metastasis (P < 0.01), but it was independent of age at diagnosis, gender and tumor location (P > 0.05). (3) There was a significantly positive correlation between preoperative serum VEGF and HGF levels (r = 0.7667, P < 0.01). (4) Post-operational serum HGF levels in 54 laryngeal squamous cell cancer patients who underwent surgical intervention increased significantly, peaked at day 3 after operation. Serum HGF levels of survivors during follow-up period gradually decreased at day 7 and day 14 after operation. The postoperative serum levels of VEGF were decreased significantly than that of preoperation. CONCLUSION HGF and VEGF may play an important role in the development and progression of human laryngeal cancer. Elevated serum HGF and VEGF levels predict a more aggressive biological behavior in laryngeal squamous cell cancer.
Adult ; Aged ; Carcinoma, Squamous Cell ; blood ; pathology ; Case-Control Studies ; Female ; Hepatocyte Growth Factor ; blood ; Humans ; Intraoperative Period ; Laryngeal Neoplasms ; blood ; pathology ; Male ; Middle Aged ; Postoperative Period ; Vascular Endothelial Growth Factor A ; blood