Objective To analyze the existing problems in the management of outpatient, to change the traditional manage-ment mode and to provide convenience for outpatient medical care.Methods By adopting the establishment of outpatient manage-ment by walking -around team, making the inspection content and quality standards of walking -around management and implemen-ting three class patrol management, We realized the transformation of the traditional outpatient management mode .Results After im-plementing the management by walking around, outpatients'satisfaction were improved and complaints reduced.Conclusion Man-agement by walking around has great effect on meeting the medical needs of patients, improving the quality of clinic service, optimi-zing the management process, and improving the hospital's reputation.

Objective To investigate the relationship between the expression of DEK and Hpa infection in uterine cervical carcinogenisis.Methods Formalin-fixed,paraffin-embedded samples including 45 cases of squamous cell carcinomas,25 cases of cervical intraepithelial neoplasia CINⅢ,and 20 cases of CINI-Ⅱ,10 cases of normal cervical tissues were studied using polymer detection system for immunohistochemical technique to examine the expression of DEK and Hpa.Results The positive ratios of DEK in cancer tissues,normal cervical intraepithelial lesions,normal cervical tissues positive rates were 88.9％,24.4％,10.0％,respectively.The positive ratio of expressions of DEK in cervical carcinomas was significantly higher than CIN and normal cervical tissues (x2 =38.054,P ＜0.01 ;x2 =5.774,P ＜0.05).The positive ratios of expressions of Hpa in normal cervical tissues,CIN and cervical cancers were 75.6％,24.4％ and 10.0％,respectively.The positive ratio of expressions of Hpa in cervical carcinomas was significantly higher than CIN and normal cervical tissues ( x2 =31.69,P ＜ 0.01 ; x2 =12.94,P ＜ 0.01 ).The expression of DEK and Hpa in cervical lesions was highly related in the cervical cancer tissues( r =0.617,P =0.001 ).Conclusions DEK and Hpa possibly played an important role in the development of cervical cancer.Cervical intraepithelial lesions and cervical carcinoma might be associated with changes in the expression of DEK and Hpa,and interact together to influence the development of CIN and cervical cancer.

Objective To assess the prevalence and clinicopathologic significance of the microsatellite instability(MSI),PTEN mutations and their correlations in endometrial carcinogenesis.Methods The MSI analysis was performed using five microsatellite markers in paired uterine endometrial carcinoma(UEC) and atypical endometrial hyperplasia(AH).PTEN mutations were detected by single-strand conformation polymorphism(FCR-SSCP) analysis and DNA sequencing in UEC,AH and normal epithelium(NE).Rescults There was a significant difference in the incidence of PTEN mutations among AH,UEC and NE(P<0.01).PTEN mutations changed significantly in AH-the direct precursor to UEC(P<0.01).PTEN mutations correlated significantly with the clinical stage of the UEC(P<0.05).In UEC with MSI,PTEN mutations were detected in the short coding mononucleotide repeats(A) in 2(18.2%) of the 11 carcinomas.PTEN had a substantially higher frequency of mutations in UEC with MSI compared with the frequency of mutations in UEC without MSI(P<0.05).Conclusion PTEN mutations and MSI were two of the most common genetic alterations and correlated with each other in uterine endometrioid carcinoma.PTEN mutations might be secondary to deficiencies in mismatch repair and give some explanation for the frequent presence of PTEN mutations in MSI positive UEC.

Objective To detect COX-2 mRNA in cervical cancer and normal cervix, and explore the pathogenesis of adenocarcinoma of the uterine cervix. Methods COX-2 expression was detected by RT-PCR to explore the relationship between COX-2 and the adenocarcinogenon of cervical cancer in 36 cases of adenocarcinoma of the uterine cervix and 15 cases normal cervical tissue. Results The positive rate of COX-2 mRNA in adenocarcinoma of the uterine cervix tissues (55.6%) was higher than that of normal tissues ( 20. 0% ), the difference was significant ( P ＜ 0. 05). The expression of COX-2 mRNA was associated with stages and clinical grading of tumor ( P ＜ 0. 05), but no significant difference was found between stages and clinical grading of uterine cervix adenocarcinoma( P ＞ 0. 05). Conclusion The hyper expression of COX-2 mRNA in uterine cervix adenocarcinoma took part in the carcinogenesis of tumor.

Objective To study the clinical,image and pathological features of cerebral gliomatosis.Methods 2 cases with cerebral gliomatosis underwent routine MRI scan, contrast enhance MRI scan and pathologic examination of the lesions. Their clinical manifestations were observed during the past 2 years.Results Main clinic features of the 2 patients were headache, dizziness, nausea, vomit, diplopia, hemiplegia, hemianesthesia and ataxia. Cranial MRI scan showed long T 2 signals in the bitemporal lobes, biparietal lobes, corpus collosum, thalamus, caudate nucleus and putamen. Brain stem and cerebellum were also involved in 1 patient. The borders of the lesions were unclear and no mass-effect phenomenons were found. Contrast enhancement occurred only in 1 patient after Gd-DTPA injection. The biopsies in the 2 patients showed diffuse infiltrative growth of most astroglioma cells. The shape of nucleus was round or ellipse and the staining of nucleus was comparatively deep. Cleavage of nucleus was seldom. The 2 patients died in 4 to 6 months after the onset of the disease.Conclusions MRI scan and pathologic examination are essential diagnostic methods for cerebral gliomatosis. The prognosis of cerebral gliomatosis is poor.

Objective To study the pathologic and molecular genetic characteristics of Chinese patients with oculopharyngeal muscular dystrophy(OPMD).Methods The ultrastructural muscle biopsies in 6 patients were carried out by using transmission electron microscopy.The DNA was obtained through blood samples from patients(n=11) and the at-risk individuals(n=16).Amplification of the PABPN1 gene mutation region was performed by polymerase chain reaction(PCR).The sequences were obtained and compared with the genomic sequence of the human PABPN1 gene.Results Intranuclear inclusions(INIs) were found by electron microscopy in 4 patients,and the rate of appearance was 18%,20%,34% and 40%.Sequence analysis of exon 1 of PABPN1 gene showed abnormal expansions of the GCG-repeat—(GCG)_8 and(GCG)_(10) in 9 patients.Conclusions INIs might be found by electron microscopy in muscle biopsies of OPMD patients.The rate of appearance of INIs should have positive relationship with the amount of the GCG-repeat.PABPN1 gene mutations might be present among Chinese patients with OPMD,and should have a negative relationship with the age of onset.

Objective To investigate the effects of Xuebijing injection on T-lymphocyte subgroups and clinical efficacy in treatment of patients with severe pneumonia.Methods 60 patients with severe pneumonia were selected into the study.The patients were randomly divided into Xuebijing group (n =30) and control group (n =30).Patients in the control group were given routine therapy.The Xuebijing group received the treatment of routine therapy combined with Xuebijing injection.The changes of T lymphocyte subgroups and clinical efficacy were compared between the two groups.Results The levels of CD3,CD4,CD4/CD8 after treatment in Xuebijing group and control group were significantly higher than those of before treatment (t =4.95,4.89,4.96,3.13,3.11,3.09,all P ＜ 0.05),those in the Xuebijing group were significantly higher than control group (t =3.89,3.56,3.78,all P ＜ 0.05).The total effective rate in the Xuebijing group was 93.3％,which was significantly higher than 76.6％ in the control group (x2 =4.55,P ＜ 0.05).Conclusion Xuebijing injection combined with routine western medicine is quite effective in treatment severe pneumonia.Xuebijing can improve the immune function of patients.

Patients with advanced cancer often suffer from cachexia. The researches on cancer cachexis using Chinese medicine include theoretic and clinical studies. The thesis also includes:a systemic comparison to review the progress in recent years, a simple analysis on the problem and shortages of the researches, and a suggestion on the future direction,

Objective To investigate clinical effect of mild hypothermia therapy assisted intracranial hematoma evacuation in treatment of cerebral hemorrhage.Methods One hundred and ten patients with cerebral hemorrhage were selected in Affiliated Hospital of North China University of Science and Technology from December 2011 to December 2013,and were randomly divided into two groups.Fifty-five patients treated intracranial hematoma evacuation as control group.Another 55 patients treated mild hypothermia therapy assisted intracranial hematoma evacuation as observation group.Treatment effect was compared between two groups.Results Serum S100β,neuron specific enolization (NSE) enzyme,tumor necrosis factor α (TNF-α),creactive protein(CRP),cognitive function score,daily life ability score,neurological function defect score before and after treatment in control group were (0.82±0.12) μg/L and (0.53±0.09) μg/L,(19.42±2.30) μg/L and (10.36±1.07) μg/L,(3.62±0.57) mg/L and (1.54±0.30) mg/L,(29.43±4.36) g/L and (10.25± 1.07) g/L,(13.42± 1.58) points and (25.03± 1.19) points,(21.45± 3.27) points and (37.92 ± 5.83)points,(13.27± 1.35) points and (4.84 ± 1.08) points,the differences were significant (t =8.471,11.834,17.026,22.539,12.230,10.619,25.531,P ＜ 0.05).Serum S100β,NSE,TNF-α,CRP,cognitive function score,daily life ability score,neurological function defect score before and after treatment in observation group were (0.84±0.13)μg/L and (0.41±0.10) μg/L,(19.48±1.76) μg/L and (8.75±0.84) μg/L,(3.64± ±0.61) mg/Land (1.17±0.29) mg/L,(29.58±3.62) g/L and (6.02±1.18) g/L,(13.29±1.34) points and (27.58± 1.27) points,(21.68±4.02) points and (48.26±7.14) points,(13.46± 1.21) points and (3.57±0.85) points,the differences were significant(t=13.498,16.739,25.728,41.836,13.769,15.857,36.352,P＜0.05).Compared with serum S100β,NSE,TNF-α,CRP,cognitive function score,daily life ability score,neurological function defect score before treatment,there were no difference between two groups (P ＞0.05).Serum S100β,NSE,TNF-α,CRP,neurological function defect score after treatment in observation group were lower than control group(t =5.926,4.839,6.162,10.054,6.714,P＜0.05).Cognitive function score,daily life ability score after treatment in observation group were higher than control group (t =4.008,5.973,P ＜0.05).Postoperative Glasgow prognosis classification in observation group (14 cases of grade Ⅰ,27 cases of grade Ⅱ,11 cases of grade Ⅲ,2 cases of grade Ⅳ,1 case of grade Ⅴ) was better than control group(8 cases of grade Ⅰ,12 cases of grade Ⅱ,23 cases of grade Ⅲ,7 cases of grade Ⅳ,5 cases of grade Ⅴ),the differences were significant between the two groups (Z=17.085,P =0.002).Total effective rate in observation group 94.5％ (52/55) was higher than control group 78.2％ (43/55),the differences were significant between the two groups (Z =6.253,P=0.012).Conclusion Mild hypothermia therapy assisted intracranial hematoma evacuation in treatment of cerebral hemorrhage,can significantly reduce inflammatory factor and S100βlevel,improve neurological function,has significant effect and good prognosis.It is worthy of clinical use.

OBJECTIVE To understand the resistant bacteria infection condition of earthquake casualty and provide evidence for reducing their transmission in hospital.METHODS The staff members of Department of Hospital Infection Management monitored the bacteria cultures and report 38 resistant bacteria infective wounded every day.Set up the system measures to manage resistant bacteria infection of earthquake casualty and monitored,guided and checked the implement countermeasures.RESULTS Among 419 samples,there were 70 resistant bacteria and 97.1% were G-bacteria,the main pathogens were Acinetobacter baumannii,Pseudomonas aeruginosa,Enterobacter cloacae,Klebsiella pneumoniae,and Escherichia coli.The main infective sites were respiratory tract and wounds.The resistant bacteria had the high drug resistance to the third and fourth cephalosporins,aminoglycosides and sulfonamides.The sensitive rate to amikacin,gentamicin,imipenem,piperacillin/tazobactam,sulfamethoxazole/trimethoprim compound,tobramycin and nitrofurantoin.CONCLUSIONS Real-time monitoring the earthquake casualty with resistant bacteria infection can find the infective wounds in time and make effective intervention measures.It is the important method to prevent and control the hospital infection.