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.

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.

Objective To evaluated the risk factors of urethral recurrence ( UR) following radical cystectomy ( RC) in patients with bladder urothelial carcinoma.Methods The clinical data of 350 male patients who underwent RC between January 2005 and January 2013 were retrospectively analyzed.The mean age was 63 years (rang 46-76) years.176 cases had the history of non-muscle-invasive bladder cancer.15 cases were were found the tumor invasion into the prostatic urethral.The way of urinary diversion after RC included 172 cases were orthotopic neobladder, 90 cases were cutaneous diversion and 88 cases were ileal couduitin.331 cases underwent preoperation intravesical instillation.36 cases underwent systemic chemotherapy after operation.148 cases were found the multiple tumor lesions, which was more than 2 sites. The pathological stage was more than T2 satge in 189 cases.And 177 cases were diagnosed as high-grade urothelial carcinoma.Multivariate Cox regression analyses were used to evaluate the risk factors associated with the UR.Results There were 350 cases in this study, UR was observed in 28 cases ( 8%).On multivariate Cox regression analyses, previous history of NMIBC (HR=15.205,95%CI 3.718-62.180,P<0.001), prostate urethral involvement(HR=5.233,95%CI 1.106-24.754,P=0.037) and Non-orthotopic neobladder(HR=6.656,95%CI 1.840-24.077,P=0.004)which the operation of cutaneous diversion and ileal couduit , were independent risk factors of UR following RC.Intravesical instillation before operation ( HR =0.470, 95%CI 0.010-0.217, P <0.001 ) was the protective factor of the UR.Conclusions Previous history of NMIBC, prostatic urethral involvement and Non-orthotopic neobladder were independent risk factors of UR.Intravesical instillation before operation was protective factor of UR.Urethrectomy for patients with high risk factors and intravesical instillation before operation were important.

BACKGROUND:Previous studies have demonstrated that transplantation of control ed release glial cellline-derived neurotrophic factor and bone marrow mesenchymal stem cells-derived neuron-like cells can effectively promote the motor function and sensory function recovery of rhesus monkeys with spinal cord injury.
OBJECTIVE:To validate whether co-transplantation of control ed release glial cellline-derived neurotrophic factor and bone marrow mesenchymal stem cells-derived neuron-like cells exhibits better protective effects on spinal cord glial scar of rhesus monkeys with spinal cord injury than celltransplantation alone.
METHODS:Twelve rhesus monkeys were col ected to prepare animal models of acute severe spinal cord injury using modified Al en’s method, and then randomly divided into three groups:experimental group, co-transplantation of control ed release glial cellline-derived neurotrophic factor and bone marrow mesenchymal stem cells-derived neuron-like cells;control group, simple transplantation of bone marrow mesenchymal stem cells-derived neuron-like cells;blank control group, PBS. After 5 months, paraffin specimens of the spinal cord were made for detection of morphological and compositional characteristics of glial scar, regeneration of nerve fibers in the scar, glial scar area, and average absorbance of glial fibril ary acidic protein.
RESULTS AND CONCLUSION:Glial scar in the injured spinal cord was composed of astrocytes and histocytes. Less spinal cord glial scar area and lower absorbance value could be observed in the experimental and control groups as compared with the blank control group (P<0.05). In addition, in the blank control group, neurofilament negative fibers could be observed in the glial scar, and astrocytes proliferated obviously. The experimental and control groups showed less fibers passed through the scar area. The glial scar area and average absorbance in the experimental group was lower than that in the control group (P<0.05). These findings suggest that compared with simple transplantation of bone marrow mesenchymal stem cells-derived neuron-like cells, co-transplantation of control ed release glial cellline-derived neurotrophic factor and bone marrow mesenchymal stem cells-derived neuron-like cells shows better protective effects spinal tissue structure after spinal cord injury, which may be one of mechanisms by which the number of glial scars is reduced to a greater extent.

AIM: To investigate the effects of metformin on airway inflammation, remodeling and neovascularization in a mouse model of chronic asthma and its possible mechanisms.METHODS: BALB/c mice were randomly divided into saline group, ovalbumin (OVA) group and OVA+metformin group, with 8 in each.At the end of OVA exposure, blood and bronchoalveolar lavage fluid (BALF) were collected for the measurement of OVA specific IgE and leukocyte counts.Lung tissue sections were stained with hematoxylin-eosin, periodic acid-Schiff and Masson's trichrome to detect inflammatory cell infiltration, goblet cell hyperplasia, and collagen deposition around the airway, respectively.Immunohistochemistry was used to evaluate the number and percentage area of new blood vessels (CD31+), and the protein level of phosphorylated AMP-activated protein kinase (p-AMPK) in the airway.RESULTS: Compared with saline group, the eosinophil percentage and OVA specific IgE in serum in OVA group were all increased obviously (P<0.01).Metformin inhibited the above increases (P<0.05).Compared with control group, a marked increase in inflammation infiltration, PAS+ cells and collage deposition in the airway mucosa in OVA group were observed.Metformin partially relieved the above changes.CD31+ vessels in the wall of bronchi showed the abundance of blood vessels observed in OVA group compared with control group, which was suppressed by the treatment with metformin (P<0.05).The protein level of p-AMPK was reduced in the lung tissue challenged with OVA as compared with control group (P<0.05), while metformin increased the protein level of p-AMPK (P<0.01).CONCLUSION: The protein level of p-AMPK in the airway in OVA group is attenuated.Metformin effectively inhibits airway inflammation, remodeling and neovascularization possibly via activating AMPK signaling pathway.

BACKGROUND:The application of anterior cervical plate for anterior cervical discectomy and fusion wil induce some complications such as dysphagia after treatment.
OBJECTIVE:To observe the clinical efficacy of the new implant Zero-P system for cervical spondylosis patients and its effect on reducing complications after treatment.
METHODS:A total of 51 cervical spondylosis cases underwent anterior cervical discectomy and fusion using Zero-P system. Neurological function was evaluated by neck/arm visual analogue scale, neck disability index and Japanese Orthopaedic Association scores pretreatment, at 3 days, 3, 6 months, 1, 2 years post-treatment. The incidence of postoperative dysphagia was evaluated using dysphagia score. Anteroposterior&lateral and dynamics X-ray films were used to evaluate the efficacy of graft fusion and internal fixation-related complications.
RESULTS AND CONCLUSION:The patients were fol owed up for 6-30 months, averagely 15.4 months. After treatment, their incision achieved stage I healing. Pain was relieved and muscle force was restored in al patients after treatment. Visual analogue scale and neck disability index scores were apparently improved. Improvement rate of Japanese Orthopaedic Association score was 85.7%. At 2 days after treatment, seven patients experienced mild and moderate dysphagia. During fol ow up, implant subsidence was not observed. No complications, such as screw loose, breakage or fixator displacement, were found. Results suggested that the new cervical stand-alone anterior fusion device in anterior cervical discectomy and fusion procedure for the treatment of cervical spondylosis has offered an excellent clinical outcome. Its design has the advantages of cervical interbody fusion and anterior cervical plate. There were less relevant complications.

Objective To evaluate the efficacy of the flexible laser endotracheal intubation light-wand device in guiding tracheal intubation in pediatric patients. Methods Ninety pediatric patients of both sexes, aged 4-8 yr, of American Society of Anesthesiologists physical statusⅠor Ⅱ, scheduled for elec-tive surgery under general anesthesia requiring oral tracheal intubation, were divided into 2 groups ( n=45 each) using a random number table method: flexible laser endotracheal intubation lightwand device group ( group A) and direct laryngoscope group ( group B) . After induction of anesthesia, orotracheal intubation was carried out with a flexible laser endotracheal intubation lightwand device in group A or with a direct la-ryngoscope in group B. The development of hypertension and tachycardia during intubation, intubation time, and rate of successful intubation were recorded. The development of complications such as sore throat, hoarseness, aphonia and dysphagia was recorded at 24 h after surgery. Results Compared with group B, no significant change was found in the total rate of successful intubation ( P>0. 05) , the rate of successful intubation at first attempt was significantly increased, incubation time was shortened, and the in-cidence of hypertension and tachycardia during intubation and sore throat after surgery was decreased in group A ( P<0. 05) . Conclusion The flexible laser endotracheal intubation lightwand device produces bet-ter efficacy in guiding tracheal intubation when compared with direct laryngoscope in pediatric patients.

Single-docking robot-assisted laparoscopic radical nephroureterectomy is difficult to deal with the distal ureter and bladder. Thirty-two patients with ureter carcinoma underwent single-docking robot-assisted nephroureterectomy in rectus rectilinear cannula placement in our hospital. The advantages include lower surgical difficulty, shorter operation time, less surgical bleeding and damage. This surgical method is a safe and effective minimally invasive treatment for ureter carcinoma.

Objective : To examine the association between acute exposure to traffic-related air pollutants (TRAP) NOX and NO2 and outpatient visits of pediatric respiratory diseases. Methods : Data regarding outpatient visits to Department of Respiratory Diseases of Beijing Children's Hospital from 2015 to 2020 were collected, and the concentrations of nitrogen oxides (NOX), nitrogen dioxide (NO2) and other TRAP were collected from the surveillance sites assigned by the Peking University Health Science Center. A time-stratified case-crossover design was employed, and a conditional logistic regression model was created to examine the association between NOX and NO2 acute exposure and outpatient visits of pediatric respiratory diseases. Results : The daily mean outpatient visits of pediatric respiratory diseases were 571 (interquartile range, 554) person-times among children at ages of 0 to 14 years in Beijing Children's Hospital from 2015 to 2020, and the daily mean outpatient visits for upper respiratory tract infections (URI), bronchitis, and pneumonia were 265 (interquartile range, 282), 143 (interquartile range, 178) and 128 (interquartile range, 120) person-times, respectively. The daily mean concentrations of atmospheric NOX and NO2 were 67.8 (interquartile range, 50.7) and 49.3 (interquartile range, 30.7) μg/m3, respectively. Conditional logistic regression analysis showed the largest lagged effect of NOX and NO2 on pediatric respiratory diseases at cumulative lags of 0 to 7 days. An increase in NOX concentrations by an interquartile range resulted in the excess risks of URI, bronchitis and pneumonia by 6.87% (95%CI: 6.37%-7.38%), 7.25% (95%CI: 6.51%-7.99%), and 5.51% (95%CI: 4.69%-6.33%), and an increase in NO2 concentrations by an interquartile range resulted in excess risks of URI, bronchitis and pneumonia by 5.71% (95%CI: 5.12%-6.31%), 5.32% (95%CI: 4.51%-6.14%), and 4.83% (95%CI: 3.91%-5.75%), respectively. NOX and NO2 presented a more remarkable effect on outpatient visits of pediatric respiratory diseases among children at ages of over 5 years. Conclusion NOx and NO2 acute exposure may increase the outpatient visits of pediatric respiratory diseases.

Objective: To investigate parents acceptance to the COVID-19 vaccine booster shots for their children aged 3-11 years in Nanjing based on the theory of planned behavior, and to provide a scientific theoretical basis for carrying out COVID-19 booster vaccination among children of this age group. Methods: A total of 1 286 parents of children aged 3-11 years in Nanjing were selected by multistage stratified cluster sampling. A questionnaire survey based on the theory of planned behavior was used to investigate their willingness to vaccinate their children with the COVID-19 booster dose, and structural equation model was used to conduct data analysis. Results: About 90.2% of parents were willing to give their children a booster dose of the COVID-19 vaccine. The model constructed based on the theory of planned behavior could explain 42.2% of the variance of vaccination acceptance. Attitudes and perceived behavioral control had a direct positive effect on parents acceptance to booster dose of the COVID-19 vaccine (path coefficients were 0.47 and 0.18, P <0.01); The direct effect of subjective norms on vaccination acceptance was not statistically significant; Perceived behavioral control and subjective norms could have indirect positive effects on vaccination acceptance through attitudes (path coefficients were 0.27 and 0.13, P <0.01). Conclusion Parents in Nanjing have a higher acceptance to vaccinate their children aged 3-11 years with the COVID-19 vaccine booster dose. The theory of planned behavior shows a good explanatory ability on parents acceptance to vaccinate their children, and attitude plays an important role in the formation of vaccination acceptance.