Big data of electronic health records ( EHR) are faced with the challenge of both information security and privacy protection in theInternet+ era. The bottleneck of information technology in centralized and relational databases-covered EHR was described, application of block chain technology in decentralization, privacy protec-tion and gene sequencing was elaborated in order to usher in new ideas for the construction of EHR.

In recent years,combined therapy based on radical resection has promoted the prognosis of gastric cancer,but the rate rate of post-surgery recurrence is still high,which is the main cause of death.It helps us take out better treatment for gastric cancer to analyze correlation factors of gastric cancer recurrence after radical resection.It is needed to reviewed the literatures about correlation factors analysis of gastric cancer recurrence after radical resection in recent years.

Objective To explore the evolution of HBV polymerase gene as a result of adefovir dipivoxil treatment in liver transplant patients with lamivudine resistance. Methods Eight patients with HBV reinfection which was lamivudine resistance received adefovir therapy (10mg/day). Sequential serum samples were obtained from 2 consecutive patients with adefovir failure, and the polymerase gene of HBV was amplified by PCR and TA cloned, and sequencing and analysis were performed in 10 random clones. Results Neither rtN236T nor A181V/T mutation, which were associated with adefovir (ADV) resistance, was found. The rtL180M mutation associated with lamivudine resistance presented before ADV treatment, and several previously unreported amino acid substitutions were observed in the reverse transcriptase domain. Conclusion Possibly, the rtL180M mutation in the B domain of HBV polymerase reduced the susceptibility to ADV. ADV resistance mutation may occur in other sites besides rtN236T and A181V/T amino acid substitutions or do not happen early after treatment.

Objective To introduce a new appointment registration way in the outpatient department.Methods A WeChat appointment registration platform based on HIS was established with smart phone and WeChat public platform,which was gifted with the functions of online registration and payment and etc.The processes including preliminary diagnosis and return visit,cancelling appointment,treatment of appointment breaking,and the limitations during the appointment could be accomplished by the appointment registration.Results The platform realized appointment registration,information feedback and etc.Conclusion The appointment registration based on WeChat public platform contributes to satisfying the patient,enhancing medical service and distributing medical resources rationally.

Objective To compare the prognosis of sentinel node-positive breast cancer patients forgoing axillary lymph node dissection.Methods A systematic literature search (Medline,Embase,Cochrane Library)ended in April 2014 was performed to identify all eligible articles.Two reviewers independently screened and extracted data.RevMan5 was used for statistical analysis.Results A total of 1026 abstracts were retrieved and 18 clinical controlled studies finally included,the total number of patients were 47 894,7389 had micrometastases in sentinel lymph node,35 217 had macrometastases in sentinel lymph node and 5288 had positive sentinel lymph node regardless of micrometastases or macrometastases.For patients with MIC,the 5-year axillary recurrence rate,5-year disease free survival and 5-year overall survival had no significant difference between patients who only received sentinel lymph node biopsy and patients who received further axillary lymph node dissection,(OR =1.78;95％ CI:0.72-4.39,P=0.21),(OR =0.76,95％CI:0.56-1.04,P=0.08),(OR=0.77,95％CI:0.43-1.40,P=0.39).For patients with MAC,the 5-year axillary recurrence rate had no significant difference between patients who only received sentinel lymph node biopsy and patients who received further axillary lymph node dissection,(OR =1.21;95％ CI:O.76-1.91,P =0.42).For patients with positive sentinel lymph node regardless of micrometastases or macrometastases,the 5-year axillary recurrence rate and 5-year overall survival had no significant difference between patients who only received sentinel lymph node biopsy and patients who received further axillary lymph node dissection,(OR =1.29;95％ CI:0.92-1.80,P =0.14),(OR =0.96,95％ CI:0.64-1.45,P =0.84).Conclusions Among patients with limited positive SLN of breast cancer,patients forgoing ALND compared with ALND did not have obvious affect on long-term survival.

Objective To establish a capillary gas chromatography method for determination of camphol and isoborneol in Shaoshang yuhe gao ( burn healing cream) . Methods The capillary gas chromatography was adopted under the following conditions: use PEG-2000 as the stationary liquid,nitrogen as carrier gas,ZB-WAX (30 m×0. 25 mm,0. 25 μm) as the chromatographic column,and the flame ionization detector. The column temperature was programmed at 80 ℃ for 5 min as the initial temperature,then raised to 180 ℃ at the rate of 5℃·min-1 and kept for 10 min. The shunt ratio was 101. Results The liner range for camphol was 0. 487 5-31. 25 μg ( r =0. 999 6),and the average recovery was 95. 95%( n =6). The liner range for isoborneol was 0. 487 5-31. 25 μg( r =0. 999 7),and the average recovery was 96. 44%( n =6). Conclusion The method is accurate,sensitive,and can be applied to quality control of shaoshang yuhe gao.

To investigate the neuronal migration and synthesis of peptidic neurotransmitters in vitro, neuromuscular co-cultures of nodose ganglia and cardiac muscle cells of Wistar rats were established. The living cells of co-cultures were observed with an inverted contrast microscope at different culture age. At 72 h and 96 h of culture age, the neuromuscular co-cultures were examined by Holmes' reduced silver staining technique for observing the neuronal migration. Immunohistochemical staining method was used for investigating the synthesis of peptidic neurotransmitters- substance P (SP) and calcitonin gene-related peptide (CGRP). The neuronal morphorlogical maturation in neuromuscular co-cultures seems at 72 h of culture age in terms of the observation of living cells and Holmes' reduced silver staining technique. SP- and CGRP-immunoreactive neurons were observed in neuromuscular co-cultures at 96 h of culture age but not 72 h. The results indicate that the neuronal morphological maturation can not represent the maturation of neurotransmitter synthesis. The synthesis of neurotransmitters is not maturated in the neuromuscular co-cultures until 96 h of the culture age.

Objective:To discuss the clinical experience of diagnosing and managing of cerebrospinal fluid(CSF)rhinorrhea.Method:Twenty-four cases of cerebrospinal rhinorrhea were analysed retrospectively from Janu 2003 to Sept 2008, among which 18 cases from department of Otolaryngology Head and Neck Surgery and 6 cases from Neurosurgery.Result:Postoperative follow-up lasted from 4 months to 72 months. All the cases were successfully cured, among which 6 cases with conservative treatment and 18 cases under surgery,and no relapse case was found. The 18 cases under surgery included endoscopic approach(12 cases), extra-nasal approach(4 cases), transnasal approach under microscope(2 cases).Conclusion:It is not only minimally invasive, safety and efficiency of transnasal endoscopic technique for CSF leaks, but also without facial scarring after operation. Transnasal endoscopic approach can be preferred for the closure of uncomplicated CSF leak, located at the cribriform plate or the sphenoid sinus. The extra-nasal or intracranial approach may be an attractive option for more complicated and large CSF leak, or the leak site is not easily found with endoscopic.

Objective To compare the efficacy of laparoscopic and conventional open total mesorectal excision (TME) in the treatment of rectal cancer, and to explore the considerations of laparoscopic TME. Methods 75 cases of laparoscopic group and 61 cases of open surgery group were analyzed retrospectively, and cohort study was used to compare the perioperative indicators and clinicopathological results in the two groups. Results Between the laparoscopic group and the open surgery group, the operative incision [8.7 cm (8.0-10.0 cm) vs. 13.6 cm (10.0-16.0 cm)], the use of postoperative analgesics (8 cases vs. 23 cases), postoperative time to remove the drainage tube [5 d (5-6 d) vs. 6 d (6-8 d)], postoperative time to get out of bed [3 d (3-7 d) vs. 5 d (4-8 d)] and postoperative hospital stay time [6 d (5-18 d) vs. 8 d (6-25 d)] had statistical difference (all P<0.05). The cost of laparoscopic group was higher than that of open surgery group (each patient in laparoscopic group spent more about 7 000 yuan than ones in open surgery group ). There was a significant difference in the overall complication rate between the laparoscopic group and the open surgery group [6.7 % (5/75) vs. 13.1 % (8/61), P<0.05]. Conclusions The postoperative analgesics, removal of drainage tube time, hospital stay and other indicators in the laparoscopic TME are superior compared with those in the open surgery, but due to the use of high-value consumables, the cost of laparoscopic surgery is higher. Besides, laparoscopic resection of rectal cancer should be careful.