ObjectiveTo establish a mathematical formula for choosing the manner of replacement fluid infusion in continuous renal replacement therapy (CRRT), so as to provide the basis for improving the treatment effect. Methods A mathematical formula for choosing the manner of replacement fluid infusion with continuous veno-venous hemofiltration (CVVH) was taken as an example, and it was compared with the result of standard replacement fluid in order to analyze the effect of different manners of infusion.① Comparison parameters: the plasma volume (Vreturn) and some electrolyte concentration (Creturn) in back way of CRRT (if other thing was solute, filter coefficient should be 1.0).② Research objects: the actual replacement fluid (for example, the most complex should be sorted into A and B type) mode (pre or post) was compared with the standard replacement fluid (the A and B in one).③ Based on the formula of standard replacement, four equations in different conditions were derived: pre-dilution and post-dilution mode; same direction and same ratio; same direction and different ratio; different direction and same ratio; different direction and different ratio.Results The calculated results of Vreturn (except hematocrit) and Creturn were same to the standard only following the rule of same direction and ratio for A and B no matter pre-dilution mode or post-dilution mode, and it was different from the standard in others. In pre-dilution mode and post-dilution mode, it showed:① A and B in same direction and different ratio: Vreturn and Creturn were different from the standard for the alterative ratio of B.② A and B in different direction and same ratio: Vreturn was same to the standard, but Creturn was different from the standard for the completely different and more complex computational formula.③ A and B in different direction and different ratio: both Vreturn and Creturn were different from the standard. The different Vreturn was due to the different ratio of B. The different Creturn was caused by different ratio of B and the completely different computational formula.Conclusions① For parts of replacement fluid which must be separated ( for example, bicarbonate formula ), the result is same to the standard, and is predicted and mastered only following the rule of same direction and ratio. Otherwise, we need to calculate the two parameters over and over again. The result will run out of our judgment. The wrongness of losing water and electrolyte disorders maybe come out.② Accordingly,the formula could be used to analyze the same case like the separated replacement infusion, for example, a large number of citrates as regional anticoagulation were infused only in the front of filter, while the replacement fluid can be done in varied forms.

Based on the analysis of dataflow and workflow of hospital HIS?RIS and PACs,this article projects a system integration model in the digital hospital construction.By the design of a typical hospital information system,a method of all the information system workflow integration is proposed and validated,which is based on the HL7 and DICOM.

Objective To focus on the expressiveness and flexibility of OpenSDE: an application that supports recording of structured narrative data. Methods OpenSDE enabled data entry with (customizable) forms based on trees of medical concepts. The relevant scope for data entry could be tailored per medical domain by construction of a domain-specific tree. OpenSDE was intended for structuring narrative data to make these available for both care and research. Results The OpenSDE application was used at two departments in aspects of radiology, neurology, pediatrics, and child psychiatry. Conclusion OpenSDE is superior to traditional text entry method in aspects of correct and full expression and clinical decision support.

Objective To develop an integration profile for hospital clinical system and medical image information system, and discuss relative problems on regional medical image sharing based on the Cross -Enterprise Document Sharing Integration Profile (XDS). Methods As medical image constitutes important information of the patient health record, it is logical to extend the XDS integration profile to include images. The new integration profile for sharing images and image reports between multiple enterprises and the XDS for Imaging(XDS-I) was used. Results The XDS-I profile can be used in medical image sharing system in multiple enterprises. Conclusion The IHE XDS-I can give references for medical imaging regional sharing.

Obiective To develop an integration profile for hospital clinical system and medical image information system, and discuss relative problems on regional medical image sharing based on the Cross-Enterprise Document Sharing Integration Profile (XDS). Methods As medical image constitutes important information of the patient health record, it is logical to extend the XDS integration profile to include images. The new integration profile for sharing images and image reports between multiple enterprises and the XDS for Imaging(XDS-I) was used. Results The XDS-I profile can be used in medical image sharing system in multiple enterprises. Conclusion The IHE XDS-I can give references for medical imaging regional sharing.

Objective To further develop SDE for structured documentation of clinical data based on medical ontology. Methods OpenSDE was customized for the broad domain of medical ontology: medical concepts and its descriptors from history taking and physical examination were modeled into a tree structure. Results An expandable EMR system with structured data entry was developed. Conclusion Structured data entry is significant to clinical decision based on EMR.

Objective To prove with mathematical formula that the patient's blood electrolyte concentration shows a tendency to approach that of replacement-fluid after continuous renal replacement therapy (CRRT).Methods Electrolyte concentration of plasma,replacement-fluid and returning fluid were compared,and they were labeled as Cblood,Cnom,and Creturn respectively.The Creturn was calculated,and the relationship among them was demonstrated with comparison by mathematical formula.At last,according to their relationship,plasma change towards to the replacement fluid was analyzed.Results It was showed that Cblood＜Creturn＜Cnom or Cblood＞Creturn＞ Cnom,and according the relationship,it was derive that the trend of change in Cblood after circulation for m unit time was Cblood1 ＞Cblood2 ＞Cblood3 ＞ … ＞Cbloodm ＞Cblood or Cblood1 ＜ Cblood2 ＜Cblood3 ＜ … ＜Cbloodm ＜Cnom.The plasma electrolyte concentration would close to that of replacement fluid infinitely with the continue of CRRT.Conclusions With mathematical model,it is proved that the replacement fluid electrolyte concentration is the final target of the plasma.We must make up the replacement fluid correctly.And this results provide the basis for CRRT treatment of electrolyte disorder.

Objective To study the accuracy of the anteversion of femoral prosthesis in hemiarthro-plasty for treating femoral intertrochanteric fracture in the elderly.Methods Twenty femoral neck antever-sions of specimens were measured, which were control group(A).The femoral specimens were made into the model of femoral intertrochanteric fracture, which were installed femoral prosthesis according to minor trochanter(B),identifying the max diameter of cavum medulla(C),ocular estimating femoral condylar line ( D) ,combination of identifying the max diameter of cavum medulla and ocular estimating femoral condylar line( E) respectively.All the anteversion of femoral prosthesis were measured.Results The anteversion were:A group(8.98 ±4.31)°,B group (9.12 ±4.87)°,C group (9.57 ±6.49)°,D group (13.18 ± 5.83)°,E group (10.37 ±4.56)°respectively.The difference among the five groups was statistically sig-nificant.There was difference between D and A, there were no differences between B and A, C and A, E and A respectively.Conclusions In hemiarthroplasty for treating femoral intertrochanteric fracture, the an-teversion of femoral prosthesis is according to minor trochanter possibly; if the minor trochanter can not be got reduction, it is a good option according to combination of identifying the max diameter of cavum medulla and ocular estimating femoral condylar line to make sure the accuracy of the anteversion of femoral prosthe-sis.

Objective To explore the application ways of IHE XDS technology in electronic medical record (EMR) system and develop application system of clinical EMR integration. Methods The clinical EMR integration plan was worked out based on IHE XDS technical framework. Results A EMR solution based on IHE XDS was presented. It was consisted of the components of the clinical Data Entry, XDS Registry, clinical document Repository, EMR application server and the i-node accessing server. The system was tested and the result indicated that the system was effective and scalable. Conclusion IHE XDS profile can be not only used to realize the sharing of EMR documents across multiple hospital, but also support the collection clinical data within a hospital clinical system integration.

Objective To investigate the prevalence, clinical characteristics and antibiotic resistance of Haemophilus influenzae (HI) in children with acute respiratory tract infection in Suzhou. Methods Data of sputum culture of 3 167 hospitalized childhood patients with acute respiratory tract infection from January 2006 to December 2007 were collected. The incidence of positive HI and the rate of resistance to different antibiotics were calculated and beta-lactamases of the strains were detected. Results About 4.4% of total 3 167 eases were infected with HI. The infection rate was related with season and sex, more frequent between February and June, more common in boys than girls. Children younger than three years old were likely to be infected by HI, eompared with other age groups. The beta-lactamase positive rate of HI was 31.4%. The resistance rates to ampicillin, SMZ + TMP, chloramphenicol, cefaclor, ceftazidime, tetracycline and ampicillin/sulbactam were 29.6% ～ 31.9%, 66.2% -73.9%, 19.7% ～ 15.9%, 2.8% ～ 14.5%, 2.8% ～0、 28.2% ～ 2.9% and 4.2% ～ 1.4% respectively. Isolates resistance to cefuroxime、 ceftriaxone、 imipenem、azithromycin and ciprofloxacin were not found. Conclusions The infection of HI in children with actue respiratory tract infection is closely related with season and sex in Suzhou. Children younger than three years old are at high risk. The beta-lactamase positive rate of HI was high and increased rapidly. Resistance rate to azithromycin, SMZ + TMP and chloramphenicol was high, some isolates were resistant to the second, third generation of cephalosporin. Monitoring the antibiotic resistance of H! should be emphasized.