Put forward in this paper are suggestions for the solution of problems (insufficient investment of funds, shortage of professionals , incapability of interlink and interaction of hospital data) in Huanggang hospital information construction, including quickening medical information professionals training, optimizing their structure, bringing the leading role of government into full play, adding investment of funds, strengthening construction of infrastructures , establishing criteria for data, promoting interlink and interaction of data, enforcing management and maintenance of hospital information system , founding cooperative professional societies .

OBJECTIVE To evaluate the risk factors of broad-spectrum antibiotic usage more than for two weeks and primary pulmonary disease as a risk factor of nosocomial infections. METHODS A retrieval report which used retrospective case control study to analyze the two risk factors of fungi nosocomial infection was reviewed. Fixed effect model or stochastic effect model were used for statistical analysis. RESULTS Three retrospective case control studyies were investigated. The primary pulmonary disease exposure rate was significantly higher than control group. Broad-spectrum antibiotic usage exposure rate had not significant difference. CONCLUSIONS Broad-spectrum antibiotic more than two weeks isn′t a risk factor but primary pulmonary disease is the risk factor for fungi nosocomial infection.

Objective T o observe the expression changes of hypoxia inducible factor-1α (H IF-1α) and vascular endothelial grow th factor-A (V E G F-A ) in rats w ith arrhythm ias, and to explore the differences of the expression pattern in the tw o indicators of acute m yocardial ischem ia caused by arrhythm ias and coronary insufficiency. Methods T he arrhythm ia w as induced by C aC l2, and the expression changes of H IF-1α and V E G F-A w ere detected by im m unohistochem istry, W estern blotting and real-tim e PC R w ithin 6 h after the arrhythm ia in rats. Results T he expression of H IF-1α and V E G F-A show ed diffuse in the m yocardial tissue of rats died from arrhythm ias. B oth of them increased in the early arrhythm ia, then decreased. E xtensive m yocardial ischem ia happened at the beginning of arrhythm ia occurrence and its range didn't expand w ith tim e. Conclusion T he expressions of H IF-1α and V E G F-A in m yocardium of the rats w ith arrhythm ia can provide evidence for the differential diagnosis of acute m yocardial is-chem ia caused by fatal arrhythm ia and coronary insufficiency.

Fatal anaphylactic shock is common in forensic practice. However, it is difficult to diagnose for lacking specific pathological and morphologic changes in forensic autopsy. The application of some biochemical indicators is of great significance. This paper reviews the biological characteristics of some biochemical indicators and detection methods. The forensic application, problems and prospects of these indicators are also introduced in details. The stable biochemical indicators, IgE, tryptase and chymase, show great potential and advantages in the identification of fatal anaphylactic shock in forensic medicine.

Objective To explore the changes of serum IgE and tryptase caused by anaphylactic shock rats and discuss the relation to PMI and preservative environm ent of corpse and specim en. Methods Rats were used for establishing anaphylactic shock m odels and random ly divided into room tem perature group, refrigeration group, frozen group, manual hem olysis group, specim en preservation group. And the control group was also established. The blood sam ples were collected after rats were sacrificed. The de-gree of hem olysis was graded according to the color of the upper layer of the serum . The mass concen-tration of IgE and tryptase in each group was detected by ELISA. Results The levels of serum IgE and tryptase in anaphylactic shock dead rats were higher than that of the control group. Room tem perature and frozen m ade obviously differences on the levels of serum IgE and tryptase with various PMI. The levels of serum IgE and tryptase in refrigeration group show ed relatively stable. The levels of serum tryptase and IgE were elevated with differently increasing hem olysis. The levels of serum IgE and tryptase show ed no obvious changes during the specim en kept under different tem perature conditions for 25 days. Conclusion Serum IgE and tryptase obviously increased in anaphylactic shock rats. H ow ever, the levels were influenced by PMI and environm ental tem perature, especially under the conditions of room tem perature and frozen.

Objective To investigate the effect of remote ischemic preconditioning (RIPC) combined with dexmedetomidine on lung injury during perioperative period and postoperative pulmonary complications in elderly patients with thoracotomy and pulmonary dysfunction.Methods Sixty ASA Ⅱ or Ⅲ patients aged 65-76 years [mean (70.4±6.3) years],weighing 50-75 kg,with moderate and severe pulmonary dysfunction,who were scheduled for elective radical operation for esophageal cancer,were randomly divided into 3 groups (n=20,each) by using a random number table:the control group (group C),RIPC group (group OR) and RIPC plus dexmedetomidine group (group ORD).At 10 min after endotracheal intubation,group ORD was induced by three cycles of 5 min of lower extremity ischemia followed by 5 min of reperfusion,at the same time a loading dose of dexmedetomidine 0.5 μig / kg was infused iv over 15 min,and then was infused at a rate of 0.5 μg · kg-1 · h-1 until the end of operation.Group OR was induced by three cycles of 5 min of lower extremity ischemia followed by 5min of reperfusion without dexmedetomidine.Group C received only the equal volume of normal saline.Blood samples were obtained from radial artery immediately before anesthesia induction (T0),before one lung ventilation (T1),at 1 h after one lung ventilation (T2),the end of surgery (T3) and 24 h after operation (T4).Blood gas analysis was done at T1,T2,and T3.Plasma superoxide dismutase (SOD) activity and concentration of malonyldialdehyde (MDA),matrix metallo-proteinase-9 (MMP-9),interleukin-6(IL-6) and white blood cell (WBC) and neutrophil granulocyte (PMN) counts were measured at T0,T2,T3 and T4.The complications including pulmonary infection and atelectasis were recorded at 1,3 and 7 days after operation.Results At T2-3,PaO2 was higher in groups of OR and ORD than in group C Group ORD had higher PaO2 than did group OR [(265±15) mmHg,(305±23) mmHg vs.(231±17) mmHg,(273±21)mmHg,(312±24) mmHg vs.(242±18) mmHg,F=34.791 and 31.813,P＜0.01].At T2-3,RI was lower in groups of OR and ORD than in group C,and group ORD had lower RI than did group OR [(1.48±0.16),(1.14 ±0.14) vs.(1.86±0.18);(1.35±0.13),(0.96±0.09) vs.(1.73±0.15),F=119.260 and 164.855,P＜0.01].At T3-4,SOD activity was higher in group OR and ORD than in group C,and group ORD had higher SOD activity than did group OR [(83.6 ± 7.8) U/mg prot,(97.6± 9.5) U/mgprot vs.(70.5±7.4) U/mgprot;(73.5 ± 6.3) U/mgprot,(87.7 ± 8.9) U/mgprot vs.(61.6 ± 5.4) U/ mgprot,F=94.540 and 90.839,P＜0.01].At T3-4.plasma concentration of MDA,MMP-9,WBC and PMN counts were lower in group OR and ORD than in group C,and the above indices were lower in group ORD than in group OR [(7.5 ± 1.4) nmol/mgprot,(5.8 ± 1.0) nmol/mgprot vs.(9.5 ±1.5) nmol/mgprot;(8.2± 1.5) nmol/mgprot,(6.5 ± 1.0) nmol/mgprot vs.(10.1 ±1.6) nmol/mgprot;(205±23) μg/L,(173±21) μg/L vs.(237±26) μg/L,(179±16) μg/L,(158±12) μg/L vs.(203± 20) μg/L;(8.0±0.5) ×109/L,(7.2±0.6) × 109/L vs.(9.2±0.8)×109/L;(9.4±0.7) ×109/L,(8.2±0.6)×109/Lvs.(11.2±0.8) ×109/L;(7.4±0.7) ×109/L,(6.5±0.5) ×109/Lvs.(8.3 ±0.8) ×109/L,(7.8±0.8) ×109/L,(6.7±0.6) ×109/L vs.(9.2±0.9) ×109/L,F=98.872,52.723;198.307,47.622,20.319,36.935,18.197,35.036,respectively,all P＜0.01].At T2-4,IL-6 level was lower in groups of OR and ORD than in group C,and group ORD had lower IL-6 level than did group OR [(105±14) ng/L,(86±12) ng/L vs.(127±18) ng/L;(125±19) ng/L,(101±16) ng/ L vs.(156±22) ng/L;(110±16) ng/L,(89±12) ng/L vs.(132±20) ng/L,F=85.449,139.848,124.129,respectively,P＜0.01].The incidences of postoperative pulmonary infection and atelectasis were lower in group OR and ORD than group C,and group ORD had lower incidences of postoperative pulmonary infection and atelectasis than did group OR (x2 =6.303 and 14.545,P ＜ 0.05).Conclusions RIPC combined with dexmedetomidine can improve pulmonary function in elderly patients with thoracotomy and pulmonary dysfunction,may relieve the inflammatory reaction and oxidation reaction during perioperative period and finally help to improve the prognosis of patients.

Background:As a new concept of treatment for gastroesophageal reflux disease(GERD),local electrical stimulation on lower esophageal sphincter(LES)is still in a preliminary stage. Aims:To explore the ideal local electrical stimulation parameters for LES contraction and the local neural reflex path that inhibits LES contraction. Methods: Anti-gastroesophageal reflux model with electrical stimulation in vivo was established. The changes of gastroesophageal reflux were observed to explore the ideal electrical stimulation parameters for LES contraction. Effects of different drugs on gastroesophageal reflux in condition with ideal electrical stimulation parameters were observed. Results:When frequency was 10 Hz and pulse was 0. 4 ms,gastroesophageal reflux in voltage 10 V or 15 V groups was significantly decreased(P <0. 001). When voltage was 10 V and pulse was 0. 4 ms,gastroesophageal reflux in frequency 10 Hz group was significantly decreased(P < 0. 001). When voltage was 10 V and frequency was 10 Hz,gastroesophageal reflux in pulse 0. 4 ms group was significantly decreased(P < 0. 001). Local infiltration of tubocurarine or capsaicin on LES could significantly increase gastroesophageal reflux(P < 0. 05). The administration of NK1 receptor blocker L-732,138 or NO synthase inhibitor L-NAME could significantly decrease gastroesophageal reflux(P < 0. 05). Conclusions:In view of the injury of electrical energy on tissue,the ideal electrical stimulation parameters are voltage of 10 V,frequency of 10 Hz and pulse of 0. 4 ms. Local neural reflex path consisted of primary TRPV-1-positive tachykininergic neurons and nitrergic neurons in the muscle layer of esophagus could inhibit LES contraction evoked by electrical stimulation.

Objective: On the basis of typical cases, the objective of this study is to assess the service quality of primary healthcare institutions under the vertically integrated model from the perspective of demanding side.Methods: The vertical model between Renhe Hospital and Lixian Township Health Center was selected as the case study.Quantitative data were collected by exit review using Primary health-Care quality service Assessment Tool (PCAT)-Chinese version from the patients seeking services in Lixian.Quantitative data were analyzed by descriptive statistics and multiple linear regression equations while qualitative data were analyzed by thematic framework analysis.Results: Under the vertical model, the PCAT total score was 20.09.The scores on the first diagnosis, continuity of care, and comprehensiveness of care and coordination of care were 6.59, 3.27, 4.58 and 5.62 respectively.The scores on the three dimensional extensions, family-centered, community-oriented, medical culture were 3.07, 1.86 and 2.67 respectively.The difference was significant for the PCAT total score between a number of visits and the length of waiting time for services in Lixian.Conclusions: Under the vertical model, primary healthcare institutions did better in the first diagnosis while weaker in continuity and the three dimensional extensions.With the development of the integration, the primary healthcare institutions need to strengthen the continuity and downward referral in the future.Future researches and follow-up, analysis is needed to track the impact of the vertically integrated model.

Objective To compare effectiveness and short-term outcomes between robotic-assisted and laparoscopic surgery for radical resection of rectal cancer.Methods A total of 410 patients diagnosed with rectal cancer,undergoing robotic-assisted surgery (RAS) for rectal cancer (215 cases) and conventional laparoscopic surgery(CLS) for rectal cancer (195) from Jan 2016 to Dec 2018 were included into the present study.Operative characteristics,postoperative complications and pathologic parameters were evaluated between RAS and CLS group.Results The RAS group had less intraoperative blood loss[(107 ± 46) ml vs.(147 ±35)ml,t =3.695,P＜0.05],longer operation time[(209 ±55)min vs.(195 ± 55)min,t=2.508,P＜0.05],earlier first flatus[(3.4 ± 1.4)d vs.(5.3 ± 1.6)d,t =-14.952,P＜ 0.05],and first liquid diet time [(4.3 ± 1.5) d vs.(6.2 ± 2.6) d,t =-9.109,P ＜ 0.05],more number of dissected lymph nodes[(12.6 ± 4.3) vs.(10.6 ± 4.5),t =4.468,P ＜ 0.05] compared with those in the CLS group.But more expensive total hospitalization costs[(71 775 ±45 089) yuan vs.(66 789 ± 16 721) yuan,t =4.224,P ＜ 0.05].Conclusion Compared with laparoscopic surgery,robotic-assisted surgery has less blood loss,shorter time of first flatus,more lymph nodes yield.

Objective:Aimed to investigate the value of adrenocorticotropic hormone (ACTH) stimulation in adrenal venous blood sampling (AVS).Methods:Patients who diagnosed as primary aldosteronism (PA) and completed successful bilateral cannulation judged by selection index (SI) for routine and(or) ACTH stimulation AVS were enrolled. The lateralization index(LI) was calculated to compare the effect of ACTH stimulation on AVS cannulation success rate and lateralization judgment.Results:A total of 73 patients with PA were enrolled in the study, of whom 28 were confirmed as aldosterone producing adenoma (APA) after unilateral adrenalectomy. Cortisol and aldosterone in peripheral and adrenal veins were significantly increased after ACTH stimulation. The left SI was increased from 6.5(3.0-13.6) to 26.8 (16.9-40.3) ( P<0.01) and the right SI from 20.8(4.8-34.8) to 57.6(35.7-80.9) ( P<0.01) after ACTH stimulation. There was no significant difference on LI before and after ACTH stimulation [7.7(2.3-19.6) vs 5.6(1.9-14.6), P=0.14]. The success rates of left and right adrenal cannulation were increased by 15% and 10% respectively after ACTH stimulation. For 57 patients who were determined in successful cannulation by both routine and ACTH stimulation AVS, 27 patients were determined to have lateralization by both AVS methods, 21 patients were determined to have bilateralization, and the consistency of lateralization by both AVS methods was 84%(48/57). Among the 28 patients who were confirmed to be APA after unilateral adrenalectomy, the correct rate of lateralization by both AVS methods was 89% (25/28). Conclusion:ACTH stimulation is able to improve the success rate of bilateral adrenal vein cannulation, and is helpful to judge AVS results. For patients with successful cannulation, there is no significant difference in lateralization judgment for routine and ACTH stimulation AVS.