Web-based early warning management and application of EMRS crossplatform medical insurance expenses / 医疗卫生装备

Objective To integrate the self-developed Web-based early warning management system into EMR system to decrease average medical fee as well as the occurrences of cost overrun,arrearage for self-paid fee and etc.Methods The method mapped into image for users' browse based on using the user-defined URL extension characteristic of EMR system,combining the advantages of Web platform in handling Http request,applying Java as well as SQL technology to obtain source data,integrating statistical analysis for multi-dimensional comparative analysis as well as visualization technology.Results This system changed the behavior pattern of early warning and supervision in course,relieved work burden of medical staffs,and helped hospital achieve high economic management benefit.Conclusion The application of crossplatform system realizes high effect and provides approaches for expanding other functions.

Study on length of preserved ileocecum by subtotal colectomy with antiperistaltic cecorectal anastomosis / 局解手术学杂志

Objective To investigate the length of preserved ileocecum in surgical treatment of slow transit constipation ( STC) by sub-total colectomy with antiperistaltic cecorectal anastomosis .Methods A total of 82 patients with STC were divided into two groups according to the random number table method ,with 41 cases in each group ,all the patients of the two groups underwent subtotal colectomy ,intraopera-tive ileocecum was preserved length of group A was 10~15 cm,group B was 2~3 cm.The operation time,intraoperative bleeding volume, postoperative exhaust time and length of hospital stay were compared .Wexner constipation score and gastrointestinal quality of life index ,ab-dominal pain ,frequency score and emptying time of ileocecus before and after 6 months and 12 months between the two groups were com-pared.Results There was no statistically significant difference in the operation time ,intraoperative bleeding volume ,postoperative exhaust time and hospitalization time of two groups (P>0.05).Wexner constipation score,abdominal pain,frequency score of the two groups after 6 months and 12 months decreased significantly (P<0.05,P<0.01),of which the group B was lower than that of the group A (P<0.05,P<0.01). The gastrointestinal quality of life index after operation significantly increased (P<0.01),of which the group B was higher than that of the group A (P<0.01).Ileocecal emptying time of the group B 12 months after operation was shorter than that of the group A (P<0.01),the differences were statistically significant .Conclusion Subtotal colectomy with antiperistaltic cecorectal anastomosis is an effective method to treat STC,which can reduce the length of preserved ileocecum and improve the prognosis of patients .

Clinical and histopathological features of colorectal sessile serrated adenoma/polyp and its differential diagnosis / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate clinicopathological characteristics of colorectal sessile serrated adenoma/polyp (SSA/P) and its differential diagnosis from other serrated lesions.</p><p><b>METHODS</b>Clinicopathological features of all cases of colorectal serrated lesions from 5 209 colorectal biopsy samples at Shanghai Tongji Hospital from 2008 to 2013 were reviewed. Three hundred and fifty-three cases of serrated lesions were erolled in the study. Morphological features of SSA/P were investigated with an emphasis on histologic criteria for diagnosis and a literature review was performed.</p><p><b>RESULTS</b>Three hundred and fifty-three cases of serrated lesions were identified, including 25 SSA/P (7.1%), 278 hyperplastic polyp (HP, 78.8%), and 44 traditional serrated adenoma (TSA, 12.5%). Twenty-five patients with SSA/P consisted of 16 males and 9 females with a mean age of 62.2 years (aged 34-84 years) and the lesions involved sigmoid colon (14 cases), ascending colon (9 cases), rectum (1 case) and transverse colon (1 case). Grossly, the majority of SSA/P was sessile with an averaged size of 0.73 cm. Histologically, typical SSA/P had elongated crypts with prominent serration and distorted crypts architecture. The detection rates of crypts dilatation and branching in SSA/P and HP were 100% (25/25) and 24% (12/50, P < 0.01), 72% (18/25) and 4% (2/50, P < 0.01), respectively. Morphological features observed only in SSA/P included L-shaped crypts (48%, 12/25), pseudo infiltration of mucosa muscle (16%, 4/25), atypical nuclei (32%, 8/25), and increased mucus secretion (24%, 6/25).</p><p><b>CONCLUSIONS</b>SSA/P microscopically shows prominent serration and abnormal architectures of crypts. Complete tissue sectioning and correct embedding are helpful for the diagnosis. SSA/P without cytological dysplasia should be distinguished from HP, especially those with only a few distorted crypts.</p>

Adolescent mixed epithelial and stromal tumor of the kidney：one case report and literature review / 临床与实验病理学杂志

Purpose To investigate the clinicopathological features of adolescent mixed epithelial and stromal tumor of the kidney ( MESTK) and improve recognization of this rare disease. Methods Clinicopathological and immunohistochemical characteristics of MESTK occured in 17-year-old girl were studied. Reviewed the related literatures, clinical and pathological characteristics of adoles-cent MESTK were analysed comprehensively. Results Congenital perineal spill was the main clinical manifestations. Microscopically, the tumor showed nodules and was composed of a mixture of epithelial and stromal elements. Glands were lined with columnar or cilia-ted columnar cells. Stromal cells surrounding glands seemed like ovaries and away from glands seemed like the differentiation of smooth muscle. Immunohistochemical staining revealed that the epithelial cells were positive for CK7 and vimentin. Stromal cells expressed desmin, smooth muscle actin ( SMA) , ER and PR. It was noteworthy that stromal cells away from glands expressed desmin. Conclu-sions As a kind of rare benign neoplasm of kidney, MESTK often occurs in perimenopausal women. But MESTK can also occur in ad-olescence, and has nothing to do with the use of hormone. Therefore, the renal tumor occurred in teenagers with biphasic differentiation should be differentiated from MESTK.

Discussion about Ethical Construction of Community Health Service and Governmental Responsibility / 中国医学伦理学

Community health service is a public business with welfare,sociality and politics.In present dissertation governmental contributions upon ethical construction of urban community health service and extant problems among our country were discussed.We suggest that our government should take assuring welfare,enhancing management and construction of professional ethical system in the future.