Construction and practice of medical alliance referral system based on blockchain / 中华医院管理杂志

Hierarchical diagnosis and treatment system is an important measure to rationally allocate medical resources and promote the homogenization of basic medical services. The medical alliance is an important service mode and service system of hierarchical diagnosis and treatment, whose role is to perfect the up-down linkage and meet the patient′s medical needs. Informatization construction is an important starting point to promote the services of the medical alliance. In order to solve the problem of connectivity, the medical alliance needs to establish a regional referral platform and realize the integrated service of all medical institutions. Renji Hospital, Shanghai Jiaotong University School of Medicine, has built a blockchain based referral system for hierarchical diagnosis and treatment, incorporating the S2B2C mode concept, and using the traceability, tamper proof and distributed accounting features of blockchain technology, realized independent storage of data in hospitals, realized real-time information sharing and interconnection, and provided a feasible solution for medical alliance management.

Application of Flow-through latissimus dorsi musculocutaneous flap to repair the wounds in children’s limb / 中华显微外科杂志

Objective:To explore the method and clinical efficacy of Flow-through latissimus dorsi musculocutaneous flap to repair children’s limb wounds.Methods:From January, 2017 to September, 2019, the Flow-through latissimus dorsi myocutaneous flap was used to repair the limb wounds in 9 children, which were 3 cases of upper extremity wounds and 6 cases of lower extremity wounds. The patients were 5-12 years old, with an average age of 9.4 years. The wound debridement was performed in the first stage, and the wound was covered with VSD. The second operation was performed 5-8 days later. Flow-through free latissimus dorsi muscle flap was used to repair the wound, and 6 patients combined with skin grafting. During the operation, both ends of the recipient area artery were trimmed into a downward slant. The proximal end of the recipient area blood vessel was coincided with the subscapular artery, the distal end was coincided with the circumflex scapular artery, and the thoracodorsal vein and the recipient area vein were coincided. One patient had 2 thoracodorsal veins, and 8 patients had 1 thoracodorsal vein. After the operation, the patients were given anti-infection, anticoagulation and antispasmodic treatment. And regular follow-up.Results:In this group, 8 flaps survived completely, and 1 had partial epidermal necrosis, which healed under the scab. Skin grafting survives well. Nine patients were followed-up for 3 to 28 months, 7 of which were followed-up in the outpatient clinic, and 2 by WeChat. CDU showed smooth blood flow in all patients 1 month after operation, in addition of 3 after 1 year. The flap had good blood flow and soft texture. Flap plastic surgery was performed in 3 cases.Conclusion:Using Flow-through latissimus dorsi musculocutaneous flap to repair the wounds of the children’s limbs, the flap survived well after the operation, and the blood circulation of the main vessel in the affected area was smooth, which had no obvious effect on the blood supply to the distal limb of the affected area.

Thinking and practice of day care / 中华医院管理杂志

Day care is described in the paper in terms of its meaning and management.As to areas deserving attention given the initial success,the authors proposed to priortize medical insurance compensation policy,medical resource deployment,patient safety and follow-up for discharged patients.These efforts may further quality of care and patient satisfaction.

Wearable Automatic External Defibrillators / 中国医疗器械杂志

Defibrillation is the most effective method of treating ventricular fibrillation(VF), this paper introduces wearable automatic external defibrillators based on embedded system which includes EGG measurements, bioelectrical impedance measurement, discharge defibrillation module, which can automatic identify VF signal, biphasic exponential waveform defibrillation discharge. After verified by animal tests, the device can realize EGG acquisition and automatic identification. After identifying the ventricular fibrillation signal, it can automatic defibrillate to abort ventricular fibrillation and to realize the cardiac electrical cardioversion.

Expression and significance of VEGF-C and VEGF-D in differentiated thyroid carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#VEGF-C,D are known to be capable of inducing proliferation of lymphatic endothelia cell and development of lymphatic vessels, so we investigated the expression of VEGF-C,D in the differentiated thyroid carcinoma tissues microarray in order to understand the significance mechanism of cervix lymphatic metastasis of thyroid cancer.@*METHOD@#A tissue microarray containing 71 specimens was constructed, including normal thyroid tissues, thyroid adenoma, papillary thyroid carcinoma with and without lymphatic metastasis, follicular thyroid carcinoma. VEGF-C, D protein expression was detected with immunohistochemistry.@*RESULT@#The expression of VEGF-C,D were not observed in normal thyroid tissues and adenoma tissues. The expression of VEGF-C,D in papillary thyroid carcinoma was significantly higher than those in follicular thyroid carcinoma (P < 0.05) and adeno ma tissues (P < 0.01). The expression of VEGF-C,D in papillary thyroid carcinoma with lymphatic metastasis was significantly higher than those in papillary thyroid carcinoma without lymphatic metastasis (P < 0.05).@*CONCLUSION@#By inducing proliferation of lymphatic endothelia cell and development of lymphatic vessels, VEGF-C,D contributed to lymphatic metastasis of papillary thyroid carcinoma.