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??Effects of acute normovolemic hemodilution on coagulation and fibrinolysis in eldly patients undergoing hepatic carcinectomy GUO Jian-rong*??YU Jun??DU Jin-man??et al??*Department of Anesthesiology??Lihuili Hospital??Medical College of Ningbo University??Ningbo 315040??China
Corresponding author ??GUO Jian-rong??E-mail??jianrguo@126.com
Abstract Objective To observe the effects of acute normovolemic hemodilution (ANH) on coagulation and fibrinolysis on eldly patients undergoing hepatic carcinectomy??Methods Thirty liver cancer patients (ASA ??or??) over sixty years old performed hepatic carcinectomy from February 2007 to February 2008 at Lihuili Hospital??Medical College of Ningbo University were randomly divided into ANH group (groupA??n=15) and control group(group B??n=15)??Results The perioperative blood loss was not significantly different between the two groups (P>0.05). The volume of allogeneic blood transfusion in ANH group was significantly less than that in control group [??350.0±70.7??mL vs.??457.0±181.3??mL, P<0.01]??Compared with before anesthesia induction??PT and APTT in both groups prolonged significantly at 30 minutes after ANH??but they all remained in normal range??TT and DD had no significant changes between the two groups??SFMC and F1+2 increased in both groups, but without statistical significance. PAC-1 and CD62P expressions of ANH group were significantly lower than before anesthesia induction??P<0.05????Compared with group B??CD62P were significantly lower in ANH group after ANH??But there was no statistical significance between the two groups(P>0.05)??Conclusion In elderly patients undergoing resection of liver cancer, ANH has no obvious impact on fibrinolysis and coagulation function. It could therefore be safe to reduce allogeneic blood transfusion largely??     

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??CT and MRI manifestations of pancreatitis misdiagnosed as pancreatic cancer SU Tao*??WANG Jian??JIN Han-tao??et al. *Department of Emergency??Center Hospital of Xuhui District??Shanghai 200031??China
Corresponding author : WANG Jian ??E-mail??wangjian_su@yahoo.com.cn
Abstract Objective To research the key points in differential diagnosis of pancreatitis and pancreatic cancer. Methods The imaging data of 22 cases of pancreatitis misdiagnosed as pancreatic cancer between 2001 and 2010 at Changzheng Hospital Affiliated to the Second Military Medical University were analyzed retrospectively. Results Manifestations of pancreatitis misdiagnosed as localized pancreatic cancer were pseudotumorous pancreatitis of pancreatic head or pancreatic body??pancreatic necrosis and pseudocyst??inhomogeneous lipidosis??retentive extension of pancreatic duct due to pancreas divisum and accumulation of blood in pancreatic duct due to pancreas divisum. Misdiagnosed as disseminated pancreatic cancer were disseminated enlargement of pancreas with inhomogeneous density, lesser blood supply lesion and pancreatitis without effusion. Misdiagnosed as metastases outside pancreas were parapancreatic pseudocysts or inflammatory mass misdiagnosed as metastatic lymph nodes. Accessory lesions of superior mesenteric vein and splenic vein misdiagnosed as vascular invasions. Conclusion Diagnosis of atypical pancreatic cancer should be based on a comprehensive knowledge of medical history and weekly follow-ups so as to exclude the possibility of atypical pancreatitis. As for patients who have both pancreatitis and pancreatic cancer??treatments of pancreatitis with therapeutic values should always be emphasized regardless of the pancreatic cancer.     

AID算法在云南省综合性医院住院病人DRGs归组中的应用及评价

病例组合研究在我国已具有了一定的研究基础。我们在参阅文献的基础上，将病例组合的算法和应用引入云南省医院管理中，经过对云南省综合性医院住院病人病案首页资料的分析研究，研制出一套实用的DRGs病例组合方法体系，指导医院制订合理收费制度，有效控制医疗费用上涨，为我省或医疗保险机构对医院的偿付提供科学依据，以促进我省医疗保健制度的深化改革。     

慢性病患者生命质量测定量表体系之冠心病量表的效度及反应度分析

目的分析慢性病患者生命质量测定量表体系之冠心病量表(QLICD-CHD)的效度和反应度。方法用QLICD-CHD对133名冠心病患者在住院治疗前后进行测试,从而对量表的效度和反应度进行分析。效度从内容效度、结构效度、效标效度3个方面反映。其中量表的结构效度用条目和小方面及领域的相关情况、主成分因子分析情况反映。反应度通过比较治疗前后各领域及小方面患者生命质量的得分均数,计算各小方面及领域的得分变化的百分比和SMR值来考评。用到的统计学方法包括相关分析、主成分因子分析法、配对t检验等。结果量表各条目与所属小方面或领域的相关均大于该条目与其他小方面或领域的相关,且相关系数大多在0.70以上;量表可以测出患者治疗前后躯体功能、心理功能和特异模块领域的生命质量变化,其中体现症状和焦虑情绪的小方面最为显著。结论冠心病患者生命质量测定量表QLICD-CHD具有较好的效度、反应度和可行性,可以作为我国冠心病患者生命质量的测评工具。     

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??A new variation of the recurrent laryngeal nerve SHAO Tang-lei*,HUANG He, WANG Hai,et al. Department of Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China
Corresponding author:YANG Wei-ping, E-mail:yangweipingmd@126.com
Abstract Objective To discuss a new variation of the recurrent laryngeal nerve.Methods A prospective study involving 2,094 consecutive thyroidectomies was performed during January 2007 and December 2012.,and 1,652 women and 442 men, there were 2710 of RLNs dissected,and 1312 of left RLNs and 1398 of right RLNs. Results There were 5 new varied RLNs found and all were located in the right.the occurrence of the new varied RLNs were 0.18% in all RLNs and were 0.36% in right RLNs.The most important of the varied RLNs was the branch which directed to the skull. Conclusion There may be some new function which we have not been known in the RLNs.The RLNs should be more carefully protected in thyroid operation for fear of injuring the RLN and its function.     

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??Objective To detect the serum levels of soluble triggering receptor expressed on myeloid cells-1??sTREM-1??so as to investigate the significance of sTREM-1 in small infants with infectious diseases. Methods All subjects were infants aged 7 d ~3 m hospitalized from January 1??2011 to December 31??2011.Ninety-four patients were enrolled .According to the results of the pathogens the patients were divided into three groups?? 32 with bacterial infection?? 30 with viral infection and 32 controls without infection. Blood samples were collected from the enrolled patients hospitalized in 12 hours .At convalescence and recovery time the blood samples were collected from the bacterial infection patients. Serum sTREM-1 was measured by ELISA??enzyme-linked immunosorbent assay??. The data were analyzed by Paired T test and Single factor analysis of variance. Results The levels of serum sTREM-1 in acute phase in patients of three groups were as follows?? the mean level was ??240.20 ± 120.25??pg/mL in bacterial infection group?? viral infection group ??81.26 ± 13.83??pg/mL?? no-infection group ??69.42 ± 23.69??pg/mL. The bacterial infection group had higher sTREM-1 level than viral infection group and no-infection group. The difference was of statistical significance. The viral infection group had higher sTREM-1 level than no-infection group. The difference was of no statistical significance. The levels of serum sTREM-1 in acute phase?? convalescent phase?? recovery phase were as follows?? sTREM-1 level in acute phase??240.2 ± 120.25 pg/mL??was higher than convalescent and recovery phase??118.92 ± 59.74?? 73.59 ± 35.49 pg/mL??.The difference was of statistical significance. The level of serum sTREM-1 in recovery phase in bacterial infection group was ??73.59 ± 35.49 pg/ml????the level in no-infection group??69.42 ± 23.69 pg/mL??.The difference was of no statistical significance. The level of serum sTREM-1??Gram-positive bacterial infection??202.54 ± 107.14 pg/mL??and Gram-negative bacterial infection??210.36 ± 120.93 pg/mL????the difference was of no statistical significance. Serum level of sTREM - 1 to distinguish between bacterial infection and virus infection or are infected area under ROC curve for 0.983 ??95% CI 0.96 1.00???? higher than other markers CRP 0.947 ??95% CI0.883??1.01???? WBC 0.747 ??95% CI0.631??0.864???? PCT 0.950 ??95% CI0.907??0.994?? .Conclusion The sTREM-1 has high expression level in serum in infantile bacterial infection. The sTREM-1 is higher in bacterial infection group than that in viral infection group and no-infection group. The sTREM-1 declines with the recovery of the bacterial infection. There is significant difference according to the infection severity. This suggests it may be an index to bacterial infection diagnosis and evaluation of the severity of infection.