Comparison of the Emergency Severity Index (ESI) and the Taiwan Triage System in predicting resource utilization.

BACKGROUND/PURPOSE: The importance of accurate triage in Taiwan is becoming more apparent with the increasing number of emergency department (ED) patients, and resources for the National Health Insurance becoming constrained. This study compared the ability of the Taiwan triage system (TTS) and the standardized 5-level Emergency Severity Index (ESI) triage system to predict ED resource utilization. METHODS: Patients arriving at the ED were triaged by both TTS and by using a two-page checklist of ESI criteria during the 3-month study period. The ESI triage level was calculated independently to avoid bias. Disease category (trauma vs. nontrauma), length of stay (LOS) and hospitalization data were evaluated. RESULTS: A total of 3172 patients with both ESI and TWN evaluation were included. The distributions of ESI ratings within TTS level 1 were: ESI 1, 21.1%; ESI 2, 68.1%; ESI 3, 7.4%; ESI 4, 3.4%; ESI 5, 0%. For TTS level 3, they were: ESI 1, 0.1%; ESI 2, 26.2%; ESI 3, 39.5%; ESI 4, 27.5%; ESI 5, 6.8%. Hospitalization rates were 74.5%, 40.9% and 22.2% in TTS levels 1, 2 and 3, respectively; and were 96.2%, 47.0%, 30.9%, 6.7%and 6.6% in ESI levels 1, 2, 3, 4 and 5, respectively. TTS triaged more trauma patients as life-threatening/emergent condition than nontrauma patients (68.8% vs. 48.4%, p < 0.001). Triage by ESI, however, showed no significant difference in the percentage of trauma and nontrauma patients with highly acute conditions (44.2% vs. 46.6%, p = 0.230). Patients with ESI level 4 or 5 have significantly shorter ED LOS than those with ESI level 3. CONCLUSION: ESI produces more accurate discriminating patient acuity, ED LOS and hospitalization rate than TTS. Adopting a standardized 5-level triage tool might improve resource utilization planning of ED practice.     

180篇创伤骨科论文临床疗效研究方法的评估

目的了解目前我国创伤临床病例研究的主要应用手段和研究水平。方法对中华骨科学会创伤学组2002年年会投稿临床病例研究稿件进行总结分析,对稿件论述的研究范围、研究对象、病例数量、骨折分类、研究方法、随访评价、统计分析应用等方面进行统计研究。结果大会收到225篇稿件。其中随访临床病例报告180篇。报告病例1万多例、范围广,包括了当前主要的临床治疗方法。回顾性研究中,对临床资料进行统计学分析的论文仅占少数(6.1%)。对骨折分类方法及临床随访结果评价标准不统一,欠规范。无前瞻性研究报告。结论创伤临床病例研究方法有待进一步改进。     

糖化血红蛋白及糖化血清蛋白与糖尿病肾功能衰竭患者的血糖监测

糖化血红蛋白(Hb)A1c是血糖监测的苇要指标,反映检测前2～3个月的平均血糖水平.慢性肾功能衰竭(CRF)患者存在贫血、酸中毒、氧化应激、胰岛素抵抗、血液透析及促红细胞生成素(EPO)的应用等因素,对HbA1c的测定会造成影响.糖化血清蛋白(GSP)反映检测前2～3周的平均血糖水平,仅受血浆蛋白的影响,几乎不受血红蛋白和EPO治疗等以上因素的影响,且对短时间内的血糖变化更为敏感.将GSP作为糖尿病肾功能衰竭患者血糖监测指标可能比HbA1c更理想.     

nm23-H1基因转染对人胆管癌细胞系QBC939体外浸润能力的影响

目的：探讨nm23-H1基因转染对人胆管癌细胞系QBC939体外浸润能力的影响。方法：将含有全长nm23-H1 cDNA的真核表达载体通过脂腩体法转染人胆管癌细胞系。结果：转染成功的QBC939细胞，其nm23-Hl基因的mRNA、蛋白表达明显增加，转染nm23-H1基因的胆管癌细胞体外浸润能力下降，穿越matrigel的细胞数明显低于亲本QBC939细胞，代表浸润能力的IV型胶原酶（MMP-9）分泌量下降。结论：nm23-Hl基因可以抑制胆管癌细胞的体外浸润能力。     

不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with different fluids on blood rheology in patients with deep vein (femoral and iliac) thrombosis. Methods Thirty ASA I or II patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups ( n = 10 each) ; group I normal saline (NS) ; group II 6 % HES 200/0.5 ( HES) ; group IE gelofusine (GEL). AHH was performed with normal saline, 6% HES or gelofusine infusion at 20 ml·kg-1 ·h-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 fig/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 mg·kg-1·h-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8 ml/kg, RR 12 bpm). PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit (Hct), whole blood viscocity (WBV) at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.     

1,2-环己二胺柠檬酸铂(Ⅱ)及异柠檬酸铂(Ⅱ)的合成和抗癌活性

报道了1,2-环己二胺异柠檬酸铂(Ⅱ)及1,2-环己二胺柠檬酸铂(Ⅱ)的合成及鉴定方法。抗癌试验表明前者在40及80mg/kg 剂量下对小鼠 L1210、P388及S180均有明显的抑瘤作用,且有部分动物可治愈;后者对 L1210也有明显的抑瘤作用,但较前者为弱。     

Screening Mouse Genes Related to Blastocyst Implantation by Using PCR Subtraction

Objective To identify genes that may be related to embryo implantation Materials & Methods The PCR subtraction technique was applied at implantation and inter-plantation sites on day 4. 5 of pregnancy in mice. Two novel Expressed Sequence Tags (ESTs ), EST8 and EST81 were identified; their expression in tissues was analyzed by Northern blotting, and their full-length cDNAs were synthesized by PCR.Results We found that these two novel ESTs (EST8and EST81) were noticeably expressed in implantation site in the mouse on day 4. 5 of pregnancy. EST8 was expressed at high level in livers and implantation sites of the mice, while at low level in ovaries and inter-plantation sites. EST81 was predominantly expressed in implantation site and ovary, and at low level in all other tissues. Their complete cDNAs, 1 665bp and 1 264 bp respectively, were synthesized by using PCR.Conclusion The two full-length cDNAs were responsible for embryo implantation,and their functions need to be further studied.     

老年及老年前期重症肌无力的手术治疗(附23例报告)

目的总结胸腺切除术治疗老年及老年前期重症肌无力的临床效果。方法对1981年～2001年在我院行胸腺切除治疗的23例老年及老年前期重症肌无力患者的手术疗效进行回顾分析。结果在所有重症肌无力患者中老年及老年前期患者所占比例小,男性为多见;全身型为主,合并胸腺瘤及危象者多;手术总有效率43.5％。结论老年及老年前期重症肌无力的手术疗效较青壮年为差,但仍是可选择的一种重要方法。     

183例老年人骨密度检测分析

目的 :研究老年人不同疾病时骨密度 (BMD)的分布情况。方法 :用DXADAS 6 0 0EX型骨密度仪对183例老年患者进行左侧远程桡骨加尺骨BMD检测。结果 :内分泌疾病组、消化道疾病组和其它疾病组的患病率分别为 72 7% ,2 0 6 %和 31 4 %。T值比较 :三组差异明显 (P <0 0 0 1)。累积骨丢失率 (ABLR)比较 :前一组明显高于后两组病人 (P <0 0 1)。BMD比较中 ,内分泌和其它疾病组明显低于消化道疾病组 (P <0 0 0 1)。相关分析显示 ,内分泌和消化道疾病组的年龄变化与BMD呈正相关 (r =0 5 19P <0 0 0 1和r =0 5 89P <0 0 0 1) ,内分泌疾病组和其它疾病组的体重变化与BMD呈正相关 (r=0 918P <0 0 0 1和r =0 338P <0 0 0 1)。结论 :老年人骨质疏松 (OP)患病率以内分泌疾病组最高 ,消化道疾病组较低 ;随年龄和体重增加 ,BMD降低加重。     

TRH、EGF及地塞米松促进未成熟胎肺组织分化及表面活性物质合成的研究

目的 比较TRH、EGF与地塞米松对未成熟胎肺形态发育及表面活性物质水平的影响。方法 在兔妊娠第22－24d或第24－26d分别用TRH、EGF或地塞米松母体静脉注射治病，通过光镜、图像分析及电镜等技术观察胎肺的形态结构，并检测胎肺的磷脂水平。结果 光镜下，TRH、EGF与地塞米松治疗组第25d及27d胎肺肺泡腔、肺泡间隔发育均明显好于对照组；EGF、TRH与地塞米松治疗组第27d胎肺的肺泡腔与肺泡间隔的面积比无明显差异。但EGF和TRH治疗组第25d胎肺的肺泡腔与肺泡间隔之比明显小于地塞米松治疗组。电镜下，三个治疗组第27d胎肺内含有板层体的Ⅱ型上皮细胞数量明显多于对照组，但各治疗组及对照组第25d的胎肺Ⅱ型上皮细胞胞浆内几乎未见明显板层体，相反胞浆内糖原含量却非常丰富。此外，三个治疗组27d胎肺的磷脂水平均明显高于对照组。结论 EGF、TRH及地塞米松在兔妊娠第24－26d母体治疗均能促进胎肺的形态发育和表面活性物质的合成，三种治疗方法对胎肺的影响程序无明显不同；在妊娠第22－24d治疗，地塞米松对胎肺形态结构的促进作用较EGF和TRH更明显，但三者对Ⅱ型上皮细胞分化及表面活性物质的合成均无明显影响。