Pre-hospital care is an important part of the health care system. Nowadays , there are many defects in the pre-hospital emergency charging method in China. It analyzes the effectiveness and impact of adjustment the charging method. There will be a preliminary study of hospital first aid fees adjustment of changing the current method from front-line staff receiving cash to entrusting the local hospital, charge with real-time settlement of health insurance for the convenience of the patient and reduce the workload of health insurance agencies, make financial emergency center management more standardized and efficient.

Objective To investigate the diagnosis and treatment of secondary sclerosing cholangitis after billary tract operation.Methods The clinical clata of 7 cases with secondary sclerosing cholangitis after billary tract operation treated in our hospital from January 2000 to June 2008 were retrospectively analyzed.Results Recurrent episodes of bacterial cholangitis were present in all patients,and they all had history of biliary tract operation.After definite diagnosis,2 cases underwent operation and 5 cases underwent conservative treatment.Among the latter,1 case underwent endoscopic sphincterotomy and 1 case had liver transplantation.Of all the patients,2 cases recovered(2/7),2 cases died(2/7) and 3 cases are still undergoing treatment.Conclusions The prognosis of secondary sclerosing cholangitis after billary tract operation is relatively poor.The key measure is prevention,and early diagnosis together with rational treatment can have certain therapeutic effect.

Objective To investigate the effect of Tongqiao Yinao decoction ( TYD) on postoperative cogni-tive dysfunction in elderly patients and its underlying mechanisms .Methods 100 anesthetic patients for orthopedic surgery were randomly divided into the TYD-treated group and control group ,50 patients in each group .In TYD-trea-ted group,patients received 150mL TYD orally,twice daily for constitutive 15 days,beginning from the day of admis-sion in addition to conventional symptomatic and supportive treatment .While patients in control group received no TYD.Mini-mental state examination ( MMSE) was used to evaluate the patients′cognitive function before and after anesthesia.Meanwhile,blood samples of patients were also collected to test the expression levels of IL -6.Results There was no significant difference between the two groups before operation .However ,TYD-treated patients had signif-icantly lower incidence rate of POCD than the controls ( 20% in the control group , and 12% in the TYD-treated group;χ2 =4.332,P=0.037) 7 days after operation.The incidence rates of POCD in the TYD-treated group and control group were 30%and 38%1 day after operation ( P>0.05),28% and 20% 3 days after operation ( P>0.05),respectively.Compared with that before operation ,the blood levels of IL-6 in the two groups significantly increased 3 days after operation (control group,t=2.412,P=0.009;TYD-treated group,t=1.429,P=0.039).In contrast to the control group,the level of IL-6 in TYD-treated group declined to the baseline (the control group,t=0.851,P=0.049;TYD-treated group,P=0.404).Interestingly,compared with the controls,the TYD-treated patients had a significant lower level of IL-6 after operation (t=1.198,P=0.035).Furthermore,Pearson correlation analysis showed that change of IL-6 level in blood was negatively correlated with MMSE score (r=-0.782,P=0.022). Conclusion TYD can improve postoperative cognitive dysfunction in elderly patients ,presumably through decreasing the level of IL-6 in blood.

Objective To investigate the clinical effect of splanchnicectomy for pain palliation with advanced pancreatic carcinoma.Methods Altogether 27 cases were treated from January 2005 to February 2008,retrospective study was used to analyze the clinical data of them.All the patients had diverse extent pain,among these 16 cases who had underwent splanchnicectomy (therapy group),others were in control group.Results Pain extent was scored according to visual analogue scale (VAS),preoperative score of therapy group (6.06±1.93) scores,postoperative score 3 months(2.67±1.68) scores,6 months(2.69±1.75) scores,the discrepancy had statistical significance (P<0.01),preoperative score of control group (5.91±1.87) scores,postoperative score 3 months(5.11±2.03) scores,6 months(5.33±2.25) scores,the discrepancy had no statistical significance.Intergroups contrast,showing significant difference (P<0.05).Conclusion For the patients who request to deal with primary disease,splanchnicectomy is manipulated easy,short of complication,significantly relief of pain,and deserve to be spreaded.

ObjectiveTo evaluate the feasibility and outcome of overnight laparoscopie cholecystectomy (OLC).MethodsThe clinical data of 149 patients with cholecystolithiasis or gallbladder polyps who were admitted to the Tianjin People's Hospital from October 2008 to December 2010 were retrospectively analyzed.All the patients underwent LC in the morning and were discharged 24 hours later.Modified Aldrete scoring was done 4-6hours after LC.Patients were contacted by telephone 3 days after LC and reexamined in the out-patient department 7 days after LC.The hospital cost of patients who underwent OLC or LC was compared using the t test.Results OLC was successfully performed on 149 patients,and the modified Aldrete scores of 130 patients were above 9.The visual analogue scale (VAS) of 118 patients were under 4,and the VAS of 31 patients were above 4.The condition of the 31 patients were closely monitered,and were administered morphine.Of the 149 patieuts,144were discharged 24 hours after operation,and the remaining 5 patients were admitted to general ward because of fever,peritoneal effusion or abdominal pain.The incidence of postoperative complication was 2.0％ (3/149) and the mortality was 0.All the patients were followed up,and none of the patients had an emergency readmission.The duration of incapacity was 5.2 days (range,2-7 days).The mean hospital cost of patients who received OLC was ( 7888 ± 396 ) yuan,which was significantly lower than ( 12121 ± 960) yuan of patients who received LC ( t =38.97,P ＜ 0.05 ).ConclusionOLC is effective and safe,and meets the requirement of health insurance policy.

Objective To investigate the effecof arthroscopiminimally invasion fothe local excision of benign bone tumo.MethodEighpatientwith benign bone tumofrom Augus2011 to Decembe2012 were treated by arthroscopimini-mally invasive operation ,including 3 caseof osteochondrom,2 caseof bone cys,1 case of non-ossifying fibromand 2 caseof osteoid osteom.The lesion location wadetermined by the preoperative imaging dat,the arthroscope and plane cuttewere placed into the lesion arethe tumowaperformed the local lesion resection undethearthroscopimonitoring ,then the plasmwaadopt-ed to treathe resected wound surface of tumo,the bone defectwere implanted by allogeneibone .ResultEighcasewere re-covered well afteoperation .No postoperative complicationwere found .The approach incision ＜3 and the wound length ＜1 .5 cm .Two casewere filled with allogeneibone .There were no recurrence ,fracture odyfunction during the average follow up peri-odof 8-12 month.The postoperative X-ray showed thathe lesion wacompletely resected and the bone defeclesion wacom-pletely filled with allogeneibone .Conclusion The resection of deep benign bone tumoundethe arthroscopimonitoring can maximize to retain the local anatomistructure .

Bones are important supporting structure of human body. Impulse response method is a kind of vibration analysis technology which can be used to analyze dynamic characteristics of human bones. Along with the continuous development of signal processing and computer technology, impulse response method is applied more and more in bone biomechanics research. The basic principle of impulse response method and its progress in bone biomechanics research are briefly summarized in this paper. The article also discussed the pulse response method research direction.

Objective To demonstrate the incidence and relative factors of hypothyroidism after partial thyroidectomy (PTC). Methods The records of all euthyroidsm patients who underwent hemithyroidectomy from 1988 to 2000 were reviewed to determine the incidence of postoperative hypothyroidism and the predisposing factors. All the patients age, gender, serum TSH TGA and TPO levels,and the weight of resected thyroid tissue were evaluated. Hypothyroidsm patients were evaluated for the symptoms , timing of diagnosis , and thyroxine therapy. Results Hypothyroidism was diagnosed in 41(3.4%) of 1 210 patients ,inclnding subclinical hypothyroidsm in 28 and overt in 13.The mean postoperative serum TSH level was (9.22?3.36)mU/L. The mean preoperative serum TSH level was (3.14?1.05)mU/L in hypothyroidsm patients but in euthyroid patients was (1.07?0.72)mU/L(P

Impact acceleration is one of the factors to which human body is exposed in aerospace exploring. When the impact level is greater than human tolerance, it usually results in human injuries which may be fatal. Therefore, in order to reduce or avert the risk of serious injury from crash impact, human tolerance to impact acceleration is a crucial consideration in aircraft since the beginning of aviation. The study on human tolerance to impact acceleration has become a cynosure in the realm of modern biomechanics. So this paper reviews the progress of the researches.
Acceleration ; adverse effects ; Accidents, Aviation ; Adaptation, Physiological ; Aerospace Medicine ; Biomechanical Phenomena ; Computer Simulation ; Humans

Objective To explore the clinical application effect of multiple end-to-side anastomosis in free anterolateral thigh perforator flap transplantation.Methods From January,2013 to October,2017,29 cases were applied the technology of multiple end-to-side anastomosis to the same recipient vessel in anterolateral thigh perforator flap transplantation for wound repair.Fifteen cases treated with multiple end-to-side anastomosis on flap arteries,and 2-3 arteries were anastomosed,with the average of 2.13.Nine cases were treated with venous multiple end-to-side anastomosis,and 2-4 veins were anastomosed,with the average of 3.11.Five cases treated with arterial and venous multiple end-to-side anastomosis,and 4-6 vessels were anastomosed,with the average of 5.20.Distribution of wounds:10 cases with hands and wrists wounded,15 cases with forearms and elbow joints wounded,and 4 cases with lower legs and feet wounded.The soft tissue defect size was 5 cm×13 cm-11 cm×27 cm,and the flap area was 6 cm× 15 cm-12 cm×29 cm.Postoperative followed-up was performed every 3-6 months to review flap survival.Results All flaps of 29 cases survived.Venous congestion occurred in 2 flaps within 48 h after the operation,among which,1 was overcomed after released the dressing and sutures,and the other underwent surgical exploration.The venous end-to-side anastomotic stomas were unobstructed,and hematoma was formed.After the hematoma compression was removed,circulation was recovered and the flap survived.With followed-up for 6 months to 2.5 years,both donor site and recipient site of the flaps healed well and the injured distal limbs had no hemodynamic disorder.Conclusion The application of multiple end-to-side anastomosis to the same recipient vessel for free transplantation of anterolateral thigh perforator flaps is safe and reliable.