Objective To increase the recognition of the clinicians and laboratorians to hereditary spherocytosis for reducing the misdiagnosis and missed diagnosis ,and improving the diagnostic level .Methods The data in 4 cases of definitely diagnosed heredi‐tary spherocytosis in our hospital were retrospectively analyzed ,and the misdiagnosis reasons were analyzed and summarized .Results In 4 cases ,2 cases were misdiagnosed as Mediterranean anemia ,1 case was misdiagnosed as hemolytic anemia and 1 case as hemo‐globin disease .Conclusion Correctly mastering the key points of the diagnosis ,strengthening the communication between the labo‐ratorians and clinicians ,paying attention to the red blood cells morphologic examination under microscope and high level diagnosis a‐bility of blood cell morphology are the important means to reduce the misdiagnosis and missed diagnosis and improve the diagnostic accuracy rate .

In the present study, the results were as follows: ( 1 ) Thyro-tropin-releasing hormone ( TRH ) injected into the intracerebroven-tricle increased intragastric pressure & evoked the phasic contraction of stomach significantly. ( 2 ) The increased response was decreased by bilateral destruction of dorsa. motor nucleus of vagus. ( 3 ) The increase was abolished completely by either vagotomy or atropine.The aforementioned results indicate that the action of dors. motor nucleus of vagus is partly involved the central mechanism of gastric movement induced by TRH & the vagal is the efferent pathway.

Objective To evaluate the clinical value of susceptibility?weighted imaging(SWI) in detecting intramedullary hemorrhage of traumatic acute spinal cord injury. Methods From October 2012 to December 2014, 37 TSCI (traumatic spinal cord injuries) patients undergone the MRI scans including routine MRI and SWI were enrolled. Further according to ASIA classification standard, all patients were evaluated as ASIA A (n=4), ASIA B (n=4), ASIA C (n=19) and ASIA D (n=10). Referring to axial T2WI images at the same slice, the manifestations of hemorrhage in amplitude image, phase image and SWI were evaluated. At the slice with maximal size of hemorrhage area and its neighboring slices, the hemorrhage regions were manually drawn; and the total area was automatically calculated. The number of hemorrhage lesions was defined as the number of hemorrhage lesions at single slice × slice number. One?way ANOVA was used to compare the differences among different grading ASIA in terms of hemorrhage area and number. Meanwhile, the relations between hemorrhage area and ASIA grade; hemorrhage number and ASIA grade were evaluated by Spearman rank correlation. Results The hemorrhage was detected by SWI in 15 patients, including 4 ASIA A, 4 ASIA B, 7 ASIA C. Hemorrhage represents as isointense in T1WI and a slightly low signal intensity or isointense in the center companied by high intensity at circus in T2WI. In magnitude image and SWI hemorrhage appears as low signal intensity and low signal intensity in the center companied by high intensity at circus in phase image. In detecting the hemorrhage, SWI (98 lesions were detected) was 5.4 times of T2WI (19 lesion were detected). As for the number of hemorrhage, significant differences were found among ASIA grading A, B and C (grading A:22.5 ± 1.3, grading B:19.5 ± 1.3, grading C:4.0 ± 1.1;F=38.720, P<0.01); Further the pairwise comparison showed statistical significance (P<0.05); besides, the number of hemorrhage lesions closely related with the ASIA grade (r=0.864, P<0.01). For the hemorrhage area, the calculated results of grading ASIA A, B and C were (23.5 ± 0.6), (21.8 ± 1.9), (3.9 ± 0.7) mm2, respectively; there were significant differences among the different ASIA grades (F=29.987, P<0.001);furthermore the hemorrhage area also showed closely relation with the ASIA grade (r=0.778, P<0.01). Conclusions SWI is more sensitive in detecting the hemorrhage in traumatic acute spinal cord injury. The more number and area of bleeding area suggest the more severe of the damage level.

Objective To investigate the change of peripheral blood lymphocyte immunophenotype in the patients with malignant carcinoma and its clinical significance .Methods The flow cytometry was adopted to detect the expression levels of peripheral blood T lymphocyte subpopulations ,CD19+ cells ,CD3-CD56+ cells ,CD3+CD56+ cells in 167 patients with malignant carcinoma (inclu‐ding respiratory tract cancers ,gastrointestinal cancers and reproductive system cancer) and 170 normal controls as the healthy con‐trol group .The contrastive analysis was performed .Furthermore the analysis was conducted according to whether having tumor me‐tastasis and chemotherapeutic cycles .Results The total absolute value of the lymphocytes and the proportion of CD3+CD4+ cells in the patients with malignant carcinoma were significantly lower than those in the healthy control group (P<0 .05) ,but the propor‐tions of CD3+CD8+ ,CD3+CD56+ and CD3-CD56+ cells were significantly higher than those in the healthy control group (P<0 .05) .The proportion of CD3+CD4+ cells in the patients with tumor metastasis were significantly lower than those in the ones without tumor metastasis ;but the proportions of CD3+ CD8+ ,CD3-CD56+ and CD3+ CD56+ cells were significantly higher than those in the ones without tumor metastasis ,the differences were statistically significant(P<0 .05) .In the chemotherapy treatment , the proportions of CD3+CD4+ ,CD3+CD56+ and CD3-CD56+ cells were gradually increased with the increase of chemotherapeutic cycles ,but the proportion of CD3+CD8+ cells was gradually reduced .Conclusion In the process of development ,progression and treatment of tumor ,the cellular immunity function plays a dominant role ,which could be used as one of indexes for clinically moni‐toring the cellular immune function in the patients with tumor .

Objective: To conduct a characteristic analysis of the case of acute hydrogen sulfide poisoning in fishing boats for nearly ten years in a city, and to research on prevention and control measures, so as to provide scientific basis for formulating prevention strategies. Methods: In July 2018, collecting the data of acute hydrogen sulfide poisoning in fishing boats recorded by the Oceanic and Fishery Department & Health Sector from January 1, 2009 to June 30, 2018, the accident characteristics of acute hydrogen sulfide poisoning in fishing boats was analyzed, and compared the differences of hydrogen sulfide poisoning under different classification statistics. Results: In the past ten years, there were 14 acute poisonings in the city, 34 people were poisoned and 12 deaths (the case fatality rate was 35.3%) . According to the types of fishing vessels, the majority number of acute hydrogen sulfide poisoning incidents, poisoned persons and deaths occurred on fishing boats, accounted for 71.4% (10/14) , 76.5% (26/34) and 75.0% (9/12) respectively. From the location of the accident, 85.7% (12/14) of the acute hydrogen sulfide poisoning incidents occurred outside the fishing port. Fisher's exact test showed that the case fatality rate in within the fishing port was higher than that outside the fishing port (P=0.008) . From the cause of direct poisoning, the first three reasons were enter the fish room to rescue, enter the fish room to move fresh catch, to clean the fish room. The poisoning showed seasonal changes, Fisher's exact test showed that the fatality rate in summer was significantly higher than that in spring (P=0.044) , but there was no statistical significance in other seasons (P>0.05) . Conclusion The acute hydrogen sulfide poisoning of fishing boats in this city has a high case fatality rate, frequent collective poisoning, and showed seasonal changes. Blind rescue, incomplete facilities, and inadequate system are important factors leading to poisoning, so daily measures and rescue measures should be strengthened to reduce the occurrence of poisoning and casualties.

Objective: To evaluate the prognostic significance of comprehensive geriatric assessment (CGA) in Chinese elderly acute myeloid leukemia (AML) patients. Methods: 73 AML patients over the age of 60 were enrolled. CGA stratification included the following 3 instrument assessment: activity of daily living (ADL) ; instrumental activity of daily living (IADL) ; comorbidity score according to the Modified cumulative illness rating score for geriatrics (MCIRS-G) . According to CGA and age, the enrolled patients were grouped into 'fit’, 'unfit’ and 'frail’ categories. Results: The median age of 73 elderly AML patients were 75 years old. According to CGA, 37 (50.1%) patients were classified as 'fit’, 14 (19.2%) as 'unfit’, and 22 (30.7%) as 'frail’. 33 (89.2%) patients in fit group received induction chemotherapy, or demethylation treatment, as 8 (57.9%) in unfit, 10 (45.5%) in frail. The overall response rate was 68.7%、62.5%, 75.0% in fit, unfit, and frail group, respectively (χ²=0.615, P=0.769) .The early mortality (8 weeks) in three groups were different: 5.4%, 7.1%, 27.3%, respectively (P<0.05) . The 1-year overall survival in the 'fit’, 'unfit’ and 'frail’ groups was 64.9%, 28.6% and 22.7%, respectively (P<0.05) . The CGA score, age, ECOG score, WHO classification (2016) were the prognostic factors of AML patients. Conclusion CGA can be used to determine the prognosis of elderly AML patients.

Objective To measure the comprehensive geriatric assessment (CGA) in elder non-Hodgkin's Lymphoma (NHL) patients in a cross-sectional study;to compare the differences between Eastern Cooperative Oncology Group (ECOG)-performance status (PS) and CGA.Methods CGA stratification included the following 3 instrument assessments:activity of daily living (ADL);instrumental activity of daily living (IADL);comorbidity score according to the modified cumulative illness rating score for geriatrics (MCIRS-G).According to CGA and age,NHL patients,aged ≥60 years,were classified as "fit","unfit" and "frail" groups.ECOG-PS was evaluated and compared with CGA.Results According to CGA,51.6％ senior NHL patients (33 cases) were classified as "fit",12.5％(8 cases) as " unfit" and 35.9％ (23 cases) as "frail".Several comorbidities were observed in majority patients,such as cardiovascular disease,diabetes nellitus and hypertension.In the "younger aged" patients between 60 to 64ys,25％(3/12) was considered as "frail".However,this proportion increased to 42.9％ (6/14) in patients older than 80ys.Moreover,impaired CGA was observed in 38.9％(21/54) of ECOG-PS ≤1 patient.Conclusions Impaired CGA is as common as approximately half in elderly NHL patients and more than one third even in ECOG-PS ≤ 1 patients.ECOG-PS may underestimate the impaired fitness function in elder NHL patients.

Objective To evaluate the performance on comprehensive geriatric assessment (CGA) in elderly patients with acute myeloid leukemia (AML)and to investigate the differences between Eastern Cooperative Oncology Group (ECOG) performance status (PS) and CGA scoring.Methods Patients aged 60 years or over diagnosed with AML at Beijing Hospital from September 2008 to April 2018 were enrolled in this study.CGA was performed during staging procedures through application of age,activities of daily living(ADL)/instrumental activities of daily living(IADL)and the comorbidity score based on the cumulative illness rating scale for geriatrics(CIRS-G).According to CGA scores,patients were classified into a not-applicable group,an applicable group and a frail group.The difference between ECOG-PS and CGA scoring was compared.Results A total of 73 patients were enrolled in this study.There were 37 (50.7 ％),14 (19.2 ％) and 22 (30.1％) patients in the applicable,not-applicable and frail groups,respectively.Comorbidities were observed in the majority of patients,with cardiovascular disease,diabetes mellitus and hypertension among the most common disorders.In patients aged 60 to 64 years,16.7％ (1/6) were considered as frail,and the percentage of frail patients increased to 36.4％ (8/22)in patients aged 80 years and over.Moreover,functional impairment evaluated by CGA was observed in 36.5 ％ (19/52)of patients with ECOG-PS ≤ 1.Conclusions According to CGA scoring,approximately half of AML patients aged 60 years or over have functional impairment.Functional impairment is observed in some patients with ECOG-PS ≤1,indicating that ECOG-PS may underestimate functional impairment in elderly AML patients.

Comprehensive geriatric assessment clinic can identify geriatric syndrome as well as geriatric health problems, and provide comprehensive systematic diagnosis and treatment for older patients, which is conducive to reducing the number of outpatient visits and saving medical costs.However, the construction of comprehensive geriatric assessment clinic in China is just in the initial stage.There are no guiding opinions on the orientation, work content, work process, and quality management.Therefore, this consensus was conducted based on the latest evidence and expert opinions which aims to provide guidance for the construction of comprehensive geriatric assessment clinic.