The paper proposed a concept to build a management system for operating room hidden costs in an effort to better hospital management and alleviate patients' economic burden.The authors analyzed the root of such costs from the levels of operating room's design and construction,as well as management and operations,proposing a framework of such hidden costs.Based on diversified cost characteristics,they come up with a number of estimating methods,and control methods against different hidden costs by using management theories systematically.

[ABSTRACT]AIM:Toinvestigatetheeffectofintracerebroventricular(icv)injectionofacidulatedartificialce-rebrospinal fluid ( aCSF ) on the respiratory reactions and the functions of acid sensing ion channels ( ASICs ) in this process.METHODS:Healthy adult SD rats (n=30) were divided into aCSF with pH 7.4 control group, aCSF with pH 6.5 group, amiloride control group, amiloride plus aCSF with pH 6.5 group, psalmotoxin 1 (PcTx1) control group and PcTx1 plus aCSF with pH 6.5 group.The electromyogram (EMG) of the diaphragm was monitored to observe the respirato-ry responses induced by icv injection of acidulated aCSF .The ASICs blockers were also injected into the lateral cerebral ventricle firstly and acidulated aCSF was injected following the ASICs blockers to observe the effect of ASICs on the respira -tory regulation by the central chemoreceptor .RESULTS:After icv injection of acidulated aCSF , the respiratory responses of the rats were excited (P<0.05).The respiratory excitation responses disappeared after icv injection of ASICs blocker amiloride.The degree of respiratory excitation was weakened after icv injection of ASIC 1a blockers-PcTx1.CONCLU-SION:ASICs play a key role in the respiratory regulation by the central chemoreceptor and ASIC 1a partly operates in this process.

0.05).Conclusion TP may have protective effects on chronical hypoxia induced polycythemia in rats.

Objective To explore the value of 2 dimension and color Doppler flow imaging (2D CDFI) in detection of deep venous thrombosis of the lower limbs. Methods One hundred and one patients, 118 limbs clinically suspected as deep venous thrombosis were examined by CDFI and ascending phlebography. Results The sensitivity of ultrasonogram was 94 4% and accuracy was 98 4%. The highest incidence is 30 4% in the femoral vein. With the ratio 2 2∶1, the incidence of left lower limbs was much higher than the right. Because of different pathological changes in acute, subacute and chronic thrombosis, there are diverse character in 2D CDFI. Conclusions Deep venous thrombosis of the lower limbs can be diagnosed by 2D CDFI, which is a noninvasive, easy and accurate method.

Objective To observe the influence of comprehensive rehabilitation on lung function and exercise tolerance in geriatric patients with chronic obstructive pulmonary disease (COPD).Methods Totally 51 patients with COPD were enrolled in this study and divided into two groups:treatment group and control group.For treatment group,each patient was given health education about COPD and the rehabilitation program with medication therapy.The program included aerobic exercises,breathing exercises and upper limb strength training.The control group was given medication therapy only.The treatment group was tested by 6 minute walking distance (6MWT) and both groups had lung function examination before the program started,and were retested 1 year later.Results In the treatment group,lung function including vital capacity (VC),forced expiratory volume in one second (FEV1),FEV1 ％,and 6MWT were significantly improved after 1 year of treatment as compared with those indices before treatment [(2.94±0.67)L vs.(2.62±0.65) L,(2.88±0.70)L vs.(2.58±0.65)L,(1.89±0.79)L vs.(1.60±0.67)L,(80.7±28.3)％ vs.(67.7 ±25.9)％,(426.40±71.37)m vs.(326.23±110.80)m,t=2.86,2.27,4.28,4.73,-3.639,respectively,P=0.006,0.027,0.000,0.000,0.001].There was no significant difference in lung function before versus 1 year after intervention in the control group.After 1 year of intervention,the only difference was in FEV1 ％ between the treatment and control groups [(80.7±28.3)％ vs.(71.90± 16.5) ％,t=9.88,P=0.000].Conclusions Comprehensive rehabilitation can improve the lung function and exercise tolerance in geriatric patients with COPD.

Objective To observe the effect of different doses of propofol injection and propofol medium/long-chain fat emulsion injection in short time infusion on plasma ketone body ratio,to eva-lute its effecton hepatic energy metabolism.Methods Forty patients,aged 18-50 years old,ASA Ⅰ orⅡ undergoing selective surgery were randomly divided into 4 groups with 10 cases in each;propofol injection 4 mg·kg-1·h-1 maintain anesthesia (group L4 ),propofol injection 6 mg·kg-1·h-1 maintain anesthesia (group L6 ),propofol medium/long-chain fat emulsion injection 4 mg·kg-1·h-1 maintain anesthesia (group M4 ),propofol medium/long-chain fat emulsion injection 6 mg·kg-1·h-1 maintain anesthesia (group M6 ).MAP,HR,SpO2 and PET CO2 were recorded before anesthesia induction (T0 ),after tracheal intubation (T1 ),after 2 hours infusion of propofol (T2 )and operation completed (T3 ).The blood samples were collected at T1 and T2 to detect the level of acetoacetate,β-hydroxybu-tyrate and to calculate the blood ketone body ratio (the ratio of acetoacetate andβ-hydroxybutyrate). Results MAP,HR,SpO2 ,PET CO2 at T0-T3 and acetoacetate,β-hydroxybutyrate,blood ketone body ratio at T1 ,T2 showed no significant statistic difference.Conclusion Different doses of propofol and different doses of propofol medium/long-chain fat emulsion injection in short time continuous in-fusion has no obvious effect on hepatic energy metabolism;same dose of propofol injection and propo-fol medium/long-chain fat emulsion injection in short time continuous infusion has no obvious effect on hepatic energy metabolism.

Objective To analyze the risk factors for thrombosis by investigating the incidence of central venous catheter‐related thrombosis in elderly patients .Methods Four hundred and five elderly patients who underwent central venous catheterization were divided into femoral vein group(n=46) ,internal jugular vein group (n=40) and subclavian vein group (n=319) according to their catheter position ,or into thrombosis group (n=31) and non‐thrombosis group (n=374) according to the incidence of central venous catheter‐related thrombosis .T heir gender ,age ,basic diseases ,catheter position ,retention time of catheter ,and complications of central venous catheter‐related thrombosis were retrospectively analyzed .Results The incidence of central venous cathe‐ter‐related thrombosis was significantly lower in subclavian vein group than in internal jugular vein group and femoral vein group (5 .0% vs 15 .0% ,5 .0% vs 19 .6% ,P<0 .05 ,P<0 .01) .The percentage of past venous thrombosis history was significantly higher in thrombosis group than in non‐thrombosis group (19 .4% vs 6 .4% ,P<0 .05) .Conclusions Subclavian vein catheterization can significantly reduce the incidence of central venous catheter‐related thrombosis and past ve‐nous thrombosis history can predict the incidence of central venous catheter‐related thrombosis in elderly patients .

Objective We discussed the optimal method for intestinal preparation before colonoscopy examination in order to increase the success rate of intestinal examination and reduce the incidence of adverse effect. Methods We divided 120 patients who were to undergo colonoscopy examination into group A, B and C with 40 cases in each group. Group A received oral magensium sulfate 100ml and 6000ml water after that on the morning of the examination. Group B received oral magensium sulfate 50ml and 2000ml in the evening before the examination, oral magensium sulfate 50ml and 400ml water on the morning of the examination. Group C was given oral magensium sulfate 100ml and 4000～5000 water at the same time. Group A and B took part in appropriate activity and were given health education. The effect of intestinal preparation was compared between the three groups. Results The cleaning degree of group B was better than those of the other two groups (P<0.05). The adverse effect of group B was less than that of group C (P<0.01). Conclusions Oral intake of magensium sulfate in the evening before and on the morning of the examination for intestinal preparation could increase the cleaning degree of intestine, facilitate the observation of disease part and lessen adverse effect. It gave satisfying examination results and made patients satisfied.

Objective To study the influences of chitosan on swimming time, changes of blood glucose and lactic acid in mice. Methods The test groups were given chitosan by oral administration,and eighteen days later, the swimming time,blood glucose and lactic acid were determined. Results The swimming time of test groups was obviously longer than that of the control group.After thirty-minutes swimming, the elimination of blood lactic acid and the recover of blood glucose were distinctly faster than those of the control group. Conclusion Chitosan had anti-fatigue effect on mice.

Objective To analyze the second time blood screening results of ALT deferred donors,and to evaluate the importance of alanine aminotransferase(ALT) testing on the improvement of blood safety.Methods The ALT testing results of 565 360 blood donors from Feb.2006 to Jan.2008 of Shanghai Blood Center were studied retrospectively.The screening results and donation intervals of such donors who delayed their donation just because of their former unqualified ALT level were also analyzed.Results A total of 32 042 donors(5.67%) failed in ALT testing among 565 360 donors.And 3 395 ALT deferred donors participated the second time blood donation,among which 2 205(64.95%) passed the blood screening tests,while the other 1 190(35.05%) failed.Among the 1 190 unqualified blood donors,1 151(33.90%)failed again in ALT testing,and 11(0.32%) in Syphilis,12(0.35%) in HBsAg,7(0.21%) in anti-HCV and 1 in anit-HIV(0.03%).Meanwhile,donors failed both in ALT testing combined with HBsAg,anti-HCV,and anit-HIV sero-converted were 1(0.03%),2(0.06%) and 1(0.03%),respectively.And 72.64% of ALT deferred donors participated the second time blood donation within 6 months.The average donation intervals of donors with qualified ALT level but sero-converted were 140 days(from 24 to 267 days),and those with both unqualified ALT level and sero-converted were 158 days(from 91 to 220 days).Conclusion Before the new methods such as NAT were applied to blood donation screening system,ALT test could prevent the window-period failure of ELISA screening so as to improve the blood safety.