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.

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Objective Dynamic observation of plasma endotoxin (ET),plasma TXA2 and PGI2 levels and clinical symptoms in patients with severe acute pancreatitis (SAP),the protective effect of Salvia miltiorrhiza ligustrazine on the intestinal barrier in severe acute pancreatitis was studied.Methods The 60 cases of severe acute pancreatitis treated in our hospital from August,2014 to October 2015 were studied as the research object,and were randomly divided into the control group and the danchuan group.Two groups of patients received conventional treatment,such as diet,gastrointestinal decompression,early active fluid resuscitation,maintenance of stable electrolyte,anti infection,inhibition of pancreatic secretion,parenteral nutrition and other support treatment,Dan Chuan group on the basis of conventional treatment combined with 10 ml of compound Salvia miltiorrhiza ligustrazine injection of 5% glucose injection,250 ml intrave-nous drip,1 times a day.Two groups of patients with 14 days for a period of treatment,the clinical symp-toms of the two groups were observed after the end of treatment,the clinical symptoms and the changes of la-boratory index.Results ⑴In the group of Dan chuan,the time of patients relieve intestinal pneumatosis or intestinal obstruction,abdominal pain were less than the control group,the difference was statistically sig-nificant (P <0.05).⑵ The recovery time of plasma endotoxin,serum amylase,and leukocyte in the Dan Chuan group were shorter than those in the control group (P <0.05).⑶The incidence,mortality and inci-dence of complications in the control group were significantly lower than those in the control group,but the difference was not statistically significant (P >0.05).Conclusions Salvia miltiorrhiza ligustrazine has a significant effect on severe acute pancreatitis.It can improve the intestinal microcirculation by correcting the balance between PGI2 and TXA2 ,and can promote the recovery of intestinal function,reduce the incidence of intestinal bacterial and endotoxin,and reduce the incidence of complications.

Objective To investigate the variation of plasma mitochondrial coupling factor -6 and explore the significance in neonatal sepsis.Methods The study of 88 cases of pediatric inpatients in our hospital were divided into non-sepsis group (46 cases)and sepsis group (42 cases).CF-6 concentration in venous blood of all study subjects was determined by enzyme linked immunosorbent assay (ELISA).Re-sults The plasma CF-6 concentrations in peripheral venous blood of the patients with sepsis were signifi-cantly higher than those in non sepsis group(107.65 ±50.38)pg/ml vs (38.96 ±29.87)pg/ml,The con-centrations of CF-6 in the infected group were higher than those in the normal control group(P <0.05). Conclusions The concentration of mitochondrial coupling factor -6 in neonatal sepsis was significantly higher,and has a certain pathological and physiological significance in the pathogenesis of neonatal sepsis.

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.