The author proposed detailed introduction of handling of complications in the Australian AR-DRGs program,introduced considerations of complications by AR-DRGs from two aspect-the level of disease complications and the complexity of clinical treatments.The authors specifically described CCL and PCCL evaluations.This paper provides reference for the localization of DRGs program design.

Identifying biomarkers predicting clinical response to treatment of PD-1/PD-L1 pathway blockade can guide patient selection and therapeutic individualization.Some researches have shown that patients with cancer will acquire better clinical effects by blocking PD-1/PD-L1 pathway whose characteristics include higher pretreatment expression of PD-L1 by tumor cells or tumor infiltrating immune cells,the massive infiltration of intratumoral CD8 + T cells,the high mutation frequency of tumor cell gene.These biomarkers are expected to become indicators which can select patients.

BACKGROUND:Bone marrow mesenchymal stem cells are ideal as tissue engineering seed cells, but the proliferation and differentiation of mesenchymal stem cells in vitro is very different at different ages. Moreover, there are few reports on the association between age and the number of bone marrow mesenchymal stem cells. OBJECTIVE:To observe the difference in differentiation ability of bone marrow mesenchymal stem cells from rats at different ages. METHODS:We isolated, purified and amplified the mesenchymal stem cells from rat bone marrow in vitro by the whole bone marrow adherent culture;observed the morphological characteristics of mesenchymal stem cells under an inverted phase contrast microscope;detected cellsurface markers by flow cytometer. Then, mesenchymal stem cells were induced in vitro into osteoblasts and chondroblasts and verified. Passage 3 cells from rats at ages of 2, 4, 6, 8, 12 weeks and 10, 12 months were subjected to osteogenic induction at weeks 1, 2, 3. ELISA was used to determine osteocalcin content. RESULTS AND CONCLUSION:Bone marrow mesenchymal stem cells cultured in vitro were adherent and exhibited a fibroblast-like spindle shape. In vitro, cells proliferated quickly to form colonies. Flow cytometry showed that the cells were positive for CD29, CD90, but negative for CD45, and partial y expressed CD44. After osteogenic induction, cells were positive for alkaline phosphatase staining and alizarin red staining;after chondrogenic induction, cells were positive for alcian blue staining. Mesenchymal stem cells could be isolated and cultured by the method of bone marrow adherent culture in vitro. However, bone marrow mesenchymal stem cells from rats at different ages exhibit decreased proliferation and differentiation abilities with the increase of age through determination of osteocalcin content.

OBJECTIVE:To investigate the influence of sevoflurane inhalation anesthesia and propofol intravenous anesthesia on hemodynamics,stress reaction and anesthesia effects of pediatric hernia surgery. METHODS:Eight-six children underwent hernia surgery in Hubei Provincial Third People's Hospital from May 2011 to Sept. 2015 were selected as subjects and divided into tri-al group and control group according to random number table,with 43 cases in each group. Trial group was given Tirofiban hydro-chloride for injection 0.4 μg/(kg·min),ivgtt,Cisatracurium besilate for injection 0.1 mg/kg+Fentanyl citrate injection 1.0 μg/kg,iv, for anesthesia induction;given 2%-3% sevoflurane inhalation for anesthesia maintenance,and additionally given fentanyl citrate 0.5 μg/kg,iv if necessary. Control group was given Propofol emulsion injection 3 mg/kg+atracurium 0.1 mg/kg+ fentanyl citrate 1.0μg/kg,iv for anesthesia induction;given micro pump injection of propofol 3 mg/(kg·h)for anesthesia maintenance,and additional-ly given fentanyl citrate 0.5 μg/kg,iv if necessary. The onset time of anesthesia,hemodynamic parameters (SBP,DBP,HR), stress reaction indexes(NE,E,R),recovery situation and the occurrence of ADR were observed in 2 groups. RESULTS:The on-set time of anesthesia in trial group was(3.82±0.45)min,significantly shorter than control group(5.13±0.74)min,with statisti-cal significance(P<0.05). Before anesthesia induction,there was no statistical significance in SBP,DBP,HR,the serum levels of NE,E and R between 2 groups(P>0.05). The levels of SBP,DBP,HR of 2 groups at incision,5 min after incision,10 min after incision were significantly higher than before anesthesia,with statistical significance(P<0.05). Above indexes of trial group at incision,5 min after incision were significantly lower than control group,with statistical significance (P<0.05). At incision, the serum levels of NE,E and R in 2 groups were increased significantly compared to before anesthesia induction,but the trial group was significantly lower than the control group,with statistical significance (P<0.05). The postoperative eye opening time, awake time and orientation recovery time of trial group were significantly shorter than control group,while the PAED score was sig-nificantly lower than control group,with statistical significance(P<0.05). The incidence of ADR in trial group(0)was significant-ly lower than control group (11.6%),with statistical significance (P<0.05). CONCLUSIONS:Sevoflurane inhalation anesthesia has less effect than propofol intravenous anesthesia on hemodynamic indexes and is helpful to relieve stress reaction and promote postoperative revival with good safety.

Objective To compare wedge biopsy and disposable automatic biopsy gun biopsy for the diagnosis of pancreatic cancer. Methods The clinical data of 217 patients with unresectable pancreatic cancer undergoing palliative operation and biopsy were retrospectively analyzed in our hospital from March 25,2006 to March 25,2011.Group A(wedge biopsy) consisted of 120 cases and B( disposable automated biopsy gun biopsy) of 97 cases.The success rate of biopsy,the positive rate of biopsy,the accuracy of diagnosis and the incidence of postoperative complications were calculated. Results The success rate,positive rate,diagnostic accuracy and the incidence of postoperative hemorrhage of group A and B were 100％,97.5％,97.5％,1.7％ and 100％,99％,99％,1.0％,respectively ( all P ＞ 0.05 ).The incidence of postoperative pancreatic leakage in group A and B were 11.7％ and 2.1％ (P =0.007 ).Conclusions Intra-operative biopsy for the diagnosis of pancreatic cancer using disposable automated biopsy gun biopsy has significantly decreased the incidence of post-biopsy pancreatic leakage as compared with wedge biopsy.

Objective To investigate the effects of recombinant human erythropeietin(rh-EPO)on Bid mRNA and caspase-3 activity in the brain after hypoxic-ischemic brain damage(HIBD)in neonatal rats and the possible mechanism of the neuroprotective effect of rh-EPO.Methods Ninety 7 day old male SD rats weighing 12-18 g were randomly divided into 3 groups(n=30 each):group Ⅰ sham operation(S);group Ⅱ hypoxia-ischemia group(HI)and group Ⅲ rh-EPO.The animals were anesthetized with ether.Left common carotid artery was ligated with 4-0 silk and 3 days later the animals were placed in a 2 L airtisht vessel filled with 8%O2-92%N2 at 2-3 L/min for 2 h in group Ⅱ and Ⅲ.rh-EPO 3 000 IU/kg in 4 ml/kg normal saline(NS)was administered intraperitoneally after induction of hypoxia-ischemia(HI)in group Ⅲ while in group Ⅱ NS 4 ml/kg was given IP instead.Six animals in each group were killed at 6,12,24,48 and 72 h(T1-5)respectively after IP NS or rh-EPO.Their brains were removed for determination of Bid mRNA expression(by RT-PCR)and caspase-3 activity(by colorimetric method).Results The expression of Bid mRNA was up-regulated and caspase-3 activity was significantly increased in the brain at T1-5 in HIBD group(group Ⅱ)as compared with sham operation group.rh-EPO administration significantly reduced the increase in Bid mRNA expression and caspase-3 activity in the brain induced by hypoxia-ischemia.The expression of Bid mRNA was positively correlated with the caspase-3 activity.Conclusion rh-EPO has protective effects on the brain against hypoxia and ischemia by decreasing the expression of Bid mRNA and caspase-3 activity in the brain.

This paper introduces the premarket registration procedures and the post market regulatory requirements in India. According to Indian medical device act and related medical regulations on medical device, this is a preliminary discussion on the registration management system to provide referance for foreign medical device to enter India market.
Equipment and Supplies ; economics ; standards ; India

Objective To investigate the clinical significance of building core competencies evaluation system among emergency nurses. Methods 170 nursing staff in emergency department were chosen and were investigated about the general situation and previous training and training needs.Before and after training 170 nursing staff were tested for relevant knowledge,and the survival rate of critically ill patients and satisfaction degree of patients were taking for statistics. Results Training needs of core competencies of professional nurses in emergency department were as followed from high to low in sequence:first-aid equipment and facilities,first-aid skills,organization and coordination of emergency response and education and training.For nurses with different nursing work experience,the knowledge level about core competencies was also different,work experience ＞ 5 years was significantly higher than those ≤ 5years,emergency equipment and facilities and knowledge level of first-aid skills showed significant differences.After training,the level of related nursing skills of 170 nurses was better than before,in the rescue of patients,the survival rate and satisfaction degree of patients was significantly higher than before the training. Conclusions Building core competencies evaluation system for emergency nurses and applying it in clinic is feasible and has a positive meaning.

Female ; Humans ; Infant ; Mastocytosis, Systemic ; diagnosis ; pathology ; therapy

Objective:To discuss the approach of treating the patients who suffered from cystic lesions of the pancreas. Methods:According to the retrospective analysis of all the 127 patients who were diagnosed as cystic lesions of the pancreas by the following methods such as ultrasonography ,CT,MRCP,PET,ERCP,EUS and FNA. Results:48 case of cystic lesions of the pancreas (38%) were selected an initial operation,and 79 of them (62%) selected follow-up visit. Nearly 40% of the patients who chose an initial operation were confirmed to suffer a malignant tumor by pathology. 9 patients(11%) of all the patients in the follow-up accept an operation because of their cystic lesions had a variation. According to the result of the pathology after the resection,3 patients of them had a canceration. The patients in the follow-up whose lesion diameter was smaller than 3cm,not existing a solid lesions,and without signs or symptoms,didn't have a risk in the transition to the malignant mutation. The transition rate was less than 4%,which was similar to the death risk of the patients undergoing resection. Conclusion:It is significant to adopt a careful radioactive follow-up to the surrounding parenchyma of all the patients who had not an initial resection.