Research on Medical Quality Control Management in Continuous Improvement of Hospital Quality / 中国医院管理

The quality control centers of the city level supervise and manage the medical quality of related clinical and technical specialties of medical institutions.The paper researches the comprehensive control and management of various professional subjects according to the standard of quality control,improving the medical quality of the Department,improving the level of discipline development,promoting the continuous improvement of medical quality in hospitals.

Cytogenetic Abnormalities and Outcomes of 117 Patients with Multiple Myeloma Detected by FISH / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To analyze the cytogenetic abnormalities and prognostic outcomes of patients with multiple myeloma (MM) detected by fluorescence in situ hybridization (FISH).</p><p><b>METHODS</b>The clinical record of 117 newly-diagnosed patients with MM treated in department of hematology and geriatric hematology of our hospital for 7 years were collected, and their molecular cytogenetic abnormalities detected by FISH and the clinical outcome were analyzed retrospectively.</p><p><b>RESULTS</b>The detected rate of cytogenetic abnormality was 76.9%(90/117), the most common abnormality deteted by FISH was 1q21+ (71.1%), followed by 13q- (56.6%). The cross comparison method showed that 13q- and 17p13-, t(11;14) and t(4;14) were related respectively. All the patients with cytogenetic abnormalities showed no significant difference in the overall survival from cytogenetic normal patients.</p><p><b>CONCLUSION</b>The positive rate of molecular cytogenetic abnormalities detected by FISH in MM patients is high, but data from larger and longer studies are needed to evaluate the prognostic outcomes.</p>

Analysis of the diagnostic consistency of Chinese medicine specialists in cardiovascular disease cases and syndrome identification based on the relevant feature for each label learning method / 中国结合医学杂志

<p><b>OBJECTIVE</b>To analyze the diagnostic consistency of Chinese medicine (CM) specialists in patients with cardiovascular disease and to study syndrome classification and identification based on the multi-label learning method.</p><p><b>METHODS</b>Using self-developed CM clinical scales to collect cases, inquiry information, complexity, tongue manifestation and pulse manifestation were assessed. The number of cases collected was 2,218. Firstly, each case was differentiated by two CM specialists according to the same diagnostic criteria. The consistency of the diagnosis based on Cohen's Kappa coefficient was analyzed. Secondly, take the same diagnosis syndromes of two specialists as the results of the cases. According to injury information in the CM scale "yes" or "no" was assigned "1" or "0", and according to the syndrome type in each case "yes" or "no" was assigned "1" or "0". CM information data on cardiovascular disease cases were established. We studied CM syndrome classification and identification based on the relevant feature for each label (REAL) learning method, and the diagnostic rate of the syndrome was studied using the REAL method when the number of features selected was 5, 10, 15, 20, 30, 50, 70, and 100, respectively.</p><p><b>RESULTS</b>The syndromes with good diagnostic consistency were Heart (Xin)-qi deficiency, Heart-yang deficiency, Heart-yin deficiency, phlegm, stagnation of blood and stagnation of qi. Syndromes with poor diagnostic consistency were heart-blood deficiency and blood deficiency of Heart and Liver (Gan). The highest diagnostic rates using the REAL method were Heart-yang deficiency followed by Heart-qi deficiency. A different number of features, such as 5, 10, 15, 20, 30, 40, 50, 70, and 100, respectively, were selected and the diagnostic accuracy based on five features showed the highest diagnostic accuracy. The top five features which had a strong correlation with the syndromes were in accordance with the CM theory.</p><p><b>CONCLUSIONS</b>CM syndrome differentiation is strongly subjective and it is difficult to obtain good diagnostic consistency. The REAL method fully considers the relationship between syndrome types and injury symptoms, and is suitable for the establishment of models for CM syndrome classification and identification. This method can probably provide the prerequisite for objectivity and standardization of CM differentiation.</p>

Calculation of Coronary Angiographic Total Blush in Patients with Coronary Artery Disease and its Prognostic Implication / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Myocardial perfusion grade (MPG) is an accepted method of evaluating myocardial perfusion. However, it does not take into the account, the extent of the perfusion. We hypothesized that myocardial blush area times MPG (total blush) would be more accurate than simple MPG, and yield better prognostic information.</p><p><b>METHODS</b>About 34 patients were recruited after they had consented to both coronary angiography (CAG) and single photon emission computed tomography (SPECT), and divided into two groups. A special dedicated computer was employed to calculate the total blush. The CAG was performed as a conventional way. Scintigraphic technetium 99m methoxyisobutyl-isonitrile rest and stress images were evaluated quantitatively. The comparison was made between stenosis versus chronic total occlusion (CTO), MPG 1, 2 versus MPG 3, percutaneous intervention (PCI) successful versus failure. A correlation was made between ejection fraction (EF) and myocardial perfusion by MPG, total blush, SPECT, and syntax score.</p><p><b>RESULTS</b>The perfusion indices of total blush, summed difference score (SDS) and syntax score were insignificant between the two groups (P > 0.05). However, the left ventricular end diastolic volume was significantly larger in CTO (P < 0.05). The patients with stenosis had better MPG than with CTO (P < 0.05). The increased MPG was associated with increased total blush, higher syntax score, and EF (P < 0.05). Successful PCI resulted in better perfusion indicated by increased total blush, and MPG (P < 0.05) but successful PCI did not change syntax score, EF and SDS significantly. Multivariate linear analysis with EF as the dependent factor and syntax score, SDS, total blush, blush area, and MPG as the independent factors showed a significantly higher degree of correlation (R = 0.87, P < 0.05).</p><p><b>CONCLUSION</b>After PCI the total blush and EF improved significantly indicating its potential application in the future.</p>

Analysis of false-positive hyoid fractures: 12 forensic identification cases / 法医学杂志

OBJECTIVE@#To study the causes of false-positive hyoid fractures and forensic identification.@*METHODS@#Twelve cases of false-positive hyoid fractures were collected and analyzed.@*RESULTS@#Improper dissection technique (4 cases) and congenital separation (8 cases) were the main reasons for false-positive hyoid fractures.@*CONCLUSION@#True fractures can be differentiated from false-positive hyoid fractures. False-positive hyoid fracture caused by improper dissection technique can be identified through examination of peripheral muscle, soft tissue hemorrhage, and the characteristics of fracture end.

Correlation between age and general morphology of transverse section of cartilago costalis / 法医学杂志

OBJECTIVE@#To study the correlation between age and general morphology of transverse section of cartilago costalis and its forensic significance.@*METHODS@#Eighty-six corpses' cartilago costalis from the routine postmortem examination were collected and the morphological features of their transverse section were observed.@*RESULTS@#With the increased age, there were regular changes in the color, structure, and material of the general morphology of transverse section of cartilago costalis. But the changes were not affected by gender.@*CONCLUSION@#The good correlation between general morphology of transverse section of cartilago costalis and age can be used to estimate age of the deceased rapidly.

Diatom test in lung tissue of corpses in water and causes of death / 法医学杂志

OBJECTIVE@#To explore potential application of diatom test of lung tissue in investigation of cause of death in victim found in the water.@*METHODS@#Four hundred and seven cases were collected and analyzed for cause of death and the nature of case. Diatom test was performed in tissues and the amount was quantified. Forty-five rabbits died in the water (antemortem, postmortem and different seasons drowning) were randomly divided into 9 groups and the diatom content in lung tissue were tested with the method of nitric acid.@*RESULTS@#In 407 drowning cases, 372 cases showed a positive result of diatom test. In positive cases, the amount of accidents or suicide were 35 and homicide were 21. Thirty-five cases showed negative result of diatom test and majority were homicide in which bodies were thrown into the water after killing. Some drowning cases were in special circumstances. Animal experiments confirmed that a large amount of diatoms in lung tissue were detected in drowning victim and showed the same type in water. The amount of diatom in lung tissue was usually lower in the summer and winter comparing with spring and autumn.@*CONCLUSION@#The diatom test could be considered as an auxiliary evidence in determination of cause of death in body found in the water. The test results were related with manner of death. The nature of case should be synthetically determined based on autopsy, criminal scene and details of the cases, etc.

Costicartilage analysis inspection technology in the application of forensic medicine / 法医学杂志

The traditional costicartilage analysis inspection is limited to morphological inspection. In recent years, with the development of forensic radiology and molecular genetics, the costicartilage analysis inspection technology has been further enriched and developed. At present, the costicartilage analysis inspection technology have been able to be used in the practice of forensic medicine. This paper reviews the research advances about the costicartilage analysis inspection technology in the identification of human gender, age and so on in order to provide the references for forensic appraisers.

Study on the objectivity of traditional Chinese medicinal tongue inspection / 中国中西医结合杂志

The traditional Chinese medicinal (TCM) inspection on tongue features are always observed with naked eye, and the syndrome is differentiated depended only on experience. These disadvantages cannot but badly impact not only the inheritance but also the advance and development of TCM. Hence, to bring out the standardization and objectivity of TCM tongue inspection is a task urgently expected. Along with the advancing of modernized TCM research, to study the tongue feature with modern scientific and technologic approaches for making it more quantitative, objective and standardized becomes the main research orientations of tongue inspection. Taking computerized automatic reorganization of tongue feature as a main clue, the techniques involving collection, resolution and signature analysis of tongue feature were discussed in this paper.

Exploration of indication of prophylactic transcatheter arterial chemoembolization on postoperative recurrence of hepatocellular carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of prophylactic transcatheter arterial chemoembolization (TACE) on postoperative recurrence of hepatocellular carcinoma.</p><p><b>METHODS</b>A retrospective analysis was performed on clinicopathologic data of 260 hepatocellular carcinoma patients who underwent curative hepatectomy in Eastern Hepatobiliary Surgery Hospital, Second Military Medical University from January 2004 to June 2007. Among the 260 patients, 104 underwent postoperative prophylactic TACE and the other 156 were not.</p><p><b>RESULTS</b>The overall survival rates at 1- and 2-years were 84.1% and 70.5% respectively. The overall disease-free survival rates at 1- and 2-years were 69.2% and 58.4% respectively. Of 260 overall patients, the disease-free survival rates at 1- and 2-years were 72.8% and 54.9% respectively in TACE group, and 66.9% and 59.7% respectively in non-TACE group, statistically significant difference of the cumulative disease-free survival rates at 1- and 2-years between TACE group and non-TACE group were not observed (P = 0.145, P = 0.405). Of 62 patients with tumor size >or= 10 cm, the disease-free survival rates at 1- and 2-years were respectively 66.6% and 48.7% in TACE group, and respectively 44.6% and 31.2% years between TACE group and non-TACE group were observed (P = 0.025, P = 0.025). Of 38 patients with vascular tumor thrombi, the disease-free survival rates at 1- and 2-years were respectively 33.0% and 0 in TACE group, and respectively 26.2% and 21.8% in non-TACE group, statistically significant difference of the cumulative disease-free survival rates at 1-years between TACE group and non-TACE group was observed (P = 0.025), and not at 2-years (P = 0.122).</p><p><b>CONCLUSIONS</b>In non-TACE group, statistically significant difference of the cumulative disease-free survival rates at 1- and 2-Prophylactic TACE is preferred for hepatocellular carcinoma patients with high risk factors for recurrence such as tumor size >or= 10 cm and presented vascular tumor thrombi.</p>

Diagnosis and treatment for solitary necrotic nodule of the liver: report of 15 patients / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the diagnostic and therapeutic approach of solitary necrotic nodule of the liver (SNNL).</p><p><b>METHODS</b>Fifteen cases were diagnosed as SNNL from June 1999 to December 2005. The clinical characteristics, imaging findings, diagnosis and treatment were analyzed with related literature retrospectively.</p><p><b>RESULTS</b>The patients manifested abdominal pain and discomfort in 7 cases (46.7%), fever in 1 case (6.7%), debilitation in 1 case (6.7%). Lesions were screened as hypoechogenic patterns in B ultrasound, and CT scan confirmed that the lesion appeared slightly hypodense compared with the normal liver parenchyma without detectable enhanced graphic phases. No significant enhancement was on dynamic magnetic resonance imaging study. All of the nodules demonstrated hypointense and isointense signal relative to parenchyma of liver on both T1 and T2-weighted images. Histologically, the lesion composed mainly of coagulative necrosis with a homogeneous periphery, and the central zone had a rough patchy appearance with cellular debris. The coagulative necrosis was surrounded by a thin boundary of collagen fibers with scanty mononuclear, lymphocyte, plasmocyte inflammatory cells and elastic fibers. Preoperative laboratory examinations showed hepatic function slightly abnormal in 3 patients, and AFP level was normal in all patients. Diagnosis of SNNL was established in 4 cases (26.7%) preoperatively. All patients underwent liver resection with no recurrence within 3 months to 6 years follow-up.</p><p><b>CONCLUSIONS</b>Preoperative diagnosis of SNNL can be established via comprehensive analysis of clinical characteristics and imaging findings. Liver resection is the optimal therapeutic approach.</p>

The preliminary analysis of forensic crime scene investigation / 法医学杂志

Crime scene investigation is one of the important aspects in a medico-legal proceeding. This article describes the principles of forensic investigation under different circumstances including indoor and outdoor as well as moving objects/environment.

Lymph node metastasis of patients with intrahepatic cholangiocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the relationship between lymph node metastasis and prognosis in patients of intrahepatic cholangiocarcinoma (ICC).</p><p><b>METHODS</b>A retrospective clinical analysis was made in 132 cases of ICC, who admitted to our hospital from December 1996 to June 2003. Kaplan-meier method was used to calculate their survival rates, chi(2) test to compare the difference of sample rates. Logistic regression analysis was performed to determine the factors influencing lymph node metastasis and log-rank univariate analysis was used to assess the role of lymph node metastasis in the long-survival.</p><p><b>RESULTS</b>Lymph node metastasis in hepatoduodenal ligament could be detected in all 29 preoperative and 48 postoperative lymph metastatic cases, without "jumping-metastasis". Lymph metastasis was one of the major causes of postoperative mortality, and resulted in 36 of 58 followed-up death postoperatively. According to logistic analysis, pathological types of the carcinoma (chi(2) = 4.071, P = 0.044) and periductal-infiltrating tumors (chi(2) = 3.872, P = 0.037) were significant predictors of lymph node metastasis. In all 98 radical resections, 46 cases performed skeletonization of the hepatoduodenal ligament while other 52 cases not. The median survival of the two groups was 20 months and 13 months respectively (chi(2) = 9.82, P < 0.01).</p><p><b>CONCLUSIONS</b>Lymph nodes in the hepatoduodenal ligament may be sentinel nodes for ICC lymph node metastasis. Aggressive treatment of lymph node metastasis in the hepatoduodenal ligament is an important strategy to improve the long-survival of postoperative ICC patients.</p>

Applicational study of 3D reconstruction with spiral computed tomography in evaluation of anatomical complicated bones fracture / 法医学杂志

OBJECTIVE@#To investigate forensic diagnosis application of three-dimentional reconstruction with spiral computed tomography in fracture of anatomical complicated bones.@*METHODS@#Selected eleven patients of bone fracture who were examined with SCT 3D and conventional X-ray examination. The location, number and characteristics were observed and analyzed.@*RESULTS@#In all of eleven patients with bone fractures, X-ray examination could detect thirty-four rib fracture, one scapula fracture, two nasal fracture, one metacarpal bone incomplete fracture and one left tibia-fibula fracture, one pubis fracture. While there were forty-seven rib fracture, one scapula smash fracture, one nasal fracture with obvious displacement and eliminate one misplace, one left tibia-fibula obsolete fracture and one sacroiliac joint dislocation, one No 5 lumbar vertebrae pedicle of vertebrae arch fracture. Combining 3D reconstruction images, coronary and sagittal reconstruction images could show clearly the fracture line, location of fracture, number of fracture, displacement and recovery.@*CONCLUSION@#3D reconstruction technique of SCT is a very useful examination method in the objective forensic diagnosis of anatomical complicated bones fracture, it excels the routine X-ray examination.

Condition and mechanism of formation of mummy in Shanghai region / 法医学杂志

To investigates the condition and the mechanism of the formation of mummy in Shanghai region. Three cases of mummy were normaly examinated. It showed that the formation condition of mummy were influenced by season, scene, and the corpse keeping methods etc. In warm and damp southern region in Shanghai, the mummy formation depended on lower temperature, dry environment season, dehydrated and hunger before death, and interfered factors like ventilating and turning over corpse frequently.