It is well known that Tokyo University Hospital (TUH) is one of the most famous medical centers around the world in Japan. Among several departments in TUH, the Department of Hepatobiliary-Pancreatic Surgery and Artificial Organ and Transplantation Division are representative predominant divisions, which have high-quality diagnostic and treatment service systems being at the leading position in the world. The authors visit the Department of Hepatobiliary-Pancreatic Surgery and Artificial Organ and Transplantation Division in 2022. When studying and working in TUH, the authors make a multi-angle comparisons of the development status and technical levels of hepatobiliary and pancreatic surgery among TUH, western countries and China. It aims to share and exchange with fellow surgeons at home and abroad, and bring benefits or enlightenment to the professional advancement of them.

目的:比较血栓四项与血栓弹力图对脓毒血症合并弥散性血管内凝血(DIC)的早期诊断价值.方法:选取脓毒血症患者215例,根据中国弥散性血管内凝血诊断积分系统(CDICS)评分分为显性DIC组(CDICS评分≥7分)、非显性DIC组(5分≤CDICS评分<7分)以及未发生DIC的对照组(CDICS评分<5分).比较三组血栓四项[凝血酶-抗凝血酶复合物(TAT)、血栓调节蛋白(TM)、组织纤溶酶原激活物-纤溶酶原激活物抑制剂-1复合物(t-PAI-C)、纤溶酶-α2纤溶酶抑制物复合物(PIC)]及血栓弹力图参数[凝血因子激活时间(R)、血块形成的速率(K)、弹力图最大切角(α角)、弹力图最大振幅(MA)].采用受试者工作特征(ROC)曲线分析上述指标的诊断效能.对两种检测方法与CDICS评分结果进行Kappa一致性分析.结果:显性DIC组TM、TAT、PIC、t-PAI-C、R、K、α角均高于非显性DIC组,MA低于非显性DIC组(P<0.05).血栓四项和血栓弹力图单独检测结果虽然有效,但诊断效能低于CDICS评分.血栓四项及血栓弹力图参数与CDICS评分具有弱至中等的一致性(P<0.05).结论:在脓毒血症合并DIC的早期诊断中,血栓四项阳性诊断率更高,但无法快速、全面地评估凝血全貌,不可代替血栓弹力图的动态监测,临床可以将两者联合应用,进而提高诊断效能.

Objective:To study the effect oftriamcinolone acetonide on the tumor necrosis factor (TNF)-α,interleukin (IL)-1β and IL-6 levels in the aqueous fluid of patients after age-related cataract surgery.Methods:92 patients with age-related cataract who were treated from June 2014 to June 2016 in our hospital were selected and divided into the observation group (n=46) and the control group (n=46) according to the random number table.All the patients underwent phacoemulsification combined with intraocular lens implantation.The observation group was injected with triamcinolone acetonide in the anterior chamber after IOL implantation,the control group was injected with compound balanced salt solution,at 24h postoperation,pranoprofen Eye Drops was used,continuous medication was treated for 1 months.The changes of intraocular pressure,corneal endothelial cell count,uncorrected visual acuity,best corrected visual acuity,ocular signs and inflammatory factors were compared between the two groups before and at 7 days after operation,the anterior chamber reaction at 1 day and 7 days postoperation and the incidence of adverse reactions were compared between two groups.Results:There was no significant change in the intraocular pressure and corneal endothelial cell count before and after operation between the two groups (P ＞0.05);after operation,the uncorrected visual acuity,best corrected visual acuity and ocular signs score of both groups were significantly improved(P＜0.05),the uncorrected visual acuity,the best corrected visual acuity and the integral of ocular signs of observation group were significantly better than those of the control group (P＜0.05);compared with preoperation,the TNF-α,IL-1β and IL-6 levels in the aqueous fluid were significantly decreased (P ＜0.05),the levels of TNF-α,IL-1β and IL-6 in the aqueous fluid of observation group were significantly lower than those of the control group (P ＜0.05);the anterior chamber reaction of observation group at 1 day and 7 days after the operation were higher than those of the control group at 1 grade the 3 and the 4 grade of the anterior chamber reaction were lower than those of the control group (P ＜ 0.05);the incidence of adverse reactions in the observation group was significantly lower than that of the control group(P＜0.05).Conclusion:Triamcinolone acetonide anterior chamber injection is effective for age-related cataract patients after surgery,which can effectively alleviate the postoperative anterior uveitis,reduce the complications and promote the postoperative visual recovery,which may be related to the inhibition of the expressions of TNF-α,IL-1βand IL-6 in the aqueous fluid.

目的:通过前瞻性随机对照研究,探讨IPC配合CPM机功能锻炼在下肢骨折术后预防下肢深静脉血栓的效果.方法:2014年10月至2015年10月期间收治足踝部闭合性骨折192例(踝关节骨折及跟骨骨折).年龄60～83岁,平均68.81岁.分为试验组及对照组,试验组A组96例,对照组B组96例.两组患者均采用相同术式,基本资料无统计学差异.试验组以常规术后抬高患肢、术后次日行IPC治疗2次/日配合CPM机功能锻炼(术后第2d行CPM机锻炼5d出院).对照组常规术后抬高患肢、次日行IPC治疗2次/日及术后24h鼓励和指导患者做主动肌力锻炼,每疗程4～7d,根据患者具体情况确定具体疗程.试验组期间观察患者小腿的皮肤温度色泽,小腿肿胀及足背动脉搏动情况,并于6个月后随访,记录AOFAS评分.结果:试验组无下肢深静脉血栓形成,对照组发现1例下肢深静脉血栓患者,经过积极治疗痊愈恢复.AOFAS评分试验组(83.06±7.2)分;对照组(81.01±9.3)分,试验组满意度98％优于对照组为92％.结论:下肢骨折术后应用IPC配合CPM机功能锻炼能加强动脉灌注,加速局部血液循环,起到改善肢体功能的作用,在我科患者使用后收到良好效果,有效预防了下肢深静脉血栓的形成,有效促进了患者肢体功能的恢复,值得临床推广应用.

目的通过对感染患者血液中降钙素原（PCT）、D-二聚体、纤维蛋白降解产物（FDP）、未成熟粒细胞百分比（IG%）、未成熟粒细胞绝对值（IG#）的检测回顾性分析,来探讨这5项指标在感染机体中的相关性。方法随机选择感染患者88例,健康体检者36例,同时进行PCT、D-二聚体、FDP、IG%、IG#的检测,使用统计软件SPSS13.0进行correlate分析,观察感染患者这5项检测指标的相关性。结果 PCT与D-二聚体、FDP、IG%、IG#相关系数分别为:0.560、0.436、0.284、0.285（P＜0.05）,PCT与其他4种指标之间具有一定正相关性;D-二聚体与IG%、IG#之间相关系数分别为:0.175、0.167（P=0.056,0.064＞0.05）,D-二聚体与IG%、IG#之间无明显相关性。FDP与IG%、IG#之间相关系数分别为:0.078、0.064（P=0.390,0.478＞0.05）,FDP与IG%、IG#之间无明显相关性;PCT、D-二聚体、FDP、IG%、IG#指标的AUC（曲线下面积）分别为:0.898、0.829、0.573、0.565、0.559。结论在感染机体中PCT与D-二聚体、FDP、IG%、IG#分别具有一定的正相关性,D-二聚体、FDP与IG%、IG#之间不具有明显的相关性。PCT与D-二聚体对感染患者的诊断具有良好效力。

Objective To study the influence,interference and corrective measures of different hemolysis sample on the accuracy of conventional chemical test.Methods Measuring 32 biochemical tests markers,including H,HGB,TBIL,DBIL,ALT,AST,TP,ALB,GGT,ALP,TBA,AFU,GLU,UREA,CREA,UA,CHO,TG,HDL-C,LDL-C,Apo-A1,Apo-B,LDH,CK,CK-MB,K+,Na+,Cl-,Ca2+,IP,CO2 and AMY of different hemolysis sample by HITACHI 7600-020 automatic biochemical analyzer,and multiple regression analysis was used through comparing with the hemolytic serum(H=0) to obsearve changes of biochemical markers and expected acceptability of corrected value.Results Hemolysis had a produced interference on conventional biochemical including ALT,AST,TP,ALB,GLU,LDH,CK,CK-MB,K+,Na+,Cl-,Ca2+,IP,CO2 and had a negative interference on TBIL,DBIL,GGT,ALP,TBA,AFU,UA and had statistical significance compared with H=0 when P0.05 or P0.01,especially the higher hemolytic index(H),the more obvious interference.According to the standard of the CL1A' 88 and using method of binary regression correction,correct value of TBIL,DBIL,GGT,ALP and LDH,CK,Ca reached 100% expected acceptable range.More than 90% correct value of ALT,TP,ALB,UA,GLU,K+,Na+,Cl-,CO2,IP reached anticipated acceptable range;87.5% correct value of AST reached desired acceptable range;77.5%,72.5% and 47.5% correct value of AFU,CK-MB,TBA respectively achieved the desired acceptable range.Conclusion Different hemolytic specimens have a different interference and influence on conventional chemical testing of the different biochemical markers.By binary regression correction,90%(28/31) biochemical markers acheve the requirment of the expected acceptability(expected acceptable value ≥ 90%);however,AFU,CK-MB,TBA are rectified unsatisfactory(expected acceptable value77.5%),that is,hemolytic specimens are not suitable for AFU,CK-MB,TBA determination.

注意力缺陷障碍伴多动症(attention deficit hyperactivity disorder,ADHD)是一种危害学龄儿童心身健康和智力发育成长的精神卫生疾病.若不早期诊断、治疗,将影响他们的升学、就业和社会生活,部分儿童甚至出现违拗行为、反社会倾向及精神心理问题,对患者本人、家庭和社会可造成不同程度的危害.据统计,我国约有1.3%-13.4%的儿童患有这种障碍[1].