Setting quantity and quality of services as the base, patient satisfaction as the core of the performance appraisal and salary distribution system are important content of the current comprehensive reform of township hospital. To guarantee the profits for public in township health cares, prevent profiteering behavior, mobilize the staff’s work enthusiasm and establish an effective performance appraisal and salary distribution system are the most focused and considered problems for a great number of township health cares. The example hospital introduced the “progressive scoring” and “incremental increase in return”, which had positive effect.

OBJECTIVE To observe the effect of clonidine on the proinflammtory cytokine and haemodynamics in hypoxia and trauma rats. METHODS Forty male SD rats were randomly divided into 5 groups: (A) hypoxia control group (n=8), (B) trauma control group (n=8), (C) hypoxia and trauma group(n=8), (D) hypoxia trauma clonidine precondition group (n=8), (E) hypoxia trauma colindine postcondition group (n=8). Except B group, the rats of each hypoxia group were placed in a sealed hypoxia chamber which O2 concentrate were maintained at (10 ?0.5)% for 6 days, 7h per day. Except A group, the rats of each trauma group received pharyngeal trauma after anesthesia. The rats in D and E group received clonidine 30 ?g/kg before 10 minutes or right after the pharyngeal trauma respectively. The mean artery pressure (MAP) and heart rate (HR) on the several moment around the trauma were recorded. The serum level of TNF-?, IL-6 was measured 1h after trauma. The tissues from lung and kidneys were taken to study the pathologic changes through microscope. RESULTS The MAP and HR raised obviously in each trauma group except D group on the trauma moment (P

2*!cm. Conclusions Large invasive and metastatic carcinoid tend to be malignant, and the prognosis is usually poor, with which a radical resection may help.

Objective To evaluate circumferential mucosectomy for the treatment of prolapsed hemorrhoids. Methods Ten patients with Ⅲ or Ⅳ degree of circular prolapsed hemorrhoids were operated on with circumferential mucosectomy using circular stapler. The mean age was 65 years old with hemorrhoids history of 3～25 years. Results Hemorrhoids in 8 of the 10 patients disappeared immediately after operation and 2 disappeared on the second day postoperatively. 3 patients complained local pain and 6 patients suffered from temporary urine retention after operation. No significant edema or bleeding ensued. The mean postoperative hospital stay was 4 days. No recurrence developed at an averaged 2 months′ follow up. Conclusion The new technique provides a significantly less painful choice of treatment for severely prolapsed circular hemorrhoids. However, the long-term outcome remains to be identified.

Objective To discuss the importance of regulatory role of panaxoside Rg1 in Cdk5 in the process of hippocampal neuron radioactive damage protection.Methods Radioactive brain damage in vivo 40 models were built,and divided into 4 groups,including 0 Gy group (short for blank group),pure panaxoside Rg1 preconditioning group (short for control group),30 Gy group (short for model group),and 30Gy + panaxoside Rg1 preconditioning group (short for traditional Chinese medicine group).Hippocampal neurons were separated and trained.Hippocampal neuron apoptosis condition was tested in every group by 4′,6-diamidino2-phenylindole (DAPI) staining method.The p35 and p25 protein expressions were tested with Western blot.Cdk5 was restrained by Cdk5 restrainer roscovitine.Hippocampal neuron damage after Cdk5 blocking-up was observed with changes of X ray in every group.Results Compared with blank group,no significant difference was found in nuclear shrinkage percentage,the number of neuron survival,and the protein expression levels of p35 and p25 in control group ; nuclear shrinkage percentage and the protein expression levels of p35 and p25 were significantly increased and the number of neuron survival was significantly decreased in the model group and traditional Chinese medicine group (P ＜ 0.05).Compared with model group,nuclear shrinkage percentage and the protein expression levels of p35 and p25 were significantly decreased and the number of neuron survival was significantly increased in the traditional Chinese medicine group (P ＜ 0.05).For the addition of dimethyl sulfoxide (DMSO) in every group,the nuclear shrinkage percentage was not significantly changed in control group compared with blank group,was significantly increased in model group and traditional Chinese medicine group compared with blank group (P ＜ 0.05),and was significantly decreased in traditional Chinese medicine group compared with model group (P ＜ 0.05).Conclusions Panaxoside Rg1 can reduce neuron apoptosis by controlling Cdk5,and plays a protective role in hippocampal neuron radioactive damage.

Objective To research and develop the model of external reciprocating sports intermittent hypoxia box for rats. Methods Two animal cabins (28 cm?20 cm?15 cm) and one hypoxia chamber (80 cm?80 cm?60 cm) which covered each cabin in turn were developed. 4 male SD rats were placed in each animal cabin. The hypoxia chamber in which low O2 concentration was maintained with filling high-pure Nitrogen continuously, moved to and fro between two animal cabins, and driven by a servomotors. Two animal cabins were covered in turn by the hypoxia chamber and get the same low O2 concentration as in the hypoxia chamber. The goal volume fraction of oxygen in hypoxia chamber was (10?0.5)% and the time of unilateral movement from one animal cabin to another was 4 s, the cycle time of intermittent hypoxia was 180 s, the retention time was 86 s (including the hypoxia and normoxia time was 90 s respectively). The hypoxia chamber runs 8 h per day. The numerical value on artery blood gas of rats in which hypoxia chamber inside and outside was measured Results The reciprocating sports intermittent hypoxia chamber can be operated safely and reliably. The lowest PaO2 is (4.766? 0.536) kPa(or (35.75 ?4.02) mmHg) and the lowest SaO2 is 0.69 ?0.08 when the animal cabin in hypoxia chamber. Conclusion The chronic intermittent hypoxia model for rats is established by self-developed external reciprocating sports intermittent hypoxia chamber.

Objective To compare the effects of subgluteal(SG) and sub-subgluteal-fold(SSGF)approach for ultrasound-guided siatic nerve block. Methods One hundred forty-eight patients undergoing lower limb surgery were randomly divided into two groups to receive SG approaches and SSGF approaches to sciatic nerve block under real time ultrasound guidance. A combined posterior lumbar plexus block under ultrasound guidance was performed for sufficient surgery anesthesia. 20 ml of 0. 5% ropivacaine was used for sciatic nerve and lumbar plexus block separately. Measurements included skin-to-nerve distance,reorientation of the needle during block and execution time,rates of sensory and motor blockade after 15 min and 30 min of injection, quality of surgery blockade, duration of the sensory and motor block, and postoperative complications related to sciatic nerve block. Results In SSGF group, execution time and reorientation of needle for sciatic nerve block was significantly less than those of the SG group( P ＜0.01).But motor blockade in the SG group was quicker when compared with SSGF group ( P ＜0.01). There were no significant differences in the quality and duration of blockade between the two groups. Conclusions Both SG and SSGF approach can be used for sciatic nerve block with equal sensory and motor block rate,whereas sciatic nerve block via SSGF approach was faster and easy to perform than the SG one.

ObjectiveTo discuss the incidence,endoscopic manifestion and pathological features of the upper-gastrointestinal polyps ( stomach and deodenum) in FAP patients. MethodsDuring 2004 -2010 a total 57 FAP patients at Changhai Hospital underwent screening for polyps in upper-gastrointestinal tract by gastroscopy and sideward-viewing duodenoscopy. Biopsies were taken on the polypoid lesions.ResultsGastric polyps were found in 38 patients (67％).Most polyps were located at gastric body and antrum,the pathologic diagnosis was hyperplastic. Duodenal polyps were found in 12 patients (21％) including 7 cases of adenomatous polys. ConclusionsUpper- gastrointestinal polyps are the most common extra-colonic manifestion in FAP. Most stomach polyps are located at gastric body and antrum and are hyperplastic.Polyps at duodenum may be adenomatous,which is a precusor of carcinoma.

Objective To investigate the clinical manifestations of early postoperative internal hernia. Methods Patients who were diagnosed with early postoperative small bowel obstruction(EPSBO)within 30 days after operation and underwent laparotomy between 1994 and 2006 were included for study.Clinical and radiological findings were analyzed. Results Totally 38 EPSBO patients were identined.among those,9 patients(23.7%)had an internal hera ag the cause of the howel obstruction.Other causes included intestinal adhesions in 27 patients(71.1%),gallstone ileus in 1 patient(2.6%)and stoma obstruction in 1 patient(2.6%).In the internal hernia group,6 cases were male and 3 cases were female witIl a mean age of 53.6 years.The mean time from the primary operation to symptom development was 7.8 d(range,2～17 d)and the mean time of conservative treatment Was 3.4 d(range,1～8 d).The main clinical features included:complete mechanical obstruction with symptoms rapidly progressing and early bowel strangulation.Specific radiologic abnormalities misht be identified,especially by contrast-enhanced CT.In this series,intestinal strangulation was found in 6 patients with bowel necrosis in 4 eases,necessitating howel resection in 5 patients.Wound infection developed in one cage and there was no perioperative death.Conclusion Internal hernia can occur early postoperatively and it bears a high risk of strangulation and bowel necrosis.Prompt operative intervention should be carried out in highly suspicious patients in order to avoid complications and achieve good outcome.

Objective To investigate the effectiveness of the combination of general anesthesia ( GA) and single-shot bilateral thoracic paravertebral block ( TPVB) by ropivacaine in the patients undergoing off-pump coronary artery bypass surgery ( OPCAB) . Methods Forty patients with coronary heart disease scheduled for elective OPCAB surgery were randomly divided into two groups:general anesthesia group (group A, n=20) and general anesthesia combined with bilateral thoracic paravertebral block group (group B, n=20). The frequency of hemodynamic abnormalities and dosage of vasoactive drugs during the period of operation were recorded. Meanwhile, other reference data were recorded, such as the consumption of sufentanil during operation and postoperative analgesia, the time of endotracheal tube retention and intensive care unit ( ICU) stay. Results Two cases were excluded from the study in group B for failure block. Compared with group A, the frequency of hypertension and the amount of nicardipine was lower during operation in group B (P<0. 05), the consumption of sufentanil was less both during operation (P<0. 01) and postoperative analgesia (P<0. 05). Moreover, the time of tracheal tube retention and ICU stay were shorter in group B (P<0. 05). Conclusion The findings of this study indicate that GA combined with single-shot TPVB is superior to GA alone in improving haemodynamic stability in patients undergoing OPCAB surgery. The combination therapy can also reduce the use of opiates and shorten the time of recovery.