Three hundred and nine community health service (CHS) practitioners were selected with randomized cluster sampling for survey with the job satisfaction questionnaire-occupational stress indicator (OSI).Degree of the job satisfaction was (68 ± 12)%.Position, work experience, income,feeling of recognition, degree of motivation, the scope for career development, the space for personal ambition and the relationship between salary and work load were potential influencing factors of job satisfaction to CHS practitioners.The authors suggest to establish the dynamic mechanisms of satisfaction study and to formulate comprehensive and effective incentive measures for CHS practitioners.

A clinical emergency skill contest using emergency care simulator (ECS) was carried out　on May 2011.Total 30 family physicians in 10 teams from Shenzhen community health centers participated in　the contest.The performance and the scores of each item were analyzed.The overall score was 61.3 ± 11.9.The average score for general treatment was 33.0 ± 6.9 with a score rate of 66％ (33/50) ; the average　score for cardiopulmonary resuscitation was 23.2 ± 7.2 with a score rate of 57.5％ (23/40) ; the average　team score was lowest (5.0 ± 1.1 ) with a score rate of 50.0％ (5/10).The results indicate that family　physicians should strengthen clinical skill training of emergency care,particularly in on-site response and　teamwork.

Objective To study the technique of modified multi-slice spiral CT aniography(MSCTA) for displaying the whole length of the carotid arteries and the origin of the vertebral arteries,and to evaluate its clinical value.Methods A total of 152 patients underwent modified MSCTA of extracranial carotid artery which scanned from skull base to aortic arch with contrast medium injected from the femoral vein, the image quality and the detection of lesions were assessed in comparison with that of DSA in a few of cases. Results (1) The jugular vein was displayed in 4 cases, only accounting for 2.63%. (2) The carotid segments including the proximal common carotid artery(CCA), the middle CCA, the carotid bifurcation, the internal carotid artery(ICA) bulb and the distal ICA could be visualized adequately by MSCTA,the showing rates were 97.69%,97.69%,97.69%,95.62% and 97.64%,respectively. Furthermore, moderate or severe stenosis detected by MSCTA in 17 cases was closely corresponding with the results of DSA. Conclusion Modified MSCTA of extracranial carotid artery can display the whole length of extracranial carotid artery and the origin of the vertebral arteries satisfactorily without the interference of the jugular, subclavian and innominate veins, and can improve its clinical application.

Objective To investigate the effects of lipopolysaccharide(LPS) on myelin phagocytosis during Wallerian degeneration after early peripheral nerve injury in rats.Methods Fifty male Wistar rats were recruited and randomly divided into LPS group(n=20),model group(n=20) and sham group(n=10).The right sciatic nerves of rats in the LPS and model groups were cut and sutured end-to-end,while the sciatic nerve of sham group rats were only exposed.Immediately after surgery,the rats in LPS group were given microinjections of LPS(2 g/L) into the surgical site in a final volume of 1 μL,and the rats in other two groups were injected with the same volume of saline.The sciatic nerves were taken at 1.5 h,24 h and 7d after surgery.Real-time quantitative PCR(qRT-PCR) was applied to detect the dynamic expressions of IL-1β mRNA and MCP-1 mRNA.Immunofluorescence staining was used to test the expression of CD68+ macrophages in sciatic nerves.HE staining was used to observe the pathological alterations of sciatic nerves tissue.ORO staining was used to observe sciatic nerves demyelination.LFB staining was used to detect the sciatic nerves myelin.Sciatic function index was used to evaluate the recovery of motor function in rats.Results Compared with the model group,qRT-PCR indicated that the expression of IL-1β and MCP-1 from LPS group were increased at 1.5 h and 24 h after surgery(P<0.001, P<0.001),respectively.Compared with the model group,the expression of CD68+ cells was increased significantly at 7th day after surgery(P<0.05).Histological examination showed that compared with the model group,a lot of inflammatory cells and Schwann cells were found at sciatic nerve stump in the LPS group at 7th day after operation.ORO staining showed that the degree of demyelination in the LPS group was higher than that in the model group.LFB staining showed that the sciatic nerve stump demyelination appeared in both model group and the LPS group at 7th day after operation,but compared with the model group,myelin debris clearance in the LPS group was significantly accelerated(P<0.05).Finally,compared with the model group,the SFI in the LPS group was increased significantly at 20 d after surgery(P<0.05).Conclusions The results confirm that LPS is possible to manipulate the innate immune response to accelerate myelin clearance during Wallerian degeneration after early peripheral nerve injury in rats.

Objective To investigate the clinical curative effect of Prepenem for pathogen from cranial neu-rosurgieal patients with lower respiratory tract infection after traeheotomy and to provide basis for treatment of such pa-tients. Methods Thirty-two cranial neurosurgical patients with lower respiratory tract infection after tracheotomy were enrolled in the study with original empiric therapy with Prepenem. And the pathogenic bacteria in sputum from patients with lower respiratory tract infection after traeheotomy were stricdy identified and analyzed by automatic mi-croorganism analyzers. The clinical efficacy of Prepenem was identified after treatment. Results The straim of bacte-rial species(48) and funni(5) from 32 specimens were isolated. 15 strains were infected by one kind of bacteria and 38 strains were infected by two kinds of bacteria. Among the pathogen, gram-negative bacilli were about 64. 1% and Klebsiela pneumoniae (18. 8%)was the most predominant, gram-positive coccobacteria were about 26. 4% and Staph-ylococcus aureus(13.2%)was the most predominant,funni were about 9.4% and C. albicans (5.7%)was the most predominant. The drug sensitivity test showed that the ratio of drug resistance of bacteria isolated from sputum was high,but gram-negative bacilli were highly sensitive to imipenem. Staphylococcus aurens was sensitive to Nitrofuran-toin and Rifampicin. Satisfied clinical curative effect was shown by the de-escalation therapy for all patients. Conclu-sions Gram-negative bacili in cranial neurosurgical patients with lower respiratory tract infection after tracheotomy are the main pathogenic bacteria from lower respiratory tract infection, and Staphylococcus aureus are the main gram-positive cocci. So the drug sensitivity test of sputum should be done more often and antibiotics must be selected ac-cording to the drug sensitivity test. In general, this kind of infection can be controlled by prepenem effectively.

ObjectiveTo assess revascularization and vessel anastomosis in digital replantations with DSA.MethodsTwelve cases of digital replantations underwent digital subtract angiography during 2 to 4 days after fingers reattachment. The vessel anastomosis,hemodynamics,stenosis and discontinuation were investigated.The unobstructed and smooth anastomosis was suggested as early stage survival of the reattached fingers,the spasm and stenosis of the reattached vessels were considered as mild vascular crisis,and the discontinuation of hemodynamics were indicated as severe vascular crisis.ResultsThe total 27 vessels were clearly displayed on DSA.Of these vessels,23 vessels were unobstructed and smooth,all digits were survived.Diagnosis coincidence of early stage survival was 100%(23/23). Two vessels were obstructed,which were testified having thrombus by operation research.The other 2 vessels were spasm,the digits were also survived ultimately by expectant treatment.All 4 abnormal vessel anatomosis were found by DSA.Conclusion DSA is important modality in assessing revascularization and blood circulation for digital replantations,guiding in dealing with the vascular crisis,and in predicting early stage survival of the reattached digits.

Objective To investigate the expression of cyclooxygenase-2 (COX-2) and epidermal growth factor receptor (EGFR) in astrecytomas, as well as the correlation between them. Methods The expression of COX-2, EGFR and PCNA were respectively detected by immunohistochmical (S-P) method in 68 astrocytomas and 5 cases normal brain tissue. Proliferation index (PI) was calculated and the correlation of COX-2, EGFR and PI was analyzed. Results COX-2 and EGFR were negative expression in normal brain tissue. The positive expression rate of COX-2 and EGFR in high grade astrocytomas was significantly higher than that in low grade astrocytomas(73.53% vs 44. 18% ,67.65% vs 38.24%, P <0. 01 ), and the PI was significantly higher than that in low grade astrocytumas as well as normal brain tissue(46.11 ± 10. 68vs 23. 04±6. 25,4. 52±0. 95, P <0. 01 ). The PI in COX-2 positive group was higher than that in negative group( P <0. 01 ). The positive expression rate of COX-2 in the group with EGFR positive expression was higher than that in the negative group. Conclusions The expression of COX-2 and EGFR was related to pathological feature of astrocytomas. COX-2 may promote the proliferation of tumor cells. There was a static correlation between the expression of EGFR and COX-2 in astrocytomas. EGFR signal transduction probably modulated the expression of COX-2 in astrocytomas cells.

Five general practitioners were trained for application of the enhancing CalgaryCambridge guide in consultation.The consultation time in 50 patients were recorded before and after training and the satisfaction degree of patients was investigated by questionnaire survey.Results showed that the length of consultation time after training was longer than that before training (490 s vs 277 s,P ＜ 0.05) and also longer than that of specialists (490 s vs 268 s,P ＜0.05).The overall satisfaction rate of patients was increased after training (72％ vs 88％,P ＜0.05).The results indicate that training of Calgary-Cambridge guide for doctor-patient communication can improve the communication skills of general practitioners.

Objective To evaluate the treatment efficacy of leukocyte reduction in hyperleukocytic acute myeloid leukemia (HAML) patients with leukostasis grading score (LGS).Methods The data of 54 HAML patients were analyzed retrospectively.The relationship between LGS and leukocyte stasis symptoms or early mortality was observed, and the impact of leukapheresis on LGS was analyzed.Results Among 54 patients with HAML, there were 1 case of M1, 16 cases of M2, 10 cases of M4, 20 cases of M5 and 7 cases of unclassified AML.Based on clinical symptoms and LGS system, 3 cases were LGS 0, 15 cases LGS 1, 17 cases LGS 2, and 19 cases LGS 3.In patients with LGS ≤ 2, the rates of type Ⅰ respiratory failure, central nevers system (CNS) symptoms and early mortality caused by leukostasis were significantly lower than those in patients with LGS 3 (P ＜ 0.05).The LGS of HAML patients was reduced by leukocyte reduction therapy (P ＜ 0.000 1).The LGS of HAML patients treated by leukapheresis and low dose chemotherapy was improved significantly than that of patients treated without leukapheresis (P =0.008).Among 37 cases receiving induction chemotherapy, 20 cases reached complete remission (CR) after the first cycle of induction chemotherapy.CR rate of patients with LGS ≤ 2 was no significantly different compared with that of patients with LGS 3 (P =0.703).Conclusions LGS can be used to evaluate the degree and the improvement status of leukostasis after treatment in HAML patients.The early death often occurres in patients with high LGS.Leukapheresis combined with low-dose chemotherapy can effectively improve the LGS of HAML patients.

Medical imaging is an interdisciplinary subject closely related to clinical and pathological subject. Its clinical reading skills' training has become the focus of postgraduate teaching. In the process of clinical teaching, the interactive reading mode of problem-based learning (PBL) combined with multi-disci-plinary team (MDT) was introduced into clinical reading meeting. The tutors chose the reading cases proved by pathology; designed in-depth issues step by step for execution of PBL teaching; guided postgraduates to delineate imaging signs and propose the diagnostic results, evidences and differential diagnoses according to the step from localizing to qualitative and then to pathological diagnosis;then guided postgraduates to attend in-depth case analysis of MDT and analyze the correlation or inconsistency between the imaging diagnosis and clinical and pathological diagnosis; exercise document retrieval and verbalization, multimedia design, and writing level of the records of the reading cases and papers. The interactive reading mode of PBL com-bined with MDT has achieved significant effects, which is worthy of further exploration and promotion.