Writing is a general course in universities.In writing,critical thinking can also be taught.Writing makes critical thinking visible.In teaching,teachers should change teaching methods and to emphasize on process and on students' learning.

[ABSTRACT]OBJECTIVETo investigate the safety of the head and neck muscle pedicle flap or flaps with single vascular pedicle.METHODSThe characteristics of thoracoacromial artery were investigated in 20 autopsy cases. Farthest point into the muscle were checked by preoperative ultrasonography and intraoperative localization with perspective observation, the muscles 1-2 cm above the farthest point were cut off from the donor site, forming a simple arteriovenous island flap pedicled pectoralis major muscle. Using the same technology and methods, sternocleidomastoid island and lower trapezius island flap were harvested.RESULTSAnatomical observation revealed thoracoacromial artery single type accounts for 12.5% (5/40), double vessel type 67.5% (27/40), multiple vessel type 20% (8/40). The rate of furthest point localization with preoperative ultrasound was 29.1% (14/48), the DSA successfully developed breast artery perforator in 66.7% (12/18) of the cases. Forty eight pectoralis major island muscle flaps, 12 internal mammary artery flaps, 18 chin flaps, 4 lower trapezius island myocutaneous flaps, 4 sternocleidomastoid island myocutaneous flaps, 3 transverse cervical artery island shaped flaps, 3 thoracoacromial artery perforator island flaps were harvested. Two flaps were failure. Partial necrosis occurred in 3 pectoralis major myocutaneous flaps.CONCLUSIONThe design of single vascular pedicle island flap for the head and neck defects is feasible and safe, and patients benefite not only for easily shaped the island flap, but also for the region appearance and function preservation in both the donor site and recipient site.

Based on modern management theories and in light of the realities of China and leadership practice, the paper analyzesd the characteristics of deputy leaders in a hospital and discussesd the specific ideas, qualities and capabilities that they must possess. It was put forward that in order to make accomplishments in strategic management and implementations, deputy leaders in the hospital should position themselves appropriately, improve their qualities, persist in learning, enhance their capabilities, attach importance to investigations and enhance their communicative ability. At the same time, they should have such qualities the as strict self-discipline, dedication, exploration, responsibility, and self-restraint as well as good communication skills. They should also have the capabilities for strategic implementations, detail management, grasp of the overall situation, harmonious teamwork, complex thinking and accomplishments in accordance with the circumstances.

The paper gives a comprehensive account of the current situation of SARS treatment and analyzes the features of the disease and its prevention and treatment, viz. SARS treatment has been conducted without RCT studies; the life quality of cured SARS patients has lowered; there is the possibility of repeated SARS outbreaks and spread; and the effectiveness of some therapeutic regimes needs to be ascertained. For this reason, it is suggested that evidence-based medicine be used in screening therapeutic regimes for SARS and that systematic assessments and standardizations be conducted so as to work out favorable regimes for SARS treatment and make efficient use of limited health resources.

Lactoferrin has antitumoral activity. Lactoferrin exerts anti-carcinogenic effects via its ability to modulate host immunity, suppress proliferation, induce apoptosis, block cell cycle, inhibit angiogenesis, regulate carcinogen-metabolizing enzymes and sequester iron, etc. Safety and no toxicity of lactoferrin provide a new selection for cancer treatment.

Objective To investigate the clinical effect of laparoscopic radical hysterectomy in the treatment of early-stage endometrial cancer.Methods A total of 60 consecutive patients preoperatively diagnosed as having stage Ⅰ or Ⅱ endometrial cancer from August 1998 to December 2004 was divided into two groups,receiving either laparoscopic(Laparoscopic Group) or open radical hysterectomy(Open Group).According to the involvement of the muscular layer,whether or not a pelvic lymphadenectomy was required was determined.Perioperative parameters and survival time were prospectively studied.Results As compared with the Open Group,the Laparoscopic Group presented a longer operation time(247.8?77.8 min vs 196.6?63.7 min;t=2.789,P=0.007),similar blood loss(265.0?187.6 ml vs 350.0?210.9 ml;t=-1.649,P=0.104),similar number of resected lymph nodes(22.0?5.0 vs 22.8?5.2;t=-0.607,P=0.546),insignificant difference in complication rate (10/30 vs 15/30;?2=1.714,P=0.190),earlier time to first passing flatus(44.3?11.1 min vs 55.2?12.8 min;t=-3.524,P=0.000),and shorter hospital stay(8.7?3.2 d vs 10.2?2.0 d;t=-2.177,P=0.034).The patients in the Laparoscopic Group were followed for 28.6?17.4 months with tumor-free survival.In the Open Group,a follow-up for 28.9?16.6 months found 3 deaths form metastasis or recurrence.Conclusions Laparoscopic radical hysterectomy and pelvic lymphadenectomy may be an alternative for early-stage endometrial carcinoma.

The principal role of neutrophils in tissue repair has long been thought to be confined to killing bacteria and clearing necrotic tissue. However, recent studies have shown that neutrophils are also one of the sources of pro inflammatory cytokines and growth factors, such as IL 1, TNF ?, bFGF, VEGF,TGF ? 1 that probably serve as the earliest signals to activate local fibroblasts, epidermal cells and vascular endothelial cells and initiate tissue repair. It was also reported that neutrophils improved the proliferation removal of injured epithelial cells in airway and corneal epithelial cells. It is very important for the successful tissue repair that the function of neutrophils is normal.

Objective To summarize studies about palliative care (PC) in mainland China and to provide a guidance for propagandizing the concept of palliative care and to carry out related investigations.Methods Key words of Shu Huan Yi Xue,Gu Xi Zhi Liao,An Ning Liao Hu,Ling Zhong Guan Huai,Shu Huan Yi Liao,together with conception,acceptance were used in CBM.And palliative care AND China AND(acceptance OR acknowledgement OR concept OR conception) were used in PubMed.Above searches were for articles,without any other limitations such as publishing date,author,journal,type or language.Eligible articles investigating acceptance of palliative care in mainland China were screened out with artificial work.Descriptive analysis was adopted as a statistic method.Results A total of 35 articles related with palliative care were picked out.Most of the investigation methods were questionnaire.The palliative care-accepting degrees were 25.3 ％ to 86.6％ in overall,25.3％ ～70.8％ in the elderly,30.8％ ～ 56.2％ in advanced stage of cancers,61.7％ ～ 68.4％ in families of patients,and 56.6％～95.8％ in health care workers.In the subgroup analysis,the acceptance showed no difference between genders.But age,followed by careers,degrees of medical education and religions and nationalities were all effective factors for the acceptance of palliative care,which was mostly agreed in all the articles.Conclusions People in mainland China are insufficient very much in the perception of palliative care idea.More publicity and education are needed to popularize the palliative care idea.More studies with better design and more rigorous protocol are needed to have a better understanding of the acceptance of palliative care.

Objective To explore the clinical application of determination of troponin I(cTnI) by enzyme linked fluorescent(EL-FA) method .Methods The concentration of cTnI in serum was detected by chemiluminescence immunoassay(CLIA) method and ELFA method .The precision test ,linear test ,recovery test and interference test were done on ELFA method .The correlation analy-sis was done on the results of cTnI detected by ELFA method and CLIA method .Results Determination of the concentration of cTnI by ELFA method ,the intraassay coefficient of variation(CV) of high(30 .00 μg/L cTnI) and low (0 .12 μg/L cTnI) values were 2 .81% and 1 .62% ,the interassay CV were 5 .67% and 3 .52% .Reliable detection range detection of ELFA method was 0 .00-30 .00 μg/L .When the total bilirubin concentration less than 450μmol/L ,hemoglobin concentration less than 1 .5 g/L ,three glycerol concentration less than 7 .0 mmol/L ,the ELFA method for the determination of cTnI was without interference .Determina-tion of the concentration of cTnI had a good correlation between ELFA method and CLIA method(r=0 .971) .Conclusion The EL-FA method has good precision ,recovery and linear range ,and has a good correlation with the CLIA method ,and the ELFA method is rapid and convenient ,suitable for the emergency inspection ,can satisfy the clinical requirements .