Objective To learn the cognitive appraisal of the necessary conditions for the medical services delivery synergy by doctors at county and township levels,and to provide evidence for the health policy in question.Methods One county-level public hospital and one township hospital were randomly sampled from five sampled counties of Yancheng city in Jiangsu province for a field survey.The questionnaire was designed to cover such dimensions as institutional,information,service,interpersonal and management,in an effort to learn the cognitive appraisal of such doctors on such aspects as the two-way referral between county-township medical institutions,medical information sharing,good personnel relationships of medical workers,service collaboration,and necessity of inter-agency physician teams. Results These doctors in general presented different appraisal for two-way referral between county-township medical institutions,medical information sharing,service collaboration,good inter-personnel relationships and necessity of inter-agency physician teams.Those of lower academic titles considered it necessary to set up inter-agency physician teams(χ2=6.723,P<0.05);while county public hospitals′physicians considered that two-way referral between county-township medical institutions and inter-county agency information sharing as necessary to achieve the synergy of medical services delivery (P<0.05);most township physicians considered that good personnel relationships and service collaboration as necessary to achieve the synergy (P<0.05 ).Conclusions The characteristics of county and township physicians′appraisal of the necessary conditions for synergy of medical services delivery deserve attention,for improvement of their appraisal of two-way referral and information sharing among institutions.

Objective To investigate the causes,diagnosis and treatment of small intestinal bleeding.Methods The clinical datas of 34 cases of small intestinal bleeding confirmed by surgery and pathology were analyzed retrospectively.Results Tumor was the first cause of small intestinal bleeding(13/34),there was no significant difference between the number of benign and malignant tumor,other causes were inflammatory small intestinal diseases(9/34),small intestinal diverticulum(7/34),angiodysplasia(4/34) and heterotopic pancreas(1/34).There were 11,3 and 2 cases who were diagnosed by double contrast barium meal,angiography and radionucleide scanning respectively,18 cases were diagnosed by exploratory laparotomy.Most patients were treated by intestinal segmentectomy.Conclusion Neoplasia is the most common cause of small intestinal bleeding,other causes are inflammatory small intestinal diseases,small intestinal diverticulum andangiodysplasia.Acombination of double contrast barium meal,angiography,radionucleide scanning,exploratory laparotomy and/or enteroscopy are helpful to diagnose small intestinal bleeding.Medical or endoscopic thyrapy is the first choice for treating small intestinal bleeding,surgical procedure,mainly intestinal segmentectomy,is the second choice.

To culture creative persons with ability,experimental teaching systems has to be revolutionized.Comparatively concentrated and appropriately dispersed experimental managing pattern can be adopted to build up a new experimental teaching system,which combines systematic teaching and further exploration.The questions on how to develop open laboratory,change traditional experimental teaching pattern,improve the use of instrument and laboratory,pool fund to avoid repeated construction,and achieve fully share of resources are discussed in this article.

Objective To analyse the alterative characteristics of electrophysiology by detecting somatosensory evoked potential(SEP) during cerebral remodeling after transfer of healthy C7 nerve root both in patients and normal individuals. Methods From 2002 to 2003, 12 cases of the left total brachial plexus nerve root avulsion were surgically treated by transferring healthy C7 nerve root to impaired median nerve through bridged ulnar nerve. The waveform of SEP of bilateral cortical expressions were recorded after stimulating median nerve of impaired upper extremity at the wrist and elbow. Meanwhile, latent period and amplitude of wave of SEP, and nerve conduction velocity from the level of wrist to elbow were exhibited and compared. Results There were differences of the latency and amplitude of SEP in normal individuals between two sides of cerebrum to some extent. In the healthy sides (first group), difference of latency of SEP on two sides of cerebral cortex had no statistical significance but in the reverse for the amplitude of SEP. For the diseased sides(second group), difference of amplitude of SEP for both sides of cerebral cortex between the patients and the nonmal individuals were of statistical significance, but on the contrary for the change of latency of SEP. Conclusion Cerebral cortex dominating affected extremity is able to bring up functional remodeling electrophysiologically after nerve transfer of healthy C7 nerve root. Shortened latency and augmented amplitude discrepancy of SEP recorded on both sides of cerebral cortex were preliminary electrophysiological criterions. After contralateral C7 nerve root transfer, the examination of SEP can offer data of corresponding cortex "reinnervation", which provides objective evidence for further treatment to promote functional recovery and cortical plasticity.

Objective To evaluate the clinical significance of single-incision video-assisted thoracoscopic surgery(SI-VATS)in elderly patients undergoing pneumonectomy. Methods The clinical data of elderly patients received pulmonary resection by SI-VATS and three-port video-assist-ed thoracoscopic surgery(TP-VATS)last year were analyzed. Results The SI-VATS group was significantly better than the TP-VATS group in in-cision length,drainage time,as well as the 1st,3rd,7th day VAS score and one month satisfaction after operation(all P<0.05). However,no sig-nificant difference was found in operation duration,blood loss,lymph node number,or complications(all P>0.05). Conclusion SI-VATS pul-monary resection is safe,feasible and with less invasive.

OBJECTIVE:To introduce a self-cure method for the cough caused by cold.METHODS:By placing control group and trial group,30 cases(control group)were assigned to receive Dextromethorphan Hydrobromide oral liquid and 32 cases(trial group)to employ self-cure method for cough caused by cold.And a self-cure method for the cough caused by cold was induced.RESULTS & CONCLUSION:The practice of self-cure method can speed up the self-cure of cough caused by cold and this method deserves to be popularized.

Objective To study the effect of extract of leave ginkgo biloba (EGb) for protection of the motor and sensory neurons axotomy-induced in rats. Methods Thirty male Sprague-Dawley rats weighing 180－ 220 g (8－ 9 weeks of age), were randomly divided into control group and EGb24/6 group. Models of sciatic nerve injury were established by transection of left sciatic nerve at 0.5 cm away from the points of muscular innervation. The proximal stump of sciatic nerve was double ligated to inhibit nerve regeneration. The distal end of the nerve was implanted into the biceps femoris. Then 2 ml of normal saline was given to control group, and 2 ml of EGb24/6 to the EGb24/6 groups daily. The rats were sacrificed in 7,14,28 days after surgery respectively, and then 4％ paraformaladehyde was perfused transcardially. The L4－ 6 spinal cord and L5 dorsal root ganglion (DRG) were harvested. HE staining and CV technique were used for detection of the motor neurons and compared with contra-lateral side. TUNEL technique was used for detection of apoptotic motor and sensory neurons. Eletron microscopic technique was used for observation of change of L5 DRG neurons. Result The number of motor neurons was significantly higher in EGb24/6 group in each postoperative period than that in control group (P

Objective To evaluate the predictive value of MRI features in the diagnosis of placenta increta/percreta preoperative-ly.Methods We retrospectively reviewed MRI of 39 pregnant women who were suspected to have placenta increta/percreta by the ultrasound previously.1 7 patients were defined as placenta increta/percreta according to the surgical-pathological results,while 22 patients were defined without abnormal placentation.We assessed the presence or absence of the specialized MRI features of placenta increta/percreta.The binary logistic regression analysis was used to determine the valuable MRI findings for predictive of placenta increta/percreta.Results The tenting of the superior wall of bladder or the infiltration of adjacent organs were the most useful signs to predict placenta percreta,with the highest odds ratio (OR)value of 70,P =0.008.The low signal intensity bands on T2 WI and focally interrupted interface of placenta/myometrial were valuable signs to the predictive of placenta increta,with the OR value of 6.4 and 5.6 respectively according to the univariate analysis.On multivariate regression analysis,the low signal intensity bands on T2WI was independent predictive factor for placenta increta(OR 6.6,P =0.02),while the focally interrupted interface of placen-ta/myometrial was not independent factor (OR 3.1 6,P =0.1 75).Conclusion The most useful predictive MRI features for placenta increta/percreta are tenting of the superior wall of bladder and the infiltration of adjacent organs,followed by the low signal intensity on T2 WI.The focally interrupted interface of placenta/myometrial is useful factor.

Objective To investigate the incidence of contrast induced nephropathy (CIN) among different patient groups after contrast agent injection.Methods A total of 1243 patients were included in this study (male =694,female =549).The SCr level one week before and 72 hours after the CT examination and the incidence of CIN were recorded and comparison was made among groups according to sex,age,body mass index (BMI),the history of high blood pressure (HBP),diabetes mellitus (DM),chronic kidney disease (CKD),chronic heart failure (CHF),tumor,nephrotoxicity drug (NTD) usage.The frequency,type,dose and injection velocity of the contrast media(CM)were also recorded.Multivariate predictors of CIN were identified by Logistic regression using step-wise selection with entry and exit criteria of P ＜0.10,results were tabulated as odds ratios (OR) with 95％ confidence intervals (CI).Results Among 1243 consecutive patients,the incidence of CIN was 5.5％ (68/1243).Patients with a history of HBP,DM,CHF,CKD or tumor presented with higher incidence of CIN than that of controls (5.9％,51/868 vs.4.5％,17/375).CIN developed in 9 of 203 patients (4.4％,9/203) with CKD and in 59 of 1040 patients (5.7％,59/1040)without CKD.There was no significant difference between the two groups(x2 =0.51,P =0.30).In CKD (-) group,the incidence of CIN was higher in females,patients with DM and patients using LOCM than those of males,DM (-) and using low osmolality contrast medium (IOCM) (P ＜ 0.05),but there was no statistical significance in CKD (+) group.Logistic regression analysis showed that women,age ≥ 75 years,DM,LOCM,NTD,tumor,the time of using CM more than once per month were the most significant predictors of CIN (OR ＞ 1).Conclusion Women,age ≥ 75 years,LOCM,NTD,tumor,and the frequency of using CM more than once per month were more likely to develop CIN.

Objective To observe the results of restoration of shoulder abduction by spinal accessory nerve transfer which was sectioned infraclavicularly to repair the suprascapular nerve in avulsed brachial plexus injury. Methods The donor nerve of accessory nerve was sectioned at the level of medial and lateral muscular branch entering the trapezius; the proximal segment was used for the transfer to repair the suprascapular nerve. The function of shoulder abduction was followed-up for 2-4 years in 49 patients with avulsed brachial plexus injury, the function of the trapezius after operation was also measured by physical check up and electrophysiological detection in 20 patients. Results The average range of the shoulder abduction was 61? , the muscle strength of the trapezius was unaffected on the upper and middle parts except the lower parts after the operation. Conclusion The shoulder function of the patients with brachial plexus injury recovered satisfactorily after transfer of the accessory nerve sectioned infraclavicularly to repair the suprascapular nerve; the muscle strength of the trapezius was unaffected on its upper and middle portion.