Setting up a system wherein general practitioners play the role of the “goalkeeper” in the delivery of community health services may guide the rational flow of health resources from the upper to the basic levels, match the allocation of health resources to the demands, improve the effectiveness of health resources allocation, reinforce preventive strategies, and construct a highly efficient and economic health services system. By introducing the role of general practitioners in Britain, Australia and the United States, the paper aims to draw some enlightenment which will contribute to the establishment of such a system in China in the following aspects: ①perfecting the system of national supporting policies; ② making a good analysis of the parties interested; ③improving the makeup of the medical insurance system; ④accepting useful suggestions from relevant learned societies; ⑤ training general practitioners;⑥ establishing standards for the cooperation between general practitioners and specialists.

Objective To study the effects of different ranges of isokinetic quadriceps training for improving the func-tion of knee joint after total knee arthroplasty (TKA),and provide the theoretical and clinical experiences for the early reha-bilitation of TKA.Methods A total of 73 TKA cases were randomly allocated into 3 groups for isokinetic quadriceps train-ing with ranges of 0°-30° (n=25), 31°-60° (n=24) and 61°-90° (n=24). The isokinetic quadriceps training was for two months. The isokinetic muscle strength and the IKS scores were recorded before and after the training in three groups. Re-sults After training, the isokinetic muscle strength increased significantly in three groups (P<0.05). The IKS scores in-creased significantly only in 0°-30° training group after training (P<0.05). There was no significant difference in IKS score before and after training in 31°-60° group and 61°-90°group. The IKS score after training was positively correlated with the isokinetic muscle strength only in 0°-30° group (P<0.05). Conclusion After TKA, isokinetic quadriceps training with a 0°-30° range of motion can improve the strength of quadriceps and the knee function.

Objective To discuss the clinical efficacy and mechanism research progress of acupuncture-moxibustion in treating toothache, for providing better treatment methods and clinical evidence.Method Taking “toothache”, “acupuncture”, “moxibustion”, “acupoint” as the key terms, clinical research literatures about acupuncture-moxibustion in treating toothache during the recent 10 years were retrieved by using computer, and were then arranged and analyzed.Result There is a variety of acupuncture-moxibustion methods in treating toothache, and the methods are effective.Conclusion Acupuncture-moxibustion therapy is effective in treating toothache, and deserves a large-sample multi-centered randomized research.

Objective:To evaluate the changes in the transverse dimension and the perimeters of the maxillary archs produced by 3 self-ligating appliance systems during the leveling and aligning phases. Methods: 45 patients who had class I skeletal pattern and upper arch crowding 3-6 mm were divided into 3 groups with 15 subjects in every group. The dental casts were analyzed. Results: Statistically significant increases were recorded of all dentoalveolar widths (with the exception of intermolar width measured lingually) and arch perimeters. The increase in arch perimeter showed a significant negative relationship with the individual perimeter of the maxillary arch before treatment. No significant change was found in arch depth. Conclusion: The self-ligating appliance systems produce statistically significant increases in the transverse dentoalveolar width and the perimeter of the maxillary arch during the leveling and aligning phases of treatment.

OBJECTIVE: Autotransplantation with cultured autologous limbal stem cell is viewed as the best treatment. Therefore, it is necessary to further recognize the molecular biological character of limbal stem cell and histological anatomy and to study the progression of transplantation of autologous limbal stem cell.DATA SOURCES: The papers of Medline January 1995 to December 2002 were looked up in computer by retrieved words "limbus cornea, stem cells,autotransplant" of English version. Simultaneously, the papers of January 1995 to January 2002 of Chinese version were looked up by the same retrieved words in Chinese on http:∥www.wanfangdata.com.cn.STUDY SELECTION: It is to examine initially the papers relevant with studies on histology and physiopathology of limbal stem cells and relevant with DATA EXTRACTION: More than 120 papers of relevant literatures were collected in total and 15 papers of those met the criteria and selected for synthetic analysis.cells: Stem cells of corneal epithelium present similar characters as other committed stem cells, with very strong capacity of proliferation and cell division, in poor differentiation state, long cellular cycle and unparallel divipapillary structure of limbal basal palisades of Vogt are limbal stem cells.sion of stem cells are controlled by serum-source factors and various kinds of cellular factors, the changes in factors in microenvironment affect directly the proliferation and division of limbal stem cells and result in various limbal stem cells of the healthy eye from the patient with several ocular surface diseases cultured are grafted to amniotic membrane carrier for ocular surface autotransplantation on affected eye. It is observed after operation that corneal epithelium is regenerated in 2 to 5 days and visual sensibility is remarkably increased in l month. It is visible in 4-month observation after operation that corneal epithelium is integrative and neogenetic vessels are removed persistently.CONCLUSION: Autotransplantation of cultured limbal stem cells is still at the phase of experimental research, in which, initial success has been achieved in treatment of ocular surface diseases; but the remote therapeutic effect of such transplantation is required a further clinical observation. A further study is expected on proliferation, differentiation, physiology and biochemistry of cultured limbal epithelial stem cells, on screening of unique monoclonal antibody of stem cells, on purification and culture in vitro in stem cells, as well as on how to control the differentiation of stem cells and the influence of cellular factors on stem cells. Whether is it possible to apply allogeneic transplantation of cultured limbal stem cells for disorders of both eyes with deficiency of any source of autologous limbal stem cells? Whether is it possible to reduce incidence of rejection by the possible alternations on antigenicity of cultured limbal stem cells? There would be more prospects in the study on those topics.

Objective To optimize the adsorption and desorption conditions for total alkaloids from Cortex Phellodendri with AB-8 macroporous resin.Methods With the adsorption and desorption volume of total alkaloids as the observation indexes,the experiment of dynamic adsorption with AB-8 macroporous resin was carried out to observe the effect of the sample volume,flow rate,water volume for removing impurity,and the concentration and volume of eluant on the total alkaloids from Cortex Phellodendri.Results The optimal adsorption conditions were as follows:sample volume being 50mL for each milliliter of the resin,flow rate being 20mL/h(equal to 2 column volume),water for impurity eluent being 30 mL(equal to 3 column volume),and the eluent being 60 mL(equal to 6 column volume) of 40% ethanol.Under the above condition,the purity of the total alkaloids was 40.06%,which is 2.56 times as much as the total alkaloids before loading the column.Conclusion This methed is simple and shows good purifying effect.

Objective To select a best type of macroporous resin for the isolation and purification of total alkaloids from Rhizoma Coptidis.Methods With the adsorption rate and desorption rate of total alkaloids from Rhizoma Coptidis as the observation indexes,an initial selection of macroporous resin was carried out in AB-8,HP20,LD605,ADS-3,ADS-5,D151,DA-201,XAD7 and NKA-9.After the initial selection,the desorption rate of berberine hydrochloride was used as the index for the further selection.Results Of the nine types of resin,ADS-3 had good adsorption and desorption activities,with an adsorption rate being 97.26% and a desorption rate being 84.82%.Meanwhile,the amount of desorpted berberine hydrochloride was up to 9.311 mg.Conclusion ADS-3 shows good adsorption and desorption properties for total alkaloids and berberine hydrochloride,and can be used for the isolation and purification of total alkaloids from Rhizoma Coptidis.

Objective To investigate the effect of atorvastatin on circulating endothelial progenitor cells (EPCs) and BP in hypertensive patients with normal lipid profiles.Methods Thirty-eight hypertensive patients were randomly to receive conventional anti-hypertensive drugs (n=18) or conventional anti-hypertensive drugs plus atorvastatin(20 mg QN)combination treatment (n=20).Eight healthy subjects were given atorvastatin (20 mg QN) for 8 weeks as control group.Before and after treatment,peripheral blood were drawn to isolate and culture EPCs.The circulating EPCs were identified by direct fluorescent staining under a laser scanning confocal micro- scope.EPCs populations were assessed using the colony forming unit assay (EPC-CFU) through a inverted phase contrast microscope 10 days after culture.Results After treatment,SBP was decreased (conventional treatment from 165.8?10.3 to 132.7?10.3 mmHg;combined group from 163.7?10.2 to 127.9?10.1 mmHg P

OBJECTIVETo observe the effect of postoperative analgesia with dexmedetomidine on the survival rate of amputated finger replantation.

METHODS91 cases, who was going to receive amputated finger replantation, were randomly divided into group A (n = 48) and B (n = 43). PCIA (patient-controlled intravenous analgesia) was set immediately after operation in group A (fentanyl 1.0 mg + tropisetron 4.0 mg + 10 mg + dexmedetomidine 200 microg + saline 100 ml) and group B (same as group A except dexmedetomidine). Background infusion is 2 ml/h with a bolous of 0.5 ml and lockout time is 15 min. postoperative VAS score, Ramsay score, condition of replanted fingers and other adverse events at the 0-6 h, 6-12 h, 12-24 h and 24-48 h were recorded and analyzed.

RESULTSThe age, sex, height, weight, amputated time (Ts), revascularized time (Tt) in the two groups were not statistically different (P > 0.05). Postoperative VAS score in the two groups was significantly different at the 0-6 h, 6-12 h, 12-24 h and 24-48 h (P < 0.05), but Ramsay score was not (P > 0.05). The highest and lowest postoperative VAS score and Ramsay score were markedly different between two groups (P < 0.05). 3 of the 60 fingers in group A experienced vascular crisis and 2 underwent vascular explore surgery. 13 of 56 fingers in group B occurred vascular crisis, and 10 underwent vascular explore surgery, showing significant difference between the two groups (P < 0.05). PCIA adverse reactions showed no difference between the two groups (P > 0.05). Bradycardia and hypotension didn't happen in any patients in the two groups. 4 weeks after surgery, the survival rate was 96.7% (58/60) in group A, and 83.9% (47/56) in group B (P < 0.05).

CONCLUSIONPostoperative analgesia with dexmedetomidine as an adjuvant can increase the survival rate of replantation fingers with high safety.

Adolescent ; Adult ; Analgesia ; Dexmedetomidine ; therapeutic use ; Double-Blind Method ; Female ; Finger Injuries ; surgery ; Humans ; Male ; Postoperative Care ; Replantation ; Young Adult

Adult ; Epiglottis ; Humans ; Laryngeal Neoplasms ; pathology ; surgery ; Male ; Neoplasm Recurrence, Local ; Sarcoma, Synovial ; pathology ; surgery