Description of the practice, significance and principles of networking operation for primary medical institutions in Shenzhen, and an introduction to the strategy and implementation assurance. The paper covered the following features of such operation: establishment and upgrading of the primary patients movement system; establishment of the tiered health service system; establishment of the consultation and referral system based on networking operation; establishment of multi-institution practice system for physicians within the network; establishment of medical resources sharing system within the network; support for joint research programs; experiment in effective medical insurance payment and health service price support system; diversity and loose structure of institutions within the network

Objective To investigate the clinical features , treatment regimen , and prognosis evaluation of tertiary peritonitis (TP). Methods Seventy-eight cases with TP were randomly enrolled into 2 groups, including the simple western medicine-treated group (32 cases) and the integrated traditional Chinese and western medicine-treated group (46 cases). The prognoses were evaluated according to the acute physiology and chronic health evaluationⅢ (APACHEⅢ, APⅢ) scoring. Results The mortality rate was 71.9% (23 of 32) in patients received the simple western medicine and was 32.6%(15 of 46) in patients received the integrated traditional Chinese and western medicine with significant difference between these two groups (P < 0.01). There was a significant correlation between AP Ⅲscore and actual mortality (r=0.73,P<0.01), and predicted mortality (r=0.76, P<0.01). Conclusions The therapeutic effect is acceptable and satisfactory for the TP patients received the integrated traditional Chinese and western medicine. The AP Ⅲ scoring system can be used to predict the prognosis of TP patients.

Objective To analyze the internal fixator remove time in different age patients after non-fusion cross injured vertebral screw of thoracolumbar vertebral fracture. Methods Sixty-eight patients who had underwent non-fusion cross injured vertebral screw were divided into 2 group according to the age:young group (20-44 years, 36 cases) and middle aged group (45-59 years, 32 cases). The numeric rating score (NRS), Oswestry disablility index (ODI), discoideum index (DI) and kyphotic Cobb angle 6, 9, 12 and 15 months after surgery were compared between 2 groups. Results The kyphotic Cobb angle, ODI and NRS 9, 12 and 15 months after surgery in 2 groups were significantly lower than those 6 months after surgery, which was in young group: (37.34 ± 6.86)° , (36.81 ± 6.78)° and (36.90 ± 6.97)° vs. (56.31 ± 3.56)° , (2.45 ± 0.55)%, (2.24 ± 0.53)% and (2.09 ± 0.41)% vs. (3.02 ± 0.89)%, (18.46 ± 2.73), (18.44 ± 3.05) and (18.28 ± 2.98) scores vs. (19.79 ± 2.85) scores, and in middle aged group: (37.11 ± 6.80)° , (35.58 ± 5.48)° and (35.40 ± 5.44)° vs. (56.03 ± 3.68)° , (2.21 ± 0.41)%, (2.08 ± 0.43)%and (1.97 ± 0.39)%vs. (3.04 ± 0.93)%, (19.17 ± 2.99), (18.57 ± 2.98) and (18. 43 ± 2.92) scores vs. (20.95 ± 2.49) scores. There were statistical differences (P<0.05). The DI 12 and 15 months after surgery in young group were significantly lower than that 6 and 9 months after surgery:(50.59 ± 4.60)%and (47.57 ± 4.30)%vs. (56.60 ± 3.98)%and (56.32 ± 3.87)%, and there were statistical differences (P<0.05). The DI 15 months after surgery in middle aged group was significantly lower than that 6, 9 and 12 months after surgery:(47.95 ± 4.87)%vs. (56.34 ± 3.97)%, (56.13 ± 3.88)%and (55.63 ± 3.94)%, and there were statistical differences (P<0.05). Conclusions The internal fixator remove time in the young patients after non-fusion of cross injured vertebral screw of thoracolumbar vertebral fracture is 9 months after surgery, and in the middle aged patients is 12 months after surgery. Intervertebral disc degeneration is one of the risk factors for delayed removal.

Objective To investigate the prevalence rate and related factors of excessive daytime sleepiness (EDS) in the elderly. Methods Epworth Sleep Scales (ESS) was used to make a randomized questionnaire among the retired elderly. Results 1 000 questionnaires were released and totally 768 qualified answers were returned. The mean score of ESS was 4.22?0.10 and the score ≥8 was used as an abmormal value. The prevlence rate of EDS in the elderly group was 10.9%. Regression analysis was done based on ESS score as dependent variable, and age, sex, duration of sleep, difficulty in falling asleep, early wakeup, daytime sleepiness, habitual snoring and loud unstable snoring as independent variables. It was showed that daytime tiredness(r=1.458, P

Objective To investigate the distribution and drug resistance of bacteria in 1 -6 months infants with lower respiratory infection(LRI).Methods Induced sputum was extracted from 326 infants with LRI who were 1 -6 months.Antibiotic susceptibility tests were performed after bacteria had been identified.Results 61 cases were detected pathogenic bacteria and the detection rate of bacteria was 18.71%.5 cases were detected two kinds of bacte-ria.66 bacterial strains were isolated among which gram -positive bacteria(33 strains)accounted for 50.00% and gram -negative bacteria(33 strains)accounted for 50.00%.Staphylococcus aureus was the most common gram -pos-itive bacteria and Streptococcus pneumoniae was the second.13 strains were methicillin -resistant Staphylococcus au-reus(MRSA).Hemophilus influenzae was the most common gram -negative bacteria,followed by Klebsiella pneumo-nia and Escherichia coli among which ESBL positive Klebsiella pneumonia were 5 cases and ESBL positive Escherich-ia coli were 4 cases.The common gram -positive bacteria had higher rate of penicillin resistance.MRSA had higher rate of penicillin,oxacillin,erythomycin and clindamycin resistance.Resistant strains to vancomycin and rina thiazole amine were not found.The common gram -negative bacteria had higher rate of ampicillin,ampicillin/shu tan,cefazo-lin and ceftriaxone resistance and had lower rate of cefepime,ceftazidime,piperacillin/he azole temple and imipenem resistance.Conclusion The common pathogenic bacteria in 1 -6 months infants with lower respiratory infection were Staphylococcus aureus,Hemophilus influenzae,Streptococcus pneumoniae,Klebsiella pneumonia and Escherichia coli. We should pay attention to the common antibiotic resistance.MRSA and ESBL positive bacteria were the common mul-tiple drug resistant bacterias.Reasonable selection of antibiotics should be based on susceptibility results earlier.

Objective To investigate the anticoagulant effect of polysaccharides from the heads of Rana temporaria chensinensis(Chinese Forest Frogs). Methods In-vitro experiments were applied to test the effect of polysaccharides on recalcification time, prothrombin time, thrombase time , the activities of thrombin, hydrolyzing fibrin content, activated fibrin dissolve zymogen and blood clotting.. In the in-vivo experiment, bleeding time was measured by cutting mouse tail and clotting time was measured by glass sheet method. Results The polysaccharides from the heads of Chinese Forest Frogs had an obvious anticoagulant effect in a dose-effect manner, but had on thrombolytic action. It could prolong the bleeding time and the clotting time in vivo. Condusion The polysaccharides from the heads of Chinese Forest Frogs have the anticoagulatant activities in vitro and in vivo.

Objective: To determine the transdermal absorption of phloretin and ligustilide in Fufang phloretin cream.Methods: In vitro percutaneous absorption test using the Franz intelligent transdermal absorption apparatus was adopted, an HPLC method was used to determine the contents of phloretin and ligustilide in the accepting solution at different time points, and then the cumulative release amount and the total penetration amount were calculated to evaluate the percutaneous absorption behavior.Results: Phloretin and ligustilide showed a good linearity within the range of 0.044 2-4.42 μg·ml-1(r=0.999 9) and 0.048 7-4.87 μg·ml-1(r=0.999 9), respectively, the average recovery was 99.85% and 99.92%, and RSD was 0.67% and 0.66% (n=9), respectively.The in vitro permeation behavior of phloretin and ligustilide through the skin of rats fit Higuchi equations(r>0.9), suggesting a good linear correlation between the cumulatine penetration amount (Qn) and (time).Conclusion: Fufang phloretin cream has a good percutaneous permeation property in vitro.

By analyzing the present development and reform experiments for public hospitals in Shenzhen,the author proposed the following directions for such a reform:1) Accelerating steps of the development strategy "One Large and One Small",to achieve a balanced deployment of local healthcare resources;2) Building a public hospitals group with reasonable resources deployment and information resources sharing;3) Advancing reforms of public hospitals,building an administrative system of public hospitals featuring separation between government functions and hospitals operations and that between hospital administration and hospital building;4) Improving the supervision mechanism for public hospitals featuring distinct rights and responsibilities and powerful regulatory practice;5) Building a scientific operation system of efficient incentives and self constraints;6) Building a service model for public hospitals featuring separation of medical service and pharmaceuticals sales and normalized system.

Objective To explore the prevalence of self reposed mania/hypomania symptoms of depressive disorders and the difference between the two self-rating symptoms questionnaires in setting of psychiatric clinic of a general hospital.Methods 102 outpatients who were diagnosed with depressive disorders by ICD-10 in department of psychiatry of Tongji Hospital of Tongji University were continuously investigated and fulfilled the Chinese Version mood disorder questionnaire(CV-MDQ)and the Chinese Version 32 items hypomania check list(CVHCL-32).The positive mania symptoms were elevated with at least seven positive mania items reported by the CVMDQ.The positive hypomania symptoms were elevated with at least fourteen positive hypomania items reported by the CV-HCL-32.Results The internal consistency(Cronbach alpha)of the CV-MDQ was 0.808(95% CI=0.767～0.845,P<0.01).The internal consistency(Cmnbach alpha) of the CV-HCL-32 was 0.916(95% CI=0.898～0.930,P<0.01).11 patients(10.8%) reported positive mania symptoms by the CV-MDQ.14 patients (13.7%)had been reported positive hypomania symptoms through the CV-HCL-32.The ability of discriminating mania or hypomania between the two scales was significantly different(Kappa=0.227,P<0.05).Compared to the patients who were reported negative hypomania symptoms by the CV-HCL-32.the 11 patients with positive hypomania symptoms by the CV-HCL-32 had much earlier age in first episode(35.0 vs 50.5,z=-2.065,P<0.05),much longer months in total disease course(60.0 vs 22.0,z=-2.102,P<0.05)and present episode (12.0 vs 6.0,z=-2.180,P<0.05),and much higher frequency of relapse(2.5 vs 1.0,z=-2.168,P<0.05),but no significant differences at age,gender and education.No significant differences appeared between CV-MDQ positive and negative group.Conclusion Mania or hypomania symptoms may be screened by CV-MDQ and CV-HCL-32 from the outpatients with depressive disorders who are diagnosed by ICD-10 in general hospital.whether CV-HCL-32 is superior to CV-MDQ when screening bipolar Ⅱ disorder is worthly further study.

Objective To evaluate the impact of sequence on the quality of bowel preparation in patients with anesthesia for same-day sequential bidirectional endoscopy and propose the optimal procedural sequence.Methods Single center blinded randomized observational study.Sixty-five patients were randomized to either the gastroscopy-first group or the colonoscopy-first group.Bowel cleanliness according to Boston bowel preparation scale (BBPS) scores were evaluated,also done the propofol dosage,caecal intubation time,procedure duration and complications.Results The BBPS score of entire colon showed no difference (6.72 ± 1.34 vs.6.89 ± 1.50,P =0.638),but the BBPS of ileal-cecum portion was higher in the colonoscopy-first group (1.21 ±0.54 vs.1.55 ±0.73,P =0.035).The total procedure time,propofol dosage and complications were similar between the two groups.Conclusion The bowel cleanliness of ileal-cecum portion in colonoscopy-first group is better than that of gastroscopy-first group during sequential bidirectional endoscopy in patients with propofol sedation.We propose colonoscopy first in patients with suspicious ileal-cecum lesion.