A summary is made on a11 the experiences from five attached general hospitals which carried out Shanghai new policy of Work rescheduling and organization restracturing.The external pressure and internal motive of the change from"compulsory rescheduling"to"voluntary rescheduling" are analyzed.A search for the distribution of the points for attack on the problem of hospital control of medical cost is made.A comparative study is conducted on the relationship between time and the inten- sity of the control,the inner relationship between the independent variables and the intensity of control. The conclusion shows the change of the hospital's control role to the voluntary one has something to do with the equalibrium of relative forces.The point for breakthrough lies at the control of drugs.A search for the points for attack on the problem of hospital control of medical cost is not only necessary for arresting the rocketing of medical cost,but also helpful for capturing the confidence of the concerned and strengthening hospital management,thus laying a good foundation for a stable transition to a new healthcare insurance program.

The study on attitudes towards people with disabilities is one focus of special education, rehabilitation psychology and rehabilitation counseling. This article reviewed the measurement methods of the attitude towards people with disabilities from directed methods and indirect methods, and their limitation and future research tendency in this field were prospected.

A typical investigation on third-tier general hospitals, third-tier specialty hospitals, second-tier district or county central hospitals, urban community hospitals, and rural township health centers in Shanghai was conducted so as to examine the responsiveness of outpatients and inpatients to the health system. Most of the patients surveyed said that they could get prompt attention and that they had convenient access to medical information from the community or the mass media. More than half of the inpatients and outpatients thought that they had autonomy with regard to treatment and a greater number of patients made their own choices of doctors and nurses. Most of the patients were willing to talk freely with their doctors about their confidential medical history and could get rational explanations about their conditions from the doctors. The results indicate that reform of the health system in Shanghai has attached importance to the responsiveness of patients and that good effects have been achieved.

Objective:To analyze and the smile line of Zhuang-Chinese youths.Methods:1 00 Zhuang volunteers aged 1 8-25 years were recruited for this study.The faces were individually registered by digital videography.The length and thickness of upper lips and mandibular incisor crown height appearance at rest,smile and laugh were recorded.Statistical analysis was performed using Mann-Whitney-U Test and non-parametric analysis.Results:The upper lip in men was longer than that in women at rest(P<0.05 ).The upper lip length increased and thickness decreased at smile and laugh in all subjects,in men was longer and thicker than in women(P<0.05),but there was no significant difference of upper lip thickness at rest between sexes(P<0.05).The mandibular anterior teeth,gingival papilla of all subjects were appeared at smile and laugh,there was no significant difference between sexes(P<0.05). Gingiva appearance at smile was in less than 1 0%of the subjects.39%subjects had high smile line,46%had average smile line and 1 5% had low smile line.Conclusion:Most of the Zhuang youths have moderate smile line,less high smile line and least low smile line.

Objective To establish a simple ,stable acute liver injury model induced by CCl4 to observe effects of hepatocyte transplantation .Methods CCl4 plant oil with different concentration of 20% and 50% was used in mice by intraperitoneal injection , of which the dose was 2 mL/kg ,and then materials were taken at different time points respectively .Mice survival rate ,alanine amin-otransferase (ALT) ,aspartate aminotransferase (AST) and the pathological changes of the liver were detected .Results Mice sur-vival rate in 20% CCl4 intraperitoneal injection was significantly higher than that of 50% .ALT and AST in experiment group were significantly higher than that of control group ,but there was no significant difference between two experimental groups .Pathologi-cal examination showed that mice liver cells showed typical cytoplasmic ,ballooning ,scattered punctate ,piecemeal necrosis and in-flammatory cell infiltration in 20% CCl4 intraperitoneal injection ;while in 50% CCl4 ,there was obvious fibrosis ,in addition to the mentioned heavier lesions .Conclusion 20% -50% CCl4 intraperitoneal injection in 2 mL/kg dose can induce different degrees of relatively stable liver injury ,and its concentration determines the degree of liver injury .Acute liver injury induced by 20% -50%CCl4 was an ideal model for hepatocyte transplantation experiment .

OBJECTIVE To investigate the clinical features and causes of nosocomial infection in schizophrenics with tuberculosis so as to take effective measures for better prevention and treatment.METHODS A retrospective investigation was used to analyze the clinical features and causes of nosocomial infection in 207 schizophrenics with tuberculosis.RESULTS The rate of nosocomial infection in schizophrenics with tuberculosis was 39.13%.The main infection way was via respiratory tract,followed by skin,soft tissue and gastrointestinal tract.The period and degrees of tuberculosis,the history of smoking,psychiatric symptoms and the complications were the causes of nosocomial infection.CONCLUSIONS Controlling psychiatric symptoms actively,preventing and treating somatic complications,using antibiotics rationally and less or no smoking are the effective measures to avoid nosocomial infection in schizophrenics with tuberculosis.

Objective To observe the effect and safety of the treatment of urethral stricture with guide wires leading a balloon dilatation catheter.Methods The clinical date of 25 cases of male patients suffering traumatic posterior urethral stricture were analyzed retrospectively,was treated with a balloon dilation catheter led by guide wires.Results All our patients were cured successfully with a guide-wire-leading balloon dilatation catheter expanding only once and there were no complications such as urethral perforation,rectal injury etc.Although 2 cases had not been ohviously improved risht after dilatation,but improved furtherly six months later.The follow-up was six to twelve months.23 cases were cured.2 osses were improved.The recovery rate was 92%.The effective rate was 100%.Conclusion It was safe and effective to treat urethral stricture with balloon dilation catheter led by guide wires.

Objective To analyze the bloodstream infections caused by vancomycin‐resistant Enterococcus (VRE)in West China Hospital and examine the risk factors of such infections for best control of VRE infections .Methods Case‐control method was used to compare the bloodstream infections due to VRE with those caused by vancomycin‐susceptible Enterococcus(VSE)from August 2010 to August 2014 in West China Hospital .The data were compared by T‐test ,Chi‐square test (univariate analysis) and logistic regression analysis (multivariate analysis) using SPSS 19 .0 software .Results A total of 31 VRE strains were isolated from bloodstream infections in the study period ,including 5 (16 .1 % ) strains of vancomycin‐resistant Enterococcus faecalis and 26 (83 .9 % )strains of vancomycin‐resistant Enterococcus faecium .In the past four years ,the prevalence of vancomycin‐resistant E . f aecalis in bloodstream infections was 1 .5% ,1 .6% ,1 .8% ,and 1 .2% ;while the prevalence of vancomycin‐resistant E . f aecium in bloodstream infections was 3 .8% ,4 .4% ,5 .8% ,and 7 .1% .Such VRE bloodstream infection was mainly found in Intensive Care Unit (ICU)(13 ,41 .9% )and Department of Neurosurgery (4 ,12 .9% ) .More than 90% of the isolates were resistant to ampicillin and erythromycin .But less than 20% of the strains were resistant to quinupristin‐dalfopristin and linezolid . Univariate analysis indicated that prolonged hospital stay , ICU admission , venous catheter ,prior carbapenem exposure , prior vancomycin/norvancomycin exposure were associated with VRE bloodstream infections .Logistic regression analysis confirmed that venous catheter was an independent risk factor of VRE bloodstream infections .Conclusions Venous catheter is an independent risk factor for VRE bloodstream infections . Infection control measures should be strengthened to prevent the outbreak of VRE‐related bloodstream infections .

Objective To investigate the dosimetric performance of two algorithms for correcting the presence of tissue inhomogeneities,the finite site pencil beam (FSPB) and X-ray voxel Monte Carlo (XVMC) plans were implemented in the MONACO system,with the accuracy of application to clinic treatment of two algorithms were evaluated.Methods In a non-uniform artificial anthropomorphic phantom,regular open fields and intensity modulation radiated therapy (IMRT) plans of the MONACO were measured by using calibrated EBT2 films,and the dose accuracy of the two kinds of plans was analyzed by comparing the planned and measured plane dose.Results In an anthropomorphic phantom,the deviations between the calculated values by XVMC and the measured values by films were less than ± 2％.While the deviations of FSPB values between calculation and measurements was within ± 3％,except at the condition of 15 MV,10 cm ×2 cm field,the dose error in lung was up to 6.51％.The verification of individual IMRT beams based on films showed that the pass rates of calculation by XVMC and FSPB were larger than 90％ with γ criterion of 3％/3 mm and 4％/4 mm,respectively.At 3％/3 mm,the pass rates of FSPB were in the range of 80％-90％.At the same time,the pass rates of all individual fields were higher than 90％.Conclusions The accuracy of dose calculation of XVMC is better than that of FSPB when being in multi-segments and non-uniform media.The error of algorithm can be controlled within ±3％,for the calculation by XVMC.And the dose deficiency of PTV arising from algorithm can be avoided.

Objective To investigate the clinical efficacy and mechanism of vacuum-assisted closure (VAC) in the preoperative and postoperative treatment of bedsore united with skin flap.Methods Twenty two cases with bedsore were randomly divided into experimental and control groups.In the control group,the surgery of flap was performed after the treatment of continuous negative pressure about 7-10 days and the VAC was not applied after operation.While in the experimental group,VAC was not used before operation.It was applied on flaps as soon as sutured the border of flap and decubitus ulcers and removed after 7-10 days.By comparing the general appearance of two groups,microvessel count and the detection rate of bacterial culture and other indicators,the clinical effects of two treatments were investigated and the preliminary mechanism was analyzed.Results After preoperative VAC treatment,11 cases of control group showed a little granulation tissue growth,less subcutaneous hematoma and wound effusion,increased microvessel count and negative bacterial culture.However,there were 4 cases of death cavity residual,subcutaneous hematoma and wound effusion,positive bacterial culture and another 4 cases of delayed healing with skin flap repairing bedsore.The application of VAC in experimental group showed close contact of flap with the basement,less effusion,increased microvessel count and negative bacterial culture.One case of skin flap had a small area of separation,after the dressing of skin and the flap survived.The other wounds healed by first intention.Conclusions The use of VAC to repair bedsore can reduce the number of operation,and it is beneficial to the flap survival.