BACKGROUND:In the research of the active above-knee prosthesis, the existing motion pattern recognition methods have shown promising results, but the further improvement of the recognition accuracy and the reduction of the response time are stil necessary. OBJECTIVE:To establish a terrain recognition system based on the random forest algorithm, achieve the identification of the front terrain, and obtain the motion mode of the subject on the terrain for the control of artificial limb. METHODS:A laser distance sensor and an inertial measurement unit sensor were fixed on the waist to col ect the terrain information and human motion signals. The col ected data were filtered and the characteristic values were extracted from the data. The random forest algorithm was applied in the establishment of the classifier, which was used to recognize the terrain. RESULTS AND CONCLUSION:The results showed that the terrain recognition system could recognize level ground, stair ascent/descent and ramp ascent/descent at a high accuracy, which could contribute to the control of the active above-knee prosthesis.

Objective To evaluate the short?term efficacy and safety of endoscopic photodynamic therapy ( PDT ) for esophageal squamous cell carcinoma ( ESCC ) and precancerous lesion. Methods Retrospective analysis was performed on 30 patients with early ESCC or precancerous lesions who received PDT between September 2013 and April 2015 in Endoscopy Center, Henan Tumor Hospital,and its indications were summarized. The main outcomes including histological complete response rate ( CR ) , recurrence rate and adverse events after treatment of one year were analyzed. Results Three patients with middle grade dysplasia( MGD) , 18 with high grade dysplasia( HGD) and 4 with squamous cell carcinoma in situ, all negative lymph node metastasis, received PDT. CRs were 72?0%(18/25) and 88?0%(22/25)after one PDT session in 3 months and 12 months, respectively. One?year follow?up showed 3 recurrences ( 12?0%) ,4 ( 16?0%) severe strictures, and no perforation. Five patients with advanced squamous cell carcinoma received palliative PDT. Partial remission rate was 60?0%( 3/5) after one PDT session in 3 months, and 40?0% ( 2/5) after 12 months. Two died of tumor metastasis, one died of gastrointestinal bleeding one year after PDT. No perforation occurred. Conclusion Endoscopic photodynamic therapy for esophageal squamous cell carcinoma and precancerous lesions is safe and feasible, with remarkable short?term effect. As for the patients with advanced squamous cell carcinoma, it is equally safe and effective in the short term.

Objective To evaluate the value of the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and P-POSSUM in predicting the risks of orthopedic surgeries for senile patients with femoral neck fracture.Methods A total of 108 patients with femoral neck fractures who underwent hip joint replacement were retrospectively studied using POSSUM and P-POSSUM scoring system to predict their mortality and complication rate.The difference between predictive value and observed value was analyzed by chi-square test.Meanwhile,the patients were divided into two groups based on their POSSUM scores.The differences between two groups were analyzed.Results According to POSSUM scores,47 patients were predicted to have complications(the mean rate was 43.52％),but only 37 did actually (the rate was 34.26％).There was no significant difference between predicted values and observed values (P =0.238).The predicted death toll was 11 cases (the mean rate was 10.19％),but actually only 2 patients died (the rate was 1.85％).Predicted value was higher than observed value.In terms of complications,death toll agreed well with the predicted values calculated by P-POSSUM (predicted death of 4 cases' the mean mortality being 3.70％ ; actual death of 2 cases' the mortality was 1.85％) without significant difference (P =0.625).We divided the patients into two groups with the POSSUM scores 40,and there was no significant difference between predicted values and observed values (P =0.527,P =0.285).Conclusions POSSUM has better predictive ability of morbidity,but overestimates mortality.P-POSSUM more accurately predicts mortality than POSSUM.The predicted results of POSSUM and P-POSSUM scoring systems are satisfactory in the high risk group.

Covered in the paper are the significance of rural doctors′professional development and their professional characteristics,as well as systematic insights on such key factors of professionalism of these doctors,as their professional qualifications,functional positioning,practicing approach,professional guarantee,professional development,social identity,professional stability,and professionalism.Based on such thoughts,the authors recommend on reforms of professional development for rural doctors by stages and levels.

BACKGROUND:Hydroxyapatite (HA) artificial bone,as bone grafting substitute,would not cause inflammatory reaction or immunological rejection and possesses good biocompatibility after transplantation into human body.It is a novel implant material with bone conduction ability.OBJECTIVE:To investigate the efficacy of HA artificial bone in bilateral open-door posterior cervical expansive laminoplasty and to make a comparison with autogenous bone.DESIGN,TIME AND SETFING:A retrospective case analysis was performed at the Department of Spine Surgery,Hungpuyuan Branch,the First Affiliated Hospital of Sun Yat-sen University from March 2001 to December 2008.PARTICIPANTS:Seventy patients with cervical spondylosis complicated by compression in 3 or more segments or by cervical stenosis and additional fifteen patients with cervical stenosis complicated by cervical trauma were included in this study.METHODS:A bilateral open-door posterior cervical expansive laminoplasty was performed,in which,23 patients received autogenous bone transplantation (autogenous bone group) and 62 patients underwent HA artificial bone transplantation (HA group).MAIN OUTCOME MEASURES:① Japanese Orthopaedic Association (JOA) score pdor to and after surgery,surgery time,and intraoperative bleeding.② HA artificial bone-host biocompatibility.RESULTS:All eighty-five patients were followed up for more than 3 months.There was no significant difference in JOA scores no matter prior to or after surgery between the autogenous bone and HA groups (P＞0.05).The surgery time averaged 85.2 minutes (range 65-110 minutes) in the HA group and averaged 116.4 minutes (range 75-150 minutes) in the autogenous bone group.The intraoperative bleeding averaged 210 mL (range 130-400 mL) in the HA group and averaged 260 mL (range 170-500 mL) in the autogenous bone group.There were no material-host response and other severe complications found in each group,except HA artificial bone fragmentation in 3 patients from the HA group.CONCLUSION:HA artificial bone yields good efficacy and causes fewer complications in bilateral open-door posterior cervical expansive laminoplasty;in addition,it requires less time for surgery and causes less bleeding.

Objective To evaluate the clinical efficacy of monosegmental pedicle instrumentation in management of thoracolumbar burst fractures. Methods A total of 67 patients with traumatic thora-columbar burst fractures (type A3.1 and A3.2) were treated with monosegmental pedicle instrumentation in our department from October 2003 to February 2008. Imageologic effect was observed by measuring sagittal index and wedge index via X-ray and clinical outcomes evaluated by using low back outcome score. Results All operations were performed successfully, with average operation duration of 93 mi-nutes and average intraoperative blood loss of 157 ml. Of all, 65 patients were followed up for 4-27 months (average 19.8 months), which showed that all the patients achieved bony fusion, with no implant failure except for one with screw loosening. The sagittal index and wedge index were 13.06°and 42.9% preoperatively and 4.47° and 21.78% postoperatively, with statistical difference (P <0.01). The final follow-up showed no significant correction loss except for two patients (P < 0.05). The low back outcome scores of all patients at follow-up were improved significantly (P < 0.05). Conclusions Monoseg-mental pedicle instrumentation has advantages of minimal invasion, short operative duration, less blood loss and less vertebral motion segment loss and hence is an effective and reliable operative technique for thoracolumbar burst fractures.

Objective To study the quality of outpatient prescriptions for patients of different age groups at both township and village level,for the purpose of evaluating the outcomes and problems of the ongoing healthcare reform at primary levels.Methods 100 outpatient prescriptions of April 2015 were mechanically sampled randomly from two township hospitals and 8 village clinics in counties A and B in Hubei province.These prescriptions were analyzed for the drug count per prescription,percentage of intravenous prescriptions,that of antibiotics,that of hormones and average cost per prescription.Results At the township hospitals,the drug count per prescription(2.02)of county A was less than that of county B(3.26),while the percentage of intravenous prescriptions(30.30%),that of antibiotics(47.98%)and hormones(6.57%)of county A were significantly less than those of county B(50.65%,69.08% and 15.13% respectively).At village clinic level,the percentage of intravenous prescriptions(31.05%)of county A was higher than that of county B(20.34%),the average prescription costs(￥29.28)of county A was less than county B(￥31.45);while in terms of children′s prescriptions,average drug count of county A(2.50)was higher than county B(2.09),and its proportion of antibiotics(65.91%)was higher than county B(45.56%).Conclusions General primary care reform is faced with challenges of poor control of intravenous injection and use of antibiotics,particularly at village clinics and pediatric drug use in terms of prescription quality control.Both township and village levels should strengthen the supervision over the drug suppliers,guide the demand side to rationally use drugs and focus on the reasonableness of the medication of village clinics and children.

The countywide healthcare reform in Anhui province since 2015 was analyzed in the paper.The reform is based on the integration of healthcare management system and health service system of the new rural cooperative medical system (NCMS).The core of reform is regional global per capita budget of NCMS.The reform promotes the county′s healthcare institutions to shift from profit oriented to costs control, improves their quality of care, emphasizes disease prevention and control, and maintains residents health.Next, we should pay attention to the rationality of funds balance and benefits distribution, and the training of county healthcare personnel.

This paper analyzed and concluded successful experience and mechanisms of regional global per capita budget implemented since 2015 in Anhui province,including the formation of mutual incentive and restraint mechanism, the mechanism of controlling expenses spontaneously and resource allocation efficiently.After the reform, flow of hospitalized patients was more rational, and the financial burden of patients was alleviated, while the capacity of medical institutions was improved notably in pilot counties.The successful experience of Anhui province can put forward corresponding suggestions to guide the future work in other areas.

The hematopoietic microenvironment provides an important place for hematopoietic stem cell (HSC) to self-renew, directional differentiation and maintain relative homeostasis, and it can regulate hematopoietic activity through various cellular components and factors. HSC is a primitive pluripotent stem cell in the blood system featured by the potential ability to self-renew for a long time and to differentiate into various mature blood cells, which exists in the bone marrow (BM). HSC plays an important role in regulating and maintaining the physiological balance of various cellular components of the blood system in the body, to ensure the continuous regeneration of the blood system. The hematopoietic microenvironment affects the development of HSC all the time, but the related cellular molecules and signals in the microenvironment still need to be studied in depth. This paper reviews the main components of the hematopoietic microenvironment, signaling pathways and the effects of abnormal changes on the diseases.