Objective To investigate the protective effect and mechanism of recombinant hirudin on avulsed flap and to explore the application of recombinant hirudin in clinical treating avulsed flap.Methods 108 Sprague-Dawley rats were randomly divided into three groups:local injecting recombinant hirudin (group A),local injecting low molecular heparin (group B),and local injecting physiological saline (group C).The far ends were sutured after forming dorsal avulsed flap with local freeing.The levels of P-selectin and VEGF were detected,and the inflammatory cell aggregation and formation of microthrombus were observed in pathological section.On 14th postsurgery day the survival rate of flap was calculated.Results The content of P-selectin in group A was lower than that of groups B and C,with a statistical difference (P＜0.05).The content of VEFG in group A was higher than that of groups B and C,with a statistical difference (P＜0.05).On 14th postsurgery day,group A was higher than that in groups B (P＜0.05)and C (P＜0.01) in the survival rate of flap.Conclusions Locally injected recombinant hirudin can actively suppress the production of P-selectin,reduce accumulation of inflammatory cells,prevent information of microthrombus,improve ischemia and anoxia of avulsed flaps,decrease injuries of endotheliocyte,enhance the expression of VEGF,and stimulate hyperplasia of neogenesis capillaries that elevate survival rate of avulsed flaps.

Objective To explore the usefulness of enhanced patient education in increasing the patients' knowledge and awareness of peripherally inserted central catheter (PICC) protection.Methods Totally 200 patients with PICC in Neijiang First People's Hospital from June 2009 to June 2012 were divided into control group (odd numbers,conventional patient education,n =100) and observation group (even numbers,enhanced patient education,n =100) according to their admission numbers.The patients' knowledge and awareness of PICC protection were analyzed after treatment,and the incidences of adverse events and catheter indwelling time were also compared between these two groups.Results Compared with the control group,the observation group had significantly higher PICC protection knowledge rate (91％ vs.78％,P =0.001),awarehess rate (95％ vs.80％,P=0.011),lower incidence of adverse events (1％ vs.5％,P =0.034),and longer PICC indwelling time [(125.8 ± 10.6) d vs.(106.7 ±8.2) d,P =0.026].Conclusion Enhanced patient education can effectively enhance the patients' knowledge and awareness of PICC protection.

Several key issues in the diagnosis of osteoporosis were discussed. The definition of osteoporosis and some concepts in bone fracture risk evaluation were explained, so as the methods to avoid the common misunderstandings in clinical practice. Finally, the parameters used in determination of bone metabolism and bone mass were listed, and their application and limitation were analyzed. It may help the clinicians to make correct choice of these parameters.

Currently the most effective treatment strategy for breast cancer is standardized multi-discipline comprehensive treatment. However, there are no effective models that can accurately predict prognosis, so that no guidance of individualized treatment has yet been set up, resulting in a proportion of patients with low risk who received chemotherapy with little benefit. With the development of genomics, several gene sets have been demonstrated to be helpful in predicting of breast cancer prognosis and grading the patients' benefit from chemotherapy, thus avoid overtreatment. 21-gene Oncotype Dx was reported as one of them and has been demonstrated to be effective and accurate in various clinical studies. This paper summarizes researches on 21-gene Oncotype Dx in breast cancer.

Conductive education is an education system aiming at helping the handicapped people improve the impaired and abnormal function through education. This article started from the current status of conductive education in clinical rehabilitation and analyzed the causes for imbalance between supply and demand of conductive education professionals. Meanwhile strengthening and ex-panding the coverage and strength of general conductive education was proposed and bringing con-ductive education into the compulsory course of rehabilitation therapy major was recommended. Finally, training conductive educational professionals with high-quality was regarded as the most fundamental measure to solve these problems.

Objective: To evaluate the effectiveness of the Demin Circle in on-site first-aid training among fishermen, so as to provide insights into improving the on-site first-aid knowledge and skills among fishermen. Methods : Deep-sea male fishermen were sampled from Putuo District of Zhoushan City, Zhejiang Province and randomly assigned to the intervention and control groups. Participants in the control group received training pertaining to conventional first-aid knowledge, while participants in the intervention group were given the Deming Circle. The knowledge, awareness and skills of on-site first-aid, and satisfaction with the first-aid training were evaluated among fishermen before and after the training using questionnaire surveys and on-site first-aid skill operations. Results: A total of 327 questionnaires were allocated, and 273 valid questionnaires were recovered, with an effective recovery rate of 83.49%. There were 132 respondents in the control group and 141 in the intervention group, and there were no significant differences between the two groups in terms of age or educational level ( P>0.05 ). The increase of the score of on-site first-aid knowledge, proportion of active learning of on-site first-aid knowledge, proportion of active elimination of potential dangers and proportion of active implementation of on-site first-aid, and seizing the skills of cardiopulmonary resuscitation, trauma first-aid, airway foreign body disposal and calling the police were all higher in the intervention group than in the control group ( P<0.05 ). Following training, the score of satisfaction with the training was significantly higher in the intervention group than in the control group [( 9.13±0.49 ) vs. ( 7.08±0.72 ) points, P<0.05 ], and the score of willingness to continue the enrollment in the Deming Circle was significantly greater in the intervention group than in the control group [( 65.13±3.11 ) vs. ( 43.62±3.79 ) points, P<0.05 ]. Conclusion Deming Circle is superior to conventional first-aid training for improving the effectiveness of on-site first-aid training among fishermen.

Objective To observe the effect and mechanism of Ligustrazine ( LIG ) on the Airway smooth muscle( ASM) of isolated guinea pigs. Methods The normal guinea pig bronchus were made into tra-chea spiral,and randomly divided into LIG group, LIG+Propranolol group, LIG+Atropine, LIG+Nifedipine group,LIG+Glibenclamide group and the control group. The effect of different concentrations of LIG on the ASM was respectively observed in the resting tension and the high tension caused by histamine,and the ASM re-laxation rate were compared between each groups. Results (1)It had diastolic function for LIG on the isolated guinea pigs ASM in the resting tension and the high tension caused by histamine. (2)In the resting tension,com-pared with the group LIG,the diastolic function was antagonism by the concentration of LIG 10-7 ~10-6. 5 mol/L in the group LIG+Propranolo (P<0. 05). The diastolic function had no significant difference by the concentra-tion of LIG 10 -7.5 ~10 -3 mol/L in the group LIG+atropine and LIG+Glibenclamide(P>0. 05). The diastolic function was improved remarkably by the concentration of LIG 10 -6 ~10 -4 mol/L,in the group LIG+Nifedip-ine (P<0. 05). (3)In the high tension caused by histamine,compared with the group LIG,the diastolic function was antagonism obviously by the concentration of LIG 10 -6. 5 ~ 10 -5 mol/L in group LIG+Propranolol ( P<0. 05);The diastolic function had no significant difference by the concentration of LIG 10 -8 ~10 -3 mol/L in group LIG+atropine,and LIG+Glibenclamide (P>0. 05);The diastolic function was improved remarkably by the concentration of LIG 10 -6.5 ~10 -5 mol/L in group LIG+Nifedipine (P<0. 05). Conclusion It has dias-tolic function for LIG on the isolated guinea pigs ASM in the resting tension and the high tension caused by his-tamine. The effect and mechanism may be related with the competitive exciting beta 2 receptor and the inhibitor of Ca2+ internal flow. It provides a theoretical basis for the clinical application of LIG in treating asthma.

Objective: To develop an improved method for the primary isolation and culture of highly purified endometrial glandular epithelial cells in vitro.Methods: Normal endometrial tissues were isolated and cultured in vitro by double collagenase digestion and selective wall-pasting.Results: Highly purified endometrial epithelial cells were successfully isolated and cultured.Conclusion: Epithelial and interstitial cells of the endometrium can be successfully isolated with high purity by double collagenase digestion and selective wall-pasting.

Objective:To compare and analyze the changes and the influencing factors of out of pocket(OOP) expenditure before and after the new medical reform.Methods:2000-2015 time series data was used to compare the changes of OOP in different years.The cross-section data was applied to compare the OOP of China and other countries.The principle component analysis method was used to research the contribution rates of different factors for the OOP ratio changes.Result:According to the vertical comparison,it found that the OPP ratio showed steady decreasing trend.The horizontal comparison found that there were great gap for OOP ratios of China and other countries.The per capita GDP,under five mortality and proportion over 65 years were significant factors for OOP.Conclusion:The OOP ratio still needed to be devreased,which needed to promote the economic growth,implement medical insurance system,improve the public health input and decrease the health economic burden for residents.

The Auditory Apperception Measurement Model (AAMM) is often used to test the ability of people's auditory learning. Through learning auditory signals,the testees' apperception abilities are tested under different process of learning. In this paper,the AAMM is built,and the design and realization of the software is introduced.