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 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 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 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.

Objective To observe the effect of Montelukast (MTL)on the airway smooth muscle(ASM)iso-lated from asthmatic guinea pigs.Methods The bronchus of asthmatic guinea pigs were made into trachea spiral. These bronchus were divided into 6 groups:MTL group,MTL +Nifedipine group,MTL +Glibenclamide,MTL +Prop-ranolol group,MTL +Atropine group and control group.The effect of different concentrations of MTL on the ASMin the resting tension was observed and the ASMrelaxation pigs were compared among the groups.Results MTL in 1 0 -7.5 -1 0 -3.0 mol/L had diastolic effect on the asthmatic guinea pigs ASM[(0.31 ±0.1 2)% -(99.61 ±0.40)%],and compared with the control group,there were significant differences[0 -(1 2.77 ±0.33)%,all P <0.05].In the resting tension of asthmatic guinea pig ASM[(1 1 .48 ±1 .63)% -(94.03 ±1 .87)%],the diastolic function was remarkably improved at 1 0 -6.0 -1 0 -3.5 mol/L of MTL in MTL +Nifedipine group,and the differences among the groups had statis-tical significance (all P <0.05).The diastolic function was antagonism at 1 0 -7.5 -1 0 -6.5 mol/L of MTL in MTL +Pro-pranolol group [(0.1 6 ±0.07)% -(2.73 ±0.84)%]and the differences among the groups had statistical signifi-cance (all P <0.05).The diastolic function had no significant difference between 1 0 -8.0 -1 0 -3.0 mol/L of MTL in MTL +Atropine group and MTL +Glibenclamide group (all P >0.05).Conclusions It has diastolic function for MTL on the isolated asthmatic guinea pigs ASMin the resting tension.The effect may be related with inhibitor of Ca2 + inter-nal flow and the competitive exciting β2 receptor.

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.

OBJECTIVE:To provide reference for standardization of drug package.METHODS:5 dose-related items stated in a total of 426 package inserts of chemical drugs collected from the drug storeroom in our hospital were investigated and analyzed.RESULTS:Only 32.39% of the package inserts were with complete labeling.The labeling rate for special group was low and only 40% labeled the maximal dose.Less than 2% of child dose stated the doses according to body surface area,and the problem of over-dose was common.Only 27.46% had the item of "under supervision of a physician".CONCLUSION:It is necessary to strengthen supervision on drug package inserts and improve cognition on the importance of drug package inserts.

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.

Objective To discuss the pathological morphological features of the macrofollicular variant of papillary thyroid carcinoma ( MFPTC ) .Methods Clinical data of 2 cases of MFPTC were reviewed .The his-topathological and immunohistochemical features were analyzed .Relevant literatures were reviewed .Results The histological characters of MFPTC mainly included its multiple macrofolliculus , plenty of colloid and atypical nuclear morphology.Immunohistochemistry stain showed cytokeratin-19, Galectin-3 and HBME-1 expressed simultaneously. Conclusions MFPTC is a thyroid papillary carcinoma with unique histological characters .It should be differen-tially diagnosed from some benign lesions such as nodular goiter and follicular adenoma .Immunohistochemical stain of cytokeratin-19, Galection-3 and HBME-1 may be very helpful in the diagnosis and differential diagnosis .