The score of the final test papers of rehabilitation medicine among the fiveyear prgram clinical students of Grade 2005 in our university were analyzed,which showed that the test paper had the degree of difficulty and discrimination was good,which reflected the students’real level.And at the same time we found that students could not to make good use of learning to analyze and work out a solution. Therefore,we should pay attention to the combination between teaching and clinical practice,increase student’chance of learning on the job, and properly append such subjects as application, synthetic and evaluation in the test papers.

This article reviews the history and development of the pacing,introduces the latest technology of pacing at home and abroad and promotes the clinical development of pacing therapy.With the development of the pacing technology,it is used more widely than before.It is applied to the patients not only with slow-arrhythmia or conductive diseases,but also with disorders of electrical or non-electrical diseases.This review introduces some new therapies.

BACKGROUND: Leukoaraiosis is a group of changes in image. Since the firm pathogenic mechanism on leukoaraiosis has been unknown, the evaluation at the earlier stage of the disease has not been emphasized commonly and there is rather less recognition of the alternations on its electrophysiological system.OBJECTIVE: To probe into the clinical characteristics and alternations on image and evoked potential in simple leukoaraiosis and subcortical arteriosclerotic encephalopathy(Binswanger' s disease) and carry on the comparison with healthy people.DESIGN: Retrospective comparative study based on patients and healthy people.SETTING: Department of neurological internal medicine of one university hospital and department of neurological internal medicine of one railway central hospital.PARTICIPANTS: Outpatients or inpatients with cerebral vascular disorders in Qilu Hospital Affiliated to Shandong University were collected from August 1995 to March 2000. Totally 114 cases were leukoaraiosis, of which, 79 cases were males and 35 cases females. And 41 cases were Binswanger' s disease,of which, 28 cases were males and 13 cases females. Fifty healthy aged people who received routine physical check were randomized from the clinic of the hospital as the control.METHODS: The analysis was carried on the risk factors, clinical characteristics and CT exam in 114 cases of leukoaraiosis and 41 cases of Binswanger' s disease, of which, 74 leukoaraiosis cases and 35 Binswanger' s disease cases had received cranial MRI exam. Of those, 43 cases of simple leukoaraiosis associated with hypertension, 30 cases of Binswanger' s disease and 50 cases in the normal control were selected to carry on the examinations of body-sensory evoked potential, brain stem auditory evoked potential and visual evoked potential.coronary heart disease, diabetes, hyperlipemia, smoke, cerebral apoplexy,evoked potential and visual evoked potential.RESULTS: According to practical management analysis, 114 cases of leukoaraiosis, 41 cases of Binswanger' s disease and 50 cases in the control were diversification, mainly characterized as slightly declining of memory and loss of gait stability. Hypertension is predominated anong risk factors in Binswanger' s disease group (95.1% ), mainly characterized as physical signs of local neural focus, obvious cognitive disturbance and cerebral in CT exam that 70.2% (80/114) of cases presented brain whiter-matter abnormity in type Ⅰ. It was indicated in MRI exam that 72% (53/74) of cases presented brain whiter-matter abnormity, type Ⅰ, 27% (20/74) presented type Ⅱ and 1% (1/74) presented type Ⅲ. For Binswanger's disease patients, it was indicated in MRI exam that 54% (19/35) of cases presented brain white-matter abnormity, type Ⅲ, and 46% (16/35) presented type Ⅳ.Symmetrical extension of bilateral ventricles presented in Binswanger' s disbody-sensory evoked potential was 84% (36/43), of which, the mild abnormity occupied 60% (26/43) and moderate abnormity 23% (10/43); The abnormity rate of brain stem auditory evoked potential was 63% (27/43) and that of visual evoked potential was 54% (23/43). In Binswanger' s disease group, the abnormity rate of body-sensory evoked potential was 97% (29/30),of which, mild abnormity was 7% (2/30), moderate abnormity was 47%(14/30) and severe abnormity was 43% (13/30); The abnormity rate of brain stem auditory evoked potential was 87% (26/30) and that of auditory evoked potential was 83% (25/30).CONCLUSION: The risk factors of simple leukoaraiosis are diversified,without obvious physical signs of local neural focus. The diagnosis of it is mainly depended on abnormity Ⅰ of brain white matter described in images,manifested as remarkable dysfunction of cerebral eletrophysiology. Binswanger' s disease patients are mainly characterized as hypertension, relevantly obvious cognitive disturbance and common seizure of cerebral apoplexy. Abnormity Ⅲ of brain white matter indicated in CT exam, abnormity Ⅲ or Ⅳ of that in MRI exam are the image evidence for diagnosis. Remarkable abnormity also presents in cerabral electrophysiology, in which, abnormal body-sensory evoked potential is especially significant.

Objective To investigate the biocompatilility of human acellular amniotic membrane(HAM) with vascular smooth muscle cells(VSMCs) and to explore the possibility to construct tissue engineering bladder with HAM as the scaffold and VSMCs as the seed cells. Methods After physical and 1% trypsogen preparation,the HAM was mixed with VSMCs taken from rats for culture in vitro.Histological obserbation was done under inverted microscope and scanning electron microscope respectively.20 rats were divided into two groups.Hemicystectomies were performed in 20 rats,and 10 of them were repaired with HAM grafts with VSMCs on the half bladder,the other 10 were repaired with HAM grafts without VSMCs as the control group.The rats underwent postoperative assessment of bladder volume at the 2nd,4th and 8th weeks,and the grafts were observed by light microscope at the 2nd,4th and 8th weeks after surgery. Results The physical and 1% trypsogen treated HAM was pure with hollows and undamaged collagen fibers.The VSMCs could grow,adhere to and differentiate on the surface of HAM and into the hollows.At the 2nd,4th and 8th weeks after surgery, the bladder volumes of the experimental group were not different significantly compared with those of the control group.Epithelialization and smooth muscle cells regeneration occurred with the infiltration of inflammatory cells in the 2nd week after grafting,and the HAM were absorbed.In the 4th and 8th weeks,it was difficult to delineate the junction between the host bladder and grafts by histology.Conclusion HAM can be used as the scaffold to construct tissue engineering bladder as it has good biocompatibility with VSMCs without disturbing the cell form and the graft can be absorbed quickly.

Objective:To investigate the efficacy of endolymphatic sac surgery for Meniere's disease,and compare the effects of endolymphatic sac decompression with endolymphatic-mastoid shunting.Method:Twelve patients(13 ears)undergoing endolymphatic-mastoid shunting and eleven patients (11 ears) undergoing endolymphatic sac decompression were retrospectively compared for hearing results and vertigo controlled rates.All of them have been followed up for more than two years after surgery.Result:According to Chinese Meniere's disease diagnosis and curative effect standard evaluation criteria pubilished in 2006,for vertigo symptom of endolymphaticmastoid shunting group,9 cases(69.2%) achieved grade A(eompletely controlled),4 cases (30. 8%) achieved grade B(fundamentally controlled).There were 8 cases(72.7%)with grade A, 2 cases (18.2%)with grade B and one case(90% ) with grade C among 11 patients who received endolymphatic sac decompression.There was not statistically significant differences in postoperative speech pure tone average and vertigo controlled rate between the two groups.Conslnsion:Endolymphatic sac decompression and endolymphatic-mastoid shunting are effective management with less complication for intractable Meniere's disease. Particularly,the vertigo symptoms were controlled signifisantly. Patients with Meniere's disease in advanced clinical stages may also be relieved.

Aim To study the effect of proteasome inhibitor MG132 on the expression of caspase-3 and apoptosis in cultured human umbilical vein endothelial cells.Methods Human umbilical vein endothelial cells was treated with MG132 (2,5 ?mol?L~(-1)) for 24 h. The apoptotic cells were determined by DNA fragment analysis and flow cytometric analysis. The level of caspase-3 mRNA was quantified by reverse transcription-polymerase chain reaction (RT-PCR). The protein contents of caspase-3 were analyzed by immunocytochemistry.Results The results showed that the increase of the degree of human umbilical vein endothelial cells apoptosis was concentration dependent. MG132 could up-regulate the gene/protein expression of caspase-3.Conclusions The results implicated that proteasome inhibitor MG132 induced human umbilical vein endothelial cells apoptosis by accumulation of caspase-3.

Objective To investigate the mental health status of patients with cervical spondylosis and the curative effect of psychotherapy.Methods71 patients of cervical spondylosis with psychological obstacles were randomly divided into the experiment group (32 cases, treated by physiotherapy combined with psychotherapy simultaneously) and control group (39 cases, treated by physiotherapy only). The patients' somzatization and mental health status were evaluated by the Symptom Checklist-90 (SCL-90) and the table of curative effect estimation of cervical syndrome before and four weeks after treatment.ResultsThere was no significant difference between two groups in the degrees of somzatization and scores of SCL-90 before treatment. After four weeks treatment, both two groups had improvement in the physical symptom and psychological condition, but the curative effect of the experiment group was better than the control group ( P<0.05).ConclusionBecause having a long disease course, the patients with cervical spondylosis have different level mental health troubles. Psychotherapy is helpful to improve curative effect.

Objective To investigate the effect of self-efficacy theory in rehabilitation on stroke patients with hemiplegia complicated psychological disorder. Methods 26 cases were divided into the combined therapy group (13 cases, accepted physical therapy with self-efficacy) and the routine physical therapy group (13 cases). They were assessed with General self-efficacy scale (GSES), Fugl-Meyer Assessment before and 1, 3 months after treatment, as well as symptom checklist (SCL-90) before and 1 month after treatment. Results The scores of GSES raise 63% in the combined therapy group 1 month after treatment, obviously different from that of routine physical therapy (P<0.01).The score of Fugl-Meyer Assessment of the combined therapy group were increased from (53.08±13.04) to (90.07±6.54 ) and from (56.46±12.95) to (81.77±8.51)in the routine physical therapy group (F= 85.53,P<0.05). All the scores of depression, anxiety, compulsion, hostility in SCL-90 were markedly lower in the combined therapy group than in the routine physical therapy group(P<0.01). Conclusion Utilization of self-efficacy theory in rehabilitation can improve the emotion and effect of rehabilitation.

Objective To explore the effect of different nasal feedings in enteral nutrition for elderly patients with severe brain hemorrhage. Methods Eighty elderly patients with severe brain hemorrhage were assigned into the observation group and control group according to the odd and even numbers at admission with 40 in each group. The control group was treated with graded injection nasal feeding, and the observation group was treated with continuous infusion nasal feeding. The nutrition indicators and enteral nutrition complications were compared between the two groups. Result The nutrition indicators in the observation group were better than those in the control group and the rate of enteral nutrition complications in the observation group was lower than that in the control group (P<0.05). Conclusion Continuous infusion nasal feeding can improve the nutritional status of elderly patients with severe cerebral hemorrhage and effectively reduce the incidence of complications of enteral nutrition. So it is worthy of clinical application.

OBJECTIVE:To optimize the placement of extra-machine medicines in the automated pharmacy and establish a ra-pid dispensing area to shorten medicine dispensing time. METHODS:12 588 prescriptions made within one week were collected from the outpatient pharmacy of our hospital,in which 29 kinds of extra-machine medicines used frequently were clustered on the basis of Pearson correlation coefficients. The extra-machine medicines used at a higher frequency were arranged in the storage posi-tions near to the medicine dispensing window,and those related to the above-mentioned medicines were stored in the positions adja-cent to them,thereby a rapid dispensing area was established. The effect of the above-said method was evaluated by comparing the time it took for the pharmacist to dispense medicines one week before and after the establishment of the rapid dispensing area. RE-SULTS:29 kinds of extra-machine medicines were clustered into 4 major categories,and stored in 4 positions in the rapid med-icine dispensing area respectively,and then the position codes were assigned. After the rapid dispensing area was established,the average single prescription dispensing time for the pharmacist decreased by about 9 s (40.43 s vs. 31.43 s,P<0.01). CONCLU-SIONS:The establishment of the rapid dispensing area based on cluster analysis method has increased the efficiency of dispensing medicines in the outpatient pharmacy of our hospital.