Rehabilitation medicine is not the continuation and repetition, but supplement of the clinical medical treatment, and also makes up for its limitations. Medical postgraduate, mastering modern medical theory and clinical skills, should know the basic knowledge and skills of modern rehabilitation medicine well. So it is necessary to bring rehabilitation medicine course into the core curriculum of clinical medicine graduate degree.

Objective To explore mood disorders after left and right cerebral hemisphere injury,to search for possible mechanisms and to provide the basis for designing rehabilitation protocols and assessing prognosis.Methods Fifty-one cases with brain injury were recruited from a rehabilitation center and divided into left and right hemisphere injury groups with 26 and 25 cases,respectively.Hamilton rating scale for depression (HRSD) scores were analyzed. Results The left hemisphere patients had significantly higher HRSD total scores and higher scores indicating 15 kinds of mood disorders (depression,feelings of guilt,suicidal thoughts etc.).Right hemisphere injury patients had significantly higher diurnal variation,depersonalization or derealization and paranoid symptoms. Conclusions The lateralization of the cerebral hemispheres may display itself in mood and emotion.After left or right hemisphere injury,the depression presentation is different,so treatment,prognosis assessment and psychological intervention should be different for left and right hemisphere injuries.

To explore the clinical value of repairing massive soft tissue defects of shank and foot with diverse combined flaps with the help of 3D-CTA technique. Methods From March, 2011 to May, 2018, 7 pa-tients with massive soft tissue defects (defect area:21 cm×14 cm-53 cm×16 cm) of shank and foot were treated with combined flaps, including free anterolateral thigh flaps(ALTP) combined with local transferred sural neurocuta-neous vascular flaps in 2 cases, free ALTP combined with local transferred supracondylar flap in 2 cases, free thora-co-umbilical flaps plus local transferred gastrocnemius muscular flaps in 1 case, and free ALTP plus free thoraco-um-bilical flap in 1 case.Free ALTP and free thoraco-umbilical flap respectively combined with double bridge flaps using the both ends of posterior tibial vessel from the healthy limb to form vascular pedicles in 1 case. All cases received 3D-CTA to observe the distribution and anastomosis of perforator vessel. Regular followed-up was made post-opera-tively. Results All patients had been followed-up for 6-18 months. Outpatient service combined with telephone follow-up was adopted. All flaps survived, and flap shape, colour and lustre, elasticity got good recover. At the last follow-up, thermann scale function assessment: 4 cases were excellent, 2 were good, and 1 was fair. Conclusion It is a feasible and effective method to repair massive soft tissue defects of shank and foot using differently combined flaps. Although the surgery can be risky, the method can effectively reduce the rate of limb disability, restore the limb func-tion and shorten the course of treatment.Preoperative 3D-CTA can get the vessel anatomical structure and diameter at donor and recipient sites, which will guide the operation program design and implementation so as to shorten the oper-ation time and improve the accuracy rate of vascular anastomosis.

Objective To investigate the CD34~+ umbilical cord blood hematopoietic stem cells (CD34~+ UBSC) transfected with interleukin 21 (IL-21) against the ovarian cancer effect in tumor-bearing nude mice. Methods CD34~+ UBSC were obtained from the UBSC by a magnetically activated cell sorting technique and then transfected with recombinant plasmid plRES2-IL-21-EGFP after the CD34~+ UBSC were proliferated in vitro. The therapeutic effect was evaluated by the size of the tumor and the life span in nude mice treated with the CD34~+ UBSC-IL-21. The expression of IL-21 and its bioactivity in CD34~+ UBSC-IL-21 and in local neoplasitc tissues were respectively detected by reverse transcription-polymerase chain reaction (RT-PCR), immune fluorescence technique, ELISA, Western blot, immunohistochemistry and splenocyte proliferative activity. The NK cell cytotoxicity and the numbers of NK cells, serum level of IFN-γ and TNF-αwere simultaneouly detected by FCM and ELISA, respectively. Results CD34~+ UBSC were cultured and transfected with pIRES2-IL-21-EGFP successfully. CD34~+ UBSC-IL-21 could inhibit the tumor growth and extended nude mice life span compared with other groups (P < 0.01). The expression of IL-21 in the neo-plastic tissue, serum level of IFN-γ and TNF-α , NK cell activity and the numbers of NK cells of mice origin and of human origin in splenocytes were increased significantly in the nude mice treated with CD34~+ UBSC-IL-21 compared with other groups(P <0.01). Conclusion The CD34~+ UBSC transfected with IL-21 have competent against ovarian cancer in tumor-bearing nude mice. The findings may establish a foundation for gene therapy of the ovarian cancer by CD34~+ UBSC-IL-21 in clinic application.

Objective To investigate the effects of rhein on insulin sensitivity of diabetic rats induced by high fat feeding and low dose streptozotocin (STZ), and the possible mechanisms. Methods (1) Fifty-five Wistar rats were randomly divided into normal control group (NC,n=15) and diabetes group (DM, n=40). The NC rats were fed with regular chow and DM rats were fed with high fat diet. Five weeks later, the DM rats were injected with STZ 30 mg/kg once. The 30 diabetic rats were randomly divided into two subgroups, diabetic control group (DM-C) and diabetic group treated with rhein (DM-T). DM-T rats received intragastric administration of rhein and DM-C rats were given equal doses of solvent. All rats were sacrificed eleven weeks later, the blood sample was collected. The body weight, fasting blood glucose (FBG), HbA1C, triglycerides (TG), tolal cholesterol (TC), glycosylated serum protein (GSP) and Fasting insulin (FINS) concentrations were examined.The insulin sensitive index (ISI) and homeostasis model assessment for insulin resistance (HOMA-IR) werecalculated. (2) The PPART and GLUT-2 expression in hepatic tissue were detected by immunohistoehemistry and Western-blot. Results At the end of experiment the FBG [(22.57±3.23 vs 7.11±1.44) mmol/L,P<0.01],HbA1C[(12.49±1.96 vs 8.36±0.84)%, P<0.01], TG [(0.89±0.29 vs 0.58±0.17)nunoL/L,P<0.01],GSP [(57.29±4.14 vs 13.43±2.70)μmoL/L, P<0.01] and tumor necrosis factor-α [TNF-α,(1.365±0.133 vs 1.233±0.159) μg/L, P<0.05] and the liver weight index (0.032±0.004 vs 0.024±0.002, P<0.01) in DM-C rats were higher than those in NC rats. Besides, the ISI of DM-C rats decreased [In(ISI),-5.46±0.61 vs -4.81±0.75, P<0.05] and HOMA-IR elevated [In(HOMA-IR),2.34±0.64 vs 1.70±0.78,P<0.05]. The expression of PPARγ [11 131.7(5 723.1-18 979.4) vs 48 782.1(21 576.7-108 829.5), P<0.01] and GLUT-2 (0.98±0.35 vs 1.29±0.27, P<0.05) of DM-C rats decreased markedly compared with NC rats. Compared with DM-C rats, FBG [(15.94±3.16) mmol/L], HbA1C[(10.51±1.74)%], GSP[(47-31±6.09) μmol/L] in DM-T and the In (HOMA-IR), (1.86±0.30) rats decreased (P<0.05 or P<0.01), and In (ISI), of DM-T rats increased (-4.97±0.29, P<0.05). The expressions of PPARγ [35 156.3(24 554.3-86 660.9)] and GLUT-2 (1.55±0.55) of DM-T rats were up-regulated markedly compared with DM-C rats (P<0.05 or P<0.01). Conclusion Rhein decreased FBG, HbA1C and GSP, and improved the insulin sensitivity in diabetic rats, which might be related to the up-regulated expressions of PPARγ and GLUT-2 in hepatic tissue.

Objective To retrospectively evaluate the relevant factors for hepatitis B virus-associated glomerulonephritis (HBV-GN).Methods A total of 86 patients with pathologyproven HBV-GN and 135 HBV carriers with non-HBV-GN were included in this retrospective casecontrol study.Logistic regression analysis was used to detect the relevant factors for HBV-GN.Results On univariate analysis,the factors associated with HBV-GN were as follows: male (OR 2.79,95%CI 1.48-5.25,P=0.001),HBeAg positivity (OR 2.60,95%CI 1.49-4.53,P=0.001),HBV replication (OR 3.63,95%CI 1.80-7.33,P＜0.01),liver cirrhosis (OR 4.58,95%CI 1.41-14.91,P=0.011),and elevated alanine aminotransferase (ALT) (OR 2.53,95%CI 1.42-4.51,P=0.002).On multivariate analysis,the associations remained significant for male (OR 2.21,95%CI 1.12-4.33,P=0.022),HBV replication (OR 2.77,95%CI 1.28-5.97,P=0.01),liver cirrhosis (0R 4.55,95%CI 1.29-16.10,P=0.019) and elevated ALT (OR 1.96,95%CI 1.04-3.69,P=0.037).Compared with HBV-associated IgA nephritis (HBV-IgAN) in multivariate model,HBV-associated membranous nephropathy (HBV-MN) or membranoproliferative glomerulonephritis (HBV-MPGN) was significantly associated with male (OR 6.51,95%CI 1.76-24.11,P=0.005) and HBV replication (OR 7.22,95%CI 1.68-30.97,P=0.008).Conclusions Male,HBV replication,liver cirrhosis and elevated ALT may be predictive factors for HBV-GN.Compared with HBV-IgAN,HBV-MN or HBV-MPGN is significantly associated with male and HBV replication.

Objective To investigate the value of MR on diagnosis of intracranial primary lymphoma in immunocompetent patients.Methods The MR features of 28 cases with pathology proved intracranial primary lymphoma were analyzed retrospectively.Conventional MRI scans,enhanced MRI scan were observed.Immunohistochemical staining were done and the results were compared with the MR imaging signs. Results Twenty-eight cases were all B-cell type Non-Hodgkin's lymphoma,16 cases were single lesion (57%)and 12 cases were multiple lesions (43%).The tumors mainly located in the deep white matter,7 cases in callus corpus and grew crossing the midline supratentorial.The lesions presented mass or node (20/28),11 cases showed massive edema.On T1WI,lesions were mostly hypo-or iso-intense to gray matter.On T2WI,tumors showed iso-or hyper-intense.All lesions presented hyper-or iso-to hyper-intense on diffusion weighted imaging(DWI).Most lesions show marked mass-like or nodular-like contrast enhancement on MR imaging,8 cases presented"incision sign",5 cases showed"fist sign"and 7 cases showed"butterfly-like".Immunohistochemical staining showed that GFAP(-) was 78.6% (22/28),as well as CD20 (+)96.4% (27/28),CD79α(+)67.9% (19/28),CD10(+)10.7% (3/28),Bcl-6 (+)75% (21/28),Mum1 (+)89.3% (25/28).Ki-67 was greater than or equal to 50% (22/28).Among the 28 patients,25 cases (89.3%) showed an"activated non-germinal center B-cell(non-GCB)"in origin and 3 cases(10.7%)were considered as a"GCB"subset.Conclusion The imaging features of marked mass-kike or nodular-like on MRI enhancement scan and hyper-or iso-to hyper-intense on DWI are helpful in the diagnosis and the differential diagnosis of intracranial primary lymphoma.

Objective To acquire,evaluate and integrate the best evidence of perioperative exercise interventions in patients with liver cancer and provide evidence-based references for clinical medical staff.Methods Following the"6S"Evidence Resource Pyramid model,literatures in perioperative exercise interventions published between January 2010 and June 2022 were retrieved from various databases,including BMJ Best Practice,UpToDate,Guidelines International Network,National Guideline Clearinghouse,National Institute for Health and Clinical Excellence,Scottish Intercollegiate Guidelines Network,Medlive,Cochrane Library,JBI,Web of Science,PubMed,Embase,CINAHL,CNKI,SinoMed,Wanfang Data,American Cancer Society,American College of Sports Medicine and International Liver Cancer Association from January 2010 to June 2022.Two researchers evaluated the quality of the retrieved literatures and extracted evidences that met the inclusion criteria.Results A total of 22 articles were included,yielding 26 pieces of evidence across seven themes:the necessity of exercise,evaluation before exercise,preoperative exercise program,postoperative exercise program,exercise monitoring,health education and effect evaluation.Conclusions This study provides a summary of the best evidence regarding perioperative exercise interventions in the patients with liver cancer.The findings offer valuable references for clinical healthcare providers to deliver evidence-based care for the patients with liver cancer.

Objective: To investigate the expression of galectin-3 protein in human breast cancer tissues and the effect of silencing galectin-3 gene on the migration, invasion and apoptosis of human breast cancer MCF-7 cells. Methods: The relative expression of galectin-3 protein in 15 cases of breast cancer tissues and corresponding para-cancerous tissues were detected by Western blotting; The expression of galectin-3 protein in paraffin sections of 100 cases of breast cancer tissues were detected by immunohistochemistry, and the correlation between galectin-3 expression and the clinicopathological characteristics of breast cancer patients was also analyzed. Galectin-3 siRNA were transfected into human breast cancer MCF-7 cells by liposome, then Real-time PCR and Western blotting were used to detect the mRNA and protein expression of galectin-3. The effect of galectin-3 gene silencing on cell migration and invasion ability of MCF-7 cells were detected by Transwell method. The effect of galectin-3 gene silencing on apoptosis of MCF-7 cells were detected by flow cytometry. Results: Western blotting detection showed that the relative expression of galectin-3 protein in breast cancer tissues were significantly higher than that in para-cancerous tissues (P<0.05); Immunohistochemistry detection showed that the positive expression rate of galectin-3 protein in breast cancer tissues was 67.00%, the positive expression rates in the lymph node metastasis, hormone receptor (ER, PR) negative groups were significantly higher (P<0.05), and the positive expression rate of galectin-3 protein were increased with the increase of TNM stage and histological grade (P<0.05); Galectin-3 siRNA transfection could significantly reduce the mRNAand protein expression of galectin-3 in MCF-7 cells (P<0.05), and reduce the invasion and migration ability but significantly improve the rate of apoptosis of MCF-7 cells (P<0.05). Conclusion: Galectin-3 is highly expressed in breast cancer tissues, and its silence can inhibit the invasion and metastasis of MCF-7 cells and induce apoptosis of MCF-7 cells. Galectin-3 can be used as a new target for biological therapy of breast cancer.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.