Reforming the managerial system and the educational system of higher medical education is the requirement of the social development in the twenty-first century. The article expounds the fundamental characteristics of medical education including small scale, longer-duration program, and high expenditure. It emphasizes the significance of following the rule of medical education, and analyzes the important position of medical college and the relation of medical college to affiliated hospitals and other related colleges in the comprehensive university. Based on the requirement of the social development and the trend of higher medical education internationalization, it also analyzes the necessity of the adjustment on the medical educational system and the way of the adjustment.

OBJECTIVETo observe the effects between acupuncture combined with rehabilitation and simple rehabilitation for shoulder pain after stroke, and to select the best plan of acupuncture manipulations at different stages by orthogonal design.

METHODSNinety patients were treated with comprehensive rehabilitation, and nine cases without acupuncture were arranged into a control group. Eighty-one patients of orthogonal design were applied by acupuncture with the same acupoints and course. The VAS score and its weighted value were regarded as the observation indices,and the effects between the acupuncture group and the control group were compared. The optimal plans of acupuncture manipulations of the early stage and the later stage were chosen after the first course treatment and the third course treatment separately. The acupuncture depth (factor A:A: shallow depth less than 25 mm, A(II): modest depth 25-40 mm, A(III): deep depth 40-50 mm), the acupuncture angle (factor B:B(I): perpendicular insertion, B(II): horizontal insertion, B(III): oblique insertion), needle manipulated frequency (factor C: C(I): zero time, C(II): one time, C(III): three times) and needle retained time(factor D:D(I):20 min, D(II): 30 min, D(III): 60 min) were studied. The differences among all factors and the diversity among major factors at different stages were analyzed.

RESULTS(1) Acupuncture combined with rehabilitation at the early and the later stage acquired better improvement than simple rehabilitation (all P < 0.01). (2) The optimal acupuncture manipulation plan at the early stage was A(III) B(III) C(I) D(I), which was deep acupuncture and oblique insertion for 20 min with zero-time manipulation; the optimal acupuncture manipulation plan at the later stage was A(III) B(III) C(III) D(I), which was deep acupuncture and oblique insertion for 20 min with three-time manipulation. (3) There was significance for acupuncture depth and angle at the early stage (both P < 0.01) and there was significance for insertion depth, acupuncture angle and manipulating frequency at the later stage (all P < 0.05). (4) At the early stage, the insertion depth was statistically significant between A(I) and A(II), A(I) and A(III), A(II) and A(III) (P < 0.05, P < 0.01), and the statistical significance was existed between B(I) and B(III) (P < 0.01). At the later stage, the insertion depth was statistically significant between A(I) and A(III), A(III) and A(II), A(I) and A(II) (P < 0.05, P < 0.01), and the statistical significance was existed between C(I) and C(III), C(II) and C(III) (P < 0.05).

CONCLUSIONAcupuncture combined with rehabilitation acquire apparent effect for shoulder pain after stroke. At the early stage,the optimal plan is deep and oblique insertion for 20 min with zero-time manipulation. At the later stage, the best plan is deep and oblique insertion for 20 min with 3-time manipulation.

Acupuncture Therapy ; Aged ; Aged, 80 and over ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Shoulder Pain ; etiology ; rehabilitation ; therapy ; Stroke ; complications ; Treatment Outcome

Objective To evaluate the effects of an intervention programme of health education and life style modification on postmenopausal osteoporosis women. Methods A total of 120 postmenopausal osteoporosis women were enrolled in this one-year randomized controlled follow-up study and assigned to the intervention group ( Group A, n = 60) or the control group ( Group B, n = 60). Both groups were treated with alendronate sodium. In Group A, education program was performed once a season in the form of face-to-face consultation or group session. In Group B, no additional intervention was used. The primary outcome was patients' compliance in follow-up. The secondary outcomes were change in bone mineral density (BMD).BMD was measured by dual-X-ray absorptiometry (DXA) on lumbar spine and hip at baseline and 12 months after the intervention. Results After one-year intervention,51 subjects in Group A and 38 in Group B completed the follow-up. Groups A showed better compliance. BMD on lumbar spine and hip was significantly increased in both groups when compared with baseline. The changes of BMD on lumbar (0.042+0.067 vs 0.026±0.070,P=0. O29) or Words region (0.029 +0. 129 vs 0.023±0. 143,P=0. 041 ) showed statistical significance between the two groups. Conclusion For alendronate sodium treatment, health management ensures the effectiveness of the therapy and improves the compliance of the patients.

Objective To investigate the effects and mechanisms of prostaglandin E2 receptor subtype 3 (EP3) on transforming growth factor β1 (TGF-β1)-induced mouse mesangial cells damage. Methods Primary mouse mesangial cells were separated and cultured. Three siRNAs were synthesized and transfected into mesangial cells for silencing EP3 by LipofectamineTM 2000 and the best one was chosen. MCs were grouped into: (1)control group; (2)TGF-β1 (10 μg/L) group; (3)NC-siRNA plus TGF-β1 (10 μg/L) group; (4) EP3-siRNA group; (5)EP3-siRNA plus TGF-β1 (10 μg/L). Then the proliferation of MCs was evaluated by CCK-8 assay. The expression of PGE2 and cAMP in cell supernatant were detected by ELISA. The mRNA and protein expression of fibronectin (FN), connective tissue growth factor (CTGF), cyclooxygenase-2 (COX2), membrane-bound prostaglandin E2 synthase 1 (mPGES1) were detected by real - time quantitative PCR and Western blotting. The phosphorylation of p38 MAPK and ERK1/2 was decected by Western blotting. Results Compared with control group, the cell proliferation induced by TGF-β1 was increased (P<0.05), the expression of PGE2 and cAMP were improved, mRNA and protein expression of FN, CTGF, COX2 and mPGES1 were up-regulated (all P<0.05). Compared with TGF-β1 group, the cell proliferation in EP3-siRNA plus TGF-β1 group was reduced, the expression of FN, CTGF, COX2 and mPGES1 mRNA and protein were downregulated (all P<0.05), the phosphorylation of ERK1/2, p38 MAPK were also declined (P<0.05). Conclusion EP3-siRNA may reduce TGF-β1-induced cell damage through upregulating the expression of cAMP, repressing the activity of ERK1/2 and p38 MAPK, inhibiting the expression of COX2 mPGES1 and PGE2 by feedback, then decreased the expression of FN and CTGF.

Objective:To summarize the development of the HIV/AIDS designated hospital system, analyze the main issues and explore solutions for this system. Methods:184 leaders/experts of three levels of healthcare facilities ( provinces, cities and counties) from 30 provinces engaged in AIDS prevention and control for over five years, and 2,432 people living with HIV/AIDS(PLWHA) from seven provinces were investigated through two different question-naires. Results:According to the staff responses, the issues of surgery and hospitalization are difficult and outstand-ing for PLWHA due to the current designated hospital system with scores of 6. 49 in severity. Of the ten largest prob-lems, ranked third is the need for improved AIDS prevention and control. 2 367 (97. 3%) PLWHAs had an aware-ness of the designated hospitals, 1,376 received treatment in the designated hospitals, and 85. 5% believed that the illness was effectively treated, while 9. 0% thought that the medical technology of the designated hospital was limited;18 . 7% of hospitalized HIV/AIDS patients or those who received surgery experienced prevarication by the non-des-ignated hospitals. Policy analysis shows that China’s designated hospital system for PLWHA has developed gradually with the characteristics of periodic and temporary changes. Conclusion:The designated hospital system for PLWHA in China has played an important role, but there are still several problems. The government should improve the existing system by strengthening the comprehensive medical service capacity of designated hospitals, improving the mechanism of consultation and referrals, coordinating the non-designated hospitals to provide technical support, reducing dis-crimination and fear from medical staff against HIV/AIDS, decreasing the risk of occupational exposure, and enhan-cing the communication among hospitals, CDCs and patients.

OBJECTIVETo observe the effect of anisodamine (Ani) injection on the survival rate and histologic result of flaps with ischemia-reperfusion injury, so as to demonstrate the protective effect of Ani on the flap survival.

METHODSA total of 48 healthy male Wistar rats were randomly divided into model control, normal saline(NS) and anisodamine groups, with 16 rats in each group. An 3 cm x 6 cm axial flap was formed at the right lower abdomen with abdominal superficial blood vessel as the pedicle. 0.5 cm x 0.5 cm skin tissue was taken from the middle part of flaps in each group, immediately after operation, 12, 18, 24 h after operation. The superoxide dismutase (SOD), nitric oxide (NO), nuclear factor-kappaB contents in the specimens were detected. The histologic study was also performed. The flap survival rate was recorded 7 days after operation.

RESULTSFlap survival rate was (78.6 +/- 7.3) % in Anisodamine group. 12, 18, 24 h after reperfusion injury, the SOD was (103.3 +/- 3.9), (82.6 +/- 3.8), (67.5 +/- 4.6) U/mg; the NO was (5.33 +/- 2.05), (4.75 +/- 1.68), (4.15 +/-1.59) nmol/mg; the NF-kappaB was 0.211 +/- 0.039, 0.313 +/- 0.033, 0.096 +/- 0.028. The contents of SOD, NO and NF-kappaB had the statistical difference of at different time. The skin pathological changes in Anisodamine group was obviously better than those in NS group. Flap survival rate in Anisodamine group was significantly higher than that in NS group.

CONCLUSIONSIn the flap with ischemia-reperfusion injury, Anisodamine can reduce the damage of free radical, increase the blood flow, reduce the production of NF-KB, decrease inflammatory reaction. So Anisodamine can increase the survival rate of flaps with ischemia reperfusion injury.

Animals ; Graft Survival ; drug effects ; Male ; NF-kappa B ; analysis ; Nitric Oxide ; analysis ; Random Allocation ; Rats ; Rats, Wistar ; Reperfusion Injury ; prevention & control ; Solanaceous Alkaloids ; therapeutic use ; Superoxide Dismutase ; analysis ; Surgical Flaps ; blood supply ; pathology ; Vasodilator Agents ; therapeutic use

Objective: To study HER2 levels in the serum and breast cancer tissues and their correlation with clinical parameters,so as to explore drugs selection and prognosis prediction of breast cancer.Methods: Sixty-seven pathologically-confirmed breast cancer patients,20 patients with breast benign tumor,and 20 healthy women,who were treated in Fujian tumor hospital from Jan.2008 to Oct.2008 were included in this study.Expression of HER2 in breast cancer tissues was examined by immunohistochemistry,and serum HER2 level in breast cancer patients was examined by ELISA.Results: Serum level and positive rate of serum HER2 in breast cancer patients were significantly higher than those in healthy women and breast benign tumor patients(P

Objective To investigate the clinical significance of ultrasound guided biopsy of peritoneum in diagnosis of unex-plained ascites .Methods A total of 95 patients with unexplained ascites after conventional examination were collected ,then under-went ultrasound inspection which showed thickened peritoneum and the relations to surrounding tissues around the planned perito-neum puncture point ,and conducted the peritoneal biopsy .Results A total of 95 were successfully biopsied with 2 -4 peritoneal tissues .Pathological examination showed that 37 cases (38 .9% ) were diagnosed as peritoneal metastatic carcinoma ,41 cases (43 . 1% ) with peritoneal tuberculosis ,5 cases (5 .2% ) with peritoneal mesothelioma ,1 case (1 .1% ) with eosinophilic granuloma ,4 ca-ses (4 .2% ) with fibrous hyperplasia ,and 7 cases (7 .4% ) with chronic inflammatory cell infiltration .The positive rate of ultra-sound guided peritoneal biopsy was 88 .4% .Conclusion The ultrasound guided biopsy of peritoneum is of clinically great signifi-cance in diagnosis of unexplained ascites .

Objective To study the physiological indicators and arterial blood gas values,and create a reliable data for researchers using beagle dogs.Methods Beagle were sampled before and after Zoletil anesthesia (10 mg/kg) via intramuscular injection.Then aterial blood gas was detected by blood gas analyzer.Then the physiological indicators,including heart rate,blood pressure and body temperature were measured via large animal ECG.Results For blood gas values,the pH value decreased significantly (P ＜ 0.01).pCO2 increased significantly and pO2 decreased significantly,the differences were significantly (P ＜ 0.05).In contrast,levels of Lac and HCO3-remained unaltered,indicating a typical respiratory acidosis.For physiological indicators,blood pressure increased slightly,but not significant.The heart rate increased significantly (P ＜ 0.01) and body temperature decreased significantly (P ＜ 0.01).There was no difference between sexes.Conclusion Zoletil anesthesia causes respiratory arrest and respiratory congestion,which further induced respiratory acidosis.Meanwhile,anesthesia also results in elevated heart rhythm and lower body temperature.These data indicate that warming and airway clear are necessary during anesthesia in Beagles.Moreover,it should be considered about the effects of anaesthetics when comparing differents in animals before and after treatment.