Objective To provide references for building the medical rehabilitation system in China by learning the progress and compliance of rehabilitation departments construction at tertiary hospitals. Methods Comparative and quantitative methods were used for dynamic analysis qualitative interview to learn the index compliance of the hospitals in question in 201 1-2012.Results Compared with 201 1, average days of stay of the rehabilitation departments declined in general,yet with insufficient therapists;introduction of early rehabilitation intervention was but 57.1%,and the functional assessment rate of rehabilitation service was less than satisfactory.Conclusion Lack of manpower,varying levels of medical rehabilitation services,and neglect for functional assessment were found to be the main problems in construction of medical rehabilitation departments for the time being.

Objective To set up the isolated perfused rat liver model. Methods Rat livers were harvested after the cannulation of the portal vein and bile duct. The reperfusion solution was Krebs-Henseleit solution containing bovine albumin serum and sodium taurocholate. The original CZ-1 isolated perfused rat liver system contained two subsystems: recirculating perfusion system and heat-exchange system. Then we modified the original CZ-1 system and omitted the heat-exchange system.The modified CZ-1 system consisted of a thermostatically regulated water bath,a peristaltic pump,a 4-neck round-bottom flask, a flow meter, an in-line manometer, a glass organ chamber, an iron support and a set of recirculating pipe line. Then the livers were connected via the portal vein to the modified CZ-1 system for 120 min. After 120 min reperfusion, bile production was evaluated. Routine HE staining and electron microscopic examination of hepatic tissues were also performed. Results The was not significantly different from that reported by references. Hepatic tissues in reperfusion group were also morphologically normal Conclusion The CZ-1 isolated perfused rat liver system was cost-effective and reliable to use. It was easy to run and is the ideal model for investigation of organ preservation solution.

Objective To investigate the expression of heat shock protein 5 (HSPA5) in breast carcinoma and to study its relationship with clinical and pathological factors.Methods HSPA5 from 97 cases of breast carcinoma and 40 cases of adjacent tissues of breast carcinoma were examined by immunohistochemical method.Results The overall positive rate of HSPA5 in 97 cases of breast cancer was 81.4 ％ (79/97).The positive rates of HSPA5 in cancer tissues and paired normal tissues were 32.5 ％ (13/40) and 7.5 ％ (3/40),respectively.The expression rate of HSPA5 in tumor tissues was significantly higher than that in normal tissues (x2 =7.813,P =0.038).The expression of HSPA5 in breast carcinoma was correlated with histologic grade and lymph node metastasis (x2 =22.233,P =0.007; x2 =5.342,P =0.024).Conclusion The occurrence of breast carcinoma and the formation of invasion may be related with overexperssion of HSPA5.

Chest contusion is the soft-tissue injury disorders that the external violence directly destroys the chest wall and the soft tissues, causing chest pain, fullness, and symptoms aggravate when the chest moves. Chinese medicine showed many treatments with clinical efficacy. Therefore, Chinese medicine has been widely used in clinics. This paper was to review the research progress of Chinese medicine treatment for chest contusion.

Objective To determine the median effective dose(ED50)of etomidate inhibiting responses to endotracheal intubation when combined with dexmedetomidine in the patients with obstructive jaundice. Methods American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients with obstructive jaundice,aged 45-63 yr,with body mass index of 18-30kg/m2,scheduled for elective operations under general anesthesia,were divided into control group(group C)and dexmedetomidine group(group D)using a random number table. At 15min before induction of anesthesia,normal saline 0.1 ml/kg was infused intravenously in group C,and dexmedetomidine 0.4 μg/kg was infused intravenously in group D. Anesthesia was induced with midazolam 0.05 mg/kg,fentanyl 4 μg/kg,etomidate and cisatracurium 0.15 mg/kg. The ED50 of etomidate was determined using Dixon′s up-and-down method. Etomidate was injected intravenously at the initial dose of 0.2 mg/kg in the first patient in each group. Each time the dose increased/decreased in the next patient according to whether or not the increase in mean arterial pressure and/or heart rate ≥ 20% of the baseline value within 3min after endotracheal intubation. The ratio between the two successive doses was 1.1. The number of patients in whom inhibition was effective or ineffective was recorded,and the ED50 and 95% confidence interval of etomidate inhibiting responses to intubation were calculated using Probit analysis. Results The ED50 (95% confidence interval)of etomidate inhibiting responses to intubation was 0.185(0.162-0.201)mg/kg in group C,the ED50(95% confidence interval)of etomidate inhibiting responses to intubation was 0.129(0.093-0.143)mg/kg in group D,and there was significant difference between the two groups(P<0.05).Conclusion When combined with dexmedetomidine,the ED50 of etomidate inhibiting responses to endotracheal intubation is 0.129 mg/kg in the patients with obstructive jaundice.

Objective To investigate the expression of MUC-1 and CD44v6 in breast carcinoma and its diagnostic value.Methods 93 cases of breast carcinoma were examined by immunohistochemical method for MUC-1 and CD44v6.Results The positive rates of MUC-1 and CD44v6 were 71.0 ％ (66/93) and 63.4 ％ (59/93),respectively.The expression of MUC-1 in breast carcinoma was correlated with histologic differentiation (14.3 ％,69.4 ％,100.0 ％) and lymph node metastasis (22.9 ％,100.0 ％) (x2 =36.147,63.047,both P ＜ 0.0001),but had no relationship with the type of breast carcinoma,tumor clinical stages,and tumor size (all P ＞ 0.05).The expression of CD44v6 in breast carcinoma was correlated with tumor clinical stages (6.3 ％,64.6 ％,93.1％) and lymphnode metastasis (20.0 ％,89.7 ％) (x2 =9.507,45.662,both P＜0.05),but had no relationship with tumor type,tumor clinical stages and tumor size (all P ＞ 0.05).Conclusion MUC-1 and CD44v6 may play important roles in the development of breast carcinoma and the biologic behavior of breast carcinoma may be closely related with over expression of MUC-1 and CD44v6 protein.MUC-1 and CD44v6 can be used to predict the prognosis and direct the treatment of breast carcinoma.

Objective To investigate the effect of exogenous hydrogen sulfide (H2S) on neuronal apoptosis during focal cerebral ischemia-reperfusion (I/R) in rats.Methods One hundred eight male Sprague-Dawley rats,aged 6-8 weeks,weighing 250-270 g,were randomly divided into 3 groups (n =36 each) using a random number table:control group (group C),I/R group and H2S group.Focal cerebral ischemia was induced by middle cerebral artery occlusion in anesthetized rats.A nylon thread with a rounded tip was inserted into the left internal carotid artery and advanced intracranially to block blood flow into the middle cerebral artery.Middle cerebral artery occlusion was maintained for 90 min followed by reperfusion.In group H2S,0.25％ NaSH (a donor of exogenous H2S) 10 mg/kg was injected intraperitoneally at the onset of reperfusion.The equal volume of normal saline was given in C and I/R groups.At 1,3 and 7 days of reperfusion,neurological deficit was scored,and corner test was performed.Brains were removed for determination of myocardial infarct size,Bax-,Bcl-2-and caspase-3-positive cells,and cell apoptosis.The percentage of myocardial infarct size,rate of Bax-,Bcl-2-and caspase-3-positive cells and apoptosis rate were calculated.Results Compared with group C,the neurological deficit score was significantly decreased,and the corner score,percentage of myocardial infarct size,rate of Bax-,Bcl-2-and caspase-3-positive cells and apoptosis rate were increased at each time point of reperfusion in I/R and H2S groups (P＜0.05).Compared with group I/R,the neurological deficit score and Bcl-2-positive cells were significantly increased,and the corner score,percentage of myocardial infarct size,rate of Bax-and caspase-3-positive cells and apoptosis rate were decreased at each time point of reperfusion in group H2S (P＜0.05).Conclusion The mechanism by which exogenous H2S attenuates focal cerebral I/R is related to inhibition of neuronal apoptosis in rats.

Objective To compare the clinical efficacy of transdorsal-to-plantar (TDP) or transplantar-to-dorsal (TPD) retrograde endovascular angioplasty in treating below-the-knee arterial occlusion diseases, and to compare it with conventional anterograde endovascular angioplasty. Methods A total of 96 patients with below-the-knee arterial occlusion diseases (112 diseased lower extremities in total), who were admitted to authors’ hospital during the period from Oct. 2009 to July 2011 to receive conventional anterograde endovascular angioplasty, were enrolled in this study. The clinical data were retrospectively analyzed. Among the 112 diseased lower extremities, conventional anterograde endovascular angioplasty failed in 27, and TDP or TPD retrograde endovascular angioplasty had to be carried out. A total of 71 patients (85 diseased lower limbs) were successfully treated with conventional anterograde endovascular angioplasty (routine group), while 20 patients (22 diseased lower limbs) were successfully treated with retrograde endovascular angioplasty (retrograde group). The preoperative ankle-brachial index(ABI), the coronary angiography-based thrombolysis in myocardial infarction (TIMI) flow score, the dorsal or plantar arterial pulse score, the postoperative limb salvage rate and target vessel patency rate were calculated, and the results were compared between the two groups. Results The technical success rate in the retrograde group and the routine group was 75.9% and 74.0%respectively (P>0.05). Preoperative ABI value of the retrograde group and the routine group was 0.55± 0.21 and 0.56±0.14 respectively, after the treatment which increased to 0.93±0.19 and 0.89±0.18 respectively (P>0.05). Preoperative TIMI score of the retrograde group and the routine group was 0.1 ±0.5 and 0.8 ±0.8 respectively, which significantly increased to 2.5±0.6 and 1.8±0.8 respectively (P<0.000 1). In the retrograde group, the blood flow perfusion of the distal foot tissue was improved. The primary target vessel patency rate at 12 months and 24 months after the treatment in the retrograde group and the routine group were 63.6%(14/22), 45.5%(10/22) and 52.9%(45/85), 37.6%(32/85) respectively (P>0.05). Twenty-four months after endovascular angioplasty Kaplan-Meier analysis indicated that the limb salvage rate of the retrograde group and the routine group was 95.5%and 96.5%respectively (P>0.05). Conclusion Compared with conventional anterograde endovascular angioplasty for the treatment of below-the-knee arterial occlusion diseases, retrograde endovascular angioplasty via TDP or TPD path can immediately improve the blood flow with obvious improvement of ABI score, primary target vessel patency rate as well as the limb salvage rate. Therefore, retrograde endovascular angioplasty should be regarded as an effective supplementary technique when anterograde angioplasty fails.

Objective To investigate the effects of early estrogen replacement therapy(ERT) with different doses on aortic endothelial senescence and its possible mechanism. Methods Twenty- eight healthy New Zealand white female rabbits were randomized into four groups: group A(n=7), in sham operation;group B(n=7), ovariectomized;group C(n=7), ovariectomized and in low-dose ERT(estradiol benzoate 200 μg,im, QOD) ;and group D(n=7), ovariectomized and in high-dose ERT (estradiol benzoate 1000 μg,im,QOD). All rabbits were fed with high fat diet and the rabbits in group C and group D were given ERT from the 7th day after the operation. Blood samples taken via ear central artery before the operation and after the high fat diet for 4 and 12 weeks were used to determine the concentrations of serum estradiol(E2), total cholesterol(TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), trigtyceride (TG) and asymmetric dimethylarginine(ADMA). After 12 weeks, the aorta was separated for histopathologic analysis and the areas of senescent endothelium and atherosclerotic plaque were calculated.Results (1)After ovariectomized, the concentration of serum estradiol(E2) was significantly lower in group B than in other groups (all P<0.05). Twelve weeks later, the level of E2in was higher group D than in group A and C(both P<0. 05), but there was no significant difference between group C and group A (P< 0. 05). (2)After the high-fat diet for 4 and 12 weeks, there was a notable increase of TC, LDL-C, TG and HDL-C levels in rabbits of each group(all P<0. 01). After 12 weeks, the levels of TC and LDL- C were remarkably higher in group B than in other groups(all P<0. 01), however, the levels of TG and HDL-C were lower in group B than in other groups(all P<0. 01). The concentrations of TC and LDL-C in group C and group D were lower than those in group A (all P<0.01), but the differences of the levels of TG and HDL-C in group C and group D were not significant in comparison with group A (all P>0. 05). There were no significant differences in the lipid levels between group C and D (all P> 0. 05). (3)After 12-week high fat diet, there were a striking increases of serum ADMA level in all four groups (all P>0. 05). The level of ADMA was higher in group B than in other groups (P< 0. 05) andlower in group C and D than that in group A (both P<0. 05). There was no significant difference between group C and D (P<0. 05). (4)12 weeks later, the areas of senescent endothelium and atherosclerotic plaque in group B were significantly larger than those in other groups (all P< 0. 01), and the areas were smaller in group C and D than those in group A (all P<0. 01), there was no significant difference between group C and group D(both P>0.05). (5)Linear correlation analysis showed that there was an obvious positive correlation between the areas of senescent endothelium and atherosclerotic plaque(r=0. 962, P<0. 01), and both of them were positively correlated with the levels of serum AMDA (r=0. 812,0. 824,0. 755,0. 797,0. 749,0. 727), TC (r=0. 812,0. 824) and LDL-C(r=0. 755,0. 797) (all P<0. 01) and negatively correlated with the concentration of serum E2 (r=-0. 762,-0. 743, both P<0. 01).Conclusions Early ERT can improve serum lipid metabolism, reduce ADMA level, inhibit vascular endothelial senescence and attenuate atherogenesis. The delaying effect of estrogen on endothelial senescence may be due to its improving lipid metabolism and lowering ADMA level.

Objective: The aim of our work was to investigate the effects of n-3 polyunsaturated fatty acids on apoptosis, granzyme B and perforin expression of intestinal epithelial cells of chronic rejection after small intestinal transplantation. Methods: Small bowel transplantation was performed and rats were divided into three groups: Group 1, Lewis-to-Lewis, group 2, F344-to-Lewis, dietary corn oil, Group 3, F344-to-Lewis, dietary fish oil. All recipients were killed after 16 weeks of posttransplantation. The apoptosis rate of mucosal cells were evaluated by flow cytometry. The expressions of granzyme B and perforin were analyzed by reverse transcriptase RT-PCR. Results: A high apoptotic rate was observed when the allografts demonstrated one or more histological features of chronic rejection. N-3 polyunsaturated fatty acids decreased the rate of the apoptosis and inhibitted the expressions of granzyme B and perforin. Conclusion: N-3 polyunsaturated fatty acids can suppress the chronic rejection in small intestinal transplantation.