With the emerging of aging society and advances of information sciences, telemedicine has gradually become a new medical model.Telemedicine can be used in health monitoring, disease diagnosis, counseling, education, chronic disease management and long-term care in elderly population;particularly in management of chronic heart failure, diabetes and other chronic diseases, as well as in referral and continuous medical care.To promote telemedicine in the elderly population can break the physical limitations of different health care settings, so that geriatrician and the allied team members are enable to maximize their values in providing corresponding health services.This article reviews the progress of telemedicine in foreign countries, which would be of reference value for development of telemedicine for elderly people in China.

Institute of Pediatric,Suzhou University Affiliated Children's Hospital,Suzhou 215003,China Objective To explore the long-term effects of physical exercise on neonatal seizure-induced learning,memory deficit and the expression of zinc transporter-3(ZnT3)in rat hippocampus.Methods Sprague Dawlev rats aged 6 days were randomly divided into a recurrent-seizure group(RS)and a control group. At postnatal dav 6(P6),the recurrent seizures were induced by inhalation of the volatile agent flurothyl once a day for consecu tive 6 davs.The rats in the control group were placed in the container for an equal period of time as those in the RS group without exposure to flurothyl. Y-maze test was performed to evaluate learning and memory capacity at postnatal day 29 to 35 and 61 to 67,respectively.During the period of postnatal day 51 to 56,all the animals in the RS andcontrol groups were subject to a 30-minute daily aerobic exercise program for consecutive 6 days.All the animals weresacrificed at postnatal day 78,and the in situ hybridization method was used to detect the expression of ZnT3 mRNA in hippocampus. Results ①The number of trials needed for getting correct response to the electric stimulation in the first Y-maze test was(60±14.1)and(37.5±17.2)for the RS and control groups,respectively(P＜0.05),while that in the second Y-maze test carried out 24 hours later was(27.5±14.1)and(21±11.01)for the RS and the control groups,respectively(P＞0.05).②Memory test revealed no significant difference between the RS and thecontrol groups(P＞0.05).③In situ hybridization detection showed that the expression of ZnT3 mRNA in hippocam pus was not significantly different between the two groups.However,there showed a significant difference between the dentate gyrus and CA3 in the RS group with regard to the expression of ZnT3 mRNA(P＜0.05). Conclusions Physical exercise improves the learning capacity of neonatal seizure-induced cognitive deficit and might have effects on the regulation of zinc transporter gene expressions in hippocampus.

The samples of experimental and control groups were obtained by 1 ∶ 1 matching method and divided into development (242 pairs) and sign (156 pairs) groups.Through a 10-month group and case type intervention,Gesell test was performed for 5 zone development quotients of large motor,fine motor,adaptability,speech and personal-social to determinate the effectiveness of interventions.Before intervention,t values of the development group were 1.07,1.42,0.78,0.62 and 1.67 while those of sign group-1.48,-1.96,1.82,1.78 and-1.73 respectively.The inter-group comparison of various developmental quotient differences had no statistical significance (P ＞ 0.05).After intervention,t values of the development group were 9.85,8.92,3.57,11.21 and 9.30 for inter-group comparison and-31.65,-36.94,-46.26,-37.56 and-49.85 for intra-group comparison.The results of sign group were 10.91,9.61,10.75,12.01 and 14.36 for inter-group comparison and-23.20,-31.75,-44.94,-33.58 and-54.58 for intra-group comparison.Between intra-group and inter-group,the comparison of the developmental quotient differences had statistical significance (P ＜ 0.01).In two experimental groups,the post-intervention developmental quotients in 5 zones are better than those pre-intervention levels.It shows that preventive intervention of infant mental health is effective.

Objective To investigate antibiotic resistance and molecular epidemiology profile of methicillin-resistant Staphylococcus aureus (MRSA) in Shanghai. Methods The antibiograms of 140 MRSA isolates from 5 hospitals for 13 drugs were analyzed by agar dilution and broth dilution. The PVL gene and SCCmec were detected by PCR; The clonal relatedness of 140 isolates were determined by PFGE and 39 strains were chosen to be characterized further by spa typing. Results All 140 MRSA are PVL negative and most of them were identified as SCCmec Ⅲ [45.7% (64/140)], followed by SCCmec Ⅲ a [25.0% (35/140)], SCCmecⅢb [14.3% (20/140)], SCCmecⅡ [10.7% (15/140)] and SCCmecⅣ [4.3% (6/140)]. All isolates were susceptible to vancomycin, teicoplanin and daptomycin. The resistance to gentamicin, sulphamethoxazole and clindamycin was 98. 6% (138/140), 98. 6% (137/140) and 97. 9% (137/140), respectively. Resistance to erythromycin, ciprofloxacin and tetracycline was above 80%, and resistance to rifampicin was 10. 7% (15/140). Sixteen different PFGE patterns(A-P) were found and most of MRSA belonged to group C[30. 7% (43/140)] ,B[13.6% (19/140)]and Ⅰ [10. 7% (15/140)]. Among 39 strains with prevalent PFGE patterns, 4 spa genotypes were identified: t002133. 33% (13/39)] ,t030 [12. 82% (5/39)] ,t037[51.28% (20/39)]and t459[2. 57% (1/39)]. Conclusions Sixteen different PFGE patterns and 4 spa genotypos were found from 5 hospitals in Shanghai. The most popular MRSA clone is PVL negative, SCCmec Ⅲ, with resistant profile of erythromycin, ciprofloxacin,clindamycin,etracycline, gentamicin,and sulphamethoxazole [E-C-L-T-G-M-]. This result suggests that hospital infection control and reasonable antibiotic usage are critical.

Objective To determine the genetic background and evolutional route of macrolideresistance Streptococcus pneumoniae(MRSP)strains in Shanghai.Methods Forty-seven MRSP clinical isolates were genotyped by pulse field gel electrophoresis(PFGE)to detect the donal relationship of therm.Serotyping and muhilocus sequence typing(MIST)on 6 multi-resistant strains wag used to investigate the evolutional relationship between serum types and international epidemic strain among MRSP strains in Shanghai.Results There were 2 epidemical clones(type A 45%,type B 17%)in MRSP clinical isolates containing both the ermB and the mefE genes in Shanghai.MIST analysis showed that all 6 multi-resistant strains whose PFGE pattern was A type belonging to Asia clonal complex-CC236(Taiwan19F-14 clone).There was a novel ST-ST2116,which might derived from CC236 due to the recombination with alldic change.Conclusion,The high prevalence of erythromycin-resistant Streptococcus pneumoniae containing both the ermB and the mere genes in Shanghai is partly due to the clonal spread of a few mtdtidrng-resistant clones.

Objective To analyze the clinical features of patients with open injuries combined with infections in Chinese Wenchuan earthquake and summarize the therapeutic experience. Methods An analysis was done on 54 patients with open injuries combined with infection transferred to our depart-ment from May 13, 2008 to June 10, 2008. Thorough debridement was performed based on general sup-porting management and anti-bacterial thempies done on the basis of results of bacteria culture and sus-ceptibility test. In the meantime, other managements including high-pressure oxygen therapy and external fixation were done for open fractures. Results Infection could be found in all open injuries, primarily combined infections with G+ coccus and G- bacillus or anaerobic. Moreover, most of the patients were infected by anaerobia. Of all, 1 patient with amputation received multiple debridement and repair because of severe infection of the amputation site and no death occurred. All patients recovered uneventfully, with sound wound healing, except for 2 patients. External fixation was stable and in good position. Conclu-sions The repeated and thorough debridement and the timely closure of wounds on the basis of energeti-cally anti-infection measures are key to diminishing the mortality rate and mutilation rate. Appropriate ad-junctive therapy can dramatically improve the curative effect.

Objective To study the clinical application of finger reconstruction by transplantation of two second toes and evaluate the postoperative appearance and function regarding the reconstructed hand and donor feet. Methods Defect of fingers were treated by transplantation and reconstruction with a total of 74 cases,including two second toes transplantation for both thumbs in 2 cases,thumb with index finger in 10 cas es, index finger with middle finger in 8 cases and middle finger with ring finger in 17 cases. Results Sevetythree fingers survived except 1 failed. During the follow up examination made from 3 to 36 months, the reconstructed fingers could move, write and dress with ease, pinch forcefully, show good recovery of manual work and the sensation of pain and warmth. Two-point discrimination found to be between 5 to 10 mm. Both donor feet have symmetrical appearance with normal gait and satisfactory motion. Also, no pain was complained.Conclusion Transplantation of two second toes from both feet is a good method to reconstruct defect of multiple fingers, and has little effect on the appearance and motion of feet.

Objective To test the hypothese that extreme low estrogen level will lead to elevation of blood pressure.Methods Thirty-two adult male SD rats were submitted to following approaches:control(n=8),orchi- ectomy(n=8),orchieetomy plus letrozole,an inhibitor of estrogen synthese [5 mg/(kg?d)by gavage,n=8], letrozole treatment in intact testis rats(n=8).Four weeks after treatment,SBP,serum testosterone(T),estradiol (E_2),nitric oxide(NO),endotheline(ET),thromboxane(TXB_2),prostacyelin(6-Keto-PGF_(1?)),atrial naturetic pep- tide(ANP),C type natriuretic peptide(CNP)were determined.Results SBP was increased significantly after or- chiectomy compared with control rats(orehiectomy:171?17 vs control:156?14 mmHg,P

Despite the clinical and experimental concerns about the deleterious effects of neonatal seizures on brain development,the underlying mechanism of seizure-induced brain damage is still not clear.Moreover,early therapeutic intervention studies are also less available.For this reason,the study was performed to explore the long-term effects of neonatal seizures and physical exercise on learning,memory and the expression of calcium/calmodulin-dependent protein kinase Ⅱ(CaMKⅡ).Twelve neonatal rats for each group were assigned:the single-seizure group(SS),the recurrent-seizure group(RS) and the control group.The volatile agent flurothyl was used to induce 30 min seizure attack.At postnatal day 6(P6),the single seizures induced only once and recurrent seizures induced once per day for consecutive 6 days.Control rats were placed into the container for an equal amount of time to their counterpart without exposure to flurothyl.Morris water-maze test were performed at P27～P31,P58～P61 and P80～P82,meanwhile at P51～P56,the RS and SS groups were submitted to forced running exercise.In situ hybridization method was used to detect the expression of CaMKⅡ mRNA in hippocampus.The results are as follows:(1) Escape latency.In the first two Morris water-maze tests,there was a decreasing trend of escape latency in three groups,and the escape latency of RS group was much longer than that of control group.After physical exercise,in the last Morris water-maze tests,the diference of escape latency in three groups is not significant.(2) Searching strategy.In the first Morris water-maze test,there was a decreasing trend of marginal strategy and an increasing trend of taxis strategy in three groups,but the frequency of marginal strategy was higher and the frequency of taxis strategy was lower in RS group than that in SS and control group in the third and fourth day(P

Objective To detect the lymph node micrometastasis in resected pancreatic head carcinoma, to investigate the role of lymphatic micrometastasis in clinical staging and predicting prognosis of the pancreatic head carcinoma. Methods Pancreaticoduodenectomy with extended lymph nodes dissection were performed in 20 patients with pancreatic head carcinoma. All the lymph nodes were taken out by operating microscope method and metastasis was diagnosed by routine histological examination with hematoxylin and eosin staining, and the presence of lymph node micrometastasis was examined by immunohistochemisty. Results A total of 677 lymph nodes were found in the 20 eases, routine histological examination revealed metastasis occurred in 87 lymph nodes in 13 cases. Of the 590 negative lymph nodes by routine histological examination, 57 lymph nodes in 3 cases were diagnosed as having micrometastasis by immunohistochemisty. With the combination of routine histological examination and immunohistochemisty, the percent of patients with positive lymph nodes increased from 65% (13/20) to 80% (16/20), the detection rate of metastasis lymph node increased from 12.9% (87/677) to 21.3% (144/677) with significant difference (P <0.05). The detection of lymph node micrometastasis changed the staging of Ⅱ A to Ⅱ B in 3 patients. Tumor metastasis and recurrence rate of patients with lymph nodes micrometastasis within one year after operation was 75%, while it was 25% of patients without lymph nodes micrometastasis. Conclusions The detection of lymph node mierometastasis metastasis was helpful in the determination of clinical staging and predication of prognosis.