It is one of the problems to be thought over on how to improve students' employment ability and to solve the difficulties of employment in the course of higher education and teaching. It is a contradiction between the medicos's difficulty of employment and the demand of medicos from old people support industry. Based on employment of students, it is a feasible approach for education of rehabilitation major to meet the demand of old people support industry.

Analyzed in this paper is the feasibility to carry out rural area-oriented remote medical education and to establish the remote medical education center by making use of the advantages in medical colleges and universities according to the medical and health situation and the requirement of remote medical education in rural areas, which was followed by some suggestions put forward for how to effectively run the remote medical education center with the poor medical conditions and few opportunities for rural medical staff to improve their medical care level taken into consideration.

Objective To study the effect of extract of leave ginkgo biloba (EGb) for protection of the motor and sensory neurons axotomy-induced in rats. Methods Thirty male Sprague-Dawley rats weighing 180－ 220 g (8－ 9 weeks of age), were randomly divided into control group and EGb24/6 group. Models of sciatic nerve injury were established by transection of left sciatic nerve at 0.5 cm away from the points of muscular innervation. The proximal stump of sciatic nerve was double ligated to inhibit nerve regeneration. The distal end of the nerve was implanted into the biceps femoris. Then 2 ml of normal saline was given to control group, and 2 ml of EGb24/6 to the EGb24/6 groups daily. The rats were sacrificed in 7,14,28 days after surgery respectively, and then 4％ paraformaladehyde was perfused transcardially. The L4－ 6 spinal cord and L5 dorsal root ganglion (DRG) were harvested. HE staining and CV technique were used for detection of the motor neurons and compared with contra-lateral side. TUNEL technique was used for detection of apoptotic motor and sensory neurons. Eletron microscopic technique was used for observation of change of L5 DRG neurons. Result The number of motor neurons was significantly higher in EGb24/6 group in each postoperative period than that in control group (P

Purpose　To observe exogenous epidermal growth factor (EGF) influence upon sensory neurons axotomy-induced and change ultra-structure of sensory.　Methods　Eighteen male Sprague-Dawely rats weighing 180-200 g(8-9 weeks of age)were randomly divided into two groups.One as control,the other was treated with EGF.Sciatic nerve injury model was set up by transecting left side sciatic nerve at 0.5 cm away from performed muscle.The proximal stump of sciatic nerve was ligated to inhibit nerve regeneration.Then 5 μl of normal saline in the control groups and an equal volume of EGF solution (containing 10 μg EGF) in the EGF treated groups were injected into the proximal of ligated nerve.The rats were sacrificed in 7,14,28 days of operative intervals respectively and transcardialy perfused with 4% para-fromaladehyde.The L5 dorsal root ganglion(DRG) were harvested.Eletromicroscope technique was used to observe the changes of L5 DRG sensory neurons axotomy-induced.　Results　A series of changes happened in the control group.The size of the nucles decreased.Nucleoplasm was scattered.The nucleolus was pale.Edema,loss of crest and matrix was found in the mitochondria. Satellite cells detached from the soma.The ultrastructure of L5 DRG sensory neurons in EGF groups get near to normal following nerve injury.　Conclusions　EGF could protect sensory neurons.

Objective To explore the relationship between CRP and glucose metabolism in advanced solid tumor patients. Methods 32 advanced stage malignant tumor patients with mild pain took celecoxib 200mg/qd orally, the plasma level of CRP, FBS, FINS, IR were measured before taking drug and 5 days later. Results CRP is well related with FINS, IR, P level, CRP[(8.17?1.76) mg/L vs (4.37?0.65) mg/L], P(876?123)pmol/L vs (621?145) pmol/L], FINS[(14.23?7.21) ?U/L vs (9.83?3.37) ?U/L] and IR [(3.2?1.01) vs (1.9?0.78)] all were improved significantly after taking celecoxib. Conclusion CRP has some relationship with abnormal glucose metabolism in advanced stage malignant tumor patients, taking celecoxib may improve this abnormal glucose metabolism.

Objective To explore the clinical application and follow-up results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in treating proximal humeral fractures. Methods From December 2006 to September 2008, MIPPO using locking plate was employed to treat 36 patients (23 males and 13 females) with proximal humeral fracture. According to AO classification, there were four patients with type A2 fractures, 10 with type A3 fractures, five with type B1 fractures, 11 with type B2 fractures, three with type C1 fractures and three with type C2 fractures. Longitudinal or transverse incision was made through anterolateral acromial approach to separate the deltoid muscle and expose the fracture fragments. The direct and indirect reduction of the fractures were performed under direct vision. The locking plate was inserted distally beneath the deltoid muscle and a longitudinal incision was made at the lateral end of the plate. Locking screws were inserted to the proximal and distal plates. Postoperative follow-up was done to provide guidance to functional exercise and evaluate the clinical results. Results The operation lasted for (50.1±11.3) minutes, with intra-operative blood loss of(76±18.7) ml and average operative incision of (4.5±0.8) cm. All the patients were followed up for 12-17 months (average 14 months), which showed that the time of bone healing was (10. 1 ±1.2) weeks. Neer scoring standards showed the total excellence rate of 86%. Conclusion MIPPO is an ideal method for treatment of proximal humeral fractures, for it has the advantages such as safety, minor trauma, short bone healing time, alleviation of pain and good X-ray reduction.

Objective To evaluate the efficacy of laryngeal mask airway (LMA) Supreme in the elderlypatients with hypertension.Methods Forty elderly patients with more than 1-year history of hypertension,aged65-75 yr,weighing 45-70 kg,with body mass index ＜ 35 kg/m2,were randomized into 2 groups (n=20 each):intratracheal intubation group (group T) and LMA Supreme group (group S).Anesthesia was induced with fenta-nyl,propofol and vecuronium.LMA Supreme was inserted in group S or intratracheal intubation was performed ingroup T for mechanical ventilation.Anesthesia was maintained with sevoflurane,propofol and vecuronium.Thesystolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR) and pulse oxygen saturation(SpO2) were recorded after entering the operating room (T0),at 0,1,2 and 5 min after LMA insertion or intuba-tion (T1-4),at skin incision (T5),and immediately after removal of LMA or extubation (T6).Venous blood samples were taken at T0-4,6 for determination of plasma epinephrine (AE),noradrenaline (NE) and dopamine (DA)concentrations.The insertion and removal responses,LMA insertion/intubation time and the number of inserting LMA/intubation were recorded.The lung compliance,airway peak pressure,airway sealing pressure and airway plateau pressure were detected after LMA insertion/intubation.The side effects occurred in the pharynx were recorded after removal of LMA or extubation.Results Compared with group T,the SBP,HR,insertion and removal responses,incidence of side effects and plasma AE,NE and DA concentrations were significantly decreased and LMA insertion/intubation time was significantly shortened in group S (P ＜ 0.05).Compared with the baseline value at T0,the concentration of plasma NE was significantly increased at T2 in group S,the concentration of plasma NE was significantly increased at T1-4.6 and the concentration of plasma AE and DA was significantly increased at T1.3 in group T (P ＜ 0.05).Conclusion LMA Supreme has better efficacy for airway management in the elderly patients with hypertension than intratracheal intubation,with lower insertion and removal responses and fewer side effects occurred in the pharynx.

Objective:To compare the clinical effects of Zero-profile (Zero-p) intervertebral fusion and titanium plate combined with cage fusion in treating symptomatic adjacent segment disease (ASD) after anterior cervical discectomy and fusion (ACDF).Methods:Retrospective analysis was performed on 26 patients who underwent ACDF and readmission due to concurrent symptomatic ASD from October 2014 to June 2019. There were 17 males and 9 females, aged 54.15±8.60 (range 41-68) years. The index level included C 2, 3 1 case, C 3, 4 3 cases, C 4,5 9 cases, C 5, 6 6 cases, C 6, 7 7 cases. Twelve cases underwent anterior cervical decompression with Zero-p intervertebral fusion and fixation (Zero-p group), while 14 cases underwent anterior cervical decompression with titanium plate combined with cage fusion and fixation (titanium plate group). The following parameters, including operative duration, intraoperative blood loss, Japanese Orthopaedic Association (JOA) score, visual analogue score (VAS), neck disability index (NDI), dysphagia Bazaz grade, bone graft fusion Eck grade, C 2-C 7 Cobb angle, and related complications, were compared between the two groups. Results:The operation was performed successfully in all the patients. The patients were followed up for averagely 33.38±21.26 (range 12-71) months. The operation duration was 95.83±5.47 (range 89-105) min in the Zero-p group, which was shorter than 121.28±8.24 (range 106-131) min in the titanium plate group. The Bazaz classification of dysphagia in the Zero-p group was superior to the titanium plate group at 1 month after operation ( W=126.00, P=0.022). Neither group had dysphagia 3 months after surgery. The JOA score increased from preoperative 9.50±1.31 to 14.33±0.78, and VAS decreased from 5.33±1.67 to 0.83±0.72 in the Zero-p group. The NDI decreased from 43.62%±9.31% to 14.99%±3.26%, and C 2-C 7 Cobb changed from 8.26°±2.92° to 14.80°±4.18° in the Zero-p group. The JOA score increased from preoperative 9.14±1.79 to 14.71±0.73, and VAS decreased from 5.43±1.55 to 1.43±0.76 in the titanium plate group. The NDI decreased from 43.76%±8.47% to 14.22%±4.59%, and C 2-C 7 Cobb changed from 5.53°±9.04° to 14.68°±6.89° in the titanium plate group. No complication, such as screw loosening or breakage or esophageal injury, occurred during the follow-up. Conclusion:Both methods can achieve good clinical effects in treating symptomatic ASD and can restore the physiological curvature of the cervical spine to a certain extent. Furthermore, the advantages of Zero-p intervertebral fusion include shorter operation duration, reducing soft tissue injury and less postoperative dysphagia.

Objective: To investigate the efficacy of prussian blue (PB) or its combination with hemoperfusion (HP) in the treatment of acute thallium poisoning. Methods: Forty-seven patients with acute thallium poisoning with complete data hospitalized in the 307th Hospital of PLA from September 2002 to December 2017 were enrolled, and they were divided into mild poisoning group (blood thallium < 150 μg/L, urinary thallium < 1 000 μg/L) and moderate-severe poisoning group (blood thallium ≥ 150 μg/L, urinary thallium ≥ 1 000 μg/L) according to the toxic degrees. All patients were given symptomatic supportive treatments such as potassium supplementation, catharsis, vital organ protections, neurotrophic drugs, and circulation support. The mild poisoning patients were given PB with an oral dose of 250 mg·kg^-1·d^-1, while moderate-severe poisoning patients were given PB combined HP continued 2-4 hours each time. The PB dose or frequency of HP application was adjusted according to the monitoring results of blood and urine thallium. Data of gender, age, pain grading (numeric rating scale NRS), clinical manifestations, blood and urine thallium before and after treatment, length of hospitalization and prognosis were collected. Results: Of the 47 patients, patients with incomplete blood and urine test results, and used non-single HP treatment such as plasmapheresis and hemodialysis for treatment were excluded, and a total of 29 patients were enrolled in the analysis. ①Among 29 patients, there were 20 males and 9 females, median age of 40.0 (34.0, 49.0) years old; the main clinical manifestations were nervous system and alopecia, some patients had digestive system symptoms. There were 13 patients (44.8%) in the mild poisoning group with painless (grade 0) or mild pain (grade 1-3) with mild clinical symptoms, the length of hospitalization was 17.0 (14.2, 21.5) days. There were 16 patients (55.2%) in the moderate-severe poisoning group with moderate pain (grade 4-6) or severe pain (grade 7-10) with severe clinical symptoms, the length of hospitalization was 24.0 (18.0, 29.0) days. ② After treatment, the thallium concentrations in blood and urine in the mild poisoning group were significantly lower than those before treatment [μg/L: blood thallium was 0.80 (0, 8.83) vs. 60.00 (40.00, 120.00), urine thallium was 11.30 (0, 70.10) vs. 370.00 (168.30, 610.00), both P < 0.01], the thallium concentrations in blood and urine in the moderate-severe poisoning group were also significantly lower than those before treatment [μg/L: blood thallium was 6.95 (0, 50.50) vs. 614.50 (245.00, 922.00), urinary thallium was 20.70 (1.95, 283.00) vs. 5 434.00 (4 077.20, 10 273.00), both P < 0.01]. None of the 29 patients died, and their clinical symptoms were improved significantly. All the 27 patients had good prognosis without sequela in half a year follow-up, and 2 patients with severe acute thallium poisoning suffered from nervous system injury. Conclusion In the acute thallium poisoning patients, on the basis of general treatment, additional PB in mild poisoning group and PB combined with HP in moderate-severe poisoning group can obtain satisfactory curative effects.

OBJECTIVE: To investigate the efficacy of prussian blue (PB) or its combination with hemoperfusion (HP) in the treatment of acute thallium poisoning. METHODS: Forty-seven patients with acute thallium poisoning with complete data hospitalized in the 307th Hospital of PLA from September 2002 to December 2017 were enrolled, and they were divided into mild poisoning group (blood thallium < 150 μg/L, urinary thallium < 1 000 μg/L) and moderate-severe poisoning group (blood thallium ≥ 150 μg/L, urinary thallium ≥ 1 000 μg/L) according to the toxic degrees. All patients were given symptomatic supportive treatments such as potassium supplementation, catharsis, vital organ protections, neurotrophic drugs, and circulation support. The mild poisoning patients were given PB with an oral dose of 250 mg×kg^-1×d^-1, while moderate-severe poisoning patients were given PB combined HP continued 2-4 hours each time. The PB dose or frequency of HP application was adjusted according to the monitoring results of blood and urine thallium. Data of gender, age, pain grading (numeric rating scale NRS), clinical manifestations, blood and urine thallium before and after treatment, length of hospitalization and prognosis were collected. RESULTS: Of the 47 patients, patients with incomplete blood and urine test results, and used non-single HP treatment such as plasmapheresis and hemodialysis for treatment were excluded, and a total of 29 patients were enrolled in the analysis. (1) Among 29 patients, there were 20 males and 9 females, median age of 40.0 (34.0, 49.0) years old; the main clinical manifestations were nervous system and alopecia, some patients had digestive system symptoms. There were 13 patients (44.8%) in the mild poisoning group with painless (grade 0) or mild pain (grade 1-3) with mild clinical symptoms, the length of hospitalization was 17.0 (14.2, 21.5) days. There were 16 patients (55.2%) in the moderate-severe poisoning group with moderate pain (grade 4-6) or severe pain (grade 7-10) with severe clinical symptoms, the length of hospitalization was 24.0 (18.0, 29.0) days. (2) After treatment, the thallium concentrations in blood and urine in the mild poisoning group were significantly lower than those before treatment [μg/L: blood thallium was 0.80 (0, 8.83) vs. 60.00 (40.00, 120.00), urine thallium was 11.30 (0, 70.10) vs. 370.00 (168.30, 610.00), both P < 0.01], the thallium concentrations in blood and urine in the moderate-severe poisoning group were also significantly lower than those before treatment [μg/L: blood thallium was 6.95 (0, 50.50) vs. 614.50 (245.00, 922.00), urinary thallium was 20.70 (1.95, 283.00) vs. 5 434.00 (4 077.20, 10 273.00), both P < 0.01]. None of the 29 patients died, and their clinical symptoms were improved significantly. All the 27 patients had good prognosis without sequela in half a year follow-up, and 2 patients with severe acute thallium poisoning suffered from nervous system injury. CONCLUSIONS In the acute thallium poisoning patients, on the basis of general treatment, additional PB in mild poisoning group and PB combined with HP in moderate-severe poisoning group can obtain satisfactory curative effects.
Adult ; Female ; Ferrocyanides ; Heavy Metal Poisoning ; Hemoperfusion ; Humans ; Male ; Middle Aged ; Thallium/poisoning*