The training system of rehabilitation talents and its problems were reviewed. The paper discussed a training system as to how to enhance students' clinical operating skills and innovation abilities to ensure the teaching quality and level in order to promote students'employment competitive, mainly from the aspects of teaching system, group of teachers and training base of training rehabilitation talents' clinical operating ability.

This study aimed to develop the calculation method of pre-hospital emergency physician allocation gap and apply it to Shanghai.In order to reduce the ambulance dispatch lag frequency, through the analysis of its da-ta in the Shanghai urban area, the research group obtained the gap and extended the data to Shanghai city.The peak method establishes the association between pre-hospital emergency physician increment and the ambulance dispatch lag decrement.Based on descriptive statistics, the peak method by which the Shanghai ambulance dispatch lag data were analyzed uses the SAS programming software.This method of using programming software provides it with good reliability and validity.After an increase of 40 duty vehicles (381 pre-hospital emergency physicians), the ambu-lance dispatch lag ratio would drop from 25.61 percent to 0.22.Therefore, the association between the pre-hospital emergency physician increment and the ambulance dispatch lag decrement was established and can provide a scientif-ic evidence for the policy formulation.

Objective:The research aimed to figure out the geographic availability of the residence in the aspect of receiving health service thereby studying the spatial distribution regulation and the distance attenuation coefficient of the inpatients.It also provides the decision-making basis for the regional health planning.Methods: Select 23 medical institutions and randomly pick up patients from each of them, calculate the distance between the inpatients home and the medical institutions, then simulate the corresponding probability patients using the Geographical Infor-mation System ( GIS) .Perform a variety of curve fitting models according to the determination and simulation graph-ics coefficient choosing the most appropriate model, and draw corresponding the distance attenuation coefficient.Re-sults:An exponential curve model is better than power curve model for the secondary medical institutions inpatients distribution and contrarily for those in the tertiary medical institutions.The mean distance attenuation coefficient was 0.51 for exponential curve model of secondary comprehensive medical institutions inpatients and its average was 0.50 for the secondary specialist medical institutions inpatients.The mean distance attenuation coefficient was 0.84 for the power curve model of the tertiary comprehensive medical institutions inpatient and its average was 0.53 for tertiary specialist medical institutions inpatients.Conclusion: The secondary medical institutions inpatient probable attenua-tion trends with distance are faster than in tertiary medical institutions, those for the comprehensive medical institu-tions inpatient are faster than in the specialist medical institutions.In the regional health planning, for different lev-els, categories of medical institutions should adopt different distance attenuation coefficients to calculate the health re-sources level.

Objective To discuss the value of the posterior long segments pedicle screws fixation in surgical treatment of thoracolumbar fracture-dislocation,and summarize the experience.Method s We reviewed the clinical information of 27 cases of thoracolumbar fracture-dislocation since July 2007 to March 2010; all the cases were treated with the posterior long segments pedicle screws fixation.In these cases,20were male,7 were female.And the age ranged from 18 to 58 years old (average age was 35 years).The posterior approach was used,and the pedicle screws were inserted into the 2 vertebrae above and below the fractured vertebrae.Posterior decompression and bone grafts for fusion were also accomplished during the operation.Results Follow-up ranged from 7 to 25 months,averaging 14 months.Completely restoration of the dislocation was got in 25 cases and the spine sequence resumed to nearly normal.One case with lateral dislocation failed to complete correction; another 1 case operated 20 days after surgery failed to complete correction of forward dislocation.At the last follow-up,the mean Cobb angle loss was 3 degrees,the height of the vertebral had obvious loss compared with that of post-operation.The loosen of screw nut was found during the follow-up,but no dislocation and secondary deformity were observed after fixation.There was no death,no infection.Conclusions The technique of posterior long segments pedicle screw fixation is of great value in the clinical applications,since it has the following advantages:the operation is simple,trauma is small,the fixation is firm,good restoration of fracture and dislocations can be easily got,and most importantly,it can effectively prevent long-term vertebral height loss and the backward protruding deformity.

OBJECTIVE:To determine the therapeutic effect of transpedicular instrumentation without fusion on patients with thoracolumbar burst fractures.METHODS:A total of 63 patients with thoracolumbar burst fractures (the inclusion criteria was neurologically intact spine with a kyphotic angle >20° and/or decreased anterior vertebral body height > 50%) who were treated with transpedicular instrumentation without fusion were studied,including 40 cases treated by AF internal fixation,16 cases by Tennor screw-rod fixation system and 7 cases by Diapason screw-rod fixation.All patients underwent a radiological and clinical assessment (including the loss of kyphotic angle,decreased anterior vertebral body height,the midsagital diameter of the canal and the Low Back Outcome Score) preoperatively,postoperatively and after 24 months.The deformity of angulation was measured by Cobb angle.RESULTS:All pstients were followed for a 24 months,with average stay of 13.4 days.There were averaged 3.8 days from admitted to operation,and the internal fixation was removed within 8-12 months in 51 cases,followed a 9.4-day hospital stay.According to low back outcome score,46 patients achieved excellent,9 good,5 fair and 3 poor,with excellent and good rates of 88%.The Cobb's angle was 20.1° preoperatively,6.2° postoperatively,and 11.9° after 24 months.The average lose of anterior vertebral body height was changed from 49.1% preoperatively to 17.4% postoperatively,which was 20.4% after 24 months.The midsagittal diameters was 49.8% (n=63) preoperatively,78.1% (n=28) postoperatively,and 91.7% (n=25) after 24 months.The implant failure occurred in 5 patients.The radiographic parameters had no associativity to the outcome of LBOS.CONCLUSION:Transpedicular instrumentation without fusion is conductive to treating burst fractures of the thoracolumbar spine without nerve injury.The routine posterior or posterolateral fusion is unnecessary in the operative management of these fractures.

Objective To explore the clinical efficacy and application value of hemivertebra resection for treating congenital ky‐phoscoliosis .Methods 30 cases of congenital kyphoscoliosis and hemivertebral deformity in our hospital from January 2011 to Jan‐uary 2013 were selected as the research subjects .Among them ,12 cases of simple vertebral and non‐structural bending were per‐formed the posterior hemivertebral resection and short segment pedicle screw fixation ;3 cases of complicating lordosis and hemiver‐tebral protruding to the ventral side were performed the anterior hemivertebral resection and bone graft fusion fixation ;15 cases of complicating structural compensatory curve were performed the posterior transpedicle hemivertebral resection and compensatory bend long segment fixation and fusion .The clinical effects of surgical treatment for all patients were performed the comparative a‐nalysis .Results The mean postoperative kyphosis Cobb angle and the average final follow‐up Cobb angle were (8 .6 ± 3 .14) °and (11 .2 ± 7 .23) °respectively .The ultimate orthopedic rate of kyphosis was 58 .6% ;the average postoperative Cobb angle and and the average final follow‐up Cobb angle of scoliosis were (12 .8 ± 5 .47)°and (16 .2 ± 6 .24)°respectively ,the final orthopedic rate of scoliosis was 66 .5% .The mean Cobb angle of kyphosis and scoliosis after operation was significantly less than that before opera‐tion ,the difference was statistically significant(P< 0 .05) .Kyphosis and scoliosis were significantly improved .No significant post‐operative complications occurred .The effects were satisfied by the patients .Conclusion The hemivertebral resection has significant effect for treating congenital kyphoscoliosis with high kyphoscoliosis orthopedic rate and is worthy of further clinical study .

OBJECTIVETo explore a new method for mentoplasty.

METHODSThe bilateral prominent mandibular angle or outer lamina was resected through the intraoral approach. The resected bone fragments were shaped and rigid fixed to the chin with miniplates and screws.

RESULTSA total of 30 patients (28 females, 2 males) accepted chin augmentation with this method. The mandibular angle bone was used in 20 cases and the mandibular outer lamina was used in 10 cases. The operative results were satisfactory, and the patient's facial contour was improved substantially.

CONCLUSIONNo rejection reaction was found after this procedure. Chin augmentation with autogenous mandibular bone is an ideal method for genioplasty.

Adult ; Bone Transplantation ; methods ; Chin ; surgery ; Female ; Humans ; Male ; Mandible ; surgery ; Reconstructive Surgical Procedures ; methods ; Transplantation, Autologous ; Treatment Outcome

OBJECTIVETo investigate the treatment of square face with compositive methods. METHODS A total of 71 patients with square-shape face were treated. According to the different face skeleton and desire of patient, mandible angle curved-osteotomy and mentoplasty were used as main methods and zygomatoplasty, buccal fat pad resecting and other aesthetic methods as assistant methods to recontour the whole face skeleton.

RESULTSThe face skeleton of all patients was improved with satisfaction. The following-up period was 6 months to 2 years. In this patients group, massive haemorrhage was occurred during operation in one patient, mental nerve of of one side was injured in two patients, the lip mucosa was wounded in five patients.

CONCLUSIONMandible angle curve-osteotomy and mentoplasty combined with other assistant aesthetic operations were ideal methods to recontour square face. The result was satisfactory.

Adolescent ; Adult ; Cheek ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Mandible ; surgery ; Osteotomy ; Surgery, Plastic ; Treatment Outcome

Objective To objectively study the current progress of China Healthcare Improvement Initiative, and its effectiveness and shortcomings for further improvement. Methods Questionnaires were customized by expert consultation and pre-investigation, and distributed by the National Health Commission in April 2018 to the hospitals.Data of 5 469 hospitals were recovered and analyzed with a statistics software for descriptive analysis.Results Implementation progress of the five working systems varied with regions, and rooms of improvement were found in such aspects as outpatient appointment, clinical pathway management and social work system.In 2017, the proportion of outpatient appointments of 5 469 hospitals averaged 19.1%.Progress of the ten major service models also varied, as defects were found in such service models as continuous medical service, intelligent service, and interconnection service.In 2017, only 6.7% of the 5 469 hospitals had put in place hierarchical integrated clinical pathways within their medical alliances.Conclusions Improvement of the medical services calls for not only the efforts of medical institutions themselves, but also top-level design by the local health authorities. In particular, an online information platform should be established for the whole region, to unify the information standards and processes, and corresponding mechanisms and system support are needed.

Objective:To investigate the effect of STIM1 on the survival and proliferation of breast cancer cells and its preliminary mechanism analysis.Methods:Normal mammary epithelial cells MCF-10A as control,the expression of STIM1 in MCF7, HCC1569,MDA-MB-231 and BT549 breast cancer cells were detected by Western blot;STIM1 siRNA sequence(STIM1-siRNA group) were transfected into MDA-MB-231 cells,and the negative control group and the blank control group were set up,the protein expression of STIM1 in each group were detected after cells were transfected for 48 h;MTT method was used to detect cell activity cells were transfected for 24 h,48 h and 72 h;cell apoptosis was detected after cells were transfected for 48 h by flow cytometry;the mRNA expression of IL-6 and TNF-α were detected by RT-PCR;the expression of PCNA,Bcl-2,Bax,Caspase3,STAT3 and p-STAT3 protein were detected by Western blot.Results:The expression of STIM1 protein in breast cancer cells was significantly higher than that in MCF-10A cells (P<0.05);the expression of STIM1 protein in MDA-MB-231 cells transfected STIM1-siRNA was significantly lower than the control group(P<0.05);compared with the control group,cell viability in STIM1-siRNA group decreased significantly in cells were transfected for 48 h and 72 h,the apoptosis rate in 48 h was significantly increased,the expression of IL-6 and TNF-α mRNA sig-nificantly decreased,the expression of PCNA,Bcl-2 and p-STAT3 protein were significantly decreased,the expression of Bax and Caspase3 protein increased significantly.Conclusion:STIM1 gene is highly expressed in breast cancer cells.Inhibition of STIM1 expression by RNA interference can down regulate the activity of cancer cells,induce apoptosis,enhance immunity and by down regulation STAT3 signal.