Objective To study the diagnostic significance of the gray degree of lip-around and facial edge skin on the spleen-stomach symptoms.Methods With the International ColorCheck,160 cases of facial digital images were got from physical examination groups.The gray degree of the upper and lower lip-around and facial edge skin were judged.Questionnaires of spleen-stomach symptoms were also collected from the people.Results Logistic results showed that the dark upper lip-around skin were closely related with dry mouth,stomach pain,etc; the dark lower lip-around skin were closely related with hiccups,etc; the dark facial edge skin were closely related with bloating- afternoon,bad-breath,vomiting,cool-stomach,the thick white fur and so on.Conclusion The gray degree of lip-around and facial edge skin implied the status of the spleen and stomach function,which could be used as diagnostic indicators for spleen and stomach symptoms.

BACKGROUND: In follow of the gradual decrease of senile gonad function in the body, traditional Chinese medicine views that deficiency of essential qi is the chief reason of body senility. OBJECTIVE: To observe the effects of tian nian yin on serum testosterone content, superoxide dismutase activity in testicular tissue and apoptosis of testicular seminiferous cell in subacute senile rats. DESIGN: Randomized controlled experiment. SETTING: Human Anatomy Department of Chengde Medical College. MATERIALS: The experiment was performed in Institute of Basic Medicine of Chengde Medical College from April to July 2003, in which,40 SD male rats were employed and randomized into 4 groups, 10 rats in each group. In model group, medicinal group and the control, D-galactose was injected 200 mg/(kg·d) to prepare subacute senile animal model, once a day, continuously for 40 days. No any management was given in model group after modeling success. In medicinal group, gastric infusion with tian nian yin [composed of zhi heshouwu (Radix Polygoni Mutiflori Preparatea),huainiuxi (Radix Achyranthis Bidentatae), roucongrong (Herba Cistanchis),fuling (Poria), danshen (Radix Salviae Miltiorrhizae) and yinyanghuo (Herba Epimedii), it was decocted till 1.5 g/mL with raw herbs contained] was administrated once a day, totally for 30 days after modeling success. In the control, gastric infusion was administrated with physiological saline of same usage as the medicinal group after modeling success. INTERVENTIONS: In every group, enzyme linked immunosorbent assay (ELISA) was used to determine testosterone content in serum. Xanthine oxidase assay (XOD) was used to determine superoxide dismutase activity in testicular tissue and immunohistochemical method (IHC) was used to observe apoptosis of testicular seminiferous cell. MAIN OUTCOME MEASURES: ① Testosterone content in serum. ②Superoxide dismutase activity in testicular tissue. ③ Apoptosis of testicular seminiferous cell RESULTS: Forty rats all entered result analysis. ① Testosterone content in serum: Testosterone content in model group was lower than normal group [(0.52±0.15) μg/L, (1.26 0.32) μg/L, (t=3.004, P ＜ 0.05)], and that in medicinal group was higher than model group [(1.16±0.32) μg/L,(0.52 0.15) μg/L, (t=2.321, P ＜ 0.05)]. ② Superoxide dismutase activity in testicular tissue: Superoxide dismutase activity in model group was lower remarkably than the normal group [(107.22±9.33) kNU/g, (147.73±11.90) kNU/g,(t=13.339, P ＜ 0.01)], and that in medicinal group was higher remarkably than model group [(141.05±14.57) kNU/g, (107.22±9.33) kNU/g, (t=9.970,P ＜ 0.01)]. ③ Apoptosis of testicular seminiferous cell: Percentage of apoptotic seniniferous tubule and apoptotic rate of positive cell in model group were higher remarkably thannormal group respectively [(53.95 ±2.02)％compared with (34.21±2.10)％, (8.67±0.80)％ compared with (3.86±0.52)％,(x2=7.9, P ＜ 0.01, x2=5.01, P ＜ 0.05)], and those in medicinal group were lower remarkably than model group[(35.33±2.18)％ compared with (53.95±2.02)％, (4.68±0.74)％ compared with (8.67±0.80)％, (x2=7.02, P ＜ 0.01, x2=3.96, P ＜ 0.05)]. CONCLUSION: The apoptosis of testicular seminiferous cell was increased in senile modelgroup. Tian nian yin in gastric infusion decreased apoptotic rate of positive cell. It is explained that tian nian yin eliminates surplus oxygenic free radical, decreases apoptosis and improves seminiferous function in animal model.

Objective: To explore the effects of the bi-directional referral system from the perspective of the medical service consumer.Methods: A balanced panel data which was adjusted by Propensity Score Matching was employed to evaluate the effects of two-way referral system using difference-in-difference (DID) for the 2013 and 2015 data.The evaluation indicators including actual cost sharing ration, out-of-pocket cost per unit, the possibility of high cost, annual inpatient visits and length of hospital stay per unit were used.Results: Compared with the control group, the two-way referral system resulted in an 11.3% (P<0.001) increase in actual cost sharing ratio and an increase of 0.710 (P<0.001) annual inpatient visits in the intervention group.However, the policy did not significantly reduce the possibility of high-cost medical expenses and reduce the length of hospitalization and the annual cost hospitalization.Conclusion: Based on the key findings of the analysis of this study, the two-way referral system has beneficial effects on reducing inpatient financial burden and optimizing resource allocation.

Objective To investigate the effect of graded motor imagery ( GMI) therapy combined with rou-tine occupational therapy on the recovery of upper extremity function after stroke. Methods Thirty stroke survivors who met inclusion criteria were randomly assigned to a control group ( n=15) or a GMI group ( n=15) . The control group received routine medication, conventional physical therapy and routine occupational therapy ( one hour a day) , while the GMI group received 30 minutes of routine occupational therapy and 30 minutes of graded motor imagery therapy every day in addition to conventional medication and physical therapy. Before and after four weeks of treat-ment, the patients in both groups were evaluated using the Fugl-Meyer Assessment for the Upper Extremities ( FMA-UE) , the Box and Block Test ( BBT) and Brunnstrom arm and hand staging. Surface electromyography of the biceps brachii and triceps brachii was performed as the affected elbow flexed and stretched in maximum isometric contrac-tions, and the co-contraction ratios ( CRs) were calculated. Results After the treatment, the average FMA-UE score, Brunnstrom arm and hand stage, BBT and CR scores in both groups had improved significantly. The average improvement in the GMI group was significantly greater than in the control group. Conclusions Graded motor im-agery therapy can significantly promote motor recovery of the upper extremities of hemiplegic patients after a stroke.

Objective:To observe the effect of functional electrical stimulation (FES) combined with an ankle-foot orthosis (AFO) and gait training on lower limb motor function, gait parameters and the joint angles of hemiplegic stroke survivors.Methods:Thirty-two stroke survivors who met the inclusion criteria were selected and randomly divided into a control group ( n=10), an orthosis group ( n=10), and a combination therapy group ( n=12). In addition to routine medication and rehabilitation, the control group received only gait training, the orthosis group received gait training and an AFO and the combination therapy group was given FES, an AFO and gait training. All three groups were treated for four weeks. Then, the Fugl-Meyer lower extremity assessment (FMA-LE), the Brunnstrom lower extremity assessment (BRL), and Functional Ambulation Categories (FACs) were used to evaluate the lower limb motor function and walking ability of the three groups. The gait parameters of the three groups were quantified using a three-dimensional gait analyzer, and the changes in the hemiplegic gait before and after treatment were compared among the three groups. Results:After the treatment the average FMA-LE, FAC and BRL scores, time-space parameters, and joint angle parameters of all three groups had all improved significantly. After the intervention the average indicators in the combined therapy group (including stride frequency, stride length and walking speed) were all significantly better than in the other two groups.Conclusions:Adding FES to gait training with an AFO can effectively improve lower limb motor function and the walking ability of hemiplegic stroke survivors.

Objective To investigate the effect of hyperbaric oxygen (HBO) on the behaviors, organizational morphology and the expression of protein kinase R-like ER kinase (PERK) in rats with spinal cord injury. Methods Thirty-six male Sprague-Dawley rats were randomly divided into normal group, sham group, model group and HBO group, with nine cases in each group. The normal group did not receive any treatment, the sham group received only laminectomy, and the other two groups were established spinal cord injury model with modified Allen's method. Six hours after operation, the model group was treated with regular air, and HBO group received HBO treatment for seven days. The recovery of locomotor function was evaluated by BBB (Basso Beattie and Bresnahan) on the day before operation and six hours, three days, seven days after operation. HE staining was used to observe the change of tissue morphology in injured spinal cord, and the expression of PERK in spinal cord was detected by Western blotting. Results There was no neurological deficit in the normal group and the sham group. The neurological score was lower in the model group than in the sham group three days and seven days after operation (P < 0.05), and was higher in HBO group than in the model group seven days after operation (P < 0.05). There was no obvious structural change in the normal group and the sham group, however, the model group showed swelling cells, condensed cytoplasm, and nucleus pycnosis hyperchromatic, and the HBO group showed slighter swelling cell compared with the model group. The expression of PERK was higher in the model group than in the sham group, and was lower in HBO group than in the model group seven days after operation (P < 0.05). Conclusion HBO could reduce the expression of PERK in the injured spinal cord, and improve the recovery of hind limb locomotor function in spinal cord injury rats.

OBJECTIVETo observe the effects of electroacupuncture (EA) on the activation of microglia cells in the Lto Lspinal cord in rats with neuropathic pain, so as to investigate whether EA could inhibit the activation of spinal microglial cells and regulate the expression of brain-derived neurotrophic factor (BDNF) to achieve the analgesic effect.

METHODSForty male Sprague Dawley rats were randomly divided into a normal group, a sham-model group, a model group and an EA group, 10 rats in each one. The rats in the normal group received no treatment; the rats in sham-model group were treated with operation to exposure sciatic nerve for 2 to 3 min (no knot); the rats in the remaining groups were treated with model establishment of chronic constrictive injury (CCI). 7 days after model establishment, the rats in the EA group were treated with EA at "Zusanli" (ST 36) and "Yanglingquan" (GB 34), 30 min per time, once a day for consecutive 7 days. Only immobilization was used in the remaining groups the mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) of affected side feet were respectively measured before model establishment and 3 days, 5 days, 7 days, 10 days, 12 days and 14 days after model establishment; 14 days after model establishment, rats were sacrificed; the immunohistochemical method was used to measure the expression of Iba1 and BDNF in the sample of Lto Lspinal cord; real-time fluorescent quantitative PCR was used to measure the expression BDNF mRNA.

RESULTSCompared with the sham-model group, the pain threshold was decreased significantly in the model group (<0.05), leading to hyperpathia. After EA treatment, compared with the model group, the pain threshold was increased significantly in the EA group (<0.05). 14 days after operation, the microglia cells in the Lto Lspinal cord, expression of BDNF and level of mRNA in the model group were significantly higher than those in the normal group and sham-model group (all<0.01); those in the EA group were significantly lower than those in the model group (all<0.01).

CONCLUSIONSThe analgesic effect on neuropathic pain is likely to be achieved by EA through inhibiting the activation of spinal microglia cells and down-regulating the expression of BDNF.