Through the investigation on medical students' understanding of hospice care and their cognition and attitudes on voluntary services in hospices in Wenzhou,this paperconcluded that medical students accepted hospice care highly but knew little about it,and medical students were willing to participate in hospice care but actually rarely attended it.It is also suggested that universities should strengthen the propaganda and education of hospice care and volunteer service,joint efforts should also be given to expand the service opportunities and channels,and trainings should be provided to improve the development of hospice care volunteer services among medical students.

Objective To investigate the clinical efficacy of warm needling plus palm pressing spine reduction technique in treating postpartum thoracic facet joint disorder.Methods Forty patients with postpartum thoracic facet joint disorder were randomly allocated to treatment and control groups, 20 cases each. The treatment group received warm needling plus palm pressing spine reduction technique and the control group, warm needling alone. The numeric pain rating scale (NPRS) score, the Oswestry Disability Index (ODI) score and the Quality of Life Scale score were recorded in the two groups before and after treatment and the clinical therapeutic effects were compared between the two groups.Results The total efficacy rate was 95.0% in the treatment group and 75.0% in the control group; there was a statistically significant difference between the two groups (P<0.01). There were statistically significant pre-/post-treatment differences in the NPRS score and the ODI score in the treatment group (P<0.01). There was a statistically significant pre-/post-treatment difference in the NPRS score in the control group (P<0.01). There were statistically significant post-treatment differences in the NPRS score and the ODI score between the treatment and control groups (P<0.01,P<0.05). There were statistically significant pre-/post-treatment differences in the SF-36 PF, RP, BP, VT, SF and MH scores in the treatment group (P<0.01,P<0.05). There were statistically significant pre-/post-treatment differences in the SF-36 PF BP, SF and MH scores in the control group (P<0.01,P<0.05).Conclusion Warm needling plus palm pressing spine reduction technique is an effective way to treat postpartum thoracic facet joint disorder.

Objective To evaluate the efficacy and side-effects of the levonorgestrel-releasing intrauterine device (Mirena) in the treatment of dysfunctional uterine bleeding .Methods 45 cases of dysfunctional uterine bleeding diagnosed by pathology were installed with Mirena.The endometrial thickness by ultrasound hemoglobulin increase and pathologic changes of endometria were recorded before and 24 months after the installation.ResultsThe endometrial thickness before and after the insertion of Mirena were(15.6 ±4.2) mm and (3.2 ± 1.3)mmrespectively (P ＜ 0.01) .Six months after the insertion of Mirena, patients' hemoglobulin was significantly increased from (97.6 ± 8.2)g/L to (123.7 ± 8.1)g/L (U = 2.26, P ＜ 0.05) .After the installation of Mirena, patient experienced metrorrhagia.Conclusions Mirena is a device providing effective and continual therapy for dysfunctional uterine bleeding .It can not only significantly reduce the menstrual blood loss but also reverse the complex hyperplasia effectively.

BACKGROUND: Researches find that grape seed proanthocyanidins (GSP) can eliminate free radicals, protect heart against ischemia-reperfusion injury and enhance learning and memory abilities in experimental animal, but their effects on the cerebral ischemia-reperfusion injury remain unclear.OBJECTIVE: To study the protective effects of proanthocyanidins derived from grape seeds on the cerebral ischemic reperfused brain by measuring the total antioxidative capacity (T-AOC), nitric oxide synthase activities and malondialdehyde (MDA) content in brain tissue of mice.DESIGN: A completely randomized and controlled study.SETTING: Department of Pathophysiology and Functional Central Laboratory, Jinzhou Medical College; Department of Neurology, the First Affiliated Hospital of Jinzhou Medical College.MATERIALS: The experiment was conducted in the Department of Functional Central Laboratory, Jinzhou Medical College from March to August 2004. Forty Kunming mice, provided by the Experimental Animal Center, Jinzhou Medical College, were randomly divided into five groups: sham control group, cerebral ischemia-reperfusion group (IR group) and cerebral ischemia-reperfusion treated with low or high dose of GSP or nimdipine (IR+GSP or IR+Nim) group with eight mice in each group.METHODS: ① Animal model establishment: The animals were anesthetized with ether. Then they were incised through median incision of the neck. The bilateral common carotid arteries were then occluded by microaneurysm clips for 30 minutes. After removing the clips, return of flow was visualized in the arteries. ② Model group and control group:The mice in low or high dose of GSP treated group or nimdipine treated group were injected GSP or nimdipine 10, 40, 2 mg/kg body mass respectively during the common carotid arteries occlusion and again at 24hours after reperfusion, while the mice in sham control group were injected the same volume distilled water with 40 mg/kg body mass. After 72-hour reperfusion, nitric oxide synthase activities, the total antioxidative capacity and MDA content in brain tissue of mice in each group were detected with chemical chromatometry. ③ The results were assessed by t test.MAIN OUTCOME MEASURES: Nitric oxide synthase activities, the total antioxidative capacity and MDA content in brain tissue of mice in each group were detected.RESULTS: Data of forty Kunming mice was entered the results analysis without any loss. ① Total antioxidative capacity: Total antioxidative capacity in cerebral ischemia-reperfusion group was obvious lower than that in the sham control group (t=8.145, P=0.000) while total antioxidative capacity in low or high dose of GSP treated group and nimdipine treated group was obvious higher than that in the cerebral ischemia-reperfusion group (t=6.313, 8.956, 4.14, P ＜ 0.01). ② Nitric oxide synthase activities: Nitric oxide synthase activities in cerebral ischemia-reperfusion group was obvious higherthan that in the sham control group (t=12.541, P ＜ 0.01), while nitric oxide synthase activities in low or high dose of GSP treated group and nimdipine treated group was obvious lower than that in the cerebral ischemia-reperfusion group (t=2.231, 8.956, 7.260, P ＜ 0.05-0.01). ③ MDA content: MDA content in cerebral ischemia-reperfusion group was obvious higher than that in the sham control group (t=7.883, P ＜ 0.01), while high dose of GSP treated group and nimdipine treated group was obvious lower than that in the cerebral ischemia-reperfusion group (t =5.234,4.518, P ＜ 0.01).CONCLUSION: GSP exerted a protective effect on the cerebral ischemic reperfused brain by enhancing total antioxidative capacity and reducing lipid peroxidantion and nitric oxide synthase activities.

Aim To investigate the role of GDF11 in palmitate induced skeletal muscle insulin resistance.Methods The C2C12 cells were sorted into control group, GDF11 intervention group, palmitate group and GDF11 combined with palmitate group.Cell viability was measured by CCK-8, and the glucose uptake was determined by 2NBDG.The mRNA level of myotube marker genes(desmin,myogenin), insulin mediate glucose uptake related genes(GLUT-4,IRS-1) and PGC-1α were tested by RT-PCR.The protein expression of PGC-1α was detected by western blot.Results GDF11 had little effect on cell viability of skeletal muscle cells.Compared with control group, the glucose uptake and the expression of GLUT-4,IRS-1,PGC-1α were significantly decreased by palmitate intervention.Compared with palmitate group, the glucose uptake and the expression of GLUT-4,IRS-1,PGC-1α were not significantly changed by GDF11.Conclusion Palmitate can induce skeletal muscle cell insulin resistance, but GDF11 may not significantly improve the skeletal muscle cell insulin resistance.

Objective To study the validity,reliability and sensitivity of the simplified Chinese version of modified Barthel index (MBI) in evaluation of activities of daily living(ADL) of Chinese stroke patients. Methods Forty Chinese stroke patients (26 males and 14 females,aged 59.65±11.68 years) participated in the study.The duration of the disease averaged 21.20±19.44 days.All the patients were evaluated for three times with MBI.Barthel Index (BI) and the motor component of Functional Independence Measure (M-FIM)independently by twophysiatrists.Spearman correlation coefficients between MBI and Barthel index (BI),between MBI and M-FIM were used to test the validity of MBI.Intraclass correlation coefficients (ICC) were used to test both interrater and intra rater reliability of MBI.Sensitivity of MBl was analyzed with the Wilcoxon signed rank test and paired t-test.Results MBI was highly correlated with BI in each item and total score(r=0.816～1.000,P<0.01),and with M-FIM in total score(r=0.935～0.981,P<0.01).There were high reliability with MBI in the results collected by same assessor and different assessors(ICC=0.866～0.997).Furthermore,MBI was more sensitive than BI in majorities of its items and its total scores as well.Conclusions MBI has good validity and reliability as well as sensitivity in assessment of ADL of Chinese stroke patients.

Objective To explore clinical efficacy of local random flap in reconstruction of facial skin and softtissue defects caused by lesions resection and injury.Methods Forty-six cases with facial skin and soft-tissue defects were cured by constructing and transplanting different local random flap that is designed according to parts,shapes and sizes of defect between July of 2008 and June of 2013.Results All the cases obtained satisfactory effects for full survivorship of flap,one-stage healing of wound,tiny scar and pigmentation,and good appearance by following up from 3 months to 6 months after operation.Conclusions Using local random flap in repair of facial skin defect could get satisfactoried functional and aesthetic efficacy,and it is worth being applicatied in the clinic.

Objective To analyze the present situation of technical efficiency in TCM hospitals throughout the country, discuss the influencing factors causing inefficiency and propose corresponding suggestions. Methods The technical efficiency in 60 TCM hospitals in the country was analyzed using the stochastic frontier cost model for panel data and the influencing factors causing inefficiency were discussed using the multiple stepwise regression method. Results The average technical inefficiency was 22.59% and inefficiency showed an upward trend as the areas shifted from the eastern through the middle to the western regions. Five factors, including the utility rate of beds and the proportion of health technicians among the entire hospital staff, were statistically significant so far as the effect on the increase of the overall cost was concerned. Conclusion The stochastic frontier cost model for panel data is the best method for evaluating the technical efficiency in TCM hospitals. On the basis of the above analysis, suggestions for strengthening scientific management, improving the utility rate of resources and reducing unnecessary waste are put forward.

BACKGROUND: Studies have confirmed that nerve growth factor can promote wound tissue to release al kinds of endogenous growth factors and growth factor receptors, which play a positive regulatory role. The nerve growth factor can promote cel proliferation and accelerate wound healing, thus making the wound healing developed from the passive waiting healing to active control healing. OBJECTIVE: To investigate the effects of local application of nerve growth factor on the expressions of transforming growth factor β1 and basic fibroblast growth factor in rat burn wounds. METHODS: Twenty-four adult Sprague Dawley rats were used in the study, and Ⅱ degree deep burn wound was made on the back of rats. Then, these rats were randomly divided into four groups. After burn wound debridement, the wounds were covered with gauzes containing 1, 2.5 and 5 μg/mL nerve growth factor solution and normal saline respectively. At 3, 5, 9 and 14 days after treatment, the wound healing time and percentage of residual wound were observed. Then, wound tissues were cut for histological examination, in order to detect the expressions of transforming growth factor β1 and basic fibroblast growth factor in wounds, as wel as the cel ular DNA cycle. RESULTS AND CONCLUSION: The wound healing time in the treatment groups was shorter than that in the control group, especial y in 5 ug/mL nerve growth factor treatment group (P < 0.01), and the percentage of residual wound in the treatment groups was less than that in the control group. The histological examination showed the number of nucleated cells in the superficial dermis of the treatment groups was significant increased when compared with that in the control group; the expressions of transforming growth factor β1 and basic fibroblast growth factor in the treatment groups at different time points were stronger than those in the control group, and the expressions at 5 and 9 days were stronger than those at 3 and 14 days; percentage of cells in S phase of the treatment groups was significantly increased, especial y in 5 mg/L nerve growth factor group (P < 0.01). The results indicate that local application of nerve growth factor can accelerate wound healing by increasing the expressions of transforming growth factor β1 and basic fibroblast growth factor, stimulating mitosis and promoting proliferation.

Objective To observe the clinical efficacy of the early activity on preventing deep vein thrombosis after joint replacement. Methods A total of 90 patients who undergone skeleton and knee joint replacement from January 2014 to January 2015 were randomly divid-ed into the observation group and the control group (with 45 cases in each group)according to the random number table method.The control group were given routine nursing care to prevent thrombosis,while the observation group were given intervention nursing,namely implementa-tion of early activities.The related symptoms of deep venous thrombosis and D-dimer level of high blood coagulation state of plasma of the two groups were observed and compared before and after treatment.Results The symptoms of deep vein thrombosis of the observation group in the early postoperative period were less than that of the control group,and the difference was significant(P <0.05).The D-dimer level of the observation group was lower than that of the control group 7 days after the operation with a significant difference (P <0.05).Conclusion Systematic nursing intervention of early activities can significantly reduce the related symptoms of forming deep vein thrombosis after joint re-placement.In addition,it has an apparent effect on lowing the high blood coagulation state and preventing deep vein thrombosis.