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 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.

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 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: After tissue-engineering products transplantation, angiogenesis played an important role in the function restoring of defective organs. The natural tissue-engineering materials had a wide application in tissue engineering due to its favorable biocompatibility and degradability, at the same time its pro-angiogenic function enhanced the achievement ratio of tissue-engineering products transplantation. Therefore, they attract much attention during recent years. OBJECTIVE: To summarize the research status of incubating induced angiogenesis of tissue-engineered natural scaffold, so as to give some theoretical basis for further study on clinical application of natural tissue engineering materials. METHODS: Relevant literatures in PubMed and Springerlink published between January1995 and June 2009 were searched by compute with the key words of "tissue-engineering products, natural materials" in English. While relevant Chinese articles in CKNI published between January1999 and June 2007 were also searched with the key words of "tissue-engineering natural materials, collagen, chitosan, fibrin" in Chinese. After primary selection, inclusive articles were those about study and experimental study of induced angiogenesis of tissue-engineered natural scaffold. Exclusive criteria: repetitive and obsolescent articles. A total 35 literatures were finally analyzed in accordance with the criteria. RESULTS AND CONCLUSION: The natural tissue engineering materials were synthesized by macromolecules out of normal tissue, whose multiple bioinformation provided signal for cells and benefited for cellular adhesion and maintenance. Collagen protein, fiber gel protein, and chitosan summarized in this study were beneficial for inducing angiogenesis but limited to mechanical characteristics. Therefore, to construct natural materials inducing angiogenesisis is prospect.

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.

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.

Objective To evaluate the relationship between the existence of DME and the SFCT in DR pa-tients. Methods We collected 70 cases which were clinical diabetic involving 122 eyes. They are 36 men with 64 eyes and 34 women with 58 eyes. The average age is 56.7 ± 9.7 year-old. All patients had been examined by oph-thalmologic examination. Grouping: patients without diabetic retinopathy (NDR) group; mild-to-moderate NPDR group; severe NPDR group; PDR group. The last three groups were divided into two subgroup groupsrespectively , which were cases with and without significant macular edema (CSME + / CSME). EDI was used to measure the SFCT. SPSS 17.0 software was used for statistical analysis. Results The average SFCT of NDR group, mild-to-moderate NPDR group, severe NPDR group and the PDR group respectively were (282.94 ± 104.21)μm, (313.62 ± 94.40)μm, (382.44 ± 76.91)μm, (335.00 ± 73.82)μm. Compared with the NDR group, SFCT was thicker than the other three groups, and difference was statistically significant (F = 2.786, P = 2.786). There were no statisti-cally significant difference of SFCT between the mild-to-moderate NPDR/CSME - group and mild-to-moderate NPDR/CSME + group, severe NPDR/CSME - group and severe NPDR/CSME + group PDR/CSME-group, PDR/CSME + group. Conclusions The SFCT of DR patients could potentially be thickenedas disease became serious. When considered the same degree DR, there is no obvious difference of SFCT between patients with CSME and without CSME.

The original meaning of Portfolio is briefcase, generally translated as study archives in our country, with learners as the center, through the process of goal setting, feedback learning, self-reflection, steps, to show yourself and target revision form of process evaluation with learners as the center, to continuously promote the personal comprehensive ability through reflective learning progress. Portfolio, introduced in clinical admissions bilingual teaching, through six aspects such as individual learning, classroom display, clinical teaching, practice process and result display and target changes, and through the learning process assessment (fuzzy comprehensive evaluation method) and professional knowledge assessment (mini) method evaluating the clinical practice, evaluates Portfolio, in order to improve the medical students' clinical thinking and their comprehensive ability of lifelong learning,and promote the medical students' all-round development.

Objective To observe the clinical efficacy of auricular acupuncture plus acupoint injection at Zusanli (ST 36) in treating shoulder pain due to gynecologic laparoscopy.Method Totally 120 patients with shoulder pain due to gynecologic laparoscopy were randomized into a treatment group and a control group, 60 cases in each group. The treatment group was intervened by auricular acupuncture plus acupoint injection at Zusanli (ST 36), while the control group was by ordinary analgesics. The clinical efficacies were compared after 2 treatment courses.Result The Visual Analogue Scale (VAS) scores, Present Pain Intensity (PPI), and the item scores of the Short-Form (36) Health Survey (SF-36) were significantly changed in both groups after treatment (P<0.01,P<0.05). There were no significant differences in comparing the VAS score, PPI, and the item scores of SF-36 between the two groups (P>0.05). The total effective rate was 95.0% in the treatment group versus 75.0% in the control group, and the difference was statistically significant (P<0.05).Conclusion Auricular acupuncture plus acupoint injection at Zusanli (ST 36) is effective in treating shoulder pain due to gynecologic laparoscopy, and it can effectively reduce the occurrence of complications.