Objective To observe the injury to the heart,liver and kidney induced by hind limb ischemia/reperfusion(I/R),and to study the protective effect of H2S by attenuating this injury,in order to offer a theoretical basis for therapeutic application.Methods A model of hind limb I/R was reproduced.28 rats were divided randomly into 4 groups:normal control group(C,n=8),ischemia 4h group(I,n=8),ischemia 4h and reperfusion 4h group(I/R,n=6)and I/R+NaHS group(n=6)(NaHS can provide H2S for rats in vivo).The concentrations of CK,CK-MB,Tn-T,ALT,AST,Cr and urea in blood plasma were determined.The pathological changes in the heart,liver and kidney were observed with HE staining.Results The concentration of CK,CK-MB and Tn-T in I group increased significantly compared with that in C group,and that in I/R group was higher than in I group.No significant difference was found in plasma concentration of ALT,AST,Cr and Ur between C group and I group,while it they were increased significantly in I/R group compared with that in I group,and that in I/R+NaHS group were decreased significantly compared with that in I/R group.Pathological examination revealed pathological findings of injury to the heart,liver and kidney in I group,and even more serious injuries were found in I/R group than in I group,while the they were less marked in IR+NaHS group compared with that in I/R group.Conclusion Hind limb ischemia/reperfusion may result in injury to the heart,liver and kidney.H2S may attenuate injury to remote organs follawing hind limb ischemia/reperfusion.

0.05).At the same time,loss of ranges of neck motion was 4.6??4.0?in group A and 11.6??7.8?in group B,significant difference was also seen(P

A brief description of performance appraisal as used in the healthcare sector, and an analysis of problems existing in performance appraisal for posts in community heahhcare organizations in the country. The paper proposes a job-analysis based performance appraisal for such posts, featuring the appraisal model of "performance + skills + attitude+ work intensity". On the basis of work analysis, a job description should be worked out for such healthcare workers as doctors, nurses and prevention workers in community healthcare organizations, aided by a targeted job-based performance appraisal system. These efforts can effectively enhance the job performance in such organizations, catering to the healthcare needs of community residents.

Objective To evaluate the preliminary outcome of cannulated screw internal fixation in treatment of the tarsometatarsal joint injuries.Methods From January 2005 to October 2010,21 patients(14 males and 7 females)with the tarsometatarsal joint injuries were treated.Their age ranged from 21 to 62 years(average 38.2 years).According to anatomical three-column classification,there were four patients with single medial column injury,four with medial and middle column injuries,three with middle and lateral column injuries,two with single lateral column injury and eight with three column injuries.The injury causes included traffic injury in nine patients,machine injury in eight and fall from height injury in four.The period from injury to admission was 2-15 hours(mean 5 hours).During operation,open reduction was performed,followed by internal fixation with the cannulated screw.X-ray examination was done in the regular follow-up and function was evaluated by using Maryland scoring system.Results Of all,19 patients were followed up for 4-47 months(mean 20 months),which showed no infection,loosing or breakage of the internal fixation.According to the Maryland scoring system,the clinical outcome was rated as excellent in eight patients,good in seven,fair in two and poor in two,with excellence rate of 79％.Conclusions The three-column theory plays an important role in clinical diagnosis and therapy of the tarsometatarsal joint injuries.Open reduction and cannulated screw internal fixation may attain satisfactory clinical results in treatment of the tarsometatarsal joint injuries.

Objective To investigate and optimize the condition of purification and crystallization of oncogenic protein MDM2.Methods MDM2 was expressed in E.coli expression system, and purified by Ni-NTA chelating affinity chromatography and molecular sieve chromatography.The secondary structure of purified protein was analyzed by circular dichroism spectroscopy (CD).Then the crystallization condition of MDM2 was screened and optimized by sitting-drop vapor-diffusion method.Results High purity of MDM2 was obtained by Ni-NTA chelating affinity chromatography and molecular sieve chromatography purification.CD analysis indicated the secondary structure of MDM2 was ordered.Protein-crystallisation experiments illustrated that MDM2 was prone to crystallization under lower pH.Conclusion The optimum pH of MDM2 protein crystallization is 5.5, the optimum protein concentration is 10 mg/mL.

Objective Although the correlation between high risk human papilloma virus (hrHPV) infection and cervical cancer ( CC ) or cervical intraepithelial neoplasia ( CIN ) is well known , vaginal cancer ( VC ) or vaginal intraepithelial neoplasia ( VAIN) also caused by hrHPV has not received enough attention .This article aims to explore the clinical characteristics of VC or VAIN after operations of CC or CIN in order to provide evidence for the treatment of these diseases . Methods The clinical charac-teristics and treatment of 15 cases with VC or VAIN after operations of CC or CIN were reviewed from Jan 2010 to May 2013 in our hos-pital. Results The mean age was (53.6 ±10.82) years, ranged from 39 to 73 years.The duration from the first operation to devel-oped VAIN or VC was (25.07 ±18.31) months, ranged from 1 to 60 months.There are 4 cases developed VC, 4 cases VAINⅢand 2 cases VINⅡfrom 10 CC patients;and 3 cases developed VC , 2 cases VAINⅢfrom 5 CINⅢpatients.hrHPV test were positive in all 15 patients.Treatment in these series were performed including total vaginectomy in 8 patients (3 VC, 4 VAINⅢ and 1 VAINⅡpatients), pelvic lymphonectomy in 1;upper vaginectomy in 2 patients (1 VC, 1 VAINⅢ), radiation or chemo-radiation therapy in 3 (3 VC), interferon muscle injection combined with topical application of estrogen and acyclovir gel in 2 (1 VC, 1 VAINⅡ). Conclusion Careful follow-up after CC or CIN operations are very important because continued hrHPV infection may result VC and VAIN lesions.Vaginectomy may be the best therapy .Interferon muscle injection combined with topical application of estrogen and acyclovir gel are also alternatively therapy , especially for hard to operate patients . Radiation therapy seems to be not very adaptable for VAIN patients .

Purpose To investigate the clinicopathlogical characteristics, diagnosis and differential diagnosis of ovarian small cell car-cinoma hypercalcemic type ( OSCCHT) associated with acute renal dysfunction. Methods A case of OSCCHT associated with acute renal dysfunction was reported. The clinical and pathologic data, treatment and pathological examinations were analyzed and the related literatures were reviewed. Results A 29-year-olds women was presented to hospital with inappetence and significant weight loss for 2 months. The laboratory examination showed abnormal renal function, and pelvic cavity mass, possibly coming from adnexa of the uterus was seen by radiography. Serum levels showed significantly increased serum calcium with acute renal dysfunction. An emergency opera-tion was performed just after renal function partially recovered by 2 times hemodialysis. During surgery, right ovary tumor with a size of 12 cm × 10 cm × 10 cm was inspected. Microscopically, the tumor cells were arranged in a diffuse solid pattern, mutiple nodules were separated by fibrous tissue. some small folliculars and pseudoglandular cavities with acidophilia secretion within nodules could been ob-served. Tumor cells were medium to large with eosinophilic cytoplasm, round or oval vesicular nucleus, increased karyoplasmic ratio and pathologic mitosis. Immunohistochemistry revealed that the tumor cells expressed EMA, CKpan, C-erbB-2 ( +) , CA125 ( focal+) and Ki-67 proliferation index was about 60%, while ER, PR, Syn, CgA, PTH, Inhibin, CD99, AFP, PLAP, CD30 and CD20 were not expressed. Conclusion Ovarian small cell carcinoma hypercalcemic type with acute renal dysfunction is a very rare with a rapidly progressive and highly malignant tumor. The final diagnosis mainly lies on clinical information ( hypercalcaemia) , morphology and immunohistochemistry, combined with electron microscopy and molecular biological detection when necessary.

Rational distribution of health human resources that can keep,use and manage is the key process to strengthen the rural three-level health service network,and to be sure,the sense of identity plays a pivotal role in it.This study,with qualitative research of sociology and research in historic culture,analyzed the influence of the status quo of social,cultural and historical background on rural doctors as health human resource.Through the field observation and individual in-depth interview,it explored the current condition of relationship mode and interaction way behind village life,analyzed the influences of them upon health human resource,and put forward some suggestions to adapt rural culture environment,following the view of existence determines consciousness of historical materialism.

Endometrial receptivity is key to clinical pregnancy by in vitro fertilization-embryo transfer(IVF-ET)technique.Endometrial thickness(EMT)is a major index for pregnancy monitoring,but the optimal time indicating endometrial receptivity is controversially uncertain.Multiple studies have demonstrated the correlation between EMT and IVF pregnancy outcomes and EMT of a moderate range is essential for good pregnancy outcomes and a thin endometrium produces negative pregnancy outcomes.In this paper,we reviewed the research on the im-pact of EMT on IVF-ET pregnancy outcomes in terms of timing of EMT measurement,clinical pregnancy rate,live birth rate,ectopic pregnancy rate,placenta praevia,and low birth weight,investigating the mechanism of occur-rence and treatment of thin endometrium so as to provide clinical references for improving IVF pregnancy outcomes.