This paper introduces orthopedic resident training system of America including its devel-opment, certification system, selection system, clinical training mode and investigate system. And we hope to improve orthopedic resident training of China by analyzing the new rule of Chinese standardized resident training and the training experience of Peking Union Medical College Hospital.

Pancreatic cancer is one of the most malignant tumors.Targeted therapy has become an important part of the treatment of pancreatic cancer.The signaling pathways such as hepatocyte growth factor/c-MET (HGF/c-MET) signaling pathway, inhibition of which may exerts an antitumor effect, play extremely important roles in the occurrence and development of pancreatic cancer.Therefore, the research of HGF/c-MET targeted inhibitors opens up a new avenue for treatment of pancreatic cancer.

Objective To observe the clinical efficacy of comprehensive rehabilitation therapy in treating post-stroke shoulder- hand syndrome.Method Sixty patients with post-stroke shoulder-hand syndrome were randomized into a treatment group and a control group, 30 cases in each group. The treatment group was intervened by acupuncture plus correct posture, rehabilitation training, wax disc method, and intermediate-frequency medicinal penetration therapy; the control group was only by acupuncture plus correct posture. Before and after intervention, the limb function, pain, swelling degree, and activities of daily life were measured, and the clinical efficacies were compared between the two groups.Result The total effective rate was 93.3% in the treatment group versus 66.7% in the control group, and the difference was statistically significant (P<0.01). In the treatment group, the indexes (Fugle-Meyer Assessment of upper limb, movement range of shoulder, Global Perceived Effect, Visual Analogue Scale, and swelling score) were significantly changed after intervention (P<0.01). After treatment, the indexes of the treatment group were significantly different from those of the control group (P<0.01).Conclusion Comprehensive rehabilitation therapy can significantly improve pain, swelling, motor function of the affected limb, and activities of daily life in post-stroke shoulder-hand syndrome.

Objective To investigate the proliferation and the change of antigen on the cord blood CIK cells. Methods Cord blood CIK cells were generated by culture cord blood mononuclear cells in the presence of ?-IFN on day 0 and rhIL-2, antiCD3 MCAb on day 1. CIK cultures were analysed on different time point by FACS(Fluorescence activated cell sorter). The killing efficacy in tumor cell lines and primary leukemia cells were detected by MTT assay. Results After 2~3 weeks of culturing cord blood CIK cells expanded about 64.14?16 folds and CD+3 CD+56 cells which were the major cytolytic effector in CIK cells proliferated about 900 folds. Cord blood CIK cells have great cytotoxity against tumor cell lines as well as primary leukemia cells. Conclusions Cord blood MNCs can be cultured to CIK cells and the times of expansion are very high. Cord Blood CIK cells are highly efficient cytolytic effector cells.

BACKGROUND:The cryopreservation of single tissue has achieved great advancement and is gradual y applied in clinics. However, the cryopreservation of complex tissue is rarely reported.
OBJECTIVE:To investigate the morphological change in rabbit limb tissue after replantation through different rewarming methods, find the best rewarming methods of compound textured blood vessels, and provide theoretical basis for the feasibility of limb replantation after long-term cryopreservation.
METHODS:Thirty New Zealand white rabbits were randomly divided into control group, slow freezing-slow thawing group, and slow freezing-rapid thawing group. The right posterior limbs of al the rabbits were cut off 1 cm above the knee joint. Except control group, the latter two groups were given limb replantation after thawing, and then the right posterior limb was again cut off after the replanted limbs were survived for 6 hours. For al groups, the histological changes and gross observation in aorta tissue were observed by light microscopy and transmission electron microscope, and the results were analyzed with statistical methods.
RESULTS AND CONCLUSION:In the slow freezing-slow thawing, slow freezing-rapid thawing groups, the pathological changes (gross specimen, light microscope, electron microscope) of rabbit limbs 6 hours after replantation were worse than those in control group. Compared with slow freezing-rapid thawing group, better integrity of endothelial cells and less damage of the organel es were found in slow freezing-slow thawing group. Through deep cryogenic freezing-thawing process, rabbit limb blood vessels can maintain the structural integrity after replantation and survived at 6 hours. Slow freezing-slow thawing is better than slow freezing-rapid thawing for the preservation of severed limbs, providing evidences for the long-term survival fol owing a deep cry ogenic treatment after the severed limb replantation.

Objective To evaluate No.16a2b1 lymphadenectomy for D2 gastrectomy of advanced gastric cancer.Methods In this study,we retrospectively analysed the data of 100 patients with advanced gastric cancer from April 2004 to April 2005.All the patients were in stage T3-4.50 patients underwent D2 plus No.16a2b1 lymphadenectomy while the other 50 patients underwent standard D2 operation.Results The metastatic rate of No.16a2b1 lymph node was 18％ ;The bleeding volume,operation time,postoperative intestinal function recovery time and the incidence of postoperative complications between D2 plus No.16a2b1 lymphadenectomy group and standard D2 operation group were [(351 ± 121) ml vs.(305 ±-105) ml,t=2.03],[(192±50) vs.(172±40),t=2.22],[(5 ±2) days vs.(4±-2) days,t=3.33],and [10％ (5/50) vs.8％ (4/50)] respectively.All differences were not statistically significant (P ＞0.05).While 5 year survival rates were 24％ (12/50) vs.6％ (3/50) respectively,the difference was statistically significant (P ＜ 0.05).Conclusions No.16a2b1 lymphadenectomy is necessary,feasible and prolongs survival for advanced gastric cancer patients,especially in stage T3 and T4 undergoing D2 operation.

Objective: To observe the safety and efifcacy of excimer laser coronary atherectomy (ELCA) for treating the patients with coronary chronic total occlusion (CTO). Methods: A total of 3 coronary CTO patients treated by ELCA in our hospital from 2015-01 to 2016-11 were analyzed. The patients received guide steel wire gone through occlusion segment under the guidance of offside coronary angiography; drug-eluting stent implantation was conducted after ELCA treatment. The operative success rate with complication was observed and the occurrence of MACE was followed-up. Results: The device performing and interventional therapy were succeed in all 3 patients. No coronary dissection, perforation, slow relfow and thrombosis were occurred during the operation; no angina, myocardial infarction, target vessel revascularization and death were observed by follow-up study. Conclusion: Application of ELCA combining drug-eluting stent implantation was safe and effective for treating the patients with coronary CTO.

Objective To investigate the effect of microRNA-1 (miR-1) on the fibrosis of cardiac fibroblasts induced by high glucose. Methods The primary cultured fibroblasts from 1-3 days old Sprague-Dawley (SD) rats, were randomly divided into 4 groups (n = 3): normal glucose + lentivector-vehicle (CON+Lv-Vehicle group), normal glucose + lentivector-miR-1 (CON+Lv-miR1 group), high glucose + lentivector-vehicle (HG+Lv-Vehicle group), high glucose + lentivector-miR-1 (HG+Lv-miR1 group). Fibroblasts were cultured in glucose concentration 5.5 mmol/L and 25 mmol/L DMEM culture, and were injected lentiviral vector carrying miR-1 silencer sequence or the same volume of lentiviral vector. After 12 hours, the medium was replaced with fresh complete medium. After 3 days when transfection efficiency was up to 90%, the cellular miR-1 content was detected by real-time reverse transcription-polymerase chain reaction (qRT-PCR). The secretion of collagen Ⅰ and Ⅲ were measured by enzyme linked immunosorbent assay (ELISA). Expression of collagen Ⅰ and Ⅲ, matrix metalloproteinase 2 and 9 (MMP-2, MMP-9), autophagy related protein LC3B-Ⅱ, P62/SQSTM1 and Cathepsin D were assessed by Western Blot. Results Compared with the CON+Lv-Vehicle group, the content of miRNA in the CON+Lv-miR1 group had no statistical significance. Compared with the CON+Lv-Vehicle group, high glucose increased the amount of miR-1 (2-ΔΔCt: 1.82±0.17 vs. 1.00±0.04), collagen Ⅰ and Ⅲ secretion (mg/L: 14.55±0.33 vs. 7.28±0.22, 157.50±13.22 vs. 61.25±8.54) and expression (gray value: 432.35±56.00 vs. 100.00±15.00, 320.35±47.00 vs. 100.00±15.00), the level of MMP-2, MMP-9 and the expression of autophagy related protein LC3B-Ⅱ and P62/SQSTM1 (gray value: 249.0±21.0 vs. 100.0±15.0, 142.3±20.0 vs. 100.0±16.0, 178±19 vs. 100±14, 378.3±20.0 vs. 100.0±15.0), decreased the expression of lysosomal associated protein Cathepsin D (gray value: 60±14 vs. 100±10), and the differences were statistically significant (all P < 0.01). Compared with the HG+Lv-Vehicle group, the amount of miR-1 in the HG+Lv-miR1 group was significantly decreased (2-ΔΔCt: 1.21±0.10 vs. 1.82±0.17), collagen Ⅰ and Ⅲ secretion (mg/L: 10.68±0.54 vs. 14.55±0.33, 87.25±13.55 vs. 157.50±13.22) and expression (gray value: 179.41±45.00 vs. 432.35±56.00, 173.41±50.00 vs. 320.35±47.00), the level of MMP-2, MMP-9 and the expression of autophagy related protein LC3B-Ⅱ and P62/SQSTM1 (gray value: 172.0±23.0 vs. 249.0±21.0, 90.0±17.0 vs. 142.3±20.0, 138±15 vs. 178±19, 265.0±17.0 vs. 378.3±20.0) in the HG+Lv-miR1 group were decreased and the expression of lysosomal associated protein Cathepsin D was higher (gray value: 110±17 vs. 60±14), and the differences were statistically significant (all P < 0.05). Conclusions The expression of miRNA-1 was up-regulated in cardiac fibroblasts cultured in high glucose, and miRNA-1 silencing inhibited cardiac fibroblast induced fibrosis in high glucose. The mechanism may be related to the recovery of autophagy flux, up-regulation of Cathepsin D expression and inhibition of collagen production.

Acupuncture Therapy ; Aged ; Female ; Humans ; Radiotherapy ; adverse effects ; Tonsillar Neoplasms ; radiotherapy ; Xerostomia ; etiology ; therapy

Objective To investigate the effect of hydrogen sulfide (H 2 S or NaHS)on myo-cardial ischemia reperfusion injury induced in type 2 diabetic rats in vivo and the role of AMP-activated protein kinase (AMPK)signal pathway.Methods The induced type 2 diabetic rat models were anesthetized,left thoracotomy were performed.All the models were randomly divided into six groups (n = 14):group Sham;group IR:the left anterior descending artery was ligated 30 min, reperfused for 4 hours;group CC:prior to thoracotomy,compound c was intraperitoneally injected 250 μg/kg,then received the same treatment as group IR;group DMSO received the same treatment as compound c group but DMSO was injected intraperitoneally as control;group NaHS:the left ante-rior descending artery was injected NaHS 0.05 mg/kg then reperfused for 4 hours;group CC +NaHS:prior to thoracotomy,compound c was intraperitoneally injected 250 μg/kg,then NaHS 0.05 mg/kg injected intravenously and reperfused 4 hours.All the rat models euthanatized,infarcted area was detected by TTC assay.The AMPK,LC3 and p62 were analyzed by Western blot.Results Com-pared with group Sham,the infarcted area and concentration of AMPK,LC3 and p62 were increased in other groups (P <0.05).Compared with group IR,the infarcted area and concentration of LC3, p62 markablely decreased in group NaHS (P < 0.05 ).Compared with group NaHS,the infarcted area and concentration of LC3,p62 significantly increased but AMPK down-regulated in group CC+NaHS (P <0.05).Conclusion Hydrogen sulfide could alleviate myocardial infraction via AMPK sig-nal pathway in type 2 diabetic rats'IR models.