Classroom teaching is an important part of university education.We explore the methods to improve classroom teaching and the four criteria of it,and believe that cultivating people is much more important than barely imparting knowledge in modem society.And this,for university teachers,is duty-bound and challenging as well.

To analyze and summarize the connotation,elements,procedure and efficacy of cooperative learning in European medical education and provide reference to innovate our medical education.

Title is the "eye" of the whole paper concentrating and generalizing the basic content. The function, standardization and writing skills need to be paid attention to in the process of writing English titles in medical papers by authors.

Objective:To investigate the number and distribution of macrophages (Mφ) and natural killer(NK) cells in hepatocellular carcinoma (HCC), paraneoplastic,cirrhosis and normal liver tissues and their relationship with the prognosis of HCC patients.　Methods:Surgical specimens from 60 cases of HCC, 62 cases of cirrhosis and 23 cases of normal liver tissues were investigated by immunohistochemical staining of CD68 and CD57 with a streptavidin-horseradish peroxidase detective system.The correlation of the number of Mφ and NK cells in different tissues with the clinical tumor parameters was also studied.　Results:①The order of the number of Mφ from the highest to the lowest was:paraneoplastic,cirrhosis, normal, HCC(P<0.05)；and the number of NK cells from the highest to the lowest was:HCC, paraneoplastic, normal, cirrhosis(P<0.05).②The number of Mφ decreased successively with the decrease of the HCC differentiation(P<0.05)；There was no relationship between the number of NK cells in HCC and histological grade. ③There was no relationship between the number of Mφ in HCC and clinical TNM stage ；The number of NK cells in HCC had degressive tendency with the clinical TNM stage(P<0.05). ④The number of Mφ and NK cells in HCC in the cases with metastasis in 15 months was significantly lower than that without metastasis(P<0.05, 0.01）.⑤There was a linear positive correlation between the number of Mφ and NK cells in HCC (r＝0.344, P<0.05).　Conclusion:The number of Mφ and NK cells in HCC in the cases with metastasis is significantly lower than that without metastasis；The number of Mφ has a close correlation with the HCC differentiation, and positive correlation with the number of NK cells；The number of Mφ and NK cells might be important markers to estimate the immune status and useful factors to predict the prognosis of HCC patients.

Objective:To investigate the number of CD+68 cells in hepatocellular carcinoma (HCC),paraneoplastic tissues,cirrhosis tissues and normal liver tissues and their clinical significance.Methods:Surgical specimens from 60 cases of HCC,62 cases of cirrhosis and 23 cases of normal liver were investigated by immunohistochemical staining of CD+68with streptavidin-horseradish peroxidase detective system.Results:(1)The order of the mean number of CD+68cells in the tissues from the highest to the lowest was:paraneoplastic,cirrhosis,normal liver and HCC tissues(P〈0.01);(2)The number of CD+68cells in the tissues decreased successively with the decrease of HCC differentiation (P〈0.05);(3)There was no relationship between the number of CD+68cells in HCC and its clinical TNM stage;(4)The number of CD+68cells in the cases with metastasis within 15 months was significantly lower than that without metastasis (P〈0.05).Conclusion:The number of CD+68cells might be an important marker to estimate the immune status and a useful factor to predict the prognosis of HCC patients.

Objective To investigate the radiological characteristics and the relationships between the parameters by X?ray and direct magnetic resonance arthrography (dMRA) in non?completely dislocated dysplasia hips. Methods We retro?spectively reviewed patients (above 13 years old) with dysplasia hips from August 2009 to August 2012. These patients were classi?fied as Hartofilakidis typeⅠand typeⅡ. 188 patients (274 hips) involved 28 males (30 hips) and 160 females (244 hips), average aged 27.3 years (range 13-47 years). Standard pelvic A?P, bilateral 65° oblique X?rays, and dMRA were conducted in each pa?tient. Lateral central?edge angle (LCE), anterior central?edge angle (ACE), femoral neck?shaft angle (FNSA), and tonnis acetabu?lar index (AI) angle were measured based on the X?ray. The dysplasia hips were classified into 4 grades (GradeⅠ:CE 11°-20° , GradeⅡ:CE 1°-10°, GradeⅢ:CE-9°-0°, and GradeⅣ:CE≤-10°). Femoral neck anteversion angle (FNA), labral tear, labral inversion, and labral cyst was observed on dMRA films. Variance analysis and rank correlation were applied to find the relation?ship between CE grades and the relevant parameters by using SPSS 19.0. Results LCE has negative correlation with AI and grade of osteoarthritis, and has positive correlation with age, ACE. However, there was no relationship between FNSA and FNA. There was significantly different in Shenton's line, labral tear, labral inversion, cartilage lesion, among different grade of LCE. Conclusion LCE is an important parameter used in evaluating for dysplasia hips without complete dislocation. LCE can reflect age of onset, ACE, AI angle and degree of joint damages. Evaluation for the severity of non?completely dislocated dysplasia hips can be conducted according to grades of CE.

Objective To investigate clinical results of the treatment of posterior shoulder instability in a combined way of bone block procedure and posterior capsulorrhaphy. Methods The double contrast CT arthrography was performed for 5 patients suffering from posterior shoulder instability so as to detect the pathology. The treatments combining bone block procedure and posterior capsulorrhaphy were carried out according to the pathological conditions of bone and soft tissue. Results The double contrast CT arthrography showed posterior bone defects, posterior glenoid labrum tear and enlargement of posterior capsular cavity. After the bone block procedure and posterior capsulorrhaphy, no patients complained shoulder instability in the follow-up of 5 to 38 months. Conclusions Many pathological factors may induce posterior shoulder instability, which should be corrected by an appropriate operation rather than a “standard”method of operation. For patients involving several pathological factors, a combined operation may be needed in order to correct various pathological changes.

Objective To investigate the value of diffusion weighted imaging (DWI)in identification of different molecular sub-types for breast cancer classifications.Methods All patients with breast cancer were divided into four subtypes groups by immuno-histochemistry results including Luminal A subtype,Luminal B subtype,HER2-over expressing (HER2-OE)subtype,and triple negative breast cancer (TNBC),respectively.The means of maximum,average,and minimum ADC of the lesions in all patients were recorded.The analysis of ANOVA and least significant difference test (LSD-t )were used for the statistical evaluation.Results There were significant differences in maximum ADC,average ADC,and minimum ADC among Luminal A subtype (n=21),Lu-minal B subtype (n=22),HER2-OE subtype (n=1 7)and TNBC subtype (n=12)groups (P =0.025,0.039 and 0.041,respec-tively).However,paired comparison in mean of maximum ADC,average ADC and minimum ADC by LSD-t multiple comparisons among Luminal A,Luminal B,HER2-OE and TNBC respectively were not significantly different.Conclusion DWI may be difficult to discriminate the molecular subtypes of breast cancer classification before surgery or biopsy.

Objective To investigate the value of ADC histogram analysis in the assessment of response to neoadjuvant chemotherapy (NACT) in patients with in locally advanced breast cancer (LABC). Methods Thirty?five female patients with invasive ductal carcinoma proved by pathology before NACT and treated with operation after NACT were retrospectively analyzed. All patients were received MR examination (including non?enhanced MRI, enhanced?MRI, and DWI) breast before NACT. After neoadjuvant chemotherapy, 19 of 35 patients were categorized as responders and 16 were categorized as non?responders according response evaluation criteria in solid tumors criteria. Per?patient weighted ADC histograms were generated. Mean ADC, mode ADC, maximum ADC, minimum ADC, median ADC, skewness, and kurtosis were analyzed by using t test between responders and non responders groups. ROC curves were constructed to determine the optimum threshold for each histogram parameter to differentiate non?responders and responders in breast cancers. The optimal threshold values, determined by maximal Youden index were selected when significant differences existed in two groups. Results Mean, minimum, skewness, and kurtosis of ADC between responders and non?responders group were(0.955 ± 0.135)× 10?3mm2/s,(0.535 ± 0.115)×10?3mm2/s,0.85±0.61, 2.93±0.17,and(1.103±0.233)×10?3 mm2/s,(0.650±0.104)×10?3mm2/s,-0.42± 0.17, 3.11 ± 0.25,respectively. Significant differences were found mean ADC, minimum ADC, skewness, and kurtosis (t=2.345, 3.096, 8.051 and 2.524,P<0.05), and there was no differences in mode, median, maximum between responders and non?responders(P>0.05).We set the optimal threshold criteria of mean ADC (0.956×10?3mm2/s), minimum ADC (0.580×10?3mm2/s), skewness (0.890), sensitivity, specificity of three parameters for predicting responders in LABC were 73.7%,62.5%, 78.9%,68.8%, and 63.2%,75.0%, respectively, and the areas under ROC curve of mean ADC, minimum ADC, skewness was 0.678, 0.770, and 0.890, respectively. Kurtosis of responders and non?responders did not get cutoff value for much more overlap. Conclusion ADC histogram analysis is valuable in predicting LABC in patients with NACT effect, the minimum and skewness of ADC is highest sensitivity, specificity, respectively.

Objective To investigate the clinical efficiency and safety of femoral head reduction osteotomy for young patients with coxa magna or coxa plana.Methods Between June 2012 and September 2015,the clinical characteristics of 12 patients (13 hips) with coxa magna or coxa plana who underwent femoral head reduction osteotomy were analyzed retrospectively.There were 6 males (7 hips) and 6 females (6 hips) with average age 18.1 years (range,10-25 years).The etiology of the femoral head deformity was multiple epiphyseal dysplasia in 6 hips and Legg-Calvé-Perthes sequela in 7 hips.The head reduction osteotomy was conducted through the surgical hip dislocation approach combined with extended retinacular soft-tissue flap extending technique.All patients underwent simultaneous periacetabular osteotomy and relative lengthening of the femoral neck,of which four also underwent proximal femur derotational osteotomy.All patients received the standardized rehabilitation procedures.The postoperative complications,gaits,the range of motion (ROM) of the hip,Harris hip scores,iHOT scores and VAS were analyzed postoperatively.In addition,the lateral center-edge (LCE) angle,sphericity index and coverage rate of femoral head were assessed as well.Results The average follow-up duration was 28.8 months (range,12-45 months).All patients achieved osteotomy healing of the femoral head and greater trochanter with average healing time 3.7 months (range,3-7 months).Nine of 12 patients had significant gaits improvement.The Harris hip scores (81.08± 12.36 vs.88.38 ± 8.96,t=2.41,P=0.033),iHOT score (51.90± 15.07 vs.67.69±8.70,t=3.63,P=0.003),LCE angle (-1.82°±16.57° vs.36.02°±7.72°,t=10.52,P=0.000),sphericity index of anteroposterior pelvic radiographs (71.08％± 10.32％ vs.81.22％±8.61％,t=7.17,P=0.000) and the coverage index (48.79％±11.85％ vs.87.46％± 10.44％,t=8.56,P=0.000) were all significantly improved when compared to those preoperatively.The VAS score (4.46± 2.37 vs.1.23±0.93,t=4.25,P=0.001) was significantly decreased when compared with that preoperatively.However,for the sphericity index of 65° false profile (78.96％± 10.39％ vs.80.36％±8.42％,t=0.411,P=0.688) and the average hip ROM (264.62°± 32.05° vs.255.00°±40.31°,t=0.89,P=0.391),they did not achieve statistical significant difference.One case of femoral head necrosis site was localized at the lateral-superior part of femoral head,and there was no progression after 3 years follow-up.Moreover,no revision or total hip arthroplasty were observed due to other complications (osteoarthritis,hip pain or non-union).Conclusion The femoral head reduction osteotomy can correct deformity,improve femoral head sphericity,relieve pain and improve gaits and hip function.This procedure leads to satisfied clinical outcomes for patients with coxa magna or coxa plana in early follow-up.