188Re-HEDP is a bisphosphonate which preferentially incorporates into the sites of bone metastases.It interacts with bone metabolism,suppresses the activity of osteolysis,and gathers in tumor bone metastases.Recently,researches show that 188Re-HEDP has some advantages for palliation of bone metastasisrelated pain because of its favorable physicochemical and biological characteristics,188Re-HEDP radioisotopes therapy will be an effective method for bone metastatic tumors.

From the perspective of institute of medical higher education, a set of index system which include three first level indicators has been constructed, for medical academic postgraduate ed-ucation internal evaluation with the method of expert advice as well as in-depth interview, and then through Delphi consulting, the weight of every indicator has been calculated. The weight of three first level indicators are 0.28 (educational condition), 0.42 (educational process), 0.30 (educational results) respectively. Finally, how to carry out internal evaluation and how to apply the results effec-tively have been discussed.

Objective To investigate the proportion of follicular fluid CD56~+ natural killer (NK) cells to the total lymphocytes and the ac-tivated CD56~+ NK cells to the total CD56~+ NK cells. To provide an evidence for improving the clinical pregnancy rate in in vitro fertilization (IVF) treatment by regulating the function of NK cells. Methods Triple color flow cytometry was used to analyze the proportion of CD56~+ NK cells and activated CD56~+ NK cells in mature follicular fluid. The IVF treatment outcome was closely followed up. The relationship be-tween the proportion of CD56~+ NK cells and activated CD56~+ NK cells and the IVF treatment outcome was analyzed statistically. Results The proportion of CD56~+ NK cells and activated CD56* NK cells in mature follicular fluid of women who got pregnancy by IVF treatment was (15.57±3.10)% and (2.63±0.94)% respectively,while the proportion of the women who didn't get pregnancy was (19.12±5.37)% and (4.06±2.08)% respectively,which was significantly higher than the pregnant group(P< 0.05). Conclusion The women with lower propor-tion of CD56~+ NK cells and activated CD56~+ NK cells in mature follicular fluid of is easier to get pregnancy by IVF. An altered NK cells pro-file in follicular fluid could therefore influence fertility in IVF treatment outcome.

Objective To evaluate the clinical outcome of Osteoset artificial bone mixed Rifampicin for injection after radical debridement in the treatment of sacroiliac joint tuberculosis,and compare with debridement alone.Methods From May 2005 to August 2010,48 patients with sacroiliac joint tuberculosis patients underwent two different surgical methods were selected as analysis subjects in the Orthopedics Department of Chest Hospital of Hebei Province.Among them,27 cases underwent radical debridement and fusion with Osteoset artificial bone combined with Rifampicin for injection (Grafting group),and 21 case were treated with radical debridement only(Control group).The local wound healing,adverse reactions and regular imaging examination (pelvic X-ray and CT scan) were observed,and the surgical time,the intraoperative blood loss,postoperative 6 months and 12 months,18 months bone graft fusion rate,and Majeed scoring results of the patients were recorded and statistically analyzed.Results All patients were followed up from 20 to 30 months with an average of 24 months.There was no significant difference in terms of surgical time and operative bleeding between the two groups(P＞0.05).The rate of bone fusion in grafting group was 33.33％ (9/27) of 6 months after operation,88.9％(24/27) of 12 months after operation,and 96.3％ (26/27) of 18 months after operation.While that in control group was 4.76％ (1/21) of 6 months after operation,42.85 ％ (9/21) of 12 months after operation,and 42.85％ (9/21) of 18 months after operation.The differences of these parameters between the two groups were significant(x2 =5.85,20.92,15.90;P＜0.05).According to Majeed scoring system,the excellent and good rates were 100％ (27/27) in grafting group,76.19％ (16/21) in control group,the difference was statistically significant(x2=7.18 P＜0.05).Conclusion With Rifampicin loaded Osteoset artificial bone can recruit bone graft mass during the bone fusion for sacroiliac joint tuberculosis,and reduce the adverse reactions,achieve bone fusion earlier than the control group.

BACKGROUNDTo study the diagnostic significance of detecting p53 gene mutation in peripheral blood of lung cancer patients.

METHODSPCR-SSCP was used to detect p53 gene mutation in peripheral blood of 46 samples (lung cancer 28, benign lung diseases 8, healthy people 10).

RESULTSOf the 28 lung cancer patients, 4 cases (squamous cell carcinoma 1, adenocarcinoma 1, small cell lung cancer 2) had p53 gene mutation. The positive rate was 14.29%. Of the 4 positive lung cancer patients, one patient was in stage II, one in stage III, and the other two in stage IV. No p53 mutation was found in peripheral blood of 8 benign lung disease patients and 10 healthy persons.

CONCLUSIONSDetection of p53 gene mutation in peripheral blood cells may be helpful to the diagnosis of lung cancer, especially to the accurate staging of lung cancer.

Objective To improve the clinical oncology practice ability of professional degree postgraduates,and to explore the role of using standardized patients (SP) in problem-based learning (PBL) teaching method.Method Fifty-two professional degree postgraduates who studied clinical oncology in 2016 and 2017 in our department were taken as the research object,of which 26 were in the experimental group,26 were in the control group.In the experimental group,SP was used in PBL teaching method.In the control group,the traditional PBL teaching method was performed.After the end of the training course,data were analyzed using SPSS 19.0 software,count data and measurement data were analyzed using chi square test and t test to carry out the significant test between the two groups of data,the training effect was compared between the two groups.Results The score marked by experts in the experimental group was higher than that of the control group [(80.27 ± 6.41) vs.(74.77 ± 7.59)],the difference was statistically significant.The results of questionnaire survey showed that the experimental group was significantly higher than the control group in terms of patient satisfaction,clinical skills and participation in teaching activities (P＜0.05).Conclusion Introducing the SP into PBL teaching method could not only make PBL lively but also make SP teaching deeply.The organic combination of PBLand SP in the training process could improve the clinical oncology graduate students' abilities of clinical thinking,practice,doctor-patient communication,problems treatment,and humanistic care.This teaching model is worth promoting in the teaching of clinical oncology for profes-sional degree postgraduates.

Exosomes is a kind of nano-sized vesicles secreted into the extracellular environment. Exosomes contain many bioactive molecules including proteins, nucleic acids and lipids. Exosomes participate in the exchange of substances and information between cells, thus playing important roles in many physiological and pathological processes. In recent years, exosomes are found to be critically involved in the occurrence, development, metastasis and drug resistance of gastric cancer. Exosomes are present in various types of body fluids including blood and gastric juice. The detection of proteins and nucleic acids in exosomes from grastic cancer patients will be helpful to the early diagnosis, the evaluation of therapeutic effects, and the prediction of prognosis. This review summarizes the role, mechanism and clinical significance of exosomes in gastric cancer, in order to provide some new ideas and methods for the early diagnosis and treatment of gastric cancer.

Objective:To investigate the clinical value of zoledronic acid in improving the prognosis of osteoporotic hip fracture and preventing its sequential contralateral hip fracture.Methods:A retrospective study of 206 patients diagnosed with hip fragile fractures in China Medical University Affiliated Shengjing Hospital and treated with anti-osteoporotic drugs after surgery was conducted. The prognosis of patients with hip fracture using survival rate analysis and the risk factors of acute febrile complications with multivariate analysis after zoledronic acid treatment were evaluated. Furthermore, chi-square test and multivariate analysis was used to explore whether zoledronic acid decreases the occurrence of the contralateral sequential fracture.Results:The 3-year survival rate of patients with overall hip fracture was higher in zoledronic acid treatment group compared with control group( P=0.026), with the incidence of fever at 53.3%. The age [ OR=0.786, P=0.027, the area under receiver operating characteristic (ROC) curve was 0.724] and cardiopulmonary complications ( OR=0.043, P=0.025, the area under ROC curve was 0.628) were significantly correlated with the occurrence of acute febrile response. The incidence of sequential contralateral fractures in zoledronic acid treatment group was significantly lower than that in control group ( χ2=4.356, P=0.037). The application of zoledronic acid ( OR=0.160, P=0.007, the area under ROC curve is 0.586) and the type of femoral neck fracture ( OR=0.196, P=0.001, the area under ROC curve is 0.607) were statistically associated with the occurrence of sequential fractures. Conclusion:Zoledronic acid treatment improves the outcome of patients with osteoporotic hip fracture and reduces the incidence of sequential hip fractures, especially femoral neck fracture. Senile age and cardiopulmonary complications might be associated with lower risk of acute febrile reactions after zoledronic acid treatment.

[摘 要] 小细胞肺癌（SCLC）是肺癌中恶性程度最高的一种类型，其在全部肺癌病例中约占13%~15%。初治SCLC患者虽然对化疗和放疗具有较高的敏感性，但容易复发，导致患者生存率较低。2018年以来，随着IMpower133和CASPIAN研究相继成功，SCLC进入了免疫治疗时代，化疗联合免疫检查点抑制剂已成为广泛期SCLC的一线治疗标准方案。同时，免疫治疗在局限期SCLC中也取得了初步成功。SCLC的免疫治疗虽然取得了一些进展，但免疫治疗整体上带来的生存获益有限，缺乏有效的预测生物标志物，对复发/难治性SCLC缺少治疗手段，SCLC免疫治疗未来仍面临诸多挑战。本文回顾国内外SCLC免疫治疗临床研究的最新进展，分析不同类型的免疫治疗药物、生物标志物及新型免疫治疗靶点，探讨SCLC免疫治疗的联合策略和发展前景。

Triggering receptor expressed on myeloid cells-1 (TREM-1) is a member of the immunoglobulin superfamily. As an amplifier of the inflammatory response, TREM-1 is mainly involved in the production of inflammatory mediators and the regulation of cell survival. TREM-1 has been studied in infectious diseases and more recently in non-infectious disorders. More and more studies have shown that TREM-1 plays an important pathogenic role in kidney diseases. There is evidence that TREM-1 can not only be used as a biomarker for diagnosis of disease but also as a potential therapeutic target to guide the development of novel therapeutic agents for kidney disease. This review summarized molecular biology of TREM-1 and its signaling pathways as well as immune response in the progress of acute kidney injury, renal fibrosis, diabetic nephropathy, immune nephropathy, and renal cell carcinoma.