Intertrochanteric fractures occur mostly in the elderly population. Direction of fracture line, lesser trochanteric fracture, comminution and displacement are the chief concerns in radiological diagnosis of intertrochanteric fractures. Interchanteric fractures can be classified by Evansgrading, Jensens modification of Evansgrading, AO classification, and so on, which are to judge the stability of the fracture. Currently, the basic priciple of management is operation and fixation. The common implants of internal fixation consist of two basic kinds: gliding compression screws with lateral plate, such as dynamic hip screws (DHS), and intramedullary nail fixation, such as Gamma nails and proximal femoral nails. Exteranl fixators are only applied in cases of severe multiple trauma and elderly patients, and artificial joint replacements in those of serere comminuted fractures combined with high osteoporosis.

Radiotherapy has been proven to enhance tumor-specific immune response and provide targets for immune drugs. Immune checkpoint inhibitors represented by PD-1/PD-L1 combined with radiotherapy can enhance anti-tumor activity and exert abscopal effect. In this article, research progress on the basic study and clinical trials and challenges of radiotherapy combined with PD-1/PD-L1 inhibitors in the treatment of breast cancer were reviewed.

Impacted femoral neck fractures should be treated operatively as displaced fracture. Many authors suggested emergency operation. The principle of treatment of femoral neck fractures is anatomic reduction, fragmental compression,and rigid fixation. Closed reduction must be done in most cases. When close anatomic reduction can not be achieved, open reduction should be considered.Implants used recently consist of pins , screws,hook pins and gliding screws with side plate. Every implant has its own advantages, disadvantages and indications. The principle of treatment of femoral neck fractures in young patients is emergency operation (within 12h after trauma), anatomic reduction (open reduction when necessary), and rigid fixation with screws. Some authors stated the necessity of anterior capsularoctomy.

Osteoporosis is considered as the most important factor which causes the fracture of the femoral neck. Comminution of fracture and rigidity of fixation are greatly affected by the degree of osteoporosis. Femoral neck fractures in young patients are mainly caused by severe trauma. Although Garden classification is widely accepted in classifying femoral neck fractures, in the recent decades some doctors have found out some shortcomings in Garden classification in practical application. It has been suggested to classify the femoral neck fractures simply into displaced and undisplaced ones. Arthroplasty used to be thought as the choice of treatment of femoral neck fractures in the elderly. Application of arthroplasty must accord with the indications, not only with the age of the patient or the degree of the displacement of the fracture. There is no X ray diagnosis specially for the avascular necrosis of femoral head secondary to femoral neck fracture, other than Ficat Arlet grade system. MRI is considered to be the only method to diagnose the avascular necrosis of femoral head at an early stage and to defect its extent and location.

To review the outcome of the endovascular treatment of aortoiliac occlusive disease,the recent literature concerning endovascular treatment as well as aortoiliac occlusive disease was extensively reviewed,and the research and development were summarized.The results are:(1) In most cases,endovascular invention is better than surgery ; (2) Stent placement has a higher technical success rates and a better longterm outcome than percutaneous transluminal angioplasty,primary or selective stent placement,which is better,is controversial; (3)Covered stents perform better than bare stents in longer-term patency and clinical outcome ; (4)Endovascular treatment of complex AIOD provides excellent early and long-term results,similar to those obtained in the treatment of simple lesions.So,in general,endovascular treatment of aortoiliac occlusive disease provides excellent clinical results,further research is needed.

Objective:To provide the scientific reference basis in order to establish a perfect cost controlled system for medical consumable. To analyze game factors, such as main resource, the price-off influence and price-off aspiration and so on, from different views, such as medical institutions, patients, manufacturers and other stakeholders and so on, based on game theory and situation of medical consumables management.Methods: To collect the management information of medical consumables cost from a tertiary referral center hospital in Fujian in recent 3 years, and adopt descriptive study to analyze the income situation of medical consumable, medical consumable proportion and medical consumable cost per capita.Results: The medical consumable proportions from 2013-2015 were 14.44%, 16.27% and 18.75%, respectively. Medical consumable cost per patient from 2013-2015 were 3547.95RMB, 4122.3 RMB and 5059.02RMB, respectively. All of these datum contained the drug information.Conclusion: It is obvious that the medical consumable proportions and medical consumable cost per patient were enhancement from 2013 to 2015. The necessity of medical consumable leaded to the direct influence on medical cost. On the other hand, the artificially high price and unreasonable implement of medical consumable are the urgent problems and must be resolved as soon as possible.

The consistgncy of fostering high quality persons with excellent medical knowledge and medical moral has been the basic change of higher medical education adapting to current medical model and it is start and stay point of realizing medical educational goal.Therefore,higher medical school should focus on the stutas and function that medical ethical moral education plays in education according to the present condition of students' moral realizing level.This article puts forward that higher education school should make full use of medical ethical moral course and arouse major teacher's teaching positivity and strengthen medical ethical moral propaganda and educating function of managing work.

Objective:To provide scientific references for establishing a whole informatization management system of reagent used in science and research of hospital based on the root cause analysis (RCA). And to find existed problems and analyze main reasons from reagent management, material, time, financial, personnel and other factors through fishbone chart, and to provide relative management measurement of informatization.Methods: The reagent consumptions used in science and research of a tertiary referral center hospital in Fujian province in 2015 year were collected, and then the purchase amount and ratio of them were analyzed.Results: The purchase amount of reagent for science and research of this tertiary referral center hospital in Fujian province was more than 2.55 million RMB in 2015 year, and the ratio of national clinical key special projects was 23.32% and that of provincial clinical key special projects was 6.85%. The two items spent more purchase amount, and the type and ratio of reagent of various department was different depended on their own various developed situation.Conclusion: The informatization management and service mode of reagent used in science and research have very important role in the construction of soft power of hospital. In present, a series of disadvantages existed in various clinical and research department, for example, the use of reagents are scatter, involved professional span is larger and disperse, and accurate trace, dynamic tracking and flexible deploy machines are difficultly achieved. Therefore, how to promote comprehensive informatization management for relative resource, for optimizing structure configuration, for controlling cost and ensuring quality of reagent has became the most important task for informatization management of reagent used in science and research.

Paternity testing has to be cautiously practiced,since it involves issues coming from all aspects including ethics,legislation,family and society.If the educational backgrounds of the litigants prevent them from fully understanding the ethical and legal issues involved in paternal testing,it would thus be impossible to achieve a real "informed consent" for the litigants.It is our point of view that in these cases,and when no alternative solutions are available,it is the responsibility of those who perform paternity testing to advise the litigants give up the application for paternity test.Besides,it is time for judicial departments to place on the agenda the establishing of a technique standard for paternity testing and relevant judicial procedures,in order to protect the basic rights of informal consent and autonomy of litigants in paternity testing practices.It is in this article that some ethical and legal issues commonly involved in paternity testing are discussed.

BackgroundAllogenic immunological rejection is still the common cause of keratoplasty failure.Organ culture is a good choice for gradually attenuating corneal antigeniciy.However,the complicated regulatory mechanism of such allogenic rejection with organ culture gratts is unclear until now.ObjectiveTo investigate the changes of several Thl/Th2 cytokines and T lymphocyte subsets in the rat corneal allogenic transplantation rejection with organ culture grafts.MethodsThirty-six SPF Wistar rats served as donors,and 72 SPF SD rats served as recipients in this study.Seventy-two SD rats were divided into two groups randomly.Organ culture and fresh grafts from Wistar rats were performed on 36 recipients SD rats,respectively.Six normal SD rats were served as the normal control.After transplantation,graft survival time was observed ; Aqueous humor levels of IL-2,IFN-γ,IL-4 and TNF-α were measured by enzyme linked immunosorbent assay.Immunohistochemistry was performed to examine CD25 expressions in grafts.Levels of TNF-αmRNA,IFN-γmRNA,IL-4mRNA and CD25mRNA in grafts were detected by using reverse transcription polymerase chain reagction.The levels of CD28subsets in peripheralblood were determined by Flow Cytometry.The use of experimental animals followed the Statement of ARVO.Results The mean rat graft survival time was longer in the organ culture grafts group( 13.78 d) than that with fresh gratts( 10.56 d)(t=14.945,P =0.000 ).The aqueous humor levels of IL-2,IFN-γ,IL-4 and TNF-α were higher in two allograft groups at day 6,day 13 and day 24 after transplantation than that in the normal control,which peaked at day 13,and the fresh grafts group had the highest level( F=324.891,416.416,240.661,364.533,P=0.000).At day 13,CD25 was weakly expressed in frozen section of two operation groups.The expression of TNF-α and IFN-γmRNA in organ culture grafts group was markedly less than in fresh grafts group at day 13 after surgeries (t =2.464,P =0.039;t=5.438,P=0.001 ),whereas there was no significient difference in IL-4 and CD25 mRNA levels between them (t=-0.782,P =0.457,t =0.712,P =0.497).The percentages of CD28 of the fresh graft group increased significantly and more weakly expressed in organ culture grafts group (P =0.016 ). Conclusions Th1/Th2 cytokines and CD28 lymphocyte subsets may play important roles during corneal allograft rejection with organ culture grafts.