Objective To discuss the causes and treatment of angulated healing of long bone shaft fracture at lower limbs. Methods 12 cases of patients with the angulated healing of femoral and tibiofibular fractures were treated surgically in our hospital. In the operation, the plane and angle of the osteotomy were designed according to the specific angulation to restore the normal vertical alignment of the knee joint so that traumatic arthropathy of the knee could be treated or prevented. Results All the patients were followed up for 6 months to 12 years (averaging 66 months). Their lameness was greatly improved, the pain at their knee joints was relieved, and the occurrence or development of the arthropathy were obviously delayed. Conclusions When the angulation of healed long bone shaft fracture at lower limbs exceeds the physical weight bearing line, the condition should be treated surgically. The corrected angulation can delay the occurrence and development of arthritis at the knee. Moreover, corrected angulation and restored alignment is a good method to treat arthropathy of the knee joint.

OBJECTIVE:To understand the situation of essential medicines and promote their rational use in our hospital. METHODS:The prescription variety and cost percentages of essential medicines in outpatient department in the two halves years of 2013 in our hospital(eye and ENT specialized hospitals)were compared;the medicines with forefront prescription kind percent-ages in eye and ENT departments were sorted and rankings in 4 quarters were compared. RESULTS:After the approval of the Na-tional Essential Medicine List(2012 edition),compared with the first half year of 2013,prescription variety and cost percentages of essential medicines in outpatient department in the second half year were significantly increased (P<0.01). Prescription variety and cost percentages of essential medicines in eye department in the second half year were significantly increased(P<0.01),in the top 20 prescription variety,totally 2 kinds were contained by the list 2012 edition and 3 were contained by the supplementary list of Shanghai(2012 edition). Compared with the first half year of 2013,prescription variety and cost percentages of essential medi-cines in ENT department in the second half year were significantly decreased(P<0.01),the cost percentage was significantly in-creased(P<0.01),in the top 20 prescription variety,totally 2 kinds were contained by the list 2012 edition and 3 were contained by the supplementary list of Shanghai (2012 edition). CONCLUSIONS:The prescription variety and cost percentages of essential medicines in our hospital show increase trend. Nevertheless,the non-essential medicines are still dominant and further improvement of essential medicines is still needed. Medicine variety and dosage forms of eye in ENT department are insufficient concluded in Es-sential Medicine List. Further adjustment of Essential Medicine List still needs more consideration for the medication characteristics in specialized hospital.

Objective:To observe the diuretic action of Liniao Capsules (LC). Methods: The urinary effects of LC were studied in the loading rats with water.Results: LC could significantly increase the urinary output, shorten the latent period of emiction, and reduce the contents of TP in urine and BUN in blood serum. Conclusion: LC exerted the significant diuretic effect in rats.

Objective:To predict the dose of lumbosacral spine (LS) and pelvic bone marrow (PBM) based on kernel density estimation (KDE) in patients with gynecological tumors.Methods:Fifteen patients with gynecological tumors receiving radiotherapy plans with dose limitation for LS and PBM in our hospital were selected as training data for machine learning. Another 10 cases were selected as the data for model validation. The minimum directional distance between the dose point in the organs and the edge of the planned target volume for the LS and PBM was calculated. Model training was performed by KDE. The accuracy of the model prediction was evaluated by the root mean square error. The model was utilized to predict the actual planned doses of the LS and PBM, and a linear fitting was performed on the predicted dose volume histogram (DVH) and actual results. The prediction effect was assessed by the goodness of fit R 2. Results:In terms of the DVH parameters required by the planner, the prediction doses from the model were similar to those of the verification plans: the difference of PBM V 40Gy was 2.0%, the difference of the mean dose was 1.6 Gy, and the difference of LS V 10Gy was -0.4%. In the unrequired DVH parameters, except for the PBM V 10Gy, the predicted values of the model were significantly high. The difference between the DVH predicted by the model and the actual plan was small, and the R 2 of the LS and PBM were 0.988 and 0.995, respectively. Conclusions:The model based on KDE method can accurately predict the doses of the LS and PBM. This model can also be used as a method to ensure the quality of the plan, and improve the consistency and quality of the plan.

Objective To evaluate the effect of acupuncture on the quality of recovery during the early period after gynecological laparoscopic surgery using the Quality of Recovery?40 questionnaire ( QoR?40). Methods Sixty patients, aged 20-60 yr, with body mass index of 18.5-28.0 kg∕m2, of American Society of Anesthesiologists physical status ⅠorⅡ, scheduled for elective gynecological laparoscopic surgery, were equally and randomly divided into either control group ( group C ) or acupuncture group (group Acu) using a random number table. Bilateral Neiguan (PC6) and Hegu (L14) acupoints were stimulated for 30 min starting from the time point before skin incision and immediately after the end of surgery. The quality of recovery was assessed using the QoR?40 on 1 day before surgery, and at 24 and 48 h after surgery. The patient′s cognitive function was assessed using Mini?Mental State Examination. The requirement for rescue analgesics was recorded. The occurrence of nausea and vomiting was also recorded. Results Compared with group C, the global QoR?40 and Mini?Mental State Examination scores were significantly increased, and the incidence of nausea and vomiting and requirement for rescue analgesics were decreased at 24 and 48 h after surgery in group Acu ( P<0. 05 ) . Conclusion Acupuncture can improve the quality of recovery during the early period after gynecological laparoscopic surgery using the QoR?40.

Objective To evaluate the effect of isoflurane preconditioning on the expression of hippocampal GluR1 subunits-containing α-amino-3-hydroxy-5-methyl-4-isoxazolepropionate(AMPA)receptors in a rat model of focal cerebral ischemia-reperfusion(I/R).Methods Forty-eight pathogen-free healthy male Sprague-Dawley rats,weighing 250-280 g,aged 7-8 weeks,were divided into 3 groups(n=16 each)using a random number table:sham operation group(group S),focal cerebral I/R group(group I/R)and isoflurane preconditioning group(group IPC).Focal cerebral I/R was induced by occlusion of the middle cerebral artery for 2 h followed by reperfusion to induce cognitive decline in I/R and IPC groups. Rats were exposed to 1.5% isoflurane for 1 h every day for 5 consecutive days,and the model was established at 24 h after the last exposure in group IPC. Eight rats in each group were selected to perform Morris water maze test for 6 consecutive days starting from 9 or 23 days after operation. The rats were sacrificed at 14 and 28 days after operation,and the hippocampal tissues were obtained for determination of the expression of GluR1 mRNA(by using real-time polymerase chain reaction)and GluR1 protein(by Western blot).Results Compared with group S,the escape latency was significantly prolonged at each time point after operation,the frequency of crossing the original platform quadrant and percentage of swimming distance at the original platform quadrant were decreased at 14 and 28 days after operation,and the expression of GluR1 protein and mRNA was down-regulated at 14 days after operation in I/R and IPC groups(P<0.05).Compared with group I/R,the escape latency was significantly shortened at 10-13 days after operation,the percentage of swimming distance at the original platform quadrant and frequency of crossing the original platform quadrant were increased at 14 days after the operation,and the expression of GluR1 protein and mRNA was up-regulated at 14 days after operation in group IPC(P<0.05).Conclusion The mechanism by which isoflurane preconditioninig improves the cognitive function is related to up-regulation of the expression of hippocampal GluR1 subunits-containing AMPA receptors in a rat model of focal cerebral I/R.

Objective To evaluate the effect of isoflurane preconditioning on autophagy during focal cerebral ischemia-reperfusion (I/R) injury in rats.Methods Thirty-six healthy male Sprague-Dawley rats,weighing 250-280 g,aged 7-8 weeks,were divided into 3 groups (n =12 each) using a random number table:sham operation group (group S),cerebral I/R group (group I/R) and isoflurane preconditioning group (group IP).Focal cerebral I/R was induced by 2 h middle cerebral artery occlusion followed by 24 reperfusion.Group IP inhaled 1.5％ isoflurane for 1 h per day for 5 consecutive days,the other two groups only inhaled 30％ oxygen,and focal cerebral I/R was induced at 24 h after the last inhalation.At 24 h of reperfusion,neurologic deficit was assessed and scored,the rats were then sacrificed,and brains were removed for determination of cerebral infarct size (using triphenyl tetrazolium chloride staining) and expression of microtubule-associated protein 1 light chain 3-Ⅱ (LC3-Ⅱ) and Beclin-1 (by Western blot).Results Compared with group S,the neurologic deficit scores and cerebral infarct size were significantly increased,and the expression of hippocampal LC3-Ⅱ and Beclin-1 was significantly up-regulated in I/R and IP groups (P＜0.05).Compared with group I/R,the neurologic deficit scores and cerebral infarct size were significantly decreased,and the expression of hippocampal LC3-Ⅱ and Beclin-1 was significantly upregulated in group IP (P ＜ 0.05).Conclusion The mechanism by which isoflurane preconditioning ameliorates focal cerebral I/R injury is related to enhancement of autophagy in the rats.

Aims Toevaluatethepharmacodynamic efficacy of different types of antiangiogenic agents as HM-3 on a non-small cell lung cancer xenografts tumor model .To explore the interaction between the antian-giogenic agents and the tumor microenvironment,and to offer suggestions for clinical therapy.Methods Thenon-smallcelllungcarcinomaxenograftmodelwas established in Balb/c nude mice.The model mice were treated with Docetaxel(10 mg·kg-1 )as the positive control.The mice were parallelly treated with,HM-3 at the doses of 3 mg · kg-1 and 48 mg · kg-1 and, Avastin(5 mg·kg-1 ).The parameters include tumor volume,tumor weight and immunohistochemical analy-sis.Result Animalexperimentsshowedthatdocetaxel had good anti-tumor activity.Tumor growth inhibition by tumor weight of G2 docetaxel(10 mg·kg-1 )group was 60. 80%.Tumor growth inhibition by tumor weight of G3 HM-3(3 mg·kg-1 )group,G4 HM-3(48 mg· kg-1 )group ,G4 Avastin(5 mg·kg-1 )group,were 43. 60%,-34. 80%,44. 40%,respectively.Con-clusion Theantigiogeniceffectisaffectedbytumor growth stage,tumor microenvironment and their work-ing mechanisms.Angiogenesis inhibitors HM-3 has a certain effect of inhibiting tumor growth,but to little a-vail.HM-3 shows on inhibitory effect in a dose-de-pendent manner at the doses of 0~6 mg·kg-1 .HM-3 at a high dose of 48 mg · kg-1 has no inhibitory but promoting effects on human non-small cell lung carci-noma A549 xenografts in nude mice .Special dose-effect relationship indicates that dosage should be paid attention to in the clinical use of blood vessel inhibi-tors.

Objective:To explore the effect of online appointment system of standardized patients (SP) in cardiology practice teaching.Methods:The undergraduate students who entered the cardiology department of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine for clinical practice in 2018 and 2019 were selected as teaching objects, and they were divided into traditional teaching group ( n=30) and appointed SP teaching group ( n=30). After the teaching, SPSS 19.0 software was used for data analysis to compare the teaching effect of the two groups. Results:The scores of SP teaching group were higher than those of traditional teaching control group, with statistical significance ( P<0.05). Conclusion:Through constructing SP database and typical case database, online appointment system of SP for medical history inquiry and doctor-patient communication skills training can effectively solve the problems such as lack of clinical practice cases and doctor-patient contradiction, and greatly improve the teaching efficiency.

Objective: To observe the effects of electroacupuncture (EA) pretreatment on M1 polarization of alveolar macrophages (AMs) in rats with acute lung injury (ALI) induced by lipopolysaccharide (LPS), and to explore the potential protective mechanism of EA.Methods: Forty Sprague-Dawley rats were randomly divided into a normal group, a model group, and three groups of EA pretreatment [including a Chize (LU5) group, a Zusanli (ST36) group and a Chize (LU5) plus Zusanli (ST36) group], with eight rats in each group. The model rats of ALI were established by instilling LPS [2 mg/(kg·bw)] into the trachea of rats for 3 h. The rats in each EA pretreatment group were pretreated with EA for 30 min per day at the corresponding bilateral acupoints 6 d before instilling LPS. Three hours after modeling, the pulmonary function of the rats was tested, and the lung tissue was taken to calculate the ratio of lung wet weight to dry weight (W/D). The pathological lung changes and the injury score were observed by hematoxylin-eosin staining. The contents of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and myeloperoxidase (MPO) in rat's bronchoalveolar lavage fluid (BALF) were detected by enzyme-linked immunosorbent assay. The mRNA and protein expression levels of M1 macrophage markers clusters of differentiation 86 (CD86), inducible nitric oxide synthase (iNOS), and its signaling pathway factor Toll-like receptor (TLR) 4, and nuclear factor-κB (NF-κB) p65 in the alveoli were detected by fluorescence quantitative polymerase chain reaction and Western blot, respectively. Results: After being induced by LPS, the pulmonary function of the model rats showed that the forced expiratory volume in 0.1 s (FEV0.1), forced expiratory volume in 0.3 s (FEV0.3), and their respective ratios of FEV to forced vital capacity (FVC) (including FEV0.1/FVC and FEV0.3/FVC) were significantly decreased (P<0.01), while the W/D of lung tissue was increased (P<0.01). The score of lung injury was significantly higher (P<0.01). The contents of TNF-α, IL-1β, and MPO in the BALF and the mRNA and protein expression levels of CD86, iNOS, TLR4, and NF-κB p65 in the lung tissue were significantly increased (P<0.01). After EA pretreatment, the FEV0.1, FEV0.3, FEV0.1/FVC, and FEV0.3/FVC were significantly increased, the lung injury score decreased significantly, and the contents of TNF-α, IL-1β, and MPO in the BALF and the expression levels of CD86, iNOS, TLR4, and NF-κB p65 mRNAs and proteins in the alveoli decreased significantly (P<0.05 or P<0.01). Compared with the other two single acupoint groups, the contents of TNF-α, IL-1β, and MPO in the BALF and the expression levels of CD86, iNOS, TLR4, and NF-κB p65 mRNAs in the alveoli in the Chize (LU5) plus Zusanli (ST36) group were significantly lower (P<0.01). Conclusion: EA pretreatment at Chize (LU5) and Zusanli (ST36) can inhibit inflammation and reduce pulmonary injury in ALI rats induced by LPS. The effect of the combination of Chize (LU5) and Zusanli (ST36) is better than that of using these two acupoints separately, and its mechanism may be related to the inhibition of AMs' M1 polarization by down-regulation TLR4/NF-κB signaling pathway.