The professionalism view of qualified person and some reasonable proposals for the promotion of the professionalism are put forward. The necessity of the professionalization of qualified person and the effective measures of perfecting the professionalization are studied by the comparative analysis between home and abroad combined with the game model analysis. Under the current national conditions, qualified person are repositioned, and after learning the advanced experience of the EU, the registration system is strictly carried out, which can promote the professionalism of qualified person and make relevant measures in order to restrict the behavior of qualified person.

Objective To investigate the clinical features of rotavirus enteritis combined with hepatic lesion. Methods Hepatic function and B type ultrasonic wave inspection were carried out among 485 cases of rotavirus enteritis and clinical features of 108 cases united with hepatic lesion were analyzed. Results (1) Among 108 cases of rotavirus enteritis united with hepatic lesion, ALT increased in 30 cases, accounted for 27.8% of all patients and AST increased in 18 cases (16.7% ) ; ?-GT increased in 10 cases , constituting 9.3% of all patients . simultaneous increased of ALT and AST occurred in 24 cases, accounting for 22.3% ; simultaneous increased of ALT , AST and ?-GT occurred in 12 cases, accounting for 11.1% ; simultaneous increased of transaminase and cholochrome ( TBIL or DBIL ) in 3 cases , accounting for 2.7%; hepatic disfunction and tumefaction were also observed in 8 cases (7.4% ) ; The total cases of increase in ALT were 66 (61.1%) ; the total cases of increase in AST are 54 ( 50 % ) ; The total cases of increase in?-GT are 21 (20.4%). (2)After two weeks , ALT returned to normal in 60 cases ( 90.9%) ; AST returned to normal in 51 cases (94.4%) ; ?-GT returned to normal in 21 cases ( 95.5% ) ; Cases with TBIL or DBIL increased and ALB decreased, hepatic tumefaction recovered within 2 weeks. Conclusion The cases of rotavirus enteritis may be combine with hepatic lesion, increase in ALT and AST are most frequently observed. The prognosis is fairly good after antivirus and protect hepatic therapy , most of the sick children recover from hepatic function lesion and hepatic tumefaction within 2 weeks.

BACKGROUND:Pelvic fractures are mostly caused by high energy trauma. With the development of imaging techniques and in-depth study of the anatomical structure of the pelvis and biomechanics, internal fixation and external fixation materials are gradual y being used in the repair of pelvic fracture. OBJECTIVE:To summarize features and applications of external fixation stent material, percutaneous screw fixation, percutaneous sacral iliac screw material for internal fixation and intramedul ary tensile screw material for internal fixation after pelvic fracture. METHODS:We retrieved Wanfang Database and PubMed for studies on the application of internal fixation material and external fixation material in pelvic fracture from 1994 to 2015. Al data were analyzed and summarized. RESULTS AND CONCLUSION:Application of pelvic external fixation materials contributed to the stability of early pelvic fractures, showed smal injury, could increase the reliability of fixation. However, the biomechanical stability of external fixation materials was lower than other internal fixation, could only be used for the early temporary fixation of unstable pelvic fractures in particular cases. Internal fixation materials can achieve anatomical reduction, accorded with the requirements of the physical mechanics of the pelvis, improve the stability of the pelvis, and have become the first choice for repair of unstable pelvic fractures. Currently used methods are percutaneous hol ow screw fixation, percutaneous fixation of the sacral iliac screw, and intramedul ary lag screw fixation. The combination of external fixation and internal fixation can effectively restore the stability of the pelvic cavity. Therefore, we should consider the location, type and stability of the fracture to select the appropriate internal fixation and external fixation materials.

Age Determination by Skeleton ; Body Weight ; drug effects ; Child ; Drugs, Chinese Herbal ; therapeutic use ; Estradiol ; blood ; Female ; Humans ; Puberty, Precocious ; blood ; drug therapy ; physiopathology ; Yin-Yang

OBJECTIVE: To observe the intervention effect of acupuncture at the anterior oblique parietotemporal line on gray matter remodeling in patients with hemiplegia of cerebral infarction based on voxel-based morphology (VBM), and to reveal the advantages and central effect sites of scalp acupuncture for hemiplegia of cerebral infarction. METHODS: A total of 18 patients with hemiplegia of cerebral infarction in the right basal ganglia and 18 healthy subjects were enrolled and T1 structural scan was performed. The patients were randomly divided into scalp acupuncture group and non-scalp acupuncture group, with 9 patients in each group. SPSS20.0 was used to analyze the degree of neurological deficit (NIHSS) before and after treatment, and SPM8 software package was used to compare the change in gray matter after treatment between the two groups, the difference in gray matter between patients and healthy subjects. RESULTS: After treatment, the scalp acupuncture group had a significant reduction in NIHSS (P<0.05), while the non-scalp acupuncture group had no significant change in NIHSS (P>0.05); the scalp acupuncture group had a significantly lower NIHSS than the non-scalp acupuncture group after treatment (P<0.05). Compared with the healthy subjects, the patients with cerebral infarction had a voxel increase of gray matter in the bilateral cerebellum; after 2 weeks of treatment, the scalp acupuncture group had a voxel increase of gray matter in the motor-related cortex (such as the cerebellum, the anterior cingulate, the basal nucleus, and the medial frontal gyrus) and some parts of the sensory cortex, while the non-scalp acupuncture group had a slight voxel increase of gray matter in few brain regions which were not associated with motor. After treatment, the scalp acupuncture group had a voxel increase in the brain regions of the basal ganglia, mainly the lenticular nucleus and the claustrum. Compared with the non-scalp acupuncture group after treatment, the scalp acupuncture group had a greater gray matter increase in the brain regions mainly in the bilateral cerebellar cortex. CONCLUSION: Acupuncture at the anterior oblique parietotemporal line can promote neurological function recovery in patients with hemiplegia, possibly by promoting gray matter remodeling in the motor centers of the extrapyramidal system (mainly the bilateral cerebellum and the contralateral basal ganglia) and some parts of the sensory cortex and inducing functional compensation in corresponding brain regions.

OBJECTIVE:To explore the training method for the postgraduates majoring in medicine management,and provide reference for the teaching effect of medical management. METHODS:Based on the existing problems in the training mode of post-graduates majoring in medical management,the foundation,feasibility implementation process of the coalition of college and enter-prise were analyzed. RESULTS & CONCLUSIONS:The training mode of coalition of college and enterprise can really make teach-ers,students and enterprises to achieve a win-win situation;at the same time,through the feasibility analysis of the training mode, the performance evaluation method of multi-level evaluation system and fuzzy comprehensive evaluation are put forward to finally achieve the exploration of training management mode of undergraduates from the perspective of operational level. But in the owner-ship of intellectual property rights,technology security,personal safety of graduate and other aspects still exist some problems and need further improvement.

Objective To study the significance of pain symptoms and physical signs to diagnosis of deeply infiltrating endometriosis (DIE).Methods Totally 500 patients with laparoscopic diagnosis of endometriosis were studied retrospectively and divided into two groups depending on the existance of DIE.The pain symptoms and gynecological physical signs were recorded detail,and the correlation with diagnose of DIE were analyzed.Results (1) The significance of pain symptoms:the sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV) and OR,95％ CI of each pain symptom were:dysmenorrhae (90.5％,37.2％,59.6％,79.3％,5.66,3.46-9.28),chronic pelvic pain (35.2％,82.6％,67.4％,55.4％,2.58,1.70-3.91),dyspareunia (46.2％,80.6％,70.7％,59.6％,3.56,2.39-5.32),dyschezia (51.0％,73.7％,66.5％,59.5％,2.91,2.00-4.24),respectively.(2) Pelvic physical examination:the sensitivity,specificity,PPV and NPV of each physical sign were:fixed uterine:73.6％,71.2％,79.5％,64.0％; fixed ovarian cyst:94.1％,20.3％,63.3％,70.0％; uterosacral ligaments nodule:47.1％,97.5％,96.6％,54.9％; uterosacral ligaments nodule with tenderness:81.7％,75.0％,83.1％,73.2％; rectovaginal septum nodule:32.2％,100.0％,100.0％,49.4％; rectovaginal septum nodule with tenderness:32.2％,100.0％,100.0％,49.4％; blue nodule in posterior vaginal forni:14.9％,100.0％,100.0％,43.7％.Conclusions In the symptoms,the dysmenorrheal has the highest sensitivity and NPV for the diagnosis.And chronic pelvic pain has the highest specificity,and dysparaunia has the highest PPV for the diagnosis.In pelvic vaginal examination,fixed uterine,fixed ovarian cyst and the nodule on uretosarcal ligment and rectovaginal septum with tenderness,the blue lesion on posterior fornix have the strong significance for DIE.So record the symptom detail and careful digital vaginal examination,especially the vaginal-recto-abdominal examination could improve the diagnosis DIE obviously before procedure.

Objective To observe the anti-inflammatory effects of three kinds of aconine from Radix Aconiti Lateralis Preparata ( Fuzi) on macrophages, as well as the effects of their combination with sinomenine. Methods The effect of three monoester alkaloids from Fuzi, benzoylaconine ( BAC) , benzoylmesaconine ( BMA) and benzoylhypaconine ( BHA) , on RAW264.7 cells proliferation was detected by cell counting kit 8 (CCK8) in vitro. RAW 264.7 macrophage cells were stimulated by lipopolysaccharides (LPS) and then treated with different concentrations of BAC, BMA, and BHA. Tumor necrosis factor alpha ( TNF-α) and interleukin 6 (IL-6) secreted by RAW264.7 cells were measured by enzyme-linked immunosorbent assay (ELISA) . The anti-inflammatory effects of three monoester alkaloids combined with sinomenine were evaluated by Zhengjun Jin Q method. Results The concentrations of TNF-α and IL-6 secreted by LPS-stimulated RAW264.7 cells were increased significantly ( P<0.01) , and then were inhibited by BAC ( 20, 30 μmol/L) , BMA ( 40, 80, 160μmol/L) and BHA ( 40, 80, 160 μmol/L) significantly ( P<0.01) . Antagonistic effects were present when 30 μmol/L of BAC or 160 μmol/L of BMA or 160 μmol/L of BHA was respectively used together with 100 or 300 μmol/L of sinomenine (Q<0.85). Conclusion The three kinds of monoester alkaloids from Fuzi exert anti-inflammatory effect on macrophages, and the effective dose of BAC is lower than that of BMA and BHA. The combination of BAC, BMA or BHA at the analyzed dosage with sinomenine has antagonistic effect.

Objective To investigate the effect of berberine on the polarization of mice RAW264.7 macrophages induced separately by lipopolysaccharide (LPS) and interleukin-4 (IL-4). Methods Mice RAW 264.7 macrophages cultured in vitro were divided into model group, medication group, and blank control group. Both model group and medication group were given either LPS (in final dose of 100 ng/mL) or IL-4 (in final dose of 10 ng/mL). Additionally, the medication group was treated with berberine in final dose of 20 μmol/L. The blank control group was given the same volume of phosphate buffered saline ( PBS). Real-time fluorescence quantitative polymerase chain reaction (PCR) was used to detect the mRNA expression of arginase-1 (Arg-1), inducible nitric oxide synthase ( iNOS) , suppressor of cytokine signaling2 ( SOCS2) and SOCS3. Enzyme-linked immunosorbent assay (ELISA) was used to determine the contents of tumor necrosis factor alpha (TNF-α) and IL-10. Results The content of TNF-αand the mRNA expression levels of iNOS and SOCS3 in macrophages induced by LPS were increased, and then were down-regulated by berberine (P<0.05 or P<0.01) . The content of IL-10 and the mRNA expression level of Arg-1 in macrophages induced by IL-4 were increased, and then were down-regulated by berberine ( P<0.05), but berberine had no effect on the mRNA expression level of SOCS2 ( P>0.05). Conclusion Berberine has an effect on inhibiting the M1 and M2 polarization of macrophages in vitro, suggesting that berberine may play a regulatory role in the dynamic balance of M1/M2.

Objective To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.