The training of residents constitutes the primary work of Graduate Medical Education.Reviewing the historical development of the training of residents,we find that it has experienced four stages and trended to establish the medical specialist training system.

The quality of doctoral degree conferring depends on the quality of doctoral dissertation.Based on the quality evaluation of doctoral dissertation in medical School of Shanghai Jiaotong University in 2005,the author points out the problems existing in doctoral dissertation nowadays and makes some explorations on how to improve the quality of doctoral degree conferring.

Based on the relevant theories and methods concerning the evaluation of higher education, authors used student questionnaires to evaluate the teaching quality of the 23 courses in the postgraduate curriculum, including basic theoretic courses, specialty-related basic courses and courses of methodology for scientific research. The methods used involve 'evaluation by students' and the integrated evaluation of both the quantitative and qualitative aspects of various factors. The easy-to-use student's questionnaires make it possible to find, with respect to students, teachers, and courses, many factors affecting the teaching quality, and at the same time, to provide the close following-up of the process of postgraduate training.

Objective To systematically assess the clinical efficacy and safety of acupuncture treatment for vertigo with excess syndrome. Methods Chinese and English literature about acupuncture treatment of vertigo with excess syndrome published in recent years was comprehensively searched. The quality of the retrieved literature meeting the inclusion criteria of randomized controlled trial was assessed and its data was collected. A Meta analysis of the included studies was carried out.Results Finally, 10 articles with randomized controlled trials containing a total of 688 patients were included in the analysis. The included literature was assessed at lower quality using Cochrane evaluation member manual 5.1. A Meta analysis showed that the efficacy rate of acupuncture treatment for vertigo with excess syndrome was higher than that of Western drugs alone [M-H OR 4.84, 95%CI (2.39, 9.81),P<0.0001]. Combined acupuncture and Chinese herbal medicine was superior to Chinese herbal medicine alone [M-H OR 3.82, 95%CI (2.06, 7.10),P<0.0001]. Vertigo symptom and function scoring showed day 3 of treatment [MD 4.66, 95%CI (2.97, 6.35)], day 7 of treatment [MD 0.95, 95%CI (0.03, 1.86)] and day 14 of treatment [MD 0.89, 95%CI (0.71, 2.49)]. There were statistically significant differences in the vertigo symptom and function scores between the two groups of patients at day 3 and 7 of treatment. There were no statistically significant differences in the scores between the two groups of patients at day 14 of treatment. Conclusions Acupuncture or combined acupuncture and Chinese herbal medicine are effective and highly safe in treating vertigo with excess syndrome, but high-quality, multi-center and large-sample RCT studies still need to be conducted for validation and support.

Objective To study the effect of cervical disc replacement in the treatment of cervical spondylotic myelopathy(CSM).Methods 21 patients with CSM(17 cases of spondylotic myelopathy,2 cases of radiculopathy and 2 cases of acute soft disc herniation)were treated by anterior decompression and replaced by the Bryan cervical disc prosthesis. Results All cases were: followed for 4～12 months, average 8 months. The pre-operative JOA score was 8.5 and post-operative score was 15.5 on average. There were no prosthesis, curve was good. Replaced segment achieved stability and restored partial of normal ROM. There was no subsidence of implant and no worsening of pre-operative symptoms, post-operative 21 cases remained flexion/extension movement at replaced segments at latest follow up. There was no neck stiffness and restriction of movement complained by the patients. Conclusion The Bryan cervical disc replacement for the treatment of CSM has offered an excellent early clinical outcome.

BACKGROUND:At present, it remains unclear whether delayed functional exercises after arthroscopic rotator cuff repairs could elevate the healing rate of tendon. The opportunity of functional exercises after rotator cuff repairs is stil controversial, and there is no relevant system evaluation.
OBJECTIVE:To systematical y evaluate the differences in curative effects of early and delayed functional exercises after arthroscopic rotator cuff repairs.
METHODS:We searched the Pubmed, EMBASE, Cochrane Central Register of Control ed Clinical Trials, Chinese Biomedical Literature Database, Wanfang Data, China National Knowledge Infrastructure, and Chongqing VIP Database. The key words were“arthroscopy, rotator cuff, rehabilitation”. The references of the included literatures were re-retrieved. The deadline of retrieval was August 15, 2012. The included literatures were randomized control ed trials on early and delayed functional exercises after arthroscopic rotator cuff repairs. Methodological quality evaluation, screening and heterogeneous test were conducted. REVMAN5.1 software was utilized to analyze the extracted data.
RESULTS AND CONCLUSION:We included three randomized control ed trials, including 237 patients:119 in the early movement group and 118 in the delayed movement group. During fol ow-up at 1 year after operation, no significant differences in range of motion, pain degree, American Shoulder and Elbow Surgeons Scale, Simple Should Test scores and re-tear rate of rotator cuff were detected between the two groups. Results confirmed that compared with delayed functional exercises, early functional exercises after arthroscopic rotator cuff repair did not have advantages on the improvement of joint function and range of motion, but also did not negatively affect cuff healing. Postoperative rehabilitation can be modified to ensure patient’s compliance.

Objective To investigate the effect of hypoxia on the proliferation and expressions of hypoxia-inducible factor-1α(HIF-1α),vascular endothelial growth factor(VEGF) and matrix metalloproteinase-9(MMP-9) in keratinocytes obtained from oral lichen planus(OLP) lesions.Methods Hypoxia environment was induced by a airtight incubator.Five groups were included,normoxia control group,hypoxia control group(12,24,36,48 h).The effect of different treatment time of hypoxia on cellular proliferation was determined with cell counting kit-8(CCK-8).The mRNA and protein expressions of HIF-lα,VEGF and MMP-9 were analyzed respectively by quantitative real-time polymerase chain reaction with SYBR Green Ⅰ and Western blotting.Results The growth activity of keratinocytes obtained from OLP lesions in the hypoxia groups(0.340±0.002,0.415±0.006,0.546±0.006) was reduced than that in control (0.431±0.001,0.620±0.004,1.022±0.005)(P＜0.01).The mRNA levels of VEGF(2.087±0.291,3.189±0.573,5.402±0.563) and MMP-9(2.936±0.500,4.083±0.300,6.374±0.858) were elevated by hypoxia(P＜0.05).The protein levels of HIF-lα(0.414±0.093,0.751 ±0.056,0.875±0.040),VEGF(0.393 ±0.046,0.557±0.078,0.767±0.045) and MMP-9(0.250±0.053,0.384±0.038,0.611±0.092) were all remarkably elevated by hypoxia (P＜O.05).However,hypoxia had no effect on HIF-1α mRNA expression.The mRNA expression of HIF-1α after hypoxia exposure for 36 h(1.412±0.094) and 48 h(1.417±0.446) was higher than that of control group,however,there was no significant difference.A positive correlation was noted between HIF-1α and VEGF in protein level(r=0.905,P=O.O00),and the same correlation found between HIF-1α and MMP-9(r=0.881,P=0.000).Conclusions Hypoxia conditions may inhibit the proliferation of keratinocytes obtained from OLP lesions.Hypoxia conditions can promote the protein expressions of HIF-1α and both the mRNA and protein expression of VEGF and MMP-9 in keratinocytes obtained from OLP lesions exposed to hypoxia.The relative high expression of HIF-lα may be involved in multiple aspects of OLP progression through the regulation of its downstream target genes.

Oral lichenoid drug reactions(OLDRs)are inflammatory reactions of the oral mucosa caused by the use of specific drugs in sensitive individuals and are classified as oral lichenoid lesions(OLLs).Its clinical and pathological manifestations do not have significant specificity compared to other types of OLL.Various types of drugs have been re-ported to induce OLDR,including antihypertensive drugs,nonsteroidal anti-inflammatory drugs,hypoglycemic drugs,an-tipsychotics,and immunosuppressants,among other drugs.Apart from local or systemic administrate glucocorticoids,the most effective treatment measure is to stop using suspicious drugs.Most patients can achieve significant relief from mu-cosal ulcers and erosion,but white lines may still remain.OLDR has been widely reported in the literature.However,due to a lack of systematic understanding,we do not have a recognized standard for the diagnosis and treatment of this disease.There are still doubts about the causal relationship between related drugs and oral lichen-like lesions.In re-sponse to the abovementioned problems,we searched the literature on drug-related oral lichen planus and lichen-like le-sions at home and abroad over the past 20 years,most of which were case reports and only a few of which were case-con-trol studies.This article describes the current research status of lichenoid lesions from four perspectives:concepts,sus-picious drugs,clinical and pathological manifestations,and treatment prognosis.We hope to provide a theoretical refer-ence for the prevention,diagnosis,and clinical treatment of related lichenoid lesions.A literature review demonstrated that there are still many unclear issues related to the etiology,pathogenesis,clinical diagnosis and treatment,treatment prognosis,and other aspects of this disease,and further clinical and basic research is needed for in-depth exploration.

Burning mouth syndrome (BMS) is a chronic oral and facial pain disorder characterized by burning pain in the oral mucosa, with multiple pathogenic factors including psychosocial, neuropathological, endocrine, and immune factors. There is still a lack of effective treatment options that have been demonstrated to work. With the development of research on the pathogenesis and treatment of BMS, multidisciplinary comprehensive treatment has gradually been introduced and become a new trend of diagnosis and treatment. Before multidisciplinary treatment, it is necessary to go through a full and comprehensive diagnosis and analysis, select the best comprehensive treatment plan, take the diagnosis and treatment of stomatology as the basis and premise, and apply other multidisciplinary combined treatment, including the treatment of concurrent diseases, psychological interventions, correction of bad habits, etc. A combination of laser therapy and psychological intervention is a more effective treatment method among the current treatment methods, with high comfort and good acceptance by patients. If necessary, mecobalamin tablets, clonazepam α-lipoic acid and other drugs can be used to nourish nerves and provide symptomatic treatment. The comprehensive multidisciplinary treatment of BMS is expected to become a new trend and provide a new strategy for improving the therapeutic effect.

Objective·To explore the correlation between the quantitative results of autofluorescence imaging under computer assistance and the grade of epithelial dysplasia in oral leukoplakia.Methods·From April 2016 to January 2024,357 patients with oral leukoplakia who visited the Department of Oral Mucosal Diseases at Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,were included.Autofluorescence images of the lesions were obtained using a handheld autofluorescence device.These images were converted to grayscale images to obtain quantitative metrics.An ordered multinomial Logistic regression model was fitted in Python,and cumulative probability plots were generated.The dataset was divided into training and testing sets,and a decision tree was generated.Different hyperparameters were adjusted to achieve optimal model performance.Accuracy,precision,and F1 scores were calculated.The model performance was visualized using a confusion matrix.Results·As the degree of epithelial dysplasia increased,the relative mean color level showed a declining trend.In the binary classification of epithelial dysplasia,there was no overlap between the cumulative probability curves of different categories.In the four-category classification,only severe epithelial dysplasia overlapped with other category curves,indicating good discriminative ability of the model.In binary pathological grading,when the training and testing set ratio was 4∶1 and the maximum depth was 2,the accuracy,precision,and F1 scores were 0.792,0.801,and 0.795,respectively.In the four-category pathological grading,when the training and testing set ratio was 9∶1 and the maximum depth was 4,the accuracy,precision,and F1 scores were 0.611,0.537,and 0.569,respectively.Conclusion·Computer-assisted quantitative analysis of autofluorescence images can be used by oral mucosal specialists as a reference to predict the degree of epithelial dysplasia in patients with oral leukoplakia and to monitor their risk of cancer.