Objective:To evaluate the application of flipped classroom based on rain classroom in standardized residency training of orthopedics.Methods:Sixty-two orthopedics residents were randomly divided into flipped classroom teaching group and traditional teaching group, with 31 residents in each group. The flipped classroom teaching group the flipped classroom teaching mode based on rain classroom, including three aspects: learning in advance before rain classroom, personalized discussing cases in class and teaching after class. The theoretical knowledge, clinical skills and evaluation of teaching activities were compared between the two groups. SPSS 19.0 was used for rank sum test and chi-square test.Results:All the residents completed the evaluation of theoretical knowledge, clinical skills and effect. The results showed that the scores of theoretical knowledge and clinical skills in the flipped classroom teaching group were (88.7±10.3) points and (26.8±2.2) points, which were significantly higher than those of the traditional teaching group (79.2±18.6) points and (20.4±2.9) points, with statistical significance ( P<0.05). The evaluation of teaching activities, including participation, satisfaction, enthusiasm and learning effect, was significantly better than that of the traditional teaching group ( P<0.05). Conclusion:In the orthopedics standardized residency training and teaching activities, the application of flipped classroom teaching mode based on rain classroom is conducive to improving students' learning performance, cultivate their autonomous learning ability, and improve their learning satisfaction and enthusiasm.

OBJECTIVE:To provide reference for rational use of cancer pain narcotic drugs in our hospital. METHODS:The amount of narcotic drugs in our hospital was analyzed statistically during second quarter of 2012 to second quarter of 2015. RE-SULTS:12 specifications and 4 dosage forms of narcotic drugs were involved in our hospital during second quarter of 2012 to sec-ond quarter of 2015. Total amount of narcotic drugs was in an increasing tendency. Oxycodone hydrochloride sustained-release tablet was the largest quantity of narcotic drug used and grew fastest. The amount of surgical drugs kept stable,while total amount of oral preparation increased significantly,in particular,a significant increase in Morphine tablets. CONCLUSIONS:The application of narcotic drugs in our hospital is basically reasonable. The preferred oral principle has been implemented,and treatment of cancer pain is more standardized.

Objective To investigate the expressions of thymidylate synthase (TS) and adenosine triphosphate (ATP)-binding cassette superfamily G member 2 (ABCG2) in advanced gastric cancer (GC) and to explore their correlation with clinical pathological features.Methods A total of 80surgical specimens of advanced gastric cancer patients were collected.The expressions of TS and ABCG2 in gastric cancer tissues and adjacent normal gastric tissues were detected by immunohistochemical method.The expression of P-glycoprotein in gastric cancer tissues was also examined.The correlations between TS,ABCG2 and clinical pathological features and P-glycoprotein were analyzed.Chi-square test was performed for two groups comparison and Kruskal-Wallis H test were used for multi-groups comparison.Results The positive rates of both TS and ABCG2 in gastric cancer tissues [85.0％ (68/80) and 90.0％ (72/80)] were higher than those of adjacent normal gastric tissues [62.5 ％ (50/80) and 78.7 ％ (63/80)],the differences were statistically significant (x2 =11.466 and 16.463,P=0.009 and 0.001).There were close correlation between the expression of TS,ABCG2 and tumor TNM stage,differentiation status,invasion depth (TS:x2 =30.686,61.470 and 40.545 ; ABCG2:x2=48.192,63.150 and 47.512; all P＜0.01).The later the tumor staged,the worse the cells differentiated and the deeper the tumor invaded,the higher level they expressed.Both TS and ABCG2expressions in gastric cancer tissues were correlated with the expression level of P glycoprotein (x2 =43.977and 29.509,both P＜0.01).Conclusion TS and ABCG2 may be potential indexes to predict the degree of malignancy,progression,drug resistance and prognosis in gastric cancer.

Objective:To explore the effect of radiotherapy on the FHIT protein expression and cell apoptosis of cervical squamous carcinoma and discuss the relationship between FHIT protein expression and cell apoptosis. Methods:Expression of FHIT protein was measured by immunohistochemical method and cell apoptosis was detected by TdT-mediated dUTP terminal nick end labeling (TUNEL) staining in 50 cases of squamous cell cervical carcinoma at ⅡB-ⅢB stages before, during (Dt 10 Gy and Dt 30 Gy), and after radiotherapy. Results:Of the 50 patients, the positive rates of the expression of FHIT protein was 56% at Dt 10 Gy, 68% at Dt 30 Gy, and 84% after radiotherapy, which were significantly increased compared with that before radiotherapy (36%, P<0.05). The positive rates of cell apoptosis was 52% at Dt 10 Gy, 64% at Dt 30 Gy and 78% after radiotherapy, which were significantly elevated compared with that before radiotherapy (28%, P<0.05). In the process of radiotherapy, cell apoptosis was positively related to the expression of FHIT protein (P<0.05). Conclusion:Radiotherapy reinforces the expression of FHIT protein and induces apoptosis cocurrently. FHIT protein has regulatory effects in cell apoptosis induced by radiotherapy.

Many medical journals have already digitalized their publishing procedure,but not achieved digital publishing yet.Utilizing digital technology,digital publishing can achieve the functions that paper media cannot,such as information storage,fast search,real-time publishing,individualized information and interaction with readers.These functions entail digitalization of medical journals,and involve a range of macro- and micro-modifications,including laws,industry policies,personnel training,and culture development.There is a long way to go for Chinese medical journals to enter the stage of digital publishing.

Objective To investigate risk factors for postoperative delirium in elderly patients with hip fractures and determine whether the delirium can influence the outcome of hip fracture.Method A retrospective case control study was performed for 521 patients (≥60 years) with hip fractures treated surgically from January 2012 to December 2014.There were 170 males and 351 females, with the age of (79.3±8.3)years.Confusion assessment method (CAM) was applied to diagnose delirium after surgery, and the subjects were divided into delirium group (n=159) and control group (n=362) according to the presence of delirium.Univariate and multivariate analyses were performed to identify the riks factors for postoperative delirium, including age, gender, comorbidities, body mass index, American Society of Anesthesiologists (ASA) classification, type of fracture, haemoglobin, PaO2, albumen, type of anesthesia, type of anesthesia, amount of bleeding, time between admission to surgery, length of operation, type of operation and amount of blood transfusion.Perioperative complications and mortality within 1 year after operation were compared between the two groups.Results Univariate analysis revealed dementia, ASA classification, haemoglobin, PaO2, albumen, interval between admission to surgery, anesthesia method, operation time, and surgery methods were risk factors for postoperative delirium incidence (P<0.05).While multivariate analysis showed only dementia (OR=6.211, 95%CI 2.482-23.498), long interval between admission to surgery (OR=3.505, 95%CI 1.478-6.342), arthroplasty (OR=2.015, 95%CI 1.783-3.481), and PaO2≤60 mmHg (OR=2.766,95%CI 1.783-5.039) were the significant risk factors for postoperative delirium after hip surgery in the elderly.Incidences of lung infection, wound infection, cardiovascular events, cerebrovascular events and deep venous thrombosis in delirium group were higher than those in control group, but only incidences of lung infection and wound infection reached significant differences (P<0.05).Mortality in delirium group was higher than that in control group within 1 year after operation, but there was significant difference only within 3 months after operation (P<0.05).Conclusions Incidence of delirium is high after hip fracture surgery in the elderly.Dementia, long interval between admission to surgery, arthroplasty and PaO2≤60 mmHg are significant risk factors for postoperative delirium incidence, and the delirium patients are associated with high early mortality.

AIM: To establish the method of determining astragaloside Ⅳ and salidroside in Zhenqi Fuzheng Capsule(Fructus Ligustri Lucidi,Radix Astragali,etc.). METHODS: Astragaloside Ⅳ was determined by HPLC-ELSD on Inertsil ODS-3 C_(18) column(250 mm?4.6 mm,5 ?m) using a mobile phase of acetonitrile-water(37∶63).The flow rate was 1.0 mL/min and detector parameters were set as follows: drift tube temprature was at (106 ?C);carrier gas(air) flow rate was 2.7 L/min.Salidroside was determined by RP-HPLC on the same column using a mobile phase composed of acetonitrile-water with gradient elution.The detection wavelength was at 278 nm and the flow rate was 1.0 mL/min. RESULTS: Calibration curve of astragaloside Ⅳ was linear between 0.76 ?g and 3.8 ?g under the chromatographic condition,R=0.999 5.The average recovery of astragaloside Ⅳ was(98.4%).RSD was 0.9%(n=6).And the calibration curve of Salidroside was linear between 0.4 ?g and 4 ?g,R=0.999 9.The average recovery of salidroside was 100.7%.RSD was 2.1%(n=5). CONCLUSION: These methods were simple,accurate and sensitive,so it can be used for the quality control of Zhenqi Fuzheng Capsule.

Objective:To provide policy recommendations for Beijing public health departments to grasp the dy-namic allocation of healthcare resources and the advantage of medical functional dispersal, and making appropriate health policies to rationally adjust the allocation of health resources. Methods:To study the dynamic function of Bei-jing medical, this study uses the method of accounting of cases summary of the annual report on health finance through the descriptive analysis of the gross fixed capital formation in various regional government-run health facili-ties. Results:The results of this study show that the quality of medical health administrative resources was higher, but effectively dispersed in 2015. By contrast, the basic public health resources allocation was unbalanced. Conclu-sion:This study puts forward the corresponding health policy suggestions. On one hand, it is important to make fur-ther policy to encourage high quality medical resources to be effectively relieved and the regional planning should be done according to market demand by avoiding the blind construction at the early stages. On the other hand, much at-tention should be paid on the balanced development of the basic public health service ability and the coordinated de-velopment of administrative capacity in health, and supporting policies should be formulated, which should rationally allocate the public health resources for a better overall medical functional dispersal.

For attracting more social charity funding into the health field, in-depth interviews are conducted into four health foundations in Beijing, presenting three aspects of existing problems and obstacles in the foundations devel-opment in this article. Firstly, the foundations have low effect in fundraising, poor information publication, little com-munication between other facilities and vague mechanism in donation. Secondly, the social public has erroneous views leading to deviant behavior. Finally, some annual inspection standards of the foundation are not suitable for the health field. Based on the above analysis, suggestions about how to improve transparency and fundraising ability in foundations and change the public erroneous views in donation are proposed. The governments might be suggested to get more relax-ed on the annual inspection standards of the foundations, and build an information platform in healthcare field as well.

BACKGROUND:Lithium chloridecan promote the proliferation and osteogenic capacity of bone marrow mesenchymal stem cels in the necrotic region after avascular necrosis of the femoral head, which has become an issue of concern. OBJECTIVE:To compare the advantages and disadvantages of bone marrow stem cel transplantation combined with lithium chloride in the treatment of rabbit femoral head necrosis. METHODS: Passage 2 bone marrow mesenchymal stem cels from 1-week-old New Zealand rabbits were cultured in 0, 5, 10, 20, 40 mmol/L lithium chloride. Forty-eight healthy adult New Zealand rabbits were selected to make femoral head necrosis models in the right femoral head using liquid nitrogen freezing method and then randomized into four groups: model group with no implantation; lithium chloride group given lithium chloride treatment at 3 days after modeling; cel transplantation group given gelatin sponge implantation and bone marrow mesenchymal stem cel suspension injection into the femoral head after modeling; combined group given bone marrow mesenchymal stem cel suspension injection and lithium chloride treatment. Intraperitoneal injection of lithium chloride (45.2 mg/kg) was given daily beginning at the postoperative 3rdday, and the treatment duration was 4 weeks. RESULTS AND CONCLUSION:Lithium chloride at 10 mmol/L had the maximum effect on the proliferation of rabbit bone marrow mesenchymal stem cels, and if the concentration of lithium chloride was > 10 mmol/L, the promotion role of lithium chloride began to decline. After combined treatment, the morphology of the femoral head was restored a little, with increased bone density and thickened trabecular bone; the level of β-catenin in the femoral head was significantly increased in the combined group compared with the cel transplantation group or the lithium chloride group. These findings show that bone marrow stem cel transplantation combined with lithium chloride treatment can promote the recovery from femoral head necrosis by increasing bone mass of the trabecular bone and bone density of the femoral head in the necrotic region.