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 establish the cell line stably expressing INSIG2 and observe its effecet on fat metabolism after overexpression of INSIG2.Methods The eukaryotic expression plasmid pcDNA3.1(+)-INSIG2 was constructed,which was transfected into 3T3-L1 cells.The expression of INSIG2 and related genes were detected by RT-PCR and immunohistochemistry,the contents of FFA in cell culture medium and adipocyte differentiation were detected by ELISA and Oil Red "O"staining respectively.Results After pcDNA3.1(+)-INSIG2 was transfected into the 3T3-L1 cells,the expression of INSIG1 mRNA and FAS mRNA were down-regulated,the content of FFA in the cell culture medium was decreased and adipocyte differentiation was drepressed.Conclusion The cell line stably expressing INSIG2 was successfully established,the transfected INSIG2 may have a drepressant effect on fat metabolism.

Objective To establish a method for the in-vitro culture of astrocytes from cerebral cortex of neonatal rats.Methods Astrocytes were isolated from cerebral cortex of the neonatal SD rats aged 24 hours,and then were cultured in the high-glucose DMEM medium with 10% fetal bovine serum added.The morphological features of astrocytes were examined under inverted microscope.The growth of the third generation of astrocytes was observed with counting plate method and methyl thiazolyl tetrazolium (MTT) assay.Results The astrocytes from cerebral cortex of neonatal rats grew well,the astrocytes showed typical morphological features,and no other kinds of cells was found.Conclusion A simple and practical in-vitro culture method for rats astrocytes is established.

Objective To study Curcumine's growth-inhibitory effects and morphological changes on sarcoma grafts of S180 mice,with further inquiry into the possible mechanism.Methods A total of 30 cases of S180 mice were assigned randomly into 3 groups: saline group(blank control),CTX group(positive controlled) and Curcumine group.① The anti-tumor effect on internal organ of mice was observed to study the tumor inhibition rate in different groups.② Influence of curcumine on mice's immune system was studied by comparing the index of thymus and spleen.③ The growth and patho-morphologic changes of tumor cells were observed.④To calculate the index of apoptosis cells and observe the morphological changes of all groups' apoptosis cells under electroscope.Results ① The inhibitory rate was 68.32% in the curcumine group,70.43% in the positive controlled group.Compared to blank control group, these two groups had significantly elevated tumor inhibition rate(P0.05);however,positive thymus index in control group had significant decrease compared with that in the other two groups(P0.05).③ Under electroscope,curcumine group and positive control group had significant decrease in growth of tumor,degree of tumor infiltration,number of nucleus fission,and blood vessel number compared to those in negative control group(P

Objective To explore clinical features and antimicrobial resistance of lower respiratory tract infection (LRTI)with Streptococcus pneumoniae (S .pneumoniae)isolated from children in Nanjing.Methods Clinical data of children with confirmed S .pneumoniae LRTI through sputum culture at a children’s hospital in Nanjing between July 2013 and June 2014 were analyzed retrospectively,S .pneumoniae strains were performed antimicrobial susceptibility testing through K-B method and minimum inhibitory concentration (MIC)testing.Results Among 197 children with S .pneumoniae infection,72.59% were <3 years old,63.96% occurred in autumn and winter, 57.87% had elevated leukocyte count,cough and fever were the most common clinical symptoms,complications of digestive and circulatory system were also common.The resistance rates of S .pneumoniae to azithromycin, penicillin,and erythromycin were 94.92%, 92.98%, and 88.83% respectively; the sensitivity rates to vancomycin,chloramphenicol,meropenem,ceftriaxone,and ofloxacin were all > 90%,vancomycin was up to 98.98%.Conclusion The percentage of S .pneumoniae LRTI is high in children < 3 years old,most occur in autumn and winter,resistance rates to azithromycin,penicillin,and erythromycin are all high,antimicrobial agents should be selected for the treatment of infection according to antimicrobial susceptibility testing.

Autophagy is an active research area in the biomedical field as its role has been identified in many physiological and pathological processes. Accordingly, there is a growing demand to identify, quantify and manipulate the process accurately. Meanwhile, there is great interest in identifying compounds that modulate autophagy because they may have applications in the treatment of a variety of autophagy-related diseases. In this review, we summarize the current status of autophagy screening systems to facilitate identification of autophagy modulators.

Objective To compare the clinical efficacy and safety between percutaneous vertebroplasty (PVP) and conservative treatment for osteoporosis vertebral compression fracture (OVCF).Methods A total of 55 patients undergoing PVP and 65 patients with conservative treatment for OVCF in our hospital from 2006 to 2011 were retrospectively analysed.The degree of pain and personal life before treatment and after treatment at different time points were investigated by visual analogue scale (VAS) pain scale and Oswestry Disability Index (ODD.Results The degree of pain in lower back was reduced after the treatment.The VAS pain scales in PVP group versus control group were (8.3±0.5) vs.(8.50.6),(6.9±0.7) vs.(4.5±0.7),(5.40.6) vs.(3.4±0.5),(4.8±0.3) vs.(2.8±0.5),(4.0±0.4) vs.(2.3±0.4),(3.1±0.5) vs.(2.0±0.2)before treatment and 1 week,1,3,6 and 12 months after treatment,respectively.The VAS pain scales were reduced more rapidly in PVP group than in control group,showing a better relief of pain.There were differences in VAS pain scales between the two groups at different time points (t=17.89,19.74,28.38,24.49,14.01,respectively,all P＜0.01).The ODI scores in PVP group and control group were [(88.8±5.0) vs.(87.2±5.1)],[(72.6±7.8) vs.(53.1±6.3)],[(62.0±8.5) vs.(37.2±6.0)],[(47.1±12.6) vs.(26.5±3.6)],[(36.7±9.3) vs.(17.9±5.5)],[(24.3±10.0) vs.(9.4±2.5)] before treatment and 1 week,1,3,6 and 12 months after treatment,respectively.The ODI scores were reduced more rapidly in PVP group than in control group,showing a better recovery of daily life.There were differences in ODI scores between the two groups at different time points (t=15.00,18.17,11.74,13.20,10.72,respectively,all P＜0.01).Conclusions PVP can alleviate pain and restore daily life rapidly.It shows advantages in rccovery of the fractured vertebrae height.

BACKGROUND:In treatment of lumbar diseases, lumbar fusion therapy fails in 20%of cases and may lead to a series of complications such as pain, intervertebral space col apse, and delayed kyphosis deformity.
OBJECTIVE:To observe the effect of nucleus pulposus on interbody fusion after removing the anterior column disc of rabbit lumbar vertebra.
METHODS:A total of 36 healthy Japanese white rabbits were randomly and equal y divided into three groups, with 12 rabbits in each group. (1) Group of anterior longitudinal ligament+bone grafting:The L3 intercalated disc were wel exposed and anterior longitudinal ligament was stripped, obtaining a space to L3 intercalated disc, then the iliac bone was implanted. (2) Group of excising anterior 1/3 disc+bone grafting:After the anterior 1/3 disc tissue was excised, the iliac bone was implanted and sutured as Group of anterior longitudinal ligament+bone grafting. (3) Group of excising anterior 1/3 disc+fixation:After the anterior 1/3 disc tissue was excised, the iliac bone was implanted and the anterior column fixation was performed.
RESULTS AND CONCLUSION:Biomechanical testing showed that, at 12 weeks, the verticality tensile force in the group of anterior longitudinal ligament+bone grafting was obviously higher than other two groups, and have better fusion rate and could bear stronger force. Lateral position lumbar radiography showed that, the bone graft was absorbed and no new bone grew into the intervertebral space in the group of excising anterior 1/3 disc+bone grafting at 12 weeks;the formation of osseous bridge was found in the group of excising anterior 1/3 disc+fixation;complete bony fusion was found in the group of anterior longitudinal ligament+bone grafting. Histological examinations showed that, at 12 weeks, no bone tissue formed in the group of excising anterior 1/3 disc+bone grafting;a smal amount of bone trabecula and osteocytes were observed in the group of excising anterior 1/3 disc+fixation;a great quantity of newborn bone trabecula and osteocytes, remodeling lamel ar bone and canalis haversi structure were observed in the group of anterior longitudinal ligament+bone grafting. The stability of anterior column has notable effect on interbody fusion, after the anterior column disc is destroyed, the free nucleus pulposus may affect spinal fusion, so restoring the stability of the anterior column may promote interbody fusion, but stil cannot get solid spinal fusion.

BACKGROUND: Lung protective ventilation strategies and positive endexpiratory pressure (PEEP) have been widely used as an effective ventilation pattern in clinical practice of administration of acute respiratory distress syndrome (ARDS) in recent years, but there arestill great arguments on the therapeutic effects.OBJECTIVE: To observe the changes of oxygenation index and inflammatory transmitters in peripheral blood and bronchoalveolar lavage fluid(BALF) of different lung areas [superior area of lung (upper lobe), ventral side of inferior lung (heart lobe), and dorsalis inferior lung (diaphragm lobe)] of ARDS dogs caused by pulmonary and extrapulmonary insults under lung protective ventilation treatment.DESIGN: A randomized control animal study.SETTING: Department of Respiratory Medicine, the General Hospital of Chinese PLA.MATERIALS: Twenty-four adult healthy male mongrel dogs were randomly divided into four groups with 6 dogs in each: pulmonary ARDS experimental group, pulmonary ARDS control group, extrapulmonary ARDS experimental group and extrapulmonary ARDS control group.METHODS: Models of extrapulmonary ARDS were induced by intravenous injection of oleic acid (0.1-0.15 mg/kg), and the pulmonary ARDS models were established by intratracheal administration of diocty sulfosuccinate sodium salt. After lung injury, the experimental groups received lung protective ventilation treatment (tidal volume: 8 mL/kg, PEEP: 0.981 kPa)for 3 hours, and the control groups also received ventilation of large tidal volume (tidal volume: 14-17 mL/kg, PEEP: 0 kPa).MAIN OUTCOME MEASURES: ① changes of oxygenation index in each group; ② dynamically observed the changes of the inflammatory transmitters [tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL1β) and interleukin-6 (IL-6)] in pe. Ripheral blood and BALF of different lung areas (upper lobe, heart lobe and diaphragm lobe) of ARDS dogs under lung protective ventilation treatment.RESULTS: All the 24 dogs were involved in the analysis of results. ①After lung injury, the oxygenation indexes were significantly decreased in all the groups, and the oxygenation indexes after lung protective ventilation in the experimental groups were obviously higher than those in the control groups (P ＜ 0.05). At 2 and 3 hours after lung protective ventilation, the oxygenation indexes in the extrapulmonary ARDS experimental group were markedly higher than those in the pulmonary ARDS experimental group (P＜ 0.05). ② After lung injury, the levels of the inflammatory transmitters in peripheral blood were all obviously increased in all the groups, which were decreased to different extent after the lung protective ventilation treatment,but the therapeutic effect in the pulmonary ARDS experimental group was not as good as that in the extrapulmonary ARDS experimental group. ③The levels of inflammatory transmitters in BALF of lung upper lobe and heart lobe were obviously higher in pulmonary ARDS dogs than in extrapulmonary ARDS dogs.CONCLUSION: The ameliorations of the release of inflammatory transmitters and oxygenation index at different areas are obviously different between ARDS dogs caused by pulmonary and extrapulmonary insults, and lung protective ventilation has good effect on extrapulmonary ARDS dogs,but has bad effect on pulmonary ARDS ones.

BACKGROUND:Lateral retinacular release is effective to treat anterior knee pain, but it has not been confirmed through the parameters of the knee joint. OBJECTIVE: To analyze the relevant parameters on the axial X-ray films of the patela before and after lateral retinacular release and then to find out the efficient parameters for patelofemoral joint disorders on the axial X-ray film of the patela, which are of most clinical significance. METHODS: Fifty patients with anterior knee pain were included randomly who admitted at the Department of Joint Surgery, Affiliated Hospital of Jining Medical University from February 2009 to December 2013, including 45 cases of Outerbridge I-III undergoing arthroscopic lateral retinacular release+articular cartilage repair and 5 cases of Outerbridge IV undergoing lateral retinacular release+knee joint surface replacement. RESULTS AND CONCLUSION:After lateral retinacular release, the congruence angle, patelofemoral index and tilt angle were al reduced significantly (P < 0.05 orP < 0.01), but there was no change in the lateral patelofemoral angle (P > 0.05). The patelar trajectory restored to the corresponding central position of the femoral condyle, and meanwhile, no joint hematoma, deep vein thrombosis and patelar subluxation occurred. These findings indicate that the lateral retinacular release is of great significance for treatment of anterior knee pain induced by lateral patelofemoral compression.