Objective To summarize the experience of diagnosis and treatment of occult spontaneous pneumothorax in young adults.Methods To review and summarize the imaging data and treatment process of 22 cases of occult spontaneous pneumothorax.Results Surgical treatment was performed in 22 patients.Among them,VATS operation in 18 cases,VATMoperation in 4 cases.Operation difficulty was severe adhesion free existed in the apex of lung and pleural top.22 patients with the successful completion of the operation,no major bleeding during the operation,no open chest surgery.1 -3 years follow -up without recurrence.Conclusion Surgical treatment is the first choice for occult spontaneous pneumothorax in young adults.Often due to severe adhesion of the chest,surgery is difficult,the surgeon should be fully prepared before surgery.Patients with good prognosis,due to the difficulty of early diagnosis,clinicians should pay attention to.

Objective To explore the influence of ozone therapy on high-sensitivity C-reactive protein (hs-CRP) and matrix metalloproteinases-3 (MMP-3) in synovial fluid of patients with knee osteoarthritis,and to investigate the possible mechanism.Methods Sixty-two patients with knee osteoarthritis were divided into observation group and control group by random digits table method with 31 cases each.The patients of observation group were treated with ozone,while the patients of control group were treated with hyaluronic acid once a week for 5 weeks.The efficacy was evaluated and the level of hs-CRP and MMP-3 in synovial fluid were detected before and after treatment.Results The total effective rate in observation group was 100.00％ (31/31),significantly higher than that in control group [87.10％ (27/31)],and there was significant difference (x2 =4.28,P ＜ 0.05).After treatment,the level of hs-CRP and MMP-3 in observation group was (6.68 ±2.15) mg/L,(69.84 ± 16.97) μ g/L,significantly lower than that in control group [(8.72 ± 2.39) mg/L,(85.43 ± 19.52) tμ g/L],and there was significant difference (t =3.53,3.36,P ＜ 0.01).Conclusion There is significant effect of ozone therapy of patients with knee osteoarthritis,its mechanism may be reducing the level of MMP-3 and inhibiting inflammatory reaction.

Objective To study the scale and structure of health professional education in China's colleges and universities and their changes from 1998 to 2012. Method Descriptive analyses of national data were conducted, mainly including calculation of absolute numbers, average rates of change per year, and percentages. Results The number of colleges and universities involved in health professional education increased from 189 in 1998 to 590 in 2012.The number of health professional students who were enrolled by, studied in and graduated from these colleges and universities respec-tively reached 587 thousand, 2 104 thousand, and 508 thousand in 2012, with annual growth rates of about 15 percent. The proportion of diploma graduates rose from 42.9 percent in 1998 to 54.0 percent in 2012, which was bigger than those of students at other education levels. In 2012, health professional educational institutions per 10 million popu-lation in western China was less than eastern and middle China by 1.1 and 0.9, respectively. Health profes-sional graduates per 10 thousand population in western China was less than eastern and middle China by 3.3 and 1.6, respectively. Public institutions and their students respectively accounted for 78.1 percent and 85.1 percent though private institutions and their students increased more quickly than public ones. Student-faculty ratio rose from 7.1∶1 in 1998 to 20.0∶1 in 2012. Conclusion The scale of health profes-sional education has been expanding at a decreasing growth rate in China. The disciplinary composition of health professional students has some-what improved and private schools increased at a quicker rate than public ones. However, the gap in scale of education between western China and middle/eastern China has been widening. Education re-sources per student cannot keep pace with the expansion of students, which has affected education of health professionals in many aspects.

OBJECTIVE To analyze the correlation factors and preventive measures of lower respiratory tract infection after general anesthesia with laryngeal mask airway.METHODS In surgery 158 cases of general anesthesia with laryngeal mask ventilation in gynecology and orthopedic wards were analyzed retrospectively.RESULTS Forty-three cases were found in hospitals with lower respiratory tract infection,accounting for 83% of the total lower respiratory tract infection in the wards at the same period.CONCLUSIONS The anesthesia way,the age,the operation time,whether gastric tube,the abuse of antibiotics and whether the anesthesia equipments strictly disinfected and managed may be the important factors which can cause the lower respiratory tract infection.

Objective To approach on the expression pattern of MMP-2 and E-Cadherin in the effects of gastrin on gastric canc-er cells ,so as to investigate their role in the metastasis and invasion of gastric cancer .Methods Genomic DNA modified by sodium bisulfite was used as a template .RQ-MSP detect the methylation status of the gene promoter .The relative amount of Methylation status was performed with comparative threshold cycle (2- △ t ) method .Results MMP-2 and E-Cadherin genes in gastric cancer cells were at hemimethylated status in gastrin before and after the intervention .Gastrin can reduce the methylation levels of MMP-2 gene(P<0 .05) ,but the could be effected by proglumide receptor antagonist to some certain extent (P>0 .05) .Gastrin can pro-mote the methylation levels of MMP-2 gene ,but proglumide decrease that effect (P<0 .05) .Conclusion Gastrin plays a certain role in the biological behavior of gastric cancer impact by changeing on the expression pattern of MMP-2 and E-Cadherin in the effects of gastrin on gastric cancer cells .

Objective:To analyze employment status and its tendency of eight-year program clinical medical graduates and explore its implications to talent cultivation using employment data from a university in Beijing.Methods:Descriptive analysis was used in this study. Indicators that were analyzed included quantity of employment, employment rate, employment region and specialty.Results:Between 2009 and 2021, a total of 2 281 eight-year clinical medical students graduated in the university. Among them, 2 188 (96.0%) of them were employed in the year of graduation. On average, 90.8% (2 034/2 241) of them were employed by medical institutions although the percentage decreased over years. A majority of them chose to work in economically developed provinces of eastern China. Those chose to work in Beijing accounted for 78.7% (1 723/2 188), the highest percentage among all provinces. The top two specialties of choice were surgery and internal medicine, which respectively accounted for 33.0% (753/2 281) and 24.4% (557/2 281). Only a few of them chose to study some specialties that were challenged by a serious shortage of physicians, including pediatrics, mental diseases and mental health.Conclusion:Although the employment status of eight-year clinical medical graduates are good, it is still necessary to pay attention to the new tendency of employment, and further improve training scheme. Meanwhile, more guidance on choice of secondary specialties are needed to build a competent talent team for specialty development. Finally, education of curriculum iedology and politics should be strengthened to encourage them to work in specialties and remote provinces that face a serious shortage of physicians.

Objective:To investigate the efficacy and safety of accelerated epithelium-off corneal collagen cross-linking (CXL) in the treatment of corneal ectasia after keratorefractive surgery.Methods:An observational case series study was performed.Twelve patients (22 eyes) diagnosed with corneal ectasia after keratorefractive surgery in the First Affiliated Hospital of Army Medical University were enrolled from January 2016 to December 2018.All the patients received accelerated epithelium-off CXL and were followed up for 12 months.Before and 1 week, 1, 3, 6, and 12 months after the operation, the uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) converted to the logarithm of the minimum angle of resolution (LogMAR) unit were measured.The sphericity, cylindricity, and spherical equivalent were examined by Topcon auto refractor.The maximum keratometry (Kmax) of the front surface, mean keratometry (Km) of the front surface, Km of the back surface, symmetry index of front surface (SIf), symmetry index of back surface (SIb), thinnest corneal thickness (TCT), total aberrations, total high-order aberrations, coma aberration, trefoil aberration and spherical aberration were detected by the Sirius analyzer.The depth of corneal demarcation lines was determined by optical coherence tomography.The intraocular pressure was measured by the non-contact tonometry.The corneal endothelial cell density was assayed by the endothelial cell densitometry.The inflammatory reaction and haze were observed with a slit lamp at different time points after surgery.This study adhered to the Declaration of Helsinki.The study protocol was approved by the First Affiliated Hospital of Army Medical University (No.KY2020063). Written informed consent was obtained from each patient before entering the cohort.Results:Among the 22 eyes of 12 cases, 3 eyes of 2 cases (13.64%) underwent small incision lenticule extraction, and 19 eyes of 10 cases (86.36%) underwent excimer laser in situ keratomileusis.The UCVA (LogMAR), BCVA (LogMAR), cylindricity and spherical equivalent before the operation were 0.61±0.42, 0.24±0.23, (-2.83±2.39)D, (-3.60±2.66)D, which were significantly worse than 0.45±0.31, 0.12±0.15, (-2.11±1.67)D, (-3.12±2.31)D at 12 months after the operation ( t=4.054, 4.956, -3.728, -2.742; all at P<0.05). The front surface Kmax, front surface Km and SIf at 12 months after the operation were (48.37±5.80), (41.49±3.04), (5.36±4.07)D, which were significantly lower than (49.61±5.97), (41.66±2.97), (5.85±4.18)D before the operation ( t=5.949, 2.278, 2.719; all at P<0.05). There was no significant difference in sphericity, Km of the back surface, SIb, TCT, total aberrations, total high-order aberrations, coma aberration, trefoil aberration, spherical aberration, intraocular pressure and endothelial cell density between before and 12 months after the operation (all at P>0.05). Grade 0.5-2 haze occurred in 8 eyes of 4 patients one month postoperatively.After administration of prednisolone acetate eye drops, haze decreased or disappeared 3 months postoperatively, with UCVA and BCVA unchanged.A corneal demarcation line with a depth of (285.40±51.61)μm was found in 11 eyes of 6 cases at 1 month after operation. Conclusions:Accelerated epithelium-off CXL can significantly improve visual acuity, reduce corneal astigmatism and corneal curvature, as well as effectively prevent the progress of corneal ectasia.