After the examinations for three years, the Medical Licensing Examination System of our country has been basically established. The major characters of Chinese National Medical Licensing Examination are:examination management dependent on the administrative system, multi educational levels and two physician categories, performance skill and theoretic knowledge included, specialties of traditional medicine and examination qualification for traditional medicine, and standard setting guided by the certain policy. The problems needed to be resolved further are: to further facilitate the scientific, equitable and standard level of Performance Skill Examination,to actively and gradually improve the educational levels of examinees, to establish the examinational organizations of provinces, and to settle the stable examinational professionals.

The aim of China National Medical Licensing Examination (CNMLE) is to check and assess examinee's requirement for medical practice. In a certain extent, the score result of Medical Licensing Examination reflects the examinee's mastery degree of knowledge, ability and skills (SAKs) learned in medical school. Through the subject diagnostic analysis on the Medical Licensing Examination for certain samples, this research reviewed the clinical medical student's mastery degree of different SAKs. The author wishes the conclusion of this paper would be helpful to some aspects of medical education.

Objective This paper aims to use components as the key factors to explore the feasibility of evaluation method about the learning effect of Web-based PBL.Methods We distributed a questionnaire to 101 students of clinical class of 2007 and 2008 grade in Guangzhou Medical University,and electronically distributed after 2 weeks.Cranach's α coefficient WaS used to evaluate intrinsic consistency reliability of the questionnaire.We applied principal axis factoring to extract components and to explain components which were orthogonally rotated by varimax.Multi-factor regression model Was simulated with key factors and the model's performance of fitting WaS tested.Results Multi-factor regression mode(WPBLSUM)=0.545 Collective collaboration capabilities+0.202 Self-learning and quest skills+0.137 linical reasoning and problem-solving capabilities+0.116 memorizing and understanding of medical knowledge.The coefficient of determination R2Was 0.998 and the corrected coefficient of determination R2Was 0.998.indicating that the model's fit results are obvious.Conclusion This paper demonstrates that using components as the key factors to simulate and assessing the Web-based PBL learning effect is feasible,which assesses the Web-based PBL learning effect well from four different aspects.

Objective To explore the role of cancer stem cells in EMT-induced acquired resistance to EGFR-TKIs in NSCLC. Methods The EGFR del E746-A750 mutated human lung adenocarcinoma PC-9 cell line and gefitinib acquired resistance cell line PC-9/AB were used in this study. EMT was assessed by western blotting assay. The sensitivity to gefitinib was tested with CCK8. Flow cytometry for antibody analysis was used to quantify CSCs within the cell lines. Results Compared with PC-9, PC-9/AB underwent EMT and showed no-table resistance to gefitinib (P < 0.01). Compared with PC-9, the proportions of CSCs were much higher in PC-9/AB. Conclusion EMT plays an important role in the acquired resistance to EGFR-TKIs in NSCLC , possibly through the up-regulation of CSCs.

BACKGROUND:Extraction of a wel fixed cementless femoral stem or a cemented stem is difficult during revision of total hip arthroplasty. The extended trochanteric osteotomy provides excellent methods, and combining with long-stem cementless prosthesis can better reduce postoperative complications.
OBJECTIVE:To retrospectively analyze the recent clinical curative effect after extended trochanteric osteotomy combined with long-stem cementless prosthesis in hip revision.
METHODA total of 25 patients undergoing hip revision were selected from the Department of Osteoarthrosis, Pingdingshan First People’s Hospital, China from May 2008 to May 2013. Of them, 17 patients were subjected to the extended trochanteric osteotomy combined with single-incision and double-approaches. The femurs were reconstructed with long-stem cementless prosthesis. Al patients were fol owed-up for 12 to 60 months. Pre-operative and post-operative Harris hip scores, the post-operative complications, the bone cutting length, the length of stem in contact with cortical bone, the length of the end of bone cutting to the end of the prosthesis were recorded.
RESULTS AND CONCLUSION:17 patients were fol owed-up. The mean length of bone was 17 cm (15-23 cm). The mean length of stem in contact with cortical bone was 6.4 cm (4-11 cm). The mean length of the end of bone to the end of the prosthesis was 11.5 cm (8-18.5 cm). After fol ow-up, the mean Harris hip scores were improved from (39.0 ± 13.6) scores preoperatively to (75.0 ± 14.9) scores postoperatively (P<0.01). Subsidence occurred in two hips. The cutting sites of 17 cases of extended trochanteric osteotomy were fixed wel . These data suggested that the operation through single-incision and double-approach to the hip, while preserving the attachment of the external rotators and posterior capsule, wil strength rear hip stability and prevent postoperative dislocations. Recent effects were satisfactory, but the long-term outcomes should be further investigated.

BACKGROUND:In clinical application, the structure of crista lambdoidalis of L5 was unclear. It needs to expose more tissue to define L5 entry point through transverse process or superior and inferior articular process. This increased the risk of trauma and iatrogenic superior intervertebral degeneration. Therefore, it is necessary to expose L5 entry point with a minimaly invasive way. OBJECTIVE:To investigate the accuracy of L5 pedicle screw insertion with the entry point of mastoid process slope by imaging. METHODS:Mastoid process was located on the base of L5 superior articular process. A cant was formed when the highest point of L5 mastoid process backward protuberance extended inwards and downwards. The cant was defined as mastoid process slope; it was lateral to pedicle medial superior side internaly, medial to transverse process root and superior to the top of crista lambdoidalis. The slope was first easily touched and exposed in lumbar posterior surgery through paraspinal muscle space approach. Fifty patients of lumbar spine disorders were treated by L5 pedicle screws fixation through the entry point of mastoid process slope. According to preoperative radiographic and CT images, pedicle screw insertion direction of the sagittal and transverse sections was calculated. The diameter of pedicle screw was 6.5 mm. The condition of intraoperative successful rate of screws placement at one time was analyzed. The accuracy of screw placement was evaluated by postoperative radiographic and CT images. RESULTS AND CONCLUSION:With the method of the mastoid process slope, the successful rate of screw placement at one time was 96% (96/100). Totaly 100 screws were inserted into L5. According to the criterion by Gertzbein, 95 screws (95%) totaly located in pedicles and 5 screws (5%) encroached on the pedicle from medial wal. Three (3%) out of 5 inaccurately placed screws cut out less than 2 mm of the inner wal, while 2 (2%) between 2 mm and 4 mm, without neurologic deficits. The method of mastoid process slope had a high successful rate of screw placement. Combined with preoperative X-ray films and CT images could obtain a high accuracy rate of screw insertion.

This study was aimed to establish a HPLC method for the determination of isogarcinol. Daojin Inertsil WP300 C18 (4.6 mm× 150 mm, 5μm) was employed with methanol and water (75?25) as the mobile phase. The flow rate was 1.0 mL·min-1. The column temperature was set at 40°C. The detection wavelengthγ was set at 277 nm. The results showed that the linear range of isogarcinol was 0.005 7-0.039 9μg. The average recovery rate was 99.58%. The relative standard deviation (RSD) was 1.25%. The contents of isogarcinol inGarcinia mangostana,Garcinia oblongifolia,Garcinia oligantha,Cratoxylum cochinchinense andCalophyllum membranaceum were 0.285%, 0.199%, 0.857%, 0.161% and 0.006%, respectively. Isogarcinol was not detected inCratoxylum formosum orCalophyllum inophyllum. It was concluded that the method was convenient, accurate with high sensitivity, good stability and repeatability. It can be used for determination of isogarcinol content in Chinese herbal medicine.

Objective To study the Diagnosis and treatment of thyroglossal duct cyst or fistula. Methods The clinical data of 67 patients with thyroglossal duct cyst or fistula treated by surgery were analyzed retrospectively. Results The diagnosis rate preoperatively was 92.5% and the accuracy diagnosis rate by B type ultrasonography was 96.1%; all cases were treated by operation, of them, 14 cases underwent simple cyst resection, 12 with resection of partial periosteum of hyoid and 41 with resection of middle segment of hyoid( Sistrunk's operation ). 54 cases were followed up, recurrence in cases with cyst was 4 of 43 (9.3%) and recurrence in cases with fistula was 2 of 11(18.2%)respectively. Conclusion Ultrasonography shows certain characteristics and clinical value to diagnose and distinguish thyroglossal duct cyst. Postoperative recurrence is due to the selection of operation procedures and control of infection of focus. The Sistrunk's operation properly performed previou to cyst infection should reduce recurrence rate markedly.

Objective To investigate the relationship between abnormal metabolism of aggrecan and joint destruction in patients with rheumatoid arthritis (RA).Methods 140 RA patients with duration less than 24 months were enrolled into this study.The study also included 100 normal controls and 95 patients with other rheumatic diseases.Three monoclonal antibodies (5D4,7D4 and BC-3) of aggrecan were used to detected aggrecan catabolic fragments in serum of RA patients and the other two groups of controls by enzyme linked immunosorbent assay (ELISA),and the correlation of aggrecan catabolic fragments with joint damage were analyzed.Sharp evaluation of hand joints in RA patients were performed at baseline and after one year follow-up.Calculating the area under the receiver operating characteristic curve (ROC) was used to evaluate the sensitivity and specificity of aggrecan catabolic fragments detected in serum of RA patients.Results Both levels of 5D4 fragment and BC-3 fragment of RA group were higher than those of normal control [5D4 of RA:(5.8±2.1) ng/μl,normal control:(2.2±1.3) ng/μl;BC-3 of RA:(11.1±3.4) ng/μl,normal control:(5.0±2.1) ng/μl,F=38.65,24.07,P＜0.001).There was no difference in 7D4 fragment among three groups (F=0.589,P=0.478).Both two fragment levels of RA patients with anti-CCP positive were greater than those patients with anti-CCP negative [5D4:(5.6±1.3) ng/μl vs (4.4±1.1) ng/μl,F=21.23,P＜0.01;BC-3:(12.2±3.9) ng/μl vs (9.3±2.8) ng/μ1,F=27.14,P＜0.01].Linear Regression showed that serum fragments detected by 5D4 and BC-3,and anti-CCP positive were risk factors for Sharp deterioration after one year follow-up.The sensitivity and specificity of combined detection of two aggrecan fragments in serum of RA patients for the prediction of joint Sharp were 56.5％ and 84.2％ respectively.Positive predictive value and negative predictive value are 74.3％ and 70.6％.respectively.Application of areas of ROC to identify the best evaluation of Sharp was 0.798.Conclusion There is positive correlation between aggrecan catabolic fragments in serum and joint Sharp evaluation of RA patients.Detection of aggrecan catabolic fragments in RA patients may predict early joint destruction.

The reasons why some medical treatment facilities (MTF) can not be repaired and returned on time in some medical therapy units are explained. Countermeasures are put forward: repairing and supervising mechanisms must be established between the medical therapy units and factories in time; professional maintainers can be asked to repair MTF or cooperate with technicians in hospital when necessary so as to keep MTF in good condition.