Through the analysis of current situation of the setup of local professional institutions,the principles and characteristics,the author put forward countermeasures and suggestions to optimize the local medical professional institutions’ setup,to help local medical institutions’development and improve the quality of medicinal higher education.

BJECTIVE: To explore the effect of different convergent conditions on accuracy of simulation results from a three dimensional finite element model of the pelvic ring.METHODS: A first-order linear load of 600 was applied on the S_1 vertebral endplate in an established three-dimensional finite element model. The step length was set to 0.1 s. The boundary condition was set as constraint of 6 degrees of freedom in the proximal femur. Static and dynamic explicit convergences with 6 different weight scale factors were calculated retrospectively,and all the simulated results were compared with the experimental results in order to verify the accuracy. RESULTS: The static convergence predicted most accurate with the linear regression coefficient 0.88. With the increase of weight scale factor, the time cost decreased. However, the accuracy of the predicted results decreased. There was statistically difference between the simulation results and experimental results when the weight scale factor achieved 3 000 (P<0.05) and the coefficient of linear regression was lower than 0.8.CONCLUSION: It suggested that as for the complex finite element model, especially when the model contains complex contact conditions, dynamic explicit convergence can be an alternative solution to static convergence if the latter failed. Also proper weight scale factor should be used to decrease the time cost under the condition that the error was in the limited.

BACKGROUND:Studies addressing coronary heart disease are largely dependent on the establishment of myocardial infarction animal models. It is very important that exploring a safe method with easy operation, less damage, long time survival and high survival rate for myocardial infarction animal model OBJECTIVE:To compare the pros and cons of two kinds of thoracotomy anterior descending coronary artery ligation to do myocardial infarction animal model. METHODS: Thirty healthy male New Zealand white rabbits were randomly divided into three groups: control, median sternotomy incision, and left sternal incision. The anterior descending coronary artery was ligated after thoracotomy. The operation time, amount of intraoperative bleeding, postoperative food intake, and recovery time of eating were monitored during the surgery and within 24 hours after the surgery. And myocardial enzyme indexes were also monitored within 24 hours after the surgery. Rabbits were detected with ultrasonic echocardiogram at 4 weeks. RESULTS AND CONCLUSION:Different levels of ST segment elevation appeared in median sternotomy and left sternal incision groups by echocardiogram. The success rate of modeling was 70% in median sternotomy incision group, and 80% in left sternal incision group. Within 24 hours post-surgery, the myocardial enzyme indexes in the two groups were significantly increased compared with before surgery (P < 0.05). At 4 weeks, the left ventricular ejection fraction and the left ventricular shortening fraction were significantly decreased when compared to before surgery (P< 0.05). The operation time was shorter, the amount of bleeding was less, the time of eating recovery was less and the amount of eating was much in median sternotomy group than in left sternal incision, with significant differences between he two groups (P < 0.05). The median sternotomy incision for the ligation of anterior descending coronary artery is better than the left sternal incision to establish myocardial infarction models.

Objective To review the long-term oncologic and functional outcomes of surgical treatment for pelvic chondrosarcoma at a single institution to further delineate surgical strategy of resection and function reconstruction.Methods All of 165 patients with pelvic chondrosarcoma that had been surgically treated between July 2000 and Dec 2013 were reviewed retrospectively.There were 102 male and 63 female patients who had a mean age of 43.5 (range,13 to 75) years.The resection type included Type T 16,type Ⅱ 18,type Ⅲ 11,type Ⅰ+Ⅱ 19,type Ⅱ+Ⅲ 63,type Ⅰ+Ⅳ 15,type Ⅰ+Ⅱ+Ⅲ 10 and type Ⅰ+Ⅱ+Ⅳ 13 cases.The pathology diagnosis was grade Ⅰ in 15,grade Ⅱ in 88,grade Ⅲ in 20,dedifferentiated in 28,mesenchymal in 12 and clear cell chondrosarcoma in 2 patients.Nine cases were secondary lesion following multiple exostoses.114 patients received no previous treatment while others were referred due to recurrent tumor.En bloc resection was achieved in 142 patients and intralesional resection in 23 cases.Twelve patients had a hemipelvectomy to achieve local tumor control,whereas 153 patients underwent a limb-salvage procedure.Spinal screw-rod system was used to reconstruct anterior pelvic ring after ilium resection.Modular hemipelvic endoprosthesis was utilized to reconstruct periacetabular defect after tumor resection while no reconstruction was performed after ischium and pubis resection.Results The median duration of follow-up was 54.1 (range,l0 to 159) months.147 (89.1％) patients were alive at the final follow-up,seven of which were alive with tumor.The estimated 5-year survival was 81.5％.Thirty-three patients (20％) had local recurrence,and twenty (12.1％) had lung metastasis.Recurrent case,sacroiliac joint involvement and intralesional resction were three risk factors for postoperative recurrence.Patients who received type Ⅱ+Ⅲ resection and reconstruction had a mean functional score of 23 according to MSTS 93.The mean MSTS 93 for patients with type Ⅰ+Ⅱ and type Ⅰ+Ⅱ+Ⅳ resection and reconstruction was 18.The wound complication rate was 15.8％.Two aseptic loosening and 2 pubic connection plate breakage were observed in hemipelvic endoprosthesis reconstruction.Conclusion Tumor grade correlates with overall or disease-free survival.For low-grade chondrosarcoma,adequate surgical margin can provide long-term local control while for high-grade cases,distant metastasis is the main case of treatment failure.Adequate surgical margin can be achieved in cases with acetabulum involved.However,aggressive surgical resection of pelvic chondrosarcoma still remains as a challenge for orthopaedic oncologists when the tumor invades the iliosacral joint,which necessitates careful preoperative plan and skilled surgical techniques.

OBJECTIVE To investigate the knowledge situation about prevention and treatment of oral infective diseases in diabetic inpatients and analyze the effects of education intervention.METHODS In this study,100 cases of diabetic patients with oral infective diseases were studied by questionnaires and educated on prevention and treatment of oral infective diseases.Comparison was made to evaluate improvement of knowledge about prevention and treatment of oral infective diseases.RESULTS Diabetic inpatients learnt less about the etiology,clinical manifestations and prevention and treatment of oral infective diseases.After individualized education,patients′ relevant knowledge levels were significantly increased(P

In recent years (2007 to 2011),although the overall number of rabies cases in China has decreased,there is evidence of emerging or re-emerging cases in regions without previous rabies cases or with low incidence of rabies.To investigate the origin and the factors affecting the spread of rabies in China,specimens were collected from 2007 to 2011 from provinces with emerging and re-emerging cases and tested for the presence of the rabies virus.Positive specimens were combined with sequences from GenBank to perform comparisons of homology and functional sites,and to carry out phylogenetic analyses.Out of these regions,five provinces had 9positive specimens from canine and cattle,and 34 canine or human specimens were obtained from previously high-incidence provinces.Complete sequences of G gene were obtained for these samples.Homology of the sequences of these 43 specimens was 87％-100％ at the nucleotide level and 93.7％ -100％ at the amino acid level.These G gene sequences were combined with reference sequence from GenBank and used to construct a phylogenetic tree.The results showed that 43 specimens were all assigned to China clade I and clade Ⅱ,with all specimens from emerging and re-emerging areas placed within clade I.Specimens isolated from Shanxi and Inner Mongolia in 2011 were distinct from previously-isolated local strains and had closer homology to strains from Hebei,Beijing and Tianjin whereas new isolates from Shanghai were tightly clustered with strains isolated in the 1990s.Finally,Shaanxi isolates were clustered with strains from adjacent Sichuan.Our results suggest that the rabies cases in emerging and re-emerging areas in China in the last 5 years are a consequence of the epidemic spreading from of neighboring provinces and regions experiencing a serious epidemic of rabies.

Objective To investigate the effectiveness of femoral troehanter reconstruction and artificial femoral head replacement in treatment of unstable intertrochanterie fractures in the elderly pa- tients. Methods Femoral trochanter reconstruction and artificial femoral head replacement was done on 106 patients with unstable intertrochanterie fractures. There were 45 males and 61 females, at age range of 80-105 years (average 88 years). Most of patients slipt in the room and got fractured. According to the Evans classification, there were 31 patients with type ⅢA fractures, 45 with type ⅢB and 30 with type IV. We used 4 kinds of methods to reconstruct the fracturad imertrochanters : (1) shape of" ∞ " ten- sion band fixation after intertrochanterie fracture reduction;(2) wire loop fixation of the lesser troehanter around proximal femur;(3)defect within the femoral ealear was filled with bone cement and remodeled; (4) for patients with relative intact base of femoral neck, the intertrochanterie fracture was transformed in- to femoral neck fracture and the femoral ealear was fixed with femoral prosthesis stem. Results All the operations continued successfully, with duration of the operation for 45-70 minutes (average 55 minutes). No artificial femoral head dislocation occurred during hospitalization. Of all, 79 patients were followed up for 6-48 months (average 16 months). No Late loosening, dislocation or infections occurred, with total excellence rate of 87.3%. Conclusions For elderly patient with unstable intertrochanterie fractures, reconstruction of femoral intertrochant and artificial femoral head replacement can restore the proximal femoral anatomy, maintain stability of the hip joint and help early functional exeereise, as can reduce ease fatality rate and improve the quality of life.

BACKGROUND:Transforaminal endoscopic discectomy needs to dissociate the ligamentum flavum, and if
combined with the continuous dilator and working channel, it can keep the intact ligamentum flavum no matter how smal the incision may be (even 3-5 mm).
OBJECTIVE:To present the technique of interlaminar endoscopic lumbar discectomy with ligamentum flavum splitting.
METHODS:We performed operations on 16 male and 14 female patients by interlaminar endoscopic lumbar
discectomy with ligamentum flavum splitting. The average age of the patients in the study was (48±15) years. The chief complaint before surgery was radiculopathy confined to one leg. The anatomic operative level was L 3-4 in
one case, L 4-5 in 13 cases and L 5-S 1 in 16 cases. The ruptured disc migrated superiorly in four cases and
inferiorly in seven cases, and intraoperative electromyo-graphic monitoring was performed in al surgeries. The
ligamentum flavum was split, and after withdrawing the working channel, the ligamentum flavum could reset itself. RESULTS AND CONCLUSION:The total operation time was 20-40 minutes, and the fol ow-up period was
(149±108) days. There were no abnormal signals on the intraoperative electromyography in any cases, and the reported symptoms were immediately improved in al patients after the operation. Fol ow-up magneticresonance imaging showed a disappearance of the ruptured disc without defect in the ligamentum flavum. There were no operation-associated complications in al the patients. Interlaminar endoscopic lumbar discectomy with
ligamentum flavum splitting is a feasible approach.

Objective To generate data on the current medical rehabilitation resources in Hubei province so as to improve the management of rehabilitation quality.Methods Medical institutions on the second level and above were investigated using a questionnaire which covered installations,personnel,equipment and field of operations.Results A total of 176 questionnaires were recovered.Among them,166 (94.3％) of the hospitals had established a department of rehabilitation medicine,and 122 (69.3％) had set up an independent rehabilitation ward,accounting for a total of 3,359 beds.Altogether,there were 1,260 rehabilitation physicians (36.7％ of the assigned personnel),904 therapists (26.3％) and 1,272 nurses (37％).Senior physicians,therapists and nurses were 26％,3.1％ and 28.3％ of the respective totals.Conclusion Rehabilitation medicine in Hubei Province remains relatively poorly developed.It is weak in terms of building the discipline,management and devices,especially in a serious lack of professionals and rehabilitation therapists.

AIM:To observe the effects of adipose differentiation-related protein ( adipophilin) on the expres-sion of inflammatory factors in RAW264.7 macrophage and to clarify the related mechanism.METHODS:The cell models with high expression and low expression of adipophilin were constructed by transfecting PA317 packaging cells with stable high or low expression adipophilin retroviral vectors into the RAW264.7 cells.The concentrations of IL-6, MCP-1 and TNF-αin the cell culture medium were detected by ELISA.The protein levels of AP-1, p-AP-1, ERK1/2 and p-ERK1/2 were measured by Western blot.The protein levels of adipophilin, p-ERK1/2 and p-AP-1 and the releases of the inflamma-tory factors in the RAW264.7 cells treated with or without ERK1/2 inhibitor PD98059 or AP-1 inhibitor curcumin were de-termined.RESULTS:The RAW264.7 cells with high expression of adipophilin had higher levels of IL-6, MCP-1 and TNF-α, and higher protein levels of p-AP-1 and p-ERK1/2 than those in the cells with low expression of adipophilin. ERK1/2 inhibitor had no significant effect on the expression of adipophilin, but the protein expression of ERK1/2 and AP-1 was significantly inhibited (P<0.05).The administration of AP-1 inhibitor curcumin had no significant effect on the protein expression of adipophilin and ERK1/2, but the protein expression of AP-1 was significantly inhibited (P<0.05). At the same time, the releases of inflammatory factors IL-6, MCP-1 and TNF-αwere significantly decreased.CONCLU-SION:Adipophilin may regulate the expression of inflammatory factors through ERK1/2-AP-1 pathway in RAW264.7 mac-rophages.