The examination system for the licensing of doctors was eventually established against a background of constant growth of China's socialist market economy. Conduction of the professional qualification examination is the prerequisite of the State's adoption of the professional license system. It is also the inevitable choice for developing a mature and standard socialist market economy. The paper reviews the process of the establishment of the system, out- lines the features of the examination in content design, organization and implementation, and puts forward measures for perfecting the system in China. The measures include: further improving the organization and management system and the rules and regulations for conducting the examination; grasping the features and patterns of criterion-referenced test- ing in the field of medical examinations; rendering the examination system more scientific, ettectine and reliable; and deepening reform of medical education under the framework of the new medical examination system. [

Objective To evaluate open acromioplasty for treating acromion impingement syndrome combined with rotator cuff injury. Methods From March 2004 to August 2007, 20 cases of acromion impingement syndrome combined with rotator cuff injury were treated in our department. During open acromioplasty, we repaired the rotator cuff, and reconstructed the insertion site with anchor screws for patients who had been diagnosed as complete rupture of superspinatus tendon. Postoperative rehabilitation program was conducted and all patients were followed up at our outpatient clinic. ASES (American Shoulder and Elbow Surgeons) scoring system was used to assess the outcome of the patients. Results Eighteen patients were followed up regularly for an average of 11 (6 to 13)months. The mean ASES score was 90. 5 postoperatively. A significant difference was found between the preoperative and postoperative ASES scores in this group (t= 13.865, P<0.01). Conclusion Open acromioplasty can achieve good outcome in treatment of acromion impingement syndrome combined with rotator cuff injury, and can be carried out by primary hospitals.

BACKGROUND:Adult stem cells are capable of proliferation and differentiation, which are an important part of tissue engineering. Although several studies have demonstrated that human adipose-derived stem cells obtained from elective liposuction procedures represent the characters of mesenchymal stem cells and can be induced to differentiate into myocardial cells, less is known about the characters of extrapericardial adipose-derived stem cells and their differentiation into myocardial cells.
OBJECTIVE:To explore the culture of extrapericardial adipose-derived stem cells in vitro and their ability to differentiate into myocardial cells.
METHODS:The extrapericardial adipose tissues were obtained and then isolated, cultured and passaged in vitro. The expressions of cellsurface specific antigens (CD44 and CD90) were detected by immunofluorescence assay at different time periods, and the fluorescence intensity was compared. After induced and cultured with myocardium induction medium for an optimal period,α-actin and cardiac troponin T expressions were detected by immunocytochemical detection and the phenotypic identifications were performed.
RESULTS AND CONCLUSION:During the in vitro culture, extrapericardial adipose-derived stem cells adhered to culture flask wal and proliferated strongly. The cells appeared to be shuttle-shaped and exhibit a vortex alignment. They were positive for CD44 and CD90, and the fluorescence intensity reached the peak at passages 3 and 4, but negative for CD34 and CD54. After induced and cultured with myocardium induction medium, the differentiated cells were muscle-like cells, the expression ofα-actin and cardiac troponin T were positive, and the number of cells reached the peak at passages 3 and 4. These findings suggested that the extrapericardial adipose-derived stem cells from human represent the morphological and cellular immunological characters of mesenchymal stem cells, and they can be induced to differentiate into myocardial cells. In addition, there is the best induction period.

rabbits were divided randomly into control group ( n =8),pseudo operation group ( n =8) and chitin group ( n =8) with the rabbit iliac artery restenotic models The chitin tubes were localized on the adventitia of restenotic iliac arteries in chitin group but not in pseudo operation group The determinations for the area of neointima,neointima/media area ratio,neointima/media thickness ratio and 3 H TdR incoperation demenstrate that chitin can inhibit intimal proliferation of restenotic iliac artery This findings suggest that local adventitial chitin administration may be effective for the prevention of restenosis

BACKGROUND:The tourniquet is usualy fuly used or bilateraly used in partial time during bilateral total knee arthroplasty. However, very few people try to use it on one side and on the other side in partial time.
OBJECTIVE:To investigate the effective strategy of using a tourniquet in simultaneous bilateral total knee arthroplasty.
METHODS:80 patients (160 knees) with severe osteoarthritis who underwent simultaneous bilateral total knee arthroplasty in the Department of Orthopedics, Chinese PLA Medical School from January to December 2013 were divided into two groups according to the different tourniquet strategies. In test group (n=40), left knees did not receive tourniquet, and right knees received tourniquet in partial time. In control group (n=40), al knees received tourniquet in the whole time. The perioperative and postoperative blood loss, 3-day postoperative thigh sweling rate and pain visual analog scale, 3-week and 1-year postoperative Knee Society Score were recorded in both groups.
RESULTS AND CONCLUSION:There were no statisticaly significant differences between two groups in perioperative total blood loss (P > 0.05). However, postoperative blood loss in test group was less than that in control group (P < 0.05). The visual analog scale scores were significantly lower in the test group than in the control group at 3 days after surgery (P < 0.05). Visual analog scale scores on the left side were lower than on the right side in the test group at 3 days post surgery (P < 0.05). Bilateral thigh sweling rate was significantly lower in the test group than in the control group at 3 days after surgery (P < 0.05). The thigh sweling rate was lower on the left side than on the right side in the test group at 3 days after surgery (P < 0.05). Knee Society Score was higher in the test group than in the control group in the early stage, and no significant difference in long-term Knee Society Score was detected (P > 0.05). These findings verify that taking the strategy that the first knee without tourniquet and the second knee with part time tourniquet technique in simultaneous bilateral total knee arthroplasty wil aleviate pain and sweling after operation and promote early functional rehabilitation without increasing the perioperative total blood loss.

BACKGROUND: The total knee replacement is considered as one of the most effective and successful operations to cure terminal or severe gonarthritis. How to lower the revision rate as well as increace the effect of prostheses after the knee replacement should be solved urgently.OBJECTIVE: To retrospectively analyse the clinical applications and curative effects of different knee prostheses.DESIGN: Based on patients who accepted knee replacement, preoperative and postoperative condition was observed and compared so as to compare the postoperative effect of different types of knee prostheses replacements.SETTING: Department of Orthopedics, General Hospital of Chinese PLA.PARTICIPANTS: A total of 398 patients (523 knees) were selected from the Department of Orthopedics, General Hospital of Chinese PLA from January 2002 to January 2005, including 276 unilateral knee replacements (276 knees) and 122 bilateral knee replacements (244 knees). Patients were respectively diagnosed as osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS), pigmented villonodular synovitis (PVNS), etc.METHODS: According to the pathogenetic condition, patients received total knee replacements with different knee prostheses. Types of knee prostheses: ① According to the replacing range, it could be divided into unicondylar prostheses and total condylar prostheses; total condylar prostheses could be subdivided into posterior cruciate ligament (PCL)-retaining and PCL-substituting prostheses. ②According to the degree of mechanical constraint, it could be divided into unconstrained, semiconstrained or fully constrained prostheses. ③ According to whether imitating meniscus-function, it could be divided into tibial plateau rotatable sliding type and fixed type. Follow-up was conducted on patients that mentioned above after half a year. Knee joints were scored by using knee joint scoring system of American special surgical hospital (HSS scoring with the total score of 100 points, those above 85 were considered as excellent; 70-84 as good;60-69 as fair; below 60 as poor). Feller scoring (total score of 30 points; the higher the points were, the better the symptom was) criteria was used in patellar scoring. Investigation and comparison on pain-degree of anterior region of knee,range of motion of knee joint and the stabilization were done during the follow-up, ap and lateral views of patella from 30 degrees and 90 degrees were taken in radiography.MAIN OUTCOME MEASURES: Preoperative and postoperative scores of HSS, patella, anterior pain of knee, function of patella, the maximum flexion and tibiofemoral angle.RESULTS: Follow-up was conducted in 372 patients (490 knees) with the follow-up rate of 93.4%. ①Therapeutic effect:Excellent and good rate of the operation was 89%. Pain and function of patients after operation were obviously ameliorated, effect on pain-amelioration and range of motion of knee joint activation were significant. ② Score of HSS, patellar,anterior pain of knee, function of patellar and the maximum flexion were markedly increased than those before operation (P ＜ 0.01). ③ There were no marked significances in comparison of score of HSS, patellar, anterior pain of knee, function of patellar, the maximum flexion and tibiofemoral angle on different knee prostheses replacements (P ＞ 0.05).CONCLUTION: Prostheses should be chosen carefully and appropriately according to the indications, contraindications,anticipated attainable functions, service life as well as pathogenetic conditions, and then satisfactory curative effect will accordingly be achieved.

OBJECTIVE To re-evaluate systematic review/meta-analysis of escitalopram in the treatment of depression， and to provide reference for clinical use of escitalopram. METHODS Retrieved from CNKI， Wanfang database， VIP， SinoMed， PubMed and the Cochrane Library， etc.， systematic review/meta-analysis of escitalopram in the treatment of depression were collected from the construction of the database to May 17， 2022. The literatures were screened according to the inclusion and exclusion criteria， the basic information of the included literatures was extracted， and the methodological quality， reporting quality and evidence quality of the included literatures were evaluated by using AMSTAR 2 scale， PRISMA statement， and GRADE system， respectively. RESULTS A total of 16 systematic reviews/meta-analyses were included. The results of efficacy comparison showed that escitalopram in the treatment of depression was superior to sertraline in improving the total effective rate， and was comparable to paroxetine， duloxetine and fluoxetine in improving cure rate. The results of safety comparison showed that the safety of escitalopram was higher than that of paroxetine and venlafaxine. The overall methodological quality evaluation of AMSTAR 2 scale was low， and all of them were rated as extremely low； main reason was the lack of many key items. PRISMA score was between 12 and 23 points. Among them， there were 5 literatures with scores ＞21 points， and the reports were relatively complete， 10 literatures with scores between 15 and 21 points， and the reports had certain defects， and 1 literature with scores ≤15 points， with serious information missing. The results of the grading of GRADE evidence showed that， of the 160 included outcome indicators， 69 were moderate evidence， 64 were low-level evidence， and 27 were very low-level evidence. CONCLUSIONS The total effective rate of escitalopram in improving depressive patients is not inferior to that of sertraline； compared with paroxetine， escitalopram is safer. However， the evidence level of the above conclusions is low.

Objective:To investigate the morphology character of sagittally unstable intertrochanteric fractures and reduction methods.Methods: A retrospective study was used to analyze the clinical data of sagittally unstable intertrochanteric fractures cases,which were treated with proximal femoral nail anti-rotation (PFNA) fixation from March 2009 to June 2016.In the study,36 cases were followed up completely,in which 17 cases accepted open reduction,and the other 19 cases accepted minimally invasive reduction.The operation time,amount of bleeding,the fluoroscopy times,postoperative radiographic measurements,such as tip-apex distance (TAD) and sliding distance of the spiral screw,and hip Harris scores were analyzed.The morphology character of the fractures was documented and investigated.Results: The average follow-up time was 15 months.The amount of bleeding of the open reduction group was (170.5±19.7) mL,and the amount of bleeding of the minimally invasive group was (54.7±12.5) mL.The amount of bleeding of the minimally invasive group was significantly less than that of the open reduction group (P<0.001).Between the two groups,there were no significant differences in other evaluation parameter,including operation time (P=0.054),the fluoroscopy times (P=0.053),fracture healing time (P=0.305),postoperative radiographic measurements,such as TAD (P=0.317) and sliding distance of the spiral screw (P=0.206),and hip Harris scores (P=0.459).In regard to morphology character of the fractures,the proximal anterior unstable fractures with separation displacement were more common than the proximal posterior unstable fractures with impaction.The characteristic feature of the proximal anterior unstable fractures was the proximal anterior and medial long oblique fracture,and a V shape cortical defect in the distal fracture fragment on the externally rotation X-ray.Conclusion: Sagittally unstable intertrochanteric fractures can be divided into the proximal anterior unstable fractures with separation displacement,and the proximal posterior unstable fractures with impaction.The two types have their own morphology character individually.The reduction should be performed by minimally invasive techniques.

Objective To investigate the effects of different fine particulate matter (PM2.5) components (water-soluble, organic, water-soluble+organic) in vivo on the NOS/NO system in the endothelial cells from rat thoracic aortas. Methods Three PM2.5 components were used to inject by vein in rat tail. ELISA and immunohistochemical technique were used to examine the change of NOS/NO system in the blood-serum and the endothelial cells from rat thoracic aorta. Results Compared with control group, three PM2.5 components increased NO level of rat blood-serum [control, (38.00±5.40) μmol/L; water-soluble group, (44.66±16.59) μmol/L, t =3.58, P< 0.05; organic groups, (58.28±12.30) μmol/L, t =12.85, P <0.01; mixtural component group, (84.02+19.24) μmol/L, t =31.39, P<0.01]; increased iNOS level of rat blood-serum [control, (17.47±5.33) U/ml; water-soluble group, (21.87±4.63) U/ml, t =4.92, P <0.05; organic groups, (25.27±6.58) U/ml, t = 6.22, P<0.05; Mixtural component group, (32.79±5.86) U/ml, t =32.84, P <0.01]. Mixtural component decreased eNOS level of rat blood-serum [(12.58±4.59) pg/ml vs (17.47±2.97) pg/ml, t =5.91, P <0.05], no significant difference on eNOS level of blood-serum among other component groups (P >0.05). Three components decreased the expression of eNOS protein in the endothelial cells from rat thoracic aorta(control, 164.68±4.80; water-soluble group, 185.43±5.63, t =4.26, P <0.05; organic groups, 194.07±9.77, t =5.26, P <0.05; Mixtural component group, 209.24±15.43, t =43.19, P <0.01), increased the expression of iNOS protein (control, 160.17±5.79; water-soluble group, 134.78±8.22, t =5.21, P <0.05; organic groups, 134.78±8.22, t =5.98, P <0.05; Mixtural component group, 81.62 ±10.59, t =34.98, P <0.01) in the endothelial cells from rat thoracic aortas.Conclusion Three components of PM2.5 induced the dysfunction of endothelial cells and disorder of NOS/NO system in the endothelial cells.

Objective To study the inhibition of tumor necrosis factor-alpha(TNF-α)cytokine expression of BV-2 cells induced by hypoxia-reoxygenation injury by siRNA targeting TLR4 gene via the RNAi mechanisms.Method BV-2 mouse microglial cell line was cultured in six-well plates and randomly divided into group N(nor-mal group),group H(hypoxia-reoxygenation),group T(hypoxia-reoxygenation+TLR4-siRNA transfected group),group C(hypoxia-reoxygenation+pEGFP-H1/control-siRNA transfected group)and group B(hypox-ia-reoxygenation+pEGFP-H1 transfected group).Group H,group T,group C and group B were cultured in hy-poxia condition for 3 h followed by reoxygenation for 24 h.The plasma was transfected into BV-2 cells mediated by lipofectamine 2000.The efficiency of transfection were detected by flow cytometry to observe the expression of EGFP.RT-PCR method was used to detect the level of mRNA of TLR4 or NF-кB p65.Westem blot methed was used to test the expression of TLR4 protein.and ELISA was used to test the level of TNF-α in the supernatants.Analysis of variances was used for statistical analysis.Results The expression of EGFP gene waa;(67.58±7.16)% after transfection by flow cytometry analysis.Compared to group N,the TLR4 mRNA,NF-кB p65 mR-NA,TLR4 protein level and the TNF-α quantity in group H,group T,group C and group B increased after the hy-poxia-reoxygenation treatment(P＜0.01).While the expression of the TLR4 mRNA,NF-кB p65 mRNA,TLR4 protein level and the TNF-α quantity in the group T down-regulated compared to group H,group C and group B(P＜0.01).And there were no changes in group C,group B and group H about observation index(P＞0.05).Conclusions The siRNA targeting TLR4 mRNA could inhibit the inflammatory reaction released by BV-2 cells in-duced by hypoxia-reoxygenation stimulation.