Objective Carry out the reform of the online learning mode of prehospital training for refresher doctors , and evaluate the effect of reform in Peking Union Medical College Hospital .Methods An exploration was carried out on the refresher doctors prehospital training mode from traditional classroom teaching to online learning , Estab-lished the online learning system .Evaluated the effect of online learning by the way of questionnaire investigation andreexaminationamong289refresherdoctors.Results 289refresherdoctorshavecompletedthestructuredon-line courses of prehospital training , and the average pass rate of the first test was 42.2%.The questionnaire and retest was conducted , A total of 262 doctors completed the work , The recovery rate was 90.7%, and the average pass rate of retest was 74.9%, showing improvement by 32.7%.Conclusions Online learning mode is an effec-tive tool for knowledge dissemination , and has a better learning effect .

OBJECTIVE:To discuss the relationship between the changes in pla sma endotoxin levels and use of antibiotics in patients with serious traumatic injury before and after operation.METHODS:The plasma bacterial endotoxin levels were dynamically detected by kinetic turbidimetric assay in20patients with severe traumatic injury used with different antibiotics before and after operation,at the same time the normal control group was established.RESULTS:Plasma endotoxin levels in patients with severe traumatic injury increased remarkably before and after operation,as compared with the normal control group(P0.05).CONCLUSION:Intestine-borne endotoxin induced in a stress condition can strengthen the pathological reaction of the body ,therefore dy?namic detection of plasma endotoxin can provide guidance for clinical therapy.

By using extracellular single unit recording technique, locally suppressive effects of a single dose of ketamine on sub-cutaneous (s. c. ) bee venom-induced increase in firing of wide dynamic-range (WDR) neurons in spinal dorsal horn were investi-gated on urcthane-chloralose anesthetized cats. Injection of bee venom s.c. into the cutaneous receptive field (RF) resulted in asingle phase of prolonged, persistently increased firing of WDR neurons over background activity for more than 1 h. Local pre-treatment with ketamine (100 mM, 0. 1 m l) into the center of RF where bee venom was injected produced a dramatic suppressionof the increased neuronal firing by 60% (3.10± 0.42 spikes/s, n= 5) when compared with saline pre-treated group (7.61 ± 0.17spikes/ s. n = 5 ). Moreover, local post-treatment with the same dose of ketamine also produced a profound suppression of the in-creased neuronal activity by 81% (1.51±0.06 spikes/s, n=5) when compared with the saline post-treated group (7.76±0.15spikes s, n=5). However, s.c. administration with the same dose of ketamine into a symmetrical region on the bee venom un-treated contralateral hindpaw produced no affection on the increased firing of the WDR neurons, suggesting that the suppressiveaction of local ketamine was not the result of systemic effects. The present result suggests that ketamine may exert its localantinociceptive effects mainly through the peripheral NMDA receptors in addition to its partially potential blocking effects onsodium and voltage-sensitive calcium channels.

Objective To explore the correlation factors for surgical treatment in lumbar spinal tuberculosis.Methods A total of 46 patients with lumbar spinal tuberculosis who underwent surgical treatment were analyzed.The possible correlation between the clinicopathologic features and clinical outcome were analyzed by Logistic regression analysis.Results Nine patients failed in surgical treatment.Multiple analysis showed that the number of infected vertebrae (OR =6.44,95％ CI:2.47-19.92) and internal fixation (OR =10.76,95％ CI:3.50-18.74) had significant correlation with the clinical outcome.Conclusions Surgical treatment for lumbar spinal tuberculosis has a favorable outcome in patients.The number of infected vertebrae and internal fixation are significant risk factors for poor outcome.

Objective To study the job demand of vocational medical laboratory technology in Jiangsu Province ,and as a basis to build curriculum system of vocational medical laboratory technology .Methods We surveyed 128 medical laboratory related institu‐tions in Jiangsu Province ,the survey included the demand for talent ,changing needs of reasons ,demand for vocational talent and job skill requirements ,data of the survey results were collected and analyzed .Results Demand for vocational talents for tertiary hospi‐tals were small ,while the primary health care institutions and relevant private medical institutions and companies were exuberant . The main jobs were clinical testing technology direction and pathological examination technical direction .In addition ,blood transfu‐sion and transfusion technology direction ,testing reagents and equipment marketing direction and technical for andrology laboratory direction also were needed .Conclusion According to the survey results ,we determine educational objectives ,basic requirement and specialty orientation of vocational medical examination major ,and propose clinical laboratory specializing in the basic platform+specialty orientation modulefor the curriculum system of vocational medical examination major .

Objective To evaluate the imaging features of phyllodes tumor of the breast.Methods 35 patients with phyllodes tumor of the breast confirmed by surgery and histopathology were collected.All clinical and imaging findings were analyzed.Results 35 cases with 36 lesions were classified as benign (1 9 lesions),borderline (8 lesions),and malignant (9 lesions).The typical ap-pearances on mammography were ellipse (1 6/36)or lobulated (20/36)mass.Most of them were high density (30/36)and clear boundary (28/36).No evidence of calcification,spiculated margin,skin thickening,nipple retraction and enlargement of axillary lymph nodes were detected.On MRI,1 lesion presented as lobulated mass with nonuniform hypointensity on T1 WI,hyperintensity on T2 WI and DWI.The time-intensity curve was Ⅱ type on dynamic contrast enhancement MRI.Conclusion The clinical and ima-ging features of phyllodes tumor are characteristic.These features are helpful to preoperatively diagnose,the final diagnosis would confirmed by histopathology.

BACKGROUND:Conservative treatment is mostly invalid in treatment of severe degenerative lumbar scoliosis-induced low back pain, so surgical intervention is general y required. Repair methods are decompression, rigid fixation, and selective interbody fusion for the“responsible vertebra”to re-establish normal lumbar curvature, spinal balance and good stability. OBJECTIVE:To investigate clinical curative effect of local decompression and selective interbody fusion with pedicle screw fixation technique for the treatment of degenerative lumbar scoliosis. METHODS:Data of 57 cases of degenerative lumbar scoliosis from Armed Police Corps Hospital of Hunan Province from January 2011 to January 2014 were retrospectively analyzed. According to clinical characteristics of the patients, selective fusion, local decompression and pedicle screw fixation were used for repair. The imaging analysis and Suk criteria were used to evaluate fixation, decompression and bone fusion. Japanese Orthopaedic Association scores were utilized to assess therapeutic effect. RESULTS AND CONCLUSION:(1) Operation time was 157-255 minutes, averagely 176 minutes. Amount of bleeding was 480-1 700 mL, averagely 835 mL. Postoperative drainage volume was 140-210 mL, averagely 155 mL. (2) 57 patients were fol owed up for 12-38 months. Postoperative X-ray revealed that Cobb’s angle was (3.8±2.1)° on the coronal plane after treatment, and the correction rate of lordosis was 54%. The sagittal Cobb’s angle was (6.3±10.5)°, and the correction rate of lordosis was 35%. According to Suk standard, the fusion rate of vertebra was 95%. According to low back pain score system recommended by Japanese Orthopaedic Association scores, the effective rate was 91%at the end of fol ow-up. (3) There were 2 cases of cerebrospinal fluid leakage, 1 case of nerve injury, and 1 case of pedicle screw failure, no infection, no blood vessel injury. (4) These findings suggest that according to imaging data and self clinical features, local decompression and selective interbody fusion with pedicle screw fixation technique for the treatment of degenerative lumbar scoliosis can rebuild and stabilize degenerative lumbar scoliosis in the coronal and sagittal planes to different degrees, with satisfactory clinical curative effect.

Objective To investigate the roles of cell apoptosis and the gene expressions of Fas, FasL, bcl-2 and bax in acute rejection of pancreaticoduodenal transplantation and to evaluate the function of duodenum biopsy for early detection of rejection in rats. Methods Wistar and SD rats were divided into two groups: ①Wistar rats that underwent allogenic pancreaticoduodenal transplantation from the organs of SD rats; ②Wistar rats that received homogenic transplantation. The grafts were then harvested on day 3, 5 and 7 after the transplantation, and all graft samples were observed with HE staining and TUNEL was also used to detect apoptotic cells. The expressions of Fas, FasL, bcl-2 and bax were measured by immunochemical method. According to Nakhleh’s score, pathologic features of transplanted pancreas and duodenum were ranged from one to three scores in order. Results The percentage of same or different scores between the pathological scores of pancreas and duodenum in allogenic pancreaticoduodenal transplantation group were 61.1% (11/18) and 38.9% (7/18) respectively, and there were 6 specimens of pancreatic tissue got higher scores with only one higher score for duodenum. There were significant differences of histopathologic rejection scores and apoptotic indices between the two groups, respectively (P

Objective To evaluate the sensitivity and specificity of a rapid one-step test for the detection of Helicobacter pylori antigen in stool samples. Methods 13C-urea breath test (13C-UBT) and rapid urease being taken as “gold standard”, Helicobacter pylori stool antigen (HpSA) was detected with Atlas rapid one-step test among patients with syndromes in upper alimentary tract. These patients were divided into two groups. One was pretreatment group that included 62 cases and the other one was post-treatment group with 42 cases. Results In pretreat_ment group, there were 24 Hp positive cases and 38 negative ones according to the golden standard, 27 positive and 35 negative according to one-step HpSA assay, and the sensitivity and specificity was 100% and 92% respectively; In post-treatment group, 15 positive and 27 negative according to the golden standard, 19 positive and 23 negative according to one-step HpSA assay, and the sensitivity and specificity 93%and 81% respectively; the total sensitivity and specificity was 97% and 88% respectively. Conclusions HpSA rapid one-step test has good sensitivity and specificity in diagnosis of Hp infection and judgment of Hp eradication.

Objective To investigate the expression of phosphorylation-mammalian target of rapamycin (p-mTOR) in endometrial carcinoma. Methods The expressions of p-mTOR protein in tissues from 45 cases of endometrial adenocarcinoma, 7 endometrial atypical hyperplasia, and 6 normal endometrium were detected by immunohistochemistry SP method. Results The expression of p-mTOR protein maily restricted to cytoplasm. Compared with normal endometrium, the expression of p-mTOR protein in the cases of endometrial atypical hyperplasia and endometrial adenocarcinoma was significantly up-regulation(2.36 ± 0.76vs 6.21 ± 1.19, 15.82 ± 2.64)( F = 11.37, P ＜ 0.05 ). There was significant difference of p-mTOR protein in different histology class in endometrial adenocarcinoma (F = 8.27, P ＜ 0.05), but there was no significant difference of p-mTOR protein in different pathological grade in endometrial adenocarcinoma (P ＞0.05).Conclusion The expression of p-mTOR protein may participate in the occurrence and development of endometrial carcinoma.