To understand the continuing medical education status of Beijing Shijitan Hospital,so as to continue to reform and improve the teaching management of continuing medical education.,literature and information retrieval methods were used and relevant personnel was interviewed about the content,form,time and suggestions of continuing medical education.The results indicate the presence of training content is too wide,training methods are too simple,and there is lack of medical humanities quality training and other issues in continuing medical education.Variety of training methods should be increased,the quality of medical humanities education and training should be enhanced,featured training should be developed to make the continuing medical education more scientific,standardized and highly efficient.

Objective:To study the direct effects of gradient concentration inteiferon-a(IFN-a) on lymphoma cells line Daudi and Jur-kat and a group of 15 cases refractory lymphoma. Methods: The effects of IFN-a on the growth of tumor cells were assayed by MTT, apoptosis were measured by flow cytometty, TUNEL and electron-microscope, 15 refractory lymphoma cases were treated by local injection of IFN-a combination chemotherapy.Results: Low-dose IFN-a did not have any significant effects on growth of Daudi and Jurkat cells, high-dose IFN-a (10 000U/ml) not only have significant anti-proliferative effects with dependence of time and dosage but also can induce apoptosis on both Daudi and Jurkat cells. 5 patients achieved a complete remission and 7 patients achieved a partial remission, the overall response rate was 80% .Conclusion:IFN-a( 10 000 U/ml) had significant anti-proliferative effects and inducing apoptosis on lymphoma cells.Local injection of IFN-a is one of effective therapy on refractory lymphoma.

Objective: This work aimed to investigate the negative prognostic factors of bronchioloalveolar carcinoma (BAC) and adenocarcinoma with BAC characteristics, based on the 2004 pathological classification by the World Health Organization (WHO), which were further verified with the new pathological classification of lung adenocarcinoma (WHO 2011), to identify crucial factors that determine the prognosis of BAC and adenocarcinoma with BAC features, and to prove the coherence of the two pathological classi-fications in assessing clinical prognosis. Methods: Upon pathological diagnosis, some of the 193 cases of BAC or adenocarcinoma with BAC features were categorized into adenocarcinoma in situ (AIS) or minimally invasive adenocarcinoma (MIA), based on the 2011 WHO classification. Gender, age, tumor size, familial cancer history, smoking history, TNM stage, symptoms, duration of symp-toms, and the choice of treatment were recorded and analyzed for prognosis. The survival rate was calculated by Kaplan-Meier method. Log-rank test was introduced to compare the survival rate. Univariate and multivariate factors for the survival rate were analyzed by Cox proportional hazards regression model. Results:The overall 1-, 3-and 5-year survival rates were 84.3%, 60.6%, and 45.6%, respec-tively. Cox univariate analysis revealed that the tumor size, symptoms, TNM stage, pathological outcomes, and the choice of treatment were all prognostic factors. Cox multivariate analysis revealed that TNM stage was an independent prognostic factor for patients with BAC. Data from patients with AIS and MIA revealed better survival. Conclusion:The overall survival rate of BAC and adenocarcino-ma with BAC features are superior to that of other non-small cell lung cancer (NSCLC). The clinical symptoms are non-specific com-pared with other types of NSCLC. Clinical stage at diagnosis is a key prognostic factor, such that early correct diagnosis significantly improves survival. The new classification criteria of WHO, released in 2011, is more elaborate and more conducive to clinical practice.

BACKGROUND:Many studies have shown that matrix metal oproteinases 1, 3, 9 and 13 play an important role in articular cartilage degeneration and destruction, but there is less special research on the articular synovium. OBJECTIVE:To observe the effect of long-distance running on the expressions of matrix metal oproteinases 1, 3, 9 and 13 in the synovium.
METHODS:Fifteen male Wistar rats were divided into three groups:control group, tablet group and uphil group. Rats in the control group received ordinary captivity;rats in the tablet group ran on the horizontal treadmil (0°) at the speed of 1 km/h for 1 hour daily, and lasted for 45 days;rats in the uphil group daily ran on the horizontal
treadmil (0°) at the speed of 1 km/h for 1 hour, and lasted for 15 days, and then the rats ran on the uphil treadmil (+20°) at the speed of 1 km/h for 1 hour daily and lasted for 30 days. The knee joint synovium injury models with varying degrees were established. The dual hind knee joints were obtained after modeling for paraffin-embedded. Then the overal sagittal slices were obtained for hematoxylin-eosin staining and immunohistochemical staining, and the experimental results were observed and analyzed.
RESULTS AND CONCLUSION:After long-distance running, the expression of matrix metal oproteinases 1 in synovium of the tablet group and uphil group was increased when compared with that of the control group (P<0.05), but there was no significant difference between tablet group and uphil group (P>0.05). There was no significant difference in matrix metal oproteinases 3 expression (P>0.05). The expressions of matrix metal oproteinase 9 and
matrix metal oproteinase 13 in synovium were in gradient increasing state (P<0.05), which were lowest in the control group, increased in the tablet group and highest in the uphil group. The results indicate that long-distance running
exercise can influence the normal physiological structure of rat knee joint synovium by changing the expression of matrix metal oproteinases.

Adult ; Back Muscles ; physiopathology ; Fasciitis ; physiopathology ; therapy ; Female ; Humans ; Male ; Moxibustion ; Muscular Diseases ; physiopathology ; therapy

Objective To assess the correlation between the pregnancy‐associated plasma protein A (PAPP‐A)level with gesta‐tional diabetes mellitus(GDM )in primiparous women .Methods The nonparametric test and Logistic regression analysis were used to retrospectively analyze 168 pregnant women of GDM and 273 normal pregnant women ,including age ,body weight ,PAPP‐A ,freeβ‐human chorionic gonadotropin(fβ‐hCG) .Results The age had significant difference between GDM group and control group(P<0 .01) ,the PAPP‐A concentration and corrected multiple of the median (MoM )of PAPP‐A in the GDM group were significantly lower than those in the control group(P<0 .01) .Conclusion Low level of PAPP‐A during early pregnant stage in primiparas is strongly associated with GDM and can be used as the risk factor of GDM .

Objective To summarize our surgical experience in repair and functional reconstruction for compound defects of proximal phalanx and dorsal skin at multiple digits,Methods Six patients with multiple digital defects were treated in our department between June 1996 and March 2005.At the first stage,free iliac bone grafts were used to repair defects of proximal phalanges and temporary syndactyly between adjacent affected fingers was created through digital palmar skin sutures.The defects were covered with free flap transfer finally.Dorsalis pedis flaps were used in four patients,a lateral arm flap in one and a lateral thoracic flap in one respectively.At the second stage,a partial debulking procedure and division of syndaetyty followed three to six months later.Additional procedures were performed in three eases to reconstruct the digital extensor function through tendon transfer.The follow-ups ranged from six months to nine years.Results The flaps survived uneventfully in the six patients postoperatively.The dorsal aspects of reconstructed fingers demonstrated an aesthetically pleasing effect after the flap debulking procedures and division of syndactyly.Follow-up X-Ray examinations showed good lilac bone union and nearly normal structure of digital bone.The distal interphalangeal extension restored to normal in the three cases after extensor reconstruction.Conclusions Iliac bone graft to repair phalangeal defects and free flap transplantation to cover skin defects can be a good treatment for compound defects of proximal phalanx and dorsal skin at multiple digits.Secondary plastic procedure may greatly improve the appearance of a reconstructed digit,and extensor re- construction the function of distal interphalangeal extension too.

Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases. However, due to its complex pathogenesis, there are no officially approved drugs for NAFLD treatment currently. Therefore, it is extremely urgent to find safe and effective anti-NAFLD drugs. Nowadays, lipid-lowering drugs are the main option for NAFLD therapy, but the clinical efficacy of chemical drugs is also very limited, as well as the frequent side effects or adverse reactions. Traditional Chinese medicine (TCM) has attracted more and more attention in the treatment of NAFLD due to its unique advantages through multiple targets and pathways with few side effects. In recent years, numerous studies have demonstrated that the imbalance of gut microbiota plays an important role in the occurrence and development of NAFLD. This review systematically summarizes the experimental and clinical evidences of TCM active compounds and TCM prescription involved in the regulation of intestinal flora in the treatment of NAFLD in recent years, so as to provide a reference for further exploring the pathogenesis of NAFLD and exploring TCM treatment methods.

Objective To explore the trend of changes of Th1 and Th2 cytokines within 6 months after adult liver transplantation (LT). Methods Twenty-three patients from Tianjin First Center Hospital were chosen as the patient group with an average age of (52.7 ± 7.6), range from 37 to 63 years old, including 21 males and 2 females. Twenty healthy staffs from Tianjin First Center Hospital formed the control group (C) with 15 males and 2 females whose average age was (31.0 ± 6.1) ranged from 22 to 24 years old. The patient group was treated with tacrolimus after LT as main immunosuppressive drug. The peripheral blood at time points before (T0) and 1 month (T1), 3 months (T3), 6 months (T6) after LT at 9:00 AM were collected. The blood sample was also collected form control group but only one time. Levels of IL-2, IFN-γ, IL-10 and TGF-βwere detected by ELISA. Results (1) The concentration of IL-2 showed a continuous up-going trend, which was not such obvious between T1 and T0, and until T3 reached a higher concentration than T0. The concentration at T6 was higher than T0 and T1. There were no significant differences in concentrations of T0 to T3 between patient group and control group, while T6 reached a higher concentration in patient group than that of the control group. (2) The concentration of IFN-γexperienced a shortly down-going trend from T0 to T3, and started rising, reached the peak at 3 months after the operation, then started its down-going trend. There were no significant differences in the concentrations of IFN-γfrom T1 to T6, and T3 reached a higher concentration than T1 while T6 was lower than T3. Only at T3, the concentration of IFN-γwas higher in patient group than that of control group. (3) There were no significant differences in the concentrations of IL-10 at various time points in patient group, and there were no significant differences in the concentrations of IL-10 at different time points between two groups (P>0.05). (4) The concentration of TGF-βshowed a gradual decline after the operation, and reached its bottom at T6, and which was lower than T0 to T3. Compared with the control group, the down-going trend was not such obviously at T0 and T1, and the concentration was down at T3 and T6(P<0.05). Conclusion Our results suggest that there is a tendency of an increasing Th1 cytokine expression at early stage in post-transplantation, while the TGF-βof Th2 cytokine is a decreasing trend. This tendency may associate with the autoimmunity response caused by LT and the immunosuppressive drugs.

OBJECTIVE: To analyze the characteristics of medical malpractice from different grades of hospitals and to explore forensic investigation strategies in assessing medical dispute. METHODS: A total of 206 cases of medical dispute from 2009 to 2010 investigated by the Department of Forensic Medicine in Nanjing Medical University were selected and analyzed according to fault incidence, fault-prone part, and degree of causality in the treatment. RESULTS: Among the 206 cases analyzed, tertiary hospitals, secondary hospitals and primary hospitals showed medium, high and low error rate, respectively. A majority of medical malpractice cases were distributed in the departments of surgery, medicine and gynecology. CONCLUSION The frequency and severity of medical malpractice in primary hospitals were high, which were gradually reduced in tertiary and secondary hospitals.
Dissent and Disputes ; Expert Testimony ; Forensic Medicine ; Gynecology/statistics & numerical data* ; Hospital Departments/statistics & numerical data* ; Humans ; Incidence ; Malpractice/statistics & numerical data* ; Medical Errors/statistics & numerical data* ; Retrospective Studies ; Time Factors