Objective To build a scientific,rational and practical evaluation index system for medical tutors.Methods Evaluation framework was initially constructed on the basis of literature analysis.Two rounds questionnaires investigation were conducted soon using Delphi method and the data were analyzed using descriptive analysis,independent samples of non-parametric test (Kreskas-Wallis test),expert reliability analysis,analytic hierarchy process and other methods.Results The results of two rounds of expert questionnaires showed that both recovery rate and acceptance rate of the questionnaires were more than 90％ and overall expert coefficient was 0.8957.The coordinate coefficient of the second-class index was 0.181,x2 =27.148,P ＜ 0.001,and that of the third-class index was 0.157,x2 =127.03,P ＜ 0.001.Experts' opinions were highly consistent.Conclusions Evaluation index system including three first-class indexes,seven second-class indexes and twenty-eight third-class indexes was established for medical tutors.The evaluation index system is of great importance in safeguarding postgraduate culturing quality and strengthening teaching staff construction.

Objective The laterally spreading tumor (LST) of the large intestine have received a great deal of study in Japan, but no report of such cases was found in China. We here of report 46 cases of LST (47 lesions, because one of the patients was found to have two lesions) diagnosed in our hospital in last two years. The morphological features under endoscopy, pit pattern, pathology and treatment under endoscopy were studied. Methods The 47 lesions of LST were found in a total of 5 735 patients who underwent colonoscopic examination in the last two years (from 01-12-2000 to 30-11-2002). The site, size and morphological features of LST were recorded, and the pit pattern was classified with magnification. 42 patients (totally 42 lesions) received colonoscopic surgery, and the rest refused to accept endoscopic therapy, therefore only a biopsy was done for pathological study. In those patients who accepted colonoscopic surgery, 14 patients were treated by mucosal resection (EMR) after injection of saline solution, 24 were treated by piecemeal mucosal resection (EPMR) after injection of saline solution, in 3 patients the lesion was removed by high frequency loop resection, and Cap-EMR was performed using distal hyaline hat attachment fitted to the end of endoscope. The resected or biopsy specimens were studied pathologically. Results 47 lesions of LST were found in a total of 5863 patients who underwent colonoscopic examination. The distrihution of LST lesions were as follows. 22 lesions were situated in the rectum, 10 lesions in the sigmoid colon, 7 lesions in the descending colon, 4 lesions in the transverse colon, 2 lesions in the ascending colon, and 2 lesions were located in the cecum. Macroscopic type: 25 lesions were homogeneous granular type, 12 lesions were mixed nodular granular type, 8 lesions were flat elevated type, and 2 lesions were pseudo-depressed type. The pit pattern as revealed under magnifying endoscopy indicated that 2 lesions were of type II pit, 8 lesion of type II+III L pit, 9 lesions of type III L pit, and 28 lesions of type IV. The pathological diagnosis revealed that 28 lesions were villous adenomas in which 7 lesions showed early malignant degeneration (6 intramucosal cancer and 1 submucosal cancer). 11 lesions were tubular adenomas, in which 1 was intramucosal cancer, 2 lesions were hyperplastic polyp, and 6 lesions were mixed hyperplastic polyps (serrated adenomas). Conclusion The LST manifest some special features, and their incidence may be higher in China than in Japan. EMR or EPMR may be considered as a good method for treatment for LST.

Objective To evaluate the relationship between endoscopic rectal aberrant crypt foci (ACF) and colon neoplasm, including lesions with high risk of aggressive progression (adenoma with diameter ≥ 1cm, villus adenoma, tubular-villus adenoma, adenoma of high grade dysplasia, or cancer). Methods The rectum of 212 patients who underwent colonoscopy was stained by 0. 4% indigo armine, and the patient was classified into different grade according to the number of rectal ACF, namely Grade 0 as no ACF, Grade Ⅰ as 1-4, Grade Ⅱ as 5-9 and Grade Ⅲ as more than 10. The correlation between rectal ACF grade and colon lesions was analyzed. Results Of 212 patients, 72 were classified as Grade 0, 48 as Grade Ⅰ , 41 as Grade Ⅱ, and 51 as Grade Ⅲ. The detection rate of colon neoplasm and lesions with high risk of aggressive progression in patients with rectal ACF were significantly higher than that in patients without rectal ACF (OR at 95% CI was 22. 352 (6. 716 -74. 395) and 7. 982 ( 1. 838-34. 672), respcetively). Conclusion Rectal ACF may predict the detection of colon lesions, including those with high risk of aggressive progression.

Objective To investigate expression level of endoplasmic reticulum stressmarker GRP78 in the testicular tissue in rats with different phases of morphine-dependence. To explore the role of ERS in morphine-de-pendence. Methods SD rats were divided into 6 groups: morphine (mor) -withdrawal group, mor-extinct group, mor-kindling group and their control groups, normal saline (NS)-withdrawal group, NS-extinct group, NS-kindling group. The experimental rats were injected with morphine subcutaneously on increasing dosage to establish the con-ditioned place preference (CPP) model. The rats in control groups were injected NS. Then the rats were suffered from withdrawal for 48 h, extinction and kindling by morphine, separately. The GRP78 expression level in testicular tissues of rats in the time point mentioned above were measured using Western Blot. Results The time of rats in the paired-box was (528.0 ± 81.0) s, which was significantly higher than that in the NS control group (P<0.001). It was (396.8 ± 116.9) s after extinctive phase, which was significantly higher than that the withdrawal phase of rats (P < 0.001). Also it was (396.8 ± 116.9) s after kindling with morphine which was significantly higher than that the extinctive phase of rats (P < 0.001). These changes of the time indicated that the animal models of extinction and kindling were established in the study. The GRP78 levels were down-regulated in 48 h after withdrawal (P <0.05), and increased a bit afterextinctive phase, but up-regulated highly after kindling with morphine (P < 0.01). Conclusion ERS may be related in the morphine dependence and it might play an important role of testicular dys-function in male drugabuser.

According the development requirement of medical imaging skill,centered on diseases,we discussed the teaching reform of imaging diagnostics course,including the optimized integration of the course,bilingual teaching,teaching methods,format of subject test and strengthening practice teaching,hoping to improve the whole team' professional quality.

Objective To study the effect of the uncertain deflection of the Delta4 phantom (ScandiDos AB,Sweden) in setting up on the Gamma index passing rate during the VMAT plan verification.Methods Two patients with head and neck cancer,two with lung cancers and one with pelvic cancer receiving VMAT radiotherapy were randomly chosen.By means of Eclipse8.6 TPS the treatment plans elaborated for the five patients were picked up to make the verification plans and Delta4 was used to perform dose verification On VARIAN Clinac Ⅸ.The Delta4 phantom was precisely set up first,and then it was deflected in a given angle towards the horizontal direction in relation to the center of the linear accelerator isocenter to perform the dose verification for 11 times successively.To figure out the relationship between the deflection angle of the Delta4 phantom and the Gamma index passing rate.Results As the Delta4 phantom was deflected by 0.0°,0.2°,0.4°,0.6°,0.8°,1.0°,1.2°,1.4°,1.6°,1.8° and 2.0° in sequence,the measured Gamma index passing rates presented a slight decline,but all greater than 90％ (DD 3％,DTA 3 mm).Conclusions In the VMAT plan verification,the Gamma index passing rate of Delta4 has no dependence on the uncertain deflection of the Delta4 phantom provided that the uncertain deflection of the Delta4 phantom is no greater than 2°,but the passing rates of DD and DTA vary significantly with the uncertain deflection of the Delta4 phantom.

Objective To investigate the anti-proliferation mechanisms of Phenethyl isothiocyanate (PEITC)in human lung cancer cells line NCI-H446. Methods Human lung cancer cell line NCI-H446 was cultured in vitro,and treated with 10,30,50μmol/L PEITC for 24 h respectively. Cell viability and apoptosis were analyzed by methylthiazolyldiphenyl-tetrazolium bromide (MTT)assay and flow cytometry,respectively. Phosphorylation of Akt,activation of caspase-3 and caspase-9 in NCI-H446 cells,and production of cytochrome C in cytoplasm were detected by Western blot. Expression of phosphatase and tensin homologue (PTEN)was detected by real-time PCR. Results PEITC significantly reduced NCI-H446 cells proliferation in dose-dependent manner (P<0.05 ),and apoptosis was also inducted after PEITC administration. PEITC also markedly induced expression of caspase-3 and caspase-9,as compared with control group. And the level of cytochrome C in the cytoplasm was also increased after treatment with PEITC.Furthermore,PEITC treatment significantly increased the mRNA level of PTEN in NCI-H446 cells. Conclusion PEITC may be used as a potential anti-lung cancer agent by regulationg PI3K/AKT pathway and increasing PETN expression.

Objective To explore the value of prenatal MRI in the diagnosis of fetal simple expansion of lateral ventricle(ventriculomegaly), and follow up the nervous system development status after birth. Methods Simple expansion of the lateral ventricle fetus by prenatal MRI examination were collected in Huzhou Maternal and Child Care Hospital from May 2013 to June 2015, 126 cases of live births in expansion group, 50 normal cases were recruited in the same period as the control group. In expansion group, fetal subgroup analysis was done:(1) unilateral or bilateral lateral ventricle expasion:one group was 98 cases was lateral ventricle expansion (77.8%, 98/126), expansion of bilateral ventricle group was 28 cases (22.2%, 28/126). (2) Prenatal MRI in the diagnosis of the lateral ventricle of expansion: expansion of the lateral ventricle width was greater than 10.0 mm, if both sides were expanding, the expand width was the heavier one side, divided into 3 subgroups: ①Expansion in group A (lateral ventricle width 10.0-12.0 mm) were 88 cases (69.8%, 88/126).②Expansion in group B (lateral ventricle width 12.1-15.0 mm) were 29 cases (23.0%, 29/126). ③Expansion of group C (lateral ventricle width> 15.0 mm) were 9 cases (7.12%, 9/126). All 176 cases were followed up after birth at the 3rd, 6th, 12th, 18th month (corrected age was used for premature babies), and Gesell developmental schedules (GDS) were used to evaluate the neurobehavioral development. Results (1) The MRI results after birth:21 cases were followed up by MRI after birth. In group A, 11 cases had MRI and 9 were normal (the ventricular width<10.0 mm after birth) , the other 2 cases were stable (the ventricular width measured first time after birth was ≥10.0 mm, but the difference was within 2.0 mm from the MRI before birth). In group B, 4 cases had MRI, 1 was normal, 1 was stable, and 2 cases were getting better (the ventricular width measured first time after birth was ≥10.0 mm, but the width decreased more than 2.0 mm from the MRI before birth). In group C, 6 cases had MRI. 3 cases were getting better and 3 cases were stable. (2) Overall GDS results:expansion group after the birth of the 3rd, 6th, 12th, 18th month GDS evaluation results compared with control group, respectively, the differences were not statistically significant (all P>0.05). (3) The GDS results among the subgroups:in each evaluation after birth, there were no statistically significant differences between group A and the control group (all P>0.05). The GDS results of group B at the 3rd and 6th month were lower than those of the control group (P<0.05); while there were no statistically significant differences between the 2 goups at the 12th and 18th month (P>0.05). And for group C, statistically significant differences were found compared to the control group at each follow-up time (all P<0.05). (4) GDS results at different times after birth in the expansion group:there was no statistically significant difference between the results at the 3rd and 6th month (P>0.05). But when the result at the 3rd month was compared to the results of the 12th or 18th month, the differences were statistically significant (P<0.05). GDS result of 6th months after birth compared with 12th and 18th months, respectively, there were no statistically significant differences (P>0.05). There was no statistically significant difference between the results at the 12th and 18th month (P>0.05). (5) The GDS results in unilateral and bilateral ventricle expansion:at the 18th month, among the 98 unilateral cases, 86 (87.8%, 86/98) had normal GDS results(>85 scores);8 (8.2%, 8/98) had borderline results (75-85 scores);4 (4.1%, 4/98) had delayed results (<75 scores). Among the 28 bilateral cases, 23 (82.1%, 23/28) had normal GDS results;3 (10.7%, 3/28) had borderline results; 2 (7.1%, 2/28) had delayed results. There was no statistically significant difference (P>0.05). Conclusions Among the simple expansion of lateral ventricle, those whose ventricular width are≤12.0 mm may not need clinical treatment. If the width is between 12.1 to 15.0 mm, closely follow-up and targeted rehabilitation training after birth are recommended. When the width is more than 15.0 mm, the risk of the central nervous system function delay is significantly increased, and early intervention might improve the prognosis.

The oral and maxillofacial region contains oral organs and facial soft tissues. Due to the complexity of the structures and functions of this region, the repair of related defects is complicated. Different degrees of defects require different repair methods, which involve a great combination of medicine and art, and the material requirements are extremely high. Hence, clinicians are plagued by contemporary oral repair materials due to the limitations of bone harvesting, immune rejection, low osteogenic activity and other problems. Decellularized extracellular matrix has attracted much attention as a bioactive scaffold material because of its nonimmunogenic properties, good osteogenic properties, slow release of growth factors, promotion of seed cell adhesion and maintenance of stem cell characteristics. This article reviews the sources, preparation methods, application and research progress of extracellular matrix materials in the repair of oral and maxillofacial defects to provide an overview for fundamental research and clinical development.

Objective:To explore the treatment of levator complex in conjoint fascial sheath suspension correction on severe ptosis, and to seek a reliable and less complications operation.Methods:From October 2016 to February 2020, 40 eyes of 24 patients with severe ptosis (6 males and 18 females, aged from 10 to 73 years, with an average of 34.4 years) were divided into study group and control group. 20 eyes in study group were treated with combined fascia sheath suspension and levator palpebrae muscle complex tension-free shortening correction, while 20 eyes in control group were treated with combined fascia sheath suspension and levator palpebrae muscle complex tension-free shortening correction The effects and complications of the two groups were compared.Results:Follow-up studies were conducted at 1 week, 3 month and 6 months after operation. There was no significant difference between the two methods at different time points after operation, and the incidence of complications in the study group was less than that in the control group at 1 week after operation.Conclusions:Combined with fascial sheath suspension and levator palpebrae muscle complex tension-free shortening in the treatment of severe blepharoptosis has less complications and reliable curative effect in the early postoperative period, but it still needs to be improved to obtain more lasting curative effect.