Based on the minimum basic requirements of global medical education (GMER), and taking example of training experience of domestic and foreign medical students' learning clinical skills , we have made a detailed analysis of the backgrounds , necessity and feasibility of opening course clinical basic skills to the order-oriented medical students in Chongqing. We have also put for-ward some countermeasures and suggestions to ensure the quality of teaching , so as to promote the course smoothly.

Objective To observe the influence of the stress and displacement when the normal sacroiliac joint is exerted load simulating oblique-pulling manipulation, and to analyze the stress and displacement distribution when a three-dimensional finite element model of normal pelvis is exerted by oblique-pulling manipulation. Methods Lateral position was simulated on the three-dimensional finite element model of normal pelvis and it exerted loads horizontally forth and back, then the stress and displacement distribution were calculated. Results When the normal sacroiliac joint was exerted load simulating oblique-pulling manipulation, stress of the pelvis was mainly concentrated on the anterior inferior part of the left iliac fossa from the front view, with a maximum stress of 0.540E+07. The maximum value of internal and external strain of normal sacroiliac joint was 8.682 × 10-4m;the maximum value of anteropostreior strain was 3.337 × 10-4m;and the maximum value of up and down strain of normal sacroiliac joint was 3.284 × 10-4m. Conclusions The focus of the sacroiliac joint stress is mainly on the anterior and posterior superior borders when the normal pelvis exerted oblique-pulling manipulation. The internal and external strain of normal sacroiliac joint is maximal, the anteropostreior strain ranges the second, and the up and down strain is minimal.

It is very significant that state trains rural-oriented medical students for grassroots health institutions.In combination with the characteristics of Chongqing rural-oriented medical students,the article analyzed and explained the reasons of building autonomous-cooperative learning model,discussed the connotation and the correlation theory of this model.Based on the above,the article designed and carried out autonomous-cooperative learning model,summarized the construction strategy from the aspects of organization and management mechanism,competitive and encouraging mechanism and evaluation mechanism,which explored a practical education pattern that suits rural-oriented medical students.

BACKGROUND: Cervical rotation manipulation is a non-surgical method of cervical spondylosis, showing significant treatment efficacy. But the safety for patients with carotid artery atherosclerosis remains obscure. OBJECTIVE: To analyze the hemodynamic changes of atherosclerotic carotid arteries treated by cervical rotatory manipulation, and to explore the effect of cervical rotatory manipulation on the hemodynamics of atherosclerotic plaque. METHODS: Eight cases of stenosis of ramification of the carotid artery with plaque on MRI. The hemodynamic model of carotid artery atherosclerosis was established, assigned with general boundary conditions and simulated the cervical stretch during cervical rotatory manipulation. All models were grouped and stretched into 0％ (control group), 7％ and 16％ stretch to simulate the hemodynamic changes of atherosclerotic plaque. The hemodynamic parameters, including average wall shear stress, the maximum wall shear stress, the average maximum wall shear stress, the blood velocity of the plaque, and blood flow vectorgraph were compared among groups. RESULTS AND CONCLUSION: (1) All hemodynamic parameters had no significant differences between 7％ stretch and control groups (P＞ 0.05). Compared with the control group, the wall shear stress, the maximum wall shear stress, and the maximum wall shear stress in the 16％ stretch group were significantly increased (P ＜ 0.05), and other indexes showed no significant differences. (2) In summary, different stretches by cervical rotatory manipulation possess different effects on plaque, and a 16％ stretch may affect the hemodynamics of plaque.

Objective To introduce small group learning in the course of introduction to gen-eral practice to cultivate students' ability of active learning and innovation. Methods Totally 221 students of 2008 grade A and B classes were enrolled as teaching objects and were divided into 20 groups. Introduction to general practice was used as learning materials. One week before the class, teacher gave students learning task and A and B classes carried on class discussion respectively. Re-view speaking was conducted by the representatives of groups. Effectiveness was evaluated through the observation,interview,questionnaire survey and answer scoring points. Results Overall support per-centage to small group learning was 91%. Percentages of students who believed that small group learn-ing was beneficial to cultivating the ability of active learning and innovation were 88% and 73% re-spectively. Conclusions Introducing small group learning in the course of introduction to general practice is effective and conductive to training students' ability to study and innovate.

Objective To analysis the existing problems of targeted admission medical education program in rural areas,and make a suggestion.Methods Interviewing 22 targeted admission medical graduates of the Class of 2015 and 2016 in Chongqing and 53 interviewees including clinical college leaders,teaching managers,teacher representatives and leadership and managers of township health and medical institutions.All interviews were recorded for further analysis.Results Of the 75 interviewees,67 (89.3％) were satisfied with the status,and 37 (49.3％) believed that there was a need for improvement.Students generally think that the current curriculum is reasonable and satisfactory to the teaching effect.Practical skills are generally recognized by employers;However,there is a big gap between career planning and employment expectation.Conclusions Interview results showed that targeted admission medical education program in rural areas is generally progressing well.However,problems remain in some areas including curriculum and teaching conditions,practical skills teaching,training of post competency,"stay in rural areas" issue and career planning.The college should specially strengthen the training of the comprehensive quality,clinical skills,social responsibility and professional pride of serving the gross-roots unit,and strengthen the policy publicity and career planning education.The local management department should further support the policy construction and carry out unified management to reduce the gap of treatment between different township hospitals.Rural medical units should pay attention to humanistic care and team culture construction.The state should publicize and enhance the social status and professional influence of general practitioners to enhance their professional identity and self-confidence.

BACKGROUND:Cervical rotatory manipulation is widely used in the treatment of neck-related diseases with a clear curative effect,but it also has some risks in clinical practice.The previous study of our group found that cervical rotatory manipulation can reduce the tensile mechanical properties of the atherosclerotic carotid artery,but it is not clear about the effects of different cervical rotatory manipulations(positioning/non-positioning)and different degrees(mild/moderate/severe)of atherosclerosis on the tensile mechanical properties of the carotid artery. OBJECTIVE:To explore the effects of different cervical rotatory manipulations and different degrees of atherosclerosis on the tensile mechanical properties of the internal carotid artery. METHODS:The 120 male New Zealand rabbits were randomly divided into eight experimental groups with different degrees of atherosclerosis and different cervical rotatory manipulations:severe atherosclerosis + positioning/non-positioning cervical rotatory manipulation,moderate atherosclerosis + positioning/non-positioning cervical rotatory manipulation,mild atherosclerosis + positioning/non-positioning cervical rotatory manipulation,and normal rabbit + positioning/non-positioning cervical rotatory manipulation,as well as three model control groups:mild/moderate/severe atherosclerosis + non-cervical rotatory manipulation,and the blank control group.Two-factor analysis of variance was used to explore the main effects and interactive effects of different cervical rotatory manipulations and different degrees of atherosclerosis on the tensile mechanical properties of the internal carotid artery.One-way analysis of variance was applied to explore the influence of different cervical rotatory manipulations on the tensile mechanical properties of the internal carotid artery under the same degree of atherosclerosis. RESULTS AND CONCLUSION:(1)Both different cervical rotatory manipulations and different degrees of atherosclerosis were the main effect factors affecting the tensile mechanical properties of the internal carotid artery.(2)For both mild and severe atherosclerosis,both positioning and non-positioning cervical rotatory manipulations reduced the maximum stress of the internal carotid artery(P<0.05)and also increased the physiological elastic modulus of the internal carotid artery(P<0.05).(3)For moderate atherosclerosis,positioning and non-positioning cervical rotatory manipulations also increased the physiological elastic modulus of the internal carotid artery(P<0.05).Non-positioning cervical rotatory manipulation reduced the maximum strain of the internal carotid artery(P<0.05),and its maximum strain was also less than the internal carotid artery of the positioning cervical rotatory manipulations(P<0.05).(4)For the normal internal carotid artery,in addition to the maximum strain,both positioning and non-positioning cervical rotatory manipulations had no statistically significant effects on other tensile mechanical indicators of the internal carotid artery(P>0.05).(5)The results suggest that both positioning and non-positioning cervical rotatory manipulations may increase the stiffness of the atherosclerotic internal carotid artery,reducing its elasticity and brittleness.Therefore,both positioning and non-positioning cervical rotatory manipulations may increase the risk of cardiovascular events in mild/moderate/severe atherosclerotic internal carotid artery,and the more severe the atherosclerosis is,the greater the risk of positioning/non-positioning cervical rotatory manipulation treatment,but the risk of positioning cervical rotatory manipulation is not lower than that of non-positioning cervical rotatory manipulation.

Objective To analyze the influence of ligaments surrounding sacroiliac joints (SIJs) on stability of SIJs by finite element method. Methods The finite element lumbar spine-pelvis-femur model was established. Based on this normal model, all SIJ ligaments in both sides were removed in turn, to establish models without iliolumbar ligaments, sacroiliac anterior ligaments, sacroiliac posterior ligament, sacrotuberous ligaments, sacrospinous ligaments, sacroiliac interosseous ligaments, respectively. The models were used to simulate physiological motions of the spine. The range of motion (ROM) and average stress on the left and right SIJs were analyzed and compared with the normal models. Results Compared with the normal SIJ model, no significant differences in the ROM of bilateral SIJs were found in the models without sacrotuberous ligaments, sacrospinous ligaments and sacroiliac posterior ligaments; for the model without acroiliacinterosseous ligaments, there was no significant difference in the ROM of the left SIJs under spinal right rotation and ROM of the right SIJs under spinal extension, but the ROM of bilateral SIJs increased significantly under the other spinal physiological activities. Under the physiological activities of the spine, the average stress of the SIJ surface in the left and right sides of the model without acroiliacinterosseous ligaments significantly decreased. Conclusions Of all the sacroiliac ligaments, the sacroiliac interosseous ligaments showed the maximum influences on the stability of SIJs. The research findings are helpful to investigate the mechanism of SIJ subluxation and provide certain theoretical basis for clinical treatment of SIJ subluxation.

The orbitofrontal cortex (OFC) is involved in diverse brain functions via its extensive projections to multiple target regions. There is a growing understanding of the overall outputs of the OFC at the population level, but reports of the projection patterns of individual OFC neurons across different cortical layers remain rare. Here, by combining neuronal sparse and bright labeling with a whole-brain florescence imaging system (fMOST), we obtained an uninterrupted three-dimensional whole-brain dataset and achieved the full morphological reconstruction of 25 OFC pyramidal neurons. We compared the whole-brain projection targets of these individual OFC neurons in different cortical layers as well as in the same cortical layer. We found cortical layer-dependent projections characterized by divergent patterns for information delivery. Our study not only provides a structural basis for understanding the principles of laminar organizations in the OFC, but also provides clues for future functional and behavioral studies on OFC pyramidal neurons.