This paper,starting with sociology,mainly analyzes the factors which affect the college curriculum settings from such aspects as politics and ideology,economy and technology development level,educational thinking and perceptions as well as cultural tradition,which will be useful for reference on college curriculum settings.

Exploring a pattern of teaching hospital evaluation to solve the problem of its present teaching hospitals being not enough to meet the needs of undergraduate education in the coming a couple of years due to the adjustment of enrolling system and the increase of student number .Through the evaluation ,the university is intended to attain the goal of promoting the building and development in medical treatment,teaching and research of all kinds of teaching hospitals,and the goal of "promoting the development and improvement through evaluation ,combining the evaluation with development ".

We adhere to the scientific development concept,innovate teaching supervision mode, improve teaching supervision system ,open up the working thought of focusing on guidance in combination with supervision,foster people-oriented supervision concept and expand the content of teaching supervision. The reform and innovation of implement teaching supervision in the university have only played an extremely important role in changing the study style,teaching style,management style and some other important aspects which affect undergraduate education quality but also helped enhance the teachers` awareness of ethics teaching quality and professionalism and comprehensive improve the teaching quality.

Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in 143 multiple trauma patients combined with spine and spinal cord injuries admitted to our department between March 2004 and March 2009.The parameters including injury cause,segment of injuries,associated injuries,complications,treatment methods and outcomes were analyzed.Results Falling and traffic accidents were the main causes for the injuries of spine and spinal cord,accounting for 53.8%(77 cases)and 38.5%(55 cases),respectively.The injured segments involved 101 lumbar vertebrae(50.8%),61 thoracic vertebrae(30.7%),29 cervical spines(14.6%)and 8 sacrococcygeal vertebrae(4.0%).The associated injuries were located at chest(163 regions,38.6%),abdomen(84 regions,19.9%),head and neck(77 regions,18.3%),extremity(65 regions,15.4%),face(17 regions,4.0%)and body surface(16 regions,3.8%).The early complications included electrolyte disturbances in 33 patients (16.8%),respiratory infection in 30(15.3%)and abdominal distention in 19(9.7%).The late complications were malnutrition in 26 patients(13.3%),amyotrophy in 23(11.7%)and deep vein thrombus in 11(5.6%).Treatment methods were operations and expectant treatments in 106 patients (74.1%)and 37(25.9%)respectively.According to American Spinal Injury Association(ASIA)scale,there were 20 patients(14.0%)at grade E before treatment and 53(37.1%)at grade E after treatment.Of all,12 patients were died of mainly multiple organ failure(MOF),cerebral hernia and malnutrition,with mortality rate of 8.39%.There showed an increase of complication and mortality rate with increase of ASIA grade(P ＜ 0.05).Conclusions The spine and spinal cord injuries in patients with multiple trauma are mainly caused by high energy injuries and characterized by high injury severity,complex associated injuries,multiple complications,difficult management and high mortality rate.

Objective To study the radiation-induced mitochondrial damage and energy metabolic alteration in pancreatic exocrine cells,and to explore underlying mechanism.Methods Rat pancreatic exocrine cells (AR42 J) were divided into control group and experimental group irradiated with 6 Gy of X-rays.Mitochondrial membrane potential was detected at 24,48,72 and 96 h,the lactic acid and ATP production were detected at 24 h and 48 h,and reactive oxygen species (ROS) were detected at 24 h after irradiation.The expressions of energy metabolism related factors of HIF-1α,LDHA and PDH were detected by Western blot.The animal experiments were conducted to confirm the changes.According to random number table,eight rats were randomly divided into two groups with 4 rats in each.The irradiated group was exposed to 12 Gy of X-rays,while the control group sham-irradiated.Results Compared with the nonirradiated control group,the mitochondrial membrane potential (△Ψm) of the experimental group was progressively decreased at 24-96 h after irradiation (t =5.438-17.687,P＜0.05).The ATP content in the experimental group decreased at 24 h and 48 h (q=17.300,8.328,P＜0.05),the lactic acid increased (q =21.790,16.250,P＜0.05),and the ROS level increased (t =7.935,P＜0.05).The expressions of HIF-1α and LDHA were significantly increased,but PDH was reduced after radiation.Silencing HIF-1α by siRNA eliminated radiation-induced energy metabolic alteration.These changes were confirmed with animal experiments by locally irradiating rats.Conclusions The expression of HIF-1α is upregulated by irradiation,which leads to the change of energy metabolism as the enhancement of glycolysis pathway and the inhibition of aerobic oxidation of mitochondria in pancreatic exocrine cells.

"Westward Migration Spirit" is the precious spiritual wealth of Chinese Communist Party and the Chinese nation. The course teaching team takes the undergraduate students of clinical medicine as the teaching object, tries to integrate the "Westward Migration Spirit" into the cultivation of medical students’ medical professionalism, so as to endow new connotation of medical professionalism and promote the improvement of medical students’ professionalism. Through literature review, expert consultation and questionnaire survey, the paper sorted out the context of "Westward Migration Spirit" of Chongqing Medical University, and typical examples with the spirit of medical science and humanity were selected and integrated into the teaching. A questionnaire was designed to investigate the evaluation of 425 clinical medicine undergraduates and 5 teachers on the medical professionalism course integrated with "Westward Migration Spirit" . The results show that the students and teachers have good feedback to the medical professionalism courses integrated with the "Westward Migration Spirit" , and the course has a significant positive effect on the cultivation of medical students’ medical professionalism.

Objective To investigate the safety and effectiveness of vacuum sealing drainage treatment on limb salvage in multiple trauma patients combined with Gustilo type ⅢC fracture.Methods A retrospective case control study was conducted to analyze the clinical data of 102 patients diagnosed with multiple trauma combined with Gustilo type Ⅲ C fracture admitted to Tongji Hospital from October 2005 to October 2015.There were 66 males and 36 temales,aged 17-65 years [(34.2 10.1) years].The injury severity score (ISS) ranged from 18 to 26 points [(19.8 ± 3.2)points].There were 34 patients with femur fracture,66 with tibia/fibula fracture,35 with femur and tibia/fibula fracture.Among the patients,58 were treated with VSD (VSD group) and 44 were treated with routine dressing change after emergency operation (routine group).The two groups were compared for active bleeding,re-vascular exploration,osteofascial compartment syndrome,wound infection and necrosis,gas gangrene,delayed amputation,systemic inflammatory response syndrome (SIRS),sepsis,deep venous thrombosis (DVT)incidence,per capita debridement times,length of stay,skin graft/skin flap rate,fracture fixation rate,incidence of refractory wounds,incidence of nonunion,incidence of complete nerve damage,British medical research council (BMRC) score,and amputation rate/salvage rate.Results All patients were followed up for 6-14 months [(8.4.2.1) months].There was no significant difference in limb salvage rate between the two groups after operation (P ＞ 0.05).Among the indexes of limb salvage treatment after operation,no significant differences were found between the routine group and VSD group in active bleeding,gas gangrene,re-vascular exploration and delayed amputation (P ＞ 0.05);the wound infection and necrosis rates were 32％ and 15％ (P ＜ 0.05);the incidence rates of osteofascial compartment syndrome were 22％ and 7％ (P ＜ 0.05).During the hospital stay,there were no significant differences in DVT incidence and fracture internal fixation rate between the two groups;SIRS incidence rates of routine group and VSD group were 92％ and 73％ (P ＜0.05);the incidence rates of sepsis were 28％ and 10％ (P ＜ 0.05);the per capita debridement times in routine group and VSD group were 4.2 times and 3.2 times,respectively (P ＜ 0.05);hospitalization durations were 42.1 days and 30.2 days (P ＜0.05);skin graft/skin flap rates were 69％ and 46％ (P ＜ 0.05).In the follow-up results,there was no significant difference in the amputation rate/salvage rate between the two groups (P ＜ 0.05).The incidence of refractory wounds was 28％ in routine group and 10％ in VSD group (P ＜ 0.05);the incidence of nonunion was 22％ and 6％ (P ＜ 0.05);the incidence of complete neurological damage was 36％ and 12％ (P ＜ 0.05);the excellent and good rate of BMRC score was 83％ and 96％ (P ＜ 0.05).Conclusions VSD technology can promote wound healing after operation,prevent complications,reduce the number of debridement operations and shorten hospital stay,significantly improving the prognosis and limb function of patients.It is a relatively safe and effective method for the treatment of multiple trauma combined with Gustilo type Ⅲ C fracture.

Objective:To explore the relevant risk factors and prognosis of patients with intrahepatic cholangiocarcinoma (ICC) who experienced recurrence within 6 months after surgeryMethods:This retrospective study included a total of 259 patients with ICC a treated at He'nan Provincial People's Hospital and He'nan Cancer Hospital from Jan 2018 to Jan 2020. The clinical and pathological data ,differences between the group with recurrence within 6 months and the group without recurrence within 6 months were compared using the chi-square test. Logistic regression analysis was used to determine the relevant risk factors for recurrence within 6 months. Kaplan-Meier method was used to construct survival and recurrence curves, and survival rates were calculated.Results:The overall survival and recurrence-free survival of patients in the group with recurrence within 6 months were significantly shorter. CA19-9, tumor longitudinal diameter, microvascular invasion, and neural invasion were identified as independent risk factors for recurrence within 6 months after ICC surgery ( P<0.001). Conclusion:The patient population experiencing recurrence within 6 months after ICC surgery has an extremely poor prognosis and possesses a specific tumor microenvironment. CA19-9, tumor longitudinal diameter, microvascular invasion, and neural invasion were identified as independent risk factors for recurrence within 6 months after ICC surgery.