Objective:To evaluate the application of flipped classroom based on rain classroom in standardized residency training of orthopedics.Methods:Sixty-two orthopedics residents were randomly divided into flipped classroom teaching group and traditional teaching group, with 31 residents in each group. The flipped classroom teaching group the flipped classroom teaching mode based on rain classroom, including three aspects: learning in advance before rain classroom, personalized discussing cases in class and teaching after class. The theoretical knowledge, clinical skills and evaluation of teaching activities were compared between the two groups. SPSS 19.0 was used for rank sum test and chi-square test.Results:All the residents completed the evaluation of theoretical knowledge, clinical skills and effect. The results showed that the scores of theoretical knowledge and clinical skills in the flipped classroom teaching group were (88.7±10.3) points and (26.8±2.2) points, which were significantly higher than those of the traditional teaching group (79.2±18.6) points and (20.4±2.9) points, with statistical significance ( P<0.05). The evaluation of teaching activities, including participation, satisfaction, enthusiasm and learning effect, was significantly better than that of the traditional teaching group ( P<0.05). Conclusion:In the orthopedics standardized residency training and teaching activities, the application of flipped classroom teaching mode based on rain classroom is conducive to improving students' learning performance, cultivate their autonomous learning ability, and improve their learning satisfaction and enthusiasm.

BACKGROUND:In treatment of lumbar diseases, lumbar fusion therapy fails in 20%of cases and may lead to a series of complications such as pain, intervertebral space col apse, and delayed kyphosis deformity.
OBJECTIVE:To observe the effect of nucleus pulposus on interbody fusion after removing the anterior column disc of rabbit lumbar vertebra.
METHODS:A total of 36 healthy Japanese white rabbits were randomly and equal y divided into three groups, with 12 rabbits in each group. (1) Group of anterior longitudinal ligament+bone grafting:The L3 intercalated disc were wel exposed and anterior longitudinal ligament was stripped, obtaining a space to L3 intercalated disc, then the iliac bone was implanted. (2) Group of excising anterior 1/3 disc+bone grafting:After the anterior 1/3 disc tissue was excised, the iliac bone was implanted and sutured as Group of anterior longitudinal ligament+bone grafting. (3) Group of excising anterior 1/3 disc+fixation:After the anterior 1/3 disc tissue was excised, the iliac bone was implanted and the anterior column fixation was performed.
RESULTS AND CONCLUSION:Biomechanical testing showed that, at 12 weeks, the verticality tensile force in the group of anterior longitudinal ligament+bone grafting was obviously higher than other two groups, and have better fusion rate and could bear stronger force. Lateral position lumbar radiography showed that, the bone graft was absorbed and no new bone grew into the intervertebral space in the group of excising anterior 1/3 disc+bone grafting at 12 weeks;the formation of osseous bridge was found in the group of excising anterior 1/3 disc+fixation;complete bony fusion was found in the group of anterior longitudinal ligament+bone grafting. Histological examinations showed that, at 12 weeks, no bone tissue formed in the group of excising anterior 1/3 disc+bone grafting;a smal amount of bone trabecula and osteocytes were observed in the group of excising anterior 1/3 disc+fixation;a great quantity of newborn bone trabecula and osteocytes, remodeling lamel ar bone and canalis haversi structure were observed in the group of anterior longitudinal ligament+bone grafting. The stability of anterior column has notable effect on interbody fusion, after the anterior column disc is destroyed, the free nucleus pulposus may affect spinal fusion, so restoring the stability of the anterior column may promote interbody fusion, but stil cannot get solid spinal fusion.

Autophagy is an active research area in the biomedical field as its role has been identified in many physiological and pathological processes. Accordingly, there is a growing demand to identify, quantify and manipulate the process accurately. Meanwhile, there is great interest in identifying compounds that modulate autophagy because they may have applications in the treatment of a variety of autophagy-related diseases. In this review, we summarize the current status of autophagy screening systems to facilitate identification of autophagy modulators.

Objective To compare the clinical efficacy and safety between percutaneous vertebroplasty (PVP) and conservative treatment for osteoporosis vertebral compression fracture (OVCF).Methods A total of 55 patients undergoing PVP and 65 patients with conservative treatment for OVCF in our hospital from 2006 to 2011 were retrospectively analysed.The degree of pain and personal life before treatment and after treatment at different time points were investigated by visual analogue scale (VAS) pain scale and Oswestry Disability Index (ODD.Results The degree of pain in lower back was reduced after the treatment.The VAS pain scales in PVP group versus control group were (8.3±0.5) vs.(8.50.6),(6.9±0.7) vs.(4.5±0.7),(5.40.6) vs.(3.4±0.5),(4.8±0.3) vs.(2.8±0.5),(4.0±0.4) vs.(2.3±0.4),(3.1±0.5) vs.(2.0±0.2)before treatment and 1 week,1,3,6 and 12 months after treatment,respectively.The VAS pain scales were reduced more rapidly in PVP group than in control group,showing a better relief of pain.There were differences in VAS pain scales between the two groups at different time points (t=17.89,19.74,28.38,24.49,14.01,respectively,all P＜0.01).The ODI scores in PVP group and control group were [(88.8±5.0) vs.(87.2±5.1)],[(72.6±7.8) vs.(53.1±6.3)],[(62.0±8.5) vs.(37.2±6.0)],[(47.1±12.6) vs.(26.5±3.6)],[(36.7±9.3) vs.(17.9±5.5)],[(24.3±10.0) vs.(9.4±2.5)] before treatment and 1 week,1,3,6 and 12 months after treatment,respectively.The ODI scores were reduced more rapidly in PVP group than in control group,showing a better recovery of daily life.There were differences in ODI scores between the two groups at different time points (t=15.00,18.17,11.74,13.20,10.72,respectively,all P＜0.01).Conclusions PVP can alleviate pain and restore daily life rapidly.It shows advantages in rccovery of the fractured vertebrae height.

Objective To explore clinical features and antimicrobial resistance of lower respiratory tract infection (LRTI)with Streptococcus pneumoniae (S .pneumoniae)isolated from children in Nanjing.Methods Clinical data of children with confirmed S .pneumoniae LRTI through sputum culture at a children’s hospital in Nanjing between July 2013 and June 2014 were analyzed retrospectively,S .pneumoniae strains were performed antimicrobial susceptibility testing through K-B method and minimum inhibitory concentration (MIC)testing.Results Among 197 children with S .pneumoniae infection,72.59% were <3 years old,63.96% occurred in autumn and winter, 57.87% had elevated leukocyte count,cough and fever were the most common clinical symptoms,complications of digestive and circulatory system were also common.The resistance rates of S .pneumoniae to azithromycin, penicillin,and erythromycin were 94.92%, 92.98%, and 88.83% respectively; the sensitivity rates to vancomycin,chloramphenicol,meropenem,ceftriaxone,and ofloxacin were all > 90%,vancomycin was up to 98.98%.Conclusion The percentage of S .pneumoniae LRTI is high in children < 3 years old,most occur in autumn and winter,resistance rates to azithromycin,penicillin,and erythromycin are all high,antimicrobial agents should be selected for the treatment of infection according to antimicrobial susceptibility testing.

Objective To establish the cell line stably expressing INSIG2 and observe its effecet on fat metabolism after overexpression of INSIG2.Methods The eukaryotic expression plasmid pcDNA3.1(+)-INSIG2 was constructed,which was transfected into 3T3-L1 cells.The expression of INSIG2 and related genes were detected by RT-PCR and immunohistochemistry,the contents of FFA in cell culture medium and adipocyte differentiation were detected by ELISA and Oil Red "O"staining respectively.Results After pcDNA3.1(+)-INSIG2 was transfected into the 3T3-L1 cells,the expression of INSIG1 mRNA and FAS mRNA were down-regulated,the content of FFA in the cell culture medium was decreased and adipocyte differentiation was drepressed.Conclusion The cell line stably expressing INSIG2 was successfully established,the transfected INSIG2 may have a drepressant effect on fat metabolism.

Objective To establish a method for the in-vitro culture of astrocytes from cerebral cortex of neonatal rats.Methods Astrocytes were isolated from cerebral cortex of the neonatal SD rats aged 24 hours,and then were cultured in the high-glucose DMEM medium with 10% fetal bovine serum added.The morphological features of astrocytes were examined under inverted microscope.The growth of the third generation of astrocytes was observed with counting plate method and methyl thiazolyl tetrazolium (MTT) assay.Results The astrocytes from cerebral cortex of neonatal rats grew well,the astrocytes showed typical morphological features,and no other kinds of cells was found.Conclusion A simple and practical in-vitro culture method for rats astrocytes is established.

Objective To study Curcumine's growth-inhibitory effects and morphological changes on sarcoma grafts of S180 mice,with further inquiry into the possible mechanism.Methods A total of 30 cases of S180 mice were assigned randomly into 3 groups: saline group(blank control),CTX group(positive controlled) and Curcumine group.① The anti-tumor effect on internal organ of mice was observed to study the tumor inhibition rate in different groups.② Influence of curcumine on mice's immune system was studied by comparing the index of thymus and spleen.③ The growth and patho-morphologic changes of tumor cells were observed.④To calculate the index of apoptosis cells and observe the morphological changes of all groups' apoptosis cells under electroscope.Results ① The inhibitory rate was 68.32% in the curcumine group,70.43% in the positive controlled group.Compared to blank control group, these two groups had significantly elevated tumor inhibition rate(P0.05);however,positive thymus index in control group had significant decrease compared with that in the other two groups(P0.05).③ Under electroscope,curcumine group and positive control group had significant decrease in growth of tumor,degree of tumor infiltration,number of nucleus fission,and blood vessel number compared to those in negative control group(P

Objective To explore virtual three-dimensional (3D)model for intravascular interventional devices,the method of preoperative simulation and its value in clinical work.MethodsThe virtual models including catheter,guide wire,stent and coil were established by using the 3D moulding software of 3D Studio MAX R3. The interventional preoperative simulation was performed on personal computer including 21 patients of cerebral aneurysm embolization ( anterior communicating artery 5,posterior communicating artery 10,middle cerebral artery 3,internal carotid artery 2,and vertebral artery 1 ),during interventional procedures,the surgeon relied on the simulation results for plastic micro-guide wire,catheter and the release of micro-coils and stents.Results( 1 ) All the virtual instruments and real instruments had similar shape,the overall tine for constructing virtual model was about 20 hours.The preoperative simulation took 50 to 80 minutes. (2) The simulation result of catheter insertion in the 18 cases had relevant value to guide micro-catheter,molding micro-guide wire tip,and shortened the operating time.For embolization,the simulation results of filling coil and releasing stent were similar to surgical results in 76％ of the patients (16/21).(3)For teaching and training,93％ (38/41) of doctors in training believed that preoperative simulation facilitated the understanding of surgery. ConclusionsThe method of virtual model of intravascular interventional devices was reliable.The preoperative simulation results could be used to guide practical clinical operation with relatively high degree of similarity,and could play a role in promoting researches on interventional virtual operations.

ObjectiveTo study the clinical efficacy and safety of Narcotrend (NT) monitor for the prevention of awareness during general anesthesia.MethodsFour hundred and thirty-two patients with elective extubation and general anesthesia (ASA Ⅰ-Ⅱ) were divided into observation group and control group with 216 cases each by random digits table.All patients were treated with total intravenous anesthesia.The patients were given anesthetics by NT monitor in observation group and detemined by the clinical experience of anesthesiologists in control group.The mean arterial pressure (MAP),heart rate (HR),respiratory rate(RR),pulse oxygen saturation(SpO2),NT stages (NTS),NT index (NTI),total sedatives,awaking time,extubation time,Ramsay score was recorded.All patients in the postoperative on the first day and the fourth day were followed-up two times to understand the perception and memory in patients undergoing the situation.ResultsThere was no know in operation in observation group,there was 1 case with suspectedknow and 1 case with definite know in control group.Compared with control group,the awaking time and extubation time was decreased in observation group [ ( 6.0 ± 2.8 ) min vs.( 10.0 ± 4.9 ) min,( 12.0 ± 5.5 ) min vs.( 19.0 ± 6.9) min] (P ＜ 0.05 ); MAP and HR was even more stable.In addition to midasolam,the remaining amount of the drug was less (P ＜ 0.05 ).Ramsay score at awaking,extubation and out of the operating room in observation group was lower than that in control group (P ＜ 0.05).ConclusionNT monitor for total intravenous anesthesia increases the safety of general anesthesia,and it can be reduced to some extent,intraoperative awareness.