To train self-learning ability,clinical reasoning and comprehensive analytical ability of clinical medical postgraduates,we introduced the classic cases from the New England Journal of Medicine (NEJM) and made the coherent learning method of Learn classic cases-report clinical cases-write case reports.Students were required to learn the classic cases of NEJM independently,to report clinical cases based on classic cases' level and to write a high level case report.We encouraged students to learn independently and to learn to use it.The practice has proved that the coherent learning method is a gradual and systematic learning method,which can train clinical medical postgraduates' all-round abilities and help them to grow up to qualified doctors.

ObjectiveTo evaluate the effect and safety of recombinant human erythropoietin (rhEPO) in treatment of lung cancer chemotherapy-related anemia.MethodsNinety-eight lung cancer chemotherapy-related anemia patients were divided into treatment group and control group with 49 cases each by random digits table method.The patients in treatment group were given rhEPO and chalybeate.The patients in control group were merely given chalybeate.The hemoglobin (Hb),hematocrit,allogeneic blood transfusion rate and quality of life between two groups were observed and compared.ResultsThree cases were rejected in treatment group,and 3 cases with anergy and dizzy and 2 cases with local injection site pain and sclerosis recovered spontaneously.Hb and hematocrit showed downward trend after treatment in control group,but there was no significant differences (P ＞ 0.05).Hb and hematocfit had upgrade trend after treatment in treatment group,and there were significant differences between after 4 - 8 months treatment and before treatment (P ＜ 0.05 ).The allogeneic blood transfusion rate was 24.5％ (12/49) in control group and 6.5％ (3/46) in treatment group,and there was significant difference between two groups (P ＜ 0.05 ).The quality of life in treatment group was increased compared with that in control group.There were significant differences in the effective rate after 4 or 8 weeks treatment between two groups [52.2％(24/46) vs.6.1％(3/49) and 95.7％ (44/46) vs.20.4％ ( 10/49 )].ConclusionsrhEPO is effective and safe in treatment of lung cancer chemotherapy-related anemia.rhEPO has little adverse reaction and can improve the quality of life.

Objective:To analyse the quality control assessment results of arsenic testing laboratories of national endemic disease prevention and control institutions from 2006 to 2020, so as to further strengthen the quality control of arsenic determination in laboratories of national endemic disease prevention and control institutions, and to ensure the accuracy and reliability of national endemic arsenic poisoning monitoring data.Methods:The water arsenic and urinary arsenic test results of arsenic quality control laboratories from 2006 to 2020 were collected and evaluated by Z-ratio scoring method(│Z│≤2 was qualified, 2 < │Z│ < 3 was basically qualified, │Z│≥3 was unqualified), and the qualification rates of water arsenic and urinary arsenic in different years and different provinces were calculated.Results:From 2006 to 2020, the number of laboratories participating in water arsenic quality control in 14 provinces has increased from 25 to 167, and the number of laboratories participating in urinary arsenic quality control increased from 22 to 90. The standard deviation of laboratory assessment samples was relatively stable, all < 0.05 mg/L. The quality control assessment results from 2006 to 2020 were calculated according to │Z│ < 3, the qualified rate of water arsenic ranged from 64.0% to 100.0%, and that in urine was 54.5% to 100.0%. The quality control assessment results from 2009 to 2020 were calculated according to │Z│≤2, the qualified rate of water arsenic was 84.6% - 100.0%, and that in urine was 83.6% - 100.0%. Among the 13 water arsenic assessment results from 2009 to 2020, according to │Z│≤2, provincial laboratories reported all qualified years for 8 times, prefecture, city and county-level laboratories reported all qualified years for 2 times; there were 8 provinces with all qualified laboratories at province level and 3 provinces with all qualified laboratories at prefecture, city and county-level. Among the 13 assessment results of urinary arsenic from 2009 to 2020, according to │Z│≤2, the provincial laboratories reported all qualified years for 6 times, and the prefecture, city and county-level laboratories all qualified for 1 times; there were 6 provinces in which all provincial laboratories were qualified, and there were 6 provinces in which all prefecture, city and county-level laboratories were qualified.Conclusions:The quality control work of laboratories is improving day by day, but there are still some problems in individual links. Laboratories at all levels should continue to strengthen the construction of laboratories and the training of relevant personnel, further improve the theoretical and technical level of inspectors, and continuously improve the detection quality, to make the analysis data more reliable and comparable, so as to ensure the quality of arsenic poisoning prevention and monitoring work.

BACKGROUND:The sodium alginate film, jointly developed by our research team and the Institute of Polymer Material of Qingdao University, has good biocompatibility and is often used for the preparation of a variety of composite materials. OBJECTIVE: To observe the effect of sodium alginate film wrapping and covering nerve anastomotic stoma on the regeneration of injured sciatic nerve in rats. METHODS: A total of 36 male Wistar rats were randomly divided into two groups after the right sciatic nerve was cut. Control group: The nerve stump was sutured through epineurial end-to-end anastomosis; Experimental group: The nerve stump was sutured through epineurial end-to-end anastomosis, and wrapped with sodium alginate film, forming a regenerative environment for sciatic nerve regeneration. The degradation and absorption of sodium alginate film, as wel as the adhesion at suture site were observed post-operation. Interleukin-2 and interleukin-4 positive expression was detected with immunohistochemistry method. The histological sections were also detected with hematoxylin-eosin staining and osmium tetroxide staining. RESULTS AND CONCLUSION:At 4-6 weeks post-operation, sodium alginate film was mostly degraded and absorbed in the experimental group. The experimental group rats had less local adhesion, slighter infiltration of inflammatory cels, and fewer fiber tissue hyperplasia than control group rats. The contents of interleukin-2 and interleukin-4 were almost the same between the control and experimental groups at 1, 7, 14 days post-operation. At 6 weeks, the regenerated nerve fibers were distributed evenly with uniform shape, the number of nerve fibers, axons and myelin sheath were significantly better than the control group (P < 0.05). Sodium alginate film has good biological degradability and histocompatibility and plays an important role in promoting sciatic nerve regeneration.

Objective To construct 131 I labeled anti?EGFR immunoliposome nanoparticle ( 131 I?Cetuaximab ( C225)?BSA?PCL) , and investigate its inhibitory effect on EGFR?overexpressing cancer cells in vitro. Methods Anti?EGFR liposome nanoparticle C225?BSA?PCL and non?targeted liposomes BSA?PCL were constructed. The products were observed with transmission electron microscopy and dynamic light scat?tering. The EGFR?targeted binding and cellular uptake in EGFR?overexpressing cancer cells were observed with flow cytometry and confocal microscopy. Anti?EGFR and non?targeted liposomes were labeled with 131 I using the chloramine?T method. The targeted cell killing effects of 131 I labeled liposomes were analyzed using MTT assay. The time?dependent cellular uptake analysis was used to evaluate the slow?release effects of the 131 I labeled liposomes. The independent?samples t test was used for data analysis. Results The EG?FR?targeted liposome C225?BSA?PCL and non?targeted liposome BSA?PCL were successfully constructed, and the effective diameters were approximately 130-180 nm. Flow cytometry and confocal microscopy re?vealed significant uptake of C225?BSA?PCL in EGFR?overexpressing tumor cells. BSA?PCL could also bind to cells with minimal and weak tumor retention. The EGFR?targeted radioactive liposome 131I?C225?BSA?PCL showed greater targeted cell killing effect than non?targeted liposome 131I?BSA?PCL,the IC50 values of 131I?C225?BSA?PCL and 131 I?BSA?PCL were 0. 03-1. 32 and 0. 25-12. 19, respectively. The uptakes of 131 I?C225?BSA?PCL was higher than that of 131 I?BSA?PCL ( t=3.03-16.86, all P<0.05) and reached the maxi?mal level at 4 h after incubation. Conclusions The EGFR?targeted liposome C225?BSA?PCL demonstrated superior cellular binding and uptake on EGFR?overexpressing cancer cells compared with BSA?PCL. The EGFR?targeted radioactive liposome 131 I?C225?BSA?PCL had favorable intracellular retention and excellent targeted cell killing effect, and could effectively suppress the growth of EGFR?overexpressing cancer cells.

Objective To investigate the biological effects of internal radiation and therapeutic effectiveness of 131I-labeled anti-epidermal growth factor receptor (EGFR) in colorectal cancer of model mice.Methods Nano-liposome characterized for EGFR-targeting was constructed.The efficacy of cellular binding and uptake of the liposome was evaluated by the analysis of confocal microscopy observation and the iodide uptake assay.After intra-tumor injections of 74 MBq (740 MBq/ml) 131 I-antiEGFR-BSA-PCL,131 I-BSA-PCL,131 I or an equivalent volume of normal saline.The biological effects of internal irradiation and therapeutic efficacy of the liposomes on colorectal cancer modeled in a male BALB/c mouse were evaluated by means of tumor size,body weight,histopathology,and SPECT imaging.Results The confocal fluorescence images showed that the antiEGFR-BSA-PCL was successfully internalized into LS180 cells.The 131I uptake efficacy of 131I-antiEGFR-BSA-PCL was significantly higher than that of 131I-BSA-PCL in LS180 cells (t =2.77-5.40,P ＜ 0.01).Tumor size measurement showed that tumor growth was inhibited by the treatment with 131 I-EGFR-BSA-PCL and 131I-BSA-PCL,but had no significant differences between these two groups (P ＞0.05).It was found that the 131I-antiEGFR-BSA-PCL was markedly taken up by the tumor and reac hed its uptake value of (21.61 ± 1.0 1) and (20.58 ± 0.65)％ ID/g at 72 h following drug injection,which was higher than the uptake value of 131 I (t =9.36,8.69,P ＜ 0.01).SPECT imaging assay showed that,after being injected into mouse tumor,the 131 I-EGFR-BSA-PCL and 131I-BSA-PCL were uniformly distributed inside the tumor.Conclusions 131 I-antiEGFR-BSA-PCL obviously suppresses the development of colorectal cancer in mice.

Objective To investigate the effect of the percutaneous autologous bone marrow stem cell transplantation for the treatment of nonunion of tibial fracture. Methods From 2007 to 2011,the data of 11 patients with tibial nonunion who received autologous bone marrow stem cell transplantation was analyzed retrospectively. Taking bone marrow,examine,isolation,cultivation and expansion marrow mesenchymal stem cells( MSCs) ,and then marrow needle was inserted into the site of the nonunion under the X-ray,the MSCs were injected into the site of nonunion. Compression bandage was applied after operation. X-rays following-up were reviewed. Results All 11 patients were followed up from 4~27 months,with average of 13 months,X-ray showed:fracture healed well,no adverse events happen. Conclusion Satisfactory out-come can be obtained by percutaneous autologous bone marrow stem cell transplantation in treatment of tibial nonunion. Clinical application value is high,especially to patients who had suffered from severe skin and soft tissue injury with keloids healed.

Objective To investigate the clinical outcomes in the treatment of complex acetabular fractures through a single supra-ilioinguinal approach after the application of preoperative 3D printing and rapid prototyping simulating the operative procedure.Methods From January 2013 to January 2016,24 cases of complex pelvic and acetabular fractures in our hospital were retrospectively analyzed.Among them 18 cases were male and 6 were female.The average age was 39.2+±13.8 years (range,24-68 years).According to Letoumel-Judet's classification,there were 6 cases of transverse,4 cases of T shaped,4 cases of combined anterior column and posterior hemi-transverse (ACPHT) and 10 cases of 2-column fractures.The time from injured to operation averaged 9 days (range,4-18 days).Before operation,pelvic AP view,three-dimensional CT as well as CTA of iliac blood vessels was taken routinely in all cases.The CT and CTA scan data were then imported into Mimics software for 3D reconstruction.Surgical simulation and optimal placement of internal fixations were performed on computer.After that,the individual simulated model of the pelvis was printed by the use of 3D printing and rapid prototyping technique.The order of reduction,selection and optimal position of the implants were determined.The plates were bent before operation and the length and direction of the screws were recorded.A uniform supra-ilioinguinal approach was used in all cases.Results The length of incision averaged 9 cm (range,8-13 cm).The operative time average 130 min (range,90-220 min).The blood loss averaged 600 ml (range,300-1 500 ml).Once a satisfactory reduction was obtained,single placement of the plates was achieved.In accordance with the preoperative plan,the plates were perfectly fitted to the bone surface.The 24 patients were followed for an average time of 18.3 months (range,15-30 months).The fractures healed in all cases.The average healing time was 4.2 months (range,3-6 months).According to Matta criteria,there were 16 cases of excellent,6 cases of good,2 cases of poor and the excellent rate was 91.7％ (22/24).The average modified Merle d'Aubigne score was 16.5 (range,13-18).The functional outcome was excellent in 13 cases,good in 6 cases and poor in 5 cases.The excellent rate of hip functions was 79.2％ (19/24).There were 2 cases of femoral lateral cutaneous nerve injury (recovered one month later) and another 1 case of fat liquefaction of the incision happened three days postoperatively (the wound healed completely after several dressing changes).No inguinal hernia or abdominal wall hemias was found.No other postoperative complications was found.Conclusion The application of 3D printing and rapid prototyping technique allows preoperatively simulating reduction in vitro,determining the optimal position of the implants,bending the plates and measuring the length of the screws in advance,which could largely reduce the operative time,intraoperative blood loss and occurrence of postoperative complications.Adopting supra-ilioinguinal approach for the treatment of complex acetabular fractures with a small incision and less trauma,a full exposure could be obtained,so the reduction and fixation of the anterior,posterior and middle column (also named pubo-ischiatic column) could be completed in a direct visualization,resulting in a satisfactory clinical outcomes.

Objective To investigate the effect of autologous platelet rich plasma along with bone transportation in tibia defect.Methods This was a randomized single-blind placebo controlled clinical trial.From Jan 2013 to Mar 2015,28 patients (28 cases) suffering from tibia defect because of trauma or osteomyelitis were randomly assigned to PRP group (PRP along with bone transportation,n=15) or bone transportation group (bone transportation only,n=13) through random number table and sealed envelop method.PRP group:male to female 12∶3,average age:40.9 years old,average bone defect:7.1 cm,6 caused by trauma,9 by osteomyelitis;while bone transportation group:male to female 10∶3,average age:37.7 years old,average bone defect:6.5 cm,3 caused by trauma and 10 by osteomyelitis.Bony results and tibia function were evaluated according to the Association of the Study and Application of the Method of Ilizarov (ASAMI) protocol.The external fixation index,complications and VAS pain score were also evaluated.Results The mean follow-up time was 21.8 m in PRP group and 23.2 m in bone transportation group and there were no loss to follow-up.There were no differences between two groups on postoperative VAS pain score:1st d postoperative (3.33±2.58 vs 4.46±2.73);7th d postoperative (2.67±2.09 vs 3.00±2.20);and 2 weeks postoperative (1.46± 1.77 vs 2.62±2.72).There was significant difference between two groups on external fixation index (37.9±7.7 d/cm vs 46.9± 13.7 d/cm).According to the ASAMI protocol,all patients achieve bone union,except 2 cases in control group which need revision surgery;excellent and good rate of bone defect union was 93％ in PRP group while 77％ in control group;while no difference was found on complication and lower extremity function.Conclusion Application of PRP along with bone transportation in the treatment of tibia defect resuits in shorter healing duration and external fixation duration.But no short-term postoperative analgesic effect,lower extremity function,and complication rates were found.

Objective The aim of this study was to determine the effect of a new method of cardiac assistant therapy with an extra-aortic balloon pump on the experimental dogs in which myocardial ischemia or infarction were induced, and to ob serve its effectiveness and feasibility. Methods Twelve animal models of myocardia 1 infarction were established with the method of left anterior descending coronary artery ligation. They were divided randomly into two groups, six in the experimental group and six in the untreated group. The end points observed were the differences between the two groups in the blood pressure, cardiac function, myocardial enzymes, infarction size and routine blood variables before procedure, 1,2, 3, 4, 5 and 6 hours after myocardial infarction. Results All six dogs in the experimental group were survived, with a mortality rate of 0.The number of death in the control group was three, with a mortality rate of 50%. Measurements such as mean blood pressure,cardiac output, cardiac index in the experimental group were better than those in the control group ( P ＜ 0.05 ). Mean heart rate before myocardial infarction in the experimental group was 156 beats per minute, as compared with 148 beats per minute in the control group, and was 128 vs. 67 beats per minute respectively six hours after myocardial infarction. The cardiac output was 3.48 vs. 4.98 liters per minute before myocardial infarction and was 6.10 vs. 0.85 liters per minute six hours after myocardial infarction. The average pressure was 94 mm Hg vs. 99 mm Hg before myocardial infarction and was 70 mm Hg vs. 33 mm Hg six hours after myocardial infarction. Conclusion The extra-aortic balloon pump significantly improved the hemodynamic variables of the experimental animals after myocardial infarction and reduced mortality. Injury to the blood cells may be the potential disadvantage.