Mixed reality technology can achieve a 3D reconstruction of the patient's imaging data and organically combine the real scene. This allows to simulate a real medical operation in clinical teaching. Combined with large data analysis, mixed reality technology allows to build situational awareness data models, thus providing data support for teaching interaction and disease simulations. In the present work, the application of mixed reality technology and situational awareness in clinical teaching of cardiac macrovascular surgery is explored innovatively. These technologies open a new avenue for teaching, solving the issue that stymies traditional teaching approaches and improving the teaching efficiency. It is thus important to explore and promote the applications of this innovative teaching methodology particularly in clinical teaching.

OBJECTIVE:To provide reference for medical costs control in China. METHODS:Based on main characteristics of the United States health service system,information asymmetry,principal-agent theory and Freedman’s consumption theory were used to analyze the advantages of restrictive relationship among doctors,hospitals and health insurance institutions in control-ling medical costs and improving the quality of diagnosis and treatment. The growth rate of medical cost,the percentage of drug ex-penditure and other aspects were compared between China and the United States;the effect of restrictive relationship on medical cost control was demonstrated. RESULTS & CONCLUSIONS:In the United States,there are hierarchical medical system and two-way referral system;for-profit hospitals and non-profit hospitals are mutually complementary;different natures of health insur-ance system,different payment methods and strict“commercial bribe”monitoring system are carried out;doctors,hospitals and health insurance restrict each other. Not only there are many advantages in theory,but also in practice the growth rate of medical cost and the percentage of drug expenditure are superior to our country. Finally it controls the rapid growth of medical cost to a cer-tain extent. Combined with our national conditions,learning from the United States experience,restrictive relationship among doc-tors,hospitals and health insurance institutions is established to control the increase of medical cost in China through reducing infor-mation asymmetry and standardizing payment audit;establishing a scientific pattern of mixed payment;strengthening the indirect impact of the health insurance institutions on doctors and hospitals,etc.

Objective:To prepare a novel vascular endothelial growth inhibitor-soluble chimeric protein VEGI~+,so as to lay a basis for studying its biological activity.Methods:Chimeric molecule VEGI~+ was constructed by grafting oligopeptide CTTH- WGFTLC to extraeellular region of VEGI(VEGI_(23-174)).Before ligation into pET30a(+)expression vector,PCR product of the recombinant gene was cloned into pGEM-T vector and verified by restriction enzyme digestion and DNA sequencing,then pET30a-VEGI was used to transfect BL21(modified E.coli strain).The chimeric protein was purified by metal affinity chro- matography.Western blotting and coomassie blue staining were used for protein identification.Results:The chimeric molecule VEGI~+ was confirmed by restriction enzyme digestion and DNA sequencing.The constructed pET30a-VEGI was confirmed by enzymatic digestion.The expression was mainly in the form of inclusion body.SDS-PAGE electrophoresis and Western blotting revealed a chimeric protein about 23000,with a purity of about 90%.Conclusion:We have successfully constructed the recom- binant plasmid pET30a-VEGI~+ and expressed it in E.coll.And we have obtained high purity of soluble chimeric protein VEGI~+ through affinity chromatography.

Objective To investigate the radiologic and angiographic findings of dilated superior ophthalmic vein(SOV)associat- ed with orbital arteriovenous malformations(AVM).Design Retrospective case series.Participants Six cases of orbital AVM patients, with clinical symptoms and signs mimicking a carotid cavernous fistula(CCF).Methods Examinations of the six cases,such as CT, MRI,and selective cerebral angiography,were summarized and analyzed.Main Outcome Measures Images findings and hemodynam- ics.Results All patients were found with dilated SOV on CT and MRI.Additional radiographic findings included proptosis and AVM. All six AVM were located at the orbit,and one of them was also found with AVM in brain.The main draining vein was SOV in all cas- es.The branches contributing to the fistula's blood supply were the middle meningeal artery,the internal maxillary artery,and the oph- thalmic artery.Conclusions Orbital AVM can cause similar clinical signs and radiologic features to those associated with a CCF.How- ever,the bulging cavernous sinus cannot be found in most AVM.Angiography is necessary for definitive management,non-invasive techniques have an important role in pre-angiographic diagnostic decisions.(Ophthalmol CHN,2007,16:395-398)

Objective To evaluate the efficacy of methylprednisolone pulse therapy in the treatment of thyroid-associated oph- thalmology. Design Meta analysis. Participants Published literatures about methylprednisolone pulse therapy for thyroid-associated ophthalmopathy. Methods A meta-analysis of published randomized clinical trials was used. Published literatures were selected for study based on a computerized search of the literature and a manual search of the bibliographies of relevant papers. Studies meeting se- lected criteria were reviewed systematically by meta-analysis. Data was extracted on the basis of the intention-to-treat principle. Treat- ment effect was measnred as relative risk(RR) of response rates. Main Outcome Measures The effective rate and the relative risk(RR). Results A total of 6 articles were included in this meta-analysis. The RR (95%CI) were 7.50 (1.14, 49.26) when comparing methylpred- nisolone pulse therapy with placebo, 3.33 (0.51, 21.89) when comparing methylprednisolone pulse therapy with surgical decompression, and 1.50 (1.12, 2.00) when comparing methylprednisolone pulse therapy with oral steroids. The combination of methylprednisolone pulse therapy and orbital radiotherapy was significantly effective than oral steroids combined with orbital radiotherapy which pooled RR (95% CI) was 1.42 (1.11, 1.81). Conclusions Methylprednisolone pulse therapy appears to be an effective treatment for thyroid-associated ophthalmology, and seems to have increased effect when given with orbital radiotherapy.

Objective To study the expression and significance of Th17 cells from peripheral blood of patients with rheumatoid arthritis (RA). Methods Intracelluar flow cytomete detection of IL-17/IFN-γ and IL-17/IL-6 was established using anti-CD3/Anti-CD28/IL-23 as stimulators after isolation of untouched human CD4~+T cells from PBMC. There were three groups in the present study: ①healthy controls group; ② RA stable group; ③RA active group. Results The isolation of untouched human CD4~+T cells from PBMC was effective and its purity was over 90%. The percentage of intracelluar IL-17 in CD4~+ T cells from RA patients was increased significantly. Such percentage in active group (1.54±0.41) was higher than that of stable group (0.70±0.21, P<0.01) and both of them were higher than those of healthy controls (0.42±0.12, P<0.01). Under anti-CD3/Anti-CD28/IL-23 stimulation, the percentage of intracelluar IL-17 was also increased significantly(P<0.01). The porcentage of intracellular IFN-γ was similar to that of IL-17, while that of IL-6 was not significantly different. There is an correlation between IL-17 and IFN-γ or IL-6. Conclusion There is an abnormal expression of IL-17 and IFN-γ in human CD4~+T cells in RA patients, which is related to disease activity . Th17 cells may be used as a new marker for the assessment of RA activity.

Objective To study the follow-up management strategies after improving stoves for controlling coal-burning type endemic fluorosis in Guizhou and to provide a scientific basis for exploring the follow-up management measures.Methods In 2006 - 2009,three counties of Puding,Bijie and Liuzhi with improved stoves in 2005 and implemented follow-up management measures for subsequent three years were chosen,3 towns were chosen randomly in each chosen county,2 villages were selected randomly in each chosen town,10 households were investigated randomly in each chosen village,and 20 students were investigated of the knowledge of fluorosis control.The investigation included also the usage of the stoves,dehydration methods of grain and related conditions.Results ①The head of the family and student awareness of fluorosis control were 82.6％(743/900)and 91.7％ (1650/1800),respectively,and 35.0％ ( 385/1100 ) and 61.0％ (6605/10 835 ),respectively,before the test,and the difference was statistically significant( x2 =33.04,1189.12,all P ＜ 0.01 ).②The rates of chimney out of the house were 88.5％(69/78) and 100.0％(102/102),respectively,compared with those before the trial[74.4％(2125/2856) and 2.1％(104/4984),respectively],the difference was statistically significant(x2 =720.56,4295.38,all P ＜ 0.01).The iron stove and the table stove's airtight utilization rates were 85.9％(67/78) and 100.0％(102/102),respectively.③The corn and the hot pepper's correct drying rates were 100.0％(180/180).Compared with those[27.2％(49/180) and 32.2％(58/180),respectively]before the trial,the difference was statistically significant(x2 =26.68,37.38,all P ＜ 0.01 ).The corn and the hot pepper's washing rates before eating were 95.0％(57/60) and 98.3％(177/180),respectively.Compared with those[85.0％(153/180) and 77.8％(140/180)]before the trial,the difference was statistically significant(x2 =135.00,490.82,all P ＜ 0.01 ).Conclusions The target population's awareness and knowledge of fluorosis prevention and related behavior are significantly elevated and enhanced after implementation of the three years post-management,which has reached the desired goal.The strategies of the follow-up management suits Guizhou province and widespread application is suggested.

Objective: To screen candidate antigen for therapeutic HBV vaccine with a novel adjuvant DC-Chol. Methods: BALB/c mice were injected with DC-Chol liposome and HBsAg prepared from CHO and Yeast respectively. One week later, IL-4, IL-2, IFN-?were measured by ELISA or ELISPOT. Results: The levels of IL-2, IFN-?of HBsAg from Yeast with DC-Chol liposome were 20 and 119 times higher respectively than those of HBsAg from CHO with DC-Chol liposome. ELISPOT assay showed that the counts of spot-forming cells of IL-4 and IFN-?of HBsAg from Yeast with DC-Chol liposome were 2.8 and 46.3 times higher respectively than those of HBsAg from Yeast with Al(OH)3. Conclusion: HBsAg prepared from Yeast together with DC-Chol liposome may be an appropriate candidate for therapeutic HBV vaccine .

Objective To investigate the diagnosis and the microsurgical treatment of intramedullary hemangioblastoma in cervical spinal cord.Methods The signs of MRI,and the results of operations were analysed in 26 patients with the tumors.Rusults The tumors can be classified into two types:Solid type (14 cases)and cystic type(12 eases).All the tumors underwent total removal and were all hemangioblastoma confirmed by histopathologic examinations.Postoperatively,neurological status were improved in 17 patients, remained in 7 cases and worse in 2 cases.Conclusion For intrameduUary hemangioblastoma of cervical spinal cord MRI is of significant importance in the diagnosis of localization and the nature of the tumors which is conductive to selecting appropriate operative methods.There is high risk in operating at cervical section,but microsurgical total resection is the optimal method to stop the development of the clinical presentation.Opera- tive methods varied with the different typer of the tumor.It is the most important principal that dissection is performed along the correct interface and the tumor should be removed en bloc after it is devascularized.

Objective To investigate the impact of hepatectomy combined with splenectomy on hepatitis B virus (HBV) reactivation in patients with hepatocellular carcinoma (HCC) ≤5 cm and with hypersplenism.Methods This is a retrospective case-control study on 167 patients with HCC ≤5 cm and with hypersplenism who underwent hepatectomy combined with splenectomy at the Shengli Oilfield Central Hospital between May 2008 and June 2015.64 patients underwent hepatectomy combined with splenectomy,and 103 patients hepatectomy alone.The patients were assigned to the hepatectomy combined with splenectomy group (the combined group,n =61) or the hepatectomy alone group (the control group,n =61) using propensity score matching (PSM).Logistic regression was used to evaluate the relative clinical factors associated with HBV reactivation.The stratified Chi-squared test was utilized to determine the impact of the surgical procedure and preoperative anti-viral therapy on postoperative hepatitis B virus reactivation of these patients.Results The serum PLT level,Child-Pugh grading,tumor diameter and surgical procedures were shown to be independent risk factors associated with postoperative HBV reactivation (P ＜ 0.05).To study the impact of preoperative anti-viral therapy on postoperative HBV reactivation:-the incidence of HBV reactivation was higher in the control group than in the combined group (19.7％ vs.6.6％,P ＜ 0.05).In the combined group,there was no significant difference between patients who received anti-viral therapy and those who were treatment-naive (5.3％ vs.7.1％,P ＞0.05).In the control group,a higher incidence of HBV reactivation was found in patients with treatment-na(i)ve than in patients who received anti-viral therapy (26.1 ％ vs.0,P ＜ 0.05).For the patients who received anti-viral therapy,there was no significant difference between the combined group and the control group (5.3％ vs.0,P ＞ 0.05).In patients with treatment-na(i)ve,a higher incidence of HBV reactivation was observed in the control group than the combined group (26.1％ vs.7.1％,P ＜ 0.05).Conclusions In patients who were not treated with antiviral therapy,hepatectomy combined with splenectomy decreased the incidence of postoperative HBV reactivation in patient with HCC ≤5 cm and with hypersplenism.For the patients who received preoperative anti-viral therapy,the incidence of postoperative HBV reactivation was not decreased with hepatectomy combined with splenectomy.