Adult medical education has its own particularity.Its quality is affected by students' work units,families,schools,their own and other factors.Changing concepts,optimizing management,promoting personal quality education,setting up early warning mechanism,and doing full co-ordination are effective ways to improve the quality of adult medical education.

Objective To compare the bone microstructure and osteoblast and osteoclast activity in different regions of osteonecrosis of the femoral head.Methods The osteonecrosis femoral heads were collected from 10 patients (Ficat Ⅳ) who had undergone total hip arthroplasty from March 2011 to May 2013.There were 6 males and 4 females.Their average age was 47.7 years old (range,40-57 years).The samples were divided into subchondral bone region,necrotic region,sclerosis region and healthy region according to radiographic results,then the bone microstructure,micro mechanism and osteoblasts/osteoclasts activity were analyzed byMicro-CT,RT-PCR,Nanoindentation,immunohistochemistry and Trap staining.Results According to the micro-CT results,the continuity of trabecular bone in necrotic region was damaged.The number of trabecular was increased and the gap was narrowed in sclerosis region.The shape and number of trabecular bone were normal in the healthy region.The elasticity moduli in different regions were:subchondral bone region 13.808±4.22 GPa,necrotic region 13.999±3.816 GPa,sclerosis region 17.266±3.533 GPa and healthy region 11.927±1.743 GPa.The hardness were subchondral bone region 0.425±0.173 GPa,necrotic region 0.331±0.173 GPa,sclerosis region 0.661±0.208 GPa,and healthy region 0.423±0.088 GPa.The trap staining of subchondral bone in healthy region and necrotic region were positive while other regions were negative.Immunohistochemistry staining showed that compared with necrotic region,the RANK and RANKL staining level increased significantly in subchondral bone and necrotic region,while Runx2 and BMP2 staining level increased significantly in sclerosis region.Conclusion The mechanical properties of trabecular have no significant difference between necrotic region and healthy region in the progress of the osteonecrosis,while the bone structure has obvious changes.An active bone resorption is observed in subchondral bone and necrotic region,while a higher bone formation activity is found in sclerosis region.

BACKGROUND: Bone and exact reduction and internal fixation should be kept to fully repair the function of patella in comminuted patellar fracture operation. Currently, comminuted patellar fracture without a unified therapeutic standard has been a difficulty in clinic.OBJECTIVE: To compare the effects of modified AO tension band, titanium cable cerclage and nickel-titanium (Ni-Ti) patellar concentrator fixation in the treatment of comminuted patellar fracture.DESIGN: Prospective comparative observation.PARTICIPANTS: Totally 60 patients with simple unilateral closed comminuted patellar fracture were enrolled at Department of Orthopaedics of Changzheng Hospital from November 2004 to November 2006, including 32 males and 28 females aged 28-59 years. Inclusive criteria contained diagnosis of having simple unilateral closed comminuted patellar fracture and injury timing of less than 7 days. The patients all signed the informed consent.METHODS: The patients were assigned into modified AO tension band group (n =22), titanium cable cerclage group (n = 21) and Ni-Ti patellar concentrator group (n =17) according to their will. Twelve patients in the modified AO tension band group received simple modified AO tension band internal fixation, and ten received modified AO tension band internal fixation and extraction. Patients in the titanium cable cerclage group received titanium cable cerclage. Ten patients in the Ni-Ti patellar concentrator group received simple Ni-Ti patellar concentrator internal fixation, and seven received internal fixation and extraction.MAIN OUTCOME MEASURES: ①Postoperative host and material reaction, intraoperative blood loss, medical cost and workday loss, and ②active range of knee motion at month 3 after operation and functional recovery and curative effect at month 6 after operation.RESULTS: Totally 60 patients were involved in the result analysis. ①Host and material reaction was not found in all patients. Blood loss was significantly more in the patients of simple Ni-Ti patellar concentrator internal fixation group than patients of simple modified AO tension band internal fixation group and titanium cable cerclage group, whereas workday loss was less than that of the simple modified AO tension band internal fixation group (P < 0.05). Medical cost was obviously more in the titanium cable cerclage group than the simple Ni-Ti patellar concentrator internal fixation group and the simple modified AO tension band internal fixation group (P < 0.05). ②Active range of knee motion was the largest, about mean 108°, and long-term functional score of injured knee was the highest, about mean 21.3 points, with the excellent and good rate of 95.2%, and no sever complication appeared in the titanium cable cerclage group. These were much better than those of the other groups (P < 0.05).CONCLUSION: Modified AO tension band fixation and patellar concentrator fixation in the treatment of comminuted patellar fracture have excellent effects in some patients. Titanium cable cerclage fits for the treatment of comminuted patellar fracture and has better recovery of knee joint function.

Objective To observe the changes of the peripheral blood T lymphocyte subsets following acute spinal cord injury and investigate the possible mechanism of these changes. Methods The SCI models of rats were made by Allen's method. Forty SD rats were divided into four groups, ie,normal control group, sham operation group, 100 g·cm group and 200 g·cm group. The expressions of CD4 and CD8 subsets of the peripheral blood T lymphocyte of the injured rats were determined by immunofluorescence labelling and flow cytometry at different times after injury. Results It was found that the expression of CD4 was significantly reduced to (30.40±4.76)% in 100 g·cm group and to (26.54± 9.34) % in 200 g·cm group, which were significantly lower than that of normal control group ( P ＜0.01 ). At 36 hours after injury, the ratio of CD4/CD8 was significantly reduced to 1.81 ± 0.55 in 100 g·cm group and and 1.29 ± 0.50 in 200 g·cm group, with statistical difference (P ＜ 0.05).Conclusions The immunoreaction is significantly depressed at the early stage of acute spinal cord injury. The severer injury results in more significant decrease of CD4 and ratio of CD4/CD8. The changes of CD4 and CD4/CD8 ratio can be used to indicate the severity of spinal cord injury.

Objective To analyze the retrieval of master and doctorial dissertations entitledsystematic review/meta analysis in domestic universities of traditional Chinese medicine. Methods Master and doctorial dissertations entitledsystematic review/meta analysis in domestic universities of traditional Chinese medicine retrieved from China Dissertation Full-text Database were analyzed using Excel and SPSS 17. 0,respectively. Results Of the 423 master and doctorial dissertations included in this study,71. 9% were retrieved from both Chinese and English databases, 27. 7% were retrieved from Chinese databases,82. 8% were retrieved from two or more Chinese databases,54. 1% were retrieved from two or more English databases. The most frequently retrieved Chinese database was CKNI, followed by VIP, CBM and Wanfang. The most frequently retrieved English database was PubMed, followed by Cochrane Library, EMBASE and OVID. Conclusion The low use of traditional Chinese medicine databases is the main prob-lem in retrieval of master and doctorial dissertations entitledsystematic review/meta analysis in domestic univer-sities of traditional Chinese medicine. No significant difference is found in retrieved doctorial dissertations and mas-ter dissertations between 211and non-211 universities of traditional Chinese medicine.

AIM: To investigate the effect of panretinal photocoagulation(PRP)combined with intravitreal injection of conbercept as an adjuvant to neovascular glaucoma secondary to central retinal vein occlusion(CRVO).

METHODS: This was a prospective case-control study. Patients diagnosed with neovascular glaucoma(stage Ⅰor Ⅱ)secondary to CRVO in our hospital from January 2014 to March 2019 were enrolled and randomly divided into two groups. Patients in combination group were treated with both PRP and intravitreal conbercept injection. In the other group(PRP only group)patients were treated with PRP only. Changes of best corrected visual acuity(BCVA), intraocular pressure(IOP)and iris neovascularization(NVI)were observed before treatment, 1wk, 1mo, 3mo, 6mo and 9mo after treatment.

RESULTS: Sixty patients 60 eyes were enrolled, with the mean age of 54.45±6.08 years. 56.67% were males. There were no significant difference between two groups in age and gender. After treatment, all the indexes of the two groups improved obviously with significant different(F=154.992, 92.519, 30.696, 82.374, all P<0.001), visual acuity improved, IOP decreased, and NVI decreased at different time points. The difference was statistically significant compared with the control group one week after treatment(F=50.870, 24.265, 13.125, 11.829, all P<0.001), and it was maintained continuously.

CONCLUSION: For eyes with CRVO secondary with neovascular glaucoma, intravitreal injection of conbercept combined with panretinal photocoagulation PRP is better than panretinal photocoagulation PRP only.

Objective To explore the characteristics of cesarean scars pregnancy(CSP)and discuss differ-ent therapeutic methods and clinical outcomes. Methods Clinical data of 96 cases of CSP were collected from Sep-tember 2013 to October 2016 and patients′ clinical features,intra-operative findings,β-HCG,vaginal bleeding duration,hospital stay and cost and effects of different treatments were recorded and analyzed. Results The types of CSP were the determinant of lesion resection ,followed by the tumor size and blood β-HCG levels. The cases of uterine lesion resection and general uterine curettage with UAE had less blood loss than those without UAE. The cases of uterine lesion resection had short hospital stay and those with general uterine curettage had longer vaginal bleeding duration. Conclusion TVCD and MRI have important values in the diagnosis of CSP. During the treatment of CSP,personalized treatment planning,early diagnosis and treatment exert influence on reducing complications.

Human gut is a huge microbial habitat.Gut microbiota provides nutrition for human body, regulates metabolism and intestinal epithelial development, and induces innate immunity, and has significant impacts on growth, development and aging.Gut microbiota is influenced by genetics, living environment or life pattern, diseases and other factors, and also interacts with organs of the whole body through various of ways.The lung and the large intestine have embryological homology, common mucosal immune system, secretory function and other modern biological basis.Gut microbiota not only regulates the function of the gastrointestinal tract, but also affects the health and disease of the respiratory system, forming the " gut-lung axis". Intestinal microecological mediation and regulation based on the theory of gut-lung axis has achieved beneficial effects on the prevention and treatment of respiratory tract infection, asthma, and other respiratory diseases.

ObjectiveTo establish an animal model of intracerebral hemorrhage (ICH) in rat and to observe the changes in behavior, brain edema and tissue structure during absorption of the hematoma.MethodsAn animal model of ICH was established by stereotactically infusing 100 μl (the first time 20 μl, the second time 40 μl, the third time 40 μl) of autologous caudal artery blood into caudate nucleus in the rats. The behavior of rats with ICH was assessed by Bederson score, beam-walking test, bilateral forepaws grasp and measurement of forelimb placing. The brain edema and the change in histology were observed.ResultsThe successful ratio of this model was 75%. There were significant behavioral changes and brain edema at 6 h after the ICH in rats of the experimental group compared to those of the control group. The worse behavioral changes and brain edema was at 48～72 h after hemorrhage. In the earlier period, the nerve cells were swelling. A lot of glial cells appeared around the hematoma in the late period.ConclusionThis ICH model is reproducible, and the obvious behavioral change and histological changes are similar to clinical patient with ICH.