The reflective behaviors of teachers are a primary factor affecting teaching quality.However,the reflective behaviors of teachers can be propelled only by enhancing stimulus to teaching work,completing training system of continuing education on teaching theory and techniques to increase the teaching theory of teachers and performing teaching summarization of courses and assessment system.Only in this way can the teaching level and teaching quality of teachers be enhanced.

Objective To study the intestinal microflora changes in children with Henoch-Sch?nlein purpura (HSP). Methods The feces of 64 children with HSP (the experimental group) and 25 healthy children (the control group) were collected. 16S rRNA/DNA fluorescent quantitative polymerase chain reaction were performed to detect bacterial content of Lactobacillus, Biifdobacterium and Escherichia coli in feces. Results The amounts of Lactobacillus, and Biifdobacterium in the HSP group were lower than those of the healthy group, and the amounts of E.coli were higher, but the differences were not statistically signiifcant. The amounts of Lactobacillus and Biifdobacterium in the HSP children with gastrointestinal symptoms (abdominal pain, vomiting, e.g.) were signiifcantly lower than those in HSP children without gastrointestinal symptoms and in the healthy group. The difference was signiifcant (P<0.05). Conclusions It suggests that intestinal microlfora in children with HSP in acute phase may exist disorders, especially in the HSP children with gastrointestinal symptoms.

Objective To investigate the clinical effect of azithromycin on ankylosing spondylitis (AS). Methods Sixty-four AS patients with active disease were enrolled in this study. Among them, thirty-two AS patients (treatment group)received Azithromycin treatment at a dose of 0.5 g once a day for a period of 5~7 days , and another thirty-two patients receiving conventional treatment served as control (control group). BASDAI, CRP and ESR served as the disease activity evaluation index. Results Activity indexes in two groups of in the first 4~ 20 weeks of the treatment were decreased compared with those before the treatment (P < 0.05), while a rise was found in the 20 ~ 24 week and activity indexes gradually returned to pretreatment levels. At 0 ~ 16 weeks , the disease activity index of treatment group was below normal levels but that of control group was higher than the normal level with significant difference (P < 0.05). Conclusion The treatment of Azithromycin can control the disease activity of AS in the long term, which would be a new proposal in AS treatment.

Objective To investigate insulin sensitivity and beta cell function in female systemic lupus erythematosus (SLE) patients with different glucose tolerances. Methods Insulin sensitivity and beta cell function were compared between SLE patients and non-SLE subjects in the states of normal glucose tolerance (NGT), impaired glucose tolerance (IGT)and diabetes mellitus (DM) respectively.Furthermore, risk factors for insulin sensitivity and beta cell function in SLE patients were analysed by linear regression. Results In NGT state, insulin sensitivity and beta cell function of newly diagnosed SLE patients without glucocorticoids treatment were not significantly different from those of normal control group ( P ＜0. 05). Compared with newly diagnosed SLE patients without glucocorticoids treatment and normal control group, HOMA insulin resistance index (HOMA-IR) , In (HOMA-β), In (early phase insulin secretion index, EISI ) and In ( late phase insulin secretion index, LISI ) of SLE patients with glucocorticoids treatment were significantly higher( 1.91 ± 1.04 vs 0. 81 ±0. 75,0. 94 ±0. 27;5.05 ±0. 65 vs 4. 01 ±0. 63,4. 23 ±0.47;3. 14±0.81 vs 2.42 ±0.39,2.50±0.65;2.30 ±0.55 vs 1.62 ±0.57,1.56 ±0.43;P ＜0.05),while In ( Matsuda index, MI ) was significantly lower ( 4. 53 ± 0. 54 vs 5. 27 ± 0. 68,5. 18 ± 0. 38; P ＜0. 05). In IGT and DM state, HOMA-IR (2. 84 ± 1. 87 vs 1.82 ± 1.22, 3. 18 ±2. 29 vs 2. 94 ±2. 26) and In (HOMA-β) (5. 18 ±0. 93 vs 4. 06 ±0. 58, 3. 99 ± 1.04 vs 3.43 ±0. 83) were significantly higher in SLE patients with glucocorticoids treatment than those of non-SLE subjects ( P ＜ 0. 05 ) respectively. BMI and In (daily glucocorticords doses) were independent risk factors for insulin sensitivity, and age, the SLE disease activity index(SLEDAI) and In(daily glucocorticords doses) were related factors beta cell function.Conclusion In NGT, IGT and DM state,SLE female patients with glucocorticoids treatment have reduced insulin sensitivity and increased beta cell function, these changes are related to the use of glucocorticoids.

OBJECTIVETo discuss the effect of surgical staging and using craft bone with vancomycin for the treatment of calcaneal fractures.

METHODSFrom January 2006 to December 2012,13 patients with open calcaneal fractures were treated including 9 males and 4 females with an average of 35.2 years old ranging from 23 to 66. All cases were emergency cases. According to Sanders classification of calcaneal fractures, 2 cases were type II, 7 cases were type III, 4 cases were type IV. According to Gustilo-Anderson soft tissue injury classification, 8 cases were type II, 2 cases were type III A, 2 cases were type III B, 1 case were type III C. Firstly a thorough debridement or VSD procedures were applied,secondly calcaneal fracture were treated with open reduction, plate fixation and bone graft complex with antibiotics. Based on clinical examination, radiographic evaluation, and American Foot and Ankle Surgery Society (AOFAS), ankle function were evaluated after operation.

RESULTSOpen wounds were headed after dressing and repairing,, lateral calcaneal wound were healed during the first period. All patients were followed up for 6 to 36 months (means 14.5 months). Fracture healing time was 14 to 20 weeks (means 16.2 weeks). Last follow-up AOFAS ankle-hindfoot score was (80.0 +/- 7.4) ranging from 55 to 95.

CONCLUSIONFor patients with open fractures, through reasonable clinical evaluation, staging operation, using bone graft with antibiotics can reduce the incidence of postoperative wound infection and promote fracture healing.

Adult ; Aged ; Anti-Bacterial Agents ; administration & dosage ; Bone Transplantation ; methods ; Calcaneus ; injuries ; surgery ; Female ; Fracture Fixation, Internal ; Fracture Healing ; Fractures, Open ; surgery ; Humans ; Male ; Middle Aged

? AlM: To evaluate the clinical application of simply performing phacoemulsification or combining intravitreal Ranibizumab injection in the treatment of cataract combined with diabetic retinopathy.
?METHODS:Forty-six patients (46 eyes) were recruited in this study. All of the patients were non-proliferative diabetic retinopathy without significant macular edema. They were randomly divided into two groups, the control group simply performed phacoemulsification, while the study group performed intravitreal Ranibizumab injection and phacoemulsification. Observation of indicators included the condition of best corrected visual acuity (BCVA), intraocular pressure, macular retinal thickness and complication at preoperative and postoperative 1, 6mo.
? RESULTS: BCVA and macular retinal thickness of patients in two groups had no differences in the preoperative and postoperative 1mo. At postoperative 6mo, the BCVA of the study group was better than that in the control group, while its macular retinal thickness was thinner than that in the control group (P<0. 05). The ratio of macular edema ( central macular thickness was >60μm than that in control group) was 13. 0% eyes in the study group which was significantly lower than the control group (47. 8%;P = 0. 033). The complications was no significant differences in two groups and neither occurred severe complications.
?CONCLUSlON: lntravitreal Ranibizumab injection can reduce the development of macular edema and improve the BCVA after phacoemulsification.

Objective To study the association of liver fat content (LFC) with insulin resistance and β cell function. Methods One hundred and nine subjects including 31 cases with impaired glucose regulation (IGR), 31 newly diagnosed type 2 diabetes (NT2DM) and 47 normal controls (NC) with normal metabolic parameters were involved in the study. LFC was measured by 1H magnetic resonance spectroscopy (1H MRS) and the insulin resistance and β cell function were evaluated by oral 75 g glucose tolerance test. Results (1 ) LFCs were3.83% (2.35% ～7.59% ) ,12. 82% (8.10%～21.37%), and 21.99% (11.89%～34.43%), being progressively raised in the respective NC, IGR, NT2DM groups(P<0.01). (2) The subjects were divided into four subgroups according to LFC Quartile: Quartile 1 (LFC<4. 04% ) , Quartile 2(4. 04% ≤LFC<9. 77% ), Quartile 3 (9.77% ≤LFC<20.78% ) ,and Quartile 4( LFC≥20.78% ). Homeostasis model assessment of insulin resistance index (HOMA-IR) values were elevated significantly and progressively starting from Quartile 2(P<0. 01). (3) Insulin from 0 to 30 min ( △I30), the ratio of insulin from 0 to 30 min to glucose from 0 to 30 min ( △I30/ △G30) , C peptide from 0 to 30 min (△CP30) had a trend of increase in Quartile 2,then trended to decrease in Quartile 3. In Quartile 4, △CP30 and △I30/△G30 sharply decreased (P<0.05 or P<0.01). The ratio of C peptide from 0 to 30 min to glucose from 0 to 30 min ( △CP30/△G30) began to decrease from Quartile 3 (P<0. 05). The ratio of area under curve of C peptide to area under curve of glucose (CPAUC/GAUC) was significantly decreased from Quartile 3(P<0.05). From Quartile 3,glucose level became abnormally elevated to impaired fasting glucose and impaired glucose tolerance (P<0.01). (4) LFC was positively correlated with HOMA-IR (rs =0. 618 ,P<0.01), but was negatively correlated with △CP30(rs =-0.282), △CP30/△G30(rs = -0. 404), and CPAUC/GAUC(rs = -0. 308,all P<0.01). (5) Stepwise regression analysis demonstrated that LFC was the strongest predictor of HOMA-IR. Conclusions When LFC accumulated to 4% , insulin resistance occurred and the early phase of insulin secretion was compensatively increased. As the LFC further accumulated to 10% , both the early phase as well as β cell function in whole were deteriorated, and hyperglycemia developed.

Objective:To evaluate the efficiency of the tibial coronal alignment after total knee arthro-plasty with the extramedullary cutting system guided by the tibial tubercle and anterior tibial tendon,and to discuss the potential risk factors for the postoperative malalignment.Methods:A retrospective study of 212 primary unilateral TKA surgeries (in 188 patients)in our hospital between June to December in 2014 had been analysed.All the cases were performed by one surgical group.An extramedullary tibial cutting guide system had been used,with a landmark of one third inner-medial tibial tubercle as a proxi-mal anatomy reference,and anterior tibial tendon as a distal marker.The mechanical axis of lower ex-tremity in full-length X-ray was measured before surgery,and the tibial prosthetic coronal alignment was checked two weeks postoperation,evaluating the accuracy of this extramedullary cutting system guided by our method.Results:Since good alignment was defined as an angle within 3 degrees of the perpendicular to the mechanical axis,the tibial component positions were acceptable in 191 knees (90.1%),five knees were in valgus postoperative,and sixteen knees were in varus.There were seventeen(8.7%)in 179 knees with a preoperative varus presented malalignment after surgery,and four in 12 preoperative valgus kneess howed malalignment also,no statistical difference was found by Chi-square test (χ2 =2.778,P=0.096),which cannot define the relationship between the varus or valgus deformity preopera-tion and the malalignmentposition in tibial prosthesis after surgery.Twenty-two knees suffered a severe preoperative deformity as a varus or valgus angle larger than 20 degrees with absolute value of mechanical axis before surgery and tibial prosthetic coronal alignment were 21.95°(20.00°,26.90°)and 1.85° (0.10°,7.10°),showed a significant difference (Z =2.11,P =0.035 )compared with the data [10.65°(0.50°,19.80°)in preoperative mechanical axis and 1.10°(0.00°,4.60°)in the tibial pros-thetic coronal alignment]of 190 knees who presented a mild deformity before surgery(less than 20 de-grees),the result indicated the severe preoperative deformity might be a potential mal-alignment risk fac-tor within this cutting system in TKA surgery.Conclusion:The tibial coronal alignment after total knee arthroplasty could achieve good results with extramedullary cutting guide,by using one third inner-medial tibial tubercle and anterior tibial tendon as a proximal and distal anatomy marker.Postoperative varus might occur in this system,and tibial prosthetic malalignment appeared more often in the patients who suffered a severe deformity before surgery.

Objective To observe the expression of P21 and CDK6 in cervical squamous cell carcinoma,and to investigate the relationship between their expression and cervical squamous cell carcinoma.Methods The expression of CDK6 and P21 in 100 cases of cervical squamous cell carcinoma,20 cases of cervical CIN lesions and 20 cases of normal cervical tissues were detected by immunohistochemical ABC method,and the relationship between them and tumor differentiation,invasion depth,lymph node metastasis and clinical stage were analyzed.Results The expression rates of P21 and CDK6 in cervical squamous cell carcinoma tissues were significantly higher than those in CIN lesions and normal cervical tissues;The low expression of P21 was associated with the depth of tumor invasion,lymph node metastasis and clinical stage (P＜0.05),and was not associated with the degree of tumor differentiation (P＞0.05);The high expression of CDK6 was associated with tumor differentiation,invasion depth,lymph node metastasis and clinical stage (P＜0.05).Conclusion The abnormal expression of P21 and CDK6 may play an important role in the occurrence and development of cervical squamous cell carcinoma,and the two may have a certain significance in the prognosis of cervical squamous cell carcinoma.

Objective:To compare the pain control efficiency of continuous adductor canal block (ACB) and femoral nerve block (FNB) in total knee arthroplasty.Methods:From April to September 2016,patients with severe knee osteoarthritis undergoing primary unilateral total knee arthroplasty (TKA) were prospectively observed,and all the patients were randomized received ultrasound-guided continuous ACB or FNB after surgery.Numeric pain rating scales (NPRS)pain scores in rest and activity 2,6,12,24 and 48 h after surgery were collected,and the preoperative and postoperative quadriceps strength at 24 and 48 h were analyzed.Opioids consumption and anesthesia related adverse effects were also recorded.Results:In the study,40 patients were enrolled,with 20 patients in each group,male ∶female =7 ∶ 33,the age:(63.8 ± 10.1) years,and the body mass index (BMI):(28.5 ± 3.5) kg/ m2.The general conditions were comparable between the two groups.Though the rest pain 2 h after surgery [ACB =0.0(0,6),FNB =3.0(0,5),P=0.004] and activity pain 12 h post operation [ACB =3.0(3,0),FNB =5.5(0,10),P =0.004] were lower in ACB group compared with FNB group,there was no statistical difference in the other pain checking points between the two groups.The quadriceps strength 24 h and 48 h after surgery were (85.3-± 27.6) N and (80.0 ± 30.1) N in ACB group,(69.0 ± 29.4) N and (64.4 ± 32.0) N in FNB group,both of them were declined by time.The exact data were higher in ACB group,however,there was no statistical difference between the two group by repeated measurements variance analysis(F =2.703,P =0.108).Four patients in ACB group and five in FNB acquired additional use of dolantin once (100 mg/per time) within 24 h.And among them,three patients acquired once dolantin in ACB,two in FNB,from 24 to 48 h postoperation.There were five patients who suffered nausea postoperation in ACB group,and one who reported xerostomia.Four patients in FNB had nausea with vomiting,and three experienced xerostomia.Deep vein thrombosis appeared in 2 patients in FNB group,but no one in ACB group.Conclusion:Continuous ACB is not superior in pain control after TKA compared with FNB,and the quadriceps strength could be reserved more by this method,which performed early benefits in fast rehabilitation.