Objective To discuss the treatment method and effect of the application of the dorsal branches island flaps of the digital arteries in clinic.Methods During January,2010 to February,2015,a total of 20 cases of palmar soft tissue defect of the 2nd-5th distal segments of single fingers were incorporated and repaired by the dorsal branches island flaps of the digital arteries in the base of the distal phalanx.The size of the selected flaps was 3.5 cm × 2.5 cm-2.0 cm × 2.0 cm.In addition,palmar soft tissue defect (n =15) of the 2nd-5th middle and distal segments of single fingers were repaired by the dorsal branches island flaps of the digital arteries at the 1/3 site of the proximal digital arteries,and the selected flaps size was 4.5 cm × 2.5 cm-3.0 cm × 2.0 cm.Full-thickness skin graft urethroplasty was used in the donor sites.Flap shape,texture,sensory recovery and texture of the skin region,function recovery of the wounded fingers were followed up at 1,3,and 6 months after operation.Results Thirty-five patients were followed up from 6 to 13 months (average of 7 months).All flaps survived completely in the incorporated 35 cases postoperatively.Flaps had satisfactory appearance,fine texture,and soft texture in the skin transplantation area.The postoperative improvement of sensory function was between S2 and S3,and the two-point discrimination was 10-15 mm.Assessment of the upper limb function using the standard issued by the Hand Surgery Society of Chinese Medical Association graded 23 cases as excellent,10 cases as good,and 2 cases as fair.Conclusion The dorsal branches island flaps of the digital arteries are characterized by easy dissection,reliable blood supply,and no major blood vessels needed to be sacrificed,which is an effective procedure for finger soft issue defect repairing.

It is obvious that the quantities and quality of the achievements in medical research in the past 11 years have a clear upward trend considering the findings about self-regulated learning of medical students in major domestic educational journals published from 2005 to 2015.The contents mainly focus on the teaching modes and systems of self-regulated learning,the introduction and import of foreign research results and the cultivation of medical students' self-regulated learning ability.The research category is mainly on the study of overall medical students.While the basic and clinical specialties are also involved.The theoretical research is a little more than empirical research.At present,the lack of depth in theoretical research and less comprehensive empirical research is waiting to resolve.Also the related research has problems such as the lack of depth and breadth,the lack of landmark achievements and the homogeneity of results,as well as the lack of innovation and authority.

Objective:To analyze the self-efficacy of medical students in independent learning and its influencing factors, and to explore the ways to improve their self-learning ability.Methods:A questionnaire survey was conducted among medical students in 6 medical institutions of higher learning in Guangdong Province. A total of 2 480 questionnaires were issued, and 2 282 were recovered. SPSS 19.0 was used to conduct statistical analysis including Kruskal-Wall test and multiple comparisons.Results:There were 47.72% of the medical students who had a strong autonomous learning drive, and more than half of the medical students had strong autonomous learning ability with strong self-efficacy of independent learning. The influence of family location, family guidance degree and different grades on self-efficacy of medical students was different, and there was no significant difference between 5-year and 8-year clinical medical students in self-efficacy of independent learning.Conclusion:Family factors have a great influence on self-efficacy, and senior medical students have the strong ability of self-learning compared with junior medical students. Therefore, we should give full play to the positive impacts of family and school factors to further improve the independent learning ability and efficiency of medical students.

BACKGROUNDTo evaluate the reversal effect of high dose tamoxifen on multidrug resistance to EP regimen in patients with non-small cell lung cancer.

METHODSA total of 41 patients with NSCLC were studied, who were resistant to EP regimen and were proved to have P-gp protein overexpression. All patients were randomizedly divided into two arms. Reversal group (n=21) received oral tamoxifen 100?mg, 2 times everyday on D1-5, together with EP regimen. Control group (n=20) were only given EP regimen.

RESULTSIn reversal group, complete response occurred in 1 patient, and partial response in 5; disease remained stable in 11 patients, and tumor progression occurred in 4 patients. The response rate was 28.6%(6/21). In control group, no response occurred; 9 patients had stable diseases, and the other 11 progressed. There was a significant difference in response rate between the two groups (P=0.012?1). In reversal and control groups, the median survivals were 8.4 and 4.6 months respectively (P < 0.01), and 1-year survial rates were 38.1% and 35.0% respectively. Reversal of P-gp occurred in 7 cases of reversal group (33.3%),and none in control group (P= 0.005?2) . There was no significant difference in toxicities between the two groups (P > 0.05).

CONCLUSIONSHigh dose tamoxifen can remarkably downregulate the expression of P-gp and partially reverse the multidrug resistance to EP regimen for non-small cell lung cancer.

Objective To investigate the community structure and spatial distribution of wild myomorpha in the plague foci of Lianghe County,Yunnan Province.Methods From December 2015 to October 2016,in Mangdong,Hexi,Nangsong and other places in Lianghe County,forest landscape samples were randomly selected in different altitude gradients (1 000 ～,1 200 ～,1 400 ～,≥ 1 600 m).Peanut was used as a bait for trapping myomorpha,and the community structure of myomorpha was analyzed.Results A total of 663 myomorpha were collected and the density was 7.97％ (663/8 320),which were divided into 16 species,11 genus,5 families,and 3 orders.Rattus tanezumi (30.62％,203/663) was the dominant species.In the 1 000-＜ 1 200 m altitude gradient,the richness of myomorpha was the highest (13 kinds).In the 1 400-＜ 1 600 m altitude gradient,the index of diversity (2.094 2) was the highest.With the increase of altitude,the ecological dominance were increased,and the values were 0.672 2,0.774 2,0.842 8,and 0.882 4,respectively,whereas the evenness presented a decreasing trend,and the values were 0.269 2,0.197 1,0.142 8,and 0.162 0.Conclusions The Rattus tanezumi has presented a single dominant distribution at different elevation and the number and the species of the wild rodent with superior position have increased with the altitude increased in Lianghe focus.With the increase of altitude,the diversity and the evenness have increased,whereas the richness and the dominance have decreased.

Objective To isolate, culture and expand SD rat synovial mesenchymal stem cells in vitro and identify their potential multilineage differentiation. Methods Traumatic osteoarthritis models were made in SD rats. Synovial tissue was collected under aseptic conditions. The synovial tissue was digested with type I collagenase to isolate synovial mesenchymal stem cells. Cells were purified by limiting dilution of the monoclonal culture and expanded in vitro. After the third passage of culture, growth curve determination, adipogenesis induction, osteoinduction and chondrogenesis induction were performed. Real-time qPCR and Western blot were used to detect the expression of proteoglycan and type Ⅱ collagen after chondrogenic differentiation. Results In the present study, rat synovial mesenchymal stem cells exhibited a homogeneous, fibroblast-like, spindle-shaped morphology after passage in vitro. Synovial mesenchymal stem cells were subjected to adipogenesis induction, osteoinduction and chondrogenesis induction and being identified. Under the influence of inflammatory factors, mRNA of type Ⅱ collagen and proteoglycans was positively expressed in differentiated cells induced by chondrocytes using real-time qPCR and Western blot. Conclusion Rat-derived synovial mesenchymal stem cells still have good chondrogenic potential in inflammatory environment.

Objective:To explore the differential expression profile of miRN in the development of diabetes nephropathy (DN), and further explore the mechanism of miR-126-5p involved in high glucose induced injury of renal tubular epithelial cells.Methods:Firstly, we downloaded existing chip data from the Gene Expression Integrated Database (GEO) and used GEO2R, miRanda, gene ontology (GO) analysis, and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis to mine differential miRNAs. Subsequently, a high glucose induced HK-2 cell injury model was used and divided into three groups: high glucose model group, si-HOTAIR group, and si HOTAIR+ miR-126-5p inhibitor group. The three groups of cells were sequentially transfected with siRNA-NC, siRNA-HOTAIR, and siRNA-HOTAIR+ miR-126-5p mimic, and cultured in a medium containing 60 mmol/L glucose. Flow cytometry was used to detect changes in apoptosis levels in each group, while cell counting kit-8 (CCK-8) was used to detect changes in cell proliferation.Results:Through data mining analysis using GEO, it was found that compared to ordinary mice, DN mice had 74 upregulated miRNAs and 80 downregulated miRNAs in their kidney tissue. Enrichment analysis results showed that miRNAs could target signaling pathways such as Wnt, PKG, MAPK, and Rap1, and miR-126-5p was significantly downregulated. In the high glucose induced HK-2 cell injury model, the experimental results showed that the inhibitory effect on cell proliferation activity was more significant at a high glucose concentration of 60 mmol/L ( P<0.05); High glucose stimulation significantly reduced the expression of miR-126-5p ( P<0.05). The results of flow cytometry showed that compared with the high glucose model group, the apoptosis rate of the si-HOTAIR group significantly decreased ( P<0.05), while the apoptosis rate of the si-HOTAIR+ miR-126-5p inhibitor group significantly increased ( P<0.05). The CCK-8 experiment showed that compared with the high glucose model group, the cell viability of the si-HOTAIR group significantly increased ( P<0.05); The cell viability of the si-HOTAIR+ miR-126-5p inhibitor group was inhibited ( P<0.05). Conclusions:miR-126-5p can inhibit high glucose induced apoptosis in HK-2 cells and protect them.

Objective:To investigate the current situation of medical students' autonomous learning in Guangzhou universities, analyze the main factors that affect medical students' self-regulated learning, and explore the strategy for improving the ability of medical students' self-regulated learning.Methods:A stratified sampling survey was conducted among 2 480 medical students from 6 universities in Guangzhou using the self-designed "Questionnaire on Medical Students' Autonomous Learning". SPSS 22.0 was used for statistical analysis of the collected data.Results:There were statistically significant differences in the frequency of self-regulated and professional learning ( χ2=21.33, P<0.001), the self-regulated learning effectiveness and gender differences ( χ2=4.86, P=0.027), the scholastic year system and self-regulated learning necessity cognition ( χ2=4.65, P=0.031), and the family guidance and the suitability of self-learning method selection ability ( χ2=32.43, P<0.001). Conclusions:The schools, individuals and families jointly influence the self-regulated learning of medical students. The three parties should cooperate with each other to improve the self-regulated learning ability of medical students and cultivate high-quality medical talents with life-long learning ability.

Objective To compare and analyze the soil eight metal elements contents of rat holes of three plague foci in Yunnan Province.Methods The soils were collected from the rat holes in Yulong,Jianchuan,and Lianghe plague foci.Calcium (Ca),iron (Fe),zinc (Zn),chromium (Cr),lead (Pb),manganese (Mn),cadmium (Cd),and copper (Cu) were quantified with flame atomic absorption spectrometry (FAAS).Data input,calculation and collation were conducted through Excel 2007,and statistical software SPSS 20.0 was used to carried out statistical analysis through rank sum test.Results The medians of Ca content in the rat hole soil of Yulong County,Jianchuan County,and Lianghe County,respectively,were 85.40,308.56,and 0.00 mg/kg;the medians of Fe were 2 569.07,1 950.16,and 975.72 mg/kg;the medians of Zn were 5.64,4.02,and 2.04 mg/kg;the medians of Cr were 1.09,3.06,and 0.71 mg/kg;the medians of Pb were 3.61,29.56,and 22.80 mg/kg;the medians of Mn were 223.01,212.97,and 80.43 mg/kg;the medians of Cd were 0.00,2.02,and 2.94 mg/kg;and the medians of Cu were 1.92,1.08,and 0.51 mg/kg.The contents of eight metal elements were statistically different in the soil samples between Yulong,Jianchuan,and Lianghe plague foci (H =80.538,127.687,202.583,185.359,124.747,150.057,91.346,228.546,P ＜ 0.05).Conclusions The content of Fe in soil of the three plague foci in Yunnan Province is abundant.The contents of metal elements of Yulong County and Jianchuan County are similar.

Objective To investigate the geographic landscape features in Yulong plague natural focus.Methods Four altitudinal gradients (2 400-,2 600-,2 800-,≥3 000 m) were selected as study objects in Yulong plague natural focus from December 2015 to November 2016 to collect and analyze geographic landscape factors (topography and terrain,climate,water areas,vegetation and soil) based on the literatures about this plague focus.Results Yulong plague natural focus was an area with mid-mountain and subalpine topography in northwestern Yunnan Province,and its terrain had the character of lower in the southeast and higher in the northwest.This area belonged to plateau warm temperate monsoon climate of low latitude with an average month temperature 13.6 ℃ from 2005-2016,month air relative humidity averaged 59.4％,and rainfall averaged 884.5 mm a year,which concentrated mostly from June to September.About 98.1％ of the water area in Yulong County was controlled by Chin-sha River.The vegetation and soil were characterized by vertical distribution along with altitude gradients obviously.Conclusion The unique geographical landscape of the plague natural focus in Yulong County is one of important factors affecting the occurrence and epidemic of the plague.