The paper described the necessity of establishing standardized residency training system,and introduced the progress of such training on a unified platform in Shanghai since 2010.In its summary of the success and experiences in Shanghai, the authors proposed to step up three-level management,set up a government-funded risk fund;guarantee income and welfare of residents and encourage their sense of belongings;encourage motivation of clinical teachers to enhance training quality;to build a systematic postgraduate medical education system in alignment with the standardized specialists training.

OBJECTIVE: To compared the similarity between Cordyceps Sinensis and Solid Fermentation of Cordyceps Militaris in chemical components by TLC. METHODS: The similarity in total constituents and different extract fractions were compared between Cordyceps Sinensis and Solid Fermentation of Cordyceps Militaris by TLC. RESULTS: Solid Fermentation of Cordyceps Militaris and Cordyceps Sinensis were basically similar in that their TLC spots occurred at the corresponding place except a slight difference in size. CONCLUSION: Cordyceps Sinensis and Solid Fermentation of Cordyceps Militaris have similar chemical constituents, which remains to be further studied.

OBJECTIVE:To establish the quality standard of Baji zhenyang tablets.METHODS:Panax ginseng,Herba Epimedii and Carthamus tinctorius in the tablets were identified by TLC,and the content of icariin in Herba Epimedii was determined by HPLC.RESULTS:The TLC spots of P.ginseng,Herba Epimedii and C.tinctorius were distinctive and well-separated.The linear range of icariin was 0.080 04～0.640 32 ?g(r=0.999 8).The average recovery was 101.29%(RSD=0.98%,n=6).CONCLUSION:The established standard is applicable for the quality control of Baji zhenyang tablets.

Objective To investigate the relationship between Oxfordshire community stroke project(OCSP) classification and imaging classification in acute cerebral infarction. Methods Two hundred and thirty-six patients with acute cerebral infarction were retrospectively evaluated with OCSP classification and imaging characteristics. Results According to OCSP classification,of all the 236 patients with acute cerebral infarction,28(11.9%) experienced total anterior circulation infarction(TACI),71(30.1%) partial anterior circulation infarction(PACI),94(39.8%) lacunar infarction(LACI),and 43(18.2%) posterior circulation infarction(POCI).The consistency was found in 171 cases(72.5%) between the OCSP classification and imaging classification,with the accuracy of 76%(25/33) for TACI,81%(34/42) for PACI,71%(81/114) for LACI and 66%(31/47) for POCI. Conclusion OCSP classification can predict the location and size of cerebral infarction with a high accuracy,and is well consisted with the imaging findings.

ObjectiveTo evaluate the efficacy of biapenem in percutaneous nephrolithotripsy for the prevention and control infections.MethodsA retrospective study was accomplished.The clinical data of 68 patients with PCNL which used biapenem for prevention and control infection from Aug 2009 to Feb 2011 in the hospital of Hubei Provincial Corps of CAPF were collected,the treatment effect of biapenem in percutaneous nephrolithotripsy was evaluated.Results57 cases use the injection biapenem each 0.3g,2 times a day intravenously 7 to 14 days could effectively prevent postoperative infections in perioperative period;11 cases of urinary infection and systemic inflammatory response syndrome after pereutaneous nephrolithotripsy use injection biapenem each 0.3g,every 8-hour intravenously 7 to 14 days,were effective treatment of postoperative infections.ConclusionBiapenem was effective in the prevention of infection in percutaneous nephrolithotripsy.

BACKGROUND: The proliferation and differentiation of mesenchymal stem cells (MSCs) lack of regulatory functions. Following combining with suitable vectors, MSCs cannot highly effectively proliferate and differentiate, which are keys to prevent MSCs entering the clinic. It is of great importance to effectively regulate the differentiation of stem cells into osteoblasts using pulse electromagnetic field.OBJECTIVE: To investigate the differentiation of mouse MSCs into osteoblasts in vitro following stimulation of pulse electromagnetic field.DESIGN, TIME AND SETTING: The cytological in vitro controlled study was conducted at the Laboratory of Department of Orthopaedics, Puai Hospital of Tongji Medical College, Huazhong University of Science and Technology from May 2004 to October 2007.MATEIRALS: Totally 20 BALB/C mice were supplied by the Experimental Animal Center of Tongji Medical College. Pulse electromagnetic field deviser was designed and made by the Department of Electric Machine, Naval University of Engineering.METHODS: Mouse bilateral femur was sterilely isolated. BMSCs were harvested by the Percoll density gradient centrifugation,and purified and proliferated by the adherent method. Cells at the third passage (2×10~7/L) were incubated in a 6-well plate, and then divided into 4 groups. Cells in the blank control group were incubated in the complete medium. Cells in the pulse electromagnetic field underwent pulse electromagnetic field radiation of 50 Hz, sinusoidal wave, and 1 mT, twice a day, once 30 minutes, with an interval of 12 hours, totally 10 days. Cells in the osteogenic induction group were incubated in the complete medium, supplemented with dexamethasone, sodium glycerophosphate and VitC. Cells in the pulse electromagnetic field + osteogenic induction group were subjected to the same pulse electromagnetic field radiation and then incubated in the complete medium.MAIN OUTCOME MEASURES: The differentiation of BMSCs was measured.RESULTS: Results of alkaline phosphatase staining showed that cells were negative in the blank control group, but weakly positive in the pulse electromagnetic field group, positive in the osteogenic induction group, and strongly positive in the pulse electromagnetic field + osteogenic induction group 10 days following intervention. Compared with the blank control group,absorbance value of type I collagen immunohistochemistry was significantly greater in the osteogenic induction group, pulse electromagnetic field + osteogenic induction group (P < 0.05, P < 0.01).CONCLUSION: Pulsed electromagnetism fields of 50 Hz, waves of sine, with the intensity of 1 mT could promote alkaline phosphatase and type I collagen expression and enhance the differentiation of mouse BMSCs into osteoblasts in vitro.

Objective To investigate the therapeutic effect of lengthening and rotational osteotomy of the fibula for lateral malleolar malunion. Methods Twenty-three patients who had suffering from the traumatic arthritis of ankle were due to lateral malleolar malunion treated with lengthening and rotational osteotomy from October 2005 to July 2008. Special radiographs were use to fully detect the extent of shortening and rotation of the fibula. The Lengthening and rotational osteotomy could be conducted with a special compression/distraction device and bone graft. The function of the ankles was evaluated by the American Orthopedic Foot Ankle Society (AOFAS) scoring system. Serial radiographs of the ankle were made to assess the bone healing and changes of posttraumatic osteoarthritis. Results Seventeen of 23 patients were followed up, with a mean 29.1 months (12-45 months). All the fractures were healed. The mean bone healing time was 13.3 weeks (11-16 weeks) and the mean time of total weight-bearing was 12.1 weeks (11-15 weeks). The ankle function score had improved from 29 (21-47) preoperatively to 81 (56-91)12 months after the operation. There was 5 in excellent, 8 in good, 3 in mild, 1 in poor, and the rate of good outcomes was 76.5%. After the operation, 1 patient had a skin necrosis around the wound which healed by conservative treatment. A slightly aggravated degeneration of the ankle joint was seen in 2 patients who responded to conservative managements. No failure of the internal fixation was noted in this group. Conclusion The outcomes demonstrate that reconstructive lengthening osteotomy is well worthwhile when there is absent or minimal osteoarthritic change, regardless the time from the original injury. Lengthening of the fibula is an important step in the treatment of the painful ankle when the fibula become shorter after injury, even when degenerative changes of the joint are already present. The lengthening of the fibula could lead to a good outcome in ankle with lateral malleolar malunion.

BACKGROUND: Quiet a number of researches has reported the morphological changes of global ischemic reperfusion model. However, there are few reports on the ultrastructural changes of cortex in early reperfusion, especially the change of blood brain barrier.OBJECTIVE: To explore the changes of brain cortex neurons, glial cells and blood brain barrier in order to provide reliable evidence for clinical treatment.DESIGN: A randomized and controlled trial.SETTING: Department of Neurosurgery, Departnent of Anesthesia and Electron Microscope Room of Beijing Tiantan Hospital.MATERIALS: The experiment was conducted to 6 Wistar rats in Beijing Neurological Surgery Research Institute of Capital University of Medical Sciences during February 2003 to February 2004. The rats were randomly divided into two groups with one of ischemia-reperfusion group and sham operation group with 3 rats in each group.INTERVENTIONS: To prepare global ischemic reperfusion model of rats. Brain was removed from ischemic group in one hour of reperfusion and from sham operation group one hour after the operation. Electronic microscope technique was used to observe the ultrastructural changes of cortex.MAIN OUTCOME MEASURES: Ultrastructural changes of cortex.RESULTS: The neurons of cortex shrank to certain degree in the early stage of ischemic reperfusion(1 hour) . The glial cells were swollen with dissolved chromosome in nucleus and unclear nuclear membrane. The foot protrusions around blood vessel slightly swelled and separated from basement membrane. Mircro-tubes were partially dissolved.CONCLUSION: In early stage of reperfusion injury, the cortex neurons, glial cells, cellular framework and blood brain barrier already changed which suggested that the protective treatment such as reducing brain edema, protecting blood brain barrier should start as early as possible.

Objective To explore the curative effect and security of transurethral holmium laser resection for adult ureterocele.Methods 22 cases with adult ureterocele were retrospectively studied.Eight adult ureterocele cases were male and 14 cases were female.The mean age was 36.5 years (ranged from 20 to 67years).All of the patients were unilateral onset,15 cases on the left side and 7 cases on the right side.The mean course of the disease was 31 months (ranged from 15d to 12 years).The clinical presentations were varied.All 22 cases were treated by tran-surethral holmium laser resection.About one -third of cyst wall were left in order to avoid vesicoureteral reflux and hydronephrosis.Results All 22 cases succeeded uneventfully.The pathologic study confirmed that 22 cases were ure-terocele.The mean hospital stay was 8days (ranged from 6 to 12days).Mean follow -up time was 17 months (12 -26 months),while 2 cases were lost.All 20 cases urine alalysis was normal.Five patients showed no hydronephrosis, while 10 cases showed less hydronephrosis.Cystoscopy showed all 20 cases ureteral healing was smooth,and none showed recurrence of ureterocele.Voiding cystourethrography showed none of vesicoureteral reflux.Conclusion Transurethral holmium laser resection would be a good choice for adult ureterocele,because the treatment has the advantages of simple operation,low requirement of equipment,safety and reliability.Especially for the primary level hospital,transurethral holmium laser resection is worth further clinical promotion.

BACKGROUND:Studies have shown that malnutrition was associated with death of elder people after fracture of hip, but there were no above-mentioned reports in China.
OBJECTIVE: To retrospectively analyze the relationship of blood albumin, total lymphocyte count and hemoglobin levels to prognosis when elder patients with fracture of hip were on admission.
METHODS:130 elderly patients with hip fractures aged ≥ 70 years were included underwent either total hip arthroplasty or bipolar arthroplasty. Admission serum albumin, total lymphocytecount and hemoglobin levels were recorded. The patients were fol owed up for 1 year or til the death. Survival data were available in 92 patients. Rates of survival were calculated by the Kaplan-Meier method and the Log-Rank test. Cox proportional hazard regression model received prognostic multivariate analysis.
RESULTS AND CONCLUSION:Of the 92 patients, albumin<35 g/L in 20 cases (22%), total lymphocyte count<1.5×106/L in 67 cases (73%), and hemoglobin<120 g/L in 56 cases (61%). Kaplan-Meier method showed that the survival rate of patients with normal albumin (≥ 35 g/L) was significantly higher than those with reduced albumin (<35 g/L) (P<0.01). No significant difference was detected in the survival rate of patients with normal total lymphocyte count (≥ 1.5×106/L) and reduced total lymphocyte count (<1.5×106/L) (P>0.05). The survival rate of patients with normal hemoglobin (≥ 120 g/L) was significantly higher than those with decreased hemoglobin (<120 g/L) (P <0.05). Cox multivariate analysis displayed that albumin decrease is an independent prognostic factor for death of patients with hip fracture. Results indicated that the prognosis of elder patients with hip fracture was strongly associated with their nutritional conditions. Albumin and hemoglobin levels at admission can be considered as important indexes for judging patient’s prognosis.