Objective To investigate the impact of osteotomy mode on the callus morphology in the ex-tension area of tibial bone transfer and its efficacy.Methods The information of the patients with bone defect treated in 910 Hospital of Joint Logistics and Security Force of Chinese People's Liberation Army from May 2016 to June 2022 was collected.By comparing the general data of the patients with different osteotomy meth-ods(minimally invasive osteotomy group,subperiosteal osteotomy group and extraperiosteal osteotomy group),callus morphology in the extension area(sunken type,uniform type and protruding type),healing in-dex,Ilizarov Method Research and Application Society(ASAMI)bone healing and functional evaluation and other information,the curative effect differences of different osteotomy methods on tibial bone transfer were investigated.Results The incidence rate of sunken type of callus in the extension area was 15.8%in the mini-mally invasive osteotomy group,18.9%in the subperiosteal osteotomy group,and 14.3%in the extraperioste-al osteotomy group,with statistically significant differences among the three groups(P<0.05);in which,the incidence of sunken type of callus in the minimally invasive osteotomy group was lower than that in the subpe-riosteal osteotomy group(χ2=10.178,P=0.005),but there was no statistically significant difference when compared to the extraperiosteal osteotomy group(χ2=0.102,P=0.814),the difference betrrween the extra-periosteal osteotomy group and subperiosteal osteotomy group also had no statistical difference(χ2=0.084,P=0.772).The incidence rate of uniform type of callus in the minimally invasive osteotomy group was lower than that in the subperiosteal osteotomy group(χ2=6.579,P=0.013),but there was no statistically signifi-cant difference when compared to the extraperiosteal osteotomy group(χ2=0.443,P=0.506).The difference in the subperiosteal osteotomy group and extraperiosteal osteotomy group also had no statistically significant(χ2=2.602,P=0.107).The incidence rate of protruding type of callus in the minimally invasive osteotomy group was higher than that in the subperiosteal osteotomy group(χ2=9.795,P=0.002),and the incidence rate of protruding type of callus in the extraperiosteal osteotomy group was higher than that in the subperios-teal osteotomy group(χ2=5.170,P=0.023),however,there was no statistically significant difference be-tween the minimally invasive osteotomy group and the extraperiosteal osteotomy group(χ2=0.308,P=0.579).There were no statistically significant differences in healing index,ASAMI scores,contact point non-union,pin tract infection and refracture incidence rate rates among the three groups(P>0.05).Conclusion Sub-periosteal osteotomy in the single plane tibial bone moving does not show the expected results in favor of the extension area mineralization,on the contrary,extraperiosteal osteotomy has the similar clinical efficacy to minimally invasive osteotomy.

Objective To observe the clinical effectiveness of the experience of famous traditional Chinese medicine doctors in the treatment of residual sleep disturbances in patients remitted from major depressive disorder.Methods The 108 patients remitted from major depressive disorder with residual sleep disturbances who were treated in the department of Psychosomatic Medicine,Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University from June 2021 to December 2023,were randomly divided into acupuncture group(acupuncture treatments consisted of 24 sessions duration over 8 weeks)and medication group(patients take estazolam 1 mg daily for 8 weeks),54 cases in each.Assessments were carried out at baseline,4,8,12 and 20 weeks,including the Pittsburgh Sleep Quality Index(PSQI),Insomnia Severity Index(ISI),Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA),and SF-36.Results The difference in PSQI,ISI,HAMD,HAMA,and mental health scores(P<0.05)in the acupuncture group was greater than in the medication group.The total effective rate of the acupuncture and medication groups was 72.22%and 14.81%,respectively,and the difference was statistically significant(P<0.05).Conclusion Acupuncture can obviously improve sleep quality,alleviate symptoms of depression and anxiety,and improve quality of life in patients with major depressive disorder.

Objective To observe the clinical effectiveness of the experience of famous traditional Chinese medicine doctors in the treatment of residual sleep disturbances in patients remitted from major depressive disorder.Methods The 108 patients remitted from major depressive disorder with residual sleep disturbances who were treated in the department of Psychosomatic Medicine,Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University from June 2021 to December 2023,were randomly divided into acupuncture group(acupuncture treatments consisted of 24 sessions duration over 8 weeks)and medication group(patients take estazolam 1 mg daily for 8 weeks),54 cases in each.Assessments were carried out at baseline,4,8,12 and 20 weeks,including the Pittsburgh Sleep Quality Index(PSQI),Insomnia Severity Index(ISI),Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA),and SF-36.Results The difference in PSQI,ISI,HAMD,HAMA,and mental health scores(P<0.05)in the acupuncture group was greater than in the medication group.The total effective rate of the acupuncture and medication groups was 72.22%and 14.81%,respectively,and the difference was statistically significant(P<0.05).Conclusion Acupuncture can obviously improve sleep quality,alleviate symptoms of depression and anxiety,and improve quality of life in patients with major depressive disorder.

【Objective】 To establish a method to determine the content of the effective ingredient PCA (p-coumaric acid) in Shuang Bailian mixture and to investigate its anti-cancer mechanism. 【Methods】 High performance liquid chromatography (HPLC) was used to determine the content of PCA in Shuang Bailian mixture. The CCK8 method was used to detect the antitumor activity of PCA on esophageal cancer cells and the semi-inhibitory concentration of PCA on esophageal cancer cells. Moreover, the nude mice were used to investigate the anticancer effect of PCA. Western blotting was used to detect the expressions of apoptosis-related proteins (cleaved caspase 3, cleaved PARP, Bad, Bcl-2, PI3K, AKT, p-PI3K and p-AKT) in esophageal cancer cells and tumor tissues of nude mice. 【Results】 The concentration of PCA in Shuang Bailian mixture was 16.84 μg/mL. The linear regression equation of PCA was y=204 402x +360 904 (15-40 μg/mL), the RSD of the precision experiment was 2.66%, the RSD of the stability experiment was 2.35%, 3.22%, 1.58%, and 4.08%, respectively. The RSD of the repeatability experiment was 4.01%. The mean value of the recovery rate was 97.83% and the RSD value was 6.16%. CCK8 results showed that the half maximal inhibitory concentration (IC50) of PCA in KYSE30 and KYSE140 cells was 36 μg/mL and 55 μg/mL, respectively. The results of nude mice tumor experiments showed that after 30 days of administration, the tumor xenograft in control mice continued to increase in size, while the cisplatin group, PCA group, and PCA combined with cisplatin administration could effectively inhibit the growth of transplanted tumors in tumor-bearing mice. In addition, Western blotting results showed that compared with the control group, the cisplatin group, PCA group, and PCA combined with cisplatin group could effectively increase the protein expressions of cleaved caspase 3, cleaved PARP, and Bad, but decrease the protein expressions of Bcl-2, p-PI3K, and p-AKT in tumor tissues and KYSE30 and KYSE140 esophageal cancer cells. 【Conclusion】 The concentration of PCA in Shuang Bailian mixture was 16.84 μg/mL, and the HPLC content determination method conditions were sensitive and stable. PCA may have an active anti-tumor effect by regulating the PI3K/AKT/Bcl-2 signaling pathway and inducing apoptosis in esophageal cancer cells.

The cultivation of research ability can promote eight-year medical students to explore the uncharted academic fields and solve complex clinical problems. One of the firts pilot universities to provide eight-year programs, Xiangya Medical College of Central South University builds on its profound experience in medical education, and establishes a curriculum structure aiming at improving the students' research ability. In the general education stage, cross-disciplinary courses are set up. In the core medical education stage, basic medical innovation experiment extracurricular research courses are set up, and a two-year overseas exchange program is set up in the postgraduate training stage. Different evaluation methods are also designed to meet the specific needs in each stage. This program has achieved preliminary effects.

Objective To compare the effectiveness and safety of ultramini percutaneous nephrolithotomy (UMP) and retrograde intrarenal surgery (RIRS) in treatment of moderate-sized (about 1-2 cm) renal lower caliceal calculi.Methods From March 2015 to December 2016,patients in our hospital scheduled for surgery due to renal lower caliceal calculi with the greatest diameter of 10-22 mm were prospectively analyzed.Patients were randomized into two groups according to the random number table.Group UMP's operational channel was only F14 and the nephroscope's diameter was 1 mm.200 μm holmium laser lithotripsy was used to break the stones which was rushed out by eddy cuurent.In Group RIRS,all patients needed placing a F6 double J stent preoperatively for two weeks.A flexible ureteroscope sheath required imbedding intraoperatively.The stones were smashed by 200 μm holmium laser lithotripsy through the WOLF flexible ureteroscope.The intraoperative and postoperative datas including stone-free status and the complications were compared.Results 100 patients were enrolled in the study 50 patients in Group UMP,28 were male and 22 were female,mean age was 43.4 ± 7.9 years old.Mean stone size was 14.5 ±3.0 mm(range 10-22 mm).Among them,18 cases were complicated with mild and moderate hydronephrosis.The other 50 cases were allocated to Group RIRS,including 31 males and 19 females.Their mean age was 44.5 ± 8.3 years old and mean stone size was 13.7 ± 3.1 mm (range 10-21 mm).Among them,16 cases were complicated with mild and moderate hydronephrosis.No statistically significant difference were seen between the two groups (P ＞ 0.05).After three months' follow-up,one-time stone free rate(SFR) of UMP group was 94.0％ (47/50),which was significantly more superior than the 72.0％ (36/50) of the RIRS group(P ＜ 0.05).The intraoperative decrease in hemoglobin were (7.8 ± 3.3) g/L vs.(3.1 ± 3.4) g/L,and operating time(26.5 ± 6.1) min vs.(43.3 ± 6.3) min.Significant differences were also seen between the two groups(P ＜0.05).There was more blood loss and less operating time in the group of UMP.The hospital stay,delayed hemorrhage and postoperative fever between the UMP and RIRS groups were (4.3±1.3)d vs.(3.24 ± 1.21)d,8.0％ (4/50)vs.0(0/50),16.0％ (8/50)vs.12.0％ (6/50) respectively.No significant differences were seen (P ＞ 0.05).Conclusions Both UMP and RIRS procedures are effective and safe in the treatment of moderate-sized renal lower caliceal calculi.Compared with RIRS,UMP may be more effective and has less operating time,however wtih more intraoperative blood loss.

Objective To investigate the characteristic changes of biochemical markers of mineral metabolism, vascular calcification, and renal osteodystrophy in an adenine-induced rat model of chronic kidney disease (CKD). Methods A total of 20 male Sprague Dawley rats (SD rats) were randomly divided into two groups: the normal group fed with a diet without adenine, and the CKD group fed with an adenine-containing diet (7. 5 g/kg) for the first 4 weeks and then a diet without adenine for the following 2 weeks. At the end of the 2nd week, serum biochemical markers were detected. At the end of the 6th week, the SD rats were sacrificed and serum biochemical markers were detected once again. The aortas were collected for pathological examination and detection of vascular calcium and phosphorus contents. Femurs and the fifth lumbar vertebrae were taken for bone mineral density (BMD) measurement and bone histomorphometric analysis. Results At the end of the 2nd and 6th weeks, compared with the normal control group, the levels of serum creatinine, urea nitrogen, phosphorus and parathyroid hormone (PTH) in the CKD group were significantly increased (P＜0. 05 or P＜ 0. 01), and the level of serum calcium was significantly decreased (P＜ 0. 05 or P＜ 0. 01). Medial layer vascular calcification of the aorta occurred in 50％ of the rats in the CKD group, but was not observed in the normal control group. Vascular calcium and phosphorus contents were significantly higher in the CKD group compared with the normal control group (P＜ 0. 05). The BMD of total femur, cortical and trabecular bone tissues of the femur, and the fifth lumbar vertebra was significantly decreased in the CKD group (P＜ 0. 05 or P＜ 0. 01). The histomorphometric analysis showed that both bone resorption and bone formation of the trabecular bone in the CKD group were increased, indicating a high bone turnover status. The volumes of both trabecular and cortical bones of rats in the CKD group were significantly lower than that of the normal control group (P ＜ 0. 05 or P ＜ 0. 01). However, the trabecular bone mineralization was not significantly different between the two groups. Conclusions The adenine-induced rat model of chronic kidney disease (CKD) established in this study shows reduced serum calcium and increased serum phosphorus and PTH, and medial layer vascular calcification of the aorta. With respect to renal osteodystrophy, this model shows a high trabecular bone turnover, normal trabecular bone mineralization, and low bone volume of cortical and trabecular bone, which meets the characteristics of osteitis fibrosa. This model may become a useful tool for future study of chronic kidney disease-mineral and bone disorder (CKD-MBD).

As one of the first pilot eight-year clinical medicine education institutions, Xiangya School of Medicine has already put it into practice for almost 12 years. After years exploring and reforming, its cultivating plan has already been built up. This paper will make a brief comparative analysis between 2004 version and 2012 version in cultivating objectives, model and characteristics, demonstrated the development and reform of its eight-year program education, shown its features such as strengthening the basic knowledge, emphasizing the clinical skills, cultivating the capabilities, and broadening the international perspectives, and attempt to contact the residency and research training, in order to provide the reference for the eight-year program education reform.

[ ABSTRACT] AIM:To investigate the effect of the overexpression of voltage-gated chloride channel family protein 3 ( ClC-3) gene on bones of mice .METHODS: The tail gene detection assay was used to confirm the overexpression of ClC-3.The male FVB mice of three months old were divided into two groups , the wild type ( WT) group and the ClC-3 overexpressed (ClC-3 transgene) group.The body weight, length and weight of the right tibias were measured .The upper and middle parts of the tibias were dissected , decalcified, paraffin-imbed, sectioned and stained with HE staining .The bone morphology metrology was used to analyze the changes of bone structures .The percent trabecular area (%Tb.Ar), trabecular number ( Tb.N) , trabecular width ( Tb.Wi) and trabecular separation ( Tb.Sp) of cancellous bone in the upper part of the tibia were measured.The total tissue area (T.Ar), cortical area (Ct.Ar), percent cortical area (%Ct.Ar), marrow area ( Ma.Ar) and percent marrow area (%Ma.Ar) of the cortical bone in the middle part of the tibia were detec-ted .RESULTS:The wild type mice and the ClC-3-overexpressed mice were verified by the tail gene detection assay . Compared with WT group , the body weight and the length and weight of the tibia were decreased in ClC -3 transgene mice (P<0.05).In the cancellous bones of ClC-3 transgene mice, the%Tb.Ar and Tb.Wi were decreased (P<0.05), the Tb.Sp was increased (P<0.05) and the Tb.N was not significantly changed .In the cortical bones of ClC-3 transgene mice, the T.Ar, Ct.Ar and%Ct.Ar were decreased (P<0.05), the%Ma.Ar was increased (P<0.05), and the Ma. Ar was not significantly changed .CONCLUSION:ClC-3 overexpression may lead to the reduction of the bone mass and the destructure of the cancellous and cortical bones .The results suggest that ClC-3 may be involved in the regulation of bone resorption and/or formation.

Primary nephrotic syndrome(PNS) is a common kidney disease. However,its mechanisms remain unclear,and immunity might to play an important role in PNS. This article will review the pathology from cellular immunity,humoral immunity and the immunity involved in podocytes. It is useful for further understand-ing,and it may help guide the diagnosis,prognosis and therapeutic strategies.