Objective:To explore the feasibility and effect of remote medical education model using online film reading training to improve the ability of ophthalmologists in the Xinjiang Uygur Autonomous Region (hereinafter referred to as "Xinjiang Region" ) in diagnosing fundus diseases.Methods:The three-level film reading training system of Xinjiang Production and Construction Corps system division hospital-Corps Hospital-Peking Union Medical College Hospital was established. From June 2022 to January 2023, 4 159 posterior color fundus images were continuously collected from Department of Ophthalmology of Xinjiang Corps Hospital and 4 divisional hospitals in the Corps medical system. Among them, hypertensive retinopathy, diabetic retinopathy, exudative age-related macular degeneration (AMD), atrophic AMD and retinal vein occlusion were 3 073, 651, 43, 186 and 206 cases, respectively. The images were divided into 3 rounds (first, second and last) according to the proportion of diseases. The doctors who participated in the training (hereinafter referred to as the "training") were 15 ophthalmologists from the Corps Hospital of Xinjiang Region and the division hospital of the Corps system. There were 7 male and 8 female. Age was (38.1±4.0) years. The titles of senior, deputy senior, intermediate and junior are 1, 6, 5 and 3 respectively; Bachelor's degree and master's degree are 13 and 2 respectively. The working time of fundus disease specialty was (9.6±3.3) years. The film reading system training was conducted before the first round of labeling, and after each round of film reading, the doctors of Peking Union Medical College Hospital gave feedback and explanation on the film reading results. The diagnostic consistency, sensitivity and specificity were compared by paired sample t test. Spearman or Pearson correlation analysis was conducted between the improvement of diagnostic level and professional title, education, age and working hours of ocular fundus disease. Results:All the participating doctors completed the first, second and last reading. After each round of film reading, the film reading summary was carried out for 2 hours. The average diagnostic agreement rates of participating physicians were 53.0%, 67.0% and 75.0%, respectively. The sensitivity and specificity were 0.38, 0.69, 054 and 0.66, 0.85, 0.96, respectively. There was significant difference between the first and last examination ( P<0.001). The sensitivity of the second reading was significantly higher than that of the first reading, and the sensitivity of the last reading was significantly lower than that of the second reading, with statistical significance ( P<0.05). The specificity of the second reading was significantly higher than that of the first reading, and the last reading was significantly higher than that of the second reading, with statistical significance ( P<0.05). There was no significant correlation ( P>0.05) between the improvement of diagnostic level of participating physicians and educational background ( Rho=0.07), professional title ( Rho=0.13), age ( r=0.20), and working time of ophthalmofundus disease specialty ( r=0.26). Conclusions:Relying on the three-level online telemedicine training, it can improve the ability of ophthalmologists in Xinjiang region to diagnose fundus diseases. The preliminary telemedicine education model has demonstrated potential for feasibility and effectiveness in remote areas with inadequate medical resources.

Objective:To explore the feasibility and effect of remote medical education model using online film reading training to improve the ability of ophthalmologists in the Xinjiang Uygur Autonomous Region (hereinafter referred to as "Xinjiang Region" ) in diagnosing fundus diseases.Methods:The three-level film reading training system of Xinjiang Production and Construction Corps system division hospital-Corps Hospital-Peking Union Medical College Hospital was established. From June 2022 to January 2023, 4 159 posterior color fundus images were continuously collected from Department of Ophthalmology of Xinjiang Corps Hospital and 4 divisional hospitals in the Corps medical system. Among them, hypertensive retinopathy, diabetic retinopathy, exudative age-related macular degeneration (AMD), atrophic AMD and retinal vein occlusion were 3 073, 651, 43, 186 and 206 cases, respectively. The images were divided into 3 rounds (first, second and last) according to the proportion of diseases. The doctors who participated in the training (hereinafter referred to as the "training") were 15 ophthalmologists from the Corps Hospital of Xinjiang Region and the division hospital of the Corps system. There were 7 male and 8 female. Age was (38.1±4.0) years. The titles of senior, deputy senior, intermediate and junior are 1, 6, 5 and 3 respectively; Bachelor's degree and master's degree are 13 and 2 respectively. The working time of fundus disease specialty was (9.6±3.3) years. The film reading system training was conducted before the first round of labeling, and after each round of film reading, the doctors of Peking Union Medical College Hospital gave feedback and explanation on the film reading results. The diagnostic consistency, sensitivity and specificity were compared by paired sample t test. Spearman or Pearson correlation analysis was conducted between the improvement of diagnostic level and professional title, education, age and working hours of ocular fundus disease. Results:All the participating doctors completed the first, second and last reading. After each round of film reading, the film reading summary was carried out for 2 hours. The average diagnostic agreement rates of participating physicians were 53.0%, 67.0% and 75.0%, respectively. The sensitivity and specificity were 0.38, 0.69, 054 and 0.66, 0.85, 0.96, respectively. There was significant difference between the first and last examination ( P<0.001). The sensitivity of the second reading was significantly higher than that of the first reading, and the sensitivity of the last reading was significantly lower than that of the second reading, with statistical significance ( P<0.05). The specificity of the second reading was significantly higher than that of the first reading, and the last reading was significantly higher than that of the second reading, with statistical significance ( P<0.05). There was no significant correlation ( P>0.05) between the improvement of diagnostic level of participating physicians and educational background ( Rho=0.07), professional title ( Rho=0.13), age ( r=0.20), and working time of ophthalmofundus disease specialty ( r=0.26). Conclusions:Relying on the three-level online telemedicine training, it can improve the ability of ophthalmologists in Xinjiang region to diagnose fundus diseases. The preliminary telemedicine education model has demonstrated potential for feasibility and effectiveness in remote areas with inadequate medical resources.

Objective:To investigate the application effect of the blended teaching model of "intelligent teaching" and "wisdom learning" in the practice teaching of integrated traditional Chinese and Western medicine in internal medicine.Methods:According to the principle of randomization, 54 interns in Class 1 of integrated traditional Chinese and Western medicine in the grade of 2019 were selected as control group and received traditional teaching, and 56 interns in Class 2 were selected as observation group and received blended teaching with "intelligent teaching" and "wisdom learning". After 6 months of internship, the two groups were compared in terms of the scores of theoretical assessment (basic theoretical knowledge and professional theoretical knowledge), clinical practice ability [Leicester Assessment Package (LAP)], and degree of satisfaction with teaching. SPSS 17.0 was used to perform the t-test and the chi-square test. Results:At the end of internship, compared with the control group, the observation group had significantly higher score of basic theoretical knowledge (41.53±3.42 vs. 38.71±3.38, P<0.05), score of professional theoretical knowledge (39.49±3.14 vs. 37.85±3.07, P<0.05), LAP score (84.32±6.65 vs. 78.46±6.17, P<0.05), and degree of satisfaction with teaching ( P<0.05). Conclusion:For interns majoring in integrated traditional Chinese and Western medicine, the blended teaching model of "intelligent teaching" and "wisdom learning" can strengthen their mastery of theoretical knowledge, enhance their clinical practice ability, and improve their degree of satisfaction with teaching.

Objective To evaluate the feasibility,safety,and cosmetic results of single-incision laparoscopic appendectomy by using conventional instruments. Methods From January 2013 to May 2014,clinical data of 52 patients undergoing single-incision laparoscopic appendectomy in our hospital were retrospectively analyzed. The appendectomy was performed by using conventional instruments through three 5-mm trocars via a 2-cm curved incision above the umbilical margin. Results The single-incision laparoscopic appendectomy was successfully completed in all the 52 cases without conversion to conventional laparoscopic or open surgery.The mean operative time was 43 ±7 min (range,30 -90 min).The average postoperative hospital stay was 2.5 ±0.5 days (range,1 -7 days).During follow-up visits for 1 -3 months,there were no postoperative complications.The scars were not obvious in all the patients. Conclusion Laparoscopic appendectomy can be achieved through a single incision by using conventional instruments.This approach is feasible,safe,and concealing.

Femoral head necrosis and nonunion is a common complication after surgery of femoral neck fracture.Recently,femoral neck shortening have caused attentions which can impact the function of hip.Incidence,mearsurement,influence factor,prevention and treatment of femoral neck shortening have been retrospective reviewed.Amount of femoral neck shortening with sliding compression system is significantly more than length of stability system,which is result from its own mechanism.However,effcacy of length of stability system still need a large scale of sample.It uses radiography to diagnose shortening.The present measurement methods include displacement of femoral head,xyz-axis measurement,the length of exposed screw,the collapse of femoral head.However,position,the angle of screen and the defect of the method would increase deviation.A measurement with simple,wide application and accuracy need to continue to explore.Apart from patients' condition,shortening also affected by the pattern and quality of surgery.Overall,older women,displacement fracture,unsatisfactory reduction will increase the risk and shrinkage of shortening.In addition,the pattern of the internal fixation becomes the research focus in the field of orthopedic clinical research.Including the transformation of sliding compression system device and design of novel device.How to combine them together organically could be a future development direction.Meanwhile,there are still in exploratory stage to decide whether biological combined with internal fixation can prevent shortening.Intertrochanteric osteotomy can achieve union and correct the limblength discrepancy,However,it did not restore the length of femoral neck.So,it is unknown that whether the method can solve the slight shortening which have impacted the hip function.

Objective To discuss the operative methods and cnrative effect of calcaneal tuberosity fracture.Methods The data of 15 patients with calcaneal tuberosity fracture was retrospectively analyzed who received treatment between January 2008 and June 2011.There were 9 males and 6 female,with the age ranging from 31 to 68 years (average,51.4 years).All the patients had unilateral acute injury,with the left foot in 7 cases and the right foot in 8 cases.According to the Beavis classification,there were 3 cases in type Ⅰ and 12 cases in type Ⅱ.All the cases in type Ⅰ and 10 cases in type Ⅱ were treated with open reduction and screw fixation.The other 2 cases in type Ⅱ with larger fragment involving a portion of the subtalar joint were treated with plate and screw fixation.The effect of the treatment was assessed according to the ankle and hindfoot score system of American Orthopaedic Foot and Ankle Society (AOFAS) after the operation.Results Ten patients were followed up for 12 to 36 months (average,20 months).The healing time in these patients ranged from 8 to 25 weeks (average,12 weeks).The postoperative score ranged from 47 to 100 points (average,91.1 points).There were 7 cases which received excellent effect,2 cases,good,and 1 case,poor.The rate of excellent and good was 90％.Necrosis of skin and soft tissue and exposure of the plate happened to one patient,who eventually healed after 3 weeks by debridement with plate preserved and peroneal artery perforator flap transplantation.Loss of reduction happened to another patient,who was treated with the revision surgery by open reduction and screw fixation again.Conclusion To patients with obvious Fracture displacement whose soft tissues are irritated severely.Emergency open reduction and internal fixation operation should be offered to prevent the necrosis of the flaps as far as possible.To patients with small fractures,it is advisable to choose open reduction and large diameter screw fixation,while plate and screw fixation may be better for patients with larger tuberosity fragment,especially when the fracture line extends to the facet of the subtalar joint.

Objective To explore the necessity and function of the sustentaculum tali screw placement for the treatment of Sanders type Ⅱ calcaneal fracture.Methods The data of Dicom that CT scan with bone was input into Mimics 12.0 software and Ansys 13.0 software for construction of calcaneus three-dimensional finite element model.Then,this model was imported into Solidworks 2010 software.Type Ⅱ calcaneal fracture model was established according to Sanders type cutting of calcaneus.Geometric parameters of AO calcaneal plate and screws were imported to the Solidworks 2010 software.Two internal fixation simulations were established based on the calcaneal model.In one model,the steel was placed on the outside with bone and the cancellous' bone screws were infiltrated respectively into the vertical bone since two screw holes which under the articular surface behind the steel plate,two screw holes which rear of the steel plate,a screw hole of the below calcaneus,two screw holes which in front of steel plate.In another model,a cortical bone screw was infiltrated into the sustentaculum tali through the bottom screw hole of articular surface of the steel plate.The two internal fixation models were loaded under the same condition,and non linear finite element analysis was carried out.The stress distribution in the two internal fixation models was calculated respectively.Results The maximum principal stress focused on the cortical bone of sustentaculum tali in both of the models under the same condition of loading.Bone joint displacement,maximum principal stress of calcaneal and internal fixation system in the model with sustentaculum screw fixation were smaller than that in the model without sustentaculum screw fixation.The stress in the model with sustentaculum screw fixation was more dispersed.Conclusion The placement of sustentaculum tali screw is essential for fixation of type Ⅱ calcaneal fracture to achieve the biomechanical stability and can be used in clinical.

ObjectiveTo observe the effect and security of Batroxobin vein injection on patients with diabetes mellitus and acute cerebral infarction.Methods66 patients with diabetes mellitus and acute cerebral infarction were treated with Batroxobin vein injection and assessed with the scale of neurological deficit before treatment and at 3rd and 6th day after treatment.At the same time the coagulant function and the count of blood platelet were measured.ResultsAfter treatment,the concentration of fibrinogen in blood plasma of patients decreased and scores of neurological deficit assessment improved both significantly(P<0.001).The total validity of Batroxobin vein injection was 93.9%.No side actions of drug were found.ConclusionBatroxobin vein injection can be used as a therapeutic method of dissolving thrombus in patients with diabetes mellitus and acute cerebral infarction in early stage.