After years of exploration, Central South University has comprehensively reformed and upgraded the curriculum in both horizontal and vertical integration, including optimizing and constructing a basic clinical core curriculum system with organ system integration as the main line, utilizing the advantages of comprehensive universities to further advance the cross-teaching reform of science, engineering, arts and medicine, strengthening pre-medical education with the goal of early exposure to medicine, promoting the reform of early contact clinical integrated teaching according to the concept of "early, multiple and repeated clinical practice", and accelerating the integration of clinical skills training courses with the support of clinical skills simulation teaching. After the integration, the faculty team has gradually matured and the teaching quality has been significantly improved, which has strengthened the students' medical thinking and overall literacy.

Objective:To investigate the serum 25-hydroxyvitamin D [25(OH) D] levels in elderly patients with hip and vertebral compression fractures (VCF).Method:Ninety patients (58 males and 32 females) aged over 60 years with hip fracture and 120 patients (88 males and 32 females) aged over 60 years with VCF admitted in the Aviation General Hospital from January 2017 to June 2019 were enrolled. Serum 25(OH)D levels were measured.Results:Serum level of 25 (OH) D in hip fracture patients was (9.0±6.8) μg/L, the 25 (OH) D level was lower than the normal value(<19.0 μg/L)in 79 patients and<3 μg/L in 24 patients. The level of 25(OH)D in VCF patients was (16.7±10.6) μg/L, the 25 (OH) D level was<19.0 μg/L in 78 patients (65.0%) and <3 μg/L in 10 patients (8.3%). The low level of 25(OH)D was negatively correlated with age in two groups ( r=-0.367, P=0.01; r=-0.313, P=0.04). The mean level of 25 (OH) D in the hip fracture group was lower than that in the VCF group ( t=5.960, P<0.01), and the low 25(OH)D rate in the former group was significantly higher than that in the latter group (χ 2=14.14, P<0.01; χ 2=12.74, P<0.01). The 25(OH)D value of female VCF patients was (14.5±8.8) μg/L, which was significantly lower than that of male patients (22.5±12.9) μg/L ( t=3.882, P<0.01).Among hip fracture patients, the 25(OH)D level in patients with fracture history was (8.3±6.9) μg/L, which was significantly lower than that of patients without fracture history (10.8±6.9) μg/L, and the difference was statistically significamt ( t=2.123, P=0.04). The serum osteocalcin level was (20.5±19.8) μg/L in patients with fracture history, which was significantly higher than that in patients without fracture history [(10.6±5.4) μg/L, t=3.245, P<0.01]. Conclusion:Elderly patients with new hip fractures have more severely low vitamin D level than patients with new VCF, and patients with previous fracture history have lower vitamin D levels than patients without fracture history.

Objective:To analyze long-term outcomes and prognostic factors of gastric cancer patients after robotic radical total gastrectomy.Methods:A retrospective case-control study was conducted. Inclusion criteria: (1) receiving robotic radical total gastrectomy; (2) gastric adenocarcinoma was confirmed by postoperative pathology; (3) no previous history of other malignant tumors; (4) no preoperative chemotherapy or radiation therapy performed. Exclusion criteria: (1) age <18 years old or age >80 years old;(2)distant metastasis before surgery, or palliative surgery; (3) conversion to laparotomy;(4) R1 or R2 resection; (5)emergency surgery; (6) remnant gastric cancer or recurrence; (7)died of severe complications during hospitalization or within 1 month after surgery. Overall survival rates (OS) and disease-free survival rates (DFS) were evaluated using the Kaplan-Meier method. Cox regression analysis was used to identify prognosis factors for overall survival.Results:According to the above criteria, 166 gastric cancer patients who underwent robotic radical total gastrectomy between March 2010 and November 2018 were included in this study. Roux-en-Y reconstruction was performed in all patients. Reconstruction were achieved using extracorporeal method through a minilaparotomy in 149 case and intracorporeal anastomosis in 17 cases. The number of harvested lymph nodes was (34.8±17.5), and the number of harvested lymph nodes at group 2 was (10.1±6.7). The number of patients with lymph node metastasis of group 2 was 73 (44.0%). The median follow-up time was 25 months (range 2-109). There were 55 (33.1%) cases of recurrence during follow-up. The 3- and 5-year overall survival rates were 55.8% and 46.2% respectively. The 3- and 5-year disease-free survival rates were 53.4% and 45.4% respectively. The 5-year overall survival rates grouped based on TNM stage were 78.9% for stage I, 58.5% for stage II, and 37.1% for stage III. The 5-year disease-free survival rates grouped based on TNM stage were 78.9% for stage I, 59.2% for stage II, and 34.6% for stage III. Univariate analysis suggested that TNM stage, the number of harvested lymph nodes and number of harvested lymph nodes at group 2 were associated with overall survival rates (all P<0.05). Multivariate analyses revealed that TNM stage ( P<0.001; stage IIIB: HR=5.357, 95%CI:1.182 to 24.275; stage IIIC: HR=11.937, 95%CI: 2.677 to 53.226) and number of harvested lymph nodes at group 2 ( P=0.034; 6-10: HR=0.562,95%CI:0.326 to 0.969; >10: HR=0.388, 95%CI: 0.176 to 0.857) were independent prognostic factors for overall survival. Conclusion:The long-term outcomes of robotic radical total gastrectomy were satisfactory. TNM stage and number of harvested lymph nodes at group 2 were independent prognostic factors for overall survival.

Objective:To analyze long-term outcomes and prognostic factors of gastric cancer patients after robotic radical total gastrectomy.Methods:A retrospective case-control study was conducted. Inclusion criteria: (1) receiving robotic radical total gastrectomy; (2) gastric adenocarcinoma was confirmed by postoperative pathology; (3) no previous history of other malignant tumors; (4) no preoperative chemotherapy or radiation therapy performed. Exclusion criteria: (1) age <18 years old or age >80 years old;(2)distant metastasis before surgery, or palliative surgery; (3) conversion to laparotomy;(4) R1 or R2 resection; (5)emergency surgery; (6) remnant gastric cancer or recurrence; (7)died of severe complications during hospitalization or within 1 month after surgery. Overall survival rates (OS) and disease-free survival rates (DFS) were evaluated using the Kaplan-Meier method. Cox regression analysis was used to identify prognosis factors for overall survival.Results:According to the above criteria, 166 gastric cancer patients who underwent robotic radical total gastrectomy between March 2010 and November 2018 were included in this study. Roux-en-Y reconstruction was performed in all patients. Reconstruction were achieved using extracorporeal method through a minilaparotomy in 149 case and intracorporeal anastomosis in 17 cases. The number of harvested lymph nodes was (34.8±17.5), and the number of harvested lymph nodes at group 2 was (10.1±6.7). The number of patients with lymph node metastasis of group 2 was 73 (44.0%). The median follow-up time was 25 months (range 2-109). There were 55 (33.1%) cases of recurrence during follow-up. The 3- and 5-year overall survival rates were 55.8% and 46.2% respectively. The 3- and 5-year disease-free survival rates were 53.4% and 45.4% respectively. The 5-year overall survival rates grouped based on TNM stage were 78.9% for stage I, 58.5% for stage II, and 37.1% for stage III. The 5-year disease-free survival rates grouped based on TNM stage were 78.9% for stage I, 59.2% for stage II, and 34.6% for stage III. Univariate analysis suggested that TNM stage, the number of harvested lymph nodes and number of harvested lymph nodes at group 2 were associated with overall survival rates (all P<0.05). Multivariate analyses revealed that TNM stage ( P<0.001; stage IIIB: HR=5.357, 95%CI:1.182 to 24.275; stage IIIC: HR=11.937, 95%CI: 2.677 to 53.226) and number of harvested lymph nodes at group 2 ( P=0.034; 6-10: HR=0.562,95%CI:0.326 to 0.969; >10: HR=0.388, 95%CI: 0.176 to 0.857) were independent prognostic factors for overall survival. Conclusion:The long-term outcomes of robotic radical total gastrectomy were satisfactory. TNM stage and number of harvested lymph nodes at group 2 were independent prognostic factors for overall survival.

Objective: To understand the awareness of sexual knowledge among primary and secondary school students, as well as their attitudes towards school sex education and to provide a reference for school-based sex education. Methods: A total of 5 531 primary and secondary school students were selected from Beijing, Chongqing, Heilongjiang (Harbin and Jiamusi) and Hubei (Wuhan and Xiaogan) by stratified cluster sampling and were investigated with self-reported questionnaire. Results: Sex-related knowledge scored 62.33±19.35, with a pass rate of 61.9%, and the excellent rate 17.5%. Sexual knowledge of junior high school students scored 64.30±19.07, with the pass rate of 64.7%, and the excellent rate 22.0%. A large proportion of primary students reported unaware of pubertal growth and HIV/AIDS-related knowledge, and a large proportion of junior high students unaware of reproductive physiology. Multivariate Logistic regression analysis showed region, grade, gender, and suburban areas were related to the level of sexual knowledge(P<0.05). More than 76.0% primary students and 85.9% middle school students agreed on the importance of school sexuality education. 59.7% of primary school students and 73.3% of junior high school students hoped to include school sexuality education in compulsory education courses; 59.8% of primary school students and 68.3% of junior high school students felt that school sexuality education should be equipped with specialized teachers. Conclusion Chinese primary and secondary school students are lack of sexual knowledge. As students have strong wills to get more information on sexual knowledge, schools should provide them with more comprehensive and effective sex education through appropriate courses and activities.

Objective: To understand the needs of primary and secondary school students, parents and teachers for comprehensive sexuality education content, and to explore the applicability of comprehensive sexuality education content in China. Methods: By using the method of stratified cluster sampling, 5 571 primary and middle school students and 4 835 parents from Beijing, Chongqing, Heilongjiang (Harbin and Jiamusi) and Hubei (Wuhan and Xiaogan) were selected for questionnaire survey. Depending on the physical health monitoring points of various provinces and cities, 176 sexuality education related teachers in nine regions were surveyed. The development of the questionnaire was based on the content framework of comprehensive sexuality education proposed in the International Technical Guidelines for Sexuality Education. Results: Students had a higher demand for knowledge on the concepts of "relationship" (53.4% for primary school students, 57.6% for junior high school students) and "health and well-being skills" (71.1% for primary school students, 55.9% for junior high school students). Parents had higher demand for most comprehensive sexuality education content with the exception of lower need for "sex and sexual behavior (74.7% of primary school parents, 80.8% of junior high school parents)" and "sexual and reproductive health (primary parents 74.3%, junior high school parents 75.8%)". Teachers had a high demand for most comprehensive sexuality education content, but primary school teachers had a lower need for "values, rights, culture and sex(65.9%)", "sex and sexuality(60.1%)" and "sexual and reproductive health(66.8%)". The results of correspondence analysis showed that junior middle school teachers had the highest demand for comprehensive education content, followed by primary school parents, junior middle school parents, primary school teachers, junior middle school students and primary school students. Conclusion Teachers and parents have a higher demand for most comprehensive sexuality education content, while lower demand for some relatively sensitive content. Students have a relatively low demand for comprehensive sexuality education content. It is recommended to further improve the content of school sexuality education based on the actual needs of China.

Objective: To analyze the postoperative complications of Da Vinci robotic total gastrectomy for gastric cancer, and explore the risk factors for postoperative complications. Methods: The retrospective case-control study was conducted. The clinicopathological data of 173 patients with gastric cancer who were admitted to the First Affiliated Hospital of Army Medical University from March 2010 to March 2019 were collected. There were 138 males and 35 females, aged from 34 to 76 years, with an average age of 60 years. All the 173 patients underwent Da Vinci robotic total gastrectomy for gastric cancer. Observation indicators: (1) postoperative complications; (2) analysis of risk factors for postoperative complications of Da Vinci robotic total gastrectomy for gastric cancer. Count data were expressed as absolute numbers or percentages. Univariate analysis was performed using the chi-square test or Fisher exact probability. Indicators with P<0.1 were included into multivariate analysis, and multivariate analysis was performed using logistic regression model. Results: (1) Postoperative complications: of the 173 patients, 45 had postoperative complications, with a incidence rate of 26.0%(45/173). Among the 45 patients, 5 had gradeⅠpostoperative complications, 31 had grade Ⅱ postoperative complications, 2 had grade Ⅲa postoperative complications, 3 had grade Ⅲb postoperative complications, 1 had grade Ⅳa postoperative complications, 1 had grade Ⅳb postoperative complications, and 2 had grade Ⅴ postoperative complications. The incidence of serious complications was 5.2%(9/173). Of the 5 patients with gradeⅠcomplications, 1 of fever was improved after antipyretic treatment, 2 of incisional fat liquefaction were improved after dressing change, 1 of vomiting was improved after being given antiemetic, and 1 of delayed recovery of gastrointestinal function was improved after symptomatic treatment. Among 31 patients with gradeⅡcomplications, 12 patients had pulmonary infection, including 6 of pulmonary infection alone, 3 combined with pleural effusion, 1 combined with abdominal infection, 2 combined with intestinal obstruction, and all were improved after conservative treatment; 7 of fever were improved after anti-infection treatment; 4 patients had deep venous catheter infection including 1 combined with bilateral pleural effusion, and were improved after removing catheter and anti-infection treatment; 3 patients had anastomotic leakage including 1 with pulmonary infection and abdominal infection, and were improved after conservative treatment; 2 patients had duodenal stump leakage (1 combined with pulmonary infection, 1 combined with pulmonary infection and pleural effusion) , and were improved after conservative treatment; 1 patient had abdominal hemorrhage, and was improved after conservative treatment; 1 patient had intestinal obstruction, and was improved after conservative treatment; 1 patient had abdominal infection, and was improved after conservative treatment. Of the 2 patients with grade Ⅲa complications, 1 had duodenal stump leakage combined with abdominal abscess, and was improved after puncture and drainage; 1 had pleural effusion combined with pulmonary infection, and was improved after puncture and drainage. Among the 3 patients with grade Ⅲb complications, 1 of abdominal hemorrhage was improved after reoperation, 2 of anastomotic leakage were improved after being placed jejunal nutrition tube under painless gastroscopy. Of the 2 cases, 1 combined with abdominal infection and 1 combined with pleural effusion and abdominal infection were improved after puncture and drainage. Among the 2 patients with grade Ⅳ complications, 1 of Ⅳa encountering respiratory failure was improved after treatment due to misinhalation of anesthesia, and 1 of Ⅳb suffered from multiple organ failure and was improved after treatment due to anastomotic leakage. Two patients with grade V complication died, including one with anastomotic leakage, abdominal hemorrhage, and multiple organ failure, and the other with respiratory failure and cardiac insufficiency. In the 173 patients, the incidence of comprehensive complication index (CCI) ≥ 25.2 was 11.0%(19/173). (2) Analysis of risk factors for postoperative complications of Da Vinci robotic total gastrectomy for gastric cancer: univariate analysis showed that body mass index (BMI), volume of intraoperative blood loss, and operation time were the related factors affecting the postoperative complications (χ²=4.275, 5.057, 5.463, P<0.05). BMI and volume of intraoperative blood loss were the related factors affecting the postoperative serious complications (χ²=7.517, 5.537, P<0.05). Age, BMI and Charlson Comorbidity Index were the related factors affecting CCI ≥25.2 (χ²=8.946, 7.890, 4.062, P<0.05). Multivariate analysis showed that tumor diameter ≥ 3 cm and tumor located at esophagogastric junction were independent risk factors for postoperative complications [odds ratio (OR) =4.350, 2.175, 95% confidence interval (CI): 1.352-14.000, 1.018-4.647, P<0.05)]. BMI ≥25 kg/m² was an independent risk factor for serious complications after operation (OR=5.156, 95%CI: 1.120-23.738, P<0.05). Age ≥60 years, BMI ≥25 kg/m², and history of abdominal surgery were independent risk factors for CCI≥25.2 (OR=30.928, 3.557, 6.009, 95%CI: 1.485-644.19, 1.082-11.691, 1.358-26.592, P<0.05). Conclusions The Clavien-Dindo classification of patients after Da Vinci robotic total gastrectomy for gastric cancer is mostly gradeⅡ. The main complications are pulmonary-related complications. CCI can better predict the risk factors for serious complications after operation. Tumor diameter ≥ 3 cm and tumor located at esophagogastric junction are independent risk factors for postoperative complications; BMI ≥25 kg/m² is an independent risk factor for serious complications; age ≥60 years, BMI ≥25 kg/m², and history of abdominal surgery are independent risk factors for CCI≥25.2.

Medical simulation teaching is an emerging and developing teaching method in our coun-try. At present, the simulation teaching centers are developing rapidly in higher education institutions, but how to improve the effectiveness in the operation of the centers is still a subject that needs to be discussed. Based on our own experience, this paper analyzes the related factors in developing medical simulation teach-ing centers, making summary and demonstrations from aspects of team building, teacher training, docking needs, staffing and so on, so as to provide references and suggestions for the construction of medical simu-lation center higher education institutions.

Objective To prepare quercetin liposome and to explore the antitumor effect of quercetin liposome.Methods The cholesterol and lecithin were used as membrane materials,quercetin nano liposome was prepared by thin film ultrasound method.The zeta potential and particle size distribution of quercetin liposome were tested by Malvern laser particle size analyzer and transmission electron microscope respectively.In order to explore the anti-tumor effect of quercetin nano-liposome,the mouse model of cervical cancer was established.After tail vein injection of quercetin and quercetin nano-liposome for 15 days,the tumor inhibitory rate,the thymus (spleen) index were analyzed,and the pathology of tumor tissues was further observed.Results Under the condition of lecithin∶cholesterol ∶ quercetin =8 ∶ 2 ∶ 1,the hydration time of 15 min and the ultrasonic time of 15 min,the quercetin nano-liposome was prepared,and the particle size distribution was uniform and the potential was-10.8.The tumor inhibitory rate of quercetin nano-liposome treatment group was 54.16％,which was significantly higher than that of the quercetin treatment group (x2 =6.477,P ＜ 0.05).The pathology results of the tumor tissues showed that nanocrystallization of quercetin could increase the anti-cancer effect of quercetin.Conclusion Both quercetin and quercetin nano-liposome exhibit significant effect on the tumor growth,and the inhibitory rate is increased after quercetin was nanocrystallization.Our study will provide theoretical basis for the application of quercetin nano-liposome in the treatment of cervical cancer.

BACKGROUND: Bone marrow-derived mononuclear cells (BM-MNCs) hold the potential of differentiating into osteoclasts. Polygonatum sibiricum polysaccharide (PSP) may inhibit the differentiation of BM-MNCs into osteoclasts and it is expected to become a new drug for the treatment of osteoporosis. OBJECTIVE: To investigate the effect of PSP on the differentiation of mouse BM-MNCs into osteoclasts induced by receptor activator of nuclear factor kappa-B ligand (RANKL) and bone resorption in vivo. METHODS: Mouse bone marrow-derived macrophages cultured in vitro, the effect of macrophage colony stimulating factor and PSP (5, 10, 20, 40, 80,160, 320, 640, 1280, 2560 mg/L) on the proliferation of mouse BM-MNCs was detected by cell counting kit-8 assay to determine the PSP concentration range; the mouse BMMs were cultured and induced in DMEM medium containing macrophage colony stimulating factor, RANKL and 5, 10, 20, 40, 80,160, 320, 640 mg/L PSP, respectively; those cultured without PSP served as control group. The morphological changes of cells were observed under an inverted microscope.; the number of osteoclasts was detected by tartrate-resistant acid phosphatase staining; the mRNA expression levels of osteoclast-related genes including tartrate-resistant acid phosphatase, matrix metalloproteinase-9, cathepsin K, and nuclear factor of activated T cells c1 were evaluated by quantitative real-time PCR. A mouse model of calvarial osteolysis induced by lipopolysaccharide was established to receive PSP intervention, and then micro CT scanning, three-dimensional reconstruction and relevants software were used for quantitative analysis of bone volume/volume percentage, trabecular number, trabecular bone spacing and thickness. The number of osteoclasts was identified by tartrate-resistant acid phosphatase staining and quantitative analysis of bone resorption area was conducted. RESULTS AND CONCLUSION: Compared with the control group, the concentration of PSP below 640 mg/L showed no significant effect on the proliferation of BMMs (P > 0.05). Different concentrations of PSP (40-640 mg/L) significantly reduced the number of osteoclasts, osteoclast differentiation and maturation, and the mRNA expression levels of tartrate-resistant acid phosphatase, matrix metalloproteinase-9, cathepsin K, and nuclear factor of activated T cells c1 TRAP, MMP-9, CtsK and NFATc1 (P < 0.05). Compared with lipopolysaccharide, PSP could effectively alleviate the lipopolysaccharide-induced calvarial osteolysis, and the bone volume/volume percentage, trabecular number, and trabecular bone spacing were significantly decreased (P < 0.05); additionally, the number of osteoclasts and the area of bone resorption were decreased significantly (P < 0.01). To conclude, PSP can inhibit the differentiation and maturation of mouse BMMs to osteoclasts and alleviate lipopolysaccharide-induced calvarial osteolysis.