BACKGROUND:Inhibition of osteoclast activity by bisphosphonates slows the progression of osteoporosis.However,serious complications of bisphosphonates,such as osteonecrosis of the jaw and atypical femur fracture,limit the clinical application of bisphosphonates.Effective alternative therapies need to be sought to improve existing clinical dilemmas. OBJECTIVE:To prepare strontium-containing mesoporous bioactive glass nanoparticles loaded with bisphosphonates(BPS@Sr-MBG)and analyze its activity against bone loss. METHODS:Strontium-containing mesoporous bioactive glass nanoparticles(Sr-MBG)were prepared by sol-gel method and added to alendronate saturated solution for the preparation of BPS@Sr-MBG.(1)Cell experiment:Mouse bone marrow macrophages were inoculated in 96-well plates and supplemented with ɑ-MEM complete culture medium containing macrophage colony stimulating factor and activator-ligand of nuclear factor κB receptor for osteoclast induced differentiation experiment.Meanwhile,they were cultured in three groups.The blank group was added with PBS.The control group was added with bisphosphonate,and the experimental group was added with BPS@Sr-MBG.After 5 days of culture,the differentiation of osteoclasts was observed by F-actin ring staining.(2)Animal experiments:Twenty-four female C57/BL mice were randomly divided into four groups with six mice in each group.Except sham operation group,ovariectomy group,BPS group and BPS@Sr-MBG group were used to construct osteoporosis model.One week after model establishment,mice in BPS group and BPS@Sr-MBG group were intraperitoneally injected with bisphosphonate solution and BPS@Sr-MBG solution,respectively.Mice in the sham operation group and ovariectomy group were intraperitoneally injected with PBS once a week.After 8 weeks of continuous injection,mouse femurs were taken for Micro-CT scanning and hematoxylin-eosin staining. RESULTS AND CONCLUSION:(1)Cell experiment:F-actin ring-formation staining demonstrated that compared with blank group,the area proportion and number of osteoclasts in the control group were decreased(P<0.01).Compared with the control group,the area proportion of osteoclasts and the number of osteoclasts in the experimental group were decreased(P<0.01).(2)Animal experiments:Micro-CT scanning results of femur showed that compared with the sham operation group,bone density,trabecular bone volume fraction,trabecular thickness and trabecular number of mice in the ovariectomy group were decreased(P<0.05,P<0.01),while trabecular distance and structural model index were increased(P<0.01).Compared with the ovariectomy group,the above bone parameters in the BPS group and BPS@Sr-MBG group were significantly improved(P<0.01),and the improvement in the BPS@Sr-MBG group was more obvious.The Micro-CT scanning results were further confirmed by hematoxylin-eosin staining of the femur.(3)The results show that BPS@Sr-MBG can exert anti-osteoporosis activity through anti-osteoclastic effect and promoting bone formation.

In order to understand the potential target and related mechanism of action of Termina-lia Chebula treatment,network pharmacology and molecular docking methods were used in this experiment,and the challenge test of Salmonella from yak was performed.The active ingredients and potential targets of Terminalia Chebula were screened through HERB cluster identification database,TCMSP database and SwissTargetPrediction web page tool,and"gastroenteritis"was searched through OMIM and GeneCards database.Cytoscape and STRING databases were used to construct the Terminalia Chebula PPI network to screen out key targets,the intersection targets between Terminalia Chebula and enteritis were obtained through Venny platform,and gene ontol-ogy(GO)and Kyoto encyclopedia database of genes and genomics(KEGG)were enriched through DAVID database.The core target of screening was verified by molecular docking.After that,the gastrointestinal inflammation model of mice was established,the pathological changes of gastroin-testinal tract were observed,and the effect of Terminalia Chebula on the target protein was veri-fied by Western blot test.The results showed that:after analyzing and sorting out 8 main active in-gredients of Terminalia Chebula,118 targets of Terminalia Chebula were screened,11 161 targets of gastroenteritis and 100 targets of intersection were obtained;the core targets of PTGS2,CASP3,SLC3A2,Bax,Bcl-2 and TP53 of Terminalia Chebula and enteritis were obtained through PPI network.GO and KEGG enrichment analysis collected 337 items and 138 items,respectively,mainly related to chemokine pathway,PI3K-Akt signaling pathway,apoptosis related pathway,i-ron ion transport related pathway,NF-κB signaling pathway,etc.The results of molecular docking showed that chebulidic acid,the first active component of chebulidic acid,can bind to Bax,Bcl-2,PTGS2 and SLC3A2 through hydrogen bonding,hydrophobic action,π-π packing force and other intermolecular forces.The pathological tissue sections showed that Terminalia Chebula could sig-nificantly recover gastrointestinal tissue injury.Western blot test results showed that Terminalia Chebula can regulate the process of apoptosis and iron death through Bax/Bcl-2 and PTGS2/SLC3A2 pathways to achieve the effect of treating intestinal inflammatory damage.The results showed that Terminalia Chebula can regulate the occurrence and development of enteritis by regu-lating apoptosis and iron death through Bax/Bcl-2 and PTGS2/SLC3A2 pathways.Terminalia Chebula has the characteristics of multi-target and multi-pathway in the treatment of enteritis.

Objective To evaluate the application effect of mini-clinical evaluation exercise (Mini-CEX) in the clinical teaching of orthopedics. Methods A total of 60 students who finished their orthopedics internship in Renji Hospital of Shanghai Jiao Tong University from January 2017 to July 2017 were in-volved and randomly divided into the experimental group and the control group with 30 students in each group. The experimental group received Mini-CEX while the control group received traditional lessons. Sur-veys and tests were conducted after the internship and the results were recorded. All statistical analyses were performed with the independent sample t test and Chi-square test using SPSS software (version 21.0). Results Except for communication skills, the medical counseling skills, physical examination skills, humanistic qualities, clinical diagnosis, organization and overall clinical competence were higher in the experimental group than in the control group and the difference was statistically significant (P<0.05). The improvements in clinical diagnosis ( χ2=6.674, P=0.036), professional knowledge and skills ( χ2=6.455, P= 0.040), clinical practice skills ( χ2=6.673, P=0.036) and satisfaction ( χ2=6.881, P=0.032) were greater in the experimental group than in the control group and the difference was statistically significant (P<0.05). No significant difference was observed in the inspiration of learning interest(χ2=4.025, P=0.134) and the improve-ments in language proficiency ( χ2=4.993, P=0.085), medical history acquisition ability ( χ2=1.564, P=0.458), humanistic qualities ( χ2=2.982, P=0.255) and teamwork ( χ2=2.651, P=0.266) between the two groups. Conclusion Mini-CEX not only achieves higher satisfaction but also helps students to improve their pro-fessional knowledge and skills, clinical diagnosis and clinical practice skills. Besides, Mini-CEX in the clinical teaching of orthopedics can effectively improve the quality of teaching and the satisfaction of students, thus providing a new teaching mode worthy of popularization.

Objective To study the quality of outpatient prescriptions for patients of different age groups at both township and village level,for the purpose of evaluating the outcomes and problems of the ongoing healthcare reform at primary levels.Methods 100 outpatient prescriptions of April 2015 were mechanically sampled randomly from two township hospitals and 8 village clinics in counties A and B in Hubei province.These prescriptions were analyzed for the drug count per prescription,percentage of intravenous prescriptions,that of antibiotics,that of hormones and average cost per prescription.Results At the township hospitals,the drug count per prescription(2.02)of county A was less than that of county B(3.26),while the percentage of intravenous prescriptions(30.30%),that of antibiotics(47.98%)and hormones(6.57%)of county A were significantly less than those of county B(50.65%,69.08% and 15.13% respectively).At village clinic level,the percentage of intravenous prescriptions(31.05%)of county A was higher than that of county B(20.34%),the average prescription costs(￥29.28)of county A was less than county B(￥31.45);while in terms of children′s prescriptions,average drug count of county A(2.50)was higher than county B(2.09),and its proportion of antibiotics(65.91%)was higher than county B(45.56%).Conclusions General primary care reform is faced with challenges of poor control of intravenous injection and use of antibiotics,particularly at village clinics and pediatric drug use in terms of prescription quality control.Both township and village levels should strengthen the supervision over the drug suppliers,guide the demand side to rationally use drugs and focus on the reasonableness of the medication of village clinics and children.

Objective To evaluate the application of scenario-based training and medical simulator in the orthopedics education. Methods A total of 60 students from Shanghai Jiao Tong University School of Medicine who finished their orthopedics internship from January 2016 to July 2016 were involved. They were randomly divided into the study group and control group with 30 students each. The study group re-ceived 2 classes of scenario-based training and medical simulator assisted education during their internship in the orthopedics department while the control group received 2 classes of traditional lessons instead. Sur-veys were conducted after the internship and the scores of internship were also recorded. Result The overall satisfaction was higher in the study group than the control group [(8.6±0.6) vs. (8.1±0.5), P=0.001]. On the part of learning interest, clinical thinking, clinical practice and group working, the study group also received better evaluation (P<0.05). The study group achieved better scores in the final examination than the control group [(84.4±2.6) vs. (82.5±3.4), P=0.018]. Conclusion The combination of scenario-based training and medical simulator can improve the ability of medical students in the orthopedics education, and receive higher satisfaction.

Substance P (SP) and calcitonin gene-related peptide (CGRP) are the neuropeptides released from the sensory nerve endings.Neuropeptides play a role in bone and the relevant organs.It exerts functions in regulation of the bone metabolism,fracture healing and pain by a certain way.The biological properties and distributions of SP and CGRP are closely related to the pathogenesis and development of bone metabolism,fracture healing and pain.

Objective :To compare the clinical efficay between dynamic hip screw (DHS)and proximal femoral nail(Intertan) fixation after closed reduction for the treatment of elderly patients with Evans type Ⅰ intertrochanteric fracture .Methods :Among 70 elderly patients with intertrochanteric fracture (Evans Ⅰ ) undergoing surgical treatment ,30 cases (DHS Group) were treated by closed reduction and DHS internal fixation and the other 40 cases (Intertan Group) were treated by closed reduction and Intertan fixation .Results :All the patients were followed up for 6-24 (12 .0 ± 3 .0) months .All the fractures were healed and no complication such as failure of internal fixation or femoral head necrosis occurred . There was statistically significant difference between operation time the DHS group and the Intertan group with 40-90 (63 .6 ± 8 .4) min and 40-90 (55 .6 ± 9 .8) min in DHS Group and Intertan Group ,respectively .And the intraoperative blood loss were 100-200 (145 .4 ± 22 .5) mL and 100-200 (92 .4 ± 25 .5) mL in DHS Group and Intertan Group ,respectively .Furthermore ,the duration of stay were 6-16 (11 .2 ± 2 .8) days and 6-9 (7 .9 ± 1 .1) days in DHS Group and Intertan Group ,respectively .There were significant difference regarding operation time ,intraoperative blood loss ,and duration of stay between the two groups(P< 0 .05) .Wound healing were achieved by postoperative liquefaction wound care in 4 cases of DHS group .There was no significant difference regarding fracture healing time between the 2 .5-4 .0 (3 .4 ± 0 .8) months in DHS Group and the 2 .5-4 .0 (3 .2 ± 0 .7) months in Intertan Group(P> 0 .05) .There were statistically significant differences between the two groups regarding Harris function scores after operation ,which were 67-84 (73 .5 ± 5 .1) points in DHS Group and 70-86 (77 .9 ± 3 .7) points in Intertan Group , and function scores which were 23-40 (30 .8 ± 3 .2) points in DHS Group and 25-44 (34 .4 ± 2 .9) points in Intertan Group (P<0 .05) .There was no significant difference between two groups regarding pain scores ,which were 20-44 (34 .9 ± 4 .8) points in DHS Group and 20-44 (35 .8 ± 5 .0) points in Intertan Group ,and activity range scores ,which were 2-4 (3 .0 ± 0 .8) points in DHS Group and 2-4 (3 .0 ± 1 .0) points in Intertan Group (P> 0 .05) .Conclusions :The Intertan and DHS internal fixation are effective methods for the treatment of elderly patients with intertrochanteric fractures .Intertan showed less trauma ,shorter duration of stay ,and better recovery of hip function .

This paper made systematic description of the three objectives of sustainable development designed for the policy based on the sustainability theory for the health sector.The essential drug system for secondary hospitals comprises the list coverage and allocation percentage of essential drugs,requirements for bidding and purchasing as well as pricing practice; management and conditions of these hospitals,including leadership determination and competency,doctors prescription behavior,and supportive reforms at these hospitals; external policies and social environment,including government financial subsidy,medical service prices adjustment,medical insurance,and the awareness and attitude of the people on essential drugs.

Objective To confirm the connotation, constitution and classification of the stakeholders in public hospital. Methods The stakeholders of public hospital were proposed through the brainstorm method and literature search. On this basis, the expert consultation scale was developed by using the score-based approach for reference The stakeholders of public hospital were confirmed and classified through two-round expert consultation. Results The research confirms 16 stakeholders of public hospital on the 80% level of support ratio by experts. There were 10 core stakeholders, 5 latent stakeholders and 1 marginal stakeholder. Conclusion Appropriate stakeholder management strategy should be taken for different types of stakeholders.

Objective To give an empirical study on the interests claims of patients in public hospitals. Methods By questionnaire investigation, to sum up data using factor analysis and pairedsamples T test, and to compare difference between different kinds of patients using ANOVA. Results The interests claims of patients can be summed up to six factors and there is no significant difference between different kinds of patients. Conclusion At current stage, public hospitals need improve medical technique and cut down medical expenses.