To train self-learning ability,clinical reasoning and comprehensive analytical ability of clinical medical postgraduates,we introduced the classic cases from the New England Journal of Medicine (NEJM) and made the coherent learning method of Learn classic cases-report clinical cases-write case reports.Students were required to learn the classic cases of NEJM independently,to report clinical cases based on classic cases' level and to write a high level case report.We encouraged students to learn independently and to learn to use it.The practice has proved that the coherent learning method is a gradual and systematic learning method,which can train clinical medical postgraduates' all-round abilities and help them to grow up to qualified doctors.

AIM and METHODS: To investigate the expression of adhesion molecule β2 integrins (CD11a、 CD11b) and L-selectin(CD62L )on Acute Lymophocyte Leukemia(ALL) cells and its Clinical Implications. Adhesion molecules CD11a、CD11b、 CD62L of 45 ALL patients and 25 health people were measured by flow - cytometric analysis. RESULTS :①CD11a and CD11b expression were lower on ALL cells than the normal hematopoietic cells. The rate of low expression was 100% for CD11b, 50% for CD11a,respectively. CD62L expression were higher on ALL cells than the normal hematopoietic cells.②The CD11a was lower expressed on B - ALL than T- ALL. CD62L was higher on T- ALL than B- ALL. ③The expression of CD11a in the invasion group was much higher than that in the non - invasive group( P < 0.05).④The levels of CD11a,CD11b were returned to normal levels at remission. CONCLUSION: These results suggest that there are abnormalities in the expression of cell adhesion molecules in ALL which may help identify ALL subtypes and the treatment effect.

Objective To explore the significance and correlation between MCP-1 and cardiovascular complication of diabetes. Methods 65 patients with diabetes and 64 patents with IGT and 60 healthy persons as control group are chosen from a population of 1231residents at Jiangnan community in Guangzhou city. Ultrasonic inspection of carotid artery was applied to the intimae media thickness (IMT),and the levels of-MCP-1 were detected by Elisa. Result There was significant difference in the levels of MCP-1 among the normal control group, IGT group and DM group (P=0.000).The levels of MCP-1 in IGT complicated with AS patients were significantly higher than that in IGT alone patients. The levels of MCP-1 in DM complicated with AS patients were significantly higher than that in DM alone patients. The levels of MCP-1 were positively correlated with IMT in these patients. A forward LR Logistic regression analysis showed that IMT was a dependent variable, gender, MCP-1 and age are independently correlated with IMT. Conclusion MCP-1 is correlated with diabetes and its cardiovascular complication and it may be served as the target of therapy.

Objective To detect the mRNA and protein expression of downstream quinine nicotinamide adenine dinucleotide (NADH) dehydrogenase 1 (NQO1) and heme oxygenase 1 (HO-1) induced by blood nuclearrelated factor E2 (Nrf2) in the peripheral blood of those exposed to arsenic in the endemic area of coal arsenic poisoning in Guizhou Province,and to discuss its role in the process of occurrence and development of liver injury due to coal arsenic poisoning.Methods Jiaole and Changqing villages in coal-burning-borne arsenism areas in Xingren County of Guizhou were selected as the survey sites,and 161 cases of arsenic-exposed residents were selected as the arsenic exposed group based on physical examination.They were divided into non-patient group (21 cases) and patient group (140 cases) according to the Diagnostic Criteria of Endemic Arsenism (WS/T 211-2001),and the patient group was further divided into mild hepatosis group (52 cases),moderately severe hepatosis group (36 cases) and non-apparent hepatosis group (52 cases) according to the Diagnostic Criteria of Occupational Chronic (GBZ 59-2010).Moreover,45 residents from one village neighboring to non-epidemic area were selected as controls.Peripheral blood samples were collected from all subjects.And mRNA expression of NQO1 and HO-1 were detected by RT-qPCR.Content of NQQ1 and HO-1 were detected by enzyme linked immunosorbent assay (ELISA).Results (①)Results of mRNA expression of NQ01 and HO-1:the relative expression level of mRNA of NQO1 and HO-1 in peripheral blood went up gradually as the degree of liver injury of population exposed to arsenic increased (F =5.548,10.961,all P ＜ 0.05);thereinto,the relative expression level of mRNA of NQO1 of mild hepatosis group (median:0.918) was higher than that of the control group (0.576,P ＜ 0.05),the relative expression level of mRNA of NQO1 of moderately severe hepatosis group (1.243) was higher than those of control group,non-patient group (0.653),non-apparent hepatosis group (0.636) and mild hepatosis group (all P ＜ 0.05);the relative expression level of mRNA of HO-1 of non-patient group (1.059),non-apparent hepatosis group (1.225),mild hepatosis group (1.553) and moderately severe hepatosis group (1.604) were higher than that of control group (0.767,all P ＜ 0.05);the relative expression level of mRNA of HO-1 of mild hepatosis group was higher than that of non-patient group (P ＜ 0.05);the relative expression level of mRNA of HO-1 of moderately severe hepatosis group was higher than those of non-patient group and non-apparent hepatosis group (all P ＜ 0.05).②)Results of protein expression of NQO-1 and HO-1:the level of protein expression of NQO1 and HO-1 in serum went up gradually as the degree of liver injury of population exposed to arsenic increased (F =19.685,17.725,all P ＜ 0.05).Thereinto,the protein expression of NQO1 and HO-1 of non-apparent hepatosis group,mild hepatosis group and moderately severe hepatosis group [NQO1:(6.272 ± 0.744),(6.336 ± 0.628),(6.714 ± 0.540) U/L;HO-1:(45.150 ± 4.813),(45.283 ± 5.049),(48.610 ± 5.365) U/L] were higher than those of control group and non-patient group [NQO1:(5.550 ± 0.730),(5.750 ± 0.427) U/L;HO-1:(39.856 ± 5.249),(42.375 ± 3.014) U/L,all P ＜ 0.05],the protein expression of NQO1 and HO-1 of moderately severe hepatosis group were higher than those of non-apparent hepatosis group and mild hepatosis group (all P ＜ 0.05).Conclusion The expression of mRNA and protein of NQO1 and HO-1 is closely related to the occurrence and development of liver injury due to arsenic exposure in coal arsenic poisoning areas.

Objective To construct a ciaR gene-knockout (ΔciaR) mutant of Streptococcus pneu-moniae ( S. pneumoniae) and to investigate the effects of CiaR in CiaH/CiaR, a streptococcal two-component signal-transducing system, on the expression of genes encoding penicillin-binding proteins ( pbps genes) and cia-dependent small RNAs (csRNAs). Methods Electrophoretic mobility shift assay (ESMA) was per-formed to detect the recombinant CiaR (rCiaR)-binding pbps genes. A suicide plasmid pEVP3ciaR for ciaR gene knockout was constructed and then aΔciaR mutant was obtained through homologous recombination and insertion inactivation of the suicide plasmid, and screening with chloromycin. The mutant was identified using PCR and sequencing analysis. E-test was used to detect the minimal inhibitory concentrations ( MIC) of penicillin ( PCN) and cefotaxime ( CTX) against S. pneumoniae strains. Changes and differences in the expression of pbps genes and csRNAs in theΔciaR mutant and its wild-type strain before and after treatment with 1/4 MIC of PCN or CTX were detected using real-time quantitative RT-PCR. Results The rCiaR could bind to the promoter regions in pbp1a, pbp1b and pbp2b genes of S. pneumoniae. The ciaR gene in ΔciaR mutant was inactivated by insertion according to the results of PCR and sequencing analysis. After treatment with 1/4 MIC of PCN or CTX, the expression of pbps genes at mRNA level ( pbps-mRNAs) in theΔciaR mu-tant was significantly increased (P<0. 05), but the levels of csRNAs were significantly decreased (P<0. 05);whereas a significantly decreased pbps-mRNAs (P<0. 05) and increased csRNAs (P<0. 05) were observed in its wild-type strain. The result of E-test showed that the MICs of PCN and CTX against ΔciaR mutant were increased by 250-fold as compared with those against its wild-type strain. Conclusion The CiaR can enhance the drug resistance of S. pneumoniae to PCN and CTX through down-regulating the expres-sion of PBP1a, PBP1b and PBP2b and up-regulating the expression of csRNAs to inhibit the expression of PBPs.

BACKGROUND:Olfactory bulb neurogenesis, transformation and maturation have been considered the hot topic. Olfactory bulb experience and nervous activity can influence olfactory bulb neurogenesis. However, no study reports that olfactory bulb functions can affect olfactory bulb neurogenesis in guinea pigs.
OBJECTIVE:To investigate the effect of unilateral olfactory functional deprivation on doublecortin, calbindin and parvalbumin expression in olfactory bulb of juvenile guinea pigs.
METHODS:Total y 24 guinea pigs were randomly divided into two groups, which were kil ed after establishing olfactory functional deprivation model through electric cautery injury at the left peripheral nostrils. At 3 and 6 weeks after modeling, the specimens were harvested. The expression change of doublecortin, calbindin and parvalbumin in two sides’ olfactory bulb of juvenile guinea pigs was detected by immunohistochemistry.
RESULTS AND CONCLUSION:The number of doublecortin, calbindin and parvalbumin positive cells in olfactory bulb at the un-deprived side was significantly higher than that at the deprived side at 3 and 6 weeks (P<0.05). This finding indicates that olfactory neural activities can affect neurogenesis and transformation in guinea pigs.

Objective To investigate the effects of sodium arsenite (NaAsO2) on the expressions of Cyclin D1 and Cyclin dependent kinase 4 (CDK4) in human normal liver cells (L-02).Methods L-02 cells were exposed to different doses of NaAsO2 (0,50,100,150 μmol/L) for 24 h,flow cytometry was used to detect the cell cycle,real time quantitative PCR and Western blotting were used to detect the Cyclin D1,CDK4 mRNA and protein expression.Results Cell cycle detection:compared with the control group G0-G1 phase [(60.33 ± 0.40)％],except 50 μmol/L NaAsO2 group [(54.58 ± 0.40)％],the numbers of cells in 100 and 150 μmol/L NaAsO2 groups [(64.60 ± 0.62)％,(83.13 ± 0.25)％] were increased,the differences were statistically significant (all P ＜ 0.05);cell proportion of S phase in the control group,50,100 and 150 μmol/L NaAsO2 groups [(34.35 ± 0.30)％,(29.89 ± 0.32)％,(29.50 ± 0.44)％,(11.93 ± 0.12)％] were decreased,the differences were statistically significant (all P ＜ 0.05);cell proportion of G2-M phase was compared between the control group,50,100 and 150 μmol/L NaAsO2 groups [(5.32 ± 0.11)％,(15.54 ± 0.14)％,(5.90 ± 0.20)％,(4.93 ± 0.15)％],the difference was statistically significant (F =908.359,P ＜ 0.05).Cyclin D1 and CDK4 detection:the expressions of Cyclin D1 mRNA (0.48 ± 0.17,1.00 ± 0.31,1.00 ± 0.21,2.06 ± 0.53) and protein (0.65 ± 0.02,0.64 ± 0.05,0.71 ± 0.10,0.84 ± 0.05) were compared betwee the control group,50,100 and 150 μmol/L NaAsO2 groups,the differences were statistically significant (F =167.886,46.575,all P ＜ 0.05);the expressions of CDK4 mRNA (1.04 ± 0.19,1.00 ± 0.21,1.29 ± 0.22,2.31 ± 0.31) and protein (0.67 ± 0.04,0.74 ± 0.03,0.83 ± 0.07,0.94 ± 0.04) were compared betwee the control group,50,100 and 150 μ mol/L NaAsO2 groups,the differences were statistically significant (F =95.171,145.848,all P ＜ 0.05).Conclusions Treatment of L-02 cells with NaAsO2 has changed the expressions of Cyclin D1,CDK4 mRNA and protein,which leads to L-02 cell cycle arrested at G0-G1 phase,ultimately leads to cell damage.

AIM and METHODS: To investigate the expression of adhesion molecule ? 2 integrins (CD11a、CD11b) and L-selectin(CD62L )on Acute Lymophocyte Leukemia(ALL) cells and its Clinical Implications. Adhesion molecules CD11a、CD11b、 CD62L of 45 ALL patients and 25 health people were measured by flow-cytometric analysis. RESULTS:①CD11a and CD11b expression were lower on ALL cells than the normal hematopoietic cells. The rate of low expression was 100% for CD11b, 50% for CD11a,respectively. CD62L expression were higher on ALL cells than the normal hematopoietic cells.②The CD11a was lower expressed on B-ALL than T-ALL. CD62L was higher on T-ALL than B-ALL. ③ The expression of CD11a in the invasion group was much higher than that in the non-invasive group(P

0.05).CONCLUSION:Nedaplatin combined with docetaxel is effective and safe for advanced NSCLC with high short-term efficacy and mild toxic side reaction in digestive tract and kidney.but the long-term efficacy of it require further study.