Systemic review of all the relevant randomized controlled trials (RCTs) was performed. RCTs were identifiedfrom Cochrane Library, MEDLINE, EMBASE. Limited evidence showed that problem-based learning in continuingmedical education increased participants' knowledge, performance and patients' health. Moderate evidence also showedthat doctors are more satisfied with problem-based learning. Problem-based learning may work in continuing medicaleducation, however,the evidence is too weak to be recommended. Rigorously large sample, well-designed randomizedcontrolled trials are required.[

Based on analyzing problems that traditional medical eduction mode faces,the author puts forward the construction of education mode of evidence-based medicine in medical students. And at the same time ,the article also makes research and discussion in relation to the following aspects: how to introduce evidence-base medicine into medical education; how to effectively implement teaching of evidence-based medicine.

[Objective]To explore the efficacy of combination of TCM and WM on venous ulcer. [Method] Administer oral taking and external application of Chinese medicine decoction on the base of operation to 73 cases. [Result] All cases had effect, 72 limbs were cured, 5 recurred. [Conclusion] Combination of TCM and WM can improve cure effect, reduce recurrence rate, much better than pure operation or TCM therapy.

180% elevation of PKC activity in the retinal vasculature.????????except ??? distributed in the membrane and cytosolic fraction in retinal vessels in normal or diabetic rats,the expression of ?????-PKC significantly increase in the membrane pool OD Value 282%?32%?340%?26%?187%?14% respectively ,but ?????-PKC expression significantly decrease in cytosolic pool in retinal vessels of diabetic rats compared with nondiabetic rats,OD value 71%?11%?63%?8%?84%?6%,respectively,however ? isoenzym expression in cytosolic pool significantly increase 208%?6%,compared with normal rats.Conclusion:Diabetes can induce the translocation of ?????-PKC from cytosol to membrane pool,but ? isoform translocated from membrane to cytosol pool in retinal vessels of diabetic rats.

Objective:To investigate the expression of protein kinase C (PKC) isoforms ?,? in diabetic rats and evaluate the relation between altered PKC ?,? expression and the pathogenesis of diabetic retinopathy (DR).Methods:Wistar rats were randomly divided into control group and diabetic group induced by streptozotocin;osmotic shock method was used to isolate the retinal vessels of rats;and PKC isoforms ?,? espression were determined after 2 weeks,2 months,4 months and 6 months follw-up.DR was assessed by quantitative morphometry of capillary bed.Results:Diabetes could induce the translocation of PKC isoform ? from cytosol to membrane pool after 2 weeks,2 months,4 months and 6 months,but ? isoform translocated from membrane to cytosol pool in retinal vessels of diabetic rats after 2 weeks,2 months,4 months and 6 months.Diabetic rats showed pericyte decrease and capillary basement thickening in deep capillary bed of retina after 6 months follow-up.Conclusion:The expression of PKC isoforms ?,? varies in different stages of DR,and the effect of PKC isoforms on the pathogenesis of DR is different.

Objective:To construct the phage display library of randomized P2/NC protease cleavage sequences in HIV-1 Gag protein,so as to provide evidences for studying the effect of drug resistance-associated mutations on susceptible cleavage sequences of HIV-1 PR.Methods: CAP2 fragments and NC fragments of HIV-1 gag were generated by PCR.StuⅠ restriction site was introduced to the 5′ terminal of CAP2 fragments and the protease cleavage sequences of 3′ terminal of CAP2 fragments were randomized.The overlapping CAP2 sequence was introduced to the 5′ terminal of NC fragments and Sal Ⅰ restriction site was introduced to the 3′ terminal.CAP2 and NC fragments were linked by overlapping PCR method and the fused CAP2 and NC fragments were cloned into pCANTAB5S-LD3 to construct the phage display library of the P2/NC cleavage site in HIV-1 Gag protein.Results: As much as 2.1?10~6 clones were obtained in the phage library and the titer was 3.0?10~(12)TU/ml.There were 52.1% clones containing inserted CAP2/NC fragments.Sequence analysis of 12 samples showed that nucleotide acids and amino acids were randomly distributed at randomized PR cleavage sites.Nine of 10 positive monoclonal phages specifically bound to human IgG.Conclusion: CAP2/NC protease cleavage sequences of HIV-1 Gag protein have been successfully randomized and its phage display library has been constructed,which may help to screen the phages containing susceptible cleavage sequences of PR with drug resistance-associated mutations and establish the phage model for in vitro screening of PR inhibitor.

Objective To investigate the clinical values of dexmedetomidine in general anesthetic for laparo-scopic cholecystectomy.Methods One hundred patients admitted to our center with cholelithes were prospectively studied.According to the principle of completely random digital table,all patients were randomly signed to dexmedeto-midine group or control group.The primary outcomes were hemodynamic changes and postoperative complications. Results There was no significant differences at t0,t1,t2,t3,t4 and t5 in mean arterial pressure (P >0.05).There was no significant difference in heart rate at t0 (P =0.503),however,compared with the control group,patients in the dexmedetomidine group got a significant reduction in t1,t2,t3,t4 and t5 in heart rate(all P <0.05).Compared with the control group,the operation time of the dexmedetomidine group was significantly shorten[(1 18.52 ±15.42)min vs.(127.24 ±19.14)min,t = -5.673,P =0.021 ],the rate of movement of the center of the operation was significantly decreased (36% vs.64%,χ2 =7.840,P <0.001),the incidence rate decreased significantly (0% vs. 10%,χ2 =5.263,P =0.022).There was no difference between the two groups in intra -operative bleeding volume, hypertension,hypotension,tachycardia,postoperative drainage volume,postoperative bleeding,infection and vomiting (all P >0.05 ).Conclusion Dexmedetomidine contributed to maintaining the hemodynamic stable in general anesthetic for laparoscopic cholecystectomy,and reducing the rate of shivering.

Objective To study the clinical characteristics of silent paraganglioma ( PGL) .Methods A total of 21 patients with silent PGL confirmed by surgical pathology and hospitalized in the First Affiliated Hospital of chongqing Medical University from Mar .2008 to Dec.2013 were enrolled in this study .The clinical manifesta-tions, hormone level, imaging findings, pathologic characteristic, treatment and follow-up data were reviewed and analyzed retrospectively .Results Among the 21 cases of silent PGL , 8 were male and 13 were female, with 47.05 years as the mean age(ranging from 26 to 67 years old).PGL tumors in silent group were mainly located in the right side, and left to right ratio was 2∶5.Silent PGL with tumor diameter <3 cm, 3-5 cm, >5 cm were 5, 7,and 9 cases respectively.Its constituent ratio was 23.8%, 33.3% and 42.9% respectively, significantly higher compared with that of symptomatic PGL (9.8%,43.9%,and 46.3%respectively).Silent PGL can be i-dentified from other adrenal incidentaloma based on enhanced CT value in each period .Biochemical examination or functional imaging further could facilitate the diagnosis of silent PGL .All the 21 cases were conducted with surgical treatment , and hypertensive crisis occurred to 4 cases during operation .Conclusions Silent PGL is not easy to be detected due to its non-specific clinical manifestations .The diagnosis needs the combined analysis on anatomical imaging characteristics , biochemical examination , functional imaging and pathological findings .Sur-gery is the most effective treatment .Postoperative pathological tips and long-term follow-up are both required for PGL, no matter benign or malignant .

OBJECTIVE:To discuss the effect and safety of dezocine on hemodynamics and inflammatory cytokines in esoph-ageal cancer patients with one-lung ventilation(OLV). METHODS:80 esophageal cancer patients were randomly divided into ob-servation group and control group,40 cases in each group. All patients received 0.5 mg penehyclidine hydrochloride+0.1 mg/kg midazolam+4 μg/kg fentanyl+2 mg/kg propofol+0.15 mg/kg cisatracurium for anesthesia induction,propofol 4-10 mg/(kg·h)+remifentanil 0.1 μg/(kg·min)were pumped after double-lumen endobronchial catheter. Observation group received 1 mg dezocine by Intravenous injection in surgical skin incision,control group received the same amount of normal saline. Hemodynamic parame-ters [heart rate (HR),mean arterial pressure (MAP)] and inflammatory cytokine levels in 2 groups before anesthesia induction (T1),when skin incision(T2),5 min after dezocine/normal saline(T3),OLV 30 min(T4),recovery two-lung ventilation 10 min (T5)and end of the operation(T6)were compared,and the incidence of adverse reactions was observed. RESULTS:There was no significant difference in HR and MAP in 2 groups at T1,T5 and T6(P>0.05);HR and MAP in observation group at T2,T3 and T4 were significantly lower than control group,the difference was statistically significant(P<0.05). There were no significant differ-ences in TNF-α and IL-8 at T1,T2 and T3 and IL-6 at T1,T2,T3 and T4 between 2 groups(P>0.05);TNF-α and IL-8 at T4,T5 and T6 and IL-6 at T5 and T6 in observation group were significantly lower than control group,the differences were statistically signifi-cant(P<0.05). And there was no obvious adverse reactions during treatment. CONCLUSIONS:Dezocine shows more stable hemo-dynamics and lower expression level of inflammatory cytokines in esophageal cancer patients with OLV,with good safety.

Mammals have three genes with homology to the hh gene.These comprise Sonic hedgehog(Shh),Indian hedgehog(Ihh),and Desert hedgehog(Dhh).Shh has been shown to play a crucial role in embryogenesis and the development of ectoderm.Shh has the great relationship with the forming all the system.Shh-Patched-Smoothened signal pathway will lead the embryogenesis in the normal way.Otherwise,the abnormal embryogenesis,malformation,and tumor will be happened.