Assessment or evaluation of student performance in a problem-based learning (PBL) curriculum is difficult to plan or implement.Many medical schools which have switched to a PBL learning format usually use traditional evaluation methods based on factual recalls, which usually has a negative influence on the learning style of the students, thereby reducing the impact of PBL. The purpose of this review is to discuss the various evaluation methods with a particular focus on methods applicable to PBL, so that we can make intelligent use of these methods in our PBL curriculum. In combination with evaluation methods adopted at McMaster University, the article makes an elaboration about them.

Objective To investigate the clinical characteristics and prognosis of patients with different molecular subtypes of breast cancer.Methods A cohort of 716 breast cancer patients which had clear immunohistochemical detection were investiged.Their molecular subtypes were categorized as Luminal A,Luminal B,HER-2 over-expressing and basal-like subtypes,based on detection of ER,PR,HER-2 expression,and the clinical data including characteristics,relapse,prognosis and prognostic factors of the patients with different subtypes of breast cancer were analyzed retrospectively.Results There were no significant differences among different molecular subtypes at the age,menopausal status,production times,clinical stage,and radiation therapy(P ＞0.05).There were significant differences among different molecular subtypes at axillary lymph node starus (x2 =17.208,P =0.001),turner size (x2 =20.528,P =0.000) and operation method (x2 =24.242,P =0.000) and chemotherapy regimens (x2 =10.711,P =0.013).Univariate and multivariate analyses showed that clinical stage (x2 =17.005,P =0.002),axillary lymph node status (x2 =11.267,P =0.000) and molecular typing(x2 =125.634,P =0.000) were independent prognostic factors affecting long-term survisal rate.Conclusion Breast cancer patients in different subtypes have different long-term survival rate.The patients in basal-like subtype have the worst long-term survival rate.Molecular subtypes may provide important information to predict the prognosis of breast cancer.

Objective To explore ways to improve effect of antiretroviral therapy in acquired immune defi-ciency syndrome patients with comorbid malnutrition, in an effort to enhance quality of life and reduce cost. Methods 126 AIDS patients with comorbid malnutrition were randomly divided into treatment group ( n=63) and control group (n=63). Patients in the treatment group were given nutrition support besides antiretroviral ther-apy (ART), while those in the control group only received ART. After 3 months, the two groups were compared in terms of body mass index, skinfold thickness, CD4+T cell count and human immunodeficiency virus load. Re-sults The two groups were comparable before treatment in BMI, skinfold thickness, CD4+T cell count and HIV load (P>0. 05). After treatment, the treatment group, compared with the controls, had higher BMI [ (23. 23± 3. 15) kg/m2vs. (17. 25±1. 83) kg/m2], thicker skinfold [ (42. 9±6. 8) mm vs. (34. 5±5. 2) mm in males;(97. 6±17. 4) mm vs. (92. 3±14. 7) mm in females], higher CD4+T cell count (χ2=12. 573, P<0. 01), and lower HIV load (χ2=8. 683, P<0. 01). Conclusion Nutrition support may improve treatment of AIDS patients with comorbid malnutrition, as manifested in better BMI, skinfold thickness, CD4+T cell count and HIV load.

Head and neck squamous cell carcinoma(HNSCC)is characterized by high recurrence or distant metastases rate and the prognosis is challenging.There is mounting evidence that tumor-infiltrating B cells(TIL-Bs)have a crucial,synergistic role in tumor control.However,little is known about the role TIL-Bs play in immune microenvironment and the way TIL-Bs affect the outcome of immune checkpoint blockade.Using single-cell RNA sequencing(scRNA-seq)data from the Gene Expression Omnibus(GEO)database,the study identified distinct gene expression patterns in TIL-Bs.HNSCC samples were categorized into TIL-Bs inhibition and TIL-Bs activation groups using unsupervised clustering.This classification was further validated with TCGA HNSCC data,correlating with patient prognosis,immune cell infiltration,and response to immunotherapy.We found that the B cells activation group exhibited a better prognosis,higher immune cell infiltration,and distinct immune checkpoint levels,including elevated PD-L1.A prognostic model was also developed and validated,highlighting four genes as potential biomarkers for predicting survival outcomes in HNSCC patients.Overall,this study provides a foundational approach for B cells-based tumor classification in HNSCC,offering insights into targeted treatment and immunotherapy strategies.

Objective:To analyze the mutation sites and characteristics of phospholipase CE1( PLCE1) gene in children with primary nephrotic syndrome(PNS) in Zhuang, Guangxi, China, so as to explore the expression status of PLCE1 protein in peripheral blood of PNS patients. Methods:(1)Blood samples of 154 Zhuang children with PNS and 98 healthy children of Zhuang nationality from July 2015 to September 2017 in Affiliated Hospital of Youjiang Medical College for Nationalities were collected to sequence PLCE1 gene with FastTarget target gene capture method in the combination with next generation sequencing.Based on the comparison between mutation results and information from the database, the pathogenicity, phenotype and distribution characteristics of these mutation sites were discovered and appraised.(2)The concentration of PLCE1 protein in serum samples were measured by enzyme-linked immuno sorbent assay, then the data of PNS group and healthy control group were compared and analyzed statistically with SPSS 25.0. Results:(1)A total of 18 low-frequency mutations of PLCE1 were observed, 5 of them(c.670C>T, c.578T>C, c.923G>T, c.4916C>T, and c. 5927_5929del) were found only in the PNS group, and 3 of them occurred in both PNS group and healthy control group: c.176C>T, c.389T>C, and c. 4304C>T.Five newly discovered mutations (c.923G>T, c.958T>A, c.1151C>T, c.2341A>G, and c. 3592G>C)were discovered and only c. 923 G>T is pathogenic mutation of PLCE1.(2)The concentration of PLCE1 protein in healthy control group was 414.65 (231.20, 729.81) ng/L and the level of PLCE1 in PNS group was 237.84 (116.14, 535.85) ng/L, ( Z=-3.212, P<0.001), and the value of PNS group was lower than that in the healthy control group. Conclusions:(1)As a new pathogenic mutation of PLCE1, c.923G>T was found.(2)The phenotype of PLCE1 gene mutation in Zhuang children with PNS was diverse, and they may differ by race and region.(3) PLCE1 protein of serum may act as a protective protein to guarantee various life activities of cells by participating in multiple signal transduction pathways.

Objective: To retrospectively analyze the epidemiological characteristics of supernumerary teeth in patients aged 4-18 years old and the influencing factors on the selection of anesthesia methods, and to provide a reference for the selection of anesthesia plans for children and adolescents with supernumerary teeth. Methods: This study is a retrospective study approved by the Institutional Ethics Committee. Based on clinical electronic medical record system and cone beam CT (CBCT) data, a retrospective analysis was conducted on 2 210 patients 4-18 years of age who underwent supernumerary tooth extraction at the School of Stomatology, Fourth Military Medical University from August 2019 to July 2021. Inclusion criteria: ① Age 4-18 years old; and ② The American Society of Anesthesiologists (ASA) classifies anesthesia into grades I-II; and ③ Have complete oral and anesthesia case records and relevant imaging data. Exclusion criteria: ① Incomplete medical records or unclear imaging data; and ② Patients with ASA grade II or above. Patients’ gender and age, the number of supernumerary teeth, arch, location, orientation, eruption status, reason for appointment, anxiety level, degree of cooperation, anesthesia method, and other relevant information were collected and statistically analyzed. Results: A total of 1 865 eligible patients were included, with an average age of (8.9±3.2) years old. There were more male patients (71.37%, 1 331 cases) than female patients (28.63%, 534 cases) (P < 0.001), with a gender ratio of 2.49:1. The majority of supernumerary teeth were single (75.97%, 1 417/1 865), primarily located in the maxilla (97.2%, 1 812/1 865) and the anterior dental region (94.2%, 1 757/1 865), and in a centric position (77.3%, 1 442/1 865). The majority of patients with erupted supernumerary teeth were active in seeking treatment (97.67%, 335/343). Patients with supernumerary teeth located in the maxilla and mandible bones, as well as in the nasal floor, were mainly referred to the department for diagnosis, accounting for 94.38%(1 361/1 442) and 90.00% (72/80) (χ2=1 363.24, P < 0.001), respectively. Regarding anesthesia methods, the largest proportion of patients received nitrous oxide sedation-assisted local anesthesia or nerve block anesthesia, accounting for 38.07% (710/1 865), followed by local anesthesia, accounting for 35.23% (657/1 865). The proportion of patients receiving midazolam intravenous sedation with local anesthesia or nerve block anesthesia and general anesthesia was relatively small, accounting for 20.86% (389/1 865) and 5.84% (109/1 865). Patients 13-18 years of age with supernumerary teeth in the mandibular and posterior regions and without anxiety had the highest proportion of local anesthesia use (P < 0.001). In contrast, patients who had supernumerary teeth located at the base of the nose (50%), severe anxiety (94.12%), and poor cooperation (98.18%) had the highest proportion of general anesthesia use (P < 0.001). There was no significant difference (P = 0.35) in the incidence of intraoperative and postoperative complications after the extraction of supernumerary teeth. However, the proportion of anesthesia-related complications, such as dizziness, coughing, and respiratory depression, occurring in patients who received general anesthesia was higher than local anesthesia, accounting for 3.81% (P = 0.006). Conclusion There is a gender difference in the incidence of supernumerary teeth in patients 4-18 years of age, with a higher prevalence in males. The majority of supernumerary teeth are single and located in the maxillary anterior region, predominantly in a centric position. Patients whose teeth had erupted were more likely to seek medical treatment voluntarily, while patients with supernumerary teeth located in the maxilla and mandible bones, as well as in the nasal floor were more likely to be referred to the department. Patients with high levels of anxiety, poor cooperation, young age, multiple teeth, and high surgical difficulty were more inclined to choose general anesthesia.