Objective To investigate and analyze the effects of problem-based learning used in clinical nursing education. Method The research papers on the effect of problem-based learning used in clinical nursing education were retrieved via CNKI, Wanfang,VIP,PubMed,ProQuest and Google scholar websites and then analyzed by Revman5.0 software.Results Totally 11 RCTs were included.Meta-analysis showed that PBL could significantly promote students’examination scores,self-study ability, critical thinking and clinical skill,but insignificantly improved the effect in improvement of their theory learning,interest and ability in cooperation.Conclusions PBL is a scientific clinical teaching method,which can stimulate students’initiative and exploratory learning and enhance effects of clinical teaching.Meanwhile,we suggest formulating evaluation criteria and implementing rigorous RCT designs in the future.

Objective:To understand the influence factors of suicidal ideation among college students of military medical university and to provide reasonable suggestion for preventing suicide among college students.Methods:701 college students were investigated and multiple logistic regression was used to analyse the major influence factors for suicidal ideation Results:Multiple logistic regression analysis shows the major influence factors for suicidal ideation are score,depression,life events and social support.Conclusions:According to the influence factors of suicidal ideation,taking appropriate measures to prevent suicide among college students is an urgent task.

Objective To investigate the clinical efficacy and safety of sitagliptin combined with metformin in treating patients with type 2 diabetes with non-alcoholic fatty liver diease (NAFLD).Methods Sixty-five patients with type 2 diabetes with non-alcoholic fatty liver admitted into our hospital from June 2012 to June 2015 were randomly divided into two groups.Thirty-three patients in control group were treated with metformin only,and thirty-two patients in observation were treated with sitagliptin combined with metformin.The changes in body mass index (BMI),fasting plasma glucose (FPG),2-hour postprandial glucose (2hPG),Hemoglobin Ale (HbAlc),homeostasis model assessment of insulin resistance (HOMA-IR),and liver function index including that aminopherase of alanine acid (ALT),aminopherase of aspartic acid (AST),gamma-glutamyl transterase (GGT),triglyceride (TG),and total cholesterol (TC) were detected before and after 16 weeks of treatment.And the total effective rate and safety were analyzed and compared.Results After treatment,HOMA-IR,FPG,2hPG,HbA1c,ALT,AST,GGT,TG,and TC were remarkable improvement (P ＜ 0.05),and HOMA-IR,HbA1c,AST,ALT,GGT,and TG were significantly better than those of control (P ＜ 0.05).Additionally,the total effective rate in observation group with 90.9％ was significantly higher than that of control group with 42.4％ (P ＜ 0.05).And difference in incidences of adverse effect between observation group with 15.6％ and control group with 9.1％ were not significant.Conclusion Sitagliptin combined with metformin treatment had a good ability on treating patients with type 2 diabetes with NAFLD by improvement of metabolic syndrome and liver function.

Objective To develop a method for the primary culture of retinal Müller cells of adult rabbit in vitro. Methods Retina was isolated from adult rabbit, cut into 1 mm × 1 mm pieces, and placed into Dulbecco modified Eagle medium/F12 containing 20 % fetal bovine serum to culture. Cultured cells were identified by inverted phase contrast microscope, transmissim electron microscope and immunohistochemistry staining method. Results Visible cell processes grew out from the retinal tissues after three days culture, and more cells grew radically around the retina after seven days culture. The cultured cells were often inflated at one side and had one long process at another side, and the nuclei were elliptical and there were two or more than two nucleoli under inverted phase contrast microscope. The cytoplasm was rich and contained abundant microfilaments in eight to ten nanometers under transmission electron microscope. Immunohistochemistry assay showed that 95% of the cells were positive for glial can be cultured by the explant culture method.

BACKGROUND:Fracture of the distal humerus is a common type of fracture. Conservative treatment or metal implant fixation can be used during the clinical treatment of elderly patients, but the choice of specific treatment options stil lacks of clear conclusion. OBJECTIVE:To explore the clinical repair effect and biocompatibility of titanium aloy implant internal fixation for aged patients with distal humeral fractures. METHODS: A total of 41 elderly patients with humeral fractures, who were hospitalized in Danzhou Municipal First People’s Hospital from July 2011 to July 2014, were enroled in this study. In accordance with the wishes of patients, repair program was selected. 22 patients in the control group received conservative treatment. 19 patients in the observation group received titanium aloy implant fixation. After 12 months of folow-up, elbow joint activity, elbow joint function recovery and adverse reactions were observed and compared in the two groups. RESULTS AND CONCLUSION: After conservative treatment and internal fixation, each index score and total score of range of motion of shoulder joint were significantly higher in the two groups as compared with pre-treatment (P < 0.05). Each index score and total score were significantly higher in the observation group than in the control group (P < 0.05). Curative effect evaluation results showed four excelent patients and three good patients in the control group, eight excelent patients and four good patients in the observation group. The excelent and good rate was significantly lower in the control group than in the observation group (P < 0.05). Two patients suffered from mild inflammatory hyperplasia during taking out the fixator in the observation group, and the remaining patients did not affect inflammatory hyperplasia or capsular tissue. In the observation group, after surgery, one case experienced numbness of the ulnar nerve, which disappeared after treatment with trophic nerve. One case suffered from wound infection, which was controled by antibiotic treatment, and did not induce a serious outcome. After folow-up, none of them had nonunion or internal fixation loosening. The results show that titanium aloy implant fixation for the treatment of distal humerus fractures can get better repair effect compared with conservative treatment, can effectively improve the elbow joint function, and titanium aloy material has good biocompatibility.

Objective To develop a method of quantitative analysis of multi-components by single marker( QAMS) for determination of quercetin, kaempferide,isohamnetin in Chuipencao granules,providing method to control the quality of Chuipencao granules.Methods The analysis was performed at 30 ℃,on an Shimadzu C18 column(250 mm ×4.6 mm,5μm),and the mobile phase was methanol-0.4% phosphoric acid solution .The flow rate was 1.0 mL/min, and the injection volume was 10 μL.Quercetin as a reference to establish the relative correction factor kaempferol and between isorhmnetin, the method was evaluated for reproducibility, and the difference between calculated and measured values was compared. Results Quercetin, kaempferol and isorhmnetin respectively 32.36-426.43μg, 11.56-136.87μg, 10.45-155.68μg showed a good linear relationship, and the regression equation was: Y=3625.8X-13658 (R2 =0.9998), Y=2682.9X-10253(R2 =0.9999), Y=3012.2X-11223 (R2 =0.9999).The average recoveries were 99.3%, 99.6%, 98.5% (RSD were less than 1.0%).Determination of 10 batches of Chuipencao granules with QAMS and external standard method, kaempferol and isorhamnetin were measured, and measured values were basically the same.Conclusion The QAMS method is reliable and accurate, which might be used for the quality control of Chuipencao granules.

Objective To explore the clinical , EMG and genetic characteristics of children with hereditary neuropathy with liability to pressure palsies phenotype (HNPP).Methods One case of HNPP diagnosed by gene were reported, and combined with the literature , the clinical, electromyography and genetic characteristics were summarized.Results Female patient, 11 years and 8 months, left foot could not be dorsal flexion and numbness appeared after the movement in 10 d before admission ,EMG showed multiple peripheral nerve injury .Patient's father and uncle were very similar to the history .Genetic examination showed 1363.2 kb heterozygous deletion on the chr17:14095421 -15458636, and the diagnosis was HNPP .Conclusions When limb weakness happened in children after slight stretch or compression , perform EMG examination as early as possible .Children with extensive peripheral nerve damage , limited limb paralysis , and a similar family history , should pay attention to HNPP , and gene examination should be given .

Macrophage migration inhibitory factor(MIF),a potential pro inflammatory cytokine,is a pivotal regulatory element in the nature and adapted immune.This article aims to introduce the histocellular sources,genetic structure,protein structure and biological activity of this cytokine,and further to explore its role in the pathogenesis of septic shock,and its antagonist in the treatment of this disease.

ObjectiveTo investigate the clinicopathologic features of lymphoblastic lymphoma (LBL).Methods21 cases of LBL were examined by light microscopy and immunohistochemistry,and analyzed with clinical features.Results21 cases of LBL patients ranging in age from 4 to 86 years old,including 17 cases originated from the lymph nodes, the other 4 were from the nasopharynx, breast, pleura and mediastinum respectively. Histopathologically: lymphoid cells were median sized, showing a diffuse infiltration. The neoplastic cells had fine chromatin, higer nuclei mitoses. The tumors were positive for TdT and CD99.ConculsionPatients especially who have enlarged lymph nodes in adolescents favor the diagnosis of LBL.The tumor cells show a diffuse infiltration,usually with median size,fine chromatin.The positivity for TdT in immunostaining can confirm the diagnosis of LBL.

About half of the world population and more than 90% of rural households in the developing countries still use unprocessed biomass fuels (wood, dung and crop residues) as the fuels. These substances, burning in the open fire or in the simple stoves, can cause indoor air pollution and the pollutants exposure in women and children is more serious. Biomass smoke contains lots of toxic and harmful substances which may impact the health of human. This article presented a recent research progress in the indoor air pollution and health effects caused by combustion of biomass fuels in China and in the world.