ObjectiveTo evaluate the result of problem-based learning combined with Casebased learning teaching model in the clinical probation of digestive medicine.MethodsPBL combined CBL teaching method and traditional teaching method were used respectively among 120 medical students who were divided into two groups randomly. Educational effects were evaluated through examination and ques-tionnaire.Results The PBL combined CBL group test scores are significantly higher than traditional teaching group ( P＜0.05 ).96.4％ students thought it was necessary to have PBL combined CBL teaching.ConclusionsPBL combined CBL teaching method is an effective teaching method for medical students.

In order to explore the effect of glial cell line derived neurotrophic factor (GDNF) on the motor neurons of the spinal cord, the present study investigated the localization of GDNF in the lumbar segment of the spinal cord on postnatal 1、3、7、10、14 and 28 days in rats with immunohistochemical staining method. The results showed that the positive GDNF immunoreactivity was present in the motor neurons of the ventral horn on postnatal 1、7 and 28 days, the motor neurons on postnatal 3 days were also weakly stained in rats,and some neurons of the dorsal horn and some glial cells had positive immunoreactivity. Furthermore, GDNF was found in the glial cell of the dorsal root in all groups of the postnatal spinal cord. The present results suggested that GDNF might play important roles in the development and function of the motor neurons of the spinal cord. More experiments should be done to explain why there is no positive immunoreactivity in the motor neurons between postnatal 7 and 28 days.

AIM:To observe the protective effect of nicorandil on myocardial ischemia reperfusion injury in patients undergoing valve replacement.METHODS:Sixty patients undergoing valve repalacement were randomly divided into 3 groups:control(Ⅰ)group,nicorandil delayed precondictioning(Ⅱ)group and nicorandil preconditioning(Ⅲ)group.20 mg nicorandil was given i.v.24 h before operation in group Ⅱ,whereas in group Ⅲ,20 mg nicorandil was given i.v.after induction of anesthesia.Blood samples were taken from coronary venous for determination of cTnI,TNF-?,IL-6 levels at aortic clamping(T0),15 min(T1),30 min(T2),60 min(T3),90 min(T4)after aortic declamping.Right atria myocardium tissue were taken at T0 and T2 to observe the histopathological changes with electron microscopy.RESULTS:The levels of cTnI,TNF-?and IL-6 in group Ⅱand Ⅲ were significantly lower than those in group I.Myocardium injury was obviously lighter in groupⅡand Ⅲ than that in group Ⅰ,whereas the levels of cTnI,TNF-?,IL-6 and myocardium injury were lower in group Ⅱ than those in group Ⅲ.CONCLUSION:Nicorandil is effcetive in decreasing myocardial ischemia repefusion injury in patients undergoing valve replacement,The protective effect of nicorandil delayed preconditioning is more obvious than precondictioning.

Objective To investigate the expression of HLA-DR and distribution of dendritic cells(DC) in endometrial carcinoma and to evaluate their influence on clinical staging and prognosis.Methods The 86 cases of patients with endometrial carcinomas were detected by immunohistochemical SP method for HLA-DR and S100 positive dendritic cells,and the predictive value in clinical stage and prognosis were analyzed.Results The positive rate of HLA-DR expression was 27.9%(24/86),which was decreased with the increase of clinical staging(P0.05).There were 46.5%(40/86) of the cases with a dense infiltrate(≥10/HPF) of S100 positive DC.There was significant difference on the density of DC infiltrating among the patients with different clinical stages and prognosis(all P

Objective To analyze and evaluate the joint teaching of subspeciahy teachers in the application of diagnostics probation.Methods 293 clinical medical undergraduates of Grade 2009 were randomly divided into experimental group(the joint subspeciahies teaching group,n=153) and control group(traditional teaching group,n=140).The two groups of students were divided into the 14-16 study group.The diagnostics probation teaching content(all general physical examination and ECG examination)was decomposed in the experiment group and students were taught by different subspecialties teachers while the students of the control group were taught by a teacher of internal medicine.The final examination grades and operative performance of the two groups were compared,evaluated and U tested.At the same time the questionnaire smvey was conducted to the students in the experimental group.Results The experimental group's theory examination score was (75.2 ± 8.9) and the operative assessment score was (88.5 ± 6.2),higher than that in the control group(70.9 ± 10.7 and 84.6 ± 5.5),the difference was statistically significant(P=0.001).The questionnaire results showed 92.8％(142/153)medical students improved their clinical skill,86.9％(133/153) medical students were satisfied with the joint teaching of subspecialty teachers.Conclusions The subspecialty teachers' joint teaching can improve students' clinical practice ability.It is a valuable teaching method in diagnostics teaching.

Objective To study effects of GDNF and HSV GDNF on apoptosis of spinal cord motoneurons after scratch injury in vitro. Methods In the period of culture cell,motor neurons were periodically observed and counted.Scratch injury was executed on culturing 12th day,in the same time,cultured neurons were divided into 4 groups,and each group was given corresponding medium(medium serum free control group,serum group,HSV GDNF group,GDNF group).On the 4th and 7th day after scratch injury,TUNEL staining was respectively performed,and the number and the mean densities of apoptotic motoneurons were observed. Results The number of living motoneurons was in inverse proportion to time of scratch injury in each group.The number of apoptotic motoneurons from control group,HSV GDNF group to GDNF group was successively decreased as well as the mean densities of apoptotic motoneurons on the 4th and 7th day after scratch injury.Furthermore,the effects of groups with serum were no better than those of medium serum free groups,in the same time,difference was not obviously in HSV GDNF group and GDNF group. Conclusion GDNF and HSV GDNF can decrease apoptosis of injured motoneurons in vitro .It suggests that GDNF and HSV GDNF might play an important role in the growth and development of motor neurons.

Objective To explore the influence of delineator and contouring criteria training on the delineation of the tumor bed and whole breast target after breast-conserving surgery.Methods Twelve brcast cancer patients after breast conserving surgery were selected.Tumor bed marked by clips was defined as gross target volume 1 (GTV1),tumor bed formed by seroma was defined as GTV2 and the whole breast was defined as clinical target volume (CTV).Five junior radiation oncologists first delineated GTV1,GTV2 and CTV for each patient following their own criteria.After contouring criteria training,they then delineated GTV1,GTV2 and CTV for the same group of patients again.The differences of the volumes of GTV1,GTV2 and CTV before and after training among different delineators were compared.One-way ANOVA or matching t-test was performed.Results The inter-delineator variability on GTV1,GTV2 and CTV delineation before training was statistically significant (F =11.16,7.54 and 3.78,P =0.000,0.000 and 0.009).After training,the inter-delineator variability on GTV1 and GTV2 delineation had statistical significance (t =4.78 and 4.24,P =0.002 and 0.005),but the inter-delineator variability on CTV delineation had no statistical significance (t =1.52,P =0.209).The coefficient of variance of the GTV1,GTV2 and CTV before and after training was significantly different (t =3.14,2.81,2.70,P =0.009,0.017 and 0.021).The matching index of GTV1,GTV2 and CTV before and after training was significantly different (F =16.08,8.61,8.48,P =0.000,0.000 and 0.000).Conclusions In delineating the target of breast cancer,application of the criteria of target delineation can reduce the difference among the delineators,especially for CTV.

Objective To evaluate the diagnostic value of ultrasonic elastography (UE) in benign and malignant thyroid nodules by Meta analysis. Methods Computer was used to search China national knowledge infrastructure(CNKI), Wanfang database, and relevant Chinese articles about UE in assessing diagnostic accuracy of benign and malignant thyroid nodules were collected. According to the diagnostic test criteria recommended by Cochrane Screening and Diagnostic Test Group, the literatures were screened and feature information was included in the study. The quality evaluation tool of diagnostic test accuracy(QUADAS-2) was used to assess the quality of the literatures; Meta analysis was performed with Meta-DiSc 1.4 software, and receiver operating characteristic curve(SROC) was drawn. Results According to the key words, two hundred and thirty-one articles were retrieved initially, and finally 16 articles were included after screening; the quality of five articles was grade A; eight was grade B; and three was grade C. Sixteen articles contained 1 325 patients with 1 641 thyroid nodules. The pooled sensitivity and specificity were 0.87 [95%confidence interval (CI): 0.84 - 0.89] and 0.84 (95%CI: 0.82 - 0.86), respectively; the pooled positive and negative likelihood ratios were 5.85 (95%CI:4.47-7.65) and 0.17(95%CI:0.13 - 0.21), respectively; the area under the curve of SROC was 0.93, standard error(SE) =0.01. Conclusion The results of meta-analysis suggest that UE has high value in the diagnosis of benign and malignant thyroid nodules.

Objective To investigate the clinical effect of a new type of disposable heparin freedialysis tube in uremic patients without heparin dialysis. Methods A total of 110 patients withoutheparin dialysis were divided into control group and observation group by random digits table method with55 cases each. Based on the same pre dialysis and dialysis for heparin saline flushing of discontinuoussaline on the control group using the traditional dialysis pipe for hemodialysis without heparin, theobservation group used disposable non heparin dialysis pipe for hemodialysis without heparin. The numberof patients with venous catheter blockage, blood loss and completion of dialysis time in two groups wasrecorded. Results The number of patients with venous catheter blockage, blood loss and completion ofdialysis time was 6, 6, 47 cases in control group and 0, 0, 54 cases in observation group. The differences were statistically significant (χ2=4.407, 4.407, 4.356, P<0.05). Conclusions The new disposableheparin free dialysis tube can reduce the loss of blood and prolong the treatment time, and the operation issimple, safe and effective, and has good application value and application prospect.

Objective To investigate the efficacy and safety of enriched-calorie formula in post-operative infants with congenital heart disease and malnutrition.Methods All malnourished infants less than 6 months diagnosed congenital heart disease: ventricular septal defect and had undergone surgery in Guangzhou Women and Children`s Medical Center from December 1,2014 to May 30,2015 were included in this study.All cases were randomly divided into intervention group(energy-enriched formula,intervention group)and control group(standard formula,control group)for enteral nutrition intervention and observed for 3 months.Body mass,body length,upper arm circumference,blood prealbumin(PA),retinol binding protein(RBP),and B-terminal pro-brain natriuretic peptide(NT-proBNP)were measured before and after ICU,after discharge,and 1 month and 3 months after operation.Results Fifty-one cases were in intervention group and 50 cases in control group,respectively.There were no significant differences in body mass,body length,arm circumference,PA,RBP,mean enteral nutrition starting time,mechanical ventilation time,length of ICU stay,hospitalization time,and average fluid intake between the two groups(all P>0.05).The average caloric intake in intervention group was significantly higher than in control group [(437.24±6.68)kJ vs.(312.43±86.22)kJ,P=0.001].There was no significant difference in NT-proBNP,PA,and RBP at different time points between the two groups(all P>0.05).The improvement of nutrition in intervention group was significantly higher than that in control group at 1 month(25.0％vs.4.9％,P=0.011)and 3 months(64.1％vs.15.7％,P<0.001)after operation.Body mass increased in intervention group [(0.067±0.348)kg] compared with that in control group,and decreased [(0.125±0.425)kg] in control group(P=0.015).Body weight[(5.46±1.36)kg vs.(4.80±1.01)kg,P=0.008],weight for age Z score(WAZ)(-2.79±1.28 vs.-3.75±1.27,P<0.001),and height for weight Z score(WHZ)(-2.47±1.43 vs.-3.62±1.77,P=0.001)one month after surgery were significantly higher than those before operation.Body weight [(6.78±1.42)kg vs.(5.72±1.01)kg,P<0.001] arm circumference [(12.80±1.17)cm vs.(12.00±0.90)cm,P<0.001],WAZ(-1.60±1.17 vs.-3.10±1.40,P<0.001),height for age Z score(HAZ)(-1.41±1.63 vs.-2.10±1.41,P=0.034),and WHZ(-0.86±1.31 vs.-2.59±2.13,P<0.001)of the two groups at 3 months postoperative were significantly higher than those before operation,and the growth rate of intervention group was faster than control group.There were no significant adverse reactions in both groups.Conclusion Calorie-enriched formula powder can help malnourished infants to catch up after congenital heart disease surgery.