Objective s To train postgraduate medical students the ability of effectively using network resources and independently studying,and to explore new model of clinical liver cancer teaching. Methods The teaching model of problem-based learning (PBL) to clinical liver cancer teaching was applied. Results The teaching model of PBL changed graduate student the status of passive acceptance to active participation. The teaching process was full of livingness,and the teaching quality was improved. Conclusion The teaching model of PBL can break through the limitations of passive acceptance of book knowledge in traditional teaching model and improve the ability to handle the comprehensive clinical knowledge of liver cancer,which provides a new model to the teaching of liver cancer to graduate medical students in clinic.

Objective To investigate the effect of Biyankang Tablets on quality of life and recurrence rate in patients with chronic rhinosinusitis after functional endoscopic sinus surgery (FESS). Methods A total of 78 patients with chronic rhinosinusitis treated in our hospital during October 2014 to November 2016 were selected, and they were randomly divided into the control group and the traditional Chinese medicine (TCM) group according to the order of admission, with 39 cases in each group. Both groups were treated with FESS, and the TCM group was additionally treated with Biyankang Tablets. The clinical efficacy, inflammatory factors [interleukin-4 (IL-4), interleukin-8 (IL-8)], the prognosis [visual analogue scale (VAS) score of rhinosinusitis and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)], drug safety and recurrence rates in the two groups were observed. Results After treatment, the total effective rate of treatment in TCM group was significantly higher than that in the control group (89.74% vs 71.79%) (χ2=4.044, P<0.05). After treatment, IL-4, IL-8 and VAS scores in the two groups were significantly decreased, and the scores of EORTC and QLQ-C30 were significantly increased, and the changes of scores in TCM group after treatment were more significant than those in the control group (P<0.05). After treatment, there was no significant difference in the incidence of adverse reactions between the two groups, and the recurrence rate in TCM group was significantly lower than that in the control group in 1 year after treatment (P<0.05). Conclusion TCM Biyankang Tablets is significantly effective in the treatment of patients with chronic rhinosinusitis after FESS. It can significantly inhibit the expression of inflammatory factors, effectively improve the prognosis and quality of life, and significantly reduce the recurrence rate.

Objective: To research the application of perspective imaging of intense laser proton beam in tumor cells, experi-ments are carried out on an ultra-intense picosecond pulsed laser facility, and the results of perspective imaging on biological samples by high energy proton beam, which is excitated among the interaction of picosecond laser with solid target, is showed. Methods: The laser energy is 12 J, the pulse width of laser is 1.5 ps, the laser focal spot diameter is 15 μm, the coefficientf or the off-axis paraboloid lens is 1.5. The target used in the experiment is made by coating a CH film with 1 μm on the back of the 15 pan-thick Cu. The distance between the proton source (laser spot) and the ant sample is 7 mm (i.e. the object distance), the distance between the sample and the RC film is 63 mm (i.e. the image distance). The detector is a stack of RCF or CR-39 films. Results: The ant is taken as the sample, a high energy proton beam, which is excitated as above on the rear surface of target, makes a 2-dimensional perspective imaging of an ant with high contrast, nanometer spatial resolution and density reso-lution. Conclusions: The result provided possibility of the application of perspective imaging of intense laser proton beam in tumor cells.

Objective This study investigates the effect of collectivism-individualism on parenting goals of middle school students' parents. Methods COLINDEX and Kohn's Parental Values Survey were used. 378 parents participated in the study. Results Fathers had higher score(3.23±0.73) on individualism than do mothers (3.05±0.44,F(1,359)=5.25,P <0.05);and highly educated (college or above) parents had higher scores(4.00±0.86) than do those with less education(for senior high school:3.91±0.81; junior high school or below:3.83±0.97,F(2,363)=4.72,P <0.01). Regression analysis indicated that collectivism had significant effects on goals of "take responsibilities and adapt to environment" ( P <0.01) and "conform to norm and obey parent" ( P <0.01). Both collectivism and individualism had significant effects on goal of "explore and be enterprising" ( P <0.05;P <0.01). Conclusion Parents with high collectivistic value expected their children to assume responsibilities,to adapt to the society,to adhere to norms and to obey authority. However,parents with high individualistic value encouraged their children to be independent and enterprising.

Objective To understand the incidence trend of ventilator -associated pneumonia(VAP)in ICU and to evaluate the effects of the interventions on the incidence of VAP,so as to provide scientific evidences for the prevention of VAP.Methods A study of 149 patients with VAP occurred in the 3 710 patients of ICU before and after intervention during 7 /2010 -12 /2014 in Wujin People's Hospital,Changzhou city was conducted.It was divided into two stages:baseline survey and stem expectations,VAP interventions included:training and education,chlorhexidine oral care and maintain appropriate endotracheal tube cuff pressure,elevated head of bed to up to 30°and improved hand hygiene.Hospital infection control professionals collected the number of patients,basic information,length of hospital stay,days of receiving mechanical ventilation and the VAP incidence data in ICU.And then change of the VAP incidence of the intervention before and after the intervention was compared and evaluation of the effect of combined intervention measures.Results Prospective data from 3 710 patients hospitalized in ICU were collected for an aggregate of 14 831 days,the utilization rate of ventilator was 55.2%.The occurrence of VAP was 149 cases.The average rate of VAP was 18.2 cases per 1 000 ventilator -day.VAP was associated with a crude mortality of 7.56%and with increased ICU LOS of 13.2d.As the results of the interventions,the rate of VAP was decreased from 52.38 /1 000 during 7 /2010 -6 /2011 to 5.71 /1 000 during 1 /2014 -12 /2014.Conclusion The rate of VAP in the inves-tigated ICU has led to a decreased incidence of VAP under the comprehensive interventions.

Objective To evaluate the efficiency of montelukast and ketotifen combind with BCG-PSN(polysaccharide nucleic acid fraction of bacillus calmette guerin for injection) in decreasing the incidence of asthma following brochiolitis.Methods 30 patients with brochiolitis were given montelukast,ketotifen and BCG-PSN,compared with 31 patients with brochiolitis without the treatment.The total course were two months for oral montelukast,three months for oral ketotifen,and six months for injecting BCG-PSN.The time of follow up was over 1 year and the cases of patients developed asthma were investigated,serum level of IgE,IgA,IgG,IgM were tested before and after the treatment.Results After follow up 1 year,1/30(3%) of patents with brochiolitis receiving treatment developed asthma compared with 9/31(29%) of the controls with brochiolitis(P

Objective To explore the construct validity of collectivism and individualism scale( COLINDEX) and the reliability and construct validity of its Chinese revision;and to study the development of middle school students' value. Methods The revised scale was used and 5875 middle school students were tested. Resuits Two-factor model of COLENDEX was not substantiated by data,while three factors were abstracted by EFA and confirmed subsequently by CFA. Four factors were abstracted from the Chinese revision of COLINDEX, and four-factor model was confirmed. The Cronbach's alpha coefficients of the total scale (0.90) and four sub-scales (0.84,0.76,0.84 and 0.74 )were all significantly high. MANOVA was performed to detect gender and grade differences of means in the four dimensions of the revised scale. The main effects of gender and grade reached the significant level; however, interaction between them did not. Conclusion Collectivism and individualism, two dimensions of Chinese middle school students' value, were not mutually independent. The revised version of COLINDEX was qualified to be used in further research. The grades on collectivistic items of middle school students were higher than those on individualistic items.

Objective:To study the effect of recombined TNF ? combined with induction of apoptosis and its relation with expression of bcl 2 in SW480 human colon cancer cells.Methods:The inhibitive effect of 5 Fu and TNF ? was measured by MTT.Apoptosis of colon cancer cells was studied by TUNEL.The expression of bcl 2 gene was determined by immunohistochemical analysis.Results:After SW480 colon cancer cells were treated with combination in various concentration of 5 Fu and 3 000 U/mL of TNF ? for 48 h,MTT assay revealed a significant decrease of relative viability in compasrison to the control.When SW480 colon cancer cells were treated with 3 000 U/mL of TNF ? and 125 ug/mL of 5 Fu in combination for 48 h,TUNEL method showed the number of nick end positive cells was significantly increased in comparison to the control.The expression level of bcl 2 gene lowered significantly than that of the control group.Conclusion:These results confirmed that combined TNF ? and 5 Fu could synergistically induce apoptosis in SW480 cells and decrease the expression level of bcl 2 gene.

Objective Investigate the reasonable surgical approach combined with frozen sections pathological features of papillary thyroid microcarcinoma.Methods Clinical data of 96 cases papillary thyroid microcarcinoma nearly 5 years of follow-up in our clinic referral was retrospectively analyzed.Metastasis and recurrence rate were compared between group of ipsilateral lobe plus isthmus resection (unilateral group) and group of ipsilateral lobe plus isthmus resection and contralateral lobe subtotal (bilateral group).Metastasis and recurrence rate were compared between group of central lymph node dissection (dissection group) and non-dissection group (non-dissection group),and the injury rate of the recurrent laryngeal nerve was also compared between the two groups.Results The diagnosis of cancer by intraoperative frozen pathology were 53 cases (55％).Whether in high or low risk populations,the metastasis and recurrence between unilateral and bilateral groups showed no significant difference (P ＞ 0.05).Whether in high or low risk populations,the metastasis and recurrence between dissection group and non-dissection groups showed no significant difference (P ＞0.05).The temporary injury rate of recurrent laryngeal nerve in dissection group were higher than thatin non-dissection group both in high-risk populations (P =0.040,P ＜ 0.05) and low risk populations(P =0.037,P ＜ 0.05).Conclusions Intraoperative frozen pathological diagnosis of papillary thyroid microcarcinoma is difficult.The reasonable surgical approach for the first time is ipsilateral lobe plus isthmus resection.Preventive cervical dissections operation should not be carried out if the exploratory of lymph node showed no metastasis.

Objective To observe the occurrence of cardiovascular adverse events in patients undergoing mechanical ventilation with dexmedetomidine sedation,and to evaluate its safety in intensive care unit (ICU).Methods A prospective randomized controlled trial was conducted.Adult critical patients undergoing mechanical ventilation over 48 hours admitted to ICU of Zigong First People's Hospital in Sichuan Province were enrolled.The patients were divided into dexmedetomidine group (Dex group) and midazolam group (Mid group) according to the randomise number generated by computer.The patients in both groups were given slow intravenous infusion of 0.05 mg/kg midazolam and 1-2 μg/kg fentanyl to induce anesthesia before tracheal intubation,followed by 0.06 mg· kg-1· h-1 midazolam and 20-50 μg· kg-1 · h-1 fentanyl or 0.1-0.2 μg· kg-1 · h-1 sufentanil for continuous intravenous pumping to maintain analgesia and sedation;on the next day,the patients in Dex group was given dexmedetomidine (with the initial dose of 0.4 μg· kg-1 · h-1,and maintenance dose of 0.1-0.7 μg· kg-1 · h-1),and midazolam was stopped half an hour later;the original sedation and analgesia plan remained unchanged in Mid group.The goal of sedation was to maintain a Richmond agitation-sedation scale (RASS) score of-2 to 1 or a Ramsay sedation score of 3 to 4;patients were given midazolam if obvious agitation occurred,in combination with propofol for sedation if necessary;wakeup test was performed every day.Observation endpoints included patients discharged from ICU,death or mechanical ventilation over 28 days.Occurrence of cardiovascular adverse events during sedation such as hypertension,hypotension,bradycardia,tachycardia and arrhythmia,dose of sedatives and analgesics,duration of mechanical ventilation,length of ICU stay and 28-day mortality were observed in two groups.Results A total of 383 patients were enrolled,with 190 patients in Dex group and 193 in Mid group.There was no statistically significant difference in general data such as gender,age,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and predicted mortality between two groups.Doses of midazolam,propofol and fentanyl in Dex group were reduced as compared with those of Mid group,while the dose of sufentanil was similar in two groups.The Ramsay score and RASS score of Dex group were significantly reduced as compared with those of Mid group (3.34± 0.63 vs.3.95 ± 0.86,-1.33 ±0.87 vs.-1.98 ± 1.27,both P ＜ 0.01).Bradycardia was prominent in Dex group,which was observed in more than half of patients at the beginning of the treatment (1-2 hours),but the patients requiring isoprenaline treatment for heart rate lower than 50 bpm were less than that of Mid group (3.7％ vs.5.2％,x 2 =0.506,P =0.477).The incidences of hypotension (45.3％ vs.68.4％),tachycardia (16.3％ vs.33.7％) and arrhythmia (14.7％ vs.31.1％) in Dex group were significantly lower than those of Mid group (all P ＜ 0.01),and no other cardiovascular adverse events such as cardiac arrest,sinus arrest,hyperglycemia or hypoglycemia were observed in two groups.There was no statistically significant difference in duration of mechanical ventilation between Dex group and Mid group [days:5 (2,28) vs.4 (2,56),Z =-1.917,P =0.055],but compared with Mid group,the length of ICU stay in Dex group was significantly prolonged [days:9 (2,67) vs.6 (2,57),Z =-4.302,P =0.000],and the 28-day mortality in Dex group was significantly reduced (22.6％ vs.44.6％,x2 =20.610,P =0.000).Conclusion Long time dexmedetomidine sedation is safe in critical patients undergoing mechanical ventilation,which can significantly reduce cardiovascular adverse events except bradycardia,and lower the 28-day mortality.