Problem-based learning ( PBL ) has become the major teaching method to cultivate medical student's autonomous learning and their ability to solve problems.It's basic elements are the scene authenticity and problem construction.Thoratic surgery clinical probation is the most important part of clinical teaching.The author summerized and analysized the PBL teaching experience in thoratic surgery and had some new understanding and experience on the problem construction,and therefore made some exploration and improvement to it and got some good teaching effect.

Infection can complicate different stages of acute pancreatitis.The probability of infection is related to the existence and extent ofpancreatic necrosis: up to 30% of patients with pancreatic necrosis develop infection.The timing of infection is variable and usually peaks in the second to fourth week after the onset of pancreatitis.IPN(infected pancreatic necrosis)is the most common type of secondary pancreatic infection.Infectious complications in severe acute pancreatitis are associated with considerable morbidity and mortality.Antimicrobial therapy is one of the fundamental elements of therapy.Diagnosis of secondary pancreatic infection is challenging and radiologic characteristic (air bubble sign) and CT guided fine-needle aspiration (FNA) are reliable diagnostic strategies.Antibioticuse should be rational in terms of a rational indication, a rational spectrum, and a rationalduration.Prophylactic antibiotics are not beneficial in improving prognosis.The only rational indication for antibiotics is documented infection.The empirical antibiotics should cover common microbials of hospital-acquired intra-abdominal infection and with good pancreatic penetration.Also, fungal infections are often present in thesepatients, and early diagnosis and antifungal coverage should be considered.Duration is in fact largely determined by the presence and efficacy of source control.When there is no or minimal residual infection left after a source control procedure, a duration of 7 to 10 days is probably sufficient.On the other hand, if the source of infection has not been removed completely, prolonged courses until the residual necrosis has been sterilized are necessary.

As an important organ of the human body,vascular endothelial cells (VECs) play a vital role in heat stressinduced tissue damage.Its integrity not only serves as a barrier for maintaining vascular permeability but also has major impact on cellular structure and function during acute phase response to heat stress.In heat stroke,a series of acute and complicated pathophysiological changes,including microcirculation change,damage VECs and thereby induce or aggravate multiple organ dysfunction syndrome (MODS).Meanwhile,studies have shown that,during heat stroke,VECs are the major responding cells and one of the most common cells that experience morphological and functional changes.Therefore,VECs damage might be an important mechanism involved in heat stroke.This article reviews the mechanism of heat-induced damage of VECs and its effect on vital organs.

There exist a series of problems in heat stroke treatment,such as,pathogenesis is still unclear,clinical classification is too simple and has no intrinsic relation with pathophysiological process and prognosis,missing of indexes for hierarchical diagnosis and prognosis prediction,and lack of targeted therapeutic norms.All of these factors could lead to high mortality and disability by heat stroke.Our research team started an epidemiological investigation of heat stroke since 2002.On the basis of discovering organ injury rule,system info and treatment technology on critical medicine were applied to heat stroke treatment.Research on organ injury mechanism for heatstroke was carried out based on translational medicine idea,and periodic research results were also achieved.A series of key technologies for heat stroke treatment were obtained.These technologies were popularized in 30 hospitals across the country,thus improving ability of heat stroke treatment.

Objective To explore the relationship between oncology and military medicine in order to remove theoretical barriers to the development of oncology in military hospitals .Methods The documentary evidence was obtained from cita-tion networks .Results Military hospitals and institutes in China and abroad have conducted studies on oncology , including the long-term survival of Hodgkin′s disease patients in a study of 388 military cases during World War Ⅱ, a study of leuke-mia within the former West Germany Armed Forces , and a study on melanoma in the Armed Forces .Also,some foreign doc-umentation paid special attention to special weapons and equipment , special military operations and special military envi-ronment-related issues of cancer epidemiology , such as cancer following nuclear weapon tests , the association of selected cancers with service in the U .S.military in Vietnam or after the Gulf War .The Military Cancer Institute of the United States published a total of 206 articles between 2001 and 2013 .Conclusion To make closer the relationship between oncol-ogy and military medicine , we should find out more about the relationship between general medicine and military medicine , learn foreign from experience on development of oncology , and explore the military medical value of oncology .

The endocrine system with the normal aging is characterized by a progressive loss of reserve capacity,resulting in a decreased ability to adapt to environmental demands.This loss of homeostatic regulation reflects important alterations in hormonal synthesis,metabolism,and action.However,these changes may have no significant clinical manifestations,especially under non-stress conditions.This review discusses the endocrine system in the elderly in general.

Objective To investigate and analyze the cause of the illness, types and conditions combined with dysfunction of important organs and death of severe heatstroke patients in military hospitals in southern China. Methods 117 cases of heatstroke patients from Jan 1988 to Mar 2005 admitted to 8 military hospitals were retrospectively analyzed. Results 94.02% of the cases occurred during military drill; 10% of patients complained of slight discomfort before or during the drill; the incidence of thermoplegia, heat cramp and heat exhaustion were 43.26%, 42.55% and 13.86%, respectively, in severe heatstroke, and the respective death rate was 9.76%, 5% and 23%. The incidence of severe heatstroke combined with liver dysfunction was 31.9%, with central nervous impairment was 14.9%, and with MOF was 21.3%. All patients survived when no organ dysfunction occurred; the death rate in those with single organ dysfunction was 3.6%, while it was 35% in MOF patients. Conclusion An attempt to set up a predicting index of heatstroke might be beneficial for scientifically supervising the military drill for the servicemen. Reduction of the core temperature is the“the first critical point”in the treatment. Other “critical point” in the treatment may also be emphasized for those with MOF. The present therapeutic system for heat stroke as executed in the military needs to be perfected.

Objective To determine the incidence of thrombogenic events during the prostate operation period in patients discontinuing aspirin.Methods Among a retrospective cohort of 342 patients admitted in our institution for benign prostatic hyperplasia (or prostate cancer),combined with acute coronary syndrome (or stroke),we studied 4 patients who had not been taking aspirin before thrombogenic vascular event.Data on age,sex,vascular disease risk factors,and clinical outcome were collected.Results The 4 patients' mean age was 78.8±5.9 years.Each patient had at least two following risk factors:atrial fibrillation,old cerebral infarction and type 2 diabetes.80％ patients had a clinical history of hypertension.2 of the 4 patients stopped aspirin before a surgical procedure and developed acute ischemic stroke and acute myocardial infarction,separately.The other two patients developed acute ischemic stroke without aspirin prescription.The median time between admission and thrombogenic events was 15.5± 10.5 days.All patients were not given finasteride on admission.Conclusions This study should alert clinicians to know the risk of aspirin withdrawl perioperatively in patients at high risk of cardiovascular and cerebrovascular diseases.

Objective To investigate and compare the food consumption concepts and behaviors of Beijing's urban and suburban residents. Methods Intercept questionnaire surveys were conducted on 287 urban customers shopping at a Jingkelong supermarket located in Chaoyang district and 307 suburban customers shopping at a Meilianmei supermarket located in town of Changping, Changping district at 2 randomly chosen times (all between 1:00PM and 5:00PM) from October to December 2007 in each supermarket. Results 93.1% of Beijing residents went to supermarket as their primary place for food shopping. 47.8% and 38.2% of residents thought the most important factors considered for their food shopping were "food hygiene and safety" and "its effects on health" respectively. Suburban residents were concerned more about "food hygiene and safety", while urban residents more about "effects on health" (P

Objective To observe the influences of combined therapy of ulinastatin and thymosin ?1 on the immune state in the treatment of sepsis and multiple organ failure(MODS),and to evaluate the therapeutic rationality.Methods 46 patients with sepsis and 18 patients with MODS were randomly divided into two groups.The patients in control group were treated with classical SSC therapy,those in treatment group were treated with the combined ulinastatin and thymosin ?1 therapy.The contents of IL-6 and IL-10 were detected with ELISA at the beginning of and after the treatment.Results After treatment,the concentrations of IL-6 and IL-10 declined significantly in treatment group,while no apparent changes were observed in the control group.There existed a significant difference between the two groups(P