General/family medicine is a newly established major in medical education to meet the demands in general/family doctors. It is a new educational reform subject for medical schools to enhance the teaching for students in general medicine. Pathophysiology is a bridging course for foun-dational medical courses to be connected to clinical courses, and it is also a required course for med-ical students in cultivating students' critical thinking abilities. In military medical schools, there are certain features in the students. It is quite common to find these students have less desired academic foundation, and they come from different areas in the military units and will go back to certain units upon graduation. In the teaching of the course of pathophysiology, it has been proved that the following methods can help promoting the quality of teaching and learning. These methods include adjusting the teaching contents to emphasize the key points, selecting teaching methods to enhance interactions, and utilizing the advantages of internet and multi-media facilities in case discussions. However, there is still a long way to go to find out better ways in adjusting the course contents to the needs of general medicine education and sequencing the foundational courses in the medical courses.

Objective To observe the changes of respiratory musc]e strength by traditional Chinese medicine combined with cholinesterase inhibitors in myasthenia gravis (MG) patients.Methods Thirty-four cholinesterase inhibitor-resistant patients,of them 14 were MG patients with stage Ⅰ ,and 20 were stage Ⅱ ,were treated with bromide dimethylcarbamate ( 360-480 mg/d ).Traditional Chinese potion were administered in those without effectiveness,and the dosages of bromide dimethylcarbamate decreased with Traditional Chinese potion lasting for 4-6 months.Vital capacity ( VC ),maximal voluntary ventilation ( MVV ),maximal inspiratory pressure ( PIM ),maximal expiratory pressure ( PEM ),respiratory centre driving pressure ( P0.1 ),residual volume ( RV )were measured before and after treatment.Results The amelioration of VC,MVV,PIM,PEM,P0.1 ,RV,respiratory muscle strength and other indicators of 34 MG patients were not obviously after treatment with cholinesterase inhibitor alone ( P ＞ 0.05 ).After treatment with traditional Chinese medicine combined with cholinesterase inhibitors,VC,MVV,PIM,PEM ( before treatment:76.66% ± 18.59%,68.03 % ± 10.45 %,43.25 % ± 18.16%,21.75 % ±14.44% ) increased significantly in all 34 MG patients( after treatment:86.91% ± 14.87% ,75.11% ± 11.17%,52.66% ±20.32% ,28.56% ± 10.06% ) ( P ＜ 0.05).RV decreased from 164.94% ± 67.97% to 143.16% ±79.21% (P ＜0.01 ),and respiratory muscle strength,endurance and other indicators significantly improved (P ＜0.01).PIM(65.80% ±28.03% to 52.66% ±20.32%),and PEM (37.03% ±20.57% to 28.56% ±10.06%)improved more significantly in group stage than in group stage (P ＜0.01 ).Respiratory muscle endurance in stage Ⅰpatients ( 108.71% ± 17.56% ) improved significantly than stage Ⅱ patients (96.01% ± 14.12% ,P ＜ 0.01 ).Conclusions Traditional Chinese medicine combined with cholinesterase inhibitors could effectively improve the lung function and respiratory muscle strength in patients with resistance of the cholinesterase inhibitors.The improvement of lung function,respiratory muscle strength were more obviously in stage Ⅰ patients than in stage Ⅱ patients.Respiratory muscle strength and endurance were improved greater in stage Ⅱ than in stage Ⅰ patients.

MRDC is thefirst self-developing large integrated microbial resources database in the Chinese microbiological field. It includes Microbial Character Bank, Microbial Product Market Information Bank, Microbial Names Bank, Microbial Nomenclature Bank, RKC Code Bank for International exchange and one Microbiological Information Numerical Taxonomic System named MINTS.

Objective To explore the effectiveness of KAP-HBM-TTM(KHT)-based health management on patients with chronic diseases in community. Method From April 2014 to June 2015, 834 patients with chronic diseases living in Desheng Community were randomly sampled and assigned to the intervention group (n=423, and the control group n=411). The K-H-T mode was used for the intervention group, and the routine management mode was applied to the control group. Using self-made questionnaire we tested two groups of patients' knowledge, attitude and life-style behavior. Chi-square test was used for data analysis. Result After one year KHT-based health management, the proportion of patients with reaching the standard knowledge such as diagnosis based, risk factors, correct treatment method, life-style for prevention of chronic disease and regular check-up of the intervention group (84.9%, 88.0%, 95.2%, 89.6%, 96.9%) obviously raised compared with the control group (56.3%, 53.6%, 59.5%,55.8%, 62.7%), and the difference was statistically significant (? 2=81.270, 118.394, 155.166, 119.672, 150.173,P<0.05). The proportion of patients with reaching the standard attitude such as on the importance of chronic diseases, the family doctor service, the nurses' health management and changing risk factors of the intervention group (80.8%, 78.2%, 81.8%, 77.5%) obviously raised comapred with the control group (59.0%, 54.3%, 52.8%, 56.5%), and the difference was statistically significant (?2=46.573, 52.429, 78.435, 40.744,P<0.05). The proportion of patients with reaching the standard life-style behavior such as diet, physical exercises, psychological states, correct medication, monitoring blood pressure and glucose of the intervention group (76.7%, 72.2%, 90.6%, 99.3%, 86.1%,42.0%) obviously raised than the control group (30.9%, 30.6%, 58.0%, 73.1%, 57.5%, 28.9%), and the difference was statistically significant (? 2=174.142, 142.147, 115.318, 119.783, 83.164, 15.341,P<0.05). The rate of blood pressure and glucose control of the intervention group (84.2%, 74.8%) also improved as compared with the control group (74.3%, 60.0%), and the difference was statistically significant (? 2=11.598, 20.576,P<0.05). Conclusion KAP-HBM-TTM (KHT)-based health management was proved to be effective in the control of chronic diseases of community and improve the effectiveness of the management.

Objective To discuss the clinical efficacy of video-assisted thoracoscopic surgery(VATS)for bilateral bullous lung disease operation.Methods VATS procedures were performed on 120 patients with bilateral ballous lung disease.56 patients were operated in one-stage with traditional incision surgery.Results 120 patients were cured.The mean duration of chest drainage after surgery was 4.7 days.Postoperative complications occurred in 14 cases,including pulmonary edema,pneumothorax again respiratory failure and so on.The mean postoperative hospital stay was 14.5 days.The patients were followed up 1 to 60 months.Conclusion VATS is an effective and preferred method for bilateral bullous lung disease.compared with conventional open techniques for bilateral bullous lung disease,the advantages of VATS include shorter hospital stays,less postoperative pain and earlier return to work.

Objective To investigate the feasibility,advantage and clinical effect of video-assisted thoracoscopic in the treatment of sharp injury hemopneumothorax.Methods 53 cases in our hospital of sharp injury hemopneumothorax who need operation treatment were divided into the observation group (VATS group) and the control group(Open group),which were treated by Video-assisted thoracoscopic surgery and the traditional thoracotomy surgery respectively.The clinical effects,such as operative time,intraoperative blood loss,hospital stays,postoperative chest lead flow and so on were compared.Results The operation time,bleeding volume,length of hospital stay,postoperative chest lead flow and pleural drainage days have significant difference (all P ＜ 0.05).Conclusion VATS has shorter operative time,less intraoperative blood loss and quicker recovery after operation,which is a better and safer treatment of sharp injury hemopneumothorax and deserves further clinical application.

Objective To investigate the effect of norcantharidin on growth inhibition and induction of apoptosis of human rectal cancer Colo 320 cells. Methods Norcantharidin (NCTD) in different concentrations were added to rectal cancer Colo 320 cells. Morphological characteristics of apoptosis were observed using the light microscope and transmission electron microscope. The expressions of Bag-1 and Bcl-2 proteins were tested by Western blotting. The growth inhibition of Colo 320 cells on the cell cycle was observed by flow cytometry. Results The apoptosis morphological changes of Colo 320 cells were observed by the light microscope and transmission electron microscopy. Flow cytometry analysis showed that the cell count of G2/M phase in experimental group was higher than that in control group ( <0.05) but the cell counts of G0/G1 and S phases have decreased in experimental group after treatment with NCTD at the concentrations of 5μg/mL, 10μg/mL and 20 μg/mL, and presented dosage dependence relations. The expressions of Bag-1 and Bcl-2 proteins have decreased. Conclusion Norcantharidin has inhibitory effect on rectal cancer Colo 320 cells, and the effect may be related to the cell cycle arrest and apoptosis.

Objective To observe the change of learning and memory and the expression change of GABAR1 and N-methyl-D-aspartate receptor 2B (NMDAR2B)in right frontal lobe of the brain of the aged rats after the inhalation of sevoflurane.Methods Fifty male SD rats were randomly divided into control group (group C,n=10)and experimental group (group T,n=40).The control group received air at room tempreture.Experimental groups were divided into two groups:group T1 (2 h)and group T2 (4 h)according to the time of inhalation of sevoflurane at 3% concentration.Ev-ery group was equally divided into two groups and Morris water maze was performed on day 1 and day 7 after sevoflurane inhalation.Then the right frontal lobe was gathered and the mRNA transcription and protein expression of GABAR1 and NMDAR2B were detected by Quantitative Real-time PCR and immunofluorescence technique.Results Compared with group C,the escape latency was prolonged in groups T1 and T2 after 1 day of inhalation of sevoflurane (P<0.05),and the times of space explora-tion reduced (P<0.05).mRNA transcriptional and protein content of GABAR1 were significantly upregulated in frontal lobes of groups T1 and T2,mRNA transcriptional and protein content of NMDAR2B were significantly down-regulated (P<0.05).After inhalation of sevoflurane for 7 days, the protein expression of NMDAR2B in the frontal lobe of group T1 was lower than that of group C (P<0.05).In group T2,the escape latency was prolonged (P<0.05),the number of space explo-ration traversals was decreased (P<0.05),the expression of GABAR1 protein in frontal lobe was up-regulated (P<0.05),and the expression of NMDAR2B protein was down-regulated (P<0.05), and the amplitude was higher than that in group T1 (P<0.05).Conclusion Continuous inhalation of sevoflurane can reduce the spatial memory ability of aged rats,and the effect of prolonged inhalation is greater and longer.This effect is related to the expression of neurotransmitter receptors such as GABAR1 and NMDAR2B in the frontal lobe.

Objective To establish a simple scoring system for the diagnosis of liver fibrosis in chronic hepatitis B (CHB), and to observe its sensitivity and specificity. Methods Two hundred and thirty-three patients diagnosed as CHB by liver biopsy were divided into model group (N = 154) and validation group (N = 79). The general information, biochemical parameters and imaging data of all patients were observed. With hepatic fibrosis being obvious or not as the end point of primary study in the model group, we established a simple scoring system for the diagnosis. The cut-off, sensitivity and specificity of the system were tested in the model group by ROC curve, and its diagnostic efficacy was tested in the validation group. Results(1) A simple scoring system for the diagnosis of liver fibrosis called MDFS was established in the model group, and the dimensions of the system included sex, HBV-DNA, Fibroscan (FS) value and splenomegaly. In MDFS, male, HBV-DNA≥ 107 U/mL,FS value≥7.3 kPa, and splenomegaly were assigned 1 point, -2 points, 3 points, and 2 points respectively. (2) The best cut-off value in MDFS was 2 points.(3) ROC curve of the model group indicated that the specificity and sensitivity were 92.86% and 54.76% respectively, the area under curve(AUC) was 0.790, and the Youden index was 0.4762. In the validation group, the diagnostic cut-off value was over 2 points, and the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 52.17%, 82.35%, 2.96, and 0.58 respectively. (4) The scoring results of MDFS for different traditional Chinese medical syndromes of CHB showed that the scores of blood stasis blocking collaterals > damp-heat accumulation > deficiency of spleen and kidney yang> liver depression and spleen deficiency = stagnation of liver Qi. Conclusion The MDFS diagnostic scoring system has medium efficiency. The specificity of MDFS is relatively high and MDFs has a relatively low misdiagnosis rate for the diagnosis of obvious hepatic fibrosis in CHB. The MDFS is expected to be a noninvasive and simple diagnosing way for hepatic fibrosis in CHB.

Leishmaniasis is a prevalent cause of death and animal morbidity in underdeveloped countries of endemic area. However, there is few vaccine and effective drugs. Antimicrobial peptides are involved in the innate immune response in many organisms and are being developed as novel drugs against parasitic infections. In the present study, we synthesized a 5-amino acid peptide REDLK, which mutated the C-terminus of Pseudomonas exotoxin, to identify its effect on the Leishmania tarentolae. Promastigotes were incubated with different concentration of REDLK peptide, and the viability of parasite was assessed using MTT and Trypan blue dye. Morphologic damage of Leishmania was analyzed by light and electron microscopy. Cellular apoptosis was observed using the annexin V-FITC/PI apoptosis detection kit, mitochondrial membrane potential assay kit and flow cytometry. Our results showed that Leishmania tarentolae was susceptible to REDLK in a dose-dependent manner, disrupt the surface membrane integrity and caused parasite apoptosis. In our study, we demonstrated the leishmanicidal activity of an antimicrobial peptide REDLK from Pseudomonas aeruginosa against Leishmania tarentolae in vitro and present a foundation for further research of anti-leishmanial drugs.