PBL ( Problem-based learning) is a problem-based and student-centered learning pattern.PBL teaching method has been applied to evidence-based medicine ( EBM ) courses for international students.By this method,the students' learning enthusiasm was stimulated,the ability of ananlyzing and resolving problem was improved,and good teaching effect was achieved,which provided knowledge to improve further EBM teaching and evidence-based clinical practice.

Objective To explore the value of Montreal Cognitive Assessment (MoCA) in the diagnosis of mild cognitive impairment. Methods Mini-mental state examination (MMSE) was used in 532 elderly persons aged 60 years and over in Xuzhou city Gulou county. The 69 healthy people and patients with mild cognitive impairment were chosen to undergo MoCA. Then the sensitivity and specificity of MoCA were analyzed. Results According to MMSE, there were 19 patients with mild cognitive impairment (27. 5 %), 50 healthy persons (72.5 %). While according to MoCA, there were 58 patients with mild cognitive impairment (84.1%), 11 healthy persons (15.9 %). The consistency of the two scales was not good. And compared with MMSE, the sensitivity of MoCA was 94.7%, and the specificity was 20. 1%. Conclusions In the diagnosis of mild cognitive impairment, MoCA is more sensitive than MMSE.

Type 1 diabetes mellitus and autoimmune thyroid disorders are the most common combination of autoimmune polyendocrine syndrome type Ⅲ(APS Ⅲ). However, APS Ⅲ combined with myasthenia gravis is rare. We described a male patient with myasthenia gravis, type 1 diabetes mellitus, and Hashimoto thyroiditis, who was diagnosed as APS Ⅲ. The human leukocyte antigen (HLA)type was analyzed in this patient. We subsequently reviewed 11 cases of APS Ⅲ combined with myasthenia gravis. This review revealed that HLA-DR9/DQ9 might be a specific HLA subtype associated with APS Ⅲ and complicated with myasthenia gravis .

In recent years, there has been a comprehensive reform of higher medical education in the Medicine School of Wuhan University. According to the need for reform, the teaching of neurology has to be changed from the traditional form to a new form, and be integrated into the clinical pathophysiology and therapeutics (CPPT) courses. Currently neurology in CPPT takes the form of theoretical lectures, case discussions, combined with practical lessons to observe sections under the microscope and clinical practice, for the cultivation of students'!self-learning ability and clinical thinking. In the commissioning process, it exposes some problems in teaching process due to the characteristics of the course in neurology. For example, the knowledge of neuroanatomy is insufficient and review lessons relatively too short, and the teaching effect may be worse due to the fact that teachers have busy clinic work. In addition, students participate in case discussions with less enthusiasm. To solve these problems, we take some measures to promote teaching reform in neurology, such as increasing the review hours of neuroanatomy section in the CPPT neurology, training a group of specialized medical teachers to enrich and stabilize teacher team, adjusting the content and form of discussion class to improve students'!interest and participation, and increasing assistant jobs by the student to assist discussion teaching.

The stody explored the stalus and influential factors of Medical Marketing teaching and made some Droposition to teaching.The results showed that some students were dissatisfied with the teaching style,the curriculum,or the teaching effect,whose proportion was 42.6 percent,22.3 percent,14.3percent respectively.Main influential factors of Medical Marketing teaching were age,learning interest,evaluation to the curriculum and evaluation to the teaching.It was the findings through the study that the status of taaching was presented from two aspects,namely the students disliked the learning of curriculum and the teaching style was monotonous.Therefore it was urgent to develop the teaching reform and to arouse students'interest.

To bring up teaching quality of health service management and students' integrated ability,the author advanced his thoughts and opinions for teaching reform in teaching contents,teaching methods,examination modes and teachers ability based on the characteristics of health service management and combined with teaching practice.

Objective To study the risk factors of severe hand-foot-mouth disease (HFMD) among children.Methods The clinical data of 1 570 children with HFMD at Linyi People's Hospital in Shandong Province in 2011 were collected,retrospectively.The data were analyzed using univariate and multivariate Logistic regression.Results The mean age of severe HFMD (including severe and critical HFMD) was (25.0± 14.0) months old,predominantely aged between 1 and 5 years old,while mild HFMD was (27.1±15.8) months (t'=-2.717,P=0.007).There were 61.0％ and 65.9％ boys in two groups,respectively (x2 =3.894,P=0.048).Fever,convulsion,tremor,nausea and vomiting were more frequently seen in severe HFMD.The neutrophil count and the level of creatine kinase in severe HFMD were both significantly higher than that in mild HFMD.Univariate analysis revealed that age (odds ratio [OR]=1.799,95％CI:0.984-1.997),girl sex (OR=1.234,95％CI:1.001-1.522),high fever (OR=2.110,95％CI:1.816-2.452),convulsion (OR=1.878,95％CI:1.578-2.236),nausea and vomiting (OR=1.760,95％CI:1.456-2.128),neutrophil count (OR=1.031,95％CI:1.025-1.037) and creatine kinase (OR=1.002,95％CI:1.001-1.003) were risk factors for severe HFMD.Multivariate Logistic regression showed that high fever (OR =1.751,95％ CI:1.487-2.062),convulsion (OR=1.451,95％CI:1.204-1.749),nausea and vomiting (OR=1.269,95％CI:1.027-1.568),neutrophil count (OR=1.028,95％CI:1.021-1.035) were independent risk factors.Conclusions Body temperature,neurological manifestations and trend of neutrophil counts should be carefully monitored in children with HFMD.Prevention of the development of severe HFMD mainly relies on the identification of risk factors and adoption of precautions in time.

Objective:To discuss strategies in treatment of poorly differentiated thyroid carcinoma (PDTC) .Methods:Clinical data of 31 cases with PDTC were reviewed retrospectively, who were treated in Department of Head & Neck Surgery, Sichuan Cancer Hospital & Institute by primary surgical resection with or without adjuvant therapy. 27 cases had total thyroidectomy compounded neck dissection or extened total thyroidectomy when trachea or esophagus involved. 4 cases underwent partial resection of tumor. 11 cases were treated with external beam radiotherapy (EBRT) after surgery, 10 cases were treated with postoperative radioiodine, and 8 cases had chemotherapy.Results:The median follow-up time was 18 months (ranged from 3-96 months) . 19 patients died of local recurrence or distant metastasis. Kaplan-Meier analysis and Log-rank analysis was used to compare the differences between groups. Five-year survival was 35.9%. Compared to the cases with partial resection, the cases with surgical disease clearance had longer survival ( P=0.00) . The same statistical difference was found between patients with or without radioiodine ( P=0.017) . The patients treated with radioiodine had longer survival. No statistical differences were found among patients with or without chemotherapy or EBRT. COX regression analysis showed stage of tumor ( P=0.005) , total resection ( P=0.006) and postoperative radioiodine ( P=0.013) were same to predict longer survival. Conclusions:Thorough resection of tumor is the most important therapy for PDTC. Postoperative radioiodine is recommended for patients with high recurrence risk. EBRT is recommended to control local unresectable PDTC.

Objective To investigate the stroke occurrence of chronic kidney disease (CKD) and its related factors, especially the carotid atherosclerosis. Methods The data of stroke occurrence in 700 CKD patients hospitalized in Renji Hospital during 2007 were analyzed retrospectively. The incidences of stroke were compared among CKD [Ⅰ-Ⅱ, CKD Ⅲ-Ⅴ non-dialysis patients and dialysis patients. Carotid atherosclerosis of 409 CKD patients was examined by color Doppler ultrasound. The related factors were selected by Spearmnan correlation analysis and Logistic regression analysis. Results Of 700 CKD patients, 67 cases (9.57%) experienced at least one episode of stroke, which was much higher than that of general population. The related factors of stroke in CKD included GFR, age, SBP, CRP, Lpa, serum glucose, pre-albumin, HDL and carotid atherosclerosis. Logistic regression revealed that SBP (β=1.021, P=0.042), CRP (β=1.008, P=0.024) and carotid atherosclerosis (β =3.456, P=0.025) were risk factors of stroke in CKD. Incidence of carotid atherosclerosis was high (50.37%) in CKD patients, besides it was significantly higher in CKD patients with stroke history as compared to those without stroke history (80.0% vs 47.4%, P<0.01). Conclusions The incidence of stroke is quite high in CKD patients, which is closely associated with hypertension, inflammation and glyeolipid metabolism disorder. Carotid atherosclerosis is common in CKD patients with stroke, which may be helpful in screening cerebrovascular diseases in CKD patients.

Objective To evaluate the diagnosis, treatment and prognosis of primary duodenal carcinoma. Methods The clinical data of 41 cases with primary duodenal carcinoma admired during 2000-2007 were analyzed retrospectively. Results Clinical manifestation was not specific, including abdominal pain, abdominal distention, jaundice, bowel obstruction or bleeding. The correct diagnosis rate of endoscopy, duodenography, ultrasound and CT was 86%, 90%, 20% and 33% respectively. 23 cases underwent pancreaticoduodenectomy, 6 cases received segmental duodenectomy, 9 cases received bypass operation and 3 cases underwent biopsy. Overall postoperative 5-year survival rate was 18%. Univariate analysis revealed that the operation types, tumor histology, depth of tumor invatian, lymphatic invasion correlated with prognosis. Multivariate analysis showed that only the operative types, depth of tumor invasion and lymphatic invasion were independent prognostic factors. Conclusions Duodenography and endoscopy are major methods for diagnosis of primary duodenal carcinoma. Pancreaticoduodenectomy is the choice of therapy for primary duodenal carcinoma.