To establish the PBL designed experiment teaching model and to evaluate its teaching effectiveness.we use the questionnaires and the experiment skill test and the experiment content related written examination and the theoretic examination to evaluate its teaching effectiveness. The PBL group is significantly higher in the comprehension and the synthesizing ability and so on than the control group (P<0.05). The PBL group has significantly higher mean scores in the experiment content related written examination than the control group (P< 0.01). The PBL group has significantly higher scores in the theoretic examination than the control group (P< 0.01). The PBL designed experiment teaching can better train students for the innovative thinking ability and the scientific research capabilities.

Objective Based on the published articles,this paper aims to study the pattern and probability of lymph nodes metastasis in nasopharyngeal carcinoma (NPC) and establish a radiotherapy standard for selecting and delineation of clinical target volume of neck lymphatics for NPC patients with N0 or N1.Methods Clinical trials about NPC by MRI as the main or only diagnostic imaging way were collected and extracted from database,such as WanFang,CBM,PubMed,Cochrane Library.Statistical analyses were performed using Stata software,version 12.0.Results Twenty-one clinical trials from 963 original articles were included in this analysis.The most commonly involved regions included retropharyngeal (67％) and level Ⅱ lymph nodes (71％).The overall probability of levels Ⅲ,Ⅳ and Ⅴnodal involvement were 37％,14％ and 21％,respectively.Low-risk node groups included levels ⅠA,ⅠB,Ⅵ nodes,and the rates of lymph node metastasis were 0,2％,2％ and 1％,respectively.Nodal metastases followed an orderly pattern of top-down,and the probability of skip metastasis between levels varied between 0.5％ ～7.9％.Conclusion Lymph node metastasis in NPC follows a predictable and orderly pattern.The rarity of metastasis in certain nodal groups andskip metastasis suggest that reduced treatment volume is feasible in conformal radiotherapy for NPC patients with No or N1.

Problem based learning(PBL) pedagogy has been widely used in medical teaching process.But how to best use and develop PBL teaching,many universities try actively.According to PBL philosophy and the disciplines characteristics,the department of Pathophysiology in Central South University designed and carried out CPBL(Case and Problem Based Learning,CPBL) pedagogy.From the perspective of students,the authors have compared the CPBL pedagogy with PBL pedagogy in other academies,and make some positive recommendations.

Objective To investigate the clinical roles of lysine methyltransferase 5A(KMT5A)in human hepatocellular carcinoma(HCC)and its functions in cell migration and invasion. Methods The expression levels of KMT5A of 60 cases were detected by immunohistochemistry(IHC). KMT5A siRNA was used to down-regulate the expression of KMT5A in SMMC-7721 cells. Cell migration and invasion were measured by wound healing assays and transwell assays,respectively. Immunoblotting was used to detect the expression of MMP-2 after siRNA trans-fection. miR-186 mimics were transfected into SMMC-7721 cells and the mRNA levels of KMT5A was detected by qRT-PCR after transfection. Results High expression of KMT5A was associated with large tumor diameter (>5 cm,P=0.047)and advanced TNM stage(Ⅲ+Ⅳ,P=0.035). The expression of KMT5A was knocked down by siRNA in SMMC-7721 cells. Down-regulation of KMT5A suppressed cell migration(P=0.031,P=0.006)and invasion(P=0.010),and impaired MMP-2 expression(P=0.040). Overexpression of miR-186 could significantly inhibit the expression of KMT5A(P = 0.007). Conclusions Over-expression of KMT5A in HCC tissues associ-ates with poor clinical features. KMT5A knockdown inhibits the migration and invasion on HCC cells.

Objective To investigate the dynamic changes of the contents of brain water and Ca,Fe,Cu,Zn,Mg and microvascular damage in hippocampal tissue of radiation-injured rat brain.Methods The rats were randomly divided into control group,protective group (with intraperitoneal injection of 10％ MgSO4,400 mg/kg body weight + a single dose of 20 Gy electron beam irradiation in whole brain) and irradiation alone group (with intraperitoneal injection of normal saline,400 mg/kg body weight + a single dose of 20 Gy electron beam irradiation to the entire brain) with 18 rats assigned to each group and 3 rats sampled at each time point.Radiation-induced brain injury (RBI) was modeled by irradiating the rat' s whole brain with 5 MeV electrons.A dry-wet weight method was used to detect brain water content (BWC),and the level of microvascular damage was detected with HE staining of brain tissue slices,and the contents of Ca,Fe,Cu,Zn,Mg in hippocampus were detected with inductively coupled plasma atomic emission spectroscopy at different time points after radiation.Results BWC in the irradiated rats at 7,14 and 30 d post-irradiation was higher than that of control group (t =3.21,-2.11,2.82,P ＜0.05),andBWC in the protective group was less than that in the irradiated group (t =2.84,4.33,1.90,P ＜ 0.05).Microvascular thrombosis was induced in the radiated brain but this thrombosis was reduced by MgSO4.Thecontents of Ca and Fe in the brain tissue after 1,3,7 d of irradiation was higher than that of control group(t =11.41,6.81,14.03,17.17,6.89,9.12 and 5.43,5.66,3.60,P ＜ 0.05),and the content of Cain the protective group at various time post-irradiation was less than that in the irradiated group (t =5.35,5.28,11.02,14.26,5.68,9.10,P ＜0.05).The content of Cu (1,7,14,60 d post-irradiation) andZn (1,7,14,30,60 d post-irradiation) of the irradiated group was less than that of the control group(t =4.24,3.76,4.76,3.86 and 5.25,4.78,26.53,6.67,11.37,P ＜ 0.05),and the content of Cuin the protective group at different time points post-irradiation was less than that of the irradiated alonegroup (t =4.23,3.57,4.01,4.73,3.78,3.44,P ＜0.05),the content of Zn in the protective group(14 d post-irradiation) was higher than that of the irradiated group (t =6.21,P ＜ 0.05).The content ofMg in the irradiated group (7 d post-irradiation) was less than that of the control group (t =5.85,P ＜0.05).Conclusions The contents of Ca,Fe,Cu and Zn were imbalanced in the radiation-injured ratbrain,and the supplement of MgSO4could recover the balance of Ca,Fe,Cu and Zn content and alleviateradiation-induced brain injury.

Objective To investigate the effect of lineal polypeptide injection on immune function of severe sepsis patients in ICU.Methods 40 severe sepsis patients in ICU were randomly divided into two groups after signed the consent form:the treatment group (20 cases)and the control group (20 cases).On the 1st day of antibiotic therapy, the patients in the treatment group were simultaneously treated with lineal polypeptide intravenous injection,while the patients in the control group received the same routine treatment,but without lineal polypeptide injection,all with a 10 days treatment course.Blood bacteria culture and drug sensitivity test were completed after entering the hospital. The scores of Sequential Organ Failure Assessment(SOFA)before treatment and at day 3,7 and 10 of therapy were evaluated.The peripheral blood of patients was taken and send to the clinical laboratory.The WBC,NEU%,PCT, hs -CRP,IL -6,total T lymphocytes (CD +3 )and T lymphocyte subgroup (CD +4 ,CD +8 ,CD +4 /CD +8 )were detected in both the treatment group and the control group.Adverse drug events were also detected in the process of therapy. Results Compared with before treatment[(5.56 ±2.03)points],after 7 days of lineal polypeptide therapy,the SOFA score of the treatment group[(3.48 ±1.83)points]decreased significantly(t =2.793,P <0.05),and after 10 days therapy,the descending degree in the treatment group was more significantly and declined earlier than the control group (t =4.401,P <0.01 ).In the aspect of improving the inflammatory markers,two groups were all improved after therapy,but the degree of improvement in the treatment group was better than the control group.After 7 days therapy,IL -6 level was (37.61 ±7.51)mg/L in the treatment group,while (50.49 ±7.68)mg/L in the control group (t =1.969,P <0.01),and the improvement of NEU% was not found in control group.In the aspect of improving the immune function,the CD +3 ,CD +4 ,CD +4 /CD +8 ratios were increased significantly [before therapy:(41.27 ±6.91)%,(19.65 ±5.29)% and (0.96 ±0.42);after 3 days therapy:(46.57 ±7.11 )%,(24.99 ± 7.70)%,(1.27 ±0.39)],and CD +8 [before therapy:(25.62 ±5.18)%,after 3 days therapy:(23.51 ±3.19)%] was decreased dramatically after 3 days of lineal polypeptide injection treatment,there was significant improvement in time and degree in the treatment group compared with the control group (t =1.390,t =1.407,t =3.974,t =2.081, all P <0.05).No severe adverse drug events were found.Conclusion As an immune modulator,lineal polypeptide injection could effectively improve the immune function of severe sepsis patients in ICU.

The misuse of toxic drugsisseriousone of the threats of public health. In this study, toxic Hyoscyami Semen and its adulterants were identified by DNA barcoding. The genomic DNA was extracted from 61 samples including Hyoscyami Semen and its adulterants by reagent kit method. Their ITS2 sequences were amplified, and purified PCR products were sequenced. Sequence assembly and consensus sequence generation were performed using CodonCode Aligner v 4.25. The genetic distances, variable sites and the neighbor-joning (NJ) phylogenetic tree were computed by MEGA 6.0 in accordance with the Kimura 2-parameter(K2P) model. The results showed that the intra-specific genetic distances of Hyoscyamusniger were 0.005 which were smaller than inter -specific ones (0.360) of H. niger and their adulterants. The NJ tree showed that H. niger was clustered into one monophyletic branch, and clearly separated with other species. Therefore, ITS2 sequence was able to identify Hyoscyami Semen and its adulterants to ensure the safty of medicines.

Objective To estimate whether the ligation of bilateral internal carotid artery in combination with one vertebral artery can lead to chronic cerebral hypoperfusion. Methods The sham operation, 2?VO and 3?VO rat models were subjected to the matching operation. Four weeks after operation,the cortical blood flow was determined. The learning and memory abilities were measured with Morris water maze test eight weeks later,then the rats were sacrificed to observe the morphological change of hippocampal CA1 region. Results Compared with the sham operation group((47±8.797)ml·min-1·100 g-1),the cerebral blood flow of 2?VO((24.30±8.999)ml ·min-1·100 g-1) and 3?VO((9.870±2.208)ml·min-1·100 g-1) were significantly decreased (P<0.01). Compared with the sham operation group((8.33±4.88)s),escape latencies of Morris water maze of 2?VO group ((14.78±7.84)s) and 3?VO group((14.86±7.96)s) in the fifth days also presented significantly increased (P<0.01),but rare difference between the two groups. Compared with the sham operation group[ (37.20±9.21) s, (10.01.±2.91)times],the target quadrant swimming time and crossing times of 2?VO group((20.13±5.80)s, (6.60±3.19)times) and 3?VO group((20.05±5.76)s,(6.55±2.59)times) in the fifth days also presented signifi?cantly decreased (P<0.01). There were distinct pathomorphology changes in hippocampal CA1 region of the two groups. Conclusion The ligation of bilateral internal carotid artery in combination with one vertebral artery can lead to chronic cerebral hypoperfusion,and can make the similar ethology representation with the 2?VO models.

Objective To observe the efficacy of 810 nm diode laser therapy for keratosis follicularis.Methods A total of forty-eight patients with keratosis follicularis were treated by 810 nm diode laser,energy range from 9 to 10 J/cm2,frequency 10 Hz,pulse width 400 ms.Treatments were carried out in three times at 8-week intervals,and clinical efficacy was evaluated after third treatment (6 months).Results The total effective rates of keratosis follicularis were 91.7％.With the increase of the number the curative effect were obviously improved.The treatment effective rate was 52.1％ (25/48) for the first time.The treatment effective rate was 75.0％ (36/48) for the second time.And the third time was 91.7％ (44/48).the patients skin texture was obviously improved in the six-month of follow-up except adverse reaction appeared in five patients in the short term.Conclusions 810 nm diode laser is safe and effective for keratosis follicularis.

Objective To understand the prevalence of negative life events and its association with depressive, anxiety symptoms and dissatisfaction of school life among middle school students in Shaoxing, and to provide scientific evidence for further interventions. Methods A total number of 3 197 students (including 1 134 urban and 2 063 town adolescents) were recruited from 2 middle schools in Shaoxing, their average age was (13.73 ± 1.03) years. The Multidimensional Life Events Rating Questionnaire for Middle School Students (MLERQ), Depression Self-rating Scale for Children (DSRSC) and Screening for Child Anxiety Related Emotional Disorders (SCARED) were used to assess the mental health status, while the school life satisfaction was evaluated by the School Life Satisfaction Rating Questionnaire for Adolescents (SLSRQA), and the data were analyzed by descriptive statistics and multivariate logistic regression models. Results The prevalence of the negative life events was 84.9%, unsatisfactory examination performance (48.6%), unreached the teacher's expectation (46.2%), parental chatter (41.4%), unbalanced learning (37.9%), and getting parents scold (27.6%) constituted the main negative life events. The prevalence of depressive symptom, anxiety symptom, and dissatisfaction of school life were significantly higher among middle school students living with negative life events (41.1%, 22.6%, 26.0%) than those without negative life events (20.9%, 3.5%, 16.5%), (?2=71.33, 94.78, 19.83, P<0.001). The prevalence of the psychosomatic health involvement significantly increased with the increase of the number of the dimensions and events (P<0.001). The multivariate logistic regression showed that negative life events were the risk factors of depression, anxiety and dissatisfaction of school life. Their OR values were 2.483 (1.951-3.160), 7.245 (4.411-11.899) and 1.733 (1.325-2.267), respectively. The risk of occurring mental symptoms among children with the number of dimensions≥4 and/or the number of events≥12 was two times higher than those of children without such increase in numbers of dimensions and events. Conclusion The status of negative life events is serious among middle school students in Shaoxing. There are statistical associations between negative life events and mental symptoms.