Primary biliary cirrhosis (PBC)is an autoimmune disease.Ursodeoxycholic acid (UDCA)is the only safe and effective drug for the treatment of PBC,as proved by randomized controlled clinical trials,so it is advocated as first-line therapy.Alternative therapies are urgently needed for patients with poor response to UDCA.In addition to the efficacy of UDCA,the classification of alternative and adjuvant therapies for UDCA nonresponders and the latest research progress in these therapies are reviewed;the efficacy of existing drugs and treat-ment prospects are evaluated,but more long-term clinical studies are needed to confirm the efficacy of immunosuppressants such as budes-onide and etanercept and other drugs.A number of novel molecular therapies for PBC are also undergoing clinical trials.There is currently no consensus on the medical treatment for patients with poor response to UDCA.Although studies have shown that some drugs can improve liver function and liver biochemistries,there is no definitive evidence that they improve long-term outcome.

Objective To improve the diagnosis and management of primary biliary cirrhosis (PBC). Methods Clincal data of 78 cases of PBC patients were reviewed. The clinical manifestations,the results of laboratory tests,and response to therapy in all the PBC patients were analysed retrospectively. Results Among 78 patients 68 were female. The mean age was 50.4?9.3years at the time when definite diagnosis was made. The major symptoms in these patients were pruritus,fatigability,and jaundice. The major signs included hepatomegaly,splenomegaly,and ascites. Very high levels of serum alkaline phosphatase (ALP) and serum gamma glutamyl transpeptidase (GGT),hyperbilirubinemia,and hypergammaglobulinemia were also detected in most of the patients. The aminotransferase levels were only slightly elevated,but the AST/ALT ratio was reversed. It took 12 months (ranging from 2 months to 10 years) to confirm the diagnosis after the onset of clinical manifestations. Ursodeoxycholic acid reduced the serum levels of ALP and bilirubin in 80% of patients and improved the symptom of pruritus and fatigability in 73.4% of patients. Conclusion PBC mainly affects middle-aged women with hepatosplenomegaly, jaundice,pruritus and fatigability as presenting features. Liver function tests typically revealed a cholestatic pattern accompanied by hypergammaglobulinemia and a positive antimitochondrial antibody (AMA) including M2 subtype (AMA-M2). Ursodeoxycholic acid could improve the abnormal liver function tests and clinical symptoms in PBC patients.

Primary biliary cholangitis (PBC)is a commonly seen cholestatic liver disease.Currently,ursodeoxy-cholic acid (UDCA)is the only drug approved for the effective treatment of PBC.However,up to 40% of PBC patients had poor response to UDCA.Farnesoid X receptor (FXR)can inhibit the synthesis of bile acid,regulating the transport of bile acid and playing a role in anti-hepatic fibrosis.This article reviewed the role of FXR in treatment of PBC.

Clinical practice course during the physical diagnosis studying is very important for the medical undergraduate students. It’s a bridge between the medical basic knowledge and clinical work. Several aspects such as moral education,learning attitude,scientific schedule,mas-tering the basic medical knowledge and physical examination,typical case and communicating skill must be emphasized in the clinical practice course.

Long educational system is an effective form in training high-level medical talents.Doctor-patient communication skill is one of tbe basic qualifications for 8-year program medical students.Standardized patients can be applied in training and evaluating of the 8-year program medical students'ability to deal with doctor-patient relationship so as to cultivate their communication competence.

Student as standard patient(SSP) was defined as student receiving relative medical training,who was willing to act as a human analogue as a patient and could be used as not only a patient but also a teacher in clinic practice.The results indicates that the using of SSP in the clinical teaching of endocrinology could promote the students'level in practice and in the meanwhile,it could be useful to testing the learning result.

BACKGROUND: Adipokines are secreted by adipose tissue, including a series of cytokines and chemokines. Additionally, adipokines have been found to play certain roles in pro- and anti-inflammatory regulation. OBJECTIVE: To analyze the regulatory effect of various adipokines in the inflammatory process of autoimmune response and immune diseases, thus providing the strategy for controlling and treating autoimmune diseases and searching effective indexes for assessing disease development, incidence of complications and prognosis. METHODS: CNKI and PubMed databases were retrieved for the articles addressing the role of adipokines in autoimmune diseases published from 1986 to 2016 using the keywords of adipokine, autoimmune in English and Chinese, respectively. RESULTS AND CONCLUSION: Adipose tissue plays a critical role in metabolism regulation, and its effect on the immune system has emerged through a series of studies concerning adipokines regulating immune response. Adipokines exert various functions, and regulate metabolism and inflammation. In the development and occurrence of autoimmune diseases, some factors for immune responses remain unclear, and in-depth studies on adipokines will be helpful for lifting the veil of autoimmune diseases.

AIM: To observe the expression of undulin(Un) in liver tissue and to clarify the diagnostic significance of serum Un in experimental rat liver fibrosis. METHODS: Rat liver fibrosis was induced by carbon tetrachloride. The expression of Un in liver tissue was detected by immunohistochemical method. Serum Un levels was measured by enzyme immunoassay.RESULTS: Expression of Un increased in fibrotic liver than normal liver, and it was mainly distributed in portal tract stroma, central veins and fibrotic septa in fibrotic liver. Also, the level of serum Un was significantly higher in fibrotic liver than normal liver.CONCLUSION: These data suggest that Un should be a component of the hepatic extracellar matrix, and its expression could be increased greatly in fibrotic rat liver. Serum Un levels may be used as an indicator in liver fibrosis diagnosis.

To improve the knowledge of students and strengthen the teaching effects of internal medicine teaching,the characters,teaching methods and notices of clinical guideline were analysed. Moreover,according to previous teaching experiences,a few unique opinions on it were put forward. The results showed that clinical guideline was one of the most important ways in internal medicine teaching.

To improve the quality of clinical practice education,questionnaires were distributed to the medical interns. Corresponding responses were proposed based on humanities quality,quality of clinical practice and its factors,views on after-department examination and training for clinical skill. The result shows most of students realized the importance of clinical practice. After reformation for clinical education,after-department examination could efficiently improve interns’ability to resolve practical problems. Management of teachers,development of students’clinical thinking and ability of communication between doctor and patient should be enhanced .