Chinese higher medical education has undergone a series of education reform project .College excellent courses construction is an important component of the project .To enable medical students to master the basic surgi-cal theory and skills, and to develop high -quality, high -level medical personnel , the surgery department in Shengjing Hospital of China Medical University has scored some achievements in constructing excellent courses . Some ideas and methods are summarized in the construction of excellent courses .

In light of the unfulfilled docking of the previous curriculum system of clinical medicine science specialty in higher vocational colleges and with the requirement of being a first-line physician,we put forward our reform sketch for Clinical Medicine Transboundary Curriculum System targeting at fostering technical and skilled genius that will be qualified for the post of clinical physician in primary heahh-care institution,following the principle of quality-first,capability-centered and knowledge-based and attempting to establish a unified system combining quality,capability and knowledge,and analyze the difficulty during the implementation of the reform ideas and measures that could be taken.In this way,it will be possible for us to comprehensively dock curriculum initiatives with the capability of the post,curriculum content with professional criteria,professional teaching with clinical applications,vocational education and lifelong study,and hence,it will be helpful for us to foster qualified genius for first-line medical institution.

Pancreatic ductal adenocarcinoma is a devastating and malignant disease,with a five year survival rate of less than 5％.Despite our improvement of surgical techniques and adjuvant medical therapy,most patients with pancreatic cancer have a dismal prognosis.The poor outcome of this tumor is associated with a high degree of drug resistance.Recently,the emerging knowledge of the molecular basis of pancreatic cancer may provide new avenues to get better prognostication for individual patients based on the molecular profile of obtained tissue by a biopsy or from resected specimens.So some novel drugs targeting signal pathway both within cancer cell and cancer microenvironment are undergoing preclinical.This article reviews the different targeted approaches in pancreatic cancer.

Objective To observe the mechanism of elevated parathyroid hormone(PFH) leading to erythrocytes life span shortened in the patients with chronic kidney disease(CKD).Methods Serum samples of 30 healthy people and 75 CKD patients were collected.Patients were divided into three groups according to their renal function.Intact parathyroid hormone(iPTH)was detected by immunochemiluminometry.The erythrocytes phosphatidylserine (PS) exposure and intracellular calcium concentration ([Ca2+]i)were measured by flow cytometry. Results (1)Levels of serum iPTH,[Ca2+]i and erythrocytes PS exposure increased gradually with the decline of renel function in stages 3 to 5 of CKD,the differences were significant with CKD 1 to 2 stages and healthy control group(all P＜0.05).(2)Pearson correlation analysis revealed,during CKD 3 to 5 stages,Hb was negatively correlated with iPTH and erythrocyte PS exposure respectively (r=-0.830 and-0.791,all P＜0.01);iPTH was positively correlated with[Ca2+]i and erythrocyte PS exposure (r=0.882 and 0.924,all P＜0.01),whereas negatively correlated with serum Ca respectively(r=-0.544,P＜0.01);erythrocyte PS exposure was positively correlated with[Ca2+]i(r=0.923,P＜0.01)and not correlated with serum Ca(r=-0.138,P=0.365).(3)The linear regression equation of[Ca2+]i(Y)for iPTH(X)was Y=3.327+0.213X(F=21.529,P＜0.05).The multiple linear regression equation of erythrocytes PS exposure(Y)for PTH (X1)and[Ca2+]i(X2)was Y=-0.303+0.283X2+0.139X1(F=6.59,P＜0.01). Conclusions By increasing intracellular calcium,iPTH can lead to an increase of the erythrocyte PS exposure.which will cause the occurrence of erythrocytes life span being shortened.As a result,the renal anemia will become more severe.

MicroRNAs (miRNAs) act by binding to complementary sites on target messenger RNA (mRNA) to induce mRNA degradation and/or translational repression. To investigate the influence of miRNAs at transcript levels, two human miRNAs (miR-1 and miR-124) were transfected into HeLa cells and microarrays used to examine changes in the mRNA profile showed that many genes were downregulated and that the fold decreases in levels of these target mRNAs differed remarkably. Features depicting interactions between miRNAs and their respective target mRNAs, such as the number of putative binding sites, the strength of complementary matches and the degree of stabilization of the binding duplex, were extracted and analyzed. It was found that, for a given target mRNA, both the quality and quantity of miRNA binding sites significantly affected its degree of destabilization. To delineate these types of interactions, a simple statistical model was proposed, which considers the combined effects of both the quality and quantity of miRNA binding sites on the degradation levels of target mRNAs. The analysis provides insights into how any animal miRNA might interact with its target mRNA. It will help us in designing more accurate methods for predicting miRNA targets and should improve understanding of the origins of miRNAs.

Objective To investigate the distribution characteristics and drug resistance of pathogenic bacteria in ICU . Methods The bacteria identification and drug sensitive test were carried out on all pathogenic bacteria in ICU of our hospital from January 2013 to December 2013 .Results A total of 187 strains of pathogenic bacteria were separated ,among them 37 strains (19 .79% ) were Gram‐positive bacteria ,which was dominated by staphylococcus aureus ,with drug resistance rate to vancomycin , teicoplanin and linezolid of 0 .00% ;135 strains were Gram‐negative bacteria (72 .19% ) ,which was dominated by pseudomonas aeruginosa ,acinetobacter baumannii ,klebsiella pneumoniae and escherichia coli ,the drug resistant rate of acinetobacter baumannii to cefoperazone/sulbactam and minocycline was lower (43 .59% ,46 .15% ,which of pseudomonas aeruginosa to amikacin ,cefotaxime , cefoperazone/sulbactam were 27 .91% ,32 .56% and 30 .23% ,respectively ;15 strains(8 .02% ) of fungi were isolated ,which were mainly candida albicans and candida tropicalis .Conclusion Regular detection of distribution types and drug resistance change can provide the basis for climical rational use of antibacterial drugs .

Objective To study the role of lipid metabolic disorders of liver in the formation of calcium bilirubinate gallstone caused by biliary partial obstruction and infection in rabbits. Methods Forty-nine rabbits were divided randomly into 3 groups: the gallstone group A (n=15) and B (n=22), and the control group (group C, n=12). The calcium bilirubinate gallstone model was set up by using partial biliary obstruction and infection in rabbits. Following items were measured:(1)Concentration of plasma triglyceride (TG), phospholipids (PL), total cholesterol (TCh), free cholesterol (FCh), cholesterol with high desitity lipoprotein and its sub-components (HDL-Ch, HDL 2-Ch and HDL 3-Ch); (2)Concentration of bile glycocholic acid (GCA), glycodeoxycholic acid (GDCA) and FCh. Results (1) Compared with group C, the plasma PL increased sighificantly in both group A (P0.05). The plasma HDL-Ch in group B and HDL 2-Ch in group A and B were significantly lower than those in group C (P

MicroRNAs(miRNAs) act by binding to complementary sites on target messenger RNA(mRNA) to induce mRNA degradation and/or translational repression.To investigate the influence of miRNAs at transcript levels,two human miRNAs(miR-1 and miR-124) were transfected into HeLa cells and microarrays used to examine changes in the mRNA profile showed that many genes were downregulated and that the fold decreases in levels of these target mRNAs differed remarkably.Features depicting interactions between miRNAs and their respective target mRNAs,such as the number of putative binding sites,the strength of complementary matches and the degree of stabilization of the binding duplex,were extracted and analyzed.It was found that,for a given target mRNA,both the quality and quantity of miRNA binding sites significantly affected its degree of destabilization.To delineate these types of interactions,a simple statistical model was proposed,which considers the combined effects of both the quality and quantity of miRNA binding sites on the degradation levels of target mRNAs.The analysis provides insights into how any animal miRNA might interact with its target mRNA.It will help us in designing more accurate methods for predicting miRNA targets and should improve understanding of the origins of miRNAs.

Abstract: By report a case in which the main symptom was cholestasis in an infant and the diagnosis of Alagille syndrome (ALGS) was made after a tortuous treatment process, so as to provide clinicians with experience in diagnosing this type of patient. The patient was a 1-year and 11-month-old male who was admitted to the hospital with "abnormal liver function found for more than 1 year". Physical examination showed a wide forehead, sunken eye sockets, wide eye spacing, a sharp chin, and a grade II systolic murmur in the pulmonary valve region. Biochemical findings showed abnormal liver function accompanied by significant elevation of total bile acids and γ-glutamyl transpeptidase. CT scan of the thoracic vertebrae showed sagittal vertebral fractures in the thoracic 3-7 vertebrae, and pulmonary arteriography showed pulmonary stenosis and genetic testing indicated a JAG1 mutation. Combining the patient's specific facial features, heart defects, spinal deformities, and bile stasis clinical symptoms, along with the genetic analysis results, the final diagnosis was confirmed as Alagille syndrome. Alagille syndrome is the most common cause of chronic cholestasis with phenotypic features and is a dominant inherited disease involving multiple systems. Most patients present with bile stasis as the main symptom within the first three months after birth. Alagille syndrome needs to be distinguished from various forms of cholestasis in infancy, and since biliary atresia requires early surgical treatment, most children with cholestasis as the main clinical manifestation are considered to have biliary atresia at an early stage and undergo a caesarean section. If Alagille syndrome is misdiagnosed as biliary atresia, and surgery may worsen the prognosis. Therefore, the biggest challenge in the early diagnosis of Alagille syndrome is how to distinguish it from biliary atresia. Therefore, physicians need to improve their knowledge of rare cholestatic liver disease in clinical practice to accurately identify rare cholestatic liver disease in the early stages of the disease, and improve improve their diagnosis and treatment levels.

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