Through the questionnaire survey we try to know about the students evaluation of the effectiveness of PBL teaching model.PBL can make students explore and use theoretical knowledge,and improve their ability to analyze and solve problems,but the disadvantages should still be improved.

BACKGROUND: Teeth are often cut by high-speed turbine engine which drill and friction also will irritate the dental nucleus and periapex directly and cause pain. Eutectic mixture of local anesthetics (EMLA) was reported in dental caries treatment for pain released.OBJECTIVE: To observe the analgesia effect and influence on electra vital force of EMLA when used for dental caries preparation. DESIGN: Self matched-pairs control randomly observation.SETTING: Department of Dentistry, the Stomatological College, the Fourth Military Medical University of Chinese PLA. PARTICIPANTS: Fifty patients including 28 males and 22 females were selected from the Department of Dentistry, the Stomatological College, the Fourth Military Medical University of Chinese PLA from January 2000 to January 2001. Their ages ranged from 18 to 55 years, and the mean age was 36 years. Inclusion criteria: ① Patients whose suffered from teeth only had a superficial hole and needed to be filled. The patients should have 2 teeth that need therapy at the same time and the 2 teeth should in different quadrant regions of the mouth; ② Patients without allergy history of local anesthetics; ③ Patients had signed in the informed consent; patients without cardiovascular diseases or dental ulcer. The experiment was in accordance with the ethics standards, and all patients provided the informed consent.METHODS: ① Grouping and intervention: Assigned to groups with self matched-pairs control method randomly by the side of coin to decide the experiment and teeth; the teeth for experiment were smeared with 2 g of EMLA (Astra AB, Sweden) on the surface of tooth and the bilateral periodontal mucous membrane with cotton bud, after 5 minutes smearing to treat the teeth. The control teeth were not smeared the EMLA to treat. ② Visual analogue scales (VAS) scores and electra vital force: The electra vital force (SYBLONENDO USA) of teeth was measured after 5 minutes, and the VAS score was recorded to evaluate the pain of teeth when incised and ground and compare it with that of control group.MAIN OUTCOME MEASURES: VAS scores and electra vital force.RESULTS: Fifty patients were included in the final analysis. ① VAS scores: The average VAS scores of teeth during treatment after smeared with ELMA were 2.54±0.84. While that of teeth not smeared with EMLA was 7.42±0.51 (P < 0.01). ② Electra vital force: The average value of electra vital force before smeared with EMLA was 45.76±1.56 while that after smeared with EMLA was 64.34±2.28 (P < 0.01).CONCLUSION:EMLA can improve the electra vital force of teeth and has analgesia effect during the dental caries treatment.

Thyroid nodules are very common.Its etiological factors include hyperplasia,adenomas,cancer,cysts,and thyroiditis.Most of thyroid nodules are benign.The management of thyroid nodules whether thyroidectomy or observation is according to their nature.So,the key of the therapy is to identify that they are benign or malignant.We should comprehensive evaluate patients' history,physical examination,laboratory examination,and auxiliary examination for judging the nature of thyroid nodules and making decision in the choose of thyroidectomy or observation.

Aim To investigate the difference in pharmacokinetics between gatifloxacin mesylate(GATM) and gatifloxacin(GAT) in SD rats in vivo.Method The plasma concentration-time courses of GAT in rats were measured by HPLC method after a single oral dose of GATM and GAT,and the pharmacokinetic parameters were estimated by program 3p97 software.Results The results shown that both of GATM and GAT plasma concentration-time courses were best fitted to two-compartment models after a single oral dose(GATM 23.43 mg?kg~(-1)and GAT 20 mg?kg~(-1),respectively).The major average pharmacokinetic parameters of GATM were as follwing: T_(2)?: 9.13 h,AUC: 15.05 mg?L~(-1)?h,C_(max): 4.41 mg?L~(-1),and T_(max): 0.5 h,respectively.On the other hand,the pharmacokinetic parameters of GAT were as follwing: T_(2)?:10.70 h,AUC:13.84 mg?L~(-1)?h,C_(max):4.25 mg?L~(-1),T_(max):0.5 h,respectively.Conclusion Under the equi-mole dose condition treated as above,both of pharmacokinetic characters between GATM and GAT were not significantly differences in rats

Objective To evaluate application of antihypertensive drugs.Methods We counted up and analyzed the sum of money,using frequency,quantity and dayly therapeutic fees of the antihypertensive drugs by methods of money ranker and DDDs analysis.Results The most often used antihypertensive drugs were the three as follows:calcium channel blocker,?-receptor blocker and angiotensinⅡ receptor antagonist.We earned more money for the three antihypertensive drugs:calcium channel blocker,angiotensinⅡ receptor antagonist and angiotensin converting enzyme inhibitor.Conclusions The using of antihypertensive drugs is rational.And also we should avoid adverse reaction caused by these drugs compatibility use and ensure medicative safety.

Proton pump inhibitors as a kind of acid drug are widely used in clinical.However,it is overused all over the world although generally safe and effective.Studies have shown the uncertainty of potential long-term adverse effects,especially the contact with the mechanism of gastric cancer.Clinicians should pay more attention to the potential carcinogenic risk of long-term proton pump inhibitors in treatment.The mechanism of pathophysiology and the clinical researches of proton pump inhibitor-induced gastric neuroendocrine tumors,gastric carcinoma,and gastric cardia cancers are summarized as follows.

Objective To investigate the effect of endoscopic sphincterotomy(EST) combined with endoscopic papillary large balloon dilation(EPLBD) in the treatment of common bile duct stones. Methods A total of 128 patients treated with EST combined with EPLBD for common bile duct stones were divided into 0 min group, 1 min group, 3 min group and 5 min group, according to the different balloon expansion times. The balloon was extended to the required diameter and was maintained to the corresponding time, and then decreased the pressure to remove the balloon. Patients were given routine monitoring and treatment after operation. All patients were observed more than 48 h to determine whether there were early complications such as pancreatitis and bleeding. The effectiveness of EPLBD was evaluated by the stone diameter, expansion balloon diameter, ERCP operation time and use of stone breaker. The safety was evaluated by the occurrence of complications including postoperative pancreatitis, bleeding and perforation. Results All patients were successfully removed stones. There were no significant differences in the maximum diameter of stone, the diameter of bile duct dilatation and the diameter of balloon dilatation between groups. No bleeding, perforation, biliary tract infection and acute pancreatitis were found in patients. There were no significant differences in the utilization rates of stone breaker between groups. ERCP operation times showed a trend of decreased first and then increased in 0, 1 and 3 min groups (P<0.05). There was no significant difference in ERCP operation time between 3 min group and 0 min group. There were no significant differences in incidence rates of high amylase between groups. Conclusion EST combined with EPLBD is a safe and effective treatment for early stage of larger common bile duct stones, of which 1 minute group shows better effect.

OBJECTIVE:To investigate the postoperative analgesic effect of Dexmedetomidine combined with Remifentanil on patients in lung cancer resection and its effect on immune function. METHODS:60 lung cancer patients in lung cancer resection were randomly divided into control group(30 cases)and observation group(30 cases). All patients with endotracheal intubation re-ceived lung cancer resection under general anesthesia. After surgery,control group received Remifentanil hydrochloride 10μg/(kg·d)+Ondansetron hydrochloride injection 16 mg,adding into 0.9% Sodium chloride injection co-formulated into 100 ml;observation group received Dexmedetomidine hydrochloride injection 0.75 μg/(kg·d)+Remifentanil hydrochloride 10 μg/(kg·d)+Ondansetron hydrochloride injection 16 mg,adding into 0.9% Sodium chloride injection co-formulated into 100 ml. Background doses in 2 groups were 2 ml/h,self-controlled amount was 2 ml,lockout time was 15 min. Visual analog pain score (VAS),IFN-γ,IL-10 level,T cell subsets(CD3+,CD4+,CD8+,CD4+/CD8+)after 6,12,24,48 h and the incidence of adverse reactions in 2 groups were observed. RESULTS:VAS scores after 6,12,24,48 h in observation group were significantly lower than control group,and VAS scores after 24,48 h in 2 groups were significantly lower than that after 6 h,with statistical significance(P<0.05). IFN-γ levels after 6,12,24,48 h in observation group were significantly lower than control group,and IFN-γ levels after 12,24,48 h in 2 groups were significantly lower than that after 6 h,IL-10 level after 12,24,48 h in observation group were significantly higher than that 6 h and control group,with statistical significance(P<0.05). CD3+after 6,24,48 h,CD4+after 6,12,48 h,CD4+/CD8+af-ter 12,24,48 h in observation group were significantly higher than control group,CD8+ after 12,24 h were significantly lower than control group,CD3+,CD4+ after 12,24,48 h in 2 groups,CD4+/CD8+ in control group,and CD8+ after 12,24 h in observa-tion group and after 24 h in control group were significantly lower than that after 6 h,with statistical significance(P<0.05). There was no significant difference in the incidence of adverse reactions in 2 groups(P>0.05). CONCLUSIONS:The postoperative anal-gesic effect of Dexmedetomidine combined with Remifentanil on patients in lung cancer resection is superior to Remifentanil alone, it can improve the immune function,with good safety.

BACKGROUND:Studies suggested that blood loss was great during total knee arthroplasty, even blood transfusion was needed. Application of the tourniquet wil destroy the coagulation system, and is not conducive to hemostasis after replacement. Recently, tranexamic acid has been extensively used to reduce blood loss during total knee arthroplasty, because of low price, simple administration pathway, and effective effects on hemostasis. OBJECTIVE:To summarize the application and safety of tranexamic acid in total knee arthroplasty. METHODS:The first author retrieved PubMed and Chinese Journal Ful Text Database for articles from inception to October 2015. The key words were tranexamic acid, total knee arthroplasty, hemorrhage. More than 200 articles were retrieved, and finaly 50 articles met the inclusion criteria. RESULTS AND CONCLUSION:Tranexamic acid is a fibrinolytic inhibitor, can reversibly block the binding of plasminogen to fibrin, effectively inhibit fibrinolysis, and reduce hemorrhage after total knee arthroplasty. Nevertheless, there were significant differences in the use, dose and effect of tranexamic acid on hemostasis among different studies. Tranexamic acid was an effective drug for hemostasis during total knee arthroplasty. During total knee arthroplasty, tranexamic acid had been used to reduce dominant blood loss and hidden blood loss after arthroplasty, and could not increase the risk for venous thrombosis of lower limb. Currently, the timing of use, dosage, route of administration, and possible complications of tranexamic acid remain controversial.

Objective To study the diagnosis and treatment for the syndrome of inappropriate antidiuretic hormone secretion in neurosurgery.Methods Retrospective analyze clinical situation, treatment, and process of final diagnosis in 6 SIADH cases.Result Diagnosis of SIADH and differential diagnosis with CSWS is very difficult.In clinic the experimental therapy of restricting water and natrium is a important method of differential diagnosis,but also a effective therapy.Conclusion Speciality of SIADH is (1)hyponatremia(Na +≤128 mmol/L),natriuresis(Na +≥80 mmol/24h),(2)ADH assay is no significant for SIADH and CSWS,(3)no hypervolemia and edema exhibition,(4)restrict water is effective in treatment.