Problem-based and student-centered learning patten brings new challenges to the both sides of teaching and learning.Clinical probation is the first step of medical students.The problem-based learning patten is used to clinical probation and achieves good results.It helps to improve medical students' quality and should be applied in China medical education.

To study the relationship between asthma and bronchial hyper responsiveness(BHR).The reactivity of bronchi to inhalation of methacholine, the plasma levels of substance P(SP),soluble P selection (sP selectin),vasoactive intestinal peptide(VIP), and fibronectin(Fn) were assessed in 68 cases of asthma, 62 patients with cough variant asthma(CAV), and 43 healthy subjects.It was showed that the tests of airway reactivity were all positive in 68 cases of asthma and 62 cases of CVA.Dmin in asthma and CVA was(8 81?9 67)u and(5 97?4 37)u,respectively,in these two groups of patients. Dmin in asthma patients was higher than in CAV patients ( P

Objective To evaluate the changes of respiratory mechanics and central drive in sleeping patients with chronic obstructive pulmonary disease (COPD).Methods A total of 14 patients with moderate to severe COPD (age 63.7± 6.4 years) and 10 healthy volunteers,admitted to our hospital from October 2010 to October 2011,were chosen in our study.After performing routine pulmonary function test,all subjects were monitored by respiratory mechanics,diaphragm electromyogram (EMGdi) and polysomnography (PSG) in waking and sleeping state.The different physiological parameters were recorded and calculated on a continuous basis in time sequence for 30 minutes.Results In sleeping state as compared with waking state,there were no differences(P＞0.05) in respiratory rate(RR) and the ratio of inspiratory time to duration of one breath (Ti/Ttot),but there were reductions (P ＜ 0.05) in the tidal volume (VT),minute ventilation (VE),mean inspiratory volume per second(VT/Ti),dynamic lung compliance(CLdyn),root mean square (RMS)and pulse oxygen saturation(SpO2).Meanwhile there were significant increases (P＜0.05) in airway resistance(Raw) and pressure-time product(PTP) in COPD group.In normal group,there were no differences (P＞0.05) in all above physiological parameters in sleeping state compared with waking state.Conclusions There are abnormal changes in respiratory mechanics characterized by increased airway resistance and work of breathing,meanwhile in reduced central drive and requirement of ventilation,which may be the main reasons for hypopnea and hypoxemia in sleeping COPD patients.

Objective To establish a dot blot hybridization technique for rapid detection of staphylococci and methicillin-resistant staphylococci.Methods Three pairs of primers were designed according to nuc gene of staphylococcus aureus,mecA gene of methicillin-resistance,tuf gene of staphylococci.Specific DNA probes were synthesized by polymerase chain reaction and labeled with biotin.The bacterial DNA inoculated on nitrocellulose filter was hybridized with these probes.The sensitivity and specificity were detected.Results The DNA probes with 270bp,310bp and 370bp were amplified by the three pairs of primers respectively.The probes were specific.Among 50 clinical isolates of staphylococcus aureus tuf and nuc gene were all positive and mecA gene in 22 isolates were positive.Positive rate of tuf,nuc and mecA gene in 30 staphylococcus epidermidis were 100%,0 and 30% (9/30) respectively.No hybridization in other non-staphylococci occurred.The established method could detect as low as 1ng of bacterial DNA.Conclusion The dot blot hybridization is of high value in rapid,effective identification of methicillin-resistant staphylococci.

Objective To explore the effects and mechanism of cigarette smoke extract (CSE) on the proliferation of air?way smooth muscle cells (ASMCs) and the expression of CCAAT/enhancer-binding protein (CEBPα) and calreticulin. Meth?ods (1) The ASMCs were stimulated with different concentrations of CSE for twenty-four hours. According to the concentra?tions of CSE,the cells were divided into control group, 2.5%CSE group, 5%CSE group and 10%CSE group. The prolifera?tion of ASMCs was measured by MTT colrimetric method. The CEBPαmRNA was analyzed by RT-PCR. Western bloting as?say was performed to detect the levels of CRT and CEBPαprotein. (2) In 10%CSE group, transfection of the siRNA respec?tively for negative control or calreticulin was performed in accordance with instructions. The cell proliferation and the expres?sion of calreticulin and CEBPαwere compared in negative control siRNA group and calreticulin siRNA group. Results (1) With the increasing of the concentrations of CSE, the protein expression of CEBPαdecreased gradually (P<0.05), while the proliferation of ASMCs and the protein expression of calreticulin increased (P<0.05), but the expression of CEBPαmRNA in ASMCs showed no significant difference in groups with different concentrations of CSE (P>0.05). (2) Under the 10%CSE, the expression of CEBPαwas significantly higher in CRT siRNA group than that in negative control group (P<0.05),but the cell proliferation and CRT were significantly lower in the calreticulin siRNA group than those in negative control siRNA group (P<0.05). Conclusion The CSE exposure contributes to the expression of calreticulin protein,and then inhibits the translation of CEBPαmRNA,thus promotes the proliferation of ASMCs.

Objective To understand the coronary characteristic of acute coronary syndrome patients with ischemic J wave. Methods Comparison was made between 60 acute coronary syndrome patients with ischemic J wave and 60 acute coronary syndrome patients without ischemic J wave. All patients were examined by Holter monitoring electrocardiogram and coronary arteriongraphy. To distinguish the stenosis degree was defined in three degree based on Genisini score of 0, 1-80, and 81-160. Plaque types were divided into Ⅰ,Ⅱ, Ⅲ by Ambrose classification,the coronary and plaque characteristics of acute coronary patients were observed with ischemic J wave. Results There were no significant difference of stenosis degree between the two groups ( U = 3. 0686, P = 0. 0022), whereas there were significant difference of plaque types (x2 =16. 0890, P = 0. 0003) and coronary vessel numbers(x2 =12. 1045, P = 0. 0024). The degree of stenosis, the plaque types, and number of stent in coronary vessel were positively correlated with ischemic J wave(r =0. 44,0. 34,0. 31 ;P <0. 05). Conclusions The acute coronary syndrome with ischemic J wave patients is often not only accompanied with serious coronary stenosis and high incidence rate of multivessel disease,but also high probability of unstabilized plaque. Ischemic J wave can be a predictor of super-acute ischemic of myocardium.

Objective To analyze the related factors of obstructive sleep apnea syndrome (OSAS) in type 2 diabetes mellitus (T2DM) patients. Methods 289 participants were enrolled and 254 people finished the whole process. Portable sleep monitor was used to detect the breath situation during sleep , and related factors were also analyzed. Finally , 183 subjects were diagnosed as OSAS and 71 subjects were not. Results 254 T2DM subjects were enrolled, with 108 males (59%) and 183 participants were diagnosed as OSAS (72%). OSAS group had a higher diabetic duration,body mass index, 2 h plasma glucose,fasting insulin, C peptide level, systolic blood pressure, triglyceride, low density lipoprotein cholesterol, and homocysteine levels(P<0.01). The prevalences of dyslipidemia , hyperuricemia , high blood pressure , non-alcoholic fatty liver disease and metabolic syndromein OSAS group were also higher than that in compared groups. Logistic regression analysis showed that body mass index, dyslipidemia and high homocysteine level were independent risk factors of OSAS. Conclusions The prevalence of OSAS in T2DM was higher. Blood glucose level , body mass index and multiple metabolic parameters in OSAS patients elevated significantly. Obesity and insulin resistance were major factors during the process of the disease.

Objective To analyze the correlation between emphysema extent measured by high resolution computed tomography (HRCT) and pulmonary function tests, symptom score in patients with chronic obstructive pulmonary disease ( COPD ) , and to study the value of HRCT in the emphysema quantification in the clinical evaluation of COPD patients. Methods 78 patients with stable COPD were recruited to take the HRCT scan , and emphysema extent was qualified by measuring the proportion of low attenuation area in the whole lung (LAA%). Correlations between LAA% and indices of pulmonary function test, bronchial dilation test, mMRC scale, CAT score and six minutes walking distance (6MWD) were assessed. Results LAA% was negatively correlated with FEV1/FVC and DLCO%pred, and the correlation coefficients were -0.759 and -0.589 (P <0.01), respectively. LAA% was positively related to mMRC score (r = 0.342, P < 0.01), and negatively asso-ciated with 6MWD (r = -0.365,P< 0.01). There was no association between LAA% and indices of bronchodila-tion test (⊿FVC, ⊿FVC%, ⊿FEV1, ⊿FEV1%) (P > 0.05). Conclusions The severity of emphysema measured by HRCT is well correlated with the clinical symptoms , pulmonary function tests and exercise capacity in COPD patients. It can be used to diagnose emphysema early and to evaluate the severity of the disease com-prehensively. Thus, the risk factors of COPD can be controlled and the prognosis of the patients can be im-proved.

Objective:To examine the changes of mimecan protein expression in development of atherosclerosis induced by sinoaortic denervation,and to explore the effects of mimecan knock down on the proliferation and migration of vascular smooth muscle cells.Methods:The animals were randomly divided into a sham group and a model group (n=8 in each group).The rat model of blood pressure variability was established by sinoaortic denervation,and the hemodynamic indexes were recorded 20 weeks after the surgery to confirm the success of the model.The thoracic aorta was excised and stained with immunohistochemistry to observe the pathological changes of smooth muscle tissues and the changes of mimecan expression.The mice vascular smooth muscle cells were isolated,and which were treated with mimecan siRNA to knock down the mimecan expression,The cell proliferation was observed by 5-ethynyl-2'-deoxyuridine (Edu) in corporation test and the changes of cell migration was observed by wound healing test.Results:Twenty weeks after sinoaortic denervation,the blood pressure variability in the model group was significantly increased compared with that in the sham group,suggesting the model was successfully established.In addition,the increased blood pressure variability in the model group promoted the proliferation and migration of the vascular smooth muscle cells in thoracic aorta,while the expression of mimecan protein was significantly decreased.In in vitro assays,the knock down of mimecan in mice vascular smooth muscle cells could promote the cell proliferation and migration.Conclusion:Mimecan plays a protective role in the development of sinoaortic denervation induced atherosclerosis through amechanism involving suppression of the proliferation and migration of vascular smooth muscle cells.

Objective:To investigate the central mechanism of moxibustion in treating chronic inflammatory visceral pain(CIVP)and its analgesic effect from the perspective of the p38 mitogen-activated protein kinase(MAPK)/Ets-like transcription factor 1(ELK1)signaling pathway in the spinal cord. Methods:Clean-grade male Sprague-Dawley rats were randomly divided into a normal group,a model group,a herb-partitioned moxibustion(HPM)group,a sham-HPM group,a p38 MAPK inhibitor group,and a dimethyl sulfoxide(DMSO)group.CIVP rat models were prepared using an enema mixture of 2,4,6-trinitrobenzene sulfonic acid solution and 50%ethanol.The HPM group was treated with HPM;the sham-HPM group was treated the same as the HPM group,but the moxa cones were not ignited;rats in the p38 MAPK inhibitor group received L5-L6 intrathecal injection of p38 MAPK inhibitor(SB203580);rats in the DMSO group received L5-L6 intrathecal injection of 2%DMSO.Abdominal withdrawal reflex(AWR),mechanical withdrawal threshold(MWT),and thermal withdrawal latency(TWL)were used to observe pain-related behaviors in each group.Hematoxylin-eosin staining was used to observe the morphological changes in rat colon tissue.Western blotting and real-time quantitative reverse-transcription polymerase chain reaction were used to detect the phosphorylated protein and mRNA expression of apoptosis signal-regulating kinase 1(ASK1),MAPK kinase(MKK)3/6,p38 MAPK,ELK1,and mitogen and stress-activated protein kinase 1(MSK1)in the spinal cord. Results:Compared with the normal group,CIVP rats had severe colonic inflammatory injuries,and the pathological injury scores increased significantly,along with increased AWR scores under different colorectal distension(CRD)stimulation pressures and decreased MWT and TWL;the mRNA and phosphorylated protein expression of p38 MAPK,ELK1,MSK1,ASK1,MKK3,and MKK6 all increased in the spinal cord(P<0.01).After HPM treatment,the colon injuries were repaired,and the pathological injury scores decreased;under different CRD stimulation pressures,the AWR scores decreased,and the MWT and TWL increased;the mRNA and phosphorylated protein expression of p38 MAPK,ELK1,ASK1,and MKK3 in the spinal cord also decreased,with statistically significant differences compared with the model group and the sham-HPM group(P<0.01).There were no significant differences in the above indicators between the HPM group and the p38 MAPK inhibitor group(P>0.05),and the same was true regarding the comparisons between the model group and the DMSO group. Conclusion:HPM exerted analgesic effects via downregulating the mRNA and phosphorylated protein expression of ASK1,MKK3,p38 MAPK,and ELK1 in the spinal cord of CIVP rats.The inhibition of spinal p38 MAPK/ELK1 signaling pathway activation may be one of the mechanisms by which HPM relieves pain in CIVP.