Objective To explore the effect and experience of problem-based (PBL) teaching in neurosurgical clinical training and improve the quality of the neurosurgical clinical training. Methods 600 clinical medical students of Grade 2011 in their probation in our department of neurosurgery were chosen as the subjects of study and were randomly divided into the experimental (PBL, 15 groups, 20 people/group, over 300 people) and control groups (CBL+ LBL, 15 groups, 20 people/group, over 300 people). In experimental group, PBL which is a problem-based, student-centered and teacher-directed pedagogy was adopted. In control group, CBL (case-based learning) + LBL (lecture-based learning) were adopted. After probation, two groups of students had the unified test and assessed their teaching methods by questionnaire survey and at the same time, the questionnaire survey about PBL' impact on the various aspects was done only to experimental group students. SPSS 15.0 software was used to do statistical analysis and data were processed by description analysis, t test, Mann-Whitney U test and correlation analysis. Results The scores of theoretical knowledge and general ability in PBL group [(40.57 ±3.24), (41.23 ±4.56) individually] were higher than these in control group [(37.21 ±4.05), (36.51±4.11) individually]. The differences demonstrated statistically meanings. Through the surveys, the students in experimental group showed the high satisfaction (97.0%, n=291) in PBL teaching. Most of the students considered that their abilities of team cooperation (96.7%, n=290), and self-directed learning (92.7%, n=278) were improved by PBL teaching. The students in experimental group illustrated their attitudes in satisfaction of teaching; interests of clinical training, participation of teaching and understanding of knowledge were superior to the control group. The differences demonstrated statisti-cally meanings. Conclusion PBL teaching got a good effect in neurosurgical clinical training. This method, which improved students' participation and motivation of study and contributed to the training of medical students' comprehensive abilities, is suitable for modern neurosurgical clinical training.

BACKGROUND:There is little attention focused on the effect of isokinetic testing about the variation of angular velocity on pain and muscle strength in the evaluation of curative effect of McConnel taping. OBJECTIVE: To evaluate the changes of quadriceps muscle strength and perceived pain levels in patients with patelofemoral pain syndrome before and after corrective McConnel taping in isokinetic testing. METHODS:A total of 34 patients with patelofemoral pain syndrome were evaluated in isokinetic testing for concentric contraction muscular strength, including the maximum torque, the total work, and the average work in 60 (°)/s and 180 (°)/s angular velocity, before and after the interventions of McConnel taping. The visual analogue scale scores were recorded. RESULTS AND CONCLUSION: The visual analogue scale scores were slightly decreased in angular velocity of 60 (°)/s after obturation when compared to before obturation (P > 0.05), while the scores were significantly decreased in angular velocity of 180 (°)/s (P < 0.05). The maximum torque, the total work, and the average work were slightly increased after obturation, but showed no significant difference in angular velocity of 60 (°)/s (P > 0.05), while significantly increased in 180 (°)/s angular velocity (P < 0.05). McConnel taping significantly improves the curative effect in patients with patelofemoral pain syndrome under low load joint movement.

AIM:To investigate the effects of curcumin on the abilities of migration and invasion in the lung cancer PC-9 cells, and to observe the relationship between curcumin and nectin-4 expression.METHODS:The viability, migration and invasion of lung cancer PC-9 cells treated with curcumin or transfected with siNectin-4 were measured by MTT assay, wound healing test and Transwell assay , respectively.The protein levels of nectin-4, p-AKT and AKT in the PC-9 cells treated with curcumin or transfected with siNectin-4 were detected by Western blot .RESULTS:Curcumin in-hibited the viability of PC-9 cells.The wound healing rates and the numbers of the transmembrane cells in curcumin 10μmol/L and 20 μmol/L groups were decreased compared with control group without curcumin treatment .The expression level of nectin-4 was reduced after curcumin treatment for 24 h.The viability of the PC-9 cells was significantly inhibited after transfected with siNectin-4 for 48 h or 72 h (P<0.01), and the wound healing rates was decreased in siNectin-4 group compared with NC group (P<0.01).The numbers of the transmembrane cells in siNectin-4 group was significantly reduced (P<0.01).Curcumin and knockdown of nectin-4 suppressed the activation of AKT pathway in PC-9 cells.In si-Nectin-4+curcumin group , the cell viability reduced compared with curcumin group , and wound healing rates , cell inva-sive ability and AKT phosphorylation levels were decreased .CONCLUSION:Curcumin inhibits migration and invasion of the lung cancer PC-9 cells via down-regulation of nectin-4 expression and inhibition of AKT pathway .

AIM:To explore the molecular mechanism through which curcumin reverses hepatocyte growth factor (HGF)-induced resistance to gefitinib in lung cancer cells.METHODS:The methods of MTT assay, wound healing assay and Western blot were used to observe the effects of HGF, curcumin and gefitinib on the migration, drug susceptibility, epithelial-mesenchymal transition, and related signaling pathways in the PC9 lung cancer cells.RESULTS:HGF reduced susceptibility of the PC9 cells to gefitinib, and curcumin significantly reversed HGF-induced resistance to gefitinib.HGF induced migration and epihelial-mesenchymal transition, and promoted c-Met/AKT/mTOR pathway activation in the PC9 cells.Gefitinib alone did not prevent the above activities.However, combined with curcumin, gefitinib prevented the above activities.CONCLUSION:Curcumin reverses HGF-induced resistance of the PC9 cells to gefitinib by preventing epithelial-mesenchymal transition and inhibiting c-Met/AKT/mTOR activation.

Objective To investigate the clinical characteristics,minimal invasive operation technique and perioperative management of lateral ventrieular tumors.Methods The clinical characteristics,image diagnosis,surgical approaches and postoperative management and surgical outcomes of 65 consecutive cases of lateral ventricular tumors were retrospectively analyzed.Results In our series,total resection was achieved in 54 cases,and subtotal resection was achieved in 11 cases.Lateral ventricular tumors were mostly found in male and in the left side.Headache caused by increased intracranial pressure was the most common clinical symptom.Ependymocytoma and astrocytic glioma are the most common pathologic diagnosis.Postoperative complications included fever (26 cases),hydrocephalus (9 cases),intraventricular hematoma (7 cases) of which 2 cases were evacuated by craniotomy,epilepsy (7 cases),wound infection (3 cases).Postoperative death was happened in 3 cases.Two of them died of respiratory failure due to postoperative epilepsy.Conclusion Early discovery of lateral ventricle tumors,meticulous operation,subtle micromanipulation and right postoperative treatment are the criticality to improve the rate of total resection of lateral ventricle tumors through microsurgical treatment and reduce postoperative complications and mortality.

This research explored the synergistic effects and the potential mechanisms of RCE-4 and various nonsteroidal anti-inflammatory drugs (NSAIDs) on the proliferation of cervical cancer Ca Ski cells. The MTT assay and CalcuSyn V2.0 software were used to detect cell proliferation and calculate the combination index (CI); the expression levels of various proteins were analyzed using Western blot assay; mitochondrial membrane potential (MMP) was assessed using JC-1 staining; acridine orange/ethidium bromide (AO/EB) double-fluorescence staining was used to detect the apoptosis of Ca Ski cells; a co-immunoprecipitation (Co-IP) assay was used to analyze the relative content of Bcl-2-Beclin 1 complex in Ca Ski cells. The results demonstrate that the combination of RCE-4 and NSAIDs increases the inhibition of Ca Ski cells compared to the single-RCE-4 group, and celecoxib provided the best synergistic effect among the four NSAIDs tested, with a CI of 0.32. The combination of RCE-4 and celecoxib significantly down-regulated the expression of cyclooxygenase-2 (COX-2) and nuclear transcription factor-κB (NF-κB), and promoted the expression of non-steroidal anti-inflammatory drugs activity gene-1 (NAG-1). In addition, autophagy induced by RCE-4 was markedly inhibited in combination with celecoxib, which was associated with down-regulation of the expression of microtubule-associated protein 3 (LC3)-II, Beclin 1, p62 and autophagy-related gene (ATG) 3/4B/5/7/14. RCE-4-induced apoptosis was significantly enhanced by altering the depolarization of mitochondrial membrane potential and the expression of B cell lymphoma-2 (Bcl-2), B cell lymphoma-xl (Bcl-xl), Bcl-2 associated X protein (Bax), Bcl-2/Bcl-xl-associated death promoter (Bad) and cleaved cysteinyl aspartate specific proteinase (cleaved-caspase) 3/7/9. Furthermore, the formation of the Bcl-2-Beclin 1 complex was significantly inhibited in Ca Ski cells treated with RCE-4 in combination with celecoxib. Taken together, this research shows that the combination of RCE-4 and celecoxib has a significant synergistic effect on the proliferation of Ca Ski cells by promoting apoptosis, inhibiting autophagy and disturbing the formation of the Bcl-2-Beclin 1 complex, which may be a novel strategy to increase the sensitivity of anti-cervical cancer drugs.

Objective: To analyze the mortality trend of bladder cancer among residents in Qidong, Jiangsu Province from 1972 to 2016, so as to provide the basis for the prevention and treatment strategy of bladder cancer in Qidong. Methods: The data of bladder cancer was collected from Qidong Cancer Registry.The crude mortality rate ( CR ), age-standardized rate by Chinese population in 2000 (CASR) and world population in 1960 ( WASR ), truncated rate (35-64 years) and cumulative rate ( 0-74 years ) were calculated. The annual percent change ( APC ) was used to analyze the trend of mortality in bladder cancer. Results: During from 1972 to 2016, There were 1 497 deaths due to bladder cancer in Qidong from 1972 to 2016. The CR, CASR and WASR were 2.96/105, 1.83/105 and 1.80/105, respectively. The APCs in CR, CASR, WASR of bladder cancer were 5.29%, 1.86% and 1.81%, respectively ( P<0.05 ), showing upward trends. The truncated rate, cumulative rate and cumulative risk were 1.47/105, 0.17% and 0.17%, respectively. The CR, CASR and WASR in males were 4.71/105, 2.97/105 and 3.31/105, respectively, which was higher than that of 1.26/105, 0.75/105, and 0.66/105 in females ( P<0.05 ). The APC of CR, CASR and WASR in males were 5.71%, 1.96% and 2.17%, respectively ( P<0.05 ), all showed upward trends. For females, the APC of CR was 4.47% ( P<0.05 ), showing an upward trend, but there was no significant change in CASR and WASR ( P>0.05 ). The CR of bladder cancer was high among people aged more than 55 years. The CR in 55-64-year-old group, 65-74-year-old group and more than 75-year-old group showed upward trends, with APC of 4.50%, 2.22% and 4.51%, respectively ( P<0.05 ). Conclusions From 1972 to 2016, the mortality of bladder cancer in Qidong showed an upward trend, which was relatively high in men and people aged over 55 years.

Objective To study the medical image three dimensional visualization system(MI-3DVS)in the diagnosis and treatment of hepatolithiasis.Methods The data of 64-slice spiral computed tomography of 54 patients with hepatolithiasis who were admitted to the Zhujiang Hospital of the Southern Medical University from August 2008 to August 2010 were collected.The liver and bile duct were three dimensionally(3D)constructed.Preoperative diagnosis and pathological classification were made according to the results of the 3D model of liver and bile duct.The optimal surgical procedure was determined by simulating operations based on the 3D model.The compliance of simulated operation and actual operation was observed,and residual stones were detected by cholangiography.Results Of the 54 patients,11 were with type Ⅰ,5 with type Ⅱ(including 2 patients with type Ⅱ a and 3 with Ⅱ b),38 with type E.There were 23 patients with intrahepatic bile duct stricture and 27 with atrophy-hypertrophy syndrome complex.The anatomy of intra-and extrahepatic bile duct,dilation and stricture of the bile duct,site,size and number of the bile duct stones were clearly displayed in the MI-3DVS.The compliance rate of simulated surgery and actual surgery was 94%(51/54).There was no residual stones in 51 patients who received elective surgery and the rate of residual stone of the 54 patients was 6%(3/54).Conclusion Acurate preoperative diagnosis and intraoperative precise operation can be achieved and the rate of residual stone can be reduced by using the MI-3DVS.

Objective To study the characteristics and clinical features of positive response during head - up tilt test (HUT) in children. Methods Forty- nine cases of syncope and aura of syncope were included in the study. All of them underwent HUT (tilt angle 60 degree,lasting 45 minutes). During the test,children' blood pressure,heart rate.electrocardiography and clinical symptoms and signs were dynamically observed. Results The common syncope aura symptoms were headache, dizziness, chest distress, difficulties in breathing, pale, perspiration, blurred vision, auditus depression and symptoms related to digestive symptoms. Among the 28 positive cases, 7 cases were of vaso - inhibitory pattern (25%), with a decrease in blood pressure and an increase in heart rate, 3 cases inhibitory pattern (11%), with a decrease in heart rate but withoilt'blood pressure changes, 4 cases mixed pattern (14 %), with decreases in heart rate and blood pressure obviously, 10 eases POTS (36%), with an increase in heart rate by 30 bpm or up to 120 bpm within 10 minutes while testing, and 4 cases orthostatic hypotension (14%), with a decrease in blood pressure within 3 minutes. Conclusion HUT can be regarded as the main tool in differential diagnosis of unexplained syncope in children.

Objective To assess the clinical value of 16-slice spiral CT in the diagnosis of multiple carcinomas in unilateral upper urinary system. Methods The imaging findings of 16-slice spiral CT of 10 patients suffered from multiple carcinomas in the unilateral upper urinary system proven pathologically were analyzed. Results Among 10 cases, 6 cases had multiple carcinomas in the unilateral renal pelvis and ureter and simultaneously involved urinary bladder, 3 cases had the multiple carcinomas in the unilateral renal pelvis and ureter, and 1 case had the multiple carcinomas in the lower and middle ureter and involved urinary bladder. CT images clearly presented the thickened irregular renipelvic and ureteric wall with stenosis and/or mass in the renipelvic and ureteric cavity. The urinary bladders involved by carcinoma were depicted as thickened irregular wall of urinary bladder or the mass in the wall of urinary bladder. The images of curved reconstruction clearly showed the extention of the multiple carcinomas and the changes of the urinary tract involved by the multiple carcinomas. Enlarged retroabdominal lymph nodes were detected in 3 cases simultaneously, and 2 of them were proved metastasis, the imaging findings were absolutely identical to that of the operation and pathological examination. Conclusion Sixteen slice spiral CT can clearly and accurately depict the location and extention of multiple carcinomas in the unilateral upper urinary system.