There are some characteristics in the teaching of amateurish adult medical students.As a bridge connecting basic medicine and clinical medicine,pathophysiology is very important in medical education.Aiming at the specialties of amateurish adult medical students,it has very realistic significance for us to explore and reform the teaching methods of pathophysiology,in order to improve the teaching quality and effect.

Objective To compare the gemcitabine (GEM) plus S-1 and gemcitabine alone in the treatment of advanced pancreatic cancer (PC) by meta-analysis.Methods Articles were searched in PubMed,Cochrane library,Embase,CNKI,and CBM up to August 1st,2013.Only randomized controlled trails (RCTs) for GEM + S-1 and GEM alone in advanced PC were included.Two reviewers retrieved and collected data respectively.Data were selected basing on inclusion and exclusion criteria.The meta-analysis was base on survival advantage (include overall survival and progress free survival),object response rate,disease control rate and adverse reaction.Results A total of 3 trials with 772 cases were included.Meta-analysis demonstrated that GEM plus S-1 significantly improved the progress free survival (HR:0.64,95％CI:0.54-0.75,P ＜ 0.000 01) and overall survival (HR:0.81,95％CI:0.68-0.96,P =0.01),improved object response rate (RD:0.16,95％ CI:0.10-0.21,P ＜ 0.000 01) and disease control rate (RD:0.10,95％ CI:0.03-0.17,P =0.009) also.However,the incidence of WHO 3/4 grade adverse reaction was increased significantly in the GEM + S-1 group.Neutropenia,thrombocytopenia,and gastrointestinal reaction were increased by 18％ (P =0.02),18％ (P =0.008) and 8％ (P ＜ 0.000 01)respectively.Conclusion GEM combined with S-1 can improve the chemotherapy effect compared with GEM alone.The adverse reactions also increase significantly,but the overall survival is benefit.

Objective: To study the clinical value of home monitoring system of pacemaker and implantable cardioverter-deifbrillators (ICD) in relevant patients.
Methods: A total of 33 patients with home monitoring system of pacemaker implantation or ICD treated in our hospital from 2011-02 to 2014-07 were retrospectively recruited. There were 28 patients with dual chamber pacemaker, 4 with ICD and 1 with cardiac resynchronization therapy pacemaker (CRTP). The patients included 23 male and 10 female at the age of (68.4 ± 9.2) years. The rate of successful data transmission, threshold changes and arrhythmia occurrence were analyzed.
Results: Up to 2014-10, a total 24516 messages were successfully transmitted with the success rate of 97.4%, the rate of no-message transmission was 2.6%. The home monitoring system fund 89 abnormal events including 73 disease related events (82.0%) and 16 system related events (18.0%).
Conclusion: Home monitoring system was a safe, reliable and effective monitoring equipment for cardiovascular implantable electronic devices; according to transmitted message, the parameters of devices could be adjusted in time for treating arrhythmia in relevant patients.

Objective To explore the levels of T lymphocyte subsets in asthmatic children and discuss their relationship.Methods 30 children with acute asthma attacks were divided ito disease control(bronchopneumonias)group(25 cases)and healthy control group(14 cases).Flow cytomerty was used to analyze the T lymphocyte subsets in them.Results CD 4+ and CD 4+/CD 8+T cell of the patients of the maderate to serere degree were both significantly higher than those in normal control.Conclusion(1)CD 4+ T cell plays an important role in asthma chronic airway inflammation.(2)There were no significant difference in the level of CD4+ T cell,CD8+ T cell,CD4+/CD8+ T cell between the patients with asthma of mild degree and those of moderate or severe degree group,but CD 8+ T cell a little higer in the latler patlents,which still needs further research.

Aim To investigate the protective effects of dihydrolycorine on hypoxia/reoxygenation (H/R) injury in cultured neonatal rat cardiomyocytes. Methods The hypoxia/ reoxygenation injury model of cultured neonatal rat cardiomyocytes was developed. The cell livability, the activity of lactate dehdrogenase (LDH) and superoxide dismutase (SOD), and the content of malondialdehyde (MDA) were determined in the cultured neonatal rat cardiomyocytes injured by H/R. Results Compared with normal group, the cell livability and the SOD activity of model group were decreased respectively, whereas the activity of LDH and the content of MDA of model group were increased significantly (P

Mitogen-activated protein kinase (MAPK) signaling pathways are involved in multiple important cellular responses. To activate their downstream protein kinases by phosphorylation is a crucial manner for MAPK family members to fulfill their physiological functions. Downstream of MAPKs, there exist three structurally related MAPK-activated protein kinases (MAPKAPKs or MKs), i.e., MK2, MK3 and MK5. Once upon activated by MAPKs, MKs signal to different cellular targets, to regulate gene expression at the levels of transcription and translation, control cytoskeleton remodelling and cell cycle, and mediate cell migration and embryonic development. Recently, based on the gene knockout studies, the function divisions among different MK subfamily members are gradually clear, leading to tremendous advancements of our knowledge on MKs.

Echocardiography was once clinically considered as a tool for diagnosing coronary artery disease with limited sensitivity and specificity. Recently with the developments of modern electronic technologies,limitations of poor image quality were overcome and several new technical modalities,such as color kinesis(CK),Doppler tissue imaging(DTI)and anatomic M-mode echocardiography(AME)have been demonstrated to be useful for enhancing the accuracy and clinical applicability of the echocardiography. These new noninvasive ultrasonic technologies,adding more direct and quantitative information on specific topics of cardiac function,may play an important role in the study of coronary artery disease.

Child ; Gastroenterology ; history ; History, 20th Century ; History, 21st Century ; Humans ; Pediatrics ; history ; Societies, Medical ; history

ERCP has revolutionized the treatment of adult pancreatic diseases.After many years of clinical application,the current adult treatment technology has reached a mature state.With the development of pediatric endoscopic techniques,in recent years,therapeutic ERCP techniques in children has been progressing from the research stage to the stage of practical application and has become an important treatment for pancreatic diseases in children.This article mainly reviews on ERCP in diagnosis,treatment and complications of pancreatic diseases in children.

Objective:To evaluate iron metabolism disorders in sepsis patients and explore the effect of iron deficiency on mortality.Methods:Patients ( n=130) who were admitted to the emergency intensive care unit (ICU) of the First Affiliated Hospital of Dalian Medical University from September 2016 to July 2018 and met the diagnostic criteria of Sepsis 3.0 were selected, and sex- and age-matched healthy volunteers ( n=20) were enrolled as a control group. Peripheral venous blood samples were collected in sepsis patients on day 1, 3 and 7 after admission, or in the healthy volunteers upon enrollment, to detect iron metabolism-related indicators and interleukin-6 (IL-6); the Sequential Organ Failure Assessment (SOFA) score was calculated upon hospital admission. Iron metabolism-related indicators were compared between the groups; the correlation of plasma iron with hemoglobin, hepcidin, ferritin, IL-6, sTFR/log ferritin and the ability of plasma iron to predict 28-day death of sepsis patients were analyzed. Results:Sepsis patients developed significant anemia on day 3 after admission; plasma iron, transferrin, iron saturation, total iron binding capacity and unsaturated iron binding capacity in the first week of admission were significantly lower than those in the control group; distribution width of red blood cells, ferritin, IL-6, hepcidin and soluble transferrin receptor were significantly higher than those in the control group. Distribution width of red blood cells, ferritin and hepcidin on day 3 and 7 after admission, and plasma iron and iron saturation on day 7 after admission were significantly higher than those on day 1. However, total iron binding capacity and unsaturated iron binding power on day 7, and sTFR/log ferritin on day 3 were significantly lower than those on day 1. Patients in the survival and non-survivor groups in the first week of admission had significant anemia on day 3 and 7, but the anemia was worse in the non-survivor group. Transferrin, total iron binding capacity, and unsaturated iron binding capacity in the non-survivor group in the first week of admission, and plasma iron in the non-survivor group on day 3 and 7, were significantly lower than those in the survival group. Ferritin, IL-6 and hepcidin in the non-survivor group in the first week of admission, and iron saturation on day 7 were significantly higher than those in the survival group. Spearman correlation analysis showed that plasma iron was negatively correlated with IL-6 ( r=-0.391, P<0.01), ferritin ( r=-0.293, P=0.001) and hepcidin ( r=-0.209, P=0.017), but not with hemoglobin ( r=0.005, P=0.958). The area under the operation curve (AUC) for plasma iron for predicting 28-day mortality in sepsis patients was 0.524 (95% CI: 0.416-0.631, P=0.656). Conclusions:Sepsis patients have significant anemia and iron metabolism disorders in the early stage, while non-survival patients are more severe. Reduced plasma iron level has no capacity to predict 28-day mortality of sepsis patients. In addition, decreased plasma iron level is not related to decreased hemoglobin, and thus iron supplementation should be cautious in sepsis patients.