AIM: To investigate the effect of problem - based learning ( PBL) used in the teaching of medical students'evidence-based medicine ( EBM) .
METHODS: Five classes ( total 147 students ) were randomly selected as experimental ( PBL ) group, at the same time, another 5 classes ( total 149 students ) were also randomly selected as control group, using traditional teaching method ( lecture-based learning, LBL ) in 2010 grade. The final examination scores of the experimental group were compared with control at the end of term. In addition, all students were interviewed using self -administered questionnaire to obtain their evaluation for PBL practice. SPSS13. 0 software was used for statistical analysis.
RESULTS: The homogeneity test in baseline survey showed that the basic characteristics between the two groups of students were no significant differences, and were comparable (P>0. 05). Final exam results showed that in addition to the scores of the EBM basic knowledge indicated no significant difference between two groups of students (P>0. 05), for the 5 steps of EBM procedure, namely, asking questions, finding the best evidence, evaluating the evidence, using and practicing the evidence, re - evaluating the evidence, and the total scores between the two groups, there were significant statistically differences (P<0. 05). The results to student learning evaluation showed that there was no significant difference between the two groups (P>0. 05) in aspects of better understanding classroom knowledge, improving language expression ability, and writing skill exercises. And other residual items had a significant difference ( P<0. 05), especially in aspects of improving enthusiasm for learning, self - study ability, improving learning efficiency, information analysis and utilization ability, team collaboration, and communication between teachers and students, however, there was a very significant difference (P<0. 001) between the two groups.
CONCLUSION: PBL teaching mode can effectively improve teaching effectiveness and the quality of EBM teaching, so the this teaching mode is worth further popularizing.

OBJECTIVETo study clinical value of shear wave elastography (SWE) in the evaluation of neck-shoulder myofascial pain syndrome.

METHODSFrom December 2013 to July 2014,30 patients diagnosed as neck-shoulder myofascial pain syndrome were in the treatment group,including 17 males and 13 females, with an average age of (44 ± 3) years old. Thirty healthy people were in the control group, including 22 males and 8 females, with a mean age of (37 ± 5) years old. The patients in the treatment group were treated with manipulation, once every other day, total 7 times. The SWE was used to detect tension part of trapezius muscle of patients in the treatment group before and after treatment, as well as to detect muscle belly at the descending part of trapezius muscle in the control group. The tissue elasticity and Yang's modulus value were recorded and compared.

RESULTSThe tissue elasticity chart of patients in the treatment group before treatment was mainly greenish blue with the score of 3.70 ± 1.53, and the Yang's modulus was (43.4 ± 15.6) kPa. The tissue elasticity figure after treatment was mainly blue with the score of 2.40 ± 0.87, and the Yang's modulus was (29.0 ± 5.9) kPa. Whereas in the control group, the tissue elasticity figure was mainly blue with the score of 1.60 ± 0.72, and the Yang's modulus was (24.0 ± 7.6) kPa. These were statistical differences between the two groups (P = 0.000).

CONCLUSIONSWE can be used as an evaluation method of manipulation treatment for neck-shoulder myofascial pain syndrome, which is an objective and sensitive detection method.

Adult ; Elasticity Imaging Techniques ; methods ; Female ; Humans ; Male ; Middle Aged ; Musculoskeletal Manipulations ; Myofascial Pain Syndromes ; diagnosis ; therapy ; Neck ; Shoulder

Objective To describe the MRI features and pathologic findings of biliary cystadenocarcinoma(BCAC)and to assess the diagnostic value of MRI in those tumors.Methods Five cases of BCAC were collected.All cases were proved by pathology.Non-enhanced and multiphase-enhanced MRI were performed in all cases.MRCP were performed in two cases.The MRI features of the five cases were reviewed retrospectively and correlated with pathologic findings.Results Histological evidence demonstrated five cases of BCAC.Four cases were solitary,whereas the other case was multifocal.All cases were solid and cystic lesions.Two cases were unilocular,whereas the other three cases were multilocular. Multiple mural nodules and irregular thickening cystic walls were presented in all cases.The cystic parts of the lesions were homogeneous in signal intensity and showed no enhancement after contrast administration in the five BCAC.Septa were present in three BCAC with multilocular cyst.On MRCP the bile duct dilatation was found in two BCAC.Conclusion MRI can reveal the characteristic findings of BCAC and accurate preoperative diagnosis can be made.

AIM:To observe the changes in serum cytokines in patients with lumbar disc herniation(LDH) following Shenshi Tongluo therapy(discharging damp and dredging collaterals).METHODS:①Forty-three patients with LDH(cold-damp arthralgia type) were selected from Wangjing Hospital,China Academy of Chinese Medical Sciences from February to December 2005,and randomly divided into experimental group(n =22) and control group(n =21).The informed consent was obtained from all subjects.Meanwhile,30 healthy volunteers were selected as controls.②The patients in the experimental group orally took modified Semen Coicis decoction(Semen Coicis,eucommia bark,Radix dipsaci,cocculi,Chinese clematis root,caulis millettiae,angelica root,achyranthis,and paeoniae radix) according to Shenshi Tongluo therapy,one dose daily for 4 weeks.The patients in control group took Yaotong Ning capsule,4 pills per day,once daily for 4 weeks.③ Contents of serum interleukin-1 ?(IL-1?),IL-6,tumor necrosis factor-?(TNF-?) in patients were detected using radioimmunoassay before and after treatment.Clinical outcome was evaluated using visual analog scale(VAS) and assessment criteria for low lumbar pain of Japanese Orthopedic Association(JOA).RESULTS:①Contents of serum IL-1?,IL-6,and TNF-? in patients were higher than healthy people(P

The recombinant adenovirus Toll like receptor 4 (TLR4) shRNA vector (pGSadeno-TLR4) was constructed and transfected into human aortic vascular smooth muscle cells (HA-VSMC).After HA-VSMC were treated with palmitate or different signaling pathway inhibitors,the mRNA and protein levels of interleukin-6 (IL-6)and NF-κB activity were tested with real-time PCR and ELISA,respectively.The results showed that palmitate increased mRNA and protein levels of IL-6 in HA-VSMC in a dose-dependent manner.The expression of IL-6 mRNA reached peak after treatment with 400 μmol/L of palmitate for 6 h,being 10.43 fold of control (P＜0.01).Treatment with 400 pmol/L of palmitate for 24 h maximally upregulated the protein level of IL-6,which was 2.18 fold of control (P＜0.01).NF-κB inhibitor parthenolide markedly inhibited palmitate-stimulated increased in IL-6 mRNA level by 65％ and protein level by 59％ (both P＜0.01).Protein kinase C (PKC) inhibitor chlerythrine suppressed palmitateinduced IL-6 mRNA expression by 24％ and IL-6 protein level by 28％.By contrast,extracellular signal-regulated protein kinase inhibitor PD98059 and phosphatidylinositol 3-kinase inhibitor wortmannin had no effect on the induction of IL-6 by palmitate.Blockade of TLR4 with pGSadeno-TLR4 significantly suppressed palmitate-induced IL-6 mRNA expression by 72％ and IL-6 protein expression by 75％ (both P＜0.01),along with decrease of NF-κB p65 activity decreased by 62％.These results suggest that TLR4/NF-κB and PKC pathways mediate palmitate-induced IL-6 expression in HA-VSMC.

In order to understand the porcine epidemic diarrhea virus (PEDV) origin and variant characteristics in Liaoning province,diagnosed by PCR,separated by Vero cell,and identified by cell pathological observation,RT-PCR and S gene sequence analysis,1 PEDV strains (LN-2015-1) was successfully isolated from a pig farm of Liaoning province.Analysis of S gene sequence showed that compared withCV777 strain,there were the longest 9 bp insertion,6 bp deletion and 13 bp continuous mutation in addition to point mutation.There also were the longest 3 AA insert,2 AA deletion,and 3 AA or more continuous mutation.The epitope analysis showed that there were 16AA mutations in the 5 epitope regions.Homology analysis show that it had the highest sequence similarity of 99.2％ with HB-HA2015 strain,higher sequence similarity of 98.5％-98.8％ with the domestic and foreign representative strains isolated since 2010,and lower sequence similarity of 93.2％-95.6％ with the traditional strain isolated before 2010;the phylogenetic analysis showed that LN-2015-1 was clustered into the same group with home and abroad variation strain in recent years,and formed a small subgroup with HB-HA2015 at the same time.The evolutionary distance was far from the traditional strains.

Antibody-drug conjugate (ADC) is a new class of therapeutics composed of a monoclonal antibody and small cytotoxin moieties conjugated through a chemical linker. ADC molecules bind to the target antigens expressed on the tumor cell surfaces guided by the monoclonal antibody component. The binding ADC molecules can be internalized and subsequently the toxin moieties can be released within the tumor cells via chemical and/or enzymatic reactions to kill the target cells. The conjugation combines the merits of both components, i.e., the high target specificity of the monoclonal antibody and the highly potent cell killing activity of the cytotoxin moieties. However, such complexities make the pharmacokinetic and metabolic studies of ADCs highly challenging. The major challenges should include characterization of absorption, distribution, metabolism and excretion, investigation of underlying mechanisms, assessment of pharmacokinetic- pharmacodynamic relationship, and analytical method development of ADC drugs. This review will discuss common pharmacokinetic issues and considerations, as well as tools and strategies that can be utilized to characterize the pharmacokinetic and metabolic properties of ADCs.

A2B adenosine receptor is involved in the control of mast cell degranulation, interleukin-8 synthesis and cell growth. A2B adenosine receptor antagonists may serve as novel drugs for asthma, Alzheimer' s disease, cystic fibrosis and type-II diabetes. Therefore, seeking for the highly selective A2B adenosine receptor antagonists has been one of great interest. The molecular basis, structure-activity relationship of selective A2B adenosine receptor antagonists and their interactions with A2B adenosine receptor were reviewed.
Adenosine ; pharmacology ; Adenosine A2 Receptor Antagonists ; Adenosine A3 Receptor Antagonists ; Adenosine-5'-(N-ethylcarboxamide) ; pharmacology ; therapeutic use ; Animals ; Anti-Asthmatic Agents ; therapeutic use ; Asthma ; drug therapy ; Humans ; Pulmonary Artery ; drug effects ; Structure-Activity Relationship ; Xanthines ; pharmacology

Objective To research the effect of community nursing intervention on improving the life quality of type 2 diabetes patients. Methods In order to understand the level of self-efficacy, the implementation of self-care behavior and quality of life in community patients with type 2 diabetes, 214 cases of Daqing community patients with type 2 diabetes were investigated using self-efficacy scale, self-care behavior scale and the general quality of life questionnaire. At the same time, collective guidances such as expert instruction, multimedia health education and nursing skills training combined with individual guidance were utihzed to intervene patients with type 2 diabetes for six months. Results There were significant differences between self-efficacy and self-care behavior in patients with type 2 diabetes before and after the intervention (P<0.01). The body's function, psychological function, social function and total score of life of quality of life before and after the intervention were obviously different (P<0.05), but the material life before and after the intervention had no significant difference (P> 0.05). Conclusions The intervention of community nursing can enhance self-efficacy and self-care behavior, thereby improving the quality of life in patients with type 2 diabetes.

objective To explore the impact ot ideal health behaviors and health tactors on the detection rate of the carotid plaques.Methods Subjects with previous stroke,TIA,myocardial infarction were excluded from the study.A total of 5852 employees (active and retired employers from Tangshan Kailuan company) aged 40 years and over were included through stratified random sampling.Information was obtained from the unified questionnaire,measurements of blood biochemistry and carotid artery ultrasonography.Results (1) The carotid artery plaque detection rates were 67.0％,52.3％,50.5％,44.3％,37.2％,31.9％,26.1％ and 4.2％ in the groups with0,1,2,3,4,5,6 and 7 components of ideal cardiovascular health behaviors and health factors,respectively.(2) The carotid artery plaques total burden score [TBS:M (Q1,Q3)] were7(7,7),7(5,7),7(5,7),5(3,5),5(3,5),5(3,5),3(3,3),3(3,3) in the groups with 0,1,2,3,4,5,6 and 7 components of ideal cardiovascular health behaviors and health factors,respectively.(3) Multiple logistic regression analysis showed that 3,4,5 and greater than 5 components of ideal cardiovascular health behaviors and health factors were protective factors against carotid plaques compared to less than 2 components of ideal cardiovascular health behaviors and factors (all P ＜ 0.05),the OR (95％ CI) values were 0.78 (0.62-0.98),0.53 (0.62-0.98),0.52 (0.39-0.71) and 0.40 (0.25-0.64),respectively.Conclusion Increasing ideal cardiovascular health behaviors and factors are negatively linked with the detection rate and TBS of the carotid plaques.