Learning modes based on the initiatives of students has become a new way in the development of medical students' quality.The second clinical medical college of Southern Medical University performed an improved teaching method:meliorated PBL based on TBL and taking clinical and scientific research ability as the core,which combined the advantages of PBL and TBL in view of the importance of clinical and scientific research ability for medical students.Practice proved that this teaching method was effective in improving comprehensive quality of medical students and cultivating more comprehensive talents for the society.

Objective To review the clinical manifestation,pathological characteristics,treatment and prognosis of borderline phyllodes tumor of the prostate. Methods A case of borderline phyllodes tumor of the Prostate was reported and relative literature was reviewed. Results A 32-year-old man was admided to hospital with a history of aggravated dysuria 2 weeks and urinary retchtion one day. The enlarged prostate was palpated softly and smoothly by DRE.The serum PSA was 20.62 ng/ml.Transrectal ultrasonography and MRI revealed a well-demarcated poly-cystiform tumor which compressed the right lobe of the prostate to flattening.The diagnosis of benign stroma tumor which was not differentiated maturity obtained after transrectal sextant needle biopsy,and the transvesical enucleation was performed under epidural anesthesia.The tumor was histologically diagnosed as borderline phyllodes tumor of the prostate. Microscopic examination showed the tumor was composed of epithelial and stroma cells.The stroma cells proliferated obviously with atypia and mitosis,and the epithelial cells propagated without atypia.Immunohistochemical staining was performed.Vimentin was typically positive,PSA and PAP was positive,and SMA was negative.Forty days after the enucleation,the tumor recurrenced then radical prostatectomy was performed.The diagnosis of low potential malignant phyllodes tumor of the prostate was made.The tumor was limited in tegument and the cross-section of urethra was infiltrated.The patient received external radiation to the whole pelvis(66 Gy)1 month postoperatively.At 6 months'follow up,the patient was asymptomatae. Conelusions The right diagnosis can not be obtained by needle biopsy because hyperptastic epithelial cells can not get and the recurrences of phyllodes tumor increase malignant potential.Radical prostatectomy is the most reliable method of treatment at present.

BACKGROUND: Weightlessness is one of the important reasons to cause lower limb muscle atrophy of the astronauts, which is serious harm to the health of astronauts. OBJECTIVE: To explore the progress of weightlessness that cause lower limb muscle atrophy. METHODS: A computer-based online search of PubMed database and CNKI database was performed to search related articles between May 1981 and March 2013 with the key words of “weightless, weightlessness, muscle, atrophy, space” in English and Chinese, respectively. Literatures related to progress of weightlessness that cause lower limb muscle atrophy were selected; in the same field, the literatures published lately in authoritative journals were preferred. RESULTS AND CONCLUSION: A total of 409 literatures were primarily selected, and 47 documents were involved for summary according to the inclusion criteria. The progress of weightlessness that cause muscle atrophy is the hot topic among the space medical research. The main reasons that cause weightlessness muscular atrophy include the reduced muscle spindle neurotrophic factor synthesis caused by reduced information transmission of peripheral sensory nerve, damage of muscle cel ultrastructure, substantial decline in mitochondrial myofibrils, troponin decreasing, decreased intracel ular calcium content, and decreased antigravity muscle blood flow in lower limbs.

Objective To investigate the changes of extravaacular lung water during the perioperative period of orthotopic liver trans-plantation. Methods 24 consecutive patients with end-stage fiver disease undergoing orthotopie liver transplantation (OLT) were studied. In all patients a 5 French fiberoptic catheter with a thermistor was placed in the brachial artery and connected to the PiCCO system. Extravascular lung water (EVLW) and intrathoracic blood volume (ITBV) were monitored. After induction of anesthesia and achievement of stable hemodynamic and respiratory conditions, the baseline values of hemedynamic data, ITBV and EVLW were recorded. The patients were studied during the anhepatic stage, the Ist hour and 2nd hours after reperfusion of the graft. Final measurements of all the values were immediately determined after operation. Results EVLW remained statistically unchanged during the whole study period in all patients though all of them were increased, compared to normal values. EVWL was positively correlated with ITBV (r = 0. 822, P < 0. 05). Conclusion The changes of EVLW during perioperative period of orthotopic fiver transplantation were very little. Circulative volume overload may be perhaps the most important cause of the increase of EVLW.

Objective To evaluate the clinical features,pathological grades,treatment and prognosis in bladder cancer patients under 40 years.Methods A retrospective review of transitional cell carcinoma of the bladder in patients under 40 years who had been treated from January 1994 to April 2005 were conduc- ted.The patients were divided into 2 groups(group A,20-30 years;group B,31-40 years)based on their age.The differences in pathologic grading,recurrence rate and positive rate of urine cytology were compared between the 2 groups.The statistical analyses were performed using x~2 test.Results The incidence of bladder cancer in patients under 40 years was 4.2%(92/2200).The male/female ratio was 2.7:1.0.At initial visit,86%(68.7% in group A and 91.1% in group B)of the patients presented with gross hematuri- a;and 25.0% in group A and 33.9% in group B concomitantly had frequency and dysuria.The mean disease course in the 2 groups was 3.8 months for male and 6.9 months for female.Solitary tumor occurred in 19 ca- ses(100.0%)in group A and 63(86.3%)in group B;and multiple carcinomas,in 10 cases(13.7%)in group B.All were superficial bladder cancers in group A,while 6(8.2%)were invasive carcinomas in group B.According to WHO pathological grading of bladder cancer,in group A,10 cases(52.6%)had G_1,8 (42.1%)had G_2 and 1(5.3%)had G_3 tumors;in group B,8 cases(11.0%)had G_1,49(67.1%)had G_2 and 16(21.9%)had G_3 tumors(P＜0.01).The positive rate of urine cytology was 53.3% in all 92 ca- ses(25.0% in group A and 60.7% in group B,P＜0.05).The diagnostic rates by B-ultrasound and cysto- scopy were 98.6% and 100.0%,respectively.Of the 92 patients,11(12.0%)were treated by partial cys- tectomy,73(79.3%)by TUR-Bt and 8(8.7%)by cystectomy.The follow-up was 3-115 months(mean, 39 months).The overall recurrence rate was 12.0%,with 5.3%(1/19)in group A and 13.7%(10/73)in group B.Of 10 patients with multiple carcinomas,6(60.0%)developed recurrence;and of 82 with solitary tumors,5(6.1%)developed recurrence,with significant difference between them(P＜0.01).Two of the multiple carcinoma patients developed invasive carcinoma.Conclusions In bladder cancer patients under 40 years,the positive rate of urine cytology,pathological grading and recurrence rate increase with age.Multi- ple tumors,invasive carcinoma and long-term smoking are high risk factors for tumor recurrence.TURBt is the main surgical method for treating bladder cancer patients under 40 years.

The androgen receptor (AR), a nuclear hormone and transcription factor, is the most therapeutic relevant target in pros-tate cancer (PCa) and in the castration-resistant prostate cancer (CRPC). Significant efforts have been focused on understanding the mechanisms involved in the development and progression of CRPC. Recent work has revealed the importance of epigenetic events in-cluding the regulation of AR signaling by methylation, acetylation, and non-coding RNA in the tumorigenesis and development of PCa. We summarize recent findings on the mechanisms of epigenetic regulation of AR signaling in PCa.

ObjectiveTo study the value of serum phosphopyruvate hydratase PH protein for the diagnosis of cerebral injuries in patients with brain malignant tumor.MethodsSerum PH protein levels were detected by enzyme-linked immunosorbent assay in 56 patients with brain malignant tumor. Compare the differences among the status of cerebral injuries.And compare the differences among the patients with general with different radiotherapy methods 32 cases,three dimensional conformal radiothrapy 24 cases,and different peritumoral brain edema levels(cmild 18 cases, moderate ao cases severe 30 cases). Results Before radiotherapy the levels of serum PH protein in patients and the health control were (4.12±0.56),(4.66±0.62)μg/L,no significant differece(P＞0.05).And there was also no significant difference between the before and after radiotherapy for the cerebroma,the levels were(7.84±0.72) μg/L,(t=3.89,P=0.001 ).The PH levels of general radiation therapy and three dimensional comformal radiotherapy were (13.59±0.92),(6.14±0.52)μg/L.There was cignificant difference(P=0.002) After radiotherapy,The levels of serum PH protein of the different dropsical degree,mild,moderate and severe were(4.47:±0.55),(6.17±0.62),(15.21±0.86) μg/L, respectively,showing significant difference(F=15.61,P=0.0001).The therapies influenced the serum PH levels(P＜0.05)ConclusionHigh levels of serum PH protein are associated with severe cerebral injuries in brain malignant tumor.So high serum PH level may serve as an progressive predictor of the injury.

The changes of interstitial cells of Cajal(ICC)distribution and connexin 43(Cx43)expression in gastric muscle layers were assayed in gastroparesis models of streptozotocin-induced diabetic rats.The results showed that gastric emptying was significantly delayed,the contraction frequency and amplitude of gastric muscle segments were greatly decreased,Cx43 gray values were significantly increased and Cx43 distributed homogeneously with ICC immunopositivity in the model rats.These changes appear to be related to the pathogenesis of diabetic gastroparesis.

Objective To compare the dosimetric difference between volumetric modulated arc therapy (VMAT) and static intensity modulated radiotherapy (IMRT) for esophageal carcinoma.Methods Thirty patients were selected in this study,including 5 cases in the cervical,5 the lower thorax,10 the upper thorax and 10 the middle thorax.VMAT plans with a single arc and IMRT plans with five fields designed for each patients.Planning target volume (PTV) were prescribed to 60 Gy in 30 fractions.Delta 4 was used to verifie the dosimetric of treatment plans.Using paired t-test or Wilcoxon signed-test to compare the dose distribution on planning and organs at risk (OAR).The monitor units and treatment time were also evaluated to measure the treatment efficiency.Results All the VMAT and IMRT plans can satisfy the clinical dosimetry requirements.VMAT had better conformal index for PTV than IMRT (P =0.008).VMAT was better than IMRT by reducing the Dmax of spinal cord (P =0.032),while the V30,V40 and Dmean of heart were significantly higher (P =0.041,0.012,0.002).For cervicals,the V5,V10,V15 and mean dose of lung were significant higher in VMAT than those in IMRT (P =0.002-O.002,0.002).For uppers,the values of heart V30 and Dmean were significantly larger in VMAT than IMRT (P =0.030,0.026).However,the Dmax of spinal cord in VMAT was lower than IMRT (P =0.006).For middles,VMAT reduced V10,V15,V20 of lung (P =0.015,0.028,0.041).There were no significant differences between VMAT and IMRT in the lowers (P =0.262-0.998).The 3 mm/3％ γ pass rate was 92.75％ for VMAT and 92.98％ for IMRT (P =0.826).The average MU of VMAT (460.66 MU) was reduced by 11.84％ compared with IMRT (522.55 MU) (P=0.001).The delivery time of VMAT (139.6s) compared with IMRT (298.73 s) was reduced by an average of 53.27％ (P =0.000).Conclusions Compared with IMRT,VMAT improved the OARs dose sparing and the target CI with similar dose distribution to the target.VMAT required fewer MU,shorten the treatment time significantly.The implementation of Synergy is stable and reliable.

BACKGROUND:Currently, the research about effect of non-dextran coated superparamagnetic iron oxide nanoparticles on cellproliferation and cytotoxicity is relatively much less. OBJECTIVE:To evaluate the effects of 0, 25, 50, 75, 100 mg/L non-dextran coated superparamagnetic iron oxide nanoparticles on the proliferation and cytotoxicity of rat bone marrow mesenchymal stem cels. METHODS:Culture media containing 0, 25, 50, 75, 100 mg/L non-dextran coated superparamagnetic iron oxide nanoparticles were prepared for culture of bone marrow mesenchymal stem cels. After 24 hours of culture, the cels were confirmed using Prussian blue staining, and cellcounting was detected using cellcounting kit-8. Meanwhile, lactate dehydrogenase activity in the supernatant and intracelular superoxide dismutase activity were detected. RESULTS AND CONCLUSION:Loading of non-dextran coated superparamagnetic iron oxide nanoparticles in BMSCs was confirmed by Prussian blue staining. The percentage of cels labeled with non-dextran coated superparamagnetic iron oxide nanoparticles was up to 100% when the cels were incubated with a non-dextran coated superparamagnetic iron oxide nanoparticle solution of 50 mg/L and above, but 25 mg/L was insufficient to label al of the cels. Furthermore, as the concentration of non-dextran coated superparamagnetic iron oxide nanoparticles decreased, the cellproliferation rate decreased gradualy. The 25 mg/L group had a minimum cellproliferation rate, but the 25 and 50 mg/L groups showed no statisticaly significant difference (P > 0.05). Therefore, 50 mg/L is considered as the appropriate concentration of non-dextran coated superparamagnetic iron oxide nanoparticles, under which, the labeling efficiency is higher and the cytotoxicity is lower.