The developmental speed,scale,structure,and efficiency of postgraduate education in recent 20 years in military medical universities were described and compared with those in the other universities in China.We also discussed the advantages and insufficiency of postgraduate education in military medical universities and investigated primarily the mutual relationship between the speed,structure,and the scale,so as to lay basis for formulating the further developing strategies.

Objective To investigate the effects of arsenic trioxide plus thalidomide on immune function of patients with myelodysplastic syndrome (MDS).Methods Fifty-seven MDS patients (Low risk,medium risk and high risk) and 30 healthy volunteers were selected as our subjects.Thirty-four cases with medium risk Ⅱ and high risk MDS patients were randomly divided into A and B groups.Seventeen MDS patients in A group were treated with arsenic trioxide plus thalidomide,and 17 MDS patients in B group were treated with low-dose cytarabine.Lymphocyte subsets in peripheral blood were examined by flow cytometry (FCM).The adverse effect of arsenic trioxide and thalidomide were recorded.Results Compared with control group,the number of T lymphocytes(CD3 +),B lymphocytes (CD3-CD19 +) and NK cell (CD3-(CD16 CD56) +) of patients with MDS were significantly lower,and the differences were statistically significant (t =2.157,2.349,2.958 ; P ＜ 0.05 or P ＜ 0.01).The helper CD3 + CD4 + T cell (Th) ratio decreased in MDS patients than that of control group (t =2.412,P ＜ 0.05).The inhibition CD3 + CD8 + T cells (Ts) ratio increased (t =2.749,P ＜ 0.01).Th/Ts ratio inversion was seen in MDS patients.As the progression of MDS increase,Ts cell expression gradually increased and NK cells ratio gradually decreased.However,there was no significant difference among three groups.Th cells and B lymphocytes in the risk group were lower than that in the low risk group,and the difference was statistically significant (F =4.896 and 4.516,P ＜0.05),but there was no significant difference in the terms of the number of T lymphocytes,Th cell,ratio of Th/Ts and B lymphocytes among MDS groups.Number of T lymphocytes,B lymphocytes and NK cell count in group A after treatment were increased than that before treatment (t =2.435,2.468,2.653,P ＜ 0.05).In group A,2 cases were complete remission,4 cases with partial remission,and 5 cases with hematologic improvement.The total effective rate was 64.71％ (11/17),and curative effect is obviously better than that of B group (x2 =4.253,P ＜ 0.05).Meanwhile adverse effect was mild.Conclusion The cellular and humoral immune function decreased in MDS patients.The treatment of arsenic trioxide plus thalidomide on MDS is proved safety and efficacy,which might work by improving immune function of MDS patients.

Objective:To compare the effects of transverse abdominis plane block and incision infiltration anesthesia on the early postoperative recovery in the patients undergoing thoracoscopic lung resection with general anesthesia.Methods:Eighty American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients, regardless of gender, aged 50-78 yr, with body mass index of 18-30 kg/m 2, scheduled for elective thoracoscopic lung resection under general anesthesia, were divided into 2 groups ( n=40 each) using a random number table method: incision local infiltration group (group D) and transverse abdominis plane block group (group E). In group E, the patients were changed to the lateral position after completion of anesthesia induction, ultrasound-guided transverse abdominis plane block was performed on the affected side, with 0.25% ropivacaine hydrochloride 30 ml injected. In group D, infiltration anesthesia with 0.25% ropivacaine hydrochloride was performed before incision. Postoperative patient-controlled intravenous analgesia was carried out, and flurbiprofen axetil was intravenously injected for rescue analgesia when the numerical rating scale score at rest >3 or numerical rating scale score≥6 while coughing. Quality of Recovery-15 scale scores were assessed at 1 day before surgery and 24 and 48 h after surgery. Plasma concentrations of interleukin-6 (IL-6) and IL-1β were measured by enzyme-linked immunosorbent assay before incision, at the end of surgery, and at 24 h after surgery. The amount of remifentanil used during surgery, the number of effective pressing times of patient-controlled analgesia within 48 h after surgery, requirement for rescue analgesia, first ambulation time after surgery, time to first flatus, length of hospital stay, and occurrence of nausea and vomiting and pulmonary infection within 48 h after surgery were recorded. Results:Compared with group D, Quality of Recovery-15 scale scores were significantly increased, the amount of remifentanil used during surgery and the number of effective pressing times of patient-controlled analgesia were reduced, the rate of rescue analgesia was decreased, the time to first rescue analgesia was prolonged, and the time to first flatus was shortened in group E ( P<0.05). There were no significant differences in the plasma concentrations of IL-6 and IL-1β at various time points, time to first ambulation after surgery, length of hospital stay, and incidence of nausea and vomiting and pulmonary infection between the two groups ( P>0.05). Conclusions:Compared with incision infiltration anesthesia, transverse abdominis plane block can reduce intraoperative consumption of opioids, alleviate postoperative pain, and promote early postoperative recovery when used for thoracoscopic lung resection under general anesthesia.

Objective:To explore the mediating role of mindfulness in part-time nursing faculty between intrinsic motivation and work engagement.Methods:A total of 376 part-time nursing faculty were investigated with Work Preference Inventory, Five Facet Mindfulness Questionnaire-Short Form and Utrecht Work Engagement Scale. SPSS 25.0 statistical software was used to perform t test on the data. Results:The intrinsic motivation of part-time nursing faculty positively predicted work engagement ( β=0.74, P<0.001). The positive predictive effect of intrinsic motivation on job engagement was weaker than before ( β=0.55, P<0.001). Mindfulness as an intermediary variable reduced the positive predictive effect of intrinsic motivation on work engagement from 0.979 to 0.504. The indirect effect of intrinsic motivation on work engagement through mindfulness was significant (path coefficient=0.50, P<0.001), and the intermediary effect accounted for 48.51% of the total effect. Conclusion:Mindfulness plays an intermediary role between intrinsic motivation and work engagement of part-time nursing faculty. Paying attention to the mindfulness level of part-time nursing faculty plays a positive role in improving their work engagement level.

Objective:To explore whether a longitudinal integrated clerkship (LIC) model is more conducive to medical students' post competency and satisfaction with clerkships compared with the traditional block rotation clerkship.Methods:We selected 72 students who participated in graduating clerkships at The First Affiliated Hospital of Harbin Medical University from June 2018 to June 2019. They were equally divided into experimental group and control group to adopt LIC and traditional block rotation clerkship models, respectively. After completing the clerkships, the two groups were evaluated for post competency through objective testing of theoretical medical knowledge and basic clinical skills and rating of the other five competence items by the students themselves and their teachers. At the same time, a questionnaire was delivered to both groups for the degree of satisfaction with clerkships. The t-test and chi-squared test were performed using SPSS 23.0. Results:The objective tests and students' self-evaluation showed that the experimental group had significantly higher scores of theoretical medical knowledge [(8.02±1.11) vs. (7.50±0.97)], basic clinical skills [(7.63±0.90) vs. (6.93±0.73)], medical professional responsibility [(7.74±0.56) vs. (7.31±0.78)], clinical communication [(8.10±1.06) vs. (7.22±0.60)], team work [(7.84±0.62) vs. (7.11±0.69)], literature searching [(6.25±0.60) vs. (4.78±0.84)], and scientific research ability [(4.26±0.88) vs. (2.46±1.20)] compared with the control group (all P<0.05). The experimental group had significantly higher teacher-rated scores of medical professional responsibility [(8.03±0.74) vs. (6.59±0.70)], clinical communication [(7.95±0.73) vs. (6.87±0.67)], team work [(7.96±0.75) vs. (6.95±0.69)], literature searching [(4.84±0.84) vs. (3.30±0.69)], and scientific research ability [(4.53±1.03) vs. (2.70±1.05)] than the control group (all P<0.01). The scores of satisfaction were all higher in the experimental group than in the control group in terms of course arrangement satisfaction [(7.17±0.91) vs. 6.56±0.84)], teacher-student interaction satisfaction [(7.08±0.69) vs. (6.28±0.82)], self-improvement satisfaction [(7.28±0.45) vs. (6.36±0.49)], and clinical work smoothness [(7.72±0.82) vs. (6.81±0.71); all P<0.01]. Conclusion:Compared with the traditional block rotation model, the LIC model is more helpful for improving the post competency of medical students. LIC is a new clinical clerkship model that can potentially replace the traditional block rotation clerkship.

BACKGROUNDTo investigate the biological effects of anti VEGF₁₆₅ ribozyme on human lung adenocarcinoma cell.

METHODSHammerhead ribozyme (VRz) against VEGF₁₆₅ gene transcripts (site 212) and its paired mutant ribozyme (mVRz) were designed and synthesized, and the cleavage activity of the ribozymes on target RNA in a cell-free system was observed. The replication-incompetent adenovirus-mediated eukaryotic expression vectors (rpAdVRz) containing VRz and mVRz gene were constructed and identified. Then the human lung adenocarcinoma cells (A549) were infected with recombinant adenovirus. The biological characteristics of A549 cell before and after infection in vitro were inspected by Northern blot, laser confocal imaging system analysis, flow cytometry and transmission electron microscopy.

RESULTSVRz specifically and efficiently cleaved the VEGF₁₆₅ mRNA. The rpAdVRz was successfully constructed and infected A549 cell. The level of VEGF₁₆₅ expression decreased 87% in rpAdVRz infected cells compared with the other groups, but their biological characteristics were not influenced by the expression of the exogenous gene.

CONCLUSIONSThe adenovirus mediated hammerhead ribozyme against VEGF₁₆₅ can significantly decrease the expression of VEGF₁₆₅. This provides an experimental basis for human lung cancer gene therapy with antiangiogenesis method.

Objective To analyze the spatial and temporal distribution of smear positive pulmonary tuberculosis (PTB) in Liangshan Yi autonomous prefecture in Sichuan province from 2011 to 2016. Methods The registration data of PTB in 618 townships of Liangshan from 2011 to 2016 were collected from"Tuberculosis Management Information System of National Disease Prevention and Control Information System". Software ArcGIS 10.2 was used to establish the geographic information database and realize the visualization of the analysis results. Software OpenGeoda 1.2.0 was used to conduct the analyses on global indication of spatial autocorrelation (GISA) and local indication of spatial autocorrelation (LISA). Software SaTScan 9.4.1 was used for spatio-temporal scanning analysis. Results From 2011 to 2016, the registration rate of smear positive PTB in Liangshan declined from 56.97/100000 (2666 cases) to 21.11/100000 (1038 cases). The global spatial autocorrelation coefficient Moran's I ranged from 0.25 to 0.45 and the difference was significant (all P=0.000). Local autocorrelation analysis showed that"high-high"area covered 43, 34, 37, 34, 42 and 61 townships from 2011 to 2016, respectively, mainly in Leibo county. Spatial temporal clustering analysis found one class Ⅰ clustering in the area around Bagu township of Meigu county and two class Ⅱ clustering in the areas around Liumin and Hekou township of Huili county, respectively (all P=0.000). Conclusion Obvious spatial temporal clustering of smear positive PTB distribution was found in Liangshan from 2011-2016. Hot spot areas with serious smear positive PTB epidemic and high spread risk were mainly found in northeastern Liangshan, including townships in Leibo and Meigu counties. Targeted TB prevention and control should be conducted in these areas.

Esophageal squamous cell carcinoma (ESCC) is one of the most common malignant tumors with a poor prognosis. 4-nitroquinoline-1-oxide (4NQO) is a water-soluble quinoline derivative that can successfully induce the production of squamous cell carcinoma in vivo. Establishing and optimizing experimental methods for 4NQO induced ESCC formation in mice can provide a more suitable in situ model for the study of ESCC.

Objective:To explore the correlation between the self-directed learning ability of medical students and the effect of flipped classroom teaching.Methods:The questionnaire survey was used. From November to December 2020, 123 students of 5-year program enrolled in 2019 in Peking University Health Science Center were chosen as the study objects and Neurobiology is a required course for them. The Medical Students' Autonomous Learning Ability Assessment Scale (MSALAAS) was used to assess the students' self-directed learning ability. The final examination score and a questionnaire survey were used to assess the teaching effect of the course. Descriptive analysis and Mann-Whitney analysis were used to analyze the change of self-directed learning ability of students after the course. One-dimensional linear regression was used to analyze the influence of self-directed learning ability on the final examination score, course experience and course assessment. Results:The total score of MSALAAS was increased from [(109.84 ± 14.12) points] to [(113.65±15.88) points] ( P<0.05) after the course. If the total score of the MSALAAS was referred to as an independent variant, and the final examination score, the course experience and course assessment was referred to as a dependent variable, respectively. The one-dimensional linear regression analysis showed that the total score of the MSALAAS was correlated with the final examination score ( B=0.248, t=3.59, P<0.001), the course experience ( B=0.049, t=3.15, P=0.002) and course assessment ( B=0.048, t=3.18, P=0.002). Conclusion:Flipped classroom teaching can promote the improvement of the self-directed learning ability of medical students. In converse, the students with higher self-directed learning ability might achieve higher examination score and get the better course experience and assessment.

N6-Methyladenosine (m⁶A) is the most abundant internal modification in eukaryotic mRNA, playing critical role in various bioprocesses. Like other epigenetic modifications, m⁶A modification can be catalyzed by the methyltransferase complex and erased dynamically to maintain cells homeostasis. Up to now, only two m⁶A demethylases have been reported, fat mass and obesity-associated protein (FTO) and alkylation protein AlkB homolog 5 (ALKBH5), involving in a wide range of mRNA biological progress, including mRNA shearing, export, metabolism and stability. Furthermore, they participate in many significantly biological signaling pathway, and contribute to the progress and development of cancer along with other diseases. In this review, we focus on the studies about structure, inhibitors development and biological function of FTO and ALKBH5.