Objective This study discusses the role of case-based learning (CBL) in the development of common competency in medical students.Methods One hundred and twenty-one students of Grade 2013 and Grade 2014 majoring in clinical medicine were divided into study (Grade 2014:63 students) and control (Grade 2013:58 students) groups.The study group was composed of 5 teams,with 12 or 13 students in each team.CBL and traditional lecture-based learning (LBL) were applied to the study and the control groups respectively.After the courses,a questionnaire with 10 indicators of medical students' common competency was scored by the students.The scores were entered into SPSS 19.0 for two independent-samples t-test.Results The effective questionnaire recovery rates for the study and the control groups were 92.1％ and 98.3％ respectively.For the medical students' post competency index,students in the study group scored significantly higher than those in the control,with knowledge mastery,study interest,learning initiative,independent learning,problem analyzing,problem solving showing the following scores,respectively:(5.57 ± 0.77),(5.28 ± 1.01),(5.16 ± 0.91),(5.05 ± 1.05),(5.10 ± 0.89),and (5.09 ± 1.01),compared to those in the control showing the following scores,respectively:(5.14 ± 0.99),(4.82 ± 1.12),(4.75 ± 1.07),(4.46 ± 1.09),(4.70 ± 1.03),and (4.68 ± 0.97),and the differences were statistically significant (P＜ 0.05).Besides,students in the study group performed much better in communication,collaboration,information collection,or critical thinking than those of the control (P＜0.05),with scores in the study group showing (4.97 ± 1.08),(5.33 ± 0.94),(5.21 ± 0.97),and (4.98 ± 0.96),respectively and those in the control (3.93 ± 1.16),(1.95 ± 0.85),(2.21 ± 0.98) and (2.12 ± 0.91),respectively,and the differences had statistical significance.Conclusion CBL can promote the early development of medical students' common competency during basic medical education and compared to the traditional LBL,teaching in smaller teams is much better in ability training.

OBJECTIVE: To provide references for optimizing the selection of medical insurance drugs and drug review in China.METHODS: The Canadian common drug reviewers' basic duties and the Canadian common drug review process were introduced,and the existing problems in drug review and the countermeasures were analyzed.RESULTS & CONCLUSIONS: In view of the problems occurred in Canadian drug review such as redundant delay and tedious,lack of transparence and job responsibility system and so on,the corresponding measures had been taken such as defining drug review time,helding long range e-meeting,and establishing public committee etc.Chinese common drug review should draw experiences from the Canadian drug review to explore a more economical,timely and transparent practice in Chinese medical insurance drug selection and drug review.

Objective:To optimize the alcohol extraction process of Yiqigutuo granules. Methods: Using the L9 (34 ) orthogonal design method, the active ingredients astragaloside and ferulic acid in the formula were quantitatively analyzed by HPLC. The concen-tration and amount of ethanol, extraction times and extraction duration and the other parameters affecting the extraction volume were ex-amined. Results:Analysis of variance showed that the ethanol concentration and extraction times had significant influence on the ex-tract content and the extraction of ferulic acid. The best alcohol extraction process was as follows:70% ethanol of 10-fold volume, ex-tracting 3 times with 1. 5h for each time. Conclusion:The process is stable, and suitable for the industrial production.

Objective To explore the pathogenic course,clinical features and prognosis on hallervorden spatz disease(HSD).Methods To review and sum up clinical data of three patients of 1985 with HSD in one family,and followed up survey in 2001.Results The same parents had three(2 males,1 female) of six children who were suffered from HSD.Clinical features include bilateral pigmentary degeneration of the retina,optic atrophy and progressive dementia,and lay in bed after several years with convulsive seizure,opisthotonus,limb rigidity,hyperreflexia, pyramidal sign positive;they were suited therapy to the illness.2 cases for death,another case for progressive deterioration,the patient lost labour ability and couldn't take care of himself.Conclusion HSD is kindred hereditary disorder,major cases occur the symptoms before 20 years old (progressive deterioration).After attacking about 20 years the patients died.The HSD gene located on chromosome 20p12.3 p13.

Objective We report the pathological features of lung in the dead patients with severe acute respiratory syndrome (SARS). Methods Post-mortem lung and pulomonary hilar lymph nodes tissues of 3 patients dead from SARS were studied by histology and immuhistochemistry with rabbit anti-Fas polyclonal antibody, mouse anti-PCNA, mouse anti- CD83,mouse anti-CD4 and mouse anti-CD8 monoclonal antibodies. Results The surface of lung from 3 cases were shown red or purplish red color. Histopathological examination showed that diffuse interstitial exudative or leakage inflammation and alveolar damages with a pronounced increase of of monocytes in the interval at various levels of progression and severity. There were hyaline-membrane formation, desquamation and apoptosis of type-2 pneumocytes in alveolar spaces. Fibrin thrombus and thrombo-embolism could be found in blood capillary and bronchial artery respectively. We observed some fibrin deposition in alveoli interval. No obviously giant-cell infiltrate within the alveolar lumen. The positive cell of proliferative cell nuclear antigen (PCNA) was rare. Fas antigen were expressed in a lot of type-2 pneumocytes, monocytes of the interval and pulomonary hilar lymph nodes. Comparison with the lymph nodes of chronic inflammation, there were obviously disorganization and attenuation of lymphocyte in lymph nodes of SARS. The proportion of CD4 positive lymphocytes were rare, but CD83 and CD8 positive lymphocyte seemed no decreased, relatively. The seminal changes such as decreased lymphocytes ,white pulp atrophy,hemorrhage and necrosis,and decreased expression of lymphocytes for CD4 antigen could also observe in spleen. Conclusions Severe damages of lung and immunological system damages might lead to death of patients with SARS.

Objective To observe pulmonary fibrosis in severe acute respiratory syndrome (SARS) and to discuss the mechanisms of pulmonary fibrosis in SARS. Methods Hematoxylin and Eosin staining (H&E), histology staining and immuno-histochemical staining (SP methods) were used to investigate the lungs from 4 autopsy cases. Antibodies against collagen type Ⅲ, ?-smooth muscle actin(?-SMA), Fas, FasL and transforming growth factor ?1(TGF-?1) were used for immunohistochemical studies. Results All these four lung tissues showed different degree of pulmonary fibrosis, including the organization of exudative fibrin, glomerulus-like fibrosis in alveolar spaces, the thickening of the alveolar septum, proliferation of fibroblasts, the hyperplasia of collagen fibers and the consolidation of lungs. Sirius red staining and collagen type Ⅲ staining showed the type Ⅲ and the type Ⅰ collagen fibers were the main components of the hyperplastic collagen fibers. ?-SMA were expressed in fibroblasts, immunoreactivity to Fas, FasL, TGF-?1 were all positive and located in plasma of pneumocytes, macrophages and lymphocytes. Conclusions The pulmonary fibrosis can be observed early in SARS patients and the pathogenesis may be involved in the co-effect of many effective cells, inflammatory mediators and cytokines.

Cirrhosis of the liver results in portal hypertension, which is a tortuous and dilated portal vein. The hemorrhage of digestive tract caused by dilation and rupture of lower esophagus and gastric fundus is the main cause of death in patients with cirrhosis. The treatment methods of digestive tract hemorrhage in liver cirrhosis include drug therapy, endoscopic hemostasis, interventional therapy to control hemorrhage and surgical hemostasis. These methods are mainly used to control hemorrhage and solve hypersplenism, but cannot solve the fundamental problem of cirrhosis. Stem cells can repair damaged liver cells and help restore liver function. Under the guidance of B-ultrasound, precise intrahepatic portal vein puncture and infusion of autologous bone marrow nucleated cells can improve cirrhosis through autologous bone marrow stem cells. Little damage to patients, little risk. Cell therapy combined with conventional therapy can treat both the symptoms and the root causes of digestive tract hemorrhage in cirrhosis.

Objective: To establish the quality standards for Lingyangqingfei capsules. Methods: Microscopic identification of products, TLC identifications of Fructus Gardeniae and Cortex Moutan were carried out.Baicalin was determined by HPLC. Results: Baicalin in Lingyangqingfei capsules was about 1.5mg/capsule. The average recovery was 99.82% and RSD was 0.96%. Conclusion: The result is accurate and the reproducibility is good. This method can be used as the quality control of this preparation.

Objective To investigate the clinical features of rotavirus enteritis combined with hepatic lesion. Methods Hepatic function and B type ultrasonic wave inspection were carried out among 485 cases of rotavirus enteritis and clinical features of 108 cases united with hepatic lesion were analyzed. Results (1) Among 108 cases of rotavirus enteritis united with hepatic lesion, ALT increased in 30 cases, accounted for 27.8% of all patients and AST increased in 18 cases (16.7% ) ; ?-GT increased in 10 cases , constituting 9.3% of all patients . simultaneous increased of ALT and AST occurred in 24 cases, accounting for 22.3% ; simultaneous increased of ALT , AST and ?-GT occurred in 12 cases, accounting for 11.1% ; simultaneous increased of transaminase and cholochrome ( TBIL or DBIL ) in 3 cases , accounting for 2.7%; hepatic disfunction and tumefaction were also observed in 8 cases (7.4% ) ; The total cases of increase in ALT were 66 (61.1%) ; the total cases of increase in AST are 54 ( 50 % ) ; The total cases of increase in?-GT are 21 (20.4%). (2)After two weeks , ALT returned to normal in 60 cases ( 90.9%) ; AST returned to normal in 51 cases (94.4%) ; ?-GT returned to normal in 21 cases ( 95.5% ) ; Cases with TBIL or DBIL increased and ALB decreased, hepatic tumefaction recovered within 2 weeks. Conclusion The cases of rotavirus enteritis may be combine with hepatic lesion, increase in ALT and AST are most frequently observed. The prognosis is fairly good after antivirus and protect hepatic therapy , most of the sick children recover from hepatic function lesion and hepatic tumefaction within 2 weeks.