To evaluate the effect of problem-based learning (PBL) in internal medicine teaching for residency training of general medicine.Fifty two residents of general medicine were divided randomly into PBL teaching and traditional teaching groups with 26 in each.The evaluation was conducted in combination of examination scores and questionnaire survey in both groups.In questionnaire survey the residents of PBL group responded positively about the use of PBL in teaching, and rated themselves as having much better competencies in problem solving and self-directed learning.The scores of case analysis examination in PBL group were higher than those in traditional teaching group ( 73.7 ± 4.1 vs.71.1 ± 4.8, P ＜ 0.05 ).The results suggest that the application of PBL has better effect than traditional teaching in residency training of general medicine.

AIM: To investigate the effect of exercise training(EX) on the arterial baroreflex and possible mechanisms in rats with chronic heart failure(CHF).METHODS: Experiments were carried out in four groups: EX-CHF,CHF,EX-sham,and sham. CHF was induced by left coronary artery ligation,and EX consisted of 4 weeks of treadmill running. Baroreflex function,plasma angiotensin II(Ang II) and central AT1 receptor expression were determined.RESULTS: (1) The average slope and maximal gain of the baroreflex curve in CHF rats were lower than those in sham rats(P<0.01). EX significantly enhanced baroreflex parameters in CHF group but not in sham group.(2) EX decreased plasma Ang II in CHF rats ［(137±27)ng/L vs (263±55)ng/L,P<0.01］,but had no significant effect on plasma Ang II in sham rats ［(75±17)ng/L vs (92±21)ng/L］.(3) Expression of AT1R protein in the PVN of CHF rats was higher than that in sham rats(1.20±0.21 vs 0.70±0.14,P<0.01). EX reduced AT1R protein level in CHF rats(0.90±0.13),but had no impact in sham rats(0.60±0.16).CONCLUSION: EX restores the attenuated arterial baroreflex function in CHF rats,involving in decrease of plasma Ang II and downregulation of AT1R in the PVN.

Objective To survey the current clinical practice of chronic non-cancer pain (CNCP)management including opioid use in Chinese subgroup report of Current Practices of Cancer and Chronic Non-Cancer Pain Management:A Pan-Asian Study (ACHEON).Methods This questionnaire-based survey included 100 pain physicians and 250 patients experiencing CNCP in the period of September to December in 2013.Results CNCP management training was believed by 40％ of physicians,while 30％ reported adequate pain-relief training on opioid use.Opioids were not considered as the best choice for CNCP management by 65％ of physicians.The majority of location of pain with CNCP was legs/feet (59.2％) and neck (39.2％),arthritis (37.22％),overuse (26.91％),and poor posture (35.56％) were reported as the primary causes of pain.A portion (81.6％) of patients was under treatment,while 66.67％ of patients claimed to be satisfied with their current pain treatment.74.51％ of patients reported that CNCP management was effective pain-relief.Conclusions The Chinese physicians were insufficient cognition of CNCP management on opioid use.The CNCP education and cognition strengthening,CNCP management practice and patient's satisfaction are still necessary for Chinese physicians and patients.

Objective To Compare the postoperative recovery of continence after 3D and 2D laparoscopic radical prostatectomy.Methods A retrospective analysis of 72 patients underwent radical prostatectomy in our department from January 2013 to December 2015,including 38 cases underwent 3D laparoscopic radical prostatectomy,3D group's mean age was (64.2 ± 6.0)years,mean of preoperative PSA was (14.5±7.6)ng/ml,Gleason score (13 cases≤6,17 cases =7,8 cases ≥8),the mean prostate volume (41.4 ±9.1) ml,the classification of clinical stage in 3D group included 2 cases in cT1,26 cases in cT2,9 cases in cT3a,1 cases in cT3b,mean body mass index was (22.8 ± 2.2) kg/m2,mean of MUL (membranous urethral length) was (15.6 ±2.6) mm;34 cases in the 2D group,3D group's mean age was (61.9 ±6.6)years,mean of preoperative PSA was (16.7 ±6.8) ng/ml,Gleason score (10 cases≤6,18 cases =7,6 cases ≥8),the mean prostate volume (42.1 ± 10.6) ml,the classification of clinical stage in 3D group included 1 cases in cT1,28 cases in cT2,5 cases in cT3a,mean body mass index was (21.7 ± 1.9) kg/m2,mean of MUL(membranous urethral length) was (15.5 ± 2.5) mm.All patients got a good function of micturition and urinary continence before the surgery.We compared surgical time,bladder neckurethral anastomosis time and blood loss in two groups.Membranous urethral length(MUL) were measured on preoperative and postoperative magnetic resonance imaging (MRI).Postoperative continence rate was analyzed at 2 weeks,4 weeks,8 weeks,12 weeks,24 weeks and 36 weeks after the remove of the catheter.Results All the operations were completed successfully by the same surgeon and none was transferred to open surgery.The age,PSA value,Gleason score,prostate volume,TNM stage,BMI (body mass index)and other relevant aspects of the clinical data showed no significant difference (P ＞ 0.05).The time of bladder neck-urethral anastomosis is less than the 2D group [(12.9 ± 1.7) min and (15.7 ±2.6) min,P =0.021],MUL loss in the 3D laparoscopic surgery group is less than that of 2D laparoscopic [(0.5 ±0.1) ml vs.(0.6±0.2) ml,P =0.044],the two groups in operative time [(162.7 ± 17.1) min vs.(175.7 ± 15.7) min,P =0.802],intraoperative blood loss[(191.1 ± 31.6) ml vs.(211.8 ±43.2) ml,P =0.021],intraoperative blood transfusion rate [5.2％ (2/38) vs.8.8％ (3/34),P =0.662],postoperative incidence of urine leakage [7.9％ (3/38) vs.14.7％ (5/34),P =0.463],postoperative the MUL [(15.1 ± 2.6) mm vs.(15.0 ± 2.6) mm,P =0.767),there was no statistically significant differen.All patients were followed up for urinary function at least 36 months.The continence rate between two groups at 8 weeks (60.5％ vs.35.3％),12 weeks (73.7％ vs.47.1％) got significantly difference.Conclusions Compared with 2D laparoscopic,3D laparoscopic may help early postoperative recovery of urinary continence after laparoscopic radical prostatectomy.

Objective To study the effect of nasal decontamination on clinical index of elderly patients with long -term indwelling nasogastric tube.Methods 89 elderly patients with long -term indwelling nasogastric tube were randomly divided into nasal decontamination group and routine treatment group.The sputum culture positive rate of bacterial and the incidence of pulmonary complications,pharyngitis,sinusitis of the two groups were observed. Results Sputum Staphylococcus aureus positive rates in the nasal decontamination group and conventional group were 13.043% (6 cases)and 39.535% (17 cases)respectively,the difference was significant(χ2 =8.139,P =0.004).The incidence rates of pulmonary infection in the nasal decontamination group and conventional group were 4.348% (2 cases)and 18.605% (8 cases)respectively,the difference was significant(χ2 =4.529,P =0.033). The incidence rates of pharyngitis in the nasal decontamination group and conventional group were 10.870%(5 cases)and 37.209% (16 cases) respectively,the difference was significant (χ2 =8.553,P =0.003 ). Conclusion Nasal decontamination can decrease the positive rate of sputum bacterial culture,the incidence of pulmonary infection and pharyngitis in elderly patients with long -term indwelling nasogastric tube.For its efficacy and safety,it deserves clinical application.

Objective To summarize the modernization of information demand of clinical teaching and management of nursing interns, evaluate the effect of development of the nursing intern teaching management information platform in the clinical effect. Methods Through literature retrieval, inductive method, on the basis of the needs analysis of nursing interns, clinical teachers, Nursing Education Center personnel a total of 41 people were divided into 5 groups with 5-7 people each. Brainstorming method was used to build the initial module and design the questionnaire and the interview outline. The clinical teaching teacher questionnaire was investigated in 101 part and in-depth interviews. Results The recovery of 100 valid questionnaires, the effective questionnaire 99.0%(100/101) and in-depth interviews with 15 excellent clinical teachers, the final 7 first level indices and 55 two level indices; finally running test platform development and 6 months, again the clinical teacher interviews, trial platform had a satisfactory result. Conclusion The nursing intern teaching management information platform is helpful to improve the teaching quality of nursing interns and management efficiency.

Objective To study the clinical value of procalcitonon (PCT) for predicting development of acute kidney injury and outcomes in patients with acute pancreatitis (AP). Methods 205 inpatients with acute pancreatitis in our hospital were enrolled in our study during January 2012 to March 2013. According to acute kidney injury (AKI) occurred in three consecutive days or not, the patients were divided into AKI group (n = 32) and control group (n=173). Crea, Urea, CysC and PCT, serum amyloid A (SAA), interleukin-6 (IL-6) and C reactive protein (CRP) were analyzed. The predictive validity of these indicators was constructed by receiver operating characteristics (ROC) curve. Results PCT, IL-6, and CRP level of AKI group showed significant higher in AKI group than control group (P<0.05). However, there were no statistically significant difference of the level of Urea, Crea, Cys C and SAA between the two groups (P>0.05). The AUC value of PCT showed significant higher than the AUC value of CRP, IL-6 and SAA(P<0.05). Conclusion PCT is a early, sensitive, specific biomarker for predicting AKI of patients with AP.

Objective Coronary heart disease (CHD) is a multifactorial disease. This meta-analysis was performed to evaluate the relationship between angiotensinogen gene polymorphisms and CHD in the Chinese population. Methods We searched literature in pubmed (1990-2010.8) and CNKI (1990-2010.8) for all the relevant studies on 2 angiotensinogen polymorphisms (M235T and T174M) and risk of CHD. The meta-analysis software Stata 10.0 was used for ascertaining heterogeneity among individual studies and for combining all the studies. Furthermore,Egger's test and sensitivity analysis were performed to insure authenticity of the outcome.Results Ten associations studies on 2 angiotensinogen polymorphisms (M235T and T174M) were included in this meta-analysis. In a combined analysis, the summary per-allele odds ratio for CHD of the M235T polymorphism was 1.374 (95% confidence interval, 1.019 to 1.852) and T174M polymorphism was 4.089 (95% confidence interval, 1.697 to 9.851). Conclusions The M235T polymorphism had weak but statistically significant association with CHD while the T174M polymorphism was more strongly associated with a CHD risk in Chinese population, but further confirmation studies are needed.

Leptomeningeal metastasis (LM),with a high omission rate in diagnosis in approximately 5 ％～8 ％ of all patients, is increasingly recognized as a lethality complication. The diagnosis of LM remains challenges,but commonly can be established by CSF cytology or by definitive neuroimaging. Although a combination of focal radiotherapy,intrathecal chemotherapy,and systemic chemotherapy may be necessary to achieve optimal treatment of patients, but prognosis is unacceptable and therapy remains palliative in most patients.

Objective To analyze testing results and values of blood heterotypic lymphocyte in flu patients.Methods 100 cases of influenza patients and 100 healthy people were collected.The observation group for flu patients and control group of healthy people.Extraction of peripheral blood in patients with microscopic examination observing leukocyte,neutrophil,lymphocyte,intermediate cells,atypical lymphocytes under a microscope,and calculated the percentage in the patients in the two group cells to make analysis and comparison.Ratio in peripheral blood of patients and analysis of specific lymphocytes were also calculated between different ages.Results Peripheral blood lymphocytes in observation group was (11.1 ± 2.6) ％,which was significantly higher than than of the control group [(1.5 ± 0.5) ％].The difference was statistically significant (chi-square =16.9,P ＜ 0.05) ; White blood cells,the ratio of neutrophils,lymphocytes in observation group were obvious differenent compared with the control group(t/chi square are:13.2,11.3 and 12.6,P ＜ 0.05) ;Three ages of influenza patients peripheral blood lymphocytes of the opposite sex ratio has no difference(P ＞ 0.05).Conclusion Detection of peripheral blood lymphocyte heterosexual has great significance to the diagnosis of influenza with simple,convenient and feasible characters.It is worth to be used widely in clinical practice.