Accidents, Traffic ; Forensic Medicine ; Hoarseness ; Humans

University of Manchester who first introduced Problem based learning(PBL)to the UK medical education,and adopted this new curriculum in 1994.Notably,Cambridge and Oxford have always had a high proportion of student-centred and self-directed learning,and have therefore not introduced PBL.Other medical schools have followed the example of Manchester,now PBL has become the mainstream curriculum in British medical edacation.First,this article is going to introduce how PBL curriculum is structured at Manchester medical school,and then reflect and give some thoughts on its current practice.

Objective To investigate the role of TL1A in the generation and differentiation of peripheral blood Th17 in rheumatoid arthritis.Methods The peripheral blood mononuclear cells (PBMCs) of RA were isolated and stimulated with PHA in the presence or absence of TL1A.Naive CD4+ T cells from RA was cultured under Th17-polarizing conditions with or without TL1A.The percentage of Th17 was detected by flow cytometry (FCM) analysis.The DR3 expression on CD4+ T cells from PBMCs of RA patients and healthy controls (HC) were analyzed by using FCM.Data were analyzed with t test and U test.Results TL1A could significantly up-regulate the percentage of Th17 in PBMCs of RA [(7.5±2.3)％ vs (5.2±1.5)％,t=2.647,P＜0.05].Compared to the HC groups,TL1A could significantly induce Th17 differentiation from naive T cells [(37.7±1.9)％ vs (29.5±2.0)％,t=6.455,P＜0.05].The percentage of CD4+DR3+ T cell in PBMCs of RA [(0.56±0.87)％] was significantly higher than that of HC [(0.13±0.04)％,P＜0.05].The percentage of CD4+DR3+ T cell in PBMCs when stimulated with PHA was increased in RA patients,[(4.51±1.34)％ vs (1.11±0.29)％,t=2.915,P＜0.05],but no obvious increase in HC [(0.199±0.104)％ vs 0.072％±0.029)％,t=1.644,P=0.1988].Conclusion TL1A can promote the generation and differentiation of Th17 in the PBMCs of RA,and this effect may be mediated by the binding of TL1A with DR3.

Objective To investigate the feasibility of differentiation between prostate cancer and prostatitis by using metabolic ratios provided by 3D 1H Magnetic Resonance Spectroscopic Imaging (MRSI). Methods Metabolic changes were evaluated in 42 voxels with prostate cancer and 30 voxels with prostatitis in the peripheral zone using MRSI. The results were based on the pathologic findings by biopsy. The (choline + creatine)/Citrate (CC/C) ratio and the changes of choline and citrate levels were evaluated in each voxel with cancer or prostatitis, t test was used to determine the power of the CC/C ratio in differentiation between prostate cancer and prostatitis. Results The CC/C ratio for cancer voxels (1.28±0.41) was significantly different from the ratio in the voxles with prostatitis (1.03±0.40), t=6.45, P<0.05, due to greatly increased choline level in the cancer voxels. When CC/C ratio of 0.8 was taken as the criteria for the diagnois of prostate cancer, the sensitivity, specificity and accuracy were 65.5%, 71.4% and 66.7%, respectively. Positive predictive value(PPV)and negative predictive value(NPV) were 90.5% and 33.3%, respectively. The CC/C ratio was higher than 0.86 in 66.7% voxels with prostatitis (20 voxels of total 30 voxels), which mostly depended on the level of choline. When citrate level was used as an auxiliary index to evaluate prostatitis (Cit/norm, Cit≥0.75), the misdiagnosis rate of prostate cancer was reduced to 26.6%(8 voxels of total 30 voxels). Conclusions The metabolic ratio of CC/C can be used to differentiate prostate cancer from prostatitis. The misdiagnosis rate is reduced when citrate is not or slightly decreased relative to normal citrate level (Cit/norm, Cit≥0.75).

OBJECTIVE:To explore the effects of dobutamine on hemodynamics,tissue perfusion and respiratory function in patients with ARDS caused by septic shock. METHODS:Totally 26 patients with ARDS caused by septic shock were given Dobu-tamine hydrochloride injection 5 μg/(kg·min) by continuous pump for 20 min ,increasing by 5 μg/(kg·min) every 20 min to 15μg/(kg·min)for 6 h. Mean artery pressure(MAP)maintained at about 65 mmHg during continuous pump. Hemodynamic index-es [HR,MAP,cardiac output(CO),stroke volume(SV),total end diastolic volume(GEDV),intrathoracic blood volume index (ITBI),extravascular lung water index (ELWI),systemic vascular resistance index (SVRI)],tissue perfusion indexes (norepi-nephrine,urine volume,blood oxygen saturation,blood lactate)and ventilator parameter indexes(positive breathing pressure,min-ute ventilation volume,respiratory rate,peak inspiratory pressure and plateau pressure)of all patients were recorded before medica-tion,6,24,48 h after medication. RESULTS:There were no statistical significances in HR,MAP,GEDV,ITBI,blood oxygen saturation,blood lactate and respiratory rate before and after treatment (P>0.05). CO,SV,urine volume and minute ventilation volume of all patients 6,24,48 h after medication were significantly higher than before medication,and those indexes increased gradually as medication time. ELWI,SVRI,positive breathing pressure,peak inspiratory pressure and plateau pressure of all pa-tients after medication were significantly lower than before medication,and those indexes decreased gradually as medication time, with statistical significance(P<0.05). The levels of norepinephrine in all patients 24,48 h after medication were significantly low-er than before medication and 6 h after medication,with statistical significance(P<0.05);but there was no statistical significance between before medication and 6 h after medication(P>0.05). CONCLUSIONS:The early application of dobutamine ELWI,tis-sue perfusion and respiratory function in patients with ARDS caused by septic shock,and can keep hemodynamics stable.

Spontaneous miscarriage is the most common complication of the first trimester,among which 90% are early miscarriage that occurs prior to the 12th week of the gestation.Low progesterone level may be the main cause of the early miscarriage.This article discusses the incidence,pathogenesis,progesterone treatment,and prediction marker of early miscarriage to provide clues for the clinical work.

Twenty patients with prostate cancer and 20 patients with benign prostate hyperplasia (BPH) in the transitional zone underwent magnetic resonance imaging (MRI) /magnetic resonance spectroscopic imaging ( MRSI ) examinations. The choline + creatine/citrate (CC/Ci) ratio and the choline/creatine (Cho/Cr) ratio were evaluated in each voxel with cancer or BPH confirmed by pathological results.Discriminant analysis was used to determine the power of the two ratios in differentiation between cancer and BPH. The CC/Ci ratio and Cho/Cr ratio for cancer voxels were significantly higher than those in the voxels with BPH in the transitional zone (CC/Ci: 2.26 ± 1.35 vs. 0.81 ±0.22, t =5.17, P ＜0. 01, Cho/Cr:4. 12 ± 1.65 vs. 1.25 ±0. 35, P＜0. 01 ). As for the discriminant function with the CC/Cr ratio and the Cho/Cr ratio, the specificity, sensitivity, and accuracy were 99%, 86%, 93% respectively for the differentiation between cancer and BPH.

Objective To explore the clinical utility of arterial spin-labeling (ASL) magnetic resonance(MR)imaging for the detection of cerebral blood flow (CBF) abnormalities in patients with Alzheimer disease(AD). Methods Twenty-two subjects with probable AD and twenty normal control subjects underwent ASL and structural MR imaging. Among them, 16 AD patients and 11 control subjects were also examined with single photon emission computed tomography(SPECT). The CBF images were obtained by processing ASL perfusion data. The CBF values of bilateral frontal lobe, temporal lobe, temporoparietal junction, parietal lobe, occipital cortices and hippocampal areas were measured by CBF images. And the CBF values of cerebral structures between AD and control subjects were compared. Results ASL perfusion imaging in AD revealed marked hypoperfusion mainly in temporal lobe (72.7%), temporoparietal junction (54.5%), parietal lobe(45.5%). The brain regions involved were similar to those seen with SPECT. The CBF values of bilateral frontal lobe, temporal lobe, temporoparietal junction, parietal lobe and hippocampal areas were significantly decreased compared with control subjects (all P<0.05). The CBF values of right frontal lobe, left temporoparietal junction, left parietal lobe in patients with AD were positively correlated with the mini-mental state examination score (r= 0.49, 0.54, 0.64, all P<0.05). Conclusions ASL MR imaging can show regional hypoperfusion in AD patients, which is similar to that seen with SPECT. The results suggest ASL MR imaging is an useful tool for assessment of cerebral blood flow in patients with AD.

Objective:To investigate the effect of scutellarin on P-gp protein expression and activity in Caco-2 cells. Methods:Scutellarin(25,50 and 100 μmol·L-1 )was incubated with Caco-2 cells respectively for 24 h,48 h and 72 h. The expression of P-gp was determined by western blot assay and the activity of P-gp was determined by Rhodamine-123 assay. Results:P-gp protein ex-pression levels were significantly increased by scutelarin. After the incubation for 24 h with scutellarin,P-gp protein expression was up-regulated 2. 34-,2. 65-and 2. 00-fold in Caco-2 cells. After the incubation with scutellarin for 48 h,P-gp protein expression was up-regulated 2. 70-,4. 66-and 3. 13-fold. After the incubation with scutellarin for 72 h,P-gp protein expression was up-regulated 2. 82-, 2. 62-and 1. 84-fold. The intracellular accumulation of rhodamine-123 was significantly decreased by scutellarin,indicating that the ef-flux transport activity of P-gp was increased by scutellarin in Caco-2 cells. Conclusion:Scutellarin can significantly up-regulate P-gp protein expression and increase the efflux transport activity of P-gp in Caco-2 cells.

Objective To investigate the expression in the VEGF,TGF-?1 of cervical squamous car- cinoma infected by HPV16,18.Methods Cells exfoliated from cervix(collected by clinician)of 99 women with cervical cancer and 54 women as a control group were analyzed blindly by human papillomavirus type 16 and 18 Fluorescent Polymerase Reaction Diagnositic kit.The expression of VEGF,TGF-?1 of the positive HPV16,18 of 38 women with cervical squamous cancer were studied by immunohistochemical stain.Results The positive expression of HPV16,18 was observed in 53 in the case of cervical cancer with positive rates of 54 %,but the positive rates was 7 % in the control group(P