Problem-based learning ( PBL ) has become the major teaching method to cultivate medical student's autonomous learning and their ability to solve problems.It's basic elements are the scene authenticity and problem construction.Thoratic surgery clinical probation is the most important part of clinical teaching.The author summerized and analysized the PBL teaching experience in thoratic surgery and had some new understanding and experience on the problem construction,and therefore made some exploration and improvement to it and got some good teaching effect.

Objective To explore the relationship between oncology and military medicine in order to remove theoretical barriers to the development of oncology in military hospitals .Methods The documentary evidence was obtained from cita-tion networks .Results Military hospitals and institutes in China and abroad have conducted studies on oncology , including the long-term survival of Hodgkin′s disease patients in a study of 388 military cases during World War Ⅱ, a study of leuke-mia within the former West Germany Armed Forces , and a study on melanoma in the Armed Forces .Also,some foreign doc-umentation paid special attention to special weapons and equipment , special military operations and special military envi-ronment-related issues of cancer epidemiology , such as cancer following nuclear weapon tests , the association of selected cancers with service in the U .S.military in Vietnam or after the Gulf War .The Military Cancer Institute of the United States published a total of 206 articles between 2001 and 2013 .Conclusion To make closer the relationship between oncol-ogy and military medicine , we should find out more about the relationship between general medicine and military medicine , learn foreign from experience on development of oncology , and explore the military medical value of oncology .

As an important organ of the human body,vascular endothelial cells (VECs) play a vital role in heat stressinduced tissue damage.Its integrity not only serves as a barrier for maintaining vascular permeability but also has major impact on cellular structure and function during acute phase response to heat stress.In heat stroke,a series of acute and complicated pathophysiological changes,including microcirculation change,damage VECs and thereby induce or aggravate multiple organ dysfunction syndrome (MODS).Meanwhile,studies have shown that,during heat stroke,VECs are the major responding cells and one of the most common cells that experience morphological and functional changes.Therefore,VECs damage might be an important mechanism involved in heat stroke.This article reviews the mechanism of heat-induced damage of VECs and its effect on vital organs.

There exist a series of problems in heat stroke treatment,such as,pathogenesis is still unclear,clinical classification is too simple and has no intrinsic relation with pathophysiological process and prognosis,missing of indexes for hierarchical diagnosis and prognosis prediction,and lack of targeted therapeutic norms.All of these factors could lead to high mortality and disability by heat stroke.Our research team started an epidemiological investigation of heat stroke since 2002.On the basis of discovering organ injury rule,system info and treatment technology on critical medicine were applied to heat stroke treatment.Research on organ injury mechanism for heatstroke was carried out based on translational medicine idea,and periodic research results were also achieved.A series of key technologies for heat stroke treatment were obtained.These technologies were popularized in 30 hospitals across the country,thus improving ability of heat stroke treatment.

Infection can complicate different stages of acute pancreatitis.The probability of infection is related to the existence and extent ofpancreatic necrosis: up to 30% of patients with pancreatic necrosis develop infection.The timing of infection is variable and usually peaks in the second to fourth week after the onset of pancreatitis.IPN(infected pancreatic necrosis)is the most common type of secondary pancreatic infection.Infectious complications in severe acute pancreatitis are associated with considerable morbidity and mortality.Antimicrobial therapy is one of the fundamental elements of therapy.Diagnosis of secondary pancreatic infection is challenging and radiologic characteristic (air bubble sign) and CT guided fine-needle aspiration (FNA) are reliable diagnostic strategies.Antibioticuse should be rational in terms of a rational indication, a rational spectrum, and a rationalduration.Prophylactic antibiotics are not beneficial in improving prognosis.The only rational indication for antibiotics is documented infection.The empirical antibiotics should cover common microbials of hospital-acquired intra-abdominal infection and with good pancreatic penetration.Also, fungal infections are often present in thesepatients, and early diagnosis and antifungal coverage should be considered.Duration is in fact largely determined by the presence and efficacy of source control.When there is no or minimal residual infection left after a source control procedure, a duration of 7 to 10 days is probably sufficient.On the other hand, if the source of infection has not been removed completely, prolonged courses until the residual necrosis has been sterilized are necessary.

The endocrine system with the normal aging is characterized by a progressive loss of reserve capacity,resulting in a decreased ability to adapt to environmental demands.This loss of homeostatic regulation reflects important alterations in hormonal synthesis,metabolism,and action.However,these changes may have no significant clinical manifestations,especially under non-stress conditions.This review discusses the endocrine system in the elderly in general.

To investigate the classification and modeling of traditional Chinese medicine (TCM) syndromes in post-hepatitic cirrhosis by partial least-squares (PLS) method, and to study the clinical application of PLS method in TCM research.

Objective To investigate the effect of high altitude aviation on the pressure and diameter of the trachea cannula cuff after injecting air or water. Methods In the circumstance 5 km height and 795 hPa cabin pressure, the air injected cuffs were divided into two groups, one was under the ground circumstance, the other was in the high altitude aviation environment. The volumes of injected air were 5 ml, 7 ml, 9 ml, 11 ml, 13 ml, 15 ml, 17 ml, and the cuff pressure and its diameter were measured. The water injected cuffs were also divided into two groups of ground and high altitude aviation environment. The volumes of injected water were 10 ml, 12 ml, 14 ml, 15 ml, 16 ml, and the cuff pressure and its diameter were measured. The results were compared between the ground circumstance and high altitude aviation environment. Results The diameter of injection air group versus under the ground circumstance group had the statistical significance (t=5.000-9.449, P<0.05), when the injection air was larger than 15 ml, the pressure effect had statistical significance (t=5.000, 8.000, P<0.05). Water injection group had not statistically significant. Different water volume injection had no effect on pressure and diameter (P>0.05), while different air volume injection had significant effect on pressure and diameter (F=5.132, 5.980, P<0.01). When the water volume was 10 ml, the cuff pressure was (24.00±4.62) cmH2O (1 cmH2O=0.098 kPa) , which was appropriate to the range of cuff pressure (20-30 cmH2O). Conclusions In high altitude aviation environment the trachea cannula cuff should adopt water injection, and the best water volume is about 10 ml.

Objective To investigate and compare the food consumption concepts and behaviors of Beijing's urban and suburban residents. Methods Intercept questionnaire surveys were conducted on 287 urban customers shopping at a Jingkelong supermarket located in Chaoyang district and 307 suburban customers shopping at a Meilianmei supermarket located in town of Changping, Changping district at 2 randomly chosen times (all between 1:00PM and 5:00PM) from October to December 2007 in each supermarket. Results 93.1% of Beijing residents went to supermarket as their primary place for food shopping. 47.8% and 38.2% of residents thought the most important factors considered for their food shopping were "food hygiene and safety" and "its effects on health" respectively. Suburban residents were concerned more about "food hygiene and safety", while urban residents more about "effects on health" (P

Objective To analyze the immune state and discuss the effects of immunoregulation therapy of combined use of ulinastatin and thymosin ?1 in the treatment of posttraumatic sepsis. Methods Forty-eight patients with posttraumatic sepsis admitted to ICU during Oct. 2005 to Oct. 2007 were included and randomly divided into treatment group and control group (24 each). Patients in control group received conventional SSC treatment, while those in treatment group received conventional SSC treatment plus immunoregulation therapy with a combination of ulinastatin and thymosin ?1. Peripheral blood CD14+ monocyte HLA-DR expression was detected by flow cytometry to determine the innate immunity of posttraumatic septic patients on day 1, 5, 7 and 28 (or death), and serum levels of IL-6 and IL-10 were assessed by ELISA to evaluate the nonspecific immunity at day 1 and 28 (or death). APACHE Ⅱ scores were recorded on day 1, 5, 7 and 28 (or dearth). Ten healthy volunteers were enrolled as healthy controls. Results At admission the expression of CD14+ monocyte HLA-DR was lower than 30% in 9 posttraumatic septic patients. The expression levels of CD14+ monocyte HLA-DR in the patients in treatment group were much higher than those in control group (P0.05). Before treatment, no significant difference existed in APACHE Ⅱ scores between treatment group and control group, while this score in the patients in treatment group was much lower than that in control group on day 5, 7 and 28 (P0.05). Conclusions There is immunosuppression in some posttraumatic patients with somplication of sepsis. All these patients manifest exaggerated nonspecific immunity at the early stage, and then manifest immunodepression as sepsis progresses. The immunoregulation effects of a combination of ulinastatin and thymosin may facilitate the balance of pro-inflammatory and anti-inflammatory media, thus ameliorating septic symptoms. No improvement in 28 day mortality has been seen, probably due to limited number of patients in present study.