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 explore the clinical features of children infected with macrolide-resistant (MR) Mycoplasma pneumonia(MP) isolates and genetic typing of all isolates.Methods Polymerase chain reaction(PCR) of MP positive in 96 nasopharyngeal or bronchoalveolar lavage fluid (BALF) samples were collected from patients diagnosed as MP pneumonia in the Affiliated Children's Hospital of the Capital Institute of Pediatrics from January 2013 to October 2015.Fifty-five cases were male,41 cases were female;19 cases (19.8％) were 1 to 3 years old,18 cases (18.7％) were more than 3 to 5 years old,59 cases(61.5％) were more than 5 to 13 years and 2 months old.These samples were tested for MR associated mutations in the 23S rRNA of MP,and were divided into the MR group and the macrolide-sensitive (MS) group.Furthermore,the genotype of all the isolates were performed by conducting P1-restriction fragment length polymorphism(P1-RFLP) analysis and multiple-locus variable-number tandem-repeat analysis (MLVA) method.The clinical characteristics including the age,gender,hospitalization duration,symptoms,signs,fever duration,fever duration after macrolide therapy,white blood cell count,C-reactive protein (CRP),chest X-ray and/or chest computed tomography,which were compared between different groups.SPSS 11.5 software was used to analyze the statistical data.Statistical significance was determined at the 0.05 level of a two-tailed test.Results MR mutations were identified in the 23S rRNA gene in 81 specimens (84％),and the 96 specimens were divided into MR group(81 cases) and MS group (15 cases).There were statistical differences in fever duration,hospitalization duration,the incidence of complications and CRP level between the MR group and MS group (t =2.061,Z =-3.368,x2 =5.856,Z =-2.165,all P ＜ 0.05).There were no statistical differences in age,white blood cell count,consolidation percentage on chest radiography and fever duration after macrolide therapy(all P ＞ 0.05).All the 96 isolates were performed by adopting P1-RFLP typing,but 5 isolates were not typed successfully,while 81 cases (89.0％) isolates were typed as P1-Ⅰ and 10 isolates(11％) were typed as P1-Ⅱ c.The hospitalization duration and the fever duration after macrolide therapy in the P1-Ⅰ were longer than the P1-Ⅱ c group,and the difference was statistically significant (Z =-2.197,2.237,all P ＜ 0.05).There were no statistical differences in age,fever duration,white blood cell count,CRP level,consolidation percentage on chest radiography and the incidence of complications (all P ＞ 0.05).Seventy-three cases (90％) of P1-Ⅰ group were MR isolates,8 cases (10％) were MS isolates;3 cases (30％) of the P1-]Ⅱ c group were MR isolates,7 cases (70％) were MS isolates.The MR isolates in P1-Ⅰ group were much more than P1-Ⅱ c group.There was obvious statistical difference in the proportion of MR isolates between 2 groups (x2 =19.209,P ＜ 0.01).All the 96 isolates were performed by modified MLVA typing,82 cases(85.5％) were typed as M4-5-7-2,11 cases(11.5％) were typed as M3-5-6-2,1 case (1.0％) was typed as M4-5-5-2,and 2 cases (2.0％) were typed as M4-5-6-2.Because there were less cases of the M4-5-5-2 and M4-5-6-2 type,only the clinical data of M4-5-7-2 and M3-5-6-2 group were compared.The hospitalization duration and the fever duration after macrolide therapy in the M4-5-7-2 group were longer than the M3-5-6-2 group,and the difference was statistically significant(Z =-2.406,-4.472,all P ＜ 0.05).There were no statistical differences in age,fever duration,white blood cell count,CRP level,consolidation percentage on chest radiography and the incidence of complications(all P ＞ 0.05).Seventy-four cases (90％) of the M4-5-7-2 group were MR isolates,8 cases (10％) were MS isolates;4 cases (36％) of the M3-5-6-2 group were MR isolates,7 cases (64％) were MS isolates.The MR isolates in M4-5-7-2 group were much more than M3-5-6-2 group.There was obviously statistical difference in the proportion of MR isolates between 2 groups (x2 =17.022,P ＜ 0.01).Conclusions In the MR group,the children had longer fever duration and hospitalization duration,higher incidence of complications and higher CRP level than those in the MS group.The MR rates of MP in China was high.P1-Ⅰ and M4-5-7-2 are the predominate genotypes.There may be a correlation between genotype and MR.

Theaflavins are a category of natural compounds characterized with the benzotropolone skeleton. Theaflavins have many pharmacological actions, such as antioxidant, regulating blood-lipid, hypoglycemic, antiviral, anti-inflammation, hypouricemic, anti-bacterial, anti-tumor, anti-osteoporosis. Theaflavins is one of the research focuses of natural active ingredients in tea, and it is more and more widely used in the development of terminal products with health food, medicine, cosmetics, animal feed, plant pesticide, and so on. Based on the literatures review of theaflavins in recent years, taking the theaflavins structure as the starting point, the biological activities of theaflavins were reviewed, the research and application of theaflavins in health food, medicine and other fields were focused on, in order to provide reference for the application and development of theaflavins.

Objective To explore the feasibility of endothelial function of dorsal artery of foot in patients with type 2 diabetes(T2DM) by high frequency ultrasound combined with warm bath test.MethodsThirty-five patients with T2DM and thirty normal people were collected,all subjects were examined by high frequency ultrasound.Diameter of brachial artery in baseline and after reactive hyperaemia were detected;Diameter of dorsal artery of foot in baseline and after the foot immersed in 40℃ warm water for 5 minutes were acquired.Flow mediated dilatation of dorsalis pedis artery(FMDDPA) and flow mediated dilatation of brachial artery(FMDBA) were calculated and compared.Multiple stepwise regression analysis was used to examine the correlation between FMDDPA and hemoglobin A1c(HbAlc). Results The FMDDPA and FMDBA were decreased in patients with T2DM (P<0.01).The FMDDPA and FMDBA were correlated significantly(r=0.864,P<0.01).In stepwise regression analysis,HbA1c is the most affecting factor for FMDDPA (R2=0.321,P<0.01).Conclusions Ultrasound combined with warm bath test can be used to detect the change of endothelial function of dorsal artery of foot in patients with T2DM,which have a certain clinical application value in endothelial function of terminal limb artery.

Dalbergiae Odoriferae Lignum as a traditional Chinese medicine (TCM) has been widely used for promoting blood circulation and removing blood stasis. Flavonoid compounds are main chemical constituents of Dalbergiae Odoriferae Lignum, which exert anti-inflammatory property. However, the underlying anti-inflammatory mechanisms of flavonoid compounds are incompletely understood. It has been reported that isoliquiritigenin, liquiritigenin, naringenin and butein possess anti-inflammatory property. The purpose of this study is to illuminate the anti-inflammatory mechanism of flavonoid compounds based on the protein interaction network (PIN) analysis on molecular network level. 130 targets of the main medicinal ingredients of flavonoid compounds were gained though database retrieval. A protein interaction network of flavonoid compounds was constructed with 589 nodes and 216 interactions. By a graph theoretic clustering algorithm Molecular Complex Detection (MCODE), 26 modules were identified and analyzed by Gene ontology (GO) enrichment. Two modules were associated with anti-inflammatory actions. The most interesting finding of this study was that the anti-inflammatory effect of flavonoid compounds may be partly attributable to inhibite FOS, PTGS2 expression, inhibite of IL-1beta release, and block the MAPK pathway and toll-like receptor pathway.
Anti-Inflammatory Agents ; pharmacology ; Dalbergia ; chemistry ; Drugs, Chinese Herbal ; pharmacology ; Flavonoids ; pharmacology ; Humans ; Protein Binding ; drug effects ; Protein Interaction Maps ; drug effects ; Proteins ; metabolism

In this paper, Fourier transform infrared spectroscopy fingerprint analysis of Marsdenia tenacissima samples was used to develop a reliable method of tracing the geographical origins. Forty-eight samples from four provinces of China were analyzed by FTIR. We analyzed and characterized the fingerprints in both the full spectrum peaks and characteristic peaks, then the principal component analysis and the cluster analysis were carried out. The results of fingerprint analysis, correlation analysis, principal component analysis and cluster analysis can identify the geographic origins correctly, which verified and supplemented each other; the identification results and the actual location showed a high degree of consistency, namely the lower the space distance, the greater the similarity of different samples. These results revealed the obvious superiority and practical value in comparison to the more tedious and time-consuming wet chemistry method normally used. Using appropriate metrology methods can trace the geographical source correctly. The M. tenacissima materials from the region of Maguan should be considered as genuine medicinal materials taking into account the good quality.
China ; Cluster Analysis ; Drugs, Chinese Herbal ; analysis ; classification ; standards ; Geography ; Marsdenia ; chemistry ; classification ; Medicine, Chinese Traditional ; Principal Component Analysis ; Quality Control ; Reproducibility of Results ; Spectroscopy, Fourier Transform Infrared ; methods

OBJECTIVETo investigate the abundance of metabolic proteins in adult and fetal human livers.

METHODSAdult liver homogenate proteins, fetal liver homogenate proteins, adult liver mitochondrial proteins and fetal liver mitochondrial proteins were obtained from fetal or adult liver tissues and examined using the antibody microarrays containing 19 liver monoclonal mitochondrial antibodies. The protein expression abundances were compared among the 4 protein fractions and the pathways related to protein metabolisms were explored.

RESULTSIn adult liver mitochondria, aldehyde oxidase and carbonyl reductase were up-regulated by 2.6 and 1.7 folds, respectively, whereas corticosteroid 11-beta-dehydrogenase isozyme 1, epoxide hydrolase 1 and fibrinogen beta chain protein were down-regulated by 1.7, 1.9 and 2.2 folds, respectively, compared to those in fetal liver mitochondria. The abundance of epoxide hydrolase 1 and glutathione transferase omega-1 was significantly different between adult and fetal liver homogenate samples.

CONCLUSIONOur results demonstrate a clear difference in the expression profiles of metabolic proteins in the liver between adults and human fetuses to allow a better understanding of the occurrence and development of the metabolic proteins and the identification of markers of liver metabolism.

Adult ; Antibodies ; genetics ; metabolism ; Fetus ; metabolism ; Humans ; Liver ; embryology ; metabolism ; Mitochondria, Liver ; metabolism ; Mitochondrial Proteins ; metabolism ; Protein Array Analysis

ObjectiveTo explore the value of virtual touch tissue quantification (VTQ) in evaluating Lauren classification of advanced gastric carcinoma.MethodsForty-one patients with gastric cancer proved by endoscopic biopsy performed preoperative VTQ examination,and the findings were compared with postoperative pathologic results via hematoxylin -eosin and Alcian Blue-Periodic Acid Schiff (AB-PAS) staining.ResultsIn 41 patients,26 cases were diagnosed as diffuse type and 15 cases as intestinal type by pathology after operation.The shear wave velocity(SWV) of diffuse type was higher than that of intestinal type [(1.72± 0.83)m/s vs (1.05± 0.66)m/s,t =2.819,P=0.008] measured by virtual touch tissue quantification (VTQ).According to the area under the ROC curve,the cut- off value of SWV in gastric cancer tissues for assessing the diffuse type was 1.045 m/s with a sensitivity of 80.8％ and specificity of 73.3 ％ respectively.ConclusionsVTQ could be considered as a promising method to distinguish the Lauren classification in patients with advanced gastric carcinoma.

Objective: To analyze the epidemiological characteristics of pertussis in Huzhou City, Zhejiang Province from 2012 to 2022, so as to provide insights into formulation of pertussis control measures. Methods: The data of reported pertussis cases in Huzhou City from 2012 to 2022 were collected through the Infectious Disease Report Information System of Chinese Disease Prevention and Control Information System. The temporal, spatial and population distributions of pertussis cases in Huzhou City from 2012 to 2022 were analyzed using a descriptive epidemiological method. Results: A total of 499 pertussis patients were reported in Huzhou City from 2012 to 2022, with mean annual reported incidence of 1.508/105, and no death was reported. The reported incidence of pertussis remained at a low level in Huzhou City from 2012 to 2021, all below 1/105, and increased to 12.625/105 in 2022. The reported incidence of pertussis appeared an overall tendency towards a rise in Huzhou City from 2012 to 2021 (Z=-29.261, P<0.001). The incidence of pertussis peaked from June to July, and a relatively higher incidence rate of pertussis was reported in Deqing (6.359/105) and Anji counties (1.725/105), while higher incidence was found among children at ages of <1 year (30.566/105), 4 years (31.896/105) and 5 years (29.485/105). Conclusion The reported incidence of pertussis was at a low level in Huzhou City from 2012 to 2021, and increased sharply in 2022. The incidence of pertussis peaked from June to July, was concentrated in Deqing and Anji counties and higher among infants under one year of age and preschool children at ages of 4 to 5 years.

Objective To report the experience and results in comparing laparoscopic radical nephrectomy (LRN) and open radical nephrectomy (ORN) in the treatment of clinical T_2 stage renal cell carcinomas. Methods Between Feb. 2004 and Jul. 2007, 30 patients (12 females and 18 males with average age of 58.0±8.5 years, range 42-68 years) received LRN and 36 patients (16 females and 20 males with average age of 60.0±9. 0 years, range 52-70 years) received ORN. The average tumor sizes in the LRN and ORN groups were (8. 5±2.2)cm (range 7-12 cm) and (8. 8±2.1)cm (range 7-14 cm) respectively. Renal cell carcinoma was histopatologically confirmed in all the patients of these 2 groups after surgery. Results The operative time in the ORN group (130±27 min) was significantly shorter than that in the LRN group (176±23 min), P<0. 01. The estimated blood loss in the LRN group (200±80 ml) was also significantly less than that in the ORN group (380±185 ml) , P<0. 01. Patients in LRN group experienced significantly earlier bowel function recovery (P<0. 01) and shorter duration of drainage (P<0. 01) than those in the ORN group after operation. No severe perioperative complications occurred in all patients. The follow-up range was 6-27 months (average 15±2 months). During the follow-up, 2 patients in the LRN group developed lung metastasis. In the ORN group, 2 patients developed liver metastasis and 1 developed lung metastasis. Conclusion LRN has the advantages of minimal invasiveness and rapid postoperative recovery comparable to those of ORN, and it might be an alternative treatment option for the clinical T_2 stage renal cell carcinomas.