Problem—based Learning(PBL) fit well with characteristic of military foreign medical students and the peculiarity of preventive medicine.In order to improve the self-studying and problem-solving ability of foreign students,attention should be paid to several key points to PBL,such as teaching content selection,informationization teaching tool application and teacher cultivation etc.

Objective To evaluate clinical features,predisposing factors,therapeutic regimen and prognosis of non-traumatic rhabdomyolysis.Methods Clinical picture,therapeutic regimen and prognosis were investigated in 39 cases with non-traumatic rhabdomyolysis by retrospective analysis.Results Non-traumatic rhabdomyolysis mostly presented fever,asthenia,myalgia and/or muscular tenderness,swelling of involved muscles,red urine and oliguria or anuria.The complications and comorbidity of rhabdomyolysis included acute renal failure(ARF),disorders of metabolites and electrolytes,compartmental syndrome,infection,and multiple organ dysfunction.Infection(33.3%)was the most common etiology of non-traumatic rhabdomyolysis,followed by drugs(25.6%),metabolite or electrolyte derangements(10.3%)and alcohol intoxication(7.7%)etc.Therapeutic regimen covered treatment of the underlying diseases,volume repletion,alkalization and dealing with the complications.For the patients with established renal failure,renal replacement therapy was essential.Overall mortality was 15.4%,while the mortality in the patients with ARF was 20.7%.If surviving ARF,the patients' renal function promised to be normalized consequently.Conclusion Non-traumatic rhabdomyolysis is a syndrome with a variety of causes,different clinical presentations and versatile combination of complications,which confounds the diagnosis.However,if treated properly and in time,the survivors in all probability will recover from ARF.

Cryptococcal meningitis is a common and refractory central nervous system infection,with high rates of mortality and disability.The experts of the Society of Infectious Diseases of Chinese Medical Association have reached this consensus after a thorough discussion.Based on the current situation of cryptococcal meningitis in China,the management of cryptococcal meningitis includes 6 aspects:introduction,microorganism identification,clinical manifestations and diagnosis,principles of antifungal therapy,treatment of refractory and recurrent meningitis,treatment of intracranial hypertension.There is not a separate consensus on human immunodeficiency virus (HIV) infection in patients with cryptococcal meningitis.This article focuses on different antifungal regimens and reducing intracranial pressure by reference to Infectious Disease Society of America (IDSA) guidelines.The importance of early diagnosis,combined long-term antifungal therapy,control of intracranial hypertension are emphasized.

ObjectiveTo observe the effect of Didang Xianxiong decoction on the ultrastructure of myocardium and the expression of connective tissue growth factor （CTGF） and low-density lipoprotein receptor-related protein （LRP） in diabetic rats. MethodThe diabetic rat model was established by the intraperitoneal injection of high-dose streptozotocin （55 mg·kg^-1） and the rats were further fed for 3 weeks. Forty model rats were randomly assigned into model group， a Xiao Xianxiongtang （4.05 g·kg^-1·d^-1） group， Xuefu Zhuyutang （6.30 g·kg^-1·d^-1） group， Didang Xianxiong decoction （8.10 g·kg^-1·d^-1） group， and alagebrium chloride （ALT-711， 3 mg·kg^-1·d^-1） group， with 8 rats in each group. Ten normal healthy rats were randomly selected as the blank group. The corresponding drugs were administrated by gavage， and the blank group and the model group were given distilled water at a dose of 10 mL·kg^-1·d^-1 for 8 weeks. The myocardial tissue was collected from the rats under anesthesia at the end of the 8^th week for pathological examination. The expression of CTGF and its receptor LRP in the myocardial tissue was detected by immunohistochemistry and Western blot. ResultCompared with the blank group， the modeling led to obvious ultrastructural damage of the myocardium， up-regulated the expression of CTGF （P<0.01）， and did not significantly change the expression of LRP. Compared with the model group， the drugs alleviated the damage in myocardium ultrastructure， down-regulated the expression of CTGF （P<0.01）， and did not significantly change the expression of LRP. Moreover， Didang Xianxiong decoction showed better performance than Xiao Xianxiongtang and Xuefu Zhuyutang （P<0.01）. ConclusionDidang Xianxiong decoction may protect myocardial tissue by down-regulating the high expression of CTGF in myocardial tissue of diabetic rats， thereby delaying myocardial fibrosis. The results indicate that the therapy of treating both phlegm and blood stasis has better performance than the simple method of resolving phlegm or stasis.

OBJECTIVE: To observe the effect of traditional Chinese medicine for intervention of phlegm and blood stasis in regulating TGF-β1/Smad3 signaling and relieving nephropathy in diabetic rats. METHODS: SD rats were divided into blank group (NC), diabetic model group (MC group), intervention of phlegm and blood stasis (RPDBS) group, phlegm-removing (RP) group and blood-removing (DBS) group. Diabetic models were established in all the rats except for those in the blank group. After 4 weeks of feeding, the rats in RPDBS group, RP group and DBS group were given corresponding drug intervention for 8 weeks. HE staining was used to observe the changes in renal histopathology. Western blotting and real-time fluorescence quantitative PCR were used to detect the expression levels of transforming growth factor-β1 (TGF-β1) and Smad3. RESULTS: The structure and arrangement of the glomeruli and renal tubules improved significantly in the treatment groups in comparison with those in the MC group. The expression levels of TGF-β1, Smad3 and p-Smad3 were significantly downregulated at both the protein and mRNA levels in the treatment groups ( < 0.05), and the down-regulation was more obvious in RPDBS group than in RP group and DBS group ( < 0.05). CONCLUSIONS Intervention of phlegm and blood stasis may inhibit the activation of TGF-β1/Smad3 signaling pathway and delay diabetic nephropathy and fibrosis to protect the renal function in diabetic rats.
Animals ; Diabetes Mellitus, Experimental ; Diabetic Nephropathies ; Kidney ; Rats ; Rats, Sprague-Dawley ; Signal Transduction ; Smad3 Protein ; Transforming Growth Factor beta1