Problem-based learning (PBL) has been widely used all around the country.But there are still many misconceptions on the understanding of the PBL teaching in the process of teaching practice,which reduces the PBL teaching effect.For example,it is a misunderstanding to put problems to asking for answers to the questions other than solving the problems and to put case-based learning (CBL) and team-based learning (TBL) to PBL.In this paper,we combined the references with the practice experience to compare PBL with CBL,TBL and flipped instruction in both features and connotations based on the brief discussion of the problem in PBL teaching,to further strengthen the understanding of the PBL teaching.It is only the use of clinical cases to guide students to find the defects of the knowledge required for solving the problem and the process of acquiring the scientific knowledge which is implicit in the problem through the students' autonomous learning that can be called as PBL teaching.

Aim This study was to investigate the effect of isoflurane on contracted renal arterial smooth muscle and to determine whether the MAPK pathway is involved in the intracellular signaling. Methods ①Rabbit renal arterial strips were treated with sapoin to make the sarcolemma permeability. And the calcium stored in reticulum (SR) was released using caffeine.Stead state tense was obtained when the strips were soaked in submaximal calcium concentration buffer.Then the submaximal calcium concentration buffer with various concentration isoflurane was admininstered,the change of tensions was detected.②primary renal arterial smooth muscle cells were cultured and treated with different concentration of isoflurane for different duration,and the levels of phosphorylated ERK1/2 in different groups were detected with western blot.Result Isoflurane all caused rabbit renal artery strips further contraction after they have reached equilibrium,and the tension altitude was isoflurane concentration dependent. Isoflurane upregulates ERK1/2 (p44/42) phosphorylation in cultured renal arterial smooth muscle cells in a concentration and time depend way.Conclusion Isoflurane can upregulates the tension of contracted renal arterial smooth muscle. And it may involve the activation of p44/42 MAPK pathway.

Objective To observe the clinical efficacy of different kinds of insulin combined with Metformin in the treatment of T2DM.Methods 120 T2DM patients were selected and divided into three groups according to different therapies of reducing blood sugar with 40 cases in each group.Group A was treated with insulin glargine combined with Metformin;Group B with insulin detemir combined with Metformin and Group C with protamine zinc insulin combined with Metformin .The time for reaching the standards of blood sugar and the corresponding usage amount of insulin of three groups were observed;After 6 months, the three groups were com-pared in terms of FBG, PBG HbA1c, HOMA-IR, TC, TG and LDL-C.Meanwhile, the incidence rate of hypoglycemia after treat-ment was observed.Results Time for reaching the standards of blood sugar in Group A, Group B and Group C was (6.9 ±2.3)d, (4.1 ±3.0)d and (3.8 ±1.5)d, respectively;the corresponding dosages of insulin of the three groups was (19.0 ±7.8)U, (12.1 ±5.9)U and (11.9 ±5.3)U, respectively, with significant difference between Group A and Groups C, D (p<0.05) and insignifi-cant difference between Group B and Group C (p>0.05).After 6 months, FBG, PBG, HbA1c, HOMA-IR in Group B, Group C and Group A were significantly reduced (p<0.05);with insignificance between Group B and Group C (p>0.05).6 months follow-ing the treatment, TC, TG and LDL-C in Group B, Group C and Group A were significantly different (p<0.05), with insignificant difference between Group B and Group C (p<0.05).The incidence rate of hypoglycemia in Group A, Group B and Group C was 22.5%, 20.0% and 5.0%, respectively, with those in Group B and Group C significantly lower than Group A (p<0.05) and in-significant difference between Group B and Group C (p>0.05).Conclusion The insulin detemir and protamine zinc insulin com-bined with Metformin has a better clinical efficacy in the treatment of T2DM.It can promptly control the blood sugar level and lead to a lower incidence rate of hypoglycemia.Therefore it is worthy of promotion.

Eight-year-program medical students would be officially into 'postgraduate' stage when they complete the study task of 'undergraduate'.Eight-year-program medical students should do the following four aspects to promote the transition from 'undergraduate' to ' postgraduate'.First,changing the study manner from inactive to active and fostering independent learning ability; second,strengthening the communication skills with different people; third,cultivating clinical thinking and taking advantages of various basic knowledge; fourth,emphasizing the training of scientific research thinking ability.

Bronchopulmonary Dysplasia ; therapy ; Humans ; Infant, Newborn

BACKGROUND:In high-intensity exhaustive exercise process, the body must bear the exercise intensity decreasing splanchnic blood flow“ischemia”, at the same time, along with the movement of energy and material consumption, metabolite accumulation and oxidative stress in the body cause pathological damage, leading to a decline in exercise capacity. Thus, what is the impact on kidney filtration barrier? How to adapt to the change of renal tissue? Houttuynia cordata has the functions of heat clearing and detoxifying, dieresis for treating strangurtia, hemostatic, expel ing phlegm to arrest coughing and analgesia, if it has a protective effect on the renal injury caused by acute exhaustive exercise and its mechanism has not been reported in the literature. OBJECTIVE:To explore the effect of acute exhaustive exercise on kidney filtration barrier in rats and the intervention effect of Houttuynia cordata.METHODS:After resting and watching for 3 days, Sprague-Dawley rats received adaptive running for 15 minutes at a speed of 10 m/min on a 0° treadmil . A total of 24 rats, which can finish the running, were selected. They were divided into normal control group, exhaustive exercise group and dosed exhaustive exercise group according to the weight of layer (n=8). Rats in the exhaustive exercise group and dosed exhaustive exercise group on the 10° treadmil received once exhaustive exercise. Dosed exhaustive exercise group received intraperitoneal injection of sodium houttuyfonate 10 mL/kg at 30 minutes before exercises. The normal control group did not do any exercise. RESULTS AND CONCLUSION:Compared with the normal control group, serum urea nitrogen, serum creatinine, urine protein content, malondialdehyde concentration, renal cellapoptosis and apoptosis index were significantly increased, but nitric oxide content and nitric oxide synthase activity in the renal tissue were significantly deceased in the exhaustive exercise group (P<0.05 or 0.01). Glomerular filtration epithelial cells, the kidney filtration barrier of basement membrane and podocyte damage were obvious, showing abundant cellapoptosis, occasional y necrosis. Compared with the exhaustive exercise group, urine protein content, serum creatinine, malondialdehyde concentration, renal cellapoptosis and apoptosis index were significantly reduced, but nitric oxide content and nitric oxide synthase activity were significantly increased in the dosed exhaustive exercise group (P<0.05). No obvious pathological changes were detected, but apoptosis was visible. These findings confirmed that houttuynine made a reduction in renal cellinjury induced by exhaustive exercise and possibly significantly reduced apoptosis, increased nitric oxide synthase content, decreased malonaldehyde, and apparently increased superoxide dismutase activity, and final y protected injured renal tissue induced by exhaustive exercise.

Objective To explore the teaching effects of physiology lectures and students' attitude to lectures,their suggestions for contents,forms and other aspects of lectures.Methods Random sampling questionnaire survey was conducted among 500 students of 2008 grade and 2009 grade in Xiangya medical school of central south university.The percentage of the option in the questionnaire was calculated and the findings were directly described.Results All students thought that physiology lectures were necessary.Teachers should arrange lectures which students were interested in,pay attention to inspire thinking and enhance teacher-student interaction.67.6％ of students thought that the knowledge learned from lectures can be used in expanding scientific thinking.Conclusions The lectures are popular among most students,playing an important role in cultivating students' ability of strict scientific thinking.

To improve students' experimental research skills,innovative consciousness,promote the construction of functional experimental center,we established series of “comprehensive,contrivable,innovative” experiments in medical students.

Aim To investigate the potential role of desipramine(DP) on lipoplysaccharide（LPS）-induced acute lung injury(ALI)and the mechanism of its action.Methods Kunming mice were divided into four groups randomly:NS group(NS),DP control group(DP),LPS group(LPS)and DP treatment group(DP+LPS).The model of ALI in mice was induced by lipoplysaccharidel(LPS,10 mg·kg~(-1),ip).Six hours after LPS challenged,the lung samples were taken for determination of lung wet-to-dry weight ratio(W/D),myeloperoxidase(MPO)activity,and malondialdehyde(MDA)content.The bronchoalveolar lavage fluid(BALF)samples were analyzed for total protein concentrateion and white blood cell(WBC)count.The levels of tumor necrosis factor-α(TNF-α)in lung were measured by ELISA.Results LPS could significantly increase the total protein concentration and WBC number in BALF.The lung W/D ration,MPO activity,MDA content and the levels of TNF-α in lungs all increased after ip injection of LPS.Pretreatment with DP decreased all the changes induced by the LPS.Conclusion Pretreatment with DP protects lung from LPS-induced lung injury in mice,which is,at least in part,through inhibiting the level of TNF-α and decreasing the sequestration of neutrophils and lipid peroxidation.

Objective To investigate the characters and targeted ability of FITC-CSNRDARRC molecular probe in labeling orthotopic transplantation tumor of bladder cancer in vivo.Methods From July 2013 to June 2014,the stability and characters of FITC-CSNRDARRC molecular probe were detected by spectrophotometer and molecular imaging and the optimum concentration and imaging time window were determined.30 BALB-C nude mice were randomly divided into experimental group (n =20) and control group(n =10).In control group,5 of them (group A) were ligated bilateral ureter,others(group B) were not.We established orthotropic transplanted bladder tumor (BIU-87) model by operation.And 0.2 ml probes (220 μmol/L) was then injected intravenously in all mice after 2 weeks.We obtained images and analyzed average gray value of the heart,lung,liver,spleen,bilateral kidney and orthotropic transplantation bladder tumor by using optical probe molecule fluorescence imaging system after 30 min,1 h,2 h,4 h and 12 h,respectively.Results After injected the FITC-CSNRDARRC molecular probes intravenously at 220 μmol/L,the fluorescence signal of tumor tissue strengthened gradually.The optimal imaging time window was 4 hours after injection.The illumination and temperature had little effect on the fluorescence signal.With the time passing after injection,the intensity of florescence signal progressively increasing,which reached the peak at4 h.The average gray value of tumor tissue at 1 h,2 h,3 h,4 h,5 h,6 h,8 h,12 h were 74.22,76.2,80.11,89.38,83.29,85.1,81.22,83.01,respectively.The fluorescence signal of normal tissue weakened gradually with the passage of time.Only liver and gall bladder could notice the fluorescence signal 4 hours after injection in group A.However,the relatively strong fluorescence signal could be found in liver and gall bladder in group B.Conclusions The characters of fluorescence probe are affected by its concentration.Its optimal concentration of labeling tumor is 220 μmol/L.The optical imaging time window was about 4 h after intravenous injection.The FITC-CSNRDARRC molecular probe can specifically bound to orthotopic transplanted tumor of bladder cancer in vivo.