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.

The ancient discussion and modern clinical application regarding Yingxiang (LI 20) and Neiyingxiang (EX-HN 9) in acupuncture verses are explored. Acupuncture verses are the summary of clinical experiences of acupuncture scholars in the past dynasties, of which the records on application of Yingxiang (LI 20) and Neiyingxiang (EX-HN 9) mainly focused on nasal, facial and head-eye diseases, which is characterized with overall summarization, brilliant exposition, simple language, and distinctive characteristics. Nowadays, based on the ancient usage, the clinical application about these two acupoints is continuously developing. If the ancient acupuncture verses could be understood thoroughly, the clinical practice could be better guided and its effects could be improved.
Acupuncture Points ; Acupuncture Therapy ; history ; China ; History, Ancient ; Humans ; Medicine in Literature ; Rhinitis, Allergic ; therapy

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.

Postoperative pancreatic leakage remains a persistent problem after pancreaticoduodenectomy.For patients with a soft and nonfibrotic pancreas,double binding continuous hemstitch suture is an optimal method for anastomosis.From January 2011 to June 2012,92 cases of periampullary carcinoma with a soft pancreas underwent pancreaticoduodenectomy,and then a modified technique of pancreaticogastrostomy was performed with 2 continuous hemstitch sutures placed in the mucosal and seromuscular layers of the posterior gastric wall,respectively.The median time for pancreaticogastrostomy was 12 minutes,and only 15 patients had postoperative complications.Two patients developed pancreatic leakage(1 grade A and 1 grade B)postoperatively.Pancreaticogastrostomy with double binding continuous hemstitch sutures is a simple and safe reconstruction procedure for patients with a soft and fragile pancreas who received pancreaticoduodenectomy.

Objective To provide scientific evidence for the effectiveness of upper limb training after stroke.Methods Surface electromyograms (sEMGs) of the triceps braehii and biceps brachii were recorded in stroke patients during maximum isometric voluntary contraction (MIVC).A total of 18 patients with hemiparesis were studied.During the elbow's MIVC,flexor and extensor peak torque were measured,and sEMGs of the biceps and tri- ceps brachii were recorded.Results During MIVC,the biceps braehius of the intact side registered a stronger EMG than that of the affected side when the elbow flexed,but the differenees in the triceps braehii readings were not significant.The triceps bracbius of the intact side gave a stronger iEMG than the affected side when the elbow extend- ed,but the iEMG form the biceps brachius of the affeeted side was higher than that of the intact side.The co-contrac- tion ratio (CCR) of the triceps brachius on the affected side was higher than that of the intact side.Though there was a tendency for the CCR of the biceps brachius on the affected side to be higher than the intact side,any difference was not statistically significant.For both flexor and extensor MIVC,the peak torque on the affected side was lower than that of the intact side.Conclusions Elbow spastieity in hemiplegic patients is mainly attributable to the flexor muscles.In the rehabilitation of the upper limb after stroke,it is important when training extensor strength to inhibit co-contraction of the antagonistic muscle.

Objective To evaluate a modified technique for digestive tract reconstruction after pancreaticoduodenectomy(PD).Methods 171 admitted patients were enrolled from January 2012 to January 2014 at our department.According to the preoperative CT scan and intraoperative exploration,pancreaticogastrostomy was performed in cases of soft pancreas texture,while pancreaticojejunostomy was performed in fibrotic pancreas after PD.Bypassed biliary-pancreatic reconstruction were applied on all cases.Results For the digestive tract reconstruction after PD,92 patients underwent pancreaticogastrostomy,79 patients underwent pancreaticojejunostomy.The median time for the surgery was 240.0 minutes (ranging from 186 to 414 min).Operative mortality was zero,and morbidity was 18.1％ (n =31),including hemorrhage (n =4),biliary fistula (n =3),pulmonary infection (n =2),adipose liquefaction and operative incision infection (n =0),delayed gastric emptying (DGE) (n =6),abdominal abscess (n =4).Fout patients developed a pancreatic fistula (type A in 2,type B in 2).Conclusions Modified pancreaticogastrostomy,pancreaticojejunostomy and biliary-pancreatic bypass is safe for digestive tract reconstruction after pancreaticoduodenectomy.

Objective To investigate the distribution of water fluoride and the status of water-improving defluoridation projects,thus to explore the condition of endemic fluorosis in Guangxi Province.Methods According to"The National Technical Scheme for Endemic Disease Contml in 2005",the fuorine content in water Was determined by F-ion selective electrode,children's dental fluorosis was checked by Dean method.and the skeletal fluorosis was checked by the standard of clinical scale of skeletal fluorosis.Results 305 water samples in 61 villages were examined,among which 71 waters were exceeded the standard,accounting for 23.28%(71/305).The projects of defluoriding drinking water were running well except one was discarded.The prevalence of dental fluorosis was 13.55%(356/2627),the prevalence of skeletal fluorosis was 4.02%(65/1615).Conclusions The situation of endemic fluorosis control is not optimistic in Guangxi,which needs fuaher prevention and controls.

Mounting evidence has shown that side population (SP) cells are enriched for cancer stem cells (CSCs) responsible for cancer malignancy. In this study, SP technology was used to isolate a small subpopulation of SP cells in human gallbladder cancer cell line GBC-SD, and SP cells which had superior potential for proliferation in vitro and tumorigenesis in vivo were identified. Importantly, the abundance of GBC-SD SP cells was increased by a transforming growth factor-β (TGF-β)-induced epithelial-mesenchymal transition (EMT), and this effect was accompanied with a strong up-regulation of ABCG2 mRNA expression, and a decreased sensitivity to mitoxantrone. SP cells were restored upon the removal of TGF-β and the reversion of the cells to an epithelial phenotype, and smad3-specific siRNA reduced SP abundance in response to TGF-β. In conclusion, TGF-β-induced EMT by smad-dependent signaling pathway promotes cancer development and anti-cancer drug resistant phenotype by augmenting the abundance of GBC-SD SP cells, and a better understanding of mechanisms involved in TGF-β-induced EMT may provide a novel strategy for preventing cancer progression.

Objective: To investigate the delay in identification of pulmonary tuberculosis and influencing factors among children and adolescents in Jiaxing City, Zhejiang Province from 2013 to 2022, so as to provide the reference for targeted prevention and control measures. Methods: The information of pulmonary tuberculosis patients in Jiaxing City from 2013 to 2022 were captured from the Tuberculosis Information Management System of Chinese Disease Control and Prevention Information System, including demographics, diagnosis, treatment and etiological results. The delay in identification of pulmonary tuberculosis was analyzed among children and adolescents, and the factors affecting the delay in identification of pulmonary tuberculosis were identified using a multivariable logistic regression model. Results: A total of 2 407 pulmonary tuberculosis cases were reported among children and adolescents in Jiaxing City from 2013 to 2022, including 1 522 males (63.23%). The median age was 21.00 (interquartile range, 4.00) years. There were 410 students (17.03%), and 1 856 cases with non-local household registration (77.11%). There were 596 cases with delay in identification of tuberculosis (24.76%), 895 cases with delay in healthcare-seeking (37.18%) and 128 cases with delay in definitive diagnosis (5.32%). Multivariable logistic regression analysis that children and adolescents who occurred symptoms in the first quarter (OR=1.684, 95%CI: 1.261-2.249), were diagnosed first in county-level medical institutions (OR=3.800, 95%CI: 2.898-4.983) and had positive results of etiological testing (OR=1.534, 95%CI: 1.255-1.874) were more likely to delay in identification of pulmonary tuberculosis. Conclusions The delay in identification of pulmonary tuberculosis is associated with the time of symptom onset, the level of medical institution making first diagnosis, and the results of etiological testing. It is suggested to reinforce the publicity of pulmonary tuberculosis prevention and control, expand the coverage of screening programs and improve the diagnosis capability of medical institutions.

Objective To assess the cardiovascular events after percutaneous transluminal coronary intervention (PCI) and the influence of fluvastatin on inflammation factors and prognosis of PCI patients.Methods One hundred and eighty-seven patients whose coronary stenosis ≥ 70% diagnosed through coronarography and underwent PCI from Jun.2005 to Feb.2008 were recruited in the current study.These patients were divided into two groups,the control group (n =91) was treated regularly and the treat group (n =96) was treated with additionally fluvastatin(40 mg/d).Fasting venous blood was obtained before and after medicine treatment,12,24 hours and two weeks after PCI.IL-18,IL-6 and TNF-α were measured through ELISA.Results Before medicine treatment,there were no difference of IL-18 ,IL-6 and TNF-α between the two groups( P ＞ 0.05 ).After medicine treatment,IL-18,TNF-α and IL-6 decreased significantly compared to those before treatment in both groups ( P ＜ 0.05 ),and these measurements decreased more in the treatment group ( P ＜ 0.01 ).At the 12th hours after PCI,IL-18,TNF-αand IL-6 in the control group increased to (423.5 ± 298.7 ),( 316.1 ± 72.6 ) and (42.3 ± 10.1 ) ng/L,respectively,and arrived the peak at the 24th hour,which were significantly higher than those before medicine treatment( P ＜ 0.01 ).In the treatment group,these measurements at the 12th and 24th hour after PCI were slightly higher than those before medicine treatment without significant difference ( P ＞ 0.05 ).After 12 hours ofPCI,IL- 18,TNF -αand IL-6were (276.5 ± 189.4 ),( 175.3 ± 51.9) and ( 10.1 ± 8.1 ) ng/L,which were significantly lower than those in the control group(P ＜ 0.01 ).Two weeks after PCI,IL-18,TNF-α and IL-6 in the treatment group were (137.0 ±34.2),(35.1 ± 21.6) and ( 8.7 ± 3.2 ) ng/L,which were significantly lower than before medicine treatment ( P ＜0.01 ).Conclusions PCI may aggravate the inflammation response of coronary artery.Statins may alleviate the inflammation response.IL-18,TNF-α and IL-6 are sensitive indices of early inflammation response after PCI,their changes might have prediction value for adverse cardiovascular events.Therefore these indices might be used as a target in the statins treatment in the primary prevention,as well as the evaluation of the effectiveness of PCI,statins and joint PCI and statins.