Small cell lung cancer (SCLC) has a poor biological behavior,high probability of recurrence and metastasis,and limited treatment.The Notch signaling pathway is an evolutionarily conserved pathway that regulates the growth of many cell types through local cell-cell interactions.It controls the differentiation,proliferation and survival of cells.As a ligand for the Notch pathway,delta-like protein 3 (DLL3) is highly expressed on the membrane of SCLC cells.DLL3 plays an important role in cancer initiation and epithelial mesenchymal transition,invasion and metastasis of SCLC.Rovalpituzumab tesirine is a conjugate of directed against DLL3,which shows great potential for SCLC therapy.

Objectives: To provide new ideas on how to shift students' learning attitude from passive learning to active learning, we explored and evaluated a case/problem-based and interactive teaching mode in pathophysiology curriculum. Methods: Case/problem-based and interactive teaching mode is an innovative teaching model adopted in pathophysiology curriculum for grade 2015 students of 5-year program in clinical medicine and other medical students of non-clinical majors in Xiangya Medical School, Central South University. The teaching effectiveness of the case/problem-based and interactive teaching mode was evaluated by questionnaire survey, with 460 medical students enrolled in the survey whose approval degree on current teaching mode was analyzed. Excel was used to collect and process data, complete descriptive analysis and calculation of the percentage of indicators. Results: A total of 460 anonymous questionnaires were distributed and 453 valid questionnaires were retrieved, from which the following information was obtained: ① Pre-class learners' guidance designed for current teaching mode: 88.7% of students (402/453) believed that "Pre-class Learners' Guidance" motivated them to preview relevant teaching contents before class. 82.8% of students (375/453) believed "Pre-class Learners' Guidance" improved discussion quality in class. 76.6% of students (347/453) believed "Pre-class Learners' Guidance" expanded thinking and exploring space, while it did not increase student study burden (306/453, 67.6%). ② Compared with traditional teaching mode, the case/problem-based and interactive teaching mode had following advantages: It's helpful to cultivate students' clinical thinking (414/453, 91.4%), strengthen students' memory and understanding during study (400/453, 88.3%), attract students' attention in class (380/453, 83.9%), and aroused student's interest in class discussion (327/453, 72.2%). ③ 83.4% of students (379/453) preferred current teaching mode: they believed this teaching mode could improve students' ability to analyze and solve problems (325/453,71.7%), train clinical thinking (321/453, 70.9%), improve students' self-study ability (247/453, 54.5%) and increase students' capabilities of making summary and conclusion (197/453, 43.5%). Conclusion Case/problem-based and interactive teaching mode in pathophysiology curriculum enhances students' ability of self-studying, activates classroom's atmosphere, improves teaching quality, and effectively fosters students' clinical thinking. Therefore, this teaching mode deserves to be spread and applied in classroom teaching of pathophysiology and other basic medicine disciplines as well.

Objective:To establish an analysis method for determining the contents of 7 components including ganoderic acid C2, ganoderic acid B,ganoderic acid G,ganoderic acid A,lucidenic acid A,ganoderma D and ganoderic acid F in ganoderma by QAMS. Methods:An HPLC method was used. The column was WatersX-bridge C18(250 mm × 4.6 mm, 5 μm), the mobile phase was acetonitrile(A)-1% acetic acid(B) (28:72) with gradient elution(0-30 min:A-28% to 38%;30-45 min:A-38% to 55%) at a flow rate of 1.0 ml·min-1,the column temperature was 30℃, and the detection wavelength was 254 nm. Ganoderic acid A was used as the internal reference, the correction factors of ganoderic acid C2, ganoderic acid B, ganoderic acid G, lucidenic acid A,ganoderma D and ganoderic acid F were calculated,and the contents of the 7 components were calculated by an external standard method to verify the feasibility and applicability of QAMS. Results:The relative correction factors of multiple assessments were reproducible,and the relative deviation of the contents of 6 components in 16 batches of Ganoderma lucidum was less than 2% when compared with that of the external standard method. Conclusion:QAMS is accurate and reliable in the quality evaluation of Ganoderma lucidum.

Objective: To study the quality and stability of bromhexine hydrochloride dry powder inhalations (BH DPIs). Meth-ods: BH DPIs were prepared by freeze-drying with an air jetting method. The humidity and critical relative moisture of the inhalations were investigated. The aerodynamic particle size ( Dae) and water content were also analyzed. The powder morphology was observed under a scanning electronic microscope. The fine particle fraction (FPF) and delivered dose uniformity (DDU) of BH DPIs were de-termined. The stability of the inhalations was determined by accelerated testing and long-term testing. Results: The prepared BH DPIs exhibited the following properties: the critical relative humidity was 65% ; Dae was <5 μm; the water content was less than 2% ; FPF was >30% ,and DDU was good according to the requirement of Chinese Pharmacopoeia. The accelerated testing and long-term testing both indicated promising stability of BH DPIs. Conclusion: Bromhexine hydrochloride dry powder inhalations are stable, and suitable for the use in pulmonary delivery system.

Objective    To compare the effects of transthoracic device closure and surgical closure on ventricular septal defect systemically. Methods    A systematic literature search was conducted using the PubMed, EMbase, The Cochrane Library, VIP, CNKI, CBM, Chinese Clinical Trial Register, ClinicalTrials. gov and Wanfang Database up to July 31, 2016. Quality was assessed and data of included articles were extracted. The meta-analysis was conducted using RevMan 5.0 and Stata 14.0 software. Results    Eleven studies were identified, including 5 RCTs and 6 cohort studies involving 2 504 patients. For success rate, there was no statistical difference between the transthoracic closure group and the surgical closure group in RCT (RR=0.99, 95%CI 0.96 to 1.03, P=0.70); the success rate in the transthoracic closure group was lower than that in the surgical closure group in the cohort study (OR=0.21, 95%CI 0.08 to 0.55, P=0.002). Both  results of RCTs and cohort studies showed that compared with surgical closure, transthoracic device closure reduced duration of the operation (RCT MD=–79.38, 95%CI –95.00 to –63.76, P<0.000 01; cohort study MD=–66.26, 95%CI –71.20 to –61.31, P<0.000 01) and hospital stay (RCT MD=–2.10, 95%CI –2.65 to –1.55, P<0.000 01; cohort study MD=–3.99, 95%CI –6.03 to –1.94, P=0.000 1), and the patients with blood transfusion (RCT RR= 0.04, 95%CI 0.01 to 0.11, P<0.000 01; cohort study OR=0.01, 95%CI 0.00 to 0.13, P=0.001). In the transthoracic closure group the risk of postoperative arrhythmia reduced (RCT RR=0.20, 95%CI 0.13 to 0.32, P<0.000 01; cohort study OR=0.46, 95%CI 0.31 to 0.67, P<0.000 1). In the transthoracic closure group a higher postoperative valvular regurgitation risk in RCT induced (RR=1.45, 95%CI 1.07 to 1.96, P=0.02) and the rate of postoperative valvular regurgitation in cohort study reduced (OR=0.43, 95%CI 0.20 to 0.92, P=0.03). However, there was no statistical difference in postoperative residual shunt (RCT RR=0.96, 95%CI 0.57 to 1.62, P=0.89; cohort study OR=0.52, 95%CI 0.12 to 2.25, P=0.38). Conclusion    Transthoracic device closure can shorten duration of the operation, hospital stay and reduce the patients with blood transfusion and post- and intraoperative arrhythmia risk. Therefore, transthoracic device closure may be a better approach for some ventricular septal defect patients.

Objective To study the effect of lithium chloride on the gap junction in the myocardium under chronic hypoxia.Methods Twenty-five C57BL/6J mice were randomly divided into normoxia group,hypoxia group,normoxic control group,hypoxia + saline group and hypoxia + lithium chloride group.Hypoxia group was treated with 10％ oxygen concentration for 4 weeks.Hypoxia + saline group and hypoxia + lithium chloride group were intraperitoneal injection of saline and lithium chloride.Electrophysiology and cardiac catheterization were used to assess arrhythmias,heart rate and ejection fraction.The expression of Cx43,phosphorylated glycogen synthase kinase 3β(p-GSK-3β) and glycogen synthase kinase 3β (GSK-3β) were detected by Western blot.Results Compared with the normoxia group,the hypoxia group had a faster heart rate [(448 ± 18) bpm vs.(401 ± 13) bpm,P＜0.05),and the ejection fraction was decreased [(56±5)％ vs.73±4)％,P＜0.05],arrhythmia score increased [(3.4±0.5)％ vs.(0.6±0.5)％,P＜0.05],Cx43 expression was decreased.Compared to hypoxia + normal saline group,the heart rate decreased[(412±11)bpm vs.(454±18)bpm,P＜0.05],ejection fraction increased[(69±3)％ vs.(55±4)％,P＜0.05],the score of arrhythmia decreased [(1.8±0.4) ％ vs.(3.0±0.7)％,P＜0.05] in hypoxia + lithium chloride group,the expression of Cx43 and the rate of p-GSK-3β to GSK-3β were increased.Conclusion During the chronic hypoxia,lithium chloride can sustain the gap junction through inhibition of GSK-3β signaling way,which can also reduce the rate of arrhythmia.

Objective To provide reliable reference for improving teaching methods of case discus-sion, the teaching effectiveness evaluation on classroom-site segmented discussions of a patient case was completed in internal environment system. Methods The questionnaire survey was conducted among 250 clinic students of 8-year program and of 5-year program to investigate the teaching effectiveness following implementation of the teaching plan called"classroom-site segmented study of patient case debate competi-tion seminars". The contents of questionnaire survey included: the students' view on characteristics and advantages of this teaching plan and the reasons for favoring and supporting the plan. Investigation was conducted using an anonymous questionnaire. A total of 250 questionnaires were distributed and 247 valid questionnaires retrieved. Data collection and analysis were performed by using Excel and SPSS 17.0 statistical software, percentage of each observing parameter was calculated. Results ①The students' view on ad-vantages of the plan included following: reducing students' study burden by 78.5％ (194/247), increasing the students' engagement in class activities by 85.4％(211/247), improving teaching quality in class discus-sion by 80.5％ (198/246), enhancing team spirit among students by 78.5％ (194/246), expanding students' thinking and exploring space by 84.5％ (207/245), and similarity of this teaching plan to clinical diagnosis and treatment process reached to 84.0％(197/235). ②The students' reasons for favoring and supporting this plan included: reducing students' study burden by 83.4％ (206/247), improving teaching quality in class discussion by 72.4％(179/247), and training students' ability to search clinical information by 82.4％ (203/247). Conclusion Implementation of the teaching plan, "classroom-site segmented study of patient case debate competition seminars", in internal environment system has reduced students' study burden, improved teaching quality, and effectively trained students' clinic thinking, which is widely welcomed by students, therefore providing a positive valuable reference to other discussion class.

In recent years,a considerable number of epidemiological investigations and animal studies have confirmed that metabolic diseases, such as obesity,type 2 diabetes mellitus and metabolic syndrome, have adverse effects on brain functions,inducing mood disorders and cognition impairment. Brain dysfunctions induced by obesity and related complications are associated with numerous central abnormalities,involving brain shrinkage and neurotrophic function impairment,brain insulin resistance, brain oxidative stress,and brain leptin resistance,as well as dysfunctioned dopamine motivation and the reward system. Moreover,these brain dysfunctions are mediated by several peripheral factors, such as triglycerides/free fatty acids,proinflammatory cytokines,and corticosterone/glucocorticoid. On the other hand,metabolic disturbances correlated with emotional-cognitive disorders are evident,but the mechanisms remain obscure. Because of the drawbacks of animal models, the majority of researches focus on the impact of mental stress on the metabolism of lipid and glucose. The interrela?tionship between metabolic diseases and brain functions has become one of the hot spots for research. In this review,we mainly discussed the potential mechanisms underlying mood disorders and cognition impairment induced by obesity and related complications.

Objective: To discuss the quality control method and index of traditional She medicine -Melastoma dodecandrum. Methods:The contents of gallic acid , ellagic acid and total flavonoids ( the total amount of quercetin and kaempferol) were deter-mined by HPLC. Water content, acid insoluble ash content, extract, heavy metals and harmful elements in 26 batches of herbs were also detected. Results:The content range of gallic acid, ellagic acid and total flavonoids was 9. 84-26. 31 mg·g-1 , 4. 13-16. 11 mg· g-1 and 1. 31-38. 28 mg · g-1 , respectively. The content range of water, acid insoluble ash and extract was 6. 70%-13. 90%, 1. 05%-6. 20% and 18. 00%-40. 80%, respectively. The content of Pb in all the samples was more than 5 ppm, the number of sam-ples with the content of Cd above ten thousand three was 7, and the content of As, Hg and Cu in all the samples was less than 1 ppm, ten thousand one and 20 ppm, respectively. Conclusion:The contents of gallic acid, ellagic acid and total flavonoids can comprehen-sively reflect the content of active ingredients in Melastoma dodecandrum. The contents of acid insoluble ash, Pb and Cd in Melastoma dodecandrum are relative high, which should be studied further to draw up reasonable limit.

Objective To construct a questionnaire for patients to participate in hand hygiene promotion in medical institutions,and provide a measuring tool for patients to participate in hand hygiene promotion.Methods A ques-tionnaire was constructed by methods of literature research,expert panel discussion,pre-investigation,and Delphi. Results This questionnaire was designed respectively for patients and health care workers,each contained 20 ques-tions,involving hand hygiene perception,willingness to participate in promoting hand hygiene,and participation method,et al.Conclusion A questionnaire for patients to participate hand hygiene promotion in medical institutions is preliminary constructed,which can be used for evaluating patients’and HCWs’willingness and relevant influen-cing factors of patients’participation in hand hygiene promotion in medical institutions.