With reference to the teaching reform of standardized training cases based on organ systems, a teaching case writing team has been established, integrating the teaching experts in basic medicine, clinical medicine, humanities medicine, and other fields. Through collective lesson preparation and discussion, non-fictional comprehensive scenario writing techniques have been used based on organ systems and oriented by competency development, and the teaching cases for postgraduate students were written on the basis of real cases, which lays a solid foundation for the hierarchical and progressive cultivation and improvement of the quality of competency cultivation for postgraduate students through case teaching based on organ systems.

OBJECTIV E To establish the method for evaluating the quality o f Plantago asi atica and fried P. asiatica . METHODS The fingerprints of 15 batches of P. asiatica and 15 batches of fried P. asiatica were established by HPLC. The common peaks were identified with the Similarity Evaluation System for Chromatographic Fingerprinting of TCM （2012 edition）， and similarity evaluation was performed. Analysis of chemical pattern recognition was performed by using SPSS 25.0 and SIMCA-P 14.1 software（cluster analysis ，principal component analysis and orthogonal partial least squares regression analysis ）. The markers which affected the difference in the quality between P. asiatica and fried P. asiatica were screened with variable importance projection（VIP）value greater than 1. RESULTS There were 18 common peaks in the fingerprints of 15 batches of P. asiatica and 13 common peaks in the fingerprints of 15 batches of fried P. asiatica . A total of 8 common peaks were found in both of them. Their similarities were greater than 0.920. Two common peaks were identified as geniposidic acid ，acteoside. The results of cluster analysis showed that when the spacing was 10，the 30 batches of samples could be clustered into three categories ，with S 1-S5 as one，S16-S20 as one ，S6-S15 and S 21-S30 as one . The results of the pri ncipal component analysis showed that the cumulative variance contribution rate of the first two principal components was 82.575％ . The results of the orthogonal partial least squares regression analysis showed that the VIP values of the three common peaks were greater than 1，namely peak E（acteoside）， peak D （geniposidic acid ） and peak G. CONCLUSIONS Established fingerprints are stable ，simple sina.com and rapid. It can be used for the quality evaluation of P. asiatica and fried P. asiatica ，by combining with analysis of chemical pattern recognition. Acteoside ，geniposidic acid and the component represented by peak G may be the markers affecting the difference in quality of P. asiatica and fried P. asiatica .

【Objective】 To understand the current situation of blood components distribution in domestic prefecture-level blood stations through analyzing the components distribution data of 24 prefecture-level blood stations in China. 【Methods】 The data of components distribution of 24 blood stations from 2017 to 2020 as well as the data of blood deployment of 24 blood stations from 2019 to 2020 were collected and analyzed. 【Results】 From 2017 to 2020, positive annual growth in red blood cells, plasma and cryoprecipitate was observed in 22, 19 and 15 out of the 24 blood stations, and the annual growth median rate of above three components was 5.24%, 3.80% and 3.25%, respectively. Among the 24 prefecture-level blood stations, 23 carried out the preparation of cryoprecipitate. 【Conclusion】 The distribution of red blood cells, cryoprecipitate and plasma in prefecture-level blood stations is increasing year by year. However, there is a overstock of plasma, and most blood stations need blood employment.

ObjectiveTo explore the meridian tropism of components in Bupleuri Radix （Chaihu， CH） based on the model of nonalcoholic steatohepatitis （NASH） and clarify the substance basis of the meridian tropism of CH in Xiaoyaosan （XYS） by means of principal component analysis. MethodEighty SPF male C57BL/6 mice were randomly assigned into 8 groups， with 10 mice in each group. Except that the blank group was fed with the methionine choline-sufficient （MCS） diet， the other mice were fed with methionine choline-deficient （MCD） diet for 4 weeks to establish the nonalcoholic steatohepatitis （NASH） model. After the established model was confirmed by hematoxylin-eosin （HE） staining， the mice were administrated with corresponding drugs by gavage once a day for 4 weeks. Specifically， the 8 groups were XYS group （2.874 g·kg^-1）， XYS-CH group （2.445 g·kg^-1）， XYS-CH+volatile oils （Vol， 0.163 mg·kg^-1） group， XYS-CH+polysaccharides （Pol， 24.067 mg·kg^-1） group， XYS-CH+flavones （Fla， 2.241 mg·kg^-1） group， and XYS-CH+saponins （Sap， 2.746 mg·kg^-1） group. The model group and the blank group were administrated with the same volume of normal saline. After the last administration， the mice were sacrificed for the collection of blood and liver tissue. The pathological changes of liver were observed by HE staining and oil red O staining. Enzyme linked immunosorbent assay （ELISA） kits were used to determine the levels of alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， triglyceride （TG）， total cholesterol （TC）， high-density lipoprotein （HDL）， and low-density lipoprotein （LDL） in serum as well as malondialdehyde （MDA）， superoxide dismutase （SOD）， catalase （CAT）， and glutathione peroxidase （GSH-Px） in liver. SPSS Statistics 23 was used for principal component analysis and comprehensive evaluation to determine the substance basis of the meridian tropism of CH in NASH mice. ResultCompared with the blank control group， the modeling led to hepatocyte swelling， increased fat vacuoles， and appearance of inflammatory cells. Further， the modeling elevated the levels of ALT， AST， TG， TC， and LDL and lowered the HDL level in serum， and it increased the MDA level and decreased the SOD， CAT， and GSH-Px levels in liver. Compared with the model group， the administration of XYS and XYS-CH in combination with the components of CH alleviated the oxidative damage in liver （P<0.05）. The comprehensive score of the pharmacological efficacy was in a descending order as follows： XYS > XYS-CH+Sap > XYS-CH+Fla > XYS-CH+Pol > XYS-CH+Vol > XYS-CH. Among the chemical components of CH， Sap had the best effect. ConclusionSap lowers the blood lipid level， regulates the abnormal lipid metabolism， and alleviates the oxidative damage of liver， which is the substance basis for CH to exert the meridian tropism in liver.

Objective:To investigate the long-term effects of metabolically healthy obesity on the risks of type 2 diabetes, cardiovascular disease events, and its mortality over a 23-year follow-up.Methods:Based on the results of an oral glucose tolerance test, there were 519 participants with normal glucose tolerance and 630 with newly diagnosed type 2 diabetes enrolled in 1986 and then given to assess the long-term clinical outcomes during the 23-year follow-up in Daqing. Metabolically healthy obesity was defined as the overweight and obese individuals with no metabolic abnormalities (diabetes, hypertension, hyperlipidemia). Finally, we identified 682 participants (350 with normal glucose tolerance and 332 with newly diagnosed diabetes). They were divided into five groups: 211 individuals with metabolically healthy normal weight (MHNW group), 58 with metabolically healthy overweight and obesity (MHO group), 81, 109, 223 were metabolically unhealthy overweight and obesity with hypertension (MUHO group), type 2 diabetes (MUDO group), hypertension and diabetes (MUHDO group). Incidences of type 2 diabetes, morbidity and mortality of cardiovascular disease were compared among these groups.Results:Over 23 years, instead of the morbidity and mortality of cardiovascular disease, the incidence of type 2 diabetes in MHO group was two times higher than in MHNW group ( 24.1%, 12.5/1 000 person years vs 10.9%, 5.2/1 000 person years, P=0.01), with an age, sex, and smoking history-adjusted hazard ratio ( HR) of 2.42 (95% CI 1.24-4.74, P=0.01). The morbidity and mortality of cardiovascular disease in the groups of overweight and obesity with metabolically unhealthy were higher than in MHNW group, and increased across the subjects with MUHO, MUDO, MUHDO ( P<0.05). Conclusion:Compared with metabolically healthy normal weight participants, the metabolically healthy obese group was at increased risk of type 2 diabetes but not cardiovascular disease events and its mortality. On the contrary, the overweight and obese groups with metabolic abnormalities had significant higher incidence of type 2 diabetes, morbidity and mortality of cardiovascular diseases.

After multidisciplinary treatment including radiotherapy, the median survival of patients with glioblastoma multiforme (GBM) remains approximately 1 year. The heterogeneity of the genome and proteome of glioblastoma stem cells (GSC) is the fundamental factor affecting the prognosis. Proteomics-based sensitization of key radioresistance proteins is expected to improve the prognosis of GBM patients. In this article, literature review was conducted from PubMed and other databases in the previous 10 years to systematically discuss the research progress on various commonly used protein quantitative techniques, tools for data processing analysis and the application in radioresistance and radiosensitization of GSCs.

Objective:To investigate the clinical characteristics, treatment and prognosis of QARS1 gene related glutaminyl-tRNA synthetase deficiency.Methods:To summarize and analyze the clinical manifestations, imaging, laboratory examination, genetic variant characteristics and treatment of three patients from the Fujian Medical University Affiliated Union Hospital, the 900th Hospital of People's Liberation Army, the First Medical Center of People's Liberation Army General Hsopital carrying compound heterozygous variations in QARS1 gene with a long-term follow-up in China. A literature search was conducted using Wanfang, Weipu, China National Knowledge Infrastructure (CNKI) and Pubmed databases with the keywords "QARS", "QARS1" and "glutaminyl-tRNA Synthetase"(up to December 2019). Results:Case 1, a female 53 days of age, was admitted to the Fujian Medical University Affiliated Union Hospital for treatment because of the complaint of repetitive seizures for one month after birth and fever for one day. The seizure occurred within the first 2 hours of life with multiple forms and often had a status as persisted from hours to days. The seizures were resistant to many anti-epilepsy drugs (AED) and ketogenic diet but later controlled by clonazepam. However, she died at the age of seven years. Case 2 (younger brother of case 1), a one-hour-old boy, was hospitalized because of seizures after birth for 1 hour. Intrauterine growth retardation was discovered during late-pregnancy. The boy presented seizures and microcephaly immediately after birth, and his epilepsy was pharmacoresisitant. Case 3, an 8-month-old girl, was admitted due to recurrent convulsions for nearly two months. The girl had mild developmental retardation and hypotonia after birth. The infantile spasm was observed at her age of 6 months and disappeared under treatment with Vitamin B6, vigabatrin combined with adreno-cortico-tropic-hormone and magnesium sulfate. However, the seizure pattern turned to tonic seizures later. She was seizures free now with clobazam and zonisamide treatment. All of them manifested as a syndrome composed of severe global developmental retardation, progressive microcephaly, hypotonia from the very beginning, mild hypoproteinemia and diffuse brain atrophy. Genetic studies revealed compound heterozygous variations of QARS1 gene which were not reported previously . A review of the literature reported a total of 22 patients from 18 unrelated families all over the world. Except for 5 cases without epilepsy,all the patients shared very similar clinical manifestations as classic pentalogy. The recommended effective treatment for epilepsy has not been reported yet. Conclusions:Glutaminyl-tRNA synthetase deficiency caused by QARS1 gene variations manifested as a clinical syndrome′s pentalogy, characterized by microcephaly, cerebral atrophy, intractable early-onset epileptic encephalopathy, global developmental retardation and severe muscle hypotonia.

Objective: To investigate the correlation between age-related hearing loss and cognitive impairment. Methods: 201 elderly patients, who were admitted to the Department of Otorhinolaryngology of Peking University People′s Hospital from March 1, 2017 to March 31, 2017, were evaluated with hearing screening and the Montreal Cognitive Assessment Scale. Among them, 101 were female and 100 were male, aged 60-90 years old. Taking the cognitive level as the dependent variable, and taking the age, sex, education, occupation, marital status, residence, and average hearing loss (average hearing threshold of 500, 1 000, 2 000, and 4 000 Hz), as well as the length of conscious hearing loss as the independent variables, the single factor analysis and multivariate linear regression analysis were used to screen the main factors affecting the cognitive level of the elderly. Results: Of the 201 elderly patients, 39 had normal hearing, 65 had mild hearing loss, 80 had moderate hearing loss, 16 had severe hearing loss, and 1 had profound hearing loss. The average degree of hearing loss was the influencing factor of cognitive impairment, and it mainly affected the directional force and abstract ability in the cognitive domains (P<0.05); The age, self-reported hearing loss, years of education, marital status, past ear diseases, and hypertension were relatively independent factors that affected the cognitive level(P<0.05). Conclusions Age-related hearing loss is the risk factor for the cognitive impairment, especially for abstraction and orientation, in the elderly. The self-reported hearing loss is an independent risk factor for cognitive impairment.

Objective To explore the influence of lifestyle intervention on long-term diabetes in subjects with impaired glucose tolerance (IGT) returned to normal glucose tolerance (NGT) within 6 years.Methods A total of 577 subjects (aged 25-74 years old) with IGT in Daqing were enrolled and randomly assigned to control,and diet,exercise and diet plus exercise groups in a six-year intervention trial in 1986.Subjects who were non-diabetic at the end of the intervention were followed up for additional 14 years.Results Among all the subjects,41.38％ of them who had returned to NGT from IGT within 6 years maintained NGT status after 20 years,and had a lower incidence of diabetes than subjects maintained IGT status (46.55％ vs.75.25％).Of note,in the intervention group,the percentage of participants developed diabetes in the NGT subjects was significantly lower than that in the IGT group (43.71％ vs.76.25％) after 20 years.There was high long-term risk for diabetes in the IGT subjects after the adjustment of age,sex and baseline glucose (HR=1.81,95％CI 1.27-2.58,P=0.001),whereas in the non-intervention group,no significant difference could be viewed in long-term diabetic risk between subjects maintained IGT status and those returned to NGT (71.43％ vs.65.22％) after adjusting of the same confounders (HR=1.03,95％CI 0.45-2.35,P=0.94).Conclusions IGT subjects who had returned to NGT in early years had lower risk for future diabetes than those who remained IGT.However,this beneficial effect could only be viewed in the intervention group,but not in the non-intervention group.

Objective: To investigate the expression levels and clinical significance of serum miRNAs, including miR-146a-5p, miR-155-5p and miR-124a-3p, in patients with rheumatoid arthritis (RA). Methods: The clinical data, whole blood and serum samples from 39 RA patients hospitalized in our hospital during October 2016 and October 2018 were collected. Whole blood specimens were used to determine erythrocyte sedimentation rate (ESR), and serum samples were used to detect rheumatoid factor (RF), C-reaction protein (CRP) and miRNAs. The expression levels of serum miR-146a-5p, miR-155-5p and miR-124a-3p in RA patients were detected by SYBR Green real-time fluorescence quantitative PCR. Results: The expression levels of serum miR-146a-5p (1.742±1.058) in RA patients before treatment were significantly higher than that in healthy controls (HC, 1.045±0.772), which were positively correlated with DAS28 scores (r=0.836 5,P=0.004 5), ESR (r=0.437 2, P=0.032 5) and RF levels (r=0.733 6,P=0.013 7). However, the expression levels of serum miR-155-5p (U=42.00,P=0.032 9) and miR-124a-3p (U=44.5,P=0.044 5) in RA patients were significantly lower than that in HC, and the expression levels of serum miR-155-5p were negatively correlated with RF levels (r=-0.445 3,P=0.031 6), and the expression levels of serum miR-124a-3p were negatively correlated with DAS28 scores (r=-0.538 7,P=0.025 8) and RF levels (r=-0.436 5,P=0.046 3). After treatment, the expression levels of serum miR-146a-5p (U= 60.00,P=0.003 8) in RA patients were significantly decreased, while the expression levels of serum miR-155-5p (U=64.00,P=0.005 9) and miR-124a-3p (U=85.00,P=0.042 2) were significantly increased. Conclusion The abnormal expression levels of serum miR-146a-5p, miR-155-5p and miR-124a-3p in RA patients have potential clinical significance for the diagnosis of RA.