Improving medical students' legal quality is not only the requirements of modern education and their self-improvement,but also the needs of reform on medical system in the new era and establishment of a harmonious relationship between doctors and patients.Medical universities should carefully integrate the existing law education resources and establish three staged teaching model (stages of basis law education,health law education and stage of comprehensive improvement) when being fronted with the education model which is unilateral,sporadic and lack of cohesion in order to improve the law quality of medical students.

Objective To compare the effects of hypothermic arrest circulation ( HAC) with moderate or deep hypothermic antegrade selective cerebral perfusion ( ASCP) technique in patients with DeBake type Ⅰ aortic dissection or aortic arch aneurysm undergoing total aortic arch replacement. Methods Between Feb. 2007 and Aug. 2009, 60 patients who underwent aortic arch replacement using HAC + SCP technique. Patients were divided into two groups according to the lowest nasopharyngeal temperature: moderate hypothermia (18 - 20℃) (group MH, n = 28), and deep hypothermia (23 -25 ℃) (group DH,n=32). The clinical and neurological outcomes were observed. Results The overall in-hospital mortality was 3. 33% (2/60) ; In-hospital mortality was 3. 6% in the MH group, while3.1% in the DH group. There were no significant differences regarding to preoperative the patients' character parameters in both groups. At the beginning of ASCP, the nasopharyngeal and rectal temperatures were significantly higher in group MH[MH group (23.8 ± 1. 9 ) ℃ ( 26. 6 ± 2. 4 ) ℃ vs. DH group group (29.4 ±9.3) min vs. DH group(32.9 ± 13.4) min]. The rewarming time and CPB time were significantly shorter in MH group[(65.0±13.9) min vs. (90.3 ±27.2) min; (142.8 ±34.2) min vs. (194.1 ±42.0) min, P <0. 05]. Temporary neurologic deficits occurred in four patients (6. 67% ) without significant differences between two groups ( MH group 7.14% vs. DH group 6. 25% ). No patient suffered from permanent neurologic dysfunction. There were no significant differences between two groups in other parameters including intubation time, kidney insufficiency, the stay times in ICU and hospital. Conclusion Our results demonstrate that moderate HCA + ASCP technique is a safe strategy for the treatment of patients who require conventional total arch replacement with individual arch-vessel reconstruction. Shorter CPB time in patients with moderate HCA + ASCP did not increase any other postoperative adverse effects.

Metabolic syndrome (MS)is a clinical syndrome featured by glucose and lipid metabolic disorders,hyper- tension and obesity etc.,whose key links are insulin resistance and abdominal obesity.MS is closely related with cor- onary atherosclerosis,every link of MS can lead to occurrence and development of atherosclerosis.The present arti- cle mainly stated research progress of the correlation between MS and coronary atherosclerosis in recent years.

Objective To study the expression of E-cadherin protein and Snail protein in the labial glands of patients with primary Sj(o)gren's syndrome(pSS) and to analyze their roles in the pathogenesis of pSS.Methods The expression of E-cadherin protein and Snail protein were detected by immunohistochemical method.The labial glands were obtained from 50 patients with pSS and 30 healthy controls.The data was analyzed by Chi-Square test,Fisher's exact probability and Spearman's rank correlation analysis.Results The expression rate of E-cadherin in the labials gland of the patients with pSS were lower than that in normal salivary tissues (x2=14.651,P＜0.01).The positive rates of Snail in the labial glands of the patients with PSS were 40％ and it's expression rates were significantly higher than those in normal salivary tissues (x2=28.800,P＜0.01).There was a negative correlation between lymphocyte focus score and the expression of E-cadherin (P＜0.01) and a positive correlation between lymphocyte focus score and the expression of Snail in pSS group (P＜0.01).There was a negative correlation between the expression of E-cadherin and Snail (rs=-0.484,P＜0.01).Conclusion The interaction of E-cadherin and Snail may have played an important role in the pathogenesis of PSS.

Objective To investigate the epidemiologic features of infant rotavirus (RV) diarrhea in Nanjing area .Methods The detection of group A rotavirus were performed on 7 325 outpatients from intestinal clinic of Nanjing Children′s Hospital by using immune colloidal gold method ,and the epidemiological analysis were did according to the detection results .Results In the 7 325 pa-tients ,2 353 were found rotavirus positive ,the total positive rate was 32 .12% .The positive rate of 1 -2 years old group was the highest(43 .51% ) ,compared with other age groups (P< 0 .05) .In November ,December and January ,the positive rates were 52 .20% ,46 .98% ,46 .59% ,respectively .Compared with the positive rate in other months ,there was statistically significant differ-ence(P<0 .05) .The infection rate of RV in vaccine group and non-vaccine group were 9 .06% and 38 .74% ,respectively .There was significant difference between the two groups .Conclusion Infants of 6 months to less than 3 years old in Nanjing have higher de-tection rate of RV infection ,and the infection peak appears in autumn and winter .

Objective To investigate the influencing factors on the nursing ability of caregivers who provide service for elderly Methods patients with cardiovascular disease in medical and nursing combination institutions. A total of 276 caregivers who provide service for elderly patients with cardiovascular disease in medical and nursing combination institutions in Beijing urban area were selected as research subjects using the judgment sampling method. The Chinese Caregiver Task Inventory, eHealth Results Literacy (eHL) Scale and Sense of Coherence (SOC) Scale were used to investigate the nursing ability, eHL and SOC. The scores of nursing ability, eHL and SOC of the caregivers were (28.3±6.1), (17.0±5.9) and (69.0±9.4), respectively. The results of multiple linear regression analysis showed that caregivers who regarded the occupation as a career, had general or good subjective income, cared for disabled subjects, had a good basic knowledge of cardiovascular disease and qualified eHL had P P Conclusion relatively high nursing ability (all <0.01). The higher the SOC score, the higher the nursing ability ( <0.01). Occupational recognition, subjective income, master the basic knowledge of cardiovascular diseases, disability of nursing patients, eHL and SOC were factors affecting the nursing ability of caregivers who provide service for elderly patients with cardiovascular diseases in urban medical and nursing combination institutions.

[Objective] To observe the effect of Chai Qin Pingwei Capsule (CQPC) on gastric mucosal cell apoptosis and regulatory genes in rats with bile reflux gastritis. [ Methods ] Wistar rats were randomized into 6 groups: sham-operation group (A), model group (B) , CQPC groups in the dosages of 16.66 (high) ,8.33 (moderate), and 4.17 (low) g/kg respectively (C, D and E respectively), Xiao Chaihu Granules group in the dosage of 10g/kg (F). Except the sham-operation group, the rats in other groups received B- II gastrojejunostomy to induce bile reflux gastritis and were treated with gastric gavage of corresponding drugs according to the experimental design for 4 weeks. Effects of CQPC on gastric mucosal cell apoptosis and the expression of p53 mRNA, Bax and Bcl-2 were observed by enzyme-linked immunosorbent assay (ELISA), hybridization in situ and immunohistochemistry method. [Results] Bile reflux in the model group caused the increase of gastric mucosal cell apoptosis, the up-regulation of wild-type p53 mRNA and Bax protein expression, and the down-regulation of Bcl-2 protein expression, the difference being significant as compared with the sham-operation group (P

Objective To study the relationship between T~(-786)→C mutation in the 5′-flanking region of the endothelial nitric oxide synthase gene and type 2 diabetes(T2DM) with coronary heart disease(CHD). Methods One hundred and eighty-six T2DM were selected,and of them,65 had CHD.Meanwhile,63 healthy individuals were selected as control.PCR/ASO(allele-specific oligonucleotide probe) technique was used to determine the T~(-786)→C mutation.Results Compared with control,the T/C genotype and C allele prevalences were significantly higher in T2DM with CHD(P

Objective To evaluate the efficacy and safety of helmet delivered continuous positive airway pressure (Helmet-CPAP)for hypoxemia in airway extubated patients after cardiac surgery.Methods 120 adult patients in ICU from March 2014 to July 2015,who were after cardiac surgery,were enrolled.These patients who suffered hypoxemia within 48 hours after extubation,defined as that PaO2/FiO2 with oxygen mask could not reach 200,were divided into two groups.In the control group high concentration oxygen therapy with mask was delivered,while helmet-CPAP was delivered in the experimental group.Treatment duration was 6 hours.Results Helmet-CPAP significantly improved PaO2/FiO2 (144.35 ± 24.43 vs.201.35 ± 52.97,P ＜ 0.05) and left ventricular ejection fractions(0.5383 ± 0.0844 vs.0.5540 ± 0.0844,P ＜ 0.05).Breathing rate (22.60±5.08 vs.18.53 ±4.13,P＜0.05),heart rate(102.72±17.9 vs.95.15 ±13.79,P＜0.05)and shock index (0.85 ± 0.35 vs.0.75 ± 0.15,P ＜ 0.05) were significantly lower.The rate of using mechanical ventilation (6.67％ vs.28.33％,P ＜ 0.05) and length of ICU stay[41.0(25.0,67.5) hours vs.49.5 (32.5,90.8) hours,P ＜ 0.05] was significantly less than control group.Conclusion Helmet delivered continuous positive airway pressure is an effective and safe treatment for hypoxemia in airway extubated patients after cardiac surgery.

Objective To analyze the appropriate time selection of pregnancy and delivery in women with systemic lupus erythematosus (SLE ). Methods Twenty-nine pregnancies in women with SLE in our hospital from 1998 to 2003 were retrospectively analyzed regarding the selection of appropriate time of pregnancy and delivery. Results All patients did not take any cytotoxic medicine for at least 6 months before pregnancy. Twenty-three conceptions occurred when SLE was inactive for at least 1 year. Two conceptions occurred when SLE was active without doctors' agreement SLE was diagnosed during pregnancy in the remaining 4 cases. The condition of all patients fluctuated and the gestational time at delivery ranged from 30 to 38 weeks after we modified the doses of glucocorticoid (prednisone). Among totally 29 living neonates, eight were premature neonates, three were FGR and one had serious congenital heart disease. Two neonates died of complications in early stage of neonatal period. None of the 29 neonates from all patients had neonatal lupus. Conclusion Pregnancy safety will be improved obviously if the condition of SLE is controlled and the patients are given reasonable doses of glucocorticoid and intensive monitoring. If pharmacotherapy does not work well and the condition threatens the safety of mother and fetus, or the fetus has matured, termination of pregnancy should be done on time, which reduces maternal complications and improves the perinatal mortality rate. The gestational time should be 34 to 38 weeks.