Comparing traditional lecture-based learning and problem-based learning(PBL) in medical education,PBL simulates real life clinical situation,focuses on competencies training of clinical reasoning and decision-making,and makes students learn how to learn.This article illustrates the process,critical factors,and some cognitive bias in PBL operation.It demonstrates the pure core of PBL and the practicability in China.

As we know more and more about asthma pathogenesis and chronic inflammatory disorder mechanism,and additional immunomodulator options become available.Studies have suggested that Th2 cell differentiation increases,and Th1 cell differentiation reduces in asthma.Therefore,it becomes an important immunotherapy method to modulate the Th1/Th2 response by promoting Th1 cytokines and inhibiting Th2 cytokines.At present,the use of immunomodulator such as anti-IgE antibody,anti-IL-5 agents,CpG oligodeoxynucleotides,imiquimod,bacterial extracts,Chinese medicine in asthma has already made some progress,and besidse it demonstrate great efficacy in clinical.

Primary nephrotic syndrome(PNS) is a common kidney disease. However,its mechanisms remain unclear,and immunity might to play an important role in PNS. This article will review the pathology from cellular immunity,humoral immunity and the immunity involved in podocytes. It is useful for further understand-ing,and it may help guide the diagnosis,prognosis and therapeutic strategies.

ObjectiveTo explore the mechanism of Montelukast combined with Huang Qi Huai in the treatment of asthma.MethodsForty male Sprague-Dawley (SD) rats were chosen and randomly divided into five groups:control group (Control),model group (Model),Montelukast group (MK),Huang Qi Huai group (H),Montelukast + Huang Qi Huai group (MK + H),each group has 8 rats.The other four groups except the control group were built to chronic rat asthma model.The treatment groups were administered intragastrically with Montelukast,Huang Qi Huai and Montelukast + Huang Qi Huai respectively.All animals were sacrificod; plasma and bronchoalveolar lavage fluid (BALF) and superior lobe of right lung tissues were collected.Superior lobes of right lung tissues were used to measure the expression of IL-17 in lung tissue by immunohistochemistry.The airway inflammation was analyzed by histochemistry staining with H.E.Total cells score and differential score in BALF were counted.The levels of IL-17 in the plasma and BALF were measured by Enzyme-linked immunosorbent assay (ELISA).ResultsCompared with the control group,the degree of inflammatory cell around the airway in the model group were significantly higher (P ＜ 0.05).Compared with group model,the degree of inflammatory cell around the airway in the Group MK,group H and group MK + H were significantly ameliorated ( P ＜0.05).Compared with Group MK,the degree of inflammatory cell around the airway in group MK + H was significantly ameliorated ( P ＜O.05),the expression of IL-17 in lung tissues was significantly lower ( P ＜0.05),the numbers of total cells and the concentration of IL-17 in plasma and BALF were decreased too ( P ＜0.05).Correlation analysis showed that the level of IL-17 in the plasma and BALF was positively correlated with the level of IL-17 in the lung tissue( P ＜ 0.05 ).ConclusionsCombined Huang Qi Huai adjuvant Montelukast treatment of asthmatic rat further reduced the concentration of IL-17 in the plasma and BALF,reduced the expression of IL-17 in lung tissue,improved the airway inflammation.Down regulation the expression of IL-17 was probably one of the mechanisms of anti-inflammatory.

Objective To construct the recombinant expression vector carrying human glucocorticoid receptor ?(hGR?) cDNA to provide experiences for cloning of large DNA fragments and offer experimental materials for studying the function and medchanism of hGR? by antisense nucleic acid technique. Methods hGR? cDNA was amplified from an expressional phage library of human white cells by L-PCR, and cloned into pGEM-Teasy vector. Subsequently, the hGR? cDNA fragment digested from the recombinant T vector was sub-cloned into retroviral vector pLXSN in sense and antisense orientations, respectively through an improved ligasing protocol. Results Restriction endonuclease analysis and sequencing showed that cloning and sub-cloning of hGR? were successful. Conclusion Retroviral recombinant vectors carrying sense-and antisense-hGR? cDNA were successfully constructed.

Objective To explore the relationship between the pathological classification and clinical manifestations of lupus nephritis(LN)in children by renal biopsy and laboratory examination. Methods Renal biopsy and routine laboratory tests were performed in 35 cases of LN . The pathological classification of LN was made according to the criteria of WHO1982. Results Type Ⅳ of LN was most common(37.4%), and type Ⅴ(31.7%) and type Ⅲ(20.0%) were next. Type Ⅳ and type Ⅴ usually appeared as nephritic syndrome, while Type Ⅱ and Ⅲ mainly appeared as nephritis syndrome. The frequency of hypertension and renal dysfuction was the highest in type Ⅳ. Generally the renal interstitial injury of LN was mild, but that of type IV of LN was relatively obvious. There was a positive correlation between serum creatinine level and the degree of renal interstitial injury. Conclusion Lupus nephritis in childhood possessed some features in renal pathological change and clinical manifestations. Renal biopsy was important to diagnosis, treatment and prognosis evaluation of lupus nephritis.

Objective To research Henoch-Schonlein purpura purpura (HSP) and renal pathology in children.Methods 31 hospitalized HSP children that with normal urine routine and accepted renal biopsy in our hospital.Results There were different levels of kidney pathological damage in this group of 31 cases,the results of light microscope were from grade Ⅱ to grade Ⅵ The proportion was grade Ⅱ(35.48％,11 of 31),grade Ⅲ (54.83％,17 of 31),and grade Ⅳ,Ⅴ and Ⅵ (each 1 case of 31,3.23％ ).lmmunofluorescence pathology results were showed as following:merely IgA depositional (48.38％,15 of 31 ),IgA + IgG depositional ( 19.36％,6 of 31 ),IgA + IgM depositional ( 19.36％,6of 31 ),IgA + igG + IgM depositional ( 12.90％,4 of 31 ).Microalbuminuria had been founded in 14 cases,and the microalbuminuria level of 10 cases were higher than normal value( 10 of 14,71.43％ ).Conclusions HSP children had renal pathologic dysfunction,even the urine routine were normal,and the detection of urine microalbumin was a significant marker in the early stage.

A homozygous A to G transition (AGT to GGT) in codon 16 of growth hormone receptor (GHR) gene was found in one patient with idiopathic short stature(ISS), resulting in an amino acid change(Ser16Gly). This may be a novel GHR gene mutation; and another novel Arg43Gln GHR gene polymorphism was found in Chinese people.

AIM: To elucidate the significance of glucocorticoid (GC) receptor isoform ?(GR?)in children with idiopathic nephrotic syndrome (INS) , and to evaluate the effect of sera from GC-resistant INS on the expression of GR?. METHODS: The percentage of GR? positive staining peripheral blood mononuclear cells (PBMC) and the quantity of nuclear protein of GR? in PBMC were detected by immunocytochemistry and Western blotting assay, respectively. The effect of sera isolated from children with GC-resistant INS on GR? expression was examined by cell culture in vitro . RESULTS: The number of GR? positive staining PBMC and the quantity of nuclear protein of GR? in children with GC-resistant INS were significantly higher than those in patients with GC-sensitive INS ( P

Objective To study the professional value of freshman who specializes in nursing in college,which can help us to take effective strategies to help nursing students form correct and steady professional value.Methods 208 nursing students in college were investigated with nursing professional value questionnaire.Results The total score of the professional value of freshman was (124.53±3.41)points,and caring was (32.41±1.39) points,trust was (22.98±1.64) points,justice was(26.66±l.55) points,profession was (19.73±1.27) points and behaviorism was (22.94±1.31) points among the professional value.Compared with the female nursing students,the scores of the professional values in trust,justice and behaviorism were lower in male,and the score of trust dimension was significantly lower.But the score of the item “Patients have the right to accept or refuse treatment and caring” in justice was significantly lower in female nursing students than male.Conclusions The professional value of nursing students were not optimistic,especially in male nursing students.So colleges and universities need to find effective ways to enhance the training of the professional value of nursing students.