Forensic medical talents with creative ability should have ability to find.analyze and solve problems from complex cases.According to teaching practice on the basis of PBL this article illustrates application methods of PBL teaching characters in the training of forensic medical talents with creative ability.

Simulated teaching method is a necessary complement to theoretical teaching of health law,which meets the practical-oriented reform need and cultivates students with the literacy as a legal professional.The teaching method demands more requirements on teachers,students,teaching materials,organizational management,and more attention on contextual design,preparation details,implementation activities and evaluation of teaching.

Objective To study the relationship between the mRNA degradation in the retinal cells of rat after death and postmortem interval(PMI) in order to provide a new methods of inferring PMI.Methods The level of ?-actin,Pgk1 and Rpl 4 mRNA in the retinal cell of rat were measured at different time(0,2,4,6,8,10, 12,14,16,18,20,22,24,26,28h)after death by compound fluorescence RT-PCR.The rats executed immediately were used as controls.Results Within 28h after death,the absorbance value of total RNA and the level of ?-actin,Pgk1 and Rpl 4 mRNA in the retinal cells decreased along with the prolongation of PMI.The equations of linear regression fitting the relationship between mRNA degradation and PMI were as follows:Y?-actin=-4436.205X?-actin+127581.7(r2=0.976),Ypgk1=-1993.884Xpgk1+57651.54(r2=0.973),YRpl 4=-1189.791XRpl 4+34533.46(r2=0.955).The return model had remarkable statistical significance(P

Constructivism educational theory can provide a useful guidelines for health law education,this article finds the association of constructivist theory for health law education reform,and combined the with application of relevant theories on teaching practice experience,it also discusses how to provide a real promotion for the"students'first"concept.

Objective: To observe the curative effectiveness of laser therapy in 114 cases(120 eyes) posterior capsular opacity after intraocular lenses implantation in children.Methods: When the after-cataract appear,laser therapy should be performed as soon as possible.Under conscious condition,enable the children to cooperate maximally;short effect and mild mydriatic to dilate the pupil,a 4 mm diameter transparent zone in central was made allowing for satisfactory visual performance;Began with low energy(0.4 MJ) and increased progressively according to individual reaction,total energy was 20-30 MJ every time. Results: All the eyes' visual acuity recovered to the best level prior to posterior capsular(opacity) occurrence,corrected visual acuity 0.1-0.4 in 58 eyes,0.5-0.8 in 54 eyes,1.0 in 8 eyes.90 percent were succeed in one laser shot,no intraocular lenses damage was found in slit lamp microscope examination.Conclusion: laser can resect the posterior capsular opacity effectively,improve the visual function of the affected eye.Assisted with amblyopia treatment, laser capsulotomy play an important role in visual function reconstruction in these patients.

The changes of retinal nuclear DNA content in rats after death was detected and the relationship between degradation of retinal nuclear DNA and postmortem interval (PMI) was analyzed. Ninety healthy adult SD rats, female, weighing 250+/-10 g, were randomly divided into 15 groups. At 20 degrees C, the retinal cells were withdrawn every 2 h within 0 to 28 h after death and stained with Feulgen-Vans. Index of density (ID), integral absorbance (IA) and average absorbance (AA) in retinal nucleus were analyzed by image analysis system. And the obtained data were subjected to linear regression analysis by using SPSS12.0 software. The results showed that in retinal nucleus, AA and IA were gradually declined with the prolongation of PMI, while ID had an increased tendency. Within 28 h after PMI, the regression equations were as follows: Y(AA )=-0.009X(AA )+0.590 (R(2)=0.949), Y(IA )=-0.097X(IA )+18.903 (R(2)=0.968), Y(ID)=0.122X(ID)+2.246 (R(2)=0.951). It was concluded that retinal nuclear DNA after death in rats was degraded gradually and had a good correlation with PMI.

Objective To observe the morphological change of retina and its affection on visual function after optic nerve crush in adult rat. Methods The models of optic nerve crush in rats were made. The change of retinas in different time (1,3 ,5 ,7,9,14,28,56,84d respectively) after injury were observed by light microscope, and the flash visual evoked potential (F-VEP) was recorded in normal and injured rats. Result The number of retinal ganglion cells (RGCs) was significantly reduced in the partial lesion of optic nerve crush compared with normal optic nerves without injury. The initial loss of RGCs was accelerated during 3-7days after nerve crush and then declined gradually by 14 days, and no change was observed after 28 days. The wave of F-VEP became lower and wider in one day after the crush, and the latency and amplitude of F-VEP declined gradually from one day to 14 days, and recovery response was observed by the time of 4 weeks after injury. Conclusion The secondary degeneration of RGCs following optic nerve crush is the important morphological foundation of fall of visual function, which have relativity with the regular decline of visual function.

Objective To detect nuclear DNA degradation of bone marrows and brains in rat cadavers at different temperatures,and develop a new parameter for estimating early postmortem interval(PMI).Methods The brain and bone marrow were taken out for every 4h,during 0~40h after death at 10℃ and 20℃,respectively.And the single cell gel electrophoresis(SCGE) was carried out to detect the nuclear DNA degradation.Linear regression analysis was used to assay the relationship of the comet parameter HeadDNA%,Tail Length(TL) and Olive TailMoment(TM) with PMI.Results Different decline degrees of comet HeadDNA% were found in both brain cells and bone marrow cells after death,the decline of HeadDNA% in brain cells at 20℃ was faster.Compared with degradation in marrow cells,the linear relation between degradation of brain cells and PMI was better.Conclusion with that of comet parameters TL and TM,the perfect linear relationship between HeadDNA% and PMI was also observed.Conclusion Brain tissues are more suitable for PMI estimation by detecting degradation of DNA with SCGE.The HeadDNA% is more valuable for PMI estimation than TL and TM.

Objective To investigate the effective strategies to prevent and treat biliary complications after orthotopic liver transplantation.Methods The clinical data of 316 patients who received orthotopic liver transplantation at the Fuzhou General Hospital of Nanjing Military Command from November 2001 to March 2012 were retrospectively analyzed.Cold perfusion with HTK + UW solution was applied when obtaining the liver graft,and then the liver graft was preserved in the UW solution.The bile duct was perfused with UW solution thereafter.Orthotopic liver transplantation or piggyback liver transplantation were adopted in the cadaver liver transplantation.Left liver transplantation and right liver transplantation were adopted in the living donor liver transplantation.Choledochojejunal Roux-en-Y anastomosis or duct-to-duct choledochostomy were used for biliary reconstruction.Ordinary T tubes were used for drainage before 2006,and then 6 F pediatric suction catheter or epidural catheter were applied for drainage thereafter.The Ttube was pulled out 3-6 months after the operation.Enteral nutrition was applied to patients at the early phase after operation.The immunosuppressive agents used including tacrolimus + mycophenolatemofetil + adrenal cortical hormone,and for some patients,tacrolimus + mycophenolatemofetil + sirolimus + hormone were used.Patients were followed up for 2 years to learn the incidence of biliary complications and guide the medication.The difference in the incidence of bile leakage between patients who wcrc admitted before 2006 and those admitted after 2006 were compared using the chi-square test.Results The warm ischemia time was 2-6 minutes,and the cold ischemia time was 3-10 hours.For patients who received cadaver liver transplantation,orthotopic liver transplantation was carried out for 291 times and piggyback liver transplantation for 24 times; biliojejunal Roux-en-Y anastomosis was carried out for 5 times and bile duct end-to-end anastomosis for 310 times.For patients who received living donor liver transplantation,1 received left liver transplantation and 1 received right liver transplantation,and they received bile duct end-to-end anastomosis.A total of 311 patients received immunosuppressive treatment with tacrolimus + mycophenolatemofetil + adrenal cortical hormone,and 5 patients reveived tacrolimus + mycophenolatemofetil + sirolimus + hormone.Of the 316 patients who received orthotopic liver transplantation,38 had biliary complications after the operation,including bile leakage in 18 patients,intra-and extra-hepatic bile duct stricture in 6 patients,anastomotic stricture in 6 patients,biliarycomplications included cholangitis in the portal area and cholestasis in 4 patients,choledocholithiasis and cholangitis in 2 patients and biliary infection in 2 patients.The incidence of bile leakage before 2006 was 14.00％ (7/50),which was significantly higher than 4.12％ (11/267) of bile leakage after 2006 (x2-7.676,P ＜ 0.05).Of the 38 patients with biliary complications,the condition of 35 patients was improved,and 3 patients died.Of the 18 patients with bile leakage,15 was cured by conservative treatment,3 received surgical treatment (the condition of 1 patient was improved by drainage,anti-infection treatment and nutritional support,but died of peritoneal hemorrhage at postoperative 1 month; 2 patients received peritoneal drainage,1 was cured and 1 died of peritoneal infection).For the 6 patients with intra-and extra-hepatic bile duct stricture,1 was cured by liver retransplantation and 5 were cured by conservative treatment,endoscopic retrograde cholangio-pancreatography (ERCP) or balloon dilation.For the 6 patients with anastomotic stricture,the condition of 3 patients was improved by conservative treatment,balloon dilation or stent implantation,1 gave up treatment due to hepatic cancer recurrence and died thereafter,1 received anastomosis + T tube drainage,1 was cured by recurrent tumor resection and choledochojejunostomy.Four patients with cholangitis in the portal area and cholestasis were cured by conservative treatment.For the 2 patients with choledocholithiasis and cholangitis,1 was cured by stent implantation with ERCP,and 1 received conservative treatment,and the level of total bilirubin was decreased.Two patients with biliary infection were cured by anti-infection treatment.Conclusions Most of the biliary complications could be treated by non-surgical treatments.For patients with severe biliary complications or those could not be treated by non-surgical treatment,re-exploration of the bile duct is effective.Liver re-transplantation is the only choice for patients with dysfunction of liver graft caused by severe ischemic biliary injury.

Objective To prepare Exosomes secreted by mouse hepatoma cell (H_(22)) and heat stressed Exosomes (HS-Exo) derived from heat stress-treated mouse hepatoma cell (H_(22)), in order to study the possible anti-tumor immune mechanism. Methods Exosomes and HS-Exo were purified by serial ultracentrifugation and sucrose density gradiant centrifugation, and were observed and identified by electron microscope. The components and production of the protein and the effects of the host immune response against hepatocellular carcinoma of HS-Exo were observed by using Exosomes as the control. Their immunological factors were detected by Western blot. Lymphocyte proliferation and specific cytotoxic activity of mouse splenic cells were determined by MTT. CD4~+ and CD8~+ lymphocytes infiltration in mouse tumor tissues immunized by both were analysed by immunohistochemical staining. Results HS-Exo was similar in morphology to the Exosomes, the important immune-ralated protein expressed in HS-Exo was increased (P<0.05). HS-Exo immunized mouse group showed more effective inhibition of tumor growth, better-induced lymphocyte proliferation,more significantly enhanced the cytotoxic activity of spleen lymphocytes, as well as a more prominent role in tumor therapy than Exosomes immunized mouse control group (P<0.05). Conclusions Heat stress treatment method for the preparation of HS-Exo was feasible. HS-Exo had a stronger role in the immuneactivity and tumor treatment than control Exosomes.