This paper expatiates on the concept of higher-order thinking skills. From the necessity of cultivating students with higher-order thinking skills,the paper analyzes how to cul-tivate students'higher-order thinking skills according to the constructivism and provides an im-portant reference for the educational case teaching.

The institute of higher medical education has witnessed an apparent development along with the context of mass education.However,new problems and contradictions have meanwhile limited its normal development.After an analysis of a series of structural contradictions,the writer of the present paper has put forward several measures centering around the innovative education so as to completely promote the education quality and the healthy development of the higher medical education.

Objective To explore the strategies of prevention and treatment of MRSA infection in ICU patients. Methods The clinical data of 6 patients with MRSA infection occurring at the same time in ICU were reviewed retrospectively. Results Vancomycin was given in 4 cases, 250mg twice daily, and teicoplanin was given in one case, 400mg once daily. MRSA cultures were negative in 5 cases after antibiotic treatment. Conclusions MRSA infection occurs frequently in ICU patients, and it spreads readily. Antibiotic treatment, isolation and bacteriological monitoring are very important measures for control of MRSA infection in ICU patients. [HS(1*2/3]

The current mental health of college students can not be optimistic.This paper summarized college students' psychological crisis from the perspectives of psychological crisis and crisis intervention,came up with updated research outcomes and deficiencies,and pointed out the direction of its future research and development.

Objective To evaluate the clinical diagnostic significance of clinical laboratory indexes of anti-CCP,rheumatoid factor (RF),C reactive protein(CRP)and erythrocyte sedimentation rate(SR)in rheumatoid arthritis.Methods Anti-CCP,RF and CRP were quantitatively tested in 90 patients confirmed as rheumatoid arthritis(RA)and 93 patients with non-rheumatoid arthritis(non-RA)diseases by the electrochemiluminescence immunoassay(ECLIA),immunization rate scattering turbidimetry,etc.T test results were performed the statistical and comprehensive analysis by using the ROC curves.Results The levels of anti-CCP and RF had statistical differences between the RA group and the non-RA group(P <0.05 ),while there was no statistically significant differ-ences in the levels of CRP and SR(P >0.05 ).The areas under ROC curves(AUC)of anti-CCP,RF,CRP and SR were 94.0%, 84.0%,51.7% and 56.5% respectively;the sensitivity of anti-CCP and RF was 90.0% and 74.4% respectively,while the specifici-ty was 94.6% and 86% respectively;the Youden indexes were 84.6%and 60.4% respectively;the diagnostic sensitivity of CRP was only 52.2% and the diagnostic specificity of SR was only 50.5%.Conclusion Anti-CCP and RF have the good diagnostic value for RA,moreover the diagnostic performance of anti-CCP is better than RF;CRP and SR have the poor diagnostic preformance,the combination of above indexes has more clinical significance for diagnosing RA.

[Summary] Dyslipidemia after organ transplantation is one of the important risk factors of postoperative cardiovascular disease and graft dysfunction. There are many factors that result in postoperative dyslipidemia. However, the factors influencing serum lipid levels are changing with the development of organ transplantation. In this article the effects of different anti-rejection drugs such as cyclosporine, azathioprine, mycophenolate mofetil, tacrolimus, rapamycin ( sirolimus ) , corticosteroids, and monoclonal antibody on dyslipidemia after organ transplantation were summarized in different eras.

Objective To investigate the clinical efficacy of body weight supported treadmill training (BWSTT) for the recovery of walking ability and comprehensive function after thoracolumbar spinal cord injury (SCI).Methods Sixty patients with SCIs in a thoracolumbar segment were assigned to a treatment group or a control group with 30 in each.Both groups received similar conventional rehabilitation training,but the patients in the treatment group were additionally treated with BWSTT (30 to 40 min,once daily,5 d/week,30 days for a course,a total 3 courses).The American Spinal Injury Association lower-extremity motor function assessment (ASIA),a functional comprehensive assessment (FCA),the walking ability assessment from the FCA (WA) and the modified Barthel index (MB1) were used in the assessment of the two groups before and after treatment.Results There were no significant differences in the two groups＇ average ASIA,FCA,WA or MBI results before treatment.After treatment ASIA,FCA,WA and MBI scores had all increased significantly in the treatment group compared with before treatment,and were significantly higher than in the control group.Conclusion As a supplement to conventional rehabilitation,BWSTT can improve walking ability and comprehensive function significantly after thoracolumbar spinal cord injury.

Objective To investigate the regularity of intrapulnonary lobar and segmental lymph nodes metastasis in patients with cT1N0M0 stage lung adenocarcinoma.To provide a basis for more accurate determination of N stage and indication for pulmonary segmental resection.Methods A prospective study was performed from March 2014 to December 2015.103 cases of cT1 N0M0 stage lung adenocarcinoma received lobectomy and mediastinal lymph node dissection in the thoracic surgery department of China-Japan Friendship Hospital.Intrapulmonary lobar and segmental lymph nodes were dissected and sorted carefully then sent to the pathological department with the corresponding lung specimen and other lymph nodes.Statistical analysis was carried out considering size of the lesion,imaging features,serum CEA levels,pathological subtypes and so on.Results In total 103 cases,pN0 was confirmed in 82 cases,pN1 in 15 cases,pN1 + N2 in 5 cases,and skipping-pN2 in 1 case.14 cases(93.3％) in pN1 group were detected with station 12-14 lymph node metastasis,while only 5 cases (33.3％) were detected with station 12-14 LSNs metastasis.4 cases(66.7％) in pN2 group were detected with station 12-14 lymph node metastasis,while only 1 case(16.7％) with station 13 and station 7 lymph node metastasis.If LSNs were not detected,the false negative rate of N staging could be as high as 6.1％ (5/82),The rate of missed diagnosis of lymph node metastasis might be 30％ (6/20) to N1 stations alone.41.2％ (7/17)cases with metastasis to the adjacent LSNs had been proved with metastasis to the isolated LSNs.The metastasis rate of the isolated LSNs was significantly lower(P =0.049) in pure GGNs compared with those part-solid/solid nodules.Invasive adenocarcinoma had higher metastasis rate of isolated LSNs,compared with preinvasive lesions or minimally invasive adenocarcinomas,with no statistical difference between groups (P =0.055).No significant difference in isolated LSNs metastasis rate was found between groups with different serum CEA levels(P =0.251) or tumor size(P =0.197).Conclusion Dissection of intrapulmonary lobar and segmental lymph nodes might facilitate a more accurate N stage,reduce the false negative rate of lymph node metastasis,and provide basis for more accurate assessment of prognosis and postoperative adjuvant treatment.The sampling area of lymph nodes during segmental resection should include the adjacent LSNs of the target segment.The isolated LSNs metastasis rate of cT1N0M0 stage lung adenocarcinoma with pureGGN as imaging feature is relative low,which might be suitable for segmentectomy when meeting other criteria.

Objective To investigate the improve effects of environmental enrichment on maternal behavior in the adult female rats thatexperienced early-life stress,and to explore the molecular biological mechanism.Methods The newborn Wistar rats were divided into two groups randomly,the early life stress group and the control group.Pups from the former were separated from their mothers once per day for 4 hours from PND 2-21 (day of birth was considered PND =0),and suffered vicious stimulus during the daily 4 hours maternal separation from PND 8-21.On PND 22(weaning),pups from the early life stress group were divided into two groups:12 female pups were reared singly,refered to as isolated-rearing group; another 12 were placed in a big cage that was filled with all sorts of rodents toys,refered to as enriched-rearing group; control female pups were placed in groups of 4 per cage.Mating with male rats when female pups reached PND66,then being placed in cages singly when they were detected pregnant.Maternal behavior was evaluated on the second and sixth day after delivery,and the hypothalamic OTR mRNA levels were examined by RT-PCR.Results The results of maternal behavior observation showed that the total time of retrieve and the latency of licking were significantly longer in isolated-rearing rats compared with the normal and the enriched-rearing rats (P ＜ 0.01) ; total time of licking in enriched-rearing rats was longer than the normal and the isolated-rearing rats(P＜0.01) on the sixth day after delivery;and the score of the nest building was obviously lower in isolated-rearing rats,especially on the sixth day after delivery(P ＜ 0.01).Hypothalamic OTR mRNA levels in the isolated-rearing rats showed strongly decreased compared with the normal rats(P＜0.01),but which close to normal levels in enriched-rearing rats.Conclusion Early life stress can damage some components of maternal behavior,such as retrieval,licking,nest building,but it has no obvious effect on crouching behavior; it also decreases the hypothalamic OTR mRNA levels of the adult female rats; as a kind of early environmental intervention,groups-rearing could make hypothalamic OTR mRNA levels of the female rats that subjected to early life stress restore to normal,and thus reverse the disruptions of stress in maternal behavior.

The individual intervention control of risk factors in high-risk population is one of key preventive measures of chronic disease.A total of 312 volunteers consulted physicians in one selected community.And 23 high-risk individuals of chronic disease were screened.The physicians customized the limit or requirement of diet,activity,tobacco and alcohol for each individual and made interventions of life behaviors according to the plans.The results showed that physical state of 20 (87％) of them converted from high-risk to health after interventions.Therefore customized control plan of individual risk factors is an effective control method of chronic disease.