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.

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.

ObjectiveStudy the relationship among CaSR expression, tubulointerstitial damage,metabolic disturbance of calcium and phosphorus and microvascular density around the tubulointerstitium in children with steroid-resistant nephrotic syndrome.Methods36 cases of children with primary nephrotic syndrome were divided into hormone-sensitive group and steroid-resistant group.Semi-quantitative scores for tubulointerstitial pathological evaluation of the extent of damage, automatic biochemical analyzer for the determination of serum calcium (Ca), phosphorus (P) concentration of renal tubular epithelial CaSR expression and microvessel microvascular density around the tubulointerstitium were determined by immunohistochemical assay.ResultsMore severe the tubulointerstitial damage, lower level of serum Ca and higher level of serum P were observed [(2.26 ± 0.15) mmol/L]in children of the steroid-resistant group and the steroid-sensitive group [(1.90 + 0.12) mmol/L, P ＜ 0.05].CaSR expression (4.63 + 0.78) of renal tubular epithelial cells in the steroid- sensitive group was significantly lower than that in the steroid-resistant group (6.56 + 1.22, P ＜ 0.05), but microvascular density was significantly higher in the steroid- sensitive group(2.98 +0.35 vs 2.02 +0.24, P ＜0.05).When the tubulointerstitial damage was mild, CaSR expression (4.15 +0.58) in renal tubular epithelial cells in the steroid- sensitive group (4.26 ±0.61) was lower than the steroid-resistant group(3.12 ± 0.33; 3.01 ± 0.21), and microvascular density was higher,but the difference was not significant(P ＞0.05).In the moderate tubulointerstitial damage, CaSR expression in renal tubular epithelial cells in the steroid- sensitive group (5.35 ± 0.64) was significantly lower than the resistant group (7.37 +0.81, P ＜0.01), and microvascular density was significantly higher than the resistant group (2.81 ±0.16, 2.02 ±0.14, P ＜0.05).Compared by mild and moderate tubulointerstitial damage in children with the steroid-resistant, CaSR expression (11.46 ± 1.38) in children with severe tubulointerstitial damage was significantly increased, and microvascular density (1.15 ± 0.11) was significantly decreased (all P ＜ 0.01).ConclusionsCaSR expression was increased and microvascular density around the tubulointerstitium was decreased in children with steroid-resistant nephrotic syndrome.Dut to steroid resistance, the cytotoxic of steroid damaged the renal tubular epithelial cells, the metabolic disturbance of calcium and phosphorus and the damage of blood vessel endothelium finally resulted in severe tubulointerstitial damage.

Objective To observe the effect of a repeated-sprint training on the speed-endurance of basketball players in a hypoxia environment.Methods Sixteen basketball players were divided into a hypoxiagroup and a normoxia group which had 8 persons each group.The 2 groups separatelyhad a repeated-sprint training with anaerobic power bicycles in a simulatedhypoxic environment at the altitude of 3000 meters and a normoxia environment for 4 weeks(twice a week).Before and after the training,the two groups of subjects had a shuttle run testing and a Wingateanaerobic powertestingin a normoxia environment.Then their blood were collected and measured the blood lactate level at the point-intime of after the shuttle run,3 min later,5 min later,7 min later,and 9 min later.Recorded the result of the shuttle run,the relative average power of the Wingateanaerobic powertesting,and carried on a statistic analysis of the data.Results Comparing with the performance of the shuttle run before the training,the performance of the 2 groups was improved obviously after the four-week-long training (P＜0.05).But there was no significant difference between the 2 groups(P＞0.05).The rate of blood lacticacid clearance in the hypoxia group was higher than that in the normoxia group,and there was a significant difference at 7 min (P＜0.01).The relative average power of the hypoxia group had a significant improvement(P＜0.05),while the normoxia group had no significant change(P＞0.05).There was no significant difference of the relative average power between the two groups.Conclusion Repeatedsprint training can improve basketball players' speed-endurance.Repeated-sprint training in a hypoxic environment can effectively improve basketball players' ability of reducing blood lactate in their body,and the improvement of this aerobic ability can help athletes to have a better performance in competitions.

Objective To evaluate the effect of sucralfate and acid-suppressive drugs on preventing ventilator-associated pneumonia (VAP) in mechanically ventilated patients.Methods All randomized controlled trials (RCTs),which studied the effect of sucralfate and acid-suppressive drugs on the incidence of VAP in mechanically ventilated patients,were searched from PubMed,Embase and the Cochrane Library during January 1966 to March 2013 via manual and computer retrieval.All related data were extracted.Meta analysis was conducted using the statistical software RevMan 5.2 and the quality of the RCTs was strictly evaluated with the methods recommended by the Cochrane Collaboration.Results A total of 15 RCTs involving 1315 patients in the sucralfate group and 1568 patients in the acid-suppressive drug group were included in this study.The incidence of VAP was significantly reduced in the sucralfate group (RR =0.81,95％ CI 0.7-0.95,P =0.008),while no difference was found between the two groups in the incidence of stress-related gastrointestinal bleeding (RR =0.96,95％ CI 0.59-1.58,P =0.88).No statistical difference was found in the days on ventilator,duration of ICU stay and ICU mortality in the two groups (all P values ＞ 0.05).Conclusion In patients with mechanical ventilation,sucralfate could decrease the incidence of VAP,while has no such effect on the stress-related gastrointestinal bleeding,the days on ventilator,duration of ICU stay and ICU mortality.

Objective To clarify the role of FLT3 signaling-dependent pulmonary conventional dendritic cells (cDCs) in the pathogenesis of lipopolysaccharide (LPS)-induced acute lung injury (ALI),and as well as the modulation effects of cDCs in vivo on the inflammatory responses to acute lung injury.Methods Thirty C57BL/6 male mice were divided into normal control group,LPS group,FLT3L pretreatment group,lestaurtinib,(a high efficient and specific blocker in FLT3 signal pathway) pretreatment group and vehicle (DMSD) control group.FLT3L and lestaurtinib were administrated subcutaneously for 5 days.Murine model of ALI was subsequently established by intra-tracheal application of LPS and lung specimens were harvested 6 h or 24 h later.The accumulation and maturation of pulmonary cDCs were assessed by flow cytometry.IL-6 and TNF-α were quantified to evaluate lung inflammation.Lung injury was estimated by lung wet weight/body weight ratio (LWW/BW) and histopathological assessment.Lung myeloperoxidase (MPO) activity was measured to evaluate neutrophil infiltration.Transcription factors Tbet/GATA-3 mRNA ratio was determined to estimate balance of Th1/Th2 response.IFN-γ and IL-4 were quantified to evaluate Th1-specific and Th2-specific cytokine production respectively.Results The accumulation and maturation of pulmonary cDCs peaked at 6h after LPS challenge.FLT3L pretreatment significantly stimulated the accumulation and maturation of pulmonary cDCs (P ＜ 0.05),leading to markedly deterioration of LWW/BW and lung histopathological changes.Meanwhile lung MPO activity and T-bet/GATA-3 mRNA ratio were elevated (P ＜ 0.05).Furthermore,the production of IL-6,TNF-α and IFN-γwas markedly increased by FLT3L pretreatment (P ＜ 0.05).In contrast,lestaurtinib pretreatment markedly inhibited the accumulation and maturation of pulmonary cDCs (P ＜ 0.05),leading to significant improvement of LWW/BW and lung histopathological changes.Meanwhile lung MPO activity and T-bet/ GATA-3 mRNA ratio were decreased (P ＜ 0.05).Furthermore lestaurtinib efficiently suppressed the production of IL-6,TNF-α and IFN-γ (P ＜ 0.05).Conclusion This study thus demonstrated that FLT3 signaling-dependent pulmonary cDCs could control the initiation of acute lung inflammation response to LPS-induced ALI through the regulation of neutrophil infiltration and balance of Thl/Th2 response.

AIM:To investigate peripapillary vessel density and its relationship with other ocular parameters in highly myopic eyes with peripapillary intrachoroidal cavitation (PICC), and to analyze risk factors for PICC.METHODS:Cross-sectional study.A total of 35 highly myopic eyes with PICC, 40 highly myopic eyes without PICC and 35 normal eyes were included in this study.All participants underwent fundus photography and spectral-domain optical coherence tomography (SD-OCT).OCT angiography was also performed to image the retinal vasculature in the peripapillary areas of different sectors, including the radial peripapillary capillaries (RPC) and optic nerve head (ONH) layer.The difference of morphology changes in optic disc and peripapillary vessel density between these three groups were compared.Correlations between peripapillary vessel density and PICC and risk factors for the presence of PICC were analyzed.RESULTS: Significant differences were found among the three groups in spherical equivalent refraction (SER), best-corrected visual acuity (BCVA), axial length, peripapillary atrophy β-zone (β-PPA) area, retinal nerve fiber layer (RNFL) thickness and the presence of tilted optic disc, posterior staphyloma and myopic maculopathy (MMD) (P<0.05).There were significant differences among the three groups in the peripapillary vessel density both in RPC (54.34±5.58, 57.54±7.44, 64.42±3.50) and ONH (51.24±7.43, 52.75±9.96, 61.25±4.15) layers (P<0.001).In highly myopic eyes, vessel density was significantly lower in eyes with PICC than in those without in inferotemporal area both in the RPC (56.76±6.62,63.84±6.02,67.52±4.78) and ONH (56.47±5.79,60.38±4.72,64.18±4.37) layers.The vessel density was significantly correlated with the presence of MMD, β-PPA area and RNFL thickness in the RPC layer, whereas correlated with the presence of MMD, PICC and RNFL thickness in the ONH layer (P<0.05).Tilted optic disc and posterior staphyloma were independent risk factors for the presence of PICC (OR=8.007, 95%CI: 2.045-31.348;OR=7.558, 95%CI: 1.398-50.026).CONCLUSION:Highly myopic eyes with PICC had relatively lower peripapillary vessel densities, especially in the temporal area, than those without.Tilted optic disc and posterior staphyloma were independent risk factors for the presence of PICC.

Objective To investigate the accumulation and maturation status of pulmonary conventional dendritic cells (cDCs) in the early phase of acute lung injury (ALI),and to explore the way of the inflammatory responses and lung injury modulated by cDCs in vivo.MethodsMale C57BL/6 mice were randomly ( random number) divided into the normal control group,6 h-ALI group and 24 h-ALI group.Murine model of ALI was made by intra-tracheal administration of lipopolysaccharide (LPS) and lung specimens were taken 6 h or 24 h later.The accumulation and maturation status of pulmonary cDCs were assessed by flow cytometry.IL-6 and TNF-α were quantified to evaluate the lung inflammation.Transcription factors T-bet/GATA-3 mRNA ratio was determined to estimate the balance between Th1/Th2 responses.IFN-γand IL-4 were quantified to evaluate Thl-specific and Th2-specific cytokine production respectively.Lung injury was estimated by lung wet weight/body weight ratio (LWW/BW) and histopathological assessment.Comparison between groups was performed using one -way ANOVA.ResultsCompared with normal control group,LPS challenge resulted in higher level of IL-6 and TNF-α,increased LWW/BW ratio and significant histopathological changes (P ＜0.01 ).The accumulation and maturation of pulmonary cDCs in 6 h-ALI group were significantly increased after LPS challenge (P ＜0.01 ),while the accumulation and maturation of pulmonary cDCs in 24 h-ALI group were significantly lower than that in 6 h-ALI group ( P ＜0.01 ).Compared with normal control group,the expression of T-bet mRNA in 24 h-ALI group was markedly enhanced ( P ＜ 0.01 ) and the production of IFN-γ was increased as well ( P ＜ 0.01 ).ConclusionsThe accumulation and maturation of pulmonary cDCs peaked within 24 h after LPS challenge,pulmonary cDCs may initiate and amplify acute lung inflammation of ALI by enhancing the Th1 immune response and ensuing cytokine production.

Objective To analyze the drug resistance status of mycobacterium tuberculosis in patients with double immunization of human immunodeficiency virus (HIV) and tuberculosis (TB) by phage bioassay (PhaB),and to optimize the control strategy.Methods One hundred and twelve cases of HIV/TB infected patients.in Chongqing Ninth People's Hospital were treated with PhaB method,and the drug susceptibility testing results were compared with 208 cases of simple pulmonary tuberculosis patients.Results The anti-tuberculosis drug resistance rate of HIV/TB patients was lower than that of simple pulmonary tuberculosis patients.The resistance rates of 5 common anti-tuberculosis drugs in HIV/TB patients were 7.14％ of isoniazid (INH),7.14％ of pyrazinamide (PZA),5.36 ％ of rifampicin(RFP) streptomycin(SM),and 4.46 ％ of ethambutol (EMB),compared with simple pulmonary tuberculosis(resistance rates of RFP were 17.31％,IN H 13.46 ％,PZA 11.54 ％,EMB 10.58 ％,SM 9.62 ％),RFP resistance rate of HIV/TB infected patients was lower(P＜0.05).There was no significant difference between two groups in the other four anti-tuberculosis drug(P＞0.05).The coincidence rate with the absolute concentration method were INH 96.4％,RFP 98.2％,PZA 96.4％,EMB 93.8％ and SM 96.4％,respectively.Conclusion The resistance rate of mycobacterium tuberculosis to RFP in patients with HIV/TB infection in this region is lower than that in patients with common pulmonary tuberculosis,which is related to the good medication compliance of these patients.PhaB has the characteristic of fast,simple,without special equipment,it can be used as a rapid screening of mycobacterium tuberculosis drug resistance method.

Objective To examine the expressions of FHIT gene and HER_2 in non-small cell lung cancer(NSCLC)and the relationship between the expressions and the clinicopathological features of NSCLC, and to investigate the relationship between FHIT protein and HER_2 expression. Methods FHIT protein and HER_2 expressions in 50 lung cancer cases and 21 adjacent non-cancer tissues were performed by immunohistochemistry. And the positive rates of FHIT and HER_2 were measured. Results The positive rates of FHIT protein were 30.00% in lung cancer tissues. The expression levels of FHIT were significantly lower in lung cancer tissues than that in non-cancer lung tissues (P