“Following the child’s lead” and “collaborative consultation with parents” are solidly grounded in the best practice of early language intervention. However, the success of these two practices are based on assumptions that they are valued by families and that they can be feasibly implemented by the attending speech-language pathologist (SLP). Such assumptions can be unjustified in cultures that value the use of “adult-guided instructions” over following the child’s lead and when the work setting of the SLP does not readily accommodate those practices. This article takes the form of a position paper. Through review of the literature, the paper (1) identifies the research-cultural practice gap in early language intervention in Malaysia; (2) positions the two research-informed practices – following the child’s lead and collaborative consultation with parents, on the continuum of intrusiveness in early language intervention; and (3) proposes the techniques of Milieu Teaching as an approach to bridge the research-cultural practice gap in Malaysia.
Speech-Language Pathology

Objective To investigate the level of soluble interleukin 7 receptor (sIL-7R) in serum of lupus nephritis(LN)patients and evaluate its clinical significance. Methods sIL-7R level in serum of LN patients and healthy controls were measured by ELISA , while total 24 hours urinary protein and complement C3 of LN patients were measured by BN ProSpec. The level of sIL-7R correlation with SLEDAI, total 24 hours urinary protein and complement C3 were analyzed respectively. Results The levelof sIL-7R was higher in serum of LN patients than healthy controls (P < 0.01). Moreover, its expression in serum was increased in LN patients in active stage than in LN patients in stable stage (P < 0.05). The level of sIL-7R was positively assosicated with SLEDAI, total 24 hours urinary protein(P < 0.01, P < 0.05) and negatively with complement C3 (P < 0.05). Conclusion The level of sIL-7R is upregulated in serum in LN patients and correlated with disease activity and progression, so it may be expected to become a potential marker of disease in prediction.

Objective To investigate the change of Th22 cells in the peripheral blood of the patients with primary biliary cirrhosis (PBC) and evaluate its clinical significance. Methods The proportion of Th22 cells in the peripheral blood of PBC patients and healthy controls were evaluated by flow cytometry. The cytokine IL-22 of each group was measured by ELISA and ALT, AST, GGT, TBIL and CRP were measured by Automatic biochemical analyzer. The proportion of Th22 cells correlation with IL-22 , ALT, AST, GGT, TBIL and CRP were analyzed. Results The proportion of Th22 cells was higher in PBC patients than healthy controls (P < 0.05), Moreover the frequency of Th22 was increased in PBC patients with liver cirrhosis than in PBC patients with liver non-cirrhosis (P < 0.05). The level of IL-22, ALT, AST, GGT, TBIL and CRP were increased in PBC patients (P < 0.05). Moreover Th22 frequency of peripheral blood was positively associated with IL-22, ALT, AST, GGT and CRP (P < 0.05). Conclusion Th22 may be involved in the pathogenesis of and it is a potential therapy target for PBC.

Objective To investigate the effects of interleukine-22 ( IL-22 ) on the expression of interleukin-6 (IL-6) by rheumatoid arthritis synovial fibroblasts (RASF), and to analyze their association with IL-17+CD4+T (Th17) cells differentiation.Methods RASF were isolated from six patients with rheu-matoid arthritis ( RA) and cultured in vitro.The expression of IL-6 at mRNA and protein levels by RASF were detected by qRT-PCR analysis and ELISA after treatment with different concentrations of IL -22 for dif-ferent periods of time.Anti-IL-22R1 blocking antibody and inhibitor assay were used to analyze the specific receptor and its downstream signaling pathways associated with IL-6 production.IL-22 pre-treated RASF and CD4+T cells were co-cultured for 3 days in the presence or absence of anti-IL-22R1 or anti-IL-6 to measure the percentage of Th 17 cells by flow cytometry .Results The expression of IL-6 by RASF was increased up-on IL-22 stimulation in a dose and time dependent manner (P<0.05), and that was closely related to IL-22R1 and its downstream signaling pathways of p38 and JAK2 (P<0.05).Co-culturing CD4+T cells with RASF and Transwell system indicated that the percentage of Th 17 cells was increased in IL-22 pre-treated group as compared with that in IL-22 untreated group , but it could be down-regulated by either blocking IL-22R1 or IL-6.Conclusion IL-22 promoted the expression of IL-6 by RASF and further enhanced Th 17 dif-ferentiation.Neutralizing IL-22 in synovium of patients with RA might be an effective therapeutic strategy for RA treatment.

Objective:To investigate the effects of bezafibrate (BF) on the activation,proliferation and differentiation of CD4+T cells from primary biliary cirrhosis ( PBC) patients and to elucidate the mechanisms for the immunosuppressive effects of BF and to further provide experience basis for BF target therapy PBC.Methods:PBMCs were isolated from PBC patients then CD 4+T cells were selected by MACS, and stimulated with anti-CD3, anti-CD28, in the presence of different concentration of BF.The cytokines were measured by ELISA,and the activation,proliferation and differentiation of CD4+T cells were analyzed by flow cytometry.Results:(1) BF could inhibit the activation of CD 4+T cells in PBC patients.(2) BF could inhibit the proliferation of CD 4+T cells in PBC patients in a dose-dependent manner (P<0.05).(3)BF could down-regulation IFN-γand IL-17 production of CD4+T cells in a dose-dependent manner ( P<0.05 ).Conclusion: BF could inhibit immune responses of PBC patients by suppressing CD 4+T cells activation;proliferation and cytokine production.

Objective: To understand reason for the difference of supplementary immunization activities (SIA) using measles-containing vacline (MV) among different types of universities in China. Methods: Ten universities from one city were selected by using purposive sampling method. Qualitative interviews were conducted on the implementation of MV SIA in universities, and the differences of measles vaccination and the reasons were analyzed. Results: The MV vaccination rates in the 10 universities in 2017 were 54%, 96%,95%,97%,81%,93%,13%,12%,10% and 21% respectively.The rate of four-year universities was higher than that of three-year colleges; and the rate of public universities was higher than that of private schools; the rate of provincial universities was higher than that of central government administered universities; the vaccination rates also vary within central government administered universities.The level, ownership and affiliation of colleges and universities led to the differences in medical qualification, administrators’ risk perception of disease and vaccines, and the relationship between the schools and local CDC, which in turn affected the implementation of vaccination in universities. Conclusion The different attributes of universities are the fundamental reasons that lead to the differences in the rate of MV SIA in Chinese universities. It is suggested that the differences of university attributes should be considered in the process of implementation of the policy of immunization in universities.And the vaccination policy in universities should be strengthened, the risk communication of universities, especially private universities, should be improved, and the working relationship of the Ministry of Health and the Ministry of Education should be enhanced.

Awareness, involvement and training in dysphagia management are essential to ensure that patients are appropriatelyassessed for dysphagia and provided with intervention. The study aimed to identify levels of awareness, involvement andtraining of medical officers in dysphagia management. A total of 51 medical officers from the family medicine, medical,otorhinolaryngology, surgery, and neurosurgery departments in Hospital Universiti Sains Malaysia participated in thestudy. Levels of awareness, involvement and training of medical officers in dysphagia management were reported usingdescriptive analysis. Results indicate that medical officers lacked awareness and training in dysphagia management.Referral rates to speech-language pathologists for dysphagia management were low with 58.4% of medical officers havinghad seldom or never referred patients. The results provide valuable information for addressing dysphagia managementin the hospital.

With the increasing understanding of the complex interaction between the tumor microenvironment and immune therapy, the role of immune checkpoint inhibitors in the treatment of head and neck squamous cell carcinoma (HNSCC) has gained significant attention. Immune checkpoint inhibitors targeting programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) , cytotoxic T-lymphocyte-associated protein-4 (CTLA-4) , and T cell immunoglobulin domain and mucin domain-3 (TIM-3) , such as pembrolizumab, durvalumab, tremelimumab, ipilimumab, and LY3321367, have been applied in numerous clinical trials as monotherapies and combination therapies for the treatment of recurrent or metastatic HNSCC. Further research into the efficacy and safety of these immune checkpoint inhibitors in clinical trials may provide more effective strategies for the treatment of patients with recurrent or metastatic HNSCC.

Objective To observe the clinical characteristics of non-viral liver diseases which were examined by ultrasound guided liver biopsy in order to explore the significance of liver biopsy.Methods From January 2006 to December 2015,patients with non-viral liver diseases who received liver biopsy were retrospectively enrolled.Etiology,pathological diagnosis and clinical diagnosis of the patients were analyzed;the differences in disease types between male and female,among different age (less than 60 years and over 60 years)were compared;and the consistency of two pathologists in the pathological diagnosis was analyzed.Chi-square test was performed for statistical analysis.Results Among 182 patients,there were 73 (40.1％) males and 109 (59.9％) females.The most common etiology were autoimmune liver disease (68 cases,37.4％),non-alcoholic fatty liver disease (NAFLD) (40 cases,22.0％) and drug-induced liver injury (DILI) (29 cases,15.9％).The differences in etiology between male and female,between age less than 60 years and over 60 years were statistically significant (X2 =7.31 and 5.87,both P ＜ 0.05).The consistency of two pathologists in the diagnosis of NAFLD,alcoholic liver disease,hereditary metabolic disease and neoplastic disease was good (Kappa=0.85,0.88,0.75 and 1.00).The consistency rates of two pathologists in the diagnosis of autoimmune disease,NAFLD and DILI were 52.9％ (36/68),75.0％ (30/40) and 48.3％ (14/29),respectively.The consistency rate was highest in NAFLD,and the difference was statistically significant (X2 =7.68,P=0.023).However,there was no significant difference in consistency rates of two pathologists in the diagnosis of autoimmune liver disease and DILI (X2 =0.12,P=0.859).The consistency rates between pathological diagnosis and clinical diagnosis in autoimmune liver disease,NAFLD and DILI were 60.3％ (41/68),85.0％ (34/40) and 55.2％ (16/29),respectively,and the difference was statistically significant (X2 =8.98,P=0.011).The consistency rate in NAFLD was highest.However,there was no significant difference in consistency rates between pathological diagnosis and clinical diagnosis in autoimmune liver disease and DILI (X2 =0.22,P=0.639).Conclusions The liver biopsy may guide the clinical diagnosis of NAFLD.However,to improve the diagnostic rates of autoimmune liver disease and DILI,biopsy results,history and laboratory results should be combined.

Blended teaching can promote the learning engagement of students and enhance their experience by combining online independent learning and offline class learning. We applied blended teaching in the course of Histology and Embryology in the large class of 147 nursing undergraduates in Chongqing Medical University. First, the teaching method was designed by a pre-course survey, and online resources were constructed. Second, students' online learning activities and group discussions were guided by a learning map. Then, flipped classes were carried out in offline class hours. Finally, an end-of-course survey and final exam scores were used evaluate the effectiveness of blended teaching. A total of 142 valid questionnaires were returned; 123 students (86.6%) approved of the effectiveness of blended teaching, 133 students (93.7%) showed improved abilities in various aspects, and 79 students (55.6%) were able to complete their online learning tasks in fewer hours than required for face-to-face lectures. The final exam results showed that the average score of blended teaching class increased by 3.5 points compared with that of the traditional face-to-face lecture class. In conclusion, blended teaching in Histology and Embryology in the large class can achieve good learning and teaching effects and thus holds promise for application.