At present stage,the needs of practice personnel of medical law include‘professional personnel’ (master's degree)and ‘general personnel’(bachelor's degree),but the existing training system did not make any distinction between the two and triggered the following situations:practical teaching mode convergence,content inanition,lack of resources,etc. From the real needs of the com-munity,practice teaching in master stage should focus on vocational practical trainingcourse including mock trial,common medical law disputes,professional documents writing. Practice teaching in un-dergraduate stageshould focus on the primary practical trainingcourse including court records and medical dispute mediation.

Objective To study the effects of HBeAg in new born infants on the response to anti-hepatitis B immunoglobulin combined with hepatitis B vaccination.Methods Two hundred and eight infants who were born during January 2008 to January 2011 in the Department of Obstetrics in Second Affiliated Hospital of Southeast University,including 120 serum HBeAg positive infants without intrauterine infection,and 88 HBeAg negative infants as control group were recruited in the study.Infants in both groups were vaccinated with genetically engineered hepatitis B vaccine (CHO cell) 20 μg according to a standard vaccination regimen (i.e.0,1,6) and 200 IU doses of hepatitis B immunoglobulin immediately after birth and at day 15 respectively.Hepatitis B virus (HBV) serological markers and HBV DNA were measured at birth prior to immunization.HBsAg,HBeAgand hepatitis B surface antibody (anti-HBs) were detected at 1,7,and 12 months after birth to evaluate the effects of immune response.The date were analyzed by the chi-square test and groups were analyzed by t test.Results No statistical significances of anti-HBs were observed between the serum HBeAg positive group and the serum HBeAg negative group at the 1st,7th and the 12th month of birth (t=1.285,0.563 and-0.971,respectively; all P＞0.05).The anti-HBs titers in both groups at 1 month were higher than at birth (P＜0.05).At 7 months after birth,the anti-HBs titers in both groups were even higher than those at 1 month.At 12 months after birth,the anti-HBs titers in both groups were lower than those at 7 months,but still higher than those at 1 month(F=34.3959 and 64.908,respectively; both P＜0.01).Infants who were born with positive serum HBeAg were further divided into two subgroups according to the HBeAg titers,using the median HBeAg titer (47.495 S/CO) as the cut off point.Between the two subgroups,there were also no significant differences of anti-HBs at 1 month,7 months and 12 months (all P＞0.05).The HBeAg titers in HBeAg positive infants decreased gradually after birth.At 7 months,only 3 infants remained HBeAg positive.At 12 months,HBeAg turned negative in all of the 120 infants who were previously HBeAg positive,and no anti-HBe positivity were detected.Conclusion The production of anti-HBs after combined immunization with anti-hepatitis B immunoglobulin and hepatitis B vaccine in infants is independent of HBeAg serology at birth.

Objective:Dysmenorrhea is the common gynecological problem among adolescent girls and women of reproductive age. This study aim to develop a dysmenorrhea Quality of Life (QoL) scale based on Traditional Chinese Medicine (TCM) theory.Methods:We conducted focus group discussions and in-depth interviews with TCM gynecologists and patients, and adapted items from previously published scales. We generated an initial pool of 41 items with 8 domains. Delphi method was used to item preliminary selection. Then, we administered the items to a sample of adolescent girls ( n=200), and the distribution of survey items, discrete trend, factor analysis, correlation coefficient, Cronbach’s α coefficient were used to select items. Results:After two rounds of Delphi, a total of thirty items were included in the dysmenorrhea QoL scale. The expert positive coefficient were 100% and 83.3% with high motivation. The authoritative coefficient were greater than 0.7, the results showing authoritative and reliable. The Kendall’s coefficient of concordance W was 0.333 ( χ2=128.271, P<0.001). In sample analysis, the items were deleted when they met more than two standards. The final scale retained 20 items, covering 8 dimensions. Conclusions:The methods for selection of dysmenorrhea QoL scale based on TCM theory were preferable. Given the paucity of research in this area, this new dysmenorrhea QoL scale may provide opportunities for the patient-reported outcome (PRO) evaluation in the field of TCM.

Aim: To investigate the effect of salvianolic acid B (Sal B) on liver fibrotic cells in vivo and in vitro from die perspective of apoptosis, as well as the effect on cleaved caspase-9. Methods: Diethylnitrosamine (DEN) was used to induce liver fibrosis in mice for 12 weeks. The padiological changes were detected by HE staining, and the fibrotic lesion area was determined. The cell apoptosis in the fibrotic area was observed by Hoechst 33258 fluorescence staining. The expression of cleaved caspase-9 in fibrotic tissues was detected by Western blot. The apoptotic rate of each group was detected by double standard method AnnexinV-FITC/PI, and the expression of apoptotic protein cleaved caspase-9 in HSC-T6 was detected by Western blot. Results: HE staining suggested that 12 weeks were the period of liver fibrosis in mice. No pseudoplobular structure was formed in group with low and high dose of Sal B, and the degree of fibrosis was lower than that in model group. In the fibrotic lesion area, the fluorescence staining of Hoechst 33258 showed that apoptotic cells significantly increased in group with low Sal B and high dose compared with model group. The results of the AnnexinV-FITC/PI method showed that TGF-β1 inhibited the apoptosis of HSC-T6, and Sal B promoted the apoptosis of HSC-T6 after TGF-β1 intervention and showed a concentration dependence (P <0. 01). Western blot results showed that in fibrotic liver tissues, Sal B increased the expression of cleaved caspase-9 in HSC-T6 cells compared with model group. Compared with TGF-β1 group, Sal B increased cleaved caspase-9 protein expression (P < 0. 01). Conclusions: Sal B can significantly promote apoptosis of liver fibrotic cells in vitro and in vivo, and its pro-apoptosis mechanism may be related to the up-regulation of cleaved caspase-9.

World Report on Disability discussed the current situation of persons with disabilities, health care, rehabilitation, support and assistance, barrier-free environment, education, employment, and relevant policy recommendations, adhering to the spirit of Convention on the Rights of Persons with Disabilities, using the International Classification of Functioning, Disability and Health as its theoretical structure.Based on the report, this article discussed the revelations to services of rehabilitation for persons with disabilities and their problems,which were advocating new concepts of rehabilitation services, using multidisciplinary rehabilitation model, and strengthening construction of talents in services of rehabilitation.

Objective To investigate the role of prenatal single-dose administration of dexamethasone and ambroxol on the expression of Toll-like receptor 4 (TLR4) of fetal and neonatal rats. Methods Fifty-four pregnant rats were randomly divided into three groups with eighteen rats in each group:rats treated with 0.2 mg/kg dexamethasone (group 1),0.2 mg/kg dexamethasone and 100 mg/kg ambroxol (group 2),or saline(controls) on the 17th day of gestation.The lung tissues of the offsprings were harvest independently on the 19th day of gestation,the postnatal 3 days and 7 days.The expressions of TLR4 in fetal/neonatal rat lungs of each pregnant rat were analyzed by reverse transcription-polymerase chain reaction(RT-PCR),immunohistochemistry stain,and Western blot. ANOVA and two independent samples t-test were applied. Results On the 19th day of pregnancy,TLR4 mRNA expression was up-regulated in lungs of the two treatment groups compared with controls(controls:0.26 ± 0.18,group 1:0.39 ± 0.21,t =5.866,P＜ 0.05 ; control:0.27 ± 0.22,group 2:0.46 ± 0.13,t =9.572,P＜ 0.01 ).TLR4 mRNA expression was up-regulated in group 2 compared with controls on the postnatal 3 days and 7 days(postnatal 3 d:0.59 ± 0.23 and 0.47 ±0.24,t=2.295,P＜0.05;postnatal 7 d:0.52±0.12 and 0.35±0.17,t=4.219,P＜0.05),while no significant difference was found in group 1 compared with the controls(postnatal 3 d:0.45±0.22 and 0.44±0.14,t=0.128,P＞0.05; postnatal 7 d:0.40±0.16 and 0.36 ±0.12,t=1.365,P＞0.05).Results of the immunohistochemistry demonstrated that on the 19th day of pregnancy,the protein expression of TLR4 was significantly increased in the two treatment groups (controls:0.20 ± 0.29,group 1:0.35±0.32,t=7.179,P＜0.05 ;controls:0.20±0.29,group 2:0.39±0.25,t=10.764,P＜0.01).The protein expression of TLR4 was significantly increased in group 2 on the postnatal 3 days and 7 days(postnatal 3 d:0.55±0.32 and 0.37±0.18,t=7.121,P＜0.05;postnatal 7 d:0.41±0.29and 0.25±0.24,t=6.355,P＜0.05),while no notable difference was found between group 1 and the control (postnatal 3 d:0.40±0.21 and 0.37±0.18,t=0.683,P＞0.05 ;postnatal 7 d:0.28±0.31 and 0.25±0.24,t=0.462,P＞0.05).Results of the Western blot demonstrated that on the 19th day of pregnancy,the protein expression of TLR4 was significantly increased in the two treatment groups (controls:0.15 ± 0.12,group 1:0.27± 0.20,t =7.835,P＜0.05; controls:0.16 ± 0.18,group 2:0.34±0.16,t=10.470,P＜0.01).The protein expression of TLR4 was significantly increased in lungs of the combination administration group on the postnatal 3 days and 7 days(postnatal 3 d:group 2:0.37±0.20 and 0.25±0.22,t=6.379,P＜0.05; postnatal 7 d:0.35±0.15 and 0.24±0.13,t=5.152,P＜0.05),while no notable difference could be found between group 1 and the control (postnatal3 d:0.32±0.26 and 0.25±0.16,t=1.167,P＞0.05; postnatal 7 d:0.29±0.19 and 0.24±0.10,t =1.248,P ＞ 0.05 ). Conclusions Prenatal single-dose administration of dexamethasone may up-regulate the expression of TLR4 in the rat fetal lung.The up-regulation of TLR4 might be one of the critical factors for glucocorticoid-induced maturity of fetal lung.Prenatal single-dose administration of dexamethasone and ambroxol may have effects on the regulation of TLR4 not only in fetal rats,but also in neonatal rats.

Objective:To introduce recent progress on diagnosis and treatment of benign symmetric lipomatosis(BSL).Method:Detailed clinical data of 6 patients with BSL were reviewed and analyzed.We present a summary of the clinical symptoms,physical sign,diagnosis and therapeutic methods of BSL. And related literatures were discussed together.Result:All of 6 patients have excessive subcutaneous fat deposit predominantly around neck.One patients had upper extremity localizations. Six patients had the complication of left ventricular diastolic function changes,glucose intolerance or diabetes mellitus, chronic hepatopathy, hyperuricemia and sleep apnea syndrome in one or more. One patients with several symptoms occur simultaneously, another one female patient was accompanied by all symptoms but chronic hepatopathy. Five male patient were alcohol abusers. Tatal neck lipentomy and abstinence from alcohol were performed on 5 patients. One patient refused treatment.During a follow-up of 3 months to 4 years, one patients was relapsed again,and no recurrence was seen in another 4 patients. All pathological results were nonencapsulated fat. Conclusion:BSL is a lipodystrophy caused by diffuse fatty tissue, symmetry deposition in the neck and shoulder subcutaneous fascia space or deep fascial space .The highest incidence favors to middle-aged man who is alcoholist. Chronic alcohol addiction and typical clinical symptoms help to diagnosis BSL. Lipectomy represents a successful procedure in treating BSL.

Objective To explore the risk factors of severe pneumonia caused by multi-drug resistant Klebsiella pneumonia,and antimicrobial drug resistance among these isolates.It may help to prevent and control the disease and promote to rational use of antibiotics.Methods We conducted the case-control study in our PICU.It included 89 patients with severe pneumonia caused by multi-drug resistant Klebsiella pneumonia as case group and 68 patients with severe pneumonia caused by Klebsiella pneumonia as control group during the same period.To compare the two groups on irrationality use of antibiotics (especial for third generation cephalosporin),length of stay,tracheal cannula,time of mechanical ventilation and underlying conditions (malnutrition,congenital heart disease,heredity and metabolic disease).Antimicrobial susceptibilities among 89 multi-drug resistant Klebsiella pneumonia isolates were analyzed.Results There were 63 cases (70.79％) for irrationality use antibiotics in case group,while there were 27 cases (39.70％) in control group (P ＜ 0.01).The cases for length of stay over 7 days in case group (48 cases,53.93％) were more than those cases with the same situation in control group (12 cases,17.65 ％) (P ＜ 0.01).Thirty-eight cases (42.69 ％) needed mechanical ventilation therapy in case group,while 16 cases (23.53％) needed mechanical ventilation therapy in control group (P ＜ 0.01).The cases for duration of mechanical ventilation over 5 days in case group (18 cases,20.22％) were more than those cases in control group (5 cases,7.35％) (P ＜0.05).The cases with underlying disease in case group (13 cases,14.61％) were more than those cases in control group (2 cases,2.94％) (P ＜ 0.05).Multi-drug resistant Klebsiella pneumonia isolates demonstrated that high-level resistance for penicillins,cephalosporins,aminoglycosides and quinolones,but still susceptible to carbapenems.Conclusion Several risk factors are associated with severe pneumonia caused by multi-drug resistant Klebsiella pneumonia,including irrational use of antibiotics (especial for third generation cephalosporin),long term of length of stay,endotracheal intubation,long term of mechanical ventilation,and having underlying disease (malnutrition,congenital heart disease,heredity and metabolic disease).Multi-drug resistant Klebsiella pneumonia isolates demonstrated that high-level resistance for penicillins,cephalosporins,aminoglycosides and quinolones,but still susceptible to Carbapenems.Carbapenems should be used as first-line drugs for severe pneumonia caused by multi-drug resistant Klebsiella pneumonia.

Objective To investigate the epidemiological characteristics of incipient neonatal hyperbilirubinemia. Methods The clinical data of admitted neonates with hyperbilirubinemia were retrospectively analyzed from June 2012 to May 2013. Results Two hundred and eight-four neonates with hyperbilirubinemia were enrolled and the ratio of male:female was 1.51:1. For the causes of hyperbilirubinemia, the incidences of ABO hemolytic and sepsis were higher in term infants than those in preterm infants, and the incidences of pneumonia, necrotizing enterocolitis and intracranial hemorrhage were higher in preterm infants than those in term infants (P<0.05). Compared with the preterm infants, the term infants had jaundice appearance and peak at earlier time, shorter duration of jaundice, faster decline rate of jaundice, higher levels of albumin and indirect bilirubin at the peak of jaundice (P<0.01). In the term infants, the time of jaundice appearance and peak were earlier in hemolytic group than those in non-hemolytic group (P<0.05). In preterm infants, the peak of transcutaneous bilirubin was higher in hemolytic group than that in non-hemolytic group (P<0.05). Six cases with bilirubin encephalopathy had abnormalities cranial MRI imaging, and the MRI was not entirely consistent with the peak level of bilirubin. Conclusions There are clinical differences between hemolytic and non-hemolytic hyperbilirubinemia in both term and preterm infants.

Background The integration of segregated pathways from the two eyes first appears in V1 neurons,where it not only plays a critical role in the generation of a three-dimensional visual representation.Abnormal visual experiences in critical period usually lead to amblyopia and binocular integration defects.Objective Present study was to investigate how neurons of kitten coordinate their activity patterns in response to synchronous dichoptic stimulus inputs in striate cortex.Methods Spike rate and local field potential(LFP) gamma band(20-90Hz) power of three kitten(1-1.2Kg,8-10 weeks old) to monocular and synchronous dichoptic presented gratings were assessed for 28 binocular neurons in V1 of kitten by in vivo extracellular record method under anaesthesia and paralysis.Ocular dominance index(ODI) and binocular integration index(BII) were assessed and the correlation between these two indexes were analyzed.Results In 28 cells with binocular characteristic,the absolute value of spike-ODI was significant larger than that of LFP-ODI(t=2.606,P=0.021).A positive linear correlation between the ocular preferences of spike and LFP was found(R2=0.513,F=27.423,P=0.003).In dichotic trails,binocular facilitation with BII for spike was 2.348±0.996,showing a significant reduce in comparison with BII for LFP(3.678±1.974)(t=2.671,P=0.019).Binocular integration index for two signals were greater when monocular responses of both eyes were similar(P=0.035 and P=0.124,respectively).Conclusion Both spike rate and gamma band power of LFP exhibited binocular facilitation to synchronous presented dichotic stimuli with significant facilitation induced by balanced monocular responses.Spiking activity and LFP reflect neural activities of different spatial scales and source components.