OSCE is an examination of objective evaluation of the clinical skills.This article introduced the development of OSCE at home and aboard,and compared the difference of the exam setting in America,England,Canada and China Medical University.The advantages and disadvantages of SP in OSCE were also analyzed.It was discussed that OSCE would be widely applied in China.

Fourly adult healthy patients were separately anesthetlzed with (1 )0. 95% isoflurane; (2) fentanyl 5g/kg and thiopentone 4 mg/kg; (3) upper thoracic epidural blockage and (4 ) lumbar epidural blockage,Continuous 5 min ECG were recorded before and a fier anesthesia with spectral analysis of heart rate varlability (HRV) performed by computer program. For power spectral measurement,three frequency band of HRV were evaluated and the effects of each anesthesia were compared. HRV reduced markedly in patients using 0. 95 % isoflurane. with decreases of frequency by 91. 7% (low frequency ), 84. 4% (mid frequency ). and 82% (high-frequency) respectively. In patients after administration of fentanyl 5g/kg, mid and high-frequency components declined 63. 4 % and 65. 4 %. Upper thoracic epidural block restrained the mid and low frequency components by 66 % and 65 % respectively, Following lumbar epidural block the pattern of HRV components did not change. It is concluded that different anesthesia techniques may have significant different effects on autonomic reflexes as presented by HRV.

Objective To understand the death rate and the main death causes of the senile diabetic inpatients. Methods The histories of all the death cases of senile diabetic inpatients in this hospital from 1992 to 1999 were reviewed. The death rate and causes of senile diabetics were compared with those of the non-senile diabetics. Results Senile diabetics among the total diabetic inpatients increased within 8 years (56.93% during 1992-1995 vs. 67.63% during 1996-1999,P80 yrs group being 23.60%, P

Objective To investigate the intraoperative intraperitoneal chemotherapy security with raltitrexed in advanced colorectal cancer surgical operation.Methods Sixty patients with colorectal cancer undergone surgery were randomly divided into trial group (n =30) and control group (n =30) according to the random number table method.The trial group was given surgical operation plus with intraperitoneal chemotherapy with raltitrexed.The control group was given surgical operation plus with intraperitoneal saline perfusion.Theroutine blood test,liver and kidney functions,toxic side effects and complications in two groups before and after surgery were investigated.Results The white blood cells in trial group before and after surgery was (6.36 ± 2.63) × 109/L vs.(8.20 ± 2.08) × 109/L,with statistically significant difference (t =3.06,P ＜0.05).The ratio of absolute neutrophil count in trial group before and after surgery was 65.17％ ± 10.36％ vs.72.21％ ± 10.53％ (t =3.22,P ＜ 0.05).The platelets in trial group before and after surgery was (261.03 ±84.74) × 109/L vs.(228.47 ± 58.69) × 109/L (t =2.07,P ＜ 0.05).The white blood cells,the ratio of absolute neutrophil count and the platelets after surgery had no statistically significant differeuces between the two groups (P ＞0.05).The trial group had higher 1,2 level vomiting (60.00％ vs.23.33％;x2 =8.30,P ＜ 0.05),and nausea (30.00％ vs.6.67％;x2 =5.46,P ＜ 0.05) incidence rates,but there was no statistically significant difference in other toxic side effects (P ＞ 0.05).The major complications post operation included intestinal obstruction,incision infection,abdominal cavity bleeding,and anastomotic fistula.There were equivalent complications in two groups (6.67％ vs.3.33％,x2 =0.35,P ＞0.05;10.00％ vs.6.67％,x2 =0.22,P＞0.05;0 vs.0;3.33％ vs.0,P＞0.05).Conclusion For patients with advanced colorectal cancer,intraoperative intraperitoneal chemotherapy with raltitrexed is safe and feasible,and the adverse reactions can be tolerated without increasing postoperative complications.

ObjectiveTo investigate the correlation between recent cardiac events and the score of myocardial infarction by delayed-enhancement MRI (DE-MRI).Methods DE-MRI was performed in 40 subjects with coronary artery disease.The score of myocardial infarction by DE-MRI,the ejection fraction (EF) by echocardiography,recent cardiac events (the number of weekly nitroglycerin,the number of weekly angina episodes and the onset number of heart failure in the last year),6-minute walking distance,as well as the Seattle angina questionnaire (SAQ) score were assessed.The Spearman correlation test and Kruskal-Wallis test,Mann-Whitney test were used for the statistics.ResultsThere were negative correlation between the myocardial infarction score by DE-MRI (median 12,inter-quartile range:6.0-19.8) and the 6-minute walking distance(378.93 ± 100.53 ),SAQ score (74.55 ± 11.40 ) (r was 0.66 and 0.54,P ＜0.05).The myocardial infarction score by DE-MRI was strongly correlated with the number of weekly nitroglycerin ( median 1 ; inter-quartile range:0-2.8),the number of weekly angina episodes ( median 3,inter-quartile range:1-6.5 ) and the onset number of heart failure in the last year ( median 0,inter-quartile range:0-2) (r was 0.87,0.85 and 0.89,P ＜0.05).EF [(49.2 ± 13.72)％] was negative correlation with the number of weekly nitroglycerin,the number of weekly angina episodes and the onset number of heart failure in the last year (r were 0.67,0.73 and 0.73,P ＜0.05).ConclusionDE-MRI can be used for evaluation and prediction of future cardiac events.

BACKGROUND:In recent years,it has been shown in studies that regulation of the expression of Has1 is very important to maintain neural stem cells and regulate its differentiation during the development of embryonic nervous system.Moreover,upregulation of Hes1 expression is required for quiescent adult flbroblasts resuming proliferation.This indicates that there is a close relationship between Hes1 and some potential stem cells in adult.Therefore,the study of Hes1 expression in neural stem cells and its relationship with adult neurogenasis is put on the agenda.However,the expression of Hes1 in adult brain is still not clear.OBJECTIVE:To observe the expression of Hea1 in adult mouse brain and the cell types of Has1 positive cells.METHODS:Totally 12 adult male C57BL/6 mice were randomly evenly divided into two groups by using the random number table.For the first group,the mouse brain was removed directly and immunohistochemical staining was used to detect the expression of Has1 in the adult mouse brain.For the second group,Brdu was injected intraperitoneally to every mouse with a dosage of 200 mg/kg,once a day,for 3 days.The mouse brain was removed at 4 days and then double staining was carded out to observe and analysis the cell types of Hes1 positive cells in hippocampus.RESULTS AND CONCLUSION:Hes1 was expressed in all the observed anatomical site where neural cells exist,Brdu positive cells nearly all expressed Hea1,NeuN positive cells all expressed Has1,whereas GFAP positive cells did not express Hes1 completely.Hes1 was expressed in all neurons and neural stem cells,and glial cells did not express Hes1.

Objective To investigate the relationship of plasma homocysteine with the genotype distribution of MTHFR and MTRR among Chinese Han women in Xiangtan. Methods MTHFR C677T, A1298C and MTRR A66G geno?typing was analyzed to detect the distribution of gene polymorphisms among 1 701 women from Xiangtan city then the data were compared with the rest of the Han women in Zibo, Zhengzhou, Yantai, Zhenjiang, Songzi, Huizhou, Qionghai. Plasma Hcy levels from 110 patients were measured and analyzed the correlation with gene polymorphisms. Results The frequency of MTHFR C677T genotype and allele frequencies in Xiangtan is 12.6%which is higher than Huizhou (10.9%) and Qionghai (6.1%) but lower than Zibo (43.6%), Zhengzhou (36.8%), Yantai (32.2%), Zhenjiang (21.8%) with statistically significant dif?ference (P<0.05). There is no significant different in MTHFR C677T between Xiangtan and Songzi. The frequency of MTH?FR A1298C genotype and allele frequencies in Xiangtan is 4.8%which is lower than Qionghai(7.1%)but higher than Zibo (1.4%),Zhengzhou(2.4%), Yantai(1.8%), Zhenjiang(3.5%)and Songzi(2.6%)with statistically significant difference. The frenquency of MTRR A66G genotype and allele frequencies in Xiangtan is 6.8%which is higher than Zibo (4.8%) but lower than Qionghai (9.3%) with statistically signifcant difference. Plasma Hcy concentration correlate with MTHFR C677T, Hcy concentration in TT population is higher than that in CT and CC population(μmol/L:8.52±2.01 vs 5.94±1.47 vs 5.71± 0.18);Plasma Hcy concentration also correlate with MTHFR A1298C and Hcy concentration in CC population is higher than AA and AC population(μmol/L:9.83 ± 2.26 vs 6.35 ± 2.13 vs 5.55 ± 1.75);Plasma Hcy concentration does not correlate with MTRR A66G. Conclusion The gene polymorphism of MTHFR C677T, A1298C and MTRR A66G among the Han women in Xiangtan was statistically different from other selected regions of China. Mutation in MTHFR C 677T and A1298C were associated with elevated plasma levels of Hcy.

Objective To determine sonographic features and outcome of fetal lung abnormal lesions. Methods Blood supply of the lesion, fetus hydrops and other extra-lung anomalies should be evaluated by color Doppler flow image(CDFI) when abnormal lesion was detected in fetus lung during routine scanning. The fetus with lung abnormal lesion without hydrops at the first time scanning should be monitored by ultrasound in every four to six weeks. Results Forty cases fetus presented lung abnormal lesions, which included 21 cases with hyperechogenic solid masses,15 cases with cystic-solid mixture masses,4 cases with cystic masses. Lesions of 8 cases were demonstrated systemic arterial blood supply arising from the aorta on CDFI and the diagnosis of pulmonary sequestration (PS) were suggested. Seventeen cases lesion that had small size or decreased or disappeared or remained stable in size with gestational age developing had normal neonate. Conclusions CDFI is very useful in detecting abnormal lesion of the fetal lung and differentiating pathology and evaluating the prognosis. The outcome of isolated lung lesion without hydrops and mediastinal shift that decreased or disappeared or remained stable in size had a good prognosis.

OBJECTIVE: To investigate the relation betwe en necrosis and apoptosis in the hippocampus of exogenous bFGF on this process. METHODS: With Marmarou's method we produced a severe diffuse brain injury and studied the changes in the hippocampus by adapting a modified T dT-mediated dUTP-biotin nick end labeling (TUNEL) method. At the same time we observed the effect of exogenous bFGF on neuronal necrosis and apoptosis. RESULTS: We found that together with cell necrosis there was an increase in the number of apoptotic neurons in the hippocampus CA2-3 sectors a s early as 4 h after injury, with numbers reaching a maximum at 7 d. Exogenous b FGF resulted in a definite reduction in the amount of necrosis and apoptosis. CONCLUSIONS: Neuronal necrosis and apoptosis occur in combinati on after brain injury and that one of the causes may be the insufficience expres sion of the bFGF gene in the hippocampus after severe injury. Exogenous bFGF and similar substance may prove clinically useful after brain injury by reducing ce ll necrosis and apoptosis.

Objective To evaluate the effectiveness of professional nurses in atrial fibrillation (AF) anticoagulation management system.Methods 217 consecutive patients with nonvalvular AF were enrolled.All patients received warfarin therapy for 3-6 months after catheter ablation for AF,who were divided into experimental group (n=102) and control group (n=115) by random digits table.The patients of control group adjusted their warfarin doses by following doctor's advice when discharged and by visiting the outpatient clinic regularly after discharged.The patients of treatment group adjusted their warfarin doses under the guidance of one well-trained nurse.Days of the international normalized ratio (INR) value achieved therapeutic anticoagulation range (2.0-3.0) for the first time,the effective anticoagulation rate that defined as more than 70％ of INR values between 2.0-3.0 after titration period,the ratio of times of INR value 2.0-3.0 to total times after titrating and INR monitoring frequency were compared between the 2 groups.Results In treatment group,days of the INR value achieved therapeutic 2.0-3.0 for the first time were less than that in control group (8 d vs.15 d,P＜0.01),the effective anticoagulation rate [45.1％(46/102)] and the ratio of times of INR value 2.0-3.0 to total times after titrating (67.6％±18.5％) was significantly higher than that in control group [31.3％(36/115) and 62.0％±23.1％ respectively,P＜0.05].INR monitoring during the whole period and after titrating were more frequently in treatment group [(9.4±2.2)times vs.(8.4±2.7) times,P＜0.05;(7.9±2.4) times vs.(6.3±2.8) times,P＜0.01].The number of patients in treatment group who monitor INR less than 3 times after titrating was larger than that in control group (18 vs.1,P＜0.01).Conclusions The participation of professional nurses in atrial fibrillation anticoagulation management system was helpful not only in achieving INR 2.0-3.0 more quickly but also in improving the effective anticoagulation rate.