The critical thinking as the important component of clinical synthesis skill,has become one of students'core competencies of the contemporary medical education.In pathology teaching process,encouraging students to raise doubts and difficulties,case teaching,the reflective teaching are effective ways to raise medical students' critical thinking.

AIM:Although there are many evidences showing positive effects of dehydroepiandrosterone sulfate(DHEA-S) in bone metabolism,the reasonable and thorough experiments are still needed to clear the mechanism of DHEA-S on bone metabolism by excluding the biological effect of its derivative hormone.This experiment is to study the efficacy and safety of DHEA-S in treatment of osteoporosis in elderly males.METHODS:①From October 2005 to October 2006,120 out-and in-patients with primary osteoporosis who were admitted in Shanghai 6th People's Hospital were selected.The diagnosis of primary osteoporosis referred to the new standard from WHO:without the application of sexual hormone,and over 2.5 standard deviation value of bone mineral density lower than the peak value of the same gender subject.All the cases were randomly divided into treatment group and control group(60 cases in every group).② DHEA-S 100 mg and Caltrate-D 600 mg were orally given to the treatment group;Caltrate-D 600 mg was orally given to the control group.③After 6 months,the bone density,serum biochemical markers,markers of bone resorption and formation as well as side effects were measured.RESULTS:120 osteoporosis patients entered into analysis.①Compared to the pretreatment and control group,the bone mineral density in lumbar spine 1,lumbar spine 2-4,femoral neck,and upper part of femoral bone were increased significantly in the treatment group(P 0.05).CONCLUSION:Treatment of osteoporosis in elderly males with DHEA-S is safe and effective without obvious side effects.

Objective To study the relationship between obstructive sleep apnea hypopnea syndrome(OSAHS)and carotid atherosclerosis in ischemic stroke patients.Methods 43 subjects with ischemic stroke were enrolled and divided into carotid atherosclerosis group and carotid normal group according to the intima-media thickness(IMT)and plaque of carotid arteries,which determined with high-resolution ultrasound.Polysomnography(PSG)was performed for all the patients and record the apnea-hypopnea index(AHI),oxygen desaturation index,deep duration with SaO2

Objective To study the clinical nurses and nursing students' cognition of clinical nurse specialist (CNS) and provide the basis for promoting the development of CNS.Methods Quantitative and qualitative research were adopted in this study.One hundred and ninety clinical nurses and nursing students were investigated with a questionnaire about the cognition of CNS,and the qualitative research was conducted on 9 clinical nurses selected by purposive sampling method.Results Most participants realized the importance of CNS and 78.4％ of them wished to be an excellent CNS.The cognition was different between the two groups,especially in terms of ability,working performance and status.Conclusions We should improve the clinical nurses and nursing students' cognition of CNS,and cultivate them with the core competence of CNS.Meanwhile,improving the status and confirming the role must be done to promote the development of CNS in China.

Phospholipids and their metabolites play an important role in a variety of cellular processes including cell-cell adhesion, cell growth and differentiation, apoptosis, phagocytosis as well as storage of energy. In this study, the phospholipid composition of cancer tissue and adjacent normal tissue from humans and animals were analyzed by internal extractive electrospray ionization mass spectrometry ( iEESI-MS ) . Extractive solvent at high voltage (+5. 5 kV) was injected into tissue samples using a fused silica capillary at a flow rate of 0. 5-1 μL/min, producing fine charged droplets containing analytes of tissue samples at the tip of the sample. Charged droplets were directly sampled to the atmospheric inlet of a mass spectrometer. Out of 21 different ratios of CH3 OH ∶H2 O solvent mixture, the ratio CH3 OH ∶ H2 O=30∶70 ( V/V ) showed the optimal phospholipids extraction and visibility in MS. A large number of phospholipids from different tissue samples ( such as cancer tissue and adjacent normal tissue of lung cancer, esophageal cancer tissue, pork, beef, porcine heart and porcine lung) were obtained simultaneously by iEESI-MS analysis. The experimental results demonstrated that iEESI-MS was characterized by minimal sample pretreatment, low sample consumption, and rapid analysis ( the analysis time per sample was less than 1 min) , and the selectivity and sensitivity of iEESI-MS could be improved by choosing proper solvent. Importantly, the experimental results provided new information for further studies of phospholipids in biological tissues.

Objective To compare the efficacy of lymph nodes(LNs) dissection between video-assisted thoracic surgery (VATS) and thoracotomy in the treatment of clinical stage Ⅰ lung cancer.Methods A comprehensive search of PubMed,Ovid Medline,EMBASE,Web of Science,ScienceDirect,the Cochrane Library,Scopus database and Google Scholar was performed to identify studies comparing VATS and thoracotomy in LNs dissection.The data was analyzed by RevMan 5.3 software and SPSS 18.0.Results After selection,23 articles met the inclusion criteria.2 316 patients were involved in VATS group and 3 346 patients were involved in Open group.Meta analysis showed that less total LNs(95％ CI:-1.64--0.60,P ＜ 0.0001),totalLNsstations(95％CI:-0.61--0.01,P=0.04) andN1 LNs(95％CI:-0.28--0.02,P=0.02)were dissected in VATS group.On the left side,more LNs were dissected in VATS group(95％ CI:0.51-3.22,P =0.007).The same number of mediastinal LNs (95％ CI:-0.74-0.15,P =0.20),mediastinal LNs stations (95％ CI:-0.20-0.14,P =0.76),right side LNs (95 ％ CI:-1.52-2.23,P =0.71) were harvested in both groups.Conclusion In the surgical treatment of clinical stage Ⅰ lung cancer,less total LNs,total LNs stations and N1 LNs were dissected in VATS group,while more left side LNs were harvested by VATS.The same number of mediastinal LNs,mediastinal LNs stations right side LNs were harvested in the two groups.This conclusion still needs to be further proved by more high-quality and large-scale RCTs.

Objective Design the "Nursing Obstetrics and Gynecology" network courses, and then observe the teaching effect of it. Methods The rational design of technical solutions, development and application of information resources and modem educational technology. Results The "Nursing Obstetrics and Gynecology" network courses prompt satisfaction teaching more than 90%. Conclusions "Nursing Ob-stetrics and Gynecology" network courses make our teaching program is brand new, as "Nursing Obstetrics and Gynecology" network courses of discipline and quality building a solid foundation, especially for the cultivation of young teachers to provide direct help.

Background Transscleral diode laser cyclophotocoagulation (TDCP) was used to later stage of glaucoma in the past.However,the indications of TDCP are expanding gradually over time and there are more and more reports about its application in different stages and different types of glaucoma.Objective This study was to compare the clinical efficacy of TDCP and trabeculectomy for primary acute angle-closure glaucoma (PAACG) with persistent ocular hypertension.Methods Ninety-five PAACG patients with persistent ocular hypertension were retrospectively analyzed.The patients were divided into TDGP group (62 eyes of 56 cases) and trabeculectomy group (44 eyes of 39 cases) based on the difference of treating fashions.The clinical outcomes were compared between the two groups with the evaluating indexes of visual acuity,intraocular pressure (IOP) before and 1 week,3 months and the end of following-up as well as the number of drug used and the re-treatment.Results The demography was matched between the two groups (all at P＞0.05).The number of eyes with visual improvement was significantly different among the groups (x2 =30.927,P =0.002) in the TDCP group.Compared with before treatment,the number of visual improvement in 1 week after treatment was significantly raised (x2 =16.778,P =0.002).No significant differences were seen in the eye number of visual improvement in various timepoints after treatment (all at P＞0.008).Also,the eye number of visual improvement was significantly different among the different timepoints (x2 =44.345,P＜0.001),and statistically significant change was found between the preoperation and postoperative 1 week (x2 =23.725,P＜0.001).However,there were no significant differences in the eye number of visual improvement in various timepoints after operation each other (all at P＞0.008).The IOP was insignificantly altered among the groups at various timepoints (Fgroup =3.836,P =0.053),but the change was significantly different over time (Ftime =757.078,P＜0.001).The postoperative IOP was significantly higher than that of preoperation in both groups (all at P＜0.001).The proportion of eyes using lowering-IOP drugs was 48.4％ in the TDCP group,and that in the trabeculectomy group was 27.3％,showing a significant difference between them (x2 =4.796,P =0.029).The retherapy was performed in 20 eyes (32.3％) and 2 eyes (4.5％) in the TDCP group and the trabeculectomy group,respectively.Conclusions The short-term lowing-IOP effecacy of TDCP is similar to trabeculectomy,but the longterm lowing-IOP efficacy of TDCP is not good.Compared with the trabeculectomy,TDCP shows more simple operation,less time-consuming during the surgery and milder tissue damage,but the eyes continuing to use anti-glaucomatous drugs or re-therapy are increased.

BACKGROUND: Dehydroepiandrosterone (DHEA) derived from adrenal cortex has an indirect bioeffect through differentiating into androgen or estrogen in the related peripheral tissues. OBJECTIVE: To verify the effects and mechanisms of DHEA on promoting osteoblasts (OBs) proliferation. DESIGN, TIME AND SETTING: The grouping controlled experiment was accomplished in Shanghai Sixth People's Hospital affiliated to Shanghai Jiao Tong University and Institute of Radiation Medicine, Fudan University from January 2006 to February 2007. MATERIALS: Ten SD rats were recruited, 1 day old, regardless of gender. DHEA was the product of American Sigma Company. METHODS: Rat OBs were separated and cultured in vitro. First generation of OBs cultured in a varied concentrations of DHEA (1?10-5, 1?10-7 and 1?10-9 mmol/L) for 72 hours were set up as the experiment group, while those exposed to 1?10-8 mmol/L of estradiol culture were regarded as positive controls and blank control group was set up as well. MAIN OUTCOME MEASURES: The OBs were identified by cell morphology and alkaline phosphatase (ALP) dyeing. Light microscope and methyl thiazolyl tetrazolium assay were used to detect the growth and proliferation of OBs. The formation of mineralized nodus was examined by alizarin bordeaux stain. The concentrations of osteoprotegerin in DHEA culture solution were also measured by double antibody sandwich ABC-ELISA simultaneously. RESULTS: ①Identification of primarily cultured OBs showed ALP dyeing was positive.②Proliferation rate of OBs was increased in experiment groups compared with that of the blank control group, and the most significant increase occurred in the concentration of 1?10-7 mmol/L DHEA culture (P 0.05).③ALP activity in experiment groups was higher, especially in the group with the concentration of 1?10-7 mmol/L DHEA (P 0.05).④ALP activity of unitary cell population was higher in 1?10-9 mmol/L DHEA culture group than that in blank control group (P

Objective To explore clinical value of the single-hale video-assisted thoracoscope surgery in lung surgery.Methods In our hospital from January 2015 to June 2015, a total of 60 patients was performed with lung partial resection line thoracoscope surgery, 28 routine puckering traditional video-assisted thoracoscope treatment, in the same period 32 underwent video-assisted thoracoscope surgery.Intraoperative blood loss, operating time, postoperative pain degree, and postoperative chest such as flow rate were compared between two groups.Results Two groups of patients had no perioperative death and severe complications.Intraoperative blood loss and operating time were no significant significance between single-and double-hole operation groups.The degree of postoperative pain score was (0.8 ± 0.5) in puckering thoracoscope group, and (1.2 ± 0.6) in traditional thoracoscope group, with significant difference (P =0.009).Conclusions Single-hole thoracoscope surgery in the treatment of lung diseases is feasible and reliable compared to traditional thoracoscope surgery, and patients can effectively reduce postoperative pain, and improve the quality of life.