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.

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.

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

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.

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.

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.

Objective To study and analyze the clinical effect of zoledronic acid in the treatment of bone metastasis in patients with lung cancer.Methods 50 cases of lung cancer patients with bone metastasis from January 2015 to December 2016 in our hospital were selected and randomLy divided into two groups, the control group and the experimental group, with 25 patients in each group.The control group was treated with pamidronate intravenous drug treatment, patients in the experimental group of zoledronic acid monotherapy in the treatment of.After treatment for a period of time, the relative clinical indicators of the experimental group and the control group were compared and analyzed.Results After the corresponding treatment, 3 patients in the experimental group had complications, the proportion was 12%, and 2 cases in the control group had adverse reactions, the incidence was 8%.The incidence of adverse reactions and the effectiveness of pain treatment in the experimental group were not significantly different from those in the control group, and there was no statistical significance.After treatment, the quality of life scores and general status scores of the experimental group and the control group were significantly higher than those before treatment, with statistical difference(P<0.05).There was no significant difference in the quality of life score and general condition score between the experimental group and the control group, and there was no statistical significance.Conclusion Zoledronic acid monotherapy in the treatment of metastasis corresponds largely to pamidronate treatment for lung cancer patients with bone, can improve the treatment effect and quality of life in a large extent, help the patients to relieve pain, with further clinical promotion and application significance.

Objective To investigate the clinical features,magnetic resonance imaging (MRI),treatment,and follow-up of patients with glutaric aciduria type Ⅰ (GA-1).Methods Four pediatric patients with GA-1 diagnosed in our hospital were included in this study.They were treated with special diets and carnitine supplements.MRI and tandem mass spectrometry (MS/MS) were performed,and the mental development indices were measured.Results GA-1 was confirmed 2 months,13 months,4 months,and 7 months after birth.Seizure had been observed before the disease diagnosis in three patients and disappeared after treatment.In all four patients,T2-weighted brain MRI showed frontotemporal atrophy or hypoplasia and enlarged subarachnoid space in the sylvian fissures and anterior to the temporal lobes.Diffusion weighted imaging revealed high-density lesions over both the putamen and globus pallidus.The patients were followed up for 4 to 5 years.Plasma amino acids and acylcamitine profile were monitored every 3-5 months.The mean C5DC level and C5DC/C8 were kept the higher limits of the normal ranges,especially in case 3.During the follow-up,the body weight was at-2 SD-0 and the height at-1 SD-0.Intellectual development test showed that case 1 and case 4 had mildly abnormal intelligence,whereas case 2 and case 3 had extremely severe intellectual disability.Gene test confirmed the presence of gene mutations in all four cases,including IVS10-2A ＞ C homozygous mutation in cases 1,3,and 4 and [IVS10-2A ＞ C] + [c.245G ＞c(p.Arg82Pro)] hybrid mutation in case 2.Two female children were smoothly enrolled by local kindergarten,while two male children were unable to walk alone due to delayed motor development and spastic paralysis.Conclusions The phenotype of GA-1 patients is not remarkably correlated with its genotype correlation.Newborn screening is essential for identifying GA-1 patients.

Objective To detect and analyze the levels of preoperative serum carcino-embryonic antigen (CEA) and CA15-3 in early invasive breast cancer patients and their correlation with pathological parameters. Methods Electrochemical luminescence immunoassay (ECLI) technology was used to detect serum levels of CEA and CA15-3 in 223 cases of early invasive breast cancer patients, 109 patients with benign lesions, and 30 cases of heath control. Immunohistochemical (IHC) and fluorescence in situ hybridization (FISH) were used to detect the estrogen receptors (ER), progesterone recepter (PR), and its HER-2 pathological indicators.Besides, the correlation of serum CA15-3, CEA levels and pathological parameters was analyzed. Results The serum CA15-3 and CEA levels of Breast cancer patients [(22.27±15.11) U/ml, (5.03± 0.49) μg/L] were significantly higher than that of patients in benign lesion group [(14.13±3.04) U/ml, (2.72± 0.11) μg/L] (P< 0.05). CEA level of patients with histological grade Ⅲ was (6.34 ±0.93) μg/L, significantly higher than the level Ⅰ-Ⅱ (4.23±0.50) μg/L (P< 0.05). CA15-3 level was (19.26±15.08) U/ml in T1 tumors, and CA15-3 level was (28.73 ±11.53) U/ml in T2 tumors (P<0.05). The serum levels of CEA and CA15-3 between different histology, pathologic stage, lymph node status, ER, PR, HER-2, pathological characteristics had no significant difference (P>0.05). CEA positive rate of breast cancer group was significantly higher than that of benign lesions(13.5%vs. 3.7%, 26.5%vs. 1.8%, P<0.05). 30 cases of normal control group had no positive one. The joint monitoring sensitivity of CEA and CA15-3 breast cancer group was 9.4 %, the sensitivity was 0 in benign lesion group. There was significant difference (P < 0.05). Conclusion The changes of Serum CA15-3 and CEA levels in breast cancer patients can be considered as the judgment standard for early diagnosis, pathological staging, prognosis and clinical effect monitoring.

Objective To investigate the contents of IL-1β and IL-1ra in cerebrospinal fluid of children with Japanese encephalitis, and their clinical significance. Methods Enzyme linked immunosorbent assay (ELISA) was employed to detect IL-lβ and IL-lra contents in 50 children with Japanese encephalitis and 20 children without nervous system disease (controls). Results IL-1β contents in climax stage, convalescent stage and the controls were (49. 43±14. 59) , (24. 73±14. 50) and (8. 98± 1.26)μg/L (F = 79.88, P<0.01); IL-lra contents in climax stage, convalescent stage and the controls were (177. 39±60. 19), (78. 24±44. 63) and (21. 09±3. 10) μg/L (F = 91. 53, P <0. 01). There were significant differences on IL-lβ and IL-lra contents among children with mild, moderate and severe encephalitis (climax: F = 82.36 and 66.50, P<0.01; convalescence; F = 55. 17 and 79.50, P<0.01). IL-1β content was positively correlated with IL-lra in both climax and convalescent stages (climax; r = 0. 815, P < 0.01; convalescent; r= 0.728, P < 0.01). Conclusions IL-lβ and IL-lra contents in cerebrospinal fluid are significantly increased in children with Japanese encephalitis in climax stage, which are closely correlated with the disease severity. The two indicators may participate in the pathological process of brain damages with Japaness encephalitis.