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.

Objective To compare the efficacy and safety of topical anesthesia,conscious sedation and intravenous anesthesia during endoscopic varices ligation(EVL).Methods Patients underwent EVL were divided into 3 groups to receive different anesthetic methods,namely topical anesthesia,conscious sedation and intravenous anesthesia,with 50 subjects in each group.The changes of vital signs,the tolerance to stimulation of the procedure,the time of operation,the rate of complication were recorded and compared between 3 groups.Results The procedure of EVL were completed in all patients.In topical anesthesia group,40(80%)patients had nausea and vomiting,9 cases(1 8%)tried to pull out the endoscopy.The mucosa at the entrance of the esophagus were injured in 10 cases(20%).Massive bleeding occurred in 4 patients(8%)during operation because of nausea and vomiting.In conscious sedation group,only 7 patients(14%)had mild nausea and vomiting,and no complication of variceal bleeding occurred.The mucosa at the entrance of the esophagus was injured in 5 cases(10%).In intravenous anesthesia group,no patient had nausea or vomiting.The respiratory rate,heart rate and mean artery pressure decreased during the procedure,but without significant difference(P＞0.05).The operation time in intravenous anesthesia group WaS shorter than that in other two groups,but without significant difference(P＞0.05).Conclusion EVL can be completed under 3 different anesthetic methods,while EVL under conscious sedation is more effective and safe.

Objective To know the present situation and the different humanistic caring abilities among college nursing students,so as to provide reference for education training strategy of nursing humanity care.Methods A total of 396 college nursing students were investigated by using the nursing students' humanistic caring ability scale.Results The total score of nursing students' humanistic caring ability was (110.85±21.57),with a scoring rate of 61.59％.Statistically significant differences of humanistic caring ability were found among students of different education levels,different genders and different colleges.Conclusions The level of nursing students' humanistic caring ability was low,so nursing schools and clinical teaching hospitals should strengthen the training of students' humanistic caring ability according to the characteristics of different education level,and take effective training strategies to improve college nursing students' humanistic caring ability.

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.

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.

Objective To evaluate the effects of long-term high-fat diet on skin wound repair in mice, and to explore its related mechanism. Methods A total of 16 ten-week-old C57BL/6J wild-type mice were randomly and equally divided into two groups to be fed a high-fat diet(HFD group)and a standard diet(SD group)respectively for 8 weeks. Then, an 8-mm full-thickness skin wound was created on the back of each mouse by using a biopsy punch. The degree of wound healing was observed, wound healing rate and epithelialization level were evaluated every day. The weight of mice was measured before feeding, after 8-week feeding and on day 14 after the operation. Peripheral blood samples were obtained from these mice for the determination of total cholesterol(TC)and triglyceride(TG)levels after a 12-hour fast on day 14 after the operation. Then, all the mice were sacrificed, and wound tissues were resected from the dorsal skin of mice for a histological study. The two-sample t test was used to compare the thickness of new epidermis in the wound surface, collagen deposition rate in the wound bed, count of new vessels, levels of cell proliferation and degree of inflammatory cell infiltration between the two groups. Results The average weight of mice was significantly higher in the HFD group than in the SD group after 8-week feeding(27.3 ± 0.7 g vs. 21.2 ± 0.6 g, t = 21.98, P < 0.001)and on day 14 after the operation (28.8 ± 0.7 g vs. 23.1 ± 1.1 g, t = 25.22, P < 0.001). Similarly, there was a significant increase in the levels of TC(1.35 ± 0.32 mmol/L vs. 0.99 ± 0.28 mmol/L, t = 2.24, P < 0.05)and TG(4.21 ± 0.41 mmol/L vs. 2.71 ± 0.31 mmol/L, t = 6.49, P < 0.05)in the HFD group compared with the SD group 14 days after the operation. Compared with the SD group, the HFD group showed shorter healing time (13.5 ± 0.5 days vs. 12.6 ± 1.1 days, t = 1.99, P < 0.05), lower thickness of newborn epidermis on the wound surface (47.8 ± 13.8 μm vs. 95.7 ± 13.7 μm, t = 5.68, P < 0.001), decreased number of CD31-positive vessels(8 ± 1 vs. 13 ± 3, t = 4.1, P < 0.001)and count of ki-67-positive cells(21 ± 4 vs. 49 ± 10, t = 3.33, P < 0.001), but increased count of infiltrating macrophages and mast cells (both P < 0.05). No significant difference was found in collagen deposition rate in the wound bed between the two groups (P > 0.05). Conclusion Long-term high-fat diet can affect wound healing and delay skin wound repair in mice.