Objective To summarize the principle and structure of objective structured clinical examination(OSCE)in the graduation practice examination of undergraduate nursing students.Methods A OSCE model was designed with a case running through the whole process of it by referring to the classic model of OSCE and applied it to the graduation practice examination of undergraduate nursing students of grade 2004.Results 75.0%students believed that the setup of OSCE location was reasonable and 78.1%of them thought that they were used to this kind of examination.100.0%of them considered that this examination model could objectively evaluate the general clinical capacity and at the same time make clear the future purpose of next internship stage. Conclusion The OSCE model could objectively evaluate the general clinical ability of students and truly reflect the existing problems,thus provide benefitable reforrences for the next internship stage.

Chitinase (EC3.2.1.14) catalyses the reaction of hydrolyzing the chitin into N acetylglucosamine (GlcNac) and (GlcNac) n.With the in deep study of chitinase,more and more biological function of chitinase appeared obviously.Now,we introduce the actualities of chitinase research,including substrate specificity,physiological function,antifungi function and transgenics, et al .

【Objective】 To investigate the effect of Fucongxiang Liquid (FL) on hippocampal CA1 neurons in rat models with vascular dementia. 【Methods】 Forty SD rots were randomized to four groups: pseudo-operation group, model group, Naofukang group and FL group. Rat models with vascular dementia were established by repeated cerebral ischemia/reperfusion combined with decreasing blood pressure and then were given with normal saline, Naofukang and FL respectively for 15 days. After treatment, the brain of mrs was taken out to make slices for hematoxylin and eosin staining to observe the histomorphological changes of hippocampal CA1 neurons. 【Results】 As compared with the pseudooperation group, a large amount of damaged, degenerative or even necrotic neurons were fotmd in the model group; FL and Naofukang could reduce the damage of neurons to different extents. 【Conclusion】 FL exerts a protective effect on hippocampal CA1 neurons in mice models with vascular dementia.

Objective To evaluate the immune function and the degree of bone marrow suppression of ubenimex tablets on the treatment of patients with triple-negative breast cancer underwent chemotherapy.Methods108 cases in Jiaxing hospital of traditional Chinese medicine were randomly divided into the control group and the experimental group, 54 cases in each group.The two group were all treated with AC-T chemotherapy (pirarubicin+ cyclophosphamide + docetaxel).At this basis, the experimental group were given ubenimex.Flow cytometry was used to detect the changes of T lymphocyte subsets, natural killer cell (NK cell) immune function and peripheral blood cell parameters in the two groups before and after the treatment and 6 months after the treatment.ResultsCompared to the control group, the T lymphocyte subsets and NK cell changes in the experimental group before and after chemotherapy were significantly smaller (P<0.05).The T lymphocyte subsets and NK cells in the experimental group were more accurate than those in the control group (P<0.05).The peripheral blood cells in the experimental group were significantly smaller than those in the control group (P<0.05).Compared with the control group, the whole blood cells increased significantly in the experimental group 6 months after chemotherapy(P<0.05).ConclusionIt can help to reduce the effect of chemotherapeutic drugs on the immune function and bone marrow suppression which ubenimex tablets was used on the treatment patients with triple-negative breast cancer c.Patients can be successfully complete the chemotherapy process, and the long-term and short-term adverse reactions were less, prognosis is good, clinical promotion value is significant.

Obej ctive To investigate the role of metastasis associated protein 1(MTA1)in estrogen reg-ulated expression of matrix metalloproteinase -9(MMP-9)and tissue inhibitor of metalprotease -1(TIMP-1) in estrogen receptor( ER ) positive breast cancer cells .Methods MTA1 knockdown cell model was generated based on MCF-7breast cancer cell line by transfected with MTA 1-shRNA.The mRNA and protein level of MMP-9 and TIMP-1 in wild type MCF-7(MCF-7WT)and MCF-7MTA1-shRNA before and after 17β-estradiol ( E2) treatment were examined by Real -time PCR and Western blot respectively .Results The MTA1-shRNA showed maximally 84.9%suppression of MTA1 expression in MCF-7,suggesting a satisfied MTA 1 knockdown cell model was established for subsequent experiments .After treated with E2 for 48 h,MCF-7WT showed an incre-ment of 46%(P<0.05)and 37%(P<0.05)of the mRNA and protein level of MMP -9 and a decrement of 32.3%( P<0.05)and 18.2%(P<0.05)of TIMP-1;MCF-7MTA1-shRNA showed a decrement of 32.3%(P<0.05)and 18.2%(P<0.05)of mRNA and protein expression of MMP -9 respectively but no significant differ-ence in TIMP-1 comparing with MCF-7WT before treated with Estradiol.After E2 treatment,MCF-7MTA1-shRNA didn′t show significant change of MMP -9 except decrements of 32.3%(P<0.05)and 18.2%(P<0.05)in the mRNA and protein levels of TIMP -1.Conclusion MTA1 may be involved in the pathway by which estrogen regulated the expression of MMP -9 but not TIMP-1 in ER positive breast cancer cells .

Objective To summarize the relationship between metabolic syndrome (MS),its components and T1 stage with high grade urothelial carcinoma (HGUC) of the Bladder.Methods The clinical data of 200 patients with T1 high grade bladder cancer who were admitted to our hospital from January 2010 to June 2014 were retrospectively analyzed,including 155 males and 45 females.Ages were 24 to 86 years old,average 66 years old.Based on the history or blood glucose levels,patients were divided into diabetic group (n =41) (20.5％) and non diabetes group 159 cases (79.5％);According to the body mass index (BMI) were divided into obese group (≥25 kg / m2) of 98 cases (49.0％) and non obese group (＜ 25 kg / m2) of 102 cases (51.0％).According to the blood pressure level,71 cases (35.5％) were divided into hypertension group and 129 cases of non hypertension group (64.5％).MS and its components and the relationship between the recurrence and progress of bladder cancer were analyzed.The Kaplan Meier method was used to assess MS and its components division of tumor progression free survival (progress-free survival,PFS) and recurrence free survival (recurrence-free survival,RFS) influence.Cox regression model of multi factor analysis were used to evaluate the PFS and RFs of MS and its components with bladder cancer.Results Of the 200 cases,16 cases (8.0％) were MS.Tumor recurrence occurred in 121 cases (60.5％),and 84 patients (42.0％) were in progress.Diabetes and non diabetes groups the average RFs were 21.7 and 29.3 months respectively,and the difference was statistically significant (x2 =10.115,P =0.001);The median PFS were 32.8 and 39.8 months respectively,the difference has statistical significance (x2 =14.760,P ＜0.001).Obese group and non obese group average RFs were 34.7 and 42.0 months respectively,and the difference were statistically significant (x2 =16.077,P ＜ 0.001);The median PFS were 22.8 and 32.6 months respectively,the difference was statistically significant (x2 =16.174,P＜0.001).The average RFS of MS group and non MS group were 21.5 and 28.4 months respectively,the difference was statistically significant (x2 =5.429,P =0.02);the average PFS was 35.1 and 38.7 months respectively,and the difference was statistically significant (x2 =3.854,P ＜ 0.05).Cox multivariate survival analysis showed that diabetes and obesity can increase the risk of recurrence and progression of T1 advanced stage bladder cancer (HR =1.792,P =0.013,HR =2.498,P ＜ 0.001;HR =0.559,P ＜ 0.001;HR =0.492,P ＜ 0.001).Conclusions Diabetes mellitus and obesity are high risk factors for the recurrence and progression of T1 advanced stage bladder cancer,but MS is not related to the prognosis of T1 patients with advanced bladder cancer.

Objective To investigate clinical interns' mastery and understanding status of medical core systems in order to provide reference for formulating training programs. Methods The questionnaires including medical core systems trained and self-assessment and test paper were de-signed. Then survey was carried out among 188 clinical interns of Grade 2009 of Zunyi Medical Col-lege at the end of training. All data were obtained, collected and analyzed with Excel and a SPSS 17.0. The result was described with percentage. Results ①78/41.34% and 117/62.33% clinical interns accepted training of medical core systems respectively before or during clinic training. 74/39.43%hos-pitals or 70/37.30% departments were systematically trained by medical core systems and the propor-tion of teachers who systematically or non-systematically explained medical core systems for clinical interns was 42/22.29%and 61/32.37%respectively.②The clinical interns who mastered first diagnosis responsibility systems, patient communication system, and systems of discussing difficult cases were 178/94.68%, 178/90.43%or 168/89.36%. The clinical interns who mastered rescue systems in critically ill patients, surgical classification management systems and audit system in clinical blood transfusion were 84/44.68%, 67/35.64%or 34/18.28%respectively.③8/6.90%interns fully grasped the core system of the medical situation. 165/87.71% and 165/83.43% clinical interns believed medical core systems should be mastered and 157 interns (83.43%) thought that mastering medical core system can help them better adapt to clinical medical work. Conclusion Systematic training of medical core system should be enhanced for clinical interns and mastering medical core systems is better for their future.

OBJECTIVE:To provide reference for improving the work quality of Pharmacy intravenous admixture service(PIV-AS). METHODS:The quality control monitoring system for PIVAS established and implemented in our hospital was introduced, the monitoring system was tracked and checked from initial stage of implementation (Jan. 2016) to implemented for 12 months (Dec. 2016),and the effect was evaluated. RESULTS:PIVAS in our hospital had developed quality control monitoring system that included medication error and critical error monitoring system,auditing medical order homogenization monitoring system,hand hy-giene monitoring system,high-alarm drug management monitoring system and drug liquid residue monitoring system. In initial stage of implementation,the relevant checking indexes including incidence of medication error and critical error,standardization rate of auditing medical orders,awareness rate of hand hygiene knowledge,compliance rate of hand hygiene,correct rate of hand hygiene,pass rate of high-alarm drug management and pass rate of drug liquid residue were 0.14%,57%,85%,70%,86%, 98%,75%;and after implemented 12 months,the indexes were 0.01%,87%,97%,81%,95%,100%,93%,respectively (P<0.05). CONCLUSIONS:The quality control monitoring system in PIVAS established and implemented in our hospital has ef-fectively improved the work quality of PIVAS.

Objective:To compare the differences of fluoroscopy time and dose between HIS bundle pacing and right ventricle apex pacing.Methods:This study includes thirty patients undergoing HIS bundle pacing (HIS group) and 32 patients undergoing right ventricular apex pacing (RVA group). The fluoroscopy time and cumulative dose (CD) to patients during surgery were recorded and analyzed.Results:The operation time for patients in HIS group and RVA group were (76.8±13.1) and (66.0±10.8) min ( t=3.386, P<0.001), respectively. The fluoroscopy time was (698.2±113.7) and (293.3±63.9) s ( t=14.709, P<0.001) and the CD were (391.3±70.0) and (162.3±40.5) mGy ( t=13.694, P<0.001) in HBP group and RVA group, respectively. In comparison, the fluoroscopy time and CD for HIS bundle electrode implantation were (501.2±112.3) s and (279.9±65.0) mGy, respectively, significantly higher than in the case of RVA, where the values were (103.4±30.6) s and (57.3±13.8) mGy ( t=15.864, Z=-6.524, P<0.001). Conclusions:Compared with right ventricular apical pacing, the HIS bundle pacing takes longer operation time, leading to higher radiation dose, which should be prudently selected.

Objective:To determine the prognostic values of clinical and laboratory features at the time of presentation on renal survival of patients with myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody(ANCA)-associated glomerulonephritis (MPO-ANCA-GN).Methods:A total of 172 patients with MPO-ANCA-GN and hospitalized at the First Affiliated Hospital of Nanjing Medical University from January 2005 to December 2018 were enrolled. The baseline clinical characteristics and renal biopsy pathological data were analyzed, and the renal prognosis was followed up. The clinical and pathological characteristics of different renal prognosis in all patients and 112 patients who underwent renal biopsy were analyzed, and the related factors affecting renal survival were further discussed.Results:Among these 172 patients, 81 were males and 91 were females. The median serum creatinine at diagnosis was 343.7(174.2, 606.6) μmol/L and the median estimated glomerular filtration rate (eGFR) was 15.81(7.61, 38.04) ml·min -1·(1.73 m 2) -1. In total, 76 patients (44.2%) received initial renal replacement therapy (RRT). During a median follow-up duration of 20(3, 60) months, 73 patients (42.4%) progressed to end-stage renal disease (ESRD) and required dialysis, including 6 (8.2%) patients who entered RRT during follow-up and 67 (91.8%) patients who received RRT at the beginning. Among the 112 patients who underwent renal biopsy, the proportion of patients who progressed to ESRD in the sclerotic group was the highest (15/25, 60.0%). The baseline serum creatinine level ( P<0.001), urine red blood cell count ( P=0.012) and the proportion of glomerular sclerosis ( P=0.002) in the non-dialysis dependent group were significantly lower than those in the dialysis dependent group, while the levels of eGFR ( P<0.001), serum albumin ( P=0.002) and hemoglobin ( P<0.001) were higher than those of the dialysis-dependent group. Kaplan-Meier survival analysis showed that the renal survival rate of the focal group was the highest ( χ2=19.488, P<0.001, log-rank test), while the renal survival rate of the sclerotic group was significantly lower than that of the crescentic group ( χ2=5.655, P=0.017); higher levels of serum creatinine (>320 μmol/L, χ2=77.229, P<0.001) and urine red blood cell count (>300 cells/μl, χ2=8.511, P=0.004), lower levels of rheumatoid factor (<20 IU/ml, χ2=8.610, P=0.003), serum albumin (<30 g/L, χ2=11.060, P=0.001) and hemoglobin (<90 g/L, χ2=21.921, P<0.001) were associated with lower renal survival rate; in terms of treatment, the renal survival rate of the glucocorticoids plus mycophenolate mofetil group was significantly higher than that of the glucocorticoids plus cyclophosphamide ( χ2=5.056, P=0.025) or the glucocorticoids alone group ( χ2=16.459, P<0.001). Multivariate Cox regression showed that baseline serum creatinine >320 μmol/L ( HR=8.803, 95% CI 3.087-25.106, P<0.001) and serum albumin <30 g/L ( HR=2.566, 95% CI 1.246-5.281, P=0.011) were the related factors affecting renal survival. Conclusion:Serum creatinine and albumin levels of MPO-ANCA-GN patients at diagnosis may be the related factors that affect the patient's renal prognosis.