How to cultivate and evaluate the nursing students′clinical competency is an important part of the process of higher nursing education .Objective structured clinical examination is regarded as an effective assessment method to evaluate the clinical com -petency of medical students .However , it is still at the initial stage in the nursing education in China .This article presents an overview on the design of nursing objective structured clinical examination , the present application of objective structured clinical examination in cultivating and evaluating the nursing clinical competency and the effectiveness of objective structured clinical examination .

Objective To investigate the effects of occupational therapy based on International Classification of Functioning, Disability and Health (ICF) on activities of daily living of patients with hemiplegia after stroke. Methods From May to November, 2013, 60 patients with hemiplegia after stroke were randomly divided into observation group (n=30) and control group (n=30). Both groups received routine treatment, while the control group received routine occupational therapy and the observation group received occupational therapy based on ICF. They were assessed with modified Barthel Index before and 40 days after treatment. Results The scores of items of MBI improved after treatment in both groups (t>14.86, P<0.001), and improved more in the observation group than in the control group (t>18.65, P<0.001). Conclusion The occupational therapy based on ICF can further improve the activities of daily living of patients with hemiplegia after stroke.

Objective To explore a best operative method in order to improve operative manipulated skill of simultaneous pancreas-kidney transplantation(SPKT),a model of SPKT was established in dogs.Methods 12 dogs of SPKT were performed in animal model.A renoportal end-to-end anastomoses between the renal and the spleen vein.Only two vascular end-to-side anastomoses between the donor portal vein and recipient ilio-vein,and between the donor celiac arteries and recipient abdominal aorta were constructed.Pancrease was placed in the right iliac fossa and kidney in the left.Pancreatic exocretion goes through bladder drainage.Results Combined resection was successfully performed in 6 dogs and the other underwent simultaneous pancreas-kidney transplantation.Satisfactory result was obtained in 5 survival dog for a mean of (1 5?0 8)days,although 1 dog died from hypopiesis.Conclusions The model is practically feasible and might be used in studying the problems involved in SPKT,which is effective for the treatment of end-stage diabetic nephropathy.

Dialysis patients become more and more with the development of dialysis technology , but their quality of life is menaced by all kinds of complications which resulted in physical and psychological dysfunction . However, exercise therapy may help patients return social.

Objective To evaluate the therapeutic effect of antituberculosis therapy in elderly patients with smear-negative pulmonary tuberculosis by low-dose computed tomography (CT).Methods Forty-seven elderly patients diagnosed as smear-negative pulmonary tuberculosis were rechecked with low-dose chest CT scan (120 kV, 20 mAs) after 1-12 months of antituberculous therapy respectively. These images were compared with common CT before treatment (120 kV, 200-280 mAs). Results In the elderly patients with smear-negative pulmonary tuberculosis, the most common CT signs before treatment were acinus consolidation (100%) and lobar or segmental consolidation (77%), but the cavity was seen less. After effective antituberculous therapy, tree-inbud was improved after one to three months, the acinus consolidation and lobular or segmental consolidations were improved after four to nine months, and the cavitations were slowly improved after six months. Conclusions Low-dose CT can provide sufficient information for the therapeutic effects of antituberculous therapy of smear-negative pulmonary tuberculosis in the elderly and could be used for rechecking.

Objective To investigate the expression of CD4 +CD25 +CD127 low regulatory T cells in peripheral blood mononuclear cells( PBMNCs) in order to explore the influence on the immune status and disease progression in the different period of acute ischemic stroke. Methods 60 patients with acute cerebral infarction were selected as the stroke group,and divided them into the 24~48 h group (n=16), 3~7 d group (n=22) and 8~14 d group (n=22);22 healthy human were set as the control group. To analyze the percentage of CD4 +CD25 +CD127low regu-latory T cells in the peripheral blood of acute cerebral infarction patients and healthy human with flow cytometry. Results The percentages of CD4 +CD25 +CD127 low and CD4 +CD25 high regulatory T cells in the peripheral blood of the stroke group were significantly decreased at 24 ~48 h,3 ~7 d ( P <0.01 ) when compared with the control group, and then tended to return toward the control value at 8~14 d (P>0.05);the percentage of CD4 + regula-tory T cells in the peripheral blood of the stroke group was significantly higher than control group ( P <0.05 ) . Conclusion Imbalance of regulatory T cells is very likely to play an important role in the immunological injury of acute ischemic stroke. Regulatory T cells may be involved in the pathogenesis of acute ischemic stroke,and early detection may provide a basis for treatment.

Objective To investigate the number of osteoclast (OC) precursor in the peripheral blood of patients with ankylosing spondylitis (AS) and its relationship with serum receptor activator of nuclear factor KB-ligand (RANKL) and Osteoprotegerin (OPG) concentration as well as the disease activity. Methods The peripheral blood mononuclear cells from 8 cases of AS patients and 5 healthy controls were cultured in the medium containing macrophage colony-stimulating factor (M-CSF) (25 ng/ml) and RANKL (40 ng/ml). After being cultured for 14 days, cytochemistry was applied to detect tartrate-resistant acid phosphatase (TRAP) expression and the cells with TRAP expression and ≥3 nuclei were counted and defined as OC. Bone resorption assay was used to demonstrate OC function. ELISA was used to measure serum RANKL and OPG concentration in 23 cases of AS and 17 healthy controls. The relationship was analyzed in AS patients between the number of OC precursors and serum RANKL and OPG concentration as well as the disease activity. The indicators of disease activity were Bath ankylosing spondylitis disease activity index (BASDAI), Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). T test, t' test and Spearman correlation were selec-ted. Results ① Significantly higher OC production was observed in the peripheral blood of AS patients than that of healthy control group. The OC number per ten fields was 10.9±3.4 and 6.2±1.3 respectively (P<0.05); ② There was significant difference between AS patients and healthy controls in serum concentration of OPG and RANKL and the ratio of RANKL/OPG. OPG was significantly higher in AS patients [(157±49) pg/ml] than in healthy controls [(105±20) pg/ml] (P<0.05). RANKL was significantly higher in AS patients [(5.4± 3.8) pg/ml] than in healthy controls [(1.6±0.8) pg/ml] (P<0.05). The ratio of RANKL/OPG was significantly higher in AS patients (0.037±0.026) than in healthy controls (0.016±0.008) (P<0.01 );③Significantly positive correlation was observed between the OC number and the serum concentration of RANKL (r=0.692, P=0.009), the ratio of RANKL/OPG (r=0.813, P=0.001);④ In AS patients, serum concentration of OPG was found to have significantly negative correlation with BASDAI (r=-0.444, P=0.044). Serum RANKL concentration was found to have significantly positive correlation with BASDAI (r=0.543, P=0.011). The ratio of RANKL/OPG was found to have significantly positive correlation with BASDAI (r=0.672, P=0.001). Conclusion ① More OC precursors exist in the peripheral blood of AS patients. These cells may differentiate into osteoclasts, which might play a role in joints destructions in AS;② The mechanism of high OC production is likely to be due to high RANKL concentration which is caused by inflammatory reaction.

Objective: To analyze the short-term and long-term effects of non-operative therapy in the treatment of prolapsed lumbar intervertebral discs. Methods: One hundred and sixty-five subjects were randomized in single-blind method into traction group (A), Tuina group (B), and Tuina and exercise group (C); after 2 courses of treatment, the short-term effects were evaluated. Moreover, 102 cases with significant short-term effects were randomized in single-blind method into exercise group (D) and control group (E). The relapse rates in the two groups were survey one year after treatment; and the lumbar functions were assessed respectively six months and twelve months after treatment. Results: Groups B and C had obviously better effects than group A (χ2=8.359, P＜0.01); the relapse rate after one year was strikingly lower in group D than group E (χ2=12.631, P＜0.01). Conclusion: Tuina plus functional exercise is an effective method in the prevention and treatment of prolapsed lumbar intervertebral discs.

Basic and cIinicaI studies demonstrate that depression is associated with abnormaI neuraI pIasticity in some brain regions,incIuding the prefrontaI cortex and hippocampus. Brain-derived neurotro-phic factor(BDNF)and its signaIing pathways pIay a cruciaI roIe in reguIating neuraI pIasticity and deveI-opment of depression. Ketamine or scopoIamine can produce a quick and sustained antidepressant effect,and both can quictIy activate BDNF-signaIing pathways reIated to neuraI pIasticity. In order to pro-vide the theoreticaI basis for future researches on new antidepressants,the neuraI pIasticity mechanisms of faster-onset antidepressants are reviewed in this paper.

Objective To establish a GC method for the determination of menthol in Fufang Caoshanhu Hanpian. Method HP-FFAP elastic quartz capillary vessel column was used,FID detector,programmed temperature,injection and detector temperatures was 250 ℃. Result The linear range of menthol were 0.020～ 0.300 ?g,respeetively. The average recoveries was 99.36% (RSD=1.12%). Conclusion This method is simple and accurate,and can be used for the determination method of menthol in Fufang Caoshanhu Hanpian.