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 compare the characteristics of food and nutrition intake in type 2 diabetes mellitus (T2DM) patients with or without carotid atherosclerosis and analyze the relationship between diets/C-reactive protein (CRP) and carotid intima-media thickness (C-IMT). Methods Sixty patients with T2DM were enrolled and divided into two groups based on C-IMT: group A (C-IMT ＜ 1 mm, n=30) and group B (C-IMT≥1 mm, n=30). All subjects were investigated with questionnaires including 3-day food recall They all took somatometric measurement. Blood and urine samples were collected in all subjects to examine the levels of high sensitive-CRP,C-peptide, blood glucose, glycosylated hemoglobin, blood lipid, renal function, urine microalbumin, and other indicators. Results The intakes of vegetables, fruits, and aquatic products were significantly higher in group A than in group B ( P ＜ 0. 05 ). The intake of vitamin C in group A was significantly higher than that in group B ( P ＜0. 05 ). The levels of CRP in group B was significant higher than that in group A (P = 0. 000). Positive correlation was found between CRP level and C-IMT in T2DM patients ( r = 0. 36, P = 0. 004). Furthermore, CRP was negatively correlated with the intakes of vegetables and fruits ( r = - 0. 334, P = 0. 01 ), aquatic products ( r = -0. 315, P = 0. 016), and vitamin C ( r = - 0. 2786, P = 0. 038 ), respectively. The intake of fruits was negatively correlated with C-IMT (r, = -0. 33, P = 0. 01 ). Conclusions T2DM patients without carotid atherosclerosis intake more vegetables, fruits, aquatic products and vitamin C than those with atherosclerosis. Vegetables, fruits,sea foods and vitamin C may be the protective factors against atherosclerosis in T2DM patients. CRP is associated with the development of atherosclerosis in T2DM patients.

Objective: To explore the diagnostic values of Wells score and YEARS algorithm in the patients with pulmonary embolism and to compare the areas under receiver operating characteristic (ROC) curves (AUC) of Wells score and YEARS algorithm, and to find the more suitable score method for pulmonary embolism in clinic. Methods: A total of 139 patients who were suspected with pulmonary embolism were collected, among them 48 patients were clinically as confirmed pulmonary embolism. The disease history, clinical manifestation and results of auxilliary examinations of the patients were collected. All the patients were assessed by Wells score and YEARS algorithm, respectively; the computed tomographic pulmonary angiography (CTPA) was considered as golden standard. The sensitivities, specificities, misdiagnosis rates and omission diagnostic rates, and the accuracies of Wells score and YEARS algorithm of the patients in two groups were analyzed with SPSS 22.0 software; the conformities of results of Wells socre, YEARS algorithm, and CTPA were analyzed. Then ROC curves of Wells score and YEARS algorithm in diagnosis of pulmonary embolism were made, and the AUC was calculated and compared. Results: Compared with YEARS algorithm, the specificity and accuracy of Wells score in diagnosis of pulmonary embolism were markedly increased (P<0.05), the misdiagnosis rate was decreased (P= 0.037), however the sensitivity and the misdiagnosis rate had no significant differences ( PX). 05). The Kappa value of Wells score and CTPA was 0. 45, the conformity was moderate; the Kappa value of YEARS algorithm and CTPA was 0.22, the conformity was passable; the Kappa value of Wells score and YEARS algorithm was 0. 11, the conformity was bad. The AUC of Wells score and YEARS algorithm were 0. 753 + 0. 044 ( P<0. 01) and 0. 585 + 0. 049 ( P=0. 101). Conclusion: The Wells score is superior to the YEARS algorithm in the diagnosis of pulmonary embolism.

etary oil with MCT can improve insulin resistance.

Objective To evaluate the accuracy and reliability of cone-beam computed tomography (CBCT) in the diagnosis of periodontal bone defects in the elderly.Methods The 38 teeth of 27 cases were collected and scanned both with CBCT technology and periapical radiography (PA).Periodontal bony defects were identified and linear measurements were made for all defects.All cases were treated with periodontal flap surgery with the bony defects and their linear measurements detected during operation as the gold standard.Results All periodontal bony defects were identified with CBCT with its accuracy rate of 100.0％ (72/72),but the buccal and lingual defects could not be measured by PA with its accuracy rate of 62.5％ (45/72).Linear measurements for all defects revealed no statistical differences between CBCT and direct measurement [(5.516 ± 0.393) mm vs.(5.385± 0.415) mm,t=1.948,P＞0.05],but there was a significant difference in linear measurement between PA and direct measurement [(6.311±0.439) mm vs.(5.411±0.418) mm,t=9.956,P＜0.05].Conclusions CBCT can offer the diagnostic information for periodontal bone defect from three dimensional direction in the elderly,provide objective and accurate assessment of alveolar bone resorption,and has higher accuracy and reliability.

Jaundice is frequent clinic symptoms with high incidence especially among the critical patients. The sepsis complicated with jaundice has drawn more and more consideration. However, the pathogenesis about sepsis complicated with jaundice is not confirmed and it is sometimes identified incorrectly as cholestatic jaundice. This article summarises the pathogenesis and elucidate the management about sepsis complicated with jaundice.

Objective: To investigate the relationship between Bilirubin blood lipid comprehensive index and ifbrinogen (FIB) to severity of coronary lesions in patients with coronary artery disease (CAD).
Methods: A total of 324 patients with angiography (CAG) conifrmed diagnosis were divided into 2 sets of groups.①By CAG examination, the patients were divided into 2 groups: CAD group,n=262 and Non-CAD group,n=62.②By Gensini scoring system, the patients were divided into 4 quartile groups: 1st quartile group,n=58, 2nd quartile group,n=110, 3rd group, n=80 and 4th quartile group,n=76. The blood levels of total bilirubin (TBIL), total cholesterol (TC), LDL-C, HDL-C, TG and ifbrinogen were measured and bilirubin blood lipid comprehensive index, TC/(HDL-C+TBIL) and LDL-C/(HDL-C+TBIL) were calculated respectively.
Results:①By CAG examination, compared with Non-CAD group, CAD group had increased TC, LDL-C, ratios of TC/(HDL-C+TBIL), LDL-C/(HDL-C+TBIL) and FIB,P<0.05; decreased TBIL and indirect bilirubin (IBIL),P<0.05.②By Gensini scoring system, the level of TBIL, IBIL, ratios of LDL-C/(HDL-C+TBIL), TC/(HDL-C+TBIL), HDL-C and FIB were different among 4 groups,P<0.05.③ Logistic regression analysis indicated that with excluded interactional factors, the bilirubin blood lipid comprehensive index was the independent risk factor for CAD[TC/(HDL-C+TBIL): OR: 1.668, 95% CI:1.065~2.784,P=0.028; LDL-C/(HDL-C+TBIL ): OR: 1.786, 95% CI: 1.021~2.879,P=0.030].④Correlation analysis presented that TC/(HDL-C+TBIL), LDL-C/(HDL-C+TBIL) and FIB were positively related to Gensini scoring system (r=0.423,P<0.01), (r=0.417,P<0.01) and (r= 0.293,P <0.01) respectively.
Conclusion: Bilirubin blood lipid comprehensive index and ifbrinogen were positively related to severity of coronary lesions in CAD patients.

Objective To explore the protective effect and mechanism of astaxanthin (AST) on the acute kidney injury induced by iohexol in rats.Method Thirty rats were randomly divided into five groups:control group (Ctrl);iohexol group (CM);astaxanthin group (AST,100 mg/kg),low astaxanthin dose group (LAST+CM,50 mg/kg) and high astaxanthin dose group (HAST+CM,100 mg/kg),6 in each group.The rats in AST,LAST+CM,HAST+CM groups were administrated with AST by oral gavages using an intubation needle for 10 consecutive days.The rats in Ctrl and CM groups rats in Ctrl,CM groups were given with dissolvant instead in equal volume.Except for the Ctrl and AST groups,on day 8,rats were given indomethacin,L-NAME and iohexol in their femoral vein under chloral hydrate anesthesia to build a contrast induced-nephropathy (CIN) model.At the end of the experiment (72 h after CIN induction),all rats were sacrificed.The Scr level,BUN level,renal histology,renal tissue activities in superoxide dismutase (SOD),catalase (CAT),glutathione peroxidase (GPx),Glutathione (GSH) and level of malondialdehyde (MDA) were performed.Apoptosis of renal cells was detected by Bcl-2,Bax and Caspase-3 p17 with Western blot.Results Compared with Ctrl group,the levels of Scr,BUN were significantly increased in CM group (all P ＜ 0.01);while compared with CM group,the indicators were decreased in treatment groups (P ＜ 0.01).Renal tubular structure damage,medulla congestion,loss of brush border,vacuolar degeneration,apoptosis and proteinaceous casts were observed in the CM group,and the renal injury scores were higher compared with Ctrl group (P ＜ 0.05),however,administrated with AST could significantly improve the changes (P ＜ 0.05).Oxidative stress indicators showed that MDA level were increased while SOD,GPx,GSH activities were significantly decreased at CM group (all P ＜ 0.05),and the indicators above were ameliorated in treatment groups (all P ＜ 0.05).Western blot showed that the expression of Bcl-2 was down-regulated while the Bax,Caspase 3 p17 was up-regulated respectively at CM group (P ＜ 0.05),while the HAST+CM group could prevent the changes.Conclusions Iohexol can results in oxidative stress increased in kidney,which activate Caspase-3 p17 signal path,down-regulated Bcl-2 expression,up-regulated Bax expression respectively,and lead to cell apoptosis.AST can ameliorate the changes,especially with high AST dose,which suggest that the possible protection mechanism is by ameliorating oxidative stress and inhibiting apoptosis pathways.

BACKGROUND: Serious scalding leads to dysfunction of each aspect in immune system, and activated macrophage can secret many bioactive transmitters. The relationship between macrophage dysfunction and signal conduction after scalding is unclear at present.OBJECTIVE: To observe the alternation of tumor necrosis factor- alpha(TNF-α) at different time points after scalding and the activity of nuclear factor κB(NF-κB) and alternation of protein kinase C (PKC) after the application of specific modulator H-7 to explore whether PKC participates in the modulation of TNF-α in macrophage on signal conduction level for the clarification of some mechanisms of macrophage dysfunction.DESIGN: A randomized controlled experimental study by employing experimental animals as subjectsSETTING: An institute of burn research of a military medical university MATERIALS: The study was conducted in the Laboratory (state) of the Institute of Burn Research, Third Military Medical University of Chinese PLA between January and December 1999. Experimental animals were 32 healthy clean inbreeding Kunming white mice.METHODS: 15% Ⅲ scalding was created in mice for the establishment of routine scalding model. Mice were randomly divided into 6 groups according to different time points before or after scalding, I.e. 0(normal control group), 2, 6, 12, 24, or 48 hours group. Celiac macrophages were collected for the detection of TNF-α content by radioimmunoassay, NF-κB activity by electrophoretic mobility shift analysis (EMSA), and membrane or plasma PKC activity by isotope analysis.MAIN OUTCOME MEASURES: ① TNF-α content; ② NF-κB activity; ③Membrane or plasma PKC activity RESULTS: After scalding, macrophage excessively secreted TNF-α and reached its peak of (1 085.65 ± 122.99) ng/L at 12 hours, which was significantly higher than that of control group( t = 14.92, P ＜ 0.01 ).Compared with control group, membrane PKC activity increased after scalding, which significantly heightened to(231.80 ± 31.66) nmol/min · g at 2hours( t = 7. 930, P ＜ 0.01 ), slightly decreased to close to normal level of (174.29±16.80) nmol/min· gat 6hours(t=2.531, P ＜0.05), and rapidly elevated at 12 hours [512. 10 ±33.42) nmol/min · g] and 24 hours [ (454.70 ± 21.06) nmol/min · g] to reach its peak of(530.49 ± 28.54)nmol/min. G at 48 hours( t = 29.42, 28.03, 30. 19, P ＜ 0. 01 ). Correlation analysis of the alternation between TNF-α and membrane PKC indicated a significant positive correlation( r = 0. 796 4, P ＜ 0. 05) . As indicated by EMSA image, NF-κB activity significantly elevated after scalding. Twelve hours after scalding was set as modulation point, NF-κB activity was significantly inhibited by the application of H-7.CONCLUSION: The secretion of TNF-α and the activities of PKC and NF-κB are significantly activated in celiac macrophage after scalding, and PKC-NF-κB signal pathway participates in the modulation of TNF-α expression, which provide experimental data for the modulation of immune function and rehabilitative intervention during scalding.serious scalding.

BACKGROUND: Severe scald injury leads to a variety of disorders in the immune system. Activated macrophages are known to secrete many kinds of biologically active transmitter, but the relation between the functional disorder of the macrophages and signal transduction after burn injury has not been fully understood.OBJECTIVE: To observe the changes in nuclear factor(NF) -κκB activity and expressions of IκκB-α and tumor necrosis factor(TNF) -α in peritoneal macrophage of mice at different time points after severe scald injury and after the application of specific NF-κκB inhibitor pyrrolidine dithiocarbamate (PDTC), thereby to explore the mechanism of macrophage dysfunction in light of signal transduction.DESIGN: A randomized controlled experimental research.SETTING: State Key Laboratory of Trauma, Burn and Combined Injury.MATERIALS: The experiment was carried out in the State Key Laboratory of Institute of Burn Research, Third Military Medical University during the period from January to June, 1999, using 30 healthy clean-grade Kunming mice of inbred strain.INTERVENTIONS: Common scald injury models(with third degree burn of 15% total body surface area) were established in the mice, which were randomized into 6 groups according to different time points after the injury for observation, namely 0 hour(normal control group) and postburn 2, 6, 12,24 and 48 hours. Peritoneal macrophages were collected at these time points for examining TNF-α content using radio-immunoassay and NF-κκB activity by means of electrophoretic mobility shift assay(EMSA). The expressions of IκκB-α and TNF-α mRNA were determined by immunoblotting method and reverse transcription-PCR, respectively.MAIN OUTCOME MEASURES:Examinations of ① the content of TNF-α, ② NF-κκB activity,③ expression of IκB-α, and ④ expression of TNF-α mRNA.RESULTS: Macrophage secretion of TNF-α was enhanced postburn, reaching the peak level at 12 hours[(1085.65 ± 122.99) ng/L], which was significantly higher than that in the normal control group( t = 14.92, P ＜ 0.01) .Postburn NF-κκB activity significantly increased after the injury, peaking at 2 hours[ (56. 8 ± 7.3)RDU], which occurred much earlier than the peak of TNF-α secretion( t=13. 31, P ＜ 0.01 ). Compared with that in the normal control group, IκB-α expression decreased significantly 2 hours postburn ( t =4. 23, P ＜ 0. 01) to 0. 632 ±0. 086, followed by gradual increase to the peak level to 1. 161 ± 0. 097 24 hours after the burn injury( t = 7.06, P＜ 0. 01) and then by slight decrease to 1. 149 ±0. 167 till 48 hours(t = 4. 82, P ＜ 0.01) . Twelve hours after injury was the time point for intervention with PDTC application, when NF-κκB activity and TNF-α mRNA expression both decreased significantly( P ＜ 0.01 ).CONCLUSION: NF-κB activity and TNF-αmRNA expression decrease significantly after severe scald. At high levels, IκB-α and NF-κκB maintain an interaction for their restriction. After burn injury, NF-κκB signal transduction pathway is involved in the modulation of TNF-α expression in mouse peritoneal macrophage.