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.

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.

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

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 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 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.

Objective To observe the relations ot vWF,DD concentration and venous thrombosis caused by detaining needle of different time.Sensitive indicators for early prediction of venous thrombosis would be seeked so as to provide theoretical and experimental basis for the selection of intervention time.Methods The detaining needle were placed in the vein of rabbit ears with transfusion.The changes of vWF and DD concentration for the mannitol group and the saline group were measured in different retention time,while the venous thrombosis caused by detaining needle was observed pathologically.Results The results of serological test:(1)vWF concentration:when the needle was detained for 1 day,the vWF concentration of two groups peaked.(2)DD concentration:after the needler was set,the DD concentration of both groups was higher than those before detaining needler.When the needle was detained for 1 day and 3 days,the DD concentration was significantly different from those before using detaining needle.Result of pathological observation:When the needle was detained for 1 day,the venous throm-bosis rate was 100％ for both groups with a moderate degree of thrombosis.Conclusions Detection of the concentration of vWF and DD has certain reference value for predicting detaining needle-induced venous thrombosis.In order to prevent venous thrombosis,intervention should be carried out as soon as possible after detaining needle was set.

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 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.