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 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

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.

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 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.

Background Transscleral diode laser cyclophotocoagulation (TDCP) was used to later stage of glaucoma in the past.However,the indications of TDCP are expanding gradually over time and there are more and more reports about its application in different stages and different types of glaucoma.Objective This study was to compare the clinical efficacy of TDCP and trabeculectomy for primary acute angle-closure glaucoma (PAACG) with persistent ocular hypertension.Methods Ninety-five PAACG patients with persistent ocular hypertension were retrospectively analyzed.The patients were divided into TDGP group (62 eyes of 56 cases) and trabeculectomy group (44 eyes of 39 cases) based on the difference of treating fashions.The clinical outcomes were compared between the two groups with the evaluating indexes of visual acuity,intraocular pressure (IOP) before and 1 week,3 months and the end of following-up as well as the number of drug used and the re-treatment.Results The demography was matched between the two groups (all at P＞0.05).The number of eyes with visual improvement was significantly different among the groups (x2 =30.927,P =0.002) in the TDCP group.Compared with before treatment,the number of visual improvement in 1 week after treatment was significantly raised (x2 =16.778,P =0.002).No significant differences were seen in the eye number of visual improvement in various timepoints after treatment (all at P＞0.008).Also,the eye number of visual improvement was significantly different among the different timepoints (x2 =44.345,P＜0.001),and statistically significant change was found between the preoperation and postoperative 1 week (x2 =23.725,P＜0.001).However,there were no significant differences in the eye number of visual improvement in various timepoints after operation each other (all at P＞0.008).The IOP was insignificantly altered among the groups at various timepoints (Fgroup =3.836,P =0.053),but the change was significantly different over time (Ftime =757.078,P＜0.001).The postoperative IOP was significantly higher than that of preoperation in both groups (all at P＜0.001).The proportion of eyes using lowering-IOP drugs was 48.4％ in the TDCP group,and that in the trabeculectomy group was 27.3％,showing a significant difference between them (x2 =4.796,P =0.029).The retherapy was performed in 20 eyes (32.3％) and 2 eyes (4.5％) in the TDCP group and the trabeculectomy group,respectively.Conclusions The short-term lowing-IOP effecacy of TDCP is similar to trabeculectomy,but the longterm lowing-IOP efficacy of TDCP is not good.Compared with the trabeculectomy,TDCP shows more simple operation,less time-consuming during the surgery and milder tissue damage,but the eyes continuing to use anti-glaucomatous drugs or re-therapy are increased.

Objective To explore the interventional effect of two different methods in the prevention of chemotherapy phlebitis caused by 5-fluorouracil.Methods Eighty cases of patients treated with cisplatin+5-fluorouracil (PF) chemotherapy in the First Affiliated Hospital of Guangxi Medical University from May 2015 to July 2016 were selected and divided into the observation group and control group according to admission time,40 cases in each group.The observation group was smeared with 2% anisodamine along the direction of vein puncture after peripheral venous puncture success,while the control group was smeared with mucopolysaccharide polysulphate emulsion paste.The occurrence of phlebitis and degree of local pain after intervention were compared between the two groups.The blood biochemical indexes and inflammatory factors levels before and after intervention were compared too.Results After the intervention,the distribution of phlebitis level and local pain degree had statistical difference between the two groups (Z=2.57,2.53;P=0.01);the observation group was superior to the control group in the aspects of phlebitis lesion degree and local pain alleviation;WBC,MPV and PDW in the observation group had statistical difference between before and after intervention;WBC,PLT and PCT in the control group had statistical difference between before and after intervention (P<0.05);PLT count was positively correlated with PCT in the two groups (r=0.952,P<0.05);the CRP level and WBC count after intervention had no statistical difference between the two groups(P>0.05).Conclusion 2% anisodamine can effectively prevent and alleviate the occurrence of 5-FU caused chemotherapy phlebitis and local pain.At the same time,PLT can provide a basis for preventing chemotherapy phlebitis.

Objective To study and analyze the clinical effect of zoledronic acid in the treatment of bone metastasis in patients with lung cancer.Methods 50 cases of lung cancer patients with bone metastasis from January 2015 to December 2016 in our hospital were selected and randomLy divided into two groups, the control group and the experimental group, with 25 patients in each group.The control group was treated with pamidronate intravenous drug treatment, patients in the experimental group of zoledronic acid monotherapy in the treatment of.After treatment for a period of time, the relative clinical indicators of the experimental group and the control group were compared and analyzed.Results After the corresponding treatment, 3 patients in the experimental group had complications, the proportion was 12%, and 2 cases in the control group had adverse reactions, the incidence was 8%.The incidence of adverse reactions and the effectiveness of pain treatment in the experimental group were not significantly different from those in the control group, and there was no statistical significance.After treatment, the quality of life scores and general status scores of the experimental group and the control group were significantly higher than those before treatment, with statistical difference(P<0.05).There was no significant difference in the quality of life score and general condition score between the experimental group and the control group, and there was no statistical significance.Conclusion Zoledronic acid monotherapy in the treatment of metastasis corresponds largely to pamidronate treatment for lung cancer patients with bone, can improve the treatment effect and quality of life in a large extent, help the patients to relieve pain, with further clinical promotion and application significance.