The author focuses his explanation on the scope, principles and method of examination in clinical skills and puts forward some basic ideas on the conduction of examination in clinical skills for medical practioners. These include: ①focusing on basic clinical operations, with no differentiation of specialties so far as the scope of the examination is concerned; ②adopting the modified multi-station method of examination; ③giving priority to the examination in clinical skills in designing examination items; ④giving expression to such principles as practicality, objectivity and impartiality in designing the examination in clinical skills. At the same time, the author gives an account of the implementation and primary evaluation of the 2001 examination in clinical skills in China.

950 mg/d) group was significantly higher than those in median or low calcium intake group,among girls with BB genotype. However,such significant effect was not detected among girls with b allele. Conclusion:The PTH BstBⅠ polymorphism has significant interaction effect with calcium intake on bone mass accretion in Chinese adolescent girls. High calcium intake would be beneficial to gain higher bone mass accretion for girls with BB genotype than those with b allele.

Background Mutant C57BL/6 mouse with corneal opacity (B6-Co) appears eye open at birth (EOB) phenotype,which is a good animal model in the study of developmental mechanism of eyelid.Investigating the relationship between serum response factor (SRF) and EOB phenotype can provide theoretical support for the research on the mechanism of innate defects in eyelid development in humans.Objective This study was to assess the dynamic expressions of SRF in eyelid of embryonic B6-Co mouse.Methods Total RNA was extracted from B6 and B6-Co mice eyelid tissue at embryonic day 16.5 (E16.5 d),E17.5 d and E18.5 d.The relative expression levels of SRF mRNA and protein in the eyelid tissue of B6 and B6-Co embryonic mice were assayed by real-time quantitative PCR and Western blot,respectively.In situ expressions of SRF protein in eyelid of B6-Co mice and B6 mice were detected using immunofluorescence technique.The use and care of the animals complied with the Regulation for the Administration of Affair Concerning Experimental Animals of Nantong University.Results The relative expression levels ofSRF mRNA in the eyelids were 0.41±0.06 and 0.24±0.17 in E16.5 d and E17.5 d of B6-Co mice,showing a significant decline in comparison with 1.03 ±0.17 and 1.01 ±0.09 in the B6 mice (P =0.025,0.017).The expression levels of SRF protein in the eyelids of E16.5 d and E17.5 d B6-Co mice were 0.08±0.01 and 0.08± 0.01,which were significantly lower than 0.12 ±0.03 and 0.13 ± 0.02 of B6 mice (P =0.036,0.024).However,there were no significant differences in the expression levels of SRF mRNA and protein in E18.5 d between the B6-Co mice and B6 mice (P =0.387,0.774).Immunofluorescence assay displayed that SRF was expressed in the keratinocytes of eyelids in both mice,but the fluorescence intensity was weaker in the B6-Co mice.Conclusions SRF probably interrupts the developing process of eyelid in early embryo of B6-Co mice.

BACKGROUND: Cerebral infarctional animal model provide basis for studying human cerebral infarction(CI). There are two traditional CI models, one is reproduced by craniotomy or electro-coagulation by which supplying artery are blocked, another is achieved by embolus or water gelatin micro-thrombosis. But both are difficult to perform and results were instable, which limit the application. Photochemical injury is a novel way to reproduce CI model on experimental animals.OBJECTIVE: To explore a new method of experimental research of local cerebral infarction model which is induced by photochemical injury in rabbits.DESIGN: Single sample studySETTING: Experimental Animal Center of Nantong University.MATERIALS: This study was conducted at the Experimental Animal Center of Nantong University from May to December 2003 (secondary laboratory). Totally 63 Japanese flap-eared rabbits, with birth age of 10-12 month, 33 females and 30 males, with body mass of 1.7-3.3 kg, were randomly selected.METHODS: After anaesthetized, rabbits were cut at the skin for 2 cm long at the crossing of skull center and posterior canthus, skull was exposed and periosteum was separated, then a round skull window with diameter of 0.5 cm was drilled at 0.5 cm left or (right) to sagittal suture and 0.5 cm posterior to coronal suture, after that, 35 g/L rose Bengal was slowly injected from ear-edge vein in dosage of 1 mL/kg by once. About 3minutes later, cold light source (wave length of 540 nm, power of 140 lx)was used to cast light directly onto the skull window for consecutively 8minutes, then incision was sutured. At postoperative 24 hours, neurological defects were scored in five grades [0 score represent no neural impairments; 1 score: the left posterior limbs displayed decreased muscular tension and attenuated contraction reflex; 2 scores: the left posterior limbs were paralyzed, displaying obvious abduction; 3 scores: rabbit displayed obvious adductive drag with body leant to the opposite side; 4 scores: unable to walk and unconsciousness], rabbits were put to death at postoperative 48 hours, infarctional area and volume were determined and pathological changes was also observed.MAIN OUTCOME MEASURES: Limb movement, infarctional area and volume and pathological changes.RESULTS: CI mode was successfully established on 59 rabbits, the sucmean infarctional area was (0.465±0.012) cm2, and the mean volume changes: Infarctional focus displayed typical pathological changes such as impairment, effusion and inflammation. Gentle impairment could be observed in 22 rabbits (37%), medium in 32 rabbits (54%) and severer in 5rabbits (9%).infarction model has multiple advantages, such as easy performance, quick and good repeatability, it can be used to reproduce experimental models for for a long time with low mortality, benefiting for researches on chronic tional size and depth are under control, meeting the need of researches on observed in photochemical injury, which provide basis for study on the efBut there was still some limitations: Since thrombosis was induced at the terminal artery, unfit for the study of lateral circulation and reperfusion;however it was found more similar to human microvascular diseases, thereby incapable of explaining the pathogenesis of other ischemic strokes.

Objective To describe the status of nurses′professional identity and the self-concept and to explore the relationship between nurses′professional identity and the self-concept. This will be the base for intervening nurses′professional identity. Methods A convenience sample of 250 nurses from one major hospital in Beijing was recruited. The Macleod Clark Professional Identity Scale and the Professional Self-Concept Instrument were introduced. A standard translation procedure was carried out. Results A total of 250 questionnaires were sent out, 241 questionnaires were withdrawed with an effective rate of 96.4%. The mean score of nurses′professional identity was 42.54±8.70, which was at moderate level. The mean score of nurses′professional self-concept was 86.28 ±22.86, also at moderate level, among which,knowledgescores highest (25.91±6.00), leadership scored 20.84±8.02, inter-personal relationship scored (20.28±4.18), caring scored the lowest (19.25±4.67). There was significant difference among the professional identity in the different departments (P<0.05) , while the same results were not seen in professional self-concept. Nurses′professional identity was positively correlated with professional self-concept′s four dimensions (P<0.05). Conclusions The nurse managers should pay attention to the cultivation of professional self-concept in the training of nurses in order to improve the professional identity of nurses and the whole nurses′development.

Objective To evaluate the valuse of endoscopic ultrasonography ( EUS ) for upper gastrointestinal submucosal lesions and the role of Photoshop in differentiating leiomyoma and stromal tumors. Methods Data of 656 patients with upper gastrointestinal submucosal lesions evaluated by EUS and receiving endoscopic submucosal dissection ( ESD ) from April 2010 to March 2015 were collected and retrospectively analyzed. The goldern standard for lesions size and origin was the intraoperative diagnosis of ESD, and that of the type of lesions ( leiomyoma, stromal tumor, ectopic pancreas, lipoma, etc.) was pathological and immunohistochemical finding. The consistency of diagnosis of the EUS was evaluated. In addition, Photoshop was used to differentiate diagnosis of leiomyoma and stromal tumors which were confirmed by pathology and immunohistochemistry. Results The consistency in diagnosing the size and lesion origins was 92?56%(560/605) and 88?43%(535/605)between EUS and ESD intraoperative result. The consistency in pathological types of EUS was 79?34%(480/605). Photoshop was used to analyze the EUS images of 177 stromal tumor and 241 leiomyoma. The gray value of stromal tumor was significantly higher than that of leiomyoma(59?97 VS 39?39, t=43?27, P<0?05).The echo of stromal tumor was higher. The standard deviation of gray value of leiomyoma were significantly lower than that of the stromal tumor ( 4?81 VS 5?42, t = 2?83, P < 0?05 ) , indicating the echo uniformity of leiomyoma was better. Conclusion EUS shows high accuracy rate for upper gastrointestinal submucosal lesions, providing more accurate basis for endoscopic therapy. EUS combined with Photoshop is helpful for differentiating stromal tumor from leiomyoma.

This paper analyzed the system,methods,content,scope and standards of last two competition in order to further improve the clinical skills competition for national medical students in China.According to the characteristics of medical education,the paper proposed several opinions and suggestions as follows:repechage should be cancelled in competition system and objective structured clinical examination should be used in competition; the content,scope and criteria of the competition should take the actual ability of the medical students at graduation into consideration.

Objective To study the clinical characteristics,treatment and prognosis of neonatal VACTERL association.Method The clinical data of newborns diagnosed with VACTERL association from January 2010 to December 2015 were collected and retrospectively analyzed.Result A total of 33 patients diagnosed with VACTERL association were included,including 23 males and 10 females.Among them,17 cases were term infants,15 cases premature infants and 1 case of overdue birth,with an admission age of 1 to 24 days.The most common deformities were cardiac anomalies (C) in 27 cases (81.8％),followed by anal atresia/anorectal malformation (A) in 25 cases (75.8％),renal deformity (R) in 24 cases (72.7％),limb abnormalities (L) in 20 cases (60.6％),Tracheoesophageal fistula (TEF) in 8 cases (24.2％) and vertebral abnormalities (V) in 3 cases (9.1％).11 cases (33.3％) had other deformities.Among these 33 patients,24 cases had 3 types of malformations and 9 cases had 4 types of malformations.The most common combination was ACR (n =8).20 patients had no abnormalites on chromosome karyotype test including 2 patients had normal gene microarray results.16 patients received surgical treatment during neonatal period and 13 of them recovered and discharged.Among the other 17 cases received no surgery,only 1 patient improved and discharged.A telephone follow-up was proceeded in 14 discharged cases at 1 year old.Among them,13 cases had good prognosis,however,the remaining one was dead.Conclusion VACTERL association is a rare non-random combination of multiple malformations.The early discovery and appropriately treatment after diagnosis will improve the prognosis and prevent death.Doctors should reinforce the ability to detect various types of deformities and examine the chromosome and gene properly.

Background and purpose:Increased glucose metabolism is a characteristic of malignant tumors.This characteristic might be related to a facilitative glucose transporter(Glut-1) and the proliferating activities of tumors.This study was aimed to assess the relationship among the over-expression of facilitative glucose transporter(Glut-1) and proliferating cell nuclear antigen(PCNA) as well as the fluorine-18 fluorodeoxyglucose(18F-FDG) uptake of tumors in patients with nasopharyngeal carcinoma.Methods:Between March 2005 and August 2006,40 patients with nasopharyngeal carcinoma were imaged with 18F-FDG positron emission tomography(PET).Their maximum standard uptake values(SUVmax) were measured.The expression of Glut-1 and the proliferating cell nuclear antigen(PCNA) in the 40 cases were studied in paraffin sections by SP immunohistochemistry.Results:The 18F-FDG uptake of tumors of the 40 patients with nasopharyngeal carcinoma was 9.4?1.9(SUVmax).All 40 tumors tested Glut-1 positive and PCNA positive.The Glut-1 positive cells consisted of 45.18% of the tumor cell area,whereas the PCNA positive cells consisted of 36.18% of the tumor cell area.There were correlations between Glut-1 expression levels(r=0.369,P=0.019) and the tumors' 18F-FDG uptake but no correlations were found between PCNA expression level and the tumors' 18F-FDG uptake(r=0.135,P=0.407).Conclusion:Glut-1 over-expression correlates with 18F-FDG uptake whereas PCNA over-expression does not correlate with 18F-FDG uptake in patients with nasopharyngeal carcinoma.