Objective The aim of this study was to describe nursing student-patient relationship in Yunnan province,and study its influencing factors and practice effectiveness.Methods The multi-phase stratified cluster random sampling method was adopted to investigate 483 internship nursing students in two first class hospitals in Yunnan province.Results Among 483 nursing students,379 (78.5％) students belonged to facilitative relationship,101 (20.9％) students belonged to authoritative relationship,and 3 (0.6％) students belonged to mechanistic relationship.Sociodemographic data and factors related to three type of relationship showed no statistical significance among three types of nursing students.But student's personal and professional growth,student's increased confidence and self-esteem demonstrated statistical significance among three types of nursing students.In student's personal and professional growth,students of authoritative relationship got the lowest score (3.96±0.78) compared with students of mechanistic relationship and facilitative relationship [(4.17±0.29),(4.17±0.54)],F=4.82,P ＜ 0.01.In student's increased confidence and self-esteem,no significant difference was seen.Conclusions Nursing students' perceptions of student-patient relationship are mostly facilitative.And students' personal and professional growth and confidence and self-esteem increased obviously through internship for students with facilitative student-patient relationship.

Objective Research on the correlation of dyslipidemia of civil aviation pilots and the TCM constitution aimed to explore that how professional environmental affects the lipid metabolism and the constitution.MethodsMeasure the lipid statusand TCM constitution of 656 pilots, and 496 of them with dyslipidemia were studied. The sample were stratified according to the age and the types of dyslipidemia, including young and middle-aged groups, only abnormal total cholesterol metabolism (TC), only abnormal triglyceride metabolism (TG), and both abnormal cholesterol and triglycerides metabolism groups and then the differences in prevalence of traditional Chinese medicine in different groups were analyzed and discussed. ResultsThe prevalence of abnormal lipid metabolism was 75.61% in 656 pilots. The top three TCM constitutions among the pilot with dyslipidemia were phlegm dampness constitution (35.89%), dampness heat constitution (33.06%) and deficiency of Yang(20.97%). If age was not considered, the prevalence of TCM constitutions were not significantly different between the groups of only abnormal TC and TG (P>0.05), while the prevalence of Yang deficiency and dampness heat constitutions of only either TC or TG abnormal group were significantly higher than those of the group of both abnormal TC, TG (χ2 values were 6.793, 5.077, P<0.05). Take age as considered, TC metabolic abnormalities in youth group, the prevalence of damp heat constitution of the only TC abnormal group was higher than both TC, TG abnormal group (χ2=7.637,P<0.01); and the prevalence of Qi deficiency and Yang deficiency constitution of the only TG abnormal group were higher than both TC, TG abnormal group (χ2values were 6.139, 7.525,P<0.05). In the middle-aged group, the prevalences of Yang deficiency and Qi stagnation constitution of only TC abnormal group were higher than only TG abnormal group (χ2 values were 9.750, 3.922,P<0.05), and the prevalence of Yang deficiency of only TC abnormal group was higher than both TC, TG abnormal group (χ2=5.208,P<0.05). The prevalence of Yang deficiency of both TC, TG abnormal group was higher than only TG abnormal group (χ2= 4.489,P<0.05). Conclusions The result showed high prevalence of dyslipidemia in the population of civil aviation pilots. Age and lipid metabolism status could affect the types of TCM constitution. Damp-heat constitution was the common type of TCM constitution in the population of the young pilot, and Yang deficiency and Qi stagnation constitution were the common types in the population of middle-aged people whose lipid metabolism were disorder. The group of only abnormal TC influence on TCM constitution more than both abnormal TC and TG.

Objective To investigate the significance of MTSS1 and E-cadherin expression in upper urinary tract transitional epithelial carcinoma.Methods Paraffin specimens of 60 patients with upper urinary tract transitional epithelial carcinoma between January 2005 and January 2014 were analyzed.At the same time,5 cm normal tissue adjacent to the cancerous tissue specimens in 30 patients were taken for comparison.Immunohistochemical method was used to detect the tissue MTSS1 and E-cadherin expression,and the relationships between their expression with different pathological stage,differentiated degree and lymph node metastasis were analyzed.Results MTSS1 expression rate in normal tissue (100.0％,30/30) was significantly higher than that in cancerous tissue (45.0％,27/60) and there was significant difference (P ＜ 0.05).E-cadherin expression rate in normal tissue (96.7％,29/30) was significantly higher than that in cancerous tissue (41.7％,25/60) and there was significant difference (P ＜ 0.05).The expression of MTSS1 and E-cadherin in different pathological stage,degree and with or without lymph node metastasis had significant difference (P ＜ 0.05).In patients with well differentiated,low TNM stage and no lymph metastasis,MTSS1 and E-cadherin expression rate was higher (P ＜ 0.05).There was no significant correlation between the expression of MTSS 1 and E-cadherin in cancerous tissue (P ＞ 0.05).Conclusion In upper urinary tract transitional cell carcinoma detection of both MTSS1 and E-cadherin has important significance with regards to judging the malignant degree of the tumor,lymph node metastasis and prognosis in patients.

ABSTRACT:In recent years ,there has been high prevalence of murine typhus in Yunnan Province ,People's Republic of China .A large outbreak of murine typhus occurred in Xishuangbanna Prefecture ,Yunnan Province in 2010 .However ,not all cases were confirmed by laboratory assays ;therefore ,field epidemiologic and laboratory investigations of murine typhus in Xishuangbanna Prefecture were conducted in 2011 .Blood samples were collected from clinical diagnostic cases at the acute and convalescence stages of murine typhus in Xishuangbanna Prefecture ,Yunnan Province ,from June to September of 2011 ,and blood and spleen samples were collected from mice sharing the same habitats as the patients .Immunofluorescence assays were used to test for the presence of IgM and IgG antibodies against Rickettsia typhi in sera from patients and mice .Real‐time PCR was used to detect the groEL gene of R .typhi in blood clots from patients at the acute stage and in spleen tissue from mice .A total of 1 157 clinically diagnosed murine typhus cases occurred in Xishuangbanna Prefecture ,Yunnan Province in 2011 ,with an incidence of 102 .10/100 000 .Of these cases ,80 were investigated by laboratory assays and 74 of 80 patients were confirmed to have murine typhus .The coincidence rate between the clinical diagnosis and laboratory detection was 92 .50% .The positivi‐ty rate for IgG antibodies against R .typhi was 14 .0% (14/100) for Rattus f lavipectus ,while the rate by PCR was 9 .0%(9/100) .That laboratory diagnoses confirmed that the severity of the murine typhus outbreak in Xishuangbanna cannot be ig‐nored .The distribution of host animals transmitting R .typhi underscores this conclusion .

Objective To explore the correlations between intravoxel incoherent motion (IVIM) parameters measured at different time points and histopathological markers in an orthotopic xenograft hepatocellular carcinoma (HCC) nude mice model. Methods A total of 40 HCC orthotopic bearing mouse models were established. When they grew to 21 days, 10 HCC-bearing mice were randomly selected as the baseline group (Group A) by a numeric table method. Then the rest mice were randomly selected on the 28th day, 35th day, and 42nd day of the growth by using the same method, 10 each for B, C, and D groups, respectively. All mice underwent MR IVIM study and apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo-diffusion coefficient (D*) and perfusion fraction (f) were measured. After the MRI scanning, the tumors were removed for pathological examination. The necrosis score (NF), tumor size and microvessel density (MVD) were calculated. The IVIM parameters were compared among these 4 groups by Kruskal-Wallis H test and the correlations between these IVIM parameters and histological features were studied with Spearman rank correlation test. Results One tumor in each of C and D groups was excluded because f values of IVIM were close to zero. There were significant differences found in ADC and D among all the 4 groups (P＜0.05). However, no difference was found in D*and f (P＞0.05). Compared with the baseline (group A), ADC decreased significantly at 7 and 14 days, whilst D decreased significantly at 7 days. The differences in tumor size, MVD and NF between the 4 groups were statistically significant. Compared with the baseline, the tumor size and NF significantly increased at 7, 14 and 21 days, and MVD increased at 14 and 21 days. Significantly positive correlations were demonstrated between ADC and MVD, NF (r=0.461 and 0.442, P＜0.05), between D and MVD, NF (r=0.568 and 0.519, P＜0.05) after exclusion of the data from the baseline. The parameter f from all the time points including the baseline was positively correlated with histological MVD and NF (r=0.590 and 0.458, P＜0.05). Conclusion IVIM parameters may reflect the intratumoral vascularity, tumor cell proliferation and necrosis of HCC, and they are correlated with the pathological indicators.

Objective To observe the oral part of the facial artery and facial vein and to provide anatomical data for clinical applica-tion. Methods The origin, branches, course, diameter, position of oral part of facial artery and facial vein were observed on 32 fixed cada-ves (64 sides). Results The position relation between the facial artery and facial vein is non-constant. Measure the distance from inferior border of mandible to corner of the mouth, angulus mandibulae, mental protuberance midpoint. It is (5. 49 ± 0. 63) cm, (2. 50 ± 0. 89) cm and (6. 20 ± 1. 68) cm in the left side respectively, and (5. 69 ± 0. 72) cm, (2. 56 ± 1. 08) cm and (6. 85 ± 1. 86) cm in the right side re-spectively. The diameter of facial artery in inferior border of mandible is (0. 33 ± 0. 08) cm in the left side and (0. 38 ± 0. 07) cm in the right side;while the diameter of facial vein is (0. 40 ± 0. 12) cm in the left side and (0. 42 ± 0. 18) cm in the right side. The facial artery and facial vein are not concomitant and they are not asymmetry also. The position of superior labial artery arteries is constant, but the position of inferior labial artery arteries have more variations. Conclusion The branches, course, diameter and position of oral part of facial artery and facial vein have a number of variations. The superior labial artery arteries could be positioned more easily than inferior labial artery arter-ies. Being familiar with their distribution is of great importance for clinical application.

Objective:The evidence-based and Delphi methods were used to construct the exercise program for hospitalized patients with diabetes foot to provide guidance for clinical practice.Methods:Evidence on exercise management of diabetic foot patients was systematically searched from BMJ Best Practice, UpToDate, Registered Nurses′ Association of Ontario and other domestic and foreign databases and professional association websites. The retrieval period was from the establishment of the database to April 2021. The quality of the included literature was independently evaluated, and the evidence of the literature meeting the quality standards was extracted and summarized to form the first draft of exercise program for inpatients with diabetic foot. After two rounds of Delphi expert letter consultation, the program items were revised, and the final draft of the exercise program for inpatients with diabetic foot suitable for clinical practice was formed.Results:The effective recovery rate of the two rounds of expert correspondence questionnaire both were15/15. The expert authority coefficient was 0.865 and 0.895 respectively. And the Kendall coordination coefficient was 0.232 and 0.291 (both P<0.01). An exercise program for inpatients with diabetic foot had been formed, including 5 modules(exercise evaluation, exercise prescription, exercise monitoring, post-exercise evaluation and exercise management), 12 items and 40 operational items. Conclusions:The exercise program for inpatients with diabetic foot constructed in this study is scientific and clinically applicable, which provide scientific guidance for clinical medical staff to carry out exercise practice.

Bonding of brackets to dental fluorosis has always been a difficult problem for clinicians. At present, clinical research has adopted several methods to facilitate bracket bonding, including prolonging etching time, enamel microabrasion, enamel ground, using adhesion promoter and laser etching. Prolonging etching time is suitable for mild-to-moderate dental fluorosis with easy chair-side operation; however, over-etching may cause severe tooth damage. Microabrasion can be applied to mild dental fluorosis while removing pigment deposition simultaneously; however, rubber dam protection is needed. Enamel ground can improve the bond strength to all kinds of dental fluorosis at the price of removing a relatively large amount of superficial enamel. Adhesion promoters might improve the bond strength of moderate to severe dental fluorosis; however, the current results conflict with one another. This needs further verification using larger-sample clinical trials. Laser etching has no effect on improving bond strength; however, it can remove pigment without destroying tooth enamel, which is worth further modification and enhancement.

Objective:To investigate the protective mechanism of TAK242, a specific inhibitor of Toll-like receptor 4 (TLR4), on the liver of septic rats.Methods:Eighteen male Sprague-Dawley (SD) rats were randomly divided into three groups ( n = 6 in each group). The septic model was established by intraperitoneal injection of lipopolysaccharide (LPS) 15 mg/kg. The rats in the TAK242 intervention group received intraperitoneal injection of TAK242 (5 mg/kg) before modeling, while the rats in the septic model group and the control group were injected with the same amount of solvent [10% dimethyl sulfoxide (DMSO) + 90% corn oil]. Six hours later, the blood of abdominal aorta was collected and the levels of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured by enzyme linked immunosorbent assay (ELISA). The rats were sacrificed to obtain liver, the expression levels of TLR4, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), cysteinyl aspartate-specific proteinase-3 (caspase-3), nuclear factor-κB p65 (NF-κB p65) and phosphorylated NF-κB p65 (p-NF-κB p65) were detected by Western blotting. Immunohistochemical staining was used to observe NF-κB p65 protein expression in liver, and hepatocyte injury was assessed by hematoxylin-eosin (HE) staining. Results:Serum ALT and AST levels in the septic model group were significantly higher than those in the control group [ALT (μg/L): 26.639±7.814 vs. 2.847±2.150, AST (μg/L): 28.442±8.417 vs. 5.779±3.019, both P < 0.01]. The ALT and AST levels in the TAK242 intervention group were significantly lower than those in septic model group [ALT (μg/L): 7.269±3.398 vs. 26.639±7.814, AST (μg/L): 3.580±3.115 vs. 28.442±8.417, both P < 0.01]. Light microscopy showed that the hepatocytes in the septic model group were disordered, with obvious cell edema and increased inflammatory cells infiltration; the hepatocytes in the TAK242 intervention group were more neatly arranged, with significantly reduced hepatocyte edema and reduced inflammatory cells infiltration. Western blotting results showed that caspase-3 protein expression in hepatic tissue of septic model group was significantly higher than that in the control group (caspase-3/GAPDH: 0.794±0.164 vs. 0.482±0.055, P < 0.05), and caspase-3 protein expression in the TAK242 intervention group significantly decreased than that in the septic model group (caspase-3/GAPDH: 0.482±0.056 vs. 0.794±0.164, P < 0.05), which indicated that TAK242 could attenuate hepatocytes apoptosis of septic rats. The expression of IL-6, TNF-α and TLR4 protein and the ratio of p-NF-κB p65/NF-κB p65 in hepatic tissue of septic model group were significantly higher than those in control group (IL-6/GAPDH: 1.442±0.204 vs. 1.019±0.024, TNF-α/GAPDH: 1.089±0.098 vs. 0.806±0.005, TLR4/GAPDH: 1.292±0.085 vs. 0.941±0.087, p-NF-κB p65/NF-κB p65 ratio: 1.936±0.081 vs. 1.579±0.183, all P < 0.05), IL-6, TNF-α and TLR4 protein expression and p-NF-κB p65/NF-κB p65 ratio in the TAK242 intervention group were significantly lower than those in septic model group (IL-6/GAPDH: 1.035±0.042 vs. 1.442±0.204, TNF-α/GAPDH: 0.572±0.096 vs. 1.089±0.098, TLR4/GAPDH: 0.984±0.078 vs. 1.292±0.085, p-NF-κB p65/NF-κB p65 ratio: 1.484±0.255 vs. 1.936±0.081, all P < 0.05), it is suggested that LPS-induced sepsis could activate the inflammatory response mediated by TLR4/NF-κB pathway in liver, and the activation of TLR4/NF-κB pathway was inhibited by TAK242 through the TLR4 pathway, therefore, the inflammation of liver in septic rats was reduced. Immunohistochemical staining showed that the positive expression of NF-κB p65 in liver was significantly increased in the septic model group compared with the control group; the positive expression of NF-κB p65 was significantly reduced in the TAK242 intervention group compared with the septic model group, and there was almost no positive expression in the nucleus. Conclusion:TAK242 could reduce liver function injury and protect the liver by inhibition TLR4/NF-κB pathway in septic rats.