Objective To deeply understand the nursing staff education and work status in primary hospital,provide reference for training,health care reform of grassroots in China. Methods A total of 520 nursing in five level two-grade of primary hospital were selected. A questionnaire survey was conducted on the title,education,treatment,job satisfaction,nursing training,editing. Results Primary hospital nursing staff starting education:starting education undergraduate and junior titles accounted for (36.23±9.42)%, intermediate title for (12.43±2.68)%, (3.57±2.38)%, senior titles between group differences statistically significant, P<0.05. Through continuing education after junior titles nursing bachelor degree or above accounted for (84.78±34.13)%, intermediate title to reach (60.73±17.94)%, senior titles to reach 100.00%,the differences were significant, P<0.05; (63.77±19.20)%of junior titles through continuing nursing education degrees, intermediate titles accounted for (72.32±20.62)%, and senior titles accounted for (96.43±37.50)%. Nursing staff salary: junior titles accounted for (1 082 ±258) yuan,intermediate and senior titles advanced to (1 633±426) yuan and (2 864±587) yuan,the differences were significant, P<0.05. Editing: junior titles accounted for (18.84±3.27)%, intermediate title for (56.50±6.58)%, senior titles for (85.71±17.63)%, the differences were significant, P<0.05. Turnover rate:junior titles accounted for (25.36±7.54)%, intermediate title for (-6.50±2.14)%, senior titles for (-3.57±1.53)%, the differences were significant, P<0.05. Job satisfaction survey:junior titles accounted for (26.09±6.32)%, intermediate title for (37.85±5.16)%, senior titles for (57.14±8.49)%,the differences were significant, P<0.05. Conclusions Primary hospital nursing staff starting education level is generally not high, after re-education to achieve higher degree. Job satisfaction is not high, staffing, erosion is serious. Off in the form of health care, nursing education level, the gener-al improvement in quality of care at the same time,improve the economic benefits of the nursing for the development of career of our country basic care not allow to ignore.

Objective To investigate the changes of serum transforming growth factor-β1 (TGF-β1),interleukin-10(IL-10) and interferon-γ(INF-γ) in elderly patients with hepatic fibrosis and their correlation with hepatic fibrosis.Methods One hundred and thirty-three patients diagnosed by pathological hepatic tissue were enrolled as case group who were in the first affiliated hospital of Xinxiang Medical University from 2007 to 2013.The enzyme-linked immunosorbent assay (ELISA) was applied to detect of serum levels of TGF-β1,IL-10and IFN-γ.Meanwhile 21 healthy people were recruited as control group.Results Comparison with the control group,the levels of TGF-β1 and IL-10 were significantly higher(TGF-β1:(217.4 ± 7.5) ng/L vs.(57.2±4.8) ng/L,t =15.61,P＜0.01;IL-10:(29.6 ±3.2) ng/L vs.(15.1 ±7.5) ng/L,t =11.44,P＜0.01),while IFN-γlevel was lower ((51.9 ± 3.5) ng/L vs.(75.8 ± 5.9) ng/L,P =0.03) in case group.The serum levels of TGF-β1,IL-10,IFN-γand stages of hepatic fibrosis was correlated and the correlation coefficients were 0.786,0.644 and-0.822 respectively (P ＜ 0.05).Conclusion Serum levels of TGF-β1,IL-10 and IFN-γ in patients with hepatic fibrosis are proved to be with ability of predicting the development of hepatic fibrosis and the post treatment.

OBJECTIVE:To observe the effect of Maren pills combined with lactulose preventing opioid-induced constipation (OIC) in patients with cancer pain. METHODS:281 cases of advanced cancer pain were selected and divided into Maren pills group,lactulose group and drug combination group. 3 groups were given opioid to relieve pain,and additionally received Maren pills,lactulose or drug combination(lactulose for 3 d and then Maren pills for 3 d instead,repeated in the same way)to treatment OIC prophylactically. The constipation conditions of 3 groups were observed and recorded at 2,4 and 6 weeks after the therapy. And then the data were analyzed statistically. RESULTS:The regular doses of Maren pills and lactulose alone or combination had prevention effect on OIC. Drug combination showed better long-term prevention effect;there were statistically significant difference in constipation conditions between grug combination group and other 2 groups after 4 and 6 weeks of therapy (P<0.05 or P<0.01). CONCLUSIONS:Maren pills combined with lactulose are obvious benefit for constipation prevention and relief in cancer pain patients who use opioid for a long time.

Objective:To investigate the characteristics of natural killer (NK) cell subsets and function in methicillin-resistant staphylococcus aureus (MRSA) sepsis, and to assess the influence of matrix metalloproteinase (MMP) to NK cell function in MRSA sepsis patients.Methods:Twenty-one MRSA sepsis patients who were hospitalized in our department between January 2017 and June 2018 were enrolled. Eleven healthy individuals were served as healthy controls. Peripheral blood mononuclear cells (PBMCs) were isolated. NK cell subsets were investigated by flow cytometry. NK cell function was assessed by measuring CD107a, CD69, and CD16 expression in co-culture system between PBMCs and different target cells. MMP mRNA was semi-quantified by real-time PCR in purified NK cells. The influence of NK cell function was assessed by measuring CD107a expression in co-culture system between NK cells with MMP inhibitor stimulation and target cells.Results:There was no significant difference of total NK cell percentage between healthy controls and MRSA sepsis patients ( P>0.05). CD56brightCD16 -NK [(5.36±1.02)% vs (4.30±0.89)%] and CD56 -CD16 +NK [(24.04±2.92)% vs (9.70±1.54)%] percentage was elevated ( P<0.05), while CD56dimCD16 +NK percentage [(71.22±13.03)% vs (87.64±7.05)%, P<0.01] was reduced in MRSA sepsis. NK cells recognized and killed target cells via different receptors upon activation. CD107a [(33.55±3.84)% vs (25.34±6.20)%] and CD69 percentage [(14.96±1.47)% vs(18.80±1.49)%] was decreased ( P<0.0001), while CD16 MFI was increased [(247.1±50.31) vs (189.4±57.54), P<0.01] in MRSA sepsis patients in comparison with healthy controls. MMP-1/2/3/9 mRNA relative levels were elevated in purified NK cells from MRSA sepsis patients ( P<0.01). Inhibition of MMP in NK cells from MRSA sepsis patients promoted CD107a percentage [(33.67±8.03)% vs (25.87±6.23)%, P=0.018]. Conclusions:NK cell subsets imbalance and exhaustion is existed in MRSA sepsis, which might be due to the MMP-induced down-regulation of antibody-dependent cell-mediated cytotoxicity.

Objective To investigate the expression levels of serum high-mobility group box 1(HMGB1),soluble CD163(sCD163),and prostaglandin E2(PGE2)in patients with hepatitis B virus-related chronic-on-acute liver failure(HBV-ACLF),and to evaluate the value of the three indicators used alone or in combination in predicting prognosis.Methods A total of 76 patients with HBV-ACLF who were hospitalized in Department of Infectious Diseases,The First Affiliated Hospital of Xinxiang Medical University,from July 1,2022 to September 30,2023 were enrolled,and according to the 28-day prognosis,they were divided into survival group with 48 patients and death group with 28 patients.General data were collected,Model for End-Stage Liver Disease(MELD)score was calculated,and ELISA was used to measure the serum levels of HMGB1,sCD163,and PGE2.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.The Spearman rank correlation test was used to analyze the correlation of HMGB1,sCD163,and PGE2 with MELD score;the receiver operating characteristic(ROC)curve was used to analyze the value of HMGB1,sCD163,and PGE2 used alone or in combination in predicting the prognosis of HBV-ACLF patients.Results There were significant differences between the two groups in total bilirubin,white blood cell count,the percentage of neutrophils,procalcitonin,serum amyloid A,interleukin-6,serum sodium,and serum creatinine(all P＜0.05).Compared with the survival group,the death group had significantly higher serum levels of HMGB1(Z=-2.997,P=0.003)and sCD163(Z=-2.972,P=0.003),a significantly higher MELD score(t=-6.997,P＜0.001),and a significantly lower serum level of PGE2(Z=-4.909,P＜0.001).The Spearman rank correlation test showed that HMGB1 and sCD163 were positively correlated with MELD score(r=0.431 and 0.319,both P＜0.05),while PGE2 was negatively correlated with MELD score(r=-0.412,P＜0.05).The ROC curve analysis showed that HMGB1,sCD163,and PGE2 used alone had an area under the ROC curve(AUC)of 0.717,0.716,and 0.856,respectively,while the combination of the three indicators had the highest predictive value,with an AUC of 0.930,a sensitivity of 0.778,and a specificity of 0.920.Conclusion Serum HMGB1,sCD163,and PGE2 used alone or in combination have a good reference value in predicting the prognosis of HBV-ACLF patients,and the combination of the three indicators has the highest predictive value,which holds promise for further observation and research.

Objective:In chronic hepatitis B (CHB) patients with previous 96-week treatment with tenofovir amibufenamide (TMF) or tenofovir disoproxil fumarate (TDF), we investigated the efficacy of sequential TMF treatment from 96 to 144 weeks.Methods:Enrolled subjects who were previously assigned (2:1) to receive either 25 mg TMF or 300 mg TDF with matching placebo for 96 weeks received extended or switched TMF treatment for 48 weeks. Efficacy was evaluated based on virological, serological, biological parameters, and fibrosis staging. Statistical analysis was performed using the McNemar test, t-test, or Log-Rank test according to the data. Results:593 subjects from the initial TMF group and 287 subjects from the TDF group were included at week 144, with the proportions of HBV DNA<20 IU/ml at week 144 being 86.2% and 83.3%, respectively, and 78.1% and 73.8% in patients with baseline HBV DNA levels ≥8 log10 IU/ml. Resistance to tenofovir was not detected in both groups. For HBeAg loss and seroconversion rates, both groups showed a further increase from week 96 to 144 and the 3-year cumulative rates of HBeAg loss were about 35% in each group. However, HBsAg levels were less affected during 96 to 144 weeks. For patients switched from TDF to TMF, a substantial further increase in the alanine aminotransferase (ALT) normalization rate was observed (11.4%), along with improved FIB-4 scores.Conclusion:After 144 weeks of TMF treatment, CHB patients achieved high rates of virological, serological, and biochemical responses, as well as improved liver fibrosis outcomes. Also, switching to TMF resulted in significant benefits in ALT normalization rates (NCT03903796).

Objective:In chronic hepatitis B (CHB) patients with previous 96-week treatment with tenofovir amibufenamide (TMF) or tenofovir disoproxil fumarate (TDF), we investigated the safety profile of sequential TMF treatment from 96 to 144 weeks.Methods:Enrolled subjects that previously assigned (2:1) to receive either 25 mg TMF or 300 mg TDF with matching placebo for 96 weeks received extending or switching TMF treatment for 48 weeks. Safety profiles of kidney, bone, metabolism, body weight, and others were evaluated.Results:666 subjects from the initial TMF group and 336 subjects from TDF group with at least one dose of assigned treatment were included at week 144. The overall safety profile was favorable in each group and generally similar between extended or switched TMF treatments from week 96 to 144. In subjects switching from TDF to TMF, the non-indexed estimated glomerular filtration rate (by non-indexed CKD-EPI formula) and creatinine clearance (by Cockcroft-Gault formula) were both increased, which were (2.31±8.33) ml/min and (4.24±13.94) ml/min, respectively. These changes were also higher than those in subjects with extending TMF treatment [(0.91±8.06) ml/min and (1.30±13.94) ml/min]. Meanwhile, switching to TMF also led to an increase of the bone mineral density (BMD) by 0.75% in hip and 1.41% in spine. On the other side, a slight change in TC/HDL ratio by 0.16 (IQR: 0.00, 0.43) and an increase in body mass index (BMI) by (0.54±0.98) kg/m 2 were oberved with patients switched to TMF, which were significantly higher than that in TMF group. Conclusion:CHB patients receiving 144 weeks of TMF treatment showed favorable safety profile. After switching to TMF, the bone and renal safety was significantly improved in TDF group, though experienceing change in metabolic parameters and weight gain (NCT03903796).