Objective To explore the impact of authentic leadership on silence behavior of nurses and test the mediating effect of organizational support. Methods The 354 valid questionnaires were collected using the a cross-sectional survey with Authentic Leadership Questionnaire, Perceived Organizational Support Scale and Silence Behavior Scale between September to November in 2015, using the multiple line hierarchical regression analysis to test the relationship between variables. Results Authentic leadership could significantly promote the perceived organizational support of subordinate nurses (β= 0.543, P<0.01), which in turn, significantly restrain silence behavior of subordinate nurses (β=-0.323, P<0.01), the perceived organizational support completely mediate the relationship between authentic leadership and silence behavior (β=0.175, P<0.01). Conclusions By constructing the supporting work environment, authentic leadership can eliminates nurses′ voice worry, motivates the voice motivation and efficiency, in turn to break the silence. This article propose the action mechanisms from three perspectives.

According to the related requirements of medical technology clinical application management, the specific implementation approaches of surgery physicians surgery permission management were made, including establishing surgery classification project directory library, developing surgery classification management system and the surgery permission declared, and audit program, and investigating to determine the steps of surgery permission owned by surgery physicians currently, and finding problems and solution measures in implementation surgery permission management. To prevent surgical risk, improve the quality of operation, and evaluate surgical doctors scientifically, it provides management experience and references.

Objective To observe the effect of combined treatment with rhTRAIL(recombinant human TNF-related apoptosis inducing ligand) and selective Cox-2 inhibitor Celecoxib on gallbladder carcinoma in vitro and to explore the possible mechanism of the effect. Methods Western blot analysis was used to detect the expression of c-FLIP and death receptors after treatment by Celecoxib. Apoptosis of gallbladder cell line SGC-996 after the combined treatment with Celecoxib and rhTRAIL was detected in three ways: (1) phase microscopy of the cells, (2) detection of effector caspase-3 and caspase-7 activity, and (3) determination of the proportion of apoptotic cells labeled by Annexin V-PI flow cytometric analysis using CELLQUEST software. Results Celecoxib down-regulated the expression of c-FLIPs and up-regulated the expression of DR5 in a dose- and time-dependent mode on cell line SGC-996. Apoptotic levels in the combined treatment group in cell line SGC-996 were significantly higher than those in the single drug treatment group and control group. Conclusion Celecoxib markedly sensitized rhTRAIL-induced apoptosis through the down-regulation of c-FLIPs and up-regulation of DR5 in gallbladder carcinoma cell line SGC-996.

Objective To study a new clinicopathological subtype of primary cutaneous T-cell lym phoma (PCTCL). Methods A case of T-cell lymphoma was systematically evaluated clinically and by using H-E staining, special staining,immunohistochemical staining,gene rearrangement and PCR.Results The skin lesion presented as tender nodules with mucocele. Skin biopsies showed that in the dermis and subcutaneous tissue,most of the angiotropic tumor cells were small T cells; no obvious epidermotropic phenomenon was detected.A few vessels were observed with obvious fibromucinous matrix formation. Immunohislochemical studies showed the following:CD3(+),CD43(+),CD45RO(+),CD56(a few),CD68(-), CD79?(-),CD20 (-), CD30(-), CD117(-), ALK(-), S-100(-),CD45R(-),EMA(-),SMA(-).The mucoid matrix was positive for Alcian blue staining.The rearrangement of T-cell ? receptor gene was detected.EBV was not detected with PCR.Conclusion Fibromucinous T-cell lymphoma rich in blood vessels is a new and distinct variant of PCTCL; it is not a subtype of mycosis fungoides.

Objective To explore the effects of multidisciplinary comprehensive pulmonary rehabilitation on aged patients with pneumo-coniosis. Methods From January, 2012 to January, 2015, 85 old stable inpatients with pneumoconiosis were divided into control group (n=40) and rehabilitation group (n=45). Both groups accepted routine medicine, while the rehabilitation group received multidisciplinary com-prehensive pulmonary rehabilitation for twelve weeks. They were assessed with cardiopulmonary exercise test, BODE index and quality of life before and after treatment. Results The maximum work, maximal oxygen uptake, 6-minute walk distance, scores of modified Version of the British Medical Researsh Council Respiratory Questionnaire, BODE index, activities of daily living, social activities, depression and anx-iety improved in the rehabilitation group after treatment (t>3.379, P<0.01), and were better than those in the control group (t>2.201, P<0.05). No imporvement was found in all the indices in the control group after treatment (t<2.339, P>0.05). Conclusion Multidisciplinary comprehensive pulmonary rehabilitation can effectively improve exercise tolerance and quality of life in aged patients with pneumoconiosis.

OBJECTIVE: To evaluate the diagnostic value of modified Berlin questionnaire on predicting obstructive sleep apnea-hypopnea syndrome (OSAHS)in Chinese adults. METHOD: Differ from the original version, BMI cut-off point was adjusted to 25.0 in modified Berlin questionnaire according to the Asia -Pacific obesity definition. A total number of 244 samples who experienced polysomnography (PSG) were included. After well informed, each patient finished questionnaire by an interview. The results of the original and modified questionnaires and polysomnography reports were compared with polysomnography reports to evaluate the diagnostic accuracy of the modified Berlin questionnaire. RESULT: In male population, the sensitivity and specificity of original Berlin questionnaire were 74.03% and 65.71%, respectively. The percentage of diagnostic consistency was 72.49%, and Kappa coefficient was 0.304 (P < 0.01). In aspect of modified version, the sensitivity and specificity were 92.21% and 48.57%. The percentage of diagnostic consistency was 84.13%, and Kappa coefficient was 0.437 (P < 0.01). In female population, the sensitivity and specificity of original version were 50.00% and 61.90%, respectively. The percentage of diagnostic consistency was 54.55%, and Kappa coefficient was 0.110 (P > 0.01). When comes to the modified Berlin questionnaire, the sensitivity and specificity were 76.47% and 47.62% in female subjects, and the percentage of consistency agreement was 65.45%, with a Kappa coefficient 0.248 (P > 0.01). CONCLUSION Compared to the original version, the modified Berlin questionnaire has a better diagnostic consistency with a considerable sensitivity and specificity in male population. However, in female subjects group, the consistency of the modified Berlin questionnaire was still not significant remains unsatisfactory, although P value has been improved. Modified Berlin questionnaire could be. used as a primary screening tool for male OSAHS patients. However, but the screening questionnaire for female should still be need to be further explored.
Adult ; Female ; Humans ; Male ; Middle Aged ; Obesity ; Polysomnography ; Sensitivity and Specificity ; Sleep Apnea Syndromes ; diagnosis ; Sleep Apnea, Obstructive ; diagnosis ; Surveys and Questionnaires

PurposeAlteration of the regional cerebral flow and cerebrovascular reserve (CVR) caused by cerebral artery stenosis or occlusion is an essential risk factor for ischemic stroke. This study aims to assess the CVR in patients with severe middle cerebral artery (MCA) stenosis or occlusion by using MR perfusion-weighted imaging (PWI) with CO2 inhalation stress test. Materials and MethodsPWI were performed before and after CO2 inhalation stress on 28 patients with severe middle cerebral artery stenosis or occlusion and 10 healthy volunteers. The regions of interest (ROI) were put on the affected hemisphere of the MCA blood supply area and the contralateral side in both groups. The relative cerebral blood volume (rCBV), relative mean transit time (rMTT), relative cerebral blood flow (rCBF) and CVR were measured.Results① The rCBV, rCBF and rMTT of the affected side were 149.16±33.01, 18.04±5.24, 8.65±1.81 before CO2 inhalation stress, and 156.23±21.60, 23.77±8.77, 8.72±3.01 after CO2 inhalation stress. The rCBV, rCBF and rMTT were signiifcantly increased (t=1.238, 2.561 and 2.647, P<0.05) after CO2 inhalation stress. The rCBV, rCBF and rMTT of the contralateral side were 176.22±40.12, 22.43±5.74, 8.10±3.71 before CO2 inhalation stress, and 198.54±39.87, 27.64±7.22, 8.03±2.97 after CO2 inhalation. The rCBV, rCBF was significantly increased (t=1.780 and 1.665,P<0.05) while rMTT was signiifcantly decreased (t=2.871,P<0.05) after CO2 inhalation.②The CVR of the affected side, contralateral side and control group were 18.9%, 26.8%, and 39.1%, respectively. There were significantly differences (t=1.604, 2.321 and 1.874,P<0.05) between the affected and contralateral side, the affected side and control group, the contralateral side and control group.ConclusionPWI with CO2 inhalation stress test is valuable in assessing the cerebrovascular reserve in patients with severe middle cerebral artery stenosis or occlusion.

OBJECTIVETo detect disease-causing mutations in a patient with hereditary elliptocytosis.

METHODSSodium dodecyl sulfate polyacrylamide gel electropheresis (SDS-PAGE) was used to identify the type of erythrocyte membrane protein defect. Potential mutations of the exons and adjacent introns of relevant genes were analyzed by Sanger sequencing.

RESULTSSDS-PAGE has failed to detect any difference between the patient and healthy controls. However, Sanger sequencing has detected three mutations in the SPTA1 gene in the patient, which included c.5077A>C (p.Lys1693Gln) missense mutation in exon 36, c.5572C>G (p.Leu1858Val) missense mutation in exon 40, and a IVS45nt-12C>T in intron 45. The father and grandmother of the patient were both heterozygous for c.5077A>C mutation, while her mother was heterozygous for c.5572C>G and IVS45nt-12C>T mutations.

CONCLUSIONThe hereditary elliptocytosis in the patient may be attributed to the synergistic action of c.5077A>C, c.5572C>G and IVS45nt-12C>T mutations of the SPTA1 gene.

Objective To explore the mechanism of tripterygium wilfordii polyglycoside tablets for elderly patients with relapsing refractory immune thrombocytopenic purpura (ITP),and to seek the theoretical basis for Chinese medicine treatment of this disease.Methods The clinical data of 79 patients with relapsing refractory ITP were retrospectively analyzed.According to whether the combined use of tripterygium wilfordii polyglycoside,they were divided into the control group (35 cases) and the observation group (44 cases).The control group was treated with platelet and tranexamic acid,sulfasalazine,sulforaphane sodium,hemagglutinin and other symptomatic hemostasis treatment.The observation group in symptomatic hemostasis support on the basis of treatment with tripterygium wilfordii polyglycoside tablets.The CD4+/CD8+ ratio and CD4+ CD25+ Treg expression were compared between the two groups.Results The CD4+/CD8+ ratio,CD4+ CD25+ Treg and platelet count in the control group before treatmentwere (0.96 ± 0.36),(1.21 ± 0.67) ％,(13.14 ± 6.92) × 109/L,respectively,which of the observation group were (0.92 ± 0.37),(1.19 ± 0.59) ％,(11.51 ± 6.21) × 109/L,respectively,there were no statistically significant differences between the two groups (all P ＞ 0.05).The CD4+/CD8+ ratios in peripheral blood of the observation group at 2 weeks,3 weeks and 4 weeks after treatmentwere (1.04 ±0.56),(1.55 ±0.34),(1.59 ±0.41),respectively,there were statistically significant differences between the two groups (t =9.994,9.797,all P ＜ 0.05).The CD4+ CD25+ Treg proportions in the observation group at 2 weeks,3 weeks and 4 weeks after treatmentwere (1.01 ± 0.61) ％,(1.06:±:0.57) ％,(5.92 ± 0.65) ％,respectively,there was statistically significant difference between the 4 weeks after treatment and before treatment(t =5.378,P ＜ 0.05).The CD4+/CD8+ ratios in the peripheral blood of the control group were (1.01 ±0.60),(0.89 ±0.50) and (0.96 ±0.51),respectively,and the CD4+ CD25+ Treg in control group at 2 weeks,3 weeks and 4 weeks after treatment proportions were (0.99 ±0.72)％,(1.15 ±0.66)％,(1.22 ±0.56)％,respectively,there were no statistically significant differences between before and after treatment (all P ＞0.05).There were statistically significant differences in the CD4+/CD8+ ratio and CD4+ CD25+ Treg expression between the observation group and control group at 4 weeks after treatment (t =8.589,P ＜ 0.01;t =2.369,P ＜ 0.05).There was no statistically significant difference in the platelet count between the two groups(P ＞ 0.05),but the symptoms of bleeding of the observation group was lighter at 3 weeks after treatment.Conclusion Tripterygium wilfordii polyglycoside improves the expression of CD4+/CD8+ and CD4+ CD25+ Treg in peripheral blood of elderly patients with relapsed or refractory ITP.It is an ideal drug for the treatment of relapsed and refractory ITP in the elderly,it is worth further study.

OBJECTIVE：To provide referenc e for intuitively and c onveniently cognizing the research focus of Astragalus membranaceus in the treatment of diabetes. METHODS ：Using the method of bibliometrics ，the literatures about the treatment of diabetes by A. membranaceus were retrieved from CNKI full-text database during Jan. 1st，2000-Jun. 30th，2020. Bibliometric method was used to statistically analyze the number of articles ，authors and their research directions ，keywords，distribution of research institutions ，source journals ，frequency of citations ，fund funding ，etc. VOSviewer software was used for visual display. RESULTS：A total of 2 960 literatures were included ，and the number of literatures showed an increasing trend ；the author with the most literatures was Fan Ying from Liaoning University of TCM ，whose research direction was the effect of different effective parts of A. membranaceus on serum insulin and adiponectin in diabetic animal models ；in the keyword frequency analysis ，diabetic nephropathy（845 times），A. membranaceus （615 times），diabetes（587 times），A. membranaceus injection（350 times），diabetic peripheral neuropathy （303 times），qi tonifying drug （202 times）were hot topics. There were 10 institutions with more than 20 literatures，of which Nanjing University of TCM has published the most literatures （58 pieces）. Shaanxi Journal of Traditional Chinese Medicine ，Chinese Journal of Integrated Traditional and Western Nephropathy and Inner Mongolia Journal of Traditional Chinese Medicine were the journals with a large number of； literatures；Research Progress on Chemical Constituents and Pharmacological Effects of Astragalus membranaceus published from Chen guohui and others was cited most frequently，for 690 times；there are many projects funded by national scientific research funds （including National Natural Science Foundation of China and the National Key Basic m Research Special Foundation of China ）. CONCLUSIONS ：In the past 20 years， the level of researches about A. membranaceus in the treatment of diabetes have been steadilyimproved. However ，the distribution of literature is uneven and there are few high-quality core journals. Mainly ，there are relatively few clinical trials. It is suggested that researchers should explore the methods and ideas of A. membranaceus in the treatment of diabetes from the perspectives of macro clinical efficacy ，micro pharmacology ，A. membranaceus genetic resource bank and traditional Chinese medicine formulations.