Objective To investigate the effect of endoplasmic reticulum stress (ERS)-associated apoptosis on renal interstitial fibrosis induced by unilateral ureteral obstruction (UUO) in rats. Methods Eighteen healthy male Wistar rats undergoing UUO were sacrificed at 3,7,14 days after operation. Additional seven rats underwent sham operation. Histological changes were observed by HE and Masson staining. Immunohistochemistry was performed on renal tissue for α-smooth muscle actin (α-SMA). Chromatometry was used to detect the content of hydroxyproline. Apoptosis cells were determined by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) and the electrophoresis analysis of genome DNA. The mRNA expression of glucose-regulated protein 78 (GRP78), which are important markers of ERS, were detected by RT-PCR. Western blotting was used to assess the protein level of GRP78 and cysteinyl aspartate specific proteinase-3 (caspase-3). Results Compared with sham operation group, the degree of renal interstitial and the level of hydroxyproline content of UUO group increased significantly (P<0.05). Immunohistochemistry staining indicated that a-SMA extensively expressed in renal tubular and interstitial cells. The apoptotic cells in the renal tubular and interstitium were continuously increased from day 3 to the end of experiment of UUO group. As early as 3 days after surgery, the mRNA level of GRP78 in UUO group increased compared with sham operation group (P<0.01), while the protein expression increased on day 7 after surgery (P<0.01). Prolonged ERS triggered apoptosis, the protein expression of caspase-3 increased significantly on day 3 after surgery (P< 0.05), and the expression sustained high level during the experiment afterwards. There was a positive correlation between GRP78 protein expression and hydroxyproline content (r =0.657, P< 0.01) as well as caspase-3 protein expression (r=0.714, P<0.01). Conclusions UUO induces a significant up-regulation in endoplasmic reticulum molecular chaperones at early stage, indicating that ERS response is activated in the rat kidney. Prolonged ERS can lead to renal tubular and interstitial cell apoptosis, and caspase-3-mediated ERS associated apoptosis may contribute to the fibrosis.

Objective To understand the condition of anxiety and analyze the influencing factors related to anxiety among nurses working in department of infectious diseases.Methods 206 nurses from 6 third class hospitals in Wenzhou were selected by simple random sampling method.A survey was carried out by using the socio-demo-graphic information questionnaire,working conditions questionnaire,self-rating anxiety scale and social support rating scale.Results The SAS score among nurses ranged from 36 to 72 points,and the average score was (48.32 ± 12.06)points,which was higher than the norm SAS value(t=14.39,P<0.01).The percentage of anxiety was about 55.33%.The percentage of moderate and severe anxiety was 16.51%.The main factors related to the anxiety among nurses were age(t=11.34,P<0.01),working years(t=5.68,P<0.01),moonlit night shift(t=4.42,P<0.05), worrying about making mistakes(t=7.18,P<0.01),worrying about occupational exposure(t=19.93,P<0.01) and nursing management of much criticism(t=5.68,P<0.01).Conclusion The condition of anxiety was serious among nurses working in department of infectious diseases.Interventions should be taken to reduce the anxiety level among nurses.

Objective To investigate the complications related factors in infants with mycoplasma pneumonia pulmonary(MPP). Methods According to the condition of pulmonary complications, 105 cases of infants MPP were divided into pulmonary complication group and no pulmonary complication group with 72 cases and 33 cases respectively,and the general related factors and disease related factors of two groups were analyzed. Results The incidence rate of pulmonary complication was 68.6% (72/105) in infants MPP, and the main involved extra-pulmonary systems were digestive system (54.2%), cardiovascular system (44.4%) and blood system(33.3%). Among 20 factors associated with pulmonary complications of MPP, age, feeding method (including artificial, mixing and milk three classification), season of onset, fever days, the titer of mycoplasma pneumonia (MP)-IgM, C-reaction protein, erythrocyte sedimentation rate and the initial time of using macrolides had significant differences between two groups (P<0.05). Multivariate Logistic regression analysis showed that age≥2 years, fever days≥7 d, titer of MP-IgM≥1∶160, increased C-reaction protein levels and accelerated erythrocyte sedimentation rate were the risk factors for pulmonary complications of infants MPP, while breastfeeding and using macrolides within 7 d were the protective factors. Conclusions The incidence rate of pulmonary complications in infants MPP is high, which can affect multiple systems. For children with older age, longer thermal process, higher titer of MP-IgM, and increased C-reaction protein , accelerated erythrocyte sedimentation rate and more past medical history, more attention should be paid for their higher pulmonary complications incidence.

Objective To analyse the adherence of community-dwelling stroke survivors to functional exercise regimens and explore the influencing factors.Then to establish measures to improve the situation.Methods A total of 208 stroke survivors from 10 communities were randomly recruited.Four questionnaires-a general information questionnaire,an exercise adherence questionnaire,a self-efficacy perceptions scale and a perceived social support scale-were administered.Results The mean adherence score was 34.71 ± 8.45 and the mean adherence rate was 61.98％.The compliance to physical exercise,seeking advice positively and exercise effectiveness monitoring scores ranged from highest to lowest in order.Self-efficacy perceptions and perceived social support were both positively correlated with the adherence rate.Multiple linear regression showed that the influencing factors included self efficacy perceptions,social support perceptions,self-care ability and age.Conclusions The community stroke survivors' exercise adherence was moderate in general,but it could be improved by increasing their self-efficacy and social support perceptions and their self-care ability.

Objective:To investigate the risk factors of citrate accumulation in patients with liver failure treated with regional citrate anticoagulated continuous renal replacement therapy (RCA-CRRT).Methods:The clinical data of liver failure patients with RCA-CRRT admitted to department of intensive care unit (ICU) of Nantong Third People's Hospital from January 2017 to June 2020 were retrospectively analyzed. The selected patients were divided into citrate accumulation group and control group according to whether there was citrate accumulation (serum total calcium/free calcium ratio ≥ 2.4) during CRRT. The age, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), mean arterial pressure (MAP), norepinephrine (NE) dose, blood lactic acid (Lac) concentration, liver function status, citrate dose, filter time and prognosis of the patients were compared between the two groups. Unconditional Logistic regression was used to analyze the risk factors for citrate accumulation.Results:Among 48 patients with RCA-CRRT and liver failure, 20 patients had citrate accumulation (accumulation group), and a total of 96 CRRTs were performed; the remaining 28 patients did not have citrate accumulation (control group), a total of 106 CRRTs were performed. There were no significant differences in age and APACHEⅡ score between the two groups. Compared with the control group, the MAP in the accumulation group was lower [mmHg (1 mmHg = 0.133 kPa): 66.9±13.6 vs. 86.4±8.3, P = 0.032], and the dosage of NE (μg/min: 16.3±8.4 vs. 5.9±2.8, P = 0.015) and lactic acid level (mmol/L: 4.89±1.45 vs. 2.98±0.87, P = 0.004) were higher, the damage of liver function was more serious [total bilirubin (TBil, μmol/L): 220.4±45.2 vs. 163.4±43.8, P = 0.012; Child-Pugh score: 12.0±2.5 vs. 8.8±1.4, P = 0.029; model for end-stage liver disease (MELD) score: 31.30±8.22 vs. 21.78±6.40, P = 0.041], hourly citric acid dosage (mmol/h: 27.4±6.9 vs. 19.3±4.9, P = 0.032) and total citric acid dosage (mmol: 3 393±809 vs. 1 819±502, P = 0.039) were higher. Although there were no significant differences in the length of ICU stay, total length of hospitalization stay and cost of hospitalization between the two groups, the 28-day mortality of the accumulation group was higher than that of the control group (60.0% vs. 28.6%, P = 0.039). Unconditional Logistic regression analysis showed that MAP [odds ratio ( OR) = 2.901, 95% confidence interval (95% CI) was 0.921-19.493, P = 0.019], NE dosage ( OR = 2.098, 95% CI was 1.923-12.342, P = 0.002), Lac level ( OR = 5.201, 95% CI was 3.211-9.433, P = 0.012), Child-Pugh score ( OR = 1.843, 95% CI was 0.437-7.420, P = 0.018), MELD score ( OR = 3.012, 95% CI was 0.384-12.843, P = 0.031), hourly citric acid dosage ( OR = 4.254, 95% CI was 1.734-11.839, P = 0.011) and total citric acid dosage ( OR = 4.109, 95% CI was 1.283-18.343, P = 0.001) were risk factors for citrate accumulation. Conclusion:In patients with tissue hypoperfusion and severe liver function damage, citrate anticoagulation should be avoided or the dosage of citric acid should be reduced, in order to avoid citrate accumulation.

Objective:To translate the Understanding COPD (UCOPD) into Chinese, culturally adjust it and test its reliability and validity.Methods:According to the translation principle of Brislin questionnaire, the English version of UCOPD was translated, back-translated and culturally adjusted and pre-tested to form the Chinese version of UCOPD. From December 2020 to April 2021, a total of 101 COPD patients admitted to Tianjin Medical University General Hospital were enrolled using the convenient sampling method. The reliability and validity of the scale were tested.Results:The Chinese version of UCOPD included section A and B. Section A included 3 dimensions, such as "about COPD" "managing symptoms of COPD" "accessing help and support", with a total of 18 items. The results of exploratory factor analysis showed that the cumulative variance contribution rate of the three common factors was 59.35%. The Cronbach's α coefficient of section A was 0.893, and the Cronbach's α coefficient of each dimension was 0.756-0.864. The test-retest reliability of section A was 0.954, and the test-retest reliability of each dimension was 0.779-0.887. Section B included 6 items, which were used to measure the satisfaction of pulmonary rehabilitation courses in COPD patients. However there were big individual differences, so the reliability and validity test of section B were not evaluated.Conclusions:Section A of the Chinese version of UCOPD questionnaire has good reliability and validity. It can be used to evaluate self management ability of patients with good knowledge of COPD but less confidence in symptom control and health maintenance, so as to guide clinical medical staff to formulate accurate intervention measures to improve patients' self management.

With the rapid development of information and communication technology and the internet, the application of telemental health services has become more and more extensive. This paper introduces the concept and development of telemental health, and expounds the mode and setting of telemental health services abroad. This paper focuses on the review of the implementation methods and application effects of foreign telemental health services in the rehabilitation of stroke patients, so as to provide a reference for the clinical development of telemental health services in China to promote the rehabilitation of stroke patients.

Objective:To explore the relationships between medical coping modes of patients with COVID-19 and general information and social supports.Methods:From January 28 to February 20, 2020, a total of 128 patients in a designated hospital in Wuhan with novel coronavirus pneumonia were investigated using the General Information Questionnaire and the Chinese version of the Medical Coping Modes Questionnaire (MCMQ) by convenient sampling. Pearson univariate analysis and multiple linear regression were used to analyze the relationship between the basic situation of patients with novel coronavirus pneumonia and coping modes.Results:The scores of the face dimension and avoidance dimension of patients with COVID-19 were lower than the norm model, while the yield dimension was higher than the norm model, and the differences were statistically significant ( P<0.05) . Support utilization and complexity were influencing factors of the face dimension ( P<0.05) . Support utilization and age were influencing factors of the yielding dimension ( P<0.01) . Subjective support, the complexity dimension of disease uncertainty and the number of confirmed patients in the family were influencing factors of the avoidance dimension ( P<0.01) . Conclusions:Patients with COVID-19 have poor medical coping modes, and they are prone to face the disease with a negative attitude. Patients are unwilling to face the disease and the tendency to yield to the disease is greater. And the older the patients, the less likely they are to succumb to the disease. The more patients diagnosed in the family, the less likely they are to avoid the disease. Patients with higher social supports and utilization have a more reasonable medical coping mode. This reminds medical staff to pay more attention to the psychological problems of patients in coping with COVID-19 and improve their coping modes and methods.

Objective:To explore the value of radiographic assessment of lung edema (RALE) score in evaluating the severity and prognosis of patients with acute respiratory distress syndrome (ARDS).Methods:A retrospective study was conducted. Patients with ARDS admitted to the department of intensive care unit (ICU) of Affiliated Nantong Third Hospital of Nantong University from January 2016 to November 2020 were enrolled. Clinical data of those patients were collected, and two senior radiologists who did not know the outcome of the patients independently scored each chest radiograph, the mean value of which was taken as the RALE score. The patients were divided into death group and survival group according to the 28-day prognosis. The differences of the basic data, PaO 2/FiO 2, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score and RALE score between groups were analyzed. ARDS patients were classified according to the Berlin standard and RALE scores were compared between groups. Then, the correlations between RALE score and PaO 2/FiO 2, SOFA score, APACHEⅡ score were analyzed. The prognostic capacity of RALE score for 28-day prognosis of ARDS patients were analyzed by Kaplan-Meier survival curve. Results:Of the 98 ARDS patients, 62 were included in the final analysis, 39 patients survived and 23 patients died. The 28-day mortality was 37.1%. Compared with the survival group, patients in the death group were older (years old: 72.83±12.21 vs. 64.44±14.68), had lower PaO 2/FiO 2 [mmHg (1 mmHg = 0.133 kPa): 122.66±48.32 vs. 150.26±50.40], and higher SOFA score and greater difference of RALE score between the third day and the first day after admission (D3-D1 RALE score) (SOFA score: 11.26±3.91 vs. 9.04±3.72, D3-D1 RALE score: 1.35±6.42 vs. -2.74±7.35), with statistically significant differences (all P < 0.05). However, there were no significant differences in gender, cause of ARDS, APACHEⅡ score, and RALE scores on the first and the third day of admission (D1 RALE, D3 RALE) between the two groups. Among the 62 patients, there were 11 mild cases (17.7%), 36 moderate cases (58.1%), and 15 severe cases (24.2%). The D1 RALE score of patients with mild and moderate ARDS were lower than those of patients with severe ARDS (19.09±3.65, 22.58±6.79 vs. 27.07±5.23, both P < 0.05). Correlation analysis showed that D1 RALE score was negatively correlated with PaO 2/FiO 2 ( r = -0.385, P = 0.002), and positively correlated with SOFA score and APACHEⅡ score ( r1 = 0.433, r2 = 0.442, both P < 0.001). Kaplan-Meier survival curve analysis showed that the 28-day survival rate of ARDS patients in D3-D1 RALE score ≥ -1 group was significantly higher than that in D3-D1 RALE score < -1 group (73.08% vs. 55.56%; log-rank test: χ 2 = 3.979, P = 0.046). Conclusions:The RALE score is a simple and reliable non-invasive evaluation index, which can be used to evaluate the severity of ARDS patients. The difference of RALE score in early stage is helpful to identify ARDS patients with poor prognosis.

Cardiac disease is the general term of diseases, caused by damage to the structure or abnormal function of the heart. Its morbidity and mortality have remained high, seriously threatening the lives and health of people. The tyrosine kinase receptor ErbB2 (also known as EGFR2 or HER2) was originally discovered for its oncogenic activity, however, recent studies have found that ErbB2 have protective effects in various heart diseases. Therefore, this article reviews the role and underlying mechanism of ErbB2 in myocardial infarction, myocardial ischemia/reperfusion injury, cardiac hypertrophy, heart failure, doxorubicin-induced cardiotoxic injury and diabetic cardiomyopathy. Furthermore, this article also preliminarily discusses the application prospects, limitations and development directions of ErbB2 as a clinical diagnostic marker and therapeutic target for heart disease.