Objective To investigate the factors associated with hospital infection in old inpatients with Alzheimer's disease. Methods 368 old inpatients with Alzheimer's disease were reviewed and analyzed with Logistic regression. Results There were 95 cases (25.81%) suffered in hospital infection to 116 case-times. As multivariate regression analysis, activities of daily living (OR=8.398, 95% CI: 5.343~12.098), invasive intervention (OR=2.842, 95%CI: 1.445~3.365), no insight (OR=4.457, 95%CI: 2.789~8.853), long-term use of antibiotics (OR=3.348, 95%CI: 1.693~6.336), chronic in bed (OR=3.258, 95%CI: 1.583~6.154), and antipsychotic drug (OR=2.243, 95%CI: 1.427~5.583) increased the risk of hospital infection independently, and ventilated timely (OR=0.546, 95%CI: 0.334~0.867) reduced the risk. Conclusion Good performance of basic and living nursing, less invasive intervention, reasonable use of antibiotics, antipsychotic monitoring,and intensive sterilization may reduce the incidence of hospital infection in inpatients with Alzheimer's disease.

Objective To study the whole genome DNA methylation changes induced by low dose radiation (LDR) in mouse,and mRNA expression profiles of DNMT1 and MBD2 in peripheral blood mononuclear cell (PBMC) and tissues.Methods Thirty male BALB/c mice were randomly divided into 3 groups:control,single exposure (0.5 Gy),and fractionated exposure of 6 MV X-rays for 10 d (0.05 Gy/d × 10 d).Control mice were sham-treated.To determine the immediate (early) effect of irradiation,15 mice (5/group) were sacrificed 2 h after the last irradiation.The other 15 mice were sacrificed 1 month after the last irradiation (delayed effect).Before sacrifice,blood was sampled immediately.Kidney,liver,spleen,brain and lung tissues were collected.A global DNA methylation quantification Kit and highperformance liquid chromatography (HPLC) were used to investigate the methylation level in blood DNA.The expressions of DNMT1 and MBD2 were determined by RT-PCR.Results For the early effects of irradiation,as compared with controls,fractionated exposure to X-ray irradiation led to the significant depression of global DNA methylation level in blood (t =10.19 and 8.93,P ＜ 0.05).DNMT1 and MBD2 mRNA were down-regulated in PBMC,kidney and liver (t =5.06,3.01,3.97,12.25,3.50 and 3.73,P ＜0.05),and MBD2 was also down-regulated in spleen (t =3.03,P ＜ 0.05).However,no changes were observed in single exposed group.As for the delayed effects,the methylation levels of blood were not changed in the single or fractionated exposed groups,and only MBD2 mRNA was down-regulated in PBMC and brain of fractionated exposed group (t =3.52 and 2.85,P ＜ 0.05).Conclusions Fractionated LDR exposure can induce genome DNA hypomethylation,which is tissue-specific,and may be related with down-regulation of DNMT1 and MBD2.

Objective To explore the effect of the clinical case oriented management model on nurses comprehensive ability, psychological and critical mind. Methods In 2014 on the implementation ofroutine clinical case management modelas the control group, collected 97 cases of clinical cases. In 2015 on the implementation ofthe clinical case oriented management modelas the observation group, collected 110 cases of clinical cases. Compared two methods of management to improve the nurse management theoretical knowledge, clinical practice ability and deal with the size of the case skills help. When/after clinical special case found the influence for nurses, including psychology, work in the nursing work will, enthusiasm, independent ability to deal with related cases and the nurse critical thinking ability, etc. Results The proportion of the nurses thought that it was helpful to improve the management of theoretical knowledge, clinical practice ability and deal with the size of the case skills and the case analysis of satisfaction were 98.79%(244/247), 99.19%(245/247), 98.79%(244/247), 99.60%(246/247) in the observation group, and 88.57%(217/245), 87.35%(214/245), 87.76%(215/245), 90.61%(222/245) in the control group. The differences were statistically significant (χ2=21.390-27.571, P < 0.01). The proportion of the nurse considered that special case on the psychological effects of nursing work, engaged in the willingness and enthusiasm were the main factor were 15.79%(39/247), 13.77%(34/247), 11.34%(28/247) in the observation group, and 31.84%(78/245), 31.02%(76/245), 30.61%(75/245) in the control group. The differences were statistically significant (χ2=17.475, 21.097, 27.611, P < 0.01). After special case, the percentage of nurses to independently handle the case, help others, loss rates were 97.57%(241/247), 2.02% (5/247), 0.40% (1/247) in the observation group, and 85.71% (210/245), 12.24% (30/245), 2.04% (5/245) in the control group. The proportion of nurses to independently handle the case in the observation group was higher than that in the control group, but the ratio of nurses to help others, loss rates in the observation group were lower than those in the control group, the differences were statistically significant (χ2=22.647, P<0.01).Critical thinking score, the observation group of nurses in the search for truth, open mind, analytical ability, system organization, judging thinking self-confidence, curiosity, cognitive maturity, such as total score were respectively (43.24±4.01), (43.03±4.12), (47.66±4.23), (44.21± 3.92), (44.00 ± 4.97), (52.13 ± 4.44), (48.23 ± 4.85), (319 ± 14.57) points. The control group nurses were respectively (39.00±3.56), (38.90±3.28), (43.65±2.47), (40.55±1.99), (39.00±3.40), (47.87±4.01), (41.89± 5.11), (292.23 ± 6.02) points. The differences were statistically significant(t =12.15-24.19, P < 0.01). Conclusions The clinical case oriented management model can improve nurses comprehensive ability, reduce the adverse impact of the special case for nurses, improve the clinical nurses' critical thinking ability, to ensure patient safety.

Surgical resection remains the only curative option of treatment for hepatocellular carcinoma,but centrally located tumors remain problematic.Extended right or left hepatectomy removes 60％ to 85％ of the hepatic parenchyma and is associated with more hepatic failure.Mesohepatectomy,resection of central hepatic segments (Couinaud's segments Ⅳ,Ⅴ,Ⅷ) and leaving the right and left segments in situ,preserves more functional hepatic tissues than extended hepatectomy.Despite its technical demands,mesohepatectomy should be considered as an alternative treatment for central huge hepatic tumors.

Objective To explore the effect of MICA-Ab expression on the prognosis of sensitized renal transplantation recipients.Methods A total of 51 sensitized recipients (PRA more than 20%) in our hospital from August 2007 to April 2010 were enrolled in the study.In these patients,29 cases received protein A immunoadsorption and detection of MICA-Ab was performed before and after protein A immunoadsorption.Other 22 patients received MICA-Ab detection when they were hospitalized.Associations of PRA,HLA-matches,acute rejection,and serum creatinine of postoperative week 1 and week 4 with MICA-Ab were analyzed retrospectively.Results Sixteen recipients (31.4%) had positive MICA-Ab expression but their acute rejection rate was not higher as compared to the patients with negative MICA-Ab expression.Recipients with PRA＞40% showed higher expression level of MICA-Ab than recipients with PRA≤40% (P≤0.05).HLA-match did not show influence on MICA-Ab expression.MICA-Ab positive group had no higher serum creatinine level than negative group in postoperative week 4.MICA-Ab level decreased significantly after protein A immunoadsorption.Conclusions MICA-Ab expression increases in the sensitive recipients but does not influence the prognosis.Protein Aimmunoadsorption can eliminate MICA-Ab effectively in sensitized recipients.

Intrahepatic bile duct stones located at the upper part of the hepatic duct.The percentage of intrahepatic biliary cholesterol calculus is increasing in recent years,and the incidence of this type of bile duct stones is free from infection or obstruction.The formation of intrahepatic bile duct stones might not only related to the micro-environment changes in the biliary tract,but also related to the changes of metabolic function of hepatocytes or cholangiocytes.In this article,the mechanism of biliary hydrodynamics on the formation of intrahepatic bile duct stones was reviewed.

Objective To evaluate the clinical application value of anti-β2 glycoprotein I ( anti-β2 GPI) and anti-cardiolipin antibodies ( ACA ) in the patients with antiphospholipid syndrome ( APS).Methods Serum levels of anti-β2GPI(IgG) and ACA(IgA, IgG, IgM) were determined by enzyme linked immunosorbent assay ( ELISA ) in 53 patients with APS , 27 patients with SLE accompanied by APS , 55 patients with simple SLE , 46 patients with other autoimmune diseases and 40 healthy controls.The sensitivity and specificity of anti-β2 GPI and ACA for the diagnosis of APS and the correlation of serum anti-β2 GPI and ACA-IgG levels were analyzed.The cases were identified in the Affiliated Hospital of Qingdao University during 2012.1 to 2014.2 and the data were analyzed with χ2 test, Mann-Whitney U test and Spearman correlation.Results The positive rates and serum levels of anti-β2 GPI, ACA-IgG/M, ACA-IgG, ACA-IgM were significantly higher in the APS group [77.4%(41/53), 81.1%(43/53), 56.6%(30/53), 52.8%(28/53);14.1 AU/ml, 19.6 U/ml, 17.9 U/ml] than those in the simple SLE group [16.4%(9/55), 32.7%(18/55), 20.0%(11/55), 18.2%(10/55); 4.9 AU/ml, 9.4 U/ml, 8.7 U/ml, χ2 =40.4, 25.7, 15.4, 14.2;U=255.0, 632.5, 476.5, P<0.01], other autoimmune diseases group[0%(0/46), 4.3%(2/46), 2.2%(1/46), 2.2%(1/46); 3.2 AU/ml, 2.6 U/ml, 3.4 U/ml, χ2 =60.7, 58.6, 33.9, 30.5;U=53.5, 87.0, 66.0, P<0.01] and healthy controls [0%(0/40), 2.5%(1/40), 0%(0/40), 2.5%(1/40);3.0 AU/ml, 3.5 U/ml, 2.9 U/ml, χ2 =55.3, 56.5, 33.4, 26.9;U=61.0, 124.0, 152.0, P <0.01 ] separately.The positive rate and serum level of ACA-IgA in the APS group [18.9%(10/53), 11.7 U/ml] were significantly higher than that in the other autoimmune disease group [2.2%(1/46), 2.9 U/ml,χ2 =6.9, U=581.0, P<0.01] and healthy controls[2.5%(1/40),2.1 U/ml,χ2 =4.4,U=764.0,P<0.05] separately.The specificity of anti-β2 GPI (83.6%) for APS diagnosis was significantly higher than that of ACA (67.3%, χ2 =4.0,P<0.05).Conclusions anti-β2 GPI, ACA-IgG and ACA-IgM, have higher clinical application value in the APS diagnosis and identification of SLE with or without APS than ACA-IgA.The specificity of anti-β2 GPI for APS diagnosis is higher than that of ACA.

Objective The invasion and metastasis of colon cancer often leads to treatment failure and mortality in patients . Our research is to investigate the influence of FoxM 1 to malignant human colon cancer line . Methods In two human colon cancer lines, the protein and mRNA expression levels of FoxM 1 were analyzed with the application of RT-PCR and Western blot , from which high-expressed HT-29 and low-expressed HCT-116 were determined.The expression of FoxM1 was down-regulated by RNA interfering in HT-29 and up-regulated by constructing overexpression transgenic line in HCT-116.The proliferation of the above cells was assayed by healing method;while the metastasis and invasion ability were examined by Transwell chamber assay . Results Two colon cancer lines were selected with high-expression or low-expression of FoxM1 separately named HT-29 and HCT-116.Application of PEX-2-FoxM1 raised after HCT-116 cells express FoxM1, cell scratches in HCT-116 experimetal group ([70.92 ±1.48]%) compared with HCT-116 control group([16.92 ±4.05]%)and HCT-116 blank control group([16.66 ±2.63]%) will markedly enhance its capabil-ity of healing (P<0.05), Transwell Chambers in membrane cells in HCT-116 experimetal group (186.0 ±6.8) compared with HCT-116 control group(42.0 ±2.0) and HCT-116 blank control grou (37.0 ± 2.2)was increased (P<0.05).On the other hand, the applied pG-PH-shFoxM1 can reduce FoxM1 expression in HT-29 cell, cell scrat-ches healing ability in HT-29 experimetal group ( [ 10 .37 ± 3.86]%) compared with HT-29 control group([34.63 ±2.35]%)and HT-29 blank control group([67.36 ±2.61]%) decreased significantly (P<0.05), Transwell Chambers in membrane cells in HT-29 experimetal group (53.0 ±1.8)compared with HT-29 control group(95.0 ±2.2)and HT-29 blank control grou(118.0 ±4.0) was also reduced (P<0.05). Conclusion The expression of FoxM1 is in close relation to the invasion and metastasis of CRC .The fact that the siRNA interfering FoxM1 could effectively inhibit the proliferation, metastasis and invasion, suggesting FoxM1 could po-tentially be a new molecular target for inhibiting the proliferation of human colon cancer line .

Objective To explore the effect of head nurses′tutoring and commenting on nursing ward round. Methods The nursing ward rounds performed during August 2013 to July 2014 were assigned as the control group and those nursing ward rounds during August 2014 to August 2015 as observation group: in the former group routine nursing ward rounds were done once a week and in the latter the rounds were performed by head nurses′tutoring and commenting once every week. The two groups were compared in terms of examination performances of nursing ward rounds, doctors′ and nurses′ satisfaction degree, nurses′ and student nurses′evaluation on the ward rounds and their critical thinking ability. Results The examination performances and the satisfaction degree in the observation group were significantly higher than those of the control group (P<0.05). The nurses in the observation group thought the head nurse′s commenting at ward rounds could be more effective than those from the control group in their improvement of theoretical knowledge and clinical ability (P<0.05). In terms of critical thinking by California Critical Thinking Disposition Inventory-Chinese Version), the total score and the scores on its dimensions in the observation group were significantly higher than those of the control group. Conclusion The nursing ward rounds by head nurses′tutoring and commenting can help the nurses to strengthen their ability in nursing ward rounds and improve their theory and clinical practice so that the nursing quality is improved.

OBJECTIVE To determine the drug resistance phenotype and genotype of plasmid-mediated AmpC ?-lactamase in Klebsiella pneumoniae isolated from Harbin.METHODS Isolates of K.pneumoniae with an inhibition ring to cefoxitin of ≤18 mm diameter were used.Antimicrobial susceptibilities were determined by disc diffusion method.AmpC genes were detected by PCR with six pairs of primers.RESULTS Sixty-three isolates had an inhibition ring to cefoxitin of ≤18 mm diameter and 26(11.3%)were detected to be AmpC-producing in a total of 231 clinical isolates of K.pneumoniae.Seventy-six percent,70.2%,53.8%,50.5%,57.7%,38.5% and 7.7% of AmpC-producers were resistant to cefoxitin,cefotaxime,ceftazidime,amoxicillin/clavulanic cid,ciprofloxacin,amikacin and imipenem,respectively.ACT,DHA and CIT types of AmpC beta-lactamase were detected in 13,8 and 5 isolates,respectively.No ACC,MOX and FOX were detected.CONCLUSIONS The AmpC ?-lactamase in Harbin is mainly in the types of ACT,DHA and CIT.AmpC-producing K.pneumoniae shows decreased susceptibilities to cefoxitin and third generation cephalosporins.