Objective To study genotyping and molecular epidemiology distribution of GBS pathogenic strains of GBS positive pregnant women in Guangzhou,for GBS pathogenic strains of rapid molecular diagnosis and epidemiological surveillance pro-vide certain theoretical basis and method.Methods In the Guangzhou area,used multi stage stratified sampling method col-lecting GBS positive pregnant women’s reproductive tract specimens from January to December 2015,drug sensitivity quality control standard strains:Streptococcus pneumoniae (ATCC49619)and Staphylococcus aureus (ATCC25923),took culture of bacterial,strain,identification,DNA extraction,PCR,gene detection method,through the relevant software for data analy-sis,analyzed GBS strains of gene and molecular epidemiology.Results In the study,collected 2 812 samples of secretions,af-ter identification of strains isolated from 178 strains of pathogenic GBS strains,the detection rate was 6.33%.GBS patho-genic strains to linezolid vancomycin,penicillin,nitrfurantion and other antimicrobial drug resistance rate was 0,GBS parho-genic strains to ampicillin,ciprfloxacin moxifloxacin and levofloxacintesistant parts,the restance rates were 1.1%,16.9%, 18.0% and 22.5%,but GBS pathogenic strains to erythromycin,clindamycin tetracydine antibiotics showed a high resistance rate,the resistance rates were 50.6%,47.8%(of which 20 cases of erythromycin induced clindamycin resistance accouted for 23.5%)and 73.0%.Among them,65 strains of GBS detected the mreA gene,56 strains of GBS detected the ermB gene,36 strains of GBS detected the mefA gene,28 strains of GBS detected the mefE gene,5 strains of GBS detected the ermA gene, ermC gene was not detected in the gene.Among them,carried five multidrug resistance gene of 3 strains (1.6 9%)and 4 kinds of resistant gene carried with 15 strains (8.43%),carried three resistance genes of 19 strains (10.67%),2 kinds of resistant gene carrying a 25 strains (14.04%),carried the resistance gene of 5 strains (2.81%),did not carry resistance gene of 1 strain (0.56%).The nucleotide sequences of the five drug resistance genes were 100%,and no gene mutation oc-curred.Conclusion The main GBS disease resistant gene was mreA,ermA,ermB,mrfA,mefE and its nucleotide sequence homology was 100%.The clinical need to strengthen the detection of resistant gene and molecular level and guide clinical more scientific and rational drug use.

Objective To analyse distribution and antibacterial resistance status of pathogenic bacteria isolated from blood cul‐tures of hospitalized infants ,in order to provide references for rational use of antimicrobial agents in the treatment of bloodstream infection .Methods A total of 299 strains of pathogenic bacteria isolated from positive blood culture specimens from infants(3 or less than 3 months of age) suspected with bloodstream infections in this hospital from January 2011 to May 2015 were collected ,the bacteria identification and drug sensitivity test were carried out by using the VITEK 2 Compact automatic microorganism analyzer . The composition and antibacterial resistance of these isolates were analyzed .Results Among the 299 strains of pathogenic bacteria , there were 169 strains of gram‐positive cocci(accounted for 56 .5% ) ,including 95 strains of coagulase negative Staphylococcus (ac‐counted for 31 .8% ) which was the main isolates ,and followed by 28 strains of Staphylococcus aureus(accounted for 9 .4% );there were 120 strains of gram‐negative bacilli (accounted for 40 .1% ) and mainly were Escherichia coli (53 strains ,accounted for 17 .7% );otherwise ,there were 8 strains of fungi (accounted for 2 .7% ) and 2 strains of gram‐positive bacillus (accounted for 0 .7% ) .The results of drug susceptibility test indicated that the gram‐positive cocci had multiple drug resistance to antibacterial a‐gents except for vancomycin and linezolid;the gram‐negative bacilli shown multiple drug resistance except for amikacin ,imipenem and meropenem .The fungus ,however ,displayed high sensitivty to all antifungal drugs .Conclusion Gram‐positive and gram‐nega‐tive bacteria are the main pathogens of hospitalized infants with bloodstream infection ,and are severely resistant to antibacterial a‐gents .Rational use of antimicrobial agents should be recommend for improving clinical efficacy and prohibiting the emergence of drug‐resistant strains .

Objective To investigate the status of self-management of elderly patients with chronic heart failure (CHF) in Xinjiang Region,and to explore the effects of different demographic factors on self-management.Methods A total of 704 patients with chronic heart failure were randomly selected from Urumqi,Kashgar,Khotan,Changji,Shihezi,Yili Hazakh in Xinjiang Uygur Autonomous Region via convenience sampling method and were investigated using heart failure self-management scale.Results The total score of self-management of chronic heart failure elderly patients was(47.6±11.1) and scoring rate was 59.5％.There were statistically significant differences(P＜0.01) in self-management score among patients with different ethnicity,religion,self-care ability,per capita income.The influencing factors of self-management were self-care ability,NYHA class and per capita monthly income(P＜0.05).Conclusion The overall level of self-management of elderly patients with chronic heart failure in Xinjiang Region is low,and self-management is affected by self-care ability,NYHA class and per capita monthly income.Tailored culture-based education should be provided to improve patients' self-management.

Objective To investigate the status of self-management in community-dwelling elderly patients with chronic heart failure in Pudong district and analyze demographic influence factors.Methods A total of 328 patients with chronic heart failure were randomly selected from 4 Shanghai Pudong community centers based on cluster sampling method and were investigated via heart failure self management scale.Results The total score of self-management of chronic heart failure patients was (51 .3 ±8.3),within which the scores of medication management,dietary management,psychological and social management and symptom management were (1 4.5 ±2.7),(9.1 ±2.0),(1 2.2 ±3.1 )and (1 5.5 ±3.9).Gender,religion and self-care ability were the main influencing factors of self-management,which accounted for 9% of variation.Conclusions The self-management of community-dwelling elderly patients with chronic heart failure is medium level.The self-management ability of chronic heart failure patients are affected by many factors.Targeted nursing should be performed to improve patients′self-management.

OBJECTIVETo investigate the therapeutic mechanism of point 8L54-through-point ST2S acupuncture with elongate needles in treating urinary retention after spinal cord injury.

METHODSThirty-five healthy Japanese rabbits (weight 2.5 +/- 0.25 kg, 3 months old, male or female), used as experimental subjects, were divided into 4 groups involving blank group, model group, acupuncture group, elongate needles group (5 rabbits in blank group, 10 rabbits in each of the other group 10). Modified Allen's method was used to cause spinal cord injury model for the model group, the acupuncture group and the elongate needles group, the blank group was only sham surgery. Immediately after spinal cord injury model,the elongated needle group was given the bilateral acupoints of the elongated needle penetration needling and electric stimulation, electrical stimulation 15 mm stimulation frequency of 20 to 40 times/mm, intensity 1.5 to 3 V the acupuncture group immediately was given ordinary electric needle acupuncture, given other disposals as the elongated needle group; model group was not given electric needle acupuncture, waiting 15 minutes, started to detect and record the observed indicator as the elongated needle group; the blank group was only sham surgery. The following indicators including the Tarlov score ,urinary bladder pressure point, the threshold urination, voided volume, were observed in the first day and the fifth day after surgery.

RESULTSThree groups of animals which modeled were urinary retention after operation. Compared to 1 d, Tarlov score of model group, acupuncture group and elongate needles group significantly improved at postoperative 5 d (P < 0.05). Compared with acupuncture group, the Tarlov score of elongate needles group had no significant difference at postoperative 5 d (P > 0.05). Compared with model group, values of urinary bladder pressure point decreased with varying degrees in the acupuncture group and elongate needles group at postoperative 5 d (P < 0.05); relative to the acupuncture group, the point of the bladder voiding pressure in the elongate needles group decreased more significantly at postoperative 5 d (P < 0.05); compared with model group, micturition threshold of acupuncture group and elongate needles group had been significantly improved at the fifth day after surgery (P < 0.05); relative to the acupuncture group, the improvement is more obvious in the elongate needles group. Compared with model group, voided volume of acupuncture group and elongate needles group had increased significantly at the fifth day after surgery (P < 0.05); relative to the acupuncture group, the increment is more evident in the elongate needles group (P < 0.05).

CONCLUSIONTo treat urinary retention after spinal cord injury, the method, which was point-through-point acupuncture with elongate needles in the "Zhibian" and "Shuidao", was better than general acupuncture method. The therapeutic mechanism may be related to stimulate peripheral nerve of bladder, and to rectify the dysfunction between detrusor and sphincter.

Acupuncture Points ; Acupuncture Therapy ; Animals ; Electroacupuncture ; Female ; Male ; Rabbits ; Spinal Cord Injuries ; complications ; Urinary Retention ; etiology ; therapy

Objective To investigate the status of community nurses′ cultural competence and analyze its influence factor, so as to provide evidence for enhancing. Methods A total of 537 nurses were selected from Shanghai community center and were asked to complete cultural competence scale for culture nursing awareness, knowledge and skills. Results The total score of cultural competence in Shanghai community nurses was (124. 29 ± 28. 97);the cultural awareness dimension score was (34. 69 ± 8. 47);cultural knowledge dimension score was (33. 43 ± 8. 39); and cultural skill dimension score was (56. 17 ± 14. 45). There were significant difference of cultural competence in age, department and English level (P<0. 05). Logistic regression analysis showed that English level and age were the influencing factors for the cultural competence. Conclusions The conditions of Shanghai community nurses′cultural competence are not satisfactory. The improvement of cultural competence level is a gradual process, so nursing managers and nursing educators should make scientific training and education plan to improve cultural competence of community nurses.

Objective To build a model of self-management behavior for senile patients with chronic heart failure (CHF) based on Bandura's self-efficacy theory and Clark's chronic disease self-regulation model aged CHF patients and to provide scientific evidence for formulating self-management interventions and plans for senile CHF patients. Methods Totally 881 CHF patients were investigated in 30 hospitals from 6 districts of Shanghai from December 2014 to March 2016. The statistical software AMOS 21.0 was used to conduct the path analysis, include various influencing factors, and build systematically an equation model demonstrating the internal mechanism of self-management behaviors. Results The score of self-management of aged CHF patients was (50.2±9.8). Self-concept, per capita income, heart function grading, avoidance as response, self-care ability, quality of life, resignation as response and education level were included into the multiple regression equation of self-management, and these variables accounted for 20.8% of the total variation. The structural equation model demonstrating the influencing factors of self-management for senile CHF patients fit better, and all path coefficients reached a significant level, suggesting that self-efficacy had only indirect effect on the self-management of senile CHF patients, while self-concept, per capita income, heart function grading, avoidance as response, self-care ability, quality of life, resignation as response and education level had both direct and indirect effect on their self-management. Conclusions The self-management of senile CHF patients remains at a medium and low level on the whole, and symptom management is the worst. This study has constructed a model demonstrating the internal mechanism of self-management behaviors in senile CHF patients, suggesting that medical staff should take targeted and systematic interventions according to the general condition of patients and their self-efficacy and self-concept to help improve their self-management level.

Objective To construct the molecular transmission networks of HIV-1 CRF01 AE strains circulating in China and to analyze their characteristics. Methods Sequences of the pol genes of Chinese CRF01 AE strains were downloaded from Los Alamos database and the related demographic informa-tion was checked. Transmission networks were created by four steps,including phylogenetic tree construc-tion,transmission cluster extraction,minimum genetic distance identification and network visualization. Chi-square test was performed to analyze the differences in the distribution of different populations in the networks and the differences in the distribution of subjects with different degrees among different sub-populations. De-scriptive analysis was used to investigate the transmission links between sub-populations and various regions. Results The 2 419 sequences constituted 250 separate networks including 847 nodes and 610 edges. The number of subjects covered by different networks ranged from 2 to 25. Subjects with degree ≥2 represented only 26. 4%(224 / 847)of network-individuals,but were connected with 66. 5%(563 / 847)of all network-individuals. There were 37. 6%(669 / 1 781)of men who have sex with men(MSM),28. 4%(102 / 359) of heterosexual men,16. 1%(10 / 62)of intravenous drug users(IDUs)and 30. 4%(66 / 217)of hetero-sexual women involved in the networks(χ2 =23. 774,P﹤0. 001). The percentage of subjects with degree ≥2 was high in MSM(10. 8% ,193 / 1 781)compared to that in heterosexual men(5. 6% ,20 / 359)(P =0. 002)and heterosexual women(4. 6% ,10 / 217)(P=0. 004). Of the 669 MSM in the networks,95. 5%(639 / 669)linked to other MSM and only 2. 4% (16 / 669)linked to heterosexual women. However, 15. 1%(10 / 66)of the heterosexual women in the networks linked to MSM. Of the heterosexual men in the networks,35. 3%(36 / 102)linked to heterosexual women,9. 8%(10 / 102)linked to MSM. Of the sub-jects in the networks,20. 9%(177 / 847)linked to other regions' individuals. Conclusion The super-spreaders played an important role in the molecular transmission networks of HIV-1 CRF01 AE strains even though they were in a minority. The transmission of HIV-1 CRF01 AE strains between sub-populations and various regions was complicated and active.

Objective:The current systematic review aims to evaluate the effectiveness and quality of interventions on depressive symptoms of informal caregivers of people with dementia in China and to provide evidences regarding protocols for the most effective interventions.Methods:A systematic literature search of Chinese and English databases was performed, covering randomized controlled trails published up to March 2019. The papers for final review were selected based on the inclusion and exclusion criteria. Data were extracted and analyzed with RevMan 5.3, after a quality appraisal of the included studies.Results:A total of 17 papers were identified as eligible for descriptive analysis and 14 of the papers provided estimates for meta-analysis, with 991 participants. An overall mean reduction in depression was identified among the participants of intervention group, compared to those in the control group ( SMD value was -0.75, 95% CI -0.88 - -0.62, P<0.01). Psychotherapeutic ( SMD value was -0.59, 95% CI -0.78 - -0.40, P<0.01) and psychoeducational interventions ( SMD value was -0.84, 95% CI -1.02 - -0.67, P<0.01) showed significant reductions of depressive symptoms among the caregivers. In addition, Evidence exists for the effectiveness across from the short-term ( SMD value was -0.54, 95% CI -0.82 - -0.26, P<0.01), medium-term ( SMD value was -0.68, 95% CI -0.83 - -0.52, P<0.01) to the long-term interventions ( SMD value was -0.80, 95% CI -1.08 - -0.53, P<0.01). Conclusion:Interventions targeting to reduce depressive symptoms are effective among informal caregivers of persons with dementia in China. However, insufficient evidences are found regarding the most effective protocols and more high-quality studies are needed for the target population.

Objective To investigate community nurse′s transcultural self-efficacy and analyze the influencing factors. Methods The sample consisted of 467 randomly selected community nurses form 15 community hospitals in Shanghai. The transcultural self-efficacy tool ( TSET, Chinese version) was used to investigate influencing factors and we analyzed the factors. Results The average point of transcultural self-efficacy was (7. 29 ± 1. 60); 3 dimensions′ point from high to low, the average point of them were cognition (7. 53 ± 1. 76), emotion (7. 21 ± 1. 73), communication ability (7. 15 ± 1. 71). Different departments and English levels were correlated with transcultural self-efficacy. The age, professional title, international experience were influencing factors of transcultural self-efficacy. Conclusions The transcultural self-efficacy of community nurses are in medium level in Shanghai. Nursing administrators should take measures to improve the transcultural self-efficacy of community nurses.