The distribution of collagen Ⅳ (CⅣ) and its correlation with renal histological lesions were investigated in 107 cases with IgA nephropathy. Strong positive staining of CⅣ and Fn was found in glumerruli with crescents, segmental and global sclerosis, as well as in the tubular basement membrane and interstitium. The extent of CⅣ deposit was correlated well with tubular atrophy, interstitium fibrosis, infiltration of cells and renal pathologic changes. The results show that the increment of CⅣ and Fn in glomeruli is associated with the development of crescents, glomerular sclerosis. The inflammation of interstitium may stimulate renal tubular cells to produce extravagent amounts of CⅣ, which might further result in tubular atrophy and fibrosis.

Objective To explore the clinical efficacy of enteral nutrition combined with traditional Chinese medicine (TCM) acupuncture and moxibustion for treatment of craniocerebral trauma complicated by gastric paralysis.Methods A prospective study was conducted.One hundred and sixty-seven patients with craniocerebral trauma complicated by gastric paralysis admitted to the Department of Neurological Critical Care Medicine in Affiliated Hospital of the Logistics University Chinese People's Armed Police Force from January 2013 to October 2015 were divided into single group (83 cases) and combined group (84 cases) according to the random number table method.The basic treatment program was the same in the two groups.On the basis of gastrointestinal decompression,a nasojejunal tube was indwelled in the digestive canal of the patients in single group,and the nutrient food could be given by dripping slowly and continuously through the tube into the body,while in the combined group,they were additionally treated by acupuncture and moxibustion at auricular point,zusanli and neiguan acupoints,1 time a day,each time 30 minutes.Both groups were treated consecutively for 30 days,and then the clinical efficacies were evaluated.Before and after treatment in both groups,the changes of total serum protein (TP),pre-albumin (PA),hemoglobin (Hb) were observed;the incidences of reflux,vomiting,abdominal distension,diarrhea,pulmonary infection and intestine derived infection were also evaluated.Results After treatment the levels of TP,PA,Hb were significantly higher in combined group than those in the single group [TP (g/L):36.97 ± 2.17 vs.33.14± 2.13,PA (mg/L):215.19 ± 7.91 vs.203.15 ± 6.12,Hb (g/L):126.73 ± 11.17 vs.117.61 ± 11.24,all P ＜ 0.01].The numbers of patients with reflux,vomiting,abdominal distension,diarrhea were significantly lower in combined group than those in the single group,respectively (the number of patients had reflux being 15 cases vs.31 cases,vomiting 13 cases vs.28 cases,abdominal distension 17 cases vs.29 cases,diarrhea 17 cases vs.31 cases) and pulmonary infection (17 cases vs.29 cases),intestine derived infection (4 cases vs.12 cases),all the above comparisons showing statistically (all P ＜0.05).Conclusions Enteral nutrition combined with acupuncture and moxibustion treatment can effectively enhance the patients' nutritional status,reduce gastrointestinal dysfunction and the incidence of complications,thus the prognosis of patients with craniocerebral trauma complicated by gastric paralysis is obviously improved.

Objective To investigate nursing interns’knowledge and attitude towards needle stick injury before clinical practice.Methods In 20-23 June,2015,nursing interns who were about to start clinical practice in a hospi-tal were investigated,nursing interns’knowledge and attitude towards needle stick injury were surveyed through questionnaire.Results A total of 350 questionnaires were distributed,324 (92.57%)responded questionnaires were available.40(12.35%)questionnaires were responded by male interns,and 284(87.65%)were by female in-terns;34(10.49%)interns had bachelor degree;the mean age of interns were (20.83 + 1 .24)years old.The correct answer rates about questions related to injury occurring during needle recapping and wearing gloves were low (about 60%).About 70% of the interns gave the correct answers to questions about hepatitis B infection due to needle stick injury following hepatitis B vaccination,as well as medication after injury.Score for individual question about attitude towards needle stick injury was ≤3,the major related problems were susceptibility of blood borne diseases and recapping needles.Conclusion Needle stick injury-related knowledge and attitude among nursing interns is inadequate,including recapping needles,timely report,susceptible to infectious diseases,and so on.It is necessary for schools and teaching hospitals to strengthen the education about occupational protection among nursing interns, so as to improve the attitude and ability of professional protection.

Objective To retrieve and analyze the available evidence on prevention of needlestick injuries among healthcare workers and summarize the best available evidence.Methods We searched the BMJ best practice,Uptodata,Cochrane Library(2014),Joanna Briggs Institute Library,Registered Nurses' Association of Ontario,Scottish Intercollegiate Guidelines Network,National Guideline Clearinghouse,and complementally searched the PubMed,EM-base,CNKI and Centers for Disease Control to collect literatures including guideline,evidence summary,best practice information sheet,recommended practice and systematic review.Results Nine references were selected including a clinical decision support system,3 evidence summaries,2 recommended practices and 3 systematic review.Finally,7 items of best evidence were summarized,including:wearing double gloves,never recapping needles,using blunt-tip suture,using a neutral zone for passing sharp device,adopting the safety features of sharps,using sharp disposal containers,and continuous education for needlestick injuries.Conclusion Healthcare workers should regulate their behaviors of using sharp instruments during clinical practice and guarantee personal safety by consulting high level evidence.

Nurses play a key role in disaster prevention, delivery and management of care in disaster situations. Training high education level and enhancing disaster core competencies of disaster nurses are essential part in response to mass casualty incidents and reserving the nursing talent. Masters′degree of disaster nurses began in 2013 in China. At that time, disaster nursing task force was composed of faculty members from both the Hong Kong Polytechnic University and School of Nursing in Sichuan University, and then, students of disaster nursing were enrolled by School of Nursing in Shandong University and Chuanbei College. Masters′ degree training programme of disaster relief nurses was not perfect in China. This paper reviewed the studies on masters′degree training programme of disaster relief nurses.

Objective To explore the life experiences of donors undergoing pediatric living related liver transplantation and elucidate it 's the influencing factors of quality-of-life .Methods A qualitative study was performed with a phenomenological-hermeneutic approach .Twelve living related liver transplantation donors were face-to-face interviewed by a semi-structured interview and 7-step Colaizzi method was applied for data analysis .Results Four domains and 9 sub-domains were summarized as follows :body disturbance (pain ,discomfort & physical changes) ,sense of uncertainty (recipient-dependent sensitive ,self-doubt & confusion under family pressure ) ,role conflict (patient-carer & family-social) and contentment & gratitude (willing to sacrifice ,living in the present &benefiting from social funds ) .Conclusions The levels of quality-of-life vary greatly in different donors .Body disturbance ,sense of uncertainty ,role conflict ,contentment and gratitude are the major influencing factors of quality-of-life for donors undergoing pediatric living related transplantation .

Objective:To evaluate the effects of different position interventions in patients with acute respiratory distress syndrome (ARDS) undergoing mechanical ventilation from the aspects of effectiveness and safety using the method of network Meta-analysis.Methods:Randomized clinical trials (RCTs) related to the therapeutic effect of position interventions in adult ARDS patients undergoing mechanical ventilation were retrieved in PubMed, Embase, Cochrane Library, Web of Science, CINAHL, China Biomedical Literature Database, China National Knowledge Infrastructure, VIP and WanFang Data. The search time limit was from the establishment of the database to January 2021. According to the literature inclusion and exclusion criteria, literature was screened and the quality evaluation and data extraction were carried out. StataSE 15 and Addis 1.16.6 were used for network Meta-analysis.Results:A total of 31 RCTs were included, involving5 positions of prone, semi-recumbent, side-recumbent, supine and sitting, and 3 738 patients. The prone position compared with the semi-recumbent position, the semi-recumbent position compared with the supine position could reduce the 28-day all-cause mortality of the patient, and the difference was statistically significant ( P<0.05) . Compared with the semi-recumbent position and the supine position, the prone position could reduce the length of time the patient stayed in the ICU, and the difference was statistically significant ( P<0.05) . The prone position could increase the oxygenation index of patients compared with the supine position, and the difference was statistically significant ( P<0.05) . For the total incidence of adverse events and adverse reactions, there was no statistically significant difference between any two positions ( P>0.05) . The network Meta probability ranking of all the outcome indicators showed that the prone position and the side-recumbent position had advantages, and the supine position and the semi-recumbent position had no obvious advantages. Conclusions:Current evidence shows that the prone and side-recumbent position interventions are effective and safe for the treatment of ARDS patients undergoing mechanical ventilation, and are good choices among several positions.

Objective To system review the effectiveness of rehabilitation exercise for preventing intensive care unit patients acquired weakness(ICU-AW).Methods A computerized database search was performed through the Cochrane Library,PubMed,EMBASE,Web of Science,CNKI,CBM,Wanfang and VIP database to find relevant studies. Two researchers independently selected the studies,evaluated the quality of the articles and extracted data according to the rigorous criterion,then we performed the Meta-analysis with the software RevMan5.3.Results Nine RCTs were included in this study. Comparing to routine care,Meta-analysis showed that rehabilitation exercise improved peripheral muscle strength in ICU-AW patients[MD=5.77,95%CI (2.36,9.18),P=0.0009],respiratory muscle strength[MD=20.38,95%CI(0.79,39.96),P=0.04],and quality of life[MD=27.96,95%CI(13.28,42.63),P=0.0002],shortened the duration of mechanical ventilation[MD=-2.73, 95%CI(-4.98,-0.48),P=0.02] and length of stay in hospital[MD=-1.99,95%CI(-3.28,-0.71),P=0.002], while it had no positive effect on mortality[OR=0.91,95%CI(0.51,1.62),P=0.74].Conclusions Rehabilitation exercise improves physical function of patients with ICU-AW,and reduces the bad clinically relevant indicators, and it doesn't influence the mortality,so it is worth being popularized.

Background:Celiac disease is an autoimmune enteropathy which can present with patchy mucosal lesions.Therefore,the diagnosis of the disease requires histological evaluation of multiple site biopsies.Aims:To analyze the pathological characteristics of multiple site small intestinal biopsies in adult patients with celiac disease and provide reference for early identification and diagnosis of celiac disease.Methods:The pathological data of 22 adult patients who were newly diagnosed as having celiac disease at the People's Hospital of Xinjiang Uygur Autonomous Region from August 2019 to April 2022 were collected retrospectively.All patients were positive for serum anti-tissue transglutaminase antibody IgA,and biopsies of duodenal bulb,descending part of the duodenum and terminal ileum were obtained under endoscopy.Histological examination was performed by experienced pathologists according to the modified Marsh grading system.Results:The most common pathological grade of duodenal bulb(50.0%)and descending part of the duodenum(45.5%)was Marsh Ⅲc,while those of terminal ileum was Marsh Ⅲa(63.6%).All of the bulb biopsies,95.5%of the descending part and 72.7%of the terminal ileum biopsies showed characteristic histological changes of celiac disease.Mucosal pathology was patchy in 7 patients,of which one patient was duodenal bulb and terminal ileum involved,and 6 were duodenum involved only.Fifteen patients had diffuse small intestinal mucosal pathology involving duodenal bulb,descending part and terminal ileum,of which 4 patients showed concordant histology(the same Marsh grade in duodenal bulb,descending part and terminal ileum)and 11 patients showed discordant histology.In 18 patients(81.8%),duodenum was the only affected site or duodenum showed more serious mucosal lesions compared with terminal ileum.Conclusions:Adult celiac disease may affect the whole small intestine,and the mucosal involvement may be patchy,which highlights the importance of taking small intestinal biopsies from multiple sites repeatedly in the diagnostic work-up of celiac disease.

Objective To investigate the effects of nursing intervention combined with preventive medication on adverse reactions during fundus fluorescence angiography ( FFA ) . Methods From January 2012 to 2014, a total of 2 840 patients, who underwent FFA at the Second Hospital of Hebei Medical University for the first time, were randomly assigned to nursing intervention group, preventive medication group, combination group and control group, then we compared the type and ratio of adverse reactions to figure out the most efficient measurement. Results The ratio of systematic anaphylaxis reaction and adverse reaction of digestive system and adverse reactions of nervous system were 1. 5%,1. 4% and 1. 3% in the combination group, that both were lower than these in nursing intervention group, preventive medication group and control group (χ2 =82. 747, 8.128, 7.626,respectively;P <0. 05). Conclusions The combination of nursing intervention and preventive medication can efficiently minimize the occurrence of adverse reactions during FFA.