To evaluate the status of diabetes-related knowledge and training requirement among general physicians,a questionnaire survey was conducted in 676 general physicians from 32 primary medical institutions and 5 secondary hospitals of Shanghai Pudong New Area.48.2% (261/541) of the surveyees had bachelor degree and most of them worked in secondary hospitals or primary medical institutions in affluent areas.The awareness rate of diabetic knowledge among the surveyeos was 51.6%,and there were significant differences in the awareness rate of diabetes-related knowledge between different levels of hospitals and physicians with different academic background.Only 26.6% of physicians received diabetes-related continuing education or training,there was a popular request for professional training from the surveyed physicians.

Objective To investigate the value of two-dimensional echocardiography (2DE) in detecting left ventricular regional wall motion abnormality (RWMA) in non-ST-elevation myocardial infarction (NSTEMI) by contrast with coronary angiography (CAG).Methods Totally 68 cases of NSTEMI patients (NSTEMI group)and 50 cases of normal peoples (normal group)were collected.2DE dynamic image and CAG results were comparatively analyzed in two groups.Left ventricular RWMA of all patients were observed through multi-section dynamic images by 2 experienced echocardiographic physicians.Left ventricular wall motion abnormalities were determined according to the 16 segment method of the American Society of echocardiography (ASE).2DE-RWMA was positive if there were one or more segments of motion abnormalities.All NSTEMI patients underwent CAG 2 days after 2DE examination,CAG was positive if the degree of coronary artery stenosis was more than 50％.Results In 68 NSTEMI patients,66 cases were CAG positive and 2 cases were negative,35 cases were 2DE-RWMA positive and 33 cases were negative.Taking CAG as a gold standard,the sensitivity,specificity and accuracy,positive predictive value and negative predictive values of 2DE-RWMA in diagnosis of NSTEMI were 51.52％ (34/66),50.00 ％ (1/2),51.47％ (35/68),97.14％ (34/35),3.03 ％ (1/33).Compared with the 2DE-RWMA negative patients,the rate of three branches of coronary artery stenosis in 2DE-RWMA positive patients was higher (62.85％ vs 39.39％,P＜0.05),the degree of coronary artery stenosis that reached 90％-99％ was higher (68.57％ vs 48.48％,P＜0.05).Conclusion The sensitivity of 2DE is low of NSTEMI in detecting the left ventricle RWMA.The degree of coronary artery stenosis is probably serious if 2DE-RWMA is positive,which is helpful for preliminary clinical judgment.

Objective: To analyze the relationship between inflammatory factors and relevant risk factors in patients of essential hypertension (EH) combining acute coronary syndrome (ACS) with its clinical significance. Methods: Our research included 3 groups: EH group, n=79 patients with standard criteria, EH+ACS group, n=85 and Control group, n=48 normal subjects. Blood levels of lipoprotein-associated phospholipase A2 (Lp-PLA2), tryptase (TPS) and relevant clinical, biochemical parameters were measured; risk factors for cardiovascular disease were examined and the relationship between above parameters, risk factors and ACS occurrence in EH patients was studied by Logistic regression analysis. Results: The OR values were all greater than 1 in fibrinogen (Fbg), high-sensitivity C-reactive protein (hs-CRP), TPS, atherosclerotic plaque, Lp-PLA2 and EH grading. Fbg was the most significant independent risk factor (OR=22.242, 95% CI 6.458-76.609, P<0.0001), the standardized partial regression coefficient b'as absolute value (b') was 1.079 which was the highestone in above 6 variables with the strongest impact for ACS occurrence in EH patients. Conclusion: Fbg, hs-CRP, TPS, atherosclerotic plaque and EH grading were the independent risk factors for ACS occurrence in EH patients; Fbg was the highest risk factor for ACS occurrence with the strongest impact, which provided a new direction for ACS prevention and treatment.

Objective To explore the comfort of the patients with nasal packing after nasal endoscopic surgery from the angle of the patients, and to provide references for improving the comfort of the patients and developing the nasal comfort scale. Methods The phenomenology research method was adopted in this study. Sixteen patients with nasal packing after nasal endoscopic surgery participated in the in-depth interview which interview outline was designed basis on Kolcaba K's comfort theory. Data were analyzed by using Colaizzi's phenomenological method. Results Four level-1 themes and sixteen level-2 themes were extracted. The physical discomfort included discomfort in nose, head, eye, month, face, ear, sleep, diet and movement. The psychological discomfort included sense of unevenness and anxiety. The sociocultural discomfort included discomfort in the role of patients and bad relationship. The environmental discomfort included dry, noise and bad air in the ward. Conclusions Patients with nasal packing after nasal endoscopic surgery had many uncomfortable experiences, especially the physical discomfort. So the nurses should pay attention and develop a good reliability and validity nasal comfort scale to evaluate the comfort of these patients. Then the nurses should take active measures to relieve these discomforts, improve the patients' quality of life, make nurse-patient relationship harmonious and improve patients'satisfaction.

Objective:To explore the current situation of work stress and job burnout of nursing staff in the Department of Infectious Diseases, and analyze its influencing factors.Methods:From January to June 2020, 63 nurses from the Department of Infectious Diseases of Zhejiang Hospital and the Affiliated Hospital of Chengde Medical University were selected as research subjects. Questionnaires were used to investigate general information, work stress, and job burnout.Results:63 questionnaires were issued and 60 were recovered. There was a statistically significant difference in work stress scores of nurses with different working hours, daily number of patients admitted, public recognition and respect, and training times ( P<0.05) . There were statistically significant differences in the scores of the personal accomplishment dimension of nurses with or without administrative positions and different professional titles, and in the scores of the depersonalization tendency dimension of nurses with different education levels, public recognition and respect, and training times, and in the scores of the emotional exhaustion dimension of nurses with different working hours, daily number of patients admitted, public recognition and respect, and training times ( P<0.05) . Conclusions:Nursing staff in the Department of Infectious Diseases are under high work stress, overall burnout is mild, and the personal sense of accomplishment of the nursing staff is low. The main reasons for this are closely related to the daily number of patients admitted, public recognition and respect, and the training times.

To investigate the role of CD4+, CD25+, and CD127low regulatory T cells (Tregs) in multiple myeloma (MM). Methods:Levels of CD4+T cells and Tregs, as well as expression of CTLA-4 and apoptosis-related proteins, such as CD95, bcl-2, and Caspase3 of Tregs in peripheral blood of 30 patients with newly diagnosed cases, 27 patients under of complete remission (CR) from multiple myeloma patients, and 25 healthy adults were analyzed by flow cytometry. Results:The percentage of CD4+T cells in the untreated group was significantly lower than that of the control group (P<0.05). The percentage of Tregs in CD4+T cells in the untreated group was significantly higher than that of the CR group and control group (P<0.05), which in ISSⅢpatients of the untreated group was significantly higher than that in I/II(P<0.05). No significant difference of CD95 expression in Tregs was observed among the three groups. The expression of CTLA-4 in Tregs from the untreated group was significantly higher than that of the CR group (P<0.05) and control group (P<0.01), and so was in CR group than this in controls (P<0.05). The expression of bcl-2 in Tregs in the untreated group was significantly higher than that of the CR group (P<0.05) and control group (P<0.01), and so was in CR group than this in controls(P<0.05). The expression of Caspase3 in Tregs from the untreated group and CR group were all significantly lower than that of the control group (P<0.05). The percentage of Tregs in CD4+T cells in the untreated group was positively correlated with the proportion of bone marrow plasma cells (P<0.05). The percentage of Tregs in CD4+T cells from 15 MM patients who received bortezamib and dexamethasone (VD) chemotherapy was negatively correlated to the ratio of plasma cell reduction after the first VD chemotherapy (r=0.735, P<0.01). Conclusion:The level of Tregs in the peripheral blood of MM patients was positively correlated with tumor burden and progression of disease, but was negatively correlated with curative effect. The increased level of Tregs was associated with their strengthened anti-apoptosis function.

Objective To investigate the effects and related factors of itraconazole in the treatment of invasive fungal infection (IFI) in the patients with blood diseases ( BD). Methods A total of 156 BD patients with IFI treated with itraconazole in General Hospital, Tianjin Medical University from 2005 to 2008, were retrospectively analyzed. Results Of these patients, 92 were with underlying malignant BD, and 64 with non-malignant BD; 77 possible IFI, and others proven IFI. A total of 94 (63. 5% ) patients were responded to itraconazole successfully, while 54 (36. 5% ) failed. The underlying malignant BD, post-chemotherapy, neutrophil count less than 0. 5 x 109/L, positive fungus culture, and bacteria infection were related with the response to itraconazole significantly, while patient's age, application of other antibiotics,positive C test, IFI localization, haemoglobin level and platelet counts were not Five patients was changed other anti-IFI therapy because of side effects, including gastrointestinal ill (3 cases with nausea or vomiting) and tachycardia (2 cases). Conclusions Itraconazole was effective and safe in the treatment of IFI in the patients with BD. Underlying malignant BD, agranulocytosis, bacteria infection, and delayed anti-IFI therapy might reduce itraconazole therapeutic effects.

Objective To investigate the relationship between multi‐dimensional myocardial strain and global cardiac function in different stages of cardiac dysfunction in spontaneously hypertensive rats ( SHR ) by two‐dimensional strain echocardiography . MethodsAccording to cardiac function measurements ,SHR of 28 to 102 weeks were divided into 3 groups :Normal group[ Group A , normal left ventricular ejection fraction( LVEF) and left ventricular end‐diastolic pressure( LVEDP) , n ＝13] ,diastolic dysfunction group ( Group B , normal LVEF but increased LVEDP , n ＝24) ,and systolic dysfunction group ( Group C ,decreased LVEF and increased LVEDP , n ＝ 17 ) ,with WKY rats at similar weeks of age as controls ( group a , n ＝ 7 ;group b , n ＝ 12 ; and group c , n ＝ 16 ) . Morphological parameters of left ventricular were measured by echocardiography . Using EchoPac workstation ,systolic peak longitudinal strain ,circumferential and radial strain were calculated at the left ventricular middle levels . Extracellular collagen content was observed histologically . Results Left atrial dimension increased in group B and larger in group C ,and dilated left ventricular and thickened wall were only found in group C .Systolic peak longitudinal strain of group B was significantly lower than group A and group a ( all P ＜ 0 .05 ) ,and deteriorated in group C( P ＜ 0 .05 ) ,while systolic peak circumferential and radial strain and LVEF were only significantly decreased in group C ( all P＜ 0 .05 ) ,w hile there was no significant difference between Group A and Group B( all P ＞0 .05) . Collagen content in endocardial and mid‐layer myocardium increased in group B and C , and increased epicardial collagen occurred in group C . Systolic peak longitudinal strain , circumferential and radial strain were correlated positively with LVEF( r ＝0 .65 ,0 .80 ,0 .80 ,all P ＜0 .01) . Conclusions In SHR ,systolic peak longitudinal strain obtained by echocardiography is decreased in the period of diastolic dysfunction ,w hile the damage of systolic peak circumferential and radial strain leads to the systolic dysfunction .

Objective:To explore the experience of the postoperative adult patients with obstructive sleep apnea-hypopnea syndrome from the patients′ angle and to provide references for improving the postoperative comfort of the patients.Methods:The phenomenology research method was adopted in this study. Thirteen postoperative adult patients with obstructive sleep apnea-hypopnea syndrome from Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology participated in the in-depth interview with the interview outline. Data were analyzed by using Colaizzi′s phenomenological method.Results:Three level-1 themes and ten level-2 themes were extracted. The physical discomfort included throat discomfort, lacking of enough sleep at night, restricted diet, limitation in speaking. The negative emotion included the sense of worry, helplessness, fidget and regret. The wish of support included the wish of coping strategy and being understanded.Conclusions:The main uncomfortable experience of the patients is the throat discomfort which has the chain reaction and causes the other discomfort. So the nurses should inquire patients initiatively, cooperate with doctors and patients′ family members to relieve patients′ discomfort particularly at night, and then the patients′ quality of life, nurse-patient relationship and patients′ satisfaction may be improved.

Objective:To retrieve, appraise and summarize the evidence for the airway humidification management of the inpatient with laryngectomy and tracheotomy but nonmechanical ventilation and to provide references for the clinical nursing.Methods:The evidence question was raised based on the study objective. The evidence was retrieved from some databases according to the evidence pyramid model during inception to December, 2018. The literature types included clinical practice guideline, evidence summary, best practice information sheet, recommended practice and systematic review. The quality of the literature were evaluated by the suitable evaluated tool based on their types. The level and recommedation grade of the evidence were appraised by the suitable tools of JBI.Results:Thirteen studies were recruited, including one clinical practice guideline, two evidence summaries, one best practice information sheet and nine systematic reviews. Totally thirteen items of best evidence were summarized and generalized to four categories including assessment, method, liquid and operation of airway humidification.Conclusion:The evidences of the studies are scientific and practical, but on the one hand, it is recommended that when applying the evidences in clinic, it is necessary to assess the clinical situation and chose the proper evidence. And on the other hand, there are lacking of some evidences of airway humidification and the level of some evidences is low. So it needs to create more high level evidences.