BACKGROUND: It has been reported that nanosilver-containing biomaterials produce bad biological effects after they directly contact with or are implanted into human body.OBJECTIVE: To investigate whether nanosilver yields potential adverse biological effects on human body and to evaluate its bioiogical safety.DESIGN, TIME AND SETTING: An animal experiment observation was performed at the Medical Device Center of National Institute for the Control of Pharmaceutical and Biological Products from June 2005 to August 2006.MATERIALS: Nanosilver particles and microsilver particles were purchased from Sigma Company, USA.METHODS: Thirty rats were randomly divided into 3 groups, with 5 male and 5 female rats per group: nanosilver, microsilver, and blank control. Nanosilver and microsilver particles were respectively and subcutaneously implanted for subchronic toxicity test.The nanosilver and microsilver groups were given 0.33 g/kg nanosilver and microsilver, respectively. Rats from the blank control group received identical procedure, with the exception of drug application. Four rats were selected from each group for determination of silver content in serum and some organs by plasma mass spectrometry.MAIN OUTCOME MEASURES: serum biochemical indices, organ coefficient, and silver content.RESULTS: There was significant difference in individual organ coefficient between each drug application group and blank control group. But no significant difference in absolute mass was found between each drug application and the blank control group.These findings suggested no clinical significance of organ coefficient. Other organ coefficients were in the normal range, and there was no significant difference between each drug application group and the blank control group. Patho-histological changes related to toxicity were not found. Rats from the nanosilver group did not show toxic reaction.CONCLUSION: Nanosilver produces potential adverse biological effects after implanted into human body.

Objective Although graded nursing has been implemented in nursing homes since 2001 in China, it is not popu-lar.This research aimed to investigate factors of graded nursing implementation in nursing homes by subject analysis in order to provide a reference for the construction of graded nursing system in nursing homes . Methods We performed an analysis of data retrievals for grading nursing system in nursing homes from 2005 to 2015 based on five large databases: CNKI, Wanfang, VIP, CBM, and PubMed.Subject analysis was applied in the conclusion of retrieved literature . Results There were 993 related documents by pre-liminary selection and 21 documents were concluded for subject analysis .By document acquisition , code design , subject code search , integrated subject search and subject definition , five factors including policy , professional quality , institutional management , resource supply and individual were summarized . Conclusion These five factors give a correct and overall view of the facilitators and barriers to the implementation of graded nursing in nursing homes in China , which will contribute to its improvement .

Purpose Many studies have shown that subclinical left ventricular systolic dysfunction is seen in prediabetic patients.However,its relationship with prognosis is unclear.The purpose of this study is to investigate the prognostic value of subclinical left ventricular systolic dysfunction with prediabetes.Materials and Methods This was a prospective clinical cohort study.A total of 98 prediabetes patients with complete medical record and follow up data in the physical exam center and the clinic of Yan'an People's Hospital were chosen between January 2013 and January 2014.The biochemical data,echocardiography and left ventricular global longitudinal strain (GLS) in 2 years of follow up were collected.The subjects were grouped into diabetes if the diagnosis was confirmed during follow up,or non-diabetes group if not diagnosed.After follow up,the baseline parameters were compared to screen for risk factors to develop clinical diabetes.Results During the study,38 participants were diagnosed as clinical diabetes.Cox proportional hazard regression models show that obesity [hazard ratio (HR):2.662,95％ CI 1.374-5.159,P=0.004],waist-hip ratio (HR:1.917,95％ CI:1.012-3.492,P=0.001),mitral E/e'ratio (HR:1.661,95％ CI:1.336-2.065,P＜0.001),HbAlc (HR:2.029,95％ CI:1.047-3.932,P＜0.001),global longitudinal strain (HR:0.786,95％ CI:0.728-0.848,P＜0.001) were significant independent predictors for developing diabetes.Using GLS＜18％ as cutoff value,the area under receiver operating characteristic (ROC) curve to predict development of diabetes was 0.796 (95％ CI:0.704-0.888,P＜0.001),with sensitivity and specificity of 46.7％ and 89.5％,respectively.Conclusion Among modifiable risk factors in patients with prediabetes,subclinical left ventricular systolic dysfunction is an early indicator of progressing to diabetes.Early detection of left ventricular systolic dysfunction in prediabetes can provide the basis for early clinical intervention.

Type 2 innate lymphoid cells ( ILC2s) are recently identified members of the innate lymphoid cell ( ILC) family. These cells are capable of producing Th2-type cytokines such as IL-5 and IL-13 in response to epithelial cell-derived cytokines IL-25 and IL-33 and play critical roles in allergic diseases such as bronchial asthma. Further investigations on ILC2s will enhance the better understanding of type 2 immune responses and may provide new strategies for the treatment of allergic asthma. In this review, we fo-cus on the origin, location and biological function of ILC2s as well as their possible roles in the pathogenesis of bronchial asthma.

Objective To observe the effects of the intervention of Didang Decoction at different times on changes of AMPK signaling pathway related factors in macrovascular endotheliocytes of diabetic rats; To discuss the mechanism of mitochondria energy metabolism regulating the AMPK signaling pathway for macrovascular endothelial defense function. Methods Injection of STZ into the caudal vein and administration of high fat diet wer used to generate diabetic rat model. All rats were randomly divided into the following 7 groups: control, model, metformin, simvastatin, early-, middle-, and late-stage Didang Decoction group. Western blot was used to detect the expressions of APMKα1 and PGC-1α in rat aortic endothelial cells. Changes in the intracellular AMP and ATP levels were detected by ELISA. Real time fluorescence quantitative PCR was used to detected mRNA expressions of Caspase-3, eNOS, and Bcl-2 in tissue of thoracic aorta. Results Compared with the model group, the expressions of AMPKα1 and PGC-1α in the early-stage and middle-stage Didang Decoction group and simvastatin group increased (P<0.05); the gene expressions of Bcl-2, and eNOS significantly increased in the early-stage Didang Decoction group and simvastatin group (P<0.05), while the expressions of Caspase-3 decreased significantly (P<0.05). The expression of ATP increased significantly and the expression of AMP decreased significantly in the early-stage Didang Decoction group and simvastatin group (P<0.05), and the best effects were shown in the early-stage Didang Decoction group. Conclusion Early intervention of Didang Decoction can enhance energy metabolism in the mitochondria of macrovascular endothelial cells by regulating the AMPK signaling pathway, and then plays a role in strengthening the defense function of macrovascular endothelial cells.

Purpose To investigate the mutation status of KRAS and PIK3CA gene in colorectal cancer (CRC) primary lesions and corresponding liver metastasis and its clinical significance.Methods The gene mutations of KRAS and PIK3CA were detected in 58 cases of primary lesions of CRC and corresponding liver metastasis tissue by real-time PCR.Results The mutation rates of KRAS were 31.03％ (18/58) and 25.86％ (15/58) in primary lesions of CRC and corresponding liver metastasis tissue,respectively,in which G12D was most commonly detected.The mutation rates of PIK3CA were 8.62％ (5/58) and 10.34％ (6/58) respectively,in which the most common mutation site was E545K.Only one case carried simultaneously both mutations of KRAS (G12D) and PIK3CA (E545K).The mutation of KRAS and PIK3CA had a good consistency between primary lesions and liver metastasis.Univariate analysis showed that the mutation of KRAS was related to the primary lesion of tumor location,the quantity of metastasis and the types of tumor (P ＜ O.05),PIK3 CA mutation was associated with the synchronous/metachronous liver metastasis and the quantity of metastasis (P ＜ 0.05).Multivariate Cox regression analysis showed that synchronous/metachronous liver metastasis and the mutation of KRAS were influencing factors for prognosis of CRC.The overall survival of patients with CRC who had simultaneous liver metastases was longer than those with heterotopic liver metastases;the overall survival of KRAS wild-type mutant patients was longer than those of mutant patients (P ＜ 0.05).Conclusion The G12D site of KRAS gene has the highest mutation frequency in CRC,KRAS/PIK3CA mutation has a good consistency of the primary lesions of CRC and corresponding liver metastasis.Primary lesions can be as the source of molecular detection.To achieve individualized treatment,we need to reassess the genetic status of metastasis based on the choice of targeted therapy for precision medicine.

Objective To investigate the relationship of ELK-3 and epithelial-mesenchymal transition ( EMT) for ex-ploring its possible mechanism .Methods The human hepatocellular carcinoma cells ( HCC) were divided into small interference RNA transfection group and Ras-ELK-3 pathway inhibitor group .The protein level of ELK-3 target gene EGR-1 E-cadherin ,vimentin and p38 in HCC were determined by Western blot analysis .Results The protein level of ELK-3 and its target gene EGR-1 in treated human hepatocellular carcinoma cells significantly decreased as compared with the negative control group (P<0.01).The protein level of E-cadherin was significantly increased (P<0.01), while vimentin and p38 were decreased in HCC cells with ELK-3 interference (P<0.01).Conclusions ELK-3 in-terference can inhibit the epithelial-mesenchymal transition of HCC cells by down-regulating p38.

Objective To investigate the current status of compliance with hand hygiene among health care work-ers (HCWs)in a comprehensive hospital in Xi’an.Methods Status of hand hygiene among HCWs in 73 clinical de-partments was observed directly.Results 404 moments for hand hygiene of 404 HCWs were observed,255 times of hand hygiene were implemented,181 times of hand hygiene were correct,the total compliance rate was 63.12%, and correct rate was 44.80%.Compliance rate and correct rate of hand hygiene of HCWs in intensive care unit were both higher than general wards (91.89% vs 60.22%,χ2 =14.485,P <0.001;81.08% vs 41.14%,χ2 =5.671,P=0.017).Among HCWs of different occupations,compliance rate and correct rate of hand hygiene of nurses were both the highest (73.76% and 60.18% respectively),while auxiliary persons were both the lowest (40.90% and 10.20% respectively);among five moments for hand hygiene,compliance rate was highest after body fluid and blood exposure (80.00%),correct rate was highest before aseptic procedure (62.96%).Conclusion There is a high compliance rate and low correct rate of hand hygiene among HCWs in this hospital.Compliance rate and correct rate of hand hygiene among HCWs in different departments,different occupations and different hand hygiene moments are varied,compliance with hand hygiene among HCWs should be paid extensive attention.

AIM:To explore the change of antithrombin Ⅲ( AT-Ⅲ) in the patients with atherosclerotic cere-bral infarction .METHODS:Chromogenic substrate assay was used to measure the activity of AT-Ⅲ in 55 patients with atherosclerotic cerebral infarction and 55 healthy controls , and the correlation analysis was applied to determine the AT-Ⅲactivity with the severity of damage in central nervous system and general biochemical parameters .The levels of TNF-αand IL-6 in the plasma were detected by ELISA .Immunocomplex in the plasma was measured by enzyme immunoassay (EIA). The number and phenotype of the monocytes in peripheral blood were analyzed by flow cytometry .ELISA was also applied to determine the secretion of TNF-αand IL-6 from the monocytes after the stimulation of immunocomplex .The expression of AT-Ⅲin human brain vascular endothelial cells after the stimulation of TNF-αand IL-6 was observed by Western blotting . RESULTS:The activity of AT-Ⅲsignificantly decreased in the patients with atherosclerotic cerebral infarction , and nega-tively correlated with the damage degree of nervous system function , systolic pressure , diastolic pressure , glucose , choles-terol, triglyceride, low-density lipoprotein cholesterol and homocysteine , while positively correlated with high-density lipo-protein.In addition, the plasma levels of TNF-αand IL-6 increased significantly , accompanied with the enhancement of immunocomplex level .The numbers of CD14 + CD16 + and CD14 + CD32 + monocytes in peripheral blood were not changed , while CD14 +CD64 +monocytes increased obviously .The secretion of TNF-αand IL-6 by monocytes were signifi-cantly enhanced after stimulated with immunocomplex , while the protein expression of AT-Ⅲ in the human brain vascular endothelial cells was down-regulated after co-incubated with TNF-αor IL-6.CONCLUSION:Decreased AT-Ⅲactivity in the patients with atherosclerotic cerebral infarction is one of the risk factors of cerebral infarction , and related with the dis-ease severity .The production of pro-inflammatory cytokines through immunocomplex from CD 14 +CD64 +monocytes may be involved in the mechanism .Improvement of AT-Ⅲactivity may protect against cerebral ischemia .

Based on the development trends of nursing care in the ongoing healthcare reform, the PEST model was called into play to analyze the macro-environment of nursing development in terms of such aspects as political, economic, social-cultural, and science and technology factors. Based on such, policy suggestions are raised to tackle the following challenges, namely incomplete political and legal environment for nursing, relative shortage of nursing resources, low social recognition, and poor capability of nursing technique innovation. These suggestions aim to further improve the political and legal system for nursing, explore highly efficient nursing resource allocation, enhance nursing service capability, and nurture nursing technique innovation talents.