Objective To explore the development trends in community nursing. Methods The current situation of community nursing in Shanghai was analyzed by means of questionnaire surveys and literature review. Subjects A total of 3 173 questionnaires were distributed to community nurses, hospital nurses, community residents, and hospitalized patients and 2 942 of them were retrieved, the rate of retrieval being 93.8%. Results The demand for community nursing was not satisfied, the number of community nurses was insufficient and their general quality was low. Conclusion The scope of services in community nursing needs to be expanded with demand as a guide, more community nurses need to be cultivated, and the quality of the nursing contingent needs to be enhanced.

Objective To explore the relationship between body mass index(BMI) and blood lipid,physical activity,blood pressure and electrocardiagram(ECG) lead V1 P wave terminal force(PTFv1).Methods A total of 1 548 heahy volunteers with no diabetes,cardiovascular disease and hypertension were assigned to the normal control,overweight or obese groups.The correlation between BMI and lipid profiles was analyzed.One hundred and ninty-five volunteers without exercise-induced asthma and emergency were required to do treadmill exercise test to analyze the correlation between physical activity score,blood maximum pressure and Ptfv1.Results BMI was significantly different by blood lipid (Cholesterol:F=7.57,P＜0.05; Triglyceride:F=73.40,P＜0.05),physical activity score(F=4.52,P＜0.05) and blood maximum pressure(F=1 1.75,P＜0.05) other than age(P＞0.05).In the three groups,treadmill exercise test was significantly different in Ptfv1(normal control group vs obese group:x2=5.67,P＜0.05; overweight group vs obese group:x2=6.17,P＜0.05).Conclusion With the increase of BMI,blood lipid and maximal systolic pressure were increased,although physical activity score was decreasing.Abnormal PTFv1 was significantly associated with BMI.increased Treadmill exercise test may be helpful in screening potential cardiovascular disease among high risk obesity populations.

Objective To explore the application value of uterine incision suture in multiple segment shrinkage in cesarean section.Methods 85 pregnants with uterine scar who taken cesarean section were selected.In the single month,the pregnants were included in the observation group(43 cases):after pruning scars,uterine lower segment weak muscle tissue by wrinkling suture to reinforce the thickness of the lower segment again from both sides of the suture,intermediate knotted suture the uterine incision.In the bimonth,the pregnants were included in the control group(42 cases):after pruning scars by conventional suture incision of lower uterine segment.The duration of vaginal bleeding time after operation ,postoperative 42 days ,3 months ultrasonography of uterine incision healing were observed.Results The postoperative vaginal bleeding volume of the observation group was less than that of the control group[(480.55 ±53.75)mL vs.(550.14 ±50.45)mL],the bleeding time was less than that of the control group[(21.31 ±6.78)d vs.(30.45 ±5.16)d],the differences were statistically significant(t =3.65,2.28,all P <0.05).March B -ultrasonography uterine incision after surgery,the good healing rate of the observation group was 95.35%,which of the control group was 78.57%,the difference was statistically significant(χ2 =4.35,P <0.05). Conclusion Incision under section shrinkage joint is conducive to the incision structure and muscle layer mechanical recovery and can reduce the amount of vaginal bleeding and time and defect healing of incision morphology.

The effects of mycophenolic acid (MPA) on high glucose-induced expression of transforming growth factor-beta (TGF-beta) and connective tissue growth factor (CTGF) in mesangial cells (MC) were investigated. Rat MC were cultured in the presence of different concentrations of MPA (1.0 and 10.0 micromol/L) or MPA plus high glucose for 72 h. The expression of TGF-beta and CTGF was detected by Western blot. The results showed that high glucose could induce the expression of TGF-beta and CTGF in MC, but MPA could inhibit this effects. MPA did not influence the expression of TGF-beta and CTGF in normal glucose. It was concluded that MPA might prevent the progression of diabetic nephropathy by inhibiting the expression of TGF-beta and CTGF in MC.

AIM:To reveal the characteristics and patterns of mental activity in the cerebral cortex of patients with attention deficit hyperactivity disorder (ADHD) and explore the pathogenetic characteristics of ADHD.METHODS: The ADHD patients were asked to record their mental activity, general health condition and obsessions before the onset of pathological symptoms by means of psychological introspective reports.RESULTS: The direct cause of attention distraction and failure of attention focus is the patients' inability to perform cognitive tasks (including perception, memory and recollection, imagination, association and thought)in a continuously ongoing manner in relaxation. The frequent stagnancy and pause during the course of recognition precipitated the patients in a stressful state, which contributed to the onset of various hyperactivities and also resulted in the acquisition of "silent verbal thinking". This is an important psychopathological phenomenon long been neglected. All theses abnormalities caused the patients much discomfort, which was naturally relieved by means of impulsive and irritable behaviors.CONCLUSION: A series of clinical symptoms of ADHD arises from the same pathogenic factor of difficulty in mental activity and inability to carry out the activities in the cerebral cortex in a relaxed manner. The difficulty in mental activity is the key problem of ADHD and the source of various synptoms, which should be ;reated for the first place. The cause of this key problem is possibly lowered metabolism of the cerebral cortex, and the effect of "instinct" can not be neglected in the attempt to explain the pathogenesis of ADHD.

ObjectiveTo screen the items of Advanced Cancer patient Needs Questionnaire (ACNQ)and develop a short version.MethodsA total of 80 cancer patients of middle and advanced stage were recruited.The items were screened with variation degree method and factor analysis method,combined with clinical meaning of the items.The reliability and validity of newly-development scale were confirmed with new sample of 60 cancer patients.ResnltsThrough statistical methods 12 items were removed from the original scale,forming a short version of Advanced Cancer patient Needs Questionnaire:ACNQ-29.The correlation coefficient of split half reliability was 0.913.The Cronbach′s α coefficient of all items was 0.923.Through principal components and factor analysis,7 principal components were gained including basically the 4 dimensions of physiological,psychological,spiritual and social domain with accumulation contribution of 75.478％.ConclusionsNew scale has good reliability and validity,and more easily for patients to complete.It has feasibility and practicability.

Objective To obtain Hangzhou residents' awareness, understanding, demands, and intentions of health examination and explore the factors influencing health examination. Methods Totally 1 183 residents (male: 542, female: 641, aged from15 to 80 years) were investigated by mean of questionnaire which included demographic characteristics, health status, medical behavior and awareness, the subjective reasons of unwilling to take health examination, the intention of choosing an institution, and the data of questionnaire were analyzed using single factor Chi-square test and conditional logistic regression analysis. Results Single factor Chi-square test showed that the factors affecting health examination participation which have statistical significances were as follows, gender (χ2=11.61,P=0.000), age (χ2=9.09, P=0.028), residence registration (χ2=44.16,P=0.000), marital status (χ2=8.96,P=0.03), educational backgroud (χ2=17.33,P=0.000), employment status (χ2=7.97,P=0.005), personal monthly income (χ2=22.82, P=0.000), having any kinds of health insurance (χ2=16.08,P=0.000), and the health examination fees paid by company (χ2=44.78,P=0.000). Conditional logistic regress analysis showed that the related fators which affecting the peoples participating rates of taking health examination are gender (P=0.003, OR=1.782), residence registration (P=0.000, OR=2.208), personal monthly income (P=0.009, OR=1.307), taking any kinds of insurance (P=0.004,OR=2.913)and the company organizing and paying for the healthy examination or not (P=0.000,OR=1.923). Conclusion The participation rates of taking health examination were affected by the factors such as male, younger than 45 years old, divorce, temporary residents, the jobless, low educational diploma and income, not having any insurance, taking the health examinaiton at their own expense and so on.

Objective To study the expression of interleukin-18(IL-18)during the progression of renal interstitial fibrosis in rat kidney after unilateral ureteral obstruction(UUO)and the effect of Shenfu injection.Methods The obstructive nephropathy model was established by unilateral ureteral obstruction(UUO).Fifty。Six rats were randomly assigned into shame operation group,operation group(UUOgroup)and treatment group(UUO+Shenfu).After 7 and 14 days,the renal function and histopathological changes were evaluated.Immunohistochemistry was used to examine the expression of IL-18 in renal tissue.Results In comparison with the shame opeartion group,the operation group showed obvious renal interstitial fibrosis.And the expression of IL-18 increased signifieantly(P<0.05).Compared with the operation group,the degree of interstitial fibrosis was obviously ameliorated in the treatment group,and the expression of IL-18 decreased significandy after treatment for 7 days(P<0.05),and decreased more after treatment for 14 days(P<0.05).Conclusions Shenfu injection may protect renal function by decreasing the expression of IL-18 in the progression of renal interstitial fibrosis.

Objective To describe the clinical features of invasive fungal disease in Huashan Hospital,Fudan University from January 2004 to December 2006.Methods The medical data were reviewed retrospectively for the patients with fungal infection, which was confirmed by positive fungal culture or microscopic examination with blood,sterile body fluid,deep tissue,sputum specimen or isolation of Aspergillus spp.and Cryptococcus spp.from bronchoalveolar lavage.The proven and probable cases of invasive fungal disease were included in this analysis.Results A total of 111 patients were diagnosed as invasive fungal dis-ease,including 104 proven cases and 7 probable cases.Sixty-one cases were community-acquired and the other 50 were nosoco-mial.The most common site of infection was bloodstream (51,45.9%),followed by central nervous system (44,39.6%)and respiratory system (14,12.6%).The most common pathogens were Candida spp.(50,45%),Cryptococcus (47,42.3%) and Aspergillus spp. (12, 10.8%). The community-acquired fungal infections were mostly found in central nervous system (44,72.1%),and respiratory system (12, 19.7%),mainly caused by Cryptococcus and Aspergillus. The nosocomial fungal infections occurred primarily in blood-stream (96.0%),mainly due to Candida spp.No underlying disease or risk factor was identified in more than half of the pa-tients with community-acquired infection,while almost all the patients with nosocomial fungal infection had underlying disease and predisposing factors.Indwelling venous catheter was closely associated with nosocomial bloodstream infection.Indwelling venous catheter lasted for more than 1 week in 64.7% of the patients with Candida bloodstream infection.The same fungal strain was isolated from both the cather and blood of the same patient in 11 cases.The overall mortality of these invasive fungal diseases was 14.4% (16/111).The mortality rate was 18.0% (9/50)in the patients with nosocomial invasive fungal infection, and 11.5% (7/61)in the patients with community-acquired invasive fungal infection.Conclusions The most common site of in-vasive fungal infection is bloodstream,followed by central nervous system,and respiratory system.Majority of the fungal patho-gens are Candida spp.,Cryptococcus and Aspergillus spp.The community-acquired invasive fungal disease is primarily meningitis caused by Cryptococcus.The nosocomial invasive fungal disease is mainly bloodstream infection caused by Candida spp.

Objective To study the efficacy and safety of different doses of caffeine citrate and aminophylline treatment for apnea of prematurity. Methods Preterm infants who met the inclusive criteria were admitted to NICU of JingZhou Central Hospital from October 1st, 2013 to October 1st, 2015. They were randomly assigned to three groups. Infants assigned to high dose caffeine group were received a loading dose of 40 mg / kg daily, followed by the maintaining dose of 20 mg / kg daily. Neonates in low dose caffeine group were administered with the loading dose of 20 mg / kg daily, followed by maintaining dose of 10 mg / kg daily. Infants in the aminophylline group received a loading dose of 5 mg / kg, then with maintaining dose of 2 mg / kg every 12 hours. Caffeine citrate or aminophylline therapy were continued until the infants were free from apnea for a period of 7 days or when the gestational age of 34 weeks were reached. Extubation failure rate, frequency of apnea, duration of apnea, mechanical ventilation, as well as oxygen therapy, length of hospital stay, mortality, and the adverse effects were compared among three groups. Results 90 infants were enrolled for study, with 30 in each group. Extubation failure rate, frequency of apnea, apnea duraion and oxygen therapy duration of infants in high dose caffeine groups were all significantly lower than those of infants in low dose caffeine group and aminophylline group (P < 0. 05). The incidence of tachycardia was significantly higher in the high dose caffeine group compared to the other two groups (P < 0. 05). Whereas all these factors between low dose caffeine group and aminophylline group were of no statistical difference (P > 0. 05). Duration of mechanical ventilation and CPAP, length of hospital stay, incidence of complications (BPD, ROP, IVH, PVL, NEC ), mortality were of no significant difference among three groups ( P > 0. 05 ) . Conclusions High dose caffeine therapy for apnea of prematurity is more effective in decreasing incidence of extubation failure and apnea, as well as decreasing duration of apnea and oxygen therapy. Tachycardia is the only adverse effect of high dose caffeine therapy discovered by this study.