Objective To explore the affecting factors of nursing interns' personal knowledge management (KM) ability and analyze the correlation between their KM ability and clinical practice ability.Methods A total of 345 nursing interns' KM ability and clinical practice ability were investigated by using two scales.Results Affecting factors of nursing interns' KM ability included being a cadre and being interested in nursing specialty or not.Factors affecting nursing interns' clinical practice ability were practice period,academic records,being a cadre,intention to have a nursing job,interest to be a nurse.It also showed significant positive correlation between their KM ability and clinical practice ability (r=0.761); KM ability could explain 59％ of variability of clinical practice ability(R2=0.599).Among the dimensions of KM ability,the highest positive correlation was knowledge management cognition (r=0.741).Conclusions To enhance nursing interns' clinical practice ability,we need cultivate nursing interns' interest to nursing specialty,ability to be a cadre and improve their knowledge management cognition ability.

Objective To establish a knowledge management skills evaluation tool for nursing undergraduates and then try to provide an objective basis for evaluation of their knowledge management skills.Methods After reviewing literature and research group discussion,defining the theoretical dimensions of the knowledge management skills system and developing this evaluation tool.A total of 1 139 nursing undergraduates were picked out and investigated.The data were analyzed with the SPSS 20.0 and AMOS 7.0 statistic software packages,including exploratory factor analysis,confirmatory factor analysis,reliability and validity analysis.Results The knowledge management skills evaluation tool of nursing undergraduates was a multilayered and multidimensional system,including 3 subscales (knowledge management cognition,knowledge management attitude,knowledge management behavior),8 factors (the cognition of knowledge management connotation,the intention and the belief of knowledge management,the ability of obtaining,storing,sharing,applying and innovating knowledge),36 items.Exploratory factor analysis showed that all items' factor loading were 0.433-0.851.Confirmatory factor analysis displayed a good degree of fitting.The total scale's Cronbach α was 0.933,sub-scales were 0.807-0.892.The total scale's split coefficient was 0.873,sub-scales were 0.700-0.870.The correlation coefficient between 3 sub-scales score and the total scale score were 0.875-0.912.Conclusions Because of its good reliability and validity,nursing undergraduates can evaluate their knowledge management skills by using this evaluation tool.

Objective To get the knowledge of the diagnosis and treatment of acute pulmonary embolism (APE)in primary hospital.Methods The clinical data of the patients diagnosed with APE were retrospectively reviewed.The patients were clarified into different risk-group by revised Geneva score and Wells score according to the clinical records.Results 17 patients were diagnosed with APE in this time slot,in which male 10 cases and female 7 cases,average age was (51.8 ±18.4)years old,and among them,4 cases with 4 scores of revised Geneva score,9 cases with 4 to 10 scores,4 cases with more than 11,6 cases with less than 4 Wells score,11 cases with more than 4,2 cases with low risk and 15 cases with intermediate risk.The length of hospital stay was (10.9 ±5.4)days in average.In this group,one patient was dead,seven cases improved,six cases remarkably improved and three cases were recued.Fourteen patients received anticoagulation agents and three cases without any.Eleven patients were given thrombolystic therapy,one case was operated and six cases were given interventional treatment.Conclusion Clinicians know APE and keep alert gradually.However,it should be improved in respects of treating and following the APE patients.

Objective To investigate concentration of plasma neutrophil gelatinase -associated lipocalin ( NGAL) and its clinical significance in ICU populations with sepsis.Methods Fourteen ICU patients diagnosed with sepsis and twenty-four patients with non-sepsis were enrolled in the study,and seventeen healthy adults were selected as healthy control.Blood samples were drawn from patients to measure NGAL, and Acute Physiology and Chronic Health Evaluation ( APACHE ) II and Sequential Organ Failure Assessment ( SOFA ) were performed, the outcome was recorded.Plasma NGAL concentration was measured by enzyme -linked immunosorbent assay ( ELISA) .Results On admission to ICU, the pNGAL concentrations of septic and non -septic patients were (131.4 ±116.4)ng/mL and (48.7 ±30.8)ng/mL respectively,which of healthy control was (39.07 ±12.74)ng/mL.The pNGAL was significantly higher in sepsis than non-sepsis and healthy control ( t=-3.280,3.313,P=0.003,0.021 respectively).Otherwise,no differences of white blood cell (WBC) count [(12.6 ±5.7) ×109/L vs (15.6 ±5.8) ×109/L] and SOFA scores [(7.7 ±3.3)points vs (8.6 ±3.4)points] were found in septic and non-septic patients (t=-1.554,-0.802,P=0.129,0.428).On the admission to ICU,areas under the receiver oper-ating characteristic curves ( ROC curves) of NGAL and WBC for predicting sepsis were 0.740 [95%confident inter-val(CI) 0.566,0.913,P =0.015] and 0.345 ( 95%CI 0.158,0.533,P =0.116) respectively.If pNGAL of 99.4ng/mL as the threshold for predicting sepsis, the sensitivity and the specificity was 50.0% and 85.2%. Conclusion The concentrations of NGAL in septic patients significantly increased compared with that in non-sepsis and in healthy adults.And the NGAL levels maybe another sensitive biochemical marker for predicting infection.

Objective To observe the effects of Huoxue Bushen Anshen Prescription on energy metabolism of H9c2 cardiomyocytes with oxidative stress injury.Methods H9c2 cardiomyocytes oxidative stress model was established with H2O2 to simulate myocardial injury.CCK-8 method was used to select the best conditions for modeling and the appropriate concentration of drugs.Cells were divided into normal group,model group,trimetazidine hydrochloride group and Huoxue Bushen Anshen Prescription group.Na+-K+-ATPase activity,real-time ATP generation rate,mitochondrial pressure,gycolysis rate,and long-chain fatty acid oxidationl pressure on H9c2 cardiomyocytes after treatment were performed,and the changes in energy metabolism of cardiomyocytes were observed.Results Compared with the normal group,the Na+-K+-ATPase activity,glycolytic ATP production rate,mitochondrial ATP production rate,basal oxygen consumption,non mitochondrial oxygen consumption,ATP production capacity,cellular reserve respiratory capacity and maximum respiratory capacity of H9c2 cells in the model group decreased,the glycolytic rate slowed down,long chain fatty acid basal respiration,acute response and maximum respiratory value decreased(P<0.05,P<0.01).Compared with the model group,the H9c2 cells in Huoxue Bushen Anshen Prescription group showed an increase in Na+-K+-ATPase activity,an increase in glycolytic ATP production rate and mitochondrial ATP production rate,an increase in basal oxygen consumption,non mitochondrial oxygen consumption,ATP production capacity,cellular reserve respiratory capacity and maximum respiratory capacity,an increase in basal glycolysis rate,and an increase in long-chain fatty acid basal respiration,acute response and maximum respiratory value(P<0.05,P<0.01).Conclusion Huoxue Bushen Anshen Prescription can significantly improve the activity of Na+-K+-ATPase in cH9c2 ardiomyocytes with oxidative stress injury,increase the rate of ATP production,improve mitochondrial pressure,glycolysis rate and oxidation pressure of long chain fatty acids,and improve the energy metabolism of cardiomyocytes.

Objective To explore the mechanism of Huoxue Bushen Anshen Prescription in improving the oxidative damage of H9c2 cells based on AhR-JDP2-Nrf2 axis.Methods H9c2 cells were divided into normal group,model group,TCM group,trimetazidine group,empty plasmid group,overexpression group,TCM+overexpression group and trimetazidine+overexpression group.The oxidative stress model of H9c2 cells was induced with H2O2 to imitate myocardial injury,and the cells were transfected with JDP2 overexpressed gene,intervened with Huoxue Bushen Anshen Prescription and trimetazidine hydrochloride respectively.Apoptosis was detected by flow cytometry,the contents of MDA,SOD and NADPH in cell supernatant were detected by kits,the protein expression of AhR,JDP2,Nrf2 and HO-1 were detected by Western blot,the mRNA expression of AhR,JDP2,Nrf2 and HO-1 were detected by RT-qPCR.Results Compared with the normal group,the early apoptosis rate,late apoptosis rate and total apoptosis rate of H9c2 cells in the model group increased(P<0.01),the contents of MDA,SOD and NADPH in cell supernatant increased(P<0.05),the expression of AhR,JDP2,Nrf2,HO-1 protein and mRNA increased(P<0.05).Compared with the model group,the early apoptosis rate,late apoptosis rate and total apoptosis rate of H9c2 cells in the TCM group and the trimetazidine group significantly decreased(P<0.01),the contents of MDA,SOD and NADPH decreased(P<0.05),the expression of AhR,JDP2,Nrf2 and HO-1 protein and mRNA decreased in the TCM group(P<0.05).Compared with the empty plasmid group,the overexpression group showed an increase in early apoptosis rate,late apoptosis rate and total apoptosis rate of H9c2 cells(P<0.01),an increase in MDA and NADPH content in cell supernatant(P<0.01),an decrease in SOD content(P<0.01),and an increase in the expressions of AhR,JDP2,Nrf2,HO-1 protein and mRNA in H9c2 cells(P<0.05).Compared with the overexpression group,the early apoptosis rate,late apoptosis rate and total apoptosis rate of H9c2 cells in the TCM+overexpression group and the trimetazidine+overexpression group were significantly decreased(P<0.05,P<0.01),the MDA and NADPH contents in cell supernatant were decreased(P<0.01),the SOD content increased(P<0.01),and the expressions of AhR,JDP2,Nrf2,HO-1 protein and mRNA in H9c2 cells decreased(P<0.05).Conclusion Huoxue Bushen Anshen Prescription can regulate the AhR-JDP2-Nrf2 axis by regulating the expression of JDP2,alleviate the oxidative damage of H9c2 cells,reduce the apoptosis of cardiomyocytes,and protect cardiomyocytes.

The controversy over the ultrasonic testing of thyroid volume (TVOL) in children exists in some aspects, mainly focusing on the measurement errors caused by different testing personnel, instruments and techniques. Moreover, with the development of children growth higher than before, the influence of physiological factors on TVOL and relevant correction methods should be paid attention. This paper reviews domestic and foreign literatures. Firstly, through describing the TVOL reference values of international recommended, foreign country and China, we clarify the differences between them, and analyze the current situation and characteristics of each. Secondly, by studying the ultrasonic testing methods and physiological factors which affect TVOL, this paper analyzes the importance of various factors, discusses the availability of several measurement methods and compares several TVOL correction methods. Some suggestions are put forward for further improving the reference value of TVOL of children in China.

Goiter is a kind of non-inflammatory and non-neoplastic hyperplasia and enlargement. Many studies have shown that substances such as thiocyanates and isothiocyanates can prevent the development of a variety of tumors. However, some studies have also found that such substances can lead to goiter. In this article, relevant information on common goitrogen in food are collected to explore their mechanism of action, laying a foundation for guiding residents to maintain a healthy and balanced diet.

Heart failure refers to a group of clinical syndromes caused by structural or functional abnormalities of the heart that lead to impaired ejection or filling of the ventricles. The traditional Chinese medicine （TCM） theory of cardiac and renal coordination holds that the kidney governs water and plays a key role in maintaining the balance of fluid metabolism. Therefore， the treatment of water retention in heart failure can start from the heart and kidney. The basic pathogenesis of heart failure is kidney deficiency， blood stasis， and water stagnation， and the therapies including dredging the heart and kidneys， warming yang and excreting water， tonifying kidneys and activating blood， and dredging meridians and collaterals. Aquaporins （AQPs）， the key molecular basis of water metabolism， are involved in the pathogenesis of water retention in heart failure together with the arginine vasopressin system （AVP）， renin-angiotensin-aldosterone system （RAAS）， and diuretic resistance. Studies have shown that herbal medicines that regulate the heart and kidney can alleviate water retention in heart failure by targeting AQPs， thereby delaying or even reversing the progression of heart failure. This paper expounds the TCM name and pathogenesis of heart failure from the theory of cardiac and renal coordination， the role of AQPs in the pathogenesis of water retention in heart failure， and the modern connotation of the therapy of tonifying heart and kidney for heart failure， aiming to provide ideas for the prevention and treatment of water retention in heart failure by TCM.

Coronary microvascular dysfunction （CMD） is one of the important causes of myocardial ischemia and non-obstructive coronary artery ischemic symptoms. However， effective diagnostic methods and targeted treatment strategies for CMD are currently lacking. According to traditional Chinese medicine （TCM）， the comorbidity theory of "blood-vessel-cardiac collaterals" plays a central role throughout the entire development process of CMD. It suggests that in the clinical diagnosis and treatment of CMD， the treatment of blood， vessels， and cardiac collaterals should not be neglected. In light of this， insect medicines， known for their efficacy in promoting blood circulation， resolving stasis， and alleviating spasms， hold promise as a potential treatment for CMD. However， there is currently no research or summary on the use of insect medicines for the treatment of CMD. Therefore， this article took the comorbidity theory of "blood-vessel-cardiac collaterals" as the starting point and divided the pathogenesis of CMD into five evolution stages： Beginning in the blood （changes in blood components and hemorheology）， progressing in the vessels （atheromatous plaque formation and unstable plaques）， occurring in the cardiac collaterals （microvascular endothelial damage and microvascular constriction and spasms）， ending in the cardiac collaterals （microvascular remodeling）， and resulting in energy metabolism disorders throughout the process， so as to explore the pathogenesis and evolution of CMD. In addition， based on the modern pharmacological research on insect medicines， this article discussed the clinical application of insect medicines in the treatment of CMD from four aspects： Promoting blood circulation and removing blood stasis to relieve vessels' obstruction， relieving spasms to alleviate pain， combating poison with poison to disperse stagnation， and tonifying cardiac collaterals to nourish the heart， which aims to provide a theoretical basis for the use of TCM in treating CMD， broaden the scope of medication， and improve clinical efficacy.