Objective To evaluate the influence of Peplau interpersonal theory on improvement of nurses communication skills.Methods Totally 50 nurses from a certain level-three hospital in Ningbo were selected as research object using self-control method.These nurses received 8-time Peplau interpersonal theory training.The clinical communication competence was compared before and after the training.Results The clinical communication ability of nurses after training was obviously higher than that before the training.The difference had statistical significance.Conclusions Peplau interpersonal theory training can effectively improve the clinical communication ability of nurses.

BACKGROUND: What role tumor-related genes play in the process of tumor generation, development, metastasis and prognosis has always been a thorny issue in medical field?OBJECTIVE: To study the detection of gene mutation in tumor by denaturing gradient gel electrophoresis(DGGE) and automated DNA se+uence analysis and the change of p53 gene and p53 protein during the development and metastasis of colorectal carcinoma so as to provide basis for evaluating the prognosis of colorectal carcinoma.DESIGN: Single sample study using the tissue specimen as subject.SETTING: Department of oncology in an affiliated hospital of a military medical university.PARTICIPANTS: We collected the primary focus and liver metastasis focus specimens from 41 patients with colon cancer who had hepatectomy because of liver metastasis 5 months to 5 years after radical operation for coloncancer. They were inpatients in Nanfang Hospital, First Military Medical University of Chinese PLA, from January 1994 to December 2000.METHODS: p53 gene(exons 5- 11) mutation of primary focus and liver metastasis focus specimens from 41 cases of colon cancer was examined by DGGE and automated DNA sequencing. Expression of p53 protein was detected by immunohistochemistry.histochemical staining.MAIN OUTCOME MEASURES:①Detection of the mutation of p53 gene by DGGE;②Analysis of p53 gene sequence;③Results of p53 immunohistochemical staining.RESULTS: p53 gene mutation was detected in exons 5 - 9 in 24 out of 41patients(62% ) . Among them, 6 patients had p53 mutation in liver metastasis. The others had consistent mutations in both primary coloreetal and hepatic metastatic lesions. In addition, p53 mutation was also found in the metastatic lesion in three patients. Among the 16 cases of mutation in primary colorectal and hepatic metastatic lesions, 14 cases showed that the ratio of p53 base peak to normal peak was significantly higher in hepatic metastatic lesions than in primary colorectal lesions(P ＜ 0. 001) . Results of p53 immunohistochemical staining were highly consistent with those of DGGE and DNA sequence analysis. However, gene analysis detected focus with nonsense mutation while immunohistochemistry detected overexpression of p53 protein.CONCLUSION: p53 mutation, in patients with colorectal carcinoma followed by hepatic metastases, mostly originates from primary colorectal lesion and then is kept and metastasizes into hepatic cells. The amount of mutated p53 gene and the number of tumor cells containing p53 mutation are increased in hepatic metastatic lesion. P53 mutation is positively correlated with overexpression of p53 protein.

Objective:To explore the effects of norepinephrine combined with dobutamine on the hemodynamics,blood lactic acid,creatinine clearance rate (CCr),fractional excretion ofH2O (FEH2O) and fractional excretion of sodium (FENa) of patients with septic shock.Methods:120 cases of patients with septic shock from January 2016 to December 2016 were selected as the research objectives and randomly divided into two groups with 60 cases in each group.Dobutamine was given to both groups,then norepinephrine was additionally given to the observation group,dopamine was additionally given to the control group.The clinical effect,changes of hemodynamics,blood lactic acid,CCr,FEH2O and FENa levels before and after treatment were compared between two groups.Results:The blood lactic acid and FENa levels of both groups were gradually decreased at 6,12,24 and 48 hours after treatment and were significantly lower than those before treatment;the CCr and FEH2O levels were gradually increased and significantly higher than those before treatment (P＜0.01).The blood lactic acid and FENa levels were gradually decreased at 6,12,24 and 48 hours after treatment and were significantly lower than those of the control group at same time (P＜0.01),the FEH2O level was significantly higher than that of the control group at the same time (P＜0.01).The MAP,SVRI of both groups at 6,12,24 and 48 hours after treatment were significantly higher than those before treatment,but the CI at 24,48 hours after treatment were significantly higher than those before treatment (P＜0.01),the MAP of observation group at 6,12,24 and 48 hours after treatment were significantly lower than those before treatment (P＜0.01),the MAP at 6,12 hours after treatment were significantly higher than those before treatment (P＜0.01),the HR of observation group at 6,12,24 and 48 hours after treatment were significantly lower than those of the control group,but SVRI was significantly higher than those of the control group (P＜0.01).The mortality of observation group was 18.33％ at 28th days after treatment,which was 35.00％ in the control group and significantly higher than that of the observation group (P＜0.05).Conclusion:Norepinephrine combined with dobutamine could improve the hemodynamics,reduce the blood lactate level,improve the renal perfusion and prognosis of patients with septic shock.

Objective:To explore the efficiency of a new scoring system of gastric cancer screening for early gastric cancer in health examination population.Methods:The risk score of gastric cancer was assessed based on the new scoring system in health examination population. A notice for further gastroscopy was sent to the medium-risk and high-risk people. Gastroscopy was performed on those who agreed to undergo the examination.Results:From January to April 2019, a total of 5 357 people in health system visited the Physical Examination Center of Shanghai Songjiang Clinical Medical College of Nanjing Medical University for health examination. Seven hundred and forty people were classified as medium- and high-risk groups by the new screening system, 576 in medium-risk group, and 164 in high-risk group. Among them, 131 cases (17.70%) came for further gastroscopy, of whom 91 (69.47%) were in the medium-risk group and 40 (30.53%) in the high-risk group. After gastroscopy, 4 cases of gastric cancer and 1 case of esophageal cancer were detected, and both were early cancer. In the medium-risk group, 2 cases (2/91, 2.20%) of early gastric cancer and 1 case (1/91, 1.10%) of early esophageal cancer were found. In the high-risk group, 2 cases (2/40, 5.00%)of early gastric cancer were found. The tumor detection rate of high-risk group (5.00%) was higher than that of medium-risk group (3.30%), but there was no significant difference ( P>0.05). Conclusion:Risk stratification with the new scoring system of gastric cancer screening can improve the detection rate of early gastric cancer.

Objective To evaluate the injury of pulmonary function of children with idiopathic pulmonary hemosiderosis(IPH) and the changes after treatment,and to provide some guidance for the diagnosis and treatment of IPH.Methods Twenty-one children with IPH who were admiued at Children's Hospital of Fudan University between June 2012 and May 2016 were selected.The pulmonary function and clinical data of them were analyzed.Results The general pulmonary function of 21 children with IPH before treatment with glucocorticoid was reported that 4 cases (19.05％) were normal and 17 cases (80.95％) were abnormal,including 11 cases (52.38％) with restrictive ventilatory disorder,4 cases (19.05％) with mixed ventilatory disorder,1 case (4.76％) with obstructive ventilatory disorder,and 1 case (4.76％) with small airway dysfunction.Pulmonary function test was performed on 15 cases after 1-2 months of treatment with glucocorticoid.The results showed that maximal vital capacity (VCmax％) vs.the expected value was (77.91 ± 18.86)％ vs.(60.43 ± 23.70)％,forced vital capacity (FVC％) vs.the expected value was (78.96 ±19.24)％ vs.(61.03 ±24.62)％ and forced expiratory volume in one second (FEV1％) vs.the expected value was (86.03 ± 21.69) ％ vs.(65.17 ± 26.89) ％,which were significantly higher than those before treatment,and the differences were statistically significant (t =-4.13,-4.01,-4.54,all P ＜ 0.05).Three cases were followed up for 18 to 40 months by detecting pulmonary function and the results of dynamic monitoring of pulmonary function showed a fluctuation in FVC％ [case 1:(69.6-84.2) ％;case 2:(56.1-73.7) ％;case 3:(40.4-70.2) ％].Conclusion The characteristic pulmonary function changes in children with IPH are restrictive ventilatory disorder.Pulmonary function test play a significant role in diagnosis,treatment and prognosis of IPH.

Objective To investigate changes in the firing activities of nucleus accumbens (NAc)neurons and their response to 5-HT7 receptor stimulation in a rat model of Parkinson’s disease (PD).Methods The firing activities and response of NAc neurons to 5-HT7 receptor agonist in PD rats were recorded by in vivo electroneurophysiology and neuropharmacology and then were compared with those in the sham group.Results The mean firing rate of NAc neurons was (5.46 ±0.88)Hz in the sham rats and (3.77 ±0.48)Hz in the PD rats. The firing rate of NAc neurons increased significantly compared with that in the sham rats (P <0.05).In PD rats, 65% of NAc neurons fired in bursts and 35% fired irregularly.However,in the sham rats,57.5% of NAc neurons fired in bursts and 42.5% fired irregularly.There was no significant difference in the firing pattern of NAc neurons between the PD and sham rats (P >0.05 ).Systemic administration of 5-HT7 receptor agonist AS1 9 increased the firing rate of NAc neurons in the sham and PD rats.This excitation was significant at a high dose of 1 60 μg/kg for NAc neurons in the sham rats (P <0.05).However,the excitation produced by AS1 9 was significant at a high dose of 80 μg/kg in PD rats (P <0.05).The cumulative dose-produced excitation in the PD rats was lower than that in the sham rats.The effects induced by AS1 9 were reversed by the 5-HT7 receptor antagonist SB269970 in both groups.Conclusion The reinforced firing activity of NAc neurons might be mediated by 5-HT7 receptor in the neurons of PD rats.

Aim To construct the fusion gene of human IgG3 upper hinge region and p53 tetramerization domain and to analyze its space conformation. Methods The fusion gene was obtained by recursive polymerase chain reaction (R-PCR),and was cloned into vector pUC19. The positive clone was selected and sequenced with PE310 auto-sequencer. The space conformation of the fusion gene expression product was predicted by using computer program Antheprot. Results Restriction endonuclease digestion confirmed that the fusion gene has been inserted correctly into the vector. The result of sequencing showed that the fusion gene is identical with designation. Analyzing with antheprot program showed that the fusion gene expression product could auto-assembly into a tetramer with four long and flexible linkers. Conclusion Successful construction of the fusion gene mentioned above laid the foundation for further preparation of multivalent gene engineering antibody.

Objective This study aimed to investigate the renal expression change of high mobility of nucleosome binding protein 1 ( HMGN1) in epithelia-mesenchymal transition ( EMT) process, and to study the effect of HMGN1 on renal fibrosis in the diabetic nephropathy mice model. Methods 20 C57BL/6 mice were randomly divided into control group, model group, benazepril group, and insulin group. After 8 weeks of drug intervention, blood, urine and kidney tissue samples were taken from mice. The routine physiological and biochemical indexes were detected. Renal structure and fibrosis were detected by HE and Sirius red staining, respectively. Immunohistochemistry and in situ hybridization were used to investigate the protein and mRNA expression levels of HMGN1, CD68, F4/80,α-smooth muscle actin (α-SMA) , and E-cadherin in renal tissue. Results Blood glucose, renal index, and urinary albumin to creatinine ratio ( UACR) were significantly higher in the model group than those in the normal group. In the model group, HE staining showed glomerular hypertrophy and interstitial inflammatory cell infiltration, and Sirius red showed collagen deposition in the renal tissue. Compared with normal group, HMGN1, CD68, F4/80 positive cell counts andα-SMA protein expression were all increased, while E-cadherin protein expression was downregulated in the model group ( all P<0.05) . The above indexes were not improved significantly in the benazepril group. And after intervention of insulin, the expression levels of CD68 positive cell count andα-SMA protein were decreased and the expression levels of E-cadherin protein were increased compared with the model group ( all P<0.05) . The correlation analysis showed that the level of HMGN1 was correlated with CD68, F4/80, α-SMA, E-cadherin and collagen protein, while CD68 and f4/80 were correlated withα-SMA, collagen protein and blood glucose, respectively ( all P<0. 05 ) . Conclusion HMGN1 is involved in the progression of diabetic nephropathy fibrosis, and its underlying mechanism might be related to the macrophage-mediated EMT process.

Objective To explore the effects of psychological crisis intervention in amputation patients with limbs high-voltage burns. Methods A total of 68 amputation patients with limbs high-voltage burns who were treated in Harbin Fifth Hospital from January 2011 to December 2016 were selected in this study using purposive sampling. The participants were randomly divided into the observation group (n=34) and the control group (n=34). The control group received routine psychological nursing care while the observation group was given psychological crisis intervention. The Stress Reaction (SR), SAS, and SDS were used to evaluate the effects of the intervention. Results The observation group had significantly lower scores of SR, SAS, and SDS compared with the control group [(17.89±3.66) vs. (26.89±3.98) for SR; (42.31±8.48) vs. (50.32±10.25) for SAS; (45.32±8.96) vs. (52.77±11.18) for SDS; (t=17.328,4.512,3.581;P<0.05)]. Conclusions The psychological crisis intervention can effectively improve negative emotions such as anxiety and depression in amputation patients with limbs high-voltage burns. It helps patients to develop positive attitudes towards the reality of amputation.

Objective:To explore the morphology and vessel distribution of the scapholunate interosseous ligament and anatomical basis for the clinical reconstruction of scapholunate interosseous ligament.Methods:From October, 2018 to December, 2018, 12 fresh wrist joint specimens were perfused with gelatin-lead oxide solution from ulnar or radial artery and scanned under micro-CT. The morphology of scapholunate interosseous ligament in neutral position and the distribution of nutrient vessels in the ligament were observed on reconstructed 3D images by Mimics. The width, length and thickness of palmar, dorsal and proximal ligaments were measured. The anatomical parameters at the entrance of nutrient vessels in the scapholunate interosseous ligament were taken and their relationship with the blood supply to the scapholunate was analyzed.Results:①For scapholunate interosseous ligament, it was found that the average length of the proximal sub-region was the longest, the length of palmar and dorsal sides was similar to each other and the widest and thinnest was in palmar side, while the thickness and width of dorsal and proximal were similar. ②There was no nutrient vessel in the proximal part of the scapholunate interosseous ligament. But there were abundant nutrient vessels in the palmar and dorsal scapholunate interosseous ligament, and there was no significant difference in blood supply to palmar and dorsal scapholunate interosseous ligament ( P>0.05). ③The palmar and dorsal medial nutrient vessels that supply to the scapholunate interosseous ligament enter the scapholunate from the attachment of ligament of scapholunate interosseous joint. Conclusion:The palmar side of the scapholunate interosseous ligament is wider and thinner than that of the other subareas, which makes it more vulnerable to injury from an anatomical point of view. There is abundant blood supply to the palmar and dorsal subareas of the scapholunate interosseous ligament and the supplying vessels anastomose inside the scapholunate bone. There is no distribution of blood vessel at the proximal part of scapholunate interosseous ligament, hence is difficult to heal. An injury of palmar and dorsal ligaments may affect the blood supply of scapholunate.