302 teeth with wedge-shaped defect in 168 patients were restored by SDR(smart dentin replacement,n =112),glass ionomer (n =98) and light-cured composite resin(n =92) respectively.12 to 15 month follow-up showed the success rate was 96.2％,84.8％ and 86.2％ respectively(P ＜ 0.01).SDR is an ideal material in restoring wedge-shaped defect.

Objective To explore the status quo and the correlation of professional practice environment and job burnout in head nurses. Methods Totally 646 head nurses from city state hospitals of Hunan Province was selected by cluster sampling method. Participants were investigated by using the Chinese Version of Profession Practice Environment Scale for Head Nurses and Maslach Burnout Inventory. Results The professional environment score was 215.95±22.81, which was in the moderate level. The score of emotional exhaustion (EE) in head nurses was 24.56 ± 10.64, depersonalization (DP) was 8.92 ± 4.17 and personal accomplishment (PA) was 35.55±13.08, all stating moderate burnout. Meanwhile, the scores of EE and DP were negatively correlated with professional practice environment (r=-0.350--0.161, P≤0.01), while the PA was positively correlated with professional practice environment (r=0.078- 0.271, P≤0.01). Conclusions Professional practice environment in head nurses is correlated with job burnout. Hospital leaders should pay more attention to head nurses′professional practice environment to decrease job burnout in head nurses.

Objective To assess the diet quality of pregnant women during the second trimester using the dietary inflammatory index ( DII) and to explore the correlation between the DII in second trimester of preg-nancy and preterm delivery.Methods A total of 253 women with singleton pregnancy in 16-20 gestational weeks who had received routine prenatal care between August 2014 and April 2015 at the First Affiliated Hospi-tal of Anhui Medical University were enrolled with cluster random sampling.The included women were asked to recall daily dietary intake in the 3 days prior to the survey.All dietary data were analyzed for energy and nutri-ents intake with a nutritional analysis software, followed by calculation of DII according to previous reports. Based on quartiles of the DII scores, the participants were divided into three groups, namely the anti-inflam-matory group (DII<-5.10), intermediate group (DII -5.10--2.55), and the pro-inflammatory group (DII>-2.55).The participants were followed up until delivery and the pregnancy outcomes were recorded. The relationship between the DII in second trimester of pregnancy and preterm delivery were analyzed. Results DII scores of the 253 pregnant women during the second trimester of pregnancy ranged from -7.913 to 3.872.The risks of preterm birth in the anti-inflammatory diet group, the intermediate group, and the pro-inflammatory diet group were 0, 1.6%, and 6.3%, respectively, with statistically significant differences among the groups (P=0.034).The higher DII scores (pro-inflammatory) were associated with higher inci-dence of preterm birth ( P<0.05 ) .Conclusion DII may be used to assess diet quality of pregnant women during the second trimester and to predict the risk of preterm birth.

Objective To test the clinical validity of use of the Chinese version of Munro adult pressure ulcer risk-assessment scales (Munro scales),Braden scales,Qian Weiming operation pressure ulcer risk-assessment scales (self-designed scales) in the patients with general anesthesia surgery.Methods Three investigators respectively used the Munro scales,Braden scales and self-designed scales to conduct the pressure ulcer risk-assessment on 261 patients with general anesthesia surgery before operation,at the end of operation and at exiting from anesthesia recovery room.The sensitivity,specificity,positive predictive value and negative predictive value of each assessment tool were calculated.Results The best critical values of the Munro scales before operation,at the end of operation and at exiting from anesthesia recovery room were 8.0,24.5,28.5 points respectively;which of the Braden scale were 18.5,11.5,13.5 points respectively;which of self-made scale were 12.5,13.5,13.5 points respectively.The area under the ROC curve of the three different scales at the beginning of the operation above was 0.653,0.596,0.652.The area under the ROC curve of the three different scales at the end of the operation above was 0.872,0.548,0.792.The areas under the ROC curve of the three different scales before operation were 0.868,0.773 and 0.813 respectively.Conclusion The Chinese version of Munro scales is more suitable for the assessment of operative patient's pressure ulcer risk than the Braden scale and self-designed scales,but the preoperative risk assessment needs to be improved.

Objective:To construct a virtual simulation training platform for peripheral inserted central catheter (PICC) catheterization and discuss its application in clinical training.Methods:A total of 118 nurses who attended the PICC professional and technical advanced training courses in a province in 2020 and 2021 were enrolled in this study. In 2020, the training was conducted in the form of theoretical teaching combined with practical training ( n=51), and in 2021, virtual simulation platform was introduced as a supplement on the basis of the original training ( n=67). SPSS 23.0 was used for independent-samples t-test to compare the theoretical and operational assessment results of the two years and evaluate the application effect of the platform. Through the satisfaction survey and learning log, the nurses' experience of using the platform was understood. Results:The theoretical performance and the operational performance of nurses who participated in the training in 2021 were (96.56±3.17) and (94.06±2.16) respectively, and the operational performance was better than that of nurses who participated in the training in 2020 ( t=-11.37, P<0.001), and the difference in theoretical performance was not statistically significant ( t=0.17, P=0.853). In 2021, 63 nurses (94.0%) who used the virtual simulation platform believed that the platform could assist to improve the training effect; 61 nurses (91.0%) expected the application of virtual simulation technology in the teaching and training of other knowledges. Conclusion:As a new teaching form, virtual simulation technology can significantly improve the training effect and satisfaction, and provide reference for the development of relevant teaching and training.

Objective:To observe the application value of "Internet +" based case teaching method combined with objective structured clinical examination (OSCE) teaching method in the teaching of nursing students in the Department of Nephrology, and analyze its impact on nursing student satisfaction of teaching.Methods:A total of 60 nursing students who practiced in the Department of Nephrology, Jiangsu Provincial People's Hospital from January 2021 to June 2022 were selected as the research subjects. They were randomly divided into observation group and control group, with 30 students in each group. The control group adopted traditional teaching method, and the observation group adopted case teaching method based on "Internet +" combined with OSCE teaching method. SPSS 25.0 statistical software was used for data analysis, and independent sample t-test was used to compare the clinical practical work ability and teaching satisfaction of the two groups of nursing students after teaching. Results:After 4 weeks of teaching, the total scores of clinical thinking ability, disease observation and evaluation ability, mastery of medical knowledge, standardized operation ability, communicative ability, adaptive ability, humanistic care and health literacy of the observation group were higher than those of the control group [(29.84±3.52) vs. (25.67±3.36), (5.81±1.52) vs. (4.34±1.67), (17.93±2.24) vs. (15.52±2.05), (25.72±2.73) vs. (22.17±2.56), (4.18±0.75) vs. (3.56±0.69), (83.48±6.67) vs. (71.26±7.05)], with a statistically significant difference ( P < 0.05); after 4 weeks of teaching, the teaching preparation, teaching process, teaching ability, teaching attitude, teaching effect and total score of the observation group were higher than those of the control group [(17.13±2.42) vs. (15.07±1.84), (36.44±3.12) vs. (34.07±2.49), (21.97±2.36) vs. (21.37±2.01),(17.00±2.36) vs. (16.83±2.23), (17.73±2.00) vs. (14.07±2.55), (110.27±5.51) vs. (101.40±4.58)], and the difference was statistically significant ( P<0.05). Conclusions:The case teaching method based on "Internet +" combined with OSCE can not only effectively improve the clinical practical work ability of nursing students in the department of nephrology, but also improve student satisfaction of teaching.

To investigate the effects of Mycobacterium tuberculosis heat shock protein 65(HSP65)on Treg/Th17 immune balance in ApoE-knockout(ApoE-/-)mice, ApoE-/- mice with a high-cholesterol diet were immunized with M. tuberculosis HSP65. Sera were obtained for measurement of anti-HSP65 antibodies by ELISA; the effect of administration of different antigens was investigated, respectively, using flow cytometry analysis on the number of CD4+CD25+Foxp3+Tregs and CD4+IL-17+ Th17; the production of cytokines(IL-10, TGF-β1, IL-17 and IL-21)by these cells were determined by ELISA; total plasma cholesterol(TC), triglyceride(TG), high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C)levels were detected by biochemical autoanalyzer. Atherosclerotic lesions were measured by lipid deposition stained with oil red O. The results demonstrated that the levels of anti-HSP65 IgG antibodies were increased significantly in Mycobacterium tuberculosis HSP65-treated ApoE-/- mice, revealed obvious decrease in Treg number, Treg related cytokines(IL-10, TGF-β1)levels and significant increase in Th17 number, Th17 related cytokines(IL-17 and IL-21)levels, the levels of TC, TG, HDL-C and LDL-C did not change between groups, while the atherosclerotic lesions significantly increased. Results indicate that M. tuberculosis HSP65 could interrupt the Th17/Treg immune balance in ApoE-/- mice, suggesting a potential role in the formation and progression of atherosclerosis.

An expression vector pET-28a-mGM-CSF-X10-βhCGCTP37 plasmid containing the βhCG and mGM-CSF gene was designed and constructed. The fusion protein was induced by lactose and purified by ammonium sulfate precipitation and DEAE-cellulose anion exchange column. Then dendritic cells(DC)in C57BL/6J mice were extracted and sensitized by the fusion protein to obtain DC vaccine. The DC vaccine was inoculated to C57BL of / 6J mice with prostate cancer RM-1. The results indicated that the anti-tumor effects of DC group and DC combined with paclitaxel(DP)group were superior to that of paclitaxel(Pac)group(P< 0. 01), and the anti-tumor effect of DP group was better than that of DC group. Thus, the constructed DC vaccine can inhibit the growth of prostate cancer, and have synergistic anti-tumor when used with paclitaxel.

Post-intensive care syndrome (PICS) is the most common complication in patients discharged from intensive care unit (ICU), which seriously affects the life quality of the patients. At present, there is still lack of standardevaluation methods for PICS. Continuous and dynamic assessment can earlyidentify PICS, moreover, early identification and intervention of PICS can improve the life quality of patients those patients, which is critical to improve the long-term outcome of the patients. In this paper, we reviewed the current research states of evaluation timing, contents, tools and modalities of PICS domestic and abroad, analyzed the problems and prospects of the existing evaluation methods, aiming to provide a reference for clinical staff to effectively and comprehensively evaluate PICS.

Objective:To analyze the association between exposure to ambient PM 2.5 and its components [sulfate (SO 42-), nitrate (NO 3-), ammonium (NH 4+), organic matter (OM), and black carbon (BC)] and psychological distress among school children and adolescents aged 9 to 18 years in China. Methods:Based on data from the 2019 Chinese National Survey on Students' Constitution and Health, 130 808 children and adolescents aged 9 to 18 years were included. Scoring and determination of higher psychological distress were based on the Kessler Psychological Distress Scale (K10), and annual average exposure data for air pollution were matched by survey location and time. We used a restricted cubic spline approach based on logistic regression to fit the associations between PM 2.5, SO 42-, NO 3-, NH 4+, organic matter, black carbon concentrations, and psychological distress. Logistic regression models were used to analyse different age, gender, BMI and physical activity subgroups to estimate the association between exposure to high levels of pollution and high levels of psychological distress in different subgroups. Results:The proportion of children and adolescents with high levels of psychological distress in China was 30.4%, with girls being higher than boys at 31.6% and 29.1%, respectively ( P<0.05). A non-linear positive association existed between exposure to PM 2.5, SO 42-, NO 3- and organic matter concentrations and higher psychological distress. As PM 2.5, NO 3-, NH 4+, organic matter, and black carbon concentrations continued to rise, the increase in the risk of higher psychological distress slowed, while SO 42- showed little change in the OR of psychological distress at lower concentrations but continued to rise at higher concentrations. PM 2.5 and its components were statistically associated with psychological distress in the physically inactive group but not in the physically active group. The association between high levels of pollutants and high psychological distress was stronger among students aged 9 to 12 years compared with students aged 13 to 15 years and 16 to 18 years. Conclusions:The ambient pollutant PM 2.5 and its components are associated with psychological distress in children and adolescents aged 9 to 18 years in China. High pollutant exposure is a risk factor for high psychological distress among physically inactive children and adolescents, and there are age differences in the association between PM 2.5 and components and psychological distress.