Objective? To explore the status quo and influencing factors of self-directed learning readiness in nursing undergraduates. Methods? Totally 500 full-time nursing undergraduates from Tianjin were selected using cluster sampling from March to July 2017 and investigated with the general information questionnaire, Self-directed Learning Readiness Scale for Nursing Education (SDLRS), Learning Attitude Questionnaire for Senior Nursing Students and Learning Self-efficacy Questionnaire. SPSS 21.0 was used to analyze the score and Pearson was used to analyze the correlation between self-directed learning readiness, learning attitude and learning self-efficacy. Multivariate linear regression analysis was used to analyze the influencing factors. Totally 500 questionnaires were distributed, and 429 valid questionnaires were collected. Results? The SDLRS score of the 429 nursing undergraduates totaled (149.99±15.73); the learning attitude score totaled (73.99±11.92); and the learning self-efficacy score totaled (76.26±8.17). Correlation analysis revealed that nursing undergraduates' self-directed learning readiness was positively correlated (P＜0.01) with their learning attitude (r=0.466) and learning self-efficacy (r=0.657). Multivariate linear regression analysis showed that learning self-efficacy, learning attitude, love for nursing program and difficulty in after-class learning were the influencing factors for self-directed learning readiness in nursing undergraduates, which amounted to 48.2% of the accumulated variance of self-directed learning readiness. Conclusions? The self-directed learning readiness of nursing undergraduates remains at a medium level. Their self-directed learning readiness may be improved by further correcting their attitude towards learning, improving self-efficacy and using a proper teaching model.

Objective:To investigate the level of beliefs about medication in young patients with newly treated pulmonary tuberculosis and analyze its influencing factors.Methods:This was a cross-sectional study. Using the convenient sampling method, a total of 320 young newly treated pulmonary tuberculosis patients who visited the designated tuberculosis hospitals in Kashgar Prefecture and Hotan Prefecture of Xinjiang Uygur Autonomous Region from January 2022 to April 2023 were selected as the research objects. The investigation was carried out with the General Information Questionnaire, Beliefs about Medicines Questionaire Specific (BMQ-S), 8-Item Morisky Medication Adherence Scale (MMAS-8), Brief Illness Perception Questionnaire (BIPQ) and Tuberculosis-related Stigma Scale (TSS). Multiple linear regression was used to analyze the influencing factors of medication beliefs in young patients with newly treated tuberculosis.Results:A total of 320 questionnaires were distributed in this study, and 302 valid questionnaires were collected, with an effective response rate of 94.38% (302/320). The total score of BMQ-S of 302 young patients with newly treated tuberculosis was -1.00 (-2.00, 1.00), MMAS-8 score was 5.38 (4.75, 5.75), BIPQ score was 37.00 (24.00, 44.00) and TSS score was 48.00 (44.00, 52.00). The results of multiple linear regression analysis showed that comorbidities, medication adherence, disease perception and stigma were the influencing factors of medication beliefs in young newly treated pulmonary tuberculosis patients ( P<0.01) . Conclusions:The medication belief level of young patients with newly treated pulmonary tuberculosis needs to be improved. Medical staff should correct the negative cognition of the patient's disease, emphasize the benefits of drug treatment and enhance the patients' beliefs in the necessity of medication.

OBJECTIVE: To explore the molecular pathogenesis for a pedigree affected with hereditary coagulation factor XII (FXII) deficiency. METHODS: Potential variant of the F12 gene was analyzed by PCR and Sanger sequencing. Expression plasmids were constructed by site-directed mutagenesis based on the wild-type and transiently transfected into 293T cells. FXII:C and FXII:Ag of the expression products were determined in the supernatant and cell lysate. Western blotting was used to verify the identify of the protein. RESULTS: Gene sequencing revealed that the proband has carried 46TT genetype and heterozygous p.Glu502Lys variants in exon 13, and a heterozygous p.Gly542Ser variant in exon 14 of the F12 gene. Transfection experiment suggested that the FXII:C and FXII:Ag of p.Glu502Lys variant in the supernatant were 28% and 24%, compared with the wild-type (100%) and FXII:Ag of cell lysates was 39% compared to the wild-type (100%). The FXII:C and FXII:Ag of p. Gly542Ser variant in the supernatant were 32% and 17% and the FXII:Ag of cell lysates was 59%. CONCLUSION The 46TT genetype, p.Glu502Lys and p.Gly542Ser variants of the F12 gene probably underlie the low FXII level in the proband. As shown by in vitro experiment, the p.Glu502Lys and p.Gly542Ser variants can both inhibit the synthesis and secrection of the FXII protein.
Exons ; Factor XII ; genetics ; Factor XII Deficiency ; genetics ; Heterozygote ; Humans ; Pedigree

Objective: To understand the status quo of school bullying among middle school students in Anhui Province and its correlation with family environment and education methods of students related to school bullying, so as to provide corresponding prevention and controlling measures against school bullying. Methods: The investigation has been conducted on the occurrence of school bullying among middle school students ranging from junior grade one to senior grade three in Hefei, Wuhu, Fuyang of Anhui Province, during which up to 1 826 students information has been gathered through Questionnaire Atar Platform using the school bullying scale and self designed questionnaire. SPSS 26.0 statistical software has been applied for data analysis. Results: The incidence of bullying was 41.40%, and among them, 14.46% were reported to bully others, 39.59% of them were of being bullied, and 12.65% of them were reported of bullying others and being bullied at the same time. Multivariate Logistic regression corrected model showed that quiet relationship with mother ( OR=1.76, 95%CI =1.22-2.53) was a risk factor for the bully, quiet relationship with father( OR=1.89, 95%CI=1.47-2.43 ), reorganized family ( OR=2.28, 95%CI =1.22-4.29) were the risk factors for the bullied, quiet/poor relationship between parents ( OR=1.52, 95%CI=1.06-2.17; OR=3.15, 95%CI =1.79-5.57) was a risk factor for the bully-bullied; Punishment and abuse( OR=1.45, 95%CI=1.10-1.90; OR=1.82, 95%CI=1.48-2.23; OR=1.47, 95%CI = 1.10- 1.96) were risk factors for the above three behaviors( P <0.05). Conclusion The incidence of school bullying is influenced by family environment and rearing style. In daily life, parents should be mindful of maintaining a good family relationship, fostering active communication with child, which can reduce the occurrence of school bullying.

Objective To systematically evaluate qualitative studies on the experience of transition from adolescent to adult medical care for patients with congenital heart disease(CHD),and to provide a reference for exploring CHD transition management options and developing intervention strategies.Methods A computerized search of PubMed,Embase,Web of Science,Cochrane Library,EBSCO,CINAHL,China Knowledge Network,Wanfang database,Vipshop database,and China Biomedical Literature Database for qualitative studies on the transition experience of CHD patients from adolescence to adult medical care was conducted for the period from the establishment of the database to April 2023.The quality of the literature was evaluated using the Joanna Briggs Institute(JBI)Australian Centre for Evidence-Based Health Care Quality Assessment Criteria for Qualitative Research(2016),and the results were integrated using meta-integration methods.Results A total of 9 studies were included,and 49 research results were extracted,and 11 categories were summarized.The final synthesis included 4 integrated results:①Complex attitudes towards healthcare transition,with both attachment and expectation:attachment to paediatric healthcare providers,expectation of transition to adult healthcare providers.(2)Facing multiple healthcare transition challenges:lack of adequate preparation for healthcare transition,parents withdrawing from the role of disease manager,large differences in services between paediatric and adult healthcare providers.③Expect to receive multiple supports:expect to receive comprehensive health education from healthcare personnel,expect healthcare institutions to set up healthcare transition counselling clinics and achieve handover of illness,expect to receive companionship and support from parents,expect to receive understanding and help from peers.④ Per-ceived benefits of medical transition:increased ability to manage illness,role change and personal growth.Conclusion Adolescents with CHD have a complex experience of transitioning to adult healthcare,and healthcare professionals should be attentive to their feelings,encourage them to deal with challenges positively,and provide adequate information and joint parental and peer support to facilitate a smooth transition to adult healthcare for adolescents.

Objective:In general, patients with seropositive rheumatoid arthritis (RA) are considered to show an aggressive disease course. However, the relationship between the two subgroups in disease severity is controversial. Our study is aimed to compare the clinical characteristics and prognosis of double-seropositive and seronegative RA in China through a real-world large scale study.Methods:RA patients who met the 1987 American College of Rheumatology (ACR) classification criteria or the 2010 ACR/European Anti-Rheumatism Alliance RA classification criteria, and who attended the 10 hospitals across the country from September 2015 to January 2020, were enrolled. According to the serological status, patients were divided into 4 subgroups [rheumatoid factor (RF)(-) anti-cyclic citrullinated peptide (CCP) antibody (-), RF(+), RF(+) anti-CCP antibody(+), anti-CCP antibody(+)] and compared the disease characteristics and treatment response. One-way analysis of variance was used for measurement data that conformed to normal distribution, Kruskal-Wallis H test was used for measurement data that did not conform to normal distribution; paired t test was used for comparison before and after treatment within the group if the data was normally distributed else paired rank sum test was used; χ2 test was used for count data. Results:① A total of 2 461 patients were included, including 1 813 RF(+) anti-CCP antibody(+) patients (73.67%), 129 RF(+) patients (5.24%), 245 RF(-) anti-CCP antibody(-) patients (9.96%), 74 anti-CCP antibody(+) patients (11.13%). ② Regardless of the CCP status, RF(+) patients had an early age of onset [RF(-) anti-CCP antibody(-) (51±14) years old, anti-CCP antibody(+) (50±15) years old, RF(+) anti-CCP antibody(+) (48±14) years old, RF(+)(48±13) years old, F=3.003, P=0.029], longer disease duration [RF(-) anti-CCP antibody(-) 50 (20, 126) months, anti-CCP antibody(+) 60(24, 150) months, RF(+) anti-CCP antibody(+) 89(35, 179) months, RF(+) 83(25, 160) months, H=22.001, P<0.01], more joint swelling counts (SJC) [RF(-) anti-CCP antibody(-) 2(0, 6), Anti-CCP antibody(+) 2(0, 5), RF(+) anti-CCP antibody(+) 2(0, 7), RF(+) 2(0, 6), H=8.939, P=0.03] and tender joint counts (TJC) [RF(-) anti-CCP antibody(-) 3(0, 8), anti-CCP antibody(+) 2(0, 6), RF(+) anti-CCP antibody(+) 3(1, 9), RF(+) 2(0, 8), H=11.341, P=0.01] and the morning stiff time was longer [RF(-) anti-CCP antibody(-) 30(0, 60) min, anti-CCP antibody(+) 20(0, 60) min, RF(+) anti-CCP antibody(+) 30(10, 60) min, RF(+) 30(10, 60) min, H=13.32, P<0.01]; ESR [RF(-) anti-CCP antibody(-) 17(9, 38) mm/1 h, anti-CCP antibody(+) 20(10, 35) mm/1 h, RF(+) anti-CCP antibody(+) 26(14, 45) mm/1 h, RF(+) 28(14, 50) mm/1 h, H=37.084, P<0.01] and CRP [RF(-) anti-CCP antibody(-) 2.3 (0.8, 15.9) mm/L, Anti-CCP antibody(+) 2.7(0.7, 12.1) mm/L, RF(+) anti-CCP antibody(+) 5.2(1.3, 17.2) mm/L, RF (+) 5.2(0.9, 16.2) mm/L, H=22.141, P<0.01] of the RF(+)patients were significantly higher than RF(-) patients, and RF(+) patients had higher disease severity(DAS28-ESR) [RF(-) anti-CCP antibody(-) (4.0±1.8), anti-CCP antibody(+) (3.8±1.6), RF(+) anti-CCP antibody(+) (4.3±1.8), RF(+) (4.1±1.7), F=7.269, P<0.01]. ③ The RF(+) anti-CCP antibody(+) patients were divided into 4 subgroups, and it was found that RF-H anti-CCP antibody-L patients had higher disease severity [RF-H anti-CCP antibody-H 4.3(2.9, 5.6), RF-L anti-CCP antibody-L 4.5(3.0, 5.7), RF-H anti-CCP antibody-L 4.9(3.1, 6.2), RF-L anti-CCP antibody-H 2.8(1.8, 3.9), H=20.374, P<0.01]. ④ After 3-month follow up, the clinical characteristics of the four groups were improved, but there was no significant difference in the improvement of the four groups, indicating that the RF and anti-CCP antibody status did not affect the remission within 3 months. Conclusion:Among RA patients, the disease activity of RA patients is closely related to RF and the RF(+) patients have more severe disease than RF(-) patients. Patients with higher RF titer also have more severe disease than that of patients with low RF titer. After 3 months of medication treatment, the antibody status does not affect the disease remission rate.

OBJECTIVE To establish the fingerprints of Xanthoceras sorbifolia and determine the contents of flavonoids . METHODS HPLC was adopted . Using epigallocatechin as reference ，the fingerprints of 11 batches（No. S1-S11）of X. sorbifolia were drawn with Similarity Evaluation System of Chromatographic Fingerprints of TCM （2004A edition ）. The similarity evaluation was conducted ，the common peaks were also confirmed . Cluster analysis （CA）and principal component analysis （PCA）were also performed. Epigallocatechin was selected as internal reference ，and quantitative analysis of multi -components by single marker （QAMS）was used to determine the contents of gallocatechin ，catechin，epicatechin，dihydromyricetin，taxifolin and myricetin in 16 batches（No. S1-S16）of X. sorbifolia. The results were compared with the results of one point external standard method and standard curve method . RESULTS There were 15 common peaks in 11 batches of X. sorbifolia，and the similarity of them were 0.910-1.000. A total of 7 common peaks were identified ，i.e. galliccatechin（peak 1），epigallocatechin（peak 2），catechin（peak 3），epicatechin（peak 5），dihydromyricetin（peak 6），taxifolin（peak 14）and myricetin （peak 15）. The results of CA showed that S5-S7 and S 9 were clustered into one category ，S8 and S 11 were clustered into one category ，S10 were clustered into one category，S1-S4 were clustered into one category . The results of PCA showed that accumulative variance contribution rate of 3 principal components was 99.24%；S5-S7 were clustered into one category ，S8-S11 were clustered into one category ，S3 and S 4 were clustered into one category ，S1 and S 2 were clustered into one category . With the exception of myricetin and a partial batches （S12，S14-S16） of catechin ，the RSDs measured by the three methods for galliccatechin ，catechin （remaining batches ）， epicatechin，dihydromyricetin and taxifolin in 16 batches of X. sorbifolia were less than 4% （n＝3）. CONCLUSIONS The established HPLC fingerprint and the method for content determination can be used for the quality control of X. sorbifolia. QAMS method can be used for the content determination of galliccatechin，epicatechin，dihydromyricetin and taxifolin .

Interrupted time-series (ITS) is a quasi-experimental design which evaluates the effectiveness of an intervention based on time-series outcome variables. Compared with the single group of ITS, the two groups of ITS can better control the influence of pre-interventional confounding factors and evaluate the effectiveness of the intervention. This paper summarizes the principles and statistical methods of two groups of ITS by an example of evaluating vaccine effect on the incidence of a disease in two cities. The regression model is fitted by Prais-Winsten method and Newey-West method and the results are explained and compared in detail. When the intervention is performed with other confounding interventions at the same time, the two groups of ITS can be more effective to balance the existing trends before the intervention, and evaluate the effectiveness of intervention. The method of two groups of ITS has important practical significance, providing new insights in program evaluation.

Objective: To understand the AIDS awareness and related factors as well as the demands for AIDS-related health education programs, among first-grade students from three senior high schools in Tianjin. Methods: A cross-sectional study using both stratified cluster and convenient sampling methods was conducted. Anonymous questionnaires including social demographic characteristics, AIDS-related knowledge and needs for AIDS health education were distributed to the first-grade students from two general middle schools and one vocational senior middle school in Tianjin. Results: A total of 1 082 students were responding to the questionnaires. Among them, the overall awareness rates of AIDS-related knowledge were 34.3%(371/1 082), 71.9%(778/1 082) of the students had received knowledge about AIDS and 59.4% (643/1 082) of the students had received knowledge about sexual health in the past, from the three schools. There appeared statistical differences among the two types of schools. 7.0% (76/1 082) of the students reported having had sexual behaviors. Results from the multivariate logistic regression analysis showed that, in vocational senior middle school, the awareness rate of AIDS knowledge was lower (compared with general middle school, OR=0.41, 95%CI: 0.29-0.59) and in the following items, including no need in receiving safe sex health knowledge (compared with needs of safe sex health knowledge, OR=0.62, 95%CI: 0.43-0.91), no interests in reading AIDS-related health education materials (compared with attention to AIDS health education materials, OR=0.41, 95%CI: 0.30-0.56), not aware of safe sex behavior (compared with aware of safe sex behavior, OR=0.55, 95%CI: 0.39-0.77), not aware of correct condom use, compared with aware of correct condom use (OR=0.33, 95%CI: 0.24-0.46). Conclusions The overall awareness rate of AIDS knowledge was low among the first-grade students in Tianjin. Some students reported of already having had insertive sex, sexual health knowledge has a significant impact on AIDS knowledge, suggesting that sexual health education and AIDS health education among high school students be strengthened in Tianjin.