Objective To explore literature published periodicals,the organizations of the first authors,the research direction and the quality about nursing system literature in recent four years.Methods By retrievaling the databases of China Hospital Knowledge (CHKD),VIP Biomedical,China National Knowledge Infrastructure (CNKI),Wanfang,Pubmed and Medline,each database used the same search term and retrieval type (the retrieval type differed by each database grammar),and the retrieval time was limited from Jan,2010 to Dec,2013.Results 75 nursing literature published on 35 journals were obtained,of which 19 journals published only one paper.In terms of quality evaluation,publication bias tested 36,49 forest charts,2 disputing topics,24 with exact P value cycle interpretations,16 used flowcharts,and none of the literature heterogeneity tests used graphical method.By classifying the organizations of the first authors as schools and hospitals,the number of published papers were 38 and 37 separately from 2010 to 2013.Conclusions The nursing systematic literature were always with vast amount and dispersed content,less repetitive content was seen during the literature,The structure was not rigorous,and quality remains to be improved.It should be noted that Meta-analysis study normative has its requirements and more published papers are needed.

Objective To investigate the effect of PBL combined with EBM applied in the teaching of fever of unknown origin. Methods PBL combined with EBM teaching was applied in fever of unknown origin course for 30 clinical medicine specialty(eight years) students of Tongji class of grade 2009(experiment group), while PBL teaching was applied in fever of unknown origin course for 30 clinical medicine specialty (eight years) students of Tongji class of grade 2008 (control group). After teaching, the theory examination for both basic knowledge and case analysis was organized for all students of both groups. At the same time the questionnaire survey was conducted to 30 students of grade 2009 to evaluate the teaching effect. The results were assessed by using SPSS 18.0 statistical software for the T-test of the experimental group and the control group.Inspection level was α=0.05. Results The theory test score of students in the experimental group was (93.5±3.2) point, signifi-cantly higher than that of the students in the control group(84.7±2.8). There was statistically signifi-cant difference between the scores of the two groups of students (P=0.00). Survey results showed 19 students ( 63 . 33%) thought that the development of PBL teaching combined with evidence-based medicine teaching had its necessity, and 16 students(53.33%) thought that the teaching method im-proved their clinical thinking ability of logical reasoning. Conclusion The concept of PBL combined with EBM has achieved significant resultsinthe teaching offever of unknown origin, and it is necessary to carry out this teaching mode in medical colleges with certain teaching strength.

Objective To study the relationship of the levels of serum interleukin-6 (IL-6) and C-reactive protein (CRP) with insulin resistance in normal glucose tolerant first-degree relatives (NGT) of type 2 diabetics.Methods A total of 218 normal glucose tolerance subjects , including 136 NGT of type 2 diabetes , and 82 normal control ( NC) without type 2 diabetes family history were enrolled.The levels of blood glucose, hemoglobin A1c (HbA1c), lipid, insulin, IL-6, and high-sensitivity C-reactive protein (hs-CRP) were measured.Results ⑴Compared with NC, the levels of homeostasis model assessment of insulin resistance (HOMA-IR), hs-CRP , and IL-6 in NGT were significantly increased [1.03~1.94 vs 0.42~0.95 , P <0.01;0.46~2.78 mg/L vs 0.39~1.56 mg/L, P <0.01;(13.6 ±8.99) pg/ml vs (8.08 ±3.67) pg/ml, P <0.01];⑵In NGT, hs-CRP was positively correlated with HOMA-IR and IL-6 ( r =0.326 , P <0.01;r =0.258 , P <0.05 );IL-6 was positively correlated with HOMA-IR ( r =0.350 , P <0.01).Conclusions IL-6 and CRP may correlate with the degree of insulin resistance in NGT of type 2 diabetics.

Objective:To investigate the effect of miR-218 on the proliferation and invasion of breast cancer cells.Methods: The expression of miR-218 in breast cancer tissues and breast cancer cell lines was detected by qPCR.The relationship between the expression of miR-218 and the clinicopathological parameters of breast cancer were analyzed.Double luciferase assay was used to detect the relationship between miR-218 and SNX4.MTT assay and invasion assay were used to detect the proliferation and invasion of breast cancer cells after overexpression of miR-218.MTX assay and invasion assay were used to detect the recovery level of SNX4 on the proliferation and invasion of breast cancer cells.The effect of miR-218 on the tumorigenesis of breast cancer cell lines was examined by tumorigenesis in nude mice.Results: The expression level of miR-218 in breast cancer tissue and MCF-7 cell line was higher.The expression of miR-218 was associated with pathological stage of breast cancer and lymph node metastasis.SNX4 may be the target of miR-218.Overexpression of miR-21 could inhibit the proliferation and invasion of breast cancer cells.Overexpression of SNX4 could reverse the inhibitory effect of miR-218 on breast cancer cells.Overexpression of miR-218 could inhibit the breast cancer cell line in nude mice tumorigenic ability.Conclusion: miR-218 can up-regulate the expression of miR-218 in breast cancer,and miR-218 can regulate the expression of SNX4 in breast cancer cell proliferation and invasion.

AIM:To study the effects of N-palmitoylethanolamide ( PEA) on the anxiety-and depression-like behaviors of the mouse model induced by restraint stress , and to explore the possible mechanism of anxiolytic and antide-pressant effects of PEA .METHODS:The mice were intragastrically treated with 2.5, 5 and 10 mg/kg of PEA for 21 con-secutive days once daily .Thirty min after intragastric administration , the mice ( except the normal control group ) were placed in the glass tube to accept 4-h chronic restraint stress for 21 d.After the last administration , the mice were submit-ted to the forced stress test and the open field test (OFT) to observe the effects of PEA on the depression-like behaviors. The cumulative immobility time was recorded during the 4-min interval in the forced swimming test ( FST) or during the 5-min interval in the tail suspension test (TST).The elevated plus maze (EPM) test was used to investigate the effect of PEA on the mouse anxiety-like behaviors , and the water maze method was used to investigate the learning and memory abi-lities, spatial orientation and cognitive function of mice .After the behavior tests , the serum was collected and the hippo-campus was removed . The serum contents of adrenocorticotropic hormone ( ACTH ) , cortisol ( CORT ) and 5-hydroxytryptamine (5-HT) in the hippocampus were detected by ELISA .The changes of acetylcholinesterase ( AChE) ac-tivity in the hippocampal homogenate was measured by spectrophotometry .RESULTS:Compared with model group , in the FST or TST, the immobility time in the mice treated with PEA at 2.5~10 mg/kg and fluoxetine was significantly reduced . In the OFT, the total locomotion distance and total movement time were increased significantly in the mice , but only 10 mg/kg PEA and fluoxetine increased the numbers of rearing .In the EPM test , the percentage of the time spent in open arms, the entries into open arms and the total locomotion distance in 4 arms in the mice were significantly increased .In wa-ter maze test , PEA at 5 and 10 mg/kg and fluoxetine significantly shortened the latency to find the security zone in the mice, and PEA at 10 mg/kg and fluoxetine obviously shorten the swimming distance .Compared with model group , PEA at 10 mg/kg and fluoxetine reduced the mouse serum levels of ACTH and CORT , and the adrenal index , increased the 5-HT content and decreased the AChE activity in the hippocampus .CONCLUSION:PEA produces antagonistic effects on an-xiety-and depression-like behaviors in the mice induced by restraint stress .Its specific mechanism may be related to the re-gulation of the hypothalamic-pituitary-adrenal axis function by increasing the 5-HT level in hippocampus , thus participating in the regulation of central cholinergic system .

Objective To evaluate the gene amplification and protein expression of HER-2 in gastric carcinoma with or without neuroendocrine differentiation (NED), and to explore the difference in HER-2 gene profile between these two neo?plasms. Methods Cases of gastric carcinoma with NED (n=70) and cases of gastric carcinoma without NED (n=150) were retrospectively reviewed. Gene amplification and protein expression of HER-2 genes in gastric carcinoma with or without NED were detected by combination of immunohistochemical method (IHC) and double color silver dye for in situ hybridiza?tion (DISH). Prognosis of gastric cancer patients with NED were predicted using Kaplan-Meiers survival analysis. Results Expression rates of HER-2 in gastric cancer with and without NED are 20.00%and 21.33%respectively. Amplification of HER-2 in gastric cancer with and without NED are 8.57%and 14.67%respectively. Gene amplification and protein expres?sion of HER-2 between gastric cancer with NED and without NED showed no statistical difference. Chromosome 17 multi-body positively correlated with gene HER-2 amplification in Gastric carcinoma with NED. Postoperative survival period in patients of gastric carcinoma with NED and HER-2 amplification was shorter than that in patients of gastric carcinoma with?out NED but with HER-2 amplification. Gastric carcinoma with or without NED, HER-2 gene amplification, lymph node me?tastasis and operation method obviously correlate with prognosis of gastric carcinoma patients (P<0.05). Conclusion The gastric cancer with NED is a special type of gastric cancer, there was no difference of gene amplification and protein expres?sion of HER-2 gene between gastric carcinoma with NED and without NED. Poor prognosis would be expected in gastric can?cer patients with NED and HER-2 amplification.

Objective To discuss the relationship between hepatitis B virus (HBV) genotype and HBV DNA ,liver fibrosis ,liver function and HBeAg .Methods HBV genotypes ,HBV DNA ,liver fibrosis indicators and alanine aminotransferase(ALT ) ,aspartate aminotransferase(AST ) ,total bilirubin(TBIL) ,albumin(ALB) and HBV e antigen(HBeAg) were detected in patients with serum hepatitis .All data were statistically analyzed .Results There was no significant difference of HBV DNA ,ALT ,AST ,TBIL ,ALB , procollagen- Ⅲ -peptide ,type Ⅳ collagen ,hyaluronic acid and laminin between patients with B and C genotype infection (P> 0 .05) . However ,HBeAg level in patients with C genotype infection was higher than that in patients with B genotype infection (P< 0 .05) . Conclusion There might be no significant difference of HBV DNA ,liver function and liver fibrosis between patients with B and C genotype infection ,but HBeAg level in patients with C genotype infection could be higher than patients with B genotype infection .

Objective To investigate the association between expression of the epithelial?to?mesenchymal transition(EMT)biomarkers and the malignant progression of gastric cancer in primary tumors and metastases and their possible correlation with progression of gastric cancer(GC). Methods The EMT biomarkers including E?cadherin,β?catenin,N?cadherin,Snail and TGF?β1 were detected by immunohistochemical method for 145 cases of gastric cancer(GC),25 cases of abnormal hyperplasia,13 cases of intestinal metaplasia,42 cases of lymph node metastasis and 40 cases of normal gastric mucosa tissues. Results Positive rates of TGF?β1,Snail,E?cadherin,β?catenin and N?cadherin were 73.5%,65.5%, 14.5%,53.1%and 35.9%,respectively,in gastric cancer tissues and 100%,100%,0%,27.5%and 2.5%,respectively,in normal gastric tissues, with a significant difference between the two groups(P<0.05). The decreased expression of E?cadherin andβ?catenin and the increased expression of TGF?β1 were related to the depth of invasion of gastric cancer(P<0.05). The expression of E?cadherin was correlated positively with the expres?sion ofβ?catenin,but negatively with the expression of TGF?β1. Whereas,the expression of N?cadherin was correlated positively with the expression of TGF?β1(P<0.05). The expression of E?cadherin andβ?catenin in lymph node metastasis was significantly higher than that in gastric cancer tis?sues,while the expression of TGF?β1 was lower than in gastric cancer tissues(P<0.05). Conclusion The increased expression of TGF?β1 and Snail and the decreased expression of E?cadherin,β?catenin,and N?cadherin are involved in the processes of invasion and metastasis of GC. The transformation of E?cadherin to N?cadherin and the expression of TGF?β1 may play an important role in the development of GC. In lymph node me?tastasis,the phenomenon of mesenchymal?to?epithelial transition(MET)occurs.

Objective To study the clinical,pathological and genetic features of myofibrillar myopathy caused by BAG3 gene mutation.Methods The clinical features and pathological findings of a patient with myofibrillar myopathy were analyzed.Genomic DNA of the patient was extracted from peripheral blood and the next generation sequencing was performed to explore the mutation of genes about myopathies.Results The patient presented with nine-year-old onset myopathy characterized by progressive difficulty for squatting,rigid spine and muscle atrophy in the limbs symmetrically.Peripheral neurogenic damages were found on electromyography.On muscle biopsy,myogenic and neurogenic damages with rimmed vacuoles appeared,and the deposited materials were positive for sarcoglycan,dystrophin-R and dystrophin-C.There was a reported heterozygous mutation in the exons of the BAG3 gene (c.626C ＞ T).Conclusion There is no specificity of clinical manifestation in myofibrillar myopathy,and the diagnosis of this disease mainly depends on muscle biopsy and genetic screening.

Objective Psoriasis vulgaris (PV) is easy to prone to recur and hard to cure and little research has been done on combined treatment on PV.The article was to study the clinical effects of total glucosides of paeony capsules (TGP) combined with acitretin and compound flumethasone on PV as well as the peripheral blood cytokine levels.Methods 126 patients with PV who visited our hospital from October 2015 to January 2017 were randomly divided into combined treatment group (63 cases) and control group (63 cases).Both groups were treated with oral acitretin and topical compound flumethasone, what's more, the compound flumethasone group received oral TGP treatment, 8 weeks for a course.The clinical therapeutic effects were evaluated by the levels of peripheral blood IL-17, IL-18, IL-23, TNF-α level, PASI score and percentage of total skin lesions before and after the treatment.Results After the treatment, the concentration of IL-17, IL-18, IL-23 significantly decreased(P<0.05), which was significantly less in combined treatment group compared with control group (IL-17 [61.18±8.91] vs [78.64±7.85], IL-18 [68.56±17.95] vs [79.49±18.64], IL-23 [70.13±12.16] vs [91.18±16.89] pg/ML)(P<0.05).Moreover, the TNF-α level, the PASI score and the percentage of total skin lesions significantly decreased in both groups after treatment(P<0.05), which was significantly less in combined treatment group compared with control group (TNF-α level [14.47±7.53] vs [23.49±8.12]ng/L, PASI score [4.09±1.29] vs [7.29±5.13], the percentage of total skin lesions [6.17±4.59]% vs [8.09±5.18]%) (P<0.05).Conclusion TGP combined with acitretin and compound flumethasone can significantly enhance the clinical therapeutic effects and effectively regulate the levels of the IL-17, IL-18, IL-23 and TNF-α level, which results in treating psoriasis vulgaris.