Objective To investigate and compare the argumentativeness and attitudes towards thinking and learning between clinical nurses in general adult wards and wards for patients requiring particularity healthcare for the identification and development of core communication skills.Mettods “Argumentativeness Scale” and “Attitudes toward Thinking and Learning Survey” in Chinese were used to measure a convenience sample of 504 clinical nurses in seven hospitals.Results The scores in items reflecting rationality,positivism,empathy and acceptance in 247 nurses in wards for particularity heahhcare were significantly different from those nurses working in internal medical wards for adults with internal medical problems.Conclusions To develop harmonious interpersonal relationships in nurses,we should strengthen competencies in emotional regulation and rational thinking in nurses in wards for adults with in-ternal medical problems.

Objective To provide the basis for early detection and treatment of precancerous lesions of gastric carcinoma, and reference for early discovery, diagnoses and treatment of gastric cancer, by examining the differences of expression of Helicobaeter pylori (Hp), both in the gastric mueosa and in blood serum, between precancerous lesions of gastric carcinoma patients and gastric cancer patients. Methods Used immunechromatographic method and protein chip system to determine the expression of Hp in blood serum and used immunohistochemistry to detect the expression of Hp in gastric mucosa. The patients had been diagnosed by pathological methods, 170 patients with precancerous lesions of gastric carcinoma, 111 patients with gastric carcinoma and 31 patients with superficial gastritis. Results The expression of Hp was detected on every stage of precancerous lesions and gastric carcinoma. Compared with the detection rates of Hp, precancerous lesions of gastric carcinoma was higher than gastric carcinoma and superficial gastritis, superficial gastritis was the lowest. The differences of the three were significant (P<0.01). The detection rate of Hp in the gastric mueosa (86.2%, 66.7%, 38.7%, respectively)was obviously higher than in blood serum (80.6%, 52.3%, 32.3%, respectively). Conclusions Hp participates in the process of the precancerous lesions and gastric carcinoma. The expression of Hp both in the gastric mueosa and in the blood serum could be one of the indexes, which might report the process and curative effect of precancerous lesions. With such advantages as simple and applicability, the detection of Hp in the blood serum could be used widely. The endoscopy and the detection of Hp in the gastric mucosa are suggested for patients with Hp positive in the blood serum.

Objective To evaluate the overall failure rate of one or two-stage exchange arthroplasty for infections in total knee arthroplasty (TKA) and the predictors affecting the outcome of exchange.Methods Thirty-nine cases received one or two-stage exchange arthroplasty for periprosthetic joint infections after primary TKA in Shanghai Sixth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine and Southeast Hospital affiliated to Xiamen University from January 2012 to November 2014 were reviewed.Periprosthetic tissue and articular fluid of all patients were analyzed by bacterial culture.All patients were followed up for more than one year.C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),procalcitonin (PCT) and blood routine were tested every four weeks,and the evaluation on pain,total periprosthetic function,range of motion and deformation of arthroplasty were conducted.Differences between groups were analyzed using chi-square test or Student's t test when appropriate.A stepwise selection approach in logistic regression analysis was used to screen key predictors for outcome of one or two-stage exchange for infections in TKA.Results There were 39 patients who had undergone one or two-stage exchange for infections in TKA,including 20 males (51.3％) and 19 females (48.7％) with an average age of (62.4±11.7) years.Among the 39 patients,18 gram-positive strains were isolated from specimens,and 6 gram negative strains,2 Mycobacterium tuberculosis and 1 candida albicans.Ten of 39 reimplantations developed reinfection.Between the success and failure groups,there were significant differences in the time from primary TKA to revision (P =0.023),operative time (P =0.029),multidrug resistant organisms (P =0.045),the preoperative and post-operative ESR (P=0.002 and P＜0.001,respectively) and post-operative CRP (P=0.018).Multivariable logistic regression analysis demonstrated that time from primary TKA to revision (OR =0.96,95％CI:0.92-1.00,P=0.025),preoperative ESR (OR=0.97,95％CI:0.95-1.00,P=0.045) and post-operative ESR (OR =0.94,95％ CI:0.91-0.98,P =0.002) were independent indicators associated with the outcome of one or two-stage revision.Conclusions The failure rate after revision for infected TKA is relatively high.The time from primary TKA to revision,preoperative and post-operative ESR could predict the outcome of one or two-stage revision effectively.

BACKGROUND: Tissue engineering plays an important role in treating rotator cuff injury. Promoting the healing of injured rotator cuff and preventing adhesion by regulating growth factor expression are main functions. OBJECTIVE:To compare the effects of corticosteroids and hyaluronic acid on the expressions of epidermal growth factor (EGF),platelet-derived growth factor (PDGF),transforming growth factor ? (TGF-?) and basic fibroblast growth factor (bFGF) in injured rotator cuff. DESIGN,TIME AND SETTING: The randomized controlled animal experiment was performed at the Animal Experimental Center,School of Medicine,Shanghai Jiao Tong University from July to September 2007. MATERIALS: Totally thirty-six Sprague-Dawley (SD) rats were randomly assigned into four groups: normal group (n=6),rotator cuff injury group (n=6),hyaluronic acid group (n=12) and corticosteroids group (n=12). METHODS: Full-thickness defects across 50% of the total width (5 mm) of the bilateral infraspinatus tendon were excised. Models of rotator cuff injury were created at the synovium. 0.05 mL hyaluronic acid was injected into the subacromial bursa mucosa in the hyaluronic acid group,whereas 0.05 mL corticosteroids in the corticosteroids group. MAIN OUTCOME MEASURES: At three and six weeks after injury,the infraspinatus were harvested to detect EGF,PDGF,TGF-? and BFGF by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: By using corticosteroids treatment,the expression of EGF remained greater at the six weeks than twofold at the three weeks; the expression of EGF after hyaluronic acid treatment greatly decreased at six weeks (P

OBJECTIVE To understand the distribution of common pathogens and their drug resistance trend and to provide the basis of the correct selection of antibiotics for clinic.METHODS Retrospective analysis was taken for blood culture specimens during 2 years in our hospital.And statistical analysis was done.All of 4028 cases of blood culture specimens were detected on automatic BacT/Alert3D rapid blood culture system,strains isolated were taken to VITEK-2 automatic microbiological analysis/sensitivity system for identification and drug susceptibility testing.Drug susceptibility results were analyzed using WHONET 5.3 software.RESULTS Totally 435 pathogen were isolated from 4028 cases of blood culture sample and the positive rate was 10.8%.195 Gram-negative bacteria strains accounted for 44.8%,mainly Escherichia coli,Klebsiella pneumoniae,Burkholderia cepacia,Acinetobacter baumannii,and Pseudomonas aeruginosa.Gram-positive bacteria accounted for 49.9%;mainly Staphylococcus epidermidis,S.haemolyticus and S.aureus dominated.Fungi were 23 strains(5.3%),mainly Candida albicans.Among them,extended-spectrum ?-lactamases(ESBLs) produced by E.coli and K.pneumoniae strains were 43.9% and 48.8%,respectively.Meticillin-resistant S.aureus and coagulase-negative staphylococci were 35.3% and 72.9%,respectively.But vancomycin-resistant S.aureus was not found.CONCLUSIONS The bacteria identification detected in blood culture class is quite complicated,and the drug resistance is high.Laboratories should increase the detection rate of bacterial culture and provide drug monitoring results for the clinics on time based on CLSI norms.Clinicians should use the antibiotics reasonably based on the drug susceptibility results in order to reduce nosocomial infections and the emergency of multiple drug-resistant strains.

Objective To study the effectiveness and safety of methods of transurethral bipolar plasmakinetie prostatectomy for benign prostatic hyperplasia with large volume.Methods The transurethral bipolar plasmakinetic prostatectomy with Nesbit (Nesbit group,45 cases)and prying-up technique (pryhag-up group,60 cases)were performed in 105 patients of the prostatic volume of more than 60 g.The results could be obtained by comparing operative time,intraoperative and postoperative blood loss and the time of postoperative sustained washing of the bladder between the two groups.Results In Nesbit group,the efficiency of average cutting gland was (0.79±0.17)g/min,the average intraoperative blood loss was (3.87± 1.09)ml/g,the decrease in postoperative Hb within 24 hours was (6.84±3.96)g/L,the average time of postoperative continuous washing of the bladder was 72 hours,8 patients were given by blood transfusion.In prying-up group,the corresponding data were(1.16±0.20) g/min,(1.60±0.64)ml/g,(3.87±2.33 )g/L,36 hours respectively,none of patients was given by blood transfusion.There were statistically significant in two groups(P＜0.05).Conclusions The adoption of prying-up is more favorable compared with Nesbit method in the aspects such as less blood loss,shorter operating time,less lotion,more thorough resection of the gland,higher security.It is conducive to delivering lecture,and it enables the standard operational procedure available.

Objective To investigate the clinical status of 1242 patients with diabetic kidney diseases (DKD) during their first hospitalization,and to analyze the risk factors of prognosis,so as to provide reference for clinical practice. Methods Retrospective case-control study was performed.Clinical data of 1242 patients diagnosed as DKD in first hospitalizaton from January 2003 to December 2008 were reviewed,and patients were followed up to realize the prognosis.Multiple regression analysis was carried out to screen the risk factors. Results Most of the patients were Mogensen stage Ⅳ or Ⅴ in their first hospitalization,accounting for 77.2％.24.8％ of cases was complicated with cardiocerebrovascular diseases.Scr of 36.6％ patients was higher than 176.8 μmol/L.One way ANOVA indicated that diabetes course,hemoglobin,serum albumin,Scr and Charlson index were significantly different among Mogensen stage Ⅲ, Ⅳ,Ⅴ patients.Logistic regression showed that age,albumin,Scr,cardiocerebrovascular diseases and Chalson index were risk factors for death in DKD patients (OR =1.057,0.908,1.002,2.006,1.371),but sex,diabetes course and hemoglobin were not risk factors,which was in accord with the resuh from 416 non-dialysis patients.Multiple linear regression analysis revealed serum albumin level was positively correlated with survival in non-dialysis DKD patients (P=0.003).The mean survival time was only 1.2145 year in 162 non-dialysis dead patients. Conclusions DKD patients in our hospital refer quite late,usually with poor conditions and complications.Most of DKD patients are Mogensen stage Ⅳ or Ⅴ in the first hospitalization.Age,serum albumin,Scr,cardiocerebrovascular diseases and Charlson index are risk factors of death,while gender,diabetes course and hemoglobin are not significantly correlated with death.In addition,serum albumin is positively correlated with survival time.Early diagnosis and management of risk factors are crucial for improving the prognosis of DKD patients.

Objective To investigate the cross-talk between extracellular signal-regulated kinase (ERK) and nuclear factor κB (NF-κB) signal transduction pathways in A375 human melanoma cells.Methods Cultured A375 cells were randomly divided into 5 groups:control group receiving no treatment,two U0126 (a selective inhibitor of the ERK signaling pathway) groups treated with U0126 of 10 and 5 μmol/L,and two BMS-345541 groups treated with BMS-345541 of 10 and 5 μmol/L.After 24-hour treatment,Western blot and reverse transcription PCR were performed to measure the protein expressions of NF-κB P65,phosphorylated IκBα (p-IκBα),ERK1/2,as well as p-ERK1/2,and the mRNA expressions of NF-κB P65 and ERK1,respectively.One-way analysis of variance and least significant difference (LSD)-t test were carried out for statistical analysis.Results After 24 hours of treatment with U0126 of 10 and 5 μmol/L,a significant decrease was noted in the relative expression level of NF-κB p65 protein (0.60 ± 0.04 and 0.56 ± 0.06 vs.1.54 ± 0.15,both P＜ 0.01) and mRNA (0.79 ± 0.05 and 0.75 ± 0.04 vs.0.86 ± 0.05,both P ＜ 0.01),but a statistical increase in that of p-IκBα protein (0.90 ± 0.05 and 0.70 ± 0.02 vs.0.61 ± 0.03,both P ＜ 0.01) in the two U0126 groups compared with the control group; significant differences were observed in the expression level of p-IκBo protein (P ＜ 0.01) but not in that of NF-κB p65 protein (P ＞ 0.01) between the two U0126 groups.The relative expression levels of ERK1/2 and p-ERK1/2 proteins as well as ERK1 mRNA were significantly higher in the control A375 cells than those in the cells treated with BMS-345541 of 10 μmol/L (0.73 ± 0.07,0.75 ± 0.09,1.51 ± 0.02,all P ＜ 0.01),but similar to those treated with BMS-345541 of 5 μmol/L (0.94 ± 0.11,0.99 ± 0.04,1.62 ± 0.03,all P ＞ 0.05).Conclusion There is a cross-talk between ERK and NF-κB signal transduction pathways in A375 melanoma cells.