Objective To explore the contents and modes of community nursing training and improve community care quality.Methods The training course and assessment standard were worked out according to practical work in community health service centers,including basic nursing skills,community first aid skills,hospital infection control skills,preventive health care skills and community document management skills.Toally 58 nurses from 11 community health service centers were trained for 36 hours from January to June,2016 and tested before and after training to assess the effect of training.Result After training,the scores on all skills were significantly higher than those before training (all P＜0.01).Conclusion Regular and practical training and management are the guarantee for the improvement of the community care quality.

Objective To explore the inhibitory effects of endogenous hydrogen sulfide, a novel and important gas-eous transmitter generated in mammalian tissues mainly by cystathionine β-synthase (CBS) or cystathionineγ-lyase (CSE) on the apoptosis of the rat hepatic BRL cell line in physiological condition. Methods BRL cells were cultured, and divid-ed randomly into several groups in different phases of the experiment, including negative-siRNA (control) group, CBS siRNA (CBS 1~3) group and CSE siRNA (CSE 1~3) group, which were used to select the most efficient sequences of siRNAs at 48 or 24-hour transfection. Solution group and (CBS+CSE) siRNA group were added to detect the variation of apoptosis. The BRL cell line was observed and evaluated at 0, 4, 8, 12, and 24 hrs after siRNA transfection. When the mechanisms of the apoptosis were detected, CBS/CSE siRNAs were transfected individually or jointly into BRL cells, and compared with nega-tive-siRNA group to examine the variation. The genic and protein expression of CBS/CSE were detected by RT-PCR and Western blot assay. After transfection of CBS/CSE siRNA, the apoptosis of BRL cells was detected by Hoechst stain and flow cytometry (FCM). The mitochondrial membrane potential (MMP) changes were observed by fluorescent staining. Western blot assay was used to examine the protein expression of intracytoplasm cytochrome C (Cyt C) and cleaved-caspase 3. Re-sults CBS and CSE were observed in BRL cells. After transfection of CBS/CSE siRNA, endogenous H2S generation de-creased and the apoptosis of BRL cells increased. Accordingly, the expression of intracytoplasm-Cyt C and cleaved-caspase 3 increased. Conclusion The inhibition of endogenous H2S synthesis induced the apoptosis of BRL cells under physiologi-cal condition, which may be involved in mitochondrial pathway of apoptosis.

Objective To study the relationship between the level of fluoride in urine and the prevalence of dental caries in children before and after the defluoridation, and to provide a basis for assessment of the effects of defluoridation projects and for control of dental caries.Methods Wamiao Village, in Jiangsu Province, a formerly severe endemic fluorosis area, was selected to carry out the study.All children aged 8-13 years old before the defuoridation were investigated from September to November in 2002, and children 8-10 years old who were born after the defluoridation were investigated from September to November in 2013.Urinary fluoride level of the children and the prevalence of dental caries were determined, and their relationships were analyzed.The urina sanguinis samples of children were collected in the morning, and the urine fluoride level was tested using the fluoride ion selective electrode.Dental caries diagnoses was referenced to Dental Caries.Results Totally children's urine samples were 236 and 68 respectively before and after defluoridation.Urinary fluoride level of the children was significantly decreased from (3.53 ± 1.81)mg/L (before defluoridation) to (1.39 ± 0.66)mg/L (after defluoridation, t =9.506, P ＜ 0.01);the prevalence of dental caries was increased from 52.73％ (29/55, before defluoridation) to 63.24％ (43/68, after defluoridation), however, the difference was not significant (x2 =1.383, P ＞ 0.05).The DMFT increased from 1.18 (before defluoridation) to 1.68 (after defluoridation), and the epidemic levels of dental caries were all at lower levels.The relationship between urine fluoride level and the prevalence of dental caries as well as the DMFT before defluoridation was a U-shape dose-response curve;which was gone after defluoridation.Conclusions The urinary fluoride level is significantly decreased after defluoridation for 10 years, the prevalence of dental caries is increased but not significantly.The results of this study indicate that the measure of fluoridation to prevent dental caries needs to be further validated.

Objective To establish a gestational diabetes rat model by feeding the rats with high-fat diet.Methods A total of 55 female SD rats were divided into four groups:NV group,NP group,FV group and FP group.Three months after normal feeding,the female rats in NP and FP group were put into the same cage with the male rats at the ratio of 2∶1 and were given high-fat diet or normal diet as usual.Before pregnancy and day 1,7,14,20 in pregnancy,fasting plasma glucose and body weight of rats were detected.The fasting serum insulin and serum c-peptide levels were monitored by enzyme immunoassay and insulin resistance index was calculated.At late pregnancy,glucose tolerance and the indicator of fat were tested.Liver and pancreas were dyed to be observed under microscope.FResultS Body weights of the rats raised with high-fat diet were significantly higher than those of control group and body weight during pregnancy significantly increased (P＜0.05).Fasting glucose,fasting insulin and serum C-peptide in FP group were signifieantly higher than those in NP group and insulin resistance was evident (P＜0.05).The area under curve of GTT in FP group was significantly larger (P＜0.05).The levels of serum lipids in FP group were higher than those in normal group.CorncluSiornS The gestational diabetes rat model induced by high-fat diet can be successfully established.The model presents major pathophysiological manifestations of GDM and can be used as a good model of GDM in relevant research.

Objective To observe the effects of different interventions on the body mass index (BMI) and body fat content in overweight and obese adolescents, with an attempt to design reasonable weight relief program.Methods Totally 67 overweight or obese adolescents from a middle school of Beijing were randomly divided into three groups: control group ( n = 16 ), diet intervention group ( n= 22), and combined interventions group ( n =29). The changes of BMI and body fat rate (BFR) were observed. Results BMI significantly decreased after interventions ( diet intervention group: P = 0. 000; combined interventions group: P = 0. 018 ); the change of BMI in diet intervention group was significantly larger than that in control group ( P = 0. 035 ). The trunk and body BFRs also significantly decreased after interventions (diet intervention group: P=0. 000, P = 0. 013; combined interventions group: P = 0. 000, P = 0. 000 ); the changes of trunk and body BFRs were significantly larger in combined interventions group than those in control group ( P = 0.005, P = 0. 003 ). Conclusion Diet intervention and combined interventions are both effective in achieving weight loss in adolescents, and combined interventions have superior effectiveness.

Objective To analyze the risk factors for anastomotic leak after total gastrectomy in gastric cancer patients and its impact on patients survival.Methods A total of 1 547 gastric cancer patients who underwent curative resection between 1999 to 2016 were enrolled.Results The anastomotic leak occurred in 106 of 1 547 patients;and it was happened at a median of (6.0 ± 2.1) day after surgery.The median postoperative hospital stay was (9 ± 3) days for non-anastomotic leak,lower than patients for anastomotic leak with (15 ± 5) days.The anastomotic leak was significantly correlated with age,lung function,BMI,serum albumin,intraoperative blood loss,operative time,smoking and diabetes (P ＜0.05).Multivariable analysis showed that the anastomotic leak was significantly correlated with diabetes,lung function,smoking (P ＜ 0.05).The 30-day mortality with anastomotic leak was lower than patients without leak.The 3'-and 5-year survival rate of patients with anastomotic leak were 53.9％ and 47.7％,significantly lower than those of 69.4％ and 58.5％ without anastomotic leak (P ＜ 0.05).By univariate analysis that BMI,pathological stage,tumor size,serum albumin,anastomotic leak were factors affecting prognosis (P ＜ 0.05).While multivariate analysis showed that anastomotic leakage was independently associated with worse overall survival.Conclusion Anastomotic leakage in patients who underwent total gastrectomy increases the 30-day mortality and associated with poorer 5-year survival.

Multiple sclerosis (MS) is an idiopathic inflammatory demyelinating diseases of the central nervous system, the underlying cause of which has not been cleared. Previous studies have shown that the pathogenesis of MS is related to the destruction of blood brain barrier, furthermore the drugs used to treat MS have a certain protective effect on the function of blood brain barrier. Therefore, this review combines the research progress at home and abroad to clarify the relationship between the blood brain barrier and MS in pathogenesis and treatment, proposing possible orientation of development.

Objective To investigate the application of the Healthcare Failure Mode and Effects Analysis ( HFMEA) system to reduce occupational exposure of HIV for surgical staff.Methods Based on the method of HFMEA system utilization, the occupational exposure prevention team for surgical medical staff had been set up to analyze the failure mode and the causes of potential risks,and to calculate the Risk Priority Number ( RPN) .In this study some improvement measures had been carried out, aiming at the failure mode and priority problems.We counted and implemented circumstances of exposure before and after the HFMEA implementation, and evaluated the appraisement of surgical staffs for the implementation of HFMEA.Results Before administration of HFMEA,twenty two HIV-infected patients were admitted in our institution,of which six patients caused occupational exposure, five cases of blood-borne exposure, and one cases of mucous membrane exposure.After administration of HFMEA,thirty HIV-infected patients were admitted, of which only one patient caused occupational exposure, for blood-borne exposed type.The exposure rate before and after HFMEA administration had statistical significance (χ2 =4.36, P <0.05 ).Surgical staffs rendered a positive appraisement for HFMEA administration and 32 (100) staffs recommended it to enhance the recognition of HIV patients contact safety protection and minimize HIV occupational exposure.Conclusions Could reduce occupational exposure rate for surgical medical staff by usage of HFMEA to evaluate and reduce occupational exposure of HIV patients, safe injection, personal protective equipment and medical waste management.

Objective The purpose of this study was to explore common complications and their clinicopathological features in pediatric liver transplantation.Methods Clinical and pathological data of 240 liver biopsies from 168 children that conducted liver puncture from January 2015 to May 2018 in Tianjin First Central Hospital was retrospectively analyzed.We comprehensively analyzed incidence rate and pathological features of various complications,and correlations between acute rejection and C4d staining result or Banff score.Results A total of 86.67％ (208/240) liver biopsies could be definitely diagnosed with incidence rate of main complications in descending order as follows:T cell mediated rejection (TCMR) 60.57％ (126/208),drug-induced liver injury (DILI) 17.31％ (36/208),biliary complication 8.17％ (17/208),vascular complication 3.37％ (7/208),ischemia/reperfusion injury (IRI) 2.88％ (6/208),antibody mediated acute rejection (AMR) 1.92％ (4/208),HBV infection 1.92％ (4/208),non-alcoholic fatty liver disease (NAFLD) 1.44％ (3/208),chronic rejection (CR) 0.96 ％ (2/208) and HCV infection 0.48 ％ (1/208).TCMR and AMR in acute rejection (AR) accounted for 96.92％ (126/130) and 3.08％ (4/160),and into(portal-based,PB)type TCMR accounted for 96.03％(121/126) with the detectable rate of BP type subtype TCMR of 26.45％(32/121)within 30 d.There were 65.87％ (83/126)、25.40％ (32/126) 和4.76％ (6/126) of BP TCMR samples with "Banff ACR RAI" score within 3-5,6-7 and 8-9,and RAI score was negatively correlated with postoperative time (r =0.127,P =0.084).The incidence rate of central perivenulitis (CP) and portal eosinophils infiltration (PEI) in BP TCMR was 63.63％ (77/121) 和43.80％ (53/ 121),respectively,additionally,the PEI level was positively correlate with RAI score (P＜0.05).CP TCMR and AMR occurred within 30d-365 d and 8 d-180 d,respectively postoperative,while,the two CR occurred at 1095 d and 1335 d postoperative,and significant correlation was strikingly observed between rejection subtype and postoperative time (Z =9.231,P =0.026).C4d positive rate was 10％ (24/240),which was associated with Banff score and postoperative time,besides,C4d score was also correlated with rejection subtype and RAI score.The occurrence of DILI was mainly at time of ＜90 d or ＞180 d postoperative,and the detectable rate of biliary complication within 180 d postoperative was 82.35％ (14/17),IRI Appear in ＜30d.Hepatic artery complication account for nearly 57.14％ (4/7),occurrence time is ≤90 d.Occurrence of HBV infection,CMV infection and NAFLD were mainly at ＞365 d,＜90 d and ＜365 d,respectively.Conclusion There were lots of differences in clinical and pathological features among multi pediatric liver transplantation complications.Liver puncture plays an important role in rejection subtype classification and grading,as well as in non-rejection complications identification.