The authors have applied the Omaha system in six different researches conducted in Hong Kong and mainland China in the last ten years. These researches have been conducted using different client groups,specialty nurses,and in the hospital,clinic and community settings. The Omaha system was found to be instrumental in serving as a conceptual framework for study,designing the intervention protocol,identifying clients' health problems,defining nursing interventions and evaluating research outcomes. The Omaha system is a valuable tool for research and practice and is worth exploring further for its application in mainland China,particularly in the areas of community nursing and transitional care.

A novel method for assaying the enzymatic activity of ribosome-inactivating proteins(RIPs) has been developed.The principle of the method is based on that RIP can remove some adenine bases from double-stranded supercoiled DNA molecules,subsequently,the deadenylated DNA was cleaved into nicked and linear form.After treatment with acidic aniline,the deadenylated DNA was degraded into many small fragments,and run out of the gel.The enzymatic activities of two RIPs(trichosanthin and cinnamomin) were tested using this method,the limit of sensitivity is about 50 ng(trichosanthin) and 5 ng(reduced cinnamomin) .It should be emphasized that the merit of this method is to avoid the preparation of ribosome.

Objective To evaluate the detection performance of the cobas8000 c702 fully automatic biochemical analyzer for de‐tecting the second generation Roche urine trace albumin (ALBU2) .Methods (1) The precise evaluation :with the allowable error stipulated by CLIA 88 as the basis ,the requirements were the repeat precision <1/4TEa ,and intermediate precision <1/3TEa;(2) the linear range and the evaluation of the reportable range :the EP6‐A scheme was adopted ,and extend to calculate the average re‐covery rate of dilution ,the clinical reportable range was evaluated by the average dilution recovery of 90% -110% ;(3) the carry o‐ver pollution assessment :the carry over pollution of serum albumin on urine trace albumin detection was evaluated by the judgment standard of carry over pollution rate of 0 .5% ;(4)the methodological comparative analysis :with SIEMENS BN Ⅱas the reference system ,the Roche Cobas 8000 C702 and the BN2 results were performed the correlation contrastive analysis .Results The repeat precision :low concentration CV=1 .98% .high concentration CV=1 .64% ;intermediate precision :low concentration CV=4 .35% , high concentration CV=1 .20% ;the linear range verification :the measurement range 5 .6-413 .55 mg/L ;clinical reportable range :in the maximum diluted multiples of 30 times ,the clinical reportable range was 5 .6-12 406 .5 mg/L ;the carry over pollution rate :serum albumin (42 .6 g/L) on urine trace albumin(6 .9 mg/L) ,the carry over pollution rate was 0 .28% ;the indoor comparison :in the concentration within 200 mg/L ,the regression line was Y=0 .896 X+5 .049 ,the correlation coefficient r2 =0 .994 4 ,the system shift was passed at the medical decision level .When the specimen concentration within 201-413 .55 mg/L ,the regression line was Y=0 .848X-10 .44 ,the correlation coefficient r2 =0 .917 ,the system shift was not passed at the medical decision level .Conclusion The detection of the Roche ALBU2 in the Cobas 8000 C702 platform can meet the clinical needs ,the comparison among different instruments has difference in different concentration ranges ,therefore the independent reference ranges should be established ac‐cording to the each instrument system .

Objective To evaluate the effectiveness of clinical pathways for pediatric asthma.Methods The literatures on the application of clinical pathways for pediatric asthma were collected in the databases such as PubMed,Cochrane Library,Ovid,ScienceDirect,EBSCOhost,CNKI,Wanfang and CBM while a manual search was added.The search was performed from 1980 to 2014.Two reviewers independently screened references,extracted data and assessed the risk of bias.Data was pooled and analyzed by using Revman 5.2 version.Results Eleven studies involving 2 207 participants from nearly 1 048 relevant studies met the inclusion criteria.1 174 participants were in the clinical pathway group while the other 1 033 participants were in the control group.Meta-analysis result showed that patients with asthma in a clinical pathway had a shorter length of stay,less medical cost,reduced rate of emergency room visits,and improved health education.However,clinical pathway did not appear to reduce readmission.Conclusions Clinical pathway can significandy reduce the length of hospital stay,cost,rate of emergency room visits and improve health education.

AIM:To explore the effect of aldosterone on visfatin gene expression and secretion in 3T3-L1 preadipocytes or adipocytes.METHODS:Aldosterone at concentration of 10-8 or 10-6 mol/L with or without 10-6 mol/L spironolactone was added to cultured 3T3-L1 preadipocytes or adipocytes for 24 h or 48 h.The mRNA levels of visfatin and mineralocorticoid receptor were measured using real time PCR.The concentration of visfatin in the culture medium was determined by ELISA.RESULTS:In 3T3-L1 preadipocytes treated with aldosterone,the mRNA expression of visfatin reduced and the mRNA expression of mineralocorticoid receptor(MR) increased,but the concentration of visfatin in culture medium was not regulated significantly by aldosterone.In adipocytes with aldosterone treatment,the mRNA expression of visfatin and visfatin concentration in culture medium reduced,and mRNA expression of MR increased.The effect of aldosterone was blocked by spironolactone to some extent.CONCLUSION:Aldosterone inhibits the gene expression and protein secretion of visfatin in 3T3-L1 adipocytes.

ObjectiveTo investigate the value of strain ratio (SR) in the diagnosis of Hashimoto's thyroiditis.Methods 116 patients who had been diagnosed clinically as Hashimoto' s thyroiditis were enrolled in the study.Those patients were classified into four groups:the hyperthyroidism group,the euthyroidism group,the subclinical hypothyroidism group,and the clinical hypothyroidism group.50volunteers with normal thyroid functions were enrolled as a control group.SR of the thyroid and sternocleidomastoid muscle of same side was calculated.The correlation coefficient between the elasiticity SR and the serum thyroid stimulating hormone (TSH) was evaluated and their differences in the diagnosis of Hashimoto's thyroiditis were compared.ResultsThe Spearman's correlation coefficient between the SR and the serum TSH was 0.605,which was significant (P =0.000).The SR increased in an ascending order among the group with hyperthyroidism,the control group,the group with euthyroidism,the group with subclinical hypothyroidism,and the group with clinical hypothyroidism.ConclusionsElastography SR is valuable way for evaluating the progression of Hashimoto's thyroiditis.

Objective To investigate the effects of clearing liver and purging the heart decoction( CLPHD) combined with methimazole on hormone levels in hyperthyroid rats. Methods Rats were administered with levothyroxine (600 μg·kg-1 ) for 3 weeks to establish the hyperthyroid model,and the serum contents of T3,FT3,T4,FT4,TSH and TRAb in hyperthyroid rats treated with CLPHD combined with methimazole were detected. Results Methimazole, CLPHD, and the combination therapy significantly reduced food intake,water intake and body temperature of the hyperthyroid rats. All treatments reduced levels of FT3, T4 and FT4 in hyperthyroid rats. Compared with the CLPHD mono-therapy, the combination therapy significantly lowered serum T4 in hyperthyroid rats,but not the TRAb level. Conclusion CLPHD combined with methimazole can obviously improve the function of thyroid gland in hyperthyroid rats.

Objective To develop an evidence-based community extended care model for patients with asthma.Methods Mixed research methods were applied to integrate best evidences:80 literatures were included in systemic review; 394 medical records were analyzed; 112 nurses admitted a test and a questionnaire to assess their competence on asthma care; clinical observation to both hospital and community centers were conducted; 6 multidisciplinary experts were consulted; and 100 patients admitted a questionnaire on patient needs and 17 of them were further interviewed.Results The nursing care model with the feature of hospital and community health service center collaborating to provide extended care for patients with asthma was established.Conclusions The development of a nursing care model for practice should be based on the current best evidence generating from the best research evidence,professional judgment on clinical practice requirement and patients' needs.

ObjectiveTo investigate the risk factors of metabolic syndrome ( MS ) in obese subjects.Methods A seven-year follow-up study was conducted in 413 simple obese subjects and 196 subjects with normal body weight who were recruited from community residents during physical examination in 2000.There was a 7 years follow-up.Anthropometrics,blood pressure,lipid profile,fasting blood glucose,and 2 h blood glucose after glucose loading were measured.Endothelium-dependent dilatation (EDD) test was also performed.Results Among 553 of 609 subjects who were followed up in 2007,there were 381 simple obese subjects ( simple obese group) and 172 normal weight subjects( normal weight group).Seven-year cumulative incidence of MS was 35.17％ in simple obese group and 8.14％ in normal weight group.In simple obese group,subjects with MS showed greater or higher levels of waist circumference( WC ),waist-hip ratio ( WHR ),triglyceride ( TG ),fasting plasma glucose ( FPG ),fasting insulin (FINS),and homeostasis model assessment for insulin resistance index (HOMA-IR) (all P＜0.05 ),and also decreased EDD( P＜0.05 ) as compared with those without MS.WC,WHR,and FINS were higher( all P＜0.05 ) and EDD was lower( P＜0.05 ) in subjects with MS of normal weight group than those without MS.Logistic analysis showed that the male gender,WC,WHR,FPG,HOMA-IR,and EDD were major risk factors of MS.Conclusion Central obesity,insulin resistance,and endothelial dysfunction are important independent risk factors for development of MS.

Objective To investigate relationship between adiponectin and cardiac damage induced by aldosterone in SD rats. Methods Male SD rats were treated with aldosterone infusion for 4 weeks, systolic blood pressure (SBP) was measured every week. At the end of experiment, the myocardial structure was observed, the levels of adiponectin in plasma and adiponectin mRNA expression of adipose tissue in epididymal fat pad were measured. 3T3-L1 adipocytes treated with 10-8 and 10-6 moL/L aldosterone for 24 and 48 h, adiponectin mRNA expressions and adiponectin concentrations in culture medium were measured. Results Aldosterone induced only a slight increase in the SBP of SD rats[(123±7)mm Hg, P<0.05]. However, aldosterone significantly induced cardiac ultrastructure changes, such as mitochondrial swelling and disordered internal structures. Furthermore, the level of plasma adiponectin decreased 22.8% after aldosterone treatment for 4 weeks ( P<0. 05 ). When 3T3-L1 adipocytes were treated with 10-8 and 10-6 mol/L aldosterone for 24 h, adiponectin concentrations in culture medium decreased 21.8% and 27. 2%, respectively (P < 0. 05); for 48 h, adiponctin mRNA expressions decreased 22.1% and 37.4%, respectively ( P<0. 05 ). The effect of aldosterone was reversed by spironolactone,which was partly independent of SBP. Conclusions Low level of adiponectin may be involved in cardiac damage induced by aldosterone in SD rats.