ObjectiveTo investigate the correlation between procalcitonin (PCT), C-reactive protein (CRP) and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score and sequential organ failure assessment (SOFA) score, and to investigate the value in assessment of PCT and CRP in prognosis in patients with sepsis.Methods Clinical data of patients admitted to intensive care unit (ICU) of Changzheng Hospital Affiliated to the Second Military Medical University from January 2011 to June 2014 were retrospectively analyzed. 201 sepsis patients who received PCT and CRP tests, and evaluation of APACHEⅡ score and SOFA score were enrolled. The values of PCT, CRP, APACHEⅡ score and SOFA score between survivals (n = 136) and non-survivals (n = 65) were compared. The values of PCT and CRP among groups with different APACHEⅡ scores and SOFA scores were compared. The relationships between PCT, CRP and APACHEⅡ score and SOFA score were analyzed by Spearman correlation analysis. Receiver operating characteristic (ROC) curve was plotted to assess the prognostic value of PCT and CRP for prognosis of patients with sepsis.Results Compared with survival group, the values of PCT [μg/L: 11.03 (19.17) vs. 1.39 (2.61), Z= -4.572,P< 0.001], APACHEⅡ score (19.16±5.32 vs. 10.01±3.88,t = -13.807,P< 0.001) and SOFA score (9.66±4.28 vs. 4.27±3.19,t = -9.993,P< 0.001) in non-survival group were significantly increased, but the value of CRP was not significantly different between non-survival group and survival group [mg/L: 75.22 (110.94) vs. 56.93 (100.75),Z = -0.731,P = 0.665]. The values of PCT were significantly correlated with APACHEⅡ score and SOFA score (r1 = 0.373,r2 = 0.392, bothP< 0.001), but the values of CRP were not significantly correlated with APACHEⅡscore and SOFA score (r1 = -0.073,P1 = 0.411;r2 = -0.106,P2 = 0.282). The values of PCT rose significantly as the APACHEⅡ score and SOFA score became higher, but the value of CRP was not significantly increased. When APACHEⅡ score was 0-10, 11-20, and> 20, the value of PCT was 1.45 (2.62), 1.96 (9.04), and 7.41 (28.9)μg/L, respectively, and the value of CRP was 57.50 (83.40), 59.00 (119.70), and 77.60 (120.00) mg/L, respectively. When SOFA score was 0-5, 6-10, and> 10, the value of PCT was respectively 1.43 (3.09), 3.41 (9.75), and 5.43 (29.60)μg/L, and the value of CRP was 49.30 (86.20), 76.00 (108.70), and 75.60 (118.10) mg/L, respectively. There was significant difference in PCT between any two groups with different APACHEⅡ and SOFA scores (P< 0.05 orP<0.01), but no significant differences in CRP were found. The area under the ROC curve (AUC) of PCT for prognosis was significantly greater than that of CRP [0.872 (95% confidence interval 0.811-0.943) vs. 0.512 (95% confidence interval 0.427-0.612),P< 0.001]. When the cut-off value of PCT was 3.36μg/L, the sensitivity was 66.8%, and the specificity was 45.4%. When the cut-off value of CRP was 44.50 mg/L, the sensitivity was 82.2%, and the specificity was 80.3%.Conclusions Compared with CRP, PCT was more significantly correlated with APACHEⅡ score and SOFA score. PCT can be a better indicator for evaluation of degree of severity, and also prognosis in sepsis patients.

Objective To explore the effect of training course based on the model of practical performance which was designed to improve the humanistic caring ability of nursing postgraduates. Methods After conceived, designed and trained the nursing postgraduates, we combined quantitative research method and qualitative research method to understand the effect and the true feelings of the students after taking the training. Results “Humanistic Caring Ability of Nursing Undergraduates Assessment scale (HCANU)“was used before and after 22 nursing postgraduates accepted the training. After training, their total score (86.06±5.16) was higher than before (67.70±5.00) (t=2.665, P<0.01) and 8 dimensions scores were respectively higher than before(P<0.01 or 0.05). The course has improved the humanistic caring ability of nursing postgraduates, enhanced their empathy of nursing objects and promote self-reflection. Conclusions This training course based on the model of practical performance helps to improve the humanistic caring ability of nursing postgraduates and cultivate their humantistic quality.

Objective To investigate the affect of rhTNFR:Fc on the postoperative recovery of patients with inflammatory arthritis after arthroplasty. Methods Patients with inflammatory arthritis undergoing arthroplasty were included and divided into rhTNFR:Fc group (rhTNFR:Fc only or combined with conven-tional DMARDs) and conventional DMARDs group (monotherapy with or combination of conventional DMARDs). We retrospectively analyzed the incidence of postoperative infection, wound healing time, the febrile period (body temperature ≥37.5 ℃) and the duration of antibiotics treatment after arthroplasty. x2 test and t test were used for statistical analysis. Results Sixty-seven patients were included, 18 in the rhTNFR: Fc group and 49 in the conventional DMARDs group. One postoperative infection occurred in rhTNFR :Fc group but none in the DMARDs group. There was no significant difference by Fisher's exact test (P＞0.05). The febrile duration was (4±3) days in the rhTNFR :Fc group and (3±3) days in the conventional DMARDs group, the difference was not statistically significant (P＞0.05). The wound healing time was (14.0±3.1) days in the rhTNFR :Fc group and (14.7±2.9) days in the conventional DMARDs group, which was not statistically different(P＞0.05). The duration of antibiotics treatment after operation was (14.8±9.3) days in the rhTNFR: Fc group and (10.3±2.7) days in the conventional DMARDs group, the difference was statistically significant (P＜0.05). Conclusion Using rhTNFR:Fc during perioperative period in patients with inflammatory arthritis does not increase the risk of infectious complications or extending wound healing time and the febrile duration.

Objective To investigate the team-based learning(TBL) combined with microteaching method in the teaching of undergraduate first aid courses. Methods Totally72 undergraduate nursing students randomly divided into the observation group and control group each including 36 cases by lottery. Nursing students in the observation group received TBL combined with microteaching, while nursing students in the control group received conventional teaching. Results The average score of objective structured clinical examination (OSCE) in observation group was (86.66±5.09) points and the control group was (84.47 ± 5.78) points, the difference was statistically significant (t=3.38, P<0.05). After training,the total score of Critical Thinking Disposition Inventory Chinese Version (CTDI-CV) and 5 dimensions′were (329.39 ± 25.56), (49.33 ± 4.42), (45.11 ± 6.08), (48.17 ± 6.14), (51.08 ± 6.55), (45.06 ± 5.19) points in observation group, and (325.17±27.26), (48.19±4.97),(44.42±6.30), (47.47±6.27), (50.36±7.12), (44.56± 5.13) points before training, the differences were statistically significant (t=2.11- 4.95, P<0.05). Conclusions TBL combined with microteaching method in first aid training course can improve the undergraduate nursing students′first aid ability, critical thinking ability.

Objective To explore the effects of modified herringbone-Trendelenburg position during gynecological laparoscopic operation of the elderly. Methods A total of 60 elderly patients undergoing gynecological laparoscopic operation under general anesthesia were recruited and assigned to the observation group (30 cases) and control group (30 cases) by random digits table method with 30 cases each according to admitting time;Patients in the control group were placed in conventional Trendelenburg position, while the patients in the observation group were positioned in modified herringbone-Trendelenburg position .Intraocular pressure (IOP) were measured in the patients at anesthesia induction (T1),5 minutes after general anesthesia in supine position (T2) , and 5 minutes after pneumoperitoneum while in the operation position (T3) , every 30 minutes (times 4 to 11), while supine at the end of pneumoperitoneum (time 12) and before awakening (time 13);Patients were followed up at 24 h and 48 h after surgery, researcher investigate and record the scores of the Operation Position Comfort Questionnaire, the situation of the pain in the shoulder and postoperative complications of the lower limbs. Results There was no statistically significant difference (t=-1.098,-0.772,-0.656, P>0.05) of the IOP at T1, T2, T13. The IOP in the observation group had statistically significant difference compared with the control group at T3 to T12 (t=6.523-19.866, P<0.01). The incidence rate of the postoperative complications of the lower limbs in the observation group was 6.7%(2/30) lower than 26.7%(8/30) of the control group (χ2=4.320, P<0.05) and the VAS scores of the patients in the two groups was statistically significant (t=2.471, P<0.05). The incidence rate of the postoperative shoulder pain in the observation group was 10.0%(3/30) lower than 43.3%(13/30) of the control group (χ2=8.523, P<0.01), and the Visual Analogue Scale scores of the patients in the two groups was statistically significant (t=3.575, P<0.05).The scores of the Operation Position Comfort Questionnaire in the observation group was higher than the control group (t=-2.319, P<0.05). Conclusions Modified herringbone- Trendelenburg position can reduce the elevation of intraocular pressure in elderly patients without affecting the operation ,and effectively improve the comfort of the operation position of the patients, reduce the incidence rate of the shoulder pain and postoperative complications of the lower limbs, is conducive to the operation safety of elderly patients.

Objective To evaluate the effects of peer-assisted learning (PAL) combined with peer feedback in the teaching of operating room nursing. Methods 80 undergraduate nursing students in grade 2012 were assigned to the experimental group (n=40) and control group (n=40) by random number table method. The content of this training is operating room nursing skills. Nursing students in the experimental group received peer-assisted learning combined with peer feedback teaching,while nursing students in the control group received conventional teaching. Results The students′examination scores of the experimental group was (92.25 ± 3.43) obviously higher than that of the control group (89.20 ± 3.55) U=609.500, (P < 0.05), the students' evaluation of the new teaching method was higher than that of the control group (t=-2.76--2.27, P<0.05 or 0.01). Conclusions Peer-assisted learning combined with peer feedback can improve the operational capability of the students in operating room, is helpful to stimulate students′subjective initiative and improve the teaching quality of nursing.

Objective To study the therapeutic effect of rheum(Chinese herbal medicine) preparation made by using ultrasonic technique on pro-inflammatory cytokines and sepsis in rats.In order to offer novel measure for the treatment of critically ill patients.Methods Firstly, rheum sterile solution was prepared through ultrasonic technique.Secondly, fifty healthy male SD rats were randomly(random number) divided to CLP group and rheum group.Moderate degree of sepsis model was established by using cecal ligation and puncture(CLP).Rats in group rheum received the liquid rheumpreparation via intragastric administration, while rats in group CLP received saline instead.The 7-day survival rate was recorded and was compared between two groups.In addition, another fifty-four rats were randomly(random number) divided to sham group, CLP group and rheum group(n=18 in each group).CLP was performed to induce sepsis in CLP group and rheum group.Then rats in rheum group received rheum sterile solution via intragastric administration, while rats in CLP group received saline instead.At 12 hours, 24 hours and 48 hours after modeling, six rats in each group were randomly sacrificed.Serum TNF-α and HMGB1 levels were detected by ELISA method.Levels of RAGE, HMGB1 and NF-κB P65 in small intestine were detected by Western Blot.Results Level of anthraquinones extracted from rheum by ultrasonic technique was higher than that by conwentional decoction method.The 7-day survival rate of rats in rheum group(76%) was higher than that in CLP group(48%)(P<0.05).Compared with sham group, serum TNF-αand HMGB1 levels in CLP group and rheum group were significantly increased(P<0.05).TNF-α was significantly lower in rheum group than that in CLP group at each interval(P<0.05).At 12 hours after modeling, there was no significant difference in serum HMGB1 level between CLP group and rheum group(P>0.05).At 24 hours and 48 hours after modeling, serum HMGB1 levels were significantly lower in rheum group than those in CLP group(P<0.05).Compared with sham group, protein levels of HMGB1, RAGE and NF-κB in small intestine were elevated in CLP group and rheum group at 48 hours after modeling(P<0.01), while protein levels of above biomarker were higher in CLP group than those in rheum group(P<0.05).Conclusions Rheum sterile solution could down-regulate the level of pro-inflammatory cytokines, modulate the inflammatory response, and improve the survival rate in rats with sepsis.

To investigate how Chinese rheumatologists treated patients with rheumatoid arthritis (RA). We performed a survey on the choices of first-line and second-line anti-RA therapies, prescription of methotrexate and glucocorticoids, assessment of disease activity and frequencies of follow-up at the Asia Pacific League of Associations for Rheumatology meeting 2016 in Shanghai. The majority (85.1%) of rheumatologists preferred methotrexate as first-line treatment. As alternative agents, 71.0% rheumatologists chose leflunomide or sulfasalazine. If methotrexate was not tolerable, only 8.6% rheumatologists would switch to parenteral administration. After failure of responding to methotrexate, 62.0% rheumatologists recommended to change or combine other conventional synthetic disease modifying anti-rheumatic drugs (DMARDs). Etanercept was the most popular biological option in 65.2% rheumatologists. Almost all (97.3%) rheumatologists prescribed methotrexate at an initial dose of 7.5 to 15 mg/week and 73.8% rheumatologists at a maximum of 10 to 15 mg/week. There were 49.3% rheumatologists prescribing oral glucocorticoids at first-line therapy. Surprisingly, 42.6% rheumatologists never or rarely assessed disease activity in daily work. For patients having achieved remission, 74.2% rheumatologists would follow up them every 1 to 3 months. This study suggests that most Chinese rheumatologists treat RA patients consistent with international guidelines, while the maximum dose of methotrexate, glucocorticoid as first-line treatment, assessment of disease activity and follow-up frequency are locally modified.

With their capability to undergo unlimited self-renewal and to differentiate into all cell types in the body, human embryonic stem cells (hESCs) hold great promise in human cell therapy. However, there are limited tools for easily identifying and isolating live hESC-derived cells. To track hESC-derived neural progenitor cells (NPCs), we applied homologous recombination to knock-in the mCherry gene into the Nestin locus of hESCs. This facilitated the genetic labeling of Nestin positive neural progenitor cells with mCherry. Our reporter system enables the visualization of neural induction from hESCs both in vitro (embryoid bodies) and in vivo (teratomas). This system also permits the identification of different neural subpopulations based on the intensity of our fluorescent reporter. In this context, a high level of mCherry expression showed enrichment for neural progenitors, while lower mCherry corresponded with more committed neural states. Combination of mCherry high expression with cell surface antigen staining enabled further enrichment of hESC-derived NPCs. These mCherry(+) NPCs could be expanded in culture and their differentiation resulted in a down-regulation of mCherry consistent with the loss of Nestin expression. Therefore, we have developed a fluorescent reporter system that can be used to trace neural differentiation events of hESCs.
Animals ; Cell Differentiation ; Cell Line ; Embryonic Stem Cells ; cytology ; metabolism ; transplantation ; Gene Knock-In Techniques ; Genes, Reporter ; Homologous Recombination ; Humans ; Luminescent Proteins ; genetics ; Mice ; Mice, SCID ; Nestin ; genetics ; Neural Stem Cells ; cytology ; metabolism ; Neurons ; cytology ; metabolism ; Teratoma ; pathology

Objective? To explore the effects of health failure mode and effect analysis(HFMEA) in the safety management of intraoperative radiotherapy(IORT). Methods? The HFMEA group was set up to analyze the potential risks of breast cancer patients undergoing intraoperative radiotherapy from January 2014 to April 2018. The group listed the failed modes that need to be improved, identified the invalid steps that need intervention, determined the causes of the failure and calculated the risk priority number (RPN), created the safety management plans and put them into action. Finally, the outcomes were observed and analyzed. Results? After the improvement of the HFMEA, the patients' healing rate of stage-Ⅰ incision increased from 85.42% to 98.18% with statistical significance (χ2=4.184,P＜0.05). The patients' satisfaction degree scored (98.21±3.98)from the patients and (99.02±5.89)from the surgeons, both higher than those before improvement with statistical significance (t=5.24, 3.07;P＜0.05). After the improvement, the absorbed and scattered dose of the affected and contralateral skin of thyroid gland, and the absorbed and scattered dose of the affected and contralateral skin of lens were lower than those before improvement. Conclusions? Through prospectively controlling non-standard operation behaviors and optimizing the process, the application of HFMEA in the intraoperative irradiation after conservative surgery for breast cancer can ensure patients' safety and improve the quality of surgeries.