Objective To construct clinical thinking competence index system for undergraduate nursing students.Methods The study established the Clinical Thinking Competence Evaluation Index System through Delphi method.Results The evaluation index system included 5 level-1 dimensions and 28 level-2 Index connotations.Conclusions Through quantitative research methods,Clinical Thinking Competence evaluation index system is established for undergraduate nursing students,which provides an objective standard for cultivation and evaluation of undergraduate nursing students.

Objective To investigate the elinicopathologic features of atypical endometriosis(AEM) and to discuss the relationship between AEM and tumors. Methods A retrospective analysis was performed of 163 cases of AEM, which were retrieved from the Department of Pathology files at the Tianjin Central Obstetrics and Gynecology Hospital between Jan 2004 and Dec 2006. The pathologic changes of AEM including its glandular epithelium, stroma, background and the conditions coexisting with tumor were observed. Results The AEM accounted for 4.38% (163/3724) of the endometriosis (EM) eases. Of 172 AEM foei of 163 patients, 168 were in the ovary, and the other 4 were in the fallopian tube, cervix and uterine serosa respectively. The rate of ovarian AEM was 6.81% of endometriosis. AEM associated with tumour was found in 26 cases (15.95% )and among 27 of ovarian AEM, 15 were malignant, 9 borderline and 3 benign. The AEM epithelia were mainly arranged in the form of surface epithelium. They present with characteristic features of moderate to marked pleomorphism, epithelial tufting and bud structures by microscopy. The walls of AEM cyst were presented with three layers of epithelium, endometrioid stroma and fibrosis-collngen. The endometrioid stroma were usually thin in contrast to the fibre-collagen tissue, which was often thick with scarred background. The transformation from AEM to tumor was found in most of the malignant tumors( 14/15,93% ). Conclusions AEM lesions hold some features of both EM and tumor, which may have a relatively higher potential for tumorigenesis and cancerafion. The process of damage and repair in EM foci during a long course may play a role in the development of EM into AEM and finally into tumor.

Objective: To investigate patients' satisfaction rate towards referral in a class A tertiary hospital, so as to provide the evidence for promoting the highly efficient implementation of referral. Methods : The gender, age, type of referral, referral efficiency and referral cost of patients receiving referral services in 2021 were collected through the interconnected intelligent hierarchical diagnosis and treatment collaborative platform of Henan Provincial People's Hospital. Patients' awareness and recognition of the two-way referral system were investigated using questionnaire surveys, and factors affecting patients' satisfaction with referral were identified using a multivariable logistic regression model. Results: A total of 1 268 patients receiving referral services were surveyed, including 576 men (45.43%) and 692 women (54.57%), and the respondents were predominant at ages of 18 years and older (935 cases, 73.74%). There were 535 cases with overdue referral (42.19%) and 1 157 cases with free referrals (91.25%). There were 749 cases that were aware of the two-way referral system (59.07%), and 587 cases recognized the two-way referral system (46.29%). There were 975 patients with a satisfactory attitude towards referral, with a satisfaction rate of 76.89%. There were 1 030 cases (81.23%) that considered fluent communication of referral information, with a 78.54% satisfaction rate towards referral; 569 cases (44.87%) that considered simple referral procedures, with an 81.37% satisfaction rate towards referral, and 797 cases that were satisfied with the services provided by the referred medical staff (62.85%), with a 79.42% satisfaction rate towards referral. Multivariable logistic regression analysis showed that non-overdue referrals (OR=1.846, 95%CI: 1.411-2.414), free referrals (OR=1.815, 95%CI: 1.188-2.773), awareness of the two-way referral system (OR=0.624, 95%CI: 0.472-0.826), recognition of the two-way referral system (OR=1.621, 95%CI: 1.235-2.129) were factors affecting the satisfaction with referral. Conclusions The satisfaction rate towards referral was 76.89% among the study patients, and the awareness and recognition of the two-way referral system, referral efficiency and convenience are factors affecting the satisfaction with referral.

Objective To observe the effect of Shenxian Yiganling Tablets ( SYT) , a Chinese herbal recipe with the actions of tonifying kidney and removing toxicity, combined with HBsAg gene-modified dendritic cells (DC/HBsAg) on immune response and hepatocyte damage of hepatitis B virus (HBV) transgenic mice. Methods HBV transgenic mice ( Tg mice) were immunized with injection of DC/HBsAg ( 100 μg every three weeks) through caudal vein, and then were given intragastric administration of SYT in the dosage of 12.8, 23.5, and 47.0 mg/d for four weeks. HBV Tg mice splenic T cell cytokines of interleukin 2 ( IL-2) and interferon gamma ( IFN-γ) levels as well as serum alanine aminotransferase ( ALT) and aspartate aminotransferase ( AST) conents were detected by enzyme-linked immunosorbent assay ( ELISA) . Lactate dehydrogenase ( LDH) release assay was used to detect the in-vitro cytotoxic activity of splenic HBsAg specific T lymphocytes. Serum HBsAg level of HBV Tg mice was detected by ELISA after immunization. Results Compared with DC/HBsAg administration alone, DC/HBsAg combined with SYT could significantly increase HBV Tg mice splenic T cells cytokines IL-2 and IFN-γ levels ( P<0.05 or P<0.01) , increase the cytotoxic activity of HBsAg-specific T lymphocytes ( P<0.05 or P<0.01), increase the inhibition rate of HBsAg expression (P<0.05 or P<0.01), and reduce hepatocyte damage. Conclusion SYT could enhance the immune response of Tg mice to DC/HBsAg immunization, and relieve the hepatic damage, which enable the HBV clearance process out of hepatic damage in the case of anti-HBV activity of IFN-γbeing unaffected.

AIM To explore the effect of berberine in inhibition of proliferation and induction of apoptosis of gastric cancer cell MGC 803.METHODS The MGC 803 cell morphology and cell counting were studied by Trypan blue, MTT, Methyl green pyronin stain assay, the MGC 803 cell DNA changes were investigated by flow cytometry and agarose gel electrophoresis.RESULTS Berberine could significantly inhibit the growth of MGC 803. After 48 hours of treatment with different concentration berberine (8, 4, 2, 1 mg?L -1 ), the inhibitive rate of MGC 803 were 86 7%, 65 9%, 20 0%, 0%, respectively. Meanwhile, MGC 803 showed typical apoptosis features: cell shrinkage, nuclear condensation, DNA fragmentation and formation of apoptotic bodies. A typical subdiploid peak before G 0/G 1 phase was observed by flow cytometry. The Trypan blue stain achromatophilia rates of death cells, which with well membranes, were between 60%～82%. Agarose gel electrophoresis analysis, which showed that the chromosomes of MGC 803 were broken by berberine before the structures of membrane were damaged, while DNA broke into long fragments rather than small fragments, supported that the activation effect of berberine on nuclease was mild.CONCLUSION Berberine could significantly inhibit proliferation of gastric cancer cell MGC 803 and induced apoptosis, and the cytotoxicity of berberine on MGC 803 was weak.

AIM　To explore the effect of berberine in inhibition of proliferation and induction of apoptosis of gastric cancer cell MGC-803.METHODS　The MGC-803 cell morphology and cell counting were studied by Trypan blue, MTT, Methyl green pyronin stain assay, the MGC-803 cell DNA changes were investigated by flow cytometry and agarose gel electrophoresis.RESULTS　Berberine could significantly inhibit the growth of MGC-803. After 48 hours of treatment with different concentration berberine (8, 4, 2, 1 mg*L-1), the inhibitive rate of MGC-803 were 86.7%, 65.9%, 20.0%, 0%, respectively. Meanwhile, MGC-803 showed typical apoptosis features: cell shrinkage, nuclear condensation, DNA fragmentation and formation of apoptotic bodies. A typical subdiploid peak before G0/G1 phase was observed by flow cytometry. The Trypan blue stain achromatophilia rates of death cells, which with well membranes, were between 60%～82%. Agarose gel electrophoresis analysis, which showed that the chromosomes of MGC-803 were broken by berberine before the structures of membrane were damaged, while DNA broke into long fragments rather than small fragments, supported that the activation effect of berberine on nuclease was mild.CONCLUSION　Berberine could significantly inhibit proliferation of gastric cancer cell MGC-803 and induced apoptosis, and the cytotoxicity of berberine on MGC-803 was weak.

Objective To evaluate the short term clinical efficacy of recombinant human B‐type natriuretic peptide(rhBNP) in the treatment of dilated cardiomyopathy complicating heart failure .Methods 121 patients with dilated cardiomyopathy complicating heart failure were selected ,the cardiac function grade Ⅲ - Ⅳ ,and randomly divided into the conventional treatment group(control group ,n= 61) and the rhBNP treatment group(rhBNP group ,n = 60) .The disease history was recorded and clinical symptoms , heart color echocardiography ,cardiac function ,renal function and plasma NT‐proBNP levels were observed before and after treat‐ment .Results The NT‐proBNP level after 72 h treament in the rhBNP group was significantly lower than that in the control group (P< 0 .01) ;LVEDd after 1 week treatment in the rhBNP group was significantly lower than that in the control group ( P =0 .033) ;LVEF was increased in the both groups ,but the increase in the rhBNP group was more significant compared with the con‐trol group (P< 0 .01) .The total effective rate was 91 .6% in the rhBNP group and 72 .1% in the control group with statistical dif‐fernece between the two groups(P= 0 .005) ;the average hospital stay time in the rhBNP group was significantly shorter than that in the control group(P= 0 .041) .The proportion of the major adverse cardiovascular events(MACE) occurrence had no statistical difference between the two groups(P= 0 .492) .Conclusion rhBNP is safe and effective in treating the acute decompensation of di‐lated cardiomyopathy .

Objective To compare the long-term outcomes in patients with newly diagnosed stage T1G3 bladder cancer treated with bladder preserving approach and intravesical instillation or im-mediate cystectomy.Methods of 113 patients with a median age of 64 years (range 27 to 88) diag-nosed with T1G3 bladder cancer from January 1993 to February 2007,81 cases were treated by tran-sureteral resection with additional intravesieal instillation and 32 were treated with immediate cystecto-my.Differences between the 2 groups in 5-year overall survival and tumor specific survival were calcu-lated using the Kaplan-Meier survival function and analyzed by the log rank test.Results of 81 pa-tients treated with organ preserving approach and postoperative intravesical instillation,53 patients developed local recurrence and 21 patients underwent deferred cysteetomy in a median 64 (range 6-140) months follow-up.The overall and tumor specific survival at 5 years was 64.2% (52/81) and 77.8%(63/81),and in those who had deferred cystectomy it was 61.9% (13/21) and 76.2% (16/21),respectively.Of the 32 patients treated with immediate cystectomy,the 5-year overall and tumor specific survival was 59.4%(19/32) and 75.0%(24/32) within a median follow-up of 62(range 4-141)months.There was no statistical difference of the 5-year overall and tumor specific survival be-tween patients treated with bladder preserving approach or immediate cystectomy.Conclusion Blad-der preserving approach and immediate eystectomy might have similar 5-year overall and tumor specific survival for primary T1G3 bladder cancers.

Objective The study was to find the application effect of high quality nursing service in perioperative treatment of patients with coronary heart disease.Methods Eighty patients were randomly divided into the comfort nursing group and the routine nursing group with 40 patients in each group.The comfort nursing group was given high quality nursing service,and the routine nursing group received the conventional care.The effect in two groups was compared after rehabilitation.The statistical software of SPSS 17.0 was used to analyze the data.Results The degree of anxiety was lower,the number of patients with complication was less,the degree of satisfaction was higher and the time in hospital was less in the comfort nursing group.Conclusions The comfortable nursing care should be used in peri-operative treatment of coronary heart disease,which can make patients keep the best mental state to accept and cooperate with the surgical treatment.It also can improve the care quality and patients' satisfaction degree and shorten the hospital stay.

AIM:To investigate regulatory roles of Apelin in adventitial remodeling and fibrosis in rats with transverse aortic constriction ( TAC) .METHODS:The male Sprague-Dawley rats with TAC were randomized to daily deliver either pyroglutamyl Apelin-13 ( 50μg/kg) or saline for 4 weeks.RESULTS:Histomorphometric analysis by HE and Masson Trichrome staining revealed increased medi -al and adventitial thicknesses , especially in the adventitia , in ascending aortas in rats with TAC when compared with the sham-operated rats.Downregulation of APJ receptor and elevations in phosphorylated mTOR and ERK 1/2 levels were observed in rats with TAC . There are marked increases in heart weight ( HW) , HW/body weight ratio , and aortic fibrosis in rats with TAC .The pressure over-load-mediated pathological adventitial remodeling was strikingly rescued by Apelin-13, associated with attenuation of aortic fibrosis and reduced mRNA expression of TGF-β1, fibronectin and collagen I .CONCLUSION:Our results demonstrate the importance of Apelin-13 in amelioration of aortic adventitial remodeling and fibrosis in rats with TAC via modulation of the mTOR /ERK signaling , thus indi-cating potential therapeutic strategies by enhancing Apelin /APJ action for preventing pressure overload-and fibrosis-associated cardio-vascular disorders .