Objective In order to analyze the research situation,development tendency and deficiencies in the aspects of nursing competency through investigating about 10 kinds of core nursing periodicals published from the year 2009 to 2013 in China.Methods Using bibliometrics methods to analyze the researches about nursing competency in the periodical literature including Chinese Journal of Nursing,Journal of Advanced Study for Nurses,Chinese Journal of Practical Nursing,Chinese Nursing Research,Journal of Nursing Science,Journal of Nursing Administration,Nursing Journal of Chinese People's Liberation Army,Chinese Nursing Management,Shanghai Nursing,Modern Clinical Nursing published from 2009 to 2013.Results There were 215 research papers about nursing competency in periodicals in the past five years,and a quantity of papers increased stably each year.The study contents mainly involved nursing education,training,competency model and standard system based on nursing competency and so on.Conclusions The researches on nursing competency are getting started in China.The quantity is keeping increase and the related research contents become more colorful and deeply than before.

Objective To investigate the level and influencing factors of subjective well-being of nurses and establish a model of the relationship of job stress, self-efficacy and subjective well-being. Methods Totally 438 nurses from 5 hospitals in Changchun city were investigated with the self-designed demographic questionnaire, General Well-Being Scale, Nurse Job Stressors Scale and Self-Efficacy Scale. Results The total score of subjective well-being was (71.36 ± 18.83) points. Single factor analysis found that age (F=1.759, P<0.01), department (F=1.712, P<0.01), professional title (F=1.364, P<0.05), years of working (F=1.420, P<0.05) and monthly income (F=1.632, P<0.01) were statistically significant. Multiple linear regression analysis showed that sex (t=-2.447, P<0.05), the first factor of job stress (t=-5.033, P<0.01), the second factor (t=-2.478, P<0.05), the third factor (t=-2.315, P<0.05), the fifth factor (t=-5.862, P<0.01) and self-efficacy (t=10.705, P<0.01) were the predictive effectton of subjective well-being. The result of path analysis shows that self-efficacy has a significant effect of adjustment on job stress and subjective well-being (direct effects=-0.62, indirect effects=-0.24, P<0.01). Conclusions The nurse subjective well-being is in the medium level. Hospitals and all related departments should take effective measures to reduce or eliminate unfavorable factors and increase the protective factors, and then improve the level of nurses′subjective well-being and nursing quality.

Objective To explore the influence of introducing standardized patient (SP) into problem-based learning (PBL) to the autonomous learning abilities for undergraduate nursing students based on clinical thinking training. Methods To select 2 classes randomly from full-time professional nursing undergraduate classes enrolled in 2012 from Tianjin university of traditional Chinese medicine, was divided into the experimental group and the control group by random number table method. The control group uses PBL teaching mode, and the experimental group adopts introducing SP into PBL teaching mode. Course lasts for 4 weeks, a total of 18 hours. To evaluate two groups nursing students′the percentage of asking questions by themselves and examination results in the end of the course, and evaluate nursing students′autonomous learning ability before and after the course and after three months of clinical practice respectively. Results The percentage of asking questions by themselves and examination results of the experimental group were 87.80%(36/41) and (84.24±5.12) points, (87.85±5.44) points, the control group were 68.89%(31/45) and (81.51±6.63) points, (84.40±7.96) points, the difference was statistically significant (χ2=4.46, t=2.13, 2.37, P<0.05);There was no statistical significance between two groups in the score of autonomous learning ability before the course (P>0.05), while after course and after three months of clinical practice of the experimental group were (93.71±9.56) points, (103.27±11.92) points, the control group were (85.47 ± 9.28) points , (91.36 ± 10.56) points, the difference was statistically significant (t=3.56, 4.89, P<0.01). Conclusions The teaching mode of introducing SP into PBL can train and improve the autonomous learning ability of undergraduate nursing students,and can provide reference for nursing teaching mode reform.

Objective To investigate the expression of CYP2W1 in gastric cancer and its effect on proliferation and invasion.Methods CYP2W1 protein expression in 326 gastric cancertissues and in the corresponding normal gastric mucosa was measured by immunohistochemstry.The expression of CYP2W1 mRNA in 10 randomly chosen gastric cancer tissues and its corresponding normal gastric mucosa was tested by semi-quantitative RT-PCR.4 groups pairs of gastric cancer and normal gastric mucosa cell lines were constructed.CYP2W1 expression in each of the cell line was tested.The effect of CYP2W1 expression on the proliferation and invasion capacity of the gastric cancer cells was studied by MTT experiment and transwell cell experiment.Results Expression of CYP2W1 protein in the gastric cancer tissues is higher than that in normal gastric mucosa (26.7％ vs.0,x2 =100.396,P ＜ 0.05).CYP2W1 mRNA in the gastric cancer tissues is higher than that in normal gastric mucosa [(0.413 ± 0.026) vs.(0.074 ± 0.005),t =28.115,P ＜ 0.05].CYP2W1 protein expression in the gastric cancer cell lines is higher than that in normal gastric mucosa cell lines [(0.481 ± 0.024) vs.0,t =49.097,P ＜ 0.05].The growth capacity of CYP2W1 positive gastric cancer cell is stronger than that of CYP2W1 negative cells (P ＜ 0.05),and CYP2W1 positive gastric cancer cells are also more of invasiveness,[(63 ±8) vs.(18 ±3),t =24.134,P ＜0.05].Conclusions CYP2W1 is only expressed in the gastric cancer tissues,hence it is closely related to the growth multiplication,and invasiveness of gastric cancer cells.

Tertiary lymphoid structure (TLS) is the ectopic lymphoid tissue around the chronic inflammatory site of tumor, infection diseases, autoimmunity diseases, organ transplantation and so on. TLS is regarded as the vital niche of antitumor immune response in tumor microenvironment for abundant immune cells, and is correlated with better clinical outcomes and immunotherapy response in most solid tumors. As a typical inflammation-driven cancer, hepatocellular carcinoma (HCC) is controversial with the influence of TLS on patients prognosis. In this paper, the composition, formation mechanism, recognition and clinical value of TLS in HCC were briefly reviewed.

Objective To compare endoscopic stenting with surgery for pyloric obstruction caused by unresectable gastric cancer.Methods Between June 2002 and June 2012,6 patients underwent endoscopic stenting and 70 did surgery for gastric outlet obstruction caused by gastric cancer.Results There were no significant difference in technical success rate and clinical success rate between the stenting and surgery groups (P ＞ 0.05).The stenting group had shorter time to oral intake,and shorter length of hospital stay [(2.5-± 3.1) d vs.(6.6 ± 3.5) d,t =-7.0,P ＜ 0.001].The incidence of early complications was significantly higher in the surgery group.However,the rates of late complications were significantly lower in the surgery group.Moreover,the surgery group was significantly associated with a longer patency duration [(295.8 d,95％ CI:260.7-330.8) vs.(168.2 d,95％ CI:134.7-201.7 d),P ＜0.001] and overall survival [(307.6 d,95％ CI:272.4-342.8 d) vs.(229.6 d,95％ CI:195.1-264.3 d),P =0.003].Conclusions Both endoscopic stenting and surgery are effective palliative therapy for gastric outlet obstruction caused by gastric cancer.Endoscopic stenting is associated with better shortterm outcomes.Surgery is preferable to ES in longer patency duration.

Objective To investigate the effect and mechanism of Qianggu Tongbi capsule on osteoarthritis factors in rats.Methods Osteoarthritis(OA)rat model was established by anterior cruciate ligament transection method.Rats were ran-domly divided into model group,Qianggu Tongbi capsule group and glucosamine group.HE staining was used to identify the model.Toluidine blue staining was used to observe the changes of cartilage.Real-time quantitative polymerase chain reaction(qRT-PCR)was applied to detect the expression of Toll-like receptors(TLR4)and nuclear factor kappa-B(NF-κB)in each group.The levels of IL-1β,TNF-α,and IL-6 were measured by the enzyme linked immunosorbent assay(ELISA)kit.The levels of TLR4 and p-NF-κB were detected by immunohistochemistry.Results HE staining showed that,compared with the control group,a large number of inflammatory cell infiltration and synovial tissue thickening were observed in the model group,while the inflammatory cell infiltration and synovial tissue thickening were not obvious in the Qianggu Tongbi capsule and glu-cosamine groups.Toluidine blue staining results showed that chondroitin sulfate in the cartilage tissue of the model group was significantly reduced compared with the control group,while levels of chondroitin sulfate in the Qianggu Tongbi capsule group and glucosamine group were significantly increased.Compared with control group,the expression and immunohistochemical re-sults of TLR4 and NF-κB,and the levels of IL-1β,TNF-α and IL-6 in model group were significantly increased(all P＜0.05).Compared with model group,the expression and immunohistochemical results of TLR4 and NF-KB,and the levels of IL-1β,TNF-α and IL-6 in Qianggu Tongbi capsule group and glucosamine group were significantly decreased(all P＜0.05).Conclusion Qianggu Tongbi capsule can inhibit expression of TLR4 and NF-κB by reducing the production of inflammatory factors to a-chieve the effect of treatmenting osteoarthritis.

Objective:To investigate the effect of prenatal dexamethasone on short-term outcomes and long-term neurological development in late preterm infants with twin pregnancy.Methods:A total of 315 pregnant women with twin pregnancy and their preterm infants who delivered in Peking University Third Hospital from January 2019 to December 2022 were retrospectively analyzed. The clinical data of pregnant women and preterm infants were collected. They were divided into non-medication group (93 pregnant women and 186 preterm infants), medication after 34 weeks group (123 pregnant women and 246 preterm infants), and medication before 34 weeks group (99 pregnant women and 198 preterm infants). Short-term outcomes of preterm infants were analyzed, including the incidence of neonatal respiratory distress syndrome (NRDS), wet lung, hypoglycemia, neonatal septicemia, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD) and neonatal necrotizing enterocolitis (NEC). "Ages and Stages Questionnaire-Third Edition (ASQ-3) scale" was used to follow up the late neurological development of preterm infants at the corrected age of 6-54 months, and the level of neurological development was compared.Results:(1) General conditions: the gestational age at delivery in the non-medication group [36.1 weeks (35.6, 36.6 weeks)] was later than that in the medication after 34 weeks group [36.1 weeks (35.2, 36.4 weeks)] and medication before 34 weeks group [35.2 weeks (34.2, 36.2 weeks)] groups, and the differences were statistically significant (all P<0.05). After correcting for gestational age, there was no significant difference in birth weight among the three groups ( H=3.808, P=0.149). There were no significant differences in gender and the proportion of small for gestational age among the three groups (all P>0.05). (2) Short-term outcome: the incidence of wet lung was 7.0% (13/186), 11.0% (27/246) and 16.2% (32/198) in the non-medication group, medication after 34 weeks group and medication before 34 weeks group, respectively, and the difference was statistically significant ( P=0.018). There were no significant differences in the incidence rates of NRDS, hypoglycemia, sepsis, IVH, BPD, and NEC among the three groups (all P>0.05). Logistic regression analysis with gestational age and newborn birth weight as confounding factors showed that early gestational age ( OR=0.884, 95% CI: 0.837-0.933, P<0.001) and increased incidence of selective intrauterine growth restriction type I ( OR=2.967, 95% CI: 1.153-7.639, P=0.024) could both lead to an increased incidence of wet lung. (3) Long-term outcomes: a total of 109 pregnant women completed the follow-up, and 218 preterm infants with a corrected age of 6-54 months at the end of follow-up were enrolled, including 86 cases in the non-medication group, 66 cases in the medication after 34 weeks group, and 66 cases in the medication before 34 weeks group. There were no significant differences in the scores of communication, gross motor, fine motor, problem solving and personal-social among the three groups (all P>0.05). Conclusion:Prenatal administration of a single course of dexamethasone does not affect the neonatal birth weight and short-term outcomes of twin late preterm infants, and has no adverse effect on the neurological development of twin late preterm infants with a corrected age of 6-54 months.

Objective To explore the clinical efficacy of secondary posterior internal fixation after transoral anterior atlantoaxial release under 3D operative microscopy for treatment of irreducible atlantoaxial dislocation.Methods From January 2014 to May 2016,12 patients with irreducible atlantoaxial dislocation were treated with secondary posterior internal fixation after transoral anterior atlantoaxial release under 3D operative microscopy in our hospital.They were 7 males and 5 females,with an average age of 37.1 years (from 25 to 54 years).The efficacy was analyzed in terms of their visual analogue scale (VAS),Japanese Orthopaedic Association (JOA) scoring,improvement rate of neurological function,American Spinal Injury Association (ASIA) grading,atlas-dens interval (ADI),space available for the cord (SAC) and cervicomedullary angle (CMA) before and one year after operation.Results The patients were followed up for more than one year.All the atlantoaxial joints obtained anatomic reduction.Their preoperative values of VAS (5.73 ± 1.36 points),JOA score (9.03 ± 2.12 points),ADI (8.34 ± 1.12 mm),SAC (9.53 ± 0.69 mm) and CMA (121.23°±4.32°) were significantly improved one year after operation (1.21 ±0.63 points,14.32±2.51 points,2.83 ± 0.36 mm,14.23 ± 1.22 mm and 153.53° ± 9.25°, respectively) (P ＜0.05).The improvement rate of neurological function increased gradually with the postoperative time,reaching 94.14％ ±5.11％ one year after operation.The postoperative ASIA grading was significantly improved too one year after operation (P ＜ 0.05).Conclusion Secondary posterior internal fixation after transoral anterior atlantoaxial release under 3D operative microscopy may lead to fine clinical efficacy one year after operation for patients with irreducible atlantoaxial dislocation.

Objective To explore the effect of books and toys on early childhood development in poor rural areas of China.Methods The baseline survey data of the Integrated Early Childhood Development (IECD) conducted in 2013,which was supported by the United Nations International Children's Emergency Fund (UNICEF) China Office,were analyzed retrospectively in this study.The survey was conducted in 6 counties in 2 provinces of China (Shanxi and Guizhou),and all 6 neighboring counties were located in extremely poor areas.The socio-demographic characteristics and caring behaviors of the caregivers (the lack of children's books and toys) were assessed by UNICEF's Multiple Indicator Cluster Surveys-5 and caregivers' depression was assessed by the Zung Self-rating Depression Scale.A total of 2701 children were enrolled,of these,1151(42.62％) were girls,the age (18± 10) months and 1 263 (46.76％)children were from Shanxi Province,the remaining 1 438 (53.24％) children were from Guizhou Province.The early childhood developmental status was evaluated by Ages and Stages Questionnaires (ASQ).Log-binomial model was used to analyze the association between early childhood development and the lack of children's books and toys.Furthermore,sensitivity analyses (data stratification) were made to explore the effect of books and toys on early childhood development under different caregiving conditions with different caregivers who were depressive or non-depressive.Results Among the 2 701 participants,1 537 (56.90％) children lacked of books,1 148 (42.50％) children lacked of toys,the suspected development delay (SDD) prevalences of overall ASQ,communication (CM),gross motor (GM),fine motor (FM),cognitivity (CG) and personal-social (PS) domains were 33.02％ (892/2 701),15.51％ (419/2 701),13.25％ (358/2 701),15.66％(423/2 701),14.96％ (404/2 701) and 11.81％ (319/2 701).Under adjustment of the potential confounders,the Log-binomial regression showed that children who lacked books had significantly higher risk of SDD in overall ASQ (prevalence ratio (PR)=1.27,95％CI:1.11-1.45) and CM (PR=1.64,95％CI:1.31-2.07) than those who had sufficient books.Compared with children who had sufficient toys,those who lacked the toys also had the increased risk of SDD in overall ASQ (PR=1.34,95％CI:1.19-1.50),CM (PR=1.44,95％CI:1.18-1.76),GM (PR=1.54,95％CI:1.24-1.91),FM (PR=1.86,95％CI:1.52-2.27),CG (PR=1.80,95％CI:1.47-2.20) and PS (PR=1.88,95％CI:1.49-2.39).Sensitivity analysis revealed that the lack of books increased the risk of SDD in overall ASQ of the caregivers' non-depression group (PR=1.35,95％CI:1.08-1.71) and depression group (PR=1.17,95％CI:1.01-1.38),and the lack of toys increased the risk of SDD in overall ASQ of the caregivers' depression group (PR=1.54,95％CI:1.32-1.79).Conclusion Lack of childrens' books and shortage of toys were independent risk factors for early childhood development in poor rural areas of China and both of them increased the risk of SDD significantly.