Objective To investigate the training effect and application development of the health industry standard of Nursing Grading, and to explore it'sclinical applicability. Methods An electronic questionnaire survey was conducted among nurses in 30 three general hospitals of Shandong Province from November 10 to December 10 in 2015. The questionnaire mainly included four parts: basic information, training status, application status and the clinical applicability. All the questionnaires were automatically submitted by the nurse′s cell phone or computer, 3386 valid questionnaires were recovered. Results The status of standard training:93.92%(3180/3386) nurses received a comprehensive training about the standard. The answer rates of 4 theoretical examination questions was 88.95%(3012/3386), 84.49%(2861/3386), 85.17%(2884/3386), 65.71%(2225/3386)respectively. 77.26%of the nurses needed to continue training. Application status: 97.67% (3307/3386) nurses in the hospital has begun to apply Nursing Grading standard, and 97.01% (3208/3307) and 97.76% (3231/3307) of the hospital revised the standard of care systems and work processes; 78.23% (2649/3386) nurses divide the level of care based on both the patient's condition and self-care ability presently. 74.45%(2521/3386) nurses did it as follows,the doctor determine the patient′s condition level, the nurse determine the level of patient′s self-care ability, then the nursing grading was determined according to the both. In the clinical applicability survey, the choice proportion of very agree and agreeofHelping nurses to determine the patient′s level of care and It is beneficial to improve the efficiency of nursing management was 86.30% (2922/3386) and 82.66%(2799/3386);The choice proportion of very agree and agree ofHelp nurses to improve the quality of nursing services, reflecting the value of the nursing work, to meet the needs of patients was 79.36% (2687/3386), 76.56% (2592/3386), 80.98% (2742/3386) respectively. Conclusions The hospital attaches great importance to the standard of Nursing Grading, but the training effect needs to be improved;standard has been widely used in Shandong Province Physician-nurse collaboration has become the decision-making main body of nursing grading;the standard application can not only help the nurses to do decision-making correctly and improve the efficiency. It also can help nurses to improve the quality of nursing service, and enhance patients′satisfaction. So it is very suitable for clinical practice.

Humans ; Adolescent ; DNA/genetics* ; Genotype

BACKGROUND:Previous studies have applied long-bone mechanical separation method to obtain osteoclasts, which are terminal y differentiated cells and cannot further proliferate. Therefore a large number of osteoclasts can be harvested with bone marrow cells inducing culture method and RAW264.7 cells inducing culture method to meet clinical requirements.
OBJECTIVE:To investigate the optimal method of receptor activator of nuclear factor kappa-B ligand (RANKL) induced osteoclast precursors to differentiate into mature osteoclasts.
METHODS:After bone marrow cells were isolated from mouse, RANKL and macrophage colony stimulating factor were added into the medium together, or RAW264.7 cells were cultured with RANKL to induce osteoclasts. The osteoclast precursors were treated with different concentrations of RANKL to observe the number of generated osteoclasts and evaluate the dose-effect relationship between RANKL and osteoclastogenesis. Annexin V-FITC and propidium iodide staining were used for flow cytometry to analyze the mononuclear-macrophage apoptosis during osteoclastogenesis.
RESULTS AND CONCLUSION:When 10μg/L RANKL was used, the peak of osteoclastogenesis appeared at days 6-7;when the concentration of RANKL was up to 100μg/L, the peak appeared at days 4-5. The number of new osteoclasts was dose-dependent on the RANKL concentration. 50μg/L of RANKL was the turning point in the fitted curve from osteoclastogenesis and RANKL concentration. After the RANKL concentration was more than 150μg/L, the number of osteoclasts slowed down obviously. RANKL can induce monocyte-macrophage to form osteoclasts and promote monocyte-macrophage apoptosis. The highest number of osteoclasts would be obtained to each unit of RANKL when monocyte-macrophage cells were cultured with 30μg/L of RANKL in the same vaccination density (104/cm2). Experimental findings indicate that, RAW264.7 cells or bone marrow cells inducing culture methods are simple and feasible, the optimum cellseeding density was 104/cm2;the appropriate stimulation concentration of RANKL was 30-50μg/L.

ObjectiveTo determine the effect of telmisartan on the levels of serum adiponectin and C-reactive protein(hs-CRP)in elderly hypertensive patients with unstable angina pectoris. MethodsOne hundred and twenty elderly hypertensive patients with unstable angina pectoris were randomized into two groups, telmisartan(n=60) and perindopril(n=60) groups.The levels of hs-CRP,adiponectin, lipid factors, fasting plasma glucose (FPG), insulin and insulin sensitivity index (ISI) were measured before and 6 months after telmisartan and perindopril treatments.ResultsAt the end of 6 months, the telmisartan group showed more reduction in plasma levels of hs-CRP and more increment in serum adiponectin concentrations and ISI significantly. The frequency of cardiovascular events was significantly lower in the patients of the telmisartan group than that of the perindopril group.ConclusionsCompared with perindopril, telmisartan significantly decreases plasma levels of hs-CRP and increases serum adiponectin concentrations in elderly hypertensive patients with unstable angina pectoris. It also significantly decreases the frequency of cardiovascular events in these patients.

Objective To investigate the mechanism by which remifentanil decreases blood pressure during cardiopulmonary bypass (CPB).Methode Twenty-six ASA Ⅱ or Ⅲ patients (NYHA's classification grade Ⅱ or Ⅲ ) of both sexes and aged 20-55 years were randomized to receive remifentanil (group R, n = 13) or normal saline (group C, n = 13). Remifentanil 10 μg/kg or equal volume of normal saline was administered via a venous reservoir when cardiac arrest was induced with cardioplegic solution. The flow rate resistance (SVR) were measured and arterial blood samples were taken for determination of plasma concentrations of histamine,nitric oxide (NO) and 6-keta-prostaglandin F1α(PGF1α) before T0 and at 5, 10, 15 min (T5.10.15) after remifentanil administration.Results Remifentanil administration was associated with a significant decrease in MAP and SVR at T5 and T10 as compared with the baseline values at T0 ( P ＜ 0.05); whereas in control group, MAP and SVR were significantly increased at T5, T10 and T15 as compared with the baseline values at T0 . There were no significant differences in plasma histamine, NO and PGF1α concentrations between the two groups.Conclusion Remifentanil reduces SVR and causes a decrease in BP but without altering plasma concentrations of histamine, NO or PGl2.

Objective To establish a microbial limit test for levofloxacin hydrochloride gel. Methods Ca2+ was added to neutralize the antibacterial activity of quinolone,and to form the insoluble precipitate by binding with carbomer, therefore destroying the stability of macromolecules in the gel. The microbial limit test for levofloxacin hydrochloride gel was confirmed combining with membrane filtration and plate methods. Results The normal plate counting was used in detecting the mold and yeast colony in the gel, the recovery was more than 70%.Simultaneously neutralization centrifugation and membrane filtration were used in bacterial count,with recovery less than 70%,and controlling bacteria test. Conclusion The method is accurate and practical for microbial limit test of levofloxacin hydrochloride gel, but is risky for bacterial counting and needs further risk assessment.

OBJECTIVE:To provide reference for developing the antibiotic community pharmaceutical care. METHODS:Some residents of Jiangbei district of Ningbo were randomly collected for questionnaire survey on antibiotic storage,usage,accep-tance degree and demand of pharmaceutical care,etc. And the results were analyzed statistically. RESULTS:Totally 2 000 ques-tionnaires were sent out,1 784 were effectively received with effective rate of 89.2%. 74.2% of respondents had kept antibiotics in house;61.3% lacked antibiotic knowledge and easily be confused with anti-inflammatory drugs,43.5% thought antibiotics was ef-fective for virus infections;48.4% had self-treated with antibiotics,the most common reason was cold symptoms,and it existed amount or course of antibiotics changes by themselves;only 15.1%of them had knew or heard of pharmaceutical care;majority re-spondents(88.9%)wanted to accept antibotic pharmaceutical care,hoping to learn the indications,usage and dosage,contraindica-tions,precautions and adverse reactions of antibiotics by drug consultation,lecture,etc. CONCLUSIONS:The residents lack the knowledge about rational use of antibiotics,it is urgent for pharmacists to provide antibiotic community pharmaceutical care for resi-dents with purpose,which are important guarantee for rational use of antibiotics.

Three-orientation medical talent training mainly include humanistic quality cultivation, professional quality and physical and mental quality. With professional ability as the guidance of profes-sional quality education requires students not only to grasp skilled medical technology, but also have the ability to enhance the medical technology. Based on the orientation of training target, this research mainly from habit set, authority set, set the multitude and empirical mind-set four aspects in this paper, the critical thinking, and put forward problems from finding problems, and expounds the innovative thinking of concise problem.

Objective:To construct eukaryotic expression plasmid ecording a novel surface protein Fba of GAS, and to explore its impact on host immune responses.Methods:Fba gene was amplified by PCR using strain SSI-9 (GAS M1 serotype isolates) as the template, then cloned into pcDNA3.1 for constructing eukaryotic expression plasmid pcDNA3.1/fba and sequenced. Female CD1 mice were randomly individed into 6 groups, and immunized respectively with Fba protein, M protein, pcDNA3.1/fba + Fba protein, pcDNA3.1/fba, pcDNA3.1 and PBS as control. Blood was obtained from the mice and specific antibody of IgG was detected by ELISA. Spleen cells were assessed with lymphocyte proliferation assays.CD4+T cell and CD8+T cell were detected by flow cytometry (FCM). Assay results were analyzed with SPSS10.0.Results:The IgG against Fba protein kept hightest levels in group immunized with Fba protein. The levels of lymphocyte proliferation, CD4+, CD8+T cell were significantly high in the group pcDNA3.1/fba. Conclusion:(1) Just as M protein, the antibody to Fba protein could be efficiently induced by immunization with Fba protein, which showed that Fba protein was hopefully to be a candidate protein for vaccine against GAS.(2) Eukaryotic expression plasmid pcDNA3.1/fba was successfully constructed and this recombinant plasmid could efficiently induce antibody and CD4+ T cell for againsting GAS.

Objective To evaluate the accuracy of auditory evoked potential index (AAI) in monitoring the anesthetic depth during isoflurane anesthesia.Methods Thirty ASA Ⅰ or Ⅱ patients aged 18-55 years and undergoing elective surgery under general anesthesia were enrolled in this study. The patients were unpremedicated. Anesthesia was induced with midazolam 0.05 mg/kg, fentanyl 3 μg/kg and propofol 1 mg/kg. Tracheal intubation was facilitated with recuronium 0.1 mg/kg. The patients were mechanically ventilated (VT:40 mm Hg. Anesthesia was maintained with isoflurane inhalation and intermittent intravenous boluses of vecuronium. Isoflurane was started with high-flow (FGF, 3 L/min) for 12 min followed by low-flow (LGF, 0.5 L/min). The inspired isoflurane concentration was set at 3%. The electrocardiogram (ECG), mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2), end-tidal isoflurane concentration and AAI were continuously monitored during anesthesia and recorded before induction of anesthesia (baseline, To ), immediately after induction (T1), immediately before isoflurane inhalation (T2), at 3 min(T3), 6 min (T4), 9 min (T5) and 12 min (T6) during high-flow wash-in and at the end-tidal isoflurane concentrations of 0.8 MAC (T7), 1.0 MAC (T8) and 1.3 MAC (T9) during low-flow inhalation of isoflurane, respectively.Results AAI decreased gradually while the end-tidal isoflurane concentration increased during high-flow wash-in. And AAI was negatively correlated with the end-tidal isoflurane concentrations ( r = -0.896, P ＜ 0.01 ) during low-flow inhalation of isoflurane anesthesia.