Objective To explore the current situation and influencing factors of moral distress among nurses.Methods 252 clinical registered nurses from 3 Grade-3 Level-A hospitals in Jinan were investigated by the Chinese version of Moral Distress Scale-Revised and Job Diagnostic Survey.Results The mean score of MDF was (1.06±0.46) points and the mean score of MDI was (1.05±0.63) points.The total score of MDS-R was (38.86+26.26) points.Futile care was the main source for the high frequency and high intensity of moral distress among nurses.There were significant differences in the level of moral distress among different groups of age,years of nursing experience,first education degree,professional title,position,department,staffing of government affiliated institutions and income.The result of multiple linear regression analysis showed that age,first education degree,department,professional title,and the importance of assignment,autonomy,collaboration of work were the influencing factors for moral distress of nurses.Contusions It suggested that nurses should strengthen the study of knowledge about ethics to improve their capacity of ethical decision-making,and nurse managers should pay attention to department management,strengthen the medical cooperation,and improve nurses' job autonomy to improve nurses' capacity of coping and decision-making and reduce the level of moral dilemmas.

Objective To investigate the effects of WeChat follow-up of relatives on knowledge cognition, change of behavior, visual acuity and blood glucose for diabetic retinopathy (DR) patients.Methods Totally 107 typeⅡdiabetic patients from January 2014 to December 2015 in the Department of Endocrinology were enrolled in the study, with the inclusion criteria of 60 years of age and older and diagnosed with diabetic retinopathy. Subjects were divided into the WeChat group (53 cases) and the control group (54 cases) based on the order of enrollment. The control group was given routine care and health education, while the WeChat group was given additional follow-up of relatives through WeChat with distribution of health education messages for the management of DM and DR once each week for 12 months. Questionnaires were used to collect information on patient's knowledge of DR prevention & treatment and behavior change, FBG, PBG, and HbA1c, and visual acuity were also collected to assess the effectiveness of the intervention. Chi-square test was used to compare the patients' cognitive rate, behavioral change and stage of retinopathy. The t-test was used to compare fasting blood glucose, 2 hours postprandial blood glucose, glycosylated hemoglobin and visual acuity. Results Cognitive Knowledge change on DR were analyzed for the following questions:the time of the first fundus examination after diagnosis of diabetes and occurrence of systemic complications; what are key measures for prevention of early blindness in patients with DR;fundus checkup requirements while blood glucose control is ideal;types of major eye complications for diabetic patients; when laser treatment should be done for DR patients; how long apart should patients check the fundus;what is the normal range of blood glucose;and the types of server damages of DR;etc. The cognitive rates of WeChat group after follow-up were as follows 88.7%, 67.9%, 56.6%, 96.2%, 79.2%, 67.9%, 69.8%, 94.3%, 75.5%. WeChat group compared with the Control group after follow-up (χ2 values were 16.77, 30.76, 16.30, 7.75, 9.68, 36.03, 9.25, 10.57and 9.41, respectively, all P<0.01), the difference was statistically significant. The results of WeChat group before and after the follow-up were (χ2 values were 19.41, 38.22, 17.90, 8.23, 9.34, 38.22, 21.81, 12.08 and 25.52, respectively, all P<0.01), the difference was statistically significant. The cognitive rate for DR risk factors for the WeChat group was 24.5% before follow-up and 43.4%after follow-up;the after follow-up difference between WeChat group and the Control group was statistically significant (χ2=5.33, P<0.05). WeChat group before and after follow-up comparison (χ2=4.21, P<0.05) was also statistically significant. For values of fasting blood glucose, 2 h postprandial blood glucose and glycosylated hemoglobin, results of WeChat group before follow-up were as follows (13.18± 4.46) mmol/L, (16.17 ± 3.97) mmol/L, (10.18 ± 2.76)%;results of WeChat group after follow-up were (8.45 ± 2.26) mmol/L, (11.34 ± 2.34) mmol/L,(7.83 ± 1.40)% respectively. The after follow-up comparison between WeChat group and the Control group showed statistically significant differences (t values were-7.06,-7.30, and-6.37, respectively, all P<0.01). Within the WeChat group, before and after follow-up comparison were all significantly different (t values were 6.83, 7.59 and 5.54, respectively, all P<0.01). The vision of WeChat group before follow-up was 0.68 ± 0.18, after follow-up was 0.71 ± 0.20. There were no significant differences in the two groups after follow-up, before and after follow-up WeChat group, the Control group before and after follow-up about visual acuity comparison (t values were 1.02,-1.10, and 0.57, respectively, all P>0.05). The two groups of patients were compared in balanced diet, regular eating time, meal volume, wearing loose clothing and exercise shoes and socks before each exercise, exercising for more than 30 min, weekly checkup of blood glucose, blood sugar test before and after the exercise and other measurements of behavior changes were significantly different (χ2 values were 11.54, 11.77, 13.68, 5.89, 10.23 and 8.72, respectively, all P<0.01 or 0.05). There were no significant differences in self-withdrawal of medication and Retinopathy stageⅠand stageⅡpatients and between these two patient groups (χ2 values were 1.20, 0.01 and 0.01, respectively, all P>0.05). Conclusions The practice of WeChat follow-up of relatives can improve cognition ability for DR patients aged 60 years and older, it can promote the healthy behavior and the BG monitoring effectively.

Objective To observe the relations of sleep structure changes and cognitive behavior abnormalities in children with idiopathic epilepsy.Methods All night polysomnographies, day attention test and Achenbach child behavior checklist were done on 64 children with idiopathic epilepsy and 20 healthy controls the requirement. Spearman correlations were made to evaluate the correlations between the parameters of sleep structure and the results of attention and cognitive behavior abnormalities.Results All children with epilepsy had longer stage Ⅰ sleep percentage and latency of rapid eye movement (REM) sleep compared with controls (all P

Objective To evaluate the effect of group psychological intervention and relaxation training on nurses' job burnout.Methods A total of 236 female registered nurses [mean age (27±4) years,and mean employment (17±3) years] were randomly assigned to the intervention group (n=120) and the control group (n=116).The intervention group had 60-minute group psychological intervention,10-minute psychological relaxing exercises and 20-minute progressing muscle relaxing exercises per week for 8 weeks.The control group did not receive any instrument.The participants were assessed at the 1st and 8th week by using the Job Burnout Scale.Results There was no statistical significance in three dimensions of the Job Burnout Scale between the two groups at baseline (P＞0.05).However,after the intervention,the intervention group had lower scores of EE (13.62±7.86 vs.19.83±4.89) and DP (5.25±3.27 vs.6.55±3.43) and higher scores of PA (38.28±6.34 vs.32.13±7.06) than the control group (all P＜0.01),and had lower scores of EE (18.92±8.36 vs.13.62±7.86) and DP (6.44±3.56 vs.5.25±3.27) and higher scores of PA (28.39±7.78 vs.38.28 ± 6.34) than baseline (all P＜0.01).The control group showed no significant difference in those parameters before and after the intervention (P＞0.05).In the intervention group,1-9 years employment subgroup had lower scores of EE (13.21±7.32 vs.16.91±5.63) and DP (5.61±4.33 vs.7.80±4.59) and higher scores of PA (36.34±7.28 vs.31.39±6.88) than the control group; 10-19 years employment subgroup had lower scores of EE (11.68±5.95 vs.15.14±6.43) and DP (5.11±3.65 vs.7.82±5.21) and higher scores of PA (31.24±8.90 vs.27.33±5.96) than the control group (all P＜0.01); 20-29 years employment subgroup had lower scores of EE (12.37±5.23 vs.15.36±4.98) than the control group (P＜0.01).Conclusions Group psychological intervention and relaxation training could effectively relieve nurses' job burnout.

Objective To find out about the causes of death of child-bearing women in Shenyang so as to provide basis for the improvement of child-bearing women's reproductive health. Methods A retrospective statistical survey into the death reporting system of Shenyang was conducted and a comparison was made between various age groups of child-bearing women from 1996 to 2000 with regard to the trends of changes in death, the rank order of causes of death and deaths due to malignant tumors. Results From 1996 to 2000, the death rate of child-bearing women in Shenyang was in a state of fluctuation. The case-death ratio in urban areas was 67.24 per 100 thousand people while the case-death ratio in rural areas was 45.97 per 100 thousand. Urban women aged 35 to 49 accounted for most of the deaths among child-bearing women. The rate of death due to cancers in urban areas was markedly higher than that in rural areas. The deaths of child-bearing women due to mammary and reproductive system cancers accounted for one fourths of deaths caused by cancer, with their incidence rate in rural areas being higher than in urban areas. Conclusion More work needs to be done to improve the healthcare of child-bearing women.

Objective To detect the relationship of blood pressure variability (BPV) and angiotensinogen(AGT) T235M polymorphism with Binswanger's disease (BD).Methods Totally 122 cases with BD and 108 cases with essential hypertension had been enrolled.Ambulatory blood pressure monitoring was used to get the data of BPV and mean blood pressure (MBP).PCR-RFLP was applied to detect genotype of AGT T235M.Results Distribution of MM+MT genotype and frequency of M allelic were higher in BD group (51.6％,29.9％) than in hypertension group(27.8％,16.2％)(x2 ＝13.543,11.995,P＜0.01).The variability of night time blood pressure (11.8±2.8,9.1±2.5) and 24 hours diastolic blood pressure(11.6±6.0) in BD group were increased compared with those in hypertension groups(10.9±2.4,8.2±3.2,10.1±4.6)(t＝2.59,2.64,2.09,all P＜0.05).Prevalence of anti-dipper was higher in BD group (32.8％) than in EH group (16.7％)(x2 ＝7.894,P＜0.01).Among BD patients,anti-dipper who carried MM or MT genotypes (44.4 ％) was more than that who carried TT genotype (20.3％) (x2 ＝ 8.760,P＜ 0.01).Conclusions Fluctuations of nighttime blood pressure and diastolic pressure are higher in patients with BD,and the relative frequency of MM or MT genotype is higher.Moreover,among patients with BD who carried MM or MT genotypes are apt to have anti-dipper.MM or MT genotype is related to BD by means of affecting blood pressure circadian rhythms probably.

Objective To investigate the application of PKH26 and molecular light imaging system in cartilage en?gineering. Methods Canine chondrocyte was labeled by fluorescent dye PKH26 and seeded into the porous cartilage acel?lular matrix scaffold. The cells/scaffold constructs were cultured in vitro for 1 week. Then the constructs were implanted into the dorsal pocket of nude mice. We utilized a molecular light imaging system to macroscopically observe cells/scaffold con?structs in vivo with fluorescence at the 4th weeks, and compared with X-rays taken at the same position. The fluorescence im?ages were compared with the immunohistochemical and immunofluorescent results of cartilage-like tissue in vivo. Results Luminescent images were acquired at the 4th weeks, a red color enhanced overlay of the luminescent image over X-ray photo?graphic image demonstrated the location of the implants and the cell viability and cell growth on porous CACM scaffold in vivo were very well. Histological results show that the safranin O, anti-collagenⅡimmunohistochemistry and toluidine blue stain of cartilage-like tissue is positive. Immunofluorescence examination demonstrated chondrocytes in the constructs whitch is showen red fluorescence, and anti-collagenⅡimmunofluorescent staining was showen in green while the overlap?ping image is showen in yellow. Conclusion This study outlines an applicable non-destructive method to evaluate cell growth in tissue engineering constructs in vivo using PKH26 and molecular light imaging system.

Background The light damage model of retinal pigment epithelium (RPE) cells is a research direction of retinal degeneration diseases,and RPE cell apoptosis induced by light damage and inflammation is an important pathologic basis of light-induced RPE cell damage.However,whether endoplasmic reticulum stress (ERS) paticipates in light-induced RPE cell damage is rarely reported.Objective This study was to explore the effects of ERS on light-induced RPE cell damage.Methods Human RPE cell line (ARPE-19) was cuhured,and light damage models were created by irradiating the cells for 3-,6-,12-and 24-hours with white fluorescent lamp with the intensity of (2 000±500)lx for the selection of optimal irradiating time,and the cells in the normal control group were cultured in the dark environment.The cells were divided into normal control group,light exposure group and 4-phenylb utyric acid (4-PBA) pretreated +light exposure group.The cells from 4-PBA pretreated +light exposure group were cultued firstly with 4-PBA for 30 minutes and followed by light exposure for 12 hours.The apoptisis rate of the cells and intracellular reactive oxygen species (ROS) content were detected by flow cytometry;the concentrations of interleukin 1β (IL-1β) and tumor necrosis factor-α (TNF-α) in the cell supernatant were assyed by ELISA.The relative expressing levels of activating transcription factor 6 (ATF-6),C/enhancer binding protein homologous protein (CHOP) and caspase-12 mRNA and protein in the cells were detected by real-time quantitative PCR and Western blot,respectively.Results The cultured cells showed a long spindle shape,the border was not clear,the cytoplasm was degranulation,and the cell fragments increased.Flow cytometry showed that compared with the normal control group,the ROS content in the cells and the apoptosis rate were evidently increased with the lapse of light exposure time (F=763.00,119.30,both at P＜0.01).ELISA results showed that the concentrations of IL-1β and TNF-α in the cell supernatant were significantly higher in the light exposure 6-hour group than those in the normal control group with the peak value in the light exposure 12-hour group.Compared with the normal control group,the relative expression levels of ATF-6,CHOP and caspase-12 mRNA and protein in the cells were elevated in the light exposure group and peaked in the light exposure 12-hour group.In addition,the relative expression levels of ATF-6 mRNA,CHOP mRNA and caspase-12 mRNA in the cells were significantly reduced in 4-PBA pretreated+light exposure group compared with the light exposure group (F=281.69,473.88,308.45,all at P＜0.01),and their proteins were also significantly reduced (F =47.86,57.93,106.59,all at P ＜ 0.01).The apoptosis rate,concentrations of IL-1β and TNF-α in the cell supernatant were significantly reduced in 4-PBA pretreated+light exposure group compared with the light exposure group (F =88.64,245.47,101.01,all at P＜0.01).Conclusions The light exposure at (2 000 ± 500)lx induces intracellular ROS accumulation and activates the ERS response,which results in apoptosis and inflammatory process of human RPE cells.4-PBA,a inhibitor of ERS,can suppress light-induced ERS response and therefore reduces the apoptosis rate and inhibits inflammatory process.

Objective To evaluate the relationship between spectinomycin resistance in Neisseria gonorrhoeae and mutations in the rpsE gene.Methods Genomic DNA was extracted from 4 clinical isolates of Neisseria gonorrhoeae with different levels of spectinomycin resistance.Then,PCR was performed to amplify the entire rpsE gene and the spectinomycin resistance-determining region (SRDR) in the 16S rRNA gene followed by direct sequencing.Two spectinomycin-sensitive Neisseria gonorrhoeae strains were transformed with the genomic DNA containing the mutant rpsE gene.Subsequently,the susceptibility of the transformants to spectinomycin was determined,and PCR was performed to amplify the rpsE and 16S rRNA genes in the transformants followed by sequencing.Results All the 4 spectinomycin-resistant Neisseria gonorrhoeae strains harbored an A70C transversion in the rpsE gene,but no abnormality in the SRDR of the 16S rRNA gene.No mutations were detected in the spectinomycin-sensitive Neisseria gonorrhoeae strains.The A70C transversion in the rpsE gene was also detected in the two Neisseria gonorrhoeae transformants with spectinomycin resistance.Conclusion The A70C point mutation within the rpsE gene is associated with spectinomycin resistance in Neisseria gonorrhoeae.

Objective To observe the prevention effect of Hubai powder applied on navel for nausea and vomiting induced by chemotherapy with cisplatin.Methods 97 patients who received chemotherapy with cisplatin (75mg/m2 )were randomly divided into observation group(n =49)and control group(n =48).In the control group, 30min before chemotherapy,the patients were treated with intravenous granisetron 3mg as antiemetic;Based on the control group,the observation group were treated with Hubai powder 10g applied on Shenque point in the night before the chemotherapy until the end of the next morning after chemotherapy.The curative effect of the two groups were observed.Results The acute vomiting rate of the observation group was 83.7%,which was significantly higher than that of the control group(60.4%)(χ2 =5.423,P =0.019);The delayed vomiting rate of the observation group was 85.7%,which was significantly higher than that of the control group(56.3%)(χ2 =8.867,P =0.003);The patient appetite of the observation group was obviously better than that of the control group,0 -Ⅰ degree occurrence rate of the two groups had statistical significance(χ2 =6.469,4.552,P =0.011,0.033);Ⅱ -Ⅲ degree occurrence rate of the two groups did't have statistical significance.Conclusion Hu Bai powder umbilicus can effectively prevent nausea and vomiting induced by chemotherapy with cisplatin.