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 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 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 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 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 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 influence of the different degree of internal carotid stenosis on the white matter lesion and cognition of Binswanger disease.Methods A total of 108 elderly patients with Binswanger disease from Department of Geriatric Neurology of Qilu Hospital were recruited during December 2013 and June 2014.At the end of follow-up,6 cases showed acute eerebrovaseular disease,39 (＜ 10 ％) had no internal carotid stenosis,31 (10 ％-49 ％) had mild internal carotid stenosis,32 (50％-70％)had moderate internal carotid stenosis through B ultrasound examination and MRI and MRA examination on internal carotid artery and brain.The B ultrasound examination of internal carotid artery included intima-media thickness (IMT),plaque index and the peak systolic velocity (PSV).Cognitive function of Binswagner disease was assessed by Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA).The white matter lesion was assessed by reformed visual Scheltens scale.The relationship among IMT,plaque index,PSV,white matter lesion,and cognitive function was investigated.The variation of cognition was observed after 1 year.Results There were statistically significant differences in IMT,PSV,plaque index,reformed Scheltens scale scores between groups of non,mild,moderate internal carotid stenosis (all P ＜0.05).The IMT was thicker in moderate internal carotid stenosis group than in mild internal carotid stenosis group (P＜0.05).The differences in PSV,plaque index,and reformed Scheltens scale scores between mild and moderate internal carotid stenosis groups were not significant (P＞0.05).There were positive correlation between PSV and reformed Scheltens scale scores (r=0.630,P =0.020).There were negative correlation between PSV and MMSE scores (r=-0.970,P=0.040).The scores of MMSE and MOCA both were declined after 1 year in three groups (0.61 ± 0.60,0.68 ± 0.81),(0.70±0.60,0.93±0.69),(1.06±0.68,1.13±0.76).The declination of MMSE and MOCA of BD patients was higher in moderate internal carotid stenosis group than in non internal carotid stenosis group (P＜0.05).The differences in the declination of MMSE and MOCA between moderate and mild internal carotid stenosis groups were not significant (P＞ 0.05).Conclusions Internal carotid stenosis is one of risk factors for the cognitive impairment of BD,the abnormal IMT and PSV are both correlated with white matter lesion and cognitive impairment in BD.Early standardized therapy can postpone the rate of cognitive impairment in BD.

Objective:To construct three-dimensional(3D)finite element models with 3 different retainer designs.Methods:The intact maxillary first premolar was scanned using Micro-CT.CT images were reconstructed through Mimics 10.0 software and the prima-ry 3D models were gained after improvement in the Geomagic 7.0 software,The abutments and prosthesis of cantilever resin-bonded bridg that could be identified by the FEA software were accomplished.Results:The 3D models of cantilever resin-bonded bridg with 3 different retainer designs were constructed successfully using the maxillary first premolar as the abutment.The mesh number were 553 959,468 134,516 748,respectively.Conclusion:Using Micro-CT and finite element analysis the 3D reconstruction of the cantile-ver resin-bonded bridges may be more accurate for biomechanical analysis.

Objective To explore whether CCL18 is involved in regulating the expression of miRNAs in breast cancer.Methods The expression profile of miRNAs in the breast cancer cell following CCL18 treatment was determined by miRNAs microarray analysis.Then we performed QRT-PCR and Luciferase Reporter Assay to validate the results from the miRNAs microassay.We used transient transfection to change the expression of miR98 and c-myc in breast cancer cells.We then used QRT-PCR and Western blot to analyze the mechanism by which CCL18 downregulates the expression of miR98 in breast cancer cells.Results miRNAs microarray analysis showed that cells treated with CCL18 differentially expressed 20 miRNAs genes compared with those in the control group. Our QRT-PCR and Luciferase Reporter Assay confirmed the result.The mRNA and protein expressions of C-myc and lin28 were increased after CCL18 stimulation in breast cancer cells.Transfection with c-myc siRNAs rescued the increase of lin28 and loss of miR98 expression caused by CCL18 stimulation.Our results also showed that CCL18 could upregulate the expression of N-Ras at post-transcription level.Conclusion CCL18 downregulates the expression of miR98 via N-Ras/c-myc/lin28 pathway.The downregulated miR98 increases the expression of N-Ras after transfection,which further activates c-myc/lin28 pathway and forms a positive feedback loop.