Objective To explore the attitude and caring intent toward death among nursing students,so as to provide information for nursing school to make a point of taking death education. Methods 225 samples of nursing students from three grades of Shanghai Jiaotong University were conducted questionnaire research. The Questionnaire included personal background, personal thanatopsis, students' attitude and caring intention to death. Results Students with high grade, practical experience in clinical settings, or with experience in death care showed a positive thanatopsis and high awareness while negative caring intention on death events. Against the backdrop of pre-school in rural areas showed more positive care intention. The death attitude of nursing students was also affected by their health status and other factors. Conclusions The death education should focus on the building of caring intention and caring behavior for nursing students.

Objective To analyze the difference in changes of upper airway between obstructive sleep apnea syndrome (OSAS) patients and normal population using dynamic radiography under sleeping and awake conditions.Methods 20 normal subjects and 20 OSAS patients underwent the dynamic digital radiography of the upper airway under sleeping and awake conditions.And the dynamic diameter changes of the upper airway at velopharyngeal,oropharynx and hypopharynx levels were measured and recorded.Results The velo-pharyngeal upper airway collapse in normal subjects under sleeping condition was significantly larger than that under awake condition (P <0.014).However no significant differences in the collapse of upper airway at oropharynx and hypopharynx level were observed between sleeping and awake conditions.For the OSAS patients,the upper airway collapses at velopharyngeal,oropharynx and hypopharynx levels under sleeping condition were significantly larger than those under awake condition respectively (P <0.000,P =0.001,P <0.013). During awake state,there were no significant differences in upper airway collapse at velopharyngeal,oropharynx and hypopharynx levels between normal subjects and OSAS patients under awake condition.During sleeping state,the upper airway collapses of OSAS patients were significantly larger than that of normal subjects at velopharyngeal and oropharyngeal levels (P =0.000,P =0.003). However,no significant difference was observed at hypopharynx level.Conclusion The normal upper airway represents obvious col-lapse at velopharyngeal level under sleeping condition.However,the upper airway in OSAS patients at velopharyngeal,oropharynx and hypopharynx level showed significant collapse under sleeping condition compared with that under awake condition.The upper airway of the OSAS patients represents obvious collapse at velopharyngeal and oropharyngeal level under sleeping condition,however no abnormal changes can be observed under awake condition.

Outcomes for patients with hemophilia have improved dramatically over the past 50 years.With the increased availability of safe clotting factor concentrates,the primary focus in clinical management is now the prevention of long-term complications,most notably the debilitating hemophilic arthropathy that is associated with severe disease.Definitive evidence of improved clinical results from primary prophylaxis started in young patients-with severe hemophilia A and a minimal bleeding history is presented.Furthermore,recent studies showing benefits for initiating prophylaxis in older adolescents and adults with established joint disease are examined.lnhibitors to factor Ⅷ are the most problematic complication of factor replacement therapy.Patient-specific and treatment-related factors that contribute to the risk of inhibitor formation are discussed and controversies and clinical evidence related to approaches for tolerance induction are reviewed.Immune tolerance induction is the proven method for eradication of inhibitors.This article reviews latest research presented at the 55th ASH annual meeting on the hemophilias and their clinical management.

Chelation therapy could remove transfusional iron burden. Three chelators are currently available, including deferoxamine, deferiprone, and deferasirox, which can be used as monotherapy or in combination.Several factors must be considered in the design of optimal and individualized chelation regimens,which include chelator availability and its properties,degree of organ-specific iron loading,ongoing transfusional iron burden, and patient preference. Comparative effectiveness trials may help to determine the ideal strategy. This article reviews latest research presented at the 53rd annual meeting of the American Society of Hematology (ASH) on the use of iron chelators.

Objective To explore the chronergy of fibrinolysin and its influence on fibrinogen ( FIB ) and thrombus precursor protein (TpP) in treatment of acute cerebral infarction (ACI). Methods The clinical trial adopted the randomized single-blind placebo-controlled design.Totally, 150 patients with ACI (onset time≤12 h) were chosen and randomly divided into experimental group A ( group A receiving treatment of fibrinolysin after 12 h onset of ACI ) , experimental group B ( group B receiving treatment of fibrinolysin after 24 h onset of ACI) and control group ( group C without fibrinolysin treatment) , 50 cases in each group.The patients in experimental group A and B received basic treatment for ACI and fibrinolysin treatment.Patients in group C were given the basic treatment for ACI and placebo.The level of FIB and TpP before and after 7 days treatment, NIHSS scores before and after 14 days treatment, BI scores before and after 90 days treatment, incidence rate of progressive cerebral infarction ( PCI ) , stroke recurrence and mortality rate of the three groups were analyzed to evaluate the clinical effect of fibrinolysin.Hepatic and renal function before and after 7 days treatment, incidence rates of haemorrhage and hypersensitiveness were analyzed to evaluate the security of fibrinolysin. Results The NIHSS score of patients in group A, B and C (4.0±1.6, 6.5±2.2 and 8.0±4.7) was declined significantly after treatment (P<0.05).Group A and B declined more than group C (P<0.05).Group A declined even more than group B (P<0.05).The BI score of patients in group A, B and C after treatment was 68.5±30.6, 55.6±29.2 and 49.7±28.9.The BI score of all groups increased significantly after treatment (P<0.05).Compared with group B and C, group A increased more significantly (P<0.05).The incidence rate of progressive stroke in group A, B and C was 4%, 20% and 30%, respectively.The incidence rate of progressive stroke in group A was lower than that in group B and C (P<0.05).The recurrence rate of stroke after 90 days treatment in group A, B and C was 6.3%, 8.3% and 25.5%, respectively.The recurrence rate of stroke after 1 year treatment in group A, B and C was 10.4%, 12.5% and 31.9%, respectively.The recurrence rates of stroke in group A and B 90 days and 1 year after treatment were significantly lower than those in group C (P<0.05). There was no significant difference in the mortality between the three groups (P>0.05).The FIB in group A, B and C after treatment was (2.74±0.75) g?L-1,(2.82±0.83) and (3.67±1.35) g?L-1, respectively.The level of FIB in the three groups did not decrease significantly after treatment (P>0.05).However, the level of FIB in group A and B declined significantly as compared with that in group C.The TpP in group A, B and C after treatment was (3.56±1.26) mg?L-1, (3.43±1.22) and (13.21±6.54) mg?L-1, respectively.The level of TpP in group A and group B decreased significantly after treatment (P<0.05). The level of TpP in group A and B declined even more significantly than that in group C.Fibrinolysin did neither obviously injure liver and kidney nor increase the risk of bleeding, and had low hypersensitiveness incidence rate. Conclusion Treatment with fibrinolysin within 24 h after onset of cerebra infarction benefits the patients. However, dosing after 12 h onset of ACI benefits more than dosing after 24 h.Fibrinolysin plays a role of anti-thrombosis primarily by lowering the TpP level, and its influence on fibrinogen is limited.

Adefovir dipivoxil (ADV) is commonly used as an anti-viral agent in the treatment of chronic hepatitis B,with a dose-and time-dependent nephrotoxicity.Clinical analysis was made in 4 patients with chronic hepatitis B who developed Fanconi syndrome and hypophosphatemic osteomalacia after long-term use of ADV (10 mg/d).

Objective To investigate the incidence of insomnia in patients with nasopharyngeal carcinoma during radiotherapy and analyze the influencing factors.Method A sleep quality questionnaire for patients with nasopharyngeal carcinoma during radiotherapy was designed and used for the investigation of the incidence of insomnia as well as the influencing factors related to insomnia.Results The incidence of insomnia was 42.2%.Univariate analysis revealed that radioactive xerostomia,nausea,hospital environmental noise,radioactive oral mucositis,worry about job,worry about prognosis,burp,vomiting,worry about family influence were related to insomnia in nasopharyngeal carcinoma patients during radiotherapy;multivariate analysis showed that radioactive oral mucositis,environmental noise and job stress were the independent factors leading to insomnia(All P<0.05).Conclusions There is a high incidence of insomnia in patients with nasopharyngeal carcinoma during radiotherapy.Radioactive oral mucositis,environmental noise and job stress might be the independent factors relative with insomnia during radiotherapy.

Objective To explore the effects and mechanism of atrovastatin on the expression of the NF-κB in renal tissues of diabetic rats.Methods A total of 60 male SD rats was randomly taken out 40 rats to make diabetic model by injection of 65mg streptozotoein (STZ) into enterocoelia,the rest of 20 rats were normal control group.After the model made,atrovastatin (2 mg/kg/d) was given to the treated group,and the normal control group and diabetic rats without treatment group were given equivalent water.After 12 weeks,the rats were killed.Total RNA of the renal tissues was isolated from one kidney for each rat,and the renal tissues from the another kidney was prepared for immunohistochemistry (IHC) analysis.The NF-κB mRNA expressions among three groups were determined by RT-PCR.The distribution of NF-κB in the renal tissues was observed,and compared its difference among three groups.ResultsPCR showed that NF-κB mRNA was increased in the renal tissues of diabetic rats compared to control rats ( P ＜ 0.05 ).Drug-treated rats showed significantly decreased levels of NF-κB mRNA in the renal tissues compared to the untreated diabetic group( P ＜0.05).The results were also observed in protein lelel of NF-κB expression.IHC showed that there existed positive cells in the glomerular and renal tubulointerstitum.Conclusions Atrovastatin can down-regulate the expression of NF-κB and suppress the increased level of NF-κB protein in the renal tissue of diabetic rats,and slow the progress of retinopathy.

Objective To study the relationship among depression associated type 2 deabetes mellitus (T2DM) and personality and quality of life.Methods A total of 246 cases of hospitalized T2DM patients were investigated by schedule tables:self-rating depression scale (SDS),Eysenck personality questionaire (EPQ) and adjusted diabetes-specific quality of life scale (A-DQOL).According to the results of SDS,patients were divided into depression group (171 cases) and non-depression group (75 cases).Correlation analysis and regression analysis were carried out for the collected data.Results There were differences in satisfaction,influence,anxiety Ⅰ,anxiety Ⅱ,neuroticism and extraversion between the two groups(P ＜ 0.05 or P ＜ 0.01).Depression extents was related to the quality of life,neuroticism,extraversion and course(r =-0.243-0.392,P ＜ 0.05 or P ＜ 0.01).Anxiety Ⅱ,satisfaction and course enter the regression equation of depression (β =-0.205-0.322,P ＜ 0.05 or P ＜ 0.01).Conclsion Anxiety Ⅱ,satisfaction and course are key factors inducing depression in T2DM.Neuroticism and extroversion may be the predisposing personality characteristics in T2DM patients with depression.In clinical work,it is helpful for treatment by changing personality and mood of patients.

Objective To explore the correlation of adiponectin (ADP) and type 2 diabetes mellitus (T2DM) depressive symptoms.Methods Random sample of hospitalized confirmed patients with T2DM were 76 cases,who were divided in to T2DM group (DM group,30 cases) and T2DM with depressive symptoms group (DD group,40 cases) and randomly selected 36 cases in the medical center as control group.The level of height,weight,waist circumference,hip circumference,plasma ADP,fasting plasma glucose (FPG),total cholesterol (TC),triglyceride (TG),high density lipoprotein cholesterol (HDL-C),low-density lipoprotein protein cholesterol (LDL-C),C-reactive protein (CRP),fasting plasma cortisol (COR),fasting insulin (FINS) were measured.Body mass index (BMI),waist to hip ratio (WHR) and insulin resistance index (HOMA-IR) was calculated.Results The plasma ADP level in DD group was lower than that in DM group and control group [(3.05 ± 1.07) g/L vs.(4.06 ± 1.12),(6.97 ± 1.64) g/L],there was significant difference (P ＜ 0.01).The plasma ADP level was negatively correlated with CRP,HOMA-IR,TC,FPG and SDS,but positively correlated with HDL-C.HDL-C and SDS was the independent risk factor influencing the ADP level in DD group.Conclusions T2DM patients with depressive symptoms exist the greater insulin resistance,the level of plasma ADP is specific drop; the lower level of plasma ADP is an independent risk factor for T2DM patients with depressive symptoms,there is independent correlation between them.