Objective:To comparatively analyze the changes regulation of death attitude and death education needs for undergraduate nursing students in different grades.Methods:From March to June in 2019, 766 undergraduate nursing students from Batch 2015 to Batch 2018 of a medical college were collected in cluster sampling. The investigation was conducted by using the scale of Death Attitude Profile-revised in Chinese version and the scale of death education needs. SPSS 22.0 was used for statistical analysis, LSD test for measurement data, and chi-square test for counting data.Results:There were increasing trends of scores from freshman to junior in dimensions of fear of death, approach-oriented death acceptance and escape-oriented death acceptance ( P < 0.05), and the scores decreased in senior, but without statistical difference compared with junior ( P > 0.05). In neutral death acceptance dimension, the score decreased significantly in the second year ( P = 0.001), and then returned back to the original level in the fourth year. No significantly statistical difference was found in scores of different grades in death escape dimension ( P = 0.038). The score of death education need in the fourth year was the highest ( P < 0.05) and was positively correlated with the score of neutral death acceptance dimension ( P = 0.007). Conclusion:With the increase of school year, nursing students' positive attitude for death demonstrates positive trend, while the level of negative attitude of death are becoming balanced. The fourth year is suggested to be the right time to conduct death education immediately.

Abstract: Objective To analyze the resistance and spatial distribution of Mycobacterium tuberculosis (MTB) to six commonly used anti-tuberculosis drugs in Qinghai Province from 2016 to 2019, so as to provide a reference for tuberculosis treatment and drug-resistant tuberculosis control. Methods A total of 1 182 identified strains of Mycobacterium tuberculosis in Qinghai Province from 2016 to 2019 were collected, and 6 anti-tuberculosis drugs were subjected to drug susceptibility tests and strain confirmed by the proportional method. By means of ArcMap10.7 and SaTScan10.1 software, map visualization, spatial autocorrelation analysis and spatial scanning of MTB drug resistance were performed to identify MTB drug resistance clusters in Qinghai Province. Results From 2016 to 2019, the total drug resistance (TDR) rate of 1 182 Mycobacterium tuberculosis strains in Qinghai Province was 23.77% (281/1 182), with a mono-resistance (MR) rate of 11.08% (131/1 182), a poly-resistance (PDR) rate of 3.89% (46/1 182), a multi-drug resistance (MDR) rate of 8.80% (104/1 182), and an extensive drug resistance (XDR) rate of 0.85% (10/1 182). The rates of MDR, XDR and TDR all showed a decreasing trend year by year (P<0.01). The drug resistance spectrum displayed 21 combinations. The TDR rate and MDR rate in the retreatment patients were higher than those of the initial treated patients, and the difference was statistically significant (χ2 TDR=22.784, χ2MDR=45.082, P<0.01). In terms of demographic characteristics, the TDR rate in males was higher than that in females, and the middle-aged group was higher than other age groups, and the differences were statistically significant (χ2=7.541, 10.825, P<0.05). The results of global spatial autocorrelation analysis showed that there was no statistical significance in the autocorrelation and obvious spatial clustering of MTB drug resistance in Qinghai Province from 2016 to 2019 (P>0.05), which indicated a random distribution. The results of spatiotemporal scanning showed that there was a kind of clustering area, but the clustering effect was not significant (P>0.05), indicating a random distribution. Conclusions The TDR of MTB in Qinghai Province from 2016 to 2019 showed a downward trend year by year. In comparison with the national average, the rate of multi-drug resistance and extensive drug resistance was still high, and most of the multi-drug resistance resulted from rifampicin and isoniazid. The drugresistant population mainly consisted of retreatment, males, and young and middle-aged pop

OBJECTIVETo investigate the effect of Fuzhenghuayu compound (FZHc) on expression of nuclear factor E2-related factor 2 (Nrf2) in hepatocytes under conditions of hepatic fibrosis using a mouse model.

METHODSMice were randomly assigned to a control group and a hepatic fibrosis model group. The control group was further divided into three subgroups for use as normal controls (A1), mineral oil-treated controls (A2), and FZHc-treated controls (A3); the hepatic fibrosis model group was administered carbon tetrachloride (CC14 dissolved in mineral oil and injected intraperitoneally) and further divided into four subgroups for use as 6-weeks models (B1), 10-weeks models (B2), low-dose (L)-FZHc models (C1), and high-dose (H)-FZHc models (C2). The FZHc (capsule powder diluted with double-distilled water to 0.1 g/mL) was administered via gastric perfusion to groups A3, C1, and C2 starting at week 7 of the experiment. At the end of week 6 and 10, hepatic specimens were collected and evaluated for degree of hepatic fibrosis and inflammation using routine haematoxylin-eosin staining and Masson staining. Immunohistochemical analysis was performed to measure the hepatocyte expression of Nrf2, NAD(P)H quinine oxidoreductase 1 (Nqol), a-smooth muscle actin (a-SMA) and fibronectin (FN). Real-time fluorescence quantitative PCR was used to measure Nrf2 mRNA expression. Western blotting was used to detect Nrf2 and Nqol total protein expression and Nrf2 nuclear translocation. F test, LSD test and ridit test were used for statistical analyses.

RESULTSCompared with the B2 group (ridit value: 0.09), the model groups treated with FZHc showed significantly lower degrees of hepatic inflammation and fibrosis for both the low (C1 group, ridit value: 0.32) and high doses (C2 group, ridit value: 0.40) (F =82.927, P less than 0.05). In addition, compared with the B2 group, the model groups treated with FZHc showed significantly decreased expression of a-SMA and FN proteins, with a dose-dependent trend (by immunohistochemistry: C 1 group at the end of 10 weeks, F =77.421, 118.262, P less than 0.05; C2 group, P =0.002, 0.013) and significantly increased expression of Nrf2 and Nqol proteins (by immunohistochemistry:C1 and C2 groups at the end of 10 weeks, F =182.537, 75.615, P less than 0.05 and by westen blotting: F =45.664, 127.673, P less than 0.05), which also showed a dose-dependent trend (C2 group, P =0.000, 0.014; 0.005, 0.014). Western blotting also indicated that the amount of nuclear transported Nrf2 was higher in the C1 and C2 groups at the end of 10 weeks (vs. B2 group, F =94.787, P less than 0.05), and the amount of nuclear transported Nrf2 was significantly higher in the C2 group (vs. C1 group, P =0.044). Nrf2 mRNA expression was significantly higher in the C1 group than in the B2 group (F =3230.105, P less than 0.05), and the C2 group had more substantially increased expression (P =0.001); there was no statistical difference found between groups B1 and B2 (P =0.094).

CONCLUSIONFuzhenghuayu compound increased the expression of Nrf2 mRNA and protein under conditions of hepatic fibrosis in mice and stimulated Nrf2 nuclear transport, as well as increased expression of the Nrf2 target gene Nqol that is known to suppress activation of hepatic stellate cells and decrease the deposition of FN. Therefore, Fuzhenghuayu compound may ameliorate hepatocyte injury in hepatic fibrosis in mice by exerting an antihepatic fibrosis effect.

Animals ; Drugs, Chinese Herbal ; pharmacology ; Female ; Hepatocytes ; drug effects ; metabolism ; Liver Cirrhosis, Experimental ; metabolism ; Mice ; Mice, Inbred Strains ; NAD(P)H Dehydrogenase (Quinone) ; metabolism ; NF-E2-Related Factor 2 ; metabolism

Objective:To apply self-directed learning-oriented multi-channel teaching to clinical digestive system integration course and explore its teaching effect.Methods:Seventy undergraduates of Batch 2015 majoring in clinical medicine in a medical college of Shandong Province were selected as subjects. In the clinical digestive system integration course, we designed and implemented multi-channel teaching methods including problem-based learning (PBL), integrated teaching of theory and practice, standardized patient teaching, group focus teaching and moral education. The scores of students' practice examination under the two teaching methods were compared, and the self-assessment of students' autonomous learning ability before and after the intervention was compared. SPSS 20.0 was used for t test. Results:The average total score of practical assessment in the intervention group was (86.10±6.01), which was higher than that (81.84±7.08) of the Batch 2014 students ( P<0.05). The total score of students' self-assessment of autonomous learning ability was (145.41±9.42) before the intervention. By comparison, the total score was (152.94±10.18) after the intervention. Except for the dimension of "self-innovation", the scores of self-directed learning ability in general and other dimensions were significantly different before and after the intervention ( P<0.05). Conclusion:Self-directed learning-oriented multi-channel teaching is a suitable teaching method for the integration curriculum of clinical digestive system.

Objective To investigate the effect of the timing of pronase on the quality of magnetically controlled gastric capsule endoscope(MCE).Methods 225 patients from February 2021 to March 2022 were randomly assigned to 3 groups,40 000 u of oral pronase 40 min before examination in Group A,20 000 u of oral pronase for 60 and 40 min before the examination in Group B,20 000 u of oral pronase for 40 and 20 min before examination in Group C.Gastric cavity cleanliness and gastric mucosa visualisation scores(1 to 4)were recorded for the six regions of the stomach and the sum of the scores was calculated.The detection rate of gastric lesions such as gastric polyps and the time of gastric examination were also recorded.Results 221 patients completed the study.In the mucosal visualization score,group C scored(23.56±1.37)points,which was higher than that in group A's(22.56±1.28)points and group B's(23.00±1.33)points.The difference was statistically significant(P<0.05).In the gastric cavity cleanliness score,group C scored(21.44±2.35)points,which was higher than that in group A's(20.11±2.04)points.The difference was statistically significant(P<0.01).In the total score of cleanliness and mucosal visualization score of the proximal stomach(cardia and fundus),group C was higher than group A and group B,and the difference was statistically significant(P<0.05).In the detection rate of lesions,the detection rates of gastric polyps and erosion in group C were 17.8%and 49.3%,respectively,which were higher than group A's(6.8%and 29.7%)and group B's(9.5%and 31.1%).The differences were statistically significant(P<0.05).The gastric observation time in group C was shorter than that in group A and group B,and the difference was statistically significant(P<0.05).Conclusions Oral administration of 20 000 u of pronase in divided doses 40 and 20 min before the examination can enhance the quality of magnetically controlled gastric capsule endoscope.