Objective To construct a basic competency framework for advanced practice nurses.Methods A primary index system was formed through literature review and expert consultation,the weight of each index was determined by hierarchy analysis.Results The expert authority coefficient was 0.857,Cronbrach alpha of the total system was 0.937.The index system consisted of 5 first-level items,11 second-level items and 46 third-level items.Conclusions The 62-item competency framework for APN is reliable and valid,which can provide quantified standards for selecting,training and evaluating advanced practice nurses.

OBJECTIVE: The success of joint prosthesis greatly depends on the materials, which should be a perfect combination of physics, chemistry, biomechanics and clinical sciences in choice of them. In addition, the effect of manufacture technology can not be neglected. So, it is significant to probe into the systematic basis in materials selection of joint prosthesis.DATA SOURCES: A computer-based search was conducted in Pubmed database for articles about joint prosthesis published before April 2006 with the key words of "artificial joint materials, biomaterial", and the language was limited to English. Meanwhile, Chinese Journal Full-text Database (CJFD) and Wanfang database were looked for relevant literatures published before April 2006 with the key words of "artificial joint material, biomedical material", and the language was limited to Chinese. Besides,the standards for materials were searched in Chinese service net for standard consultation with the key words of "implants for surgery" in both Chinese and English. At the same time, relevant books were also manually searched.STUDY SELECTION: Data were checked in the first trial, and related articles according to the criteria of research were looked for the full text.Inclusion criteria: ① Requirements for artificial joint material. ② Relevant standards for artificial joint of surgical implants. Exclusion criteria: Repetitive studies were excluded.DATA EXTRACTION: A total of 390 domestic and overseas articles,which were in relation to the mechanical properties of artificial joint material and bone and measurement of the overall dimensions of knee joint,were collected. There were still 242 relevant standards, while the repetitive studies and similar researches were excluded. Ten typical articles and 25 standards in collection were summed up and reviewed.DATA SYNTHESIS: ①Close combination of physics, chemistry, biomechanics and clinical sciences is sufficiently embodied in the selection of the materials. ② Two aspects must be taken into consideration: Requirements for function of the implant and the responses inside the human body.③ Main types of materials for joint prosthesis: biomedical metallic material, biomedical inorganic material of nonmetal, bioceramic, biomedical compound materials and so on. All kinds of materials that have been adopted should accord with the international or state or trade standards.④ The final determination of materials should meet the comprehensive requirements of standards, laws and regulations, as well as strategic targeting. CONCLUSION: Based on engineering, the fundamental principles of materials selection for joint prosthesis are illustrated from the following angles: clinical requirements for materials of replacement, attentions in joint prosthesis design, commonly used biomedicine materials performance, requirements of product registration and laws & regulations related to the materials, the strategy in the choice of material standard etc. As a result, a valuable system approach is provided for joint-prosthesis designers to select materials.

A method was developed for the determination of four sulfa antibiotics in groundwater, soil and excreta using solid phase micro extraction disks coupled with high performance liquid chromatography. The influence of eluent, different solid phase micro extraction membranes on the recovery of sulfa antibiotics in groundwater was investigated and it was found that when using the mixture of methyl alcohol and 1 . 0% formic acid as eluent, HLB ( divinyl benzene-N-vinyl pyrrolidone polymer ) as extraction membranes, an optimal enrichment effect was obtained. Different pretreatment methods for the 3 kinds of samples abovementioned were also examined. It was found that the signal response values obtained by using mixture of methyl alcohol and 1 . 0% formic acid as base solution of standard or sample solution was higher 8-10 times than that by using methyl alcohol only. Under the optimal conditions, good linear relationships were obtained in the sulfa antibiotics concentrations of 0 . 005-10 . 0 mg/L with the correlation coefficients>0 . 9999;The detection limits of sulfathiazole ( ST ) , sulfadiazine ( SM ) , sulfamethazine ( SM2 ) , sulfamethoxazole ( SMX ) were 1 . 08 , 3. 56, 4. 63 and 1. 84 ng/L(S/N=3), respectively. The enrichment factors for four sulfa antibiotics were 4000 times with solid phase micro extraction disks. The RSD of matrix spiked samples were 0. 1%-0. 4%(n=7). The proposed method was applied to the determination of the four sulfa antibiotics in groundwater, soil and excreta with spiked recoveries of the four sulfa antibiotics in the range of 69 . 80%-117 . 60%.

Objective To explore the effects of alanyl-glutamine (Ala-Gln) dipeptide supplemented parenteral nutrition (PN) on the short-term outcomes in critically ill adult patients.Methods In this retrospective study,we reviewed the clinical data of critically ill adult patients who were treated by standard PN from January 2006 to December 2011.The length of stay in intensive care unit (ICU-LOS),incidences of infections and multiple organ dysfunction syndrome (MODS),and mortality were compared between the group of Ala-Gln dipeptide supplemented PN (intervention group) and the group of PN without Ala-Gln dipeptide (control group).Results Finially,617 cases were enrolled in the study,including 312 cases in the control group and 305 cases in the intervention group.The ICU-LOS was significantly shorter in the intervention group than that in the control group [(17.2 ± 6.5) d vs.(16.1 ± 5.3) d,P =0.011).Compared with the control group,the incidences of infection (42.9％ vs.33.1％,P =0.011) and MODS (46.5％ vs.38.0％,P =0.030) and the mortality (34.9％vs.25.9％,P =0.014) in the intervention group patients were significantly lower.Conclusion Ala-Gln dipeptide supplemented PN can improve the short-term outcomes of critically ill adult patients.

OBJECTIVE:To investigate the effects of UGT1A6 and UGT1A9 gene polymorphisms on blood concentration of valproic acid in Han epileptic patients.METHODS:Totally 107 Chinese Han epileptic patients were selected from outpatient department of our hospital during Jan.2014-Apr.2015.They were given valproic acid monotherapy treatment for 3 months to 6 years.The steady state concentration ofvalproic acid was detected by EMIT.UGT1A6 (rs2070959,rs6759892) and UGT1A9 (rs13418420,rs2741045,rs2741049,rs6731242,rs72551330) genotypes were detected by MALDI-TOF-MS.The correlation of gene polymorphism with con centration dose ratios (CDR) of valproic acid was investigated.RESULTS:UGT1A9 rs72551330 mutation had not been detected,and the frequency of genotypes in other 6 sites were all in line with Hardy-Weinberg balance (P＞0.05).The CDR of valproic acid in pa tients with UGT1A6 rs2070959,rs6759892 mutation (AG+GG or TG+GG type) were significantly lower than those with wild homozy gote (AA or TT type),with statistical significance (P＜ 0.05).There was no statistical significance in CDR of valproic acid among patients with UGT1A9 rs13418420,rs2741045,rs2741049 and rs6731242 wild homozygote and mutation (P＞0.05).CONCLUSIONS:UGT1A6 rs2070959,rs6759892 gene polymorphisms of Han epileptic patients are associated with blood concentration of valproic acid,and the patients with UGT1A6 rs2070959,rs6759892 mutation need more dose ofvalproic acid.

From August, 1984 to February, 1985, We kept a synchronous observation of 92mothers and their babies on the relationship of iron status between them. The 92 pregnantwomen, of whom the gestational periods were not longer than 36 weeks, were divided rando-mly into wo groups: a medication group and a control group. For all, Hb, Hct, FEPand SF were tested. In the 4th week after labor, Hb, Hct and SF of the mothers ofthe medication group were higher than that of the control group (P

Objective:To observe the expression of serum nuclear factor-κB (NF-κB) and monocyte chemotactic protein-1 (MCP-1) in patients with early diabetic nephropathy (EDN) and the effect of pioglitazone on the expression of inflammatory factors and renal protective mechanism.Methods:A retrospective case-control study was conducted.From January 2019 to December 2019, the patients were divided into pioglitazone group ( n=35) and glimepiride group ( n=34). At the same time, 30 healthy people in the physical examination center of our hospital were selected as the control group.The levels of serum NF-κB and MCP-1 were detected by immunohistochemistry.The changes of fasting glucose, Hemoglobin A1C (HbA1c), renal function, urinary albumin excretion rate (UAER), and hypersensitive C-reactive protein(hsCRP), interleukin-6(IL-6), homeostasis model insulin Resistance index (HOMA-IR) were detected and compared among the three groups before treatment, pioglitazone group and glimepiride treatment group after treatment.To observe the effect of pioglitazone on serum NF-kB and MCP-1 expression in patients with early type 2 diabetic nephropathy. Results:Serum NF-κB, MCP-1, UAER, fasting blood glucose, HbA1c, HOMA-IR, hsCRP, IL-6 were significantly higher in the diabetic nephropathy group than those in the control group before treatment ( t values were 9.16, 7.61, 16.99, 17.01, 17.05, 12.01, 8.69, 6.28, all P<0.01). After 12 weeks of treatment, the levels of NF- κB, MCP-1, HOMA-IR, hsCRP, IL-6 and UAER in pioglitazone group were lower than those in glimepiide group ( t values were -5.03, -4.63, -2.35, -8.03, -3.06, -2.10, P<0.05 or P<0.01). After treatment, there were no statistically significant differences in fasting blood glucose and HbA1c between the pioglitazone group and the glimepiide group (all P>0.05). Serum NF-κB, MCP-1, HbA1c, HOMA-IR and UAER in EDN group were significantly positively correlated ( R values were 0.568, 0.532, 0.521, 0.466, all P<0.05). Conclusion:The expression of NF - κ B and MCP-1 in serum of EDN patients was increased, which indicated that there was chronic inflammation in patients.Pioglitazone could down regulate the expression of NF - κ B and MCP-1, so as to play an anti-inflammatory and renal protective role.

Objective To investigate the correlation between serum neuregulin 4(Nrg4)level and metabolic associated fatty liver disease(MAFLD)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 240 T2DM patients admitted to the Department of Endocrinology of Second People's Hospital of Yichang from June 2021 to August 2022 were collected and divided into simple T2DM group(n=120)and MAFLD group(MAFLD,n=120).120 healthy individuals were selected as the normal control(NC)group.Results The serum Nrg4 decreased gradually from NC group,T2DM group to MAFLD group(P＜0.05).Pearson correlation analysis showed that serum Nrg4 was negatively correlated with WC,HOMA-IR and hs-CRP(P＜0.05),and positively correlated with HDL-C(P＜0.05).Logistic regression analysis showed that Nrg4,WC,HOMA-IR and hs-CRP were the influencing factors of MAFLD.After adjusting for age,sex,smoking history,BMI,TC,TG,HDL-C,LDL-C,FPG,FIns,HbA1c and other factors,serum Nrg4 was still the influencing factor of MAFLD.Conclusion The decrease of serum Nrg4 is a risk factor for T2DM combined with MAFLD.

Objective To explore the feasibility and clinical outcome of lateral cervical incision via sternocleidomastoid intermuscular approach(SMIA)in the treatment of primary hyperparathyroidism.Methods The clinical data of 64 patients with primary hyperparathyroidism who underwent unilateral parathyroid surgery in the First Affiliated Hospital,School of Medicine of Zhejiang University from January 2019 to June 2022 were retrospectively analyzed.They were divided into lateral cervical incision via sternocleidomastoid intermuscular approach group(SMIA group)and linea alba cervicalis approach group(LACA group)based on the surgical incision and access route.The differences in clinical features,surgery-related outcomes and postoperative functions of the anterior cervical region were compared between the two groups.The EQ-5D-5L scale was used to assess the subjective feeling of postoperative neck discomfort,while the Hollander Wound Assessment Scale was used to assess the clinical outcome of incision healing.Results There were no statistical differences between the two groups of patients in terms of age,gender,intraoperative bleeding,parathyroid hormone or blood calcium levels before and after surgery(P＞0.05).The duration of surgery was significantly shorter in the SMIA group than in the LACA group[(39.77±5.69)min vs.(54.41±4.66)min].There was a statistical difference between the two groups in functional protection of the anterior cervical region at 1 month and 12 months after surgery(1 month,84.67±3.74 vs.79.47±5.38,P＜0.001;12 months,93.80±2.52 vs.89.94±2.39,P＜0.001),and the SMIA group was better than the LACA group.The Hollander Incision Assessment Scale scores of the SMIA group were better than those of the LACA group at 6 months and 12 months after surgery,and the difference was statistically significant(6 months,1.93±0.58 vs.2.41±0.66,P=0.003;12 months,1.03±0.67 vs.1.74±0.62,P＜0.001).Conclusion Parathyroidectomy via sternocleidomastoid intermuscular approach through lateral cervical incision is a simple,safe and effective surgical procedure,which makes it easier to search for parathyroid lesions and shortens the surgical time compared with the traditional incision,and has obvious advantages in the protection of anterior cervical region function.

Unlike adult mammalian heart, zebrafish heart has a remarkable capacity to regenerate after injury. Previous study has shown Notch signaling activation in the endocardium is essential for regeneration of the myocardium and this activation is mediated by hemodynamic alteration after injury, however, the molecular mechanism has not been fully explored. In this study we demonstrated that blood flow change could be perceived and transmitted in a primary cilia dependent manner to control the hemodynamic responsive klf2 gene expression and subsequent activation of Notch signaling in the endocardium. First we showed that both homologues of human gene KLF2 in zebrafish, klf2a and klf2b, could respond to hemodynamic alteration and both were required for Notch signaling activation and heart regeneration. Further experiments indicated that the upregulation of klf2 gene expression was mediated by endocardial primary cilia. Overall, our findings reveal a novel aspect of mechanical shear stress signal in activating Notch pathway and regulating cardiac regeneration.