Objective To understand the working stress source of nurse anesthetists and its coping measures. Methods The semi-structured in-depth interview was conducted in 11 nurse anesthetists from 4 hospitals. The collected data were analyzed and concluded by using Colaizzi’s seven step method of phenomenological analysis. Results Four themes were extracted and a series of sub-themes, including work environment, work characteristics and nature, confusion of career prospects and coping styles. Conclusions Managers should pay close attention to anesthesia care. The laws and policy of the qualifications standards for nurse anesthetists should be made, which can reduce the stress of nurse anesthetists including healthy and harmonious working environment, a professional training system of nurse anesthetists and career planning. So that we can improve the professionalism of nurse anesthetists.

Anhedonia, or markedly diminished interest or pleas-ure, is a hallmark symptom of depression.As a psychopathological symptom, anhedonia was first noted in the early 19th century.The neurobiological mechanisms that underline anhedonia and its role in diagnosing depression disorder or evaluating antidepressant response have long been aroused attention for nearly a century.Consequently, there are many measuring methods established in both the animal study and human research, which would be reviewed in the present study.

Objective To study clinical efficacy of leuprorelin acetate in treatment of uterine adenomyosis with infertility.Methods From January 1,2011 to March 31,2012,166 cycles in 166 infertile patients combined with uterine adenomyosis undergoing in vitro fertilization embryo transplant (IVF-ET) with long protocol ovum induction by leuprorelin acetate in centre of medical reproduction,ningbo women and children's hospital were studied retrospectively.In the mean time,200 cycles in 200 infertile patients with tubal factors were enrolled as control group.The volume of uterus and outcome of IVF-ET were compared and studied between two groups.Results (1) Volume of uterus:in adenomyosis group,after 2-6 cycles of injecting leuprorelin acetate (3.75 mg/28 days),the mean uterine volume was shrinked from (180 ±73) cm3 to (86 ± 67) cm3 (P ＜ 0.05).(2) Outcome of IVF-ET:the rate of embryo implantation was 39.1％ in adenomyosis group and 35.8％ in control group.The rate of clinical pregnancy was 54.2％ in adenomyosis group and 53.7％ in control group.The rate of abortion was 4.7％ in adenomyosis group and 4.2％ in control group.They all did not show statistical differences (P ＞0.05).(3) In adenomyosis group,the rate of fertilization,two pronuclear (2PN) and superior embryo were 67.2％ (319/475),60.8％(289/475) and 52.9％ (162/306) in patients with failed pregnancy and 74.2％ (423/570),67.7％(386/570) and 62.1％ (256/412) in patients with successful pregnancy after IVF-ET,which reached significant difference (P ＜ 0.05).Conclusion Leuprorelin acetate could improve volume of uterine adenomyosis and outcome of pregnancy in patients undergoing IVF-ET.

Objective To evaluate the application of liver ultrasound hemodynamic parameters in diagnosing moderate to severe esophageal varices(EV) among patients suffering from portal hypertension.Methods The control group consisted of twenty nine patients without EV.Sixty patients with EV diagnosed by endoscopy were divided into two groups equal in number according to grade of EV.One being mild,the other was moderate to severe.All patients underwent color Doppler flow imaging and contrastenhanced ultrasound,and the dynamic angiography data were collected.Time intensity curves were drawn by software to acquire the arrive time of hepatic artery (HAAT),hepatic vein (HVAT) and portal vein (PVAT).Then HV-HA interval time,PV HA interval time and PV-HV interval time were calculated.The quantitative parameters including HV-HA,PV-HA,PV-HV,damping index (DI) of hepatic vein and portal vein velocity(PVV) were compared.ROC curve was used to assess the value of the parameters above in predicting moderate to severe esophageal varices.Results The difference of PV-HV,PV HA,HV-HA,PVV,DI between the control and the moderate to severe group were statistically significant (P =0.000).PV-HV,PV-HA,HV-HA,DI in moderate to severe group showed statistically significant compared with mild group (P =0.000,P =0.002,P =0.000,P =0.002),however,PVV had no significant (P ＞0.05) difference between the two groups.Mild group contrasted to the control group,the differences of PV-HA and HV-HA were statistically significant (P =0.000),whereas PV-HV,DI,PVV displayed no significant (P ＞0.05) difference.The areas under ROC curve of PV-HV,PV-HA,HV-HA,PVV,DI were 0.952,0.775,0.847,0.699,0.808 respectively.The best cutoff value of PV-HV for diagnosing moderate to severe EV was 0.5 second,with sensitivity and specificity of 86.2％ and 94.8％ respectively.Conclusions The liver ultrasound hemodynamic parameters is helpful in the diagnosis and evaluation of moderate to severe esophageal varices,which is expected to become a new noninvasive method.

Objective To observe the effect of electroacupuncture on back three-acupoints ( namely bilateral Dazhu, Fengmen, Feishu) on the protein and mRNA expression of transforming growth factor-beta 1 (TGF-β1) and Smad3 in asthmatic rat airway remodeling model, and to explore its therapeutic efficacy and molecular mechanism. Methods Rat asthma model was established by inhalation of ovalbumin. After sensitization for 6 weeks, rats were killed. And then the airway morphological parameters of rats were measured by image analysis. The protein and mRNA expression of TGF-β1 and Smad3 in lung tissues were detected by immunohistochemistry and real-time quantitative polymerase chain reaction (qRT-PCR) respectively. Results Compared with the blank group, the standardized values of muscle cross-sectional area including airway smooth muscle area (WAm) /perimeter of the basement membrane (Pbm), and bronchial inner wall area (WAi)/Pbm were increased in the model group. The protein and mRNA expression levels of TGF-β1 and Smad3 were also increased in the model group. In electroacupuncture group, the above observation indexes were decreased, and the differences were statistically significant ( P<0.05 compared with the model group). Conclusion The experimental results indicated that back three-acupoint electroacupuncture has an effect on remodeling airway, and one of the mechanisms is probably associated with the regulation of TGF-β1/Smad3 signaling pathway.

Objective This study developed the post competency evaluation questionnaire of anesthesia nurses and tested its reliability and validity. Methods The item pool was developed through literature analysis, behavioral event interview and Delphi method, which was based on the post competency model. A total of 222 anesthesia nurses were investigated firstly, and the formal questionnaire was formed by item analysis, exploratory factor analysis and correlation analysis. Then the reliability and validity were tested. A total of 214 anesthesia nurses were investigated, the data was used to analyze the confirmatory factor, and the SEM was constructed finally. Results Six factors were identified including 35 items and the cumulative contribution of variance was 65.898%. The correlation coefficient between each factor and total score ranged from 0.793 to 0.863, and the correlation coefficient among each factor ranged from 0.512 to 0.739. The Cronbach′s α coefficient was 0.96 and the Spearman-Brown was 0.883 for the total scale. The model fitting indexes of structural equation model were as below, RMR=0.044, RMSEA=0.064, CFI=0.901, IFI=0.902, PNFI=0.727, PCFI=0.807. Conclusions This evaluation questionnaire has good reliability and validity, and it could be used as a tool to evaluate the post competency of anesthesia nurses in China.

Objective: To establish the mouse aorta dissection (AD) model through drinking water containing β-aminopropionitrile (BAPN). Methods: Forty 3-week-old C57B1/6J male mice were divided into four groups according to randomized block design: control, 0.2, 0.4 and 0.8 g·kg^-1·d^-1 BAPN groups (dissolving respective dose of BAPN in the drinking water, n=10 each group). Arterial systolic blood pressure and heart rate were measured weekly in conscious, restrained mice using a noninvasive computerized tail-cuff system. Mice those died of rupture of aortic dissecting aneurysm during the study were autopsied and the aorta was examined. After 4 weeks, survived mice were sacrificed by an overdose of sodium pentobarbital and the whole aorta was harvested and analyzed. Results: The incidence of AD and the mortality of ruptured AD was 0 and 0 in control group, 30% (3/10) and 20% (2/10) in 0.2 g·kg^-1·d^-1 BAPN group, 50% (5/10) and 40% (4/10) in 0.4 g·kg^-1·d^-1 BAPN group, 90% (9/10) and 70% (7/10) in 0.8 g·kg^-1·d^-1 BAPN group (both P<0.05 vs. control group). The incidence of AD and the mortality of ruptured AD increased in proportion to BAPN concentration increase. In 0.8 g·kg^-1·d^-1 BAPN group, 7 mice died of dissecting aneurysm rupture during the experiment, among which 5 dissecting aneurysms were mainly located in the thoracic aorta and 2 dissecting aneurysms in abdominal aorta. The diameters of thoracic aorta and abdominal aorta were (1.38±0.19) and (1.23±0.13) mm in control group, (2.43±1.56) and (1.30±0.26) mm in 0.2 g·kg^-1·d^-1 BAPN group, (2.45±1.28) and (1.30±0.31) mm in 0.4 g·kg^-1·d^-1 BAPN group, (2.87±0.57) and (1.95±0.81) mm in 0.8 g·kg^-1·d^-1 BAPN group (both P<0.05 vs. control group). The diameters of thoracic aorta and abdominal aorta in mice also increased in proportion with BAPN concentration increase. Furthermore, blood-filled false lumen formation and elastic fibers fragmentation were evidenced in hematoxylin-eosin stained and Vitoria blue-Sirius red stained aortic cross-sections of mice in the 0.8 g·kg^-1·d^-1 BAPN group. Conclusion BAPN treatment induced aortic dissection model in C57Bl/6J mice can serve as a useful wild-type mouse model for the mechanism and pharmaceutical studies of AD.

Objective:To explore the alteration of structural network, cognitive scores in patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, as well as the relationship between cognitive impairment and changes of structural networks in patients with NMDAR encephalitis.Methods:This study was a retrospective study. A total of 39 patients with anti-NMDAR encephalitis were recruited as the autoimmune encephalitis group (AE group) from the First Affiliated Hospital of Chongqing Medical University between September 2012 to December 2019, and 32 healthy volunteers with normal results of routine head MR examinations and no history of central nervous system diseases were recruited as the health control group (HC group). There were 16 males and 23 females, aged from 13 to 66 (34±15) years, with duration of disease from 11 to 110 (31±20) days in AE group, and there were 16 males and 23 females, aged from 13 to 66 (34±15) years in HC group. All subjects underwent diffusion tensor imaging (DTI) scan and cognitive function evaluation. The brain structural networks of two groups were constructed by deterministic fiber tracking techniques, and the differences of global topological properties [clustering coefficient (C p), shortest path length (L p), local efficiency (E loc), global efficiency (E glob), normalized C p (γ), normalized L p (λ), small-worldness (σ)] and local topological properties between two groups were analyzed by the graph theory approch. The correlations between characteristics of brain structural networks and cognitive function scores were further analyzed. Results:There was no significant difference in age and gender distribution between the AE group and HC group ( P>0.05). The C p [0.005(0.004, 0.007)], γ (1.76±0.13), λ (0.51±0.03) and σ value (1.57±0.13) of AE group were decreased when compared with HC group [the values were 0.007(0.004,0.017), 2.13±0.63, 0.55±0.06 and 1.73±0.36 each] ( Z=-939.00, t=-3.58, t=-4.16, t=-2.58, P<0.05). Compared with HC group, nodal efficiencies in the left middle frontal gyrus (orbital part), left and right supplementary motor areas, left olfactory cortex, left gyrus rectus, bilateral insula, left postcentral gyrus, left paracentral lobule and right heschl gyrus were changed ( P<0.05). There were five identical hub regions which contains the left middle occipital gyrus, bilateral supplementary motor areas and precuneus in both groups. However, in the AE group, three hub regions of the left middle occipital gyrus and bilateral middle temporal gyrus were reduced, and the left precentral gyrus was increased as hub region. The nodal efficiencies of the left supplementary motor areas ( r=0.393, P=0.013), right supplementary motor areas ( r=0.384, P=0.016) and left paracentral lobule ( r=0.356, P=0.026) were positively correlated with the montreal cognitive assessment scores. Conclusion:The white matter is extensively impaired in anti-NMDAR encephalitis patients and the changes of topological properties in several brain regions are correlated with cognitive decline.

The annual deaths associated with influenza is estimated to be between 290 000 and 650 000,which caused substantial burden to the society.Children have the highest incidence of influenza among all age groups,which can cause overloaded medical visits and a significant increase of hospitalization risk.The severe economic burden includes not only the direct medical costs due to outpatients and hospitalization,but also the indirect burden of school absence of children and work absence of their family members.Annual vaccination is the best measure to prevent influenza,however,influenza vaccination coverage among children in China is very low,and influenza vaccination has not yet been included in the National Immunization Program.Now,the disease burden of influenza and the vaccine usage in children in China were reviewed,and in order to provide evidence for influenza control and prevention.