Through the review on the 2 months visit to College of Nursing of Michigan State University,I'd like to share the ideas with others.The conten of nursing education,clinical nursing,nursing research and patient safety to improve quality of nursing education.

BACKGROUND:Bone marrow derived mesenchymal stem cells (BMMSCs) have multi-differentiation potentials, possessing a repairing capability for the sectional bone defects if combined with degradable porous β-tricalcium phosphate china. This provides a new idea in clinical repair of various bone defects.OBJECTIVE: To explore in radiology the curative effect of implanting porous β-tricalcium phosphate and autogenous BMMSCs compound to treat bone defects.DESIGN: A randomized controlled study with callus growth at various healing periods as subjects for observation. SETTING: Department of Orthopaedics, Renmin Hospital, Wuhan University; Tissue Engineering Center, Research Institute of Basic Medicine,Academy of Military Medical Sciences of Chinese PLAMATERIALS: This experiment was carried out at the Tissue Engineering Center, Research Institute of Basic Medicine, Academy of Military Medical Sciences of Chinese PLA between March and September 2002. Twenty China healthy adult sheep were randomized into the groups of blank control group (4 sheep), simple implantation group (8 sheep) and complex implantation group (8 sheep).METHODS: Under general anesthesia and aseptic condition, 10-15 mL of sheep marrow was extracted; MSCs were separated and cultured before combined with porous β-tricalcium phosphate china for tissue engineering bone construction. Rats in each group were cut off 21mm long metatarsus in the middle section of metatarsus bonestem. Β-tricalcium phosphate china and autogenous MSC compound was implanted into the sheep of the complex implantation group; β-tricalcium phosphate china was implanted into the simple implantation group; and the bone defects in the blank control group remained untouched. Then the incision was sutured.X-ray filming was carried out right after the operation, as well as 1, 3,and 6 months after the operation for radiological appraisal (scored for1 if bone union formed in one surface of bone defect, but scored 0 if no boneunion formed in any surface of bone defect, and scored 4 if bone union formed in front, back, lateral surfaces and the center of bone defect), Xray radiation-resisting density was analyzed to compare the results of bone defect repair.MAIN OUTCOME MEASURES: The postoperative general condition and general observation, as well as the results of the radiological analysis of the bone defects of all sheep.RESULTS: Totally 20 sheep were brought into this xperiment and all entered the stage of result analysis. ① The postoperative general condition:Sheep regained consciousness 2-6 hours after the operation without incision infection and loosing of internal fixation. Their spirit gradually was back to normal 1 week after the operation, at which time the injured legs could touch ground but were incapable of bearing load, and the affected legs could bear load 2 weeks after the operation, walked slightly lamely 3 weeks after the operation, and even moved freely without limp 4 weeks after the operation. ②The general condition 6 months after the operation: In pure implantation group, the surface white hyaline cartilage-like tissues were gradually calcified, with both ends connected with the host bone by bone bridge, but china granules could still be easily observed; while no implantation substance could be observed in compound implantation group,with the boundary between implantation substance and host bone vanished,and bone defect became basically the same as host bone. However there was no bone tissue formed in bone defect at various postoperative time points in the blank control group. ③ Radiological analysis of the bone defects at various postoperative time points: The radiological rating score was obviously higher in complex implantation group at the time poin ts of 3, 6 months after the operation compared with the pure implantation group [(2.3±0.3), (1.8±0.5); (3.3±0.5), (2.6±0.6), P ＜ 0.05]. ④ Radiological analysis of bone callus thickness and the relative value of radiation-resisting density at various postoperative time points: The bone callus thickness in the complex implantation group was obviously lower than that of the pure implantation group at the postoperative time point of 6 months (4.62 vs 7.64, P ＜ 0.05), with relative value of radiation-resisting density obviously higher than that of the pure implantation group (70.4±1.5 vs 61.18±1.2, P ＜ 0.05).CONCLUSION: Radiological appraisal and bone defect density measurement can well reflect the dynamical repairing process of bone defects; the implantation of porous β-tricalcium phosphate china and autogenous BMMSCs compound into sheep can enhance the repair of large sectional bone defect.

Objective To explore curriculum and faculty qualification of Chongqing operating room (OR) specialty certified nurse theoretical tralning program by feedback of students, and to im-prove the quality of tralning. Method Relying on the national key project of the First Affiliated Hos-pital of Chongqing Medical University, Chongqing Health administration OR nurse specialist tralning program set additional courses related to research, teaching, patient safety and first ald tralning based on operation room specialist nurse tralning outline. 81 participants were given questionnalres issued by college of nursing after the 7th OR specialist nurse theoretical tralning, and statistics analysis was made of it. Result Effective questionnalres was100%. The overall judgment on theory tralning was high, with 92.60%of the students giving overall score above 150 points (out of 170);93.84%of students sat-isfied on teaching staff ratio while 95.06% students satisfied on course content. For the 17 items, the majority scores given by the students were ≥ 9 points (a 10-points scale), on the top of the list were item “Theoretical tralning helps to enhance professional theoretical level and guide clinical practice”“Teaching content meet needs of OR specialist nurses” “Teaching content is helpful to improve the core competence of specialist nurses” (all 96.30%, 78 out of 81), while the bottom was “Instructor create an environment which fosters student participation”(85.19%, 69 out of 81). Conclusion Chong-qing OR specialist theoretical tralning has good practical and guidance property, the content meet OR nurses needs, instructor ratio is reasonable, and students are highly satisfied with it. Instructors need to encourage students' participation in class interaction, and pay attention to improving their research capabilities.

Objective To identify the effect of SBAR (situation, background, assessment, recom-mendation) in OR (operating room)nursing teaching rounds. Methods According to internship turns, rou-tine group (even number, Group A:68 students) and SBAR group (odd number, Group B:70 students) were chosen by drawing lots. Group A used conventional mode for history report, while Group B used SBAR mode. Students' performance was evaluated by OR nurse students' rounds standard scale and the reporting time was recorded. Each nurse students filled in Communication Self-efficacy Evaluation Form on the fifth week in OR. The information was input into excel. The results of the two groups were compared with SPSS 11, and the data were analyzed by chi square test and t test. Results The average reporting quality score was 16.74 for Group A, and 18.66 for Group B. The average score of Group B was higher than that of Group A. Compared with the cases scores above 18 between the two groups, the result was statistically significant, P=0.039. The average score of communication Self-efficacy in Group A was 42.88, while it was 44.94 in Group B, which showed that Group B had better score than that of Group A. Significant differences was found between the two groups when compared the cases with score above 45, P=0.010. The average reporting time was (2.42±1.16) minutes for Group A and (2.32±1.21) for Group B, and there is no significant differences between the 2 groups. Conclusion SBAR is helpful for improving students communication Self-efficacy, and making progress on nursing round reporting quality,and it is worth promoting in clinical teaching.

Objective To investigate the current situation and problems of bilingual English teaching for students majored in foreign-related nursing and to explore its countermeasures.Methods Selfmade questionnaire survey was conducted anonymously among 69 undergraduate students majored in foreign-related nursing.Students' basic information,self-evaluation of English level,classroom interaction,evaluation and satisfaction of the curriculum,their conception of curriculum necessity,elective reasons,preferences of teaching methods and learning style,learning interest,as well as confidence in learning were investigated.Excel 2007 was used to do statistical analysis.Results 92.42％ questionnaire was effectively recovered.It is suggested that this group of students' public English background was strong (90.16 ％ passed CET-4).Students have low sense of self-identity and lack of confidence in themselves (self-rated English:‘ very good' for 0％,‘ good' for 1.64％,‘ general' for 52.46％,‘ bad' for 39.34％,‘ very poor' for 6.56％).They knew the necessity of the curriculum clearly,but paid less attention to it (extracur-ricular professional English learning time of 68.85％ was less than 30 minutes; 21.31％ of them hardly took time to learn).There were significant differences in favorable proportion of English teaching among stu-dents,from less than 50％ to 100％ respectively.Poor speaking and listening ability and poor profes-sional vocabularies had negative impact on classroom interaction.Conclusions Faculty need to make efforts in inspiring students' interest of learning,improving students' English speaking and listening abilities as well as confidence cultivation and further explore curriculum planning.

Objective:To explore the clinical efficacy and risk factors of umbilical cord mesenchymal stem cells (UCMSCs) infusion at an early stage (i.e.gross hematuria) for hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods:The relevant clinical data were retrospectively reviewed for 300 patients undergoing allo-HSCT from January 2016 to July 2021.According to the presence or absence of HC, they were assigned into two groups of HC (n=89) and non-HC (control, n=211). According to whether or not receiving an infusion of UCMSCs, 51 patients of HC degree Ⅱ-Ⅳ were divided into two groups of UCMSC infusion and non-infusion.The risk factors of HC after allo-HSCT were analyzed by χ2 test.Logistic regression was employed for multivariate analysis of P<0.05.Mann-Whitney U test was utilized for statistically analyzing the duration of gross hematuria and urinary tract irritation symptoms and evaluating the clinical efficacy of UCMSCs infusion for HC. Results:Among them, 89 (29.67%) developed HC post-allo-HSCT.Clinical grades were Ⅰ (n=38, 42.70%), Ⅱ (n=36, 40.45%), Ⅲ (n=13, 14.61%) and Ⅳ (n=2, 2.25%). The median occurrence time was 29 (21.5-35.0) days post-allo-HSCT.In univariate analysis, age ≤30 years, haploid transplantation, antithymocyte globulin (ATG), acute graft-versus-host disease (aGVHD), CMV-DNA positive pretreatment significantly boosted the risk of HC ( P<0.05). In multivariate analysis, aGVHD was an independent risk factor for HC ( OR=10.281, 95% CI: 1.606-65.813, P=0.014). Among 89 HC patients, 38 grade Ⅰ patients were complete remission(CR). Among 51 patients of grade Ⅱ-Ⅳ HC, the outcomes were CR (n=48) and non-remission(NR)(n=3). And 24/51 of them received UCMSCs plus conventional treatment.The duration of gross hematuria was shorter in UCMSCs infusion group than that in UCMSCs non-infusion group [12(9-17) vs 17(12.0-26.5) day] and the difference was statistically significant ( P=0.045). And the duration of urinary tract irritation symptoms was shorter in UCMSCs infusion group than that in UCMSCs non-infusion group [18(11-30) vs 27(18.0-35.5) days] and the difference was statistically significant ( P=0.048). Conclusions:Indicated for post-ALLO-HSCT HC, infusion of UCMSCs may significantly shorten the course of disease.Age ≤30 years, haploid transplantation and preconditioning with positive ATG, aGVHD and CMV-DNA may boost the risks of HC post-allo-HSCT.And aGVHD is an independent risk factor for HC after allo-HSCT.

Objective:To evaluate the safety and efficacy of bortezomib plus highdose melphalan (L-phenylalanine nitrogen mustard) (Bor-HDM) pretreatment regimen for multiple myeloma (MM) with autologous hematopoietic stem cell transplantation (ASCT).Methods:From August 2008 to December 2021, the relevant clinical data were retrospectively reviewed for 58 MM patients undergoing MM transplantation.The conditioning regimens were Bor-HDM (n=36) and HDM (n=22). Non-hematopoietic adverse reactions, hematopoietic reconstruction time, remission rate post-ASCT and minimal negative rate of residual disease (MRD) on flow cytometry within 3 months post-ASCT and survivals were analyzed.Results:In Bor-HDM and HDM groups, median time of neutrophil engraftment was 12(8-30) and 11(8-29) day and median time of platelet reconstitution 16(8-33) and 16(7-32) day respectively.There was no significant inter-group difference ( P=0.890, P=0.638). In Bor-HDM group, the most common non-hematological adverse reactions were nausea (n=21, 58.0%) and diarrhea (n=11, 30.6%). There was no transplant-related death.Complete remission (CR) rate was (25/36, 69.4%) versus (9/22, 40.9%). The inter-group difference was statistically significant ( P=0.032). Median follow-up period was 29.0(2.0-91.0) vs. 20.5(5.0-114.0) month, 3-year progression-free survival(PFS)62.1% vs. 39.7% and 3-year overall survival(OS) 83.8% vs. 62.5%.There were relapse (n=10 vs.10) and death (n=6 vs. 7). Median PFS in Bor-HDM and HDM groups was non-attained and 27 months( P=0.047) and median OS time non-attained and 40 months respectively ( P=0.282). Multivariate analysis revealed that CR was an independent risk factor for PFS ( HR=28.896, 95% CI: 6.130-136.198, P<0.001). Non-CR was an independent risk factor for OS ( HR=3.843, 95% CI: 1.334-11.071, P=0.013; HR=28.595, 95% CI: 6.273-130.355, P<0.001). Conclusions:Bor-HDM pretreatment regimen of ASCT is both safe and efficacious for MM patients.

OBJECTIVE： To study the improvement effects and its mechanism of erythropoietin derivative helix B surface peptide （HBSP） on epirubicin-induced myocardial injury in rats. METHODS： SD rats were randomly divided into control group， model group， erythropoietin （EPO） group and HBSP group， with 10 rats in each group. Except for control group， other groups were given epirubicin 2.5 mg/kg intraperitoneally， once a week， for consecutive 6 weeks to induce myocardial injury model. EPO group and HBSP groups were given rhEPO 5 000 u/kg or HBSP 60 μg/kg intraperitoneally， 3 times a week （one day before medication， first day and third day after medication of epirubicin）， for consecutive 6 weeks. At the beginning of the first administration， the rats were weighed at the 11th week. The cardiac function was measured by echocardiography [left ventricular end-diastolic diameter （LVIDd）， ejection fraction （EF）， fractional shortening （FS） and cardiac output（CO）]. The serum levels of troponin I （cTnI） and amino-terminal B-type natriuretic peptide （NT-proBNP） were determined by ELISA. mRNA expression of PI3K and Akt in myocardial tissue was detected by RT-PCR. The protein expression of p-PI3K and p-Akt in rat myocardium were detected by Western blot. RESULTS： During research period， two rats died in model group， one in EPO group and none in HBSP group. Compared with control group， body weight， the levels of EF， FS and CO were decreased significantly in model group， while the contents of LVIDd and cTnI， NT-proBNP were increased significantly； mRNA expression of PI3K and Akt as well as protein expression of p-PI3K and p-Akt were decreased significantly， above differences were statistical significant （P＜0.05）. Compared with model group， body weight， the levels of EF， FS and CO were increased significantly in EPO group and HBSP group， while the contents of LVIDd and cTnI， NT-proBNP were decreased significantly； mRNA expression of PI3K and Akt as well as protein expression of p-PI3K and p-Akt were increased significantly， above differences were statistical significant （P＜0.05）. Compared with EPO group， the contents of cTnI and NT-proBNP were decreased significantly in HBSP group， with statistical significance （P＜0.05）. CONCLUSIONS： HBSP can improve myocardial injury in rats as much as EPO， and has less toxity. Their mechanism may be related to the activation of PI3K/Akt signaling pathway.

Portal hypertension is a serious complication of liver cirrhosis resulting from the increases in portal vascular resistance and portal blood inflow. Both etiological and non-etiological therapies can effectively reduce portal venous pressure to a certain degree, but with an unsatisfactory effect in improving prognosis. New therapeutic drugs targeting the reduction in intrahepatic vascular resistance may help to achieve the reversal of portal hypertension. Based on the pathogenesis of cirrhotic portal hypertension, this article summarizes the current pharmacotherapies from the aspects of etiological and non-etiological therapies, so as to provide a comprehensive theoretical and evidence-based basis for clinical treatment options.