Objectives To implement the guideline-based clinical practice program for identification and manage-ment of dysphagia in stroke patients,and to create a good evidence-based practice culture,and to improve the quality of clinical care. Methods In this study,we use the Iowa model of evidence-based practice as a guide, reference guide issued by RNAO to implement the corresponding implementation strategy tool,and gradually apply the program to the pilot ward. Results The implementation of the program had a positive impact on the patient level (quality of life,satisfaction and hospitalization),the nurse level(satisfaction and knowledge),and the level of eachau-ditcriteria. Conclusion It is possible to improve the clinical nursing quality by adapting the high quality guide-lines for the identification and management of dysphagia in foreign countries and this study can provide reference for the research of future guideline implementation.

PURPOSE: T helper (Th) 17 cells play a critical role in the development of asthma, but the underlying mechanism of how interleukin (IL)-17 is regulated in allergic airway inflammation is poorly understood. In this study, we investigated the impact of Bcl11b on Th17 response in asthma. METHODS: Blood samples from patients with mild asthma (MA) and severe asthma (SA) were collected. Expression of Bcl11b, IL-4, IL-5, IL-13, IL-17A and transforming growth factor (TGF)-β1 were determined in CD4+ T cells and plasma by polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA). Relative mRNA and protein levels of Bcl11b, IL-17A and genes involved in the TGF/Smad signaling pathway were examined by PCR, ELISA and western blot analysis in house dust mite (HDM)-challenged mice. Ectopic expression of Bcl11b in HDM-stimulated primary mouse splenocytes was achieved by nucleofection of Bcl11b expression plasmid. RESULTS: We found significantly decreased Bcl11b but increased IL-17A and TGF-β1 expression in patients with asthma and a strongly negative correlation between Bcl11b and these 2 cytokines in SA patients. Similar expression patterns of Bcl11b, IL-17A and TGF-β1 were also found in mice with HDM-induced allergic airway inflammation. We demonstrated further that Smad2/3 phosphorylation was increased in HDM-challenged mice and that ectopic expression of Bcl11b in HDM-stimulated primary mouse splenocytes reduced Smad2 phosphorylation and IL-17 expression. CONCLUSIONS: Our findings demonstrate a potential effect of Bc111b in controlling IL-17-mediated inflammation in asthma and suggest that Bc111b may be a useful therapeutic target for asthma.
Animals ; Asthma* ; Blotting, Western ; Cytokines ; Ectopic Gene Expression ; Enzyme-Linked Immunosorbent Assay ; Humans ; Inflammation ; Interleukin-13 ; Interleukin-17* ; Interleukin-4 ; Interleukin-5 ; Interleukins ; Mice ; Phosphorylation ; Plasma ; Plasmids ; Polymerase Chain Reaction ; Pyroglyphidae ; RNA, Messenger ; T-Lymphocytes ; Transforming Growth Factors

Objective To explore the influencing factors of sub-health status among the migrant workers in Dongguan City.Methods A total of 740 migrant workers in Dongguan city were extracted by the stratified random sampling method.The SubHealth Measurement Scale Version 1.0(SHMS V 1.0) was adopted to test the health status.The data were analyzed by Logistic regression analysis.Results The univariate analysis showed that the marital status,average daily working time,monthly family per capita income,living conditions,drinking,breakfast,nutritional status,vigils,living conditions satisfaction,sedentary desk operation and experiencing negative events had statistical significance(P＜0.05).In the Logistic regression analysis:average daily working time,vigils and experiencing negative events were the risk factors of sub-health status occurrence,their odds ratio(OR) and 95 ％ confidence interval(CI)were 1.971(1.211,3.205),2.183(1.378,3.459) and 2.135(1.353,3.369),respectively.Breakfast and nutritional status were the protective factors of sub-health status occurrence,their OR and 95 ％ CI were 0.706 (0.526,0.947) and 0.386(0.239,0.625),respectively.Conclusion The unhealthy living habits and experiencing negative events affect the health of migrant workers in Dongguan City.

Objective: To analyze the feasibility of axillary lymph node staging through sentinel lymph node biopsy (SLNB) after neoad-juvant chemotherapy (NAC) in patients with node-positive breast cancer and to explore the follow-up treatment of these patients. Methods: Clinical data of 82 patients with node-positive breast cancer before NAC in Tianjin Medical University Cancer Institute and Hospital from January 2016 to January 2018 were analyzed retrospectively. All these patients accepted SLNB after NAC. The detection rate, accuracy, false negative rate (FNR), and influencing factors were analyzed. Results: A nodal pathological complete response (PCR) was achieved in 43 of 82 patients. The PCR rate was 52.4%. The detection rate, accuracy, and FNR were 97.56% (80/82), 88.75% (71/80), and 23.08% (9/39), respectively. The accuracy of 1, 2, and≥3 SLNs detected were 90.9% (20/22), 66.7% (10/15), and 95.3% (41/43), respectively. The FNRs were 20.0% (2/10), 71.4% (5/7), and 9.1% (2/22), respectively (both P<0.05). Conclusions: Due to its overall high FNR, without clinically acceptable limits, post-NAC SLNB cannot completely replace axillary lymph node dissection (ALND) in node-positive patients. However, with no less than 3 SLNs detected, SLNB can accurately evaluate the status of axillary lymph nodes.

Objective To explore the effect of topical application of Fushan rheumatism external prescription on inflammatory cytokines and notch2 pathway in rats with collagen-induced arthritis(CIA).Methods 36 female Wistar rats were randomly divided into normal group(n=10)and model group(n=26).CIA model was successfully established in 20 rats,which were randomly divided into model group(n=10)and Fushan rheumatism external prescription group(n= 10).Treatment was initiated on day 14,and 0.4 mL ointment was evenly applied to the ankle joints of rats in Fushan rheumatism external prescription group.Normal group and model group were topical smeared with the same volume of normal saline.Activity was taken twice a day for 42 days.The joint swelling of rats was observed every week and the arthritis index was scored.Thereafter blood was collected from abdominal aorta,and then ankle joint,spleen,liver,and kidney of rats were taken out after the end of the interventions.The severity of arthritis and the pathological changes of ankle joint,liver and kidney were evaluated by HE staining;Inflammatory cytokines expression in serum were detected by ELISA;The expression of Notch2,Delta-like ligand protein 1(delta-like ligand protein-1,DLL1)and nuclear factor-κ Bp65(nuclear factor-κ Bp65,NF-κ Bp65)mRNA and protein in synovium of ankle joints and spleen were detected by qRT-PCR and Western blot,and its positive expression in ankle joints were detected by immunohistochemical method;The changes of liver and kidney function of rats in each group were detected in serum.Results Compared with normal group,the arthritis index score in model group were increased(P<0.01),joint injury and pathological score were increased(P<0.01),the levels of inflammatory cytokines TNF-α,IL-6,IL-17 and IFN-γ in serum were increased(P<0.01),the expression of Notch2,DLL1 and NF-κBp65 mRNA and protein in joints and spleen were increased(P<0.01),and the positive expression in joints were also increased(P<0.01);Compared with model group,the arthritis index score in Fushan rheumatism external prescription group were decreased(P<0.05,P<0.01),joint injury and pathological score were decreased(P<0.01),the levels of inflammatory cytokines TNF-α,IL-6,IL-17 and IFN-γ in serum were decreased(P<0.01),the expression of Notch2,DLL1 and NF-κBp65 mRNA and protein in joints and spleen were decreased(P<0.01),and the positive expression in joints were also decreased(P<0.01).In addition,no noticeable tissue damages were observed in liver and kidney in Fushan rheumatism external prescription group,and the levels of aspartate aminotransferase(AST),alanine aminotransferase(ALT),blood urea nitrogen(BUN)and creatinine(Cr)in serum were no changes(P>0.05).Conclusion Fushan rheumatism external prescription relieves arthritis symptoms and joint injury in CIA rats,and has no toxic and side effects on liver and kidney.Its mechanism may be related to the reduction of inflammatory cytokines and down-regulation of Nocth2 pathway.

This paper aims to explore the barriers of the special courses of Chinese medicine nursing development in advanced traditional Chinese medicine universities from the perspectives of students , education system and social determinants .Related-suggestions and strategies are also referred to the barriers in order to provide references for further course optimization .

Objective To evaluate the quality of evidence-based guidelines on senile functional constipation management and provide references for decision-making and the development of evidence-based guidelines suitable for China. Methods A search of Guideline International Network (GIN), National Guideline Clearinghouse (NGC), National Institute for Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), Canadian Medical Association (CMA), New Zealand Guidelines Group (NZGG), Registered Nurses Association of Ontario (RNAO), National Health and Medical Research Council (NHMRC), American College of Gastroenterology (ACG), China Guideline Clearinghouse (CGC), Medlive website, and related websites and databases were conducted to screen the guidelines on senile functional constipation management with inclusion and exclusion criteria. Appraisal of Guidelines for Research & Evaluation Ⅱ (AGREE Ⅱ) was applied on the methodological value evaluation for searched guidelines. The overall agreement among 3 appraisers was measured by the intraclass correlation coefficient (ICC). The analysis of advices from guidelines was performed. Results A total of 5 evidence-based guidelines were included, which were all from abroad. The average scores of guidelines in six domains of AGREE Ⅱ were 97.78% (scope and purpose), 78.52% (stakeholder involvement), 79.86% (rigor of development), 89.63% (clarity of presentations), 63.89% (applicability), and 86.87% (independence) respectively. The ICC were 0.887- 0.971. Considering the overall quality evaluation, 3 of them were grade A and 2 of them were grade B. The recommendations of included guidelines were almost consistent. Conclusions The overall quality of included guidelines is high. There is no local evidence-based guideline of senile functional constipation management in China. High-quality guidelines can offer the evidence support for the development of clinical practical guideline for senile functional constipation management. Foreign guidelines should be localized before their application in the clinic in China.

Objective To review the methodological quality of evidence-based guidelines on prevention and repair of perineal injury at vaginal delivery,and analyze the characteristics of guidelines to provide references for evidence-based decision-making.Methods We systematically searched websites of professional organizations,websites of clinical practice guidelines and databases for guidelines on prevention and repair of perineal injury,and used AGREE Ⅱ to evaluate the chosen guidelines.Results We identified totally 7 relevant evidence-based guidelines in this field.The average standardized scores of guidelines in 6 domains of AGREE Ⅱ were 90.21％(scope and purpose),68.25％ (stakeholder involvement),69.94％ (rigor of development),89.41％ (clarity of presentations),70.63％ (applicability),and 68.25％(independence),respectively.The overall standardized score for 7 guidelines was 75.65％,and the total score was 5.67 (7 points).For overall quality,4 of them were grade A and 3 of them were grade B.Conclusion The overall quality of included guidelines were high,but stakeholder involvement,rigor of development and independence in some guidelines needs to be improved.There was no Chinese evidence-based gui-deline in this field,and high-quality foreign guidelines could be used as evidence in combination with local conditions.

Objective To evaluate the role of tumor budding in the prognostic value of intrahepatic cholangiocarcinoma(ICC) after radical resection.Methods The clinicopathological data of patients undergoing radical resection for intrahepatic cholangiocarcinoma between 2011 and 2016 were retrospectively analyzed.The number of tumor budding was counted in a ×200 microscopic field (0.785mm2).Based on receiver operation curve (ROC),the number of tumor budding ≥ 15 was defined as high-grade group,and ＜ 15 was low-grade group.Multivariate analysis were performed on predictors of the tumor.Results Low-grade group was observed in 32 cases and high-grade group in 50.High-grade group appeared to develop tumors with higher CA199,poor differentiation,larger tumor diameter,advanced stage and high risks of lymphnode metastasis (respectively x2 =5.470,4.359,5.101,4.696,5.960,all P ＜ 0.05).Univariate analysis showed that tumor budding,CA199,differentiation,tumor diameter,T classification and lymphnode metastasis were related to the overall survival of patients with ICC (respectively x2 =11.704,4.876,5.056,5.152,8.442,16.725,all P ＜ 0.05).On multivariable analysis,high-grade group was a significant independent predictor of worse OS (HR =2.707 95％ CI 1.558-4.705,P ＜ 0.001).Conclusions High-grade tumor budding is an important negative prognostic factor for ICC.

Objective To evaluate the effects of laparoscopic splenectomy and esophagogastric devascularization(LSPD) vs.open procedure(OSPD) on stress and immune function in patients with portal hypertension due to cirrhosis.Methods From June 2015 to June 2017 a total of 66 patients underwent LSPD or OSPD procedures.Results Plasma cortisol concentration in the LSPD group was lower than that in the OSPD group (Fgroup =18.85,P =0.020).Cortisol concentration in the two groups increased firstly and then decreased with time extension (Ftime =532.08,P =0.000).The level of CD3 +,CD4 +,CD4 +/CD8 + in LSPD group was higher than that in OSPD group,and the level of CD8 + was lower than that in OSPD group (Fgroup =3.55,21.47,154.84,64.29,P ＜ 0.05),the levels of CD3 +,CD4 + and CD4 +/CD8 + in the two groups first decreased and then increased with the extension of time,and the levels of CD8 + increased firstly and then decreased (Ftime =199.22,298.48,864.33,510.23,P ＜ 0.05),the increase range of CD3 +,CD4 +,and CD4 +/CD8 + in LSED group was higher than that in OSPD group (Finteraction =19.27,18.21,79.55,35.21,P ＜ 0.05);there was no statistical significance in the complications such as:rebleeding,thrombosis and splenic fever in the two groups (x2 =0.05,0.67,0.07,0.16,P=0.829,0.413,0.789,0.693).But the postoperative chest/cavity effusion and fever (＞ 38.0 ℃,and ＞ 3 days) is OSPD group is higher than in the LSPD group(x2 =5.49,6.68,P =0.019,0.010).Conclusion LSPD effectively reduces postoperative stress,protects immune function,decreases postoperative pleural and abdominal effusion and fever.