The nurse's multiple-sites practice is currently being implemented,but there are debates regarding advantages and disadvantages.This review analyzed the background and advantages of the nurse's multiple-sites practice,and its main obstacles encountered in China,and put forward our opinions and suggestions about nurse's multiple-sites practice connecting with the practical situation.

Objective To comprehend the awareness rate and the implementation of risk factors related to Helicobacter pylori (HP) infection in families with children of Helicobacter pylori infection.To analyze the existing problems and formulate effective methods of health education.Methods Totally 558 families infected with HP were investigated with a self-designed structured questionnaire by call-back.Results 527 did not use separate eating tools,350 did not use independent tablewares,14 drank unboiled water,14 did not use bath appliances separately,7 used tooth glasses together,4 did not wash hands before eating and after toilet,no one had mouth-to-mouth feeding.248 children with HP sleeped with their family members and 246 family members used to have HP infections or stomach troubles.Conclusions The families with HP do not establish correct ways of separate eating,so the hospital need to develop multi-channel education.Most families with HP infected children have satisfactory health habits.Nearly half of the children with HP do not sleep in their own beds.Caregivers of children with HP infection should be the capital objects of health education.

Objective To investigate the status of nutritional risk and clinical outcome in children hospitalized in the general surgical department, which can provide basis for clinical nutritional support and selecting the screening tool. Methods Nutritional risk screening was performed on 506 children hospitalized in the general surgical department by using the Paediatric Yorkhill Malnutrition Score (PYMS). The data on incidence of complications, parenteral nutritional support during hospitalization, length of hospital stay and total hospital expenses were recorded. Results Of the 506 cases, 64.6%(327/506) had low nutritional risk, 27.1%(137/506) had moderate nutritional risk, and 8.3%(42/506) had high nutritional risk. Hepatic and gall diseases were the most common types of moderate nutritional risk (55.2%, 16/29), intestinal obstruction were the most common types of high nutritional risk (23.1%, 6/26). The incidence of complications, parenteral nutritional support during hospitalization, length of hospital stay and total hospital expenses were 10.2%(14/137), 21.9%(30/137), (9.54±4.95) d, (6 899.13±3 281.18) yuan RMB and 21.4%(9/42), 35.7%(15/42), (10.60±7.25) d, (7 521.64±6 026.23) yuan RMB in moderate or high nutritional risk children, and 0.9%(3/327), 3.1%(10/327), (17.17 ± 4.17) d, (4 691.96 ± 3 114.43) yuan RMB in low nutritional risk children, and there were significant differences (χ2/F=18.665-64.554, P<0.05). Conclusions Moderate or high nutritional risk is seen in children hospitalized in the surgical department. High nutritional risk score is correlated with adverse clinical outcome. PYMS can be used for nutritional risk screening in hospitalized children.

Objective To evaluate the application of nutritional risk screening in children hospitalized in general surgery department,in order to provide the basis for selecting the screening tool.Methods Nutritional risk screening was performed on 123 children hospitalized in the general surgical department by using the Assessment of Malnutrition in Paediatrics (STAMP) and Paediatric Yorkhill Malnutrition Score (PYMS).The malnutrition prevalence based on the World Health Organization (WHO) child growth standards(WHO standards) was evaluated.The data of hospital stay and total hospital expenses were recorded and analyzed.Results By using the STAMP and PYMS,76.4％ (94/123 cases) and 85.4％ (105/123 cases) of the patients had low-moderate nutritional risk,23.6％ (29/123 cases) of the patients and 14.6％ (18/123 cases) had high nutritional risk,respectively.The malnutrition prevalence was 17.9％ (22/123 cases) based on WHO standards.Children with high nutritional risk screened by STAMP,PYMS and malnutrition evaluated by WHO standards had significantly longer hospital stay(days) and higher total hospital expenses(yuan) compared with those in low-moderate nutritional risk or non-malnutrition patients,and the differences were statictically significant (hospital stay:STAMP:M =8.50 ＞ 7.00,Z =-2.608,P =0.008;PYMS:M =8.00 ＞6.25,Z =-2.761,P =0.006;WHO standards:M =8.25 ＞6.75,Z =-2.812,P =0.005.Total hospital expenses:STAMP:M =4 970.46 ＞ 2 939.07,Z =-2.913,P =0.004;PYMS:M =5 486.57 ＞ 3 294.96,Z =-3.024,P =0.002;WHO standards:M =5 515.87 ＞ 3 170.04,Z =-3.098,P =0.002).According to WHO standards,the sensitivity,specificity,Youden index,positive predictive value and negative predictive value of STAMP and PYMS were 68.2％ vs.77.3％,86.1％ vs.99.0％,54.3％ vs.76.3％,51.7％ vs.94.4％,92.6％ vs.95.2％ respectively.Conclusion Both STAMP and PYMS can be used for nutritional risk screening in hospitalized children in general surgery department,while sensitivity and specificity of PYMS are better than those of STAMP.

Hepatocellular carcinoma is a common malignancy of digestive system. Tumor markers are important for the early diagnosis and prognosis of hepatocellular carcinoma. Protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) is of high specificity and sensitivity in hepatocellular carcinoma diagnosis. In addition, previous studies suggested that PIVKA-Ⅱ played a role in proliferation, invasion and metastasis of hepatocellular carcinoma and could be used for prognosis of hepatocellular carcinoma. This article reviewed the recent advances in the underlying biological mechanism of PIVKA-Ⅱ in hepatocellular carcinoma and concluded the value of PIVKA-Ⅱ in hepatocellular carcinoma diagnosis and prognosis.

Objective To investigate the pathological features of blood vessel inflammation in facioscapulohumeral muscular dystrophy ( FSHD ) and the role of vasculitis on the pathogenesis of FSHD. Methods The clinical manifestations and myopathological features of 26 FSHD patients were retrospectively analyzed and summarized. All of the patients were divided into 2 groups; inflammatory infiltration group and non-inflammatory infiltration group. The latter was further divided into 3 subgroups;endomysial inflammation subgroup, perivasculitis subgroup and transmural vasculitis subgroup.Immunohistochemical staining were carried out in inflammatory infiltration group with anti-CD3, anti-CD4,anti-CD8,anti-CD20 and anti-SMA antibody. The control group was composed of 10 dermatomyositis ( DM)cases and 10 polymyositis ( PM) cases. Results The age of onset was (25. 2 ± 12. 6) years old and the average course was (7. 8 ±7. 3) years. The sex ratio of male to female was 1.6: 1. Five of them had family history. The main clinical features were progressive weakness and atrophy of facial, shoulder girdles and proximal upper limbs muscles. The lower distal limbs and (or) lower distal limbs and pelvic girdle muscles were involved in 18 cases. The main pathological features were shown as followed. Seventeen of them had focal inflammatory cell infiltration, including endomysial inflammation (4/17) , perivasculitis (7/17) , and transmural vasculitis (6/17). Immunohistochemical staining confirmed the major types of inflammatory cells were CD4* T lymphocytes and CD20B lymphocytes, which was familiar with DM. While in PM, CD8+ T lymphocytes were dominant The proportionality of residual muscle fibers obviously decreased in inflammatory infiltration group ( 48. 0% ± 23. 6% ) than non-inflammatory infiltration group ( 94. 3% ±3. 1% , T = 198. 000, P = 0. 000). As to CK levels, there were no significant deviation. Conclusions Obvious inflammatory cell infiltration can be seen in FSHD, the locations of inflammatory cells are endomyosium inflammation, perivasculitis and transmural vasculitis. Transmural vasculitis indicates vascular pathological factor may have something to do with pathogenesis of FSHD.

Objective To evaluate the value of high-frequency ultrasound and X-ray barium meal examination in diagnosis and typing diagnosis of congenital hypertrophic pyloric stenosis(CHPS).Methods High-frequency ultrasound and X-ray barium meal examination were made in newborns with present symptom of vomiting,and comparison was made between the two examine methods.Retrospective analysis was made in 29 cases confirmed by surgical operation.Control normal group included twenty healthy newborns.Results In 29 CHPS cases,the diagnostic accordance rate of ultrasound was 1 00%.And the diagnostic accordance rate of X-ray barium meal examination was 93.1%(27/29).In all those CHPS cases,the length of pyloric canal were≥18 mm,the diameter of pyloric canal were≥14 mm,the wall thickness of pyloric canal were≥4 mm,the stenosis inside diameter were≤6 mm by ultrasound;in X-ray barium meal examination,the length of pyloric canal were≥20 mm,the inside diameter were≥7 mm,and there was significant difference in comparison with control group(P＜0.01).The CHPS was classified into two groups as mild stenosis and severe stenosis according to the inside diameter and the wall thickness of pyloric canal.The mild type showed the wall thickness was＞4 mm and≤6 mm,the inside diameter was＞3 mm;The severe type showed the wall thickness was＞6 mm,the inside diameter was≤3 mm or obliterate.Conclusions High-frequency ultrasound has significant clinical application value in diagnosis and subtype diagnosis of CHPS,it is an easy,reliable and safe examination method.

Aim To study the influence of Sodium fer-ulate ( SF) on bone metabolism in glucocorticoid–in-duced osteoporosis rats. Methods Thirty cases of fe-male Wistar Rats(3-month-old) were divided into con-trol group, model group and SF group ( low-dose group, middle-dose group, high-dose group ) by ran-domized block design. Double fluorochrome labeling with calcein was performed before necropsy. The left tibia was taken for bone histomorphometry. Results In static parameters, the proximal tibia cancellous bone trabecular thickness, trabecular quantity and area ratio were significantly reduced in model group compared with control group;while compared with model group, those were increased in middle and high-dose SF group. Trabecular separation degree was increased in model group compared with control group, while it was decreased in middle and high-dose SF group compared with model group. In dynamic parameters, the calcula-tion parameters of cancellous bone mark perimeter rate and the bone formation rate were increased in model group compared with control group, in middle and high-dose SF group the bone formation rate was in-creased compared with model group. In bone cells, os-teoclast number per mm, osteoblast number per mm, percent osteoblast surface perimeter and percent osteo-clast surface perimeter were increased in model group compared with control group. In growth-plate, the thickness of growth-plate was increased in model group compared with control group. In bone cells and growth-plate there was no statistical significance between treat-ment group and model group. Conclusion This study demonstrates that SF can increase bone mass and im-prove bone structure,which may be related to the im-provement of bone formation. SF is effective for GIOP in rats.

Collagen α3 (IV) chains are one of the major constituent components of the basement membrane in the mammalian testis. Studies have shown that biologically active fragments, such as noncollagenase domain (NC1)-peptide, can be released from the C-terminal region of collagen α3 (IV) chains, possibly through the proteolytic action of metalloproteinase 9 (MMP9). NC1-peptide was shown to promote blood-testis barrier (BTB) remodeling and fully developed spermatid (e.g., sperm) release from the seminiferous epithelium because this bioactive peptide was capable of perturbing the organization of both actin- and microtubule (MT)-based cytoskeletons at the Sertoli cell-cell and also Sertoli-spermatid interface, the ultrastructure known as the basal ectoplasmic specialization (ES) and apical ES, respectively. More importantly, recent studies have shown that this NC1-peptide-induced effects on cytoskeletal organization in the testis are mediated through an activation of mammalian target of rapamycin complex 1/ribosomal protein S6/transforming retrovirus Akt1/2 protein (mTORC1/rpS6/Akt1/2) signaling cascade, involving an activation of cell division control protein 42 homolog (Cdc42) GTPase, but not Ras homolog family member A GTPase (RhoA), and the participation of end-binding protein 1 (EB1), a microtubule plus (+) end tracking protein (+TIP), downstream. Herein, we critically evaluate these findings, providing a critical discussion by which the basement membrane modulates spermatogenesis through one of its locally generated regulatory peptides in the testis.