Objective To investigate the relationship between post-traumatic stress disorder (PTSD) and sleep quality among emergency nurses, as well as the regulatory effects of gender on this relationship. Methods Two hundred and forty eight nurses in departments emergency of 8 tertiary general hospitals in Zhejiang province from October 2017 to February 2018 were enrolled as the respondents including 62 males and 186 females. The differences in sleep quality and PTSD among nurses of different genders were analyzed by questionnaires; the PTSD checklist and Pittsburgh sleep quality index (PSQI) were used to evaluate PTSD and sleep quality situations of different gender nurses; the correlations of PTSD, PSQI total score and each dimension score were analyzed by Pearson correlation analysis; and the regulatory role of gender on PTSD and PSQI score were analyzed by multiple linear regression method. Results The survey showed that the positive rate of sleep disorder was 46.77% (116/248) and the positive rate of PTSD was 43.95% (109/249) in emergency nurses. The total scores of PTSD and each score of following dimensions:re-experience symptoms, avoidance symptoms, high alert symptoms, and the total scores of PSQI and each score of dimensions of sleep quality, sleep entering time, sleep time, sleep efficiency, sleep disorders and using hypnotics of male nurses were significantly lower than those of the female nurses (total scores of PTSD: 33.94±9.36 vs. 38.05±5.69, re-experience symptoms: 9.43±2.62 vs. 10.40±2.39, avoidance symptoms: 14.85±4.43 vs. 16.54±3.69, high alertness symptoms: 9.66±2.35 vs. 11.04±2.49; total scores of PSQI: 7.39±1.42 vs. 8.32±3.52, sleep quality:0.91±0.42 vs. 1.08±0.49, sleep time: 1.82±0.77 vs. 1.69±0.69, sleep efficiency: 0.85±0.44 vs. 1.07±0.45, sleep disorders: 1.08±0.29 vs. 1.33±0.56, hypnotics: 0.23±0.08 vs. 0.46±0.12, all P < 0.05). Pearson correlation analysis showed that re-experience symptoms of female nurses had no significant correlations with sleep time and sleep efficiency (all P >0.05), but had significant positive correlations with other dimensions of PSQI (all P < 0.05), and the correlation coefficient was 0.22 - 0.64; in the aspect of male nurses, re-experience symptoms and hypnotic drugs, as well as high alert symptoms and sleep disorders, time function were of no correlations (all P > 0.05), but with other PSQI dimensions showed significant positive correlations (all P < 0.05), and the correlation coefficient was 0.11 - 0.43. The multiple linear regression analysis showed that the re-experiencing symptoms, avoidance symptoms and high alertness symptoms were positive predictive PSQI scores (β= 0.840, 0.970, 0.500, P = 0.026, 0.012, 0.000); the relationship between re-experiencing symptoms, high alertness symptoms and scores of PSQI could be adjusted by gender (β= 0.950, 0.290, P = 0.003, 0.032), the re-experiencing symptoms and high alertness symptoms could positively predict the PSQI scores of female nurses (β= 0.440, 0.570, P = 0.017, 0.001), and were slightly worse in predicting the PSQI scores of male nurses (β= 0.390, 0.110, P = 0.004, 0.048). Conclusion The predictive effect of PTSD different dimensions on PSQI score varies with difference in gender, and compared with male emergency nurses, the stress state of female emergency nurses is more easily to reduce sleep quality.

Flagella are the main motility structure of Clostridioides difficile that affects the adhesion, colonization, and virulence of C. difficile in the human gastrointestinal tract. The FliL protein is a single transmembrane protein bound to the flagellar matrix. This study aimed to investigate the effect of the FliL encoding gene flagellar basal body-associated FliL family protein (fliL) on the phenotype of C. difficile. The fliL gene deletion mutant (ΔfliL) and its corresponding complementary strains (: : fliL) were constructed using allele-coupled exchange (ACE) and the standard molecular clone method. The differences in physiological properties such as growth profile, antibiotic sensitivity, pH resistance, motility, and spore production ability between the mutant and wild-type strains (CD630) were investigated. The ΔfliL mutant and the : : fliL complementary strain were successfully constructed. After comparing the phenotypes of strains CD630, ΔfliL, and : : fliL, the results showed that the growth rate and maximum biomass of ΔfliL mutant decreased than that of CD630. The ΔfliL mutant showed increased sensitivity to amoxicillin, ampicillin, and norfloxacin. Its sensitivity to kanamycin and tetracycline antibiotics decreased, and the antibiotic sensitivity partially returned to the level of CD630 strain in the : : fliL strain. Moreover, the motility was significantly reduced in the ΔfliL mutant. Interestingly, the motility of the : : fliL strain significantly increased even when compared to that of the CD630 strain. Furthermore, the pH tolerance of the ΔfliL mutant significantly increased or decreased at pH 5 or 9, respectively. Finally, the sporulation ability of ΔfliL mutant reduced considerably compared to the CD630 strain and recovered in the : : fliL strain. We conclude that the deletion of the fliL gene significantly reduced the swimming motility of C. difficile, suggesting that the fliL gene is essential for the motility of C. difficile. The fliL gene deletion significantly reduced spore production, cell growth rate, tolerance to different antibiotics, acidity, and alkalinity environments of C. difficile. These physiological characteristics are closely related to the survival advantage in the host intestine, which is correlated with its pathogenicity. Thus, we suggested that the function of the fliL gene is closely related to its motility, colonization, environmental tolerance, and spore production ability, which consequently affects the pathogenicity of C. difficile.
Humans ; Clostridioides/metabolism* ; Clostridioides difficile/metabolism* ; Bacterial Proteins/metabolism* ; Virulence ; Anti-Bacterial Agents/metabolism*