BACKGROUND: Plasminogen activator inhibitor-1 (PAI-1) plays an important role in the pathophysiology of sepsis, but the exact mechanism remains debatable. In this study, we investigated the associations among the serum levels of PAI-1, the incidence of 4G/5G promoter PAI-1 gene polymorphisms, immunological indicators, and clinical outcomes in septic patients. METHODS: A total of 181 patients aged 18-80 years with sepsis between November 2016 and August 2018 in the intensive care unit in the Xinhua Hospital were recruited in this retrospective study, with 28-day mortality as the primary outcome. The initial serum level of PAI-1 and the presence of rs1799768 single nucleotide polymorphisms (SNPs) were examined. Univariate logistic regression and multivariate analyses were performed to determine the factors associated with different genotypes of PAI-1, serum level of PAI-1, and 28-day mortality. RESULTS: The logistic analysis suggested that a high serum level of PAI-1 was associated with the rs1799768 SNP of PAI-1 (4G/4G and 4G/5G) (Odds ratio [OR]: 2.49; 95% confidence interval [CI]: 1.09, 5.68). Furthermore, a high serum level of PAI-1 strongly influenced 28-day mortality (OR 3.36; 95% CI 1.51, 7.49). The expression and activation of neutrophils (OR 0.96; 95% CI 0.93, 0.99), as well as the changes in the expression patterns of cytokines and chemokine-associated neutrophils (OR: 1.00; 95% CI: 1.00, 1.00), were both regulated by the genotype of PAI-1. CONCLUSIONS Genetic polymorphisms of PAI-1 can influence the serum levels of PAI-1, which might contribute to mortality by affecting neutrophil activity. Thus, patients with severe sepsis might clinically benefit from enhanced neutrophil clearance and the resolution of inflammation via the regulation of PAI-1 expression and activity.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Humans ; Middle Aged ; Young Adult ; Genotype ; Neutrophils ; Plasminogen Activator Inhibitor 1/genetics* ; Polymorphism, Single Nucleotide/genetics* ; Retrospective Studies ; Sepsis/genetics*

OBJECTIVE: To explore the clinical features and genetic basis for a Chinese pedigree diagnosed with congenital glycosylation disease (CGD). METHODS: Clinical manifestations of two brothers were analyzed. Whole exome sequencing was carried out for the sib pair. Suspected variants were verified by Sanger sequencing. RESULTS: Both the proband and her younger brother were found to carry compound heterozygous variants of the PMM2 gene, which included a known pathogenic mutation of c.395T>C (p.I132T) and a previously unreported c.448-1(delAG) in the 5' end of exon 6 of the gene. CONCLUSION The compound heterozygous variants of the PMM2 gene probably underlay the CGD in the sib pair.
Asians/genetics* ; China ; Female ; Glycosylation ; Humans ; Male ; Mutation ; Pedigree ; Whole Exome Sequencing

Objective: To understand the epidemiologic features of the rabies in Xishuang banna prefecture of Yunnan province, China in 2008-2017 and the viral molecular-evolution characteristics. Methods: The data of rabies case questionnaire were collected. The brain tissue samples from mad dogs, suspicious sick dogs and human brain tissue, saliva and cerebrospinal fluid samples from rabies patients were collected in Xishuangbanna. Coding region of nucleoprotein and glycoprotein genes were amplified by RT-PCR and sequenced. Homology and phylogenetic analysis were performed using the relevant bioinformatics software. Results: A total of 62 cases of human rabies were occurred in 28 districts of the 3 counties, Xishuangbanna prefecture in 2008-2017. Of them, 37 cases in Jinghong county, 15 in Menghai county and 10 in Mengla county. In which 48 cases were bitten by domestic dogs (77.42%), 11 cases were bitten by wild dogs (17.74%). Rabies case was occurred every year in the past decade. The seasonal incidence was not obvious. The majority of patients were aged from 30 to 59 years-old, with the youngest 1 year-old and the eldest 91 year-old. The male to female ratio was 1.70∶1, most cases were farmers. The nucleotide sequences of nucleoprotein gene of 9 virus strains (7 from Jinghong, 1 from Menghai and 1 from Mengla) were obtained from the samples of dogs and patients. Homology and phylogenetic analyses indicated that the 5 strains belonged to clade China-Ⅰ, 3 clade China-Ⅱ and 1 clade China-Ⅵ. The nucleotide sequences of glycoprotein gene of 5 virus strains (3 from Jinghong, 1 from Menghai and 1 from Mengla) were obtained from these positive samples, and all were clade China-Ⅰ, it is same with nucleoprotein genes analysis result from these 5 virus strains. These China-Ⅰ and China-Ⅱ strains from Xishuangbanna have a closer genetic relationship with same clade strains isolated from Pu’er and other prefectures of Yunnan province as well as Sichuan, Guizhou and Guangxi. The China-Ⅵ strain from Xishuangbanna share high homology and genetic relationship with China-Ⅵ strains isolated from southwestern Yunnan and neighbouring countries such as Myanmar, Laos and Vietnam in recent years. Conclusions In Xishuangbanna, rabies mainly occurred in rural area and domestic dog was the main source of transmission. These RABV clades China-Ⅰ, China-Ⅱ and China-Ⅵ were found in this region and the China-Ⅰ was principal clade. The transmission source of China-Ⅰ and China-Ⅱ were from adjacent areas in the province and China-Ⅵ was from Myanmar and Laos.

Objective To explore the effect of medical and nursing integration notification on the truth knowing rate,anxiety,depression and quality of life in cancer patients undergoing chemotherapy. Meth-ods From February to March 2017,34 patients for the first time needing chemotherapy were included as control group,using normal disclosure.From June to July 2017,35 cases for the first time needing chemother-apy were included as the experimental group. The experimental group was informed of the medical and nurs-ing integration notification. The truth knowing rate,anxiety,depression and quality of life were compared be-fore and after three cycles of chemotherapy. Results After three cycles of chemotherapy,the truth knowing rate of patients in the experimental group (completely 57.14%,partly 34.29% and none 8.57%) was signifi-cantly different with the control group (completely 29.42%,partly 35.29% and none 35.29%,P＜0.01). The scores of anxiety and depression in the experimental group(39.43±4.60,41.86±5.23) were significantly low-er than those before chemotherapy(42.37±4.76,45.69±5.49,P＜0.01). The scores of anxiety and depression in the control group (45.74±5.20,49.74±5.42) were significantly higher than those before chemotherapy (42.77±5.62,45.56±6.27,P＜0.01).After three cycles of chemotherapy,the scores of anxiety and depression in the experimental group were lower than the control group (P＜0.01). After three cycles of chemotherapy, the total health status,body function,role function,emotional function,cognitive function,social function,fa-tigue,nausea and vomiting,and loss of appetite were statistically significant between the experimental group and control group (P＜0.05). Conclusion The medical and nursing integration notification has a positive effect on the truth knowing rate,anxiety,depression and quality of life in cancer patients undergoing chemo-therapy.

PURPOSE: The aim of this study was to evaluate the effects of reflective trainings for nursing students on their critical thinking disposition. METHODS: A total of 157 senior undergraduate nursing students sampled from Hainan Medical University in China participated in this study in 2014. They were randomly divided into experimental and control groups. The experimental group students were provided the reflective training during their entire 12-month clinical internship, whereas students in the control group were requested to keep their reflective diaries but without a formal training. Before and after the intervention, nursing students' critical thinking disposition was rated using the Chinese version of Critical Thinking Disposition Inventory (CTDI-CV). RESULTS: Before the start of the intervention, the critical thinking disposition scores of the two groups had no significant differences. At the end of the intervention, it was found that the experimental students performed better in each subscale of CTDI-CV. These include the search for truth, open mind, analytical ability, systematic ability, critical thinking, self-confidence, curiosity, and cognitive maturity. By summing the scores of all categories, the results showed that the experimental group had a significantly higher total score than that of the control group (p ≤ .044). Evaluating the score difference in each function indicated that there was a range of improvements on the critical thinking disposition because of the reflective training intervention. CONCLUSION: Reflective training during the internship period improves nursing students' disposition of critical thinking and promotes their readiness for their clinical practices in the rapidly increasing demands of the healthcare field.
Asian Continental Ancestry Group ; China* ; Delivery of Health Care ; Education, Nursing ; Exploratory Behavior ; Humans ; Internship and Residency ; Nursing* ; Students, Nursing* ; Thinking*

Objective To observe Rongxin Pills in the treatment of viral myocarditis in children (deficiency of both qi and yin and heart meridian stasis syndrome) and the effectiveness and clinical application of safety.Methods Viral myocarditis patients (280 cases,deficiency of both qi and yin and heart meridian stasis syndrome),according to 3:1 ratio as the test group (n =21 0) and control group (n =70).The test group took orally Rongxin pills each time 4.5～9 g,3 times daily;the control group oral coenzyme Q10 capsule each time 10 ～ 20 mg,twice daily.The course of treatment was 28 d.The experiment was carried out with the random and double blind method.The symptoms of myocarditis,integrated and electrocardiogram,echocardiography,myocardial enzymes,as well as the efficacy of traditional Chinese medicine and improvement of the effect of the disease were observed.Results The results of FAS (PPS) analysis showed that 28 d after treatment,the symptom score and mean of experimental group and control group were 5.975 (6.000) and 4.721 (4.788).The syndromes of the total effective rates were 91.62％ (90.59％) and 70.59％ (71.21％),curative effect the total effective rates were 90.14％ (92.08％) and 72.06％ (72.73％).The total effective rate of experimental group was higher than that of the control group,the difference was statistically significant.In this experiment,three cases of clinical adverse events were reported,which were not related to the experimental drug.It also not belongs to adverse drug reactions.Conclusion Rongxin Pill in the treatment of viral myocarditis in children (deficiency of both qi and yin and heart meridian stasis syndrome) is more effective than coenzyme Q 10 capsule,and there was no indication of higher risk of clinical application.

Truth disclosure of cancer patients is becoming more and more recognized in the world.Truth disclosure is usually regarded as the doctor's responsibility.However,the nurse has become an active participant in the truth disclosure of cancer patients both intentionally and inadvertently.This article systematically reviewed the role of nurses at home and abroad in informing patients with cancer the truth so as to provide guidance for the clinical practice.In April 2017,we retrieved articles in Pubmed,Chinese CNKI,Wanfang database,VIP database,and retrieval time is not restricted.A total of 92 literatures were retrieved and 8 articles were retrieved by manual searching.Finally,23 articles were included.Through systematic review of the literature,nurses are found to play an important role in informing cancer patients the truth.Compared with physicians,nurses have a more positive attitude for truth disclosure.Nurses have the most contact with patients and family members,if the nurses have plans to communicate with the families on telling the truth to cancer patients,there will be a positive impact on the truth disclosure attitude of family members.It is necessary to explore the strategy of truth disclosure for cancer patients with integrated medical staff in the future.

Objective To study the effects and mechanism of calycosin on oxidative stress andβ-cell apoptosis induced by streptozotocin (STZ). Methods RIN-m5F cells were divided into 5 groups:control group, STZ group, STZⅠgroup, STZⅡgroup and STZⅢgroup. The control group did not receive any treatment, while streptozotocin was added to the final concentration of 10 mmol/L in STZ group, STZⅠgroup, STZⅡgroup and STZⅢgroup. After the incubation with STZ for 6 h, calycosin was added to a final concentration of 10, 50 and 100 μmol/L in STZⅠgroup, STZⅡgroup and STZⅢgroup respectively. The cell viability and apoptosis was detected by CCK-8, LDH, caspase 3 and Tunel assay. The intracellular oxidative stress was measured using mitochondrial membrane potential, DCFH-DA, SOD activity and malondialdehyde levels assay. RIN-m5F cells were divided into control group, calycosinⅠgroup, calycosinⅡgroup and calycosinⅢgroup, which were treated with different concentrations (0,10, 50 and 100 μmol/L, respectively) of calycosin. The expression of NF-E2-related factor 2(Nrf2) in RIN- m5F cells was detected by Western blot. The translocation of Nrf2 was detected by immunofluorescence. In RIN-m5F cells were divided intoⅢgroup andⅣgroup,Ⅳgroup was pre-treated with protein kinase C(PKC) inhibitor. The effects of calycosin on Nrf2 translocation, oxidative stress and apoptosis were also observed. Results STZ could induce the accumulation of reactive oxygen species and apoptosis in RIN-m5F cells. Calycosin did not affect normal RIN-m5F cells, whereas it reduced the oxidative stress and apoptosis induced by STZ in a dose-dependent manner. The expression of Nrf2 in RIN-m5F cells was not affected by calycosin, whereas it promoted the translocation of Nrf2 into nucleus. The ability of calycosin promoting Nrf2 translocation was decreased after PKC inhibitor treatment, and PKC inhibitor could also significantly attenuate the anti-oxidant and anti-apoptotic ability of calycosin. Conclusions This study shows that calycosin may play an anti-oxidative and anti-apoptotic role by activating PKC to promote Nrf2 translocation, which is expected to be used as a new clinical drug for the prevention and treatment of diabetes mellitus.

Objective To investigate the efficacy of computer-assisted postural balance training system combined with Bobath balance training on balance disorders after cerebellar stroke.Methods Forty patients with balance disorders after cerebellar stroke were randomly divided into either a combined training group or a control group (n =20 in each group).The control group was trained with Bobath balance training and routine rehabilitation treatment.On the basis of this,the combined training group used the computerassisted postural balance training system for rehabilitation treatment.The balance function,activities of daily living and motor function were evaluated with the Berg Balance Scale (BBS),modified Barthel Index,mBI)and Fugl-Meyer Assessment (FMA) before and after treatment,and the computer-assisted postural balance training system was used to conduct the postural balance ability according to the center of gravity track length,rectangle area of track,and peripheral area of track.Results There were no significant differences in various indexes before treatment between the patients of both groups.The scores of BBS,mBI and FMA after treatment were increased obviously (all P ＜ 0.001).The the center of gravity track length,rectangle area of track,and peripheral area of track were decreased compared before treatment (P ＜0.001 or 0.05).In addition to the FMA score,all the indexes of the combined training group after treatment were significantly better than those of the control group (all P＜0.05).Conclusions On the basis of Bobath balance training,using computer-assisted postural balance training system can obviously improve the balance disorder and extremities motion ability after cerebellar stroke,and thus improving the activities of daily living in cerebellar stroke patients.

Objective To investigate the relationship of serum levels of macrophage migration inhibitory factor (MIF), matrix metallo-proteinase-9 (MMP-9), hypersensitive C-reactive protein (hs-CRP) with the severity of acute cerebral infarction (ACI). Methods 101 pa-tients with ACI were envolved and divided into 3 groups according to the scores of National Institute of Health Stroke Scale (NIHSS):mild group (group A, n=38, NIHSS score<4), moderate group (group B, n=36, NIHSS score 4-15) and severe group (group C, n=27, NIHSS score>15). Meanwhile, 44 non-ACI inpatients with atherosclerosis were included as control group (group D). Their serum MIF and MMP-9 were detected with ELISA, and hs-CRP with immunoturbidimety. Results The levels of serum MIF, MMP-9 and hs-CRP ranged from more to less as groups C, B, A and D (P<0.05). There was positive correlation of MIF with MMP-9 (r=0.301, P<0.01) and hs-CRP (r=0.309, P<0.001). Conclusion Serum MIF, MMP-9 and hs-CRP levels increased with the severity in ACI patients, which may be prediction of athero-sclerotic plaque instability.