Clinically， the occurrence of the breaking bad news is inevitable. For patients， they not only need to accept and cope with bad news， but also need to inform the bad news to their families with clear thinking and appropriate language， seeking their support and cooperation. This paper analysed the connotation and informing dilemma of bad news， investigated patients’ informing tendencies， as well as evaluated the advantages and disadvantages of three disclosure methods， including concealment， immediate informing， and staged informing. On these bases， a detailed response strategy for patients to inform their families was proposed in three parts， including pre-preparation， mid-articulation， and post-summary. In the initial phase， thorough preparation is essential. During the middle stage， when delivering bad news， use plain language and help family members adjust their emotions. In the final phase， ensure that all information and viewpoints have been fully communicated. In addition， the roles and analysis steps that doctors should play were analysed from their perspective and combined with the degree of doctor-patient trust. Effective informing of bad news is not only about communication skills， but also involves a deep understanding and respect for the psychological needs of patients and their families. Through meticulous preparation， appropriate expression， emotional support， and clear confirmation， communication and trust are promoted to face and overcome difficulties together.

Wound infections, secondary to acute and chronic wounds caused by mechanical, thermal, chemical factors, etc, not only delay wound healing but also may lead to mortality. The prolonged or inappropriate use of antibiotics lead to the growth of drug-resistant bacteria, resulting in refractory wound infections and poor treatment outcomes, which highlights the urgent need for effective therapies. Bacteriophages show great promise in treating drug-resistant wound infections due to their effectiveness in killing drug-resistant bacteria, their good resistance against bacterial biofilm (BBF) and their absence of cytotoxicity to eukaryotic cells. However, the mechanisms underlying bacteriophages′ resistance against BBF remain incompletely understood and their antibacterial efficacy for wound infections may also vary. For this purpose, the authors reviewed the biological characteristics and mechanisms of bacteriophages and their application in antibacterial therapies for wound infections, aiming to provide a reference for further research and application of bacteriophages in the treatment of wound infections.

Background: Metabolic diseases pose considerable burden on the healthcare system worldwide, indi-cating the significance of prevention and treatment. In constitution theory of traditional Chinese med-icine, phlegm-dampness constitution (PDC) is the common basis of metabolic diseases. In clinical practice, Huatan Qushi (HTQS) decoction targeting on PDC can effectively improve metabolic indicators. However, its underlying biochemical mechanism still remains unclear.Methods: Eight PDC participants received HTQS decoction for three months. Their blood was collected at baseline and 1 and 3 months after intervention started. Related biomedical indicators were detected. High-throughput sequencing and RT-qPCR were used for validation. Due to the missing data, repeated measures with missing values in mixed models were used. Results: After 3-month treatment, HDL-C level increased (P<.001) and FBG, FINS, and HbA1c all showed decreasing trend at different time points (all P < .05). After miRNA high-throughput sequencing, compared with the baseline, differential miRNAs at 1 and 3 months were screened, and target gene prediction and KEGG pathway enrichment analysis were performed. The results displayed that metabolic disease-related pathways mainly included pathways in cancer, PI3K-Akt signaling pathway, etc. Further, RT-qPCR showed that hsa-miR-1237-3p differed statistically (P =.008). Then we validated the target genes of hsa-miR-1237-3p in the"Pathways in Cancer"pathway including SDF1, AC, CRK, and HGF, also known as upstream target genes of PI3K/AKT pathway. The results showed that two indicators of CRK and HGF were in statistical significance (P=.045 and P=.036, respectively). Conclusion: PDC serves as a common basis for various metabolic diseases. Through adjusting PDC, HTQS decoction can improve biomedical indicators including blood glucose, HbA1c, insulin, and HDL-C. The target pathway is"Pathways in cancer". Specifically, HTQS decoction acts on targets of CRK and HGF by regulating hsa-miR-1237-3p, and probably exerts effects on their downstream PI3K/AKT pathway.

Objective:To construct the evaluation index system of peritoneal dialysis nursing quality, so as to provide a basis for management and evaluation of peritoneal dialysis nursing quality.Methods:Through literature review and expert interviews, the peritoneal dialysis nursing quality evaluation index system (draft) was initially determined on the evidence-based basis. The expert letter questionnaire was designed, and indexes of nursing quality evaluation were screened and revised by Delphi expert letter questionnaire and boundary value method. The analytic hierarchy process was used to determine the weight of evaluation indexes, and the evaluation system of the peritoneal dialysis nursing quality index was established.Results:The expert response rates of 2 rounds of questionnaires were 91.43% and 85.71%, and the expert authority coefficients of the 2 rounds were respectively 0.838 0 and 0.862 2, and the coordination coefficients of the first, second and third levels of indexes of the second round were respectively 0.643, 0.431 and 0.283 ( P<0.01) . The final evaluation index system included 3 first-level indicators, 18 second-level indicators and 84 third-level indicators. Conclusions:The evaluation index system of peritoneal dialysis nursing quality has good reliability and applicability. After further verification, it can be used as an evaluation tool of peritoneal dialysis nursing quality management.

Objective To culture and identify corneal fibroblasts from human keratoconus patients (HKCs).Methods HKCs and corneal fibroblasts from human healthy controls (HCFs) were cultured by tissue block adherence method.Cellular morphology and ultrastructure were observed by inverted phase contrast microscope and electron microscopy respectively.Cell viability was detected by cell counting kit-8 (CCK-8) assay.α-Smooth muscle actin (αt-SMA),collagen type 1 alpha 1 (COL1A1) and collagen type 3 alpha 1 (COL3A1) protein expression levels were detected by Western blot.This study protocol was approved by Ethic Committee of Xi'an No.1 Hospital (No.1504).Results Compared with HCFs,HKCs showed several distinguishing properties.First of all,its growth speed was faster,with collagen fibers decreased and attenuated.At the same time,mitochondrion swelled and mitochondrial cristae disappeared.Additionally,Golgi apparatus presented significant expansion and endoplasmic reticulum displayed severe swelling.There were statistically significant differences in A values between the two kinds of corneal fibroblasts at different time points after culture (Fgroup =5 023.13,P＜0.01;Ftime =38 518.16,P＜0.01),the A value of HKCs was significantly higher than that of HCFs at the same time point,and the difference was statistically significant (all at P＜0.01).The relative expression of α-SMA,COL3A1 and COL1 A1 was 120.00±5.77,158.33 ±4.41 and 88.33± 1.67,respectively in HKCs,the relative expression of α-SMA,COL3A1 and COL1 A1 was 100.00±0.00,100.00±0.00 and 100.00±0.00,respectively in HCFs,the relative expressions of α-SMA and COL3A1 were significantly increased in HKCs than those in HCFs,the relative expression of COL1 A1 was significantly decreased in HKCs than that in HCFs,with significant differences between them (t =-3.46,P ＜ 0.05;t =-13.23,P ＜ 0.01;t =7.00,P＜0.05).Conclusions HKCs are cultured and identied,which is suitable for establishing in vitro cell model of keratoconus.

Objeetive To study the differences of the biological characteristics and immune regulation function of adipose mesenchymal stem cells (AMSCs)from psoriasis patients and healthy people.Methods AMSCs were isolated and cultured from human psoriatic and healthy adipose tissue,the phenotypes and cell cycle of AMSCs taken from three generation were detected by flow eytometry.Alkaline phosphate enzyme staining and oil red o staining were used respectively to identify their adipogenic and osteogenic capacity.Next,the levels of inflammation antimicrobial proinflammatory factor were detected by PCR and ELISA.Then gene expression profile of AMSCs were screen by gene expression profile chip,as so to bolting the the gene array related with immunology gene.Results There was no significant change in cell morphology,and cell surface markers were expressed high for CD29,CD44,CD73,while lower for CD31,CD45 and HLA-DR.AMSCs of psoriasis patients and healthy people both had the ability of adipogenic and osteogenic differentiation.But the cell cycle showed the third generation AMSCs proliferation rates were slower than that of normal control,as compared with healthy controls,adipogenic differentiation ability was stronger.What'more,the level of inflammatory cytokines in psoriasis group was lower than that in controls such asIL-10,IDO,TGF-β,on the contrary the levels of proinflammatory factor in psoriasis group were higher than that in controls,such as TNF-α,IFN-γ.In addition,gene chip results suggested that psoriasis group AMSCs had obvious expression differences on JAK-STAT pathway with healthy controls.Conclusions Compared with the control,there are significant differences in patients AMSCs proliferation and adipogenic differentiation ability,immune inflammation suppression control ability is weaken,this phenomenon may be associated with JAK-STAT immune pathways related to downgrade.

Objective To select the largest non-toxic leaching solution concentration through the experimental observation of the cytotoxicity of the ostrich acellular corneal stromal leaching solution to the Chinese hamster lung fibroblasts cells(CHL) for the further chromosome distortion experiment.Methods The leaching solution made from the ostrich acellular corneal stromal material was diluted with concentrate of 1 ∶ 2,1 ∶ 4 and the original concentration were used to culture with the CHL cells,the negative and positive control were also set up at the same time,to evaluate the impact on cell growth after 24 hour by MTT colorimetric method.Results The leaching solution diluted with 1∶4 was non-toxic,and could promote the growth of the cells.Conclusion Combined with the results of classification and cell morphological features,this cytotoxicity test can be used to screen the best benchmark non-toxic concentrations for the chromosome aberration test of the CHL cells.

Objective To evaluate the status and influencing factors of early ambulation in patients following postoperative gastric cancer, and provide evidence for making reasonable evaluated standard to patients.Methods Self-designed questionnaires were used to investigate the early ambulation of 108 patients following postoperative gastric cancer from June 2013 to August 2014. Results The mean time of first ambulation was(30.82±13.83)h in 108 patients, and the average distance was(13.14±14.68)meters. 51 cases completed the early ambulation and accounted for 47.2%. The results of logistic regression analysis showed that postoperative pain and postoperative fatigue could greatly affect early ambulation of patients following postoperative gastric cancer(P<0.05).Conclusions Postoperative pain intervention and postoperative fatigue management benefits to the early ambulation for patients following postoperative gastric cancer.

Objective To explore the effect of assessment criteria in early ambulation of gastric cancer patients after surgery. Methods Totally 327 gastric cancer patients from January 2013 to March 2016 in our hospital were selected as the research object by convenience sampling method. All patients were randomly divided into the control group ( n=160) and the observation group ( n=167) by throwing a coin. Patients in the control group received routine nursing before surgery, while patients in the observation group were assessed by postoperative assessment criteria of early safety ambulation. The status of postoperative early ambulation and satisfaction degree were compared between two groups. Results In the observation group, the proportion of ambulation within 24 hours after surgery was 80.2%, and it was 46.9% in the control group (χ2=39.439,P<0.05). The satisfaction degree towards nursing work in the observation group was 95. 8%, and was significantly higher than that in the control group ( 81. 2%) . The situation of observation group with early ambulation is better than that of control group (χ2=9.115,P<0.05).Conclusions Assessment criteria of early ambulation for patients with postoperative gastric cancer is benefit for developing early postoperative ambulation and improving the satisfaction degree towards nursing.

OBJECTIVE:To establish a new semi-automatic drug dispensing mode,with proper cost,which falls in between full-automatic drug dispensing mode and manual drug dispensing mode,good work efficiency,standard and simple operation meth-od and meets national laws and regulations. METHODS:A semi-automatic drug dispensing system was designed,in which the in-formation in the drug dispensing sheet could be automatically printed on the drug bag,and automatic bagging,packaging and deliv-ery of drugs were realized. Such drug dispensing system included hardware(mechanical structures such as drug turntable and drug funnel,transmission device,etc.)and software control systems(the program of interface with hospital information system,micro control unit software,computer software,etc.). Through commissioning,formal operation and statistics,based on 18 oral drug dis-pensing sheets with the same contents,calculated the time of drug dispensing and the number of drug dispensing errors by 3 phar-macists respectively in manual drug bag dispensing mode and semi-automatic drug dispensing mode,to evaluate the effect of the semi-automatic drug dispensing system. RESULTS:From commissioning in May 2012 to formal operation in September 2012,the system operated normally and utility model patents were obtained. In the two modes,the total time of drug dispensing was 481 and 397 min (t=6.82,P<0.001),the numbers of drug dispensing errors were 25 and 7 (χ2=9.353 8,P=0.002 2),respectively. There was statistical significance. CONCLUSIONS:The semi-automatic drug dispensing system has higher efficiency and less num-ber of drug dispensing errors compared with manual drug bag dispensing mode and lower cost compared to full-automatic drug dis-pensing system. It deserves promotion.