Objective:To investigate the expression of microRNA (miR) -26a in human skin fibroblasts during photoaging induced by ultraviolet A (UVA) , and to evaluate the effect of up-or down-regulation of miR-26a expression on the methylation level of the whole genome, the target gene enhancer of zeste homolog 2 (EZH2) and cell aging.Methods:Some human skin fibroblasts were irradiated with 10 J/cm 2 UVA once a day for 7 consecutive days, RNA was extracted on days 0, 3 and 7, and real-time quantitative reverse PCR (RT-PCR) was performed to determine the expression of miR-26a; miR-26a mimics and inhibitors were transfected into fibroblasts to up-or down-regulate the expression of miR-26a respectively, and fluorescence microscopy and RT-PCR were performed to determine the expression of miR-26a and evaluate the transfection efficiency. Some human skin fibroblasts were divided into 6 groups: blank control group receiving no treatment, UVA group treated with UVA irradiation according to the above method, miR-26a mimic group transfected with miR-26a-mimics, UVA+miR-26a mimic group transfected with miR-26a-mimics followed by UVA irradiation, miR-26a inhibitor group transfected with miR-26a inhibitors, UVA+miR-26a inhibitor group transfected with miR-26a inhibitors followed by UVA irradiation. On day 7, cells in each group were collected after the end of UVA irradiation. Then, flow cytometry was performed to detect cell cycle, DNA methylation quantitative detection kit was used to detect the methylation level of whole genome, RT-PCR was conducted to determine the mRNA expression of EZH2 (a histone-lysine N-methyltransferase enzyme) , DNA methyltransferase 1 (DNMT1) and miR-26a, and Western blot analysis was performed to determine the protein expression of EZH2 and DNMT1. Statistical analysis was carried out by using one-way analysis of variance and least significant difference- t test. Results:Compared with the unirradiated control group, the expression of miR-26a gradually increased in the UVA irradiation group over time during the culture, and there was a significant difference in the expression of miR-26a between the two groups after 7 days of UVA irradiation ( t=5.295, P < 0.05) . Strong fluorescence signals were observed in the miR-26a mimic-or miR-26a inhibitor-transfected fibroblasts, suggesting a high transfection efficiency. Flow cytometry showed that the proportion of cells at G1 phase significantly differed among the blank control group, UVA group, miR-26a mimic group, UVA+miR-26a mimic group, miR-26a inhibitor group, and UVA+miR-26a inhibitor group (52.82% ± 2.56%, 78.56% ± 4.34%, 53.63% ± 3.13%, 89.52% ± 4.17%, 54.39% ± 3.86%, 65.34% ± 4.78%, respectively; F=46.728, P < 0.01) , and significantly higher in the UVA group than in the blank control group ( t=8.848, P < 0.01) , higher in the UVA+miR-26a mimic group than in the miR-26a mimic group and UVA group ( t=11.922, 3.154, P < 0.01, < 0.05, respectively) , and higher in the UVA+miR-26a inhibitor group than in the miR-26a-inhibitor group ( t=3.087, P < 0.05) , but significantly lower in the UVA+miR-26a inhibitor group than in the UVA group ( t=3.547, P < 0.05) . Detection of the genome-wide methylation level showed that the methylation level ( A450 value) significantly differed among the above groups (0.676 ± 0.024, 0.323 ± 0.043, 0.506 ± 0.035, 0.169 ± 0.024, 0.602 ± 0.036, 0.422 ± 0.029, respectively, F=97.402, P < 0.01) , and significantly lower in the UVA group than in the blank control group ( P < 0.01) , lower in the UVA+miR-26a mimic group than in the miR-26a mimic group and UVA group (both P < 0.01) , and lower in the UVA+miR-26a inhibitor group than in the miR-26a inhibitor group ( P < 0.01) , but significantly higher in the UVA+miR-26a inhibitor group than in the UVA group ( P < 0.05) . RT-PCR and Western blot analysis showed significant differences in the mRNA and protein expression of EZH2 and DNMT1 respectively among the 6 groups (both P < 0.05) , which were significantly lower in the UVA group than in the blank control group ( P < 0.05) , lower in the UVA+miR-26a mimic group than in the miR-26a mimic group and UVA group (both P < 0.05) , and lower in the UVA+miR-26a inhibitor group than in the miR-26a inhibitor group ( P < 0.05) , but significantly higher in the UVA+miR-26a inhibitor group than in the UVA group ( P < 0.05) . Conclusion:In the UVA irradiation-induced photoaging of skin fibroblasts, miR-26a expression was up-regulated, cellular proliferative activity and genome-wide methylation level decreased; up-regulation of miR-26a expression could down-regulate the expression of its target gene EZH2 and methylation-related gene DNM1, and promote cell photoaging, while down-regulation of miR-26a expression could up-regulate the expression of EZH2 and DNMT1, and inhibit cell photoaging.

Objective:To explore the effect of Traditional Chinese Medicine (TCM) syndrome differentiation and nursing on quality of life and immune function of elderly patients with middle and advanced non-small cell lung cancer.Methods:A total of 95 elderly patients with non-small cell lung cancer who were admitted to Taizhou Hospital of Zhejiang Province from March to April 2019 were selected by convenience sampling. Among them, 46 patients admitted from March to September 2018 were selected as the control group and 49 patients admitted from October 2018 to April 2019 were selected as the observation group. Patients in the control group were given routine nursing, while patients in the observation group were given TCM syndrome differentiation and nursing on the basis of control group. The the MOS Item Short from Health Survey (SF-36) score, T lymphocyte subsets and nursing satisfaction of patients before and after intervention were compared between the two groups.Results:After the intervention, SF-36 scores of patients of the two groups were lower than those before the intervention ( P<0.05) , and the SF-36 scores of the observation group after the intervention were significantly higher than those of the control group, the differences were statistically significant ( P<0.05) . After the intervention, levels of CD3 +, CD4 + and CD4 +/CD8 + in the two groups were lower than before the intervention ( P<0.05) , and the levels of CD3 +, CD4 + and CD4 +/CD8 + in the observation group after intervention were higher than those in the control group, the differences were statistically significant ( P<0.05) . The nursing satisfaction of the observation group was significantly higher than that of the control group, the difference was statistically significant ( P<0.05) . Conclusions:TCM syndrome differentiation and nursing is helpful to protect the quality of life and immune function of elderly patients with middle and advanced non-small cell lung cancer undergoing chemotherapy and improve nursing satisfaction of patients, which is worthy of clinical promotion.

Objective? To investigate the risks of malnutrition in patients with lung cancer during chemotherapy and to analyze their influencing factors. Methods? The inpatients with lung cancer receiving chemotherapy in the Department of Respiratory Medicine, Enze Medical Center from September 2017 to August 2018 were selected by convenient sampling. The 112 patients were divided into groups according to Nutrition Risk Screen (NRS) 2002. Their general information, diet and malnutrition risks were investigated successively. Logistic regression analysis was used to identify the influencing factors to malnutrition risks of the patients during chemotherapy. Results? Totally 112 patients completed the study. 28 of them showed no risk of malnutrition, while 84 had risks of malnutrition. There were statistically significant differences in age, place of residency, household monthly income, nutritional management, tumor staging, intake of protein and fat, nausea, emesis and diarrhea between two groups with different nutrition conditions(P＜ 0.01). Logistic regression analysis revealed that age, place of residency,monthly income, nutritional management, tumor staging, intake of protein, nausea, emesis and diarrhea were the risk factors of malnutrition in patients with lung cancer during chemotherapy. Conclusions? Patients with lung cancer are at high risk of malnutrition during chemotherapy. Age, nutritional management, tumor staging, intake of protein, nausea, emesis and diarrhea are the risk factors of malnutrition in patients during chemotherapy. Effective nutritional management intervention shall be made for patients as early as possible, so as to reduce the incidence and worsening of malnutrition and improve patients' effects and quality of life.

Objective To investigate the hospital work environment management, nurses' self-efficacy and work engagement and to explore the correlations among them. MethodsFrom March 2017 to March 2018, we selected 310 clinical nurses of three hospitals in Jinhua by convenience sampling. The investigation was carried out with the self-designed general information questionnaire, Chinese version of Practice Environment Scale (PES), General Self-Efficacy Scale (GSES) and Utrecht Work Engagement Scale (UWES). Correlation analysis was used to related data after being organized. In this study, 310 questionnaires were issued and 306 valid questionnaires were collected, with an effective recovery rate of 98.71%. ResultsAmong 306 nurses, the scores of PES, GSES and UWES were (95.25±12.17), (25.58±5.13) and (52.38±8.81) respectively. Pearson correlation analysis showed that the dimension scores of PES had positive correlations with the dimension scores of self-efficacy and work engagement (P＜0.05);nurses' self-efficacy was positively correlated with the dimension scores of work engagement (P＜0.05). Stepwise regression analysis used to explore the influence of work environment management between nurses' work engagement and self-efficacy showed that self-efficacy had a partial mediating effect between work environment and work engagement accounting for 37.64% of the total effect. ConclusionsNurses' work engagement has correlations with self-efficacy and work environment, and plays a mediating effect between them. Improving work environment management and nurses' self-efficacy can improve nurses' work engagement so as to provide the good nursing care for patients.

Objective To understand influence factors of the demission of extra-organizational nurses in Shanghai and measures taken by nursing managers for their demission.Methods In-depth qualitative interviews were carried out in 6 included hospital human resource directors of nursing department in Shanghai from August to November 2016 with the method of purposive sampling. Information was collected, transcribed and the themes were extracted.Results Nursing managers in Shanghai considered that the main 3 aspects of influence factors of the demission of extra-organizational nurses should be the lack of social support system, the increase of nursing professional pressure and the limitation of personal career development. The 6 themes of countermeasures taken by managers included: fading the concept of extra-organizational nurses and organizational nurses; reducing the influence of majeure factors; improving the social status of nurses; strengthening the nurse training; strengthening the humanistic care; using the incentive mechanism.Conclusions Nursing managers in Shanghai think that the demission of extra-organizational nurses is influenced by various factors. Nursing managers can adopt positive and effective measures to reduce the nurses' demission.

Objective: To investigate the effect of 21-gene recurrence score on adjuvant chemotherapy decisions for patients with estrogen receptor (ER)-positive, epidermal growth factor receptor 2 (HER-2)-negative and lymph node (LN)-negative early stage-breast cancer. Methods: One hundred and forty-eight patients with ER+ , HER-2- and LN- early stage breast cancer were recruited in the Ruijin hospital, Shanghai Jiao Tong University School of Medicine. The 21-gene recurrence score (RS)assay was performed and systemic therapeutic decisions were made before and after knowing the RS results under multidisciplinary discussion. The effects of RS assay and the other influential factors on adjuvant chemotherapy decision were further analyzed. Results: After knowing the RS results, treatment decisions were changed in 26 out of 148 patients(17.6%). Among them, 9 out of 26 patients were not recommended for chemotherapy; 16 of 26 had treatment recommendation changed to chemotherapy, and chemotherapy regimen was changed in the last one patient. Multivariate analysis showed that RS, age and histological grade were independent factors of decision-making for adjuvant chemotherapy. Conclusion Our results suggest that 21-gene recurrence score significantly influences decision making for adjuvant chemotherapy in patients with ER+ , HER-2- and LN- early stage breast cancer.

This paper reviewed research tools of pressure, pressure source, signs and symptoms, and coping styles of male nurses. Effective strategies for male nurses to cope with stress had been proposed, to instruct male nurses to master and apply pressure management methods, improve mental health, and provide basis for managers to take countermeasures at the same time.

This paper summarizes the concept of male nurses' willingness to quit and tools for measuring the willingness to quit. It is suggested there are three aspects to reduce the turnover rate of male nurses: individual factors; social supporting factors; and organizational management factors. Comprehensive interventions, such as, using professional training to cope with the impact of transition shock on the psychological capital of male nurses, creating supportive atmosphere to reduce adverse factors, building a humanized management platform, establishing pre-cognitive male nurses' separation management mechanism, and understanding the turnover intention of male nurses in time, were studied to retain male nurses.

Objective To strengthen nursing risk assessment for critical patients and improve their healthcare outcomes.Methods It formed the dynamic closed-loop management mode around the management system, early risk warning system, nurses′ observation ability, emergency procedures, information communication on account of predicting risk factors no timely,disease observation inaccuracy,emergency procedures nonstandard.Results Compared 2009 year with 201 5 year,the numbers of preventing nursing accidents by timely and effective observation increased 37 from 1 0;obviously improvement on reporting illness, communication ability,observing illness satisfied doctors(P <0.01 );the numbers of nursing adverse events was significantly decreased.The abilities of emergency situation judgment,reaction and coping measures in nurses were improve.Conclusions The closed-loop management mode can effectively improve each step′s quality and quality of critically patients care continuously.

Objective To investigate job satisfaction of clinical nurses in Shanghai, and explore the influencing factors so as to provide evidence for improving nursing quality and nursing science development. Methods A total of 1 149 nurses had been selected to take part in the nurse′s satisfaction measurement in the level two or beyond hospital, and we explored the impacted factors in order to provide evidence for the improvement of nursing quality by stratified sampling method in 2013 in 71 level two and beyond hospitals Shanghai. Results The total score of nurse′s satisfaction was over 4, and nurses were satisfied the colleague cooperation highest but the career development was lowest. The top three dimension scores of satisfaction were colleague cooperation (4. 94 ± 0. 24), supervisor support (4. 93 ± 0. 26), and leader communication (4. 92 ± 1. 75). The reward satisfaction of nursing job and satisfaction of nursing management had positive correlation with satisfaction of nurse experience (r=0. 85, 0. 82;P<0. 05). Conclusions Multiple influencing factors impacts on satisfaction of nurses, but how adjust rigid system, arrange human resources well and achieve the value. The recognition of nursing job are a significant topic and are worthy to study further for the improvement of nursing quality.