Fibroblast growth factor 21 (FGF21) is a peptide hormone predominantly secreted by the liver and plays a crucial role in maintaining whole-body energy metabolism and regulating insulin sensitivity. A large number of clinical studies have demonstrated that serum FGF21 levels are increased in obese patients with non-alcoholic fatty liver disease (NAFLD), and high circulating FGF21 is a sensitive biomarker for predicting the onset and progression of NAFLD. Injection of exogenous FGF21 can effectively alleviate pathological process in both animal models and NAFLD patients. This review aims to describe the molecular mechanism underlying the hepatoprotective effects of FGF21; to summarize the current data and challenges of the clinical trials on FGF21 analogs and receptor agonists in the treatment of NAFLD and nonalcoholic steatohepatitis (NASH); and to speculate the future directions of FGF21 as a diagnosis and treatment for NAFLD.

Purpose: This study explored the mediating effect of career calling in the relationship between familysupportive supervisor behaviors and turnover intention among nurses. Methods: Data were gathered from 563 nurses enrolled in eight public hospitals in China. They were required to complete measures of family-supportive supervisor behaviors, career calling, and turnover intention. Hierarchical multiple regression analysis and the bootstrapping procedure were used to examine the mediating role of career calling. Results: Family-supportive supervisor behaviors were positively associated with career calling, but negatively associated with turnover intention. Furthermore, career calling partially mediated the relationship between family-supportive supervisor behaviors and turnover intention. Conclusion This study provides strong evidence for an increasing body of work that emphasizes the importance of nursing leaders engaging in family-supportive behaviors for increasing employee career calling and reducing turnover intention.

Purpose: This study explored the mediating effect of career calling in the relationship between familysupportive supervisor behaviors and turnover intention among nurses. Methods: Data were gathered from 563 nurses enrolled in eight public hospitals in China. They were required to complete measures of family-supportive supervisor behaviors, career calling, and turnover intention. Hierarchical multiple regression analysis and the bootstrapping procedure were used to examine the mediating role of career calling. Results: Family-supportive supervisor behaviors were positively associated with career calling, but negatively associated with turnover intention. Furthermore, career calling partially mediated the relationship between family-supportive supervisor behaviors and turnover intention. Conclusion This study provides strong evidence for an increasing body of work that emphasizes the importance of nursing leaders engaging in family-supportive behaviors for increasing employee career calling and reducing turnover intention.

Objective:To investigate the current situation of knowledge, attitude and practice level of ICU nurses in the prevention of medical device-related pressure injuries (MDRPI) in critically ill patients and analyze its influencing factors.Methods:From May to August 2019, 540 ICU nurses in 8 Class Ⅲ general hospitals in Zhejiang province were surveyed by using "MDRPI Prevention Knowledge, Attitude and Practice Questionnaire for ICU Nurses". Current situation and influencing factors of knowledge, attitude and practice of ICU nurses in the prevention of MDRPI were analyzed and relationships among prevention knowledge, attitude and practice were explored.Results:The overall average score of knowledge, attitude and practice level of ICU nurses in the prevention of MDRPI was (3.87±0.46) . Of which, the average score of knowledge dimension items was (3.43±0.69) , the average score of attitude dimension items was (4.13±0.51) , and the average score of practice dimension items was (4.06±0.56) . There were statistically significant differences in the overall average scores of knowledge, attitude and practice in the prevention of MDRPI in ICU nurses with different genders, marital status, years of work, titles, duties, whether they are members of the wound stoma or pressure ulcer group, whether they have cared for MDRPI patients, whether they have received MDRPI training ( P<0.05) . Multiple linear regression analysis showed that years of work, whether they had cared for MDRPI patients and whether they had received training in MDRPI were influencing factors of knowledge, attitude and practice level of ICU nurses in the prevention of MDRPI ( P<0.05) . ICU nurses MDRPI prevention knowledge, attitude and practice were positively correlated ( P<0.05) . Conclusions:ICU nurses have a more positive attitude and behavior towards MDRPI prevention, but their knowledge of MDRPI prevention is relatively lacking. Nursing managers should attach importance to training on ICU nurses' knowledge of MDRPI prevention so as to improve their MDRPI recognition and nursing ability.

Objective To examine the impact of transformational hospital leadership on clinical medical workers'creative work involvement.Methods From February to July 2016,826 clinical medical workers,including 359 doctors and 467 nurses, were randomly selected to complete a transformational leadership scale, a basic needs satisfaction scale and a creative work involvement scale.The data were analyzed using correlation analysis and structural equation model.Results Transformational leadership positively affected autonomy need satisfaction(β=0.40,P<0.001),competence need satisfaction(β=0.33, P<0.001),relatedness need satisfaction(β=0.81,P<0.001)and creative work involvement(β=0.64, P<0.001)respectively.All three needs satisfaction partially mediated the relationship between transformational leadership and creative work involvement.Conclusions Hospital personnel department should launch leaderships training programs to promote transformational leadership,which in turn will meet high level of psychological needs of medical workers,thus encouraging their creative work involvement.

Objective: To know about the current state of nurses' career satisfaction in the tertiary hospital, and explore the relationship between career calling and career satisfaction. Methods: From September 2017 to December, using convenience sampling, 483 nurses distributed eight tertiary hospitals were selected to complete career satisfaction scale and career calling scale. Results: The total score of nurses' career satisfaction was (2.81+0.65) , four factors were rowed from low to high in order: financial success, power and status, employability, knowledge and skill development (2.29±0.98, 2.64±0.87, 3.10±0.69, 3.20±0.71) . There were significant differences existed in different genders, marital status, educational backgrounds, working lives and positional titles (t=2.51, -1.96, -3.59; F=7.92, 8.83, P<0.05) . The score of nurses' career calling was (3.21±0.81) . There were significant differences existed in different genders, educational backgrounds, working lives and positional titles (t=5.87, -1.96; F=5.60, 11.13, P<0.05) . Career calling is positively related to career satisfaction (r=0.528, P<0.05) . Conclusion Overall, the level of career satisfaction of nurses is low, especially the financial success. Hospital human resource management should endow more values and meanings on nursing posts, in turn enhance nurses' career calling and career satisfaction.

Objective: To investigate the effect of occupational exposure on job burnout in nurses, and to analyze the mediating effect of negative emotion between occupational exposure and job burnout and the regulatory effect of supervisor support on occupational exposure and negative emotion. Methods: From September to December, 2015, simple random sampling was used to select 543 nurses from six tertiary hospitals in Zhejiang Province, China. The questionnaires consisted of occupational exposure risk questionnaire, negative emotion questionnaire, supervisor support questionnaire, and job burnout questionnaire. Results: The total score of occupational exposure risk in nurses was 11.43±7.19; the score of emotional exhaustion was 3.19±1.24, the score of low sense of personal accomplishment was 3.02±1.21, and the score of sense of working indifference was 2.24±1.06. There were significant differences in occupational exposure score between nurses with different sexes (t=2.61, P<0.01) and working years (F=4.49, P<0.01) . There were significant differences in the scores of emotional exhaustion and low sense of personal accomplishment in nurses with different sexes (t=5.25, P<0.001) and working years (t=-3.48, P<0.01) . Occupational exposure had positive effects on negative emotion (β=0.41, P<0.05) , emotional exhaustion (β=0.47, P<0.05) , sense of working indifference (β=0.42, P<0.05) , and low sense of personal accomplishment (β=0.17, P<0.05) . Negative emotion had a partial mediating effect between occupational exposure and emotional exhaustion (total effect size 30.5%, P<0.05) and between occupational exposure and sense of working indifference (total effect size 37.1%, P<0.05) . Negative emotion had a complete mediating effect between occupational exposure and low sense of personal accomplishment (β=0.08, P>0.05) . Supervisor support negatively regulate the effects of occupational exposure and negative emotion (F=21.73, P<0.001) . Conclusion In nurses, occupational exposure has a direct positive effect on job burnout and indirectly influences job burnout via negative emotion. Supervisor support can reduce the negative impact of occupational exposure on negative emotion.

Objective: To investigate the effect of leader-member exchange on nurses’sense of calling in workplace based on self-determination theory. Methods: A total of 381 nurses were randomly selected from five tertiary general hospitals in Zhejiang province, China from October to December, 2016. They were subjected to a survey using the Leader-Member Exchange Scale, Job Autonomy Scale, Core Self-Evaluation Scale, and Calling Scale. The mediating effect was used to test the procedures and the data were subjected to hierarchical regression analysis. Results: The leader-member exchange was positively correlated with job autonomy, core self-evaluation, and sense of calling (r=0.471, P<0.001; r=0.373, P<0.001; r=0.475, P<0.001) ; the leader-member exchange had a positive predictive effect on job autonomy and sense of calling (β= 0.47, P<0.001; β=0.48, P<0.001) ; the job autonomy had a partial mediating effect on the relationship between leader-member exchange and sense of calling (F=66.50, P<0.001) ; the core self-evaluation negatively adjusted the positive relationship between leader-member exchange and job autonomy (F=27.81, P<0.001) . Conclusion High-quality leader-member exchange enhances the sense of calling by improving staffs’ job autonomy and the core self-evaluation reduces the positive relationship between leader-member exchange and job autonomy.

Objective To investigate the mechanism of family-supportive supervisor behavior (FSSB) influencing nurse silence behavior,and explore the mediating role of organizational identification between them. Methods Based on the social exchange theory (SET),916 nurses were selected to complete FSSB scale, organizational identification scale and silence behavior scale from 8 hospitals in Zhejiang Province by convenient sampling method.Results The total scores of FSSB,organizational identification and silence behavior were (3.85±0.66),(3.15±0.62),(2.82±0.46) respectively in 916 nurses. The silence behavior was negatively related to the FSSB and organizational identification (r=-0.27,-0.36;P<0.01). The FSSB was positively related to organizational identification (r =0.53,P<0.01) and negatively influenced silence behavior (β= -0.39,P<0.01),while positively influenced organizational identification (β=0.42,P<0.01) in mediating-effect analysis. Organizational identification partially mediated the relationship between the FSSB and silence behavior. Conclusions Nursing managers should give nurse more family care and support to promote organizational identification,thus decreasing silence behavior.

Fibroblast growth factor 21 (FGF21) is a metabolic hormone with pleiotropic effects on energy metabolism and insulin sensitivity. Besides its antiobese and antidiabetic activity, FGF21 also possesses the protective effects against atherosclerosis. Circulating levels of FGF21 are elevated in patients with atherosclerosis, macrovascular and microvascular complications of diabetes, possibly due to a compensatory upregulation. In apolipoprotein E-deficient mice, formation of atherosclerotic plaques is exacerbated by genetic depletion of FGF21, but is attenuated upon replenishment with recombinant FGF21. However, the blood vessel is not the direct target of FGF21, and the antiatherosclerotic activity of FGF21 is attributed to its actions in adipose tissues and liver. In adipocytes, FGF21 promotes secretion of adiponectin, which in turn acts directly on blood vessels to reduce endothelial dysfunction, inhibit proliferation of smooth muscle cells and block conversion of macrophages to foam cells. Furthermore, FGF21 suppresses cholesterol biosynthesis and attenuates hypercholesterolemia by inhibiting the transcription factor sterol regulatory element-binding protein-2 in hepatocytes. The effects of FGF21 on elevation of adiponectin and reduction of hypercholesterolemia are also observed in a phase-1b clinical trial in patients with obesity and diabetes. Therefore, FGF21 exerts its protection against atherosclerosis by fine-tuning the interorgan crosstalk between liver, brain, adipose tissue, and blood vessels.
Adipocytes ; Adiponectin ; Adipose Tissue ; Animals ; Apolipoproteins ; Atherosclerosis* ; Blood Vessels ; Brain ; Cholesterol ; Energy Metabolism ; Fibroblast Growth Factors* ; Fibroblasts* ; Foam Cells ; Hepatocytes ; Humans ; Hypercholesterolemia ; Insulin Resistance ; Liver ; Macrophages ; Mice ; Myocytes, Smooth Muscle ; Obesity ; Plaque, Atherosclerotic ; Transcription Factors ; Up-Regulation ; Vascular Diseases