Objective:To explore the clinical features and prognosis of central nervous system involvement in patients with microscopic polyangiitis (MPA).Methods:We retrospectively investigated the clinical data of 138 MPA patients hospitalized with MPA in Tianjin Medical University General Hospital from January 1, 2010 to November 1, 2019. Patients were divided into two groups according to whether they had the central nervous system (CNS) involvement or not and then Kaplan-Meier survival curve was used to analyze the survival rate between the two groups, Logistic regression model analysis was adopted to analyze risk factors, and P<0.05 was considered statistically significant. Results:①29 patients (21.0%)among the 138 MPA had CNS-affected, including 13(44.8%) males and 16(55.2%) females. CNS involvement was present at the diagnosis of MPA in 20 cases (69.0%) and after the diagnosis of MPA in 9 cases (31.0%). ②The clinical manifestations were motor impairment in 14 cases (48.3%), sensory impairment in 10 cases (34.5%), speech loss in 9 cases (31.0%), headache in 8 cases (27.6%), consciousness disorder in 7 cases (24.1%), dysphagia and bucking in 4 cases (13.8%), cranial nerves involvement in 3 cases (10.3%). The imaging manifestations of the head included infarction, hemorrhage, infarction with hemorrhage and linear dural thickening. Five patients received lumbar puncture. One patient showed elevation of cerebrospinal fluid pressure, 1 patient had elevated protein and 5 patients showed elevation of LDH.③Eighteen patients received glucocortoid combined with cyclophosphamide. CNS symptoms recurred in 6 patients, four patients had recurrent cerebral infarction. ④Median survival time was 55 months in the CNS affected group [95% CI=(14.215, 95.785)] and 86 months in the N-CNS group [95% CI=(24.378, 147.622)]. Kaplan-Meier survival curve showed that there was no significant difference in survival rate between the two groups ( χ2=0.07, P=0.794) . Conclusion:The central nervous system involvement of microscopic polyangiitis is not uncommon. The clinical manifestations are various, with motor impairment the most. The most common imaging manifestation is cerebral infarction and the patients mainly presenteas multiple cerebral infarction. However, the CNS involvement of microscopic polyangiitis is not associated with mortality.

Objective:To evaluate the effect of unilateral pediatric kidney donation for adult kidney transplantation.Methods:Retrospective analysis was conducted on the cases of children who donated unilateral donor kidney for adult kidney transplantation recipients in our hospital, and those who were followed up for more than three years were included in this study. The body weight of the recipients in group A was ≤50 kg, and the body weight of the recipients in group B was ≤70 kg.The recipients were divided into 0-5 year old donor group (group A) and 6-17 year old donor group (B group). Clinical data, recipient/kidney survival, graft function and growth, and complications of the recipient were analyzed.Results:A total of 45 adult recipients were enrolled, including 12 in group A and 33 in group B. The renal survival rate at 3 years after operation was (100%, 96.9%)/(91.6%, 93.9%). One week after the operation, the early postoperative recovery of renal function in group B was better than that in group A, and the difference of serum creatinine was statistically significant ( P<0.05), while the difference of serum creatinine in other postoperative follow-up time points was not statistically significant ( P>0.05). Within a year, both groups of grafts continued to grow, reaching adult levels in one year. There was no statistical significance in the incidence of complications between the two groups ( P>0.05). The incidence of protein in the two groups was 33.3% and 6.1%, respectively, 1 case in each group still had proteinuria at 1 year after surgery, and only 1 case in the infant donor kidney recipient in group A had proteinuria at 3 years after surgery. Conclusions:Unilateral donor kidney transplantation from children can provide good results for adult patients with uremia by selecting suitable donors according to the weight of the recipient.

As one of the important factors that impact the life of quality to the elderly,visual impairment has become a research highlight in developed countries.And some related results have been found out.It is in the primary stage of establishing the elderly community extending service system in China.Based on this background,literature about the impact of visual impairment on quality of life of the residential setting elderly and related interventions were reviewed.By drawing the experience from developed countries,we aim to innovate perfect interventions,improve the quality of life,avoid unexpected events such as fall and medication mistakes.

With the public hospitals expanding,the nurses at age of marriage or bearing are enrolled and account for large part of all health care workers in China.A significant percentage of nurses in the period of pregnancy or lactation,especially abortion and sterility,deteriorate the shortage of nursing human resources and the nurses' health.It is essential to cope with the matter in order to maintain the nurses and contribute to the professional development.In this paper,we review the human resource management of the nurses during the periods at home and abroad from the human resources,occupational protection and management approaches,which is contributed to supplement the human resource.

Objective:To investigate the effect of human Cu/Zn superoxide dismutase (hSOD1) gene with G93A mutation on Nrf2/ARE signaling pathway in NSC‐34 cell ,the transgenic cell model of amyotrophic lateral sclerosis (ALS) .Methods :The established plasmids ,hSOD1‐pcDNA3 .1(‐) ,hSOD1‐G93A‐pcDNA3 .1(‐) ,and pcDNA3 .1(‐) were transfected into NSC‐34 cells ,the transgenic cell model of amyotrophic lateral sclerosis .The models were divided into four groups according to different transfected plasmids .They were normal group ,empty group ,wild group and mutation group .The oxidative‐stress injury was evaluated by detecting the content of intracellular malondialdehyde (MDA) ,a lipid peroxidation product .The permeability of mitochondrial membrane was detected .Western blotting was used to determine the intracellular protein expression level of Nrf 2 and antioxidase ,so as to reveal the activation level of the Nrf2/‐ARE signaling pathway in each group .Results:The level of oxidative stress and the mitochondrial permeability increased in the NSC‐34 cells transfected with human hSOD1‐G93A‐pcDNA3 .1(‐) gene(mutation group ,P<0 .05) ,which implied impairment of mitochondrias .The protein expression level of Nrf2 ,significantly decreased in NSC‐34 cells transfected with hSOD1‐G93A gene(P< 0 .05) .So were heme oxygenase‐1 (HO‐1) and NAD(P)H :quinone oxidoreductase 1 (NQO1) ,downstream effector molecules of Nrf2‐ARE signaling pathway . The expression of Nrf 2 in cytoplasm significantly decreased in mutation group , while Nrf2 expression in cell nucleus significantly increased (P<0 .05) in mutation group and wild group ,especially in mutation group (P<0 .05) .Conclusions :The G93A mutation of hSOD1 gene impairs Nrf2/ARE signaling pathway in ALS cell models ,reduces the antioxidant ability of cells ,and increase the impairment of mitochondrias .

English abstract has become an important part of thesis. As a potential and highly educated professional people,full-time postgraduate nursing students can promote international exchanges and cooperation in nursing. What they write in the full English papers or English abstracts are not only the carrier to enhance mutual understanding between international peers,but also spreading Chinese culture and promoting nursing international influence. Through consulting,guiding and modifying massive literature,we analyze existing problems of nursing graduate thesis' s abstracts and put forward appropriate recommendations,in order to continuously improve the quality of nursing postgraduate thesis and English level,and to increase the academic utilization rate,and make it play its role in the international academic exchanges.

A comprehensive analysis was carried out about the influencing factors of medication safety in the elderly with multiple chronic diseases,who lived in the community and stayed at their own homes.Applicable and simple preventive countermeasures should be established to ensure the medication safety outside medical agency.We should promote extending service of hospitals,cooperate with community and nursing facility in order to increase life quality of the elderly,and supply reference for professional continuous service model including rapid aging,empty nest with advanced age,disability and dementia and elderly people with chronic diseases.

Objective To explore the opportunities and challenges which COC (continuity of care) has been facing,some strategies were proposed and improved continuously during the process of deepening medical reform in public hospital,and at the same time to supply reference for government to make relative policy.Methods By SWOT-analysis,the strengths,weaknesses,opportunities as well as threats of COC in medical reform were analyzed comprehensively.Results Depending on national relevant policies,supportive measures,the cooperation from multidisciplinary team was improved.Along with strategies of strengthening advantages,weakening disadvantages,meeting challenges and facing up to threat.COC had be approved and consented initially.Conclusions Public hospitals should demonstrate their various resources and make full use of their advantages,then guide and solid grass-roots in the new healthcare system which integrate medical,rehabilitation and elderly nursing out of the hospital.It must benefit the hospital,specialized subject,family and society.

Objective To investigate the fatigue experience of the community-dwelling frail elderly to establish the conceptual model.Methods Grounded theory was adopted.With MAXQDA v10.4.15.1for 3 levels coding,the conceptual model of fatigue experience of community-dwelling frail elderly people was structured through constant comparison and in-depth analysis.Results Multi-response,selfmanagement,safe and belonging,hitting rock bottom,accepting and transferring formed the conceptual model.Conclusions Based on the conceptual model,nurses should pay more attention to concern about the fatigue experience of community-dwelling frail elderly people,and probe different assessment methods to enrich comprehensive geriatric assessment (CGA),then improve the community health service level and the quality of elderly people's life.

Background and objective In the clinical treatment of patients with non-small cell lung cancer (NSCLC), the primary and acquired resistance of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) limits its clinical application, this need to explore new strategy or method to overcome this problem. Recently, some literatures have indicated that the antitumor role of heat shock protein 90 (HSP90) inhibitors by a variety of pathways may provide new strategy for resolving this problem. In this study, we examined the effect of 17-DMAG on NSCLC cell lines A549 and H1975 which were primary and acquired resistant to EGFR-TKI respectively, the purpose was to explore its inlfuence on cell prolifera-tion, apoptosis and the expression of EGFR in vitro as well as possible mechanism. Methods Atfer A549 and H1975 cell lines were treated with different concentrations of 17-DMAG respectively, the inhibitory rate of cell proliferation was measured by MTT assay in 24 h, 48 h and 72 h. We investigated the effect of 17-DMAG on the cell apoptosis with lfow cytometry and the ex-pression of HSP90 and EGFR with Western blot atfer treated with 17-DMAG for 48 h. Results Atfer treated with 17-DMAG, the inhibitory rate of different concentrations and time groups was signiifcant (P<0.01), and the effect was in time-and dose-dependent manner;the apoptosis rate of both two cell lines in all treated groups were signiifcantly higher than control group (P<0.01), and the effect was in dose-dependent manner. By Western blot analysis, there was no signiifcant difference between all treated groups and control group for the expression of both HSP90 and EGFR protein in A549 cell line and HSP90 protein in H1975 cell line atfer exposed to 17-DMAG for 48 h (P>0.05), while the difference was signiifcant for the expression of EGFR protein in H1975 cell line (P<0.01). Conclusion 17-DMAG inhibited the proliferation of NSCLC cell lines A549 and H1975 and also induced apoptosis of both cell lines. It down-regulated the expression of mutant EGFR protein while this phe-nomenon was not observed in EGFR-wild type cell line. hTis suggested that the mechanism maybe different between A549 and H1975 cell lines with different genetic backgroud. Our study provided new strategy for treatment with NSCLC being resistant to EGFR-TKI.