Objective:To explore the talent cultivation model of nursing professional group under the 1+X certificate system, to build a talent cultivation system for nursing professional groups with "three progressions, four integrations, and five cocultivation"Methods:From 1 July 2021 to 31 December 2023, built a professional group course system of "mutual sharing of foundations, mutual generation of majors, mutual selection of positions, and progressive improvement of abilities". Aligned course content with X certificate content. Deepen the reform of the three education systems, create a "dual teacher" teaching team that combines full-time and part-time work, and build teaching resources that connect the cloud and the ground. The application effect of this model was evaluated in 2021 nursing majors in Cangzhou Medical College by cluster sampling.Results:There were 748 students majoring in nursing in class of 2021, 150 boys aged 19-22(20.00 ± 1.23), 598 girls, aged 19-21(19.00 ± 2.57). There were 118 students majoring in midwifery in class of 2021, all of them were girls, aged 18-20(18.00 ± 2.11). There were 128 students majoring in rehabilitation therapy technology in class of 2021, 66 boys aged 19-21(19.00 ± 2.11), 62 girls aged 19-21(19.00 ± 2.54). Nursing professional group completed the "Basic Nursing Technology Training Guidance", "Elderly Care" and other 5 self-compiled textbooks, 730 students had participated in the X certificate assessment, 729 students e passed the assessment, the passing rate was 99.9%.Conclusions:The talent cultivation model of "three progressions, four integrations, and five co cultivation" in the nursing professional group can cultivate students′ professional abilities, and cultivate a composite technical and skilled talent with multiple abilities and interconnections in one job.

Urate oxidase (Uox) plays a pivotal role in uric acid (UA) degradation, and it has been applied in controlling serum UA level in clinical treatment of hyperuricemia (HUA). However, because Uox is a heterogenous protein to the human body, the immune rejections typically occur after intravenous administration, which greatly hampers the application of Uox-based agents. In this study, we used Lactococcus lactis NZ9000, a food-grade bacterium, as a host to express exogenous Uox genes, to generate the Uox-expressing engineered strains to treat HUA. Aspergillus flavus-derived Uox (aUox) and the "resurrected" human-derived Uox (hUox) were cloned into vector and expressed in NZ9000, to generate engineered strains, respectively. The engineered NZ9000 strains were confirmed to express Uox and showed UA-lowering activity in a time-dependent manner in vitro. Next, in an HUA mice model established by oral gavage of yeast paste, the UA levels were increased by 85.4% and 106.2% at day 7 and day 14. By contrast, in mice fed with NZ9000-aUox, the UA levels were increased by 39.5% and 48.3% while in mice fed with NZ9000-hUox were increased by 57.0% and 82.9%, suggesting a UA-lowering activity of both engineered strains. Furthermore, compared with allopurinol, the first-line agent for HUA treatment, mice fed with NZ9000-aUox exhibited comparable liver safety but better kidney safety than allopurinol, indicating that the use of engineered NZ9000 strains not only alleviated kidney injury caused by HUA, but could also avoided the risk of kidney injury elicited by using allopurinol. Collectively, our study offers an effective and safe therapeutic approach for HUA long-term treatment and controlling.
Animals ; Lactococcus lactis/metabolism* ; Urate Oxidase/genetics* ; Mice ; Uric Acid/blood* ; Hyperuricemia ; Humans ; Administration, Oral ; Aspergillus flavus/genetics* ; Male

Objective:To determine the effect of community management based on the Roy′s adaptation model (RAM) in patients with chronic obstructive pulmonary disease (COPD).Methods:This study was a cluster randomized controlled study, with the community as the cluster unit, and selected 805 COPD patients from 8 communities in Xuzhou City who had completed community registration before June 2019. A total of 735 patients actually completed follow-up and participated in intervention evaluation. They were randomly divided into control group (362 cases) and intervention group (373 cases) by random number table method. The control group received routine follow-up, while the intervention group received RAM intervention for 6 months. The forced expiratory volume in 1 second (FEV1)/forced volume vital capacity (FVC) ratio (FEV 1/FVC) and the modified British medical research council (mMRC) were used to assess the pulmonary function. The hospital anxiety and depression scales (HADS) were used to evaluate the mental health. The Chinese version of the Short Form Coping and Adaption Processing Scale (CAP-15) was used to assess the adaptive capacity. And the St. George′s Respiratory Questionnaire (SGRQ) was used to evaluate the quality of life in COPD patients. The t test or χ 2 test was used for pre-intervention comparisons between groups, and the repetitive measure analysis of variance (ANOVA) was used for post-intervention comparisons between groups. Results:After 6 months intervention, there were no significant differences in FEV 1/FVC radio between the two groups [(0.61±0.11) vs (0.62±0.12)] ( P=0.172). The scores of mMRC [(2.04±0.33) vs (2.77±0.31) points], HAD-A [(5.28±4.28) vs (6.99±4.41) points], HAD-D [(5.82±5.12) vs (7.27±4.93) points] and SGRQ [(40.17±9.30) vs (53.69±9.77) points] were all lower in the intervention group than those in the control group (all P<0.001). The CAPS-15 score was higher in the intervention group than that in the control group [(35.87±3.62) vs (26.1±3.47)] ( P<0.001). Conclusion:RAM could be used in community management of COPD patients, which could improve their dyspnea symptoms and psychological and physiological functions, also improve their adaptability and quality of life.

Objective:To explore the association between α5 subunit of gamma-aminobutyric acid receptor subtype 5(GABRA5) gene polymorphism and executive function in patients with major depressive disorder.Methods:From August 2018 to September 2020, one hundred and eighty depressed patients diagnosed by DSM-Ⅳ-TR criteria were included from Xuzhou Eastern Hospital, meanwhile 120 healthy controls with matching demographic characteristic were recruited.Gene polymorphisms were detected through the elbow vein blood of all subjects. The severity of the patients was assessed by 17 items Hamilton depression scale(HAMD-17). The executive function of subjects was tested by Wisconsin card sorting test (WCST) and event-related potential P300.The t test and χ2 test were used for statistic analysis by SPSS 17.0. Results:The cognitive function of depression patients with GABRA5 receptor gene carrying T allele was significantly lower than that of patients with C allele ( t=2.35-3.45, P<0.05). The cognitive dysfunction was associated with sleep and anxiety/somatization symptoms in depression patients ( r=-0.197-0.409, P<0.05). Anxiety/somatization symptoms in patients with depression partially mediated the association between GABRA5 receptor gene polymorphism and cognitive dysfunction(effect value=-0.611, 95% CI=-1.393--0.057). Conclusion:The GABRA5 receptor gene polymorphism is associated with cognitive dysfunction in patients with depression, and anxiety/somatization symptoms partially mediate the impairment of cognitive function caused by GABRA5 receptor gene polymorphism.

Objective:To explore the effect of cognitive-behavioral therapy on psychological stress and quality of life in patients with pulmonary tuberculosis.Methods:According to two-level cluster random design 461 patients with tuberculosis from 20 communities in Pizhou county of Jiangsu province were selected in the study from September 2018 to November 2018. The intervention group received cognitive-behavioral therapy for two months, while control group received routine follow-up. Anxiety, depression and quality of life were assessed by GAD-7, PHQ-9 and SF-36 scales, respectively. At the same time, the comparison between the two groups was conducted by independent sample t test, and the difference between the two groups before and after treatment was analyzed by paired sample ttest. Results:A total of 454 participants were finally included in this analysis; there were 230 cases in the intervention group and 224 cases in the control group. In the intervention group the scores of anxiety and depression after intervention were significantly lower than the baseline scores [(7.57±5.27) vs. (5.93±2.56), t=-4.245, P<0.01; (8.13±6.01) vs. (6.02±2.67); t=-4.866, P<0.01], and the quality of life score was significantly higher than the baseline score [(58.46±12.71) vs. (74.31±13.22); t=13.108, P<0.01]; while in the control group there were no significant differences in the scores of anxiety, depression and quality of life after intervention, compared with those at baseline [(7.62±5.41) vs.(7.65±5.38); (8.00±5.84) vs. (8.07±5.91); (59.11±13.25) vs. (60.51±13.76); t=0.059, t=0.126, t=1.104, all P>0.05]. However, only for patients with mild and moderate anxiety and depression symptoms in the intervention group, the anxiety and depression scores were decreased after intervention [(7.29±1.21) vs. (5.54±1.71), (11.99±1.31) vs. (9.17±1.55); (7.01±1.47) vs. (4.42±1.22), (11.88±1.12) vs. (8.39±2.33); t=8.056, t=10.020, t=13.558, t=8.852,all P<0.01]. Conclusion:Cognitive-behavioral therapy can relieve the psychological pressure and improve the quality of life in pulmonary tuberculosis patients with mild or moderate anxiety/depression symptoms.

OBJECTIVE：To study the improve ment effect of salvianolate on renal interstitial fibrosis （RIF）model rats and its possible mechanism. METHODS ：Totally 50 male SD rats were randomly divided into normal group ，model group ，losartan group （positive control group ，9 mg/kg）and salvianolate low-dose and high-dose groups （18，36 mg/kg）according to body weight ，with 10 rats in each group. Except for normal group ，other groups were given adenine 250 mg/kg intragastrically to establish RIF model. After modeling ，administration groups were given relevant medicine intragastrically ，and normal group and model group were given constant volume of normal saline intragastrically ，the volume was 10 mL/kg，once a day ，for consecutive 30 days. After last medication，the serum levels of creatinine （Scr），urea nitrogen （BUN）and 24 h proteinuria （24 h UPro ）were detected by ELISA. HE staining and Masson staining were used to observe the histopathological characteristics and fibrosis of the kidney. The degree of renal tubular injury and glomerulosclerosis were scored ，and the percentage of positive staining area of renal tissue was calculated ； immunohistochemistry and Western blot assay were used to determine the protein expression of Wnt 5a，Wnt5b，and β-catenin. RESULTS：Compared with normal group ，Scr，BUN and 24 h UPro levels ，renal tubular injury score ， glomerulosclerosis score ， the percentage of positive staining area in renal tissue ，the protein expression of Wnt 5a and β-catenin were increased significantly in model group （P＜0.05），while the expression of Wnt 5b protein was decreased significantly （P＜0.05）. Pathological changes such as mesangial hyperplasia ，fibrous tissue increase and inflammatory cell infiltration were observed under microscope. Compared with model group ，above indexes of rats were improved significantly in losartan group ，salvianolate low-dose and high-dose groups （P＜ 0.05），and the effect of salvianolate had dose-dependent trend. CONCLUSIONS ：Salvianolate has the improvement effect on RIF model rats induced by adenine ，and its mechanism may be related to inhibition of Wnt/ β-catenin signal pathway.

Objective:To explore effects of the total number of night shifts on BMI of medical workers in recent 5 years.Methods:This study was a cross-sectional study. Using the convenient sampling method, data of medical workers in Affiliated Hospital of Jining Medical University were collected from January 2016 to December 2020. The medical examination data of medical workers were obtained from the electronic information system of medical examination center, and the number of night shift and basic information of medical workers are extracted from the human resource management department. The covariates in this study included categorical variables and continuous variables. Categorical variables included gender, job title and job type. Continuous variables included age, working years, systolic blood pressure, diastolic blood pressure, white blood cells, red blood cells, hemoglobin, average hemoglobin volume, platelets, ALT, total bilirubin, total protein, albumin, urea, creatinine, uric acid, triacylglycerol, Total cholesterol, HDL-C, LDL-C and glucose. The relationship between the number of night shift and BMI was processed by generalized addition model and smoothing curve fitting.Results:Finally, a total of 908 medical workers were selected for data analysis. The average number of night shifts for 908 medical workers in 5 years was (339.0±30.8) , and the average BMI was (22.88±2.08) kg/m 2. After adjusting for confounding factors, the number of night shift showed a non-linear relationship with BMI, and the number of inflection points was 634. On the left of the inflection point, there was no significant relationship between the number of night shifts and BMI ( P=0.829) . The relationship between the two on the right side of the inflection point was significant, the effect size and 95% confidence interval were 0.02 and 0.01-0.03, respectively. Conclusions:BMI value of medical workers increases significantly with the increase of night shift number when the number of night shift is more than 634 in recent 5 years. Hospital managers can calculate and plan the number of night shifts per year to reduce the effect of night shifts on the health of medical workers.

Objective:To investigate relationships between social support and dysfunctional cognition, personality disorder in patients with somatoform disorder.Methods:One hundred and four patients with somatoform disorders and 97 healthy subjects were evaluated with the Social Support Rating Scale (SSRS), Dysfunctional Attitudes Scale (DAS) and Personality Diagnostic Questionnaire (PDQ-4). Social support ratings were compared between patients and healthy controls.The relationship between social support and dysfunctional cognition, personality disorder were analyzed.Results:The scores of social support in all dimensions of patients with somatoform disorder(total score of social support(37.18±8.12), objective social support(8.49±2.83), subjective social support(21.90±5.44), social support utilization(6.79±1.85)) were significantly lower than those in the healthy control group(total score of social support(41.82±6.87), objective social support(9.92±3.38), subjective social support(24.32±4.25), social support utilization(7.59±1.31))( P<0.05). In patients with somatoform disorder, there was a significant negative correlation between the total score of SSRS and the scores of DAS ( r=-0.245, P<0.05) and personality disorder tendency ( r=-0.292, P<0.01). Social support utilization had a significant predictive effect on dysfunctional cognition ( B=-5.384, P=0.007). Conclusion:Social support of patients with somatoform disorder is correlated with dysfunctional cognition and personality disorder tendency, which provides the basis for psychological intervention such as group and family psychotherapy.

Objective To explore the influences of serotonin transporter promoter region (5-HTTLPR)polymorphism on hypersensitive C-reactive protein(hs-CRP)in patients with depression. Method 5-HTTLPR polymorphism was detected by polymerase chain reactive-restriction fragment length polymorphism(PCR-RFLP)in 103 patients with depression and 103 healthy controls.The severity of depres-sion was evaluated by Hamilton Depression Scale(HAMD).The hs-CRP level was tested by immunofluores-cence.The influence of different genotypes on hs-CRP and the interaction of genotype and hs-CRP on the pathogenesis of depression were analyzed. Results The frequency of genotype and allele in 5-HTTLPR was no statistical significant(P=0.81,0.121)among the three groups.There were statistically significant differ-ences in hs-CRP concentration(P=0.007)among the three genotypes of the study group,and the concentra-tion of hs-CRP in SS genotype((8.1±2.7)mg/L)was significantly higher than that in LS((4.9±1.8)mg/L) and LL genotype((5.2±1.3)mg/L)(P=0.002,0.001).The retardation factor in patients were significantly differences in different genotypes(F=4.637,P=0.033).SS genotype(9.3±3.1)was significantly higher than LL(6.1±2.7)and LS genotypes(5.8±2.1)in retardation factor(P=0.008,0.007).Logistic regression analy-sis showed that SS genotype was associated with hs-CRP.The interactive effect was positive related to the morbidity of depression.The correlation of interaction between SS genotype and hs-CRP was greater than LL/LS(OR=1.890,95%CI=1.011-3.396). Conclusion SS genotype of 5-HTTLPR has strengthen effect on hs-CRP.The interaction of genotype and hs-CRP affects the onset of depression.The interaction of SS geno-type and hs-CRP is more likely to effect the onset of depression.

Objective To confirm the mediation effect of trait coping styles between childhood a-buse and psychosomatic symptoms among college students. Methods 262 medical students were investiga-ted by Psychosomatic Health Questionnaire( PHQ) ,Personal Report of Childhood Abuse( PRCA) ,Trait Cop-ing Styles Questionnaire(TCSQ),Self-rating Anxiety Scale(SAS),Suicide Ideation Scale(SIS) and Beck Depression Inventory(BDI).Structural equation models were established by Amos 7.0. Results The positive coping scores of medical students were (34.70±4.50),and (27.48±5.68) for negative coping,(7.79±5.58) for depression,(29.40±6.22) for self rating anxiety,(1.33±1.75) for suicidal ideation,(1.26±0.51) for mental symptoms,(1.27±0.52) for somatic symptoms and (3.17±4.26) for behavioral problems.Abuse total score was positively correlated with negative coping style, depression, self rating anxiety, suicidal ideation, mental symptoms and behavioral problems ( r=0.148-0.417,P<0.05) ,and negatively correlated with positive coping style(r=-0.148,P<0.05).Negative coping style was positively correlated with Beck depression,self rating anxiety,suicidal ideation,mental symptoms and somatic symptoms( r=0.252-0.350,P<0.01) ,and neg-atively correlated with positive coping style(r=-0.309,P<0.01).Positive coping style was negatively correla-ted with Beck depression,self rating anxiety,suicidal ideation,mental symptoms and somatic symptoms ( r=-0.208--0.271,P<0.01).Structural equation modeling showed that childhood abuse had an direct effect on psychosomatic symptoms( B=0.290,P<0.01) ,positive coping styles( B=-0.129,P<0.05) and negative cop-ing styles(B=0.243,P<0.01) among medical students.Positive coping styles and negative coping styles had direct effect on psychosomatic symptoms(B=-0.194,P<0.01;B=0.263,P<0.01).The model fit indexes were χ2/df=1.576,PGFI=0.585,PCFI=0.689,PNFI=0.645,RMSEA=0.047,GFI=0.951,AGFI=0.920, NFI=0.900,RFI=0.858,IFI=0.960,TLI=0.943,CFI=0.959. Conclusion The results indicate that trait coping styles as a mediator mediating the relationship between childhood abuse and psychosomatic symptoms in medical students.