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Objective:To explore the mediating effect of nurses′ self-efficacy in palliative care between the past behavioral experience of end-of-life care and core competence, and provide theoretical reference for improving the core competence of clinical nurses in palliative care.Methods:579 clinical nurses from 2 tertiary general hospitals in Shandong Province were investigated by convenience sampling method using general information questionnaire, nurses′ self-efficacy questionnaire for palliative care and palliative care nurses′ core competency questionnaire. The data were analyzed by SPSS 25.0.Results:The total score of core competence of hospice care of 579 nurses was (71.41 ± 22.74), nurses′ self-efficacy of palliative care was positively correlated with their core competence ( r = 0.648, P<0.01), past behavior experience was positively correlated with self-efficacy ( r = 0.479, P<0.01), positively correlated with core competence ( r = 0.427, P<0.01). Nurses′ self-efficacy of palliative care played a partial mediating role between the pastbehavioral experience and core competence, which accounted for 64.67% of the total effect. Conclusions:The past behavioral experience of end-stage nursing can directly or indirectly affect the core competence of nurses in palliative care through self-efficacy. It can improve the core competence of palliative care by taking active measures to enrich the past behavioral experience of end-of-life care and improve self-efficacy.
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Objective:To investigate the correlation of intestinal fatty acid binding protein and diamine oxidase with intestinal injury in strangulated bowel obstruction mice.Methods:160 SD rats were divided into 5 groups by random number table: group A ( n=32) : normal control group; group B ( n=32) : sham operation group; group C ( n=32) : simple intestinal obstruction group; The strangulated intestinal obstruction group was divided into group D ( n=32) : acute superior mesenteric artery ischemia group and group E ( n=32) : acute mesenteric arterial and venous ischemia. Except group A, other groups were given operation for modeling. Venous blood and small intestinal segment of group A was collected after anaesthesia, and venous blood and small intestinal segment of other groups were collected after modeling for 4 h. Serum samples were collected from venous blood, and intestinal fluid samples were collected by soaking the small intestinal segments. The intestinal segments were observed and the intestinal injury was evaluated. The levels of intestinal fatty acid binding protein (I-FABP) and activity of diamine oxidase (DAO) in serum and intestinal fluid were detected. Pearson correlation analysis was used to analyze the correlation between intestinal injury and the serum and intestinal fluid levels of I-FABP and activity of DAO, respectively. Results:The intestinal damage scores in group B, C, D and E were higher than that in group A, the intestinal damage scores in groups C, D and E were higher than that in group B, the intestinal damage scores in groups D and E were higher than that in group C, and the intestinal damage score in group E was higher than that in group D ( P<0.05) . The serum I-FABP level and DAO activity in group C, D and E were higher than those in group A and B, and the serum I-FABP level and DAO activity in group D and E were higher than those in group C ( P<0.05) . The level of I-FABP and DAO activity in intestinal fluid in group C, D and E were higher than those in groups A and B, and the level of I-FABP and DAO activity in intestinal fluid in group D and E were higher than those in group C ( P<0.05) . There were positive correlations between intestinal injury and the serum and intestinal fluid levels of I-FABP and activity of DAO, respectively ( r=0.972, P<0.001; r=0.899, P<0.001; r=0.961, P<0.001; r=0.828, P<0.001) . Conclusions:Intestinal injury of strangulated bowel obstruction mice is related to the intestinal ischmia. There are increases of serum and intestinal fluid levels of I-FABP and activity of DAO in strangulated bowel obstruction mice, which are closely related to the degree of intestinal injury.
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Objective To investigate the clinical characteristics and prognosis analysis of patient with bacteremia induced by Methicillin-susceptible Staphylococcus aureus (MSSA) or Methicillin-resistant Staphylococcus aureus (MRSA).Methods This retrospective study included 95 Staphylococcus aureus Bacteremia (SAB) patients admitted to Nanjing Drum Tower hospital from January 2012 to December 2017.According to the drug sensitivity tests,patients were divided into MSSA group and MRSA group.Clinical characteristics,systematic score and prognosis were compared between these two group.APACHE Ⅱ score and SOFA score were analyzed by independent-samples t test.The distribution of primary disease and basic disease,bacterium source,and prognostic factors were analyzed by Mann—Whitney U test or x2 test.The cumulative survival was calculated by the Kaplan-Meier method.Wilcoxon rank sum test was selected for survival rate comparison.Results There are 56 MSSA strain and 39 MRSA strain among the 95 SAB patients,the detection rate is 58.95％ and 41.05％,respectively.The most common primary disease of SAB is catheter-related infections(23 cases,24.21％).Compared with MSSA group,the catheter-related infections has higher detection rate of MRSA obviously (P＜0.01).The most common underlying disease of SAB is diabetes (35 cases,36.84％).Compared with MSSA,MRSA is more frequent appear in SAB patients combine with renal dysfunction (28 cases,29.47％).The third disease is cardiac insufficiency (22 cases,23.16％).The community-acquired SAB is fifty-two and the majority of strains is MSSA.The hospital-acquired SAB is forty-three and mainly of them is MRSA.The Sepsis related Organ Failure Assessment (SOFA) score of MRSA group are higher than MSSA significantly (t=2.203,P=0.024).However,there is no significant differences between MSSA and MRSA group in APACHE Ⅱ score,cases of hospitalized beyond 30 days and 28-days survival rate (P ＞ 0.05).Conclusions The majority of strains in the SAB patients is MSSA.In clinical characteristics,compared with MSSA,MRSA is more common in nosocomial infection,catheter related infection and renal dysfunction patients.There is no significant differences in prognosis between MSSA group and MRSA group.
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Objective To investigate the clinical features and prognosis risk factors of the elderly and youth patients with acute severe poisoning.Methods Adult patients with acute severe poisoning in the emergency intensive care unit (EICU) of Nanjing Drum Tower Hospital from January 2008 to December 2017 were enrolled. The patients were divided into the elderly group (age ≥ 60 years) and the youth group (16 years≤age < 60 years), the clinical data of the two groups were analyzed. The patients were divided into survival group and death group according to the prognosis of 28-day, binary multivariate Logistic regression was used to analyze the risk factors of mortality of the elderly and youth patients; receiver operating characteristic curve (ROC) was used to assess the predictive value of acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) in mortality of youth patients.Results A total of 343 patients with acute severe poisoning were included, 89 in the elderly group and 254 in the youth group. ① Clinical features: compared with the youth group, the elderly group had higher proportion of basic diseases included hypertension, type 2 diabetes and coronary heart disease, higher the initial APACHEⅡ scores at admission, higher the proportion of invasive mechanical ventilation and respiratory failure, and longer the length of EICU stay and the length of hospital stay. The main poisoning causes of elderly and youth patients were suicide (58.43％, 83.86％) and accidents (38.20％, 13.39％). The most common poisoning types of elderly patients were sedative hypnotics (23.60％) and organophosphorus pesticides (22.47％); the youth patients were mainly paraquat (42.52％) and organophosphorus pesticide (17.32％). There were 28 patients died (31.46％) in the elderly group and the cause of death were respiratory failure (53.57％), circulatory failure (32.14％) and multiple organ dysfunction syndrome (MODS, 14.29％). There were 67 patients died (26.38％) in the youth group and the cause of death were respiratory failure (59.70％), MODS (20.90％) and circulatory failure (19.40％). ② Risk factors of deaths: the APACHEⅡ score, incidence of acute kidney injury (AKI) and MODS in the elderly death group were significantly higher than those in the elderly survival group. Logistic regression analysis showed that AKI was the independent risk factor for death in elderly patients [odds ratio (OR) = 8.449, 95％ confidence interval (95％CI) =2.347-30.410,P = 0.001]. The proportion of female, APACHE Ⅱ score, and the incidence of AKI, respiratory failure and MODS in the youth death group were significantly higher than those in the youth survival group. Logistic regression analysis showed that APACHE Ⅱ score (OR = 1.175, 95％CI = 1.081-1.277,P = 0.001), AKI (OR = 34.470, 95％CI =11.681-101.722,P = 0.001) and MODS (OR = 3.834, 95％CI = 1.264-11.636,P = 0.018) were the independent factors for death in the youth patients. ③ Predictive value: the initial APACHEⅡscore was useful for predicting prognosis of youth patients with acute severe poisoning. The APACHE Ⅱ score to predict the death of the area under the ROC curve (AUC) was 0.744 (95％CI = 0.681-0.806,P = 0.001); the cut-off was 5, the sensitivity was 92.54％, the specificity was 51.34％, the positive predictive value was 65.53％, the negative predictive value was 87.31％, the positive likelihood ratio was 1.902, and the negative likelihood ratio was 0.145.Conclusions Patients with acute severe poisoning have their own clinical characteristics. To reduce the morbidity and improve the prognosis, we should strengthen the pre-hospital management and optimize the clinical treatment process.
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Objective To explore the functional activation cerebral areas evoked by mechanical stimulation induced pruritus perception imitating physiological process.Methods Scratching the planta gently to induce pruritus with brush pen wool in a group of 16 healthy volunteers,scanning BOLD-fMRI serials with a block design on a 3.0 T MR machine,and identifying the functional cerebral areas evoked by pruritus with SPM8 software for analysis.Student's t test was used to compare the difference of incidences with P＜0.05 for statistical significance.Results Several brain regions were activated by pruritus stimulus.The strongest activation evoked by pruritus was found at the contralateral thalamus and paracentral lobule(t=5.26,5.23),the most activation volumes were found at the contralateral paracentral lobule,postcentral gyrus and prefrontal lobule(146,151 and 326 volumes).Different degrees of activation were discovered at bilateral insula,preeentral and postcentral gyrus,thalamus,lentiform nucleus and cingulated gyrus.Conclusion The postcentral gyrus,paracentral lobule,insula,precentral gyrus and frontal lobe were the functional activation cerebral areas of pruritus perception evoked by mechanical stimulation.
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Objective To investigate the influence of acpuncture on free calcium in rat brain cells after focal cerebral ischemia reperfusion.Methods 145 adult male SD rats were randomly divided into control group,simple ischemia reperfusion group and acupuncture with ischemia reperfusion group.The middle cerebral artery occlusion/reperfusion (MCAO/R) rat model was established by the modified Longa occlusion method. ①The part of free calcium in rat brain cells,focal cevebral ischemia model of rats were made by thread locking up the blood vessel for 15 min.30 min later after reperfusion, the Baihui and Shuigou Point in Du meridian were acupunctured electrically 30 min.After 3h, 6h and 12h, the rat was killed and its brain cells were made into single cell suspension,marked by Fluo-3/AM.The fluorescence optical density was recorded by laser confocal microscopy.②The part of nerve functional reconstruction, focal cevebral ischemia model of rats were made by thread locking up the blood vessel for 12 hours.30 min later after reperfusion, the Baihui and Shuigou Point in Du meridian were acupunctured electrically 30 min.After 7 d, 14 d,30 d,60 d and 90 d, the rat was forced to detect it's strength of the dog.Results ①Free calcium in rats of acupuncture therapy group(6h:10.96±1.18;2h:20.9±4.37) was significantly less than that in control group in 6 h and 12 h after reperfusion (6 h: 16.87 ± 3.56,12 h: 34.10 ±1.06)(P<0.05).②The dog in rats of acupuncture therapy group was significantly more than that in control group in 7 d, 14 d after reperfusion (P＜ 0.05 ).No difference of the dog was detected in 30 d ,60 d and 90 d after reperfusion between the two groups.Conclusion Acupunture could decreases the concentration of free calcium and the expression of Caspase-3 mRNA in rat brain cells after focal cerebral ischemia reperfusion, and it can facilitate the recovery of nerve function.
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Objective To study the effect and possible mechanism of Apelin in candate on the pain behavior of rat. Methods Tail flick latency(TFL)of rat was taken as pain threshold and radiant heat as nociceptive stimulus. Microinjected Apelin into rat's caudate to observe the effect of Apelin on modulating of pain in CNS and then to study the interaction between Apelin and morphine in modulation of pain.And the contents of cAMP and cGMP in candate tissue and blood plasma were detected.Results Compared with control groups,the pain threshold of rat decreased when Apelin Was injected into caudate alone.Injected 0.5μl Apelin of 10~(-4) moL/L into rat caudate 10 min later,the pain threshold of rat Was reduced(-9.22±1.26)%and 40 min later(-16.95±1.46)%compared with normal saline group(-0.32±1.2)%,(0.17±0.80)%),and it had statistical significance(P<0.01).The contents of cAMP in caudate Was(14.08±2.25)nmol/g and blood plasma(19.94± 4.43)nmol/L compared with normal saline(133.05±20.41)nmol/g,(38.66±6.73)nmol/L,and they had statistical significance(P<0.01).Conclusions Apelin can facilitate the pain behavior of rat induced by radiant heat stimulus and consequently plays a hyperalgesia role in CNS.Apelin may have interaction with morphine and display its hyperalgesia effect through the intracellular second messenger cAMP.
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AIM: To observe the effects of Salvia miltiorrhiza Bunge.f.alba. (Sal) on the mitochondrial ultra-structure, oxidative stress and apoptosis induced by ischemia injury in a rat model of focal cerebral ischemia and reperfusion.METHODS: The middle cerebral artery occlusion/reperfusion (MCAO/R) rat model was established by a modified Longa occlusion method. Adult male SD rats were randomly divided into control group, simple ischemia reperfusion group, Sal with ischemia reperfusion group and butylphthalide with ischemia reperfusion group. To study the protective effects of Sal and its mechanism, the intervention of Sal was given and the ultra-structure of mitochondria, functions of mitochondria under oxidative stress and the incidence of apoptosis of brain cells were determined.RESULTS: Many electron dense toxic granulation and vacuolus in mitochondria were observed in the rat brain of focal cerebral ischemia and reperfusion. Under the condition of ischemia and reperfusion, the mitochondria membrane was disaggregative, and the tubular cristae of mitochondrion disappeared. MDA content was obviously increased and the activity of glutathione peroxidase decreased significantly. The apoptosis of brain cells were observed in a great quantity. The changes of ultra-structure of mitochondria and the activity of GSH-Pxase were significantly improved by the treatment of Sal. Furthermore, treatment with Sal delayed the decrease of GSH-Pxase activity, and inhibited the increase in MDA content in brain tissue after ischemia and reperfusion. The incidence of apoptosis of brain cells was also decreased.CONCLUSION: Sal protects the brain tissue from ischemia injury.
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Objective To investigate the relationship between the blood pressure in subjects with impaired glucose relation and the first-phase insulin secretion.Methods The oral glucose tolerance test was performed in 126 subjects who were divided into normal blood pressure group higher blood pressure group and hypertension group.The beta-cell function was calculated by HOMA-IR and △I30/△G30.Results ①The BMI and WHR were significantly higher in hypertension group.The serum level of lipids was changed in higher blood pressure and hypertension groups.② The fasting plasma insulin level,60、120 minutes insulin level after oral 75 game glucose were significantly higher in hypertension group.③ The HOMA-IR was significantly higher in higher blood pressure and hypertension groups,with more higher in hypertension group.④ The △I30/△G30 was significantly decrease in hypertension group.There are no different in other groups.Conclusion The higher blood pressure,the more severe insulin resistance,the more decrease first-phase insulin secretion.
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Objective To observe the effect of low molecular weight heparin(LMWH) in treatment of diabetic foot.Methods Fifty-four patients were divided into test group and control group randomly.Both two groups were given routine therapy including mediating blood glucose with Insulin,anti-infection and changing dressings,while the test group were givon LMWH 5000IU once datly every 12 hours for 15 days besides the routine treatment.Then the endothelin(ET),thromboxaneB2(TXB2),hemorheology,ankle-brachial index(ABI),ulcer healing,fibrinogen(FIB),prothrombin time(PT) and avtivated parital thromboplastin time(APTT) were observed.Results Compared to that of before treatment,there are ET,TXB2,hemorheology and better ulcer heals after treatment,The improvement in test group patients was superior to that of control group(P0.05) after treatment in two groups.No hemorrhage and other complications occurred.Conclusion LMWH is effective and safe for treatment of diabetic foot.
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Objective To study the protective effects of estrogen on brain injured by cerebral ischemia-reperfusion in ovariectomized rats.Methods 30 d after bilateral ovariectomy,the benzestrofol 100 ?g/(kg?d)were intramusculari injected in to the models of ovariectomied rats for 14 d. Then the rat models of focal cerebral ischemia-reperfusion were made. The expressions of CD54 and TNF-? in brain tissue were detected by immunohistochemistry. The apoptotic cells were assayed by TUNEL,and the ultramicrostructural changes of neuron membrane was observed by electron microscope. Results Compared with the ischemia-reperfusion group and ovariectomized group,the expressions of CD54 and TNF-? of brain tissue in the estrogen group were significantly lower,and the apoptosis was reduced (all P
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Objective To study the effects of flunarizine on the contents of SOD、 MDA、 NO、 NOS in serum and brain tissue and pathological changes in gerbils of ischemia-reperfusion cerebral injury. Methods Twentyone gerbils were randomly divided into three groups: ischemia-reperfusion group, flunarizine pretreatment group and control group. There were seven gerbils in each group. The levels of SOD, MDA, NO and NOS in the serum and brain tissue were determined, and pathological changes of brain were observed by microscopy. Results It was found that the group of ischemia-reperfusion had characteristic changes of ischemia-reperfusion injury. Compared with the control group, serum and brain contents of MDA, NO and NOS were higher but the content of SOD was lower,and the differences were significant(all P