Reconstruction of the calcaneocuboid and calcaneonavicular ligaments with the autologous semitendinosus in patients with chronic bifurcate ligament injury / 中华创伤骨科杂志

Objective:To explore the clinical efficacy of reconstructing the calcaneocuboid and calcaneonavicular ligaments with the autologous semitendinosus for chronic bifurcate ligament injury.Methods:A retrospective study was conducted to analyze the clinical data of 12 patients with chronic bifurcate ligament injury who had been treated by anatomical reconstruction with the autologous semitendinosus from March 2018 to January 2021 at Department of Foot and Ankle Surgery, The Fourth Hospital of Wuhan. There were 4 males and 8 females with an age of (41.4±9.6) years. Seven left and 5 right feet were affected; the time from injury to surgery was (9.3±4.3) months. The surgical efficacy was evaluated based on anteroposterior and lateral imaging assessments of foot weight-bearing at 6 months postoperation, comparison of the visual analogue scale (VAS) pain scores for foot weight-bearing walking and the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scores between preoperation and the last follow-up, stress test for stability of the transverse tarsal joint, recovery of movement, and occurrence of complications.Results:All patients were followed up for (18.4±4.0) months. Their sports activities were completely resumed after postoperative (6.8±3.9) months. Primary wound healing was achieved in all patients. One patient suffered from cutaneous nerve lesion and skin numbness, the symptoms of which disappeared after conservative treatment. Double harmonic curves were observed on the anteroposterior and lateral imaging films of foot weight-bearing in all patients. The spaces in the calcaneocuboid and the calcaneonavicular joints were normal, the articular positions were matched, and the calcaneocuboid joint was stable without recurrence or worsening of displacement. The VAS decreased significantly from preoperative 6.5 (5.6, 7.0) to 0.0 (0.0, 1.0) at the last follow-up, and the AOFAS mid-foot score increased significantly from preoperative (55.6±8.8) points to (92.3±2.6) points at the last follow-up ( P<0.05). The stress test for the stability of the transverse tarsal joint showed joint stability. Conclusion:Reconstruction of the calcaneocuboid and calcaneonavicular ligaments using the autologous semitendinosus is an alternative treatment for patients with chronic bifurcate ligament injury, because it can restore the stability of the bifurcate ligament and obviously improve the foot and ankle functions with limited postoperative complications.

Coexisting anti-N-methyl-D-aspartate receptor and anti-glutamic decarboxylase antibody- associated encephalitis after herpes simplex virus encephalitis: a case report / 中华神经科杂志

Herpes simplex virus encephalitis (HSE) is a common form of viral encephalitis, often with a single-phase course. A case of HSE with abnormal mental behavior as the main manifestation, admitted in Peking University Shenzhen Hospital in Octorber 2020, which improved after sufficient antiviral treatment was reported. After 2 months, abnormal mental behavior with memory deterioration recurred. It was considered as anti-N-methyl-D-aspartate receptor antibody combined with anti-glutamic decarboxylase antibody double-positive encephalitis, and improved after rituximab treatment. At present, there is no clinical report of such double antibody positive autoimmune encephalitis secondary to HSE. The purpose of this case report is to raise clinician awareness of post-HSE autoimmune encephalitis.

Application of blended learning in medical education in the world / 中华医学教育探索杂志

Objective:To discuss the application and effects of blended learning (B-Learning) mode in medical courses and education at home and abroad.Methods:Based on the identified keywords, the research retrieved 93 relevant literature from 2000 to 2017 in journal databases (e.g. Premier, Cinahl and Medline), and published journals. After two rounds of analysis, 19 domestic and foreign literature were obtained, which evaluated the application and teaching effects of the B-Learning mode in the context of medical education. Among them, there were control studies and qualitative studies.Results:There are differences in the implementation and implementation of the B-Learning model in various countries; the teaching intervention measures and the scope of intervention of the B-Learning teaching model are diverse; the B-Learning model can make up for the gap between the theoretical and practical courses in the medical education process. It helps medical students to master their knowledge and improve their clinical skills; it is necessary for teachers to carefully design teaching courses and teaching research before class to improve the teaching effect of B-Learning.Conclusion:Combining modern educational technology with traditional teaching methods can effectively improve the medical knowledge level and clinical practice skills of medical students.

Reliability and validity of Chinese version of Dietary Sodium Restriction Questionnaire in patients with chronic kidney disease / 中国实用护理杂志

Objective:To test the reliability and validity of the Chinese version of Dietary Sodium Restriction Questionnaire in patients with chronic kidney disease.Methods:From July 2020 to February 2021, a total of 120 patients with chronic kidney disease admitted to the Zhongda Hospital Affiliated to Southeast University were assessed with the Chinese version of Dietary Sodium Restriction Questionnaire, and its reliability and validity were analyzed.Results:Exploratory factor analysis showed that KMO value was 0.783, three common factors were extracted, namely attitude and subjective norms, perceptual behavior control and cognition, which could explain 58.83% of the total variation. Cronbach α coefficient of internal consistency was 0.777, and Cronbach α coefficient of three common factors were 0.849, 0.824 and 0.752 respectively. Six experts scored the questionnaire, the CVI of each item were 0.83-1.00, and the average CVI was 0.968. The correlation coefficient between each item and the total score were 0.322-0.648 ( P<0.01). Conclusions:The Chinese version of Dietary Sodium Restriction Questionnaire has good reliability and validity in the study of sodium restriction diet compliance of patients with chronic kidney disease, and can be used as a tool to evaluate the cognition, attitude and behavior of patients with chronic kidney disease.

Antimicrobial resistance profiling and molecular typing of ruminant-borne isolates of Clostridium perfringens from Xinjiang, China.

OBJECTIVES: Clostridium perfringens (C. perfringens) can cause intestinal diseases in livestock and humans, which seriously threatens the healthy development of animal husbandry and human food safety. Here, the characteristics of antimicrobial resistance and molecular typing of ruminant-borne strains of C. perfringens in Xinjiang, China were explored and profiled. METHODS: A total of 307 clinical feces collected from ruminants (cattle and sheep) with diarrheal symptoms were screened for C. perfringens. The recovered isolates were characterized in respect to their antimicrobial resistance pattern and molecular typing. RESULTS: A total of 109 isolates of C. perfringens were isolated from 307 clinical feces of ruminants, most of which displayed the multidrug resistance (MDR) phenotype. Demonstration of the quinolone-resistance gene was the highest among the isolates (70.6%). The multiplex PCR typing based on toxin genes showed that type A and type D strains made up 82.6% (90/109) and 17.4% (19/109), among which, the isolates carrying ß2 gene occupied 43.3% (39/90) of type A strains and 31.6% (6/19) of type D strains. These isolates were divided into 6 genotypes (I-VI) by enterobacterial repetitive intergenic consensus sequence-based PCR (ERIC-PCR) method. A total of 33 ST types (ST1-ST33) were identified by multilocus sequence typing (MLST) method. CONCLUSION: C. perfringens isolates with multidrug resistance (MDR) were frequent and circulating in ruminants. Among them, type A-Ⅰ-ST19 was the dominant genotype of C. perfringens, displaying obvious genetic diversity. This study provided important epidemiological data for the risk assessment of food safety associated with ruminant-borne C. perfringens in Xinjiang, China.

The cellular mechanism by which the rostral ventromedial medulla acts on the spinal cord during chronic pain.

Clinical therapies for chronic pain are limited. While targeted drugs are promising therapies for chronic pain, they exhibit insufficient efficacy and poor targeting. The occurrence of chronic pain partly results from central changes caused by alterations in neurons in the rostral ventromedial medulla (RVM) in the brainstem regulatory pathway. The RVM, which plays a key role in the descending pain control pathway, greatly contributes to the development and maintenance of pain. However, the exact roles of the RVM in chronic pain remain unclear, making it difficult to develop new drugs targeting the RVM and related pathways. Here, we first discuss the roles of the RVM and related circuits in chronic pain. Then, we analyze synaptic transmission between RVM neurons and spinal cord neurons, specifically focusing on the release of neurotransmitters, to explore the cellular mechanisms by which the RVM regulates chronic pain. Finally, we propose some ideas for the development of drugs targeting the RVM.

Analysis of the intestinal flora in novel coronavirus pneumonia patients with arterial stiffness / 中华老年医学杂志

Objective:To analyze the composition and functional characteristics of the intestinal microflora in novel coronavirus pneumonia patients with arterial stiffness, in order to provide empirical evidence for rational use of intestinal microecological modulators.Methods:Patients with novel coronavirus pneumonia admitted to our hospital between April 5 and April 19, 2020 were enrolled as research subjects.They were divided into the stiffness group and the control group according to the results of arterial stiffness.Stool samples were collected within 7 days of admission.Intestinal flora DNA was analyzed and entered into a database, shotgun metagenomic sequencing was performed, and bioinformatics analysis was conducted based on sequencing results.Results:A total of 16 patients with novel coronavirus pneumonia were included in this study, including 7 in the stiffness group and 9 in the control group.Brachial-ankle pulse wave velocity and blood pressure were higher in the stiffness group than in the control group( P<0.05). Beta diversity analysis at the phylum level showed that there were significant differences in the composition of the intestinal flora between the two groups( P<0.05). Patients with arterial stiffness had a lower relative abundance than the controls in fecal Holdemanella, Mitsuokella, Deinococcus, Lachnospira, Turicibacter, Butyrivibrio, Sporomusa, and Halanaerobium, species associated with the production of short-chain fatty acids(SCFAs), regulation of energy metabolism, anti-radiation, anti-oxidative stress and anti-inflammatory effects.The Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis showed that the intestinal flora in the control group was mainly involved in the pathways of lipopolysaccharide biosynthesis, metabolism of SCFA and other amino acids, and membrane transport, while the intestinal flora in the stiffness group was mostly concerned with the pathways of amino acid metabolism and DNA damage repair. Conclusions:The use of microbial agents capable of increasing short-chain fatty acids in patients with novel caronavirus infection may contribute to the restoration of intestinal flora homeostasis.

Molecular detection and genetic variability of Ehrlichia canis in pet dogs in Xinjiang, China.

BACKGROUND AND AIM: As a tick-borne zoonotic pathogen, Ehrlichia canis has already posed a threat to public health and safety. This study aimed to clarify the prevalence and molecular characteristics of E. canis in pet dogs in Xinjiang, China. MATERIALS AND METHODS: A total of 297 blood samples of pet dogs and 709 skin ticks (Rhipicephalus sanguineus sensu lato) were subjected to molecular detection using PCR for E. canis 16S rRNA gene, and then, positive samples were amplified, sequenced, and phylogenetically analyzed for E. canis gp36 gene. RESULTS: The PCR detection showed that the positive rate of PCR was 12.12% (36/297) in blood samples and 15.23% (108/709) in tick samples, respectively. Based on the phylogenetic analysis of E. canis gp36 protein, these E. canis strains in different geographical regions of the world can be divided into Genogroup I and Genogroup II. Among them, the Xinjiang epidemic strain XJ-6 and 533, 36, 1055, Kasur1, and Jake strains were clustered into subgroup 1.1 of Genogroup I, while the XJ-2, XJ-21, and XJ-35 strains and the TWN1, TWN4, CM180, and CM196 strains were closely related and belonged to subgroup 2.2 of Genogroup II, displaying high genetic diversity. CONCLUSION: This is the first study focusing on the molecular epidemiology of E. canis infection in pet dogs, which revealed that E. canis infection had been occurred in Xinjiang, China. More importantly, this study confirmed that the substantial variability in immunoreactive protein gp36 from E. canis strains circulating in pet dogs.

Key points for the prevention and treatment of the novel coronavirus pneumonia in the elderly / 中华老年医学杂志

The population is commonly susceptible to the 2019 novel coronavirus(2019-nCoV), especially the elderly with comorbidities.Elderly patients infected with 2019-nCoV tend to have higher rates of severe illnesses and mortality.Immunoaging is an important cause of severe novel coronavirus pneumonia(NCP)in the elderly.Due to the combination of underlying diseases, elderly patients may exhibit atypical manifestations in clinical symptoms, supplementary examinations and pulmonary imaging, deserving particular attention.The general condition of the elderly should be considered during diagnosis and treatment.In addition to routine care and measures such as oxygen therapy, antiviral therapy and respiratory support, treatment of underlying disease, nutritional support, sputum expectoration, complication prevention and psychological support should also be considered for elderly patients.Based on literature review and expert panel discussion, we drafted the Key Points for the Prevention and Treatment of the Novel Coronavirus Pneumonia in the elderly, aiming to provide help with the prevention and treatment of NCP and the reduction of harm to the elderly population.

Influencing factors of KAP in B-learning mode: taking the course of Medical Statistics as an example / 中华医学教育探索杂志

Objective:To apply the B-learning teaching mode into the Medical Statistic course, and to comparatively analyze the students' knowledge, attitude, and practice (KAP). Methods:In this study, undergraduates were investigated by self-designed questionnaires, and the reliability and validity of the questionnaire were evaluated. SAS 9.3 statistical software was used to analyze the KAP evaluation and the influencing factors of online learning with chi-square test, t test and multiple regression analysis. Results:There were significant differences in students' cognitive status in three aspects: the role of online videos ( P=0.012 9), whether to submit assignments ( P=0.040 7), and whether to participate in discussions ( P=0.009 4). In terms of attitude, there were significant differences between the role of B-learning process ( P=0.027 1) and online learning interest ( P=0.013 7). And in the terms of practice, there were significant differences in the time of online learning ( P=0.002 4), weekly login times for online learning ( P=0.015 4) and ways to solve difficulties ( P=0.004 5). Conclusion:The B-learning mode applied to the course of Medical Statistics has greatly improved students' ability in knowledge, attitude and practice (KAP), and achieved good teaching effects.

The real experience of postoperative functional exercise in PICC patients: a qualitative research / 中国实用护理杂志

Objective:To explore the real experience of functional exercise after PICC operation.Methods:Phenomenological methods were used to conduct semi-structured interviews with 15 patients who had different functional exercises after PICC. Colaizzi phenomenological analysis was used to analyze the data.Results:Through interviews, four themes were drawn: the exercise characteristics of different postoperative functional exercise, the benefits of postoperative functional exercise, the obstacles to postoperative functional exercise and the suggestions for education related to postoperative functional exercise.Conclusion:The patients with PICC think that the postoperative functional exercise is safe and practical, but the recognition and compliance of the postoperative functional exercise are still limited. It is suggested that appropriate training should be carried out among medical staff, so as to rationally select the way of postoperative functional exercise, further promote the application of postoperative functional exercise, and improve the compliance and experience of patients.

Key points for the prevention and treatment of the novel coronavirus pneumonia in the elderly / 中华老年医学杂志

The population is commonly susceptible to the 2019 novel coronavirus(2019-nCoV), especially the elderly with comorbidities.Elderly patients infected with 2019-nCoV tend to have higher rates of severe illnesses and mortality.Immunoaging is an important cause of severe novel coronavirus pneumonia(NCP)in the elderly.Due to the combination of underlying diseases, elderly patients may exhibit a typical manifestations in clinical symptoms, supplementary examinations and pulmonary imaging, deserving particular attention.The general condition of the elderly should be considered during diagnosis and treatment.In addition to routine care and measures such as oxygen therapy, antiviral therapy and respiratory support, treatment of underlying disease, nutritional support, sputum expectoration, complication prevention and psychological support should also be considered for elderly patients.Based on literature review and expert panel discussion, we drafted the Key Points for the Prevention and Treatment of the Novel Coronavirus Pneumonia in the elderly, aiming to provide help with the prevention and treatment of NCP and the reduction of harm to the elderly population.

The real experience of postoperative functional exercise in PICC patients: a qualitative research / 中国实用护理杂志

Objective@#To explore the real experience of functional exercise after PICC operation.@*Methods@#Phenomenological methods were used to conduct semi-structured interviews with 15 patients who had different functional exercises after PICC. Colaizzi phenomenological analysis was used to analyze the data.@*Results@#Through interviews, four themes were drawn: the exercise characteristics of different postoperative functional exercise, the benefits of postoperative functional exercise, the obstacles to postoperative functional exercise and the suggestions for education related to postoperative functional exercise.@*Conclusion@#The patients with PICC think that the postoperative functional exercise is safe and practical, but the recognition and compliance of the postoperative functional exercise are still limited. It is suggested that appropriate training should be carried out among medical staff, so as to rationally select the way of postoperative functional exercise, further promote the application of postoperative functional exercise, and improve the compliance and experience of patients.

Molecular Detection and Genetic Diversity of porcine Circovirus Type 3 in Commercial Pig Farms in Xinjiang Province, China.

INTRODUCTION: Porcine circovirus type 3 (PCV3) is a newly discovered porcine circovirus. The molecular characteristics and genetic evolution of PCV3 in Xinjiang province, China still being unclear, the aim of the study was their elucidation. MATERIAL AND METHODS: A total of 393 clinical samples were collected from pigs on commercial farms in nine different regions of Xinjiang and phylogenetic analysis based on full-length Cap genes was performed. RESULTS: The prevalence at farm level was 100%, while in all the tested samples it was 22.39%. Nine PCV3 strains were detected in Xinjiang province and they shared 98.9-99.3% nucleotide and 97.5-100.0% Cap gene amino acid sequence identities with other epidemic strains from China and abroad. Compared with other epidemic strains of PCV3, there were 26 base mutation sites in the Cap gene in the nine Xinjiang strains, resulting in the mutation of amino acids at positions 20, 24, 75, 77, 108, 111 and 206. Phylogenetic analysis showed that these strains can be divided into two different genetic groups, to the first of which five strains affiliated and divided between subgroups 1.1 and 1.2, and to the second of which the other four strains affiliated and similarly divided between subgroups 2.1 and 2.2. CONCLUSION: PCV3 circulates widely among commercial pig farms in Xinjiang province, China, and displays obvious genetic diversity. The results provide epidemiological information useful for the prevention and control of PCV3 infection in the pig industry.

Establishment of a high throughput sequencing technology for detection of SFTS virus genome / 中华实验和临床病毒学杂志

Objective@#The objective of this study was to establish a next generation sequencing (NGS) method for severe fever with thrombocytopenia syndrome virus(SFTS).@*Methods@#SFTS virus RNA was extracted from the patient serum inoculated and isolated by Vero cells. Two methods of random primer sequencing and oligo(dT) beads selection sequencing were used for library construction. The libraries were built based on the best amplification and purification conditions. Whole genome sequencing was performed on NGS platform.@*Results@#There were significant differences in data of 3 virus between the two methods.The sample was sequenced by random primer sequencing showed low coverage and depth. However, three samples were sequenced by oligo(dT) beads selection showed coverage was over 99% and depth was over 900.The alignment rate of database from NCBI was more than 90%. The initial detection quality of this method was 300ng RNA.@*Conclusions@#In this study, we used the method of oligo(dT) beads selection to build libraries, and established a SFTS virus genome detection based on next generation sequencing.

Characteristic profiles of biofilm, enterotoxins and virulence of Staphylococcus aureus isolates from dairy cows in Xinjiang Province, China

As an important zoonotic pathogen, Staphylococcus aureus has led to serious mastitis and endometritis in infected dairy cows. In this study, a total of 164 strains of S. aureus were isolated from dairy cows in Xinjiang Province, China, and subjected to assays to determine drug susceptibility and biofilm (BF) formation ability. Enterotoxin-related genes were detected, and the transcription levels of genes related to BF formation were determined by using reverse transcription-quantitative polymerase chain reaction. Moreover, the pathogenicity of isolates with different BF formation abilities was determined by measuring their hemolysis activity, half lethal dose (LD₅₀) and organ bacterial load. The results showed that 86.0% of S. aureus isolates could form BF. Among them, 42.1% of the strains had weak BF formation ability, and most strains with a strong BF formation ability were ica gene carriers. The S. aureus isolates displayed multidrug resistance and their drug resistance was positively correlated with their BF formation ability. Moreover, 96.3% of the S. aureus isolates carried enterotoxin genes. Among them, the detection rates of the novel enterotoxin genes were higher than those of conventional enterotoxin genes. Furthermore, isolates with a strong BF formation ability had higher LD50 but lower hemolysis ability and organ bacterial load than those of the isolates with weak or no BF ability. However, isolates without BF ability produced more severe pathological changes than those of isolates with strong BF formation ability. These findings suggest that higher BF ability and presence of novel enterotoxin genes are important characteristics of S. aureus isolates from dairy cows in Xinjiang Province, China, and such isolates may pose potential threats to food safety.

Expressions of osteopontin, matrix metalloproteinase 2 and vascular endothelial growth factor in gastric cancer and their prognostic value / 肿瘤研究与临床

Objective To investigate the relationship between the expressions of osteopontin (OPN), matrix metalloproteinase 2 (MMP-2) and vascular endothelial growth factor (VEGF) in gastric cancer and the poor prognosis of gastric cancer patients. Methods A total of 35 patients with gastric cancer after radical gastrectomy from January 2014 to March 2015 in Dalian Third People ' s Hospital were retrospectively analyzed. The expressions of OPN, MMP-2 and VEGF in gastric cancer tissues and adjacent normal tissues were detected by immunohistochemical SP staining. The relationship between the expressions of OPN, MMP-2 and VEGF and the poor prognosis of gastric cancer patients was analyzed. Results The positive expression rates of OPN, MMP-2 and VEGF in postoperative pathological tissues of gastric cancer were 80.0％ (28/35), 77.1％(27/31) and 88.6％(31/35), respectively. OPN expression was associated with vascular invasion, lymph node metastasis, degree of differentiation, degree of invasion, and Lauren classification (all P< 0.05). MMP-2 expression was associated with vascular invasion, lymph node metastasis, and degree of invasion (all P<0.05). VEGF expression was associated with vascular invasion, lymph node metastasis, degree of invasion, and Lauren classification (all P< 0.05). OPN, VEGF and MMP-2 had synergistic effects in the invasion and metastasis of gastric cancer, and the expressions of them were positively correlated (all P< 0.05). The sensitivity of combined detection of OPN, VEGF and MMP-2 (87.5％) was higher than the sensitivity of individual detection (68.8％, 62.5％ and 56.3％) (P< 0.05). Conclusions OPN, MMP-2 and VEGF expressions are closely related to the poor prognosis of gastric cancer patients, and have synergistic effects in the invasion and metastasis of gastric cancer. The combined detection of OPN, MMP-2 and VEGF may have a more accurate prediction of the prognosis of gastric cancer.

Comparison of the aesthetics stability of titanium miniscrews onto the distal molar displacement between two different implanted sites / 中华医学美学美容杂志

Objective To compare the stability and clinical efficacy of the distal molar displacement with titanium miniscrews.Methods A total of 82 Class Ⅱ patients with non-extraction (excluding orthognathic surgery) were selected.31 males and 50 females were treated with titanium miniscrews.15 males and 25 females were implanted with a miniscrews between the second premolar and the first molar on both sides of the maxillary palate.16 males and 25 females were bucally implanted between first and second molars.The failure rates and effect of molar displacement of miniscrews between two different implanted sites were compared.Results Group of implants palatally had a 17.6％ failure rate.And group of implants buccally had a 23.0％ failure rate.The failure rate of the former was lower than that of the latter.The difference was statistically significant (P＜0.05),and the former had more molar than the latter (P＜0.05)；the lateral profile was significantly improved and the clinical curative effect was better.Conclusions The stability and clinical efficacy of the distal molar displacement with titanium miniscrews in the palatal side are better.

The effect of tiotropium bromide powder on the sleep quality and lung function in patients with moderate and severe chronic obstructive pulmonary disease in stable period / 中国医师进修杂志

Objective To explore the influence of tiotropium bromide powder inhalant or budesonide powder inhalant on sleep quality and lung function in patients with moderate and severe chronic obstructive pulmonary disease (COPD) in stable period. Methods Sixty-three patients with moderate and severe COPD in stable period were divided into 2 groups by random sortition method:tiotropium bromide group(31 cases,the patients inhaled tiotropium bromide powder inhalant 5 μg/time, 1 time/12 h) and budesonide group (32 cases, the patients inhaled budesonide powder inhalant 200 μg/time, 1 time/12 h). All patients were treated for 3 months. The lung function monitoring and polysomnography were detected before and after treatment. Results Seven patients withdrawn: 3 patients were in tiotropium bromide group,and 4 patients were in budesonide group.The forced expired volume in 1 second(FEV1),forced vital capacity(FVC),FEV1/FVC,peak expiratory flow(PEF)and forced expiratory flow from 25% to 75% (MMEF) after treatment in 2 group were significantly improved compared with those before treatment, and there were statistical differences (P<0.05). The FEV1, FVC and FEV1/FVC levels after treatment in tiotropium bromide group were significantly higher than those in budesonide group: (2.29 ± 0.43) L vs. (2.01 ± 0.42) L, (4.19 ± 0.26) L vs. (3.93 ± 0.23) L and (52.03 ± 10.45) % vs. (49.73 ± 10.21) %, and there were statistical differences (P<0.05). The percentages of S1 phase,S2 phase,rapid eye movement(REM)phase and activity apnea-hypopnea index (AHI)after treatment in 2 groups were significantly improved compared with those before treatment,and the indexes in tiotropium bromide group were significantly better than those in budesonide group:(29.99 ± 8.43)% vs. (26.91 ± 11.66)%, (48.99 ± 10.26)% vs. (45.45 ± 10.13)%, (14.83 ± 8.36)% vs. (13.33 ± 7.44)% and (8.70 ± 5.11) times/h vs. (11.72 ± 10.09) times/h, and there were statistical differences(P<0.05).Conclusions Tiotropium bromide has better effect in promoting the lung function and sleep quality compared with budesonide in patients with moderate and severe COPD in stable period.

Correlations between work engagement and transformational leadership among PICC specialized nurses / 现代临床护理

Objective To explore the correlations between work engagement and transformational leadership among PICC specialized nurses.Method A total of 176 PICC specialized nurses recruited from Shandong Province by convenience sampling method were involved in the study by the Utrecht work engagement scale (UWES-9) and transformational leadership scale.Results The average scores of work engagement and transformational leadership were (39.21±11.56) and (89.68±23.52).Work engagement dedication and absorption were positively correlated to transformational lendership (P＜0.05).Conclusion Hospital administrators should plan a clear direction for the development of the PICC specialized nurses to enhance their work engagement.