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Long-term occupation of coal gangue dumping sites (CGDS) may destroy ecological environment of nearby area. However, how the CGDS affects the distribution pattern of soil seed banks and vegetation in the nearby area is not clear. In this study, we investigated soil seed bank and vegetation at different distances from the second CGDS of Yangchangwan in Ningdong mining area, Lingwu, Ningxia. The results showed that soil seed bank was mainly distributed in 0-10 cm layer and decreased with increasing soil depth. Species richness of soil seed bank and vegetation first increased and then tended to be stable with increasing distance to the CGDS. The influence range of CGDS on soil seed banks was 300-500 m and was 100-300 m on aboveground vegetation. The CGDS did not affect the vertical distribution pattern of soil seed bank, but significantly affected the horizontal distribution pattern of soil seed banks and aboveground vegetation. The key area of vegetation restoration around the CGDS was between 100 m and 300 m.

Objective: To determine the optimal examination duration by evaluating the detection rate of epileptiform discharges (EDs) with different examination duration of video-electroencephalography (EEG) in outpatients. Methods: Patients with EDs who underwent 4-hour EEG examination from Xuanwu Hospital, Capital Medical University from October 2020 to November 2021 were retrospectively enrolled, and the detection rates of EDs were calculated with examination duration of 0-0.5 h, 0-1 h, 0-2 h, 0-3 h, and 0-4 h (group A, B, C, D and E), respectively. For each patient, EDs in each hour (group H1, group H2, group H3, group H4) were counted, and the standardized amount of EDs was calculated. For each patient, EDs in wakefulness, drowsiness, non-rapid eye movement-Ⅰ (NREM-Ⅰ), NREM-Ⅱ and NREM-Ⅲ were counted, and the standardized amount of EDs in each state was calculated. Meanwhile, the sleep duration per hour of each patient was also counted (group H1', group H2', group H3', group H4'). The Wilcoxon paired test was used for intergroup comparison to determine the optimal examination duration. Results: A total of 80 patients were enrolled, and aged [ M ( Q 1 , Q 3 )]31 (21, 39) years (range: 5-68 years). There were 38 males and 42 females. The detection rate of EDs was 42.5% (34/80) in group A, 81.3% (65/80) in group B, and 100.0% (80/80) in group C, group D and group E, respectively. The standardized amount of EDs of H1, H2, H3 and H4 was 24.8% (7.8%, 44.2%), 41.5% (25.9%, 63.3%), 15.1% (1.3%, 27.8%) and 1.3% (0, 14.5%), respectively. The standardized amount of EDs of H2 was significantly higher than that of H1, H3 and H4 (all P <0.05). The standardized amount of EDs in wakefulness, drowsiness, NREM-Ⅰ, NREM-Ⅱ and NREM-Ⅲ were 9.6% (0, 28.2%), 3.6% (0, 16.9%), 3.3% (0, 11.8%), 47.3% (21.9%, 72.5%) and 0 (0, 11.5%), respectively. The standardized amount of EDs in NREM-Ⅱ was significantly higher than that in wakefulness, drowsiness, NREM-Ⅰ and NREM-Ⅲ (all P <0.05). The sleep duration in the group of the H1', H2', H3' and H4' was 13.6 (2.5, 23.6), 35.8 (16.5, 54.2), 14.5(0, 34.7) and 0 (0, 14.6) minutes, respectively. The sleep duration in the group of the H2' group was significantly longer than that in the group of H1', H3' and H4' (all P <0.05). Conclusion: The study recommends 2 hours video-EEG in outpatients, which not only ensures the detection rate of EDs, but also facilitates patient cooperation and optimizes the allocation of medical resources.

Ventilator-associated pneumonia (VAP), one of the most common nosocomial infections in critical care units, has been associated with adverse outcomes such as higher medical expenses, prolonged hospital stays, and higher mortality rates. Although studies have demonstrated the effectiveness of oral care in reducing VAP incidence and enhancing patient comfort, few critically ill patients are able to perform oral care independently. Moreover, related evaluations and execution require specialized nursing techniques that rely on well-trained nurses. Unfortunately, descriptions of oral evaluations, caring practices, and hygiene related to pathogenic mechanisms in critically ill patients are scarce in both textbooks and the scientific literature. Based on a review of the related literature, this article discusses: the pathogenic mechanism of VAP; the purpose, principals, and steps of providing oral care to endotracheal tube ventilated patients, with particular emphasis on current evidence on the effect of chlorhexidine on oral care; and the major factors impacting oral care effectiveness. This article is expected to raise awareness of oral care, update the current evidence-based knowledge base, and increase the quality of nursing care provided to critically ill populations.

Ackground & Problems: Aerosol therapy is increasingly used in pulmonary critical care and in patients with respiratory disease. However, improper application of the aerosol delivery device will decrease the therapeutic effect as well as increase the incidence of pulmonary infection. An initial assessment conducted in our intensive care unit found an accuracy rate for nursing staff aerosol-therapy execution of only 55.9%. Possible reasons identified for this low rate included lack of learning experience and resources, lack of related standard operating procedures, lack of related performance assessments, complicated / unfamiliar device assembly procedure, diffuse storage of device components, and a lack of illustrations., Purpose: This project was developed to increase the accuracy rate of performing aerosol therapy to over 90% in our intensive care unit., Methods: We designed diverse learning materials using the model of motivation, developed an evaluation system, simplified the assembly of components based on evidence-based research, improved the storage situation, and added reference illustrations., Results: The accuracy rate in aerosol therapy execution for our nursing staff increased from 55.9% to 95.0% after the intervention., Conclusions: This project used the model of motivation to develop the teaching materials. By using diverse teaching methods, including both in-person classes and online interactive quizzes, we realized high learning satisfaction and efficacy. Along with simplifying equipment handling, improving the working environment, enhancing nurses' aerosol therapy techniques, establishing standard operating procedure guidelines, and adding an evaluation system, we standardized the entire procedure for potential promotion to other intensive care units.

Background: 85%-95% of patients with cancer experience chemotherapy-induced peripheral neuropathy (CIPN), which may lead to neuropathic pain, emotional distress, functional difficulties, and interpersonal problems. Although exercise interventions have been proposed for improving and preventing CIPN, evidence regarding the efficacy of these interventions has been inconsistent and of inadequate quality. In addition, few domestic systematic reviews have examined the effects of exercise on CIPN., Purpose: To examine the effects of exercise interventions in cancer patients with CIPN using a systematic review (SR) method., Methods: An SR method was used in this paper by applying the concept of PICO using keywords P "cancer", I "rehabilitation", "exercise", C "usual care, standard of care", and O "chemotherapy-Induced peripheral neuropathy" in a search of the Ovid Medline, PubMed, Cochrane Library, EMBASE and Airiti Library databases for articles published from 2002 to 2021. Based on the inclusion and exclusion criteria, a total of 13 research articles were identified for review in this study., Results: The 13 randomized controlled trials reviewed in this SR included 909 cancer patients during or after chemotherapy who were receiving exercise interventions. The results indicate that single or combined exercise protocols have consistent benefits in terms of improving CIPN symptoms. However, because of the relatively small sample sizes (n = 19-355) and the multiple types (n = 9), frequencies (1-7 day/week), and durations (5-60 minutes/time) of exercise protocols used in these studies, future research is necessary to explore differences in the types and subgroup effects of exercise., Conclusions: The results from this systematic review indicate that the combined exercise model has consistent benefits in terms of helping prevent and alleviate the symptoms of CIPN. In clinical practice, healthcare providers may consider encouraging cancer patients to initiate mild physical activity when their physical conditions are stable and without evident side effects from chemotherapy to minimize the impacts of CIPN on daily functioning and quality of life.

Carbonaceous aerosol is an important component of atmospheric fine particles that has an important impact on air quality, human health, and climate change. In order to explore the long-term changes in carbonaceous aerosol under the background of emission reduction, this study measured the mass concentrations of organic carbon (OC) and elemental carbon (EC) of PM 2.5 , which collected in the northern suburbs of Nanjing for five years (December 17, 2014 to January 5, 2020). The results showed that the five-year average ρ (OC) and ρ (EC) were (10.2±5.3) μg·m -3 and (1.6±1.1) μg·m -3 , accounting for 31.1% and 5.2% of PM 2.5 , respectively. OC and EC concentrations were both high in winter and low in summer. According to the nonparametric Mann-Kendall test and Sen's slope, the mass concentrations of OC and PM 2.5 decreased significantly[OC: P <0.0001, -0.79 μg·(m 3 ·a) -1 , -0.29%·a -1 ; PM 2.5 : P <0.0001, -4.59 μg·(m 3 ·a) -1 , -1.58%·a -1 ]. Although EC had an upward trend, the significance and range of change were not obvious[ P =0.02, 0.05 μg·(m 3 ·a) -1 , 0.02%·a -1 ]. OC and EC decreased significantly during winter from 2014 to 2019[OC: P <0.0001, -2.05 μg·(m 3 ·a) -1 , -0.74%·a -1 ; EC: P =0.001, -0.15 μg·(m 3 ·a) -1 , -0.05%·a -1 ], and the decline was more obvious than the whole. The correlation between OC and EC showed that the sources in winter and summer were more complex than those in spring and autumn. According to the characteristic ratio of OC and EC, the contribution of coal combustion and biomass burning decreased from 2015 to 2019, whereas the impact of industrial sources and vehicle emissions became more significant. Corresponding to this was the obvious decline in OC and the slight recovery of EC. The OC/EC ratio was over 2.0, indicating that there was secondary pollution in the study area. Further calculation revealed that the variation in SOC was consistent with that in OC, showing a significant decrease[ P <0.0001, -0.47 μg·(m 3 ·a) -1 , -0.17%·a -1 ]. The average mass concentration of SOC was (5.0±3.5) μg·m -3 , accounting for 49.2% of OC. These changes indicate clear effects of the prevention and control of air pollution in Nanjing in recent years. Furthermore, future control can focus on the emissions of VOCs to reduce secondary pollution.

Background & Problem: Improving the process of care may effectively improve the quality of medical care and increase patient satisfaction. An investigation found that the process of care used in our unit was imperfect, resulting in a low preoperative enrollment rate of case managers, overly long patient waiting times for ward assignment, insufficient pre-operative knowledge, and high cancellation rates for routine operations., Purpose: The aim of this project was to review the overall process of care using the concept of patient flow to improve and formulate countermeasures to improve quality of care., Resolution: To improve the process of care, the corresponding countermeasures were formulated. 1. Set criteria for enrollment for orthopedic case managers to increase the preoperative enrollment rate; 2. Set up a specialized arthroplasty care area for central case management to reduce the time patients need to wait for the ward; and 3. Improve patient compliance with preoperative education and reduce the operation cancellation rate by distributing patient education pamphlets, filming videos of pre-operative instructions, facilitating home environment preparation, and providing education on sterilization baths., Results: After implementation of the countermeasures, the preoperative case manager enrollment rate increased from 27.8% to 84.6%; the average ward wait time for patients reduced from 73 to 41 minutes; compliance with patient education increased from 83.0% to 100%; and the operation cancellation rate reduced from 11.1% to 0%., Conclusions: This project used the concept of patient flow to review the care process used for total knee arthroplasty. This improvement strategy may be used to standardize care processes and improve the quality of medical care provided.

Objective: To investigate the effectiveness, safety, and prognosis of neoadjuvant chemoradiotherapy (nCRT) for Siewert type II and III adenocarcinomas of the esophagogastric junction (AEG). Methods: This study is a prospective randomized controlled clinical study (NCT01962246). AEG patients who were treated at the Third Department of Surgery of the Fourth Hospital of Hebei Medical University from February 2012 to June 2016 were included. All of the enrolled patients were diagnosed with type II or III locally advanced AEG gastric cancer (T2-4N0-3M0 or T1N1-3M0) by gastroscopy and CT before operation; the longitudinal axis of the lesion was ≤ 8 cm; no anti-tumor treatment was previously given and no contraindications of chemotherapy and surgery were found. Case exclusion criteria: serious diseases accompanied by liver and kidney, cardiovascular system and other vital organs; allergy to capecitabine or oxaliplatin drugs or excipients; receiving any form of chemotherapy or other research drugs; pregnant or lactating women; patients with diseases resulting in difficulty to take capecitabine or with concurrent tumors. Based on sample size estimation, a total of 150 AEG patients were enrolled. Using the random number table method, the enrolled patients were divided into the nCRT group and the direct operation group with 75 cases in each group. The nCRT group received XELOX chemotherapy (capecitabine+ oxaliplatin) before surgery and concurrent radiotherapy (45 Gy, 25 times, 1.8 Gy/d, 5 times/week). Clinical efficacy of the nCRT group was evaluated by the solid tumor efficacy evaluation standard (RECIST1.1) and the tumor volume reduction rate was measured on CT. After completing the preoperative examination in the direct operation group, and 8-10 weeks after the end of nCRT in the nCRT group, surgery was performed. Laparoscopic exploration was initially performed. According to the Japanese "Regulations for the Treatment of Gastric Cancer", a transabdominal radical total gastrectomy combined with perigastric lymph node dissection was performed. The primary outcome was the 3-year overall survival (OS) and disease-free survival rate (DFS); the secondary outcomes were R0 resection rate, the toxicity of chemotherapy, and surgical complications. The follow-up ended on December 31, 2019. The postoperative recurrence, metastasis and survival time of the two groups were collected. Results: After excluding patients with incomplete clinical data, patients or family members requesting to withdraw informed consent, and those failing to follow the treatment plan, 63 cases in the nCRT group and 69 cases in the direct operation group were finally enrolled in the study. There were no statistically significant differences in baseline characteristics of the two groups (all P >0.05). Sixty-three patients in the nCRT group were evaluated by RECIST1.1 after treatment, the image based effective rate was 42.9% (27/63), and the stable disease rate was 98.4% (62/63); the tumor volume before and after nCRT measured on CT was (58.8±24.4) cm(3) and (46.6±25.7) cm(3), respectively, the effective rate of tumor volume reduction measured by CT was 47.6% (30/63). Incidences of neutrophilopenia [65.1% (41/63) vs. 40.6% (28/69), χ(2)=7.923, P =0.005], nausea [81.0% (51/63) vs. 56.5% (39/69), χ(2)=9.060, P =0.003] and fatigue [74.6% (47/63) vs. 42.0% (29/69), χ(2)=14.306, P =0.001] in the nCRT group were significantly higher than those in the direct surgery group. Radiation gastritis/esophagitis and radiation pneumonia were unique adverse reactions in the nCRT group, with incidences of 52.4% (33/63) and 15.9%(10/63), respectively. The classification of tumor regression of 63 patients in nCRT group presented as 11 cases of grade 0 (17.5%), 20 cases of grade 1 (31.7%), 28 cases of grade 2 (44.4%), and 5 cases of grade 3 (7.9%). Eleven (17.5%) patients achieved pathologic complete response. Sixty-one (96.8%) patients in the nCRT group underwent R0 resection, which was higher than 87.0% (60/69) in the direct surgery group (χ(2)=4.199, P =0.040). The mean number of harvested lymph nodes in the specimens in the nCRT group and the direct operation group was 27.6±12.4 and 26.8±14.6, respectively, and the difference was not statistically significant ( t= -0.015, P =0.976). The pathological lymph node metastasis rate and lymph node ratio in the two groups were 44.4% (28/63) vs. 76.8% (53/69), and 4.0% (70/1 739) vs. 21.9% (404/1 847), respectively with statistically significant differences (χ(2)=14.552, P <0.001, and χ(2)=248.736, P <0.001, respectively). During a median follow-up of 52 (27-77) months, the 3-year DFS rate in the nCRT group and the direct surgery group was 52.4% and 39.1% ( P =0.049), and the 3-year OS rate was 63.4% and 52.2% ( P =0.019), respectively. According to whether the tumor volume reduction rate measured by CT was ≥ 12.5%, 63 patients in the nCRT group were divided into the effective group ( n =30) and the ineffective group ( n =33). The 3-year DFS rate of these two subgracps was 56.6% and 45.5%, respectively without significant difference ( P =0.098). The 3-year OS rate was 73.3% and 51.5%,respectively with significant difference ( P =0.038). The 3-year DFS rate of patients with the tumor regression grades 0, 1, 2 and 3 was 81.8%, 70.0%, 44.4%, and 20.0%, repectively ( P =0.024); the 3-year OS rate was 81.8%, 75.0%, 48.1% and 40.0%, repectively ( P =0.048). Conclusion: nCRT improves treatment efficacy of Siewert type II and III AEG patients, and the long-term prognosis is good.

Hip fracture commonly occurs in adult patients over 65 years old at a prevalence rate that is estimated to be 756 per 100 thousand cases. Thus, hip fracture surgery is one of the most common emergency operations in older adult populations. In addition, the incidence rate in older adults of post-operative delirium, which leads to symptoms of disturbance related to cognition, attention, perception, logic, memory, psychological activities, mood, and sleep, has been reported as 5%-61%. The many possible complications of post-operative delirium, including death, increase medical costs and family burdens if not managed properly. Proper management involves healthcare providers initiating early assessments, reducing accelerated factors, and providing appropriate care. As diagnosing and differentiating post-operative delirium in clinical practice is difficult, this condition is easily neglected by healthcare teams, resulting in adequate care not being provided to this population. The aim of this paper was to review the definition, relevant physiological and pathological mechanisms and etiologies, and medical management and nursing care of post-operative delirium using an evidence-based literature review. Suggestions for healthcare providers to improve the detection and management of post-operative delirium include using appropriate evaluation tools to detect and diagnose high-risk patients as early as possible, implementing older-adult life planning strategies, and conducting medical consultations. Furthermore, healthcare providers may initiate pain control, nutrient and body fluid supplementation, and sensory/cognition enhancement therapies to reduce the incidence of delirium, length of hospital stay, complications, and in-hospital mortality, thereby improving the quality of care provided to older adult patients with hip fractures and their caregivers.

Objective: To study the safety of two ventilator weaning strategies after high-frequency oscillatory ventilation (HFOV) for the treatment of neonatal respiratory distress syndrome (NRDS) in preterm infants., Methods: A prospective randomized controlled trial was conducted for 101 preterm infants with NRDS, with a gestational age of ≤32 +6 weeks or a birth weight of ≤1 500 g, who were admitted to the neonatal intensive care unit of Xiamen Maternal and Child Health Hospital from January 1, 2019 to June 30, 2020. The infants underwent HFOV as the preferred treatment. The infants were randomly divided into an observation group (50 infants with direct weaning from HFOV) and a control group (51 infants with weaning after HFOV was switched to conventional mechanical ventilation). The two groups were compared in terms of failure rate of ventilator weaning within 72 hours, changes in blood gas parameters at 2 hours before weaning and at 2 and 24 hours after weaning, respiratory support therapy, incidence rates of complications, and outcome at discharge., Results: There was no significant difference in the failure rate of ventilator weaning within 72 hours (8% vs 14%, P > 0.05). The observation group had a significantly shorter duration of mechanical ventilation than the control group [(64±39) hours vs (88±69) hours, P < 0.05]. There were no significant differences between the two groups in the duration of mechanical ventilation, total oxygen supply time, blood gas parameters before and after ventilator weaning, incidence rates of complications, and outcome at discharge ( P > 0.05)., Conclusions: For preterm infants with NRDS, the strategy of weaning directly from HFOV is safe and reliable and can reduce the duration of invasive mechanical ventilation, and therefore, it holds promise for clinical application.

Black carbon (BC) is an important component of atmospheric particulate matter (PM) emitted during the combustion process. Light absorption and scattering exhibited by BC affect the exchange of solar energy on Earth. In this study, continuous measurements of atmospheric particulate BC were carried out, using a BC analyzer (AE33) in the suburban area of Nanjing from January 2019 to May 2019, to realize the diurnal variations of BC during the different seasons and potential sources of BC during the clean (CD, PM 2.5 <35 μg ·m -3 ) and haze days (PD, PM 2.5 >75 μg ·m -3 ). The results showed that the average concentration of BC was (3.8±2.3) μg ·m -3 ; a higher average BC concentration value of (4.3±2.6) μg ·m -3 was observed during the winter, exceeding that during the spring period by a factor of 1.3. The higher BC concentrations during the winter was attributed to the stagnant weather conditions and additional emissions. Significant diurnal cycles of BC were observed with higher BC concentrations during rush hours of traffic, suggesting traffic origins. The Ångström exponent were 1.32 and 1.30 during the spring and winter periods, respectively, indicating that the BC was mainly produced from the traffic emissions during both the seasons. This hypothesis was also supported by the average BC/CO ratio of 0.005, which was similar to that of BC derived by traffic emissions. Moreover, we discovered that the contributions of traffic emissions to BC were 68%-87% and 72%-86% during the haze and clean periods, respectively. This indicated enhanced contributions of coal combustion and biomass burning to BC in Nanjing during the haze events. Finally, using the potential source contribution function (PSCF) and concentration weighted trajectory (CWT) analysis, we highlighted that the BC at the receptor site was mainly from the local emissions in the surrounding areas of Nanjing.

Atmospheric volatile organic compounds (VOCs) were continuously monitored via an online GC-FID/MS system in Nanjing during the autumn of 2018 to analyze the chemical characteristics, ozone formation potential (OFP), and potential sources of VOCs in this industrial region. During the sampling period, the average concentration of atmospheric total VOCs (TVOCs) was (64.3±45.6)×10 -9 . Alkanes were the most predominant VOC compound, accounting for 33.1% of the TVOC mass, followed by oxygenated volatile organic compounds (OVOCs, 22.3%) and halogenated hydrocarbons (21.8%). The diurnal cycles of VOCs revealed "bimodal" distributions. The higher concentrations of VOCs observed at 06:00-07:00 and 18:00-20:00 were attributed to the intense traffic emissions and meteorological conditions. Furthermore, maximum incremental reaction (MIR) analysis was used to estimate OFP of VOCs. The results showed that the calculated OFP in Nanjing was 267.1 μg·m -3 . Aromatic hydrocarbons and alkenes were the dominant contributors to OFPs, which accounted for 55.2% and 20.8% to the total OFPs, respectively. Finally, five potential sources of VOCs were quantified by the positive matrix factorization model, including traffic emissions (34%), industrial emissions (19%), liquefied petroleum gas (LPG) emissions (17%), usage of paints and solvents (16%), coal combustion, and biomass burning (14%). These findings suggested that control of vehicle emissions and industrial sources would be an important way to reduce VOC concentrations and improve air quality in Nanjing.

Vehicle emissions have become a major source of air pollution in urban cities. The vehicle emission inventory of the Liaoning province from 2000 to 2030 was established based on the COPERT model and ArcGIS, and the temporal and spatial distribution characteristics of six pollutants (CO, NMVOC, NO x , PM 10 , SO 2 , and CO 2 ) were analyzed. Taking 2016 as the base year, eight scenarios of control measures were designed based on scenario analysis, and the effects of different scenarios on emission reduction were assessed. Results showed that during 2000-2016, CO, NMVOC, NO x , and PM 10 emissions at first exhibited increasing trends, after which they decreased. Emissions of SO 2 exhibited fluctuating trends, while the emissions of CO 2 showed a continuous increase. Passenger cars and motorcycles were the main contributors of CO and NMVOC emissions. Heavy-duty trucks and buses were the main sources of NO x and PM 10 emissions. Passenger cars were the major contributors to SO 2 and CO 2 emissions. Vehicle emissions were significantly higher in the central and southern in Liaoning Province. At the city level, vehicle emissions were mainly concentrated in Shenyang and Dalian. The scenario analysis showed that the implementation of stricter vehicle emission standards can enhance the emission reduction effect. Moreover, accelerating the implementation of new emission standards was beneficial to reduce emissions. The integrated scenario would achieve the maximum emission reduction, with reduction rates of CO, NMVOC, NO x , PM 10 , CO 2 , and SO 2 at 30.7%, 14.3%, 81.7%, 29.4%, 12.3%, and 12.1%, respectively.

This paper was aimed to observe the interventional effect of Sedum sarmentosum total flavanones on hepatic fibrosis and its possible mechanism through the subcutaneous injection of CCl&#95;4 in rats. Sixty male SD rats were randomly divided into normal control group, model group, low-dose, medium-dose, high-dose S. sarmentosum total flavanones groups(100, 200, 400 mg·kg~(-1)) and silymarin group(200 mg·kg~(-1)). The model of liver fibrosis was established by subcutaneous injection of rats with 40% CCl&#95;4. After the modeling, the drug groups were intragastrically administered with corresponding drugs once a day for consecutively five weeks, while the normal group and the model group were given 0.9% sodium chloride solution during the same period. After the experiment, the general conditions of rats and the pathological changes of liver tissues were observed, and the contents of serum ALT, AST, HA and LN were measured. Besides, the expressions of the protein and relevant mRNA of Smad2/3, Smad4 and α-SMA in rats were detected. Compared with model group, S. sarmentosum total flavanones could significantly increase the rats' body weight, inhibit the increase of liver and spleen index in rats of liver fibrosis, reduce the levels of ALT, AST, HA and LN, and alleviate pathological changes. Meanwhile, compared with the model group, the protein expressions of Smad2/3, Smad4 and α-SMA as well as relevant mRNA expressions in S. sarmentosum total flavanones group were obviously decreased, while Smad7 expression was markedly increased. As a result, S. sarmentosum total flavanones could significantly alleviate CCl&#95;4-induced liver fibrosis, and its anti-hepatic fibrosis mechanism may be related to intervention with Smads pathway, so as to inhibit the activation of HSC.

Background: Early antiretroviral therapy (ART) is recommended as an intervention for HIV by the World Health Organization. However, the association between the CD4 count at ART initiation and the risk of adverse drug reactions (ADRs) remains unclear., Purpose: This study aimed to describe the trends related to symptom number and intensity among patients newly diagnosed with HIV in three different CD4-count-based groups and then to investigate the ADR trends for these three groups at different points in time., Methods: This multi-center cohort study recruited newly diagnosed HIV/AIDS patients who had not previously used ART from AIDS-designated hospitals in Taiwan from March 2015 to December 2016. Study measures were assessed at the time of case enrollment (T0) and during the 1st month (T1), 4-6th month (T2), and 7-9th month (T3) of ART treatment. Patients were stratified into three groups according to initial CD4 count: ≤ 350 cells/mm 3 , >350-500 cells/mm 3 and >500 cells/mm 3 . Repeated measures ANOVA and generalized estimating equations were used to estimate the relationships between the level of initial CD4 count and ADRs., Results: A total of 207 patients completed the study. Mean symptom numbers and symptom intensities decreased significantly over time in all three groups (p < .01). The largest mean reduction in both symptom number and intensity was achieved by the CD4 count >500 cells/mm 3 group. Overall, at least one ADR was reported by 85.7% of the participants at the first month of ART use, and the incidence of ADR had decreased by an average of 22% at the 7-9th month assessment (p < .001). ARDs decreased significantly over time in the CD4 count > 500 cells/mm 3 group, with the degrees of ADRs in systematic side effect most significantly decreased in this group (p = .03)., Conclusions / Implications for Practice: Number and intensity of symptoms significantly improved over time in all three CD4 count groups. The percentage of systematic side effects was most reduced in the CD4 count > 500 cells/mm 3 group. The results of this study may be referenced by HIV care providers when discussing with patients the initiation of ART and the potential risks of experiencing ADRs.

Objective: To explore the clinical features and genetic causes of autism spectrum disorder (ASD) patients with epilepsy. Methods: The clinical data of five patients with ASD and epilepsy admitted to Xuanwu Hospital between September 2017 and September 2018 were collected, including medical history, intelligence level, developmental level, physical examination, neuroimaging and electroencephalogram. High-throughput whole-genome sequencing was applied to five patients and their parents. Results: Of five patients, four were male and one was female. All five patients had mild mental retardation, and one patient had significant growth retardation and craniofacial deformity. The average epilepsy onset age was 6.3 years old (7 months to 16 years). The main epileptic type was tonic-clonic seizure with abnormal EEG results. All patients have a favorable response to anti-epileptic drugs. Whole-exome sequencing (WES) revealed copy number variation in all 5 patients. Among them, 3 cases were reported to be pathogenic, and 2 cases were not reported (chromosome 16p13.3 duplication and chromosome 21q22.3 deletion). Conclusions: The results of current study support that autism spectrum disorders with seizures is often associated with copy number variations, such as Williams-Beuren region duplication syndrome, chromosome 15q11.2 duplication syndrome and chromosome 15q11.2 deletion syndrome. We reported two novel copy number variations (chromosome 16p13.3 duplication and chromosome 21q22.3 deletion) in two autism spectrum disorder patients with epileptic seizures.

Objective: To compare the efficacy and safety of complete transperitoneal laparoscopic nephroureterectomy (CTNU) and traditional retroperitoneoscopic nehroureterectomy (TRNU) for the management of upper urinary tract urothelial carcinoma(UTUC)., Methods: We retrospectively collected the clinical data of UTUC patients who underwent CTNU or TRNU surgery from January 2011 to December 2018 in Peking University First Hospital and Fujian Provincial Hospital, and compared the clinical characteristics, perioperative parameters, and follow-up results between the CTNU and TRNU surgeries., Results: Finally, a total of 266 cases were included, with 94 cases in the CTNU group and 172 cases in the TRNU group. The proportion of left side lesions was bigger in TRNU group when compared with CTNU group (P<0.05). No significant differences were observed in clinical characteristics, such as age, gender, body mass index (BMI), American society of anesthesiologists score (ASA score) and tumor laterality. All surgery procedures were completed. The vascular resparing was performed by reason that left arteria renalis was injured accidently during surgical operation in one case of TRNU group. No serious complications were observed in both CTNU and TRNU groups. In CTNU group, operating time was (202.9±76.7) min, estimated blood loss was (68.4±73.3) mL, drainage duration was (3.9±1.5) d, drainage volume was (181.7±251.5) mL, and postoperative hospital stay was (7.8±4.1) d. In TRNU group, operating time was (203.5±68.7) min, estimated blood loss was (130.2±252.1) mL, drainage duration was (4.3 ±1.6) d, drainage volume was (179.1±167.5) mL, and postoperative hospital stay was (8.2±3.7) d. The estimated blood loss in CTNU group was significantly less than that in TRNU group (P=0.005).The median follow-up time was 39 months (range: 1-88 months). The 5-year overall survival rate (OS), cancer specific survival rate (CSS), intra-vesical recurrence free survival rate (IvRFS), disease free survival rate (DFS) of CTNU group was 75.6%, 86.9%, 73.8%, 57.5%, respectively. The OS, CSS, IvRFS and DFS of TRNU group was 66.3%, 83.5%, 75.9%, 58.6%, respectively.No significant differences were observed in the OS, CSS, IvRFS and DFS between the CTNU and TRNU groups., Conclusion: CTNU technique is a safe and effective surgical option, and further prospective randomized controlled trial is needed for further evaluation.

Objective: To study the correlation between coagulation function and gestational age in preterm infants and the possible value of coagulation function measurement in predicting hemorrhagic diseases., Methods: The clinical data of preterm infants who were hospitalized between September 2016 and August 2017 were collected. The coagulation indicators were measured within 2 hours after birth. According to the gestational age, the preterm infants were divided into late preterm infant group (n=322), early preterm infant group (n=241) and extremely/very early preterm infant group (n=128). Coagulation function was compared among the three groups, as well as between the preterm infants with and without hemorrhagic diseases within 3 days after birth., Results: There were significant differences in thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen degradation product (FDP) and D-dimer (DD) among the three groups (P<0.05). APTT, PT, FDP and DD were negatively correlated with gestational age, while TT was positively correlated with gestational age (P<0.05). The preterm infants with hemorrhagic diseases had a longer APTT and a higher level of DD (P<0.05)., Conclusions: Coagulation function gradually becomes mature in preterm infants with the increase in gestational age. Abnormal APTT and DD indicate that preterm infants may have a higher risk of hemorrhagic diseases.

The pollution characteristics and emission factors (EFs) of the volatile organic compounds (VOCs) of vehicles were investigated using the tunnel test method on weekdays and weekends in the Wujinglu Tunnel in Tianjin, China. Gas samples in the tunnel were collected with 3.2 L stainless steel canisters and 99 VOCs species were analyzed by gas chromatography-mass spectrometry (GC-MS). The concentration levels, variation characteristics, and EFs of the VOCs were analyzed. The ozone formation potentials (OFPs) and secondary organic aerosol formation potentials (SOAFPs) of the VOCs in the tunnel were calculated. Moreover, a comparison of the study results with current literature was conducted. The total concentrations of VOCs at the inlet and midpoint are (190.85±51.15) μg·m -3 and (257.44±62.02) μg·m -3 , respectively. The total EFs are (45.12±10.97) mg·(km·veh) -1 and the EFs for alkanes, alkenes, alkynes, aromatics, halocarbons, and oxygenated volatile organic compounds (OVOCs) are (22.79±7.15), (5.04±1.20), (0.78±0.34), (9.86±2.81), (0.26±0.17), and (6.25±2.27) mg·(km·veh) -1 , respectively. They are notably smaller than the values obtained in a previous test in 2009. Isopentane, toluene, ethylene, methyl tert-butyl ether (MTBE), and ethane were the top five species among the VOC EFs. The ratios of methyl tert-butyl ether/benzene (MTBE/B) and methyl tert-butyl ether/toluene (MTBE/T) are 1.07 and 0.77, respectively. This implies that the contribution of evaporative emissions from vehicles to VOCs emissions cannot be ignored. The OFPs and SOAFPs in the tunnel are (145.50±37.85) and (43.87±12.75) mg·(km·veh) -1 , respectively. Compared with the test in 2009, the OFPs and SOAFPs are 94.23% and 90.88% smaller, respectively. The sharp decrease of the OFPs and SOAFPs is closely related to stricter emission standards and the upgrade of oil products.

Objective: To investigate the value of morphometric analysis program (MAP) combined with magnetoencephalogram (MEG) in the localization of epileptogenic foci in MRI-negative pharmacoresistant focal epilepsy (MNPFE) patients. Methods: A total of 42 consecutive MNPFE patients from Epilepsy center, Xuanwu Hospital, Capital Medical University from January 2015 to December 2016 were enrolled. The analysis process of MAP and magnetoencephalography (MEG) were performed independently. When the MAP+ region and the MEG+ region was in the same lobe, the MAP+ region was defined as the MAP+MEG+ region. The analysis results of MAP and MEG were used to do correlation analysis with surgical outcomes separately or simultaneously. Results: The positive rate of MAP was 69% (29/42), and the complete resection of MAP+ region was significantly associated with seizure-free outcome ( P= 0.027). The positive detection rate of MEG was 100% (42/42), and there was no significant association between the complete resection of MEG+ region and seizure-free outcome ( P= 0.517). The positive rate of MAP+MEG+ was 43% (18/42), and the complete resection of MAP+MEG+ region was significantly associated with seizure-free outcome ( P= 0.009). Conclusion: The combination of MAP which indicates subtle structural abnormalities and MEG which pictures electrophysiological features could probably achieve better epileptogenic foci localization in MNPFE patients.

Background: Rate of contamination is a well-known indicator of quality of care in the emergency department. Blood-culture results may affect clinical decision making. From January 1, 2015 to December 31, 2015, the contamination rate of blood culture in our emergency department was 5.63%, which exceeded the maximum of 3% suggested by the American Society for Microbiology and the clinical laboratory at our hospital., Purpose: Using a quality improvement strategy, this project aimed to (1) identify potential factors contributing to the high blood culture contamination rate and (2) achieve a blood culture contamination rate below 3%., Resolution: The factors that were identified as potentially contributing to the high blood culture contamination rate were: (a) Nursing staff: lack of related education and training and ignorance of related clinical guidelines; (b) The system: inconsistent and non-evidence-based clinical guidelines (e.g., no requirement to use sterile gloves when obtaining blood cultures and changing disinfectants); (c) The patient: older patients, residents of long-term care facility, and patients whose blood culture were in the first set were associated with higher blood culture contamination rates. Our quality improvement strategy included: design a new bedside working plate, develop slogans and posters illustrating the proper blood-drawing procedure, make a video introducing current standard technology, provide continuing education, monitor contamination rates, and provide individual feedback and retraining for those with higher contamination rates., Results: The strategy was implemented from October 1, 2016 to December 31, 2016, during which period the blood culture contamination rate reduced from 5.63% to 1.51%., Conclusions: Conclusion: Improving equipment, using multiple teaching methods, and providing regular feedback not only significantly reduced the blood culture contamination rate but also enhanced the knowledge and skills of nursing staff in terms of blood culture sampling. We hope that our results are referenced by other nursing departments and used to improve the blood culture contamination rates in other clinical settings.

Self-supporting care is an emerging concept in the geriatric care system of Taiwan. The traditional care model tends to prioritize aspects such as "safety" and "convenient and effective". For older adult patients, this situation has led to excessive restrictions, enforced bedrest, and the use of adult diapers, which seriously deteriorate quality of life. The present article introduces the development and current status of self-supporting care and international empirical research results from the perspective of holistic care for older adults as well as describes the intervention strategies that are currently used in Taiwan. We look forward to the caregivers of older adults being able to apply self-supporting care in their care settings, which is expected to enhance quality of life and dignity for older adults.

Objective: To investigate the clinical features and genetic characteristics of patients with TBC1D24 gene mutation related early-onset focal myoclonic epilepsy. Methods: Clinical data of 3 patients with TBC1D24 gene mutation related early-onset focal myoclonic epilepsy of Xuanwu Hospital from November 2016 to June 2017 was collected and analyzed.Candidate gene mutations were screened by second generation sequencing. Results: Among the 3 patients, 1 was male and 2 were females.Seizure onset age was 4 months, 3 years and 5 years after birth respectively. Two patients had family history of epilepsy.They all had prolonged episodes of focal myoclonus. Two patients had mental retardation.Scalp electroencephalograms (EEG) was recorded in all 3 cases and myoclonic seizures were captured.The ictal EEGs were normal in all cases. In one patient, the ictal EEG of generalized seizure showed alpha rhythm originating from left fronto-central region. Brain magnetic resonance imaging (MRI) was normal in 2 patients. Abnormal signal was found bilaterally in cerebellum in 1 patient. The gene screening showed that two patients carried compound heterozygous mutation of TBC1D24 gene and one carried homozygous mutation, all of which were de novo mutations.All the patients were treated with multiple antiepileptic drugs (AEDs) and seizures were uncontrolled in 2 patients. One patient was followed up for 10 months without recurrence. Conclusions: TBC1D24 gene related early-onset focal myoclonic epilepsy is clinically characterized by early onset, prolonged focal myoclonus which relieved with sleep, mental retardation and poor response to AEDs.The interictal and ictal EEG usually show normal. Genetic analysis can assist in diagnosis and genetic counseling.

Loss is an inevitable experience for humans for which grief is a natural response. Nurses must have an adequate understanding of grief and bereavement in order to be more sensitive to these painful emotions and to provide appropriate care to families who have lost someone they love deeply. This article introduces four important grief theories: Freud's grief theory, Bowlby's attachment theory, Stroebe and Schuts' dual process model, and Neiyemer's meaning reconstruction model. Freud's grief theory holds that the process of grief adaptation involves a bereaved family adopting alternative ways to connect with the death of a loved one and to restore their self-ego. Attachment theory holds that individuals who undergo grieving that is caused by separation from significant others and that triggers the process of grief adaptation will fail to adapt if they resist change. The dual process model holds that bereaved families undergo grief adaptation not only as a way to face their loss but also to restore normality in their lives. Finally, the meaning reconstruction model holds that the grief-adaptation strength of bereaved families comes from their meaning reconstruction in response to encountered events. It is hoped that these theories offer nurses different perspectives on the grieving process and provide a practical framework for grief assessment and interventions. Additionally, specific interventions that are based on these four grief theories are recommended. Furthermore, theories of grief may help nurses gain insight into their own practice-related reactions and healing processes, which is an important part of caring for the grieving. Although the grieving process is time consuming, nurses who better understand grief will be better able to help family members prepare in advance for the death of a loved one and, in doing so, help facilitate their healing, with a view to the future and to finally returning to normal daily life.

In order to understand the environmental influence of oasis-desert ecotone to oasis ecological system, we comparatively analyzed the grain size characteristics of various aeolian sediments, including the sediments in oasis-desert ecotone, shelterbelt and the inside oasis and in Qira River valley. The results showed that the grain size characteristics (including grain-size distribution curve, grain size parameters, and content of different size classes) of sediments in the oasis-desert ecotone were consistent along the prevailing wind direction with a grain-size range of 0.3-200 μm and modal size of 67 μm. All of the sediments were good sorting and mainly composed of suspension components and saltation components, but not denatured saltation and creeping components (>200 μm). They were typically aeolian deposits being short-range transported. The grain sizes of sediments in oasis-desert ecotone were smaller than that in the material sources of Qira River valley and desert (0.3-800 μm), but very similar to those of the modern aeolian deposits in oasis-desert ecotone, shelterbelt and the inside oasis. The denatured saltation and creep components (>200 μm) were suppressed to transport into oasis-desert ecotone because of the high vegetation cover in oasis-desert ecotone. Therefore, like the shelterbelts, the oasis-desert ecotone could also block the invasion of desert. They safeguarded the oasis ecological environment together.

Objective: To investigate the effect of 50 mg alteplase to intermediate-risk acute pulmonary embolism (APE) with right ventricular dysfunction. Methods: From May 2011 to May 2015, a total of 73 patients with intermediate-risk APE, furthermore, right ventricular systolic pressure (RVSP)>40 mmHg and B-type natriuretic peptide (BNP)>100 ng/L, were allocated to receive 50 mg alteplase plus anti-coagulation (thrombolysis group, TG, n =35) or anticoagulation alone (control group CG, n =38) according to their will.Tricuspid annular plane systolic excursion (TAPSE), Right ventricular fractional area change (RVFAC), RVSP, BNP, CT obstruction index (CTOI) were detected at prior treatment, 1 st day, 14 th day, 3 rd month, 6 th month. The adverse events consisting of hemodynamic decompensation (within 14 days), mortality, bleeding, recurrent pulmonary embolism (PE), RVSP>40 mmHg (at 6 th month) were recorded. Results: At prior treatment, TAPSE, RVFAC, RVSP, BNP and CTOI between TG and CG were (10.9±1.4) vs (11.4±1.2) mm, (27.8±3.9)% vs (28.1±4.1)%, (55.6±7.9) vs (54.6±8.4) mmHg, (491±76) vs (482±71) ng/L and (23.4±4.2)% vs (23.7±4.5)%. There was not statistical difference between two groups (all P >0.05). From 1 st to 14 th day, these indexes had better and faster improvement in TG than CG. At 6 th month, TAPSE, RVFAC, RVSP and CTOI between two groups were (17.5±1.3) vs (15.4±1.1) mm, (49.4±3.9)% vs (46.0±2.8)%, (15.8±2.2) vs (17.8±4.2) mmHg, and (1.7±1.6)% vs (4.0±3.0)% (all P <0.05), BNP was (66±13) vs (71±15) ng/L ( P >0.05). From prior treatment to 6 th month, the tendency of variation of these index in TG was better than CG ( P <0.05). From prior treatment to 14 th day, 3 cases of hemodynamic decompensation occurred in CG, 0 case in TG.During treatment, there were not cases of death and major bleeding. At 6 th month, there were 4 cases of RVSP>40 mmHg in CG, while 0 case in TG ( P =0.048). Conclusion: 50 mg alteplase can reduce the thrombus in pulmonary artery, improve right ventricular function quickly, and decrease the risk of elevated RVSP in the long term, for the patients with intermediate-risk APE.

Advance care planning (ACP) is an emerging issue in the primary care system of Taiwan. Previous studies have attributed benefits to various types of ACP in diverse ranges of healthcare settings and populations. However, few older adults in Taiwan have had the opportunity to discuss ACP or to complete their advance directives. The present article takes the perspective of community health nursing to describe the international development and current status of ACP in the community in Taiwan. Furthermore, the intervention models and available resources of ACP are described. We look forward to healthcare professionals using ACP to assist greater numbers of community older adults, thus enhancing their terminal-stage quality of life.

Objective: To investigate the lethal blood level, the target organs and tissues, the toxicant storage depots and the postmortem redistribution in mice died of emamectin benzoate poisoning., Methods: The mice model of emamectin benzoate poisoning was established via intragastric injection. The main poisoning symptoms and the clinical death times of mice were observed and recorded dynamically in the acute poisoning group as well as the sub-acute poisoning death group. The pathological and histomorphological changes of organs and tissues were observed after poisoning death. The biodistribution and postmortem redistribution of emamectin benzoate in the organs and tissues of mice were assayed by the enzyme-linked immunosorbent assay (ELISA) at 0h, 24h, 48h and 72h after death. The lethal blood concentrations and the concentrations of emamectin benzoate were detected by high performance liquid chromatography (HPLC) at different time points after death., Results: The symptoms of nervous and respiratory system were observed within 15-30 min after intragastric injection. The average time of death was (45.8 ± 7.9) min in the acute poisoning group and (8.0 ± 1.4) d in the sub-acute poisoning group, respectively. The range of acute lethal blood level was 447.164 0-524.463 5 mg/L. The pathological changes of the organs and tissues were observed via light microscope and immunofluorescence microscope. The changes of emamectin benzoate content in the blood, heart, liver, spleen, lung, kidney and brain of poisoning mice showed regularity within 72 h after death (P < 0.05)., Conclusion: The target organs of emamectin benzoate poisoning include heart, liver, kidney, lung, brain and contact position (stomach). The toxicant storage depots are kidney and liver. There is emamectin benzoate postmortem redistribution in mice.

Biochar is one of the research hotspots in the field of the agroforestry waste utilization. A field experiment was carried out to investigate the effects of different amounts of tobacco stem biochar (0, 1, 10, 50 t · hm⁻²) on soil micro-ecology and physiological properties of flue-cured tobacco. The results showed that soil water content (SWC) increased at all tobacco growth stages as the amounts of biochar applications increased. There were significant differences of SWC between the treatment of 50 t · hm⁻² and other treatments at the period of tobacco vigorous growth. As the application of biochar increased, the total soil porosity and capillary porosity increased, while soil bacteria, actinomyces, fungi amount increased firstly and then decreased. The amount of soil bacteria, actinomyces, fungi reached the maximum at the treatment of 10 t · hm⁻². Soil respiration rate (SRR) at earlier stage increased with the increase of biochar application. Compared with the control, SSR under biochar treatments increased by 7.9%-36.9%, and there were significant differences of SRR between high biochar application treatments (50 t · hm⁻² and 10 t · hm⁻²) and the control. Biochar improved leaf water potential, carotenoid and chlorophyll contents. Meanwhile, the dry mass of root, shoot and total dry mass under biochar application were higher than that of the control. These results indicated that the biochar played active roles in improving tobacco-planting soil micro-ecology and regulating physiological properties of flue-cured tobacco.

Objective: To understand the characteristics of infections from blood donors with HBsAg⁻/HBV DNA⁺ in Xiamen area., Methods: Donors in Xiamen area were assayed by routine ELISA and those with negative results were tested by nucleic acid amplification testing (NAT). HBsAg⁻/HBV DNA⁺ samples were tested by quantitative detection of HBV DNA. Epidemiological analysis and following up examination were conducted in HBsAg⁻/HBV DNA⁺ donors., Results: Out of 130659 samples 113 were tested as HBsAg⁻/HBV DNA⁺ and with a rate of 0.09%. Among those, 62 samples were tested by quantitative detection of HBV DNA. All of the quantitative results were less than 1 × 10³ IU/ml and 93.5% (58/62) of which were less than 100 IU/ml. The possitive rate of HBsAg⁻/HBV DNA⁺ donors rose with ages. The possitive rate in male donors was higher than that in female and was lower in highly educated ones. Students and public servants had a lower positive rate., Conclusion: The possitive rate of HBsAg⁻/HBV DNA⁺ donors is higher in Xiamen and the distribution of possitive donors has certain epidemiological characteristics. It is necessary to mobilize and recruit more people with a lower rate of HBsAg⁻/HBV DNA⁺ infection.

Objective: To study the effect of total flavanones of Sedum sarmentosum (SSTF) on the apoptosis of rat hepatic stellate cells (HSC-T6) and its mechanism., Method: Different concentrations of SSTF and HSC-T6 cells were co-cultured for different period of time. The MTT assay was used to detect the inhibitory effect of SSTF on the proliferation of HSC-T6 cells. The flow cytometry Annexin-V/PI double staining method was adopted to detect SSTF's effect on HSC-T6 cell apoptosis. Western blotting and Real-time PCR methods were applied to observe the effect on the protein and mRNA expressions of apoptosis-related cytokines Bcl-2, Bax and Caspase-3., Result: SSTF significantly inhibited HSC-T6 cell proliferation and induced cell apoptosis in a dose and time dependent manner. According to Western blotting result, SSTF promoted apoptosis by inhibiting Bcl-2, Bax and promoting the protein expression of Caspase-3; according to a further Real-time PCR study, Bcl-2 mRNA levels can inhibit Bcl-2 and promote Bax and Caspase-3 expressions., Conclusion: SSTF has the effect of promoting the apoptosis of HSC-T6 mainly by inhibiting Bcl-2 and promoting protein and mRNA expressions of Bax and caspase-3.

Providing spiritual care to patients with advanced cancer may improve the quality of life of these patients and help them experience a good death. Cancer patients are eager for additional spiritual care and for a sense of peace at the end of their life. However, spirituality is an abstract concept. The literature on spiritual care focuses primarily on elaborations of spirituality theory. Thus, first-line medical care professionals lack clear guidelines for managing the spiritual needs of terminal cancer patients. The purposes of this article were to: 1) introduce a spiritual care model based on the concept of repair and recovery of relationships that addresses the relationship between the self and God, others, id, and objects and 2) set out a four-step strategy for this model that consists of understanding, empathizing, guiding, and growing. This article provides operational guidelines for the spiritual care of terminal cancer patients.

Background: Signed do-not-resuscitate (DNR) consent is the essential first step for terminal cancer patients to choose palliative care and a quality marker of terminal care. DNR consent completeness helps deliver correct information, ensure consent legal validity, reduce medical disputes, and protect patient and family rights. The DNR consent completeness rate during May and June 2005 was only 33.9% in our hospital. Reasons indicated for this low rate included: (1) lack of a standard operating procedure for DNR consent; (2) multiple DNR consent versions; (3) lack of DNR-related education; and (4) lack of monitoring procedures. Our team developed a project to resolve these problems and improve terminal care quality., Purpose: The goal of this project was to increase the rate of DNR consent completeness from 33.9% to 80%., Resolution: The plan, implemented between August and December 2009, included the following components: (1) establish standard guidelines for DNR consent; (2) simplify and unify DNR consent procedures; (3) provide DNR education for hospital staff; and (4) establish a DNR consent monitoring system., Results: The DNR consent completeness rate rose from 33.9% to 90%. The goal of this project was thus achieved., Conclusion: This project effectively improved the DNR consent completeness rate at our hospital. The project ensured patients a good death and enhanced terminal care quality and patient satisfaction. Our experience may provide a reference to help other hospitals increase DNR their consent completeness rates.

Background & Problems: Tuberculosis (TB), a disease subject to mandatory reporting, is widely distributed in our country. The Direct Observed Treatment, Short-course (DOTS) is an effective protocol to increase TB treatment success., Purpose: We developed a program in our hospital to increase discharged patient participation in DOTS, which helps ensure they receive 6 to 9 months of post-discharge medication therapy to maximize treatment outcomes., Resolution: We identified four key problems related to low TB patient participation in DOTS. These included (1) patients did not understand the DOTS program; (2) staff did not know how to conduct the DOTS protocol; (3) staff had not received in-service DOTS education; and (4) the hospital had no DOTS patient education or teaching aids available. To improve TB patient participation in DOTS, we revised patient education material, provided continuing education to nursing staff, invited physicians and community co-workers to join in the outreach program, and made posters to remind discharged patients to sign up for the DOTS program., Results: Patient participation in DOTS rose from 27.1% to 96.3% and nursing staff knowledge of DOTS rose from 86.3% to 100%., Conclusions: This program effectively increased TB patient motivation to join DOTS after hospital discharge and also improved successful recovery and treatment completion rates. Increasing post-discharge TB patient participation in the DOTS protocol is an effective strategy for achieving the national goal of reducing TB cases by 50% within ten years.

Objective: To explore the in vitro effects of anti-proliferation and apoptosis-inducing with different sequence regimens of zoledronic acid plus paclitaxel in human nasopharyngeal carcinoma cell line HNE1 so as to explore the optimal sequence regimen of these two drugs and related mechanism., Methods: The cytotoxic effects of different sequence schemes of zoledronic acid plus paclitaxel on HNE1 cells were detected by methyl-thiazol-tetrazolium (MTT) assay. Annexin V-FITC/PI double staining flow cytometry (FCM) and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) assay were used to measure the effects of zoledronic acid plus paclitaxel upon apoptosis. The expressions of mRNA of Bcl-2, Bax, Caspase3 and Caspase9 gene were detected by real-time quantitative-polymerase chain reaction (PCR) and protein was detected by Western blot., Results: All experiment groups enhanced the effect of anti-proliferation by MTT assay (P < 0.05); the treatment of zoledronic acid followed by paclitaxel was superior to the other two regimens (P < 0.05). As detected by FCM, the early apoptotic rate of control group was 2.59% ± 0.28% and the experiment groups were 13.89% ± 0.69%, 11.73% ± 0.54%, 23.97% ± 0.68%, 10.45% ± 0.16% and 8.59% ± 0.74% respectively (P < 0.05). TUNEL assay detected the late apoptosis of HNE1 cells and the experiment groups enhanced the effect of apoptosis-inducing (P < 0.05). The treatment of zoledronic acid followed by paclitaxel was superior to the other regimens (P < 0.05). Such an effect was due to the down-regulation of anti-apoptotic protein Bcl-2 and up-regulations of pro-apoptotic proteins Bax, Caspase3 and Caspase9 at the expression levels of mRNA and protein. There was a greater regulation in the group of zoledronic acid followed by paclitaxel., Conclusion: Zoledronic acid can enhance the in vitro effects of anti-proliferation and apoptosis-inducing for paclitaxel on HNE1 cell. The treatment of zoledronic acid followed by paclitaxel may be the optimal regimen. Synergistic induction of apoptosis is via the effects of Bcl-2 family and through the mitochondrial pathway.

Objective: To explore the in vitro anti-tumor effects of zoledronic acid on cell proliferation and invasion in human nasopharyngeal carcinoma cell line HNE1., Methods: The cytotoxic effects of zoledronic acid on HNE1 cells were detected by MTT assay, invasion of HNE1 cells by Transwell assay, secretion of (vascular endothelial growth factor)VEGF by (enzyme-linked immunosorbent assay) ELISA and the activities of MMP (matrix metalloproteinase) 2 and MMP9 by gelatine zymography. And the expressions of mRNA and proteins of MMP2, MMP9 and VEGF were analyzed by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot respectively., Results: After a treatment of zoledronic acid at 2.5, 5, 10, 20 and 40 mol/L for 48 h or 72 h, the highest inhibition rate of proliferation at approximately 50% was observed in the 40 mol/L group after 72 h. The inhibitory effect was not in a dose/time-dependent manner. After a 24-hour treatment of zoledronic acid at different concentrations (0, 10, 20 and 40 mol/L), the numbers of membrane-invading cells were 75.8 ± 2.6, 54.8 ± 5.4, 44.6 ± 6.4 and 38.6 ± 8.2 respectively (all P < 0.01). Gelatinase zymography demonstrated that the activities of MMP2 and MMP9 were inhibited significantly only in cells treated at 0 µmol/L. After a 24-hour exposure to zoledronic acid at 0, 10, 20 and 40 µmol/L, the concentrations of VEGF in supernatant were (5264 ± 89), (4626 ± 30), (4155 ± 40) and (1908 ± 171) g/L respectively (all P < 0.01). The expressions of mRNA and protein of MMP2, MMP9 and VEGF were down-regulated., Conclusion: Zoledronic acid can inhibit the in vitro proliferation and invasion of HNE1 cell through suppressing the secretion of VEGF, the activities of MMP2 and MMP9 and the expressions of VEGF, MMP2 and MMP9.

Objective: To study the anti-angiogenic effect of ginsenoside Rg3 (Rg3 in abbreviation) in human nasopharyngeal carcinoma HNE-1 cells in vitro., Methods: The tube-like structure (TLS) formation of HNE-1 cells, cultured in medium with different concentrations of Rg3, was determined by in vitro anti-angiogenic test based on preliminary experiment observing the TLSs formed by HNE-1 cells on Matrigel and their structural characteristics. The VEGF expression level in HNE-1 cells was determined by immunohistochemistry (IHC) and Western-blot test after 48-hour cultured in medium with different concentrations of Rg3., Results: HNE-1 cells could form TLSs and mosaic vessels when mix-cultured with CRL-2480 on Matrigel. Rg3 could inhibit the TLS formation of HNE-1 cells. After 24-hour culture in medium with Rg3 at concentrations of 0, 50, 100 and 200 µg/ml, the number of TLSs were 75.50 ± 6.86, 55.00 ± 11.92, 39.75 ± 7.93 and 24.50 ± 6.25, respectively, which were negatively correlated with the concentrations of Rg3 (r = -0.928; P < 0.01). After 48 hours of culture, the expressions of VEGF significantly declined by IHC test with results as 0.19 ± 0.03, 0.13 ± 0.02, 0.11 ± 0.01, and 0.08 ± 0.01, respectively, which were negatively correlated with the concentrations of Rg3 (r = -0.911; P < 0.01). The expressions of VEGF also gradually decreased as revealed by Western blot test, with corresponding results as 119.49, 111.51, 86.45, and 38.29. All of the tests showed significantly declined results in the group at the concentration of 200 µg/ml Rg3., Conclusion: Rg3 can inhibit the vasculogenic mimicry of HNE-1 cells, and the possible mechanism might be associated with the down-regulation of VEGF protein expression in HNE-1 cells.

Constipation is a common problem afflicting the elderly. When elderly patients complain of constipation to their healthcare providers, they are typically prescribed laxatives rather than given a clinical examination to explore the specific causes. This approach not only does not resolve the long-term problem of constipation, but may also lead to further complications (e.g., constipation alternating with diarrhea, abdominal distention, poor appetite, and ileus). Effective management of constipation in the elderly should in many cases be tailored to the symptoms and conditions of individual patients rather than simply applying evidence-based treatment. There is a lack of consistency amongst specialists on how best to deal with the problem of constipation. The aim of this article was to explore evidence-based management approaches to constipation in the elderly. A definition of constipation is given and relevant causes are first given. Pharmacological and non-pharmacological treatment approaches are then introduced with regard to effective approaches to conducting physical examinations, assessing patient medical history, and performing laboratory tests. In addition, this article also developed a constipation protocol as a reference tool in the clinical management of constipation in the elderly. The authors hope results can help reduce the problem of constipation in the elderly population.

Objective: To study the secondary metabolites of mangrove endophytic fungus BL321., Methods: The compounds were isolated by chromatographic technique. The structures were identified by comprehensive physico-chemical properties and spectral methods., Results: Five compounds were isolated and identified as 3,4a-dimethyl-2-oxo-2,4,4a,5,6,7-hexahydronaphtho[2,3-b]furan-5-carboxylic acid(1), cytochalasin C(2), cytochalasin D(3), 19,20-epoxycytochalasin C(4), ergosterol(5)., Conclusion: Compound 1 is isolated from nature for the first time. Further more, several kinds of strong bioactive compounds were islolate from this fungus indicate that it may develop to be medical source microorganism.

This study was purposed to explore the effect of bone marrow derived mesenchymal stem cells (MSCs) on the expression of CD69 on cytokine-induced killer (CIK)/natural killer (NK) cells derived from cord blood and on the quantity ratio of CD4+CD25+ T regulatory cells in CIK/NK cell culture system using Transwell non-contact cell culture system. The experiments were divided into two groups: Transwell non-contact culture and mixture culture. The ratio of MSC to CIK/ NK cells was 1:20, 1:50 and 1:100. In mixture culture groups, MSC and CIK/NK cells were co-cultured by together contact as the same ratio of Transwell non-contact culture groups. The expression of CD69 on CIK/NK cells, as well as the quantity ratio of CD4+CD25+ T regulatory cells in CIK/NK cell culture were evaluated by flow cytometry. The results showed that the expression of CD69 on CIK/NK cells in experimental groups were significantly lower than that in control group (p<0.001). As to Transwell groups, CD69 expression on the CIK/NK cells at 1:20 ratio of MSC and CIK/NK was significantly lower than that at 1:50 and 1:100 ratio. There were no differences in the expression of CD69 on CIK cells in mixture groups with various MSC ratios, whereas the expression of CD69 on NK cells at 1:20 ratio was significantly lower than that at 1:50 and 1:100. The quantity ratio of CD4+CD25+ cells in CIK/NK cell culture system of experimental groups with MSC co-culture was significantly higher than that in control. As to Transwell groups, the ratio of CD4+CD25+ cells in CIK/NK cell culture system at 1:20 and 1:50 was significantly higher than that at 1:100. The quantity ratio of CD4+CD25+ cells in CIK/NK cell culture system showed significant differences in various mixture groups. As to 1:20 ratio the amount of CD4+CD25+ cells in CIK/NK cell culture system of mixture groups was significantly higher than that in Transwell groups, while there were no differences of the quantity ratio of CD4+CD25+ cells in CIK/NK cell culture at 1:50 and 1:100. It is concluded that either by non-contact Transwell or mixed co-culture, the MSC can suppress the activation of allogeneic CB-CIK/NK cells, which maybe relate to up-regulating the ratio of CD4+CD25+ T regulatory cells in CIK/NK cell culture system in dose-dependent manner.

Objective: The secondary metabolites of the fungus ZZF13 isolated from the leaves of the mangrove sample Kandelia candel in Zhanjiang and Guignardia sp. 4382 isolated from bark of Kandelia candel (endophyte) of Mai Po, Hong Kong were studied., Methods: The compounds were isolated by siliga gel, and their structures were identified by IR, MS and NMR., Results: Four compounds were isolated from the culture of this strain. Their structures were identified as Bacillpsporin C (1), 5-carboxymellein (2), 5-methylmellein (3) and 1-(2,6-dihydroxyphenyl) butanone (4)., Conclusion: The compounds 2 - 4 are isolated from the Guignardia sp. of Marine fungi for the first time.

Occult hepatitis B virus (HBV) infection status of blood donors in a southern city in China was investigated by immunological assays and nucleic acid testing. Overall, 17 (0.19%, 95% CI: 0.11%-0.30%) of the 9023 HBsAg negative samples were found to be positive for the presence of HBV DNA. "A" epitope sequences were obtained from 14 among them. Mutation(s) in aa124-aa147 existed in 6 (42.9%, 6/14) samples and 4 (66.7%, 4/6)were G145R mutation. Ratio of genotype C in occult donors (10/17) was statistically higher than HBs-positive donors (0/15, P<0.01), which implied that HBV genotype C leaded to occult infection more easily.

Taiwan's high population density frequently blurs the administrative boundaries between communities, leading to indistinct community identifications among the population. The authors used the Helvie energy theory to assess different communities in Taiwan, employing a core (population), four internal energies (chemical, physical, biological, and psychiatric) and nine environment subsystems (transportation, health, education, entertainment, economy, politics, communication, culture, and welfare) in an analysis of urban and rural community samples. Authors found significantly different influences on community health due to different environments and energy exchange factors between the two samples. Urban and rural communities have advantages and requirements that are distinct from one another. The community health nurse (CHN) should consider the specific demands of each community and develop professional roles to incorporate the three degrees of prevention. Authors hope that this article can inspire CHNs to define the critical health problems in their communities, facilitate the development of advanced professional roles, and serve as reference in implementing health plans.

The metabolites of a marine mangrove fungus (Penicillium sp. No. 2556) were studied in this paper and six compounds were isolated from the fermentation liquid. Their structures were elucidated by spectroscopy methods as Sch54796 (1), Sch54794 (2), 4-hydroxybenzoic acid (3), urail (4), succinic acid (5), Vermopyrone (6). Among them, compounds 1, 2 and 6 were firstly isolated from Penicillium sp., Coumpounds 1 and 2 remarkably inhibited the growth of cancer cell lines hep2 and hepG2.

Objective: To study the cytotoxicity of the secondary metabolites of Marine Mangrove Fungus Paecilomyces sp. Tree 1-7 on human hepatoma cell line HepG2 cultured in vitro., Methods: Three groups were divided: compounds group, 5-Fu group and control group. The cytotoxicity was measured by MTT method when HepG2 cells were treated by different concentration of the secondary metabolites of Paecilomyces sp. Tree 1-7., Results: Secalonic acid A, tenellic acid A and alternin inhibited the growth of human hepatoma cell line HepG2, the IC50 separately were 2.0, 62.1 and 7.0 microg/ml., Conclusion: Secalonic acid A and alternin have strong cytotoxicity on HepG2 cultured in vitro.

Objective: To establish human bronchial epithelial cell lines over expressing oncogene and to investigate its application in detection of carcinogen-induced cell transformation., Methods: Mediated by retrovirus infection, human telomerase catalytic subunit, hTERT was introduced into immortal human bronchial epithelial cells (16HBE) and followed by introduction of the oncogenic allele H-Ras(V12), or c-Myc or empty vector, creating cell lines 16HBETR, 16HBETM and 16HBETV, respectively. Biological characteristics of these cell lines including morphology, proliferation, and chromosomal aberration were examined to access whether they were transformed. Soft agar experiment and nude mice subcutaneous injection were performed using pre-transformed 16HBE cells induced by known carcinogens, nickel sulfate (NiSO4) and 7, 8, -dihydrodiol-9, 10-epoxide benzo[a] pyrene (BPDE)., Results: With detection of telomerase activity and Western blotting, the expression of target proteins was verified. Thus, the transgenic 16HBE cell lines were successfully established. Cells expressing oncogene H-Ras or c-Myc grew 30.3% or 10.4% faster than control cells. However, these cells failed to form colonies in soft agar or form tumor in nude mice. 16HBETR, 16HBETM cells obtained transformed phenotype at 5 wks, 11 wks, respectively after treatment with BPDE, which are 15 wks and 9 wks earlier than control cells 16HBETV (20 wks). Meanwhile, 16HBETR, 16HBETM cells obtained transformed phenotype at 11 wks, 14 wks, respectively after treatment with nickel sulfate, which are 21 wks and 18 wks earlier than control cells (32 wks)., Conclusion: With the advantage of shorter latency, transgenic human cell transformation models could be used in potent carcinogen screening and applied to chemical-carcinogenesis mechanism study.

The metabolites of a marine streptomyces sp. actinomycete (No. 195-02) were studied and eight compounds were isolated from the fermentation liquid, structures were elucidated by spectroscopy methods as p-hydroxy-benzonitrile (1), 2-methyl-furan-3-carboxylic acid(2), furan-2-carboxylic acid (3), cyclo(Phe-Phe) (4), cyclo(Leu-Ileu) (5), nicotinic acid (6), 2-(1H-indol-3-yl) acetic acid (7) and bis(2-ethylhexyl) phthalate (8). The compounds 1, 3 and 8 were firstly isolated from Streptomyces sp., compounds 4 -7 were firstly found from marine actinomycetes. Coumpouds 4 and 5 evidently inhibited the growth of cancer cell lines hepG2 and hep2 at the concentration of 50 microg/ml.

Objective: Suavissimoside R1 was isolated and identified as an active ingredient from Roots of Rubus parvifollus L, which exhibited protective effect on dopaminergic neurons against MPP+ toxicity., Methods: The protective effects of crude extracts were investigated after mice were treated with 1-methyl4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). According to the protective effects of crude extracts, suavissimoside R1, one kind of triterpenoid saponin, was separated. It was investigated that whether Suavissimoside R1 can protect DA neurons from toxicity induced by MPP+ in rat mesencephalic cultures., Results: Suavissimoside R1 was isolated from Roots of Rubus parvifollus L. Moreover, Suavissimoside R1, in dose of 100 micromol/L, alleviated the death of DA neurons induced by MPP+ obviously., Conclusion: These results suggest that suavissimoside R1 possesses potent neuroprotective activity and can be developed to be a potential anti-Parkinson's disease drug worthy for further study.