Mammalian Yes-associated protein (YAP) is involved in the regulation of various biological behaviors. Osteoporosis (OP) is a common orthopedic disease. However, the role of YAP in the differentiation and osteoporosis of Bone marrow mesenchymal stem cells (BMSCs) is unclear. Ovariectomy (OVX)-induced OP rat model was constructed and YAP plasmid was transfected to detect bone density and alkaline phosphatase (ALP) activity. Rat BMSCs were assigned into 3 groups: sham group, OP group, and YAP group, in which YAP plasmid was transfected followed by analysis of YAP expression by real-time PCR. After 14 days of induction culture, type I collagen, Osterix and FABP4 mRNA expression was detected by real-time PCR along with Wnt5 protein expression by western blot and TGF- β secretion by ELISA. In OP rats, YAP expression was significantly down-regulated and the bone density and ALP activity decreased ( P <0.05). YAP transfection in OP rats reversed the changes in OP rats. In OP group, YAP expression was decreased, and type I collagen and Osterix expression decreased, FABP4 expression increased, β -catenin expression and TGF- β secretion decreased ( P <0.05). Transfection of YAP plasmid in BMSCs of OP group significantly reversed the above changes ( P <0.05). In conclusion, YAP level decreases in OP and up-regulating its expression in BMSCs can promote osteogenic differentiation and inhibit adipogenic differentiation by regulating Tnt5/TGF- β signaling.

Background: With the outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the effectiveness of providing mask protection is important for people. This article introduces a customized mask retainer to improve the fit performance of face masks. Methods: The participant’s 3D face scans with and without a surgical mask were taken by using a 3D face scanner. The fitter was designed on the 3D face scan data according to the facial anthropometric landmarks, and examined and adjusted on the face scan data with a mask. The fitter was 3D printed using a metal printer for Titanium. The effectiveness of the fitter on augmentation of fit of surgical mask was test according to the Chinese Standard. Tests were repeated three times per participant, and compare differences between groups by Wilcoxon Matched-Pairs Signed-Ranks Test using software (a=.05). Results: The effectiveness test of the retainer on augmentation of fit performance showed a result more than 25-fold increase of overall Fit Factor, which have met the fit requirement for KN95 respirators in China. Conclusions: Fit Factor results indicated that by using the retainer, the Fit Factors of overall and each exercise have significantly increased as compared to that of face mask alone group. It may provide a solution to the shortage of N95 respirators the world is now encountering as fighting against the COVID-19 epidemic.

目的 系统评价并整合护士进行居家远程护理服务体验的质性研究.方法 计算机检索The cocharane library、Embase、CINAHL、Scopus、Web of Science、Pubmed、中国知网、万方、维普数据库,检索时限为2010年 1 月1日-2020年7月31日.依据澳大利亚JBI循证卫生保健中心对质性研究的评价工具与整合方法对纳入的文献进行整合、分析.结果 共纳入9篇文献,提炼出53个结果,18个类别,4个整合结果.整合结果1:提高护理质量与护士形象,减轻患者负担,促进精准护理;整合结果2:居家远程护理服务的阻碍因素;整合结果3:居家远程护理服务的促进因素;整合结果4:对居家远程护理的担忧与需求.结论 居家远程护理服务的开展,促进护士职业成就感的提升,有利于减少医疗服务差距、减轻患者医疗负担.同时,需给予护士足够的资源与技术支撑,强化护士专业知识、沟通与数字化能力的培训,建立专业化、系统化居家远程护理服务体系.

综述腹膜透析延缓Ⅳ型心肾综合征患者疾病进展、Ⅳ型心肾综合征腹膜透析患者容量管理、基于"互联网+护理服务"的腹膜透析患者医院-家庭过渡期容量管理研究现状,认为需进一步探讨Ⅳ型心肾综合征腹膜透析患者容量管理策略,以延缓患者病情进展,提高患者生存质量.

Tissue damage repairing and regeneration is a research hot topic. Tissue engineering arises at the historic moment which is a defect repair compound composed of seed cells, tissue engineering scaffolds, and inducing factors. Stem cells have a limited growth period in vitro culture, and they have a pattern of replicating ageing, and these disadvantages are limiting the applications of stem cells in basic research and clinical treatment. The enhancement of stem cell differentiation ability is a difficult problem to overcome, and it is possible to enhance the differentiation ability of stem cells through histone modification so as to provide a more robust foundation for damage repairing and regeneration. Studies have shown that Histone Deacetylases (HDAC) inhibitors can improve mesenchymal stem cells in vitro induced in different directions, conversion efficiency, increasing the feasibility and safety of stem cell therapy and tissue engineering, to offer reference to promote the stem cell therapy in clinical application. Therefore, this paper mainly focusing on the usage and achievements of the deacetylase inhibitors in stem cell differentiation studies and their use and prospects in repair of bone tissue defects.

目的 总结Ⅳ型心肾综合征腹膜透析患者容量管理的相关证据,为构建Ⅳ型心肾综合征腹膜透析患者的容量管理方案提供一定的参考和依据.方法 依据循证护理方法,针对罹患Ⅳ型心肾综合征且行腹膜透析治疗患者提出循证问题,遵照"6S"证据模型系统检索相关文献,采用澳大利亚JBI循证卫生保健中心标准进行证据分级与推荐.结果 共纳入12篇文献,其中指南5篇,系统评价1篇,随机对照试验3篇,类试验性研究3篇,结合专业人员的判断,从容量管理的综合评估、干预目标及干预策略3个维度总结了33条最佳证据.结论 腹膜透析管理者应加强对Ⅳ型心肾综合征腹膜透析患者容量的规范化管理,提高临床医务人员对容量超负荷的早期识别能力,尽可能降低其心血管不良事件的发生,从而延缓其病情进展,提高其生存质量.

目的 制订肝癌术后早期下床活动方案,探讨实施效果.方法 按照入院时间将93例肝癌行肝切除术患者分为对照组45例和观察组48例.对照组实施术后常规活动护理;观察组实施早期下床活动循证实践方案,通过检索数据库获取最佳证据及整合证据,制定肝癌术后早期下床活动实践方案及流程.结果 观察组术后24 h内下床活动率、首次下床时间及术后活动量指标显著优于对照组,术后排气排便时间、胃管留置时间显著短于对照组,术后24h疼痛评分、疼痛控制满意度显著优于对照组(P＜0.05,P＜0.01);两组早期活动不良事件发生率比较,差异无统计学意义(P＞0.05).结论 肝癌术后早期下床活动最佳实践方案的实施,可加快肝癌患者术后康复,促进患者安全(并不增加患者安全事件).

Abstract Objective:To evaluate the effect of multimodal preemptive analgesia on rehabilitation exercise in patients undergoing total knee arthroplasty(TKA).Methods:Randomized controlled trials(RCTs) on the effects of multimodal preemptive analgesia on postoperative rehabilitation of TKA patients in China and aboard were retrieved from the China National Knowledge Infrastructure,Wanfang Database,and VIP Citation Database,PubMed,EMBASE,and Medline English databases.RevMan 5.3 software was used to perform the metaanalysis.Results:Eight articles that met the criteria were included.Metaanalysis showed that the VAS score of pain in the experimental group was lower than that in the control group within 72 h after surgery［SMD=-2.31,95% CI(-3.14,-1.49),P<0.01］.The knee joint activity of patients in the experimental group was better than that in the control group at 3 and 6 months after operation［WMD=11.22,95% CI(10.75,11.69),P<0.01;WMD=15.60,95% CI(12.51,18.68),P<0.01］,the HSS score of knee joint function in the experimental group was significantly improved at 6 months after operation compared with that in control group［WMD=15.62,95% CI(13.63,17.61),P<0.01］.Conclusions:Multimodal preemptive analgesia could reduce postoperative pain in patients with TKA,improve rehabilitation exercise compliance,and improve knee function recovery effect after operation.

对医疗团队资源管理模式的相关概念、主要内容及其在国内外的应用现状进行综述,以期为后续开展相关研究提供参考,总结出医疗团队资源管理模式作为改善团队表现和提升患者安全的有效工具,应引起广泛重视,并可借鉴现有的团队培训模式及管理经验,医院各级人员共同努力,推动医疗资源管理模式的运行,以满足患者的治疗需求.

Objective To understand the real experience of the head nurses in the management process of standardized training nurses and to provide a reference for perfecting the standardized training project and improving the training quality. Methods Semi-structured interviews were conducted among eleven head nurses and data were analyzed by Colaizzi method. Results Three themes were extracted as follows: positive management methods; difficulties and challenges; need of support from superior nursing managers. Conclusion Understanding the experiences and feelings of head nurses in the management process of standardized training nurses can help sum up experience and find out the defect,then pay attention to seek effective solution and enhance training result. Key words: Standardized training; In-service training; Nursing management; Human resource management; Qualitative research

对机械通气患者非语言沟通现状、影响护患非语言沟通的因素、护患非语言沟通不良所导致的影响、促进护患非语言沟通的方法等方面进行综述.阐述影响护患非语言沟通的因素包括环境因素、患者因素、护士因素,护患非语言沟通不良对患者、家属以及护士的不良影响,促进护患非语言沟通的方法有完善评估与培训、扩大替代沟通系统的运用等.

目的 分析近10年我国注册护士核心能力研究现状,梳理研究热点,为进一步开展注册护士核心能力研究提供参考.方法 在中国知网、万方、中国生物医学文献数据库中对10种护理期刊上注册护士核心能力相关研究进行检索,采用文献计量学的方法,对纳入文献进行整理分析.结果 一共纳入295篇文献,来自全国29个地域,发文量最多的地区是广东省,发文最多的机构是四川大学华西医院;文献合作度为3.83,合作率是94.24％,基金论文比是42.03％;研究热点涉及注册护士核心能力现状调查及相关性分析、有效培养/提高护士核心能力的方法及实践、明确护士核心能力特征要素/构建护士核心能力评价体系、基于核心能力设置课程/培训方案及其应用、核心能力测评量表的研制与修订等.结论 近10年,我国注册护士核心能力相关研究总体来说处于波动上升趋势;跨机构、跨地区合作水平有待加强;还需进一步规范研究设计,提高研究成果临床使用价值.

目的 分析及整合孕产妇及其伴侣经历严重产科并发症的体验.方法 计算机检索数据库并纳入国内外关于孕产妇及其伴侣经历严重产科并发症的情感体验和照顾体验的质性研究,使用Meta整合方式整理分析.结果 共纳入13篇文献并综合成3个结果:严重产科并发症给产妇及伴侣的生理、心理、社会方面造成消极影响,并持续多年;结合外界支持与自我调适实现角色成长,并感恩获得帮助;医疗服务问题及照护需求.结论 严重产科并发症对于孕产妇及其家庭造成不良影响,医护人员应关注危重孕产妇及其伴侣心理健康,满足其围生期心理保健需求,提高产科危重症护理质量.

目的 循证构建全膝关节置换术患者肌力康复护理的证据,为骨科健康教育提供实证依据.方法 计算机检索Cochrane图书馆、JBI循证卫生保健国际合作中心图书馆、美国指南网(NGC)、加拿大安大略注册护士协会(RNAO)、PubMed、EMBASE、Med-line、中国知网、万方数据库自建库到2018年6月发表的关于膝关节置换术后患者肌力锻炼有关的系统评价、临床实践指南、证据总结,并进行筛选和评价.结果 共纳入10篇文献,汇集15个条目,内容包括术前评估、早期干预、后期随访3个时期的干预策略.结论 本研究综合了系统的膝关节置换术肌力锻炼证据,可供临床康复实践借鉴或应用.

ObjectiveTo systematically evaluate the life experiences of patients with bone tumors and their families after neoadjuvant chemotherapy.MethodsThe qualitative researches on the life experiences of bone tumors patients and their family members were retrieved from these databases,including The Cochrane Library,PubMed,EMBASE,MedLine,CNKI,Wan Fang,and VIP database.Meta integration was conducted on the basis of qualitative assessment of quality research (2015) in JBI evidence-based health care center.ResultsA total of 9 articles were included,and 19 key points were summed up into 7 categories,then were integrated into 2 results.The first result was that malignant bone tumors patients and their families experienced severe trauma and stress during the diagnosis and neoadjuvant chemotherapy, which changed their ways of life and self-cognition. The second result was that patients and caregivers hoped to obtain corresponding health education and social support through various channels to improve their qualities of life.ConclusionsPatients with bone tumors and their family members were under the multiple pressures of treatment and economy during neoadjuvant chemotherapy.It is suggested that the medical workers,the society and the government should pay attention to their actual needs,provide predictive health education and long-term home follow-up care,and complete the social security system.

目的:系统评价神经肌肉电刺激对ICU患者肌力及临床结局的干预效果.方法:计算机检索Cochrane Library、Web of Science、PubMed、中国知网、维普以及万方数据库中从建库至2018年12月公开发表的关于神经肌肉电刺激在ICU患者中应用效果的随机对照试验,由两名研究人员独立对文献筛选、数据提取和文献质量进行评价.采用Revman5.3软件对符合质量标准的文献中的结局指标进行Meta分析.结果:共纳入14篇文献.6篇文献报告了患者的MRC总评分,Meta分析结果显示:观察组MRC总评分高于对照组[MD=4.14,95 ％CI(2.69,5.58),P＜0.01];6篇文献报道了患者住ICU期间的机械通气时间,Meta分析结果显示:观察组机械通气时间较对照组明显缩短[MD=-2.19,95％(-4.09,-0.30),P=0.02];5篇文献报道了患者的住ICU时间,Meta分析结果显示:观察组住ICU时间较对照组明显缩短[MD=-1.80,95％CI(-3.33,-0.27),P=0.02].结论:神经肌肉电刺激在ICU患者中应用是安全有效的,可提高MRC评分,缩短机械通气时间和住ICU时间,但仍需要多中心、大样本随机对照试验进一步证明.

Objective To understand the real experience of the head nurses in the management process of standardized training nurses and to provide a reference for perfecting the standardized training project and improving the training quality. Methods Semi-structured interviews were conducted among eleven head nurses and data were analyzed by Colaizzi method. Results Three themes were extracted as follows: positive management methods; difficulties and challenges; need of support from superior nursing managers. Conclusion Understanding the experiences and feelings of head nurses in the management process of standardized training nurses can help sum up experience and find out the defect,then pay attention to seek effective solution and enhance training result.

Objective To systematically evaluate the effects of the implementation of the cognitive behavior intervention program on the rehabilitation of patients with degenerative lumbar spine surgery. Methods 6 Chinese-English databases, The Cochrane library, PubMed, EMBASE, Medline, CNKI, Wanfang, were used for the randomized controlled trial of cognitive behavioral intervention in patients undergoing degenerative lumbar surgery. Two researchers independently retrieved and extracted data and conducted meta-analysis using RevMan5.3 software. Results The meta analysis results of 7 literatures showed that the Oswestry dysfunction index questionnaire [ MD=-9.55, 95% CI(-11.09,-8.02)] in the experimental group, pain VAS score [MD=-1.06, 95% CI(-1.70,-0.41)], fear of sport belief (TSK) [ MD=-0.84, 95% CI (-1.41,-0.28)] were significantly superior to the control group (Z=12.21, 3.23, 2.93, P<0.01). The difference was statistically significant. Conclusion Perioperative cognitive behavior intervention can alleviate preoperative anxiety, effectively improve postoperative self-pain management level and the enthusiasm to participate in rehabilitation exercise, reduce the degree of functional disability, and improve the long-term quality of life after surgery.

ObjectiveTo investigate the status quo of post⁃traumatic stress disorder in high⁃risk pregnant women，and to probe into the correlations and acting paths among disease uncertainty，coping style and post⁃traumatic stress disorder，so as to establish a relationship model of the three.MethodsA total of 306 high⁃risk pregnant women waiting for delivery in a Tertiary Grade A hospital in Nanjing were investigated by using the general data questionnaire，PTSD Checklist⁃Civilian version（PCL⁃C），Mishel's Uncertainty in Illness Scale（MUIS）and Coping Style Questionnaire（CSQ）.ResultsThe positive incidence of post⁃traumatic stress disorder in high⁃risk pregnant women was 16.3%.High⁃risk pregnant women with lower education level，non⁃one⁃child female，unfixed work，the history of illness or trauma，twin pregnancy and poor sleep quality，scored higher than others （P<0.05）.Uncertainty in illness could directly affect the level of post⁃traumatic stress disorder or indirectly work through different coping styles.The coping style played a full or partial mediator between the disease uncertainty and the symptoms of post⁃traumatic stress disorder.ConclusionsIt is suggested to strengthen the understanding and support of the psychological needs of high⁃risk pregnant women.It is recommended to provide centralized management of high⁃risk pregnant people by mean of obstetric nursing clinics，and to provide sufficient and practical guidance information related to diseases in order to reduce the uncertainty of disease.Thus，to help regulate adverse emotional reactions during pregnancy.Medical staff could relieve pregnant women stress symptoms by strengthening their positive coping styles.

目的 探讨不同职称的护士的职业认同与工作投入水平及两者关系.方法 采用护士职业认同评定量表和Utrecht工作投入量表中文版对南京地区2所医院的426名护士实施问卷调查,采用Pearson相关分析和多元逐步回归探讨不同职称护士职业认同与工作投入的关系.结果 护士的职业认同和工作投入水平均处于中等水平;不同职称护士的职业认同水平与工作投入水平均呈正相关.结论 针对不同职称的护士实施岗位管理,合理引用激励理论,提升护士职业认同和工作投入水平,能为护理对象提供更高效、优质的护理服务.