Professional identity in nursing: A mixed method research study

Professional identity is developed through a self-understanding as a nurse along with experience in clinical practice and understanding of their role. Personal and professional factors can influence its development. A recent integrative literature review synthesised factors that influenced registered nurse’s perceptions of their professional identity into three categories of the self, the role and the context of nursing practice. This review recommended that further research was needed into professional identity and how factors and perceptions changed over time. The aims of this study were to explore registered nurses’ understanding of professional identity and establish if it changed over time. A mixed-methods study using a two-stage design with an on-line survey and focus groups was implemented with registered nurses who were studying nursing at a postgraduate level in Australia or Scotland. The reported influences on professional identity related to the nurse, the nursing role, patient care, the environment, the health care team and the perceptions of nursing. Professional development and time working in the profession were drivers of changes in thinking about nursing, their role and working context and their professional identity. Additionally, participants sought validation of their professional identity from others external to the profession.     

Pretreatment with intestinal trefoil factor alleviates stress-induced gastric mucosal damage via Akt signaling

BACKGROUNDStress-related gastric mucosal damage or ulcer remains an unsolved issue for critically ill patients. Stress ulcer prophylaxis has been part of routine intensive care, but uncertainty and controversy still exist. Co-secreted with mucins, intestinal trefoil factor (ITF) is reported to promote restitution and regeneration of intestinal mucosal epithelium, although the mechanism remains unknown.AIMTo elucidate the protective effects of ITF on gastric mucosa and explore the possible mechanisms.METHODSWe used a rat model of gastric mucosal damage induced by water immersion restraint stress and lipopolysaccharide-treated human gastric epithelial cell line to investigate the potential effects of ITF on damaged gastric mucosa both in vivo and in vitro.RESULTSITF promoted the proliferation and migration and inhibited necrosis of gastric mucosal epithelia in vitro. It also preserved the integrity of gastric mucosa by upregulating expressions of occludin and zonula occludens-1. In the rat model, pretreatment with ITF ameliorated the gastric mucosal epithelial damage and facilitated mucosal repair. The protective effects of ITF were confirmed to be exerted via activation of Akt signaling, and the specific inhibitor of Akt signaling {"type":"entrez-nucleotide","attrs":{"text":"LY249002","term_id":"1257710161","term_text":"LY249002"}}LY249002 reversed the protective effects.CONCLUSIONITF might be a promising candidate for prevention and treatment of stress-induced gastric mucosal damage, and further studies should be undertaken to verify its clinical feasibility.     

Monocyte Programmed Death Ligand-1, A Predicator for 28-Day Mortality in Septic Patients

Background

Sepsis is a great health burden for millions of people worldwide and plays a critical role in the cause of death in intensive care units. Previous studies have revealed that programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) play critical roles in the immunosuppression phase induced by sepsis. The objective of this present study was to establish whether PD-1/PD-L1 expressions were associated with 28-day mortality of septic patients.

V-shaped relationship between HbA1c and all-cause mortality in the elderly with type 2 diabetes

PurposeThe optimal glycemic target for elderly patients with diabetes has not been established. The purpose of this study was to elucidate relationship between HbA1c and mortality in elderly patients with diabetes.SubjectsThree hundred consecutive elderly (≥ 65 yrs) patients with type 2 diabetes mellitus admitted for control of hyperglycemia between 2002 and 2010 were registered. Upon mortality survey at the end of 2012, 201 (70%) of them were traceable (men/women 121/80, mean age 71 yrs, duration of diabetes 11 yrs and HbA1c 9.9%). The analysis took account of the following baseline information: gender, age, duration of diabetes, HbA1c, body mass index, systolic blood pressure, eGFR, urinary albumin excretion, serum lipid levels and use of insulin and oral hypoglycemic agents. The follow-up HbA1c was also recorded.ResultsThe mean follow-up period was 5.7 yrs and 45 of the patients have died. The mortality hazard as a function of the baseline HbA1c quartile was significantly V-shaped with the nadir in quartile 2 (HbA1c 8.5–9.4%) (P = 0.02), and this relationship remained significant after adjustment for the confounders such as estimated glomerular filtration rate and insulin use. The follow-up HbA1c was 7.7 ± 1.6% and not significantly related to mortality.Discussion/ConclusionThere was a V-shaped relationship between baseline HbA1c and all-cause mortality in elderly patients with insufficiently controlled glycemia. The nadir was in Q2 in which the HbA1c value was 8.5–9.4%. No significant relationship was found between the follow-up HbA1c and mortality. Further studies are needed to clarify the relationship between HbA1c and mortality in the elderly.     

早期结直肠癌患者疾病获益感现状及其影响因素分析

背景　在生理-心理-社会医学模式下,心理因素在癌症康复中的作用受到了医生、患者的广泛关注。作为积极心理学重要领域之一,疾病获益感（BF）在癌症类型上多以乳腺癌及多癌种混合研究为主,而结直肠癌相关研究较少。目的　评估我国早期结直肠癌患者BF现状并分析其影响因素。方法　本研究为横断面研究。采取便利抽样方法,选取2014年3月-2016年6月在江阴市人民医院和南通市肿瘤医院进行住院治疗的326例早期结直肠癌患者参与问卷调查。调查方法为问卷调查,问卷内容包括：一般资料调查问卷、中文版疾病获益感量表（评估BF情况）、与医生沟通和交流问卷（评估与医生沟通和交流情况）、医院焦虑抑郁量表（评估焦虑和抑郁情绪）、生活定向测验修订版（评估乐观程度）和医学应对方式问卷（评定对疾病的应对特点,包括面对、回避和屈服）。应用多因素Logistic回归分析探讨BF的影响因素。结果　根据中文版疾病获益感量表评分将早期结直肠癌患者分为BF低水平组31例（9.5%,评分<66分）,中/高水平组295例（90.5%,评分≥66分）。BF低水平组接受手术+化疗治疗方案比例及与医生沟通和交流问卷评分、乐观程度、医学应对方式中面对得分低于BF中/高水平组,BF低水平组发生并发症比例及医院焦虑抑郁量表评分、医学应对方式中屈服得分高于BF中/高水平组,两组运动锻炼频次比较,差异均有统计学意义（P<0.05）。Logistic回归分析结果表明,接受手术+化疗治疗方案〔OR=3.294,95%CI（1.239,8.759）〕、无并发症〔OR=5.867,95%CI（1.868,19.041）〕、乐观〔OR=1.569,95%CI（1.169,2.106）〕、医疗应对方式-面对〔OR=1.477,95%CI（1.267,1.721）〕是早期结直肠癌患者BF水平的影响因素（P<0.05）。结论　南通市和江阴市地区早期结直肠癌患者BF处于中/高水平。医疗应对方式中面对、乐观、接受手术+化疗治疗方案、无并发症是早期结直肠癌患者BF的重要影响因素,临床医护工作者可结合相关因素跨学科、多平台的制定及实施干预方案,切实提高早期结直肠癌患者BF水平。     

隐丹参酮上调GRP78抑制谷氨酸诱导的PC12细胞凋亡

目的：探讨隐丹参酮(Cryptotanshinone, CTS)对谷氨酸(glutamate, Glu)诱导的神经元凋亡的影响及潜在的作用机制。方法：取生长状态良好的PC12细胞,用1 μmol/L Glu处理,Western Blot检测细胞中凋亡相关蛋白Bax、Bcl2的表达水平;以CTS(5 μmol/L或10 μmol/L)预处理PC12细胞12 h后,再用Glu刺激12 h,采用TUNEL染色分析CTS对Glu诱导PC12细胞凋亡的影响;Western Blot检测CTS预处理前后Glu刺激的PC12细胞中糖蛋白调节78(78 ku glucose-regulated protein, GRP78)的蛋白表达水平,并通过sh-RNA干扰细胞内GRP78表达,观察细胞活力的变化。结果：Glu可诱导PC12细胞凋亡,抑制胞内GRP78的表达;经CTS预处理后Glu诱导的神经元凋亡现象得到缓解,GRP78表达增加;干扰PC12细胞内GRP78表达后,可逆转CTS的抗凋亡作用。结论：CTS可通过上调GRP78的表达从而保护PC12细胞抵抗Glu诱导的细胞凋亡。     

Clear Cell Tumor of the Lung: A Retrospective Analysis

BackgroundThere have been no clinical reports on clear cell tumor of the lung (CCTL) based on large studies or epidemiological surveys in the literature. The purpose of this study was to provide a retrospective analysis of CCTL patients in China by reviewing the clinical data of reported CCTL cases.MethodsThe China academic journals full-text database search engines were used to collect the related cases from January 1979 to June 2011. The analysis was performed on patients' age, gender, symptom, nodular number, tumor size, lesion localization, chest radiograph or chest computed tomography.ResultsThirtynine cases of CCTL were reported in China. The ratio of male:female was 1.29:1. The average age at diagnosis was 43 ± 17 years. Most of them were accidentally discovered on routine chest roentgenogram or computed tomography. The ratio of asymptomatic:symptomatic was 2.25:1 (27:12). Cough, fever, sputum, dyspnea and chest pain occurred frequently in symptomatic patients. Solitary pulmonary nodule on chest radiography was found in 38 patients, and no specific lobar distribution had been noted. The average tumor size was 3.6 ± 2.4 cm in diameter. All patients were diagnosed after thoracotomy, and the postoperative courses were all uneventful.ConclusionsCCTL is a rare benign tumor with special features of clinical characteristics, radiology and pathology. The diagnosis is based on distinct pathological characteristics. Earlier operation with long-term follow-up is recommended.     

Dynamic expression of hepatic GP73 mRNA and protein and circulating GP73 during hepatocytes malignant transformation

BackgroundHepatic Golgi protein-73 (GP73) expression is related to hepatocellular carcinoma (HCC) progression. The aim of this study was to investigate the dynamic expression of GP73 mRNA and protein during hepatocytes malignant transformation.MethodsHuman GP73 expressions in 88 HCC tissues and their self-control surrounding tissues were examined by immunohistochemistry, and survival time of HCC patients was evaluated by the Kaplan-Meier method. HCC model of Sprague-Dawley rats was made by diet containing 2-fluorenylacetamide. The rats were divided into the control, hepatocyte degeneration, precanceration, and HCC groups to observe GP73 protein and mRNA alterations during hepatocytes malignant transformation.ResultsThe GP73 expression was significantly higher in the cancerous tissues than that in the surrounding tissues, with shorter survival time, and the positive rates of GP73 protein in human HCC tissues were 53.3% at stage I, 84.0% at stage II, 84.6% at stage III, and 60.0% at stage IV, respectively. The positive rates of hepatic GP73 protein and mRNA in the rat models were none in the control group, 66.7% and 44.4% in the hepatocytes degeneration group, 88.9% and 77.8% in the hepatocytes precanceration group, and 100% in the HCC group, respectively. There was a positive correlation (r = 0.91, P<0.01) between hepatic GP73 and serum GP73 during rat hepatocytes malignant transformation.ConclusionsAbnormal GP73 expression may be a sensitive and valuable biomarker in hepatocarcinogensis.