Objective To assess the cost-benefit of exchange transfusion(ET ) in the treatment of different severity of acute bili-rubin encephalopathy(ABE) .Methods Retrospective analysis was carried out on the clinical data of 137 ABE from January 2009 to December 2010 .The enrolled neonates were divided into four groups by ABE severity and interventions :40 neonates in Group SE (Subtle ABE with ET ) ,29 in Group SNE (Subtle ABE without ET ) ,49 in Group ME (Moderate to advanced ABE with ET ) ,and 19 in Group MNE (Moderate to advanced ABE without ET ) .Results The Total Serum Bilirubin (TSB) levels ,the ratio of TSB and plasma albumin (B/A) ,the proportion of neonatal hemolysis disease and the hospitalization costs per capita in Group SE were significantly higher than those in Group SNE (P<0 .05) .Without death in subtle ABE ,the rate of poor outcomes in Group SE , 15 .0% was similar to that of Group SNE ,13 .8% .The maximum benefit-cost ratio of Group SE and Group SNE was 87 .5 and 121 .5 ,respectively .The TSB levels ,B/A ,the proportion of neonatal hemolysis disease and the hospitalization costs per capita in Group ME significantly higher those in Group MNE (P<0 .05) .5 neonates died in moderate to advanced ABE ,and the incidence of poor outcomes in Group ME ,32 .7% was 2 .1 times to that of Group MNE ,15 .8% .The maximum benefit-cost ratio of Group ME and Group MNE was 89 .8 and 160 .0 ,respectively .The TSB levels and B/A in Group ME significantly higher those in Group SE (P<0 .05) ,the incidence of poor outcomes in Group ME was 2 .2 times to that of Group SE ,whereas the hospitalization costs per capita in Group ME were similar to those in Group SE (P>0 .05) .Morbidity of the severe adverse events associated with ET in Group ME ,12 .2% was 2 .4 times to that of Group SE ,5 .0% .Conclusion ET is worth of the first-line approach rescuing subtle ABE .However ,ET is needed to be weighted the advantages and disadvantages before performed on moderate or advanced ABE .It is necessary to implement phototherapy among neonates with pathologic jaundice ,which is crucial for diminishing mortality and mor-bidity of ABE and lowering medical resource consumption .

Objective To explore the mechanisms of cyclosporin induced chronic nephrotoxicity. Methods Radioimmunoassay was used to study the changes of plasma renin activity (PRA), plasma angiotensin Ⅱ (AngⅡ), and Aldosterone after rats were given low salt diet and 30 mg?kg -1 ?d -1 of CsA for 28 days. The protective effects of Radix Salviae Miltiorrhizae or benazepril on these changes were also studied. Results In CsA treated rats, PRA and AngⅡlevels were significantly elevated as compared with control groups. The elevation was not influenced by injection of Radix Salviae Miltiorrhizae, but could be blocked markedly by benazepril. There was significant difference in Aldosterone levels among the groups except benazepril treated group showing a decreased Aldosterone level.Conclusion Chronic cyclosporone nephropathy may be related to activation of renin angiotensin system, especially to the elevation of AngⅡlevels. The different effects of Radix Salviae Miltiorrhizae or benazepril on RAS suggest the different preventive mechanisms of the two drugs to chronic cyclosporine nephropathy. The plasma Aldosterone levels were not elevated in CsA treated rats, suggesting that CsA may induce relative adrenal resistance to AngⅡ.

Objective To investigate the short-term efficacy of pelvic floor electrical stimulation (PFES) and pelvic floor training (PFT) for female with idiopathic detrusor overactivity (IDO) and stress urinary incontinence (SUI). Methods PFES and PFT were performed on 70 women (average age 40±7 years old) with IDO and SUI for twelve weeks. Urinary diary, International Continence In-quiring Committee's Questionnaire (ICI-Q-SF) scores were recorded and urodynamic study was per-formed before and after the treatment. Results Fifty women (71%) finally completed treatment for twelve weeks. Urinary incontinence disappeared in 8 (16%), detrusor overactivity disappeared in 10 (20 %). The leakage was not found in 6 (12 %) in leakage point pressure measurement. Moreover, the frequency of voiding (28±5 times/72 h), frequency of leakage (10±5 times/72 h), total scores of ICI-Q-SF(10±3), max detrusor uninhibited contraction pressure (18±8 cmH20) and detrusor unin-hibited contraction duration (8±3 s) were significantly lower than those before treatment (43±8 times/72 h, 20±6 times/72 h, 17±3, 27±9 cm H2O and 13±6s,P<0.01). Maximal voided vol-ume(225±48 ml), normal desired cystometric capacity (210±48 ml), maximal cystometric capacity (247±48 ml), Valsalva leak point pressure (94±11 cm H2O) and maximal urethral closure pressure (59±8 cm H2O) were significantly higher than those before treatment (159±37 ml, 141±39ml, 178±36ml, 81±15 cm H2O and 55±8 cm H2O, P<0.01). The effective rate during three months follow up was 60%, similar to time after treatment (P>0.05). Conclusions Pelvic floor electrical stimulation and pelvic floor training could be a useful therapy to treat women with IDO and SUI. It is both convenient and economical.

Urodynamic examination is a standard way for the diagnosis of lower urinary tract dysfunction. However，it is affected by many factors. In order to increase the accuracy and repeatability of urodynamic result and promote the development of urodynamic center，some improvement measures were implemented，such as strengthening nursing work，improving examinational environment，protecting patients' privacy，providing active health education and psychological nursing.

Objective To establish a quality indicator system of nursing services for patients with urodynamics. Methods Delphi method was used in the study, and the quality indicator system of nursing services for patients was based on two rounds of consultation among 16 experts. Results The quality indicator system of nursing services for patients with urodynamics consisted of 3 first-level indicators, 8 second-level indicators and 29 third-level indicators. Experts had the same opinions on the indicators. Conclusions Nursing behavior for patients with urodynamics could be standardized based on the quality indicator system, and therefore guide nursing work and improve nursing quality. Further theoretical and empirical study is needed to verify the quality indicator system.

Objective To discuss the influence of temperature on the effects of cleaning rigid cystoscope. Methods Totally 225 sets of rigid cystoscope which were used for cystoscopy in the Urologic Laparoscopy Center of the First Affiliated Hospital of Zhengzhou University from January 2017 to June 2017 were selected, each of them included four detection points: endoscope, scope lemma, obturator and cross-structure. They were randomly divided into three groups, each group including 75 sets of cystoscope and 300 detection points. The Twist'n Fill'TM cleaner distributor developed by 3M Company was used to control the temperature at 21-30 ℃ for Group A, 31-40 ℃ for Group B and 41-50 ℃ for Group C. The cleaning results were tested through the Clean-Trace ATP Surface Test and ATP Water Test developed by 3M Company. Results The cleaning yields of Group A, B and C were 65.67%, 75.67% and 96.00% respectively, the difference was statistically significant (χ2=86.748; P<0.05). Conclusions Multi-enzymatic detergent shows the best effect at the temperature of 41-50 ℃, and it is advised that this temperature be used in cleaning rigid cystoscope.

Objective To establish a scientific and reasonable evaluation index system of nursing quality for cystoscopy. Methods After 2 rounds of Delphi survey technique, get the consensus of the evaluation indicators of the initial evaluation of the 18 experts,and ultimately build a system for nursing quality evaluation index during cystoscopy. Results After 2 rounds of expert consultation, the evaluation index system based on the three level structure of the medical quality framework includes:3 first-level indicators,8 second-level indicators,33 third-level indicators. Conclusions The evaluation index system established in this study is helpful to standardize the nursing behaviors of nurses in the examination process,improve the quality of nursing service in the process of cystoscopy, and improve the accuracy and reliability of inspection.

Objective To construct a self management program for patients with ureteral stoma, then validate the proposal. Methods The expert consensus reached an agreement after 2 rounds of Delphi expert consultation of "self management programme", according with the contents of the manual requirements,the intervention patients(41 cases)were given these self management interventions:regular one-on-one ostomy skills training, mental support and motivational interview, recording stoma diary, the control patients were given routine nursing interventions,after 1,3 and 6 months of implementation,their results of self management was evaluated. Results The total score of self-management ability was 99.32±10.41,105.34±13.75,109.18±10.91 in the control group after the intervention of 1,3 and 6 months respectively,and 106.73 ± 13.82,117.65 ± 15.47,129.43 ± 12.37 in the test group,the differences were statistically significant (t=7.847, 9.318, 11.416, P<0.01). The total score of quality of life was 167.18 ± 24.62, 173.36 ± 25.33, 179.48 ± 22.17 in the control group after the intervention of 1, 3 and 6 months respectively,and 178.66 ± 23.47,185.41 ± 22.67,213.17 ± 26.75 in the test group,the differences were statistically significant (t=6.839, 10.241, 13.926, P<0.01). Conclusions The construction of the ureterostomy self-management program, enhance patients'self-management consciousness, and improve the ability of self-management.

By reviewing the concept, content, evaluation tools and significance to clinical practice of preoperative patients' preparedness for selective surgery, this paper aims to provide some reference for enriching the content of preoperative patients' preparedness and improving the surgical satisfaction and quality of life for selective surgery.

Objective To study the risk factors of severe complications possibly associated with exchange transfusion (ET) for patients with extreme hyperbilirubinemia.Method From May 2001 to May 2018,neonates with severe complications of ET were assigned into adverse event group.The propensity score principle was used to match adverse event group/the control group with the ratio of 1 ∶ 3.The neonates in the control group received ET without any severe complications.The demographic characteristics of patients,and other clinical data were reviewed.The Logistic regression analysis was used to determine the risk factors of severe complications of ET.Result Among the 1 535 neonates who received ET during the past 17 years,71 neonates (4.6％) were identified with severe adverse events,including apnea (30.6％),necrotizing enterocolitis (18.8％),heart failure (14.1％),respiratory failure (12.9％),and shock (8.2％).The Logistic regression analysis showed that acute bilirubin encephalopathy (ABE) score ≥ 3 (OR=6.383,95％CI 2.550～15.979),ETs ≥ 2 times (OR=11.825,95％CI 2.464～56.755),cardiac murmur ≥ grade Ⅲ (OR=20.417,95％CI 4.705～40.590),and dramatic blood pressure fluctuation during ET ≥ 30 mmHg (OR=13.612,95％CI 1.795～43.342) were risk factors of ET related severe complications (all P＜0.05).Conclusion The indications should be carefully assessed before ET.The patients with ABE score ≥ 3,ETs ≥ 2 times,cardiac murmur ≥ grade Ⅲ,or dramatic blood pressure fluctuation during ET ≥ 30 mmHg should be monitored carefully and ET should be stopped in time if necessary.