0.05;estimation of merging effect value:OR merging 95%confidence interval was 2.034 - 3.004;OR merging test:x~2 =71.6119,P

Objective To screen empowerment psychological care scale items for critically ill patients through Delphi method.Methods Totally 27 experts were invited to conduct two rounds consultation by using Delphi method,and the results were summarized.Results The effective response rate of the experts' questionnaire for the first round and the second round was 90％ and 100％.The specialist authority coefficient was 0.895.The coordination coefficients for 2 rounds were 0.432 and 0.448 respectively.After two-round consultation,empowerment psychological care scale items for critically ill patients was finally formulated,containing 4 dimensions and 24 evaluation items.Conclusions The selected experts were highly representative,and they were enthusiastically involved in the consultation.And the scale has remarkable authority and coordination;it can reflect the theme of the study,provide instructive function for clinical medical personnel in implementation and evaluation of empowerment psychological care.

Health insurance is an important part of social security, and many problems have arisen in the con-struction of its legal system, such as legislative lag, lack of coordination among law enforcement, and serious disloca-tion of judicial relief. Therefore, under the vital time of performing the strategy of “rule by law”, the development and reform of the legal system for health insurance in China should be promoted. On the basis of summarizing the his-torical development of the legal system for health insurance in China, this paper proposes solutions such as centrali-zing legislative upgrades and expediting the process of unitary and special laws from the perspective of“rule by law”. The system of personal credit should be established and judicial transparency should be promoted to improve the legal system for health insurance.

Objective To compare the efficacy and safety in patients received paravertebral block and epi-dural block for postoperative rehabilitation pain after unilateral ureterolithotomy.Methods 120 ASA Ⅰor Ⅱ patients were randomly allocated into research group (n =60)and control group (n =60).After operation,the research group received paravertebral block performed with peripheral nerve stimulator,the control group received epidural block.All patients received patient -controlled intravenous analgesia (PCIA)in the same time.The operation time,amount of bleeding,postoperative hospitalization time,operation completion,number of press PCIA,occurrence rate of postopera-tive adverse reaction in 48 h,and visual analog scores (VAS)at 4,8,16 and 24 h after surgery were recorded. Results The patients of the two groups were completed the stone surgery,there was no cases of conversion to open surgery.There was no significant difference in operation time,bleeding volume,postoperative hospital stay between the two groups (all P >0.05).But the PCIA times of the research group was (2.14 ±0.45)times,which of the control group was (4.20 ±0.68)times,the difference was statistically significant (t =4.27,P =0.029).The postoperative VAS scores of the research group[4 h (2.68 ±0.480)points,8 h (2.68 ±0.48)points,16 h (2.81 ±0.43) points,24 h (2.88 ±0.49)points]were significantly lower than those of the control group[(3.12 ±0.53)points, (3.37 ±0.58)points,(3.42 ±0.52)points,(3.39 ±0.55)points],the differences were statistically significant (t =2.68,3.13,306,311,all P <0.05).Of the research group,the nausea and vomiting occurred rate (23.33%), hypotension rate (0.00%),skin itching (5.00%),the incidence of decreased muscle strength (0.00%)were significantly lower than the control group(43.3%,31.6%,28.33% and 8.33%),the differences were statistically significant(χ2 =5.40,22.57,11.76,522,all P <0.05 ).Conclusion Nerve stimulator guidance for thoracic paravertebral nerve block for upper ureter incision to take stone surgery patients can significantly reduce postoperative pain and the PCIA analgesia drug dosage and the incidence of adverse reactions.

Currently adopted surgical approaches of laparoscopic combined organ resection for gastrointestinal cancer include laparoscopic pancreaticoduodenectomy and gastrectomy, laparoscopic gastrectomy combined distal pancreatectomy and splenectomy, laparoscopic gastrectomy and cholecystectomy, laparoscopic rectal anterior resection and total hysterectomy with bilateral salpingo-oophorectomy, and laparescopic colorectal and hepatic metastases resection. Satisfactory clinical outcomes of these procedures for gastrointestinal cancer were obtained in the reported cases. However, the number of cases in current studies on laparoscopic combined organ resection for gastrointestinal cancer was too small and no control groups involved, and multicenter clinical trials were not yet conducted. In conclusion, the future of laparoscopic combined organ resection for gastrointestinal cancer is promising, while its feasibility and safety require further investigation.

Sentinel lymph node (SLN), the hypothetical first regional lymph node or group of lymph nodes to received lymphatic drainage from a primary tumor, can predict the likelihood of further nodal involvement. SLN mapping was initially applied to the treatment of breast cancer and melanoma, and it also shows gratifying effect on thyroid cancer, pancreatic cancer and gastrointestinal tumors. The development of SLN mapping in colorectal cancer has brought us a new approach to design personalized operation and adjuvant therapy plans. However,various SLN mapping techniques in colorectal cancer available present fluctuant navigation performances, which need to be replaced by an economical, convenient and accurate tracing technique. Hopefully the optimized SLN mapping can play a more important role in the management of increasing occurred early colorectal cancer.

The serial knowledge of cognate thoughts, culture, systems, language, engraving and edition of classic ancient books was organized based on their subject-guided reading activities, which plays a rather effective role in promoting the readers to read them. The selection of subject-guided reading activity contents, forms of subject-guided reading activity design, implementation of subject-guided reading activity were analyzed with the ancient e-dition of《Handbook of prescriptions for emergency》as an example. A knowledge chain-based subject-guided reading model of classic ancient books was proposed for promoting the reading of ancient books on traditional Chinese medi-cine and the reading of Chinese national culture in related academic libraries.

Objective To establish the evaluation methods of individual technology maturity based on SCI-covered papers and patent data using Gartner's Hype Cycle.Methods The SCI-covered papers and patent data were ana-lyzed by nonlinear regression analysis in combination with traditional X-radiography and photo-acoustic tomo-graphy, and represented as the bell-shaped curve and S-shaped curve for judging the technology maturity.Results The individual technology maturity was consistent with the qualitative review of experts.Conclusion The individual technology described in SCI-covered papers and patent data can be used in primary evaluation of its maturity.

The causes of dizziness and vertigo were complex.The traditional diagnostic paradigm was based on symptom quality- what do you mean dizzy? According to this system,a patient with vertigo has a different list of possible causes than those who endorselightheadedness.The new diagnostic paradigm was based on their description of the timing,triggers of symptom strengthened the context of the vertigo medicine.More emergency physicians (EPs) lacked a significant knowledge regarding bedside examination and extensively convinced neuroimaging,resulting in misdiagnosis of serious causes such as stroke,unnecessary use of neuroimaging,and failure to institute specific treatment for many patients with inner ear causes of dizziness.This article focuses on how to use bedside physical examination to more accurately diagnose patients who present with acue dizziness,vertigo,or other similar vestiblar symptoms.This,in turn,could lead to lower rates of misdiagnosis,decrease utilization of expensive imaging studies,and increase in prompt,and correct treatments,thereby to improve patient outcomes.

Objective To investigate the clinical and computed tomography (CT) features of lung isolated ground-glass opaci-ty and to analyze the predictive factors that may discriminate benign from malignant nodules .Methods Clinical features , CT charac-teristics, pathological diagnosis , and the follow-up results were retrospectively analyzed with 108 cases of isolated ground-grass opacity (GGO) that was confirmed by histopathology from January 2011 to March 2013.Results A total of 108 isolated GGOs [52 men,56 women,mean age (58.12 ±10.34)years] included 19 benign nodules and 89 malignant nodules.The diversity of age, gender, clini-cal symptom, margin (speculation, spine-like process), internal characteristics (ovule sign, air bronchograms) of the lesions were no statistically significant differences between benign and malignant GGOs ( P >0.05 ) .The lymphocyte and CT findings of shape , lobu-lation, interface (ill/well defined) and pleural indentation sign were significantly different between benign and malignant GGOs ( P <0.05 ) .Besides significant difference in pleural indentation sign was also found between bronchioalveolar carcinoma and adenocarcino -ma ( P =0.0252).Among the 44 patients who were followed up after finding GGO initially , there were 7 GGOs (7/44,15.91%) to grow up after 3years, and GGOs of 32 patients had no obvious change , besides the patients'age of malignant GGO was bigger than the benign( P =0.0416).Conclusions Clinical features were of little value to discriminate the benign from malignant GGOs .CT fea-tures including round/oval shape, lobulation, and well defined and pleural indentation sign were of important value in the diagnosis of malignant GGO .Surgical resection should be applied in the process of follow-up when the sizes of GGO become bigger or newly formed solid components were detected .GGO that can't be diagnosed should be followed up for at least 3 years.