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

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 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.

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.

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.

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.

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 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.

Abstract： Objective　To investigate the epidemiological and molecular characteristics of carbapenem-resistant Klebsiella pneumoniae isolated from blood cultures of patients with bloodstream infections in Shanxi Bethune Hospital from January 2015 to January 2022. Methods　Klebsiella pneumoniae strains isolated from blood cultures of patients with bloodstream infections at Shanxi Bethune Hospital from January 2015 to January 2022 were collected for the study. Bacterial identification, drug sensitivity testing, and an improved carbapenem inactivation test were conducted to screen for carbapenem-resistant Klebsiella pneumoniae. Next-generation sequencing was performed on all strains, while whole genome sequencing was carried out on two strains that tested positive for the modified Hodge test indicating resistance to carbapenems. Results　A total of 431 strains of Klebsiella pneumoniae were isolated from blood cultures of patients with bloodstream infections at Shanxi Bethune Hospital between January 2015 to January 2022, among which 33 were carbapenem-resistant strains including 11 highly virulent ones and 2 of these exhibited positive for the modified Hodge test. All strains were resistant to both ertapenem and imipenem, with only one strain being intermediate-resistant to meropenem. Among the 33 resistant strains, KPC-2 was detected in 26 strains and NDM-1 in 4; three strains possessed dual carbapenemase types (KPC-2/NDM-9, KPC-2/OXA-1, NDM-1/OXA-1), while four did not show any detectable carbapenem-resistance genes. Evolutionary analysis following next-generation sequencing revealed that the main sequence types (ST) among these isolates were ST11, ST147, and ST412; and the predominant serotypes were KL64, KL47, and KL25. The plasmid conjugal transfer experiments were successful in 18 strains. The two high virulence strains identified in the modified Hodge test were found to carry virulence and resistance plasmids upon whole genome sequencing. Conclusions　The detection of carbapenem-resistant Klebsiella pneumoniae in patients with bloodstream infections has been increasing annually since 2015, with an outbreak occurring in 2021. The carbapenemase KPC-2 gene was the most prevalent, with the majority of strains being of the ST11/KL64 type. Strengthening screening and control measures for clinical drug-resistant strains is crucial for effective anti-infective treatment.