Objective]To explore the clinical value of the theories in the seven papers of Yunqi.[Method] Analysing the usage of the correlation theories of Yunqi in Cases of Well-known Physicians and its sequel, consulting the commentaries and application of many well-known physicians, this paper summarizes some theories which are applicable to clinic.[Result]In the seven papers of Yunqi, the theory of avoidance of harm by restraining excess and the theory about the inconformity of pulse and disease can exclude false symptoms and infer real pathogenesis.19 questions about pathogenesis can be a reference of clinical diagnosis.The theory of South-North can be used to exclude the impact of climate on the pulse and assist diagnosis. Rationally using the theory of Suiyun contributes to infer etiology and establish therapy.[Conclusion]Cases of Well-known Physicians and its sequel reflect the application and exertion of the theories of Yunqi by ancient physicians. They help to understand the theoretical system and instruct clinical application. In addition to the theory of Suiyun, the seven papers of Yunqi also include a lot of theories which are applicable to clinic.

Objective To study the relationships between retinal microvascular disease and acute coronary event (ACE) among aged people. Methods A controlled study for senile people in communities was conducted. Xinglong Zhuang Coal Mine Community in Jining city, Shandong province was chosen to carry out the study, and the residents in that area aged≥60 years were asked to take questionnaire survey, physical and laboratory examinations. There were 139 cases met the diagnostic criteria of ACE being in the observation group, and 1 509 cases without ACE were assigned in the control group. The gender, age, smoking, alcohol intake, hypertension, diabetes mellitus, education, physical exercise, retinal microvascular disease, fasting blood-glucose, high density lipoprotein cholesterin (HDL-C), low density lipoprotein cholesterin (LDL-C), triacylglycerol (TG), systolic pressure, diastolic pressure, body mass index (BMI) were collected in the two groups to perform univariate analysis. Multivariate non-conditional logistic regression analysis was used for the factors with statistical significance to screen out the independent risk factors that could affect the occurrence of ACE. Results The univariate analysis showed:the risk factors that might cause the occurrence of ACE included age, gender, smoking, hypertension, diabetes mellitus, LDL-C, systolic pressure, diastolic pressure, BMI, and retinal microvascular disease (P<0.05 or P<0.01). In the ACE patients of observation group, the rates of presence of arteriovenous crossing sign [44.6%(62/139) vs. 27.8%(419/1 509)], hard exudates [9.4%(13/139) vs. 4.9%(74/1 509)] and cotton-wool patches [19.4%(27/139) vs. 7.3%(110/1 509)] in retinal microvascular disease were significantly higher than those in control group (P<0.05 or P<0.01). The logistic regression analysis showed:age [P=0.002, odds ratio (OR)=1.06, 95%confidence interval (95%CI)=1.04-1.09], smoking (P=0.032, OR=2.17, 95%CI=2.04-2.30), retinal microvascular disease (P = 0.010, OR = 2.33, 95%CI = 0.97 - 1.27), hypertension (P < 0.001, OR = 5.21, 95%CI=4.11-6.36), diabetes mellitus (P=0.021, OR=1.03, 95%CI=1.01-1.05) and LDL-C (P=0.020, OR=2.80, 95%CI = 2.65 - 2.99) were the independent risk factors for the occurrence of ACE. Conclusions Retinal microvascular disease is the independent risk factor for the occurrence of ACE. The retinal angiography can be a useful examination to forecast ACE.

Objective The rapid development of radiation equipment has put forward higher requirements for protective facil -ities.The aim of this study was to research the radiation protection status of treatment equipment room in thirty -three medical units from East China area , and to put forward corresponding countermeasures to improve the level of radiation protection . Methods The li-cense and archival of X-ray machine, CT, gamma knife, accelerator, after loading therapy machine were surveyed in the thirty-three medical units .The engine room size , wall thickness , lead equivalent of protection doors , and leakage level of equipment were detec-ted.All the data were evaluated and analyzed on the basis of the corresponding national standards . Results ①The inspection pass rates of radiation treatment equipments in the first class hospitals were afterloader (100%), X-ray apparatus(99%), gastrointestinal machine(98%), CT(98%), medical processing accelerator (98%), gamma knife(97%), DSA(94%), PET-CT(94%), ECT (90%), dental engine(84%)and molybdenum target drone (84%).The inspection pass rates of radiation treatment equipments in other class hospitals were medical processing accelerator (100%), X-ray apparatus(91%), CT(89%), gastrointestinal machine (80%), DSA(80%) and (80%) gamma knife.②The qualified rates of the leakage radiation levels of radiation therapy , diagnostic radiology and nuclear medicine were 100%, 99% and 97%. Conclusion The radiation protection of treatment equipments and facilities in thirty-three medical units from East China area needs to be strengthened . We should strengthen supervision , implement the rules and regulations , strictly perform the regulation of radiation protection evalua-tion, and strengthen the training of radiation protection regulations and skills .

Background:Acute-on-chronic liver failure( ACLF)is a commonly seen liver failure in China,and lacking an animal model that can effectively simulate the dynamic change of immune status of ACLF. Aims:To establish an animal model that can simulate dynamic change of immune status of ACLF by repeated administration of concanavalin A(ConA). Methods:Mice were randomly divided into normal control group and ConA repeated administration group. Mice in ConA repeated administration group were injected with ConA 15 mg/ kg through retrobulbar angular vein every 48 hours for 5 times,and mice in control group were injected with same volume of 0. 9% NaCl solution. Serum levels of IL-6,IL-10,IL- 12,TNF-α,IFN-γ,MCP-1 in peripheral blood were assessed by CBA assay,and the ratio of IL-10/ TNF-α was calculated. The expression of HLA-DR,number and proportion of CD4+ T cells and the expression of PD-1 of monocytes in peripheral blood were detected by flow cytometry. Results:Peripheral blood cytokines changed from predominated proinflammatory cytokines into predominated anti-inflammatory cytokines with the increasing in time of administration in ConA repeated administration group. Compared with control group,HLA-DR expression of monocytes in peripheral blood was significantly decreased(P <0. 05),number and proportion of CD4+ T cells were significantly decreased(P <0. 05), and PD-1 expression was significantly increased( P < 0. 05)in ConA repeated administration group. Conclusions:An animal model of ACLF immune status from systemic inflammatory response syndrome( SIRS) to compensatory antiinflammatory response syndrome(CARS)induced by repeated ConA stimulation is successfully established.

Objective To study apoptosis and antigen presentation changes of monocytes in HBV-related acute-on-chronic liver failure (ACLF) patients under immune dysfunction state.Methods Peripheral blood samples of 26 HBV-related ACLF patients (ACLF group),20 active chronic hepatitis B patients (CHB group) and 18 healthy individuals (control group) were collected.The changes of apoptosis and proliferation (Ki67) in monocytes and the expression of surface markers including human leukocyte antigen (HLA)-DR and B7 molecules (CD86) of monocytes were analyzed by flow cytometry. Results The percentage of Annexin V expressed monocytes of ACLF group (64％) was significantly higher than that of CHB group (28％) and control group (20％),and the difference was statistically significant (x2 value was 11.75 and 27.23 ; both P＜0.01),which indicated that monocytes apoptosis increased.The Ki67 expression in monocytes of ACLF group was lower than that of CHB group and control group,and the difference was statistically significant (x2 value was 4.71 and 4.83; both P＜ 0.05),which indicated that activated monocytes reduced. The mean fluorescence intensity (MFI) of HLA-DR and CD86 of monocytes in ACLF group was 22.85 and 11.63,which was significantly lower than that of CHB group and control group,indicating the antigen presentation ability of monocytes injured. The percentage of Annexin Ⅴ positive monocytes in survivals (62 ％ ) was significantly higher than that of dead patients (46 ％ ) in ACLF group.Conclusion In HBV-related ACLF patients under immune dysfunction state,the apoptosis of peripheral blood monocytes increased,and the quantity of activated cells reduced,resulting in the decline of the antigen presentation ability of monocytes.

Objective? To understand the status of psychological empowerment and turnover intention among intensive care unit (ICU) nurses and analyze the influence of psychological empowerment on turnover intention. Methods? We selected 650 ICU nurses from five ClassⅢ Grade A hospitals in Zhengzhou City as subjects by convenience sampling. The psychological empowerment and turnover intention of ICU nurses were investigated with the general information questionnaire, Chinese version of Psychological Empowerment Scale (PES) and Turnover Intention Questionnaire. The SPSS 17.0 was used to statistical analysis. Pearson correlation was used to analyze the correlation between psychological empowerment and turnover intention of ICU nurses, and multiple linear regression was used to analyze the influencing factors of turnover intention of ICU nurses. Results? A total of 650 questionnaires were sent out and 635 valid questionnaires were collected with 97.7% for the valid recovery rate. The total score of psychological empowerment and turnover intention was (44.66±7.36) and (15.03±3.40) respectively. Pearson correlation showed that psychological empowerment of ICU nurses had a negative correlation with turnover intention (r=-0.353, P＜ 0.05). Multiple linear regression analysis displayed that the main influencing factors of turnover intention of ICU nurses included whether to teach or not, the dimension of work meaning and work impact in PES (P＜ 0.01). Conclusions? ICU nurses have a medium level of psychological empowerment with strong turnover intention. Nursing managers should provide targeted intervention according to the status psychological empowerment of ICU nurses to improve the level of psychological empowerment, so as to reduce the turnover intention of them.

Objective To investigate the correlation between the degree of liver fibrosis and Aspartate aminotransferase-to-Platelet Ratio Index ( APRI ) in children with biliary atresia ( BA ) , and evaluate the clinical significance of liver fibrosis in biliary atresia.Methods A total of 97 patients with diagnosed BA were recruited between January 2010 and June 2013.AST, PLT and APRI were determined one week before laparotomy.The severity of hepatic tibrosis was.Judged by Metavir system the correlation among AST, PLT, APRI and severity of liver fibrosis were evaluated, and their diagnostic value for degree of liver fibrosis was analyzed by ROC.Results Sera AST levels and PLT counts of BA patients were found to be positively(r=0.367, P<0.01) and negatively(r=-0.403, P<0.01) correlated with Metavir scores of liver fibrosis, respectively.There existed positive correlation between APRI and the severity of hepatic fibrosis (r=0.541, P<0.01).The area under ROC curve of APRI to diagnose none or mild fibrosis and moderately severe fibrosis was 0.78, with sensitivity of 77.9%and specificity of 62.1%at the optimal cut-off value of 0.75; the area under ROC curve of APRI to diagnose moderately severe fibrosis with liver cirrhosis arrived 0.85, with sensitivity of 75.0% and specificity of 89.4% at the optimal cut-off value of 1.77.The accuracy of none or mild fibrosis, moderate fibrosis and cirrhosis diagnosed by APRI were 73.2%, 64.9%, 87.6%, respectively.Conclusion APRI can be used as a non-invasive parameter to assess the severity of hepatic fibrosis with BA.

Objective To study the status quo of turnover intention in ICU nurses in He'nan province, and analyze the correlation between the turnover intention and nursing work environment. Methods A total of 645 ICU nurses in He'nan province were selected by convenience sampling method and investigated with a general information questionnaire, the Intention of Quitting Scale (IQS) and Nursing Work Environment Scale. SPSS 20.0 statistical software program was applied to analyze the data. Results Totally 645 questionnaires were released and recycled, with 635 effective ones, and the effective recycle rate was 98.4%. The total score of the IQS was (15.03±3.40). The total score of the Nursing Work Environment Scale was (110.52±23.02), of which three sub-scales of the the nursing work environment, including leadership and management, adequate human resources and basic guarantee, had the lower score. The scores of the general scale of IQS, IQS Ⅰ and IQS Ⅱwere negatively related with the general scale of nursing work environment and its each dimension (P＜0.01). The IQS Ⅲ was negatively related with the dimension of leadership and management and basic guarantee (P＜0.01). Multiple linear regression analysis showed that education, ICU species, whether teaching, leadership and management and basic guarantee were the influence factors of the turnover intention, accounting for 23.9% of the variance. Conclusions The turnover intention of ICU nurses in He'nan province is at a high level. To reduce turnover intention, it is not only important to pay attention to individual characteristics of ICU nurses, but also to improve nursing work environment, especially leadership and management and basic guarantee.

Objective:To evaluate the diagnostic value of ultrasonic measurement of artery peak velocity variation (ΔVpeak) on predicting fluid responsiveness in critically ill patients.Methods:Databases of PubMed, Embase, Cochrane Library, SinoMed, Wanfang, CNKI and VIP were retrieved from the establishment of the database to November 2019. The retrieval literatures were about the research of ΔVpeak used to judge fluid responsiveness. According to the inclusion and exclusion criteria, the relevant literatures were screened by two researchers, and the data of the included literatures were extracted. The quality of literatures was evaluated by quality assessment of diagnostic accuracy studies (QUADAS). Meta Dics 1.4 software was used to analyze the literatures that met the quality standard by Meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio ( DOR) were calculated. The summary receiver operating characteristic (SROC) curve was drawn and the area under SROC curve (AUC) was calculated. The χ 2 test and Spearman correlation coefficient were used to analyze heterogeneity, and Deek test was used to analyze publication bias. Results:A total of 1 854 patients were enrolled in 31 studies, including 11 domestic studies and 20 foreign studies. Using 14 items of QUADAS to evaluate the quality of literatures, it was found that the enrolled literatures were all in Grade A, indicating that the overall quality of literatures was high. The scattered distribution of SROC curve was not "shoulder arm shape", and Spearman correlation coefficient was 0.062 ( P = 0.710), so there was no threshold effect. The heterogeneity test showed that I2 = 57.2% ( P = 0.001), indicating that there was a certain degree of heterogeneity among the studies, and the source of heterogeneity was non threshold effect. Meta regression analysis showed that the reason for heterogeneity was the method of volume load test [ DOR = 3.87, 95% confidence interval (95% CI) was 1.56-9.57, P = 0.004 8]. According to the results of heterogeneity analysis, there was no significant heterogeneity ( I2 = 10.6, P = 0.288 5) among the studies after removing the samples of the passive leg raising (PLR) instead of the volume expansion. A meta-analysis was done with random effects model. The results showed that the pooled DOR was 23.85 (95% CI was 17.57 to 32.37), pooled sensitivity was 0.82 (95% CI was 0.80 to 0.85), pooled specificity was 0.83 (95% CI was 0.80 to 0.85), pooled PLR was 4.17 (95% CI was 3.58 to 4.86), and pooled NLR was 0.22 (95% CI was 0.18 to 0.28). The AUC was 0.901 2 (95% CI was 0.88 to 0.93), and Q index was 0.832 5. The results of Deek funnel plot showed that there was no published bias in all the studies ( P = 0.19). Conclusions:Ultrasonic measurement of ΔVpeak has a high value in predicting fluid responsiveness. It is a reliable parameter for the evaluation of shock, critical illness and surgical operation population who need to monitor the fluid responsiveness.

Objective:To improve the teaching quality of Medical Microbiology by optimizing the teaching method,adjusting the teaching content and reforming the assessment model.Methods:The students of grade 2020 and 2021 of the same major were divided into the control group and the reform group.The control group received the traditional teaching method.The reform group received the"online + offline"blended teaching method,which integrates online learning resources and ideological and political education into the theoretical content of the curriculum.And the whole process assessment system was applied to the teaching method.The teaching quality was evaluated by the whole process examination results and questionnaire survey.Results:Compared with the control group,the score in the reform group was significantly improved(P＜0.01).Results of the questionnaire survey showed that students'satisfaction with the mixed teaching method reached 97.5% .The integration of hot issues of microbiology and curriculum ideological and political education significantly improved students'learning interest,and more students wanted to engage in the work of microbiology related fields in the future.Conclusion:The practice results show that optimizing the teaching method,adjusting the teaching content and reforming the assessment mode can stimulate the students'learning interest,improve the students'independent learning ability and improve the teaching quality.