Objective To discuss the efficacy of applying management-by-objectives(MBO) in the hospital-level nursing quality control group.Methods Goals of objective management and assessment details were set by leaders of quality control groups along with the nursing department at the beginning of the year.The nine subordinate groups performed upon the required criteria,completed the quality inspection on time and recorded group activities.At the end of the year,group leaders reported to the hospital-level nursing quality committee and head nurses about their performances,where several major honors were rewarded to the best performing groups.SPSS 17.0 software was used for data statistics.The measurement data were analyzed by paired t test data while enumeration data by chi-square test.Results Scores of assessment items were significantly raised after implementing MBO(P＜0.05).Scores of key items,such as high quality care,emergency management,nursing skill,were increased to (98.1 ± 2.2),(97.7 ±2.7),(99.6±0.6),(96.1 ±2.1)from (93.6 ±2.5)(P=0.009),(93.0 ± 2.6) (P=0.009),(96.2 ± 1.3) (P=0.000) and (89.3 ± 4.5) (P--0.000),respectively.Care complaints were sharply dropped for all inpatient wards while numbers of management innovationand process reengineering were greatly increased (x2=8.884,P=0.031).Condusion Introduction of MBO in the hospital-level nursing quality control group does facilitate the continuous improvement of care quality.

Objective To explore the joints and tendons characteristic features of high frequency ultrasound in asymptomatic hyperuricemia(AH) and to assess its value in AH diagnosis.Methods One hundred asymptomatic individuals with hyperuricemia (AH group) and 75 normouricemic subjects (control group) were examined by high frequency and color Doppler ultrasound.The joints,tendons and soft tissue of the knees,ankles and first metatarsal-phalangeal joints in two groups were examined.The correlations of serum urate(SU) level with double contour sign,bone erosion and articular cavity effusion were analysed.Results Hyperechoic deposition on the sulface of the articular hyaline cartilage (double contour sign) were found in the knees (35),ankles (17) and the first metatarsophalangeal joints (MTPJs,48) from the asymptomatic individuals with hyperuricemia,in contrast to none in the control group (P ＜0.05).Similar results were found in two groups of the bone erosion (30,25,20 vs 4,6,3,P ＜0.05),the effusion (28,36,41 vs 6,8,9,P ＜0.05) and the hyperechoic spots (19,18,22 vs 0,0,0,P ＜0.05).Patellar enthesopathy (4.5％ vs 0.6％,P ＜0.05) as well as achilles enthesopathy(8％ vs 0,P ＜0.05) and achilles tophi (6％ vs 0.6％,P ＜ 0.05) were more frequent in asymptomatic hyperuricemic than that of normouricemic individuals.No correlations between SU concentration and the presence of the double contour sign,the bone erosion and effusion were found (P ＞0.05).Conclusions There were some similar specific sonographic findings of gouty arthritis in the asymptomatic individuals with hyperuricemia.Also,these findings support high frequency ultrasound as a useful tool to detect anatomical damage in the joints,synovial tissue and tendons of asymptomatic individuals with hyperuricemia.

Objective To explore the neurasthenia situation of the population attending the postgraduate exam in medical class and its influencing factors .Methods The random cluster sampling method was adopted .The influencing factors were per‐formed the χ2 test and Logistic regression analysis .Results According to the inclusion criteria and exclusion criteria ,36 positive ca‐ses were screened out ,accounting for 8 .89% of participants ,which was higher than the value of the general population ;the statisti‐cally significant differences were noted in the factors of the confidence of attending the postgraduate exam ,stress ,adjusting ability , interpersonal situation ,reading duration ,sleep ,nutrition and dietary (P<0 .05) .Conclusion Attending the postgraduate exam such highly intensitive mental activity is the important reason causing neurasthenia among the population attending the postgraduate ex‐am ,which mainly display in the aspects of stress size ,bearing ability facing stress and regulation .

Objective:To elucidate the phenotypic and functional characteristics of CD3+ CD4+ and CD3+ CD8+ T in pleural fluid of patients with tuberculous pleurisy.Methods:PBMCs and PFCs were isolated. The frequency of CD3+,CD3+ CD4+,CD3+ CD8+ T cells and the ratio of CD4/CD8 in PFCs were analyzed by FACS. The concentration of IFN-?,IL-2 and TNF-? in the pleural fluid were analyzed by ELISA.Production of IFN-?,IL-2 and TNF-? by CD3+ CD4+ and CD3+ CD8+ T cells was detected by FACS following stimulation with BCG.Results:Higher frequencies of CD3+ CD4+ T cells and CD4+ T/CD8+ T ratio were demonstrated in PFCs when compared with PBMCs from normal donors and TB patients.ELISA analysis demonstrated that significantly high levels of IFN-? and TNF-? were detected in pleural fluid.Further analysis by FACS indicated that IL-2,TNF-? and IFN-? were predominantly secreted by CD3+CD4+T cells but not by CD3+ CD8+ T cells.Conclusion:The frequencies of CD3+ and CD3+ CD4+ T cells are increased in PFCs. Large amounts of Th1 cytokines are detected,which are produced by CD3+ CD4+ T cells,and might play important roles against TB infection.

Two sample pretreatment methods of pesticide residues in Panax notoginseng of Chinese traditional medicine were developed. For Method I, the residues were extracted from homogenized tissue with n-hexane-dichloromethane (6:4) by means of ultrasonication, the crude extract was purified by an Envi-carb/NH2 solid-phase extraction (SPE) column. For Method II, matrix solid-phase dispersion (MSPD) technique was used for extracting and cleaning up. The eluates were concentrated by rotary evaporation, and then were redissolved in dichloromethane prior to GC-MS determination. The determination was performed in selected ion monitoring (SIM) mode with the external calibration for quantitative analysis. Under the optimal conditions, the results indicated that the methods are easier and faster, the recoveries of method I for the spiked standards at concentration of 0.01, 0.5, and 2.0 mg x kg(-1) were 81.90%-102.10% with the relative standard deviations (RSDs) of 3.60%-7.10%. The recoveries of method II were 96.26%-104.20% with the RSDs of 3.52%-7.94%. The detection limits (S/N) for residues of pesticides were in the range of 0.48-1.34 ng x g(-1). The results indicated that these multiresidue analysis methods can meet the requirements for determination of residue pesticides and can be appropriate for trace analysis of residue pesticides in Panax notoginseng.

Objective To assess the effects of removing indwelling urinary catheter at different timing on urinary retention puerper as who use patient controlled analgesia(PCA)after cesarean section. Methods Taking the database of PubMed,Embase,Cochrane Library,Medline,CNKI,CBM,VIP and Wanfang before December 2016 as the retrieval sources; collecting the Results of randomized controlled trial(RCT) about the incidence of postpartum urinary retention with PCA which removing the ureteral catheter after 24 hours, 36 hours, and 48 hours respectively; using RevMan 5.3 software for statistical analysis. Results A total of 10 study papers were collected, included involving 1 639 maternity patients.The incidence of urinary retention with ureteral catheter removal after 24 hours was higher than after 36 hours, the difference was statistically significant (RR=4.95, 95% CI 3.67-6.68, P<0.01); the incidence of urinary retention with ureteral catheter removal after 36 hours was higher than after 48 hours, the difference was statistically significant(RR=3.00,95% CI 1.66-5.41,P<0.01);the incidence of urinary retention with ureteral catheter removal after 24 hours was higher than after 48 hours the difference was statistically significant (RR=11.84, 95% CI 7.84-18.66, P<0.01). Conclusion In order to prevent the occurrence of urinary retention,the more appropriate timing to remove the urinary catheter after cesarean section with PCA is after 48 hours.

Objective:To investigate the clinical characteristics and early identification of spontaneous rupture of uterus caused by placenta percreta.Methods:The clinical data of 12 patients with spontaneous uterine rupture caused by placenta percreta and admitted to the First Affiliated Hospital of Zhengzhou University from June 2014 to December 2019 were collected. The age, gestational age, gestational history, clinical manifestations, diagnostic methods, uterine operation history, rupture location, surgical method, treatment and outcome were analyzed.Results:(1) General condition: the median age of pregnant women was 37 years (range: 30-43 years), and the median gestational week of uterine rupture was 29 +6 weeks (range: 18 +3-36 +3 weeks). (2) Clinical manifestation: among the 12 pregnant women, 9 showed different degrees of abdominal pain; chest distress accompanied by waist soreness, abdominal distension in 2 cases; one asymptomatic pregnant women was found with uterine rupture during elective cesarean section. Preoperative color Doppler ultrasonography indicated that 9 of the 12 pregnant women had peritoneal effusion, and 6 of them underwent diagnostic peritoneal puncture or posterior vault puncture for non-clotting blood extraction. (3) Uterine operation history and rupture location: among the 12 cases of spontaneous rupture of uterus caused by placenta percreta pregnant women, 10 had placenta previa after cesarean section, including 4 cases of rupture at the incision of the original cesarean section, 3 cases of rupture at the penetrating placental implantation of the lower segment of the anterior wall of the uterus, and 1 case of placenta percreta occurred at the myomectomy site of the right angle of the uterus. Among the 2 pregnant women with spontaneous uterine rupture caused by penetrating placental implantation without a history of cesarean section, 1 case with history of multiple abortions, and uterine rupture occurred at the bottom of the palace, 1 had rupture of placental penetrating implantation after hysteroscopic electroresection of endometrial polyps, and the uterine rupture occurred at the anterior wall of the lower segment of the uterus. (4) Maternal and fetal outcomes: 11 pregnant women were injected with suspension RBC and 1 pregnant woman was not injected with blood products. Nine cases underwent hysteroplasty and 3 cases underwent subtotal hysterectomy. There were 11 maternal survivors and 1 maternal death; 7 neonates survived and 6 stillbirths. Conclusions:Uterine rupture caused by placenta percreta is of great harm to mother and infant, due to its heterogeneity in clinical manifestations, which increases the possibility of misdiagnosis. For pregnant women with risk factors of placenta percreta, early diagnosis should be made during pregnancy. For those who have been diagnosed with placenta percreta, when there is typical or atypical uterine rupture, doctors should be alert to the occurrence of uterine rupture.

Objective:To explore the reasonable withdrawal time at different colonic segments.Methods:It was a prospective observational study involving 465 patients who underwent colonoscopy from November 2019 to November 2020 at our endoscopy center. Colonoscopy records in our center from July 2017 to September 2017 were retrospectively analyzed as a validation set.Results:The cut-off values of withdrawal time at ascending colon, transverse colon, descending colon, and sigmoid colon and rectum determined by receiver operating characteristic (ROC) curve were 77 s, 61 s, 56 s, and 109 s, respectively. At the ascending colon, the adenoma detection rate (ADR) was significantly higher (17.3% VS 2.8%, P<0.001) when the colonoscopy withdrawal time was ≥77 s. When the withdrawal time was ≥61 s at the transverse colon (6.9% VS 2.8%, P=0.036), that over 59 s at the descending colon (6.3% VS 1.7%, P=0.019), and that ≥109 s at the sigmoid colon and rectum (31.0% VS 7.9%, P<0.001), the ADR was significantly higher. Multivariate analysis showed that withdrawal time of ≥77 s at the ascending colon ( OR=6.427, P<0.001), those ≥56 s at the descending colon ( OR=3.564, P=0.045) and ≥109 s at the sigmoid colon and rectum ( OR=5.073, P<0.001) were independent risk factors for the increase of ADR. In the validation set, when the withdrawal times at the ascending colon, the transverse colon, the descending colon, and the sigmoid colon and rectum were ≥77 s, 61 s, 56 s, and 109 s, respectively, the total ADR (48.3% VS 17.6%, OR=2.952, P<0.001) and polyp detection rate (PDR) (63.2% VS 23.0%, OR=4.191, P<0.001) significantly increased. There were no significant differences in ADR ( P=0.563) or PDR ( P=0.770) compared with those where withdrawal time was over 6 min. Conclusion:The ADR and PDR significantly increase when the withdrawal times are ≥77 s at the ascending colon, ≥61 s at the transverse colon, ≥56 s at the descending colon, and ≥109 s at the sigmoid colon and rectum.

Objective To evaluate the application of fractional exhaled nitric oxide (FeNO) in the reducing treatment of bronchial asthma.Methods From October 2015 to September 2016,60 asthmatic patients with FeNO＞25 ppb were randomized into FeNO group and control group with 30 cases in each group.Patients in both groups were treated with combined inhaled corticosteroids and long-acting beta 2 agonist (ICS/LABA) starting with low doses;the dosage was adjusted according to the symptom control alone in control group,while in FeNO group the dosage was adjusted according to the symptom control and FeNO level.After 1 year-follow up,the Asthma Control Test (ACT) scores,Asthma Life Questionnaire (mini AQLQ)scores,pulmonary function,FeNO levels,blood eosinophil counts,total IgE,hierarchical control level,cumulative corticosteroid use and cumulative months of leukotriene receptor antagonists (LTRA) use were compared before and after treatment within group,and between two groups.Stratified analysis was carried out in the patients complicated with allergic rhinitis.Results After treatment,ACT scores,mini AQLQ scores and FEV1/pred (％) were significantly higher than those before treatmentin both groups (t=10.755,10.189,8.632 and 13.311,8.102,12.456,respectively,all P＜0.05),while the FeNO,EOS and total IgE levels were significantly lower than those before treatment (t=8.005,3.313,3.924 and 8.967,3.885,3.270,respectively,all P＜0.05),and the numbers of patients with good control were significantly increased (Z=-5.035 and-4.976 respectively,P＜0.05).Compared with control group,FeNO level was lower,mini AQLQ scores of symptom scores and emotional scores were higher and the average numbers of asthma attacks per patient per year were less after treatment in FeNO group (t=2.912,4.214,4.589,U=2.154,all P＜0.05).However,there was no significant difference in cumulative corticosteroid use and cumulative months of LTRA use between two groups (U=564.000 t=1.921 and 0.165,respectively,P＞0.05).For patients complicated with allergic rhinitis,the numbers of acute asthma attack were increased and the cumulative dosage of systemic corticosteroid use was higher in control group than those in FeNO group (both P＜0.05).Conclusion The reducing treatment strategy based on FeNO level and symptom control is of clinical value for patients with bronchial asthma,especially for those complicated with allergic rhinitis.

Radiotherapy is the most common treatment for nasopharyngeal carcinoma, and the radiotherapy technique is essential for the prognosis of nasopharyngeal carcinoma. Due to the complexity of the structure of the intensity-modulated device and the accuracy of the clinical requirements of radiotherapy, it is inevitable that higher requirements will be imposed on the process of intensity-modulated radiotherapy. Currently, gaps exist in the radiotherapy equipment and personnel qualification among radiotherapy units, and thus the homogenization in the radiotherapy remains to be strengthened in China. With the application of radiotherapy information management system, digital medicine and artificial intelligence technologies in the field of radiotherapy, the original process fails to meet the application needs of the new precise radiotherapy technology. Therefore, this process is designed based on the existing radiotherapy procedures for nasopharyngeal carcinoma in combination with the latest developments in the field of radiotherapy, aiming to establish a novel standard process recommendation, ensuring the standardization and homogenization of radiotherapy and achieve the individualized intensity-modulated radiotherapy for nasopharyngeal carcinoma patients.