Objective To know the effects of using performance assessment of nursing, and then summarize certain proper methods to control the quality of nursing. Methods Set up proper indexes of nursing performance assessment, building associated quality control system and standard, and then using them in the clinical nursing. Compared the effects of using performance assessment of nursing by the in-dexes such as nuring quality of hospital, nursing quality of department and head nurses' management mea-sures. Results The quality of nursing had significant better than before after using the performance as-sessment. There was a positive tendency of nursing quality from 2004 to 2008. Conclusions Performance assessment can effective promote the working efficacy, ameliate quality of nursing, fit the nursing targets, in-crease the nursing management efficacy and patients' satisfactory, and then increase the nursing quality in all the aspects, which is a kind of scientific management model.

Heart failure (HF) is a complex clinical syndrome, which is caused by cardiac structural abnormalities and dysfunction. It can lead to ventricular filling and impaired ejection capacity with high incidence and mortality . The constant activation of the rennin-angiotensin-aldosterone system (RAAS) plays an important role in the development of heart failure. Angiotensin angiotensin converting enzyme inhibitor (ACEI), angiotensin angiotensin receptor antagonist (ARB) and aldoste?rone receptor antagonist (MRA) had been confirmed to be with good therapeutic effects therefore played important roles in heart failure treatment strategy shown by large scale clinical trials. The first PARADIM-HF data published by European So?ciety of Cardiology in annual meeting on August 30, 2014 showed that LCZ696 can reduce cardiovascular mortality risk of HF patient by 20%when combining with beta blockers and MRA . It also reduced the number of hospitalizations of patients with chronic heart failure (CHF) by 21%. LCZ696, using its unique dual phase mode verified that the regulation of neuroen?docrine is the modern concept for the treatment of heart failure. LCZ696 lead to innovation and shed new light in traditional drug treatment for heart failure.

Objective To investigate the clinical prognostic value of neutrophils to lymphocyte ratio(NLR)in patients with ST-segment elevation myocardial infarction(STIMI)who underwent percutaneous coronary intervention(PCI). Meth?ods A total of 326 patients with acute ST segment elevation myocardial infarction were enrolled. According to the neutro?phils to lymphocyte ratio, patients were divided into group T1(≤3.46), group T2(3.47-6.75)and group T3(>6.75). Basic clinical data,laboratory indexes,coronary angiography results, TIMI grading and left ventricular ejection fraction(LVEF) were collected in all groups. Incidence of adverse events in hospital such as acute heart failure, thrombosis, ventricular tachy?cardia and ventricular fibrillation, atrial fibrillation, atrioventricular block and cardiogenic shock, were recorded. Major ad?verse cardiac events(MACE), death of all causes, non-fatal MI, ischemic stroke and readmission due to heart failure at the 6-month follow-up were also noted. Results The incidence of heart failure, atrial fibrillation, ventricular tachycardia/ven?tricular fibrillation and cardiogenic shock was higher in group T3 than those in the other two groups(P < 0.05).The inci?dence of multivessel coronary artery disease was significantly higher in group T3 than that in group T1 (54.1% vs 37.0%, P<0.05). The percentage of TIMI grade 3 in post-operative infracted artery was significantly lower than that in group T1 (83.5%vs 94.4%). Left ventricular ejection fraction was significantly lower in group T3 than that of group T1 during hospital?ization (0.48 ± 0.10 vs 0.52 ± 0.10). There was no significant difference in the incidences of death, non-fatal MI, ischemic stroke at 6 month follow up. But the rate of readmission due to heart failure was significantly higher in group T3 than that in the group T1(P<0.05). Conclusion Neutrophils to lymphocyte ratio may be a useful marker to predict the prognosis of pa?tients with heart failure due to acute myocardial infarction.

Objective To investigate the role of COOH-terminus tensin like molecule (CTEN) in epithelial-mesenchymal transformation of gastric cancer and its prognostic factors.Methods The expressions of CTEN,E-cadherin and Vimentin in 220 patients with gastric cancer were detected by immunohistochemical staining.Results The positive expression rate of CTEN was 61.8％ (136/220) in gastric cancer specimens,higher than 15％ (3/20) in adjacent tissues (x2 =16.488,P ＜0.01);the positive expression rate of E-cadherin in gastric cancer specimens was 25.5％ (56/220),lower than 85％ (17/20) in adjacent tissues (x2 =30.713,P ＜0.01);and the positive expression rate of Vimentin in gastric cancer specimens was 35.0％ (77/220),higher than 10％ (2/20) in adjacent tissues.There was no significant difference in the expression of CTEN between different genders,ages,size of tumors and histopathological types (P ＞ 0.05).In different infiltration depth,the CTEN expression difference were statistically significant (x2 =54.058,P ＜0.01),CTEN expression rate in lymph node metastasis group was obviously higher than without lymph node metastasis group (x2 =15.989,P ＜0.01),and CTEN expression rate in distant metastasis group was obviously higher than without distant metastasis group (x2 =4.143,P ＜0.01).CTEN and E-cadherin expression in gastric cancer tissue showed a negative correlation (r =0.357,P ＜ 0.01),while CTEN and Vimentin expression were positively correlated (r =0.498,P ＜0.01).220 cases of patients with gastric cancer received follow-up.Median survival time of CTEN negative express group was 48.2 months (95％ confidence interal,44.0-52.5 months),69.0％ for the 5-year cumulative survival rate.The survival analysis showed median survival time of CTEN positive expression group was 41.8 months (95％ confidence interal,38.3-45.3 months),48.5 ％ for the 5-year cumulative survival rate,which were lower than that in negative group (x2 =4.884,P ＜ 0.05).Multifactor analysis showed CTEN expression,lymph node metastasis and distant metastasis were independent risk factors for the prognosis of gastric cancer patients (P ＜ 0.05).Conclusions CTEN was positively correlated with gastric cancer invasion and metastasis,and played an important role in gastric cancer epithelial mesenchymal transformation.CTEN is independent risk factor for prognosis of gastric cancer,detection of CTEN gene mutation has important significance to evaluate the treatment and prognosis of gastric cancer.

Objective To evaluate the present development and status of quality control for intensive care unit (ICU) in Sichuan Provincial traditional Chinese medicine (TCM) hospitals including integrated traditional Chinese and western medicine hospitals and ethnic hospitals, and to provide practical references for improving the service quality of ICU. Methods Supervisory Group of Sichuan Provincial Critical Care Medicine Quality Control Center of TCM was established in September 2018. From September 8th to 17th, 2018, according to the Scoring Criteria of Quality Control and Supervision Project of TCM for Critical Care Medicine, a 10-day quality control professional guidance was hand out to TCM hospitals with independent ICU in Sichuan Province. The service level of different aspects of hospital quality control was evaluated and ranked from equipment and resource support, medical team, service capacity and level, ward quality, completion of critical care core indicators, completion of quality control of TCM, development of new technologies, diagnosis and treatment schemes for dominant diseases. Results There were 52 TCM hospitals across the province that had an ICU. Thirty-three hospitals were third-class (63.5%), while the rest 19 hospitals were second-class (36.5%). Province-level, city-level and county-level hospitals were accounted for 9.6% (5/52), 38.5% (20/52), and 51.9% (27/52), respectively. Average bed ratio of ICU was 1.8%. Doctor-bed and guard-bed ratios were 0.71∶1 and 2.0∶1, respectively. The average annual admission rate of patients and the average daily admission rate of beds were higher, which were basically 1%. Ward quality was high; the incidence of nosocomial infection was controlled below 10%. Compliance rate of septic shock bundle treatment was high. The incidences of ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI) and catheter-associated urinary tract infection (CAUTI) were 0.45%, 0.22%, and 0.30%, respectively. Participation rate of TCM was about 83.4%. Average number of new technologies was about 4.4. Average number of disease schemes was about 2.62. Conclusions ICU of Sichuan Provincial TCM hospitals reaches the standard level in service capacity and level, ward quality, critical medicine quality control, and participation rate of TCM treatment. Improvements are required for other prospects, including department scale, medical personnel allocation, new technical development, diagnosis and treatment schemes of dominant diseases.

Extracellular vesicles (EVs) have recently received much attention about the application of drug carriers due to their desirable properties such as nano-size, biocompatibility, and high stability. Herein, we demonstrate orange-derived extracellular vesicles (OEV) nanodrugs (DN@OEV) by modifying cRGD-targeted doxorubicin (DOX) nanoparticles (DN) onto the surface of OEV, enabling significantly enhancing tumor accumulation and penetration, thereby efficiently inhibiting the growth of ovarian cancer. The obtained DN@OEV enabled to inducement of greater transcytosis capability in ovarian cancer cells, which presented the average above 10-fold transcytosis effect compared with individual DN. It was found that DN@OEV could trigger receptor-mediated endocytosis to promote early endosome/recycling endosomes pathway for exocytosis and simultaneously reduce degradation in the early endosomes-late endosomes-lysosome pathway, thereby inducing the enhanced transcytosis. In particular, the zombie mouse model bearing orthotopic ovarian cancer further validated DN@OEV presented high accumulation and penetration in tumor tissue by the transcytosis process. Our study indicated the strategy in enhancing transcytosis has significant implications for improving the therapeutic efficacy of the drug delivery system.