Objective:To investigate the clinical value of detection of fetal umbilical artery and middle cerebral artery blood flow by ultrasound in predicting the pregnancy outcome among births affected by velamentous umbilical cord insertion.Methods:Ninety pregnant women who undergo regular prenatal examination and delivered births with velamentous insertion of the umbilical cord from April 2017 to April 2020 in Quzhou Maternal and Child Health Hospital were included in this study. All patients were examined by transabdominal color Doppler ultrasound in the second trimester of pregnancy. The resistance index (RI) and systolic/diastolic flow velocity ratio (S/D) of fetal umbilical cord and middle cerebral artery were recorded and compared between pregnancy outcomes. The RI and S/D of umbilical cord and middle cerebral artery of births affected by velamentous umbilical cord insertion were correlated with adverse pregnancy outcome.Results:The RI and S/D of umbilical cord in births affected by adverse pregnancy outcome were higher than those in births not affected by adverse pregnancy outcome [ RI: (0.72 ± 0.08) vs. (0.63 ± 0.05); S/D: (3.08 ± 0.46) vs. (2.59 ± 0.35)]. The RI and S/D of middle cerebral artery in births affected by adverse pregnancy outcome were lower than those in births not affected by adverse pregnancy outcome [RI: (0.55 ± 0.06) vs. (0.79 ± 0.09); SD: (3.41 ± 0.37) vs. (5.26 ± 0.61)]. The differences were statistically significant ( t = 8.327-15.429, P = 0.000-0.000 < 0.05). RI and S/D of umbilical cord in births affected by velamentous insertion of the umbilical cord were positively correlated with adverse pregnancy outcome ( r = 0.779, 0.883, P = 0.004, < 0.05). RI and S/D of middle cerebral artery in births affected by velamentous umbilical cord insertion were negatively correlated with adverse pregnancy outcome ( r = -0.752, -0.847, P = 0.007, < 0.05). Conclusion:Detection of RI and S/D of umbilical cord and middle cerebral artery by color Doppler ultrasound in the second trimester of pregnancy is of certain clinical value in predicting the pregnancy outcome among births affected by velamentous umbilical cord insertion. This should be paid more attention in department of obstetrics and gynecology.

Objective To explore the clinical value of application research in business process reengineering in transferring of inpatients for check-up. Methods We reorganized transferring of inpatients for check-up and service tache by introducing the Systematic Redesign method from the therory of Business Process Reengineering. The reengineered process was adopted and applied in the transferring processes. We randomly selected patients for check-up(126 cases for electrocardiogram,130 cases for Xrayand 128 cases for CT examination)and investigated the time cost for check-up and patients satisfaction rate. The above results were compared with those patients(112 cases for electrocardiogram,112 cases for Xrayand 120 cases for CT examination)before use of reengineered process. Results The time cost for the above mentioned check-up was shorter and patients satisfaction rate were alleviated compared with those before use of reengineered process(U=14.55,12.26,13.57;x2=17.37,14.65,10.75,P＜0.01).Conclusion Application of business process reengineering in the transferring process of inpatients for check-up proved pivotal important in that it could shorten time cost for transferring process and improve patients satisfaction rate.It possessed realistic significance for increasing benefit and competitions for hospitals.

Objective To study the psychological nursing on the rehabilitation effect of patients with acute coronary syndrome(ACS)accompanied by depression.Methods 126 ACS patients were divided into the nursing group(64 cases)and the control group(62 cases)randomly.The control group adopted roUtine rehabilitative nursing measurs.While the nursing group received canonical and selective psychological nursing.The Zung Self-rating Depression Scale(SDS)and hamilton depression scale(HAMD)were used to evaluate the their psychological status.The electrocardiogram,clinical symptom and cardiovascular complications were observed and compared.Results The SDS and HAMD scores were different between the nursing group and the control group(P＜0.01)5 weeks after rehabilitative nursing but not before it.The ischemic changes of electrocardiogram,incidence frequency of angina pectoris and cardiovascular complications were significantly decreased in the nursing group compared with the control group(P＜0.05).Conclusion Psychological nursing could not only alleviate the depression of patients with ACS but also could improve the clinical symptoms of these patients and decrease the incidence frequency of cardiovascular events.

Objective To explore the prevalence and related factors of post-traumatic stress disorder (FTSD) among nurses who took part in rescue of 5.12 Wenchuan earthquake after two years.Methods The PTSD Checklist-Civilian Version (PCL-C) was used to diagnose PTSD among nurses from Mianzhu,one of the city where the earthquake happened.Results Totally 223 subjects finished the evaluation.The incidence rate of PTSD among the nurses was 1.7％(PCL-C＞50),and 8.2％ people had different degree of post-traumatic stress disorder.Comparing the three symptom clusters,hyper-arousal was the most prominent one.Different age,professional position,marriage,health condition significantly influenced the prevalence of PTSD.The risk factors of PTSD was bad health condition and being divorced or widowed.Conclusions The nurses still showed some symptoms of PTSD two years after the earthquake,individualized psychological intervention should be applied to them.

Objective To detect the levels of high mobility group box 1 protein HMGB1),tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6),C-reactive protein (CRP) in order to explore the clinical significance of HMGB1 in patients with severely traumatic brain injury.Methods A total of 75 patients composed of 40 male and 35 female with severely traumatic brain injury were hospitalized from March 2011 through March 2012.The scores of Glasgow Coma Scale (GCS) were 5-8 within 12 hours after brain injury.Casualties with history of hypertension,diabetes,severe diseases of heart,liver and kidney,and with concurrent trauma of other parts of body were excluded.Another 50 healthy subjects were enrolled as controls.Serum samples were taken from both patients and controls at admission.The levels of HMGB1,TNF-α and IL-6 were measured by using enzyme-linked immunosorbent assay (ELISA).The level of CRP was measured by using automatic biochemistry analyzer.Comparisons of the levels of HMGB1,TNF-α,IL-6and CRP between casuahies and healthy controls were carried out.The correlations of HMGB1 with TNF-α,IL-6,CRP in patients with severe traumatic brain injury were analyzed.Thereafter,75 patients were divided into two groups post hoc:the death group and the survival group.On the 1st day,the 3rd day and the 7th day after trauma,serum HMGB1 was detected.The comparison of HMGB1 was made between death group and survival group by using t-test.Results Serum HMGB1 level in the traumatic patients was higher than that of healthy controls (P ＜ 0.01).Correlative analysis showed that there was a positive correlation between HMGB1 and TNF-α (r =0.365,P＜0.05),IL-6 (r=0.530,P＜0.05),CRP (r=0.661,P＜0.05) in patients with severe traumatic brain injury.Serum HMGB1 level in the death group was higher than the survival group (P ＜ 0.01).Conclusions Increased serum HMGB1 level was found after severe traumatic brain injury.There were positive correlations between HMGB1 and three inflammatory factors,TNF-α,IL-6and CRP.Serum HMGB1 should be used as reliable hiomarker to judge the prognosis of patients with severe traumatic brain injury.

Purpose To study the hemodynamic changes of kidney interlobar artery in children with type 1 diabetes, and to explore the clinical value of the color Doppler ultrasound in diabetic nephropathy during the incubation period. Materials and Methods The study was performed in 52 children with type 1 diabetes and in 51 age-matched healthy children as control group. The resistance index (RI) of interlobar artery was measured with color Doppler ultrasonography, and the clinical data and laboratory indicators were analyzed. Results The left kidney RI, right kidney RI and average RI were all significantly higher in children with diabetes than in age-matched healthy group (P<0.01). The mean RI were correlated positively with (HbA1c) (r=0.96, P<0.01) and diabetes duration (r=0.31, P<0.01), respectively. Fasting blood glucose, glycated hemoglobin, and glomerular filtration rate were significantly higher in children with diabetes than in age-matched healthy group (P<0.01). Conclusion The RI of interlobar artery increases in children with type 1 diabetes. Early changes of renal hemodynamics in children with type 1 diabetes are detectable with Doppler sonography, and have certain value in early diagnosis of diabetic nephropathy.

Objective To observe blood gas analysis of internal carotid artery and internal jugular vein to calculate the cerebral extraction of oxygen, and to investigate the relationship between oxyhemoglobin in internal jugular vein, cerebral extraction of oxygen, and the prognosis of patients with head injury. Method Seventy patients with acute severe head injury in ICU of Taizhou People Hospital were studied, and another 80 patients with mild head injury were enrolled as controls. Twenty-four hours after first aid such as keeping airway open and circulatory and ventilation support, and emergency craniotomy, the blood samples from internal carotid artery and internal jugular vein were collected for blood gas analysis including SaO2, PaO2, SjvO2, PJVO2 > PaCO2, PJVCO2, SaO2-SjvO2, Pa-jvCCO2, CaO2-CjvO2 and Ca-jvO2/CaCO2 (CEO2, cerebral oxygen extraction). Results There were significant differences in SjvO2, PjvO2, Sa-jvO2, Pa-jvO2 Ca-jvO2 and CEO2 between two groups. Conclusions The SjvO2 and CEO2 represent the cerebral oxygen uptake and oxygen consumption precisely, and they can be used to predict the outcome of patients with severe craniocerebral trauma commendabiy.

Objective To evaluate the clinical curative effect of traditional Chinese medical massage for the treatment of congenital muscular torticollis in the infants with real-time tissue elastography technology, and to explore the clinical application value of real-time tissue elastography. Methods A retrospective analysis was carried out in 120 infants with clinical diagnosis of congenital muscular torticollis. All of the infants were treated with traditional Chinese medical massage once a day, 10 times for a course of treatment, and the treatment lasted 18 courses. The differences of image of the injured sternomastoid muscle were observed before and after treatment by real-time tissue elastography. Results Before massage therapy, the differences between the image scores of injured sternomastoid muscle and those of the healthy sternomastoid muscle were significant ( P<0.01), and the sensitivity of real-time tissue elastography for the diagnosis of congenital muscular torticollis was 93.3% . After massage therapy, the mass of injured sternomastoid muscle was reduced, and the myogenic torticollis was improved, the image scores of injured sternomastoid muscle were similar to those of the healthy sternomastoid muscle ( P>0.05) . The differences of the image scores of injured sternomastoid muscle were sternomastoid muscle ( P> 0.05) . The differences of the image scores of injured sternomastoid muscle were significant before and after therapy ( P<0.01) Conclusion Traditional Chinese medical massage has certain therapeutic effect for the treatment of congenital muscular torticollis in the infants, and real-time tissue elastography technology can reflect the changes of muscle tissue directly and noninvasively, which will provide objective basis for the clinical diagnosis and treatment of congenital muscular torticollis in the infants.

Objective To design a questionnaire to explore nursing care behavior demand from patients'vision, and verify its reliability and validity. Methods The nursing care behavior index entry pool were summed up through literature analysis and discussion, and then a questionnaire containing 40 items was designed through per-investigation. A total of 150 patients from 30 departments in general hospital of Shenyang military region were selected for questionnaire survey using the convenience sampling method. The SPSS 19.0 was used to test the reliability and validity. Results Totally 149 effective questionnaires were recycled. Finally the questionnaires contained 6 dimensions and 35 items. Six factors were extracted with exploratory factor analysis, which explained 57.976% variance respectively. Total questionnaire Cronbach alpha coefficient was 0.892, the dimension Cronbach alpha coefficient was 0.747-0.914; Total remeasuring reliability was 0.824, the remeasuring reliability was 0.733-0.867. Binary validity was 0.806, binary coefficient was 0.748-0.872. Conclusions This study scientifically and reliably built a nursing care behavior demand questionnaire from patients′vision, which can be used to survey patients′satisfaction on nursing humanities.