The paper probed into the building and application of the evaluation system for the target responsibility system centering on nursing units, in line with recent development hospital practices. It discussed the design of the target-based quantitative assessment standards for nursing units, and the methods of target-based evaluation for nursing units, which are used in the target responsibility evaluation of 21 nursing units of the hospital. Results of the practice prove that such responsibility system raises the nursing quality and efficiency, improves nurses' incentives and cooperativeness, as well as elevates the safety and creativity of nursing and its management efficiency.

Objective This study was designed to assess whether Bushen Tongluo Fang(BSTLF),a Chinese materia medica formula,can ameliorate the hypercoagulable state in rats with membranous glomerulonephritis(MGN)induced by cationized bovine serum albumin(C-BSA)in order to gain an insight into the mechanisms responsible for its therapeutic effect.Methods Seventy-two male Sprague-Dawley rats were randomly separated into six groups:the normal control group,the MGN model group,the prednisone-plus-aspirin treatment group,and the low-,moderate-,and high-dose groups of BSTLF.The model of MGN was induced by sc(preimmunization)and iv injections of C-BSA in the latter five groups.After the development of MGN model,the decoctions of BSTLF and the prednisone-plus-aspirin solution were ig administered to the treatment groups respectively twice daily for four weeks.The rats in the model group received their drinking water as vehicle controls.Urinary albumin excretion for 24 h was measured using a rat albumin ELISA kit.The platelet aggregation was analyzed by turbidimetry.The plasma level of fibri-nogen(Fib)was determined by the von Clauss assay.Radioimmunoassay was used to examine thromboxane B2(TXB2)and 6-keto-prostaglandin F1?(6-keto-PGF1?)of the renal cortex.Results Urinary albumin excretion for 24 h,maximal platelet aggregation,plasma Fib level,and TXB2 production of renal cortex in the MGN model group were significantly higher than those in the normal control group,respectively.Compared with the MGN model group,these four measurements were decreased significantly in BSTLF-treated groups.The 6-keto-PGF1? production of renal cortex in the MGN model group was subnormal but no statistically significant differences were observed between the model group and BSTLF groups.Conclusion The results of this study suggest that the administration of BSTLF could attenuate platelet aggregability,lower plasma level of Fib and reduce thromboxane A2 production by renal cortex in the rats with MGN,so that their hypercoagulable state is corrected at least partly and glomerular microthroimbosis is prevented in several ways.These effects may contribute considerably to the mechanisms of BSTLF efficacy for chronic nephritis.

Objective To analyze risk factors of continuous renal replacement therapy (CRRT) in patients with severe serum creatinine levels elevation undergoing off-pump coronary artery bypass grafting (OPCABG).Methods The perioperative data of 45 patients with severe elevation of preoperative serum creatinine levels undergoing OPCABG were investigated based on the perioperative CABG database from Feb, 2012 to Jul, 2016.The postoperative treatment rates of CRRT were recorded and the risk factors were identified by multivariate logistic regressions.Results There were 9 patients (20%) who suffered from CRRT after OPCABG in all 45 recruitment patients.Compared with non-CRRT patients, there were higher levels of serum creatinine (Cr) and blood urea nitrogen (BUN) before surgery, a lower volume of urine during surgery, a higher level of serum creatinine at postoperative 12 hour and 24 hour, longer ICU staying time and higher in-hospital mortality after surgery in patients with CRRT (P＜0.05 or P＜0.01).Multivariate logistic regression analysis demonstrated that preoperative level of serum creatinine (OR=1.05, 95% CI 1.05-1.10, P=0.046) was the independent risk factor of postoperative CRRT in patients with severe serum creatinine levels elevation undergoing OPCABG.At the value of postoperative 12 hour serum creatinine up to 166 μmol/L, the incidence of postoperative CRRT in patients increased 5% by postoperative 12 hour serum creatinine increasing 1 μmol/L(OR=1.05, 95% CI 1.01-1.08, P=0.013).However at the value of postoperative 12 hour serum creatinine above 350 μmol/L, ceiling effect was apparent.Conclusion This study shows that 20% patients with preoperative severe serum creatinine level elevation are suffered from CRRT after OPCABG procedure and preoperative level of serum creatinine is predominant factor of postoperative CRRT.

Objective To investigate the short- and mid-term outcomes of after off-pump coronary artery bypass grafting (OPCABG) in patients with severe elevation of preoperative serum creatinine levels (SEPSC). Methods The perioperative data of SEPSC patients undergoing OPCABG were investigated based on the perioperative CABG database from Feb. 2012 to Jul. 2016. The patients were also followed up for the perioperative complication, short and medium-term survival were estimated. Results The mean age of the patients was 65.4(45-85) years. The in-hospital mortality was 4.4% and the CRRT rate was 19.6%(9 case). Survival analyses revealed a survival ratio of 100% at one year, 97.6% at two years. Short-Form Mini Nutritional Assessment was used to show that 13(28.3%) patients had malnutrition. Conclusions SEPSC patients can be candidates for OPCABG procedure. The mortality in hospital and 2-year survival rate of SEPSC patients after OPCABG procedure are both considered within an acceptable range. OPCABG may be performed in these patients with a satisfactory survival rate with the development of surgical instruments and medical treatment.

Objective To investigate the effect of angiotensin converting enzyme (ACE) genetic polymorphism on the cardiovascular response to endotracheal intubation in patients with hypertension.Methods The patients with primary hypertension,ASA Ⅱ or Ⅲ,aged 54-64 yr,weighing 50-70 kg,scheduled for elective operation under general anesthesia,were enrolled in this study.Polymerase chain reaction-restriction fragment length polymorphism was used to detect the polymorphism of ACE gene.The patients were assigned into 3 groups according to their genotypes:homozygote DD group (group DD),heterozygote ID group (group ID),and homozygote Ⅱ group (group Ⅱ).Systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart rate (HR) were recorded before and after induction of anesthesia,and at 0,1.5 and 5.0 min after intubation (T0-4).The rate-pressure product (RPP) was calculated.The cardiovascular events were recorded.Results In groups DD,ID and Ⅱ,40,39 and 40 cases were included in the analysis respectively.Compared with group ID,there was no significant difference in SBP,DBP,HR and RPP at T0-4 in group DD (P ＞ 0.05).Compared with groups DD and ID,SBP,DBP,HR and RPP were significantly deceased at T2,3,and SBP,HR and RPP were significantly deceased at T4 in group Ⅱ (P ＜ 0.05).The incidences of the myocardial ischemia during intubation and cardiovascular response to intubation were significantly lower in group C than in groups DD and ID (P ＜ 0.05).Conclusion ACE genetic polymorphism exerts an effect on the cardiovascular response to endotracheal intubation in patients with hypertension,and homozygote DD and heterozygote ID have the most influence.

Objective To evaluate the prognostic accuracy of the score of toxic epidermal necrolysis (SCORTEN) scoring system in patients with toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome (SJS).Methods Clinical data were collected from 39 patients with SJS/TEN hospitalized in Peking Union Medical College Hospital during April 1992 and March 2014,and retrospectively analyzed.Among the 39 patients,13 had died,and the other 26 patients,who were matched to the dead patients in a ratio of 2:1 for age,all had a definite diagnosis and were discharged with improved conditions.The SCORTEN scoring system was used to evaluate the 39 patients with SJS/TEN and calculate expected mortality.The expected mortality and actual mortality were compared between different groups stratified by age in the 39 patients.The receiver operating characteristic (ROC) curve was drawn to assess the prognostic accuracy of the SCORTEN scoring system.Results According to the SCORTEN scoring system,15 out of the 39 patients scored 1 point,14 scored 2 points,6 scored 3 points,and 4 scored 4 points.The total number of expected deaths was 6.808,while that of actual deaths was 13.There was no significant difference between the expected mortality and actual mortality in every SCORTEN score-based group.The area under curve (AUC) was 0.832 8,indicating a good predictive ability of the SCORTEN scoring system.Conclusion The SCORTEN scoring system can predict mortality in TEN/SJS patients at early stage.

OBJECTIVE: To assess the level of diabetes knowledge, attitude and self-management activities of the patients with type 2 diabetes mellitus (T2DM), and explore the correlation between diabetes knowledge, attitude and self-care. METHODS: Totally 200 T2DM patients finished the questionnaires, including the demographic information questionnaire, the Audit of Diabetes Knowledge (ADKnowl), the third version of Diabetes Attitude scale (DAS-3) and the Summary of Diabetes Self-Care Activities (SDSCA). RESULTS: The ADKnowl score was 68.06±10.07. The DAS-3 score was 122.60±5.66. The SDSCA score was 57.98±15.30. Education level, duration of diabetes, complications and periodic review were the influential factors for self-care behaviors. The score of self-care behaviors was positively related to diabetes knowledge (r=0.176, P<0.05) and attitude (r=0.256, P<0.01). CONCLUSION Diabetes knowledge and self-care behaviors in the vast majority of T2DM patients are at a low level. Medical staff should not only emphasize the diabetes knowledge, but also pay enough attention to the attitude of T2DM patients and improve their self-care behaviors.
China ; Diabetes Mellitus, Type 2 ; psychology ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Self Care ; statistics & numerical data ; Surveys and Questionnaires

Objective To describe common dermoscopic features of primary cutaneous amyloidosis (PCA),and to explore the application value of dermoscopy in assisting the diagnosis of PCA.Methods Seventeen patients with PCA were collected from Department of Dermatology of Peking Union Medical College Hospital between April 2014 and December 2016.A total of 45 skin lesions were subjected to dermoscopy,and their dermoscopic features were analyzed.Results The common dermoscopic features of PCA included central hubs,which could be white,brown or scar-like areas,various pigment structures and shiny white streaks.Dermoscopy showed that central hubs could be observed in all the lesions (100％),while white center hubs alone were observed in 14 (31％) lichenoid lesions,both white center hubs and scar -like areas in 5 (11％) lichenoid lesions,brown center hubs alone in 8 (18％) macular lesions,both white and brown center hubs in 6 (13％) lichenoid lesions and 17 (38％) macular lesions.All the lesions showed various pigment structures.Shiny white streaks were observed in 4 (9％) lichenoid lesions.Conclusion Dermoscopy has good application value in assisting the diagnosis of PCA.

Objective To investigate the value of neutrophil CD64 combined with monocyte chemotactic protein 1 (MCP-1),interleukin-8 (IL-8) and interferon-inducible protein-10 (IP-10) in the clinical diagnosis of neonatal sepsis.Method Cases of neonatal sepsis from March 2015 to June 2016 in the department were chosen as sepsis group.35 neonates with non-infection diseases were selected as noninfection group and 40 healthy newborn infants were assigned as control group.The level of CD64 in blood were detected by flow cytometry,while the level of MCP-1,IL-8 and IP-10 of the serum in the three groups were detected by automatic biochemical analyzer.The differences between groups were compared by single factor ANOVA.The ROC curves of sepsis diagnosed by whole blood CD64,serum MCP-1,IL-8 and IP-10 were drew.Result The level of CD64,IL-8 and IP-10 of the neonatal blood in the sepsis group were significantly higher than that in the non-infection group (P ＜ 0.05) and control group (P ＜ 0.05).There were no significant difference between the sepsis group and non-infection group in MCP-1 (P ＞ 0.05),but significantly higher than that in the control group (P ＜ 0.05).The levels of serum MCP-1 and IP-10 in the non-infection group were significantly higher than those in the control group (P ＜ 0.05),but there was no significant difference between the non-infection group and control group in CD64 and IL-8 (P ＞0.05).The optimal thresholds of blood CD64,MCP-1,IL-8 and IP-10 in the diagnosis of sepsis were 35.0 MFI,58.6 ng/L,60.3 ng/L,0.46 μg/L.The sensitivity and specificity of the diagnosis of sepsis were 92.8％ and 90.6％ in CD64,70.0％ and 42.6％ in MCP-1,78.5％ and 68.0％ in IL-8,72.8％ and 54.6％ in IP-10,97.1％ and 94.6％ when combined.Conclusion The combination test of CD64,MCP-1,IL-8 and IP-10 can improve the sensitivity and specificity of the diagnosis of sepsis.

OBJECTIVEThe interrelation of yield and agronomic traits of Gentiana rigescens was studied for the germplasm and breeding variety of this species.

METHODTwelve agronomic traits, root diameter, root length, root number, root biomass, stem diameter, plant height, the first branch number, leaf length, leaf width, leaf length/leaf width ratio, calyx length, and calyx number of G. rigescens from 26 wild populations in Yunnan were determined for correlation analysis, multiple stepwise regression analysis and path analysis.

RESULTCorrelation analysis showed that there were significantly positive correlation between the traits of aboveground part and the length, diameter, number, and biomass of the root. Multiple stepwise regression analysis showed that length, width, and number of root, plant height, the first branch number, and the calyx number were the main factors that affected the root biomass. Path analysis showed that the diameter, length, and number of the root, the stem height, and the first branch number had a direct positive effect on the root biomass.

CONCLUSIONThe traits, such as high and strong stem, high number of first branch number and shrubby shape could be selected for the breeding and high yielding of G. rigescens.