As the important content of excellent quality nursing service, the performance appraisal of nursing staff was closely interrelated to their income distribution, professional title promotion and excellence choosing. Performance appraisal was the requisite part of nursing resource management. This study gave an overview about conception and development of nursing staff′s performance appraisal and summarize key performance indicator,balanced score card,SMART principle and 360 degrees performance appraisal, which was mainly used in domestic hospital. It suggested nursing manager should have complementary advantages of them and utilize foreign mature methods to explore and improve our countries performance appraisal of nursing staff and formulate the system which was in keeping with China′s national conditions.

Objective To analyze the causes of peripherally inserted central catheter (PICC) relat-ed infections, study the types of pathogens and their drug sensitivities in order to supply evidence for clini-cal medication. Methods 110 cancer patients were analyzed for PICC related infections and blood sam-pies underwent bacterial culture. Results Of 110 cases of cancer patients, catheter-related infections were found in 11 patients (10.00%), including 9 cases of local infection (8.18%), and 2 cases of hemato-ge-nous infection (1.82%). Catheter-related infections were not associated with gender, age, types of catheter, venous selection, and the inserted length of intravenous catheter. Catheter- related infections were likely to be associated with the indwelling time of catheters. Conclusions To avoid the infections related to long-term PICC, strict aseptic operation and standardized maintaining procedures are required.

Objective To detect the incidence of inherited metabolic diseases(IMD)and disorders of metabo-lism in 4 710 high - risk infants,as well as providing basis of clinical diagnosis and treatment by using urease pretreat-ment - gas chromatography - mass spectrometry(UP - GC - MS). Methods Samples were collected from high - risk infants with IMD,after removing urea,putting in internal standard,removing protein,vacuum drying and bis (trimethyl - silyl)trifluoroacetamide / trimethyl - chlorosilane derivativing,UP - GC - MS was used to analyze compo-sitions such as organic acids,amino acids,carbohydrates,pyridoxines,purines and pyrimidines,then metabolic analysis was proceeded to refer to the normal detection value of the healthy children,finally a metabolic diagnosis was made ba-sing on the clinical data such as the high - risk clinical manifestations and general biochemical tests and other special examinations. Results In the 4 710 cases,there were 98 cases of IMD(2. 1% ),326 cases of suspected IMD(6. 9% ), 2 610 cases of metabolic disorders(55. 4% ). There were 98 cases of IMD,including 57 cases of methylmalonic aciduria,12 cases of propionic acidemia,7 cases of glutaric aciduria,5 cases of hyperphenylalaninemia,maple syrup u-rine disease and multiple carboxylase defects each,4 cases of isovaleric acidemia and 3 cases of 4 - hydroxy butyric acid urine disease. Conclusions UP - GC - MS is a effective way to diagnose IMD and metabolic disorders of infants. Common IMD in Guangdong Province include methylmalonic aciduria,propionic academia,glutaric aciduria,hyperphe-nylalaninemia,maple syrup urine disease and multiple carboxylase defects. The results of the tests can provide effective guidance for diagnosis and treatment of suspected infants.

BACKGROUND: The introduction of cyclosporin A (CsA) has greatly enhanced the early survival rate of kidney graft, but the long-term graft survival rate is still limited. Whether tacrolimus prevents chronic allograft nephropathy (CAN) and prolongs survival time is now becoming a hot spot in field of renal transplantation.OBJECTIVE: To investigate the feasibility and safety of converting CsA to tacrolimus (FK506) in preventing progression of CAN. DESIGN: Observation and controlled trial.SETTING: Department of Urological Organ Transplantation, Center of Organ Transplantation, the Second Xiangya Hospital, Central South University.PARTICIPANTS: A total of 73 patients who had received kidney transplantation at the Department of Urological Organ Transplantation, Center of Organ Transplantation, the Second Xiangya Hospital of Central South University from April 2001 to October 2005, and had been diagnosed as CAN by graft biopsy (42 male patients and 31 female patients; age ranged 19-69 years), were enrolled in the study approved by the ethics committee of this hospital after their written informed consents. CsA soft capsules (Hangzhou Zhongmei Huadong Pharmaceutical Limited Company or Huabei Pharmaceutical Limited Company); mycophenolate mofetil capsules (Shanghai Roche Pharmaceutical Limited Company); prednisone acetate tablets (Second Xiangya Hospital of Central South University); tacrolimus capsules (Fujisawa Pharmaceutical Limited Company).METHODS: Seventy-three patients voluntarily participated in CsA group (n =30) or FK506 group (n =43). The two groups were homogenous regarding patients' sex, age and general data (P > 0.05). Patients in the CsA group were continued on their initial immunosuppression protocol, which consisted of CsA, mycophenolate mofetil and prednisone acetate. In the FK506 group, CsA was stopped, and FK506 was started at a dose of 0.08-0.1 mg/(kg·d) 24 hours later, twice daily, administered 2 hours after breakfast and supper. Three days later, the blood trough concentration of FK506 was tested and adjusted to a target range of 5-8μg/L. FK506 dosage adjustment was based on the blood trough concentration, serum creatinine (SCr) and its side effects. All 73 patients were treated for 12 months. MAIN OUTCOME MEASURES: SCr, glomerular filtration rate (GFR), 24-hour urine protein excretion, serum total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL) and the toxic side effects of calcineurin inhibitors (incidences of tremor, hyperglycemia and hypertension) were monitored during a follow-up of over 12 months. RESULTS: A total of 73 patients were involved in the result analysis.①12 months after conversion, the level of SCr was statistically reduced and GFR levels were markedly elevated in the FK506 group compared with the CsA group (P < 0.01). TC, TG and LDL levels in the FK506 group were significantly lower than those in the CsA group (P < 0.01).②Compared with the CsA group, the incidence of tremor was obviously increased [30% (9/30), 5% (2/43), P < 0.01] and the incidence of hypertension was obviously decreased [56% (24/43), 83% (25/30), P < 0.05] in the FK506 group.CONCLUSION: Conversion from CsA to FK506 can postpone renal dysfunction, reduce proteinuria and improve hyperlipidemia. FK506 treatment is an effective therapy in slowing the progression of CAN.

Objective To explore the prevention and treatment strategies for the infectious renal artery rupture after renal transplantation of organ donation after citizens death (DCD).Methods The clinical data of 5 donors and their corresponding recipients with infectious renal artery rupture after renal transplantation were retrospectively analyzed with review of the literature.Results The corresponding donors of 5 recipients had the potential risk factors for donor-transmitted infection (DTI):1 case of traumatic rupture of small intestine,2 cases of digestive tract injury when resecting the donor kidney from DCD donors,1 case of severe pneumonia and 1 case of multiple renal contusion.The pathogenic microorganisms were found in the culture of kidney preservation solution,including klebsiella pneumoniae in 1 case,candida albicans in i case,enterococcus.No pathogens were detected in 1 case,and kidney preservation solution taken from the external hospital was not cultured in 1 case.The pathological examination on the resected renal grafts revealed the necrosis of the arteries and the infiltration of lymphocytes.The culture of bacteria and fungi in the removed vessel walls of renal grafts and the iliac tissues showed there were 2 cases positive for candida albicans (case 2 and case 4),1 case for cryptococcus neoformans (case 1),1 case for klebsiella pneumonia (case 5).No pathogenic bacteria were detected in 1 case,but the possibility of fungal infection was more likely.In case 1,the second kidney transplantation was performed 10 months later after artery re-transplantation,and the kidney function was normal during the follow-up period.In case 4,the second kidney transplantation was performed 2 months later after transplant nephrectomy due to the refractory rejection,the transplanted kidney experienced a rapid loss of graft function,and the blood dialysis was given continuously.The remaining 3 patients survived so far,waiting for re-transplantation.No case of bleeding occurred again in the 5 recipients.Conclusion Renal graft artery rupture is one of most severe complications after renal transplantation.It is the key for preventing infectious renal artery rupture to screen strictly infection of donors and recipients,and to use sensitive and wide coverage antimicrobial to the donors before the removal of donor kidney and during the perioperative period after renal transplantation.Early detection and operation as soon as possible is the only treatment to save the lives of the recipients.

Objective To compare the clinical efficacy of kidney transplantations from donors with acute kidney injury (AKI) and without AKI,and summarize the experience of evaluation and application.Methods The clinical data of 240 kidney transplantations from donation after citizen's death (DCD) performed in our hospital between November 2011 and March 2015 were retrospectively analyzed.The recipients were classified into AKI group (n =37) and non-AKI group (n =203) according to donors' renal function and urine output.Basic characteristics and evolution of the donors and recipients were compared between the two groups.Results The donor serum creatinine was significantly higher in the AKI group than that in the non-AKI group (P＜0.01).Most transplant recipients accepted ATG for immune induction therapy in the AKI group,while Basiliximab was given in the non-AKI group,which was significantly different (P＜0.01).Delayed graft function developed more frequently and longer in the AKI group than in the non-AKI group (P＜0.01).However,patient and graft survival rates did no differ between the AKI and non-AKI groups (P＞0.05).There was no significant difference in other indexes between the two groups (P＞0.05).Conclusion The transplants from donors with AKI showed higher incidence of delayed graft function but no effect on 1-year allograft and patient survival.This type of kidney transplantation is safe and effective.

OBJECTIVEBalloon angioplasty is an alternative to surgical repair for coarctation of the aorta in children. However, its role in the treatment of neonates and infants younger than 3 months old remains controversial. The purpose of this study was to evaluate the efficacy and safety of balloon angioplasty for native coarctation by comparing children in different age groups.

METHODThis is a retrospective clinical study including 37 children treated with balloon angioplasty for native coarctation from January 2006 to December 2012. A total of 37 patients consisting of 26 boys and 11 girls underwent the procedure, with median age 10 months (range from 7 days to 6 years) and the mean body weight was 6.3 (2.5-17.0) kg. The indication of the procedure includes discrete native coarctation without aortic arch hypoplasia and a peak-to-peak systolic pressure gradient > 20 mmHg (1 mmHg = 0.133 kPa) across aortic coarctation. During one year follow-up, the approach artery injury, recoarctation and aneurysm formation were particularly assessed.

RESULTWe classified these patients into two groups according to their age. Group A consisted of 25 patients younger than 3 months and Group B of 12 patients older than 3 months. There was no significant difference between the two groups in systolic pressure gradient before balloon angioplasty (P > 0.05). The mean peak systolic gradient decreased from (38 ± 18) mmHg to (12 ± 11) mmHg immediately after angioplasty in group A and from (47 ± 18) to (17 ± 12) mmHg in group B (P = 0.000 for both). Meanwhile, the mean diameter of the coarctation segment increased from (1.8 ± 0.7) to (3.7 ± 1.1) mm after angioplasty in group A and from (2.6 ± 1.5) to (5.5 ± 1.8) mm in group B (both P = 0). The initial successful balloon angioplasty (immediate postangioplasty peak pressure gradient < 20 mmHg) was achieved in all the 37 patients; 32 patients (86.5%) have been followed up for one year. Approach arterial complications occurred in 3 patients (9.4%), all of whom were in Group A (P = 0.537). Two patients had decreased femoral artery pulse and one required surgical repair for a postoperative pseudoaneurysm at left carotid artery. At follow-up, 8 patients (25.0%) developed recoarctation, with 6 cases in Group A and 2 in Group B. There was no significant difference between groups A and B in the recoarctation rate (P = 1.000). Among them, 7 patients underwent repeat balloon angioplasty, and all showed successful relief of coarctation, and one patient required surgical repair. Two patients (2/37, 5.4%) had small aneurysms of the descending aorta immediately after balloon angioplasty, with one patient in each group (12/25 vs.1/12, P = 0.755).Late aneurysm development has not been observed in the 17 patients who have had a follow-up CTA or MRA study.

CONCLUSIONBalloon angioplasty of discrete native coarctation is effective and safe in children both younger and older than 3 months with similar incidence of approach arterial complication, recoarctation and aneurysm formation.

Angioplasty, Balloon ; Aortic Aneurysm ; epidemiology ; Aortic Coarctation ; therapy ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Heart Septal Defects ; surgery ; Humans ; Infant ; Infant, Newborn ; Male ; Postoperative Complications ; epidemiology ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome

Objective To investigate the regulatory effect of Xuebijing injection on inflammatory reaction during the preservation of isolated empty beating pig hearts with extracorporeal membrane oxygenation. Methods Twelve healthy Guangxi Bama miniature pigs were randomly divided into the Xuebijing group (n=6) and normal saline group (n=6). After the models were established in the Xuebijing group, Xuebijing injection was given at a dose of 5 mL/h through micropump in membrane oxygenator. In the normal saline group, an equivalent amount of 0.9% sodium chloride injection was pumped. Continuous pumping was performed for 8 h in both groups. The time of cardiac resuscitation and perfusion pressure, heart rate, perfusion flow rate after 8 h preservation were recorded in two groups. Pathological and ultrastructural changes of myocardial tissues in the left ventricular wall of hearts with cardiac arrest were observed after 8 h preservation. Serum levels of myocardial injury markers and inflammatory cytokines were detected in two groups at the beginning (T0), 2 h (T2), 4 h (T4), 6 h (T6) and 8 h (T8) after model establishment, respectively. The expression levels of NOD-like receptor protein 3(NLRP3), cysteinyl aspartate specific proteinase-1(Caspase-1), apoptosis-associated speck-like protein containing a CARD(ASC) messenger RNA (mRNA) in myocardial tissues were measured at T0, T2, T4, T6 and T8, respectively. Results There were no significant differences in the time of cardiac resuscitation and perfusion pressure, heart rate, perfusion flow rate after 8 h preservation between two groups (all P>0.05). Compared with the normal saline group, the levels of lactate dehydrogenase (LDH) at T4, creatine kinase (CK), LDH and α-hydroxybutyrate dehydrogenase (α-HBDH) at T6 and T8, tumor necrosis factor (TNF)-α at T4, T6 and T8, and interleukin (IL)-6, IL-18 and IL-1β at T0, T2, T4, T6 and T8 were lower, and the mRNA relative expression levels of NLRP3 and Caspase-1 at T2, T4 and T6, and Caspase-1 and ASC at T8 were lower in the Xuebijing group, respectively (all P<0.05). Hematoxylin-eosin staining and transmission electron microscopy showed that the degree of myocardial injury in the Xuebijing group was slighter than that in the normal saline group. Conclusions Xuebijing injection may effectively mitigate inflammatory response and exert certain myocardial protection effect during the ECMO preservation of isolated empty beating pig hearts.

OBJECTIVE: To explore the effect and safety of transplantation of kidneys from HBV-positive or HCV-positive donors. METHODS: From January 2002 to June 2006, 283 kidney transplantations were performed in Second Xiangya Hospital. Altogether 57 recipients were HBV-positive, including 31 from donors with viral B hepatitis (DB + /RB +), and 26 from donors with HBV-negative (DB - /RB +). Nineteen patients with hepatitis C virus underwent a kidney transplantation, including 6 who received kidneys from anti-HCV-positive donors (DC + /RC +) and 13 from seronegative donors (DC - /RC +). Recipient's liver function, acute rejection, graft survival, and patient survival had been observed for an average follow-up of 14 months. RESULTS: No significant difference was observed between the DB + /RB + group and DB - /RB + group, or the DC + /RC + group and DC - /RC + group in the rate of liver disfunction, acute rejection, graft survival, and patient survival. CONCLUSION Kidney transplantations from HBV-positive or HCV-positive donors into the matched serology-positive recipients is safe in the short term, and the long-term results need further observation.
Adult ; Female ; Follow-Up Studies ; Graft Survival ; Hepatitis B ; prevention & control ; transmission ; Hepatitis B Antibodies ; blood ; Hepatitis C ; prevention & control ; transmission ; Hepatitis C Antibodies ; blood ; Humans ; Kidney Transplantation ; adverse effects ; immunology ; Male ; Middle Aged ; Tissue Donors ; Young Adult

Objective To analyze the distribution of microorganisms in kidney perfusion fluid and perirenal drainage of the renal allografts,and provide evidence to guide clinical practice.Methods The clinical data from the kidney donors and the recipients,the microbiologic culture results of kidney perfusion fluid and perirenal drainage were retrospectively analyzed.Results Ninety-one kidney perfusion fluid samples and 91 perirenal drainage samples were collected from 61 individual renal allografts,and 48 renal allografts were paired.Fourteen (15.4％,14/91) cultured kidney perfusion fluid samples were positive,17 strains were confirmed including 13 strains of bacteria and 4 strains of fungal,and 9 (69.2％,9/13) of bacterial strains were multidrug-resistance with 7 strains resistant to carbapenems,but there was no significant heterogeneity in the outcome of recipients with positive or negative culture results of kidney perfusion fluid samples.Eight (8.8％,8/91) perirenal drainage samples from different recipients were positive,5 of 8 bacterial strains were multidrug-resistance and 3 of them were resistant to carbapenems including meropenem or imipenern.There was no significant correlation between the length of donors' hospital stay and the culture results (P＞0.05),and there was also no significant correlation between the length of recipients' hospital stay after transplantation and the culture results (P＞0.05).Conclusion The kidney with positive perfusion fluid microbiologic culture can be transplanted safely using the prophylaxis or preemptive anti-infection therapy.