Objective To explore the management of nursing adverse events based on JCI evaluation criteria, and to establish a voluntary, non-punitive nursing adverse event reporting system.Methods From January 2014 to December 2015, 680 hospital nurses implemented JCI standards, revision of nursing adverse events management system, created online of nursing adverse events reporting system, to all nursing staff of adverse event management knowledge training and improvement before the analysis of the implementation of the JCI standard, adverse event reporting process and treatment measures of awareness, took the initiative to report rate, nursing adverse events incidence, patient satisfaction rate.Results Before and after nursing staff of adverse event reporting procedure and disposal method of awareness to improve the rate of 39.43% implementation, nursing staff to take the initiative to report to enhance the rate of 7.54%,the incidence of nursing adverse events to reduce the rate of 0.07%,the patients' satisfaction rate increased by 6.15%,there were statistically significant differences(x2=13.50,10.15,12.09,231.51,all P<0.05).Conclusion Nursing adverse events management constructed based on JCI accreditation standards is helpful to avoid the occurrence of nursing adverse events, to improve the rate of patients' satisfaction to nursing, to create a secure hospital atmosphere.

Objective: To explore the effect of calcium channel blocker (CCB) treatment in patients of idiopathic pulmonary arterial hypertension (IPAH) with positive acute pulmonary vasodilator test, and to compare the hemodynamic differences between the positive and negative patients.
Methods: A total of 156 consecutive IPAH patients with acute pulmonary vasodilator test were studied. The patients were divided into 2 groups according to the testing result. Positive group, n=23 and Negative group, n=133. The positive patients were followed up by clinical or telephone visit to investigate their CCB dose, WHO PAH cardiac classiifcation and the survival conditions. Kaplan-meier curve was conducted to analyze the living condition and t test was used to compare the hemodynamic differences between the positive and negative patients.
Results: There were 43 male and 113 female patients at the male/female ratio of 1: 2.6, and 14.7% (23/156) positive patients. The average follow-up period for Positive group was (50.9 ± 3.8) months. There were 13 patients using diltiazem with the mean dose of (277 ± 108) mg/d at the range of (90-450) mg/d; 3 patients using amlodipine, 1 with the dose of 15mg/d and 2 with the dose of 7.5mg/d. The 1, 2 and 3 years survival rate for the positive patients were for 91.3%, 86.6% and 79.7% respectively. The mean pulmonary arterial pressure and pulmonary vascular resistance were lower, P=0.000, while the mixed venous oxygen saturation was higher in Positive group than Negative group, P=0.009.The NT-pro BNP level was lower in Positive group, P=0.001.
Conclusion: IPAH patients has lower ratio of positive acute pulmonary vasodilator test. The positive patients has the higher 1, 3 and 5 years survival rate and better hemodynamic parameters as the mean pulmonary arterial pressure, pulmonary vascular resistance and better level of NT-pro BNP.

Objective To explore the distribution of common gene types of thalassemia in Yangjiang, Guangdong, so as to provide a theoretical basis for clinical diagnosis, prevention and treatment. Methods A total of 9, 277 cases were collected from the Department of gynaecologic outpatient, antenatal clinic, outpatient department of Pediatrics and children's health care department from April 2015 to April 2017. PCR + conduction hybridization was used to detect alpha thalassemia and beta thalassemia. Results In 9 277 cases, the detection of α thalassemia in 1 711 cases, accounting for 18. 44％(1 711/9 277); detection of thalassemia in 671 cases, accounting for 7. 24％ (671/9 277), there are 3 kinds of β thalassemia homozygote, α thalassemia and β thalassemia with 100 cases, accounting for 1. 08％ (100/9 277), which detected 16 α thalassemia gene type 14 β thalassemia gene type. Conclusion Guangdong Yangjiang area of αthalassemia by ～(--SEA)/αα and β thalassemia major in β～(CD41-42)/βN and β～(654)/β～N, β～(-28)/β～N, α and β thalassemia gene type compound less investigation for diagnosis, treatment and prevention of thalassemia has important significance, is worth promoting in clinical.

Objective To evaluate the anatomical factor and risk assessment of right internal jugular vein (IJV) puncture-related damage to the vertebral artery (VA) at different neck planes in pediatric patients.Methods Two hundred and ten pediatric patients of both sexes,aged 6 months-10 yr,with body mass index less than 28 kg/m2,undergoing elective surgery,were enrolled in this study.At the cricoid cartilage plane,supraclavicular area plane and intermediate plane,the right IJVs and VAs were examined using ultrasound.The VA position relative to the IJV,diameters of IJVs and VAs (the diameter ratio of VAs to IJVs was calculated),extent of overlap between IJVs and VAs,and horizontal and vertical distance from VAs to IJVs were recorded,and the risk coefficient of accidental VA puncture was calculated.Results Ninety-seven percent of VAs lay deep and lateral to right IJVs.There was no significant difference in each parameter of VA position relative to IJVs between the three planes (P＞0.05).The diameter ratio of VAs to IJVs was decreased with the decreasing neck plane,the horizontal and vertical distance from VAs to IJVs was significantly shortened,the overlapping rate between VAs and IJVs was increased,and the risk coefficient of accidental VA puncture was increased (P＜0.05 or 0.01).The vertical distance from VAs to IJVs was not correlated with age,body weight or height (P＞0.05).The risk coefficient of VA damage was not correlated with age,body weight or height at the cricoid cartilage plane and intermediate plane (P ＞ 0.05).The risk coefficient of VA damage was positively correlated with the weight of pediatric patients at the supraclavicular area plane (P＜0.05,r=0.215).Conclusion Right VAs come nearer IJVs with the decreasing neck plane;the risk of VA damage increases gradually with the lowering of neck planes in pediatric patients.

Objective    To explore the association between preoperative, perioperative parameters, especially estimated glomerular filtration rate (eGFR) and postoperative atrial fibrillation (POAF) after modified extended Morrow procedure. Methods    A total of 300 hypertrophic obstructive cardiomyopathy (HOCM) patients who underwent modified extended Morrow procedure in our hospital from January 2012 to March 2018 were collected. There were 197 (65.67%) males and 103 (34.33%) females with an average age of 43.54±13.81 years. Heart rhythm was continuously monitored during hospitalization. The patients were divided into a POAF group (n=68) and a non-POAF group (n=232). The general data, perioperative parameters and echocardiographic results were collected by consulting medical records for statistical analysis. Univariate and multivariate logistic regression models were used to analyze the risk factors for POAF. Results    Overall incidence of POAF during hospitalization was 22.67% (68/300). Compared with patients without POAF, patients with POAF were older, had higher incidence of chest pain and syncope, lower level of preoperative eGFR, higher body mass index and heart function classification (NYHA), larger preoperative left atrial diameter and left ventricular end diastolic diameter, and longer ventilator-assisted time, ICU stay and postoperative hospital stay. Age, heart function classification (NYHA)≥Ⅲ, hypertension, syncope history and eGFR were independent risk factors for POAF. Receiver operating characteristic curve analysis showed that the area under the curve of eGFR was 0.731 (95%CI 0.677-0.780, P<0.001), and the sensitivity and specificity were 82.4% and 57.8%, respectively. Conclusion    Increased age, high preoperative heart function classification (NYHA), hypertension, preoperative syncope history and decreased eGFR are independent risk factors for POAF in HOCM patients who underwent surgical septal myectomy. Preoperative decreased eGFR can moderately predict the occurrence of POAF after modified extended Morrow procedure.