Objective To assess the cost-benefit of exchange transfusion(ET ) in the treatment of different severity of acute bili-rubin encephalopathy(ABE) .Methods Retrospective analysis was carried out on the clinical data of 137 ABE from January 2009 to December 2010 .The enrolled neonates were divided into four groups by ABE severity and interventions :40 neonates in Group SE (Subtle ABE with ET ) ,29 in Group SNE (Subtle ABE without ET ) ,49 in Group ME (Moderate to advanced ABE with ET ) ,and 19 in Group MNE (Moderate to advanced ABE without ET ) .Results The Total Serum Bilirubin (TSB) levels ,the ratio of TSB and plasma albumin (B/A) ,the proportion of neonatal hemolysis disease and the hospitalization costs per capita in Group SE were significantly higher than those in Group SNE (P<0 .05) .Without death in subtle ABE ,the rate of poor outcomes in Group SE , 15 .0% was similar to that of Group SNE ,13 .8% .The maximum benefit-cost ratio of Group SE and Group SNE was 87 .5 and 121 .5 ,respectively .The TSB levels ,B/A ,the proportion of neonatal hemolysis disease and the hospitalization costs per capita in Group ME significantly higher those in Group MNE (P<0 .05) .5 neonates died in moderate to advanced ABE ,and the incidence of poor outcomes in Group ME ,32 .7% was 2 .1 times to that of Group MNE ,15 .8% .The maximum benefit-cost ratio of Group ME and Group MNE was 89 .8 and 160 .0 ,respectively .The TSB levels and B/A in Group ME significantly higher those in Group SE (P<0 .05) ,the incidence of poor outcomes in Group ME was 2 .2 times to that of Group SE ,whereas the hospitalization costs per capita in Group ME were similar to those in Group SE (P>0 .05) .Morbidity of the severe adverse events associated with ET in Group ME ,12 .2% was 2 .4 times to that of Group SE ,5 .0% .Conclusion ET is worth of the first-line approach rescuing subtle ABE .However ,ET is needed to be weighted the advantages and disadvantages before performed on moderate or advanced ABE .It is necessary to implement phototherapy among neonates with pathologic jaundice ,which is crucial for diminishing mortality and mor-bidity of ABE and lowering medical resource consumption .

Objective To establish a quality indicator system of nursing services for patients with urodynamics. Methods Delphi method was used in the study, and the quality indicator system of nursing services for patients was based on two rounds of consultation among 16 experts. Results The quality indicator system of nursing services for patients with urodynamics consisted of 3 first-level indicators, 8 second-level indicators and 29 third-level indicators. Experts had the same opinions on the indicators. Conclusions Nursing behavior for patients with urodynamics could be standardized based on the quality indicator system, and therefore guide nursing work and improve nursing quality. Further theoretical and empirical study is needed to verify the quality indicator system.

Portal vein thrombosis (PVT) is one of the most common complications of liver cirrhosis. Due to coagulation disorder and the risk of bleeding in liver cirrhosis, there are many controversies over the treatment of liver cirrhosis with PVT in clinical practice. Common therapies for PVT include anticoagulant therapy, intervention, and thrombolysis. This article elaborates on the current status of the treatment of liver cirrhosis with PVT, in order to provide help for the development of standard and reasonable clinical treatment strategies.

Objective To construct a self management program for patients with ureteral stoma, then validate the proposal. Methods The expert consensus reached an agreement after 2 rounds of Delphi expert consultation of "self management programme", according with the contents of the manual requirements,the intervention patients(41 cases)were given these self management interventions:regular one-on-one ostomy skills training, mental support and motivational interview, recording stoma diary, the control patients were given routine nursing interventions,after 1,3 and 6 months of implementation,their results of self management was evaluated. Results The total score of self-management ability was 99.32±10.41,105.34±13.75,109.18±10.91 in the control group after the intervention of 1,3 and 6 months respectively,and 106.73 ± 13.82,117.65 ± 15.47,129.43 ± 12.37 in the test group,the differences were statistically significant (t=7.847, 9.318, 11.416, P<0.01). The total score of quality of life was 167.18 ± 24.62, 173.36 ± 25.33, 179.48 ± 22.17 in the control group after the intervention of 1, 3 and 6 months respectively,and 178.66 ± 23.47,185.41 ± 22.67,213.17 ± 26.75 in the test group,the differences were statistically significant (t=6.839, 10.241, 13.926, P<0.01). Conclusions The construction of the ureterostomy self-management program, enhance patients'self-management consciousness, and improve the ability of self-management.

Objective To establish a scientific and reasonable evaluation index system of nursing quality for cystoscopy. Methods After 2 rounds of Delphi survey technique, get the consensus of the evaluation indicators of the initial evaluation of the 18 experts,and ultimately build a system for nursing quality evaluation index during cystoscopy. Results After 2 rounds of expert consultation, the evaluation index system based on the three level structure of the medical quality framework includes:3 first-level indicators,8 second-level indicators,33 third-level indicators. Conclusions The evaluation index system established in this study is helpful to standardize the nursing behaviors of nurses in the examination process,improve the quality of nursing service in the process of cystoscopy, and improve the accuracy and reliability of inspection.

Objective:To explore the feelings and experiences of female patients with stress urinary incontinence during preoperative self-readiness.Methods:This is a qualitative research. From September to December 2021, a total of 12 female patients with stress urinary incontinence who underwent elective surgery in the Urology Surgery of the First Affiliated Hospital of Zhengzhou University were selected by objective sampling, and semi-structured interviews were conducted. The interview data were sorted and analyzed through Braun's six-step thematic analysis.Results:A total of four themes were extracted including lack of surgical knowledge, high expectation of surgical outcome, heavy psychological burden of surgery, and high demand for external support. The lack of surgical knowledge included three sub-themes, namely, the lack of understanding of informed consent of surgery, the passive acceptance of informed consent information of surgery, and the bias of surgical information recall. The high expectation of surgical outcome included three sub-themes, namely, complete cure of urinary leakage, unrestricted physical and social activities, and getting rid of the negative emotion of "social cancer". The heavy psychological burden of surgery included two sub-themes, namely, concerns about the effects and complications of surgery and the tension of public health events. The high demand for external support included three sub-themes, namely, the need for emotional communication with medical and nursing staff, the need for experience sharing with patients, and the need for emotional support from family members and friends.Conclusions:Medical and nursing staff should pay attention to improving the surgical knowledge of female patients with stress urinary incontinence, respect their autonomy of informed consent, correctly guide patients to establish surgical expectations, and provide them with multi-dimensional emotional support, so as to promote the improvement of patients' preoperative readiness.

Objective To study the risk factors of severe complications possibly associated with exchange transfusion (ET) for patients with extreme hyperbilirubinemia.Method From May 2001 to May 2018,neonates with severe complications of ET were assigned into adverse event group.The propensity score principle was used to match adverse event group/the control group with the ratio of 1 ∶ 3.The neonates in the control group received ET without any severe complications.The demographic characteristics of patients,and other clinical data were reviewed.The Logistic regression analysis was used to determine the risk factors of severe complications of ET.Result Among the 1 535 neonates who received ET during the past 17 years,71 neonates (4.6％) were identified with severe adverse events,including apnea (30.6％),necrotizing enterocolitis (18.8％),heart failure (14.1％),respiratory failure (12.9％),and shock (8.2％).The Logistic regression analysis showed that acute bilirubin encephalopathy (ABE) score ≥ 3 (OR=6.383,95％CI 2.550～15.979),ETs ≥ 2 times (OR=11.825,95％CI 2.464～56.755),cardiac murmur ≥ grade Ⅲ (OR=20.417,95％CI 4.705～40.590),and dramatic blood pressure fluctuation during ET ≥ 30 mmHg (OR=13.612,95％CI 1.795～43.342) were risk factors of ET related severe complications (all P＜0.05).Conclusion The indications should be carefully assessed before ET.The patients with ABE score ≥ 3,ETs ≥ 2 times,cardiac murmur ≥ grade Ⅲ,or dramatic blood pressure fluctuation during ET ≥ 30 mmHg should be monitored carefully and ET should be stopped in time if necessary.

Objective:To investigate the status quo of self-care ability of patients after sacral neuromodulation in the first stage, and analyze its influencing factors.Methods:The convenient sampling method was used to select 106 patients after sacral neuromodulation in the first stage who were admitted to Department of Urology in the First Affiliated Hospital of Zhengzhou University from July 2019 to July 2021. Questionnaires were carried out using general information questionnaire, Exercise of Self-Care Agency Scale (ESCA) and Self-efficacy for Chronic Disease 6-Item Scale (SECD6) . The t test, one-way ANOVA, Pearson correlation analysis and multiple linear regression analysis were used to explore the influencing factors of self-care ability. Results:The self-care ability score of the first stage patients after sacral neuromodulation was (80.07±21.39) , including 9 cases (8.5%) with high level, 81 cases (76.4%) with medium level and 16 cases (15.1%) with low level. There were statistically significant differences in the self-care ability scores of patients with different occupational status, medical insurance type, place of residence, residence status, educational level and per capita monthly income of the family ( P<0.05) . The total score and each dimension score of patients' self-care ability were positively correlated with the self-efficacy score ( P<0.05) . The results of multiple linear regression analysis showed that occupational status, educational level, per capita monthly family income and self-efficacy were the main influencing factors of self-care ability of patients after sacral neuromodulation in the first stage ( P<0.05) . Conclusions:The self-care ability of the first stage patients after sacral neuromodulation is generally at a moderate level and the self-care ability of patients needs to be further improved, especially the self-care skills need to be strengthened. Nursing staff should give patients individualized health guidance according to different influencing factors to help them improve their self-care ability.

Objective:To investigate the efficacy of Balanophora involucrata Hook.f.in treatment of hyperuricemia(HUA)based on network pharmacology,molecular docking,and hyperuricemia models in vivo and in vitro,and to clarify the main targets of its active components and related signaling pathway mechanism.Methods:The potential targets of Balanophora involucrata Hook.f.in treatment of HUA were identified by Databases such as the Traditional Chinese Medicine Database in Taiwan,the Chinese Herbal Medicine Identification Database,Professional Chemical Database,TargetNet Database,SwissTargetPrediction Database,GeneCards,Therapeutic Target Database(TTD),DrugBank Database,DisGeNET Database,Online Mendelian Inheritance in Man(OMIM)Database,and Venny Database.STRING Database and Cytoscape software were used to construct the active component-predictive target network and protein-protein interaction(PPI)network for Balanophora involucrata Hook.f.;topological analysis was used to select the main active components and core targets;Gene Ontology(GO)functional and Kyoto Encyclopedia of Genes and Genomes(KEGG)signaling pathway enrichment analysis were performed by R software;AutoDock Vina software was used for molecular docking validation.The NRK-52E cells were divided into blank control group,blank administration group,model group,and different concentrations(2.0,10.0,and 50.0 μmol·L-1)of erythrodiol(EDT)groups.High-performance liquid chromatography culture(HPLC)was used to detect the uric acid(UA)levels in the cell culture supernatants in various groups.The male ICR mice were divided into blank control group,blank administration group,model group,and EDT group;the mice in the last two groups were used to prepare the HUA models;kits were used to detect the levels of UA,creatinine(Cr),and blood urea nitrogen(BUN)in serum of the mice in various groups;the bilateral kidney tissue of the mice was harvested and weighed;the kidney indexes of the mice in various groups were calculated;TUNEL staining was used to observe the apoptosis in kidney tissue of the mice in various groups;Western blotting method was used to detect the expression levels of protein kinase B(AKT),phosphorylated AKT(p-AKT),phosphoinositide 3-kinase(PI3K),phosphorylated PI3K(p-PI3K),B-cell lymphoma-2(Bcl-2),Bcl-2-associated X protein(Bax),and matrix metalloproteinase-9(MMP-9)proteins in kidney tissue of the mice in various groups.Results:Six active components of Balanophora involucrata Hook.f.were identified,involving 116 intersecting targets and 14 core targets.The enrichment analysis yielded 1 828 GO terms and 145 signaling pathways.The molecular docking results showed that EDT had good binding activity with MMP-9.The high uric acid cell experiment results showed that compared with blank control group,the UA level in the cells in model group was significantly increased(P<0.01);compared with model group,the UA levels in the cells in 2.0,10.0,and 50.0 μmol·L-1 EDT groups were significantly decreased(P<0.01).Compared with blank control group,the levels of UA,Cr,and BUN in serum of the mice in model group were increased(P<0.01),and the kidney indexes were significantly increased(P<0.01);compared with model group,the levels of UA,Cr,and BUN in serum of the mice in EDT group were decreased(P<0.05 or P<0.01),and the kidney index was significantly decreased(P<0.05 or P<0.01).Compared with blank control group,the number of apoptotic cells in kidney tissue of the mice in model group was increased;compared with model group,the number of the apoptotic cells in kidney tissue of the mice in EDT group was significantly decreased.Compared with blank control group,the ratios of p-AKT/AKT and p-PI3K/PI3K and expression level of Bcl-2 protein in kidney tissue of the mice in model group were significantly decreased(P<0.05 or P<0.01),while the expression levels of Bax and MMP-9 proteins were significantly increased(P<0.01);compared with model group,the ratios of p-AKT/AKT and p-PI3K/PI3K and expression level of Bcl-2 protein in kidney tissue of the mice in EDT group were significantly increased(P<0.05 or P<0.01),and the expression levels of Bax and MMP-9 proteins were significantly decreased(P<0.01).Conclusion:The active component of Balanophora involucrata Hook.f.,EDT,has a UA-decreasing effect and may inhibit the apoptosis and alleviate the kidney injury by activating the PI3K/AKT signaling pathway.