Objective To discuss a method to show the structure of small mammary gland well by computed radiography(CR).Methods By analyzing 150 radiographs of mammary glands,the results showed that the mammary structure showed well whether or not was depended on the size of mammary gland.Using 24 steps aluminum ladder mimiced the small mammary gland and radiography was taken with various parameters and different imaging plate(IP) shading ways,then processed and printed,after that it was measured by density instrument.Results The display of grey scale of 24 steps aluminum ladder was improved if shading 10~15 mm margin of the IP by collimator or shading the central by a square cuprum plate with 22 mm length and 0.2 mm thickness.Radiography of small mammary gland by the same way was performed and the mammary structure was also showed well.Conclusion Shading the exposing areas properly by collimator or cuprum plate during CR can apparently improve the display of small mammary structure.

Objective To investigate the prenatal diagnosis and postnatal clinical outcomes of fetal congenital choledochal cyst (CCC) to improve the recognition and treatment of fetal CCC.Methods Clinical data of 23 cases of fetal CCC which were diagnosed during routine prenatal ultrasonic examination in Jinhua Municipal Central Hospital from June 2009 to May 2015 were retrospectively analyzzed. Maternal age, gestational age at diagnosis of CCC, location and size of cyst, postnatal examination, age at operation and follow-up outcomes were recorded and statistically analyzed by Wilcoxon rank-sum test.Results (1) Among the 23 cases, six (26%) were terminated and the rest 17 continued their pregnancies (74%). (2) Results of the prenatal ultrasonography of the 23 cases indicated that hepatic portal cysts were closely related to hepatic portal veins or arteries. Six of the cysts communicated with gall bladder and eight connected to intrahepatic bile duct. The maximum diameter of the cysts in the 23 cases was 16.0-31.0 mm, averagely (24.7±3.7) mm. The maximum diameter of cysts diagnosed in the third trimester was significantly larger than that in the second trimester [ 27.0 (22.0-31.0) vs 23.0 (21.0-25.0) mm,Z=-2.134,P<0.05]. (3) Among the 17 cases of continued pregnancy, one underwent cesarean section at 35+ weeks of gestation and 16 delivered at term with the average gestational age at delivery of (38.2±1.1) weeks. All neonates were re-examined by abdominal ultrasound at 1-2 postnatal weeks and confimed prenatal diagnosed of CCC. (4) The 17 neonates were re-examined by abdominal ultrasound during the second postnatal week and the results showed that cyst size remained the same in four, decreased in one and gradually increased with the gestational age in 12 neonates. Among the 16 cases of confirmed CCC, 12 received surgery, including 11 (Ⅰa, 6;Ⅰc, 3;Ⅳb, 2) within one year-old and one (Ⅰc) around 18 months old. The prognosis was uneventful. Four out of the 16 cases rejected surgical operation and were followed up in outpatient. One neonate was diagnosed with congenital biliary atresia and transferred to Children's Hospital for operation.Conclusions When fetal abdominal cyst presented with hepatic portal cyst which communicates with gallbladder or intra-hepatic duct in ultrasonography, a congenital choledochal cyst should be taken into consideration by excluding the possibility of biliary atresia in the first place. Surgery for CCC infants without symptoms or signs is suggested to be performed around three months after birth. The postoperative prognosis of CCC is favorable, so termination is not recommended for gravidas with fetal CCC in prenatal consultation.

Objective To investigate the clinical efficacy of esmolol combined with atorvastatin on se-vere sepsis complicated with cardiac insufficiency.Methods This study was a prospective,double-blind,ran-domized controlled clinical trial.A total of 153 patients with severe sepsis complicated with cardiac insufficien-cy admitted to this hospital from January 2021 to December 2022 were selected and divided into groups A,B,and C by random number table method,with 51 cases in each.Patients in group A were given routine symp-tomatic supportive treatment after admission.On this basis,patients in group B and group C were given esmo-lol,esmolol+atorvastatin,respectively.The hemodynamic indexes,serological indexes and clinical prognosis of the three groups before and after intervention were compared.Results There was no significant difference in baseline data,and hemodynamic and serological indexes of three groups before intervention(P＞0.05).Compared with before intervention,after five days of intervention,heart rate,systemic vascular resistance in-dex(SVRI),blood levels of creatine kinase-MB(CK-MB),cardiac troponin Ⅰ(cTn Ⅰ),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and high sensitive C-reactive protein(hs-CRP)in three groups were de-creased,while the values of cardiac index(CI)were increased,and the differences were statistically significant(P＜0.05).After five days of intervention,the heart rate,SVRI,blood levels of CK-MB,cTn Ⅰ,TNF-α,IL-6,and hs-CRP in group C were lower than those in group A and group B,and the levels in group B were lower than those in group A;the value of CI in group C was higher than that in group A and group B,and group B was higher than that in group A,the differences were statistically significant(P＜0.05).After intervention,the length of stay in intensive care unit(ICU)in group C was the shortest,and that in group B was shorter than that in group A,the difference was statistically significant(P＜0.05).There was no significant difference in 28 d mortality among the three groups(P＞0.05).Conclusion Esmolol combined with atorvastatin can signif-icantly inhibit the inflammatory response in patients with severe sepsis complicated with cardiac insufficiency,relieve myocardial injury and promote rehabilitation,and the therapeutic effect is better than esmolol alone.

This paper shows the concept and current research situation of heart failure readmission, and transitional care providers. It focuses on eight transitional care models which can be applied to decrease the readmission for heart failure patients, and puts forward current challenges, so as to provide references for applying transitional care to reduce heart failure readmission in China.

Objective To perform bibliometric analysis of research literature in the field of cardiac rehabilitation of coronary disease, in order to accurately grasp the research situation in the field in the world, and to provide references for further in-depth research. Methods The distribution characteristics, research fronts, and research hotspots for the cardiac rehabilitation of coronary disease were analyzed based on researching systematically of documents Web of Science before December 31st,2017, with the aid of CiteSpace software, using co-citation analysis and co-word analysis to analyze. Results A total of 2 560 articles were retrieved. The institutions and authors in United States, Canada and other European and American countries had a relatively high level of research in the field of cardiac rehabilitation of coronary disease. Gender-tailored randomized clinical trials and prospective studies were the research frontiers in this field. Randomized controlled trials and meta-analysis were commonly used research methods in this field. Exercise was the main research content of cardiac rehabilitation programs for patients with coronary disease. Mortality, quality of life, risk factors, and depression were currently the main indicators for assessing the effectiveness of cardiac rehabilitation programs in these patients. Conclusions The current research in the field of cardiac rehabilitation of coronary disease in China has gradually started. In the future, we can explore new entry points and breakthroughs in combination with current international research frontiers and research hotsopts.

Objective? To understand the status quo of knowledge, attitude and practice (KAP) of nurses in hospital and community about nutrition for stroke patients, compare their differences, and analyze the common related factors, so as to provide basis for carrying out nutritional nursing education for stroke patients in hospital-community interaction. Methods? A total of 160 neurology nurses from 7 Class Ⅲ Grade A hospitals and 161 nurses from 10 community hospitals in Shanghai were selected from August to October 2017 by convenience sampling method. The Chinese version of the Staff Attitudes to Nutritional Nursing Care Geriatric scale were applied in the investigation. A total of 340 questionnaires were distributed and 321 valid questionnaires were recovered, with a recovery rate of 94.4%. SPSS 20.0 software was used for statistical analysis. Results? The scores of nutrition knowledge, nutrition attitude and nutritional practice of the 160 hospital nurses were (58.44±12.67), (72.72±10.73) and (85.50±15.49) respectively, while those of the 161 community nurses were (53.98±13.15), (75.87±8.24) and (69.81±16.75) respectively. The differences in scores between the two groups were statistically significant (P＜ 0.05). Multiple linear stepwise regression analysis showed that the factors related to nutritional knowledge were academic qualifications and further study at work. Academic qualifications, duration of continuous nursing for stroke patients and nutritional course in school were related to nutrition attitude. Age, academic qualifications and clinical nutrition nursing training were the main factors influencing nutrition practice scores. Conclusions? There are differences in scores of nutrition KAP between hospital and community nurses. Effective nutrition nursing training can improve nurses' KAP of nutrition for stroke patients, so as to ensure the effective development of nutrition nursing services for patients.

ObjectiveTo develop and preliminarily apply a dynamic scoring information system for critically ill patients to optimize the management system for critically ill patients. Methods? Totally 55 risk factors of three groups were selected based on Acute Physiology and Chronic Health Evaluation Scoring System, Tiss-28 Scoring System 2, critical value and expert consensus and included in the information platform, which was connected to the hospital's information and data system. A dynamic scoring system was designed and developed independently. The system consisted of two modules: alarm and clinical decision-making. An operation protocol was made by the Department of Nursing and included into the nursing management system to ensure that the system could run effectively. Data of inpatients in Tenth People's Hospital of Tongji University from October 2015 to October 2017 was selected. The disease recognition of the dynamic scoring system and the existing MEWS alarm and scoring system and the success rate of treatment in critically ill patients before and after the dynamic scoring system was introduced were compared. Results? The area under receiver operating characteristic curves (AUC-ROC) of the dynamic scoring system was 0.947(95%CI 0.930-0.964), which showed higher recognition of critical illness compared with the MEWS alarm and scoring system (P＜0.05). After the dynamic information system was introduced, the success rate of treatment in critically ill patients was 68.61%, which was higher than that before it was applied (χ2=10.046; P=0.002). Conclusions? The dynamic scoring system can accurately evaluate patients' disease and provide digital data and a list of clinical decisions for nurses, thus improving the success rate of treatment in critically ill patients and enhancing nurses' clinical decision-making ability.

Objective? To investigate the application status of transitional care quality indicators for chronic disease in hospitals in China so as to provide a reference for improving transitional care quality evaluation for chronic disease. Methods? We selected nursing managers from 55 hospitals participating a national nursing conference in Shanghai in 2018 as subjects by convenience sampling. The self-designed hospital transitional care quality indicators questionnaire for chronic disease was used to investigate the usage condition of transitional care quality indicators for chronic disease in 55 hospitals. χ2 test was used to compare the utilization ratio of third-level indexes of transitional care of Class Ⅱand Class Ⅲ hospitals. Results? Among 55 hospitals, the highest usage of first-level indexes was structure index (0.813±0.164). The top 3 usage of second-level indexes included hospital readiness (0.932±0.047), patient satisfaction (0.927±0.262) and adverse event rate (0.888±0.143); the bottom 3 usage included health status of patients (0.470±0.112), external hospital extension (0.418±0.280) and connect inside and outside of hospital (0.309±0.149). In importance of second-level indexes, the top 3 usage included the adverse event rate, hospital readiness and material resources; the bottom 3 usage involved the utilization ratio of medical resources, connect inside and outside of hospital and external hospital extension. There were statistical differences in the usage rates of medical resource indexes in ClassⅡand ClassⅢ hospitals, such as readmission rate, visiting rate in emergency department, hospital stay and mortality (χ2=9.406, 5.430, 6.339, 6.339;P＜ 0.05). Conclusions? Among 55 hospitals of China, the transitional care quality evaluation for chronic disease is generally insufficient which is needed to be paid attention to. Hospitals needs to optimize the proportion of indexes, improve and pay more attention to the evaluation for process indicators and outcome indicators, and perfect management and monitor for transitional care.

Objective? To explore the development and effects assessment of transitional care on stroke in communities of Shanghai so as to provide a reference for improving the development and assessment of transitional care on stroke. Methods? From 30 to 31 October 2018, we selected nurses in 55 communities of Shanghai as subjects by convenience sampling. The self-designed questionnaire was used to investigate the general condition, development program and effects assessment of transitional care on stroke in communities. SPSS 20.0 was used to statistical data analysis. Results? Among the 55 communities, 44 (80.0%) communities carried out transitional care on stroke. A total of 29 communities were with the general level of development in transitional care on stroke, and 26 communities were the general level of effects assessment. A total of 41 communities built the linkage model, and only 14 of them had effects assessment indexes. Besides, 93.2% of communities developed two-way referral and telephone follow-up. Conclusions? Transitional care on stroke is developed in most communities of Shanghai with limitations in developing program, regional cooperation and effects assessment. The communities need further expand the development program of transitional care on stroke, improve the regional cooperation between hospitals and communities, build effects assessment indexes and pay attention to transitional model and outcome assessment of caregivers.

Objective? To understand the situation of cardiac rehabilitation from Class Ⅱ and Class Ⅲ hospitals in China, so as to provide a reference for optimizing cardiac rehabilitation. Methods? In June 2018, we selected 68 nursing managers of ClassⅡ and ClassⅢ hospitals from totals of 12 provinces, autonomous regions and municipalities directly under the central government such as Shanghai, Zhejiang Province, Jilin Province, Guizhou Province and the Xinjiang Uygur Autonomous Region as subjects by convenience sampling. We investigated the basis development condition, rehabilitation content, implementation of transitional nursing of cardiac rehabilitation in those hospitals. Results? Among 68 ClassⅡ and ClassⅢ hospitals, the score of cardiac rehabilitation was (4.75±1.73) with the lower middle level as a whole. The good development of cardiac rehabilitation included the smoking cessation guidance, diet guidance and blood pressure control. The poor development of cardiac rehabilitation involved the vocational rehabilitation guidance, assessment for quality of life and mental management. The main influencing factors of development of cardiac rehabilitation were staff shortage (70.59%), lack of perfect operational mechanism (66.18%) and lack of policy support (52.94%). Conclusions? In China, the Class Ⅱ and Class Ⅲ hospitals have developed cardiac rehabilitation in succession however with many deficiencies. Hospitals should strengthen the basic construction of cardiac rehabilitation, perfect the rehabilitation content and promote the development of transitional nursing.