Objective To study the curative effect and influence on memory function of Gabapentin (GBP) as add-on therapy for treatment of focal seizures in refractory epilepsy. Methods 96 patients with focal seizures in refractory epilepsy were randomly divided into groups GBP and Topiramate (TPM). Beside the normal medicaments, GBP or TPM as add-on therapy for certain group. According to the Clinical Memory Scale (CMS), the patient's memory function was evaluated before and after treatment. Results There was no significantly difference of total effective rate between groups GBP (75.0%) and TPM (72.9%). The scores of CMS showed almost same between before or after add-on therapy in GBP group. In TPM group, the scores of meaningless image recognition, free recall, phase portrait characteristics and memory quotient were significantly reduced after add TPM(allP

Objective: To analyze the trend of the burden of leukemia among people under 35 years in China from 1990 to 2019. Methods: Incidence, mortality and disability-adjusted life years (DALY) of leukemia among people under 35 years in China from 1990 to 2019 were collected by using the Global Burden of Disease (GBD) Study Database 2019. The trends in leukemia incidence, mortality and DALY rates were analyzed using the average annual percent change (AAPC) and age-period-cohort model. Results: From 1990 to 2019, the incidence, mortality and DALY rates of leukemia among people under 35 years in China showed a downward trend (AAPC=-2.336%, -3.604% and -3.589%, all P<0.05), with more pronounced downward trends in females (AAPC=-3.209%, -3.787% and -3.818%, all P<0.05) than in males (AAPC=-2.521%, -3.292% and -3.306%, all P<0.05). According to the age-period-cohort model, the risks of leukemia incidence, mortality and DALY rates decreased with increasing age. Among them, the children under 5 years had the highest risks of leukemia incidence, mortality and DALY rates (RR=4.697, 2.718 and 3.059). Over time, the risks of leukemia incidence, mortality and DALY rates also decreased from 1990-1994 (RR=1.217, 1.264 and 1.296) to 2015-2019 (RR=0.901, 0.696 and 0.691). With regard to birth cohorts, the risks of leukemia incidence, mortality and DALY rates first increased and then decreased, peaking in the 1986-1990 birth cohort (RR=1.335, 1.192 and 1.231). Conclusions The incidence, mortality and DALY rates of leukemia among people under 35 years in China from 1990 to 2019 showed a downward trend. Males and children under 5 years were the key populations for leukemia prevention and control.

Objective To analyze the correlation between coronary artery lesion complexity and left ventricular funotion index of patients.Methods A total of 69 patients with coronary heart disease were selected in the study and were divided into low- risk(27 cases),medium-risk(23 cases) and high-risk (19 cases) groups according to the SYNTAX score.The difference in left ventricular function among the three groups were compared by ANOVA, and the correlation between coronary artery SYNTAX score and left ventricular function index was evaluated by Spearman rank correlation analysis.Results The differences in left ventricular end-diastolic volume(EDV),end-systolic volume(ESV),stroke volume(SV),ejection fraction(EF) and muscle mass(MM) among the groups were statistically signifcant (F=7.254,9.181, 13.004, 7.544 and 5.276,P<0.05).The coronary SYNTAX score was negatively corelated with the EF (r=-0.702,P<0.05),but positively correlated with the MM (r=0.638, P<0.05).Conclusion Coronary SYNTAX score is negatively correlated with left ventricular EF, but positively correlated with MM.

This article reviews the concept, importance, and assessment tools of nurse leadership. This article introduces the characteristics of each assessment tool and its application in different cultural backgrounds, so as to provide a reference for nurses to choose appropriate assessment tools, and to provide a basis for the development of assessment tools for nurse leadership in China.

Objective To explore the correlation between serum uric acid level and coronary artery SYNTAX score of coronary heart disease.Methods A total of 69 patients of coronary heart disease were enrolled according to SYNTAX score.The patients were divided into the low risk group (27 cases),medium risk group (23 cases) and high risk group (19 cases).The differences of serum uric acid concentrations among the three groups were compared by ANOVA.Spearman rank correlation analysis was used to analyze the correlation between serum uric acid concentrations and coronary artery SYNTAX scores.Results ANOVA analysis showed that the differences of serum uric acid concentrations among the groups were statistical significant (F=4.74,P＜0.05).The Spearman correlation analysis showed that serum uric acid concentrations were positively correlated with coronary SYNTAX score (r =0.58,P ＜0.05).Conclusion Serum uric acid level and severity of coronary artery disease are positively correlative.

Objective:To measure with Zhejiang province as an example the situation of the self-evaluation health management service capability of primary medical staff in county-level medical alliances.Methods:A self-evaluation scale for health management service capability by primary medical staff was customized, covering 5 dimensions of professional attitude, interpersonal communication ability, comprehensive knowledge integration ability, professional practice ability and professional development ability, as well as 29 items. In July-September 2019, medical alliances were selected from three counties/cities based on economic development as the survey targets, and a total of 264 primary medical staff were surveyed. Quantitative data were described in mean and standard deviation, while qualitative data were described in composition ratio, and the differences were compared by Kruskal-Willis test.Results:The self-evaluation scoring of health management service capability of the primary medical staff was (59.75±18.64) points, and the average scoring of the items was (2.06±0.64) points. The scoring of knowledge integration (1.98±0.70)and professional practical ability (2.03±0.67) were lower than the average scoring of the items; gender and occupation type of primary medical staff present statistical significances in the self-evaluation scoring of health management service capability.Conclusions:Given the health management service capabilities of primary medical staff, they still need to upgrade their knowledge integration and professional practice capabilities. County-level medical alliances should enhance their training of health management knowledge and skills, promote doctor-nurse collaboration in health management services to broaden the depth of primary health management services.

Objective:To investigate the effects of standardized treatment combined with medical nutrition intervention on blood glucose level, body mass management and glucose metabolism at 3 months postpartum in patients with gestational diabetes mellitus (GDM).Methods:A total of 114 patients with GDM who received treatment in Shunyi District Hospital of Beijing from June 2017 to October 2019 were included in this study. They were randomly divided into observation group ( n = 57) and control group ( n = 57). The control group was treated with standardized therapy, and the observation group was treated with standardized therapy combined with medical nutrition intervention. Blood glucose level, body mass management, glucose metabolism outcomes at 3 months postpartum, pregnancy outcome, and neonatal outcome were compared between the two groups. Results:After treatment, hemoglobin A1c (HbA1c), fasting blood glucose, 2-hour plasma glucose (2hPG) after breakfast, and 2hPG after dinner in the observation group were (5.20 ± 0.34)%, (4.69 ± 0.31) mmol/L, (7.32 ± 2.13) mmol/L, and (7.54 ± 2.36) mmol/L, respectively, which were significantly lower than those in the control group [(6.38 ± 0.42)%, (6.34 ± 0.45) mmol/L, (9.01 ± 2.27) mmol/L, (9.35 ± 2.47) mmol/L, t = 16.48, 22.79, 4.09, 4.00, all P < 0.001]. The increases in body mass and body mass index during pregnancy in the observation groups were (12.19 ± 2.35) kg and (4.52 ± 1.13) kg/m 2, respectively, which were significantly lower than those in the control group [(16.21 ± 2.64) kg, (6.11 ± 1.25) kg/m 2, t = 8.58, 7.12, both P < 0.001]. The abnormal rate of glucose metabolism at 3 months postpartum in the observation group was significantly lower than that in the control group [5.3% (3/57) vs. 8.8% (5/57), χ2 = 0.53, P = 0.462]. The incidences of premature rupture of membranes, polyhydramnios, and cesarean section in the observation group were 5.3% (3/57), 14.0% (8/57) and 15.8% (9/57), which were significantly lower than those in the control group [22.8% (13/57), 35.1% (20/57), 40.4% (23/57), χ2 = 7.27, 6.81, 8.51, all P < 0.05]. There were no significant differences in the incidences of pregnancy-induced hypertension and postpartum hemorrhage between the two groups (both P > 0.05). The incidences of premature births, macrosomia, respiratory distress, neonatal hypoglycemia and hyperbilirubinemia in the observation groups were 5.3% (3/57), 3.5% (2/57), 7.0% (4/57), 3.5% (2/57), 5.3% (3/57), respectively, which were significantly lower than those in the control group [22.8% (13/57), 17.5% (10/57), 21.1% (12/57), 15.8% (9/57), 19.3% (11/57), χ2 = 7.27, 5.96, 5.60, 4.93, 5.21, all P < 0.05). Conclusion:Standardized treatment combined with medical nutrition intervention can effectively reduce blood glucose level in patients with GMD, control body mass, and improve glucose metabolism at 3 months after delivery.

Objective:To explore the definition and connotation of the thriving in the elderly, so as to provide reference for clinical practice.Methods:This study systematically searched databases such as China National Knowledge Infrastructure, WanFangdata, CINAHL, PsycINFO, PubMed, and Web of Science using keywords such as "aged" and "thriving". The search period was from database establishment to June 10, 2023. Walker's eight-step analysis method was used to conduct concept analysis on the thriving in the elderly.Results:A total of 14 articles were included. The defining attributes of the thriving in the elderly included good self-perception, utilizing existing resources to adjust self-expectation, and achieving self-growth and development. The antecedents were a positive attitude, high-quality caregivers and care services, a good physical and humanistic environment. The consequence was that elderly people had great adaptability, subjective experience, and health level.Conclusions:The thriving in the elderly is a subjective well-being achieved by the interaction among an individual, the humanistic and physical environment, which is affected by various factors such as individuals and environment. It is a new concept that has emerged in the international field of geriatric nursing in recent years, focusing on the positive aspects of aging and providing new directions for research in geriatric nursing.

Objective To survey the frequency of medical X-ray diagnosis and estimate the medical exposure levels of Jiangsu province in 2016,so as to be able to improve effectively the protection against medical radiation exposure.Methods All medical institutions in the province were covered in the survey for their basic medical information by means of census method.Frequencies of diagnostic medical X-ray examination were studied using random sampling method in 31 medical institutions.A linear model was established by number of outpatients number of inpatients,number of staff and number of radiation workers to evaluate the medical examination frequency.Results A total of 9 248 pieces of medical X-ray diagnostic equipment by the end of 2016 in Jiangsu province,including 1 110 CT scanners.The total frequencies of diagnostic medical X-ray examination were estimated to be 911.45 examinations per 1 000 population,covering 239.25 per 1 000 for CT scanning.The number of medical X-ray diagnostic equipment increased by a factor of 0.8 while CT scanners by a factor of 3.6 compared to 1999.Medical X-ray diagnostic frequency raised by a factor of 3.2 while CT frequency by a factor of 15.1 compared with previous data.Conclusions The medical X-ray diagnostic frequencies in Jiangsu province was 1.9 times the value given in the UNSCEAR 2008 Report,close to those in some developed European countries.Compared with the study in 2015,the present study has made greater improvement in sampling technique for selection of hospitals and equipment,frequency estimation method and acquisition of influence factors.Estimates of medical X-ray diagnosis frequency are closer to actual level.Further improvement will be needed for the future survey,so as to further study medical exposure levels and to provide basic information for better patient protection.

Objective:To evaluate the effect of clinical pathway implementation on medical efficiency and medical expenses of patients with two common rheumatic immune diseases " rheumatoid arthritis" and " ankylosing spondylitis" diseases by using diagnosis related group (DRG) related indicators.Methods:The data of patients with two common rheumatic immune diseases " rheumatoid arthritis" and " ankylosing spondylitis" included in the clinical pathway management from January 2017 to December 2019 in the Department of Rheumatology and Immunology of Jinhua Hospital, Zhejiang University School of Medicine were carried out. The impact of clinical pathway implementation on the average hospital stay, average cost and average drug cost of patients with the two diseases were analyzed and compared , so as to evaluate the effect of the implementation of the clinical pathway.Results:From the implementation of clinical pathway in 2017 to 2019, the number of patients admitted and total medical specialty services in the two groups of " rheumatoid arthritis" and " ankylosing spondylitis" increased year by year ( P<0.01). The average length of stay, average cost and average drug cost of patients in the " rheumatoid arthritis" disease group decreased year by year, with statistically significant differences between groups (all P<0.01). The average length of stay in the ankylosing spondylitis group was shortened year by year, and the difference was statistically significant ( P<0.01). Compared with 2017, the average cost in 2018 decreased significantly, and the difference was statistically significant ( P<0.01). There was no significant difference in average cost between 2018 and 2019 ( P>0.05). The average cost in 2018 was significantly higher than that in 2017 ( P<0.05). After analyzing the causes and optimizing the clinical pathway, the average cost in 2019 was significantly lower than that in 2018 ( P<0.01). Conclusions:Through the implementation of clinical pathways and continuous optimization of pathway connotation during use, the diagnosis and treatment efficiency of patients with " rheumatoid arthritis" and " ankylosing spondylitis" can be significantly improved, and medical costs can be reduced, which is in line with the current medical reform needs.