Objective To investigate and contrastive analyse the respective value of tympanograms and high resolution CT scan of temporal bone in the diagnosis of secretory otitis media .Methods The clinical data of 150 hos-pitalized patients with secretory otitis media in Department of ENTHNS ,Tongji Hospital ,Wuhan from 2009 to 2012 were retrospectively analyzed .Based on the surgical finding of tympanic cavity fluid ,the diagnostic accordance rate of tympanograms and temporal bone CT for middle ear effusion were calculated respectively ,and their diagnos-tic value were evaluated .Results The diagnostic accordance rate of tympanogram B for the middle ear effusion in secretory otitis media was 94 .5% (138/146 ears) ,the rate of abnormal tympanograms was 91 .6% (206/225 ears) , while temporal bone CT with a rate of 99 .2% (117/118 ears) .The difference between the latter two data was statis-tically significant(P<0 .01) .Conclusion The temporal bone CT scan ,with a higher diagnostic value for middle ear effusion in secretory otitis media ,could be used as a supplement to the acoustic immittance measurement ,especially to non-B tympanograms for the diagnosis of secretory otitis midia .

Objective:To investigate the value of clinical nursing path teaching based on core competencies in the clinical teaching of urology nursing students.Methods:A total of 100 nursing students who received nursing internship in Department of Urology, China-Japan Union Hospital of Jilin University, were selected as subjects and were divided into observation group and control group using a random number table, with 50 students in each group. The students in the control group received traditional teaching, while those in the observation group received clinical nursing path teaching based on core competencies. After the end of teaching, the core competency evaluation form for nursing students was used to evaluate core competencies, and the self-learning ability evaluation tool for nursing students was used to evaluate self-learning ability. SPSS 22.0 software was used for t test. Results:Compared with the control group, the observation group had significantly higher scores of core competencies (operation skills, theoretical knowledge, self-development ability, clinical nursing ability, interpersonal communication ability, and critical thinking ability) ( P<0.05). The observation group had a significantly higher score of self-learning ability than the control group ( P<0.05). Conclusion:In the teaching of urology nursing students, the application of the clinical nursing path based on core competencies can significantly improve the core competencies of nursing interns and the quality of teaching.

The rehabilitation compliance of stroke patients is generally low.Evaluating the rehabilitation motivation of patients is helpful to promote the rehabilitation management of patients,enhance the rehabilitation enthusiasm and compliance of patients,and improve the rehabilitation outcome.This paper reviews the existing stroke patients rehabilitation motivation assessment tools,and expounds the main contents,application status,characteristics and limitations of stroke patients rehabilitation motivation assessment tools,in order to provide references for the appropriate selection of clinical assessment tools,the rehabilitation management of stroke patients and the development of domestic localized stroke rehabilitation motivation assessment tools.

Objective: To evaluate the indication, safety and effectiveness of transoral robotic surgery (TORS) for oropharyngeal cancer based on our preliminary experience. Methods: Twelve patients, including six with tonsil cancer, five with tongue base cancer and one with posterior pharyngeal wall cancer, who underwent TORS with Da Vinci Si surgical system from March 2017 to October 2018 at Tongji Hospital of Huazhong University of Science Technology were respectively analyzed. And the surgical time, intraoperative blood loss, postoperative local bleeding, dyspnea, nerve function injury, oral intake time, whether or not to receive chemoradiotherapy were analyzed. Results: All tumors in the 12 patients were en bloc removed by TORS. Surgical time ranged from 25 to 80 min with an average of 34.2 min. The blood loss ranged from 10 ml to 50 ml with an average of 20.8 ml. The recovery time for oral intake ranged from 1 day to 30 days with an average of 8.4 days. No patient underwent tracheostomy after TORS. Also, no patient manifested with airway obstruction, bleeding or nerve injury symptoms after operation. All 12 patients reached pathologically negative surgical margins. The patients were followed up for 4 to 22 months, with a median of 12 months. All patients who combined with more advanced than T3 stage, or more advanced than N2 stage were recommended to oncologist, then, followed with radiotherapy or chemoradiotherapy if no relevant contradictions occurred. No local recurrence or distant metastasis case was found. Conclusion With proper indications, the application of TORS in oropharyngeal cancer is a relatively safe, effective and minimal invasive therapy, which merits more clinical applications.