Objective To understand the guidance significance of sputum smear on the sputum culture by comparing the micro-scopic detection results of sputum smear with the sputum culture results in 227 cases.Methods 227 cases of sputum specimen were collected for observing the character and smear staining by microscopy.These specimens were divided into the class A,B,C and D according to the standards and simultaneously conducted the culture.The relationship between smear and culture was analyzed.Reˉ sults Among 227 cases of sputum specimen,158 cases were qualified and accounted for 69.60%,and 69 cases were unqualified and accounted for 30.40%.Potential pathogens were detected in 128 cases,the positive detection rate was 56.39%,the positive detec-tion rate of qualified sputum specimens was 70.39% and which of unqualified sputum specimens was 28.00%.The coincidence rate of qualified sputum specimen smear results and the culture results was 72.78%.The positive rate of cytophagic bacteria in the qual-ified sputum specimens was 11.72%,in which 14 cases of cytophagic bacteria were the qualified class A sputum specimens with the positive rate of 16.67% and 5 cases of cytophagic bacteria were the class B sputum specimens with the positive rate of 6.76 %. Conclusion The sputum smear microscopic detection can provide the important information for the diagnosis and treatment of re-spiratory infections and the sputum smear has the important guiding significance for sputum culture.

OBJECTIVE: To establish and improve the quality management system of drug dismounting and subpackage in hospital.METHODS: The status quo and problem of drug dismounting and subpackage were analyzed,and improvement approaches were put forward.RESULTS: The quality management system of drug dismounting and subpackage was established and improved by enhancing personnel quality,dismounting environment,material management as well as process control.CONCLUSION: The quality management system of drug dismounting and subpackage can effectively guarantee the quality of dismounted drug and is worthy of spreading.

OBJECTIVE To investigate the qacE△1-sul1 genes in multidrug-resistant Gram-negative bacilli and their significance.METHODS A total of 225 strains of multidrug-resistant Gram-negative bacilli were clinically isolated.The genes of qacE△1-sul1 were analyzed using polymerase chain reaction(PCR).RESULTS From them 120 strains of multidrug-resistant Gram-negative bacilli were found the qacE△1-sul1 genes.The positive rate of qacE△1-sul1 was 53.3%.CONCLUSIONS There are high percentages of qacE△1-sul1 genes in multidrug-resistant Gram-negative bacilli.

Objective:To investigate the regulation of acupuncture on γ-interferon (INF-γ) and tumor necrosis factor (TNF) of lung cancer-operative cases. Methods: to determine the INF-γ and TNF contents in the blood serum of lung cancer patients by double antibody sandwich immuno-enzymatic method (ELISA); to measure the INF-γ and TNF contents of 30 lung cancer patients in the acupuncture anesthesia group and 30 lung cancer patients in general anesthesia group before the operation and at the 8th days, the 12th day after the operation respectively and make comparison between the two groups. Results:The pre-operation INF-γ contents of the two groups showed no significant difference (P＞0.05); the post-operation INF-γ contents of the two groups showed significant difference at 8th day and 12th day after the operation (P＜0.05); the acupuncture anesthesia group was superior to the general anesthesia group; the self-comparison of the anesthesia group showed significant difference at the 12th day and 8th day after the operation (P＜0.05); the pre-operation TNF contents of the two groups showed no significant difference (P＞0.05) and the post-operation TNF contents of the two groups showed significant difference at the 8th day and 12th day after the operation (P＜0.05). Conclusion:Acupuncture can increase the serum INF-γ and TNF contents of lung cancer patients and therefore regulate the immunity of the patients.

Objective To compare the value of transvaginal ultrasound and MRI in diagnosis of the first-trimester cesarean scar pregnancy (CSP).Methods The transvaginal ultrasound and MRI data of 28 patients who were initially diagnosed as CSP were analyzed. Regarding the surgery and postoperative pathology as a gold standard,the differences between transvaginal ultrasound and MRI were compared in the sensitivity,specificity,diagnostic coincidence rate and the ability in showing the internal structure of gestational sac and its relationship with the surrounding tissue.Results 22 CSP patients were confirmed by surgical pathology in a total of 28 patients,while 20 CSP patients using transvaginal ultrasound and 1 9 using MRI were correctly diagnosed respectively,and the sensitivity,specificity and diagnostic coincidence rate were 90.9%,50.0%,82.1% vs 86.4%,83.3%,85.7%,respectively,exhibiting no statistical difference in the coincidence rates between two methods (χ2 =0.132,P=0.72 ).The pregnant bursa in 20 patients was found by pathology in 22 CSP patients,and 19 pregnant bursa with transvaginal ultrasound and 17 with MRI were confirmed respectively,exhibiting no statistical difference between two methods (χ2 =1.11,P =0.29).The yolk sac in 12 patients,embryos in 8,original heart tube in 5 and local scar pregnancy sac infiltration in 3 were found with transvaginal ultrasound,meanwhile those in 2,2,0 and 9 respectively were also found with MRI,exhibiting significant differences between the two methods (χ2 =13.8,P =0.000;χ2 =7.7,P =0.006;χ2 =7.2,P =0.007;χ2 =7.1,P=0.008).The pregnancy capsule hemorrhage in 7 patients and hemorrhage in uterine cavity in 9 were found with transvaginal ultrasound, meanwhile those in 14 and 1 5 were found with MRI,exhibiting significant differences (χ2 =6.6,P =0.01;χ2 =5.0,P =0.026). Conclusion The coincidence rate in diagnosis of CSP using transvaginal ultrasound or MRI is higher.Transvaginal ultrasound is superior to MRI in showing the yolk sac,embryos and original heart tube,while MRI is better than transvaginal ultrasound in showing the hemorrhage of uterine cavity or gestational sac and the relationship between pregnant bursa and the surrounding tissue.Combination of the two methods shows more value in early diagnosis of CSP.

Objective:To investigate the predictive value of mechanism Glasgow age blood pressure score (MGAPS), revised trauma score (RTS) and modified rapid emergency medicine score (mREMS) in predicting the mortality risk of patients with acute traumatic brain injury (TBI) within 24 hours.Methods:A case control study was performed for clinical data of 1 156 patients with acute TBI admitted to Affiliated Hospital of Nantong Hospital from January to December of 2020, including 745 males and 411 females; aged 18-100 years [(59.9±15.1)years]. Glasgow coma score (GCS) was 3-15 points [15(9, 15)points]. The patients were divided into death group ( n=87) and survival group ( n=1 069) according to death or not within 24 hours. Vital signs, general data, MGAPS, RTS and mREMS were documented at emergency visit. Differences in the specific scores and severity levels of the patients using the three scoring systems were compared between the two groups. Receiver operating characteristic (ROC) curve was plotted for the three scoring systems based on the specific scores and severity levels of the patients. While the area under the curve (AUC), sensitivity, specificity, optimal threshold and Youden index were determined to estimate the value of the three scoring systems in predicting death risk in patients with acute TBI within 24 hours. Results:Death group showed significantly decreased scores in MGAPS [17(12, 19)points] and RTS [5.0(4.1, 6.0)points] and significantly increased score in mREMS [9(7, 12)points] when compared with survival group (all P<0.01). The proportion of moderate- and high-risk patients for MGAPS and proportion of high-risk patients for RTS and mREMS in death group were significantly higher than those in survival group (all P<0.01). As indicated by the ROC curve plotted based on the specific scores, mREMS had the maximum AUC (0.88), followed by MGAPS (0.86) and RTS (0.86); the sensitivity of mREMS, MGAPS and RTS was similar (80.5%, 86.2% and 82.8%, respectively), while mREMS showed the highest specificity (83.4%) compared to MGAPS (78.0%) and RTS (82.3%); the optimum threshold of mREMS, MGAPS and RTS, was 6 points, 6.08 points and 20 points; the Youden index of MGAPS, RTS and mREMS was 0.64, 0.64 and 0.65. As indicated by the ROC curve plotted based on the injury severity, MGAPS had the highest AUC (0.84), followed by RTS (0.70) and mREMS (0.59); MGAPS also had the highest sensitivity (92.0%), higher than RTS (47.1%) and RTS (18.4%); when mREMS showed the highest specificity(98.8%) compared to RTS (93.7%) and MGAPS (68.8%); the optimal threshold of MGAPS, RTS and mREMS was 22 points, 4 points and 13 points; the Youden index of MGAPS, RTS and mREMS was 0.61, 0.41 and 0.17. Conclusions:MGAPS, RTS and mREMS can be predictive in assessing the mortality risk of patients with acute TBI within 24 hours. mREMS has the highest prediction value, with an optimal threshold of 6 points when the risk assessment is made in accordance with specific scores of the patients. MGAPS has the highest prediction value when the risk assessment is assessed by the injury severity.

Objective:To explore the application effect of perforator pedicle flap in the wound repair after resection of the medium and large-sized keloids in the trunk.Methods:From January 2018 to January 2019, 10 patients, aged from 20 to 53 years old, with medium and large-sized keloids in the trunk were treated, including 3 cases in the anterior chest, 3 cases in the umbilical region, 4 cases in the lower abdomen, 8 cases were women and 2 cases were men. The size of keloids were 2.0 cm×3.0 cm to 5.0 cm×9.0 cm, and all keloids were accompanied with infection. Scars and infected tissues were removed and contracture was released completely. Pedicled flaps with intercostal perforator artery(3 cases), paraumbilical perforator artery(3 cases) or groin perforator artery(4 cases) were elevated and advanced or rotated to cover the wound. Early radiotherapy was delivered to the scar bed 5-10 Gy each time with a total dose of 15 to 20 Gy over 3 daily fractions after surgery. And other treatments, such as topical silicone gel, corticosteroid intralesional injection and elastic clothing compression were taken as adjuvant therapy. The scars were assessed by the Vancouver Scar Scale, and local morphology, hair distribution, itching, pain and patient satisfaction were analyzed and evaluated after 12 months to 24 months follow-up.Results:All flaps survived and the incisions healed primarily. The local morphology and hair distribution were normal, and the itching and pain were relieved obviously. The Vancouver Scar Scale scores vary from 1 to 6 in 9 patients. Incision hypertrophic scar with the Vancouver Scar Scale score of 9 occurred in one noncompliance patient who didn’t follow up on time and refuse to take the adjuvant treatments. 8 patients were extremely satisfied with the treatment effect, and 2 patients were satisfied with the treatment effect.Conclusions:For medium and large-sized keloids in the trunk, combined modality therapy, including local perforator pedicled flaps transplantation, early radiotherapy, topical silicone gel, elastic compression and etc, will achieve satisfied clinical effects.

Objective:To explore the application effect of perforator pedicle flap in the wound repair after resection of the medium and large-sized keloids in the trunk.Methods:From January 2018 to January 2019, 10 patients, aged from 20 to 53 years old, with medium and large-sized keloids in the trunk were treated, including 3 cases in the anterior chest, 3 cases in the umbilical region, 4 cases in the lower abdomen, 8 cases were women and 2 cases were men. The size of keloids were 2.0 cm×3.0 cm to 5.0 cm×9.0 cm, and all keloids were accompanied with infection. Scars and infected tissues were removed and contracture was released completely. Pedicled flaps with intercostal perforator artery(3 cases), paraumbilical perforator artery(3 cases) or groin perforator artery(4 cases) were elevated and advanced or rotated to cover the wound. Early radiotherapy was delivered to the scar bed 5-10 Gy each time with a total dose of 15 to 20 Gy over 3 daily fractions after surgery. And other treatments, such as topical silicone gel, corticosteroid intralesional injection and elastic clothing compression were taken as adjuvant therapy. The scars were assessed by the Vancouver Scar Scale, and local morphology, hair distribution, itching, pain and patient satisfaction were analyzed and evaluated after 12 months to 24 months follow-up.Results:All flaps survived and the incisions healed primarily. The local morphology and hair distribution were normal, and the itching and pain were relieved obviously. The Vancouver Scar Scale scores vary from 1 to 6 in 9 patients. Incision hypertrophic scar with the Vancouver Scar Scale score of 9 occurred in one noncompliance patient who didn’t follow up on time and refuse to take the adjuvant treatments. 8 patients were extremely satisfied with the treatment effect, and 2 patients were satisfied with the treatment effect.Conclusions:For medium and large-sized keloids in the trunk, combined modality therapy, including local perforator pedicled flaps transplantation, early radiotherapy, topical silicone gel, elastic compression and etc, will achieve satisfied clinical effects.

This article reviewed the concept,measuring methods,theoretical models and research progress of career resilience by retrieving and analyzing related literature at home and abroad. Besides,this paper also introduced its application in nursing management at home and abroad so as to provide the basis for nursing human resource management of China.

Objective To investigate the application value of contrast-enhanced ultrasound(CEUS) time-intensity curve in the radiofrequency ablation treatment of hepatocellular carcinoma.Methods Seventy-six patients with hepatocellular carcinoma (118 tumor lesions) conducted the ultrasound-guided radiofrequency ablation therapy.The acoustic quantitative analysis software was employed to dynamically analyze the residual ablation lesions,which were compared with the examination results of synchronous enhanced MRI,with the pathology as the gold standard,the benign and malignant tumor residual ablation lesions were performed the statistically comparative analysis.Results The accuracy of CEUS effect after liver radiofrequency ablation therapy was 82.2 ％,which of enhanced MRI was 83.9 ％;the difference between CEUS and enhanced MRI had no statistical significance(P＞ 0.05),their examination results had higher consistency;the benign residual ablation lesions after radiofrequency ablation had blood perfusion characteristics different from malignant residual lesions,the time-intensity curve showed that IMAX benign residual lesions were smaller than malignant residual lesions(P＜0.01).The benign residual lesions of RT and TTP were longer than the malignant residual lesions(P＜0.01);diagnosing benign and malignant had no statistical difference between CEUS and enhanced MRI (P＞0.05).Conclusion CEUS combined with the time-intensity curve can dynamically,intuitively and quantitatively reflect the blood perfusion differences among inactivated focus,benign and malignant residual lesions,and the surrounding liver parenchyma.