The whole chloroplast genome ofthe medicinal plant Paeonia mairei H. Lév. was sequenced using the Illumina HiSeq X Ten platform and then assembled, annotated, and characterized by bioinformatic methods in this study. The complete chloroplast genome of P. mairei is 152 731 bp in length with the typical quadripartite structure, which consists of a large single copy-region (LSC, 84 402 bp), a small single copy-region (SSC, 16 969 bp), and a pair of inverted repeat regions (IRa and IRb, 25 680 bp), with an overall GC content of 38.4%. A total of 136 predicted genes, including 90 protein-coding genes, 38 tRNA genes and eight rRNA genes were identified. Among these, seven protein-coding genes, seven tRNA genes and four rRNA genes were found duplicated in the IR regions. In addition, 28 dispersed repeats, 10 tandem repeats, and 64 simple sequence repeats were detected within the whole chloroplast genome of P. mairei. Comparative analyses between 12 Peaonia species showed that the chloroplast genomes are highly conserved in length, gene content, gene order, and GC content. Meanwhile, the noncoding sequences (intergenic regions and introns) show a higher variation than the protein coding sequences, and sequences from the LSC region and SSC region are more variable than those from the IR regions. P. mairei was inferred forming in a distinct clade with P. lactiflora, P. obovate, and P. anomala subsp. veitchii with a 100% bootstrap value and is phylogenetically closest to P. lactiflora. These results may provide a basis for further genetic studies and the development and utilization of medicinal P. mairei.

An analysis of typical cases of the incentive-restraint mechanism in the development of medical alliances in China , discovered a number of problems as follows .These include poor top-level system design, delayed reform of the medical insurance payment system , poor performance of the two-way referral system, insufficient human resources and their unreasonable distribution , shortage of a performance appraisal and salary incentive system, and low patient support.In this regard, this paper put forward policy recommendations on the pathway to carry out the incentive and constraint mechanism of medical alliances , in terms of such aspects as top-level system design , medical insurance system , personnel and remuneration system, and two-way referral system .

Objective:The three-step model of ″new nurse, professional group nurse, and clinical nurse specialist″ combines the clinical professional nursing group to promote the development of clinical nurse research capabilities and the construction of nursing research teams.Methods:A three-step model of ″new nurse, professional group nurse, and clinical nurse specialist″ was established by combining the individual development of nurses and team collaboration. Taking the clinical professional nursing group as the entry point, clinical work of the clinical professional nursing group, quality control of clinical professional nursing groups, quality control circle activities, nurse career development, and nursing research team building were integrated to implement the three-step model, thereby driving the development of clinical nurses′ research capacity and nursing research team construction. The methods of the three-step model combined with clinical professional nursing groups to promote the development of clinical nurse research capabilities and the construction of nursing research teams were implemented. The following were the eleven specific management measures: Improving the structure and echelon construction of clinical professional nursing groups, developing research plans and goals from four dimensions (departments, clinical professional nursing groups, individual nurses, and new nurses), carrying out nursing research training to clinical professional nursing groups that emphasizes both theriotical methods and practical operations, organizing nursing research projects by clinical professional nursing groups, promoting the innovation of work towards digitization and informatization, promoting clinical professional nursing groups to conduct interventional studies, launching quality control circle projects by clinical professional nursing groups, participating in and hosting nursing rounds by clinical professional nursing groups, improving the clinical technical problem by The clinical professional nursing groups, encouraging collaboration and communication between clinical professional nursing groups and physicians, facilitating the cross-integration and development of clinical professional nursing groups.Results:The three-step model has promoted the growth of nurses from the route of ″new nurse, professional group nurse, and clinical nurse specialist″, built a nursing research team and talent echelon based on the breakthrough of clinical professional nursing groups, and solved clinical practical problems and produced scientific research results.Conclusions:Implementing the three-step model combined with clinical professional nursing groups to promote the development of clinical nurse research capabilities and the construction of nursing research teams can promote the collaborative development of clinical nursing research and clinical nursing work.

Objective:To investigate the related factors that affect the timing and prognosis of early tracheostomy in patients with multiple rib fractures.Methods:A retrospective case series study was conducted on medical data of 222 patients with multiple rib fractures who underwent tracheostomy in Affiliated Hospital of Yangzhou University from February 2013 to October 2019，including 160 males and 66 females，with the age of 18 to 85 years ［（49.5 ± 16.3）years］. According to the practice management guidelines for tracheostomy timing and the use of propensity score matching technology，there were 118 patients with tracheostomy within 7 days of tracheal intubation （early group） and 104 patients with tracheostomy after 7 days of tracheal intubation （late group） before matching，and there were 87 patients in early group and 87 patients in late group after matching. Data were compared between groups including the gender，age，underlying disease，injury severity score （ISS），Glasgow coma score （GCS），number of fractured ribs，total number of rib fractures （NTRF），first rib fracture，flail chest，traumatic brain injury，combined injuries （spine，maxillofacial，sternum），acute respiratory distress syndrome （ARDS），volume fraction of pulmonary contusion（VPC），blood lactic acid （within 24 hours of admission），hemothorax，pneumothorax，mechanical ventilation time，duration of tracheostomy，time from tracheal intubation to incision，length of hospital stay，length of stay in ICU，closed thoracic drainage，number of fiberoptic bronchoscopy，multi-drug resistant bacteria infection，ventilator-associated pneumonia，antibiotic use time，duration of sedative and analgesic drugs used and 28-day mortality. The multivariate Logistic regression analysis was used to predict independent risk factors for early tracheostomy. The Pearson method was used to compare the relationship between multiple factors. The receiver operating characteristic （ROC） curve was used to predict indicators that affect the prognosis of patients with early tracheostomy，and calculate the best cut-off value. The Kaplan-Meier single factor and COX multivariate survival were used to analyze the relevant factors affecting the 28-day mortality of patients.Results:（1） In early group，the NTRF，ARDS and VPC were higher than those in late group，and the time from tracheal intubation to incision and 28-day mortality rate were lower than those in late group （ P < 0.05），while the two groups showed no significant differences in the gender，age，underlying diseases and ISS （ P > 0.05）. （2） The multivariate Logistic regression analysis showed that there was statistical significance in NTRF （ OR = 1.775，95% CI 1.439-2.188），ARDS（ OR = 3.740，95% CI 1.441-9.711），VPC （ OR = 1.087，95% CI 1.052-1.124） （ P < 0.05）； the Pearson method analysis showed a significant correlation between VPC and NTRF （ r = 0.369， P < 0.05） and a low degree of correlation between ARDS and VPC （ r = 0.179， P < 0.05），but there was no significant correlation between ARDS and NTRF （ r = 0.132， P > 0.05）. （3） The ROC curve analysis showed that the area under the curve （AUC） of the VPC and NTRF ［AUC = 0.832 （95% CI 0.770-0.893），AUC = 0.804 （95% CI 0.740-0.868）］ were significantly higher than those of the number of rib fractures ［AUC = 0.437（95% CI 0.352-0.523），GCS ［AUC = 0.519 （95% CI 0.432-0.605）］ and ISS ［AUC = 0.484 （95% CI 0.398-0.571）］ （ P < 0.05）. After calculating the Yorden index，the best cut-off value for VPC was 23.9，and the best cut-off value for NTRF was 8.5. （4） The Kaplan-Meier single factor and multivariate COX model survival analysis showed that the 28-day survival ratio of patients with early tracheostomy was significantly better than that of late tracheostomy （ P < 0.05）. Conclusions:The NTRF，ADRS and VPC are independent risk factors for the timing and prognosis of early tracheostomy. There is a significant correlation between VPC and NTRF. The VPC ≥ 23.9% and or NTRF ≥ 8.5 can be used to predict early tracheostomy in patients with multiple rib fractures. Early tracheostomy may benefit the 28-day survival of patients with multiple rib fractures.

Objective To systematically review the effect of enteral nutrition via a naso-gastric (intestinal) tube (NG) vs a percutaneous endoscopic gastrostomy/jejunostomy (PEG/PEJ) after liver transplantation,and provide support for the selection of proper nutrition.Methods Pub Med,web of science,Cochrane Library (Jan,2018),CNKI,VIP and Wanfang Date were search until Jan,2018.Two authors independently assessed the trials for inclusion and extracted the data.Discrepancies were resolved in consultation with a third reviewer,about the research of retrospective study for the effects of enteral nutrition via NG vs PEG/PEJ after liver transplantation was performed and supplemented.Publication bias were evaluated,and Meta-analyses were conducted with RevMan5.3.Results 4 studies were collected,involving 430 patients.The Meta-analysis showed that starting time of enteral nutrition of PEG/PEJ was earlier than NG (MD =-1.77,95％ CI-1.83 to-1.70,P＜0.05).The average hospitalization time of PEG/PEJ was shorter than NG (MD=-2.88,95％CI-5.19 to-0.56,P＜0.05).The diarrhea incidence of PEG/PEJ was higher than NG (OR=1.66,95％CI 1.04 to 2.65,P＜0.05),and gastroesophageal reflux incidence of PEG/PEJ was lower than NG (OR=0.29,95％CI 0.12 to 0.66,P＜0.05).The gastric retention rate of PEG/PEJ was lower than NG (OR =0.26,95％ CI 0.14 to 0.41,P＜0.05).Dislocation incidence of PEG/PEJ was lower than NG (OR =0.06,95％CI 0.01 to 0.46,P＜0.05).The pneumonia incidence of PEG/PEJ tube was lower than NG (OR=0.59,95％CI 0.36 to 0.99,P＜0.05).There were no significant differences between PEG/PEJ and NG on indwelling time,occlusion,abdominal infection,acute renal insufficiency,and acute rejection reaction.Conclusion PEG/PEJ had earlier starting time of enteral nutrition,shorter hospitalization time,lower nutrition tube placement related complications such as gastric esophagus reflux,gastric retention,dislocation rate and lower incidence of pneumonia,but the incidence of diarrhea was higher.NG is the first choice after liver transplantation,and for patients with serious basic diseases,weak digestive function or digestive system disorders PEG/PEJ can be chosen.

Objective To analyze the characteristics of papers published in Organ Transplantation in the past ten years. Methods The academic papers published in Organ Transplantation from January 2010 to December 2019 were retrieved from China National Knowledge Infrastructure (CNKI). The publication volume, the funded paper ratio, authors, research institutions and keywords were analyzed by information visualization software CiteSpace 5.3 and VOSviewer 1.6. Results From 2010 to 2019, a total of 919 academic papers were published in Organ Transplantation, with an average annual publication volume of 92, showing an overall stable trend. The funded paper ratio and the ratio of papers with funding support at the provincial level or above increased year by year, reaching 100% in 2019. High-yield authors mainly formed two research teams led by Shi Bingyi and Chen Guihua respectively. The first authors were distributed across China. In recent years, as many as 58 programmatic papers were published by national academic institutions, especially signed by Branch of Organ Transplantation of Chinese Medical Association. The average number of authors per paper was 4.94 in Organ Transplantation, and the proportion of papers contributed by two or more authors remained above 90% in recent years. According to the analysis of research institutions, the average number of institutions per paper was 1.60 in Organ Transplantation. Keyword co-occurrence network analysis demonstrated that liver transplantation, renal transplantation and organ transplantation were the research hotspots in the field of organ transplantation. Keyword cluster analysis showed that research mainly focused on 9 fields, such as liver transplantation, renal transplantation, organ transplantation, organ donation, posttransplantation complications, transplantation immunity, end-stage liver disease, xenotransplantation and stem cell transplantation. Keyword burst analysis showed that xenotransplantation, α-1, 3-galactose, transplantation immunity, apoptosis, donor specific antibody (DSA), antibody-mediated rejection (AMR) and flow cytometry were the research hotspots. Conclusions The authors that publish academic papers in Organ Transplantation come from major transplantation centers all over the country. The papers of Organ Transplantation cover the research hotspots of each branch in the field of organ transplantation, and include a large quantity of programmatic papers signed and published by national academic institutions, which show the frontier hotspots and the highest level of research in the field of organ transplantation in China, making Organ Transplantation an excellent academic journal.

Objective: To prospectively compare single-shot (SS) echo-planar imaging (EPI) and field-of-view optimized and constrained undistorted single-shot multiplexed sensitivity-encoding (FOCUS MUSE) for diffusion-weighted imaging (DWI) in evaluating thyroid-associated ophthalmopathy (TAO). Materials and Methods: SS EPI and FOCUS MUSE DWIs were obtained from 39 patients with TAO (18 male; mean ± standard deviation: 48.3 ± 13.3 years) and 26 healthy controls (9 male; mean ± standard deviation: 43.0 ± 18.5 years). Two radiologists scored the visual image quality using a 4-point Likert scale. The image quality score, signal-to-noise ratio (SNR), contrast-tonoise ratio (CNR), and apparent diffusion coefficient (ADC) of extraocular muscles (EOMs) were compared between the two DWIs. Differences in the ADC of EOMs were also evaluated. The performance of discriminating active from inactive TAO was assessed using receiver operating characteristic curves. The correlation between ADC and clinical activity score (CAS) was analyzed using Spearman correlation. Results: Compared with SS EPI DWI, FOCUS MUSE DWI demonstrated significantly higher image quality scores (P < 0.001), a higher SNR and CNR on the lateral rectus muscle (LRM) and medial rectus muscle (MRM) (P < 0.05), and a non-significant difference in the ADC of the LRM and MRM. Active TAO showed higher ADC than inactive TAO and healthy controls with both SS EPI and FOCUS MUSE DWIs (P < 0.001). Inactive TAO and healthy controls did not show a significant ADC difference with both DWIs. Compared with SS EPI DWI, FOCUS MUSE DWI demonstrated better discrimination of active from inactive TAO (AUC:0.925 vs. 0.779; P = 0.007). The ADC was significantly correlated with CAS in SS EPI DWI (r = 0.391, P < 0.001) and FOCUS MUSE DWI (r = 0.645, P < 0.001). Conclusion FOCUS MUSE DWI provides better images for evaluating EOMs and better performance in diagnosing active TAO than SS EPI DWI. The application of FOCUS MUSE will facilitate the DWI evaluation of TAO.

Objective: To prospectively compare single-shot (SS) echo-planar imaging (EPI) and field-of-view optimized and constrained undistorted single-shot multiplexed sensitivity-encoding (FOCUS MUSE) for diffusion-weighted imaging (DWI) in evaluating thyroid-associated ophthalmopathy (TAO). Materials and Methods: SS EPI and FOCUS MUSE DWIs were obtained from 39 patients with TAO (18 male; mean ± standard deviation: 48.3 ± 13.3 years) and 26 healthy controls (9 male; mean ± standard deviation: 43.0 ± 18.5 years). Two radiologists scored the visual image quality using a 4-point Likert scale. The image quality score, signal-to-noise ratio (SNR), contrast-tonoise ratio (CNR), and apparent diffusion coefficient (ADC) of extraocular muscles (EOMs) were compared between the two DWIs. Differences in the ADC of EOMs were also evaluated. The performance of discriminating active from inactive TAO was assessed using receiver operating characteristic curves. The correlation between ADC and clinical activity score (CAS) was analyzed using Spearman correlation. Results: Compared with SS EPI DWI, FOCUS MUSE DWI demonstrated significantly higher image quality scores (P < 0.001), a higher SNR and CNR on the lateral rectus muscle (LRM) and medial rectus muscle (MRM) (P < 0.05), and a non-significant difference in the ADC of the LRM and MRM. Active TAO showed higher ADC than inactive TAO and healthy controls with both SS EPI and FOCUS MUSE DWIs (P < 0.001). Inactive TAO and healthy controls did not show a significant ADC difference with both DWIs. Compared with SS EPI DWI, FOCUS MUSE DWI demonstrated better discrimination of active from inactive TAO (AUC:0.925 vs. 0.779; P = 0.007). The ADC was significantly correlated with CAS in SS EPI DWI (r = 0.391, P < 0.001) and FOCUS MUSE DWI (r = 0.645, P < 0.001). Conclusion FOCUS MUSE DWI provides better images for evaluating EOMs and better performance in diagnosing active TAO than SS EPI DWI. The application of FOCUS MUSE will facilitate the DWI evaluation of TAO.

Objective: To prospectively compare single-shot (SS) echo-planar imaging (EPI) and field-of-view optimized and constrained undistorted single-shot multiplexed sensitivity-encoding (FOCUS MUSE) for diffusion-weighted imaging (DWI) in evaluating thyroid-associated ophthalmopathy (TAO). Materials and Methods: SS EPI and FOCUS MUSE DWIs were obtained from 39 patients with TAO (18 male; mean ± standard deviation: 48.3 ± 13.3 years) and 26 healthy controls (9 male; mean ± standard deviation: 43.0 ± 18.5 years). Two radiologists scored the visual image quality using a 4-point Likert scale. The image quality score, signal-to-noise ratio (SNR), contrast-tonoise ratio (CNR), and apparent diffusion coefficient (ADC) of extraocular muscles (EOMs) were compared between the two DWIs. Differences in the ADC of EOMs were also evaluated. The performance of discriminating active from inactive TAO was assessed using receiver operating characteristic curves. The correlation between ADC and clinical activity score (CAS) was analyzed using Spearman correlation. Results: Compared with SS EPI DWI, FOCUS MUSE DWI demonstrated significantly higher image quality scores (P < 0.001), a higher SNR and CNR on the lateral rectus muscle (LRM) and medial rectus muscle (MRM) (P < 0.05), and a non-significant difference in the ADC of the LRM and MRM. Active TAO showed higher ADC than inactive TAO and healthy controls with both SS EPI and FOCUS MUSE DWIs (P < 0.001). Inactive TAO and healthy controls did not show a significant ADC difference with both DWIs. Compared with SS EPI DWI, FOCUS MUSE DWI demonstrated better discrimination of active from inactive TAO (AUC:0.925 vs. 0.779; P = 0.007). The ADC was significantly correlated with CAS in SS EPI DWI (r = 0.391, P < 0.001) and FOCUS MUSE DWI (r = 0.645, P < 0.001). Conclusion FOCUS MUSE DWI provides better images for evaluating EOMs and better performance in diagnosing active TAO than SS EPI DWI. The application of FOCUS MUSE will facilitate the DWI evaluation of TAO.

Objective: To prospectively compare single-shot (SS) echo-planar imaging (EPI) and field-of-view optimized and constrained undistorted single-shot multiplexed sensitivity-encoding (FOCUS MUSE) for diffusion-weighted imaging (DWI) in evaluating thyroid-associated ophthalmopathy (TAO). Materials and Methods: SS EPI and FOCUS MUSE DWIs were obtained from 39 patients with TAO (18 male; mean ± standard deviation: 48.3 ± 13.3 years) and 26 healthy controls (9 male; mean ± standard deviation: 43.0 ± 18.5 years). Two radiologists scored the visual image quality using a 4-point Likert scale. The image quality score, signal-to-noise ratio (SNR), contrast-tonoise ratio (CNR), and apparent diffusion coefficient (ADC) of extraocular muscles (EOMs) were compared between the two DWIs. Differences in the ADC of EOMs were also evaluated. The performance of discriminating active from inactive TAO was assessed using receiver operating characteristic curves. The correlation between ADC and clinical activity score (CAS) was analyzed using Spearman correlation. Results: Compared with SS EPI DWI, FOCUS MUSE DWI demonstrated significantly higher image quality scores (P < 0.001), a higher SNR and CNR on the lateral rectus muscle (LRM) and medial rectus muscle (MRM) (P < 0.05), and a non-significant difference in the ADC of the LRM and MRM. Active TAO showed higher ADC than inactive TAO and healthy controls with both SS EPI and FOCUS MUSE DWIs (P < 0.001). Inactive TAO and healthy controls did not show a significant ADC difference with both DWIs. Compared with SS EPI DWI, FOCUS MUSE DWI demonstrated better discrimination of active from inactive TAO (AUC:0.925 vs. 0.779; P = 0.007). The ADC was significantly correlated with CAS in SS EPI DWI (r = 0.391, P < 0.001) and FOCUS MUSE DWI (r = 0.645, P < 0.001). Conclusion FOCUS MUSE DWI provides better images for evaluating EOMs and better performance in diagnosing active TAO than SS EPI DWI. The application of FOCUS MUSE will facilitate the DWI evaluation of TAO.