Objective:To explore the obstacles of the promotion of nursing quality homogenization management under the mode of multiple hospital areas, and to make the best response strategies and management ideas according to the obstacles, so as to achieve the goal of nursing quality management with the same quality and high efficiency.Methods:Based on the theory framework of 5M1E analysis, this study made an interview outline. Through focus group interview and personal interview, 44 nurses of different positions and levels were interviewed. The interview materials were sorted out and analyzed by Colaizzi seven step analysis method, and the themes were extracted to obtain the obstacles to the promotion of nursing quality homogeneity management.Results:The factors that hinder the management of nursing quality homogeneity included: the lack of understanding and thinking on the management of nursing quality homogeneity, the incomplete integration of quality control organization system in different hospital areas, the lack of comprehensiveness of nursing quality management system and standard unification, the differences in the implementation of quality control system, standard and plan, the difference in information system, the disunity of quality control index extraction, the physics of treatment room, etc. There were six aspects of environmental layout differences.Conclusion:The homogenization of nursing quality management under the mode of "one hospital, multiple districts" is of great significance. Hospitals need to formulate feasible countermeasures and development ideas according to the obstacles of homogenization management, so as to promote the development of nursing quality management and provide patients with the same quality of nursing services.

Objective To investigate the predictive value of plasma cystatin C (CysC) in patients with acute coronary syndrome (ACS) after pereutaneous coronary intervention (PCI).Methods A total of 660 patients with ACS admitted to cardiovascular department were enrolled in this study from January 2009 to June 2010.The enrollment criteria were:(1) the stenosis degree was above 75％ in at least one coronary artery checked by coronary angiography and successful PCI; (2) normal renal function or mild dysfunction with glomerular filtration rate (GFR) ＞ 60 ml/ ( min · 1.73 m2 ).Exclusion criteria were severe liver and renal insufficiency,malignancies and valvular heart diseases.The plasma CysC levels were examined by the latex enhanced immune turbidity method within 24 hours after admission.The relevant clinical data were recorded.The patients were followed up by out-patient interview or telephone from March to June 2011 and adverse cardiovascular events were recorded.The patients were divided into four groups according to CysC level:Q1 (CysC＜1.02 mg/L),Q2 (1.02 mg/L≤＜CysC ＜1.17 mg/ L),Q3 (1.17 mg/L ≤ CysC ＜1.35 mg/L) and Q4 (CysC ≥ 1.35 mg/L).Univariate and multivariate Cox hazards regressions were established to analyze the factors related to prognosis.The proportion differences between four groups were tested by x2.The survival ratio was estimated using the Kaplan-Meier method.Statistical significance was established at a P value of less than 0.05.Results ① A total of 606 ( 91.7％ ) patients successfully accepted follow-up.Mean follow-up time was ( 14.3 + 1.7 ) months.Of them,95 patients were subjected to adverse cardiovascular events ( 15.7％ ).②The incidences of adverse cardiovascular events in Q2,Q3,Q4 were significantly higher than those in Q1 ( P ＜ 0.001 ).The rates of mortality,nonfatal myocardial infarction and target lesion revascularization in Q4 were higher than those in Q1 ( P ＜ 0.05 ).The incidences of heart failure in Q3 and Q4 were higher than that in Q1 ( P ＜ 0.05 ).③Univariate analysis demonstrated that CysC,creatinine,LVEF,age,history of PCI and NYHA grade ≥3 were the risk factors of poor prognosis (P ＜ 0.05 ).④ Multivarite cox hazards regression revealed that the elevation of CysC level remained an independent predictor of adverse cardiovascular events.The relative risk of Q3 and Q4 were 3.930 (95％ CI 1.306-11.829,P =0.015 ) and 6.380 (95％ CI 2.171-18.751,P =0.001 ) compared with Q1.⑤　The cumulative rates of survival without adverse cardiovascular events in Q2,Q3 and Q4 decreased compared with Q1 (P ＜ 0.001 ).Conclusions High plasma CysC concentration is an independent predictor of adverse cardiovascular events in patients with ACS after PCI.

Objective To construct the LV3-human EGF-like domain 7-targeted small hairpin RNA (LV3-hEGFL7-shRNA)-expressing plasmid system.Methods Sequence of hEGFL7-targeted shRNA was designed by Oligo Designer 3.0 based on the mRNA sequence of hEGFL7 which was obtained from the Genbank.They were recombined with the plasmid pGLV3/H1/GFP + Puro,and then those plasmids were identified by gene sequencing to make sure they were correctly connec-ted.Then those plasmids were transfected into 293T cells and fluorescence expression was observed.Results The sequence of EGFL7-shRNA was demonstrated that the inserted sequences were correct,and the titer of virus was 2 × 10s TU · mL-1.Conclusion The hEGFL7-targeted shRNA expressing plasmids were successfully constructed,identification can meet test requirements.

Objective To investigate the predictive value of metabolic syndrome in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).Methods A total of 660 patients with ACS admited to cardiovascular department,first affiliated hospital of zhengzhou university were enrolled in this study from January 2009 to June 2010.The enrollment criteria were:the stenosis degree were above 75％ in at least one coronary artery by coronary angiography and successful PCI procedure.Exculsion criteria were:liver and renal insufficiency,malignancies and valvular heart diseases.The relevant clinical data and labtory examination were recorded after admission. The patients were followed up by outpatients interview or telephone from March to June 2011 and adverse cardiovascular events were recorded.The patients were divided into MS and non-MS groups,and basic clinical data were compared between two groups.The proportion difference between two groups were tested by chi square. Multivariate logistic regression was established to analyze the factors related to progonosis.The survival ratio was estimated using the Kaplan-Meier method.Statistical significance was established at a P value of less than 0.05.Results ①A total of 606 (91.7％) patients successfully accepted follow-up.Mean follow-up time were ( 14.3 ±1.7 ) months.95 patients experienced adverse cardiovascular events ( 15.7％ ).②There were 393 patients (64.96％ ) satisfied the definition of metabolic syndrome.The patients in MS group were with higher BMI,SBP,DBP,blood glucose and disordered lipid (all P ＜ 0.05 ),with less fale patients (P =0.016),less current somking (P =0.008 ) and with higher platelet (P =0.037 ). The incidence of adverse cardiovascular events in two groups were 17.81％ and 11.79％ ( P ＞ 0.05 ). ③ Multivarite logistic regression revealed that the predictors of adverse cardiovascular events were age [ OR =2.628,95％ confidence interval (CI) 1.395 ～ 4.954,P =0.003 ],New York Heart Association (NYHA) ≥ 3 grade ( OR =2.310,95％ CI 1.095 ～4.870,P =0.028) and left ventricular ejection fraction (LVEF) ( OR =4.328,95％ CI 1.955 ～9.580,P ＜ 0.001 ).However,MS was not related with prognosis ( OR =1.170,95％ CI 0.583 ～ 2.345,P =0.659 ).④The cumulative survival rates of no adverse cardiovascular events in the two groups were no significant difference ( P ＞ 0.05 ).Conclusions MS is a risk factor with coronary heart disease.Howerer,it has no relationship with adverse cardiovascular events in patients with ACS after PCI.

Objective To explore the clinical and imaging features of pulmonary embolism (PE)in children with mycoplasma pneumonia (MP).Methods The clinical features,imaging manifestations and laboratory data of 6 children with MP complicated by PE were reviewed retrospectively.Results 6 cases of children were admitted with chief complaints of fever and cough,the D-dimer levels were increased obviously.Consolidation was observed in 4 cases in the right lower lobe combined with pleural effusion and in 2 cases in the left lobe,which showed homogeneous enhancement.Filling defect of pulmonary artery was observed in 1 case,and other 5 cases showed sparse pulmonary vascular in consolidation area.D-dimer returned to normal level and consolidation was absorbed after anticoagulation therapy.Conclusion MP combined with PE in children is rare,and the positive detection rate of pulmonary artery angiography is low.PE should be considered when MP continues to deterioration after anti-infection treatment,even though there is no typical imaging findings of PE.

OBJECTIVETo identify the clinical phenotype and gene mutation in two kindreds with type I inherited antithrombin (AT) deficiency.

METHODSThe coagulation and anticoagulation testing and thrombophilia screening were used for phenotypic diagnosis and immunonephelometry and chromogenic assay for plasma level of AT antigen (AT:Ag) and AT activity (AT:A), respectively. All of the seven exons and intron-exon boundaries and untranslation regions of AT gene were amplified by PCR, and the PCR products analysis was by direct sequencing. The corresponding gene sites of the two family members and healthy individuals were detected according to the gene mutation sites.

RESULTSThe plasma levels of AT:Ag of proband 1 and proband 2 were 126 mg/L and 117 mg/L, and AT:A was 49% and 48%, respectively. Heterozygotic deletion of 3239-3240delCT in proband 1 and nonsense mutation 3206A-->T (K70Stop) in proband 2 were rchaacterized in exon 2 of AT gene. And some of their family members were also detected with the heterozygotic gene mutation.

CONCLUSIONType I inherited antithrombin deficiency of the two probands were caused by AT gene mutation 3239-3240delCT and 3206A-->T (K70Stop).

Antithrombin III Deficiency ; genetics ; Heterozygote ; Humans ; Mutation ; Pedigree ; Phenotype

OBJECTIVETo study the feasibility of using tetracysteine (TC) reporter in gene therapy.

METHODSEffects of TC reporter and conventional reporter genes encoding green fluorescence protein (GFP) and luciferase (Luc) on expression and function of the therapeutic gene MGMT(P140K) were compared. Cytotoxicity and drug resistance were studied by Western blot. TC reporter used in therapy was analyzed by flow cytometry (FCM).

RESULTSThe TC reporter had no toxicity to cells and neither affected the expression or activity of therapeutic gene as compared to GFP and Luc. TC could be used in blood sample detection.

CONCLUSIONTC is a new kind of reporter gene for lentiviral vector in future gene therapy.

Animals ; CHO Cells ; Cricetinae ; Cricetulus ; Cysteine ; analogs & derivatives ; genetics ; metabolism ; Gene Expression Regulation ; Genes, Reporter ; Genetic Therapy ; Humans ; Lentivirus ; genetics ; Lymphocytes ; metabolism

The establishment of a polarized cellular morphology is essential for a variety of processes including neural tube morphogenesis and the development of the brain. Cdc42 is a Ras-related GTPase that plays an essential role in controlling cell polarity through the regulation of the actin and microtubule cytoskeleton architecture. Previous studies have shown that Cdc42 plays an indispensable role in telencephalon development in earlier embryo developmental stage (before E12.5). However, the functions of Cdc42 in other parts of brain in later embryo developmental stage or in adult brain remain unclear. Thus, in order to address the role of Cdc42 in the whole brain in later embryo developmental stage or in adulthood, we used Cre/loxP technology to generate two lines of tissue-specific Cdc42-knock-out mice. Inactivation of Cdc42 was achieved in neuroepithelial cells by crossing Cdc42/ flox mice with Nestin-Cre mice and resulted in hydrocephalus, causing death to occur within the postnatal stage. Histological analyses of the brains from these mice showed that ependymal cell differentiation was disrupted, resulting in aqueductal stenosis. Deletion of Cdc42 in the cerebral cortex also induced obvious defects in interkinetic nuclear migration and hypoplasia. To further explore the role of Cdc42 in adult mice brain, we examined the effects of knocking-out Cdc42 in radial glial cells by crossing Cdc42/flox mice with human glial fibrillary acidic protein (GFAP)-Cre mice. Inactivation of Cdc42 in radial glial cells resulted in hydrocephalus and ependymal cell denudation. Taken together, these results highlight the importance of Cdc42 for ependymal cell differentiation and maintaining, and suggest that these functions likely contribute to the essential roles played by Cdc42 in the development of the brain.
Animals ; Brain ; metabolism ; pathology ; Cell Differentiation ; Cell Polarity ; Cerebral Cortex ; cytology ; metabolism ; Constriction, Pathologic ; Embryo, Mammalian ; metabolism ; Embryonic Development ; Ependyma ; cytology ; metabolism ; Glial Fibrillary Acidic Protein ; genetics ; metabolism ; Humans ; Hydrocephalus ; metabolism ; pathology ; Integrases ; genetics ; metabolism ; Mice ; Mice, Knockout ; cdc42 GTP-Binding Protein ; genetics ; metabolism

Objective To analysis the effects on the growth of rats by repeated restraint in dermal exposure test. Methods SD rats in the restraint group was bound for 6 hours per day for 91 days according the way by dermal exposure, while SD rats in the control group didn't receive the treatment. Clinical signs, body weight and food consumption changes were observed for 91 days. When the study was terminated, hematology, clinical biochemistry, urinalyses, gross necropsy, and histopathology were carried out. Statistical methods such as the generalized estimating equation were used to compare the differences between two groups. Results The statistical results of generalized estimating equation showed that there was an interaction between the group and test time for male and female rats in body weight changes (P<0.05), and the body weight of male rats in the restraint group was lower than the control group (P<0.05) . Further analysis showed that for male rats there was significant difference between groups since the forth week (P<0.05), and the interaction was found between groups and test time (P<0.05) . For female rats, the interaction was found since the eighth week between the group and test time (P <0.05) .There was no significant differences in other parameters between two groups (P>0.05) . Conclusion Repeated restraint during dermal exposure affected the body weight gain of rats, and the sensitivity of male rats was higher than that of female rats.

Objective:Lung ultrasound (LUS) has been used in the diagnosis of neonatal respiratory distress syndrome(RDS) successfully, but there have been no multicenter prospective studies to verify its reliability or determine how to grade RDS with LUS findings.This study aimed to discuss the necessity and feasibility of using LUS findings to determine RDS grades through a multicenter prospective study.Methods:Every researcher participated in the National Neonatal Lung Ultrasound Training Course and receiving 3-6 months of lung ultrasound system training at the National Neonatal Lung Ultrasound Training Center.Patients between June 2018 and May 2020 who met the RDS ultrasound diagnostic criteria and had full available clinical data were included in this study.The LUS examination was completed immediately after the patients were admitted to the hospital.Some of them also underwent chest X-ray examination.Arterial blood gas analysis was completed immediately before or after the LUS ultrasound examination.RDS grading was performed according to the LUS findings and whether the patient had serious complications.Results:A total of 275 qualifying cases were included in this study, which included 220 premature infants and 55 full-term infants, and the primary RDS occurred in 117 cases (42.5%), and secondary RDS occurred in 158 cases (57.5%). LUS manifestations of RDS patients can be divided into three categories: (1)A ground-glass opacity sign: which could be found among 50 infants when they were admitted to the hospital (that was, at their first LUS examination). Twenty-eight of these infants were considered to have wet lungs and were not sent for special management on admission, but LUS showed typical snowflake-like lung consolidation within 0.5 to 4 hours.Twenty-two of them were given mechanical ventilation with exogenous pulmonary surfactant; Eighteen cases were controlled within 6-12 hours, but the lung lesions became more severe in the other 4 infants (due to severe intrauterine infection). (2)Snowflake-like lung consolidations: the first LUS on admission showed typical snowflake-like lung consolidation involving areas ranging from 1-2 intercostal spaces to 12 lung divisions in 204 cases.Thirty-eight infants among them the lung consolidation only had involvement of 1-2 intercostal spaces at the time of admission; Fifteen of them received invasive respiratory support and recovered within 4-12 hours.Twelve patients received noninvasive respiratory support; Seven of them recovered, while five cases developed severe lung illness.The remaining 11 patients who were not given any form of ventilator support developed severe conditions within 1-4 hours.Thirty of them showed snowflake signs involving 12 lung regions at admission.The remaining 136 patients had lung consolidation degree between the two degree above condition.(3)Snowflake-like sign with complications: Twenty-one patients had severe complications such as pneumothorax, pulmonary hemorrhage or/and persistent pulmonary hypertension of the newborn or large area atelectasis, etc, although snowflake lung consolidation did not involve all lung regions.Conclusion:(1) LUS is reliable and accurate for diagnosing RDS.RDS has the same characteristics on ultrasound for both preterm and full-term infants, both primary and secondary RDS.(2) To facilitate the management of RDS, it is necessary to classify RDS according to the ultrasound findings and the presence of severe complications.(3) Based on the results of this study, it is recommended that RDS can be divided into mild, moderate and severe degrees.The exact standards for grading are as follows: Mild RDS: the early stage of RDS, in which lung consolidation shows as a ground-glass opacity sign on ultrasound; Moderate RDS: lung consolidation shows a snowflake sign on ultrasound, not all of the lung fields are involved; Severe RDS meets one or more of the following criteria: lung consolidation shows as a snowflake sign on ultrasound and all lung regions are involved, or regardless of its degree and extent, lung consolidation has caused serious complications, such as pulmonary hemorrhage, pneumothorax, persistent pulmonary hypertension of the newborn, or/and a large area of pulmonary atelectasis.