Cbiective: To seek for effective nursing measures with the view of reducing nooocmial infection caused by methicillin resistant staphlococcus aurcus (MRSA). Method: The factores associated with nosocomial infection caused by MRSA were analysed on 205 cases from ICU during Jan. ～Jun 2000. Results: 88.6% of staphyloooccus aureus were MRSA in ICU. The percentage of nosocomial infection caused by MRSA was 7.3%. Conclusions:The rate of nosocomial infection causes by MRSA could be effectively reduce. Following proper measures were suggested:sterilization, isolation,nursing of intubation and nanagement of respiratory tract

A total of 62 critically ill patients were randomly allocated to the intensive insulin therapy group and the conventional insulin therapy group. The effect of therapy on the prognosis, the activity of NF-κB in peripheral blood monouclear cells and plasma intercellular adhesion molecule-1 level were investigated. The results showed that the intensive insulin therapy may improve the prognosis and insulin had a reliable anti-inflammatory effect in the critically ill patients.

Objective To investigate the effect of different frequencies of endoscopic ultrasonography (EUS) on diagnosis of duodenal submucesal lesions. Methods A total of 210 elevated duodenal lesions detected by routine endoscopy in 201 patients were examined by EUS at different frequencies according to lesion features and image clarity. Endoscopic resection was applied in 27 lesions with informed consents,and pathological findings were compared with the results of EUS. Results The accuracy of EUS was 81.4% (22/27). Ultrasound of low frequency was superior in displaying overview of lesion and was more suitable for lesions larger than 1.5 cm in diameter or lesions of hyperecho. On the other hand,ultrasound of high frequency was more reliable to reveal minute structures and could be employed in scanning lesions smaller than 1.5 cm in diameter. Combination of different frequencies of ultrasound could provide more details in larger lesions. Conclusion Application of appropriate frequency or combined frequencies of ultrasound in examination of elevated duodenal lesions is beneficial to achieve more accurate diagnosis.

Objective The aim of this study was to investigate the expression of WEE1 in gastric cancer and its influence on prognosis of patients. Methods Seventy-eight patients with gastric cancer were enrolled. According to the presence or absence of lymph node(LN)metastasis,the patients were divided into LN( -)group and LN( +)group. The expression of WEE1 in gastric canc-er tissues was detected by immunohistochemistry and RT-qRCR techniques. The influence of WEE1 expression on LN metastasis and prognosis of gastric cancer were analyzed statistically. Results (1)The positive rate of WEE1 in gastric cancer was 43. 6% ,of which 13 cases were a low expression and 21 cases with high expression. The positive rates of WEE1 in LN( +) group and LN( -) group were 53. 8% and 23. 1% ,respectively. (2)The results of RT-qPCR showed that the mRNA expression of WEE1 in LN( -)and LN ( +)groups was(1. 32 ± 0. 21) and(3. 64 ± 0. 41),respectively,and the difference was statistically significant(P<0. 01). (3) The results of ROC curve showed that the area under curve(AUC)of WEE1 mRNA expression level for LN metastasis of gastric cancer was 0. 806,the sensitivity was 84. 8% ,the specificity was 79. 6% ,and the diagnostic efficacy was good. T stage and LN metastasis were independent risk factors for the expression of WEE1(P<0. 05). (4)Among 78 patients,7 patients were lost to follow-up,the rate of loss of follow-up was 8. 9% ,and 41 patients died within 5 years. Among them,13,10 and 18 died in the WEE1( -)group,low-ex-pression of WEE1 group and high-expression of WEE1 group,respectively. The 5-year survival rates of the three groups were signif-icantly different(χ2 =25. 67,P<0. 001). The survival rate in the low expression of WEE1 group was not significantly different from the high expression of WEE1 group(P>0. 05),but both of them were significantly low the WEE1( -)group(P<0. 05). Conclusion WEE1 has a high positive rate in gastric cancer,and is closely related to patient stage and LN metastasis. The positive expression of WEE1 is a strong signal for poor prognosis.

Objective To investigate the status and analyze the influencing factors of structural empowerment and psychological empowerment of midwives in Suzhou.Methods Using convenience sampling,totally 309 midwives from fifteen hospitals in Suzhou were investigated with the Conditions of Work Effectiveness Questionnaire-Ⅱ (CWEQ-Ⅱ) and Psychological Empowerment Scale (PES).Results The scores of structural and psychological empowerment of midwives were (18.07±3.12) and (14.82±2.01).There was a significantly positive correlation between midwives' structural and psychological empowerment (r=0.396,P＜0.01).Hospital level and whether participate in midwifery standardization training had an impact on structural empowerment score(P＜0.05).Age,parental status,job title,salary,delivery room working hours,number of night shifts per month,and whether or not participate in teaching had an impact on psychological empowerment score(P＜0.05).Conclusion Midwives' structural and psychological empowerments are at a moderate level.Administrators should take targeted intervention to create an empowerment-allowing working environment for midwives,stabilize midwives work force,strengthen midwifery discipline construction and make full specialized features of midwives.

Objective:To observe the clinical efficacy of endoscopic submucosal dissection (ESD) in the treatment of superficial esophageal cancer (SEC), and to explore the application value of ESD in the treatment of SEC.Methods:From January 2016 to December 2019, at The First Affiliated Hospital With Nanjing Medical University, the clinical data of 368 patients with SEC and receiving ESD treatment were retrospectively analyzed, induding the general condition, the circumferential proportion of lesions, effectiveness of ESD treatment (en bloc resection rate, complete resection rate, curative resection rate, operation time and resected lesion area), incidence of complications and follow-up. 368 patients were divided into stenosis group (94 cases) and non-stenosis group (274 cases) according to the occurrence of esophageal stenosis after ESD. The circumferential proportion of lesions, operation time and resected lesion area were compared between stenosis group and non-stenosis group, and the independent risk factors of esophageal stenosis after ESD were analyzed. Independent sample t test, chi-square test and binary logistic regression analysis were used for statistical analysis. Results:Among 368 patients, 270(73.4%) were male and 98 (26.6%) were female; the age was (64.4±7.6) years old. The circumferential proportion of lesions of 231 cases (62.8%) was <1/2 circle, 49 cases (13.3%) was 1/2 to <2/3 circle, and 88 cases (23.9%) was ≥2/3 circle. The en bloc resection rate of the lesion was 98.6%(363/368), the complete resection rate and curative resection rate were both 97.8% (360/368). The operation time was (89.4±47.9) min. The area of resected lesion was (12.5±8.9) cm 2. The incidence of perforation during operation, delayed bleeding and stenosis was 0.3% (1/368), 0.5% (2/368) and 25.5% (94/368), respectively. The followed-up period was 8 to 53 months, and the median follow-up period was 25 months. During the follow-up period, no recurrence or new lesion was found, and no lymph node or distant metastasis occurred. The circumferential proportion of lesions of 38 cases (40.4%) of stenosis group and 193 cases (70.4%) of non-stenosis group was <1/2 circle, respectively, the circumferential proportion of lesions of 9 cases (9.6%) and 40 cases (14.6%) was 1/2 to <2/3 circle, respectively, the circumferential proportion of lesions of 47 cases (50.0%) and 41 cases (15.0%) was ≥2/3 circle, respectively, and the difference was statistically significant ( χ2=47.30, P<0.01). The operation time of stenosis group was longer than that of non-stenosis group, the resected lesion area was larger than that of non-stenosis group ((126.1±56.3) min vs. (76.8±37.2) min, (17.5±10.7) cm 2 vs. (10.8±7.4) cm 2), and the differences were statistically significant ( t=9.57 and 5.41, both P<0.01). The results of binary logistic regression analysis showed that circumferential proportion of lesions ≥2/3 circle, operation time and the resected lesion area were independent risk factors for the occurrence of esophageal stenosis after ESD (odds ratio=0.253, 1.018 and 1.041, 95% confidence interval 0.116 to 0.551, 1.011 to 1.025, 1.007 to 1.076, all P<0.05). Conclusions:ESD is a safe and effective way to treat SEC, with low local recurrence rate and few complications, which is worthy of further clinical promotion.

Objective To explore the application effect of objective structured clinical examination (OSCE) in the clinical practical examination for national midwifery standardized training and its significance for the training work.Methods A total of 89 candidates participated in 2016 national midwifery exam were recruited and investigated by self-designed questionnaire included general information, evaluation of measurement and effect of OSCE, and self evaluation.Results Candidates gave a high degree of evaluation and approval on OSCE, and it also had a positive guiding significance for further improving the midwifery training scheme.Conclusions The application of OSCE is in accordance with the practice demand for midwifery talents, thus it has popular value in the midwifery training and exams.

Objective:To evaluate the predictive value of anthropometric indicators in predicting cardiovascular risk in the population with metabolic syndrome(MS).Methods:A cross-sectional study was used to analyze the correlation between anthropometric measures and cardiovascular risk in subjects with MS. Cardiometabolic risk was assessed with cardiometabolic risk index(CMRI). Receiver operating characteristic(ROC) curve analysis was used to assess the predictive power of anthropometric measures for cardiometabolic risk.Results:(1) The anthropometric measures [body mass index(BMI), waist-hip ratio(WHR), waist-to-height ratio(WtHR), body fat percentage(BFP), visceral fat index(VFI), conicity index(CI), a body shape index(ABSI), body roundness index(BRI), abdominal volume index(AVI)] in the MS group were significantly higher than those in the non-MS group( P<0.05). Moreover, there were significant differences in CMRI score and vascular risk between the two groups( P<0.05). (2) Logistic regression analysis showed that the cardiovascular risk was increased with the increases of BMI, VFI, WHR, WtHR, CI, BRI, and AVI after adjusting for confounding factors in the overall population, the non-MS population, and the MS population( P<0.05). (3) In the ROC analysis, the AUC values of BMI, VFI, and AVI were 0.767, 0.734, and 0.770 in the overall population; 0.844, 0.816, and 0.795 in the non-MS population; 0.701, 0.666, and 0.702 in the MS population, respectively. For the overall population and non-MS population, the optimal cut points of BMI to diagnose high cardiovascular risk were 26.04 kg/m 2 and 24.36 kg/m 2; the optimal cut points of VFI were 10.25 and 9.75; the optimal cut points of AVI were 17.3 cm 2 and 15.53 cm 2, respectively. In the MS population, the optimal cut point as a predictor of high cardiovascular risk in young and middle-aged men with MS was 27.63 kg/m 2, and the optimal cut point of AVI in women was 18.08 cm 2. Conclusion:BMI, VFI, and AVI can be used as predictors of cardiovascular risk in the general population. BMI can be used as a predicator of high cardiovascular risk in young and middle-age men with MS. AVI can be used as a predicator of high cardiovascular risk in women with MS.

Objective To develop an expert consensus on subcutaneous injection nursing for allergic asthma in children,standardize nursing practice to reduce the occurrence of related adverse reactions.Methods The clinical guideline,expert consensus,systematic review,evidence summary and original research on subcutaneous injection of monoclonal antibody drug for children with allergic asthma were comprehensively searched in domestic and foreign databases.The time limit for retrieval was from the establishment of databases until August 2023.Combined with clinical practice experience,the first draft of the consensus was formed.From December 2023 to February 2024,27 experts were invited to conduct 2 rounds of expert letter consultation,revise and improve the contents of the first draft,and expert demonstration was conducted,and finally a consensus final draft was formed.Results The effective recovery rate of the 2 rounds of letter consultation questionnaires was 100％;the authority coefficient of experts was 0.88;the judging basis coefficient was 0.93;the familiarity coefficient was 0.83.In the 2 rounds of correspondence,the Kendall concordant coefficients of expert opinions were 0.241 and 0.252,respectively(P＜0.001 for both).The consensus includes 6 parts,including personnel management,environmental layout,indications and contraindications,subcutaneous injection operation norms,identification and treatment of adverse reactions,and health education.Conclusion The consensus is strongly scientific and practical,and can provide guidance for nursing practice of subcutaneous injection of monoclonal antibodies in children with allergic asthma.

Objective To evaluate the impact of optimizing the stroke green channel on the efficiency of acute ischemic stroke management in a county hospital. Methods A retrospective analysis of the emergency stroke green channel treatment data from Sixian People’s Hospital from May 2020 to April 2021 (before optimization of the green channel) and from May 2021 to April 2022 (after optimization of the green channel) was conducted. The rates of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) patients, as well as door-to-needle time (DNT), door-to-puncture time (DPT), and the modified Rankin scale (mRS) scores of patients three months post-treatment before and after the optimization of the stroke green channel were compared. Results Within one year before and after optimization of the green channel, the number of acute visits for ischemic stroke was 3 143 and 2 623, respectively. Before optimization, 84 and 51 underwent IVT and MT, respectively. After optimization of the green channel, the ratios of patients underwent IVT (n＝215) and MT (n＝103) significantly increased, and both DNT and DPT were significantly shortened (P＜0.000 1); the proportion of MT patients with an mRS score of 0-2 at 3 months post-discharge significantly increased (46/99 vs 13/46, P＝0.038). Conclusion After optimizing the green channel at Sixian People’s Hospital, the efficiency of stroke treatment has significantly improved, and the patients’ prognosis improved.