Objective To investigate the guidance value of procalcitonin(PCT) dynamic measurement on antibiotics usage of patients with stroke associated pneumonia(SAP).Methods One hundred and thirty-two cases with SAP were randomly divided into control group(64 cases with regular treatment) and observation group (68 cases with procalcitonin dynamic monitoring treatment).The treatment course of antibiotics in control group was according to antibiotics guidelines in China.Patients in observation group were given antibiotics for 5 days,stopped if the level of PCT was less than 0.25 μg/L,and continued to take if the level of PCT was more than 0.25 μg/L.The information were recorded including periods and cost of antibiotics usage,the periods and costs of hospitalization,clinical efficacy,mortality on the 30th day.The score of Institutes of National Institutes of Health Stroke Scale (NIHSS) and Barthel index (BI) were measured.Results (1) There were no significant differences in terms of age,gender,hypertension rate,coronary heart disease rate,diabetes rate,systolic blood pressure,the score of NIHSS in admission,pathogen and antibiotics between two groups (P ＞ 0.05).(2) After 30 days treatment,there were no significant differences in terms of clinical efficacy(86.8％ (59/68) vs.87.5％(56/64)),mortality (7.4％ (5/68) vs.7.8％ (5/64)),the score of NIHSS ((12.3 ±5.8) vs.(11.7 ± 4.5)) and BI (60.9 ± 22.3 vs 58.7 ± 21.6) between observation group and control group (P ＞ 0.05).The periods of hospitalization in observation group was (20.1 ± 5.1) d,less than that of control group ((25.4± 6.0) d,t =5.479,P ＜ 0.01).The costs of hospitalization in observation group was (8 ± 6) thousand yuan,significant lower than that of control group ((12 ± 8) thousand yuan,t =3.262,P ＜ 0.01).The periods of antibiotics usage in observation group was (11.3 ± 2.6) d,less than that of control group ((14.4 ± 3.1) d,t =6.238,P ＜ 0.01).The costs of antibiotics in observation group was (3 ± 1) thousand yuan,significant lower than that of control group ((5 ± 2) thousand yuan,t =7.331,P ＜ 0.01).Conclusion PCT dynamic monitoring can guide the safe usage of antibiotics in SAP in terms of shortening the length of hospitalization,duration of antibiotics,and reducing the costs.

Objective To evaluate the effect of acupuncture point stimulation on the urodynamics of spinal cord injury patients.Methods Sixty spinal cord injury cases were divided into a research group and a comparison group.Both groups were given bladder training, but the research group also received acupuncture point stimulation.The subjects' maximum cystometric capacity, maximum detrusor pressure and residual urine were measured, along with renal function and any urinary tract infections.The scale of activity of their daily lives was compared before and 3 months and 6 months after the treatment.Results There were no statistically significant differences between the groups before the treatment.There were statistically significant differences in maximum cystometric capacity, maximum detrusor pressure, residual urine and Barthel index (BI) after 3 and 6 months of treatment.In the research group, maximum detrusor pressure, residual urine and BI scores had all improved after 6 months compared with the 3 month values.In the comparison group only the BI score had improved significantly between 3 and 6 months, and this was not reflected in a significant change in the scale of activity in daily life.After 3 months, only the average BI differed significantly between the two groups.After 6 months all indexes except the BI and maximum cystometric capacity differed significantly.There were also significant differences between the groups in reflex voiding, percussion voiding, and abdominal pressure voiding.Conclusions Acupuncture point stimulation can improve the bladder function of spinal cord injury patients.It can also decrease the incidence of urinary tract infection and the possibility of renal dysfunction.

Through random sampling,a total of 300 residents of Beijing Changping Ming Tombs Town were selected for home-based questionnaires.The smoking rate of interviewed residents was 21.4％ (53/248).The rate in men (42/125,33.6％ ) was bigber than that in women ( 11/123,8.9％ ).The rate in those with higher education was lower than that in those with lower educational level ( x2 =27.12,P ＜ 0.05 ).The population awareness of tobacco hazards was 80.6％ (200/248).Awareness in smokers was lower than the average awareness of ex-smokers and nonsmokers ( x2 =5.07,P ＜ 0.05 ).The higher the education level,the higher the awareness of tobacco health hazards ( x2 ≈ 19.72,P ＜ 0.05 ).There were differences in awareness among different age groups (x2 =13.37,P ＜ 0.05 ).

Objective: To find out the current situation of the reproductive health about countrywomen in west of China,and explore the factor of the reproductive health under social medicine theory framework.Methods: Summarize literature about women reproductive which have been done recently,and do 608 samples survey in Xi'an of Shaanxi,which is about the current situations of social economic,reproductive health,gynecological diseases and mental health.Results: The research clarified the primary connotation about the reproductive health of countrywomen,and identified the current situation of countrywomen reproductive health in Shaanxi province of China.Conclusion: The situation of countrywomen reproductive health is far away from the demand of strategic target of "Everyone enjoys the reproductive care since 2015",and the countrywomen are on the hip in birth control,bearing culture,acquirement of health knowledge and primary diathesis.

Objective:To analyze the application value of the mechanical thrombectomy system in the treatment of acute limb ischemia.Methods:The clinical data of 50 patients with lower limb ischemia who were treated with the Rotarex mechanical thrombectomy system from Jun 2017 to Sep 2019 were retrospectively analyzed.Results:In 4 cases of popliteal artery rupture occurred during the operation. The success rate of the operation was 92%. Catheter-directed thrombolysis was used in 7 cases, percutaneous transluminal angioplasty was used in 4 cases and percutaneous transluminal angioplasty combined with stent implantation was used in 39 cases. The ankle-brachial index of these 50 patients before and after operation was 0.18±0.24 and 0.64±0.28 respectively ( t=12.87, P<0.001). Treatment was successful in 43 cases. Follow-up ranged from 1 to 24 months, 5 cases were amputated, 2 cases had no improvement of toe ulcer gangrene, 9 cases had thrombus recurrence, and no complications such as bleeding were observed. The primary patency rates at 3, 6 and 12 months were 92%, 84% and 74%, respectively. Conclusion:The mechanical thrombectomy system is safe and effective in the treatment of acute lower limb ischemia with ideal short-term patency.

Objective To improve the quality of outpatient prescriptions, to guarantee the rational use of antibi-otics and clinical use of drugs and to enhance the quality of pharmacy services through medication management system. Methods The results from rational medication management system applied in our hospital were analyzed retrospectively and evaluated comprehensively. Results The rational medication management system applied in our hospital could make a full prescription review, and the warning percentage number at all levels for each quarter over the past year reduced gradually, compared with that of the previous quarter (P<0.05). The usage rate of an-tibiotics and injection rate in internal medicine, pediatric, breast and gynecological clinic were significantly lower than those before the application of the system (P<0.05) and the usage rate of antibiotics and injection rate in department of gynecology care, child care clinic and medical examination center did not show any significant re-duction compared with those before the application of the system(P>0.05). The system played a monitoring role in the medication of antibiotics in all the departments. Conclusion The application of rational medication manage-ment system can promote the rational use of drugs in hospital and can help to improve pharmacy services.

Objective To build an evaluation index system of medical practitioners'competency for county-level public hospitals. Methods By means of the Iceberg Model based on competence and professionalism, and following two rounds of consultations of 47 experts, the evaluation indexes and weights of medical practitioners' competency were determined using SPSS frequency, mean, Kendall harmony coefficient and factor analysis. Three county-level public hospitals in Shaanxi province were selected for example verification of service competency. Results The evaluation index system of county-level public hospitals included 4 level-1 indexes and 16 level-2 indexes. The 4 level-1 indexes were diagnosis competency, treatment competency, communication competency and self-development competency. The weights of these indexes were 0.3,0.3,0.2 and 0.2 respectively. Conclusions Such hospitals should start with these competencies to strengthen the cultivation of medical practitioners' competency and constantly improve their comprehensive service level.

Objective:To survey the working status of outpatient nurses in general practice departments of general hospitals.Methods:From March to April 2021, personal in-depth interviews were conducted with outpatient nurses from general practice residency training bases in Beijing. The thematic framework analysis method was used to analyze the interview data and refine the themes.Results:Fourteen nurses working in general practice outpatient clinics were interviewed in this study. Four themes were extracted from the interview data: (1) inadequate staffing of full-time outpatient nurses in general practice departments of comprehensive hospitals; (2) unclear job functions for outpatient nurses in general practice departments; (3) no standardized patient health education in the department; (4) no relevant training received systematically.Conclusion:General practice departments in general hospitals should setup full-time general practice nurse positions, clarify the job responsibilities, strengthen the relevant training and enhance core competency for nurses working in general practice department.

Objective: To investigate the overexpression frequencies of BRE and EVI1, the correlation between BRE and EVI1 expressions and their possible clinical implications in 11q23/MLL rearrangement acute leukemia. Methods: Cytogenetic examination of bone marrow cells was performed by short-term culture method. R-banding technique was used for karyotype analysis. 47 patients were detected by interphase fluorescence in situ hybridization (FISH) with dual-color break apart MLL probe. The expressions of EVI1 and BRE genes were detected by real time quantitative reverse transcription polymerase chain reaction (RQ-PCR) . The correlation and prognostic significance were statistically tested. Results: 11q23/MLL rearrangements were confirmed by karyotyping and FISH, respectively in 47 patients. According to immunophenotypic analyses of 37 patients, 5 patients showed positive for CD19, CD79a or CD10, 1 for CD7; the others for CD33, CD13, CD14 and CD15, and 16 of them for CD34. Of the 47 patients, 18 patients showed EVI1 overexpression and most of them presented with t (6;11) and M₄/M₅. The EVI1 expression was high in t (6;11) or t (9;11) subgroup comparable with levels observed in normal subgroup (P=0.038, 0.022, respectively) . 15 patients showed high BRE expression, and most of them presented with t (9;11) and M₄/M₅. High BRE expression was found in t (4;11) , t (6;11) , t (9;11) and t (11;19) subgroups, respectively by comparing with normal subgroup. The BRE expression was higher in t (4;11) (P=0.004) or t (9;11) (P=0.012) subgroup than in t (6;11) subgroup. Patients with EVI1 overexpression had a short survival compared with those with low EVI1 expression (P=0.049) and it also did in t (9;11) subgroup (P=0.024) . Patients with t (9;11) and high BRE expression had a long survival compared with those with t (9;11) and low BRE expression (P=0.024) . Conclusion The EVI1 overexpression was significantly frequent in acute leukemia patients with 11q23/MLL rearranged, especially within t (6;11) subgroup and M₄/M₅, which was associated with an inferior outcome. High BRE expression was observed frequently in 11q23/MLL-rearranged acute leukemia especially within t (9;11) subgroup and M₅.

OBJECTIVETo report clinical and laboratory features of 4 cases of myeloid neoplasm with t (5;12) (q33;p13).

METHODSCytogenetic examination of bone marrow cells obtained from patients was performed by 24 h culture method. R banding technical was used for karyotype analysis. PDGFRβ gene rearrangement was detected by FISH using dual color break apart PDGFRβ probe. ETV6-PDGFRβ fusion genes were detected by multiple-reverse transcription polymerase chain reaction (RT-PCR). Direct sequencing analysis was performed on the PCR products in case 1. Immunophenotype analysis was carried out by flow cytometry. Four cases were treated with imatinib (IM) and followed up.

RESULTSThe diagnoses included 3 MPN and 1 AML-M2. The t (5;12) (q33;p13) was a primary abnormality in 3 cases of MPN and a secondary abnormality in 1 case of AML-M2. PDGFRβ gene rearrangement and ETV6-PDGFRβ fusion genes were detected by FISH and multiple-RT-PCR in 4 cases, respectively. The immunophenotypical analysis of leukemia cells showed positive for CD13, CD33 and CD34. Two cases obtained MMR after the treatment of IM, one case complete hematologic and complete cytogenetic response. ETV6-PDGFRβ was negative detected by multiple-RT-PCR after the treatment of IM, but relapsed and died soon in case 4.

CONCLUSIONSThe t (5;12) myeloid neoplasm was a subtype with unique features. The t (5;12) maybe a primary chromosome abnormality in MPN and a secondary in AML. MPN with t (5;12) could benefit from IM, but not for AML. Dual-FISH was a reliable tool for detecting PDGFRβ rearrangement.

Chromosome Banding ; Gene Rearrangement ; Hematologic Neoplasms ; genetics ; Humans ; Immunophenotyping ; In Situ Hybridization, Fluorescence ; Karyotyping ; Myeloproliferative Disorders ; genetics ; Polymerase Chain Reaction ; Proto-Oncogene Proteins c-ets ; genetics ; Receptor, Platelet-Derived Growth Factor beta ; genetics ; Remission Induction ; Repressor Proteins ; genetics ; Translocation, Genetic