The United States is one of the pioneers in the world to introduce a heath strategy, making its practice highly significant for other countries. The paper described the four health strategies developed by the US government in succession, including the goals, focused areas and key health indicators of the strategies in different stages. In addition, it analyzed the patterns of evolution and key features of the strategy, offering references for the development and implementation of the "Health China by the Year 2020".

Objective To explore students nurses′acceptance of case-based group assessment. Method A total of 100 student nurses participated in the survey by a self-designed questionnaire to evaluate the perception and acceptance of the student nurses. Results The score on the acceptance of case-based group assessment was (2.44 ± 0.46). The items with higher acceptance included teamwork spirit, clinical reasoning and decision-making ability, and the items with lower acceptance were improving of nurse-patient communication and the nursing skills. Conclusions The student nurses have a good acceptance of the case-based group assessment and think this assessment method can contribute to development of teamwork spirit and competency of clinical reasoning and decision-making. On the other hand, they suggest we should strengthen the ability in nurse-patient communication and optimize the links in ability assessment.

Objective To evaluate diagnostic value of the novel virtual touch tissue imaging quantification (VTIQ) technique of acoustic radiation force impulse (ARFI) shear wave elastography in the differential diagnosis between benign and malignant thyroid lesions. Methods From June to July 2014, the imaging data of 82 thyroid lesions in 75 patients proven by fine needle aspiration cytology (FNAC) biopsy on conventional ultrasound and VTIQ were retrospectively analyzed. The thyroid nodules were examined by conventional ultrasound firstly and then the lesions were classified by thyroid imaging report and data system (TI-RADS). The maximum, minimum, median and average of shear wave velocity (SWV) values were obtained from multiple SWV measurement under the VTIQ speed mode. The region of interest (ROI) was determined according to the VTIQ quality mode after the patients holding the breath. According to the FNAC cytology results, ROC curve were plotted to determine the most accurate SWV value and the cut-off value for differential diagnosis. Results According to the FNAC results, grading≥5 level was set as the positive results and FNAC<5 level as the negative results. There were 28 positive nodules and 54 negative nodules in 82 thyroid nodules. The positive rates of TI-RADS classification were consistent with the theoretical results. The SWVmax, SWVmin, SWVmedian, and SWVmean on VTIQ of negative and positive thyroid nodules were (3.2±0.6), (2.2±0.4), (2.7±0.4), (2.6±0.4) m/s, and (4.6±1.7), (3.1±0.8), (3.5±1.0), (3.6±1.1) m/s. There were significant differences between positive and negative thyroid nodules in SWVmax, SWVmin, SWVmedian, and SWVmean on VTIQ (t=3.53, 3.68, 3.32, 3.81, all P<0.01). Based on the area under curve of ROC, the SWVmean value in the nodule was the best value in comparison with other SWV values. The cut-off value of VTIQ mean was 2.9 m/s. According to ROC curve analysis, the sensitivity, specificity and Youden index for VTIQ were 70.6%, 88.5%, 0.59, respectively. Conclusion The study proved that VTIQ elastography technique plays an important role in differential diagnosis of thyroid nodules and the VTIQ SWVmean is the best parameter for differential diagnosis.

BACKGROUND: At present, there is no consensus on the effect of different dressings in the healing of donor site, and few studies have directly compared the healing effect of different dressings. OBJECTIVE: To evaluate the healing effect of five different dressings on donor site wounds by network meta-analysis. METHODS: Randomized controlled trials about different dressings in the treatment of donor site wounds were retrieved by computer in PubMed, EMBASE, Cochrane, Chinese Academic Journal Full Text Database, Chinese Biomedical Literature CD-ROM Database, WanFang Data Platform and Chinese Science and Technology Journal Database. The retrieval time limit was from inception until May 2018. Literature screening, quality evaluation and data extraction were conducted independently by two postgraduates. Winbugs 1.4.3 and Stata 13.0 softwares were used for data analysis. RESULTS AND CONCLUSION: A total of 13 randomized controlled trials were included. In the observation group, foam dressing, hydrocolloid dressing, alginate dressing or silver dressing was used. In the control group, vaseline gauze was used. The results of network meta-analysis showed that the healing time of donor sites for alginate dressing, silver dressing, hydrocolloid dressing and foam dressing was significantly shorter than that of vaseline gauze (P < 0.05) , but there was no difference in wound healing time between foam dressing, hydrocolloid dressing, alginate dressing and silver dressing at the donor site (P> 0.05) . The healing effects of different dressings were ranked as follows (from good to bad) : alginate dressing, silver dressing, hydrocolloid dressing, foam dressing and vaseline gauze. Overall findings indicate that alginate dressing may be the best choice to shorten the healing time of donor site, and further investigations are warranted.

OBJECTIVE: To separate and isolate total flavonoids from Dendrobium nobile leaves, and to investigate its anti-Alzheimer's disease (AD) activity in vitro. METHODS: Total flavonoids were obtained by ultrasonic extraction method and extracted by chloroform, ethyl acetate and butyl alcohol after the obtained extract was dispersed with water. Qualitative analysis was carried out with color reaction and TLC. The content of total flavonoids in extracts was analyzed quantitatively by Aluminum nitrate-sodium nitrite method. Antioxidant activity of extract was investigated by DPPH radical scavenging assay; the inhibitory effect of each extract on Aβ42 protein aggregation was investigated by Thioflavin T assay. Metals (Cu2+, Fe3+, Zn2+) chelating property was studied by UV-vis spectrum scanning to investigate the anti-AD activity in vitro. RESULTS: The flavonoids were found in ethyl acetate, butyl alcohol and aqueous extracts, and their flavonoids contents were 0. 03, 0. 12, 0. 05 mg/mL, respectively. IC50 of three extracts to DPPH free radicals were 0. 021, 0. 011, 0. 013 mg/mL. Inhibitory rates of them to Aβ42 protein aggregation were 43. 77％, 52. 28％, 38. 42％, respectively. Three extracts exerted metal chelating ability which was best in Cu2+. CONCLUSIONS: The total flavonoids from D. nobile leaves have good antioxidant activities, Aβ42 aggregation inhibitory activities and metal chelating activity, show certain anti-AD activity in vitro especially in butyl alcohol extract.

Objective:To analyze and compare the features of undifferentiated-typed early gastric cancer (UD-EGC) and gastric mucosa-associated lymphoid tissue(MALT) lymphoma under white light endoscopy (WLE) and magnifying endoscopy-narrow band imaging (ME-NBI).Methods:Data of patients with complete endoscopic images of WLE and ME-NBI in Shanghai General Hospital, Shanghai Jiao Tong University from March 2015 to July 2019 were retrospectively analyzed.Twenty-six UD-EGC patients and seven gastric MALT lymphoma patients in ⅠE1 stage were included, and the characteristics of the two diseases under WLE and ME-NBI were compared and summarized.Results:There were no significant differences in age, sex or infiltration depth of lesions between the two groups.Under WLE, UD-EGC was often manifested as a single lesion located in the lower part of the stomach, with unclear lesion boundaries. While MALT lymphoma lesions were mostly multifocal with clear boundaries, located in the middle of the stomach. Under ME-NBI, the microsurface pattern of UD-EGC showed dilation or disappearance of areas between the recesses, and the spiral microvascular pattern. However, the microsurface pattern of MALT lymphomas were characterized by " cross-road traffic sign" , " pebble sign" , and the presentation of residual glandular duct at the lesion was similar to that of Helicobacter pylori ( HP)-related gastritis. Furthermore, the microvascular pattern of MALT lymphomas often showed " tree like appearance (TLA)" . After HP eradication therapy, the morphology of microsurface pattern and microvascular pattern in the original lesion area gradually returned to normal. Conclusion:UD-EGC and gastric MALT lymphoma showed particular features in the number, site and boundary under WLE, and they showed significantly different microsurface pattern and microvascular pattern under ME-NBI. Differentiation of the two diseases will help reduce the risk of missed diagnosis and misdiagnosis.