Objective To investigate the algorithm and efficacy of interventional treatment for combined congenital heart diseases. Methods Thirty-four patients (12 males and 22 females) with combined congenital heart disease underwent simultaneous transcatheter therapy. The types of the congenital heart defect combination were as follow: ASD and PS (16 cases); ASD and VSD (7 cases); ASD and PDA (3 cases); ASD and MS (2 cases); VSD and PDA (3 cases); Taussig-Bing and PDA(1 case); PDA, ASD and PS (1 case); ASD, VSD and PDA (1 case). The algorithm of transcatheter intervention was: PBPV or PBMV at first followed by the occlusion of VSD, PDA and ASD successively. Transthoracic echocardiography (TTE) and X-ray examination were done 3d, 1 m and 3 m after the procedure to evaluate the outcome of the procedure. Results All patients were treated successfully at one time. No complications occurred during and immediately after the procedure. There was no residual shunt and all the occlusion devices were found in the suitable site evaluated by means of TTE and X-ray right after the procedure. In 16 patients with ASD and PS, the systolic pressure across the pulmonary valve decreased from (53?20) mm?Hg to (14?10) mm?Hg (P

Discussed in this paper is how to provide the personal , differential and intelligent information service for the users of library by putting the people-oriented purpose into its different information services .

Objective To investigate the influence of irbesartan taken before bedtime on morning blood pressure surge and urine microalbuminuria in elderly patients with essential hypertension. Methods Ninety-two patients with uncontrolled hypertension were recruited in this study and their 24-hour ambulatory blood pressure monitoring profiles were collected for analysis. After irbesartan taken before bedtime, its influence on general blood pressure, morning blood pressure surge and urine microalbuminuria was observed. Results Before irbesartan treatment,the average 24-hour ambulatory blood pressure was(140.1 ± 12. 7)mm Hg, the morning blood pressure surge was (45.6 ± 10.8) mm Hg, urine microalbuminuria level was (58.6 ± 3.7) mg/L. After irbesartan treatment,the average 24-hour ambulatory blood pressure decreased to (129. 5 t 11.8) mm Hg (t = 3.18, P ＜ 0.05), the morning blood pressure surge decreased to(14. 2 ±4. 1)mm Hg(t =5.74,P ＜0.01) ,urine microalbuminuria level decreased to(31.7±3.1)mg/L(t =5.24,P＜0.01).Conclusions Irbesartan can effectively reduce the peak morning blood pressure,improve achievement ratio of blood pressure control, decrease urine microalbuminuria level in elderly patients essential hypertension.

Objective:To explore the application effect of Roy adaptation model combined situational teaching method in pediatric nursing teaching.Methods:A total of 108 nursing students interned in our hospital in 2019 were selected and randomly divided into two groups, among which, 54 nurses who accepted the traditional teaching method were taken as the control group, and 54 ones who adopted Roy adaptation model combined situational teaching method were taken as the research group. The scores of theory and operation skills of the two groups were evaluated before and after teaching, at the same time, the comprehensive ability was assessed and the satisfaction survey was conducted among the students after the teaching. SPSS 20.0 was used for data processing, the scores of theory and operation skills comprehensive ability and nursing students' satisfaction with teaching were described with ( ± s) and t test was performed. Results:After the teaching, the theoretical knowledge and operational skills scores of the two groups were significantly improved than those before the teaching ( P<0.05), and those of all students in the research group were significantly higher than those in the control group ( P<0.05). The scores of ability to integrate theory with practice, self-learning ability, communication ability, teamwork ability, independent thinking and problem solving ability, clinical thinking ability in the research group were higher than those in the control group, with statistical differences ( P<0.05). And students in research group had significantly higher overall satisfaction scores on the teaching than those in control group had ( P<0.05). Conclusion:Application of Roy adaptation model combined situational teaching method in pediatric practice teaching can improve the theoretical knowledge and operational level of nursing students, enhance their communication ability and other abilities, and help to improve their satisfaction with teaching.

Military medical literature and information resources in neighboring countries of China, including the publication of journals and books, the institutions and their publications, were investigated in order to work out the characteristic military medical literature and information resources integration program in neighboring countries of China according to the domestic medical literature service and to lay a foundation for establishing the characteristic military medical literature support system.

Objective To explore the value of CT diagnosis of high altitude pulmonary edema (HAPE). Methods The CT findings in 16 patients unfit to high altitude were analyzed. Results The findings on CT were as follows: (1) The early stage of HAPE showed ground glass opacity, most of which located at the superior segment and posterior basis segment of inferior lobes, with the right lung to occur earlier than that of the left lung. (2)The advanced stage showed shaggy opacity. (3) The late stage lesions developed to posterior and apical segment of the superior lobes, air bronchus sign could be seen on involved segments. (4)Right lung was more serious than left lung. Conclusion CT was an ideal method to find HAPE. The accuracy of CT diagnosis in HAPE was 100%.

Objective To evaluate the value of CT guided percutaneous lumbar diskectomy (CT PLD) at plateau area. Methods Sixty eight cases of lumbar disc herniation was reated with CT PLD. (1)Before operation, diseased intervertebral disc was scanned, cases were selected, and operation plan was plotted . (2)The best puncture arrangement was chosen on the current video CT picture by designing the puncture path, noting down the puncture parameter, and marking the puncture spot on patient′s body surface. (3)Puncture was performed according to fixed parameter. (4)Operation was performed after the puncture needle was put into the disc ascertained by scan.(5)CT scan was done again after operation to observe if the puncture path had bleeding and intervertebral disc recovery. Results After 3 to 18 months′ follow up, 28 cases were prominent effective and 36 cases effective. The lumbar disc backed 1 to 4 mm. The total effective rate was 94.12%. Conclusion CT PLD is an ideal therapeutic method for lumbar disc herniation at plateau area because it is safe and effective and with less complications.

ObjectiveTo develop school refusal reason inventory (SRRI)for children and adolescents in China and assess its reliability and validity.MethodsThe primary SSRI was made based on clinical interviews and literatures.Pretest was carried out in a small sample from a clinic.Then the final SSRI was developed after qualitative analysis and item analysis.SRRI,the Screen for Child Anxiety Related Emotional Disorders(SCARED) and Child Depression Inventory(CDI) were administered to school refusers from 7 schools in Shenyang.All the schools were selected from Shenyang City and its countryside by cluster sampling.Some of the students were retested after one month.Descriptive statistics and exploratory factor analysis were carried out to examine the reliability and validity of SRRI based on all the data.Results Item analysis indicated correlation coefficients between all the items and the total marks were higher than 0.3,and they were significant.All the critical ratios of the items were higher than 0.3.The 43 items were divided into six factors ( educational modality,factor of teachers,relationship with classmates,separated anxiety,study attitude and study environment) by exploratory factor analysis.The factor loading values were 0.372 ～0.848.The cronbach's α of each factor was 0.827,0.831,0.759,0.623,0.821 and 0.808.Retest reliability was 0.644 (P ＜ 0.01 ).Its correlation coefficient with SCARED was 0.452 and 0.548 with CDI.ConclusionAccording to Chinese cultural back ground,the SSRI corresponds with psychometric indexes.There are good reliability and validity.It is helpful to understand the reasons of school refusal behavior in children and adolescents.

Objective Establishing intelligent nursing clinical decision support system to improve the safety, quality and efficiency of clinical nursing work. Methods Guided by the HIMSS EMRAM Analytics stage 7 evaluation standard, the nursing decision support system is continuously improved through the establishment of knowledge bases such as nursing plans and nursing conventions. Results By comparing the writing time of nursing documents, the correct rate of nursing diagnosis, and the incidence of nursing risk events before and after the used of the system, the results showed that after the used of the nursing decision-making support system, whole hospital′s writing time could save 222.5 hours per day, improved accuracy of nursing diagnosis from 68.33％ (205/300)to 90.67％ (272/300), the difference was statistical significace (χ2=45.907, P<0.05). Decreased incidents, hospital-wide, on falls from 0.127‰(80/631702) to 0.071‰(45/638715),and on pressure ulcer form 0.064‰ (41/631702)to 0.028‰(18/638715), the difference was statistical significace (χ2=13.004～15.071, P<0.05). Conclusion Nursing clinical decision support system is the trend of hospital informatization and is worthy of clinical application.

OBJECTIVE: To explore the clinical phenotype and genetic diagnosis of a patient featuring secondary amenorrhea, breast dysplasia and mental retardation. METHODS: Peripheral venous blood samples were collected from the patient and her family members and subjected to G-banding karyotyping and single nucleotide polymorphism array (SNP-array) analysis. RESULTS: The patient was found to have a karyotype of 46,X,der(X)(12qter→ 12q22::Xq23→ Xpter)mat, her mother had a karyotype of 46,X,t(X;12)(Xpter→ Xq23::12q22→ 12qter;12pter→ 12q22::Xq23→ Xqter), while her father and brother were both 46,XY. SNP-array analysis suggested the patient to be arr[hg19]12q22q24.33(94 792 972-133 777 562)× 3, Xq23q28(108 786 070-155 233 098)×1. CONCLUSION The abnormal phenotypes of the patient can probably be attributed to the presence of Xq23-qter deletion and 12q22-qter duplication, both have derived from her mother's balanced t (X;12) translocation.