Objective To explore the influence of uncertainty in illness in compliance of respiratory function exer-cise and rehabilitation after surgery in patients with coronary artery bypass graft (CABG) surgery. Methods Mishel uncer-tainty in illness scale and compliance of respiratory function exercise scale were used to collect data in 108 patients with CABG. The correlation of the uncertainty in illness and compliance of respiratory function exercise was analyzed. Patients were divided into three groups (high score, medium score and low score groups) according to the detection of uncertainty in illness. Values of compliance of respiratory function exercise, postoperative care time, postoperative ventilation time, postop-erative hospital stay duration, 6-min walking test (6MWD) and left ventricular ejection fraction (LVEF) were compared be-tween three groups. Results The uncertainty in illness was in medium level (95.51±9.48) in patients with CABG surgery, which was negatively correlated with compliance of respiratory function exercise (r=-0.926, P<0.01). The postoperative venti-lation time and postoperative care time were less in low score group than those of medium score group and high score group. The compliance of respiratory function exercise, 6-min walking test and postoperative LVEF were better in low score group than those of medium score group and high score group. Conclusion Medical personnel should take targeted interventions to reduce the uncertainty in illness in patients, enhance the compliance of respiratory function exercise, reduce the postopera-tive complications and promote early recovery of patients.

Objective To explore the value of Gd-EOB-DTPA enhanced magnetic resonance imaging (MRI) in the quantitative evaluation of liver function.Methods Between June 2012 and June 2013,we prospectively included 8 patients with cirrhosis and 6 patients with primary hepatic carcinoma (PHC).The Child-Pugh classification,indocyanine green retention rate at 15 minutes (ICGR15),and Primovist enhanced MR imaging were performed in all the patients.Using the deconvolution method to calculate hepatic extraction fraction (HEF),the correlations between HEF and Child-Pugh and ICGR15 were analyzed.Results For cirrhosis,there was a significant correlation between the HEF and the ICGR15 by the Pearson correlation coefficient (r =-0.971,P ＜ 0.05).For hepatocarcinoma,there was also a significant correlation (r =-0.855,P ＜ 0.05).The average HEF of PHC was 21.80％ (14.89％ ～ 35.90％).Conclusions The Gd-EOB-DTPA enhanced MRI accurately evaluated liver function quantitatively.It may be used for patients with PHC for preoperative examination.

OBJECTIVE To investigate the epidemic situation of Acinetobacter in lower respiratory tract infection and their drug resistance,in order to provide evidence for clinical anti-infection therapy. METHODS The data of Acinetobacter from the sputum specimens of inpatients in our hospital with lower respiratory tract infection during 2006-2007 were collected and analyzed with the software the software WHONET5.4. RESULTS Among all pathogens in lower respiratory tract infection,Acinetobacter accounted for 9.2% in 2006 and 7.4% in 2007,the rate in deparment of neurosurgery,surgical ICU and respiratory ICU was higher. Acinetobacter had the highest susceptible rate to imipenem and were also susceptible to meropenem and cefoperazone/sulbactam. However,Acinetobacter had higher resistant rate to imipenem and meropenem while higher susceptible rate to cefoperazone/sulbactam in 2007 than in 2006. The susceptible rate of Acinetobacter to the third and forth generation cephalosporins,amikacin,levofloxacin and aztreonam was lower than 50%. CONCLUSIONS The drug resistance mechanism of Acinetobacter is so complicated that many kinds of drugs prove poorly effective. Carbopenems are recommended when single drug is utilized and drug combination based on the clinical and laboratory information can be tried.

prognosis of patients with acute upper gastrointestinal bleeding (AUGIB). Methods A total of 130 patients with AUGIB in our hospital were enrolled in this study from August 2014 to August 2016 . Three kinds of scoring systems including Rockall, Blatchford and AIMS65 were used to evaluate the risk classification of the patients. Patients were followed up for 2 months. The incidence rates of re-bleeding and death within 2 months after admission were observed. Data of prognosis in patients with AUGIB were compared between the three scoring systems in the prognosis of patients with AUGIB, including the risk classification and the prediction accuracy of re-bleeding and death. Results There were no significant differences in the re-bleeding rate and fatality rate between the groups divided by Rockall and Blatchford scoring systems ( P>0.05). According to the grouping results of AIMS65 scoring system, the re-bleeding rate of low-risk group was lower than that in high risk group (1.45%vs. 13.11%, P=0.01), but there was no significant difference in fatality rate between the two groups (P>0.05). The values of area under the curve (AUC) of predicting re-bleeding rates by using Rockall, Blatchford and AIMS65 scoring systems were 0.6258, 0.6910, and 0.7241, and the values of AUC of predicting fatality rates were 0.7031, 0.7969, and 0.7031 by using receiver operating characteristic curve (ROC) analysis. There were no significant differences between them (P>0.05). The values of AUC of predicting re-bleeding rates by using the risk grading calculation by Rockall, Blatchford and AIMS65 scoring systems were 0.6189, 0.6139 and 0.7254 (P>0.05). But the values of AUC of predicting fatality rates were 0.6211, 0.6641 and 0.7695 (P<0.01). Conclusion The operation method of AIMS65 scoring system is simple and convenient, which is applicable to a wide range of patients with AUGIB. In the prediction of re-bleeding and mortality, AIMS65 scoring system has high accuracy and stability, which is worthy of promoting in clinical application.

Objective To investigate the genetic polymorphisms of the glutathione S-transferase M1 and T1 genes(GSTM1 and GSTT1),and eval-uate the oxidative damage in patients with non-small lung cancer(N-SCLC). Methods A total of 110 patients with N-SCLC and 100 healthy indi-viduals were recruited in this case-control study. Multiplex polymerase chain reaction(PCR)analysis was used to identify the genotypes. The activi-ty of malondialdehyde(MDA),nitric oxide(NO),and the total antioxidant capacity(T-AOC)were detected by spectroscopic analysis using assay kits. Results The frequencies of the GSTM1,T1,and GSTM1/T1 null genotypes in the patient group were significantly higher than those in control group(OR1=2.071,P1=0.009;OR2=1.900,P2=0.024;OR3=3.258,P3=0.003). The activity of MDA and NO were obviously higher in the pa-tient group compared with the control group(P<0.001),and T-AOC was obviously lower in patient group than those in control group(P<0.001). The activity of MDA,and NO were higher but the T-AOC were lower in patients with GSTM1,T1 and GSTM1/T1 null genotypes than those in pa-tients with GSTM1,T1 and GSTM1/T1 present genotypes(P<0.001). Conclusion Our results suggest that oxidative damage may play a impor-tant role in patients with N-SCLC,and the N-SCLC patients with GSTM1and GSTT1deletion genotypes are more susceptible to oxidative damage.

Objective To study the operative technique and effect of temporary balloon occlusion of the abdominal aorta for preventing intraoperative bleeding during cesarean for patients with pernicious placenta previa and placenta accreta. Methods Retrospective analysis was conducted on the intraoperative situation of forty-one cases and information of follow-up twenty-nine cases, which were pernicious placenta previa and placenta accreta and delivered in the First Affiliated Hospital of Zhengzhou University from May 1, 2013 to June 30, 2014. Diagnosis was confirmed by line of color Doppler ultrasound and MRI for all patients before operations. An interventional physician performed right femoral artery puncture and preset the abdominal aortic balloon catheter in the digital subtraction angiography operation room before cesarean. At the same time of fetal delivery, 10 ml normal saline was injected into the balloon immediately, which results in filling of the balloon and blocking of the aorta. According to the area and depth of placenta implantation and implantation or penetration of the posterior bladder wall, placenta separation, partial resection of the uterine wall and partial bladder resection and repair were performed correspondingly. Meanwhile, saline in the balloon was pumped out gradually until empty. Condition of placenta implantation, blood loss and blood transfusion volume during the operation, intraoperative and postoperative complications, the duration and dose of fetal radiation exposure, and Apgar score of neonates were analyzed. Results Among the 41 cases, penetrative placenta and implanted placenta were observed in five cases and 36 cases, respectively. The latter 36 cases including 28 cases of bladder posterior wall accreta and eight cases of bladder posterior wall penetration. For all cases, the average operation time was (68.5±15.3) min, the mean blood loss in the operation was (1 058±960) ml, among which eight received blood transfusion with an average of (600±400) ml, and the mean hospital stay was (8.2±2.3) d. Uteruses were reserved in all cases. The mean duration and dose of fetal radiation exposure was (8.1±3.6) s and (5.2±2.9) mGy, and the Apgar score of neonates was 8.7±0.5 at 1 min and 9.5±0.3 at 5 min, respectively. The patients were followed up until October 31, 2014. Among them, six were lost, six were still in puerperium, 18 were breast-feeding, and the menses of 11 had returned. Conclusion Preset abdominal aortic balloon catheter in pernicious placenta previa and placenta accrete patients might effectively reduce the blood loss during cesarean section as well as the risk of hysterectomy through temporary occlusion of the abdominal aorta.

Objective To establish a set of scientific and quantifiable performance management standard system by using Balance score card rationale so as to supply effective results management base for nursing regulator. Methods Delphi method was used to screen each level of nursing evaluation of performance standard and confirmed its weight;meanwhile, the sort of nursing care unite and nursing load were counted accordance with work intensity, risk degree and technological complexity etc and initially built performance management standard system. Results Accordance with the balance score card rationale and internal process, finance, customer, learning and growth four dimensions, a set of performance management standard and was established, including 4 first class indicator, 10 second class indicator and 32 third class indicator were derivative. The internal process, finance, customer, learning and growth factors were 29.44%, 37.56%, 20.32%, and 12.68%respectively. Conclusions Performance management standard system covers objectives of nursing management of Grade three General Hospital, and which is full of an objective, scientific, operational system possibilities, and can be used to multi-angle evaluate nursing performance, dynamic implement nurses management and achieve strategic goals.

Objective:To analyze the clinical and imaging characteristics of acute necrotic encephalopathy (ANE) in a child with human herpesvirus-6 (HHV-6) infection.Methods:Retrospective analysis was performed on the clinical data and imaging features of a case of HHV-6 related ANE from Children′s Hospital Affiliated to Zhengzhou University in March 2019.Results:The one year and seven month-old child had acute encephalopathy, recurrent convulsions, consciousness disorders, elevated serum transaminase. The number of cerebrospinal fluid (CSF) cells was normal and the protein increased. High throughput gene testing of CSF showed HHV-6. Cranial magnetic resonance imaging showed multiple symmetry damage in the bilateral thalamus, brainstem, and cerebellum. The symptoms improved after the treatment of glucocorticoids, intravenous immunoglobulin, and plasmapheresis.Conclusions:ANE is a rare severe encephalopathy, the characteristic imaging change of which is symmetry multifocal cerebral damage, especially in the bilateral thalamus. ANE should be considered for patients with frequent convulsions and disturbance of consciousness after virus infection.

Objective To establish teaching cases evaluation questionnaire for problem based learning (PBL) in "Nursing Ethics".Methods Based on the literature review, the nursing ethics PBL teaching case evaluation questionnaire was established with the theoretical frame of teaching cases evaluation standard by China Case Center for Public Policy & Management (CCCPPM), consulting undergraduate professional certificate standard, combing the characteristics of PBL teaching and nursing ethics teaching, screening initialization questionnaire entries through theoretical analysis and interviewing 15 experts with a two-round Delphi survey.Results The positive coefficients of the two-round of expert consultation questionnaire were 93.75% and 100%. The expert coefficient of authority was 0.93. The nursing ethics PBL teaching case evaluation questionnaire containing 10 entries was established.Conclusions The preliminary establishment of PBL teaching case evaluation questionnaire of "Nursing Ethics" has a high scientificity and rationality, which can provide references for the research and practice of PBL teaching case evaluation in nursing ethics.

Objective:To investigate and analyze the gap between the current clinical practice and guidelines of infant safe sleep protection strategies in China, and to provide a basis for further construction of evidence-based practice programs and evidence-based transformation of infant safe sleep protection strategies that conform to the actual situation in China.Methods:From March to May 2021, a total of 50 medical staff and 100 caregivers from the Obstetrics Ward, Neonatal Ward and Child Health Clinic in Peking University First Hospital were selected by the convenient sampling method. The survey was carried out at the organizational, the medical staff level and the caregiver. At the organizational level, the Maternity Ward, Neonatal Ward and Child Health Care Clinic of the hospital were investigated, and relevant support systems and supporting documents were reviewed. On-site observation was adopted at the medical staff level. At the caregiver level, the self-designed Infant Safe Sleep Protection Strategy Behavior Questionnaire was used to conduct the survey and the results were statistically analyzed.Results:There were 15 items with an execution rate of 0, 6 items with an execution rate of 1% to 50%, 6 items with an execution rate of 51% to 99% and 4 items with an execution rate of 100%. Multiple linear regression analysis shows that the influencing factor of caregivers' practice of infant safe sleep protection strategy was their educational level ( P<0.05) , and there was a positive correlation between them ( r=0.238, P<0.05) . Conclusions:There is still a big gap between clinical practice and guidelines of infant safe sleep protection strategies, and relevant training should be strengthened to narrow the gap between clinical practice and guidelines.