Objective To study the clinical,imaging and pathological features of hepatic angiomyolipoma,and to investigate methods in improving the preoperative diagnosis rate.Methods The imaging features and treatment experience of 73 patients with hepatic angiomyolipoma who had been admitted to the Eastern Hepatobiliary Surgery Hospital from 2000 to 2007 were retrospectively analyzed.All patients were classified according to the imaging features and corresponding treatments were applied.Results Of all patients,7 were diagnosed preoperatively.The diagnostic rate of B ultrasound,computed tomography and magnetic resonance imaging were 0,13%(7/56)and 6% (2/33),respectively.According to the results of imaging examination,6 patients were with the type of hemangioma,17 with the type of lipoma,4 with the type of leiomyoma and 46 with mixed type.One patient was treated by radiofrequeney ablation and 72 by surgical resection.Twenty-four patients were presented with pulmonary infection,pleural effusion,ascites or slight hepatic dysfunction.Postoperative immunohistochemical assay demonstrated that HMB45 had the highest positive expression rate,then followed by smooth muscle actin,vimentin,proliferating cell nuclear antigen,CD34,polyclonal carcinoembryonic antigen,CD18,CD19 and p53.One patient died of postoperative tumor recurrence.Conclusions Hepatic angiomyolipoma is easy to be misdiagnosed,while imaging classification is helpful in the diagnosis.Surgical resection is beneficial to patients with hepatic angiomyolipoma.

Objective To evaluate the effects of Massive Open Online Course (MOOC) on standardized training of nurses.Methods The 148 new nurses from August 2015 to July 2016 were selected as the control group, and trained in traditional teaching mode. The 150 new nurses from August 2016 to July 2017 were recruited as the observation group, and trained with MOOC on the basis of traditional teaching mode. The scores of core ability, including the theoretical and operational assessment, critical thinking and clinical nursing were compared between the two groups.Results After one year of training, the scores of theoretical and operational assessment of the observation group were (97.16±1.92) and (96.56±1.87) respectively, which were better than those of the control group, and the difference were statistically significant (t=12.091, 7.895;P<0.001). The scores critical thinking / academic research ability and clinical nursing ability of the observation group were (25.66±5.12) and (25.12±4.42) respectively, which were better than the control group, and the differences were statistically significant (t=2.191, 2.030;P<0.05).Conclusions The application of MOCC with traditional teaching mode on the new nurse standardized training is helpful to improve new nurses' theoretical and operational knowledge, enhance the satisfaction of clinical departments, and to cultivate new nurses critical thinking, ethical practice and other core competencies.

Objective To establish a standardized training and assessment system for new nurses in the internet age and investigate the application effect of the system on the standardized training of new nurses. Methods From March 2015 to March 2017, a standardized training program was formulated based on national training program for new nurses. Nursing training massive open online courses (MOOC) were constructed in the cooperation with software company. A scientific and efficient system for the management, training and assessment of new nurses was established depended on nursing management system and educational network platform. A number of 97 nurses recruited in 2014 were served as control group and trained with traditional training methods between March 2015 and March 2016. Another 96 nurses recruited in 2015 were acted as observation group and treated with standardized training based on the new system in the internet age between March 2016 and March 2017. The training and assessment effects of new nurses were compared between two groups. Results The perfect rate of personal information and participation rate of training of nurses in the observation group were 97.83% and 100.00%, which were significantly higher than those in the control group (χ2=7.158, 7.034;P<0.01). The training time of nurses in the observation group was (21.45±2.87) h,which was shorter than the control group's (35.12±3.75) h (t=28.479, P<0.01). The excellent and good rates for the theoretical exam of new nurses in the observation group were 17.39% and 56.52% and the excellent and good rates for operation examination and clinical practice ability examination of new nurses in observation group were 11.96% and 69.56%, which were significantly higher than those of the control group (Z=-3.736, -4.000;P<0.01). The satisfaction rate of new nurses to the training and assessment in the observation group was 97.82%, which was higher than that of the control group (82.47%). The difference was statistically significant (χ2=14.808, P<0.01). Conclusions The standardized training and assessment system using MOOC for new nurses in the internet age could improve the effectiveness of standardized training and satisfaction for new nurses, which is beneficial to the improvement of the nursing training quality and management benefit.

Objective To investigate the application and effects of navigation guidance in the diagnosis and treatment of patients so as to standardize the process of medical activities,provide convenience for patients and improve the quality of clinical service. Methods A total of 582 patients from outpatient clinic,306 hospitalized patients with MRI examinations and 124 medical staff from May 2015 to June 2015 in Hu'nan People's Hospital were randomly selected as control group. A number of 582 patients from outpatient clinic,306 hospitalized patients with MRI examinations and 124 medical staff from July 2015 to August 2015 were randomly selected as experimental group. Patients in control group went for waiting doctor,treatment,examination and taking medicine with the guidance of responsible nurses. Patients in experimental group were guided with additional navigation guidance which was designed depend on the hospital. Treatment time of patients from outpatient clinic,MRI examination time of hospitalized patients,satisfaction of patients and medical staff to treatment time,treatment procedure and clinical service were compared between two groups. Results After the usage of navigation guidance,treatment time of patients from outpatient clinic in experimental group (63.53±32.97) was shorter than that in control group (67.94±39.44). The difference was statistically significant (P < 0.05). MRI examination time of hospitalized patients in experimental group (30.90±12.19) was shorter than that in control group (33.75±13.38), with significant difference (P<0.05). Satisfaction rates of patients to waiting time,treatment procedure and clinical service in experimental group were higher than those in control group (t=-3.977,-3.355,-4.843,P<0.001). Average satisfaction rate of medical staff to treatment procedure in experimental group (84.26±9.80)% was significant higher than that in control group (80.27±9.40)% (P<0.05). Conclusions Application of navigation guidance improves the standardization and specification of diagnosis and treatment procedure and clinical service levels. It is an effective management method which could significantly short patients' treatment and examination time so as to promote the satisfaction rate of medical staff and patients.

? Frailty is a multidimensional syndrome, reflecting the decline of the body's physiological reserve. The patients are often accompanied by a variety of diseases. The postoperative complications and mortality were significantly increased on frail patients due to improper anesthesia and perioperative management. Enhanced recovery after surgery optimizes perioperative treatment and achieves rapid recovery compared with traditional measures. However, perioperative management of patients with frailty is still in the exploratory stage. Common assessment methods for weakness are the debilitating phenotype and the debilitating index. This article focuses on the perioperative related problems of debilitated patients (low nutritional status, poor mental condition, complicated condition and many complications, multi-disciplinary collaboration, prone to fall and fall), and provide the basis for the frailty management of elderly medical workers.

Objective? To evaluate the status and influencing factors of frailty among elderly people aged 60 or above in a remote area in Hu＇nan Province and to provide evidence for preventing frailty among the elderly people in remotely rural areas. Methods? Totally 101 elderly people aged≥ 60 were selected from Shizhu Village, Dongkou County, Shaoyang City, Hu＇nan Province using convenient sampling between July and September 2018. The elderly people＇s demographic indicators, complications, smoking and drinking history, physical exercise and sleep quality were collected. Vulnerable Elders Survey (VES-13) was used to evaluate the frailty among elderly people, and Logistic regression analysis was employed to analyze and screen the risk factors of frailty. Results? Totally 39 out of the 101 (38.6%) elders showed frailty. Univariate analysis showed that there was statistically significant difference in frailty between elders with different age, mode of living, number of complications and physical exercise (P＜ 0.05). According to Logistic regression analysis, the independent risk factors of frailty among the elders aged 60 or above in remote areas included aged 70-79 (OR=8.406,95%CI: 2.381-29.684,P=0.001), aged 80-89 (OR=14.087,95%CI: 2.372-83.673,P=0.004), number of complications≥ 3 (OR=8.458,95%CI: 1.307-54.754,P=0.025), and lack of physical exercise (OR=12.448,95%CI: 3.165-48.961,P＜ 0.001). Conclusions? Frailty is common in the elders in remote areas, which is associated with venerable age, multiple complications and lack of physical exercise. Therefore, we should pay attention to the frailty among the elders in remote areas and provide intervention accordingly.

Objective:To explore the relationship between the triglyceride glucose (TyG) index and impairment of renal function in community-dwelling middle-aged and elderly population.Methods:A total of 4 988 residents aged ≥45 years undergoing health check-up in Yongshun Health Service Center from January 2016 to December 2021 were enrolled and followed up. According to the quartile of the baseline TyG index, all subjects were divided into Q1, Q2, Q3 and Q4 groups. The medical history, physical examination and laboratory test results were documented. Participants were followed up through regular health check-up until March 31, 2023. The outcomes were rapid decline of estimated glomerular filtration rate (eGFR) (a loss in eGFR>3 ml·min -1·1.73 m -2 per year) and the new-onset of chronic kidney disease (CKD) during the follow-up period. Linear regression model, multivariate logistic regression model, restricted cubic spline fitting logistic regression model and ROC curve analysis were used to analyze the association between the TyG index and the impairment of renal function. Results:Among 4 988 residents, 1 396 (28.0%) were males and the age was (59.76±6.28) years. There were 1 247 participants in Q1, Q2, Q3 and Q4 groups, respectively. After 56 months of follow-up, the incidence of rapid eGFR decline and new-onset CKD was 21.9% (1 294/4 988) and 4.0% (200/4 988), respectively. Multivariate logistic regression model analysis showed that TyG index was correlated positively with rapid eGFR decline and new-onset of CKD ( OR=1.34, 95%CI: 1.17-1.52, P<0.001, and OR=1.57, 95%CI:1.19-2.06, P=0.001). Taking group Q1 as a reference, higher levels of TyG index ( Q2, Q3 and Q4 groups) was an independent risk factor for rapid eGFR decline ( P<0.05), which has a dose-response relationship (for trend P=0.002). Compared with the lowest quartile, the adjusted OR of new-onset CKD in the highest quartile was 1.85 ( 95%CI:1.13-3.03, P=0.014). The results of restricted cubic spline fitting logistic regression analysis showed a linear association between TyG index and both outcomes (both P>0.05). The area under ROC curve ( AUC) of the TyG index for predicting the two adverse outcomes were 0.536 ( 95%CI: 0.516-0.556, P<0.001) and 0.588 ( 95%CI:0.548-0.627, P<0.001), respectively. Conclusion:The elevated levels of TyG index may be used as an independent predictor of rapid eGFR decline and new-onset CKD.

Objective:To understand the current situation of the demand for Internet plus nursing service among nurses at different levels, and analyze the influencing factors, so as to provide reference for the improvement of relevant national policies.Methods:A total of 19 762 in-service nurses from 32 provinces in China were investigated by cross sectional survey in April to May 2019. The demand for Internet plus nursing services was investigated, including 5 dimensions, including institutional demand, safety demand, demand for fees, quality demand and training needs.Results:Among the 19 762 nurses surveyed, there were 135, 4 736, 8 847, 4 827 and 1 217 nurses at N0-N4 levels respectively. The safety needs of nurses ranked first(4.68±0.52). The institutional needs of N3 and N4 nurses were the most significant, and the safety needs of N0-N2 nurses were the most significant; Training demand was the third demand of nursing staff at all levels. Multiple linear regression analysis showed that education and professional title were the factors that affected nurses′ demand for Internet plus nursing service( P<0.01). Conclusions:Nurses at different levels have a high and diversified demand for Internet+ nursing services.

Objective? To investigate the leadership status of new nurses, and to provide some reference for the training and education of new nurses and efficient quality nursing service. Methods? In September 2018, a total of 129 new nurses from a ClassⅢ Grade A hospital were randomly recruited by convenience sampling method. Questionnaire survey was conducted to compare the difference of leadership among new nurses with different characteristics by General Information Questionnaire and Nurse Leadership Questionnaire. A total of 129 questionnaires were sent out and 125 valid questionnaires were collected. Results? The average leadership score of the 125 new nurses was (3.59±0.67). The score of nursing professional ability dimension was the highest (3.73±0.64), and the score of critical thinking ability dimension was the lowest (3.47±0.71). The scores of five dimensions of interpersonal communication ability, communication ability, critical thinking ability, planning and organizing ability and self-care ability of new nurses of different genders in the nurse leadership questionnaire were compared, and the differences were statistically significant (t=-3.950,-3.145,-3.389,-3.451,-2.179;P＜0.05). The difference in critical thinking ability score of new nurses with different marital status was statistically significant (t=3.235,P＜ 0.01). Conclusions? The overall level of leadership status of new nurses is low. It is suggested that in the standardized training and education of newly recruited nurses, early education and training of career leadership should be emphasized, and the strengths of different groups of nurses should be brought into play, so as to improve their professional value and quality service.

Objective:To investigate the demand of patients for home care services under the background of "Internet+" and analyze its influencing factors of their participation status.Methods:A total of 494 patients from 7 ClassⅢ hospitals in Beijing, Guangzhou and Changsha from April to June 2019 were investigated by questionnaires. The research tools included general data questionnaire and questionnaire of patients' demands or "Internet+" home care service.Results:A total of 461 valid questionnaires were collected. The degree of patients' demand for "Internet+" home care services in descending score order was diagnosis and treatment information security [ (4.64±1.69) points], service capacity [ (4.62±1.77) points], health guidance [ (4.34±3.06) points], specialty nursing [ (4.24±3.79) points]. The results of binary Logistic regression analysis showed that monthly income, medical insurance type, main caregivers, and the number of diseases suffered by family members were the influencing factors of patients' participation in "Internet+" home care services ( P<0.05) . Conclusions:Patients have a realistic demand for "Internet+" home care services. It is recommended to establish a nursing service system based on patient needs, strengthen patients' information security, expand the radius of nurses' door-to-door service, enrich the list of service items and provide patients with professional and scientific services.