Objective To establish a scientific and normative process for using physical restraint,and to increase the safety and efficiency of physical restraint.Methods On the basis of the previous studies,combined with the literature and clinical,we drafted a process framework of using physical restraint and then conducted consultation from 11 experts by using the Delphi technique.Results After 2 rounds of consulting,an evaluation form,consisted of 4 first-dimensions and 11 second-dimensions,and a process,consisted of 4 first-dimensions and 26 second-dimensions,were established.Kendall's W were 0.37 and 0.38 respectively,and expert authority coefficient was 0.84.Conclusions The results from the study is valid,feasible and reliable,however it still need to be further perfected.

Objective:To probe into effects of Mifepristone on the Th1/Th2 balance at materno-fetal interface.Methods:Sixty three healthy women in early pregnancy were randomized into two groups,30 women used mifepristone 200 mg,and 33 women as control.Their decidual tissue was collected by curettage in 48 hours of taking the drug.The Th1/Th2 cytokine expressions in decidua were analyzed by immunohistochemistry.Results:In the decidual tissue of normal early pregnancy,there were significantly higher densities of Th2 cytokines,IL-4 and TGF-?2,and lower density of Th1-type cytokine,IFN-? and IL-2.After having treated by Mifepristone,the decidual tissue appeared to significantly higher densities of Th1-type cytokines(IL-2, IFN-?).Conclusion:Our findings suggest that Mifepristone can up-regulate expression of the Th1-type cytokines,and cause a shift towards Th1 bias,which leads to abortion.

The chemical constituents of Taxus chinensis var. mairei cell cultures were investigated by chromatographic methods, including silica gel column chromatography, Sephadex LH-20 and preparative HPLC. Thirteen compounds were isolated from the 80% ethanol extract of cultured cells and their structures were elucidated by spectral data and physicochemical properties, which were identified as 2α,4α,7β,9α,10β-pentaacetoxy-14β-hydroxytax-11-ene (1), 2α,4α,7β,9α,10β-pentaacetoxytax-11-ene (2), 1β-deoxybaccatin VI (3), 2α-acetoxytaxusin (4), taxuyunnanine C (5), yunnanxane (6), 2α,5α,10β-triacetoxy-14β-propionyloxy-4 (20), 11-taxadiene (7), 2α,5α,10β-triacetoxy-14β-isobutyryloxy-4 (20), 11-taxadiene (8), 2α,5α,10β-triacetoxy-14β-(2'-methyl)butyryloxy-4 (20), 11-taxadiene (9), 13-dehydroxylbaccatin III (10), 13-dehydroxy-10-deacetylbaccatin III (11), paclitaxel (12) and (13) β-sitosterol. Among them, compound 1 is a new compound, and compounds 2, 4, 10 and 11 are isolated from the cell culture of Taxus chinensis var. mairei for the first time.

Objective To compare the effectiveness of nano-hydroxyapatite/collagen (nHAC)and autologous mesenchymal stem cells (AMSCs) for the repair of femoral defect in a rabbit model with femoral defect under the monitoring of the synchrotron radiation hard X-ray. Methods The rabbit models of traumatic bone defect were established and completely randomized into three groups. The femoral defects filled with nothing were used as control group (Group A) , the femoral defects filled with nHAC as Group B and the femoral defects filled with nHAC + AMSCs as Group C. Phase-contrast imaging with synchrotron radiation hard X-ray was applied to detect the degradation and repair process of each group at postoperative weeks 4, 8 and 12, respectively. Results Phase-contrast imaging with synchrotron radiation hard X-ray could display the reparative process. Four weeks after operation, there was collapse in some defect areas in Group A, and the degradation of nHAC and new bone formation were observed in Groups B and C. Eight weeks after operation, fibrous tissues were observed in the defect area in Group A, while osteogenesis and nHAC degradation were more obvious in Groups B and C. Twelve weeks after operation, the defect areas were still unhealed and were substituted by fibrous tissues in Group A, tissue densities of defect areas in Group C were identical with periphery areas, and trabecular bones were formed in Group C. There were statistical differences in the osteogenesis between Group A and Groups B and C,with Group C the best. Conclusion Phase-contrast imaging with synchrotron X-ray can detect the reparative process at a micro-level and plays an important role in the development of tissue engineering.

Objective To prevent the gastrointestinal intolerance in patients after laryngectomy by care bundles, so as to improve the effectiveness of enteral nutrition. Methods A total of 117 cases of laryngectomy patients were divided into control group (n=58) and experimental group (n=59) by random number table method. The patients in the control group were given routine nursing care, while the patients in the experimental group were treated by care bundles. The incidence of gastrointestinal intolerance was compared between the two groups in bloating, vomiting, gastroesophageal reflux, diarrhea and gastric retention. Results The incidences of bloating, vomiting, diarrhea and gastric retention of the experimental group were significantly lower than those of the control group, and the differences were statistically significant (P<0.05). The time of indwelling gastric tube in the experimental group and the control group was (12.35±2.29) days and (14.23±2.16) days respectively, and the difference was statistically significant (t=4.79, P< 0.01). Conclusions Care bundles can effectively prevent the occurrence of gastrointestinal intolerance in patients with indwelling gastric tube after laryngectomy.

Objective: To evaluate the efficacy and safety of nifekalan (NIF) on cardioversion in atrial fibrillation (AF) patients post radiofrequency ablation, and investigate the relevant factors related to the cardioversion efficacy of NIF. Methods: We screened patients with sustained AF rhythm after radiofrequency ablation between November 2016 and July 2018. Participants were treated with intravenous NIF 0.4 mg/kg within 5-10 minutes after ablation. We observed the adverse reaction, and monitored the rhythm, heart rate, QT interval and QTc interval before the medication and at 5, 10, 20, 120 min after the medication. According to the drug outcome of NIF, patients were divided into conversion group and non-conversion group, related factors affecting conversion efficacy were evaluated using logistic regression analysis. Results: (1)A total of 116 patients were enrolled in the study (63 males and 53 females, mean age was (64±18) years). Among them, 72 patients were converted to sinus rhythm, and the overall successful rate was 62.1%. There were 84 patients with persistent AF, of which 50 cases (59.2%) were restored to sinus rhythm. There were 32 patients with paroxysmal AF, 22 cases (68.8%) of them were restored to sinus rhythm. The conversion time was 1.5 to 12 (6.8±3.4)min. (2) In 116 patients, the QT interval and QTc interval were significantly longer after medication than before the drug administration (P<0.01), and peaked at about 10th min, and restored to the level before drug administration at about 120th min. (3) There were 8 cases of bradycardia (6.9%), 3 cases of frequent and short ventricular tachycardia (2.6%). (4) The duration of atrial fibrillation was shorter and left atrial diameter was smaller in the cardioversion group than in the non-cardioversion group (both P<0.05). There were no significant differences in gender, disease history, atrial fibrillation type and structural heart disease between the two groups (P>0.05). (5) Multifactorial logistic regression analysis showed that the duration of atrial fibrillation (OR=0.980, 95%CI 0.966-0.994, P=0.004) and the left atrial diameter (OR=0.888, 95%CI 0.814-0.967, P=0.007) were the factors that influence the cardioversion efficacy of NIF on atrial fibrillation post ablation. Conclusions The total effective rate of NIF was 62.1% in patients witrh sustained AF post radiofrequency ablation, was 68.8% in patients with paroxysmal AF. Besides, NIF has the advantage of short conversion time and few adverse reactions. Left atrium diameter and AF duration were relevant factors that influence the efficacy of NIF of cardioversion in patients with sustained AF after radiofrequency ablation.

Objective To evaluate the efficacy and safety of nifekalan (NIF) on cardioversion in atrial fibrillation (AF) patients post radiofrequency ablation, and investigate the relevant factors related to the cardioversion efficacy of NIF. Methods We screened patients with sustained AF rhythm after radiofrequency ablation between November 2016 and July 2018. Participants were treated with intravenous NIF 0.4 mg/kg within 5-10 minutes after ablation. We observed the adverse reaction, and monitored the rhythm, heart rate, QT interval and QTc interval before the medication and at 5, 10, 20, 120 min after the medication. According to the drug outcome of NIF, patients were divided into conversion group and non?conversion group, related factors affecting conversion efficacy were evaluated using logistic regression analysis. Results (1)A total of 116 patients were enrolled in the study (63 males and 53 females, mean age was (64±18) years). Among them, 72 patients were converted to sinus rhythm, and the overall successful rate was 62.1%. There were 84 patients with persistent AF, of which 50 cases (59.2%) were restored to sinus rhythm. There were 32 patients with paroxysmal AF, 22 cases (68.8%) of them were restored to sinus rhythm. The conversion time was 1.5 to 12 (6.8±3.4)min. (2) In 116 patients, the QT interval and QTc interval were significantly longer after medication than before the drug administration (P<0.01), and peaked at about 10th min, and restored to the level before drug administration at about 120th min. (3) There were 8 cases of bradycardia (6.9%), 3 cases of frequent and short ventricular tachycardia (2.6%). (4) The duration of atrial fibrillation was shorter and left atrial diameter was smaller in the cardioversion group than in the non?cardioversion group (both P<0.05). There were no significant differences in gender, disease history, atrial fibrillation type and structural heart disease between the two groups (P>0.05). (5) Multifactorial logistic regression analysis showed that the duration of atrial fibrillation ( OR=0.980, 95%CI 0.966-0.994, P=0.004) and the left atrial diameter ( OR=0.888, 95%CI 0.814-0.967, P=0.007) were the factors that influence the cardioversion efficacy of NIF on atrial fibrillation post ablation. Conclusions The total effective rate of NIF was 62.1% in patients witrh sustained AF post radiofrequency ablation, was 68.8% in patients with paroxysmal AF. Besides, NIF has the advantage of short conversion time and few adverse reactions. Left atrium diameter and AF duration were relevant factors that influence the efficacy of NIF of cardioversion in patients with sustained AF after radiofrequency ablation.

Objective To explore the effects of doctor-nurse integration cooperation mode in skin regeneration technique (ReCell technique) during stable phase among patients with vitiligo.Methods The doctor-nurse integration cooperation mode was formulated by doctors and nurses through new technique specialization training for health care provider including receiving a patient for treatment, preoperative preparation, intraoperative coordination, postoperative comprehensive nursing and so on from October 2010 to June 2015. A total of 40 patients with vitiligo during stable phase were selected along with skin lesions position in the face (14 slices), neck (18 slices), torso (35 slices), arm and leg (13 slices), finger tips of limb (5 slices). They accepted ReCell technique treatment under local anaesthesia.Results All patients recovered quickly after operation without complications. After a mean 6 months follow-up, the effective rate of treatment was 78.57% in the face, 83.33% in neck, 85.71% in torso, 76.92% in arm and leg, 20.00% in finger tips of limb.Conclusions The ReCell technique with easy operation, celerity, small damage and safety is one of the effective methods in treatment of vitiligo during stable phase. The doctor-nurse integration cooperation mode offers the important guarantee for the development of new techniques.

Objective:To deeply understand the evaluation of allergic rhinitis patients on the use of health education accurately linking system, analyze their real experience and needs, so as to provide improvement basis for optimizing intelligent mobile education system.Methods:From January to June 2021, 15 patients with allergic rhinitis were selected from the Otolaryngology and Head and Neck Surgery of Beijing Tongren Hospital affiliated to Capital Medical University by purposive sampling as the interviewee. A total of 15 patients with allergic rhinitis were interviewed semi structurally, and the results were analyzed by thematic analysis.Results:The experience of the health education accurately linking system was refined into three themes, namely, the practicality of the health education content, the effectiveness of the health education form, and the shortcomings of the education content and form.Conclusions:Through the health education accurately linking system as the carrier, the system presents standardized health education knowledge as the core of clinical application interviews. It is necessary to increase access to health information. The content of propaganda and education can mainly be short videos. The disease knowledge module can be improved according to the severity of the disease, so as to improve the quality of health education and promote the occurrence of health behaviors.

OBJECTIVE：To provide referen ce for improving commission management system of medical insurance in China. METHODS：By analyzing the problems of commission management system of medical insurance in China ，studying the specific types，responsibility division and its features of basic medical insurance contractors in the United States ，the suggestions were put forward for improving corresponding system in China. RESULTS & CONCLUSIONS ：There are some problems in the entrusted management of medical insurance in China ，including that the fair competition mechanism has not been established ；the operation and management of social security fund lacks of supervision mechanism ；the role of the government is unclear and inexperienced ； the imperfect supervision mechanism causes follow-up problems ；it is still uncertain whether the entrusted management system can improve the efficency of medical insurance management. In the United States ，the way of entrusted management of medical insurance was to introduce the third-party management. The contractors employed by the Centers for Medicare and Medicaid Services in the United States mainly included medical insurance contractor ，zone program integrity contractor ，comprehensive error rate test review contractor and statistical contractor ，supplemental medical review contractor ，qualified independent contractor and so on ，among which medical insurance contractor was in the core position. Each contractor had a clear division of labor in handling medical claims ，preventing medical fraud ，reviewing the correctness of payments ，evaluating medical records and handling appeals. This mode greatly reduced the work pressure of the government ，improved the efficiency of medical insurance management and operation，and promoted the continuous improvement of the whole system. It is suggested that China should expand the scope of social agency management ，clarify the responsibilities of government and social resources ，introduce various types of social economic organizations and establish a complete and effective performance supervision and management system in order to improve the modernization level of China ’s medical insurance governance.