Objective　To explore the molecular epidemiological characteristics of local Mycobacterium tuberculosis in Chongqing, China using genotyping methods and establish a suitable genotyping system tuberculosis genotyping in the region. Methods A total of 268 isolates collected from the sputum of tuberculosis patients at two national drug resistance monitoring sites in Chongqing from 2019 to 2021. The DNA of these isolates was extracted, and genotyping of the isolates was performed using VTNR 24 locus typing method. Epidemiological investigations were conducted on clustered isolates, and the clustering rates of isolates from the two surveillance sites were compared to analyze their transmission differences. Results In the two regions, the Hunter-Gaston discriminatory index (HGI) in Fengjie County ranged from 0 to 0.85, with 10 loci having an HGI above 0.6, 11 loci with an HGI between 0.3 and 0.6, and 3 loci with an HGI below 0.3; the highest resolution site was MIRU31, while the lowest resolution site was MIRU24. The HGI index in Fengdu County ranged from 0 to 0.81, with 12 loci having an HGI above 0.6, 9 loci with an HGI between 0.3 and 0.6, and 3 loci with an HGI below 0.3; the highest resolution site was MIRU26, while the lowest resolution site was MIRU23. In the clustering analysis, among the 140 isolates from Fengdu County, 10 samples clustered into 4 clusters, with the largest cluster consisting of 4 samples, resulting in a clustering rate of 4.1%. Among the 128 isolates in Fengjie County, 10 samples clustered into 5 clusters, with a clustering rate of 4.2%. Conclusion In Fengdu County and Fengjie County of Chongqing, the main population of the disease show independent genotypes, indicating a low recent transmission rate. The incidence of patients is mainly endogenous recurrence, that is, latent infection develops into active tuberculosis. While conducting standardized management of tuberculosis patients, prevention and control agencies should also increase the screening of latent infection at two monitoring points and carry out preventive treatment of latent infection, which is the key to reduce the incidence of tuberculosis in the two places.

Objective:To explore the efficacy and safety of escharectomy and skin grafting combined with negative pressure wound treatment in the treatment of patients with deep burn.Methods:A total of 208 deep burn patients who were treated in Haining People's Hospital from May 2018 to May 2019 were selected in the research.They were randomly divided into observation group and control group according to the random digital table method, with 104 cases in each group.The observation group was treated with escharectomy and skin grafting combined with negative pressure wound treatment.The control group was treated with escharectomy and skin grafting combined with traditional pressure bandaging.The general treatment, wound healing rate, changes of serum inflammatory factors before treatment and after treatment for 7 days, and complications of the two groups were compared.Results:The total excellent and good healing rate of the observation group (92.31%) was higher than that of the control group (79.81%) (χ 2=6.772, P<0.05). The granulation growth time [(8.23±2.16)d], wound healing time [(17.64±2.58)d], postoperative pain score[(3.16±1.24)points] and hospitalization time [(22.61±2.47)d] in the observation group were lower than those in the control group [(12.15±2.33)d, (20.25±3.16)d, (5.33±1.27)points and (26.13±2.55)d] ( t=12.582, 6.525, 12.468, 10.111, all P<0.05). At 7 days after treatment, the levels of CRP[(21.12±2.48) ng/L], TNF-α [(3.27±0.38)ng/L], IL-6 [(5.32±1.46)ng/L] and C3a [(12.13±1.62)μg/L] in the observation group were lower than those in the control group [(28.06±2.62)ng/L, (5.13±0.43)ng/L, (6.68±1.51)ng/L and (16.43±1.26)μg/L] ( t=19.618, 33.055, 6.603, 21.367, all P<0.05). The total incidence of complications in the observation group (7.69%) was lower than that in the control group (22.12%) (χ 2=8.529, P<0.05). Conclusion:Escharectomy and skin grafting combined with negative pressure can improve the wound healing rate, improve the body's inflammatory response, shorten the recovery time, reduce the occurrence of complications and has good safety.

Objective: To investigate the application effect of Power port in contrast-enhanced CT scans. Methods: Totally 220 cancer patients who needed contrast-enhanced CT scans after chemotherapy were selected in Changhai hospital From September 2017 to September 2018, including 110 cases in the observation group and 110 cases in the control group with convenient sampling method.The observation group was injected contrast medium through Power port for CT scans. Contrast medium was injected into the control group by 22G of Peripheral venous access devices (Introcan®). The incidence of contrast medium exosmosis, nursing time and patient satisfaction were compared between the two groups. Results: The incidence of extravasation of contrast medium in the observation group was 0, lower than that in the control group 9.1% (10/110), the difference was significant(χ²=10.476,P=0.015); the nursing time in the observation group was (2.60 ±0.15) minutes per time, which was lower than that in the control group (5.60 ± 5.29) minutes per time), the difference was significant (t=5.934, P=0.000); the patient satisfaction in the observation group was higher than that in the control group, the difference was statistically significant (Z=-12.695, P=0.000). Conclusions Contrast medium injection through Power port for CT scans can reduce the incidence of contrast medium exosmosis, reduce nursing hours and improve patient satisfaction.

A 29-year-old female patient received cervical injection of oxytocin injection 10 U twice daily because of postpartum subinvolution of uterus. On the 4th day of treatment,the patient received a transrectal administration of carboprost methylate suppositories 0. 5 mg due to poor efficacy of oxytocin injection. About 20 minutes after rectal medication,the patient developed diarrhea with watery stools 4 times within 70 minutes. About 2 hours after rectal medication,the patient developed persistent abdominal colic and gradually aggravated. Intramuscular injections of metoclopramide 10 mg and pethidine 100 mg were given. However,her abdominal pain did not improve obviously and abdominal ultrasound examination showed no abnormality. Her diarrhea and abdominal pain were considered to be related to carboprost methylate. Symptomatic supportive treatments with spasmolysis,antidiarrheal,potassium supplementation, fluid replacement were given continuously. Five days later,diarrhea and abdominal pain disappeared.

A 29-year-old female patient received cervical injection of oxytocin injection 10 U twice daily because of postpartum subinvolution of uterus. On the 4th day of treatment,the patient received a transrectal administration of carboprost methylate suppositories 0. 5 mg due to poor efficacy of oxytocin injection. About 20 minutes after rectal medication,the patient developed diarrhea with watery stools 4 times within 70 minutes. About 2 hours after rectal medication,the patient developed persistent abdominal colic and gradually aggravated. Intramuscular injections of metoclopramide 10 mg and pethidine 100 mg were given. However,her abdominal pain did not improve obviously and abdominal ultrasound examination showed no abnormality. Her diarrhea and abdominal pain were considered to be related to carboprost methylate. Symptomatic supportive treatments with spasmolysis,antidiarrheal,potassium supplementation, fluid replacement were given continuously. Five days later,diarrhea and abdominal pain disappeared.

Objective To investigate the reliability and validity of Hospice care quality assessment scale. Methods Eight experts in the field of hospice revised the Scale after Chinese localization. The scale data were analyzed after collation of 181 families fulfill the scale. Results The total scale Cronbach′s a coefficient was 0.851. The first dimension′s coefficient was 0.796. The second dimension′s coefficient was 0.622 and the third dimension′s coefficient was 0.827. In factor analysis of the scale, after varimax rotation, the number of characteristic roots>1 was 10 and made up of 70.88%of the total variance. Conclusions The hospice care quality assessment scale after Chinese localization has good reliability and validity and could be a tool to evaluate the clinical quality of care for dying patients.

Objective To investigate application effects of the pain nursing operation flowchart in the management of cancer pain patients .Methods Eighty-two patients were divided into the control group (40 patients) and the study group (42 patients) according to the admission time using the convenience sampling method.The patients in the control group received routine nursing .In the study group the pain nursing operation flowchart was designed based on the adult cancer pain guideline and the establishment standard of cancer pain standardized treatment example wards .The nursing form was designed corresponding to the flowchart .The standardized training was carried out in all nurses in the department for the improvement of their operation standardization . The comprehensiveness and the dynamics of the pain assessment , the timeliness of communicating with doctors , the comprehensiveness of pain propaganda and education , the timeliness of the management of adverse reactions and the satisfaction degree of discharged patients in the two treatment groups were evaluated .Results For the quality inspection of pain nursing of the patients in the study group , after using the flowchart , the qualified rates of the comprehensiveness and the dynamics of the pain assessment , the timeliness of communicating with doctors , the comprehensiveness of pain propaganda and education , the timeliness of the management of adverse reactions were 100.0%, 100.0%, 95.2%, 100.0%, 97.6%, respectively;the satisfaction degree of discharged patients was 97.6%, all of which were significantly higher than those in the control group (χ2 =9.31,6.80,4.44,8.04,7.74,4.18;P<0.05).Conclusions The application of the pain nursing operation flowchart in standardized wards of cancer pain can significantly improve the quality of pain management , which achieves good social benefits and worthy of promotion .

Objective:To investigate the predictive value of serumal retinol-binding protein 4(RBP4) level fro fetal macrosomia of non-diabetic pregnant women .Methods :The serumal levels of RBP4 of 500 non-diabetic pregnant women at 12 week ,20 week and 24 week of pregnancy were measured by immune projection turbidimetric method .Fetal macrosomia was defined as birth weight≥4000 g .The cut-off value ,sensitivity and specificity were calculated with receiver operating characteristic (ROC) curve .Results:Of the 500 non-diabetic pregnant women ,30 cases(6% ) got fetal macrosomia .The ROC curve showed that the predictive cut-off values of RBP4 at 12 week ,20 week and 24 week of pregnancy were 61 .0 mg/L ,50 .5 mg/L and 52 .5 mg/L , respectively ;the predictive sensitivity and specificity at 12 week ,20 week and 24 week of pregnancy were 42 .9% and 94 .5% , 70 .0% and 69 .5% ,76 .9% and 73 .2% ,respectively .The predictive cut-off value of RBP4 no later than 24 week of pregnancy was 51 .5 mg/L ;the predictive sensitivity and specificity were 61 .8% and 69 .5% .There was significant difference(P<0 .05) between the serumal level of RBP4 at 24 week of pregnancy in group fetal macrosomia and that in group nonfetal macrosomia . Conclusions :The predictive sensitivity of RBP4 increases in accordance with the increase of serumal level of RBP 4 .The serumal level of RBP4 of non-diabetic pregnant women at 24 week of pregnancy may have higher sensitivity and specificity in the predic-tion of fetal macrosomia .If the serumal level of RBP4 no later than 24 week of pregnancy is beyond 50 mg/L ,then the risk of fetal macrosomia will be higher .

Objective To investigate the effects of tetanic stimulation of peripheral nerve on intracranial direct electrical stimulation motor-evoked potentials (MEP) in patients undergoing cerebral functional area operation. Methods Eight patients undergoing elective brain tumor resection under propofol-fentanyl anesthesia with partial neuromuscular blockade were enrolled in the study. Both conventional MEP (C-MEP) monitoring and posttetanic MEP (P-MEP) monitoring were performed throughout the operation for each patient, and the two groups of data were recorded. For one group, direct electrical stimulation with a train of five pulses was delivered to motor cortex and pyramidal tract, C-MEP was unilaterally recorded from the abductor pollicis brevis, and P-MEP was obtained 1 s after tetanic stimulation (frequency 50 Hz, intensity 50 mA, duration 5 s) to the ipsilateral tibial nerve.For the other group, direct electrical stimulation with a train of five pulses was delivered to motor cortex and pyramidal tract, C-MEP was unilaterally recorded from the tibialis anterior, and P-MEP was obtained 1 s after tetanic stimulation (frequency 50 Hz, intensity 50 mA and duration 5 s) to the contralateral tibial nerve. Randomized crossover method was used for C-MEP and P-MEP recording in each group, with an interval of 120 s. The adverse effects were observed. Results Amplitudes of P-MEP from the abductor pollicis brevis and tibialis anterior were significantly higher than those of C-MEP. Three patients had body movement during intraoperative cortex stimulation, while there was no awareness during operation and other electrical stimulation-related nervous system impairment and complications. Conclusion The application of tetanic stimulation of peripheral nerve before direct electrical stimulation can augnent the amplitudes of MEP from the abductor pollicis brevis and tibialis anterior in patients undergoing cerebral functional area operation.

From the aspects of strengths,weaknesses,opportunities and threats,this paper analyzed external factors of the reorganizations and group building reform of public hospitals in Shanghai.Points made are as follows:Characteristics of individual hospitals should he respected instead of a generalized pattern for all;the role of the government to play in this regard should he guidance of an orderly competition,Strengthen Supervision,and promotion of the reform in property rights,These efforts will create a desirable environment for hospital groups;mid- and long-term goals for the reform should consolidate the independent legal entity status of such groups.