Objective:To apply the ORTCC (objective, rule, training, check, and culture) refined management model for the systematic management and overall construction of a specialty nurse team in a tertiary grade A general hospital, and to promote the cultivation and development of specialty nurses.Methods:The management framework of specialty nurses was investigated and a survey on their work was conducted. The ORTCC model was used to implement fine management of specialty nurses, including determining the integrated objective of "training, use, and management"(objective):, improving the rule system (rule), building a hierarchical training platform (training), streamlining the whole process check (check), and shaping the specialty nursing culture (culture). The effects were evaluated after one year of implementation.Results:After the implementation of ORTCC refined management, the number of specialty nurses increased to 367 in 2023, and a three-level progressive specialty nurse team was formed. The total and dimensional scores of perceived professional benefits ( P<0.001) and clinical competence ( P<0.001 or P<0.05) were higher than the scores in 2022. Additionally, 12 specialized nursing techniques were established, and six provincial or higher-level specialized quality improvement awards were obtained, further enhancing the capacity for specialized nursing services. Conclusions:The refined management practice of specialty nurses based on the ORTCC model provides a theoretical and practical basis for the hierarchical cultivation, effective use, and scientific management of specialty nurses in tertiary hospitals, thereby promoting specialty nurse team development and enhancing specialized service capacity.

Objective:To apply the ORTCC (objective, rule, training, check, and culture) refined management model for the systematic management and overall construction of a specialty nurse team in a tertiary grade A general hospital, and to promote the cultivation and development of specialty nurses.Methods:The management framework of specialty nurses was investigated and a survey on their work was conducted. The ORTCC model was used to implement fine management of specialty nurses, including determining the integrated objective of "training, use, and management"(objective):, improving the rule system (rule), building a hierarchical training platform (training), streamlining the whole process check (check), and shaping the specialty nursing culture (culture). The effects were evaluated after one year of implementation.Results:After the implementation of ORTCC refined management, the number of specialty nurses increased to 367 in 2023, and a three-level progressive specialty nurse team was formed. The total and dimensional scores of perceived professional benefits ( P<0.001) and clinical competence ( P<0.001 or P<0.05) were higher than the scores in 2022. Additionally, 12 specialized nursing techniques were established, and six provincial or higher-level specialized quality improvement awards were obtained, further enhancing the capacity for specialized nursing services. Conclusions:The refined management practice of specialty nurses based on the ORTCC model provides a theoretical and practical basis for the hierarchical cultivation, effective use, and scientific management of specialty nurses in tertiary hospitals, thereby promoting specialty nurse team development and enhancing specialized service capacity.

Selecting high-quality patient report outcome measures for patients with liver transplantation may properly assess health condition from their perspective, assist nurses in identifying patients′ reports of health issues, and deliver targeted nursing care for them. This paper reviewed the current status of researches on measurement tools for patient reported outcomes in liver transplantation both domestically and internationally, including the content, characteristics, disadvantages and situation recommendations of the generic and specific measurement tools. The purpose is to provide a reference for choosing patient reported outcomes measurements, symptom management as well as the caring strategies in liver transplantation.

OBJECTIVE: To determine the frequencies of deafness gene mutations among patients with non-syndromic hearing loss (NSHL) from northern Jiangsu province. METHODS: A total of 117 patients with NSHL were enrolled. The coding region of GJB2 gene, IVS7-2A>G and 2168A>G mutations of SLC26A4 gene, and 1555A>G and 1494C>T mutations of mitochondrial DNA 12S rRNA were subjected to Sanger sequencing. Patients in whom no mutation was detected were further tested by targeted gene capture and high-throughput sequencing. RESULTS: Among the 117 patients, 86 (73.50%) were found to carry mutations. GJB2 gene mutations were found in 61 patients (52.14%), including 22 (18.80%) with homozygous mutations and 39 (33.33%) with heterozygous mutations. SLC26A4 gene mutations were found in 19 patients (16.24%), including 4 (3.42%) with homozygous mutations and 15 with heterozygous mutations (14.53%). Mitochondrial 12S rRNA gene mutation was found in 6 patients (5.13%). Targeted gene capture and high-throughput sequencing of 8 patients identified 4 further cases, including 1 with RDX gene 129_130del and 76_79del compound heterozygous mutations, 1 with OTOF gene 1274G>C homozygous mutation, 1 with SLC26A4 gene 919-2A>G and IVS16-6G>A compound heterozygous mutation, and 1 with SLC26A4 gene 919-2A>G and A1673T compound heterozygous mutation. CONCLUSION The frequency of mutation among patients with NSHL from north Jiangsu was 73.50%, and GJB2 gene was most commonly mutated.
China ; Connexins ; DNA Mutational Analysis ; DNA, Mitochondrial ; Hearing Loss ; genetics ; Humans ; Membrane Proteins ; Mutation ; Sulfate Transporters

Objective To investigate the risk factors and improvement measures of thrombosis in internal arteriovenous fistula in maintenance hemodialysis patients .Methods Case control studies were performed in this study . Totals of 100 maintenance hemodialysis patients with thrombosis in internal arteriovenous fistula from January 2009 to June 2015 in Lishui Central Hospital were included in observation group, while another 100 patients with maintenance hemodialysis who did not have thrombosis in internal arteriovenous fistula were involved as control group .The related clinical and nursing data were collected , and the correlation between the thrombosis in internal arteriovenous fistula and related factors were analyzed to improve targeted nursing .Results Prevalence of diabetes , puncture failure rate , hematoma occurrence rate , high intensity in site-directed oppression , tightly binding after hemodialysis rate , oppression time longer than 30 min after hemodialysis rate, ultrafiltration rate, hemoglobin, high-sensitivity C-reactive protein, fasting blood glucose, total cholesterol, low density lipoprotein cholesterol , calcium-phosphorus product and D-dimer in observation group were higher than those in control group .The differences were statistically significant ( P<0.05 ) .There were statistically significant differences in the systolic pressure and low molecular weight heparin usage between two groups (P<0.05).The multi-factor logistic regression analysis showed that the diabetes[OR=1.417, 95%CI (1.196 -1.803), P =0.001], puncture failure[OR=1.393, 95%CI (1.185 -1.638), P =0.000], tightly binding after hemodialysis [OR=1.249, 95%CI (1.101-1.416), P=0.001], oppression time longer than 30 min after hemodialysis[OR=8.369, 95%CI (1.725 -40.596), P=0.008], systolic pressure[OR=1.031, 95%CI (1.001 -1.061), P =0.040], ultrafiltration rate[OR =1.490, 95%CI (1.146-1.937), P=0.003], high-sensitivity C-reactive protein[OR=1.594, 95%CI(1.085-2.342), P=0.017], low-density lipoprotein cholesterol [OR=9.456, 95%CI (2.534 -55.040), P=0.007] and D-dimer[OR=11.711, 95%CI (5.310-69.231), P=0.005] were independent risk factors for thrombosis in internal arteriovenous fistula in maintenance hemodialysis patients .Usage of low molecular weight heparin [ OR=0.101, 95%CI (0.017 -0.590), P=0.011] was protective factor.Conclusions Thrombosis in internal arteriovenous fistula in patients with maintenance hemodialysis is not only related to metabolic factors , but also related to nursing factors .We should strictly control the ultrafiltration rate , improve puncture success rate , strengthen the health education and nursing observation post operation so as to early spot and prevent the thrombosis in internal arteriovenous fistula .

Objective To investigate the effects of ω-3 polyunsaturated fatty acids (ω-3 PUFA) on inflammatory response of intestine and bacteria translocation in rats with traumatic shock (TS) in order to explore the underlying mechanism.Methods A total of 36 male Wistar rats provided by Academy of Military Medical Sciences Animal Center were assigned randomly (random number) into 3 groups (n =12 in each group):sham operation group,TS model group and PUFA pretreatment group.Rat models of IS were established by comminuted fracture of femur and depletion of blood,and 2 mg/kg ω-3 PUFA or normal saline were injected 12 hours and 2 hours before modeling.Blood specimens were collected and intestinal tissue samples were obtained 120 min after modeling.The serum levels of tumor necrosis factor-o (TNF-α),IL-1β,IL-10 and 8-iso-prostaglandin F 2α (8-iso-PGF2α) were measured with ELISA.Light microscopic examination was carried out for histopathological assessment of the intestina tissue and the intestinal mucosa damage index ( IMDI ) was calculated.The number of marked bacilli found in mesenteric lymph nodes,lung,liver,spleen,and kidney tissues were counted under a fluorescent microscope.The percentages for categorical variables and mean ± SD for continuous variables were expressed. Chi-square test and unpaired t-test were used for comparisons among groups,and statistical significance defined as P ＜ 0.05.Results The levels of TNF-α,IL-1β,IL-10 and 8-iso-PGF2α,the IMDI and the positive rates of bacteria translocation in TS model group were [ (325.14 ±21.17) ng/ml,(26.93 +2.58) μg/L,(7.59 ± 1.26) μg/L,(259.73 +61.32) pg/ml,(4.15 +0.37) and 58.33％,respectively] and those in PUFA group were [ (251.47 + 19.16) ng/ml,(17.81±1.94) μg/L,(9.44±1.85) μg/L,(171.44±39.25) pg/ml,(3.28±0.43) and 36.67％,respectively ].And those biomarkers in both TS group and PUFA group were higher obviously than those in sham group [ (37.02 ±5.54) ng/ml,(2.49 ±0.67) μg/L,(2.93 ±0.74) μg/L,(81.26 ± 15.18) pg/ml,(0.33 ±0.12) and 6.67％,respectively,P＜0.01].Compared with TS model group,the levels of TNF-α,IL-1β and 8-iso-PGF2α,the IMDI and the positive rates of bacteria translocation were lower,and the levels of IL-10 were higher in PUFA group ( P ＜ 0.01 or P ＜ 0.05 ).Conclusions The supplementation of ω-3 PUFA lessens the injury of intestina mucosa after traumatic shock,and it may be associated with the inhibition of inflammatory response by intestine and bacteria translocation.was carried out for histopathological assessment of the intestina tissue and the intestinal mucosa damage index ( IMDI ) was calculated.The number of marked bacilli found in mesenteric lymph nodes,lung,liver,spleen,and kidney tissues were counted under a fluorescent microscope.The percentages for categorical variables and mean ± SD for continuous variables were expressed. Chi-square test and unpaired t-test were used for comparisons among groups,and statistical significance defined as P ＜ 0.05.Results The levels of TNF-α,IL-1β,IL-10 and 8-iso-PGF2α,the IMDI and the positive rates of bacteria translocation in TS model group were [ (325.14 ±21.17) ng/ml,(26.93 +2.58) μg/L,(7.59 ± 1.26) μg/L,(259.73 +61.32) pg/ml,(4.15 +0.37) and 58.33％,respectively] and those in PUFA group were [ (251.47 + 19.16) ng/ml,(17.81±1.94) μg/L,(9.44±1.85) μg/L,(171.44±39.25) pg/ml,(3.28±0.43) and 36.67％,respectively ].And those biomarkers in both TS group and PUFA group were higher obviously than those in sham group [ (37.02 ±5.54) ng/ml,(2.49 ±0.67) μg/L,(2.93 ±0.74) μg/L,(81.26 ± 15.18) pg/ml,(0.33 ±0.12) and 6.67％,respectively,P＜0.01].Compared with TS model group,the levels of TNF-α,IL-1β and 8-iso-PGF2α,the IMDI and the positive rates of bacteria translocation were lower,and the levels of IL-10 were higher in PUFA group ( P ＜ 0.01 or P ＜ 0.05 ).Conclusions The supplementation of ω-3 PUFA lessens the injury of intestina mucosa after traumatic shock,and it may be associated with the inhibition of inflammatory response by intestine and bacteria translocation.

ObjectiveTo investigate the effects of ω-3 polyunsaturated fatty acid (PUFA) preconditioning on liver injury in a rat model of traumatic shock.MethodsForty-eight male Wistar rats aged 3 months weighing 240-260 g were randomly divided into 4 groups ( n =12 each): sham operation group (group S) ; group S + ω-3 PUFA; traumatic shock group (group TS) and group TS + ω-3 PUFA.In groups S + ω-3 PUFA and group TS + ω-3 PUFA,ω-3 PUFA 2 ml/kg was injected via the caudal vein at 12 and 2 h before induction of traumatic shock.In groups S and TS,normal saline was given instead of ω-3 PUFA.Traumatic shock was induced by fracture of femur and hemorrhage in groups TS and TS + ω-3 PUFA.The arterial blood samples were taken at 2 h after induction of traumatic shock for determination of serum activities of ALT,AST and concentrations of 8-iso-prostagiandin F2,(8-iso-PGF2α) and TNF-α.The liver was removed for determination of levels of SOD and MDA,glutathione (GSH)and microscopic examination.ResultsCompared with group S,the serum ALT,AST,8-iso-PGF2α and TNF-α levels and MDA content in the liver tissues and score of liver injury were significantly increased,but the liver tissues levels of SOD,GSH were decreased in groups TS and TS + ω-3 PUFA( P ＜ 0.01 ).Compared with group TS,the serum ALT,AST,8-iso-PGF2α and TNF-α levels and MDA content in the liver tissues and score of liver injury were significantly decreased,but SOD activity and GSH content in the liver tissues were increased in group TS + ω-3 PUFA( P ＜ 0.05 or 0.01 ).Conclusionω-3 PUFA preconditioning can reduced liver injury in a rat model of traumatic shock through inhibiting lipid peroxidation and inflammatory reaction.

Objective To investigate the effects of ω-3 polyunsaturated fatty acid (ω-3 PUFA) on acute lung injury (ALI) in a rat model of traumatic shock. Methods Thirty-six male Wistar rats aged 3 months were randomly assigned into 3 groups ( n = 12 each): control group (group C) ; traumatic shock group (group TS) and ω-3 PUFA + TS group (group to-3 PUFA) . Traumatic shock was induced by fracture of femur and hemorrhage according to the method described by Feeney in groups TS and ω-3 PUFA. In group ω-3 PUFA, ω-3 PUFA 2 ml/kg was injected via the caudal vein at 12 and 2 h before induction of traumatic shock. Arterial blood samples were taken at 120 min after traumatic shock was successfully induced for determination of serum concentrations of TNF-α, IL-1β, IL-10 and 8-iso-PGF2α by ELISA. The animals were then sacrificed and lungs were removed for-determination of W/D lung weight ratio and microscopic examination. Results Traumatic shock significantly increased serum concentrations of TNF-α, IL-1β, IL-10 and 8-iso-PGF2α, W/D ratio and pathologic scores of lung tissues in groups TS and ω-3 PUFA as compared with group C.ω-3 PUFA significantly attenuated traumatic shuck-induced increase in serum concentrations of TNF-α, IL-1β and 8-iso-PGF2α , W/D ratio and pathologic scores of lung tissues but further increased the serum IL-10 concentration in group ω-3 PUFA as compared with group TS. Conclusion ω-3 PUFA can significantly inhibit the svstemic inflammatory response and ameliorate traumatic shock-induced ALI.

Objective To evaluate the neurotoxic effects of intrathecal (IT) different concentrations of ethanesulfonic acid ropivacaine on spinal cord in rats. Methods Sixty healthy Wistar rats of both sexes weighing 210-220 g in which IT catheters were successfully placed according to Yaksh et al. were randomly divided into 5 groups (n= 12 each). The animals received 0.9% NaCl solution 0.4 ml (group C); 0.224%, 0.447%,0.671%, 0.894% ethanesulfonic acid ropivacaine 0.4 ml (group R1-4 ). The onset time and duration of the block were recorded. The animals were killed on 7th day after IT administration. The L4,5 segment of the spinal cord were removed for neuropathologic examination with electron microscope. The spinal cord injury was scored.Neurotoxicity was defined as the spinal cord injury score ≥ 2 and the spinal neurotoxicity was recorded. Results Onset time was shorter and duration of the block was prolonged with increasing concentrations of ethanesulfonic acid ropivacaine. The incidence of the spinal neurotoxicity was 0, 0, 17%, 42% and 100% in group C, R1, R2, R3 and R4 respectively. The incidence of the spinal neurotoxicity was gradually increased with increasing concentrations of ethanesulfonic acid ropivacaine. Conclusion IT ethanesulfonic acid ropivacaine can produce neurotoxicity to the spinal cord and it depends on the concentration.

BACKGROUND: About one fourth of diabetic patients suffer from diabetic retinopathy(DR) and has greatly impacted their quality of life due to the decreased vision. Social support plays important role on rehabilitation of patients.OBJECTIVE: To analyze the relationship between social support and quality of life(QOL) in patients with diabetic retinopathy in order to direct clinical practice and improve the patients' QOL.DESIGN: Cross-sectional study based on patients with diabetic retinopathy.SETTING: Department of Ophthalmology, General Hospital of Nanjing Military Area Command of Chinese PLA.PARTICIPANTS: Totally 81 patients admitted into Department of Ophthalmology, General Hospital of Nanjing Military Area Command of Chinese PLA with diabetic retinopathy during January 2002 to May 2003 were selected. Inclusion criteria: suffer from diabetic retinopathy and willing to attend this study. Exclusion criteria: people with other complications (hypertension, kidney disease) . The patients were divided into two groups according to vision: 28 cases in the group with binocular vision between 0.06 -0. 1; 53 cases in the group with vision less than 0. 05.METHODS: Investigation was conducted to the two groups from three dimensions including objective support, subjective support and usage in order to assess the social support to patients with diabetic retinopathy of different vision. And modified quality of life index (MQLI) was used to assess the QOL in patients with diabetic retinopathy that covered 5 dimensions: somatic health, mental health, social function, self-image and material base.MAIN OUTCOME MEASURES: The total score of social support and QOL of patients with diabetic retinopathy, score of somatic health, mental health,social functions and material base as well as the correlations among them.RESULTS: The total score of social support, score of objective support factor, subjective support factor and usage factor in roup with vision between 0.06 and 0. 1 were much higher than those in group with vision less than 0.05 ( P < 0.01 ). For patients with diabetic retinopathy, the social support had strong correlation with total score of QOL and factor score of other dimensions except of self-image( P < 0.05 or P < 0.01).CONCLUSION: Social support is an important factor that impacts QOL to patients with diabetic retinopathy. It will improve their QOL by reinforcing the social support.