OBJECTIVES: To explore the value of serum cystatin C (CysC) levels in evaluating renal prognosis in IgA nephropathy (IgAN) patients. METHODS: We retrospectively collected the clinical data of IgAN patients diagnosed by renal biopsy at Guangdong Provincial People's Hospital from January, 2014 to December, 2018. Based on baseline serum CysC levels, the patients were divided into high serum CysC (>1.03 mg/L) group and normal serum CysC (≤1.03 mg/L) group. The composite endpoint for poor renal prognosis was defined as ≥50% decline in estimated glomerular filtration rate (eGFR) and/or progression to end-stage renal disease (ESRD). Lasso regression, multivariate Cox regression and Kaplan-Meier survival analysis were used to identify the risk factors and compare renal survival rates between the two groups. Smooth curves fitting and threshold effect analysis were used to explore the relationship between serum CysC levels and the outcomes. A nomogram model was constructed and its predictive performance was evaluated using concordance index, calibration curve, receiver operating characteristic (ROC) curve and the area under curve (AUC). RESULTS: A total of 356 IgAN patients were enrolled, who were followed up for 4.65±0.93 years. The composite endpoint occurred in 74 patients. High serum CysC was identified as an independent risk factor for poor renal prognosis in IgAN (HR=2.142, 95% CI 1.222 to 3.755), and the patients with high serum CysC levels had a lower renal survival rate (Log-rank χ²=47.970, P<0.001). In patients with serum CysC below 2.12 mg/L, a higher CysC level was associated with an increased risk of poor renal prognosis (β=3.487, 95% CI: 2.561-4.413, P<0.001), while above this level, the increase of the risk was not significant (β=0.676, 95% CI: -0.642-1.995, P=0.315). The nomogram model based on serum CysC and 3 other independent risk factors demonstrated good internal validity with a concordance index of 0.873 (95% CI: 0.839-0.907) and an AUC of 0.909 (95% CI: 0.873-0.945). CONCLUSIONS Serum CysC levels are associated with renal prognosis in IgAN patients, and high serum CysC an independent risk factor for poor renal prognosis.
Humans ; Glomerulonephritis, IGA/diagnosis* ; Cystatin C/blood* ; Prognosis ; Risk Factors ; Retrospective Studies ; Glomerular Filtration Rate ; Kidney Failure, Chronic ; Male ; Female ; Adult ; Nomograms ; Middle Aged

Objective:To construct a competency evaluation indicator system for infection prevention and control nurses in Operating Rooms (hereinafter referred to as "IPC") and provide an objective basis for the management of IPC nurses.Methods:From June to November 2022, an initial competency evaluation indicator system for IPC nurses was developed through literature review and semi-structured interviews. The Delphi method was employed to consult 20 experts from 11 provinces and municipalities across the country. Analytical Hierarchy Process (AHP) and mean distribution method were applied to quantify and determine the weight of each level of indicators within the system.Results:Nineteen experts were finally included, with two rounds of questionnaire recovery rates of 95.00% (19/20) and 100.00% (19/19), respectively. The authority coefficients of the experts were 0.858 and 0.861, familiarity coefficients were 0.850 and 0.853, and coefficients of judgment basis were 0.865 and 0.868, respectively. The Kendall's W coefficient of concordance for the two rounds of inquiries were 0.139 and 0.202 ( P<0.05), respectively. The final IPC nurse competency evaluation indicator system included six primary indicators, 22 secondary indicators, and 66 tertiary indicators. Conclusions:The constructed IPC nurse competency evaluation indicator system is scientific, reasonable, objective, and comprehensive, providing a valuable reference for the capability training, assessment, entry standards, and qualification certification of IPC nurses.

Objective:To explore the management effect of information nurses in the reception of new surgical instruments and to provide a reference for improving the quality of instrument management in central sterile supply department.Methods:This was a quasi-experimental study. A total of 45 packages of 227 pieces received from January to July 2021 in central sterile supply department of the First Affiliated Hospital of Zhengzhou University were selected as the control group by convenience sampling method, and the conventional mode was used to receive new surgical instruments. Another 51 packages of 259 pieces received from November 2021 to June 2022 were selected as the observation group, and the information nurse management system was set up to receive new surgical instruments. The observation and comparison of the time to complete the receipt of new surgical instruments in central sterile supply department, the incidence of adverse events in the operation process and the satisfaction of medical and nursing staff with the management of new surgical instruments were conducted.Results:The receiving time for newly added surgical instruments of the observation group was 6.00(5.00, 8.00) hours and that of the control group was 28.00(20.00, 42.50) hours, with a statistically significant difference between the two groups ( Z = - 8.26, P<0.01). The incidence of adverse events of new surgical instruments was 0.4%(1/259) in the observation group and 6.2%(14/227) in the control group, there was significant difference between the two groups ( χ2 = 13.52, P<0.01). The satisfaction degree of medical staff in the observation group was 100% (50/50), higher than 72% (36/50) in the control group, and the difference between the two groups was statistically significant ( χ2 = 16.28, P<0.01). Conclusions:The implementation of the post of information nurse in the special post responsibility system in the management of new surgical instruments can effectively manage the specifications of surgical instruments, reduce the receiving time and the occurrence of adverse events, improve the satisfaction of medical staff.

Objective:To explore the effects of informatization traceability management combined with performance assessment in the nursing management of Disinfection Supply Center.Methods:In March 2021, the Disinfection Supply Center of the First Affiliated Hospital of Zhengzhou University implemented the informatization traceability management combined with performance assessment. Convenient sampling method was used to select 172 medical devices disinfected and sterilized by the Disinfection Supply Center before implementation (from March 2020 to February 2021) and 166 medical devices disinfected and sterilized by the Disinfection Supply Center after implementation (from March 2021 to February 2022) for statistical analysis. We compared the cleaning qualified rate, sterilization qualified rate, packaging qualified rate, distribution qualified rate, management effects, adverse event rate of device management, and performance assessment results before and after the implementation of the informatization traceability management combined with performance assessment.Results:The cleaning qualified rate, packaging qualified rate and distribution qualified rate after implementation were higher than those before implementation, and the differences were statistically significant ( P<0.05) . The recovery and classification time, device information registration time, ex-warehouse inspection time and manual operation time after implementation were shorter than those before implementation, and the differences were statistically significant ( P<0.05) . The device damage rate, label error rate and device loss rate after implementation were lower than those before implementation with statistical differences ( P<0.05) . The scores of theoretical assessment and operational skill assessment after implementation were higher than those before implementation with statistical differences ( P<0.05) . Conclusions:The combination of informatization traceability management and performance assessment can improve the nursing management effects of the Disinfection Supply Center, significantly increase the qualified rate of cleaning, packaging and distribution, and boost the performance assessment results of nurses, which helps to reduce the incidence of adverse events in device management.

[Abstract] Objective: To investigate the short-term clinical efficacy and safety of intraperitoneal perfusion of natural killer (NK) cells in the treatment of ovarian cancer with ascites. Methods: The clinical data of 15 ovarian cancer patients with ascites effusion, who received NK cell perfusion in the Qinhuai Medical District of the General Hospital of Eastern Theater Command from November 2016 to January 2019, were analyzed. The peripheral blood was collected to isolate the peripheral blood mononuclear cells, and to further obtain the NK cells after culture. NK cell suspension was intraperitoneally perfused into the abdominal cavity (no less than 2×109 cells/ time). The volume of peritoneal effusion, the level of serum tumor marker CA-125, the level of serum cytokines IL-2, INF-γ and TNF-α as well as the changes in peripheral blood lymphocyte subsets were detected before and after the treatment; Moreover, the clinical efficacy and adverse reactions were observed. Results: The effective rate of intraperitoneal perfusion of NK cells was 66.7%, and there were no obvious treatment-related adverse reactions. Compared with before treatment, the serum tumor marker CA-125 level significantly decreased after treatment (P<0.05), and the levels of IL-15, IFN-γ and TNF-α increased significantly (P<0.05 or P<0.01), while there was no significant changes in peripheral blood lymphocyte subsets (all P>0.05). Conclusion: Intraperitoneal infusion of NK cells in the treatment of ovarian cancer associated peritoneal effusion has a good short-term clinical efficacy with little adverse reactions, which is a promising method for the treatment of cancerous peritoneal effusion.

Objective:To explore the effects of cluster intervention guided by key points of control on cleaning quality of reused surgical instruments, and provide new clinical ideas for improving the cleaning quality of reused surgical instruments.Methods:The surgical instruments used and sent to the Central Sterile Supply Department (CSSD) at the First Affiliated Hospital of Zhengzhou University were selected. The 224 samples handled according to traditional device processing procedures (between January and May 2019) were included into the control group, while 224 samples handled with cluster intervention guided by key points of control (from June to October 2019) were included into the observation group. The cleaning quality of surgical instruments was compared between the two groups.Results:The cleaning qualification rate of reused surgical instruments was affected by multiple factors such as hospital level, management model, staffing, supervision and management, equipment, methods, and cleaning time. The cleaning qualification rate of the observation group was 98.21% (220/224) , which was higher than 91.52% (205/224) of the control group, and the difference was statistically significant ( P<0.05) . Conclusions:The cluster intervention strategy guided by key points of control can effectively improve the cleaning quality of reused surgical instruments.

Objective:To explore the application effect of the new cleaning and drying integrated device (referred to as the new device) of hard endoscope in disinfection and supply center in improving the working efficiency of nurses′ endoscopic instruments.Methods:From August 1 to 30, 2018, the first 24 sets (192 pieces) of surgical instruments for general external endoscopy recovered to the disinfection and supply center every day were used as the control group, and the hard endoscope special cleaning rack (referred to as special cleaning rack) was used for cleaning, and the pressure air gun was used for drying. From September 1 to 30, 2018, the same number, category and recovery time of devices were used as the experimental group, and new devices were used for cleaning and drying. Before using the special cleaning rack, the two groups were cleaned by hand and ultrasonic cleaning machine. The time efficiency and the qualified rate of cleaning and drying were compared between the two groups.Results:In the total time of daily cleaning, the efficiency of (408.10 ± 3.49) min in the experimental group was higher than that of (701.03 ± 2.62) min in the control group ( t value was 2.36, P < 0.01). In the control group, 95.56% of them were qualified for cleaning by Adenosine Triphosphate (ATP), 95.47% for crepe paper test, 93.89% for mirror test, 97.36% for ATP Test, 95.92% for crepe paper test and 94.61% for mirror test. There was no significant difference between the two groups ( P > 0.05). Conclusion:The new device not only ensures the cleaning and drying quality of the endoscopic instruments, but also improves the working efficiency and meets the supply demand of the instruments in the operating room.

The outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 has rapidly spread globally. Cancer patients are at a higher risk of being infected with the coronavirus and are more likely to develop severe complications, as compared to the general population. The increasing spread of COVID-19 presents challenges for the clinical care of patients with gynecological malignancies. Concerted efforts should be put into managing gynecological malignancies in an orderly manner by strictly implementing the measures that are specifically developed for controlling the spread of COVID-19. We have drafted Recommendations on Management of Gynecological Malignancies during the COVID-19 Pandemic based on our experience on controlling COVID-19 pandemic in China. We recommend that patients with gynecological malignancies should be managed in hierarchical and individualized manners in combination with local conditions related to COVID-19. Medical care decision should be balanced between controlling COVID-19 pandemic spread and timely diagnosis and treatment for gynecologic oncology patients.

Objective: To study the local morphology of post-infarction ventricular septal rupture (PI-VSR) and the left ventricular function before and after operation and to evaluate the relevant risk factors of death in patients with PI-VSR by using left ventricular opacification (LVO) combined with real-time three-dimensional echocardiography (RT-3DE). Methods: Twenty-eight patients with PI-VSR and 19 patients undergoing surgical treatment were selected. The consistency of two-dimensional ultrasound, RT-3DE and the detection of LVO on the maximum diameter, location, number and shape of ventricular septal rupture (VSR) with the surgical results were compared. Through LVO combined with RT-3DE, the changes of left ventricular function indexes before and after surgery were compared. According to the general data and clinical data of patients, independent risk factors affecting survival and prognosis were explored. Results: ①There was no significant difference between LVO and RT-3DE in detecting VSR maximum diameter and surgical results (all P>0.05). The location, number and shape of VSR detected by LVO were consistent with the surgical results (all P<0.05). RT-3DE had good consistency in detecting VSR location, shape and surgical results (all P<0.05). Among them, of LVO′s detection of VSR location and shape and the Kappa values of consistence of the intraoperative results were 0.650 and 0.883 respectively. LVO had a sensitivity of 0.923, specificity of 1.000, accuracy of 0.947, positive predictive value of 1.000 and negative predictive value of 0.857 in observing VSR shape. ②LVO combined with RT-3DE was used to evaluate the left ventricular function of postoperative patients. The parameters of left ventricular function improved significantly(all P<0.05). ③The independent risk factors affecting the 30 d survival rate included: gender, Killips pump function classification, and whether or not surgery was performed. Conclusions LVO and RT-3DE can provide more accurate anatomical information such as VSR maximum diameter, location, number and shape, which provides the basis for the selection of treatment strategy. LVO combined with RT-3DE can evaluate the changes of left ventricular function before and after surgery, which can provide reference for clinical evaluation of prognosis.

Objective: To investigate the effect of preoperative play intervention during anesthesia induction in children. Methods: Totally 120 children who met the inclusion criteria undergoing elective surgery divided into control group (n=60) and study group (n=60) by random number table. The study group admitted to the anesthesia induction room, and performed therapeutic play nursing intervention on the children for 60 minutes before the operation. The children in the control group were admitted to the general preoperative waiting room for 60 minutes before the operation, and they were subjected to routine nursing intervention. The children′s anxiety was assessed using modified Yale Perioperative Anxiety Scale (mYPAS) when the children entered the operating room before the intervention and during anesthesia induction; the children′s compliance with anesthesia induction was assessed using the Induction Compliance Checklist (ICC) . Pediatric Anesthesia Emergence Delirium Scale (PAED) score was used to observe emergence agitation. The vital signs of the two groups were observed before and after intervention. Results: There was no significant difference in the mYPAS score between the study group (32.23±4.71) points and the control group (31.58±3.72) points (P>0.05). The mYPAS score (31.92±4.03) points was lower in the study group than in the control group (59.76±5.14) points (t=-33.016, P<0.01). The ICC score of the study group (1.55±0.76) points was lower than the control group (3.04±0.62) points. The PAED score of the study group (4.76±0.92) points was lower than the control group (7.52±1.36) points (t=11.767, -13.020, P<0.05). The systolic blood pressure (96.25±3.06) mmHg (1 mmHg=0.133 kPa), diastolic blood pressure (59.39±2.77) mmHg, heart rate (118.37±15.26) times/min, and respiratory (29.75±3.17) times/min in the study group were lower than the control group (103.46±3.21) mmHg, (62.72±2.94) mmHg, (124.58±16.41) times/min, (34.81±2.96) times/min (t=12.593, 6.385, 2.146, 9.037, P<0.05) . Conclusion Preoperative play intervention for children before anesthesia induction can reduce the anxiety and fear level of children, and the children′s compliance of anesthesia is improved, and reduce the incidence of agitation during recovery.