In-patient service is a crucial link in the whole medical chain,how to construct an economical and efficient inpatient service model,so as to let patients spend the least amount of money,get the best quality medical service,and effectively improve their sense of well-being and sense of acquisition is a social problem that needs to be solved urgently.From the perspective of economics and combined with practical experience,a new inpatient service model(pre-hospitalization and pre-discharge model)is constructed,which is an upgrading and transformation of the original model on the basis of the existing business system,simplifies the existing service process of hospitalization and discharge,effectively reduces the average hospitalization day and the subperiod average hospitalization cost,and significantly improves the evaluation indexes of inpatient service compared with the traditional inpatient service model.

Objective To compare the clinical value of chest CT and Magnetic Resonance Imaging (MRI) in the diagnosis of lymph node metastasis of thoracic esophageal cancer. Methods A retrospective analysis of 90 patients with thoracic esophageal cancer lymph node metastasis diagnosed and treated in our hospital from July 2015 to June 2019. All patients underwent chest CT and MRI scans after admission, and the lesion tissue samples were taken for pathological examination after surgery. Physical examination, with pathological diagnosis results as the gold standard, analyze the sensitivity and specificity of chest CT and MRI. Results The sensitivity, specificity, positive predictive value, and negative predictive value of MRI scan was 88.73%, 94.74%, 98.44%, and 69.23%, respectively, which were higher than 69.01%, 52.63%, 84.48%, and 31.25% of the chest CT scan. In the distribution of lymph node metastasis, the middle of the thorax was the largest, and the proportions of the upper, middle, and lower thoraxes were 26.67%, 60.00%, and 13.33%, respectively. The uppermost mediastinal and paratracheal lymph nodes had the largest metastases in the upper thorax, the paratracheal and subcarinal lymph nodes in the middle thoracic segment had the most metastasis, and the next to the cardia and left gastric artery lymph nodes in the lower thorax had the largest metastases. The accuracy of MRI diagnosis is higher than that of chest CT. Conclusion Both chest CT and MRI can diagnose lymph node metastasis of thoracic esophageal cancer. The diagnostic value of MRI in diagnosing lymph node metastasis of thoracic esophageal cancer is better than chest CT. The diagnostic accuracy of MRI in each part of the lymph node is higher than that of chest CT, which can show the lymph nodes more clearly in transfer situation.

Cerebral ischemia,brain tumor,and spinal cord injury (SCI) are the central nerve disease which usually cause irreversible,severe neurologic deficits or death.Inflammation plays a key role in the associated secondary damage after central nervous system (CNS) injury.Epidermal growth factor receptor (EGFR) excessive activation has been closely implicated in the initiation and progression of inflammation.Previous studies have shown that through depressing CNS inflammation,EGFR inhibitors may play a role in the therapeutic treatment of CNS disorders.We mainly reviewed the mechanisms of EGFR signaling pathway activation mediating inflammatory damage in CNS.

Objective We tried to explore nursing postgraduates' expectations of clinical practice,and build a set of practicable clinical practice program which contributed to cultivate comprehensive ability of nursing postgraduate.Methods Using judgment sampling and snowball sampling,the questionnaire survey was conducted among 111 nursing postgraduates,and expectations of clinical practice of postgraduates with dif-ferent ages and different work experiences were compared.Results Most nursing postgraduates hold that the clinical practice was necessary.Nursing postgraduates with different ages and work experiences had different expectations of chnical practice,and the differences were statistically significant,x2 value was 11.594 and 4.416,P ＜ 0.05.Nursing postgraduate with different working experience showed statistical difference in clinical expectation of total practice time,x2=1 1.290,P ＜ 0.05.Conclusions Nursing post-graduates with different ages and work experiences have different expectations of clinical practice.Colleges should build a set of reasonable clinical practice program,based on training objectives,research direction,practice expectations of nursing postgraduates.

Objective To analyze satisfaction of the clinical practice content of nursing postgraduates with different characteristic, and to provide transformative suggestions for the construction of clinical practice scheme of nursing postgraduates. Methods Using judgment sampling and snowball sampling, the questionnaire survey was conducted among 101 nursing postgraduates, and comparing satisfaction of clinical practice content of postgraduates with different age, work experience and teaching mode. SPSS 17.0 software package was used for data description and t test. Results The total satisfaction of clinical practice content of nursing postgraduates was low, and different postgraduates′satisfaction was different. On practical operation opportunity,> 30 years old of postgraduates′satisfaction was (3.95±0.87), which was higher than those 20~30 years old, (3.35±0.90), and the difference was statistically significant, t=2.748, P<0.01. On clinical practice assessment methods and frequency, the satisfaction of postgraduates with a fixed teacher was higher than those without a fixed teacher (3.40±0.74) vs. (2.83±0.87), and the difference was statistically significant, t=3.310, P<0.01. Conclusions At present, the clinical practice content of nursing postgraduates is in shortage, and need to be further improved.

Objective To explore the changes of serum lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) and the level of lipids in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods A total of 94 candidates with sleep disorders between January-July 2011 at outpatient department were monitored with polysomnography.According to apnea-hypopnea index (AHI),they were divided into mild-to-moderate OSAHS (5 ≤ AHI ≤ 30) (n =27),severe OSAHS (AHI ＞ 30) (n =37) and normal control groups (AHI ＜ 5) (n =30).After polysomnography,their blood samples were obtained to measure the levels of serum LOX-1,triglycerides (TG),cholesterol (TC),high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C).Results The serum level of LOX-1 in severe OSAHS group was significantly higher than that in the mild-to-moderate and control groups (P ＜ 0.01).The serum level of LOX-1 in OSAHS patients was positively correlated with AHI and longest apnea time (LAT)(r =0.645 & 0.501 respectively,both P ＜ 0.01) and was negatively correlated with SaO2 (r =-0.647,P ＜0.01).No significant difference existed in serum lipids in all groups (P ＞ 0.05).Conclusions Intermittent hypoxia caused by OSAHS increases the level of LOX-1 to further promote the formation and development of atherosclerotic in patients with OSAHS.The levels of lipid can not effectively predict the severity of lipid metabolism disorder in patients with OSAHS.

Objective To evaluate the cognitive function of chronic obstructive pulmonary disease (COPD) stable patients with ExtendedScale for Dementia (ESD). Methods 37 patients with stable COPD (COPD group) and 40 healthy persons (control group) were enrolled.The COPD patients were divided into different groups as their PaO2. They were assessed with ESD and Mini Mental Status Examination(MMSE). Results The total score of ESD and the subtest scores of ESD in leaning, memory, calculation, constructive function were significantlylower in the COPD group than in the control group (P<0.001). The total score of MMSE and the subtest scores of MMSE in memory,attention and calculation, short- and long-term memory were significantly lower in the COPD group than in the control group (P<0.05). Thetotal score and the subtest scores in learning, memory, calculation of ESD were lower in patients with PaO2<60 mmHg than those withPaO2≥60 mmHg (P<0.05), same as the total score and the subtest scores in memory, attention and calculation, short- and long-term memoryof MMSE (P<0.05). Both ESD and MMSE correlated significantly with PaO2 (P<0.01). Conclusion ESD can be used as an evaluationtool for cognitive function in stable patients with chronic obstructive pulmonary disease.

Objective The aim of this study is to evaluate clinical application of BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index in patients with chronic obstructive pulmonary disease (COPD). Methods Forty patients with stable COPD in Xuanwu Hospital of Beijing during September 2003 to December 2007, were recruited in the study, including 25 men and 15 women, aged 38 to 85 years (with a mean of 62 ± 13 years). BODE index was measured for each patient, one year and three years after recruitment, respectively. Severity of COPD, including number and duration of episodes, length of each hospital stay and times of hospitalization due to acute exacerbation of COPD (AECOPD), were recorded. All data were statistically analyzed with SPSS 13.0 software for windows. Results ①There was a remarkable difference in COPD severity between patients with BODE score equal to or greater than five and these with less than five (P <0.01 ). ①BODE score inversely correlated with forced expired volume at the first second ( FEV1 ) in COPD patients (P < 0.01 for those with BODE score equal to or greater than five and P <0.05 for these with BODE score less than five, respectively). ③BODE score positively correlated with number and duration of acute exacerbation, length of hospital stay and times of hospitalization due to AECOPD (P <0. 01 for those with BODE score equal to or greater than five and P < 0. 05 for those with BODE score less than five, respectively). For patients with COPD, their BODE score in the first year positively correlated with that in the third year ( r = 0.834, P < 0.01 ). Conclusions BODE index is a better indicator to evaluate their condition severity in patients with COPD.

Objective To investigate the evaluation of cardiopulmonary exercise test (CPET) in the patients with chronic obstructive pulmonary disease (COPD), and the relationship with the pulmonary function test (PFT). Methods 26 COPD patients and 30 normal controls were examined with CPET and PFT. Results The parameters of CPET, including maximum oxygen uptake (VO2max), anaerobic threshold (AT), maximum minute ventilation (VEmax) and breathing reserve (BR) were lower in COPD group than those in control group (P<0.05). There were no significant differences in Wmax, oxygen pulse (O2pulse) between two groups (P>0.05). VO2max, AT, VEmax and BR were positively correlated with forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) in COPD group （P<0.05）, but were not correlated with forced vital capacity (FVC) and FEV1/FVC (P>0.05).Conclusion The pulmonary function of COPD patients can be evaluated with CPET, especially VO2max, AT, VEmax and BR.

Objective To discuss the influence of the smooth of bile duct examined by choledochoscope during the coInnlon bile duct exploration on the biliary tract theology.Methods Forty patients who were to undergo common bile duct exploration were divided into the control group and the test group with 20 eases in each group.The smooth of the distal common bile duct was examined by choledochoscope in the test group while by routine method in the control group.The T tube drainage volume for 24 h,the pressure,flow volume and resistance of common bile duct and amylase content of drainage were monitored in the two groups within 72 h.Results The T tube drainage volume of the second day increased.the pressure and the resistance of the common bile duct decreased,the flow volunle and amylase content of drainage reduced in the control group,which had statistical difference from those of the test group(P＜0.05).Condusion Avoidance of damaging examination of the distal common bile duct,monitoring of the pressure;flow volume and resistance of the common bile duct within 72 h after operation contributed to the confirmation of the time for clamping T tube early.