Objective:Based on the clinical indicators of severe community-acquired pneumonia in emergency department, the early warning indicators of critical condition were constructed.Methods:The general information, vital signs before entering ICU, laboratory indexes and the survival rate in 30 days of 118 patients with community-acquired pneumonia were retrospectively collected in the emergency care unit of Peking Union Medical College Hospital from January to December 2018. The indexes of death patients (24 cases) and alive patients (98 cases) underwent comparative analysis, using ROC curve to predict the clinical outcome and reliable parameters of emergency patients with community-acquired pneumonia. The best cutoff value was determined according to Youden index and then undergoing multiple factors Logistic stepwise regression analysis. Then early warning model of critical degree was finally built.Results:Eleven indicators were used to predict the criticality of patients with acute community-acquired pneumonia, including AVPU (alert, voice, pain, unresponsive) score, Glasgow Coma Scale(GCS), heart rate, pulse oxygen saturation (SpO 2), fraction of inspiration O 2, oxygenation index,potential of hydrogen, blood potassium (K +), bilirubin, urea nitrogen, and C reactive protein, the optimal cutoff values were 2 points, 8 points, 91 times per minute, 0.94, 41%, 81.20%, 7.38, 4.0 mmol/L, 10.90 μmol/L, 2.23 mmol/L, and 41.5 mg/L. Multiple Logistic stepwise regression showed that the independent factors for predicting death were GCS score, SpO 2 and urea nitrogen, and the predictive ability of the early-warning model was 83.7%. Conclusions:GCS score, SpO 2 and urea nitrogen are effective early warning indicators for the severity of severe community-acquired pneumonia in emergency department, which are conducive to the rapid and efficient early identification and treatment of critically ill patients. Therefore, they are worthy of promotion and application in clinical practice.

Objective:To analyze the application effect of cluster management measures in improving the quality of emergency medical treatment.Methods:By analyzing the problems existing in the work of emergency department, the cluster management scheme was formulated and the intervention measures were implemented from the aspects of intelligent information system, patient management system and medical service process. The accuracy and efficiency of emergency triage, the satisfaction of patients and medical staff, the incidence of medical complaints and disputes and the rate of sudden death were compared before and after cluster management.Results:Before and after the implementation of cluster management, the accuracy of triage classification was 95.0% and 98.7% respectively, and the triage time was (68.3±12.8) s and (50.5±7.2) s respectively( P<0.001). The satisfaction of patients, doctors and nurses increased, the number of complaints decreased from 15 to 5 in half a year, and the number of sudden death decreased from 39 to 23 with a significant difference( P<0.05). Conclusions:The application of cluster management measures in emergency management can improve the medical quality, the satisfaction of medical staff and patients, and ensure the safety of patients.

Objective:To analyze the correlation and predictive value between early BIS monitoring combined with lactic acid resolution (LCR) and delayed encephalopathy with acute severe carbon monoxide poisoning (ASCMP) .Methods:Select 96 cases of our hospital ASCMP patients were analyzed retrospectively in March 2020, and follow-up of 60 days, according to the outcome in patients with acute carbon monoxide poisoning (DEACMP) delayed encephalopathy group with good prognosis, compare two groups of general information, admission BIS average 24 h and 24 h after treatment the LCR, According to the 24h LCR test results, patients were divided into high LCR group (LCR>15%) and low LCR group (LCR≤15%) , analysis the BIS average, the correlation of the LCR with DEACMP and both individual and joint of DEACMP predictive value, Comparing clinical data of patients with high LCR and low LCR.Results:The mean BIS value of the DEACMP group 24 hours after admission was significantly lower than that of the group with good prognosis ( P< 0.05) . LCR of DEACMP group was significantly lower than that of the group with good prognosis after 24 h treatment ( P<0.05) . The prevalence of DEACMP in patients with high LCR was significantly lower than that with low LCR ( P<0.01) ; In the early stage, BIS mean, LCR and DEACMP were negatively correlated ( P< 0.05) , and the area under the curve predicted by BIS mean, LCR and their combination on DEACMP was 0.799, 0.847 and 0.902, respectively. Conclusion:Early BIS monitoring combined with LCR has a significant correlation with DEACMP, and the combined effect of the two is better. Early BIS combined with LCR detection can provide effective guidance for the prognosis assessment of ASCMP patients.

Objective:To analyze the correlation and predictive value between early BIS monitoring combined with lactic acid resolution (LCR) and delayed encephalopathy with acute severe carbon monoxide poisoning (ASCMP) .Methods:Select 96 cases of our hospital ASCMP patients were analyzed retrospectively in March 2020, and follow-up of 60 days, according to the outcome in patients with acute carbon monoxide poisoning (DEACMP) delayed encephalopathy group with good prognosis, compare two groups of general information, admission BIS average 24 h and 24 h after treatment the LCR, According to the 24h LCR test results, patients were divided into high LCR group (LCR>15%) and low LCR group (LCR≤15%) , analysis the BIS average, the correlation of the LCR with DEACMP and both individual and joint of DEACMP predictive value, Comparing clinical data of patients with high LCR and low LCR.Results:The mean BIS value of the DEACMP group 24 hours after admission was significantly lower than that of the group with good prognosis ( P< 0.05) . LCR of DEACMP group was significantly lower than that of the group with good prognosis after 24 h treatment ( P<0.05) . The prevalence of DEACMP in patients with high LCR was significantly lower than that with low LCR ( P<0.01) ; In the early stage, BIS mean, LCR and DEACMP were negatively correlated ( P< 0.05) , and the area under the curve predicted by BIS mean, LCR and their combination on DEACMP was 0.799, 0.847 and 0.902, respectively. Conclusion:Early BIS monitoring combined with LCR has a significant correlation with DEACMP, and the combined effect of the two is better. Early BIS combined with LCR detection can provide effective guidance for the prognosis assessment of ASCMP patients.

Objective To analyze set-up errors for irradiation of nasopharyngeal carcinoma by using kilo-voltage cone beam computed tomography (kV-KBCT) scanning, and to calculate the external margin from planning target volume (PTV) of nasopharyngeal carcinoma. Methods A total of 150 nasopharyngeal carcinoma patients in Meizhou People's Hospital from December 2014 to November 2016 were treated by image-guided radiation therapy (IGRT), kV-KBCT, CT image scanning matcthed by bone and grey alignment. PTV of nasopharyngeal carcinoma was also calculated. Results According to PTV formula, the external distance before radiotherapy guided by grey alignment was 0.5 mm in X-axis, 0.4 mm in Y-axis, 0.8 mm in Z-axis. While the distance was 0.1 mm in X-axis, 0.5 mm in Y-axis, 1.7 mm in Z-axis guided by bone alignment. After radiotherapy, the external distance guided by grey alignment was 0.4 mm in X-axis, 0.5 mm in Y-axis, 0.9 mm in Z-axis. While the distance was 0.1 mm in X-axis, 0.9 mm in Y-axis, 2.0 mm in Z-axis guided by bone alignment. There was no significant difference in set-up errors of 3 directions and 2 aligned ways before and after treatment.Conclusions The PTV within 3 mm is safe when IGRT is used for directing radiotherapy of nasopharyngeal carcinoma,and kV-KBCT is an effective image equipment.

Objective: To study the more safe and accurate guidance scheme of cone beam computed tomography (CBCT) in nasopharyngeal carcinoma. Methods: CBCT was regularly performed on 87 patients with nasopharyngeal carcinoma in Meizhou People's Hospital from November 2014 to August 2015. For each patient, 10 times CBCT scans were obtained pre-treatment. All the setup errors were obtained and analysed on the orientation X (left and right), Y (head and foot) and Z (vertical) axis. Results: With the increase of the number of CBCT scans, there was no statistically significant difference among the mean setup errors of the 10 times scans in X (left and right) and Y (head and foot) directions (all P > 0.05). And there was no statistically significant difference among the mean setup errors of 6 times scans in Z (vertical) direction, but from the beginning of the 7th, the systematic error in Z direction was increasing, the system error of the 7th, 8th, 9th, 10th time was 0.140, 0.292, 0.461, and 0.640 mm. Moreover, the difference of the mean systematic errors among the first 7 times was statistically significant (H = 15.232, P = 0.019), and the differences of the mean systematic errors among the first 8, 9 and 10 times were statistically significant (all P < 0.05). Conclusions Non-consecutive scans of CBCT could reduce the systematic and random errors. The appropriate frequency of application of CBCT based on the change law of setup errors is an ideal CBCT guidance scheme for nasopharyngeal carcinoma.

Objective:To investigate how urothelial carcinoma-associated 1 (UCA1) and miR-18a modulates acquired tamoxifen resistance and the relevant mechanisms in estrogen receptor (ER) positive cancer cells.Methods: qRT-PCR was performed to detect UCA1 and miR-18a expression in breast cancer cells.Dual luciferase assay was performed to detect the binding between miR-18a and UCA1 3′UTR.Tamoxifen sensitive MCF-7 cells were transfected with UCA1 expression vector or miR-18a inhi-bitors.Tamoxifen resistant LCC9 and BT474 cells were transfected with UCA1 siRNA or miR-18a mi-mics.CCK-8 assay was performed to detect cell viability.Soft agar assay was performed to assess cell colony formation.Flow cytometric analysis was performed to check cell cycle distribution.Results: UCA1 was significantly upregulated in tamoxifen resistant LCC2,LCC9,and BT474 cells than in tamoxifen sensitive MCF-7 cells.UCA1 expression was significantly upregulated in MCF-7 cells after treatment with 0.1 μmol/L tamoxifen.UCA1 overexpression enhanced cell viability of MCF-7 cells after tamoxifen treatment,while UCA1 siRNA significantly suppressed viability of LCC9 and BT474 cells after tamoxifen treatment.In MCF-7 cells,compared with vector control+tamoxifen group,the average cell colony number and colony size of the UCA1+tamoxifen group was 19.0％ more and 29.0％ larger respectively,while the proportions of the cells in G1 phase and in S phase were 7.3％ lower and 6.7％ higher respectively.In BT474 cells,compared with siRNA control+tamoxifen group,the average cell colony number and colony size of the si-UCA1+tamoxifen group were 54.0％ less and 42.0％ smaller respectively,while the proportions of the cells in G1 phase and in S phase were 9.0％ higher and 6.2％ lower respectively.UCA1 directly interacted with miR-18a and reduced its expression in ER positive breast cancer cells.Knockdown of miR-18a increased viability of MCF-7 cells after tamoxifen treatment,while miR-18a overexpression significantly reduced viability of BT474 cells after tamoxifen treatment.In MCF-7 cells,compared with miRNA inhibitor control+tamoxifen group,the average cell colony number and colony size of the miR-18a inhibitor+tamoxifen group were 15.0％ more and 33.0％ larger respectively,while the proportions of the cells in G1 phase and in S phase were 8.8％ lower and 5.3％ higher respectively.In BT474 cells,compared with miRNA control+tamoxifen group,the average cell colony number and colony size of the miR-18a mimics+tamoxifen group were 47.0％ less and 25.0％ smaller respectively,while the proportions of the cells in G1 phase and in S phase were 13.3％ higher and 7.9％ lower respectively.Conclusion: UCA1 can increase tamoxifen resistance of ER positive breast cancer cells via competitively inhibiting of miR-18a.

Objective To establish a knowledge management skills evaluation tool for nursing undergraduates and then try to provide an objective basis for evaluation of their knowledge management skills.Methods After reviewing literature and research group discussion,defining the theoretical dimensions of the knowledge management skills system and developing this evaluation tool.A total of 1 139 nursing undergraduates were picked out and investigated.The data were analyzed with the SPSS 20.0 and AMOS 7.0 statistic software packages,including exploratory factor analysis,confirmatory factor analysis,reliability and validity analysis.Results The knowledge management skills evaluation tool of nursing undergraduates was a multilayered and multidimensional system,including 3 subscales (knowledge management cognition,knowledge management attitude,knowledge management behavior),8 factors (the cognition of knowledge management connotation,the intention and the belief of knowledge management,the ability of obtaining,storing,sharing,applying and innovating knowledge),36 items.Exploratory factor analysis showed that all items' factor loading were 0.433-0.851.Confirmatory factor analysis displayed a good degree of fitting.The total scale's Cronbach α was 0.933,sub-scales were 0.807-0.892.The total scale's split coefficient was 0.873,sub-scales were 0.700-0.870.The correlation coefficient between 3 sub-scales score and the total scale score were 0.875-0.912.Conclusions Because of its good reliability and validity,nursing undergraduates can evaluate their knowledge management skills by using this evaluation tool.

Objective To investigate the application of modified early warning score ( MEWS) to the nursing care of the patients in Emergency Observation Room, and to explore the relationship between outcome and prognosis. Methods According to the convenience sampling method, 331 patients in Emergency Observation Room from a grade A tertiary hospital were assessed by MEWS. The observation factors included the relationship between MEWS at the first day of entering the room and patients′ observation time, MEWS after three days and prognosis. Results Patients′ MEWS at the first day had no correlation with observation time or prognosis ( r=0.052,0.097;P>0.05); patients′ MEWS after three days was related to prognosis(r =0.550, P<0.05). Moreover, the higher MEWS implied the worse conditions and higher mortality. Conclusions MEWS can imply patients′illness outcome and prognosis in order to help nurses to make nursing decision.

Objective To evaluate the impacts of the two different gastrectomy methods on the quality of life,complication and prognosis in proximal gastric cancer.Methods One hundred and two cases of proxi-mal gastric cancer in Tung Wah Hospital were collected for retrospective analysis.They were divided into proxi-mal gastrectomy/gastroesophagostomy (PG)group (n =50)and total gastrectomy/esophagojejunostomy (TG) group (n =52),according to the methods of gastrectomy and reconstruction.The postoperative complications, nutritional status and prognosis of the two groups were compared.Results The incidence of reflux esophagitis was obviously higher in PG group than that in TG group (38.0% vs 1 9.2%,χ2 =4.464,P =0.035).No sig-nificant differences were found between the two groups in the incidences of postoperative infection,bleeding and anastomotic leakage (χ2 =0.063,P =1 .000;χ2 =0.001 ,P =0.978;χ2 =0.31 1 ,P =0.577).There were no significant differences between PG and TG group in total plasma protein [(65.26 ±4.1 0)g/L vs (65.33 ± 3.75)g/L,t =-0.402,P =0.688],albumin [(39.76 ±2.1 7)g/L vs (39.59 ±2.04)g/L,t =1 .778,P =0.076],hemoglobin [(1 07.33 ±1 1 .1 0)g/L vs (1 08.09 ±1 1 .1 7)g/L,t =-1 .502,P =0.1 33]and weight loss [1 .00 ~8.00 kg vs 0.50 ~8.20 kg,t =-1 .622,P =0.1 05]in one year postoperatively.All cases were followed-up for 7 months to 1 0 years.No significant differences were found between PG and TG group in the incidences of anastomotic tumor recurrence (4.0% vs 5.8%,χ2 =0.1 71 ,P =0.679),metastasis (24.0% vs 28.8%,χ2 =0.308,P =0.579)and median survival time (53.6 months vs 49.8 months,χ2 =2.564,P =0.1 09).Conclusion Compared with PG group,the incidence of postoperative reflux esophagitis is effectively reduced,and the incidences of malnutrition,tumor recurrence and metastasis and death are not increased in TG group.Hence,TG should be a safe and effective surgery strategy.