Objective:To analyze the status of neonatal respiratory distress syndrome (RDS) management in 10 hospitals in Northwest China over the past five years and to investigate the strategies for improving the prevention and treatment of RDS.Methods:This retrospective study involved premature infants with RDS who were admitted to the neonatal intensive care units (NICU) of 10 hospitals (six in Shaanxi Province, three in Gansu Province, and one in Xinjiang Uygur Autonomous Region) of the Northwest China Neonatal Collaborative Group within 3 d after birth from January 1 to December 31, 2016, and from January 1 to December 31, 2021. Basic information, perinatal condition, treatment approaches, complications, and prognosis of the patients were compared. T-test, rank sum, and Chi-square tests were used for statistical analysis. Result:(1) This study enrolled 322 premature infants with RDS in 2016 and 349 in 2021. Premature infants at the gestational age of 30 to 33 weeks were mainly affected, and the majority were male [64.3% (207/322) and 57.3% (200/349)]. The average maternal age in 2021 was older than that in 2016 [(30.6±4.8) years vs (28.6±5.4) years, t=24.02, P<0.001], and the proportion of women at advanced maternal age was also higher in 2021 [19.2% (67/349) vs 12.4% (40/322), χ2=4.18, P<0.05]. (2) The proportions of pregnancies conceived with assisted reproductive technologies [11.7% (41/349) vs 1.9% (6/322), χ2=25.12], underwent routine prenatal examinations [58.5% (204/349) vs 30.4% (98/322), χ2=53.33], exposed to steroids [62.2% (217/349) vs 28.6% (92/322), χ2=82.58] and delivered by cesarean section or elective cesarean section [73.6% (257/349) vs 51.6% (166/322), χ2=35.06; 24.1% (84/349) vs 6.5% (21/322), χ2=39.07], as well as the ratio of cesarean scar pregnancy [7.4% (26/349) vs 3.4% (11/322), χ2=5.23] were all higher in 2021 than those in 2016 (all P<0.05). Moreover, the incidence of fetal distress [30.1% (105/349) vs 20.2% (65/322), χ2=8.68], gestational hypertension [24.6% (86/349) vs 13.0% (42/322), χ2=14.59], premature rupture of membranes [16.0% (56/349) vs 10.2% (33/322), χ2=4.89], meconium-stained amniotic fluid [12.6% (44/349) vs 5.6% (18/322), χ2=9.83], placental abruption [10.3% (36/349) vs 5.3% (17/322), χ2=5.84], gestational diabetes mellitus [10.3% (36/349) vs 1.6%(5/322), χ2=22.41], chorioamnionitis [4.6%(16/349) vs 0.9% (3/322), χ2=8.12], thyroid dysfunction [4.3% (15/349) vs 0.6% (2/322), χ2=7.88] and heart disease [4.3% (15/349) vs 0.3% (1/322), χ2=9.17] were higher in 2021 than in 2016 (all P<0.05). (3) In 2021, the rate of pulmonary surfactant (PS) usage, the dosage of porcine PS, and the proportion of bovine PS usage were all significantly higher than those in 2016 [73.6% (257/349) vs 67.1% (216/322), χ2=11.62; (178.5±38.0) mg/kg vs (165.2±42.8) mg/kg, t=7.85; 47.9% (123/257) vs 19.4% (42/216), χ2=41.72; all P<0.01]. No significant difference in the incidence of intubation-surfactant-extubation (INSURE), early PS administration (≤2 h after birth), or the arterial blood gas values before and after PS treatment was found between the cases enrolled in 2021 and 2016. The duration of antibiotic treatment [7.0 d (5.0-14.0 d) vs 5.0 d (1.0-8.0 d), Z=7.55] and assisted ventilation [144 h (81-264 h) vs 73 h (47-134 h), Z=8.20] and the median hospital stay [24 d(14-42 d) vs 16 d (10-25 d), Z=6.74] were significantly longer in 2021 than in 2016 (all P<0.01). More patients required nasal intermittent positive pressure ventilation [29.6% (100/338) vs 1.0% (3/306), χ2=97.81] and conventional ventilation [42.6% (144/338) vs 30.1% (92/306), χ2=10.87] in 2021 as compared with those five years ago (both P<0.01). (4) In 2021, the incidence of patent ductus arteriosus [15.5% (54/349) vs 6.2% (20/322), χ2=63.40], bronchopulmonary dysplasia [9.2% (32/349) vs 2.8% (9/322), χ2=12.88], persistent pulmonary hypertension [5.4% (19/349) vs 0.6% (2/322), χ2=12.85], periventricular leukomalacia [4.3% (15/349) vs 1.2% (4/322), χ2=7.52] and pneumothorax [3.4% (12/349) vs 0.3% (1/322), χ2=9.68] increased as compared with those in 2016 (all P<0.05), while the incidence of nosocomial infection decreased significantly [7.4% (26/349) vs 19.6% (63/322), χ2=21.37, P<0.001]. (5) The cure rate of premature infants with RDS was 70.8% (247/349) in 2021, which was significantly higher than that in 2016 [56.2% (181/322), χ2=15.37, P<0.001]. Moreover, the rate of withdrawing treatment and the total mortality rate was lower in 2021 than in 2016 [7.7% (27/349) vs 14.3% (46/322), χ2=7.41; in-hospital: 1.4% (5/349) vs 5.6% (18/322), χ2=8.74; out of hospital: 8.3% (29/349) vs 13.7% (44/322), χ2=4.96; all P<0.05]. Conclusions:The clinical management of RDS in premature infants in the involved hospitals has been improved. However, there is room for improvement in prenatal examinations.

Objective:To explore the influencing factors of self-management of diabetics in community so as to provide a scientific basis for personalized self-management of diabetics.Methods:From March 2016 to August 2017, this study selected 980 diabetics from 6 communities in Chaoyang District of Beijing by convenience sampling. All of patients were investigated with the self-management, nursing instruction need and medication adherence questionnaire and the medication adherence scale to understand the self-management, such as blood glucose management, exercise, medication adherence and nursing instruction need. Simple correlation and multiple regression were used to analyze the influencing factors of self-management, nursing instruction need and medication adherence.Results:Among those diabetics in community, the score of self-management was (1.76±0.25) . The score of nursing instruction need was (1.73±0.29) with medication instruction need dimension for the highest and diabetic knowledge instruction need dimension for the lowest. The score of medication adherence was (3.48±0.64) with unauthorized drug withdrawal dimension for the highest and times of taking medicine dimension for the lowest. Simple correlation showed that there were statistical differences in the scores of self-management among patients with different on-the-job situations and education levels ( P<0.05) , and in the score of nursing instruction need among patients with different education levels ( P<0.05) , and in the scores of medication adherence among patients with different ages, on-the-job situations and diagnosed ages ( P<0.05) . Multiple regression analysis showed that the influencing factor of self-management and nursing instruction need was the education level ( P<0.05) , and the influencing factor of self-management was the on-the-job situation ( P<0.05) , and the influencing factor of medication adherence was the age ( P<0.05) . Conclusions:Among diabetics in community, the self-management is influenced by the education level and on-the-job situation; nursing instruction need is influenced by the education level; the medication adherence is influenced by the age. We should increase the self-management of patients with the low level of education and on-the-job, provide nursing instruction for patients with the high level of education, promote the medication adherence of diabetics with low ages so as to improve the self-management and quality of life of patients.

Objective To investigate the influencing factors of self-care status of patients with hypertension in communities, so as to provide scientific evidences for personal self-care management of hypertension patients. Methods From March 2016 to August 2017, 1 010 hypertensive patients from 6 communities in Chaoyang District of Beijing were surveyed using general data questionnaire, Self-care Status and Nursing Guidance Needs Questionnaire and Medication Compliance Scale, to analyze the influencing factors of self-care status. Results In the 1 010 cases of hypertension patients in community, the score of self-care status was (1.70±0.22), the score of the demand of nursing education was (1.69±0.33), and the score of medication compliance was (3.54±0.58). The differences in the score of self-care status of patients with different education level and different years of hypertension diagnosis were statistically significant (P＜0.05). There were significant differences in the scores of nursing guidance needs among patients of different ages and educational backgrounds (P＜0.05). There were significant differences in the scores of medication compliance among patients of different ages, occupations and years of hypertension diagnosis (P＜0.05). Multivariate linear regression analysis showed that age, education level, years of hypertension diagnosis and occupation were the influencing factors of self-care status of patients. Conclusions Self-care status of hypertensive patients are affected by age, education level, years of diagnosis and occupations. The personal health education and guidance should be given based on patients' different social background, so as to enhance the level of self-care status and improve the patients' life quality.

OBJECTIVE:To observe the occurrence of paclitaxel(PTX)-induced muscle soreness and therapeutic efficacy and safety of diclofenac sodium. METHODS:Among 84 patients with malignant tumor receiving PTX chemotherapy,56 patients suf-fered from PTX-induced muscle soreness,among which 22 female patients suffered from medium and severe muscle soreness and then were randomly divided into group A and B,with 11 cases in each group. Group A was given Diclofenac sodium sustained-re-lease tablet 75 mg orally,once a day;group B was given Paracetamol and tramadol hydrochloride tablets one tablet orally,once a day,and then given Promethazine hydrochloride injection 100 mg subcutaneously,2-3 times a day when muscle soreness could not be born. Treatment course of both groups lasted for 5 d. The distribution of muscle soreness were observed. The onset time and dura-tion of muscle soreness were also observed as well as pain relief and the occurrence of ADR in group A and B. RESULTS:Among 84 cases,the incidence of muscle soreness was 66.67%,among which mild pain accounted for 23.81%,moderate pain accounted for 13.10%,and severe pain accounted for 29.76%. Among 56 patients with muscle soreness,earliest muscle soreness occurred on the day of medication,and most of muscle soreness occurred on 1-3 days after medication,mainly manifesting as sore,activity limitation when severe,associated with fatigue. The pain relief rate of group A and B were 100%,but the incidence of adverse re-actions in group A was significantly lower than group B,with statistical significances(P<0.05).CONCLUSIONS:Diclofenac sodi-um is similar to paracetamol and tramadol hydrochloride in the treatment of PTX-induced muscle soreness,but it is better than paracetamol and tramadol hydrochloride in safety.

Objective To describe the prevalence of workplace violence against nurses in emergency departments,and investigate its related cognition and demands of nurses. Methods A total of 385 emergency department nurses from 13 general hospitals in Beijing were recruited by convenient sampling method and were investigated with the Version of Hospital Workplace Violence Questionnaire in February to October 2014. Results The prevalence of workplace violence against nurses was 89.9% during the past 12 months. The incidence of verbal abuse,threat, physical assault and sexual assault were 89.9%,70.6%,20.5% and 3.9% respectively. The responses of nurses were mainly "tolerance and avoidance","explain patiently" and "ask for help";81.6% of the nurses considered that workplace violence was inevitable in the workplace,and 78.7% of the nurses thought the hospital was not capable of dealing with workplace violence in the past. The nurses demanded that the hospital to increase the prevention of workplace violence training,to set up a sector to deal with violence events,or to take on workplace violence policy of "zero tolerance". Conclusions Workplace violence against nurses is prevalent in emergency departments. Nurses hope the hospital to have more positive attitude against workplace violence and take more measures to prevent and deal with it. Further intervention should be conducted to reduce workplace violence against nurses by individuals,hospitals,the government and the whole society.

The shape and structure of granules are controlled by the granulation process, which is one of the main factors to determine the nature of the solid dosage forms. In this article, three kinds of granules of a traditional Chinese medicine for improving appetite and promoting digestion, namely, Jianwei Granules, were prepared using granulation technologies as pendular granulation, high speed stirring granulation, and fluidized bed granulation and the powder properties of them were investigated. Meanwhile, synchrotron radiation X-ray computed micro tomography (SR-µCT) was applied to quantitatively determine the irregular internal structures of the granules. The three-dimensional (3D) structure models were obtained by 3D reconstruction, which were more accurately to characterize the three-dimensional structures of the particles through the quantitative data. The models were also used to quantitatively compare the structural differences of granules prepared by different granulation processes with the same formula, so as to characterize how the production process plays a role in the pharmaceutical behaviors of the granules. To focus on the irregularity of the particle structure, the box counting method was used to calculate the fractal dimensions of the granules. The results showed that the fractal dimension is more sensitive to reflect the minor differences in the structure features than the conventional parameters, and capable to specifically distinct granules in structure. It is proved that the fractal dimension could quantitatively characterize the structural information of irregular granules. It is the first time suggested by our research that the fractal dimension difference (Df,c) between two fractal dimension parameters, namely, the volume matrix fractal dimension and the surface matrix fractal dimension, is a new index to characterize granules with irregular structures and evaluate the effects of production processes on the structures of granules as a new indicator for the granulating process control and optimization.

Objective To investigate the status of the emergency nurses′ turnover intention and analyse its influencing factors in level two and three hospitals. Methods A total of 385 nurses in Emergency Department of 2-level or 3-level general hospitals were investigated by turnover intention scale and Mueller/ McCloskey satisfaction scale (MMSS). Results The average turnover intention score of nurses in 2-level general hospital (2. 95 ± 0. 52) was higher than that of the nurses in 3-level general hospital (2. 56 ± 0. 58) (t = 6. 948,P <0. 01). Regression analysis showed that the age, sex, the highest diploma, working time in Emergency Department, working style, monthly income, satisfaction level were the influencing factors of emergency nurses′turnover intention ( β′ = - 0. 158, 0. 181, 0. 350, - 0. 460, 0. 360, - 0. 171, - 0. 424, respectively). Conclusions The emergency nurses′ turnover intention is in the higher level influenced by multiple factors. Measures combining with the characteristics of different grade hospital should be taken to improve the nurses′satisfaction and reduce the turnover intention.

BACKGROUND:Most stroke patients affected walking dysfunction. Virtual reality-enhanced body weight-supported treadmil training has been proposed as a strategy for gait training of cerebral infarction subjects.
OBJECTIVE:To evaluate the effectiveness of virtual reality-enhanced body weight-supported treadmil training on lower limb motor function in subacute cerebral infarction patients.
METHODS:Twenty cerebral infarction patients (within 3 months of onset) were randomly divided into experiment group (virtual reality-enhanced body weight-supported treadmil training) and control group (conventional physiotherapy). Three-dimensional gait analysis in lower limb motor function was carried out before and after 3-week gait training. Intergroup and intragroup comparisons in the fol owing parameters were done before and after training:walking speed, cadence, step time, single limb support time (%), double limb support time (%), nonparetic swing (%), step length, pace, range of motion in the lower limb, functional ambulation category, Fugl-Meyer Assessment of the lower limbs and Brunel Balance Assessment.
RESULTS AND CONCLUSION:No significant differences in patient’s gender, age, course of disease, affected. side, walking speed, functional ambulation category, Fugl-Meyer Assessment of the lower limbs and Brunel Balance Assessment were detected between the two groups before training (P>0.05). Fugl-Meyer Assessment and functional ambulation category were improved in patients of the two groups after training (P<0.05). The improvement in walking speed, cadence, step time in affected side, step time in healthy side, single limb support time in affected side (%), nonparetic swing (%), pace, step lengths in affected and healthy sides were better in the experimental group than those in the control group.

Objective To study the effects of rational emotive behavior therapy (REBT) in the rehabilitation of patients with spinal cord injury (SCI).MethodsA total of 300 SCI patients from six institutions were divided into a research group and a control group. Systematic rehabilitation was given to the patients of the control group, while systematic rehabilitation and REBT were given to the patients of the research group. All patients were followed up for 1 year. Psychological state, activities of daily living (ADL), and quality of life (QOL) were evaluated with a symptom check list (SCL-90), a modified version of the Barthel index (MBI) and the World Health Organization's quality of life assessment (WHOQOL-100).ResultsOne year after treatment, the improvement in QOL of patients in the research group was better, on average, than that in the control group. The differences were primarily in mental items. The ADL ability of patients in both groups improved, and any differences were not significant. The psychological state of patients in the research group had improved significantly 1 year after treatment, while the improvements in the control group were not significant on average, except in terms of interpersonal sensitivity.ConclusionREBT had little effect on the ADL ability of SCI patients, however, it improved their psychological state significantly, and thus improved their QOL.

Objective To explore the clinical feature of severe enterovirus 71 (EV71) associated hand foot and mouth disease (HFMD),and genotype of EV71.Methods Fluorescent quantitation PCR was done for detecting EV71.RT-PCR was performed to amplify VP1 for sequencing and identifying genotype.A retrospective analysis was performed based on the clinical data of 15 cases with severe EV71 infection.Results EV71 nucleotide was positive in all 15 cases.The genotype of EV71 was C4.All cases had abnormal temperature and followed with nervous symptoms in the early stage.Average time was 1.26 days from onset to severe complications appearance.Eleven cases progressed to neurogenic pulmonary edema.Four cases accepted nasal continuous positive airway pressure.Eleven cases accepted oral trachea cannula mechanical ventilation.Except for 3 cases died,one case abandoned,others 11 cases were cured.Conclusion The isolated strains of EV71 in this study are all C4 genotype.All cases with severe EV71 infection were followed with nervous symptoms in the early stage,most of whom would progress to neurogenic pulmonary edema.The mortality would be cut down by using mechanical ventilation in early stage.