Objective:To analyze the clinical characteristics and all-cause mortality influencing factors of patients with Keshan disease.Methods:Clinical data of patients with Keshan disease from Keshan disease areas in Sichuan Province and Yunnan Province were collected and retrospectively analyzed for clinical characteristics and survival status during regular follow-up. According to the survival status of patients, the survey subjects were divided into a survival group and a death group. All-cause mortality (referring to the death caused by various reasons throughout the follow-up period) was used as the study endpoint. Kaplan-Meier (K-M) survival curve analysis and log-rank χ 2 test were performed, univariate and multivariate Cox regression analysis were used for all-cause mortality factor analysis. Results:A total of 176 patients with Keshan disease were collected, including 92 cases in Sichuan Province and 84 cases in Yunnan Province. Among all the patients, there were 105 males, accounting for 59.66%, and 71 females, accounting for 40.34%. The age was (53.89 ± 13.19) years old. Thirty-five cases died from all causes, with a mortality rate of 19.89%. There were significant differences in age ( t = 2.09, P = 0.038), New York Heart Association (NYHA) cardiac function grading (χ 2 = 14.62, P < 0.001) and ventricular premature contraction (χ 2 = 6.82, P = 0.009) between the survival group and the death group. K-M survival curve analysis showed that patients with Keshan disease complicated by premature ventricular contraction and high NYHA cardiac function grading (Ⅲ and Ⅳ) had higher all-cause mortality (log-rank χ 2 = 8.72, 22.49, P < 0.05). Univariate Cox regression analysis showed that NYHA cardiac function grading and ventricular premature contraction ( HR = 3.09, 2.71, P < 0.05) were predictive influencing factors for all-cause mortality in patients with Keshan disease. Multivariate Cox regression analysis showed that NYHA cardiac function grading ( HR = 6.57, P = 0.002) and ventricular premature contraction ( HR = 2.98, P = 0.050) were independent factors for all-cause mortality in patients with Keshan disease. Conclusions:Among 176 patients with Keshan disease, the number of patients with poor cardiac function (NYHA cardiac function grading Ⅲ and Ⅳ) and arrhythmia is high. NYHA cardiac function grading and ventricular premature contractions are independent influencing factors for all-cause mortality in patients with Keshan disease.

Objective:To study the iodine nutrition status of key populations in Sichuan Province, so as to provide a basis for scientific supplementation of iodine and adjustment of prevention and control measures.Methods:From 2018 to 2022, the stratified cluster sampling method was used in 21 counties (district) in Sichuan Province. Each county (district) was divided into 5 areas based on east, west, south, north, and center. One township (street) was selected as a monitoring site from each area. Forty children aged 8 - 10 years old and 20 pregnant women, women of childbearing age, lactating women, and their infants and young children (0 - 2 years old) were randomly selected from each monitoring site. Household edible salt and urine samples were collected for salt and urine iodine testing. B-ultrasound method was used for thyroid examination in children.Results:A total of 52 019 samples of edible salt were collected, including 50 084 qualified iodized salt samples. The qualified iodized salt consumption rate was 96.3%, and the median salt iodine was 27.1 mg/kg. A total of 21 021 urine samples from children were tested, with a median urine iodine level of 199.5 μg/L. A total of 10 293 urine samples were taken from pregnant women, and the median urine iodine level was 172.6 μg/L. A total of 10 502 urine samples were taken from women of childbearing age, with a median urine iodine level of 174.4 μg/L. A total of 10 444 urine samples were taken from lactating women, and the median urine iodine level was 164.9 μg/L. There were 10 442 urine samples from infants and young children, and the median urine iodine level was 191.9 μg/L. A total of 21 028 children underwent thyroid examination, with a goiter rate of 1.8% (370/21 028).Conclusion:From 2018 to 2022, the iodine nutrition of key populations in Sichuan Province is at an appropriate level, and the elimination of iodine deficiency disorders continues to be maintained.

Objective:To develop and test the reliability and validity of the scale of nurses′ medication competence. To provide scientific basis for the safe medication management of clinical nurses.Methods:Based on the qualitative interview results, combined with role theory and core competence theory, the initial item pool of the scale was formed through literature analysis and discussion in the research group. The first draft of the scale was formed through expert correspondence and pre-investigation. Using the cross-sectional survey methed, from October to November 2022, a questionnaire survey was conducted among 825 clinical nurses from 6 tertiary hospitals in Dalian by convenience sampling method to test the reliability and validity of the scale.Results:Totally 20 experts were consulted, aged 35-49 years old. The nurses′ medication competence evaluation scale contained 11 dimensions, including pharmacological knowledge, medication management ability, medication evaluation ability, medication order checking and execution ability, clinical practice ability, modern technology application ability, educational consulting ability, communication and coordination ability, scientific research and learning ability, ethical and legal practice ability, quality management and risk management ability, with a total of 50 items. Exploratory factor analysis identified 11 common factors, which accounted for 86.525% of the variance. The Cronbach α coefficient of the scale was 0.975, the Cronbach α coefficient of all dimensions were 0.880-0.977, and the retest reliabilities were 0.721-0.875. The content validity index of the scale was 0.99, and the content validity index of all items were 0.83-1.00. The correlation coefficients between the scale and the Competency Inventory for Registered Nurse were 0.636-0.938. Conclusions:The nurses′ medication competence evaluation scale had good reliability and validity, and could be used as an effective tool to evaluate the medication ability of nurses.

Objective:To explore the effect of physical development on thyroid volume of children aged 8 - 10 years in Sichuan Province, and explore the thyroid volume correction method suitable for school-age children, so as to accurately prevent and control iodine deficiency disorders.Methods:From June to July 2020, Shuangliu District of Chengdu City, Pengshan District of Meishan City, Miyi County of Panzhihua City and Qingchuan County of Guangyuan City were selected as the survey counties (districts). One township (town and street) was selected from each county (district) according to the five directions of East, West, South, North and Middle, one primary school was selected from each township (town and street), and 40 children aged 8 - 10 years (gender and age balanced) were selected as the survey subjects from each primary school, height and weight were measured, the body mass index (BMI) and body surface area (BSA) were calculated. Thyroid volume was measured by B-ultrasound, and the different thyroid volume indexes [height volume index 1 (HVI1), height volume index 2 (HVI2), body mass volume index (BMIV), weight and height volume index (WHVI), body surface volume index (BSAV)] were calculated, respectively. Urine samples of all children were collected, the iodine concentration in urine was measured, and the correlation between different measurement indexes and children's growth and development indexes was analyzed.Results:A total of 805 children aged 8 - 10 years were investigated, including 403 boys and 402 girls. There were 312, 288 and 205 children in the 8-, 9- and 10-year-old groups, respectively. A total of 805 urine samples were collected, and the median urinary iodine was 251.4 μg/L. There was no statistically significant difference in thyroid volume between boys and girls ( Z = - 0.44, P = 0.661), but was statistically significant difference between ages ( H = 64.95, P < 0.001). In all age groups, thyroid volume was positively correlated with height and weight (8-year-old group: r = 0.29, 0.42, P < 0.001; 9-year-old group: r = 0.29, 0.41, P < 0.001; 10-year-old group: r = 0.34, 0.47, P < 0.001). In all age groups, after HVI1 correction, thyroid volume was positively correlated with height and weight (8-year-old group: r = 0.13, 0.32, P < 0.05; 9-year-old group: r = 0.12, 0.30, P < 0.05; 10-year-old group: r = 0.18, 0.37, P < 0.05). In all age groups, there was a positive correlation between thyroid volume and weight after HVI2 correction (8-year-old group: r = 0.20, P < 0.001; 9-year-old group: r = 0.17, P = 0.004; 10-year-old group: r = 0.26, P < 0.001). In the 8- and 10-year-old groups, there was a positive correlation between thyroid volume and height after BMIV correction ( r = 0.20, P < 0.001; r = 0.21, P = 0.003). In all age groups, there was a negative correlation between thyroid volume and height and weight after WHVI correction (8-year-old group: r = - 0.35, - 0.37, P < 0.001; 9-year-old group: r = - 0.38, - 0.39, P < 0.001; 10-year-old group: r = - 0.31, - 0.38, P < 0.001). In the 8-year-old group, there was a positive correlation between thyroid volume and weight after BSAV correction ( r = 0.11, P = 0.045). Conclusions:Thyroid volume is closely related to height and weight. It may be inappropriate to judge goiter in children only based on age. After the preliminary comparison of five correction methods, it is found that BSAV is better.

Objective:To understand the levels of selenium and T-2 toxin in the historical critical disease area of Kashin-Beck disease in Aba State of Sichuan Province.Methods:From July 2018 to February 2019, in five cities (counties) of historical critical Kashin-Beck disease areas, namely, Ma'erkang, Rangtang, Aba, Ruo'ergai and Hongyuan, one township was selected, respectively, and then one village in the historical critical disease area and one village in non-disease area were selected from the selected townships. Hair samples from 30 children aged 6 to 12 years old were collected to test selenium content in each village. Staple food samples of 10 households were collected to test the selenium and T-2 toxin contents in each village. Ten soil samples were collected from each village to test the selenium content.Results:The medians selenium of children's hair in the diseased and non-diseased villages ( n= 180, 120) were 0.260 0 and 0.330 0 mg/kg, respectively, and the diseased village was lower than non-diseased village ( Z = - 6.319, P < 0.01). In Ma'erkang and Hongyuan, the medians selenium in the diseased villages were lower than those in non-diseased villages ( Z = - 3.327, - 4.939, P < 0.01), and there were no statistically significant differences between the diseased villages and non-diseased villages in Rangtang and Ruo'ergai ( P > 0.05). The medians selenium of staple food in the diseased and non-diseased villages ( n = 110, 70) were 0.005 8 and 0.018 0 mg/kg, respectively, and the diseased village was lower than non-diseased village ( Z = - 2.263, P < 0.05). In Ruo'ergai, the median selenium in the diseased village was lower than that in non-diseased village ( Z = - 2.306, P < 0.05), and there were no statistically significant differences between the diseased villages and non-diseased villages in Ma'erkang, Rangtang and Hongyuan ( P > 0.05). The T-2 toxin contents in staple food were all less than detection limit (1 μg/kg) in the diseased and non-diseased villages ( n = 103, 65). The soil selenium contents in the diseased and non-diseased villages ( n = 60, 40) were (0.045 3 ± 0.021 5) and (0.065 8 ± 0.045 4) mg/kg, respectively, and the diseased village was lower than non-diseased village ( t = 2.672, P < 0.05). The soil selenium content in the diseased village was lower than that in non-diseased village in Hongyuan ( t = 14.838, P < 0.01). There were no statistically significant differences in the soil selenium content between the diseased villages and non-diseased villages in Ma'erkang, Rangtang and Ruo'ergai ( P > 0.05). Conclusions:The overall selenium level of children's hair is at a medium level (0.25 - < 0.50 mg/kg) in the historical critical disease area of Aba State of Sichuan Province, the selenium levels of staple food and soil are at a deficiency level (< 0.025, < 0.125 mg/kg), and the diseased villages are lower than non-diseased villages. No T-2 toxin is detected in staple food.

Objective: To investigate the self-reported prevalence, clinical characteristics, complications of allergic rhinitis (AR) and the sensitization of outdoor air pollen allergens in children in the Inner mongolia grassland region. Methods: A multistage, stratified and random clustered sampling with a face-to-face interview survey study in children from 0 to 17 years old was performed together with 10 common allergen skin prick tests (SPT) and measurements of the daily pollen count in 6 regions in the Inner mongolia grassland region from May to August of 2015. SAS 9.4 software was used for data analysis. Results: A total of 2 443 subjects completed the study. The self-reported prevalence of AR was 26.6%. The prevalence of boys was higher than that of girls (28.8% vs 24.3%, χ²=6.157, P<0.05). Subjects from urban areas showed higher prevalence than rural areas (34.7% vs 18.8%, χ²=79.107, P<0.05). There was significant regional difference in the prevalence of AR among the six areas investigated (χ²=221.416, P<0.05). The main clinical symptoms of AR were sneezing (88.2%) and nasal congestion (78.6%). Among combined diseases, asthma accounted for 16.5% (107/650), rhinoconjunctivitis accounted for 47.9% (311/650). The peak season of AR was April and July, with the top SPT positive allergens of Artemisia species and chenopodium in this area. Conclusions The prevalence AR in children in the Inner mongolia grassland region is extremely high. Sneezing is the main clinical symptom. Rhinoconjunctivitis is the most common combined disease. High summer and autumn pollen exposure is the main cause of AR.

Efficient measurement of administrative departments at public hospitals is key to performance appraisal for such units. The authors analyzed the current situation and problems of performance management of such departments of public hospitals, and made case studies for the formulating and implementing process of the performance appraisal system.Furthermore, they probed into appraisal methods for these departments and presented a performance appraisal model of " expectation-response" . Combined with the practice of the case hospitals, the authors recommended an annual personalized evaluation indicator system. Based on analysis of the operation process of the case hospitals from 2016 to 2018, namely theory study-practical exploration-experience summary-program readjustment for further practice. These efforts studied the implementation framework of performance management for these departments, summarized the by-stage practice experiences of the appraisal from the " basic version" to " specialized version" . Thus the paper provided references for their performance management of these hospitals.

Objective: To evaluate the implementation effectiveness of performance management for administrative departments. Methods: By means of questionnaires, the authors made a comparative analysis of the performance perception of service recipients of these departments before and after the implementation of the scheme, and the change of external performance appraisal results of the case hospital was analyzed through third-party evaluation. Then face to face interviews were used to conduct performance communication with the management staff. Results: Questionnaire results showed that the satisfaction of those served by these administrative departments for their work improvement and work results was generally elevated, scoring 4.31 for their satisfaction elevation(higher than 3.0 of the neutral attitude). A third party external performance appraisal indicated a capability enhancement as shown by the hospital in the appraisal indicators by the hospital′s authorities, scoring 91.52 in 2018 as compared to 82.34 in 2016. In-depth interviews exhibited that the ranking of the total scoring of performance appraisal of these departments was more in line with the staff′s psychological feelings. These departments also agreed with the appraisal system, the algorithm of performance scoring and the appraisal results. Conclusions The performance management of these departments of the hospital had achieved the goal of effective implementation and elementarily improved the efficiency of the hospital′s internal management.

Objective To investigate the cognition of medical staff on the control and treatment of venous thromboembolism ( VTE) at the municipal general hospitals in Beijing, for due countermeasures. Methods Customized questionnaires were used to survey the medical staff at 7 general hospitals in Beijing. The data so acquired were divided into approval items and disapproval items to calculate the ratio of approval items, while the comparison between those of different specialties and academic titles was subject to logistic regression analysis. Results 2 496 valid questionnaires were recovered, and the results showed that over 95% of them recognized the necessity of the VTE control and treatment work in the hospital, yet they need to improve their professional knowledge in this regard. There were differences in the cognition level among different specialties, and the higher the professional title, the better the recognition. Top three concerns for VTE work were increased workload, increased hospitalization expenses and extended hospital stay in turn. Top three difficulties in the work were patient′s compliance, coordination of auxiliary departments, and doctors′ cognition and involvement. Conclusions Cognition of VTE needs to be enhanced, and it is imperative to improve the VTE control and treatment system, carrying out the work in a scientific, standardized and economic manner.

Objective:Mineral trioxide aggregate (MTA),a wildly used pulp capping material,could affect the proliferation and differentiation of dental pulp cells.The aim of this study is to study the roles of Notch signalling and autophagy in MTA induced human dental pulp cells (hDPCs) proliferation promotions.Methods:Healthy human third molars were collected and hDPCs were isolated by a combined digestion of collagenase Ⅰ and dispase Ⅱ.MTA extracts of different concentrations (0.5,1.0,2.0,5.0,10.0 mg/mL) were used to test the cytotoxicity by cells counting kit (CCK-8) assays and to select the optimum concentration for hDPCs survival..Expressions of Notch1,Hes1,LC3Ⅱ / Ⅰ and p62 in wild type and MTA treated hDPCs were detected by western blotting.Results:MTA extracts in a concentration of 1.0 mg/mL exerted most profoundly promotion effects on the proliferation of hDPCs among all concentrations tested.MTA of high concentration (10 mg/mL) was toxically to cells.Compared with that of wild type hDPCs,the expressions of Notch1 and Hes1(P＜0.05),or p62 and LC3Ⅱ/Ⅰ (P＜0.01) in MTA treated hDPCs were significantly increased.Much lower expression of Notch1 was detected in hDPCs when autophagy was induced by Earle's balanced salt solution (EBSS) starvation for 24 h.Conclusions:MTA could up-regulated hDPCs proliferation with highly relevant in stimulating Notch1-Hes1 signalling and inhibition of autophagy.The study is supposed to provide new insight in unrevealing the mechanisms of MTA mediated dental pulp cells proliferation.