Objective:To explore more clinical characteristics and outcomes of children with severe pneumonia induced by adenovirus type 7(Adv-7).Methods:Seventy children with severe pneumonia induced by Adv-7 admitted to the pediatric intensive care unit of Guangzhou Women and Children′s Medical Center from January 2016 to October 2019 were enrolled.The clinical features, treatments and outcomes of these children were recorded.Results:(1)There were 43 males(61.4%)and 27 females(38.6%). Thirty(42.9%)patients were 0-12 months old, 28(40.0%)patients were 13-36 months old, and 12(17.1%)patients were over 36 months old.(2)The average onset time of severe pneumonia induced by Adv-7 was(11.87±7.10)days before being admitted to PICU.The average sequential organ failure assessment score was 6.80±3.13.The average Murray lung injury score was 2.49±1.15.The average P/F value was(150.57±86.25)mmHg(1 mmHg=0.133 kPa). Sixty-four cases(91.4%)were involved in two or more area of lung on X-rays.All cases were diagnosed with sepsis.(3)Laboratory examination: white blood cell count was(7.6±5.5) ×10 9/L, platelet count was(238.8±164.2)×10 9/L, and C-reactive protein was(39.4±37.2)mg/L.(4)Treatments: intravenous gamma globulin was used in 65 cases(92.9%). Intravenous glucocorticoid was used in 45 cases(64.3%). Fiberoptic bronchoscopy was performed in 43 cases(61.4%). Blood purification treatment was performed in 21 cases(30%). Sixty-three patients(90.0%)were treated with non-invasive or invasive ventilator, high frequency ventilator-assisted ventilation was used in 20 cases(28.6%). Surfactant was used in six cases(8.6%). Extracorporeal membrane oxygenation was used in 19 cases(27.1%). (5)The average treatment time for ventilation was(13.10±11.58)days.The average time for temperature recover was(4.69±4.01)days in PICU.The average PICU stay time was(15.76±12.20)days.The average length of stay was(27.04±13.10)days.There were 16 patients died and the mortality was 22.9%. Conclusion:The children with severe pneumonia induced by Adv-7 were critical and had significant lung injuries.Suffering from active clinical treatment such as extracorporeal membrane oxygenation, some of these patients still had poor prognosis.

Objective:To investigate the application value of three-dimensional visualization technology in management of middle hepatic vein (MHV) processing in associating liver partition and portal vein ligation for staged hepatectomy(ALPPS).Methods:The retrospective and descriptive study was conducted. The clinical data of 40 patients with right massive liver cancer or multiple right liver lesions who underwent ALPPS in the First Affiliated Hospital of Guangxi Medical University from November 2017 to August 2019 were collected. There were 34 males and 6 females, aged (44±9)years, with a range from 26 to 64 years. All patients underwent multi-slice computed tomography (CT) plain and enhanced scan of superior abdominal region before operation, and the data were transmitted to the liver visualization analysis software IQQA system with 1.5 mm thin-layer images to complete the three-dimensional reconstruction of the liver and its blood vessels. Patients were performed ALPPS based on results of three-dimensional reconstruction and intraoperative findings. Observation indicators: (1) results of preoperative three-dimensional reconstruction; (2) surgical situations; (3) follow-up. Follow-up was conducted using outpatient examinations and telephone interview to detect postopeartive survival of patients up to March 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were described as M (range). Count data were represented as absolute numbers. Results:(1) Results of preoperative three-dimensional reconstruction: 40 patients underwent three-dimensional reconstruction successfully, of which 37 clearly showed MHV, tumor location and relationship between them, 3 patients showed unclearly MHV and were classified based on two-dimensional images. Of the 40 patients, 12 had MHV classified as type A, 13 as type B, 9 as type C, and 6 as type D. Three-dimensional reconstruction of vessels showed 22 with umbilical veins and 9 with anterior veins. Of the 40 patients, 35 were predicted to preserve MHV, and 5 were predicted to resect MHV. Total estimated liver volume, tumor volume, and reserved liver volume were (1 012±119)cm 3, 600 cm 3(8-2 055 cm 3), (346±80)cm 3. The ratio of future liver remnant to standard liver volume was 34%±8%. (2) Surgical situations : 40 patients underwent the first-stage ALPPS, including 35 with preservation of MHV and 5 with resection of MHV, which was accorded with preoperative prediction. Thirty-four patients underwent the second-stage ALPPS, and 6 patients had failure to receive the second-stage ALPPS due to undificiency future liver remnant. The operation time and volume of intraoperative blood loss for 40 patients undergoing first-stage ALPPS were (350±79)minutes and 300 mL(range, 100-2 600 mL). Three patients received blood transfusion and no perioperative death occurred. There were 24 patients with grade A heptic insufficiency according to criteria of International StudyGroup of Liver Surgery (ISGLS) and 16 patients with grade B heptic insufficiency after the first-stage ALPPS. Twenty-eight patients had grade Ⅰ complications of Clavien-Dindo classification, including 17 with a small pleural effusion, 10 with a small pleural and abdominal effusion, 1 with hypoproteinemia; 8 patients had grade Ⅱ complications of Clavien-Dindo classification, including 5 with pneumonia, 1 with pneumonia combined with pleural and abdominal effusion, 1 with coagulation disorders, 1 with biliary fistula; 3 patients had grade Ⅲ complications of Clavien-Dindo classification, including 2 with pneumothorax and pneumonia, 1 with pneumothorax, pneumonia and coagulation disorders; 1 patient had grade Ⅳ complications of Clavien-Dindo classification as systemic inflammatory response syndrome. All patients with complications were improved after symptomatic treatment, anti infection, transfusion of fresh frozen plasma or drainage. For the 34 patients undergoing the second-stage ALPPS, the operation time and volume of intraoperative blood loss were (320±83)minutes and 500 mL(range, 200-6 000 mL). Twelve patients received blood transfusion. There were 12 patients with grade A heptic insufficiency according to criteria of ISGLS and 22 with grade B heptic insufficiency after the second-stage ALPPS. Eighteen patients had grade Ⅰ complications of Clavien-Dindo classification, including 11 with a small pleural effusion, 7 with a small pleural and abdominal effusion; 12 patients had grade Ⅱ complications of Clavien-Dindo classification, including 4 with pneumonia, 4 with coagulation disorders, 3 with massive abdominal effusion, 1 with biliary fistula; 3 patients had grade Ⅲ complications of Clavien-Dindo classification, including 1 with pneumothorax and pneumonia, 1 with massive pleural effusion, 1 with obstructive jaundice; 1 patient had grade Ⅳ complications of Clavien-Dindo classification as pneumonia and anemia. All patients with complications were improved after symptomatic treatment, anti infection, transfusion of fresh frozen plasma or drainage. (3) Follow-up: 40 patients were followed up for 2-35 months, with a median follow-up time of 17 months. The 6-month, 1-, and 2-year survival cases were 35, 26, 21 cases. Conclusion:Three-dimensional visualization technology can clearly show the MHV classification and its relationship with tumor location, which has an important guiding significance in the decision-making of MHV management in ALPPS.

Objective To implement pediatric nurses' ability level system based on the construction of pediatric nurses' ability level model and competency index databases and set up nurses' core competency requirements and advanced conditions so as to provide evidences for pediatric nurses′ ability level management. Methods Nurses' core competency requirements and advanced conditions were set up. N1 and N2 certificated of nurses' ability level were implemented in the whole hospital. Satisfaction of nurses and family members of children before and after the implementation were compared.Results A total of 354 nurses applied for N1 and N2 ability level in the whole hospital. A number of 289 out of 354 applications passed the audit and 237 out of 289 applications have been certificated. For N1 level,148 out of 180 (82.22%) applications were certificated. For N2 level, 90 out of 174 applications (51.72%) were certificated. Satisfaction rates of nurses increased from (83.88±11.886) to (89.84±10.740) after the implementation, with a statistically significant difference (t=-5.180,P＜0.01). Satisfaction rates of family members developed from 84.27% to 93.01% after the implementation. The difference was statistically significant (χ2=9.766,P＜0.05).Conclusions The implementation of nurses' ability level system improves nurses' work enthusiasm and increases nurses' work satisfaction and family members' satisfaction.

Objective To explore pediatric nurses' perceptions about patients' safety culture and identify the factors that affect patients' safety culture so as to provide evidences for improving patients' safety. Methods A cross-sectional study with convenience sampling was performed on 886 pediatric nurses working in a children's hospital from July 2016 to September 2016. Patients' safety culture was assessed using the Chinese version of the Hospital Survey on Patient Safety Culture.Results 74.1% of nurses evaluated patients' safety grade as either 'very good' or 'good'. The advantage areas with positive responsive rates higher than 75% were described as follows "feedback and communication about error", "teamwork within units" and "organizational learning and continuous improvement". Areas need to be improved with positive responsive rates lower than 50% included "staffing" and "frequency of events reported". Multiple linear regression analysis indicated that ages and overtime work of nurses were main factors that affected nurses' knowledge of patients' safety culture. The two factors explained 10.8% of total variation.Conclusions Nurses in the children's hospital has an overall high level of knowledge to patients' safety culture. However, several aspects need to be improved. It is necessary to provide positive interventions to factors that affect knowledge of safety culture.

Objective To explore the job stressors of male nurses in children′s hospital, so as to provide evidence for hospital managers in improving occupational status of male nurses and in establishing measures of improving male nurses′ cultivation and development.Methods With the method of phenomenology in qualitative research and purposive sampling used, in April 2016, 10 male nurses in Pediatric Intensive Care Unit (PICU) in a class Ⅲ grade A children′s hospital were deeply interviewed with semi-structure, with the data analyzed and themes extracted.Results The job stressors of male nurses in children′s hospital can be summarized as 4 themes:heavy workload,un-recognition by the crowd,love and marriage difficulties and career development prospect.Conclusions Adverse factors exist in work and life of male nurses in children′s hospital. Healthy development of their career depends on joint efforts made by the society,hospital administrators and the male nurses themselves.

In 1982, the concept of "nursing clinical ladder model" was put forward, which was a new type of nurse stratified training management model based on the different abilities of nurses to fix, grade,definite responsibility and fixed salary. This study reviewed the application of the domestic and international nurses training program based on model, including the basic situation, the nurse′s hierarchical training system construction and the clinical practice of model at home and abroad.

Objective To build up one bonus shares method of improvi ng nursing quality in order to simulate nurse′s the inner enthusiasm.Methods The competence model and assessment system were established for one important weight for bonus sharing of competence qualified of nursing staff,competence coefficient and performance assessment.Results The implementation of performance assessment improved nurse′s satisfaction from 76.3% to 89.2%,while the parent′s satisfaction increased from 84.3% to 93.0%(χ2 =1 3.070,9.766;P <0.05).Conclusions The bonus shares method is scientific and reasonable,which can dig out the potential of nursing staff and is worthy of promotion.

This paper was aimed to analyze the theoretical connotation with liver bodyyin with function yang, and to explain the physiological and pathological mechanism of body yin and function yang, respectively. The mechanism of its corresponding syndrome and symptoms were described and the composing principle of classical prescription for liver regulation was analyzed. The clinical significance of liver body yin with function yangwas confirmed by clinical cases. This paper argued that the liver ascending characteristics, which is a necessary guarantee for ascendingqi in the human body to adapt to the ascending gas of the world, is the key point to maintain balance of qi ascending and descending in the body. The liver ascending disorder mainly manifested for the excessive ascending and ascending deficiency, which analyzed the pathogenesis characteristic and clinical manifestation of the liver qi ascending disorder. This paper put forward a new view that the liver storing blood referred to the convergence and the conservation properties of the liver, which demonstrated the relationship between liver storing blood and controlling dispersion. It suggested that liver blood convergences liverqi so as not to make liverqi too excessive. The liver storing blood can raise spirit. Liver blood is the source of menstruation, and etc. This paper finally put forward the clinical prescription viewpoint of soothing liver and dropping inverse should raiseyin and gentle liver necessarily, releasing liver should raise liver and nourish blood and clearing away the liver-fire should cool blood and nourishyin. This research had certain clinical value.

This article was aimed to study the factors associated with sleep quality of anger-out and anger-in population based on the frequent pattern-tree (FP-Tree) growing algorithm with data mining. The algorithm of structuring frequent model FP-tree and mining frequent itemsets were designed. The database information scanned was recorded by using FP-Tree growing algorithm through state-trees. The frequent itemsets met minimum support required was generated through reducing the search space of project sets and scanning database only one. The data mining of all factors associated with emotional diseases was actualized. The results showed that factors associated with sleep quality of anger-out and anger-in population were disturbance in respiration, cough or snoring, feeling cold, hot or nightmares. The total time for program analysis was 2 seconds. It was concluded that data mining algorithm based on FP-Tree frequent itemsets can effectively realize the useful information receiving from factors associated with emotional diseases.

Objective To summarize the pattern and main characteristics of fatal cases related to medical disputes in Yancheng area. Methods Sixty fatal cases of medical disputes were retrospectively analyzed to elucidate the annual incidence, characters of distribution of hospitals, gender and age of the decedents, types of diseases, and cause of death. Results Among 60 fatal cases, most cases happened in health clinics of county, township and village. There were more males than females. The major medical specialties in-volved included internal medicine, surgery, gynecology and pediatrics, with the internal medicine specialty having the highest incidence. Conclusion Police institutions have advantages in investigation of these cas-es in their jurisdictions, which could enhance the ability of local medicolegal examination.