Objective:To survey the working status of outpatient nurses in general practice departments of general hospitals.Methods:From March to April 2021, personal in-depth interviews were conducted with outpatient nurses from general practice residency training bases in Beijing. The thematic framework analysis method was used to analyze the interview data and refine the themes.Results:Fourteen nurses working in general practice outpatient clinics were interviewed in this study. Four themes were extracted from the interview data: (1) inadequate staffing of full-time outpatient nurses in general practice departments of comprehensive hospitals; (2) unclear job functions for outpatient nurses in general practice departments; (3) no standardized patient health education in the department; (4) no relevant training received systematically.Conclusion:General practice departments in general hospitals should setup full-time general practice nurse positions, clarify the job responsibilities, strengthen the relevant training and enhance core competency for nurses working in general practice department.

ObjectiveTo identify Dendrobium flexicaule and its related species， and analyze the differences in polysaccharide composition and D-mannose content， so as to provide theoretical basis for the accurate identification and quality control of Dendrobium medicinal materials. MethodNine samples of Dendrobium （S1-S9） were identified by DNA barcoding and infrared spectroscopy， and the contents of polysaccharides and D-mannose were determined by ultraviolet spectrophotometry （UV） and high performance liquid chromatography （HPLC）， respectively. UV detection condition was 488 nm， HPLC detection conditions were the mobile phase of 20 mmol·L^-1 ammonium acetate solution-acetonitrile （81.5∶18.5） and the detection wavelength at 250 nm. ResultDNA barcoding results showed that samples S1-S3 were D. nobile， samples S4-S5 were D. officinale， sample S6 was D. huoshanense， and S7-S9 were D. flexicaule. One-dimensional infrared spectroscopy showed that only D. nobile had stable characteristics at the wavenumber of 1 570-1 467 cm^-1， showing a "W" shape， while no absorption peak was found at the wavenumber of 842-740 cm^-1， but the other Dendrobium samples had stable absorption peaks at the wavenumber of 842-740 cm^-1. In the first derivative spectrum， at the wavenumber of 785 cm^-1， D. huoshanense presented a "V" shape， while the rest of Dendrobium presented a "W" shape. At the wavenumber of 1 110 cm^-1， D. flexicaule had a stable characteristic peak. In the second derivative spectrum， at the wavenumber of 1 125 cm^-1， D. officinale presented an "M" shape， and the rest of Dendrobium was approximately "W" shape. The results of determination showed that the contents of polysaccharides in samples S1-S9 were 9.35%， 9.12%， 32.78%， 49.38%， 48.97%， 32.48%， 32.95%， 39.41% and 25.32%， and their contents of D-mannose were 1.39%， 0.47%， 13.57%， 3.04%， 33.85%， 23.57%， 16.64%， 17.47% and 19.49%， respectively. Among them， D. flexicaule had high polysaccharide and D-mannose contents. ConclusionBoth DNA barcoding and infrared spectroscopy can be used to identify D. flexicaule and its related species， and infrared spectroscopy is cost-effective and easy to operate. At the same time， D. flexicaule has high contents of polysaccharides and D-mannose， which can provide a scientific basis for rapid identification of D. flexicaule and its relatives， and provides a reference for its quality control， and resource development and utilization.

Objective:To analyze the application value of the mechanical thrombectomy system in the treatment of acute limb ischemia.Methods:The clinical data of 50 patients with lower limb ischemia who were treated with the Rotarex mechanical thrombectomy system from Jun 2017 to Sep 2019 were retrospectively analyzed.Results:In 4 cases of popliteal artery rupture occurred during the operation. The success rate of the operation was 92%. Catheter-directed thrombolysis was used in 7 cases, percutaneous transluminal angioplasty was used in 4 cases and percutaneous transluminal angioplasty combined with stent implantation was used in 39 cases. The ankle-brachial index of these 50 patients before and after operation was 0.18±0.24 and 0.64±0.28 respectively ( t=12.87, P<0.001). Treatment was successful in 43 cases. Follow-up ranged from 1 to 24 months, 5 cases were amputated, 2 cases had no improvement of toe ulcer gangrene, 9 cases had thrombus recurrence, and no complications such as bleeding were observed. The primary patency rates at 3, 6 and 12 months were 92%, 84% and 74%, respectively. Conclusion:The mechanical thrombectomy system is safe and effective in the treatment of acute lower limb ischemia with ideal short-term patency.

Background Parathion and methyl parathion are typical organophosphorus insecticides and para−nitrophenol (PNP) is their main specific metabolite. Previous studies have shown that parathion and methyl parathion may play a role as endocrine disrupting chemicals, but the evidence is limited. Objective Our aim is to evaluate association between urinary PNP concentration and thyroid function among healthy adults and whether this association has gender differences. Methods The study was based on the 2007—2008 US National Health and Nutrition ExaminationSurvey (NHANES). A total of 1071 subjects aging from 20 to 64 years with data on both urinary PNP and serum thyroid function indicators were finally enrolled. Thyroid function was evaluated by measuring serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), total triiodothyronine (TT3), total thyroxine (TT4), thyroglobulin (TG), and thyroglobulin antibody (TG-Ab). A generalized linear model was used to analyze the relationship between urinary PNP and serum thyroid function indicators and the dose-response relationship. Gender differences were also explored. Results In the total population, the positive rate of PNP was 92.5%, and the median urinary PNP concentration adjusted for urinary creatinine was 0.62 μg·g⁻¹. The median creatinine-adjusted urinary PNP concentrations in the male and female populations were 0.60 and 0.66 µg·g⁻¹ respectively. The median activities or concentrations of serum thyroid function indicators TSH, FT3, FT4, TT3, and TT4 in the total population were 1500.00 μIU·L⁻¹, 3200.00 pg·L⁻¹, 8.00 ng·L⁻¹, 1140.00 ng·L⁻¹, and 76.00 μg·L⁻¹ respectively. In the total population, a logarithmic unit increase of urinary PNP was associated with 1050.00 pg·L⁻¹ decrease in serum FT3 levels (b=−0.02, 95%CI: −0.02-−0.01), 10.50 ng·L⁻¹ decrease in FT4 levels (b=−0.02, 95%CI: −0.03-−0.01), and 10.50 ng·L⁻¹ decrease in TT3 levels (b=−0.02, 95%CI: −0.03-−0.01), all in a dose-response manner (all P_trend<0.05). After sex stratification, for every logarithmic unit increase of urinary PNP, the serum TG-Ab level was increased by 1100.00 IU·L⁻¹ (b=0.04, 95%CI: 0.00-0.08) and the serum FT3 level was reduced by 1020.00 pg·L⁻¹ (b=−0.01, 95%CI: −0.02-0.00) among males, and both showed dose-response relationships (both P_trend<0.05); every logarithmic unit increase of urinary PNP was associated with 1050.00 pg·L⁻¹ decrease in FT3 levels (b=−0.02, 95%CI: −0.03-−0.01), 10.50 ng·L⁻¹decrease in FT4 levels (b=−0.02, 95%CI: −0.03-0.00), 10.70 ng·L⁻¹ decrease in TT3 levels (b=−0.03, 95%CI: −0.05-−0.01), and 10.50 μg·L⁻¹ decrease in TT4 levels (b=−0.02, 95%CI: −0.04-0.00) among females, and there were dose-response relationships of urinary PNP concentration with serum FT3 and TT3 levels (both P_trend<0.001). Conclusion Changes in the concentration of PNP in urine are associated with changes in serum FT4, FT3, and TT3 levels and the results also show gender differences.

Objective:To form a nursing standard for shoulder-hand syndrome (SHS) after stroke in accordance with the clinical situation by expert argumentation in the best evidence systematically retrieved and screened for SHS after stroke with the method of Delphi expert consultation.Methods:According to the level of evidence, we systematically retrieved and screened relevant guidelines, evidence summary, systematic reviews, original studies and expert consensus. Two researchers who had received Joanna Briggs Institute (JBI) evidence-based training used the Appraisal of Guidelines for Research & Evaluation (AGREE) Ⅱ, JBI quality evaluation tools for systematic reviews, randomized controlled trials/experimental studies and expert consensus to evaluate the included guidelines, systematic reviews, original studies and expert consensus. The included literature was classified and summarized, and recommendations and conclusions related to SHS after stroke were screened and extracted. According to the results of the literature summary, the first draft of the clinical nursing standard for SHS after stroke was formed. Using the Delphi method, 25 experts in related fields were selected for two rounds of expert consultation to demonstrate the contents of the first draft.Results:This study included 8 guidelines including 1 evidence summary, 2 systematic reviews, 7 original studies and 2 expert consensus. The overall quality of the guidelines was Grade B; one piece of evidence summary was of good quality and was Grade B; the overall quality of two systematic reviews was low, and the overall quality of seven original studies was average. The first draft of the clinical nursing standard for SHS after stroke included 6 content frameworks and 29 recommendations. Two rounds of expert consultation were conducted, the questionnaire response rates were 89.28% and 100%, and the expert authority coefficients were 0.864 and 0.894, respectively. The Kendell's W of important content framework and recommended in the second round of expert consultation were 0.118 ( P<0.05) and 0.188 ( P<0.001) . According to the results of the expert consultation, the clinical nursing standard for SHS after stroke was formed, including 6 content frameworks and a total of 31 recommendations. Conclusions:The clinical nursing standard for SHS after stroke is based on the best available evidence and expert argumentation, which is in line with the clinical situation in my country and can be sed in clinical nursing work.

Objective: To study the value of unmethylated cytosine guanine dinucleotide oligodeoxynucleotide (DSP30) and IL-2 in the conventional cytogenetic (CA) detection of the chromosomal aberrations in chronic lymphocytic leukemia (CLL) . Methods: Bone marrow or peripheral blood cells of CLL patients were cultured with DSP30 plus IL-2 for 72 h, following which R-banding analysis was conducted. Fluorescence in situ hybridization (FISH) was performed in 85 patients. CA results were compared with data obtained by FISH. Results: Among 89 CLL patients, the success rate of chromosome analysis was 94.38% (84/89) . Clonal aberrations were detected in 51 patients (51/84, 60.71%) . Of them, 27 (27/51, 52.94%) were complex karyotype. Among 85 CLL patients tested by FISH, chromosomal abnormalities were detected in 74 (74/85, 87.06%) patients, of which 2 (2/74) patients were complex karyotypes, accounting for 2.70%. Of the 85 CLL patients examined by FISH, 50 had abnormal karyotype analysis, 30 had normal karyotype, 5 failed to have chromosome analysis. Among them, 25 cases showed clonal aberrations by FISH assay but normal by CA, and 4 cases were normal by FISH but displayed aberrations in chromosome analysis, and totally 78 (91.76%) cases with abnormality detected by the combination of the two methods. The frequency of 13q- abnormality detected by FISH was significantly higher than that by CA analysis (69.41%vs 16.67%, P<0.001) , while the frequency of 11q-,+12 and 17p- detected by two methods showed no significant difference (P>0.05) . The detection rate of complex abnormalities in conventional karyotype analysis was higher than that in FISH (50.98%vs 2.70%) . In addition, 11 low-risk and 9 intermediate-risk patients according to FISH results showed complex karyotype by cytogenetics, and were classified into high-risk cytogenetic subgroup. Conclusion DSP30 and IL-2 are effective in improving the detection rate of CA in CLL patients (60.71%) and CA is more effective to detect complex karyotype. However, FISH had a higher overall abnormality detection rate (87.06%) than CA, especially for 13q-. The combination of CA and FISH not only enhanced the detection rate of clonal aberrations to 91.76%, but also provided more precise prognosis stratification for CLL patients, thus to provide more information for clinical implication.

Nurse is one of the most common occupations in shift work. Due to the particularity of nursing work, shift work often causes nurses to suffer from shift work sleep disorders. It will not only lead to an increase in the risk of accidents in work, but also increase the incidence of nursing errors, and even seriously harm the physical and mental health of individual nurses. This paper reviews the prevalence, serious harm, related influencing factors and intervention measures of shift work sleep disorders among nurses at home and abroad, in order to expect nursing managers and nurses to raise their awareness and pay attention to shift work sleep disorders, thereby improving professional identity and happiness of nurses.

OBJECTIVE: To explore the clinical and laboratory characteristics of 5 patients with myeloid leukemia and t(12;22)(p13;q12). METHODS: Bone marrow cells were cultured for 24 h and analyzed by standard R-banding. Rearrangement of the MN1 gene was detected by fluorescence in situ hybridization (FISH) using dual color break-apart MN1 probes. MN1-ETV6 and ETV6-MN1 fusion genes were detected by reverse transcription polymerase chain reaction (RT-PCR). And the products were subjected to direct sequencing. RESULTS: Among the 5 patients, 2 had AML-M0, 2 had AML-M4, and 1 had CMML at the initial diagnosis. t(12;22)(p13;q12) was the primary abnormality among all patients. Rearrangements of MN1 gene were detected by FISH in all patients. MN1-ETV6 and ETV6-MN1 fusion genes were detected respectively in 4 and 3 patients. CONCLUSION t(12;22)(p13;q12) is a rare but recurrent chromosomal abnormality in myeloid leukemia, and is related to poor prognosis. allo-SCT is valuable for patients with t(12;22)(p13;q12).
Chromosome Banding ; Chromosomes, Human, Pair 12 ; Chromosomes, Human, Pair 22 ; Cytogenetics ; Humans ; In Situ Hybridization, Fluorescence ; Leukemia, Myeloid ; genetics ; Oncogene Proteins, Fusion ; Translocation, Genetic

Objective To build an evaluation index system of medical practitioners'competency for county-level public hospitals. Methods By means of the Iceberg Model based on competence and professionalism, and following two rounds of consultations of 47 experts, the evaluation indexes and weights of medical practitioners' competency were determined using SPSS frequency, mean, Kendall harmony coefficient and factor analysis. Three county-level public hospitals in Shaanxi province were selected for example verification of service competency. Results The evaluation index system of county-level public hospitals included 4 level-1 indexes and 16 level-2 indexes. The 4 level-1 indexes were diagnosis competency, treatment competency, communication competency and self-development competency. The weights of these indexes were 0.3,0.3,0.2 and 0.2 respectively. Conclusions Such hospitals should start with these competencies to strengthen the cultivation of medical practitioners' competency and constantly improve their comprehensive service level.

Objective To investigate current research in nursing interventions for shoulder-hand syndrome after stroke in Class Ⅲ Grade A hospitals in China.Methods Totally 215 nurses from the departments of neurology and rehabilitation of 6 Class Ⅲ Grade A hospitals from a municipality or provincial capital from 6 provinces,which scattered across the northern,northeastern,eastern,central and southern,southwestern and northwestern parts of China,were selected by convenient sampling between January and June 2016.The nurses were investigated with the self-designed Shoulder-hand Syndrome After Stroke Questionnaire.Totally 215 questionnaires were sent out,with 184 valid questionnaires collected.SPSS 21.0 software was used in data statistics.Results The 184 nurses' average scores in the dimension of attention to shoulder-hand syndrome after stroke was(4.38±0.59);and the score in reasonableness of nursing interventions for shoulder-hand syndrome after stroke was(3.98±0.88).Their scores in nursing knowledge related to patients with shoulder-hand syndrome was(48.50±16.67),and their scores in the dimensions in clinical manifestation,risk factors and interventions were(4.59±3.24),(2.67±3.90)and(4.06±1.21),respectively.The knowledge scores were sorted in descending order,and the top 3 scores were found in"nursing principles for shoulder-hand syndrome" "best period of rehabilitation training for shoulder-hand syndrome" and "observation points of affected extremities".Conclusions The nurses' attention to and knowledge about shoulder-hand syndrome after stroke is not enough.There is a lack of standards or guidelines for shoulder-hand syndrome.The process of nursing interventions for shoulder-hand syndrome is not reasonableenough and the nursing processes are not fully implemented.Therefore,nursing processes need to be further standardized.