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ObjectiveTo observe the effects of the kidney-tonifying and blood-activating prescription on the Wnt/β-catenin signaling pathway and uterine spiral artery remodeling in a mouse model of recurrent miscarriage and to explore its underlying mechanism. MethodA mouse model of normal pregnancy was established by mating CBA/J mice with BALB/c mice. A mouse model of recurrent miscarriage was established by mating CBA/J mice with DBA/2 mice. The modeled mice of recurrent miscarriage were randomized into model， dydrogesterone， and low- and high-dose Chinese medicine groups. The mice in normal pregnancy were used as the control group. Each group consisted of 10 mice， and the drug administration lasted for 14 days. After the treatment， the embryo absorption rate of each group was recorded. Hematoxylin-eosin （HE） staining was employed to observe the pathological morphology of the uterine decidua， and the physiological transformation rate of spiral arteries （SPA） was evaluated. Real-time polymerase chain reaction （Real-time PCR） and Western blot were performed to determine the mRNA and protein levels， respectively， of matrix metalloproteinases （MMP）-2， MMP-9， vascular endothelial growth factor （VEGF）， and Wnt/β-catenin signaling pathway. ResultCompared with the control group， the model group presented increased embryo absorption rate （P<0.05）， decreased physiological transformation rate of uterine SPA （P<0.05）， cellular swelling， degeneration， and disordered arrangement in the uterine decidua tissue， and down-regulated mRNA and protein levels of key factors involved in SPA remodeling （MMP-2， MMP-9， VEGF） and the Wnt/β-catenin signaling pathway （Wnt2， β-catenin， Cyclin D1， c-Myc） （P<0.05）. Compared with the model group， both the low- and high-dose Chinese medicine reduced embryo absorption rate （P<0.05）， increased SPA physiological transformation rate （P<0.05）， improved uterine decidua tissue morphology， and increased decidua vessel count. Furthermore， they up-regulated the mRNA and protein levels of MMP-2， MMP-9， VEGF， and proteins in the Wnt/β-catenin signaling pathway （P<0.05）. ConclusionRecurrent miscarriage is associated with impaired uterine spiral artery remodeling. The kidney-tonifying and blood-activating prescription can promote uterine spiral artery remodeling by activating the Wnt/β-catenin signaling pathway and promoting the expression of VEGF， MMP-2， and MMP-9， thus treating recurrent miscarriage.
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Objective:To analyze the distribution of ages at the interhospital transfer of outborn very preterm infants in China and to compare their perinatal characteristics and outcomes at discharge and neonatal intensive care unit (NICU) treatment.Methods:A total of 3 405 outborn very premature infants with a gestational age of 24-31 +6 weeks who were transferred to the NICUs of the Chinese Neonatal Network (CHNN) in 2019 were included in this retrospective study. According to the age at transfer, they were divided into three groups: early transfer (≤1 d), delayed transfer (>1-7 d) and late transfer (>7 d) groups. Analysis of variance, t-test, Chi-square test (Bonferroni correction), Kruskal-Wallis test and Wilcoxon rank-sum test were used to compare the general clinical condition, treatment, and outcomes at discharge among the three groups. Results:The median gestational age was 29.7 weeks (28.3-31.0 weeks) and the average birth weight was (1 321.0 ± 316.5) g for these 3 405 infants. There were 2 031 patients (59.6%) in the early transfer group, 406 (11.9%) in the delayed transfer group and 968 (28.4%) in the late transfer group. Infants who received continuous positive airway pressure ventilation and tracheal intubation in the delivery room accounted for 8.4% (237/2 806) and 32.9% (924/2 805), respectively. A total of 62.7% (1 569/2 504) of the mothers received antenatal glucocorticoid therapy and the ratio in the early transfer group was 68.7% (1 121/1 631), which was higher than that in the delayed transfer group [56.1% (152/271), χ2=16.78, P<0.017] and the late transfer group [49.2% (296/602), χ2=72.56, P<0.017]. The total mortality rate of very premature infants was 12.7% (431/3 405), and the mortality rates in the early, delayed and late transfer groups were 12.4% (252/2 031), 16.3% (66/406) and 11.7% (113/968), respectively ( χ2=5.72, P=0.057). The incidences of severe intraventricular hemorrhage, late-onset sepsis, necrotizing enterocolitis, and bronchopulmonary dysplasia at the corrected gestational age of 36 weeks or discharge were all higher in the delayed and late transfer groups than in the early transfer group, respectively. The incidences of retinopathy of prematurity, retinopathy of prematurity requiring treatment and bronchopulmonary dysplasia at the corrected gestational age of 36 weeks or discharge in the late transfer group were significantly higher than that in the delayed transfer group (Bonferroni correction, all P<0.017). In the late transfer group, the median age of very premature infants at discharge was 66.0 d (51.0-86.0 d), and the corrected gestational age at discharge was 38.9 weeks (37.1-41.2 weeks), and both were greater than those in the early transfer [48.0 d (37.0-64.0 d), Z=260.83; 36.9 weeks (35.7-38.3 weeks), Z=294.32] and delayed transfer groups [52.0 d (41.0-64.0 d), Z=81.49; 37.4 weeks (36.1-38.7 weeks), Z=75.97] (all P<0.017). Conclusions:Many very premature infants need to be transferred to higher-level hospitals after birth. The later the very premature infants are transferred, the higher the incidence of complications will be. It is suggested that intrauterine or early postnatal transport may improve the prognosis of very premature infants.
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Objective:To analyze the clinical features, treatment, and outcomes of fetal/neonatal atrial flutter (AFL) at the onset of the perinatal period to improve the management of this condition.Methods:This retrospective study analyzed the clinical data, treatment, and follow-up results of fetal/neonatal AFL cases transferred to Shanghai Children's Medical Center from November 2013 to August 2021. Clinical characteristics, cardioversion procedures, and outcomes were summarized. Descriptive method was used for statistical analysis.Results:A total of 21 fetuses/neonates presenting with AFL in the perinatal period were involved in this study, including 17 males and four females. Ten of them were born at full term, and 11 were preterms. All of the patients were delivered by cesarean section at 32 to 41 gestational weeks [ (36.6±1.9) weeks] with a birth weight of 2 130 to 4 450g [ (3 059±528) g]. Increased fetal heart rate was all detected after 32 weeks of gestation, and three of them were diagnosed with AFL by fetal echocardiography before being born. The heart rate remained elevated in all cases after birth. All were diagnosed as AFL based on an electrocardiogram on the day of birth, which showed a 2 to 6 over one ratio of atrioventricular conduction. Among the six cases of cardiac insufficiency and low blood pressure complicated by dyspnea and cyanosis, the symptoms were relieved in four cases after mask oxygenation and two cases after ventilation. Among the 21 cases, one was converted spontaneously to normal sinus rhythm and the other 20 recovered after medication or electrical cardioversion. Seven cases were initially treated by drug conversion with a success rate of 5/7 and hospitalized for 23 d (13-25 d). There was one with cardiac insufficiency before treatment and three newly developed cardiac insufficiency during treatment among the seven cases. Thirteen cases were offered electrical cardioversion initially, and the success rate of cardioversion was 12/13. There were five cases of cardiac insufficiency before treatment, while no new cases of cardiac insufficiency was reported during treatment. The duration of hospitalization was 11 d (9-14 d). Apart from one case, the rest 20 infants were followed up from one month to eight years old, and no recurrence was reported.Conclusions:For fetal/neonatal AFL with the onset during the perinatal period, the symptoms mainly manifest in late pregnancy. Its diagnosis depends on fetal echocardiography before birth or electrocardiogram after birth, and electrical cardioversion is a fast and effective measure. While the prognosis of perinatal-onset AFL is generally good.
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BACKGROUND@#Antenatal corticosteroids (ACS) can significantly improve the outcomes of preterm infants. This study aimed to describe the ACS use rates among preterm infants admitted to Chinese neonatal intensive care units (NICU) and to explore perinatal factors associated with ACS use, using the largest contemporary cohort of very preterm infants in China.@*METHODS@#This cross-sectional study enrolled all infants born at 24 +0 to 31 +6 weeks and admitted to 57 NICUs of the Chinese Neonatal Network from January 1st, 2019 to December 30th, 2019. The ACS administration was defined as at least one dose of dexamethasone and betamethasone given before delivery. Multiple logistic regressions were applied to determine the association between perinatal factors and ACS usage.@*RESULTS@#A total of 7828 infants were enrolled, among which 6103 (78.0%) infants received ACS. ACS use rates increased with increasing gestational age (GA), from 177/259 (68.3%) at 24 to 25 weeks' gestation to 3120/3960 (78.8%) at 30 to 31 weeks' gestation. Among infants exposed to ACS, 2999 of 6103 (49.1%) infants received a single complete course, and 33.4% (2039/6103) infants received a partial course. ACS use rates varied from 30.2% to 100% among different hospitals. Multivariate regression showed that increasing GA, born in hospital (inborn), increasing maternal age, maternal hypertension and premature rupture of membranes were associated with higher likelihood to receive ACS.@*CONCLUSIONS@#The use rate of ACS remained low for infants at 24 to 31 weeks' gestation admitted to Chinese NICUs, with fewer infants receiving a complete course. The use rates varied significantly among different hospitals. Efforts are urgently needed to propose improvement measures and thus improve the usage of ACS.
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Humans , Infant, Newborn , Infant , Pregnancy , Female , Gestational Age , Infant, Premature , Intensive Care Units, Neonatal , Cross-Sectional Studies , Adrenal Cortex Hormones/therapeutic useABSTRACT
Objective:To summarize the nursing care measures of a patient after spinal orthopedic surgery for spinal muscular atrophy type Ⅱ.Methods:The patient was provided with a goal-directed pulmonary rehabilitation nursing program during ICU resuscitation by exercise pulmonary function, monitor difficult airway extubation and alleviating anxiety.Results:The patient postoperative pulmonary function recovered well, the difficult airway was extubated smoothly and the anxiety was relieved. The patient was discharged from the hospital on the 17th day after the operation.Conclusions:Goal-directed pulmonary care can help promote pulmonary rehabilitation and improve the quality of patient survival after orthopedic surgery for spinal muscular atrophy typeⅡ.
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Objective:To systematically evaluate the dose-response relationships of resistance exercise intensity in frail elderly.Methods:A comprehensive search of randomized controlled trials on the dose-response relationships of resistance exercise for frail elderly in PubMed, Embase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Database. The documents that met the conditions were screened out, and after the data were extracted and the quality of the documents were evaluated, the RevMan 5.3 software was used for Meta analysis.Results:A total of 10 eligible randomized controlled trials were included in this study. The subjects of the study were 454 cases of frail and pre-frail elderly. After Meta analysis, there was a dose-response relationships between the training intensity of resistance exercise and the muscle strength, muscle endurance, and physical function of frail elderly. Both low-intensity and high-intensity resistance exercises can significantly increase the leg muscle strength of frail elderly people ( MD=4.58, 95% CI 3.34-5.82, P<0.05) and muscle endurance ( MD=12.27, 95% CI 6.54-17.99, P<0.05). Compared with low-intensity resistance exercise, high-intensity resistance exercise increased leg muscle strength of frail elderly people ( MD=7.97, 95% CI 0.85-15.09, P<0.05) and muscle endurance ( MD=6.94, 95% CI 5.21-8.66, P<0.05) showed more obvious advantages. The analysis of the results of the chair sitting test and the stairs climbing test shows that low-intensity resistance exercise has no obvious advantage in improving the physical function of frail elderly people, while high-intensity resistance exercise can significantly improve the physical function of frail elderly people ( MD=-5.8, 95% CI -7.3--4.29, P<0.05; MD=-1.20, 95% CI-2.17--0.23, P<0.05). Conclusions:Resistance exercise can significantly improve the muscle strength, muscle endurance and physical function of the frail elderly. High-intensity resistance exercise is more effective than low-intensity resistance exercise.
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Infection is one of the most serious diseases during the neonatal period and the leading cause of neonatal death.Early virus detection is particularly important in the vulnerable infants hospitalized in modern, family centered NICUs.These units bear increasing risks of virus transmission as they provide kangaroo care, 24 hour visiting policies, and are not only open to parents and siblings, but do also encourage their involvement.Due to the atypical clinical features, susceptibility to mixed viral-bacterial infection, lower positive rate of detection, non-specific treatment options, and causing short-term as well as long-term complications or even death if the infection is severe.Thus, it is very important to recognize respiratory virus infection early to prevent and control its spread in neonatal wards.This article aimed to elaborate the susceptibility factors, common pathogens, detection methods and the management of prevention, and control of neonatal respiratory virus infection.
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Objective:To study the predictive value of hour-specific total serum bilirubin(TSB) nomogram combined with clinical risk factors in the risk of hyperbilirubinemia.Method:Perinatal clinical data of newborns born in Shanghai Pudong New Area Health Care Hospital for Women and Children, Shanghai Pudong New Area People's Hospital and Shanghai Pudong Hospital from August 2017 to July 2018 were collected in this prospective study. Transcutaneous bilirubin (TcB) was monitored before discharge from hospital. Enrolled neonates were followed up for 28 days. The patients were assigned to neonatal hyperbilirubinemia group (NHB) and non-hyperbilirubinemia group (Non-HB) according to the occurrence of hyperbilirubinemia. The predictive value of models for the risk of hyperbilirubinemia was evaluated by receiver operating characteristic (ROC) curves and Logistic regression analysis.Result:A total of 8 664 newborns were included in this study, with 1 196 cases of hyperbilirubinemia, with an incidence of 13.8%. Logistic regression analysis showed that maternal blood type O, premature rupture of membranes, male gender, gestational age 35~37 weeks, subcutaneous ecchymosis/cranial edema, and breastfeeding were independent risk factors for NHB ( P<0.05). The area under receiver operative characteristic curve (ROC) of predischarge bilirubin risk zone only was 0.874(95% CI 0.861~0.885, P<0.05)and for all independent risk factors was 0.664 (95% CI 0.647~0.680, P<0.05). The area under ROC curve was 0.891 (95% CI 0.880~0.902, P<0.05) by combining predischarge bilirubin risk zone with clinical risk factors. Conclusion:Predischarge bilirubin risk zone combined with clinical risk factors can reasonably predict neonatal hyperbilirubinemia well.
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Objective:To analyze the correlation between capillary filling time (CRT) and lactate clearance rate in patients with septic shock, so as to provide reference for the clinical application of CRT in patients with septic shock.Methods:A prospective study was conducted on 70 patients with septic shock. CRT, mean arterial pressure (map) and sequential organ failure (SOFA) score, Acute Physiology and Chronic Health Evaluation Scoring System (APACHE Ⅱ) score, mechanical ventilation and lactate clearance rate were collected at 3 sites (forehead, knee and nail bed) respectively at 2 time points after admission and 6 hours after admission. The correlation between CRT changes and lactate clearance rate was compared.Results:When lactate clearance rate of more than 10% in 6 hours, the Pearson coefficients of the three sites were 0.823 for nail bed ( P<0.05), 0.232 for forehead and 0.254 for knee ( P>0.05). When lactate clearance rate of less than 10% in 6 hours, the Pearson coefficients of the three sites were 0.299 for nail bed, 0.247 for forehead and 0.254 for knee ( P>0.05). Conclusion:When lactate clearance rate of more than 10% in 6 hours, there is a good correlation between the CRT of nail bed and the lactate clearance rate of patients. The CRT of nail bed can be a practical tool for clinical evaluation of microcirculation.
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Objective@#To analyze the epidemiological history, clinical manifestations, treatment and the short-term prognosis of 31 cases of 2019 novel coronavirus(2019-nCoV) infection in children from six provinces (autonomous region) in northern China.@*Methods@#A retrospective analysis of the epidemiological history, clinical symptoms, signs, laboratory examinations, chest imaging, treatment and the short-term prognosis of 31 cases of 2019-nCoV was conducted. The patients were diagnosed between January 25th, 2020 and February 21st, 2020 in 21 hospitals in 17 cities of six provinces(autonomous region) of Shaanxi, Gansu, Ningxia, Hebei, Henan and Shandong.@*Results@#The age of the 31 children with 2019-nCoV infection was 7 years and 1 month (6 months -17 years). Nine cases (29%) were imported cases. Other 21 cases (68%) had contact with confirmed infected adults. One case (3%) had contact with asymptomatic returnees from Wuhan. Among the 31 children, 28 patients (90%) were family cluster cases. The clinical types were asymptomatic type in 4 cases (13%), mild type in 13 cases (42%), and common type in 14 cases (45%). No severe or critical type existed. The most common symptom was fever (n=20, 65%), including 1 case of high fever, 9 cases of moderate fever, 10 cases of low fever. Fever lasted from 1 day to 9 days. The fever of fifteen cases lasted for ≤3 d, while in other 5 cases lasted > 3 d. Other symptoms included cough (n=14, 45%), fatigue (n=3, 10%) and diarrhea (n=3, 9%). Pharyngalgia, runny nose, dizziness, headache and vomiting were rare. In the early stage, the total leukocytes count in peripheral blood decreased in 2 cases (6%), the lymphocytes count decreased in 2 cases (6%), and the platelet count increased in 2 cases (6%).Elevation of C-reactive protein (10%, 3/30), erythrocyte sedimentation rate(19%,4/21), procalcitonin(4%,1/28), liver enzyme(22%, 6/27) and muscle enzyme (15%, 4/27) occurred in different proportions. Renal function and blood glucose were normal. There were abnormal chest CT changes in 14 cases, including 9 cases with patchy ground glass opacities and nodules, mostly located in the lower lobe of both lungs near the pleural area. After receiving supportive treatment, the viral nucleic acid turned negative in 25 cases within 7-23 days. Among them, 24 children (77%) recovered and were discharged from hospital. No death occurred.@*Conclusions@#In this case series, 2019-nCoV infections in children from six provinces (autonomous region) in northern China are mainly caused by close family contact. Clinical types are asymptomatic, mild and common types. Clinical manifestations and laboratory examination results are nonspecific. Close contact history of epidemiology, nucleic acid detection and chest imaging are important bases for diagnosis. After general treatment, the short-term prognosis is good.
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Objective@#To explore the visuospatial memory characteristics of school-age children with exotropia and to analyze associated factors.@*Methods@#Based on a case-control study,45 exotropia children aged 8-12 years and 45 normal control children were recruited from 2017-2019. The "tapping test" was used to evaluate the visuospatial short-term and working memory of children.@*Results@#There was no significant differences in the scores of visuospatial short-term memory between the exotropia group and the control group [(7.64±1.69)(8.00±1.66)，t=-1.00，P=0.32)]. The scores of visuospatial working memory in the control group were higher than those in the exotropia group [(5.98±1.23)(6.80±1.53)，t=-2.81，P=0.01)]. In the reverse tapping test,the better the near stereopsis was,the higher the score was (B=0.78,95%CI=0.23-1.33,P=0.01),and the constant exotropia children performed better than the intermittent exotropia children(B=1.25,95%CI=0.16-2.24,P=0.03).@*Conclusion@#Visuospatial working memory is impaired in school-age children with exotropia,and the visuospatial working memory of exotropia children is affected by the near stereopsis and exotropia constancy.
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Objective:To explore the effect of nursing team leader rotation in ICU nursing team, so as to provide reference for optimizing the allocation of nursing human resources, promoting the cooperation of nursing team and improving the quality of nursing care.Methods:The ICU nursing team leader rotation was implemented from October 2018 to June 2019, semi-structured interview method was used to understand the feeling and experience of medical staff in the department on team cooperation, workflow, nursing quality and other aspects after the implementation of the rotation, so as to evaluate the effectiveness.Results:According to the results of interviewing, by implementing the nursing team leader after rotation, most staff feel the improvement of care team, as well as the enthusiasm of learn and work. The new leader′ ability is got promoted, former leader feeled working pressure eased, some medical workers think that nursing quality was not affected, and there performance appraisal was reduced in an acceptable range.Conclusion:The implementation of the nursing team leader rotation may be able to improve teamwork, work enthusiasm,and the ability of overall leader team, alleviate the workload, future studies could evaluate its specific effect by quantitative indicators, and discusses the impact on the quality of care and patient outcomes, to further explore the feasibility and effectiveness of the system.
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Objective:By building a patient safety oriented nursing-sensitive indicator system, this study aimed to help clinical evaluation and nursing for patients in prone position, to constantly optimize management of prone position and promote patient safety.Methods:First drew up initial indicators through literature search and personal interviews, then modified and finally formed the prone position nursing indicators within two rounds of experts consultation. Verified the indicators by evaluating nursing staff satisfaction after half-year′s implementation.Results:Finally, the indicator system included 9 first level, 13 second level and 71 third level indicators. The reliability of experts and the satisfaction of nurses were both high.Conclusions:With the purpose of patient safety, the nursing indicator system of prone position ventilation for critically ill patients are comprehensively covered ever aspect of key component. Specific effect needs to be further verified in the hospital management practice.
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Objective:We reported nursing care of a patient with postpartum cardiomyopathy treated by extracorporeal membrane oxygenation (ECMO) combined with intra-aortic balloon pump (IABP), continuous renal replacement therapy (CRRT) and prone position ventilation.Methods:Multidisciplinary cooperation was made to guide the monitor of patients' condition. Refined integrated management measures of multi-equipment were adopted and standardized management process was formulated. Strict requirements were made in treatment and nursing care to prevent hospitalized infection, humanistic care and rehabilitation exercise were conducted to improve patient′s quality of life.Results:After 47 days of nursing care, the patient′s vital signs were stable, the condition was improved and then discharged.Conclusions:Close observation under the guidance of multiple disciplines is an important prerequisite for the treatment. Integrative management of multi-equipment, strict control of hospitalized infection, humanistic care and rehabilitation exercise can effectively improve the prognosis and quality of life of perinatal cardiomyopathy patient.
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Objective:To establish a practical framework for critical ultrasonography to provide a basis for clinical practice.Methods:With reference to domestic and foreign literature, expert interviews and research groups developed a preliminary draft of the practice framework for critical ultrasonography, and conducted two rounds of consultation using the Delphi method.Results:A practical framework for critical ultrasonography was developed, including 5 primary indicators and 20 secondary indicators. In the two rounds of expert consultation, the expert′s positive coefficient was 100% and the authoritative coefficient was 0.836.Conclusions:Expert opinion has good coordination and high authority, which can provide clinical basis for ICU nurses to carry out ultrasound examination.
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Objective@#To establish a practical framework for critical ultrasonography to provide a basis for clinical practice.@*Methods@#With reference to domestic and foreign literature, expert interviews and research groups developed a preliminary draft of the practice framework for critical ultrasonography, and conducted two rounds of consultation using the Delphi method.@*Results@#A practical framework for critical ultrasonography was developed, including 5 primary indicators and 20 secondary indicators. In the two rounds of expert consultation, the expert′s positive coefficient was 100% and the authoritative coefficient was 0.836.@*Conclusions@#Expert opinion has good coordination and high authority, which can provide clinical basis for ICU nurses to carry out ultrasound examination.
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Objective@#We reported nursing care of a patient with postpartum cardiomyopathy treated by extracorporeal membrane oxygenation (ECMO) combined with intra-aortic balloon pump (IABP), continuous renal replacement therapy (CRRT) and prone position ventilation.@*Methods@#Multidisciplinary cooperation was made to guide the monitor of patients' condition. Refined integrated management measures of multi-equipment were adopted and standardized management process was formulated. Strict requirements were made in treatment and nursing care to prevent hospitalized infection, humanistic care and rehabilitation exercise were conducted to improve patient′s quality of life.@*Results@#After 47 days of nursing care, the patient′s vital signs were stable, the condition was improved and then discharged.@*Conclusions@#Close observation under the guidance of multiple disciplines is an important prerequisite for the treatment. Integrative management of multi-equipment, strict control of hospitalized infection, humanistic care and rehabilitation exercise can effectively improve the prognosis and quality of life of perinatal cardiomyopathy patient.
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Objective@#To develop a reasonable performance evaluation index system for ICU nursing workload based on the hospital information system and the "structure-process-result" model.@*Methods@#The preliminary indicators of ICU nurses' performance appraisal system were constructed by the research group. Delphi method was used for expert consultation to evaluate the importance of the indicators of the performance appraisal system. After summarizing, sorting out and modifying the expert opinions, the performance appraisal index system of ICU nurses was obtained. SPSS 19.0 software is used to describe the importance of experts' evaluation of indicators at all levels, such as mean, standard deviation, coordination coefficient of experts' opinions and degree of coordination.@*Results@#The effective recovery rate of expert consultation papers was 100%. In the first round of inquiry, the average of importance assignment was 2.05-5.00, the average of rationality assignment was 2.13-5.00, and the average of importance assignment in the second round was 4.57-5.00. The average of rationality assignment was 4.71-5.00. The coefficient of variation of all levels of indicators in the first round was 0.02-0.18, the coefficient of variation in the second round was 0.02-0.12, which was less than 0.2, the positive coefficient of experts was 100%, and the authoritative coefficient of experts in the second round was 0.86 and 0.88. After two rounds of Delphi expert consultation, the ICU nurses' performance appraisal index system was finally formed, including three first-level indicators and 37 second-level indicators.@*Conclusion@#This study is based on the information system, according to the "structure-process-result" model, using the expert consultation method to construct the ICU nursing workload performance assessment index system, and establish the weight of each index, the research results are helpful to further improve the performance appraisal system of ICU nursing staff and improve the scientific management level of ICU.
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Objective@#To explore the genetic cause for abnormal pregnancies through detecting chromosomal copy number variations (CNVs) in abortic tissues by next generation sequencing (NGS).@*Methods@#NGS technique was used to detect CNVs in abortion tissues. Parental chromosomal karyotypes were predicted based on the results. The aberrant chromosomal segments of the parents were accurately mapped by G-banding karyotyping analysis and fluorescence in situ hybridization (FISH).@*Results@#In addition to numerical chromosomal aberrations, 12 microdeletion/microduplications were detected by NGS. For 8 families where both parents accepted chromosomal karyotyping, 4 carriers of chromosomal abnormalities were identified. One marker chromosome was missed by karyotyping analysis, and a mother was confirmed to carry a cryptic balanced translocation by FISH.@*Conclusion@#NGS can facilitate detection of cryptic chromosomal translocations in couples with repeated pregnancy failure and is of great value for detecting abnormal CNVs for its high sensitivity.
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Objective@#To describes and compare the effect of humidity heat exchanger and ultrasound on artificial airway patients in a hospital at high altitude.@*Methods@#The patients with artificial airway admitted to the People's Hospital of Tibet Autonomous Region from August to December 2017 were divided into two groups according to the time of admission. A total of 125 patients in the humid heat exchanger group were humidified by the humid heat exchanger during the offline process. In the ultrasonic humidification group, 106 patients underwent airway humidification with an ultrasonic humidifier during weaning. After 24, 48 and 72 hours offline, sputum viscosity, eschar formation, airway temperature, PaO2 and PaCO2 were investigated.@*Results@#Before humidification, 1 day after humidification, 2 days after humidification and 3 days after humidification, the proportion of first degree sputum in the ultrasonic humidification group was 77.36% (82/106), 80.19% (85/106), 95.28% (101/106) and 99.06% (105/106), respectively. In the heat-moisture exchange group, 99.20% (124/125), 99.20% (124/125), 95.20% (119/125), 72.80% (94/125), respectively. There were differences between the two groups before, 1 day and 3 days after humidification. There was statistical significance (χ2= 28.35, 24.06, 28.75, P < 0.01). There was no significant difference in PaCO2 between the two groups (P > 0.05). PaO 2 in the two and three days after humidification was (92.62 ± 5.76), (91.34 ± 4.85) mmHg, which was lower than that in the ultrasonic humidification group (97.38 ± 5.55), (99.16 ± 5.43) mmHg. There were significant differences between the two groups (t= 6.367, 11.558, P < 0.01). There were significant differences between the two groups (t=6.367, 11.558, P < 0.01).@*Conclusions@#The rate of eschar formation was higher in the wet heat exchanger group, and the frequency of sputum suction was higher in the ultrasonic wetting group.