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Objective:To investigate the pathological spectrum and variation of adult renal biopsies in People's Hospital of Xinjiang Uygur Autonomous Region from 1986 to 2020.Methods:The pathological data of 5 652 adult renal biopsies from August 1986 to December 2020 were retrospectively collected, and characteristics of pathological spectrum were analyzed. Regarding every 5 years as a research stage, the whole period was divided into 7 stages to analyze the pathological features and variation of renal biopsies. The first stage (P1) started from August 1986 to December 1990. The second stage (P2) started from January 1991 to December 1995. The third stage (P3) started from January 1996 to December 2000. The fourth stage (P4) started from January 2001 to December 2005. The fifth stage (P5) started from January 2006 to December 2010. The sixth stage (P6) started from January 2011 to December 2015. The seventh stage (P7) started from January 2016 to December 2020.Results:The age was (36.47±14.86) years old (18-83 years old) in 5 652 renal biopsies. There were 2 961 males (52.39%). There were 5 636 cases of autologous kidney biopsy and 16 cases of transplanted kidney biopsy. The descending order of incidence classified by disease types were primary glomerular disease (PGD, 4 470 cases, 79.31%), secondary glomerular disease (SGD, 994 cases, 17.64%), tubular-interstitial disease (160 cases, 2.84%), and hereditary nephropathy (12 cases, 0.21%). IgA nephropathy (IgAN, 1 573 cases, 35.19%) was the most frequent pathologic type of PGD, followed by membranous nephropathy (MN, 1 028 cases, 23.00%), mesangial proliferative glomerulonephritis (MsPGN, 878 cases, 19.64%), minimal change disease (MCD, 427 cases, 9.55%), and focal segmental glomerulosclerosis (345 cases, 7.72%). Lupus nephritis (LN, 251 cases, 25.25%) was the most common type of SGD, followed by hypertension nephropathy (193 cases, 19.42%), diabetic kidney disease (168 cases, 16.90%), purpura nephritis (138 cases, 13.88%), and ischemic nephropathy (90 cases, 9.05%). IgAN was the most common type of primary glomerulonephritis and mainly occurred in the age group of 18-59 years old. PGD was the most common glomerular disease in Han nationality (78.33%), Uygur nationality (81.72%) and other ethnic (77.15%) groups. Using Bonferroni correction method, the incidence of PGD in Uygur nationality was higher than that in Han nationality ( P<0.017). From P1 to P7, the detection rates of MN and MCD were increased in common renal pathological types, meanwhile, the ratio of MsPGN was decreased (all P<0.05). From P5 to P7, the detection rates of MN in Han nationality and Uygur nationality increased in the common pathological types of PGD, meanwhile, the ratio of MsPGN decreased (all P<0.05). LN was the most common SGD. The incidence of LN in females was higher than that in males ( P<0.001). Using Bonferroni correction method, the incidence of SGD in Uygur nationality was lower than that in Han nationality ( P<0.017). There was no significant variation in the common pathological type of SGD in Han and Uygur nationalities. Chronic rejection was the main pathological type of transplanted kidney biopsies. Conclusions:PGD is the main type of kidney disease spectrum in People's Hospital of Xinjiang Uygur Autonomous Region. IgAN is the most common PGD and mainly occurrs in the age group of 18-59 years old. As time goes by, the proportion of MN and MCD is increased, meanwhile the proportion of MsPGN is decreased significantly. LN is the most common SGD.
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Objetive To study the value of urinary neutrophil gelatinase associated lipocalin (NGAL) in predicting carotid atherosclerosis in elderly type 2 DM patients.Methods Two hundred and twenty-five elderly type 2 DM patients were divided into urinary NGAL≤42 ng/mg group (n=100) and urinary NGAL＞42 ng/mg group (n=125).Their clinical data were retrospectively analyzed.Risk factors for carotid atherosclerosis were recorded.The value of risk factors in predicting carotid atherosclerosis was assessed according to the area under the ROC curve.Results The incidence of carotid atheroslerotic plaques was significantly lower in urinary NGAL≤42 ng/mggroup than in urinary NGAL＞42 ng/mg group (32.0％ vs 57.8％,P＜0.05).Age,NGAL,urinary microalbumin/creatinine (ACR),LDL-C,TC,hypertension were positively related with carotid atherosclerosis (P＜0.05) and eGFR was negatively related with carotid atherosclerosis (P＜0.05).Urinary NGAL and ACR were two risk factors for carotid atherosclerosis after adjustment for age,hypertension,hyperlipidemia,and eGFR (P＜0.05).The area under the ROC curve for predicting carotid atherosclerosis was 0.87 and 0.78 respectively.Conclusion Urinary NGAL is an independent risk factor for carotid atherosclerosis in type 2 DM patients.The accuracy of urinary NGAL is higher than that of urinary ACR in predicting carotid atherosclerosis.
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Objective To identify the high-touched object surface in different special intensive care units(ICUs) through the observation and statistical analysis on the number of touching with common object surfaces in different ICUs, so as to provide basis for hospital environmental management.Methods Direct observation method was used to observe the daily activities of health care workers, the number of touching with various common object surfaces was recorded, Poisson distribution was adopted to statistically analyze the data.Results The average number of touching from high to low was as follows : medical record folder(n=28.00), chair(n=18.38), emergency rescue cart(treatment cart, n=17.29), bed surface(n=13.90), intravenous infusion line(n=13.76), medical pen(n=13.38), and intravenous transfusion pump(n=11.81), these objects accounted for 64.01% of all surface touching number.Different special ICUs were slightly different, general ICU high-touch object included the first 6 categories;cardiothoracic surgery ICU included the above 7 categories besides keyboard and mouse;internal medicine ICU included the first 6 categories and mobile phone.Conclusion High-touched object surface varied with different special ICUs of the same hospital, hospital should make the corresponding disinfection management measures according to the actual situation of high-touched surface of each department, so as to reduce the incidence of healthcare-associated infection.
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Objective To construct an scientific quality evaluation system of master academic dis-sertation in post graduates majored in professional clinical medicine, which provides the basis for measuring the level of scientific research and the quality of graduates. Method a preliminary evaluation index system of master academic dissertation in post graduates majored in professional clinical medicine was established by literature review, expert interview and panel discussion, and the given indexes were conducted on the clinical and medical education experts by a two-round Delphi methods. Result According to the character-istics of the graduate training, combined with expert opinion, 6 primary indexes, 18 secondary indexes and 42 third-level indexes were contained. With calculating the weight of all levels of indicators, the final quality evaluation system of master academic dissertation in post graduates majored in professional clinical medicine was built. Conclusion The system is a highly scientific index system and reliable, which can reflect and emphasize the master's requirements and characteristics of the training, so as to be used as a measuring stan-dard for evaluating master academic dissertation in post graduates majored in professional clinical medicine.
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Since participating in the clinical skills competition, the hospital has made consid-erable progress in the clinical practice teaching equipment, teachers, atmosphere and standards. This paper aims to explore the significance of competition to promote clinical practice teaching and sug-gests that under the existing conditions, we should improve the clinical skills curriculum and assess-ment, establish training standards, improve the level of clinical practice teaching, to give comprehen-sive support for cultivating excellent medical talents.
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Objective To sum up the status and existing problems of standardized training of resident physician in China,and to promote residency standardized training.Methods With essayas retrieving items,resident + standardization training as the search term,all relevant papers published in CNKI from January 2004 to January 2014 with a title containing residency standardized training were reviewed.By means of literature analysis,the literature in 8 aspects was classified including the year of publication,status of journal,training base selection conditions,training objects and training time,content,specialist fields,management,assessment methods and shortages.Excel was used to make descriptive analysis of the results.Results After elimination,we took 152 papers as experimental group.In detail,12 literatures about training base selection conditions demonstrated that the level and type of hospital was the main criteria for training base;28 literatures about training objects and training time indicated that trainees were oriented to the pattern of 5+3,the latitude of PhD and Masters could be decreased properly; 36 literatures about training content focused on clinical skills and expertise.Only 19 literatures was concerned with specialist fields,which needed enriching.12 articles about management implemented management of supervisor responsibility system.22 literatures about the assessment method recommend that priority should be given to clinical skills examination to explore the hospital problems of resident standardization training.Conclusion The standardized training of resident physician has been carried out in China,but there are still some problems which need to be further improved.
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Objective To investigate the prognostic significance of serum cystatin C in multiple myeloma (MM).Methods 160 cases of newly diagnosed MM patients with average age of 61.38 years old.Determine the levels of serum cystatin C,serum creatinine,β 2-microglobulin,lactate dehydrogenase and hemoglobin before the treatment; median follow-up of 38 months,observe the relationship between serum cystatin C with overall survival (OS) and event-free survival (EFS).Results Median serum cystatin C level in 160 MM patients was higher than that in the 80 healthy controls [(0.96 ± 0.32) mg/L vs (0.71 ± 0.16) mg/L,P ＜ 0.000].All the patients in ISS stage were divided into 3 stages.Median serum cystatin C levels significantly increased in higher ISS stages [stage Ⅰ (0.70±0.13) mg/L,stage Ⅱ (0.87±0.16) mg/L,stage Ⅲ(1.23±0.33) mg/L (P ＜ 0.05)],serum cystatin C level was positively correlated with levels of serum creatinine (r =0.669,P ＜ 0.000),β2-microglobulin (r =0.672,P ＜ 0.000).lactate dehydrogenase (r =0.521,P ＜ 0.000),and negatively correlated with hemoglobin levels (r =-0.436,P ＜ 0.000).Using ROC analysis,patients with serum cystatin C levels ＞ 0.95 mg/L had significantly shorter EFS and OS patients with serum cystatin C levels ≤0.95 mg/L (median EFS:30 vs 57 months,P ＜ 0.05; median OS:43 vs 68 months,P ＜ 0.05).Conclusion Serum cystain C is not only a sensitive marker of kidney damage,but also reflects tumor burden and delivers prognostic information in MM.
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Objective:To discusses the professional quality cultivating mode construction for nursing students based on the second classroom as well as its mechanism and effects .To investigate the cognition and evaluation of nursing students on recessive education of the second classroom .Methods:Questionnaire was used in nursing un-dergraduates in three grades .The professional spirit , professional skills , humanity qualities were involved .Re-sults:For professional spirit , 44 .13% agreed for significantly increasefor their professional quality , and 33 . 20%for improved, 6.48%forreduced, or a significant reduction.For professional skills, 51.82%forsig-nificantly increase, 41 .70%for improved, 1 .21%forreduced , or a significant reduction.For humanistic quality, 91.1% of the students thought it significantly increasetheir humanistic quality .In grade 2009 and 2011 , over 50% students thought this quality was improved by the second classroom .Conclusions:Professional quality cultivating mode based on the second classroom makes nursing students 'professional spirit , professional skills, the humanities quality improved , and this cultivating mode received wide recognition and affirmation in the nursing students .
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Objective To explore the value of neutrophils gelatinases related lipid a carrier protein (NGAL),renal injury molecule-1 (KIM-1) and serum creatinine (SCr) for early diagnosis in adult cardiac surgery after acute renal injury (AKI).Methods Blood and urine samples of 65 cardiac surgery patients before and 24,48,72 h after surgery were collected,SCr,urine NGAL and KIM-1 levels was detected,among whom AKI occurred in 34 cases(AKI group),did not occur in 31 cases (non AKI group),and they were compared with 20 cases of healthy physical examination (control group).Logistic regression model was used to judge the value of early diagnosis of SCr,urine NGAL and KIM-1.Results The incidence of AKI after cardiac surgery was 52.31％ (34/65).The SCr,urine NGAL and KIM-1 levels in AKI group and non AKI group before and 24,48,72 h after surgery were significantly higher than those in control group [SCr:(62.44 ±22.26),(77.38 ±24.38),(98.24 ±25.02),(98.14 ±45.26)μmol/L and (56.67 ±21.68),(59.25 ± 15.58),(55.40 ±22.91),(40.10 ±23.45)μmol/L vs.(16.43 ±5.01)μmol/L;urine NGAL:(4.81 ±0.65),(9.48 ±3.29),(11.87 ±3.93),(7.66 ± 1.52) μg/L and (4.67 ±0.53),(8.89 ± 2.64),(11.46 ± 3.60),(7.47 ± 1.63)μg/L vs.(2.87 ± 0.48) μg/L; KIM-1:(47.93 ± 5.54),(61.89 ± 12.44),(100.21 ± 27.32),(67.69 ± 8.72) μ g/L and (47.12 ± 4.08),(56.38 ± 9.27),(90.14 ± 27.26),(69.40 ±8.90) μ g/L vs.(32.21 ± 12.54)μ g/L] (P ＜ 0.01).Urine NGAL and KIM-1 levels in AKI group and non AKI group 24,48,72 h after surgery were significantly higher than those before surgery (P＜ 0.01).SCr,urine NGAL and KIM-1 levels in AKI group 24 h after surgery were significantly higher than those in non AKI group (P＜ 0.01).Twenty-four hours after surgery,the sensitivity and specificity of urine NGAL,KIM-1 in the diagnosis of AKI,compared with that of SCr had no statistical significance (P ＞ 0.05).Conclusions The adults who accept extracorporeal circulation cardiac surgery appear high incidence of AKI.Twenty-four hours after surgery,early biological markers-urine AKI,KIM-1,has similar sensitivity and specificity with traditional diagnostic gold standard of SCr.
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Objectives To explore the changes of serum interleukin-33 (IL-33), IgA anti-endothelial cell antibodies (AECA) and IgA anticardiolipin antibodies (ACA) in acute stage of Henoch-Sch?nlein purpura (HSP) in children and its clinical signiif-cance. Methods Thirty-seven children with acute HSP admitted to hospital were selected from Nov.2012 to Jan.2013. Twenty healthy children were selected as healthy controls. The serum levels of IL-33 were measured by double anti-body sandwich en-zyme-linked immunosorbent assay (ELISA) and the serum levels of AECA-IgA and ACA-IgA were detected by double antigen sandwich ELISA. Results Serum levels of IL-33, AECA-IgA and ACA-IgA in patients with acute HSP were signiifcantly higher than those in healthy controls (P<0.001). According to different clinical types, the serum levels of IL-33, AECA-IgA and ACA-IgA were signiifcantly higher in mixed-type HSP (with joint involvement and gastrointestinal symptoms and/or kidney damage) than those in HSP patients with only joint, abdomen or renal involvement (P<0.05). Serum levels of IL-33 in acute stage of HSP had a positive correlation with AECA-IgA (r=0.752, P<0.001) and ACA-IgA (r=0.788, P<0.001). Conclusions The immune pathological injury in vessels caused by the interaction of IL-33, AECA-IgA and ACA-IgA may be the important pathogenesis of HSP, which may provide a clue for the early diagnosis and treatment for HSP.
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Medical education should combine clinical professional skills with humanities skills,integrate humanities knowledge into vocational education.Taking 2008 grade seven-year program clinical medicine students in the 2nd affiliated hospital of Harbin Medical University as fostering object,we made researches into students' understanding of doctor-patient relationship before practice and their mastering of skills.Through conducting questionnaire,we got to know the effect of humanities practice skill training for seven-year program clinical medicine students.Meanwhile,we compared students' self evaluation results before and after training,discussed on how to improve medical students' communication skills,cultural skills and the reform direction in an aim to guide students to transit from students to clinical doctor.
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Objective To investigate the effect of Roy Adaptation Model(RAM)in patients with adolescent insanity.Methods One hundred patients with adolescent insanity during October 2011 to March 2012 were randomized in equal number into two groups by random digit table:the study group and the control group.The former were intervened with RAM and the latter received routine care and health education.Seven weeks after intervention,Hamilton Depression Rating Scale(HAMD),Hamilton Anxiety Scale(HAMA) and Observation Scale(NOSIE)were used for the assessment. Results After intervention,the scores on HAMD and HAMA in the study group were significantly lower,compared to the control group(P<0.01).The scores on social function,social interest,subjective support and use of social support were all significantly higher than those of the control group(all P<0.01). Conclusions RAM can improve their ability of the patients with adolescent insanity to adapt to the environment.It may improve their mental state and their quality of life.
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Objective To evaluate the feasibility of induction with sevoflurane-midazolam-remifentail for tracheal intubation without muscle relaxants in neck brake patients.Methods Forty ASA Ⅰ or Ⅱ patients with cervical spine fracture with dislocation,aged 13-68 yr,scheduled for surgery under general anesthesia,were enrolled in this study.Anesthesia was induced with iv injection of midazolam 0.03 mg/kg and inhalation of 5%sevoflurane through a mask.Sevoflurane was inhaled at the initial concentration of 5%,followed by decrement of 1% every 30 s until 3%.When the eyelash reflex disappeared,remifentanil 2 μg/kg was injected slowly over 45s and 30 s later sevoflurane inhalation was stopped.The patients were mechanically ventilated after tracheal intubation.The time of disappearance of eyelash reflex was recorded.The intubation condition was evaluated using VibyMogensen score.Results All patients were successfully intubated at the first attempt.The time period from sevoflurane inhalation to disappearance of eyslash reflex was(69 ± 4)s.Coughing occurred in 3 cases during intubation.The satisfactory intubation conditions were found in 100% of cases.SpO2 ＞ 95% in all patients.BlS was maintained at 45-55 during the period(before intubation until 3 min after intubation).Conclusion Induction with sevoflurane-midazolam-remifentail is rapid and smooth,provides good conditions for intubation and can be applied to tracheal intubation without muscle relaxants in neck brake patients.
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Objectives To help nursing students to adapt to the environment of the job interviews by simulation interview, train the students'psychological quality and the adaptability, give the necessary guidance for seeking job after graduation. Method Five interview groups were composed by 15 nurse executives and interpersonal communication teachers from 4 hospitals, after the simulation interview, the students were surveyed using the self-desigued questionnaire. Results There are 10 items having the most significant influence, 10 items having more obvious influence the last 7items.Conclusion It can improve all aspects'ability of the students effectively through carrying out the simulation interview pertinence, and can help the students find job successfully.
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Objective To investigate the evaluation of the employing hospital about nursing undergraduate students,to understand the actual working capacity of graduates and explore the quality requirement and individual needs of nuring undergraduates according to the findings,to improve the quality of nursing undergraduates and personnel training specifications.Methods The self-evaluation questionnaires on nursing undergraduates was used to investigate eight hospitals which accepted three or more graduates of our college by letter investigation.Results The employing hospital had the highest satisfaction degree on the moral character and working attitude,respectively 98.1%and 96.2%;the satisfaction degree of management and research capability was the lowest,respectively 81.0%and 80.0%. Conclusions Overall assessment of the quality of graduates is better,the graduates' clinical competence,interpersonal relations and psychological quality is satisfactory,nursing skills and adaptability should be improved;foreign language,scientific research,administration and management capacity is rehtively weak.In the future,the college should adapt to the reeds of employers in the teaching process,strengthening the training of practical ability and adaptability,using appropriate methods to enhance research and foreign language skills,appropriately adjust training goal of undergraduates.
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Objective To summarize the principle and structure of objective structured clinical examination(OSCE)in the graduation practice examination of undergraduate nursing students.Methods A OSCE model was designed with a case running through the whole process of it by referring to the classic model of OSCE and applied it to the graduation practice examination of undergraduate nursing students of grade 2004.Results 75.0%students believed that the setup of OSCE location was reasonable and 78.1%of them thought that they were used to this kind of examination.100.0%of them considered that this examination model could objectively evaluate the general clinical capacity and at the same time make clear the future purpose of next internship stage. Conclusion The OSCE model could objectively evaluate the general clinical ability of students and truly reflect the existing problems,thus provide benefitable reforrences for the next internship stage.
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OBJECTIVE To discuss nursing department′s function in preventing hospital infection management in order to improve its level. METHODS Nursing department actively works with hospital infection management department to establish organization,consummate system,carry out measure,regulate nursing technique operation procedure and nurse conduct norm,and train the nursing staff. RESULTS The rate of hospital infection has been descended gradually from 2.29% in 2000 to 1.01% in 2005. CONCLUSIONS Nursing department is performing important function in preventing hospital infection management work.
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OBJECTIVE To analyze the reason for delayed healing of obstetric abdomen vertical cut and discuss the preventive nursing countermeasure.METHODS The discharged cases during Jul 2005 Jun 2006 and the inpatient cases during Jul 2006 to Jun 2007 were observed and monitored and at the same time the preventive nursing countermeasure was provided and the statistic of clinic material of two years was analyzed.RESULTS A satisfying effect has been made by taking objective monitoring and preventive nursing countermeasure the rate of delayed healing of obstetric abdomen vertical cut been reduced from the original 2.75% to the current 0.93%.CONCLUSIONS The key to prevent the delayed healing of obstetric abdomen vertical cut is prevention.Taking objective monitoring and preventive nursing countermeasure play an importment role in promoting healing of obstetric abdomen vrtical cut.