Prenatal diagnosis of pyruvate dehydrogenase E1-α deficiency: a case report / 中华围产医学杂志

This article reported a case of pyruvate dehydrogenase E1-α deficiency suggested by abnormal brain development during prenatal ultrasound imaging. Prenatal ultrasound revealed a mild enlargement of bilateral cerebral ventricles and the possibility of intracranial hemorrhage in the fetus at 25 +1 weeks of gestation. MRI showed the fetus with absent corpus callosum, enlarged bilateral cerebral ventricles and paraventricular cysts. After genetic counseling and careful consideration, the couple opted for pregnancy termination. To clarify the cause of the disease, whole-exome sequencing was performed on the fetal skin to detect possible variants, and which revealed a frameshift mutation c.924_930dup(p.R311Gfs*5) in exon 10 of the PDHA1 gene. Sanger sequencing confirmed the mutation was a de novo pathogenic variant, indicating that the fetus was affected by pyruvate dehydrogenase E1-α deficiency.

Meta-analysis of the application effect of multidisciplinary collaborative nursing model in breast cancer patients / 中国实用护理杂志

Objective:To evaluate the effect of multidisciplinary collaborative nursing mode on quality of life, negative emotions and self-care ability of breast cancer patients by Meta-analysis.Methods:PubMed, Medline, Cochrane Library, Web of Science, EMbase, China National Knowledge Infrastructure, Chinese Biomedical Database, VIP and Wanfang Data were searched by computer. Randomized controlled trials on the application of multidisciplinary collaborative nursing model in breast cancer patients were collected. According to the Cochrane system evaluation method, the quality evaluation and data extraction of the included studies were conducted, and the Meta-analysis was conducted by RevMan 5.3 software.Results:A total of 14 randomized controlled trials involving 1 828 patients with breast cancer were included. Meta-analysis showed that multidisciplinary collaborative nursing mode could effectively improve the quality of life of breast cancer patients, and the combined effect was statistically significant( SMD=1.11, 95% CI 0.55-1.67, Z=3.89, P<0.05), relieving anxiety of breast cancer patients( WMD= -1.36, 95% CI -2.68 - -0.03, Z=2.01, P<0.05), and depression ( WMD= -1.23, 95% CI -2.16 - -0.29, Z=2.56, P<0.05), improve the self-care ability of patients, the Meta subgroup analysis results of 4 dimensions of Exercise of Self-care Agency Scale showed P<0.05, the combined effect was statistically significant. Conclusions:Multidisciplinary collaborative nursing model can effectively alleviate the negative emotions of breast cancer patients, such as anxiety and depression, and improve the self-care ability of patients, which is of great significance to improve the quality of life of breast cancer patients.

Prospects for plasma protein products in China / 中国输血杂志

Plasma protein products, essential drugs for various clinical diseases, are therapeutic biological products extracted from healthy human plasma. The research and development of new plasma protein products, led by United States and European, has been widely deepened and enhanced. Therefore, accelerating the development of new plasma protein products in China is of great significance. This review summarizes the research and development of plasma protein products that have been marketed abroad but have not produced in China, as well as analyzes the difficulties and prospects of the development of plasma protein products in China.

Influence of different levels of heparin and antithrombin Ⅲ on human coagulation factor Ⅸ activity / 中国输血杂志

【Objective】 To study the effect of different concentrations of heparin, ATⅢ or a mixture of heparin and antithrombin Ⅲ (ATⅢ) (1∶1)on the activity of human coagulation factor Ⅸ (FⅨ). 【Methods】 The heparin or heparin/ATⅢ with different concentrations were added into human coagulation Ⅸ products or human prothrombin complex (PCC) to prepare heparin or heparin/ATⅢ samples, containing 0, 0.1, 0.3, 0.5, 0.8, 1, 2 and 4 IU per unit. ATⅢ with different concentrations were added into FⅨ or PCC to prepare ATⅢ samples containing ATⅢ 0, 0.1, 0.5 and 1 IU per unit. The FⅨ activity of the samples prepared was tested by one-stage coagulation method. Then corresponding amount of protamine sulfate were added to neutralize heparin or heparin/ATⅢ to detect the FⅨ activity again. Their influence of heparin, ATⅢ and heparin/ATⅢ with different concentrations on the activity of FⅨ were analyzed. 【Results】 When the content of heparin or heparin/ATⅢ was 0, 0.1, 0.3 and 0.5 IU per unit of FⅨ, the detection results of FⅨ titer in samples were consistent. When the content of heparin or heparin/ATⅢ per unit of FⅨ was 0.8, 1, 2 and 4 IU, the detection results of FⅨ titer were all lower than those of samples without heparin. When the ATⅢ content was 0, 0.1, 0.5 and 1 IU, the FⅨ titer of the samples was consistent. 【Conclution】 When the content of heparin or heparin/ATⅢ in the product is less than or equal to 0.5 IU per IU of FⅨ, the step of protamine sulfate adding could be omitted as it has little effect on FⅨ activity. When >0.5 IU per IU of FⅨ, however, protamine sulfate adding, to neutralize heparin, is necessary before FⅨ activity testing.

Comparison of immune reconstitution after peripheral blood stem cell transplantation and umbilical cord blood transplantation / 中华检验医学杂志

Objective:To explore the differences of immune reconstitution between peripheral blood stem cell transplantation and umbilical cord blood transplantation.Methods:A total of 300 patients (aged 18 (8, 33), 163 males and 137 females) with malignant hematological diseases who received allogeneic hematopoietic stem cell transplantation in the First Affiliated Hospital of University of Science and Technology of China from January 2018 to March 2020 were enrolled in this study, including 255 cases of umbilical cord blood transplantation and 45 cases of peripheral blood stem cell transplantation. Multicolor flow cytometry was applied to analyze lymphocyte subsets of the percentages and absolute counts in the two donor types and peripheral blood of patients after receiving hematopoietic stem cell transplantation. The differences between the two grafts were compared, and the lymphocyte subsets results were evaluated at 1, 2, 3, 4, 6, 9, 12, and 18 months after transplantation. 18-month disease-free survival (DFS) within the 300 patients under the two transplantation types were retrospectively analyzed.Results:1. The proportion of NKT cells in peripheral blood group was significantly higher than that in cord blood group (2.79% vs 0.24%, P<0.001). 2. The proportion of helper T cells in the UCBT group was higher than that in the PBSCT group, as well as the counts 6 months after transplantation ( P<0.05). 3. The proportion of NK1 cells (3 rd to 9 th month) and count (4 th to 12 th month) in UCBT group were significantly higher than those in PBSCT group ( P<0.05). 4. NKT cells in the UCBT group were lower than those in the PBSCT group (proportion and count) throughout the monitoring process ( P≤0.001). 5. The proportion of DNT cells (within 1 year) and count (within 6 months) in the UCBT group were significantly lower than those in the PBSCT group ( P<0.05). Conclusions:Compared with the peripheral blood stem cell transplantation group, the umbilical cord blood transplantation patients had a faster rate of lymphocyte reconstitution, and patients received umbilical cord blood transplantation had a stronger ability of immune reconstitution and could achieve long-term hematopoiesis.

Protective role of umbilical cord mesenchymal stem cells on encephaledema after severe cut injury / 中华创伤杂志

Objective:To observe the extent of brain edema caused by severe cut injury and the protective role of umbilical cord mesenchymal stem cells (UC-MSCs).Methods:A total of 90 female C57L mice were selected and the models of severe cut injury were prepared with surgical blade. According to the random number table, the animals were divided into control group (20 mice), cut group (20 mice), interleukin-6 antibody (IL-6-AB) before cut group (administered IL-6-AB at 18 hours before cut, 15 mice), IL-6-AB after cut group (administered IL-6-AB at 1 hour after cut, 15 mice) and UC-MSCs group (20 mice). The extent of brain edema was detected, the level of IL-6 in brain tissue by ELISA method and the expression of aquaporin-4 (AQP-4) by Western blot assay.Results:Brain water content test showed brain edema in cut group was (81.5±1.8)%, significantly higher than (77.1±2.4)% in control group ( P<0.05). Compared with cut group, brain edema in UC-MSCs group [(76.8±2.4)%] and IL-6-AB before cut group [(76.2±2.9)%] were significantly decreased ( P<0.05), while that in IL-6-AB after cut group [(82.4±1.7)%] was little decreased ( P>0.05). ELISA showed the level of IL-6 in cut group was significantly increased in mouse brain [(16.6±1.3)pg/ml], when compared with control group [(10.3±0.3)pg/ml] ( P<0.01). Compared with cut group, the levels of IL-6 in UC-MSCs group [(10.7±0.6)pg/ml] and IL-6-AB before cut group [(10.1±0.4)pg/ml] were significantly decreased ( P<0.01), while that in IL-6-AB after cut group [(14.9±1.2)pg/ml] was little decreased in mouse brain ( P>0.05). Western blot assay showed that compared with control group (1.0±0.1), the expression of AQP-4 in cut group (2.4±0.5) was significantly increased in mouse brain ( P<0.01). Compared with cut group, the expression of AQP-4 in UC-MSCs group (1.2±0.3) and IL-6-AB before cut group (1.0±0.1) were significantly decreased ( P<0.01), while that in IL-6-AB after cut group (2.3±0.3) was little decreased in mouse brain ( P>0.05). Conclusions:Severe cut injury can increase brain water content and eventually lead to brain edema through upregulating the levels of IL-6 and AQP-4 protein in the brain. Moreover, UC-MSCs effectively prevent the formation of brain edema by inhibiting the above effects.

Ultrastructural and clinical findings of mitochondrial encephalomyopathy:report of 27 cases / 中华病理学杂志

Objective@#To investigate the ultrastructural features of muscle in patients with mitochondrial encephalomyopathy for its diagnosis and differential diagnosis.@*Methods@#The clinical data of 27 mitochondrial encephalomyopathy patients who underwent left or right biceps brachii muscle biopsy at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from July 2006 to August 2017 were analyzed retrospectively. The muscle biopsy specimens were examined underlight microscope and transmission electron microscope.@*Results@#There were 27 patients (17 males, 10 females) with an age range of 12 to 62 years (mean 29 years). The age of onset ranged from 3 to 38 years. The course of disease ranged from 1 month to 24 years. Twenty-two cases presented with lactic acidosis and stroke-like episodes (MELAS) syndrome, four with myoclonic epilepsy with ragged red fibers (MERRF) syndrome, and one with chronic progressive paralysis of extraocular muscle (CPEO) syndrome. Skeletal muscle biopsy showed abundant ragged red fibers and strongly SDH-reactive vessel. Genetic studies showed 17 of 22 cases of MELAS syndrome had A3243G mutation, and the other 5 cases had no abnormality. A8344G mutation was found in 3 of 4 cases of MERRF syndrome. No single or multiple mtDNA mutations were found in the single case of CPEO. Transmission electron microscopy of all 27 cases showed diffuse proliferation of mitochondria between the myofibrils and beneath the sarcolemma, with increased spacing between muscle cells. Seven cases showed numerous glycogen and four showed subsarcolemmal lipid droplets, 13 cases showed unusual mitochondrial morphology, including mitochondrial electron-dense substances and paracrystal line inclusions ("parking lot" change)in eight cases.@*Conclusions@#Transmission electron microscopy shows significant differences in ultrastructural pathological changes among different patients with mitochondrial encephalomyopathy. Some patients with mild clinical symptoms have increased mitochondrial number, increased metabolism of glycogen and lipid droplets, while others with severe clinical symptoms have abnormal mitochondrial morphology. Typical crystalloid inclusions are found in mitochondria, which are of great value in the diagnosis of this disease.

Serum piR-015151 levels in patients with brucellosis and its clinical significance / 临床检验杂志

Objective@#To investigate the levels of serum piR-015151 in patients with brucellosis and evaluate its clinical value in the auxiliary diagnosis of brucellosis. @*Methods@#Serum samples and clinical data from 73 brucellosis patients diagnosed in the Affiliated Hospital of Inner Mongolia Medical University or Zhungeer Qi Center for Disease Control and Prevention and 65 age- and gender-matched healthy controls in the Eastern Theater General Hospital of PLA during 2016 and 2017 were collected. Serum piR-015151 levels were detected by quantitative real-time polymerase chain reaction (qRT-PCR). The diagnostic value of serum piR-01515 in brucellosis was evaluated by the receiver operating characteristic (ROC) curve. @*Results@#Serum piR-015151 levels (median \[P25, P75\]) in brucellosis patients (0.216 \[0.069, 0.426\]) were significantly higher than that in healthy controls (0.036 \[0.021, 0.070\], U=834.5,P＜0.01). The area under the ROC curve (AUCROC), sensitivity and specificity of serum piR-015151 in the diagnosis of brucellosis were 0.824 (95% CI: 0.751-0.897), 75.3% and 76.9%, respectively. @*Conclusion@#Serum piR-015151 levels in brucellosis patients increase significantly, which may be a potential marker in the auxiliary diagnosis of brucellosis.

A qualitative study on palliative care to palliative nurses / 现代临床护理

Objective To explore the cognition, practice and attitude of palliative department nurses to palliative care. Methods With the method of intention sampling, 12 nurses from Xinjiang Cancer Hospital were enrolled in the study. With the phenomenological method, the nurses were interviewed with semi-structured interviewing, the acquired data analyzed. Result 4 themes were extracted from the data:understanding of palliative care,implementation of palliative care,intervention on family members and problems at implementation of palliative care. Conclusion Palliative care nurses have a positive attitude towards palliative care. The promotion of palliative care should be strengthened.

Qualitative research on cognition and attitude of Neoplasm nurses to palliative care / 中国实用护理杂志

Objective To deeply understand the cognition and attitude of neoplasm departmentnurses toward palliative care. Methods With qualitative research phenomenological method as the guidance, purposive sampling method was adopted, from September to October 2017, ten nurses in a grade three class a tumor hospital in Xinjiang were interviewed with deep semi-structured. Colaizzi analytical method was adopted to analyze the materials which were then organized in to themes. Results Four themes were extracted from analyzing the interview materials: including the cognition of palliative care. The implementation of palliative care.The intervention of family members;The problems faced in the implementation of palliative care. Conclusions The interviewees have a positive attitude towards the implementation of palliative care.Suggestions on strengthening the construction of related disciplines and personnel training.

Pseudolaric Acid B Inhibits Proliferation, Invasion and Epithelial-to-Mesenchymal Transition in Human Pancreatic Cancer Cell

PURPOSE: This study was aimed to investigate the effect of pseudolaric acid B (PAB) on proliferation, invasion and epithelial-to-mesenchymal transition (EMT) in pancreatic cancer cells and to explore the possible mechanism. MATERIALS AND METHODS: The pancreatic cancer cell line SW1990 was cultured and treated with PAB dose- and time-dependent manners. Cell proliferation and invasion ability were measured by MTT assay and Matrigel/Transwell test, respectively. Semi-quantitative real-time polymerase chain reaction and Western blotting were conducted to detect the expression of EMT markers and the key molecules. Finally, nude mice subcutaneous transplantation tumor model was used to confirm the therapy efficacy of PAB. RESULTS: PAB could inhibit SW1990 cell proliferation and invasion in time- and dose-dependent manners. Vimentin, fibronectin, N-cadherin, Snail, Slug, YAP, TEAD1, and Survivin were down-regulated (p < 0.01), while E-cadherin, caspase-9, MST1, and pYAP were up-regulated (p < 0.05). Combined PAB and gemcitabine treatment markedly restricted the tumor growth compared with gencitabin or PAB alone groups. CONCLUSION: PAB could inhibit the proliferation and invasion ability of pancreatic cancer cells through activating Hippo-YAP pathway and inhibiting the process of EMT.

Ear-acupuncture therapy for intractable hiccups in the patients treated with endovascular embolization for bleeding from spontaneous rupture of liver cancer / 国际中医中药杂志

Objective To observe the therapeutic effect of ear-acupuncture therapy for intractable hiccups in the patients treated with endovascular embolization for bleeding from spontaneous rupture of liver cancer. Methods A total of 60 patients with intractable hiccups after endovascular embolization for bleeding from spontaneous rupture of liver cancer were randomly divided two groups using a random digit table, 30 in each group. The patients in the control group were treated breath holding combined with oral baclofen, and those in the observation group with ear-acupuncture therapy for 5 days, and then both groups were followed up for 1 week. The Karnofsky Performance Status Scale (KPS) was used for quality of life evaluation. The adverse events and recurrence during the treatment and the followed up were recorded. The therapeutic effect was evaluated. Results Total effective rate (100% vs. 76.7%; χ2=5.822, P=0.016)in the observation group was significantly higher than that in the control group. The rate of adverse events (6.7% vs. 33.3%; χ2=5.104, P=0.024)in the observation group were significantly lower than that in the control group. There was no significant difference in the KPS scores after treatment between the observation group and the control group (82.1 ± 12.6 vs. 76.5 ± 17.8; t=1.407, P=0.165). Conclusions Ear-acupuncture therapy may efficiently alleviate intractable hiccups in patients treated with endovascular embolization for bleeding from spontaneous rupture of liver cancer, and superior to breath holding combined with oral baclofen.

Association between the serum CysC,lipoprotein(a) and urinary microalbumin/creatinine ratio among elderly type 2 dibetic patients / 国际检验医学杂志

Objective To analyze the relationship between the serum CysC,lipoprotein(a) [Lp(a)] and the urinary microalbumin/creatinine ratio in elderly type 2 dibetic (T2CM) patients.Methods A total of 102 elderly patients with T2CM who were treated in our hospital from December 2014 to December 2015 were selected.The patients were divided into diabetic nephropathy(DN) group(mALB≥20 μg/min,48 cases)and non-diabetic nephropathy(NDN) group (mALB<20 μg/min,54 cases) according the levels of urinary mALB,while 30 cases of healthy controls were selected from physical examination center.The biochemical indexes,CysC,Lp(a) and UACR were detected among all cases.The correlation between indexes and UACR was analyzed by Pearson correlation analysis,risk factors for UACR among DN patients were analyzed by Logistic regression analysis.Results There were significant differences in levels of low density lipoprotein cholesterol(LDL-C),Lp(a),urea,creatinine,fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),Cysc,and UACR among these groups (P<0.05).No correlation between CysC、Lp(a) and UACR was found in normal-control group and non-diabetic nephropathy group.In diabetic nephropathy group,there was a positive correlation between CysC,Lp(a) and UACR(r=0.658,P<0.01;r=0.525,P<0.05).The Logistic regression analysis showed that diabetes duration,CysC,Lp(a) were independent risk factors for UACR(P<0.05).Conclusion In patients with diabetic nephropathy,CysC,Lp(a) are positively correlated with UACR,and CysC is a sensitive index that reflect early renal damage in T2DM patients.Lp(a) level is one of the independent risk factors for UACR,which can reveal the kidney damage in DN patients.

Rank design and application of nursing technical risk and difficulty coefficient in performance evaluation / 中国实用护理杂志

Objective To design the risk and difficulty degree of common clinical nursing operation items with the purpose of offering much fair and scientific theoretical basis for the performance evaluation. Methods Self-designed questionnaires of risk and difficulties of nursing operation items were applied on 270 clinical nurses from 5 Third-level Grade A hospitals and 15 nursing training experts from different domains. Using the methods of clustering methodology to evaluate the risk and difficulty degree of nursing operation items. Results The risk and difficulties of 45 items of common nursing technical operations were ranked into 3 levels of rank and difficulties, in which the high level included 15 risk indexes (4.0 to 10.0 points) and 14 difficulty indexes (4.0 to 10.0 points), the middle level includes 18 risk indexes (0.9 to 3.0 points) and 17 difficulty indexes (0.5 to 3.0 points), low level includes 12 risk indexes (-10.0 to-0.8 points) and 14 difficulty indexes (-10.0 to-0.4 points). Conclusions The risk and difficulty of nursing operation are ranked in this study. What′s more, it is applied on the basis of nursing performance evaluation. Thus, it is offered much fair and scientific basis for the performance evaluation and human resources arrangement of nursing. And it also benefits for clinical nursing quality and the satisfaction of nurses.

Epidemiological situation of human parasitic diseases through three investi-gations in Jinhu County,Jiangsu Province / 中国血吸虫病防治杂志

Objective To understand the epidemiological situation of human parasitic diseases in Jinhu County,so as to pro?vide the evidence for formulating further control strategy. Methods The investigated local residents were sampled by the ran?dom cluster sampling method in 1989,1999 and 2015. The infections of intestinal helminthes were detected by Kato?Katz tech?nique,the eggs of Enterubius vermicularis were examined by cellophane anal swab for children,the intestinal protozoa were ex?amined by the saline smear and iodine staining methods. Results The total rates of parasitic infections were 62.57%,9.32%and 0.49%in 1989,1999 and 2015,respectively. Compared to those in 1989 and in 1999,the infection rate in 2015 was de?creased by 99.22%and 94.74%,respectively. The numbers of detected parasite species were 14,10 and 4 in 1989,1999 and 2015,respectively. The intensities of infections were mainly mild in three investigations,and the intensities of all the infections in 2015 were mild. The species of infected parasites were mainly single,however,multiple infections were observed in 1989,in?cluding 4 parasite species(0.72%)and 3 parasite species(7.02%). Only in 1989,the difference between sexes was significant and the infection rate of the female was higher than that of the male(χ2=18.01,P<0.01). Conclusions The infection rates of human parasites are decreased gradually and stabilized at the low level in Jinhu County. However,the surveillance work still should be strengthened to consolidate the achievement.

Effects of parecoxib sodium and fentanyl multimodal analgesia on immune functions in patients undergoing hepatectomy for hepatocellular carcinoma / 中华普通外科杂志

Objective To investigate the effects of multimodal analgesia of parecoxib and fentanyl on perioperative immune functions in patients of hepatocellular carcinoma (HCC).Methods Eighty HCC patients scheduled for hepatectomy were randomly divided into two groups:parecoxib sodium combined with fentanyl group (group P,40 cases) and fentanyl group (group C,40 cases).The percentages of CD3 +,CD4+,CD8+,CD4+/CD8+ T cells,CD3-CD16+ CD56+ (NK),interleukin-4 (IL-4),interferon-γ (IFN-γ) and the ratio of IFN-γ/IL-4 were detected at the following time points:30 minutes before induction of anesthesia (T0),at the end of the surgery (T1),24 h after surgery (T2) and 72 h after surgery (T3).The analgesic effects were estimated by visual analogue scale (VAS) after surgery.Total fentanyl consumption and adverse effects were also recorded.Results The percentages of CD3 + T cells were significantly lower in group C than that in group P at T2 (t =2.155,P ＜0.05).The percentages of NK in group P were recovered nearly to baseline (T0) at T2,which was higher than that of group C (t =2.791,P ＜0.05).In group C,the percentages of CD3 + T cells and NK has not recovered to baseline at T3 (respectively t =3.065,3.231,P ＜ 0.05).In group P,IL-4 serum levels were significantly lower than those in group C,while IFN-γ serum levels were significantly higher than those in group C at T2 (respectively t =2.173,2.100,P ＜0.05).From T2 to T3,the ratio of IFN-γ/IL-4 significantly increased in group P than those in group C (respectively t =3.259,2.203,P ＜ 0.05).VAS scores at rest and on cough in group P were significantly lower than those in group C at 2 h,6 h,12 h and 24 h after operation (respectively t =8.661,9.726,9.147,7.109,P＜0.05;t =8.569,9.614,9.144,8.509,P＜0.05).The total fentanyl consumption in group P was lower than that in group C (t =2.636,P ＜ 0.05).There were no significant differences regarding the incidence of adverse effects between the two groups.Conclusions Perioperative multimodal analgesia of parecoxib sodium combined with fentanyl enhances the analgesic efficacy,and reduces the dosage of opioid consumption,helps recover the cell immunity function of HCC patients after hepatectomy.

The relative impact factors of postpartum pelvic floor muscle injury in the region of Tianjin / 天津医药

Objective To investigate the influences of different factors on postpartum pelvic floor muscle injury, and provide clinical evidence to the early prevention of pelvic floor dysfunction (PFD). Methods A total of 65 630 women, who participated the postpartum pelvic floor function screening in Tianjin, from December 2011 to December 2014 were selected in this study. The uniform detect methods was used in this study. The analysis based on the PFD was diagnosed by physi?cians of Women’s and Children’s Health Center in each district. The influences of different factors on postpartum pelvic floor muscle were analyzed. Results There were 19 452 (29.6%) women suffering from postpartum pelvic floor muscle inju?ry, with the abnormal rate 29.6%, which was higher in rural areas than that in urban areas (33.9%vs 27.8%). The abnormal rate was higher in women with junior middle education or below (34.1%) than that in women with senior middle or polytech?nic schooling (30.4%), and women with college or higher education (27.7%). There was a higher abnormal rate in women with vaginal surgery delivery (40.8%) than that in women with natural delivery (32.5%) and women with caesarean section (27.2%). The muscle abnormal rate was higher in women having given two or more than two times of deliveries (34.6% , 31.5%) than those having initial delivery (29.1%). Multiple factor analyses showed that city residency, higher education and less delivery times were protecting factors for postpartum pelvic floor muscle while vaginal surgery was a risk factor for post?partum pelvic floor muscle. Conclusion There is a high incidence of postpartum pelvic floor muscle injury in the region of Tianjin. Analyzing the risk factors and strengthening the management of pelvic floor muscle injury by early prevention or ear?ly treatment would help to reduce the incidence of PFD effectively during pre-pregnancy and perinatal periods.

Exploration of the Cultivation of Humanistic Quality of Clinicians Based on Competency / 中国医学伦理学

According to analysis the training contents of the clinician in humanistic quality based on competen-cy, the authors put forward four optimization strategies of cultivating the humanistic quality of clinicians :the area hospital builds the competency model of uniform and combines with the specialty training content ; implements young doctor tutorial system to enhance the humanities accomplishment by mentoring teaching mode ;takes diversity training to improve training effect; well establish normative culture evaluation of linkage mechanism to check the effect.

Evaluation of high?resolution manometry for POEM in treating achalasia / 中华消化内镜杂志

Objective To evaluate the effectiveness and predictive value of high-resolution manometry(HRM) for POEM in treating achalasia. Methods A total of 84 achalasia patients categorized into subtypes by HRM, who also underwent POEM, were enrolled in our study. Eckardt score, Barium esophagogram and HRM were performed before, 6 months and 1 year after POEM. Results POEM was successfully performed in all 84 patients. No perforation occurred in any patient. The Eckardt scores and esophageal diameter after POEM significantly reduced compared with those before(P<0. 05). The 4s-IRP decreased from 33. 4±9. 0 mmHg (1 mmHg =0. 133 kPa) to 14. 6±3. 8 mmHg six months after POEM (P<0. 05) and to 16. 4±3. 9 mmHg one year after POEM (VS preoperate, P<0. 05). The LESP before treatment was 41. 8±15. 4 mmHg, decreasing to 18. 4±7. 1 mmHg six months after POEM (P<0. 05) and 20. 7±7. 6 mmHg one year after POEM (VS preoperate, P <0. 05) . When categorizing patients into 3 subtypes by HRM, 4s-IRP of type II showed the most dramatic decrease six months after POEM(62. 8%), followed by typeⅠ(53. 5%), while type III had the least decrease(41. 8%). The mean decreasing rate of LESP in type III was 42. 3% six months after POEM, followed by typeⅠ(55. 3%) , while type II showed the highest rate(57. 8%). Conclusion POEM is a safe treatment for achalasia and has significant short-term efficacy with Type II responding best to POEM. HRM plays a vital role in typing AC and predicting the effectiveness of POEM and can be useful in selecting an appropriate treatment.

Application of continuing quality improvement on reducing incidence of PICC-related phlebitis in breast cancer patients undergoing chemotherapy / 现代临床护理

Objective To investigate the effect of the continuing quality improvement on PICC-related phlebitis in breast cancer patients undergoing chemotherapy. Methods Eighty breast cancer patients undergoing PICC for chemotherapy in our hospital from September to December 2014 were selected as control group, receiving routine nursing care. Another eighty patients undergoing PICC for chemotherapy from January to March in 2015 were selected as experiment group and the quality control cycle was used, the measures including investigating the present situation aiming to theme, goal setting and analyzing, working out and using countermeasures and effect comfirming. Result After applying continuing quality improvement in the experiment group the incidence rate of phlebitis in the continuing quality improvement group was significantly lower than those before continuing quality improvement and in the control group (P<0.05). Conclusion The implementation of continuing quality improvement activities can reduce the incidence of pzce-related phlebitis in patients with breast cancer during chemotherapy. It can improve the safety of PICC catheter and therefore, it is worthy of popularization.