Scope review of human caring for patients by head nurses / 中华医院管理杂志

Objective:To explore the current practice of head nurses′ human caring for patients at home and abroad, and integrate those effective measures and effect evaluation methods, so as to provide reference for nursing administrators.Methods:A framework was built on the scope review method proposed by Arksey and O′Malley, and such search terms as head nurse/nursing administrator, human caring/care/human-based, sick person/patient, nursing supervisory/charge nurse/head nurse/nurse administrator/nurse manager/nurse executive, empathy/care/compassion, patient/client were used. CNKI, Wanfang database, VIP, Chinese Medical Association Journal Full-text Database, Medical Knowledge Network (PubMed, Elsevier, Springer, Wiley, OVID, EBSCO) and the Cochrane Library were searched from their initiation to November 29, 2022. Two researchers independently screened and extracted basic characteristics of the literature, as well as the measures used by the head nurses to implement human caring for patients and the effect evaluation tools.Results:A total of 57 articles were included. This paper reviewed the measures of human caring for patients at both levels of head nurses as direct caregivers and as organizers.The measures at the level of direct caregivers included implementing human caring in their ward rounds, creating a caring atmosphere, setting up a head nurse reception day, interviewing the care needs of patients and their families, innovating working methods based on the perspective of human caring, and caring communication with patients and their families; measures at the level of organizers included building a nursing human caring mode with specialist characteristics, building a human caring mode for different patient groups, strengthening the training of nurses′ human caring ability and literacy, building a caring environment and atmosphere, simplifying the nursing work process, and establishing a continuous and diversified nurse-patient communication mode, continuing human caring for discharged patients, organizing participation of nurses in social practices of human caring, setting up caring posts, and conducting care supervision and quality control. Patient satisfaction survey was used to evaluate the practical effects of human caring, but the evaluation objects were nurses or nursing services.Conclusions:Head nurses play an important role in the implementation of human caring, and a variety of measures can be taken to directly or indirectly implement human caring for patients. It is suggested to build more human caring modes to cover more specialties and patient groups, and improve the patient satisfaction evaluation tools with head nurses as the evaluation object.

Research progress on fetal gallbladder dysplasia / 中华围产医学杂志

Gallbladder dysplasia is not common but can be associated with chromosome abnormality and/or some severe complications such as biliary atresia and cystic fibrosis. Therefore, prenatal detection of this problem is of great significance for timely management after birth. However, abnormal gallbladder development is often overlooked in routine mid-term fetal ultrasound scanning. Here, we reviewed the research progress on fetal gallbladder dysplasia, including clinical characteristics and perinatal prognosis of gallbladder duplication, echo substances in gallbladder and gallbladder cholelithiasis, ectopic gallbladder, gallbladder enlargement, and cystic fibrosis, and summarized the types, incidence, clinical features, prenatal diagnosis and perinatal prognosis of non-visualized fetal gallbladder, in order to emphasize the prenatal screening of fetal gallbladder dysplasia.

Preliminary study of shear wave dispersion imaging in the evaluation of hepatic acute graft-versus-host disease / 中华超声影像学杂志

Objective:To investigate the feasibility of using shear wave dispersion (SWD) imaging in evaluating acute graft-versus-host disease (aGVHD) of the liver.Methods:A total of 42 Wistar rats were used as receptors and 10 Fischer 344 rats were used as donors for bone marrow transplantation to establish aGVHD models. Six rats were randomly selected every week for clinical observation and scoring. Then, ultrasonic SWD was performed to obtain shear wave speed (SWS) and shear wave dispersion slope (SWDS). Then, the histological characteristics were used as a reference standard, and the rats were divided into two groups: the group without aGVHD (nGVHD group) and the group with aGVHD. The differences in the clinical score and SWD values between the two groups were compared, the meaningful indexes were screened by binary Logistic regression analysis, and the joint prediction parameters were obtained. The ROC curve was plotted and the diagnostic efficiency was compared. The correlations between SWS, SWDS, clinical score and pathological grade were analyzed.Results:Clinical score, SWS, and SWDS in aGVHD group were higher than those in the nGVHD group (all P<0.05). The correlation between SWDS and pathological grade ( r=0.774, P<0.001) was higher than those between SWS, clinical score and pathological grade ( r=0.579, P=0.005; r=0.452, P=0.034). Logistic regression showed that SWDS was a significant indicator. In addition, the AUC values determined by SWDS and predictive parameters were (0.859, 0.886), which were significantly higher than the AUC of the clinical score (0.760, P<0.05). Conclusions:SWD imaging technology may become a promising method to evaluate hepatic aGVHD.

Analysis of gene variation and clinical characteristics of Wiedemann-Steiner syndrome / 中华儿科杂志

Objective: To summarize and analyze the clinical characteristics and gene mutations of 6 patients with Wiedemann-Steiner syndrome (WDSTS). Methods: To review and analyze the clinical data, including general conditions, clinical manifestations, growth hormone, cranial or pituitary gland magnetic resonance imaging (MRI),gene results and other data, 6 cases with WDSTS admitted to the Department of Endocrinology, Genetics and Metabolism of Jiangxi Provincial Children's Hospital and the Department of Child Care of Pingxiang Maternity and Child Care from April 2017 to February 2021 were recruited. Results: Of the 6 patients, 2 were male and 4 were female. The age of the first visit ranged from 1.0 to 11.2 years. All the 6 children presented with growth retardation and mental retardation and they all had typical facial dysmorphism and hypertrichosis (mainly on the back and limbs). Among them, case 5 had a growth hormone deficiency, and case 2 and 4 had abnormalities revealed by cranial MRI. Variations in KMT2A gene were identified in these 6 patients: c.10900+2T>C,c.10837C>T(p.Gln3613*), c.4332G>A(p.E1444E), c.2508dupC(p.W838Lfs*9), c.11695_11696delinsT(p.T3899Sfs*73), c.9915dupA (p.P3306Tfs*22).Among these variations, c.4332G>A, c.11695_11696delinsT and c.9915dupA were novel mutations. Therefore, the final diagnosis of these patients was WDSTS. Conclusions: Patients presented with short stature and mental retardation, typical facial dysmorphism and hypertrichosis should be considered WDSTS. Whole-exome sequencing plays an important role in disease diagnosis and genetic counseling.

Postnatal outcomes and prognosis of fetal intra-abdominal solid masses diagnosed by prenatal ultrasound / 中华围产医学杂志

Objective:To investigate the clinical outcomes and prognosis of children who were prenatally diagnosed with solid space-occupying abdominal lesions by ultrasound.Methods:This study retrospectively enrolled 30 children with solid space-occupying abdominal lesions that were indicated by prenatal ultrasound at Children's Hospital of Fudan University from March 2015 to March 2021. Prenatal ultrasound findings, postnatal treatment, clinical outcomes, and prognosis were analyzed.Results:These subjects included 18 male and 12 female infants, with the median gestational age at the first sonographic diagnosis of 36 weeks (28 to 39 weeks). The intra-abdominal solid masses were postnatally confirmed to be located in liver, retroperitoneum, and gastrointestinal tract, which were hepatic hemangioma ( n=14), hepatoblastoma ( n=2), neuroblastoma ( n=6), abdominal teratoma ( n=4), adrenal hematoma ( n=1), adrenocortical adenoma ( n=1), hyperplasia of renal capillary ( n=1), and gastrointestinal teratoma ( n=1). The accuracy of prenatal ultrasound in detecting the location of masses was 73% (22/30) and which was 13/16 in detecting masses from liver and 9/14 in that outside the liver. Among the 30 cases, 73% (22/30) were benign tumors, and 27% (8/30) were malignant tumors (hepatoblastoma in two cases and neuroblastoma in six cases). Among 15 patients with benign tumors (hepatic hemangioma and adrenal hematoma) who received close follow-up or drug therapy, tumor/lesion regression occurred in 13 cases and the other two were observed with stable hepatic hemangiomas. Fourteen patients, including six with neuroblastoma, two with hepatoblastoma, five with teratoma, one with adrenocortical adenoma, and one with hyperplasia of renal capillary, had good prognosis after primary tumor resection or combined with postoperative chemotherapy. One hepatoblastoma case died after withdrawing treatment. The overall survival rate was 97% (29/30) with a median follow-up time of 24 months (4 to 60 months). Conclusions:Prenatal ultrasound has high accuracy in identifying the anatomic region of fetal solid space-occupying abdominal lesions. With close postnatal follow-up and proper treatment, most of the affected fetuses will have a good outcome and prognosis.

Neoadjuvant chemotherapy for patients with locally advanced penile cancer: an updated evidence / 亚洲男科学杂志(英文版)

Neoadjuvant chemotherapy (NAC) has shown promising results in patients with locally advanced penile cancer. However, no consensus exists on its applications for locally advanced penile cancer. Thus, it is unclear which kind of chemotherapy regimen is the best choice. Consequently, a systematic search of PubMed, Web of Science, and EMBASE was performed in March 2021 to assess the efficacy and safety of NAC for the treatment of patients with locally advanced penile cancer. The Newcastle-Ottawa Scale was used to assess the risk of bias in each study. This study synthesized 14 published studies. The study revealed that patients who achieved an objective response to NAC obtained a better survival outcome compared with those who did not achieve an objective response. In addition, the objective response rates (ORRs) and pathological complete response (pCR) rates were 0.57 and 0.11, respectively. The incidence of grade ≥3 toxicity was 0.36. Subgroup analysis found that the ORR and pCR of the taxane-platinum (TP) regimen group performed better than those of the nontaxane-platinum (NTP) regimen group (0.57 vs 0.54 and 0.14 vs 0.07, respectively). Moreover, the TP regimen group had more frequent toxicity than the NTP regimen group (0.41 vs 0.26). However, further studies were warranted to confirm the findings.

To establish a method of serum detection by Raman spectroscopy for the diagnosis of gastric cancer / 中华检验医学杂志

Objective:To establish a method of serum detection by Raman spectroscopy for the diagnosis of gastric cancer.Methods:Between April and November 2019, 110 patients with gastric cancer [73 males, 37 females, age (57.4±10.3) years] and 74 patients with colorectal cancer [48 males and 26 females, aged (58.3±12.2) years] were collected at the First Affiliated Hospital of Army Military Medical University, along with 100 healthy subjects [59 males and 41 females, aged (55.6±10.61) years] during the same period. Fasting venous blood serum samples were collected from the subjects. A Raman spectrometer XploRA PLUS was used in this experiment, with an excitation light source of 532 nm, a field of view of 100 times, and a spectrum range of 200-2 000 cm -1, etc. The serum samples were detected by nondestructive and non-contact rapid detection, and the Raman spectra of serum samples were collected. Using the Raman spectrum acquisition and processing supporting software LabSpec6 to smooth, baseline, and normalize the obtained Raman spectrum. Multivariate statistical analysis software SIMCA14.1 were applied to import and analyze the obtained Raman spectrum data by principal component analysis (PCA), orthogonal partial least squares discriminant analysis (OPLS-DA), and other methods for statistical analysis. An operating characteristic curve (ROC) was constructed to evaluate the model analysis effect between serum samples of healthy people and those with gastric cancer. Serum samples from the colorectal cancer group were used to verify the reliability of the model. Results:Six Raman peaks with good repeatability were detected in serum samples in health and gastric cancer group, and peaks were located at 1 001.17, 1 154.63, 1 337.89, 1 446.85, 1 515.33, and 1 658.34 cm -1, respectively. Raman intensities at six Raman peaks were significantly different between healthy and gastric cancer groups. At the displacement of 1 001.17, 1 154.63, and 1 515.33 cm -1, the Raman intensity in the healthy group was higher than that in the gastric cancer group. At 1 337.89, 1 446.85, and 1 658.34 cm -1 displacement, the Raman intensity of the gastric cancer group was higher than that of the healthy group. An OPLS-DA model was constructed to analyze the serum samples of the healthy group and the gastric cancer group. In the model, R 2 is the fitting power, and Q 2 is the predictive ability. The closer the values of R 2 and Q 2 are to 1, the better the performance of the model, and the obtained model's R 2X(cum)=0.809, R 2Y(cum)=0.819, Q 2(cum)=0.758. ROC characteristic curve was drawn based on the OPLS-DA model. The area under the curve (AUC) of the gastric cancer group was 0.998. Six peaks with good repeatability were detected in the serum Raman spectra of gastric cancer stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ, which were located at the displacement of 1 001.85, 1 155.07, 1 338.36, 1 445.75, 1 515.92, and 1 657.68 cm -1, respectively, and at the displacement of 1 155.07 and 1 515.92 cm -1. The Raman intensity of gastric cancer stage Ⅳwas significantly higher than that of gastric cancer stages Ⅰ, Ⅱ, and Ⅲ. Conclusions:According to the model reliability verification, the healthy group, gastric cancer group and colorectal cancer group can also be effectively separated based on OPLS-DA results; it showed a good performance in separating the healthy group from the gastric cancer group. It is possible to detect serum samples from healthy people and gastric cancer patients unlabeled by combining Raman spectroscopy and the OPLS-DA method in multivariate statistics.

Pharmacokinetics of FGF21-164 fusion protein in mice using UHPLC-MS/MS method / 药学学报

FGF21-164 is a fusion protein obtained by structural modification and coupling of endogenous FGF21. It is a candidate drug used in the treatment of glucose and lipid metabolic disorders caused by obesity. In this study, the candidate peptide mass spectrometry information of the protein hydrolyzed by trypsin was predicted by Skyline software and verified by high resolution mass spectrometry. The specific surrogate peptide (YLYTDDAQQTEAHLEIR) with the best mass response was selected after optimizing ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). Under ESI positive ion mode, the parent ion m/z 689.3 with 3 charge and the product ion m/z 738.4 with single charge can be monitored. After dilution by PBS, the serum samples were denatured under 60 ℃ and alkylated to reduce the matrix effect, then incubated with trypsin at 37 ℃ for 2 h, to obtain the surrogate peptide. The chromatographic separation was carried out on an EclipsePlus C18 column (2.1 mm×50 mm, 1.8 μm) using aqueous solution containing 0.1% formic acid (phase A) and acetonitrile solution containing 0.1% formic acid (phase B). Finally, the concentration of FGF21-164 fusion protein in mouse serum was quantitatively analyzed by external standard method by monitoring the above ion pairs using triple quadrupole mass spectrometer. This method showed a good linearity in the range of 2.50-500 μg·mL-1 (r = 0.998 8), and was successfully applied to the pharmacokinetic study of FGF21-164 fusion protein in mice. This experiment was approved by the Experimental Animal Ethics Committee of Shanghai Institute of Materia Medica, Chinese Academy of Sciences (batch number: 20180004040450). Compared with the endogenous FGF21, the t1/2 of FGF21-164 fusion protein was prolonged from 0.5 h to 2.6 h, which is expected to prolong the therapeutic efficacy of this protein.

Anti-tumor Effect and Mechanism of Kaempferol： A Review / 中国实验方剂学杂志

Cancer is a threat to human health. New treatments for cancer can significantly prolong the survival time of patients， but fail to improve the adverse reactions induced by chemoradiotherapy. Improving patient outcomes still requires the effort of cancer researchers. In recent years， the anti-tumor effects of active components from Chinese herbs have received wide attention. Kaempferol， a flavonoid mainly found in the medicinal plant Kaempferia galanga， can be used to treat obesity， cardiovascular diseases， diabetes and other diseases. It has also exhibited good efficacy in inhibiting the occurrence and development of liver cancer， colon cancer， lung cancer， ovarian cancer， and other malignant tumors. Kaempferol mainly exerts the anti-cancer effect by inducing apoptosis. Specifically， it promotes the production of intracellular reactive oxygen species （ROS） and triggers cell apoptosis through the mitochondrial pathway. Besides， it is capable of interfering with the cancer cell cycle， causing most cancer cells to arrest in the G2/M phase， and inducing cell autophagy， a programmed cell death， thus inhibiting cell migration and invasion and angiogenesis， synergistically improving chemotherapeutic drug efficacy， and reducing adverse effects. Kaempferol acts on a series of intracellular and extracellular targets to participate in the regulation of tumor cell signaling pathways， involving phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）， epidermal growth factor receptor （EGFR）， mitogen activated protein kinase （MAPK）， and Wnt signaling pathways， with the PI3K/Akt signaling pathway being most significant. In addition， kaempferol also plays an important regulatory role in tumor epigenetics. This paper reviewed the anti-tumor effect and mechanism of kaempferol， aiming to provide reference for in-depth study on its prevention and treatment of tumor and the development of new anti-tumor drugs.

Experience in the implementation of standardized training for dental nurses in large general hospitals / 中华医学教育探索杂志

It is an inevitable trend for dental nurses to meet the requirements for becoming a well-qualified nurse specialist who should have professional skills, basic nursing skills and holistic nursing consciousness. Combined with the daily clinical works in large general hospital, a standardized training system for dental nurses was preliminarily constructed. The strategies and experience of the professional training, including personal career planning, emergency handling capacity improvement by multi-discipline training, core curriculum system construction, dental clinical techniques strengthening, customized training strategies implementation, as well as clinical examination and evaluation, were herein discussed. In conclusion, our experience provides useful references for standardized education of the dental nurses with qualified clinical competence.

Advances in bioanalysis of antibody drugs by LC-MS / 药学学报

Liquid chromatography-tandem mass spectrometry (LC-MS) is a promising alternative or complementary method for traditional ligand-binding assays (LBA) in antibody drug bioanalysis. However, issues related to method development, sample preparation, sensitivity and quantitative accuracy need to be addressed. This paper reviews progress in bioanalysis of antibody drugs by LC-MS methods, introduces the principle of the LC-MS method for the analysis of antibody drugs, and describes the challenges faced in quantitative antibody analysis by the LC-MS method. New strategies that can be used to deal with these challenges include: selection of surrogate peptides, purification and enrichment of samples, improvement in enzymatic digest efficiency, enrichment of peptides, and use of low rate LC. We review the application of LC-MS technology in the biological analysis of antibody drugs and discuss the prospect of using the LC-MS method for the analysis of antibody drugs.

Analysis of pregnancy outcomes in patients with uterine fibroids after high intensity focused ultrasound treatment / 中国实用妇科与产科杂志

OBJECTIVE: To investigate the effect of high intensity focused ultrasound(HIFU)on pregnancy outcomes inpatients with uterine fibroids.METHODS:From October 2010 to October 2017,241 patients with uterine fibroids whowere pregnant after HIFU treatment in Suining Central Hospital and Chongqing Haifu Hospital were retrospectivelyanalyzed.The efficacy of HIFU ablation and the patient′s pregnancy outcomes were investigated.RESULTS:Among thesepatients,9 of them were conceived within 2 month after HIFU,24 were conceived between 2 and 4 months after HIFU,33 patients were conceived between 4 and 6 months,and 175 patients were conceived after 6 months of HIFU treatment.The median conception time was 9 months after HIFU(range:1 to 26 months).Among them,152 patients had deliveredbabies successfully,12 patients are still in pregnancy,3 patients had ectopic pregnancy,2 patients had incisionalpregnancy,72 patients had abortions,including 66 cases of induced abortion and 6 cases of spontaneous abortion.Causesof induced abortion included:embryonic development stopping(8 cases),increased vaginal bleeding(5 cases),hypothyroidism(1 case),use of drugs during pregnancy and being fear of fetal malformation(6 cases),and unplannedpregnancy(52 cases).Of the 152 patients who had delivered,147 had 148 full-term deliveries(1 had full-term deliverytwice)and 5 had preterm birth.No uterine rupture occured during pregnancy or childbirth,and the newborn is healthy.Before HIFU treatment,136 of 241 patients had a history of abnormal pregnancy,and only 17 of these patients hadabnormal pregnancy after HIFU treatment.The incidence of spontaneous abortion in patients after HIFU treatment wassignificantly lower than before treatment(P<0.05).CONCLUSION:HIFU is a safe and effective treatment for patients whowish to have children.It can also improve the fertility of patients with a history of abnormal pregnancy,with no additionalobstetric risks.

Distribution and risk factors of multi drug resistant bacteria in nosocomial infection in Department of Neurosurgery / 中国神经精神疾病杂志

Objective To investigate the clinical features and risk factors of multidrug－resistant bacteria (multi drug resistant organisms, MDROs) infection in Department of Neurosurgery, and to provide evidence for the prevention and control of MDRO infection. Methods Data from 437 cases of infection in hospitalized patients on January 2012－2016 year in December Third Affiliated Hospital of Guizhou Medical University were retrospectively analyzed. Patients were divided into MDROs group and non MDROs group based on the results of MDROs detection. Multi factor Logistic regression analysis model was used to analyze risk factors. Results The infection rate of MDROs was 35.51%, and the detection rate of MDROs was 33.23% . ESBLs, CR－AB and MRSA were the most common bacterial species, and the infection of respiratory tract, urinary tract and wound infection were the main infection sites. Multivariate logistic regression analysis showed that hospitalization time ＞20 d, level of consciousness (coma), occupancy of ICU ≥7 d, ventilation (invasive), number of antibiotics used≥3, combined use of antibiotics≥3, mechanical ventilation Time≥7 d were possible risk factors for MDROs infection in neurosurgical patients (P＜0.05). Conclusion The situation of MDROs infection in neurosurgery is severe. To reduce MDROs infection, it is important to shorten unnecessary hospitalization time, promptly assess and transfer out of ICU as soon as possible, improve microbial examination, avoid frequent change of antibiotics or unnecessary use of use of broad－spectrum antibiotics, reduce unnecessary mechanical ventilation time, change to non－invasive ventilation as far as possible when the condition permits, focus on patients with poor consciousness, and prevent aspiration by mistake.

The enlightenment of world suicide prevention day theme for nurses to prevent the suicide of hospitalized patients / 中国实用护理杂志

On the analysis of world suicide prevention day theme throughout the years and its basic connotation, the article elucidates the core idea of "suicide, can be prevented" from different angles. And it enlightens the nurses should combine clinical practice, according to the specific situation of the hospitalized patients to carry out suicide prevention nursing work, mainly includes: think globally, make life full of hope, diversified social support, promote understanding, focus on high-risk age bracket, attach great importance to the cultural background, strengthen the cause of survival, eliminate discrimination, psychological intervention and continuous human care.

Changes in cesarean delivery rate and indications against the background of two-child policy / 中华围产医学杂志

Objective To study the changes in cesarean delivery rate (CSR) and indications against the background of two-child policy. Methods Maternal information and indications for cesarean delivery were retrospectively obtained from medical records of 62007 women who delivered at the Obstetrics and Gynecology Hospital of Fudan University between January 2013 and December 2016. Indications for cesarean section were divided into 16 categories, such as maternal or fetal indication, repeat cesarean section, maternal request, labor arrest disorders, fetal distress, and so on. Changes in CSR and the proportion of cesarean delivery for each indication were evaluated. One-way analysis of variance, Chi-square or Fisher's exact test were used for statistical analysis. The average annual percent change (AAPC) in cesarean delivery rate was calculated by Joinpoint Analyses software. Relative contribution of each indication to the overall increase or decrease in CSR was analyzed using the data of the years of 2013 and 2016. Results The CSR dropped from 45.2％ (6683/14798) in 2013 to 38.3％ (6546/17104) in 2016. The rate of cesarean delivery due to maternal request and labor arrest disorders decreased significantly (χ2=49.402 and 14.617, both P<0.05) .The rate of cesarean delivery due to labor arrest disorders in all cases decreased sharply from 14.7‰ in 2013 to 0.9‰ in 2016 at an annual decrease of 48.0％ (95％CI: - 67.6％- - 21.5％). It was also worth noting that the rate of cesarean delivery on maternal request in all cases decreased from 119.3 ‰ in 2013 to 40.7 ‰ in 2016 at an average annual decrease of 30.1％ (95％CI: - 31.3％- - 28.9％). Despite of a limited number of cesarean delivery cases for uterine scar caused by leiomyoma resection, its rate increased from 1.4 per 1000 deliveries in 2013 to 2.9 per 1000 deliveries in 2016 with the highest average annual increase of 32.3％ (95％CI: 10.1％-60.9％), followed by the rate of cesarean delivery due to maternal pyrexia, increasing from 6.6 per 1000 deliveries in 2013 to 16.4 per 1000 deliveries in 2016 at an average annual increase of 27.4％ (95％CI: 11.0％-46.5％), and the rate of cesarean delivery due to repeat cesarean section, increasing from 67.6 per 1000 deliveries in 2013 to 113.9 per 1000 deliveries in 2016 at an average annual increase of 19.0％ (95％CI: 5.0％-34.6％). The first two positive contributors to the total decrease of CSR were maternal request and labor arrest disorders (144.2％ and 27.7％, respectively), while the first two negative contributors were repeat cesarean section and maternal pyrexia (-102.3％ and -18.9％, respectively). Conclusions The CSR is reduced after the implementation of two-child policy through active control on maternal request and application of new partogram.

Research on the Indicators of ADR Reporting by Medical Institutions in China / 中国药房

OBJECTIVE:To evaluate the indicators of ADR reporting by medical institutions in China. METHODS:The indicators of ADR reporting by medical institutions in China were presented primarily by 8 pharmacy experts with focus group interview method. System assessment method was used for evidence-based analysis of primary ADR indicators. Delphi method was used to confirm the requirement,calculation formula,definition,evaluation meaning and reference value of ADR indicators. The reliability was assessed. RESULTS:Primary indicators included the rate of ADR reporting,the rate of qualified ADR,constituent ratio of severe and new ADR. A total of 30 literatures were included(15 documents of management standard,15 literature research)in system evaluation,all of which indicated the necessity and requirement of ADR reporting. But the calculation formula, definition and evaluation meaning of ADR indicators were not mentioned. By investigation with Delphi method,the range of reference value was confirmed as follows that the rate of ADR reporting was≥0.01%;the rate of qualified ADR was≥90%;the constituent ratio of severe and new ADR was≥1%. The evaluation result was reliable. CONCLUSIONS:The indicators of ADR reporting and reference lower limit value can urge medical and health institutions to report ADR actively,improve the quality of ADR reporting and strengthen the attention of medical and health institutions to severe and new ADR.

Application of anti-osteoporotic medications in osteoporotic fractures / 中国组织工程研究

BACKGROUND: Patients with osteoporosis are prone to develop fractures, and moreover some patients are first diagnosed with osteoporosis because of a fragility fracture. Therefore, it is critical to understand the correlation between osteoporotic medications and fracture healing. OBJECTIVE: To summarize the effect of anti-osteoporosis medications on osteoporotic fracture healing in order to promote its clinical application. METHODS: A computer-based online search of PubMed, CNKI, VIP and WanFang databases between January 2012 and July 2016 was performed to retrieve the related articles with the keywords of "osteoporotic fracture, healing, bone nutrition supplements, anti-resorptive agents, anabolic agents, dual effect agents, new targeted agents" in English and Chinese, respectively. Literature concerning the effect of anti-osteoporosis medications on fracture healing was selected, and the articles published lately in authoritative journals were preferred. RESULTS AND CONCLUSION: Most of anti-osteoporotic medications have no harmful influence on fracture healing, including bone nutrition supplements (calcium and vitamin D), anti-resorptive agents (bisphosphonate, denosumab, estrogen and selective estrogen receptor modulators, statins and calcitonin), anabolic agents (parathyroid hormone), and dual effect agents (strontium ranelate). Calcium and vitamin D are the basic drugs; anti-resorptive agents exert overt anti-osteoporotic effect; and the new targeted agents like cathepsin K inhibitor and sclerostin monoclonal antibody provide more choices for the therapy of osteoporotic fracture. Partial anti-osteoporotic agents inhibit the viability of osteoclasts, so their early application may be against fracture healing. The optimal time of anti-osteoporotic medications and the effect on acute and non-acute osteoporotic fractures need to be further explored.

Association between vasoactive-inotropic score and prognosis in children with septic shock / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the association between vasoactive-inotropic score (VIS) and prognosis in children with septic shock.</p><p><b>METHODS</b>A total of 117 children with decompensated septic shock who received the treatment with vasoactive agents were enrolled. According to their prognosis, they were divided into death group with 41 children and survival group with 76 children. With the maximum VIS within the first 24 hours (24hVIS max) as the cut-off value (29.5), the children were divided into low VIS group with 78 children and high VIS group with 39 children. The 24hVIS max and the mean VIS within the first 24 hours (24hVIS mean) were calculated for all children. A receiver operating characteristic (ROC) curve analysis was performed for the association between VIS and the prognosis of septic shock.</p><p><b>RESULTS</b>Compared with the survival group, the death group had significantly higher 24hVIS max, 24hVIS mean, PRISM III score, and level of lactate before the use of vasoactive agents and after 24 hours of use (P<0.05). 24hVIS max, 24hVIS mean, PRISM III score, level of lactate before the use of vasoactive agents and after 24 hours of use, and 24-hour pH had a certain value in predicting the prognosis of septic shock, but 24hVIS max had the largest area under the ROC curve. Compared with the low VIS group, the high VIS group had significantly higher number of deaths, PRISM III score, and level of lactate before treatment and after 24 hours of treatment (P<0.05).</p><p><b>CONCLUSIONS</b>VIS is associated with the mortality of children with septic shock, and the severity and mortality of patients increase with the increase in VIS.</p>

High risk factors analysis of stillbirth / 中华妇产科杂志

Objective To explore the high risk factors of stillbirth. Methods 176 cases of stillbirth were collected in the Obstetrics and Gynecology Hospital of Fudan University from January 1st, 2010 to December 31st, 2016. All cases were analyzed retrospectively, including general profile, high risk factors of stillbirth in different years and pregnancy periods. Results (1) The incidence of stillbirth was 0.178%(176/98 785). Stillbirth occured mostly at 28-28+6gestational weeks (10.8%,19/176), and the second peak was 29-29+6weeks(10.2%,18/176),while the third common period was 37-37+6weeks(9.1%,16/176).After 39 weeks,it maintained at a low level.(2)The top 5 high risk factors of stillbirth were infection (18.2%,32/176), unexplained (13.6%,24/176), hypertention disorders in pregnancy (13.1%, 23/176), umbilical cord torsion(12.5%,22/176)and fetal malformations(10.2%,18/176).(3)From 2010 to 2012,the top 3 high risk factors were unexplained, the umbilical cord torsion and infection, while hypertention in pregnancy,infection and fetal malformation became the top 3 high risk factors after 2013.(4)Early stillbirth (20-27+6weeks)accounted for 21.6%(38/176);and unexplained(47.4%,18/38),fetal edema(13.2%,5/38), infection(13.2%,5/38),umbilical cord torsion(5.3%,2/38)were the top 4 high risk factors.Late stillbirth(≥28 weeks)accounted for 78.4%(138/176),with infection(19.6%,27/138),hypertention in pregnancy(15.9%, 22/138), umbilical cord torsion (14.5%,20/138) and fetal malformation(12.3%,17/138)being the top 4 high risk factors. Conclusions More attention should be paid to maternal complications, especially infection and hypertension in pregnancy. Antenatal fetal monitoring, timely termination of pregnancy, standard management of stillbirth and looking for the causes may help reduce the incidence of stillbirth.

Medical and non-medical factors influencing termination of pregnancy in Chinese women with fetal malformation / 中华围产医学杂志

Objective To investigate the rate of termination of pregnancy (TOP) in gravidas with prenatally diagnosed fetal malformation and to analyze the influences of medical and non-medical factors on decision making.Methods This was a prospective cohort study. Gravidas who took part in a multidisciplinary consultation due to fetal malformation and finished a questionnaire after consulting from September 12, 2012 to May 2, 2013 were recruited. Exclusion criteria were chromosomal disorders and isolated abnormal ultrasound soft markers. The questionnaire survey was conducted to understand the patient's backgrounds and to collect their feedbacks on the consultation. Decisions of the gravidas on TOP were followed up by phone in 2014 and 2016. If a gravida chose to continue her pregnancy, her baby's outcome was also recorded.T test,Chi-square test or Fisher's exact test, or rank-sum tests (Mann-Whitney or Wilcoxon) or Logistic regression was used for statistical analysis.Results (1) Altogether 229 gravidas were recruited and 10 of them were lost to follow-up, so 219 cases were finally analyzed. Among the 219 cases, 35.6% (78/219) chose to terminate their pregnancies. (2) Neonatal prognosis was predicted based on the type and severity of the disease and was divided into four levels including good prognosis (122 cases, 55.7%), medium prognosis (20 cases, 9.1%), poor prognosis (17 cases, 7.8%) and unsure prognosis (60 cases, 27.4%). (3) Gravidas who chose to terminate their pregnancies were younger than their counterparts choosing to continue to term (average age: 27.8±4.1 vs 29.0±3.9,t=2.257,P<0.05). Gravidas who went to the consultation before the 24th gestational week carried double risk of TOP than those after the 24th gestational week [termination rate: 52.5% (31/59) vs 29.4% (47/160),χ2=10.089,P<0.01). (4) Gravidas with fetal growth restriction (FGR) were at triple risk of TOP than those without (OR=2.850, 95%CI: 1.323-6.140) after adjusting for maternal age, gestational age at consultation and prognostic evaluation. Comparing with the good prognosis group, in which the rate of TOP was 19%, the unsure (OR=2.354, 95%CI: 1.108-5.004), medium (OR=16.188, 95%CI: 4.732-55.372) and poor (OR=14.515, 95%CI: 3.61-58.359) prognosis groups had higher risk of TOP. (5) There were 63 women informed us their reasons for TOP (multiple choices), among which 57 (90.5%) were due to unsure neonatal outcomes, and 10 (15.9%) were due to emotional factors. (6) Maternal satisfaction with neonatal prognosis was 2 to 5 points (medium score, ten-point system) lower in gravidas choosing to TOP than in those choosing to continue pregnancy regardless of good, unsure, or medium neonatal prognosis. No significant difference in maternal satisfaction was found among gravidas with poor neonatal prognosis.Conclusions The rate of TOP in gravidas with prenatally diagnosed fetal malformation remains high in China. Factors that can negatively influence the rate of TOP are consultation after the 24th gestational week, better perceived neonatal prognosis and higher maternal satisfaction with neonatal prognosis. Uncertainty of the neonatal prognosis is the leading cause of maternal dissatisfaction.