Influencing factors of malignant transformation of benign thyroid nodules / 公共卫生与预防医学

Objective To preliminarily analyze the influencing factors of benign thyroid nodule malignant transformation and provide a basis for early intervention of benign thyroid nodule malignant transformation. Methods Selected 158 patients with benign thyroid nodules who visited our hospital from January 2019 to January 2022 for inclusion in the study, and followed up for 3 year to observe whether the nodules had malignant changes. The age, gender and dietary habits were collected. 3 mL of fasting venous blood of subject were collected , and the level of TT3, TT4, FT3, FT4, TSH, TgAb, CEA, thyroglobulin and calcitonin were collected. Results The results of this study suggest that the plasma levels of serum TgAb, TSH, TT4, TT3, FT3, FT4, CEA, thyroglobulin, and calcitonin of subjects were not statistically significant between sexes. The results of univariate analysis showed that compared with non malignant group, the patients in malignant nodule group were younger, the longest diameter of nodule was smaller, TgAb level was higher, TSH level was higher, FT3 level was lower, the proportion of internal calcification was higher, thyroglobulin level was higher, CEA level was higher, calcitonin level was higher, and the proportion of abnormal lipid metabolism and glucose metabolism was also higher, which was statistically significant (P<0.05). Multivariate logistic regression analysis showed that TgAb positive, internal calcification, increased carcinoembryonic antigen level, dyslipidemia, elevated thyroglobulin level, and abnormal glucose metabolism, elevated calcitonin level were associated with the increased risk of node canceration, and increased total FT3 level was associated with the reduced risk of canceration (P<0.05). Conclusion TgAb positive, internal calcification, increased carcinoembryonic antigen level, small nodule diameter, abnormal blood lipids, elevated thyroglobulin level, low total FT3 level, abnormal glucose metabolism, and elevated calcitonin level are associated with the increased risk of malignant transformation of benign thyroid nodules, which should be paid attention to clinically.

Diabetic foot disease and its associated factors in Hanzhong in 2016 - 2022 / 公共卫生与预防医学

Objective To study the status of diabetic foot and its related factors in Hanzhong area in recent years, and to provide a scientific basis for the prevention and management of diabetic foot complicated by type 2 diabetes. Methods A stratified sampling method was used to select 528 patients with type 2 diabetes among permanent residents in Hanzhong from April 2016 to April 2022. Relevant medical history and laboratory examination data were collected, and the incidence of diabetic foot was calculated. The influence of related factors on the risk of diabetic foot was analyzed by regression model. Results Among 528 subjects in this study, the disease course and body type of T2DM showed that male patients had significantly longer disease, and the proportion of overweight and obesity was higher, P2=27.516，P<0.05）. The proportion of male patients complicated with diabetic foot was higher than that of female patients (P<0.05). At the same time, the incidence of Wagner Grade I was higher in males than in females (P<0.05). The effects of potential factors on the risk of diabetic foot were discussed by gender. Univariate analysis and multivariate logistic regression analysis indicated that the risk factors of diabetic foot in male T2DM patients included: Increased course of disease, increased age, poor blood glucose control, increased total cholesterol level, increased BMI level and increased platelet to lymphocyte ratio . Potential risk factors in women include increased course of disease, age, poor blood sugar control (increased glycosylated hemoglobin levels) and increased platelet to lymphocyte ratios in all cases（P<0.05）. Conclusion The current prevalence rate of type 2 diabetes patients complicated with diabetes foot in Hanzhong area is 16.29%, which is still high , and the prevalence rate of men is significantly higher than that of women. Older age, long duration of T2DM, poor blood glucose control, increased total cholesterol level, increased blood uric acid level, decreased urine pH value, and increased platelet lymphocyte ratio are potential risk factors for diabetes foot. Male patients should also pay attention to the occurrence of overweight and obesity tendency to reduce the risk of diabetes foot.

Clinical practice guidelines for prevention and treatment of postoperative gastrointestinal disorder by integrated traditional Chinese and Western medicine: a protocol / 中华麻醉学杂志

To further improve the diagnosis and treatment level of integrated traditional Chinese and Western medicine for the prevention and treatment of postoperative gastrointestinal disorder, and to promote the standardization of clinical practice guidelines for postoperative gastrointestinal disorder. It was initiated by the Chinese Society of Integrative Anesthesiology, and the " Clinical practice guidelines for prevention and treatment of postoperative gastrointestinal disorder by integrated traditional Chinese and Western medicine: a protocol" was jointly formulated by the institutions such as Gansu Province Clinical Research Center of Integrative Anaesthesiology, Center of Anesthesiology and Pain Medicine of Gansu Provincial Hospital of Traditional Chinese Medicine, World Health Organization Collaborating Center for Guidelines Implementation and Knowledge Translation, GRADE China Center, Industry Technology Centre for Medical Guidelines of Gansu Province, and Evidence-based Medicine Center of Lanzhou University. The Guidelines Formulation Committee followed the principles, methods and procedures of evidence-based guidelines formulation, assembled a multidisciplinary team of experts, and provided an evidence-based clinical practice guidelines using the GRADE method. This protocol mainly expounds the purpose and method of guidelines formulation and the publication, promotion, implementation and update of guidelines.

16S rDNA sequencing analyzes differences in intestinal flora of human immunodeficiency virus (HIV) patients and association with immune activation.

To clarify the influence of HIV on the intestinal flora and the interrelationship with CD4 T cells, the present study collected stool specimens from 33 HIV patients and 28 healthy subjects to compare the differences in the intestinal flora and CD4 T cells in a 16S rDNA-sequencing approach. ELISA was used to detect the expressions of interleukin 2 (IL-2), IL-8, and tumor necrosis factor-α (TNF-α). Meanwhile, correlation analysis with the different bacterial populations in each group was carried out. The results revealed that Alpha diversity indices of the intestinal flora of HIV patients were markedly lower than that of the healthy group (p < 0.05). The top five bacterial species in the HIV group were Bacteroides (23.453%), Prevotella (19.237%), Fusobacterium (12.408%), Lachnospira (3.811%), and Escherichia-Shigella (3.126%). Spearman correlation analysis results indicated that Fusobacterium_mortiferum, Fusobacterium, and Gammaproteobacteria were positively correlated with TNF-α (p < 0.05), whereas Ruminococcaceae, Bacteroidales was negatively correlated with TNF-α (p < 0.05). Additionally, Agathobacter was positively correlated with contents of IL-2 and IL-8 (p < 0.05), whereas Prevotellaceae, and Prevotella were negatively correlated with IL-8 content (p < 0.05). Furthermore, the top five strains in the CD4 high group (≥350/mm3) included Bacteroides (23.286%), Prevotella (21.943%), Fusobacterium (10.479%), Lachnospira (4.465%), and un_f_Lachnospiraceae (2.786%). Taken together, the present study identified that Fusobacterium and Escherichia-Shigella were specific and highly abundant in the HIV group and a correlation between the different bacterial flora and the contents of IL-2, IL-8, and TNF-α was revealed.

Application of humanistic literacy and clinical practice ability training in postgraduate courses of geriatrics / 中华医学教育探索杂志

Objective:To explore the application value of humanistic literacy and clinical practice ability training in postgraduate courses of geriatrics.Methods:Postgraduates in Zhejiang University School of Medicine were taken as research objects. The teaching curriculum combining humanistic literacy and clinical practice ability training was set as the course of experimental group, and the teacher-led teaching course was set as the course of control group. The questionnaire survey was conducted to the evaluate the teaching effect among the postgraduates from three aspects: classroom situation, knowledge application and ability training. SPSS 17.0 was used for t-test. Results:The teaching of combining humanistic literacy and clinical practice ability training in classroom atmosphere, participation, teacher-student communication, helping memory, knowledge comprehension, knowledge application, collaboration ability, expression ability, organizational ability, knowledge acquisition ability, and autonomous learning ability scores of the experimental group were (3.96±0.20), (3.92±0.28), (3.75±0.44), (3.92±0.28), (3.96±0.20), (3.96±0.20), (3.83±0.38), (3.92±0.28), (3.79±0.41), (3.88±0.34), and (3.83±0.38), which were better than those of the control group, especially in classroom atmosphere, participation, knowledge application, expression ability, and autonomous learning ability.Conclusion:The combination of humanistic literacy and clinical practice ability training can significantly improve the classroom atmosphere of geriatric postgraduate courses, enhance students' medical humanistic literacy, familiarize students with the core skills of geriatrics, and improve students' ability to express and learn independently.

ITPKA induces cell senescence, inhibits ovarian cancer tumorigenesis and can be downregulated by miR-203.

Overcoming senescence is a feature of ovarian cancer cells; however, the mechanisms underlying senescence regulation in ovarian cancer cells remain largely unknown. In this study, we found that ITPKA was downregulated in ovarian cancer samples, and the lower expression correlated with poor survival. Overexpression of ITPKA inhibited the anchorage-independent growth of ovarian cancer cells and induced senescence. However, knockdown of ITPKA promoted the anchorage-independent growth of ovarian cancer cells and inhibited senescence. Mechanistically, ITPKA was found to interact with MDM2, which stabilized P53, an essential regulator of senescence. Moreover, ITPKA was negatively regulated by miR-203, a microRNA that has been previously reported to be upregulated in ovarian cancer. Taken together, the results of this study demonstrated the tumor suppressive roles of ITPKA in ovarian cancer and provided a good explanation for the oncogenic roles of miR-203.

Clinical significance of serum homocysteine on peripheral vascular plaque in type 2 diabetes mellitus with subclinical hypothyroidism / 中国医师杂志

Objective:To investigate the effect of homocysteine (Hcy) on peripheral vascular plaque formation in patients with type 2 diabetes mellitus (T2DM) combine subclinical hypothyroidism (SCH), and to provide guidance for clinical medication and prognosis judgement.Methods:A total of 125 patients with type 2 diabetes admitted to the NO.3201 Hospital from 2018 Jan to Dec 2019 were selected. 125 patients with type 2 diabetes mellitus were divided into T2DM without plaque group (40 cases), plaque group (23 cases), T2DM with SCH without plaque group (25 cases) and plaque group (37 cases) according to thyroid function and whether they had peripheral vascular plaque. Data were collected to analyze the influencing factors of peripheral vascular disease.Results:(1) The incidence of vascular plaque in T2DM group and T2DM with SCH group was 36.5%(23/63) and 59.7%(37/62), respectively, with significant difference ( P<0.05). (2) There were significant differences in serum thyroid stimulating hormone (TSH), apolipoprotein A (ApoA), triglyceride (TG) and Hcy between T2DM group and T2DM with SCH group ( P<0.05); there was significant difference in low-density lipoprotein (LDL-C) and Hcy between T2DM groups with or without plaque ( P<0.05); there were significant differences in ApoA and Hcy between T2DM with SCH group with or without plaque ( P<0.05). (3) Logistic regression analysis showed that Hcy was the risk factors for the occurrence of vascular plaque in T2DM and T2DM with SCH group ( OR=1.640, 2.695, P<0.05). (4) Receiver operating characteristic (ROC) curve showed that the area under the curve of Hcy in T2DM group was 0.842 and Youden index was 15.75 μmol/L; The Hcy's area under ROC curve was 0.945 and Youden index was 12.9 μmol/L in T2DM with SCH. Conclusions:Hcy is closely related to the presence of peripheral vascular plaque in T2DM patients with subclinical hypothyroidism. The detection of blood Hcy level can provide new ideas for early diagnosis and treatment of peripheral vascular lesions in T2DM patients with SCH.

Recent trends in waist circumference and central obesity in Chinese children and adolescence during 1993-2015 / 中国学校卫生

Objective@#To analyze recent trends in waist circumference(WC) and central obesity rate of Chinses children and adolescence aged 7-18 from 1993 to 2015, and to provid the theoretical basis for further prevention and control of children obesity.@*Methods@#The samples were derived from the China Health and Nutrition Survey from 1993 to 2015 (both boys and girls aged 7-18). The criteria of WS/T 586—2017 were adopted as classification standard for central obesity and the coefficient of skewness-median-coefficient of variation method was used to reveal the trends of waist circumference distribution.@*Results@#From 1993 to 2015,waist circumference curves flattened and expanded at higher levels in boys and girls. The P50 and P85th percentile WC curves showed an increasing trend with high percentile increasing more obviously. WC increased 3.84 and 1.55 cm for boys and girls. The prevalence rate of central obesity increased in both genders, which increased from 4.08% to 20.64% in boys and from 6.29% to 20.98% in girls. Besides, higher increasing rate was observed among boy, and urban.@*Conclusion@#A rapid increase in waist circumference was present among Chinese children and adolescence. A gradient of increasing prevalence of central obesity was also observed in boys and girls, as well as in different BMI levels. Appropriate measures should be taken to control the increase in the course of the central obesity epidemic.

Association between resting heart rate trajectory pattern and risk of cardiovascular and cerebrovascular diseases / 中华心血管病杂志

Objective@#To examine whether the long-term resting heart rate (RHR) pattern can predict the risk of cardiovascular and cerebrovascular diseases (CVDs).@*Methods@#This prospective cohort study included 63 040 participants who took part in the health examination in 2006 and one of the health examinations on 2008 or 2010 and were free of myocardial infarction, stroke, arrhythmia, cancer and not treated with β-recepter blocker. The outcomes were the first occurrence of myocardial infarction and stroke during the follow up ended on December 31, 2015. RHRs were measured in 2006, 2008, and 2010. We used latent mixture modeling SAS Proc procedure to identify RHR trajectories. We identified 4 distinct RHR trajectory patterns based on the data derived from 2006 and on the pattern change during 2006 to 2010 (low-stable, moderate-stable, moderate-increasing, elevated-decreasing). Collected the general clinical data of the patients. Cox regression model was used to determine the association between RHR trajectory patterns and the risk of CVDs during follow up. Hazard ratio (HR) with 95% confidence intervals (CI) were calculated using Cox regression modeling.@*Results@#There were statistical significance among the 4 distinct RHR trajectory patterns on the following variables: age, gender, smoking status, drinking status, physical activity, education status, history of use antihypertensive drugs, history of hypertension,history of diabetes, body mass index, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting blood glucose, and the level of high-sensitivity C-reactive protein (all P<0.01). The moderate-increasing pattern experienced the highest risk of developing stroke and CVDs among all 4 patterns. The cumulative incidence of cerebral infarction, cerebral hemorrhage and CVDs in the order of low-stable trajectory, moderate-stable trajectory and moderate-increasing trajectory. The cumulative incidences of cerebral infarction, cerebral hemorrhage and CVDs in elevated-decreasing trajectory group were significantly lower than those in moderate-increasing trajectory group, but higher than those in moderate-stable trajectory group. Compared to the low-stable pattern, adjusted HR was 1.3 (95%CI 1.0-1.6) for the moderate-increasing pattern after adjustment for potential confounders.@*Conclusion@#Our study finds that individuals with moderate-increasing RHR trajectory pattern are associated with higher risk of cardiovascular and CVDs.

Association of programmed cell death 1 (PDCD1) gene polymorphisms with colorectal cancer among Han Chinese population / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To assess the association of programmed cell death 1 (PDCD1) gene polymorphisms with the susceptibility and/or progression of colorectal cancer.</p><p><b>METHODS</b>A hospital-based case-control study was carried out, which recruited 426 colorectal cancer patients and 500 healthy individuals. Five single nucleotide polymorphisms, namely rs36084323, rs11568821, rs2227981, rs2227982 and rs10204525, were selected for the study and genotyped with a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay.</p><p><b>RESULTS</b>The G allele of rs36084323 under a dominant model was associated with increased risk of advanced TNM staging of colorectal cancer progression (OR=1.59, 95%CI=1.02-2.48). Haplotypes G-G-C-T-A and A-G-C-C-G of the rs36084323, rs11568821, rs2227981, rs2227982, and rs10204525 were negatively associated with the occurrence of colorectal cancer.</p><p><b>CONCLUSION</b>The G allele of rs36084323 is associated with increased risk of advanced TNM staging of colorectal cancer. Conversely, the incidence of colorectal cancer is negatively associated with the haplotypes G-G-C-T-A and A-G-C-C-G of rs36084323, rs11568821, rs2227981, rs2227982, and rs10204525.</p>

Research progress of treatments on colorectal cancer in elderly patients / 中华老年医学杂志

The patients aged ≥ 60 years account for 70％ of Chinese population with colorectal cancer.However,with the increase of age,the treatment methods such as surgery,radiotherapy,chemotherapy become inappropriate and impeding factors for the self-care of the elderly.Several clinical trials show that only a part of the elderly,who are in good health condition,can get the clinical benefits from these therapies.Therefore,this review focused on the comprehensive treatments for elderly patients with colorectal cancer,then reached the best individualized treatment,so as to improve the survival and quality of life.

Research progress of treatments on colorectal cancer in elderly patients / 中华老年医学杂志

The patients aged ≥ 60 years account for 70％ of Chinese population with colorectal cancer.However,with the increase of age,the treatment methods such as surgery,radiotherapy,chemotherapy become inappropriate and impeding factors for the self-care of the elderly.Several clinical trials show that only a part of the elderly,who are in good health condition,can get the clinical benefits from these therapies.Therefore,this review focused on the comprehensive treatments for elderly patients with colorectal cancer,then reached the best individualized treatment,so as to improve the survival and quality of life.

Clinical effect and safety of methimazole or PTU combined with 131I in treatment of hyperthyroidism / 药物评价研究

Objective To explore the clinical effect and safety of methimazole combined with 131I in treatment of hyperthyroidism.Methods Patients (83 cases) with hyperthyroidism accepted in Xi'an Jiaotong University Affiliated San Er Ling Yi Hospital from June 2012 to June 2015 were selected and divided into observation group with 42 cases and control group with 41 cases.Patients in observation group were given methimazole combined with 131I,and patients in control group were given PTU combined with 131I.Then the clinical effect,thyroid gland serological indexes,adverse reations,and reoccurrence rates of two groups were observed and compared.Results The total clinical efficacy of observation group was 95.24％,which was obviously higher than 70.73％ of control group with statistically significance (P ＜ 0.05).TSH was getting higher after treatment of two groups,and T3,T4,FT3,FT4,TRAb,and TPOAb were getting lower after treatment of two groups.And TSH in the observation group was significantly higher than that in the control group,T3,T4,FT3,and FT4 were significantly lower than those in the control group (P ＜ 0.05).The adverse reaction rate of observation group (14.29％) was obviously lower than that of control group (46.34％) with statistically significance (P ＜ 0.05).The reoccurrence rate of observation group (4.76％) was obviously lower than that of control group (26.83％) with statistically significance(P ＜ 0.05).Conclusion Methimazole combined with 131I has good effect and safety in treatment of hyperthyroidism,which is worth of clinical application.

MiR-203 promotes the growth and migration of ovarian cancer cells by enhancing glycolytic pathway.

MicroRNAs (miRNAs) play an important role in the tumorigenesis of ovarian cancer. Previously, we have reported the dysregulation of miR-203 in the ovarian cancer tissues. However, the biological functions and molecular mechanisms of miR-203 in ovarian cancer remain unknown. Here, we showed that the expression of miR-203 was increased in ovarian cancer tissues compared with the adjacent non-cancerous tissues and the transcription of miR-203 was inhibited by P53. Forced expression of miR-203 in ovarian cancer promoted cell growth and migration, while depletion of miR-203 inhibited the growth and migration of ovarian cancer cells. In addition, miR-203 promoted the metastasis of ovarian cancer cells in vivo and shorted the survival of the nude mice. Mechanically, miR-203 targeted the 3'-UTR of pyruvate dehydrogenase B (PDHB) and increased the consumption of glucose and the production of lactate. Overexpression of PDHB abolished the oncogenic effects of miR-203 on the growth of ovarian cancer cells. Together, our data suggested the oncogenic roles of miR-203 in ovarian cancer by promoting glycolysis, and miR-203 might be a therapeutic target for ovarian cancer.

Effects of dexmedetomidine on onset and duration of supraclavicular brachial plexus block induced by levobupivacaine / 药学实践杂志

Objective To evaluate effects of dexmedetomidine on onset ,duration of supraclavicular brachial plexus block induced by levobupivacaine and postoperative analgesia with ultrasound guide .Methods Eighty patients undergoing elective surgeries of distal arm and forearm with class Ⅰ ~ Ⅱ ASA were enrolled ,and the patients were randomly divided into two groups ,one was control group (group C) patients with supraclavicular brachial plexus block by 30 ml of 5% levobupivacaine contained 1 ml normal saline ,the other was dexmedetomidine group patients (group D) with supraclavicular brachial plexus block by 30 ml of 5% levobupivacaine contained 100μg dexmedetomidine .The supraclavicular brachial plexus block was guided with ultrasound .Observation indicators include :sensory and motor onset blocks ,duration of sensory and motor blocks ,time to first rescue analgesia and hemodynamic parameters .Results The differences of sensory block onset between group C and D were not significant .Compared to group C ,motor block onset of group D was significantly shorter (P<0 .01) ,sensory block duration and motor block duration were longer (P<0.001) ,time to first rescue analgesia after the surgeries was longer (P<0 .001) .Mean arterial pressure and mean heart rate of group D were significantly lower than those of group C ,respectively (P<0 .02) .Conclusions Dexmedetomidine can significantly prolong the duration of block and postoperative analgesia of supracla-vicular brachial plexus block induced by levobupivacaine .

Correlation between blood glucose variability and TOAST type of patients with acute ischemic stroke / 中华神经科杂志

Objective To study the correlation between blood glucose variability and TOAST type of patients with acute ischemic stroke and provide new evidence which can improve the prognosis of ischemic stroke.Methods One hundred and forty-three hospitalized patients with acute ischemic stroke from August 2013 to August 2014 were included.All patients were estimated about the general state of health and performed laboratory examinations and other auxiliary examinations.Then the TOAST type of all cases was classified.The 24-hour blood glucose monitoring was done to the patients to calculate the blood glucose variability.One hundred and forty-three cases were divided into blood glucose variability group ( standard deviation of glucose ( GluSD )≥1.4 mmol/L, 85 cases ) and control group ( GluSD <1.4 mmol/L, 58 cases) according to glucose variability.We estimated the neurologic impairment of the patients with the US National Institutes of Health Stroke Scale ( NIHSS) and the activities of daily living with Barthel index.The relation between blood glucose variability and the prognosis of ischemic stroke was analysed with multivariate analysis.Results Differences were significant in age, history of diabetes and NIHSS score between blood glucose variability group and control group.The degree of neurologic impairment of large artery atherosclerosis (LAA) group (moderate and severe neurologic impairment:43/53(81.0%)) and cardio-aortic embolism ( CE) group ( moderate and severe neurologic impairment:15/17 ) was more serious than that in small artery occlusion ( SAO) group ( moderate and severe neurologic impairment:6/71 ( 8.5%) ) , especially in CE group.The differences were significant (χ2 =7.043,P<0.05).Blood glucose variability in patients with LAA was more obviously than that in other patients.NIHSS score and activities of daily living of the patients estimated on admission and after 2 weeks were not different in the blood glucose variability group, but the difference was significant in control group.The poor prognosis in blood glucose variability group was 2.821 times that in control group ( 95% CI 1.880 -4.233 ).Conclusions The people sufferd ischemic stroke with old age, diabetes or severe case are more vulnerable to abnormal blood glucose variability.Abnormal blood glucose variability is an independent risk factor for acute ischemic stroke and induces difficulty to recovery and poor prognosis.

Study on the HPLC Fingerprint of Dry Ginger / 中国药师

Objective:To establish the HPLC fingerprint of dry ginger to provide experimental evidence for the quality control. Methods:An Agilent TC-C18 column (250 mm × 4. 6 mm,5 μm) was used, the flow phase was acetonitrile-water with gradient elu-tion, the flow rate was 1. 0 ml·min-1 , the column temperature was 30℃, and the detection wavelength was 240 nm. The data were e-valuated by the similarity evaluation software for TCM fingerprint. Results:There were 10 common peaks in HPLC chromatogram of 10 batches of dry ginger at 240 nm, and the chemical similar coefficient was 99%. Conclusion: The fingerprint of ginger at 240 nm is highly specific and typical with a rich fund of information, which can provide useful references for the quality control and evaluation of dry ginger.

Effects of fetus gestational weeks on efficiency of Down's Screening dur-ing the second trimester / 中国现代医生

Objective To observe and analyze the effects of fetus gestational weeks on efficiency of Down's screening during the second trimester, and to provide certain reference data clinically. Methods A total of 36515 puerpera who received prenatal screening during the second trimester were selected. They were assigned to 5 groups according to their gestational weeks, which were group of 15 gestational weeks(15 to 16+6), group of 16 gestational weeks (16 to 16+6), group of 17 gestational weeks(17 to 17+6), group of 18 gestational weeks (18 to 18+6) and group of 19 ges-tational weeks (19 to 20 weeks). Detection rate and false screening positive rate of infants with Down's syndrome were compared between different gestation weeks. Results Two cases of missed diagnosis were seen in puerpera in the group of 15 gestation weeks. Detection rate of Down's screening in the group of 16 weeks to 18 weeks was 100%. No diagnosed infants with Down's syndrome were seen in the group of 19 gestational weeks. The false positive rate therefore was 7.85%. The screening results were different during different gestational weeks. Detection rate during 16 to 18 gestation weeks was 100%, and false positive rate of screening was 4.36%. In the negative groups of screened puerpera, AFP level increased with the increase of gestational weeks, and HCG level decreased with the increase of gestational weeks. In the positive groups of screened puerpera,their AFP levels were all lower than those in the nega-tive groups,and there HCG levels were higher than those in the negative groups. Conclusion Efficiency of screening is high when Down's screening during the second trimester of pregnancy is carried out during 16 to 18 gestational weeks.

Application of nurse-in-charge-led ward rounds in multi-level training of nurses / 现代临床护理

Objective To explore the effect of nurse-in-charge-led ward rounds on the multi-level training of nurses. Methods The traditional nursing ward round was adopted from Juanuary to December 2013 and the nurse-in-charge-led ward round was adapted from January to December 2014. The nurse-in-charge-led round mode and flowchart was developed by designating one nurse-in-charge to carry out the process of nursing round and other nurses in the group to carry out nursing interrogation, check-up, physical examination, nursing diagnosis, making nursing strategy and conclusion. Additionally, the two links of nurse-in-charge-led seminar and nursing feedback were added in the nursing round. The effect of nursing ward round and the results of nursing examination were compared between before and after the improvement. Results A year after implementing new nursing round mode, the effect of nursing round was significantly better than that before the implementation of new mode and the nursing examination score was significantly higher than that before its implementation (all P < 0.05). Conclusion The nurse-in-charge-led round mode can improve the effect of nursing round, improve clinical and professional ability to discover, analyze and solve problems.

Pretreatment with butorphanol to prevent injection pain of rocuronium bromide / 中国医师进修杂志

Objective To evaluate the effect of pretreatment with butorphanol to prevent injection pain of rocuronium bromide.Methods One hundred and fifty ASA Ⅰ-Ⅱ grade patients,undergoing elective surgery were divided into 3 groups by random digits table with 50 cases each.Butorphanol group received butorphanol 2 mg,fentanyl group received fentanyl 100 μg,and control group received 0.9％sodium chloride when general anesthesia induced.Anesthesia was induced with propofol 2 mg/kg and the test drug was injected over 30 s,120 s after the test drug injection,1％ rocuronium bromide 0.6 mg/kg was injected.Nausea,vomiting,apnea and bucking were recorded after drugs injection.Results The rates of rocuronium bromide injection pain in fentanyl group[10％(5/50)]and butorphanol group[8％(4/50)]were significant lower than that in control group[82％(41/50)](P ＜ 0.01).None of the patients discovered nausea,vomiting,apnea and bucking in 3 groups.Conclusion Pretreatment with 2 mg butorphanol reduced the incidence of rocuronium bromide injection pain,furthermore,there is no untoward reaction such as nausea,vomiting,apnea and bucking.