s Objective To explore the value of B mode ultrasound in the detection of amniotic fluid(AF) for fetus of 41～ 46 +6 gestation weeks.Methods B mode ultrasound was performed to monitor AF in 232 fetus of 41～46 +6 gestation weeks compared with that in 296 fetus of 37～40 +6 gestation weeks. Results There were significant differences in amniotic fluid index(AFI), amniotic fluid muddy(AFM) and cavity fetal distress(CFD) between the two groups (P

Objective:To survey the level of hospice care and the influencing factors in Shaanxi province. Methods:Interview and return visit method was used to investigate. Results:In total 235 patients, 37. 02% patients received hos-pice care. There is not significant difference between hospice users and no hospice users in sex and geographic differ-ences. There was significant difference between hospice users and no hospice users in personal ages, and in gap between urban and rural areas. and in medical payment, and in basic lesions. Malignant tumor patients receive hospice care most-ly. No patient received hospice care patients with acute trauma. The effect of ages on hospice is maximum ( OR =2. 877). Basic lesions is an important cause of influence whether patients receiving hospice care services(OR=1. 569). Conclusion:The level of hospice care is low in Shaanxi. The age and basic lesions is influencing factors of hospice care. The geographic differences has no effect on hospice care.

Perinatal glucocorticoid therapy has been proved to be effective on promoting fetal/neonatal lung maturity and has contributed to a dramatic improvement in the mortality and morbidity associated with neonatal respiratory distress syndrome.The underlying mechanisms studies are aimed primarily at accelerating the development of alveoli and pulmonary surfactant system.Meanwhile,a growing number of investigations focus on the side effects of perinatal glucocorticoid therapy on fetal/neonatal.Whether the repeat antenatal glucocorticoid and early postnatal glucocorticoid by intravenous injection is safe remains unclear.More studies are needed on the different route of giving glucocorticoid,the effect of different doses and their machanisms.This review presents the relevant information surrounding perinatal glucocorticoid therapy to enhance fetal/neonatal lung maturity,including clinical and animal studies over the last decades.

Objective To investigate the exercise performance in maintenance dialysis patients,and analyze its correlative factors.Methods Maintenance dialysis patients admitted in Tongji Hospital of Shanghai from December 2014 to March 2015 were enrolled,with their baseline data and biochemical measurement being collected.The anthropometric indexes including arm circumference,triceps skinfold,waist circumference and hip circumference were detected.The exercise activity was assessed by hand grip test,timed up and go test (3mTUG) and five times sit-to-stand test (FTSST).Patients were divided into fast group (3mTUG≤12 s) and slow group (3mTUG ＞ 12 s).Univariate and multivariable analyses were used to evaluate the factors influencing exercise performance in maintenance dialysis.Results There were 121 patients enrolled:62 on peritoneal dialysis and 59 on hemodialysis,76 men and 45 women.Patients' average age was (61.6± 13.0) years and median dialysis age was 31.7(12.3,69.0) months.There was no statistical difference between fast group (n=80) and slow group (n=41) in gender,dialysis method,dialysis age,body mass index (BMI),arm muscle area (AMA),waist-hip ratio (WHR),hemoglobin (Hb) and total cholesterol (TC).Patients in fast group were younger,had higher serum albumin,prealbumin,serum phosphate and iPTH,and less prevalence of diabetes than those in slow group.In exercise activity,patients in fast group had better performance in handgrip,3mTUG and FTSST (all P ＜ 0.05).Univariate analysis showed that,handgrip was correlated with sex (male),AMA,BMI,age,diabetes,serum phosphorus and TC;scores in FTSST was correlated with age,BMI,diabetes,WHR,dialysis method,dialysis age,prealbumin and serum phosphorus;scores in 3mTUG was correlated with age,diabetes,WHR,dialysis method and dialysis age,prealbumin,serum phosphorus and iPTH (all P ＜ 0.05).Multiple stepwise regression analysis showed that sex (male),age,AMA and diabetes were independently correlated with handgrip in dialysis patients (all P ＜ 0.05);age,dialysis method,BMI and diabetes were independently correlated with scores in FTSST (all P ＜ 0.05);age,dialysis method,diabetes and WHR were independently correlated with scores in 3mTUG (all P ＜ 0.05).Conclusions The exercise performances of patients on maintenance dialysis are impaired.Age and diabetes are independent factor associated with the exercise performances of patients on maintenance dialysis.AMA is independently associated with upper limb movement,and dialysis method,BMI and WHR are independent factors associated with lower limb movement in dialysis patients.

Objective To investigate the protective effect of glutamine(Gln) pretreatment on intestinal ischemia-reperfusion (I/R) injury and endothelial nitric oxide synthase (eNOS)/nitric oxide (NO) signaling pathway in rat model. Methods Thirty male Wistar rats were randomly divided into three groups(n=10 for each group):sham group, I/R group and Gln group. Animals were pretreated with 1 g/(kg·d)Gln by orogastric route for 7 days in Gln group, and normal saline was given to the other two groups in the same dose. Intestinal I/R was induced by 30 min occlusion of the superior mesenteric artery followed by 24 h of reperfusion. After the operation, the intestinal histopathological changes, the plasma endotoxin level, serum D-lactic acid, eNOS, inducible NOS(iNOS)activity and NO levels were detected by ultraviolet spectrophotometer. The mRNA expressions of myocardial eNOS and iNOS were detected by real-time fluorescence quantitative PCR (RT-PCR). Results After reperfusion, in IR group, extensive epithelial sloughing and mucosal ulceration of villous tips were observed, whereas these findings did not occur in Gln group and sham group. Compared with IR group, the serum NO, eNOS levels and eNOS mRNA expression of intestinal tissue were elevated in Gln group (P<0.01), but the plasma endotoxin level, serum D-lactic acid, serum iNOS and intestinal iNOS mRNA expression decreased in IR group(P<0.05). Conclusion Glutamine pretreatment has protective effects on intestinal ischemia-reperfusion injury in vivo. The mechanism may be related to the inhibition of iNOS expression and the increased expression of eNOS, thereby increasing NO activity.

OBJECTIVE:To investigate the current situation of anticoagulant therapy for patients with non-valvular atrial fibril-lation,and to provide reference for standardized anticoagulant therapy. METHODS:A total of 1056 patients with non-valvular atri-al fibrillation were collected from our hospital during Jul. 2015-Jun. 2016. According to 2012 European Society of Cardiology Guide-lines for the Management of Atrial Fibrillation,the risks of thrombosis and hemorrhage were evaluated,and the standardized anti-coagulant therapy was also evaluated. RESULTS:Among 1056 patients with non-valvular atrial fibrillation,the number of patients with thrombosis risk score ≥1 was 1028,accounting for 97.3%. 763 patients received antithrombosis therapy,and only 139 pa-tients were given warfarin anticoagulant therapy. The international normalized ratio(INR)of prothrombin time in just 30.9% of pa-tients receiving warfarin was in line with the standard before discharge. CONCLUSIONS:The anticoagulant therapy for patients with non-valvular atrial fibrillation is still not optimistic,and effective measure should be adopted to improve the standardization of anticoagulant therapy in the patients with atrial fibrillation.

Objective:To study the effect of shear stress on the expression of KLF2 and eNOS in venous endothelial cells under physiological and uremic conditions, and to explore the mechanism leading to dysfunction of venous endothelial cells.Methods:Under physiological conditions and uremia conditions, different shear stresses were simulated in the parallel plate flow cavity, and the shear stresses were applied to the venous endothelial cells of each group for 4, 12, and 24 hours. The expression of KLF2 and eNOS was detected by immunohistochemical fluorescent staining technique and real-time fluorescent quantitative PCR technique.Results:Under physiological conditions, KLF2 is obviously regulated by shear stresses. High-intensity shear stresses and physiological shear stresses will up-regulate the expression of KLF2, while low-intensity shear stresses and oscillating shear stresses will down-regulate the expression of KLF2. As the duration of action increases, the expression of KLF2 will also increase. In the state of uremia, the expression of KLF2 is significantly inhibited. Even if high shear stresses is applied, the level of KLF2 is not high-expressed as the physiological state. And under the action of low shear stresses and oscillating shear stresses, KLF2 expression is more significantly inhibited. KLF2 is mainly expressed in the nucleus. With the action of shear stresses, KLF2 is also expressed in the cytoplasm, while eNOS is mainly expressed in granular form in the cytoplasm and nucleus.Conclusions:After arteriovenous fistula operation, the expression of KLF2 and eNOS is inhibited under the action of multiple factors of uremia environment and oscillating shear stresses, which may be the main cause of the occurrence and development of venous endothelial cell dysfunction, intimal hyperplasia, and AVF failure.

Objective To evaluate the efficacy and safety of cinacalcet on secondary hyperparathyroidism (SHPT) in patients with end-stage renal disease (ESRD). Methods Patients with ESRD and SHPT for the treatment with calcimimetic agents were included in this study. MEDLINE (1996.1-2014.9), OVID (1963.1-2014.9), Chinese Wanfang database (1996.1-2014.9), CNKI (1996.1-2014.9) and the clinical control test database of Cochrane Library were searched . Related literature, including published or unpublished papers, and meeting procedding were hand-searched. Quality assessment and data extraction were conducted by two independent investigators. Meta-analysis was conducted by RevMan 5.2. Results Nineteen randomized controlled trials involving 7 702 patients were included. The meta-analysis showed that compared with conventional therapy,cinacalcet can significantly decrease serum parathyroid hormone in dialysis patients [WMD=-301.54 μg/L, 95%CI:(-344.38)-(-258.7)μg/L, P<0.05], decrease serum level of calcium [WMD=-8.3 mg/L, 95%CI:(-9.1)-(-7.4)mg/L, P<0.05], and decrease serum level of phosphorus [WMD=-3.4 mg/L, 95%CI:(-4.6)-(-2.3) mg/L, P<0.05]. The total incidence of adverse events was similar (RR=1.03, 95%CI:0.98-1.09, P>0.05). Cinacalcet increased nausea (RR =2.05, 95%CI :1.53-2.75, P<0.05), vomiting (RR =2.00, 95%CI:1.78-2.23, P<0.05), diarrhea (RR=1.15, 95%CI:1.03-1.30, P<0.05), and asymptomatic hypocalcaemia (RR=7.60, 95%CI:5.61-10.30, P<0.05), but they were usually transient, and mild to moderate in severity. The mortality was similar (RR=0.97, 95%CI:0.89-1.05, P>0.05). Conclusion Results confirm that cinacalcet suppresses parathyroid hormone and decreases calcium and phosphorus in secondary hyperparathyroidism patients receiving dialysis. Cinacalcet increases risks of nausea, vomiting, diarrhea and hypocalcaemia,without increasing mortality.

Objective To study the curative effects and adverse effects of the thalidomide combined with COMP chemotherapy in treating multiple myeloma(MM).Methods 42 patients were initially diagnosed as MM and 27 patients were refractory and relapsed MM.The small dose of thalidomide combined with COMP management and COMP management alone were used.The effective rate and adverse effects were analyzed.Changes of M-protein in serum,percentage of plasma cells in bone marrow and the level of hemoglobin were also analyzed in both pre-treatment and post-treatment periods.Results In 42 patients who were initially diagnosed as MM,the effective rate was 40.9% for 22 patients treated by chemotherapy alone and 70.0% for 20 patients treated by the thalidomide combined with chemotherapy.Statistic difference was observed between those two group.As to the 27 patients who were refractory and relapsed MM,the effective rate was 42.9% for 13 patients treated by chemotherapy alone and 84.6% for 14 patients treated by the thalidomide combined with chemotherapy.Statistic significance was present between them.Adverse effects were less and tolerated.Conclusion Treatment of small dose of thalidomide combined with COMP chemotherapy could significantly improve the effective rate with less adverse effects.

Objective To assess the effect of hemoperfusion (HP) and hemodiafiltration (HDF) on elimination of para?thyroid hormone (PTH) from plasma in long-term hemodialysis patients.Methods MEDLINE (1966—2013.8), Embase (1974—2013.8), Chinese Wanfang database (1996—2013.8),CNKI(1979—2013.8)and the clinical control test database of Cochrane Library were searched. Published reports, unpublished studies and abstract from conference were retrieved manu?ally, all of which include studies of effect of PTH elimination through hemoperfusion and hemodiafiltration. Quality assess?ment and data mining were conducted by two independent investigators who performed meta-analysis using RevMan 5.2. Re?sults A total of 12 reports (400 patients) met the inclusion criteria and were included in this study. The meta-analysis showed that the elimination rate of PTH in long term hemodialysis patients was similar between using hemoperfusion and us?ing hemodiafiltration(WMD=-0.34,95%CI:-12.66-11.98,P=0.96). What’s more the elimination rate ofβ2-MG were also similar(WMD=-2.92,95%CI:-16.64-10.8,P=0.68)between those two treatments. However,The remission rate of pruritus was higher in patients using HP group than in HDF group(RR=1.33,95%CI:1.08-1.62,P=0.006). Conclusion HP and HDF can effectively clear PTH in chronic hemodialysis patients, but there was no statistically different between the two treat?ment methods.