Objective To explore the correlation between matrix metalloproteinase‐9(MMP‐9) and cardiac function ,aneu‐rysm volume in the process of left ventricular aneurysm (LVA) formation .Methods Rabbit models of LVA were established in 20 New Zealand rabbits by lighting left anterior descending artery and left circumflex artery .Two‐dimensional echocardiography were performed at preoperative and postoperative 1 d ,2 d ,3 d ,1 w ,2 w ,3 w ,4 w .The survived animals which had LVA formed were en‐rolled .Real time three‐dimensional echocardiography was performed to obtain left ventricular volume ,LVEF and LVA volume ,The MMP‐9 serum concentration was measured by ELISA .Results (1)There were a significant increase in the serum concentration of MMP‐9 from postoperative 1 d and arrived at the peak at postoperative 3 d ,there were higher than preoperative at postoperative 4 w (P<0 .05) .(2)Compared with preoperative ,the LVEDV ,LVESV and LVAV volume at postoperative showed an increase trend (P<0 .05) ,while there was a decreasing trend in LVEF(P<0 .05) .(3)The MMP‐9 had the better relationship with LVEF at post‐operative 1 d ,2 d ,3 d ,1 w ,2 w ,3 w ,4 w ,in which MMP‐9 had the tightest relationship with LVEF at postoperative 3 d (r=0 .731 , P<0 .05) .MMP‐9 had the better relationship with LVA volume at postoperative 2 d ,3 d ,1 w ,2 w ,3 w ,4 w ,in which MMP‐9 had the tightest relationship with LVA volume at postoperative 3 d (r=0 .636 ,P<0 .05) .Conclusion The MMP‐9 had an effect on cardiac function and LVA volume in the process of LVA formation .

The application of continuous quality improvement program in standardized residency training examination in the central Hospital of Shanghai Jiading was introduced to inquire into the way to improve the quality of standardized training of resident doctors. Through the steps of FOCUS-PDCA, we continuously improved the examination content and quality compliance training personnel, and developed the examination process including test, training, supervision, learning and using. After the implementation of the project, the percentage of the departments that meet the residency training examination requirements has been increased from 33.3%to 100%in our hospital. The percentage of the students that passed the licensed medical skills examination was 96.6%in that year. 100%of the students passed the graduation comprehen-sive examination. Year-end evaluation showed that the students' satisfaction degree to the teachers increased from 94.5%to 98.2%. Thus, through the implementation of CQI project, we achieved the goal of promoting teaching and promoting learning.

Objective In order to understand the depression situation of the hospitalized tuberculosis patients.Methods Zung depression was used as a tool for assessment,the objective of 130 patients hospitalized for tuberculosis survey.Results 58.5% of the hospitalized tuberculosis patients showed symptoms of depression,compared with the secondary and 3 care patients,the rate was high among the level care patients,meaningful differences(P

Objective To investigate the neurodevelopmental outcomes and its risk factors of very low birth weight infant (VLBWI) and extremely low birth weight infants (ELBWI).Methods Data of 85 VLBWI and ELBWI hospitalized in Children's Hospital of Fudan University from October 2005 to November 2009 who had finished infant development test of Baley Scales of Infant Development Ⅱ (Bayley Ⅱ) for neurological development at corrected gestational age between 18 to 42 months were retrospectively reviewed.Twelve infants who accepted treatment in other hospital over 10 days were excluded; the rest 73 infants were divided into normal (neurodevelopment) group or abnormal group according to the definition of neurodevelopmental impairment reported by National Institute of Child Health and Human Development (NICHD) Neonatal Network.Potential risk factors of neurodevelopmental impairment were analyzed with Logistic stepwise regression.Results The mean gestational age of 73 infants was (30.4±2.3) weeks; among which 13 were smaller than 28 weeks,42 between 28 and 32 weeks,and 18 older than 32 weeks.The mean birth weight was (1208.0±208.5) g; among which 15 (20.6％) ＜1000 g,and 58 (79.4％) were between 1000 g and 1500 g.Four babies (5.5％) were diagnosed as movement retardation,and neurodevelopmental impairment occurred in 16 cases (21.9 ％),psychomotor developmental index ＜70 occurred in 6 cases (8.2％,one case complicating with cerebral palsy); mental developmental index ＜70 occurred in 2 cases (2.7％); both psychomotor developmental index and mental developmental index ＜70 occurred in 7 cases (9.6 ％,two cases complicating with cerebral palsy),and one case (1.4 ％) was cerebral palsy only.Blind in either eyes and hearing impairment requiring deaf-aid were not found in any of the 73 babies.Logistic stepwise regression showed that use of mechanical ventilation was related to neurodevelopmental impairment (OR =6.183,95％ CI:1.664-22.983,P =0.003).Psychomotor developmental index of infants who needed mechanical ventilation (77.5±15.1) was lower than that of infants did not need (87.3±15.1)(t=2.646,P=0.010).Conclusions VLBWI and ELBWI are in high risk of neurodevelopmental impairment,especially those who need mechanical ventilation.

Objective: To isolate and identify the structures of triterpenoids from the extract of Acanthopanax sessiliflorus fruits. Methods:The chemical constituents were systematically isolated by column chromatography and liquid chromatography, and their struc-tures were determined by spectral data including 1 H-NMR, 13 C-NMR, HSQC and HMBC combined with ESI-MS. Results:Totally 8 trit-erpenoids compounds were isolated and identified from Acanthopanax sessiliflorus fruits, 22-α-hydroxychiisanogenin (1), chiisanogenin (2), 3-oxo-24-methylenecycloartan (3), mangiferonic acid (4), isomangiferolic acid (5), oleanolic acid (6), betulin (7) and betulin-ic acid (8). Conclusion:Compound 3, 4 and 5 are obtained from Acanthopanax genus for the first time.

A"3+2"standardized training program of assistant general practitioner was launched in Shanghai Jiading District in 2012 in order to train new medical talent in suburb area.The program was developed through the jointed efforts among the government,medical school and train bases.The model was designed as training assistant general practitioners with distinctive sequential education process in different levels and stages.After five years of practice,the"3+2"standardized training program of assistant general practitioner has accomplished its goal,which provides a reference for training assistant general practitioners in Shanghai Municipality.

Objective:To explore the effect of scenario simulation teaching combined with flipped classroom teaching for nursing interns in the department of gastroenterology.Methods:A total of 40 undergraduate nurses of 2019 from the Department of Gastroenterology of Renji Hospital, Shanghai Jiao Tong University School of Medicine were selected as the control group, and 40 undergraduate nurses of 2020 were selected as the research group. The control group adopted the traditional clinical teaching mode, and the research group adopted the scenario simulation combined with flipped classroom teaching mode. After 3 months of clinical teaching, theoretical and nursing operational assessment were performed on the nurses, and questionnaire survey was used to evaluate the teaching effect of clinical nursing teaching and the satisfaction of teaching quality. SPSS 20.0 was used for t test and chi-square test. Results:The theoretical and nursing operation skills assessment scores of the research group were higher than those of the control group, and the difference was statistically significant ( P<0.001). The research group was significantly better than the control group in improving nursing operation skills, improving autonomous learning ability, improving nurse-patient communication ability, improving response ability, improving overall analysis ability, enhancing humanistic care awareness, cultivating team spirit, and cultivating clinical thinking ability( P<0.001). The satisfaction rate of the practice nurses in the study group with the scenario simulation combined with the flipped classroom teaching was 100.00%, and that in the control group with the traditional clinical teaching mode was 70.00%, with statistical significance ( P<0.001). Conclusion:Scenario simulation teaching combined with flipped classroom can improve the theoretical foundation and operational skills of practical nurses in the department of gastroenterology, and improve the clinical nursing teaching effect and satisfaction of practical nurses, which is worthy of application and promotion.

Objective:To explore the effect of comprehensive intraoperative physical intervention to prevent deep vein thrombosis (DVT) of lower extremity in patients with gynecological tumor surgery.Methods:From January 2020 to January 2021, 80 gynecological tumor patients undergoing surgery in Shanxi Provincial People 's Hospital were selected by convenience sampling as the research object. According to the random number table method, the patients were divided into the control group and the intervention group, each with 40 cases. The intervention group used intermittent pneumatic compression device (IPC) combined with graduated compression stockings (GCS) during the operation. In the control group, IPC was used alone for intervention. This study compared the blood flow rate and tube diameter of the lower extremity veins (common femoral vein, deep femoral vein, popliteal vein, and intermuscular vein) , blood coagulation indexes [prothrombin time (PT) , thrombin time (TT) , activated partial thromboplastin time (APTT) , fibrinogen (FIB) and D-dimer]before and after operation and the incidence of lower extremity DVT on the third day after operation between the two groups. Pearson correlation analysis was used to analyze the correlation between postoperative D-dimer and lower extremity venous blood flow rate. Results:There was no significant difference between the two groups of patients in the preoperative lower extremity venous blood flow velocity and diameter ( P>0.05) . The comparison of postoperative lower extremity venous blood flow rate between the two groups were statistically significant ( t=2.217, 4.863, 2.946, 2.397; P<0.05) . The diameters of common femoral vein, deep femoral vein and intermuscular vein between the two groups were statistically different ( t=2.117, 2.756, 2.274; P<0.05) , and there was no significant difference in the diameter of popliteal vein ( P>0.05) . There was no significant difference in PT, TT, APTT, FIB, D-dimer between the two groups of patients before operation ( P>0.05) . The differences in FIB and D-dimer between the two groups of patients were statistically significant ( t=-2.338, -3.554; P<0.05) . The incidence of lower extremity DVT in the intervention group was 2.5% (1/40) on the third day after operation, and the incidence of lower extremity DVT in the control group was 20.0% (8/40) , and the difference was statistically significant (χ 2=6.135, P<0.05) . Pearson correlation analysis showed that postoperative D-dimer and lower extremity venous blood flow rate were negatively correlated ( r=-0.484, -0.442, -0.358, -0.308; P<0.01) . Conclusions:The application of comprehensive intraoperative physical intervention of IPC combined with GCS can reduce the incidence of DVT in the lower extremities of patients with gynecological tumors, and it is worthy of clinical application.

Objective:To explore the effect of intraoperative physical prevention on the occurrence of lower extremity deep vein thrombosis (DVT) in patients with gynecological tumors after operation.Methods:From January to December 2020, convenience sampling was used to select 79 gynecological tumor patients with operations in Shanxi Provincial People's Hospital as the research object. According to the random number table method, the patients were divided into the observation group ( n=40) and the control group ( n=39) . The patients in the control group received graduated compression stocking (GCS) during the operation, and the patients in the observation group were treated with the GCS combined with the plantar arteriovenous pump. The blood coagulation indexes [D-dimer, prothrombin time (PT) , activated partial thromboplastin time (APTT) ], lower extremity (common femoral vein, deep femoral vein) venous diameter and blood flow rate before operation, immediately after operation, and on the third day after operation, and the incidence of DVT on the first day, third day, 1 month and 3 months after the operation were compared between the two groups. Results:Repeated measures analysis of variance showed that there were interaction, between-group and time effects in the comparison of D-dimer, PT, and APTT before operation, immediately after operation, and on the third day after operation between the two groups. There were interactions, between-group, and time effects in the comparison of the diameter of the common femoral vein, the diameter of the deep femoral vein, and the venous blood flow rate. The differences were all statistically significant ( P<0.05) . On the first day, third day, 1 month and 3 months after operation, the incidences of DVT in the observation group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Intraoperative GCS combined with plantar arteriovenous pump can improve postoperative coagulation function in patients with gynecological tumors, accelerate venous blood flow rate of lower extremities, and reduce the incidence of DVT in patients.

Objective To explore the application value of five row of emotional nursing program in the patients suffering from gastrointestinal operation.Methods Totals of 228 patients suffering from gastrointestinal operation were randomly divided into the observation group and the control group, with 114 cases in each group. The observation group received five rows of emotional nursing program according to the three kinds of negative emotions, and the control group was implemented the general emotional nursing care.The symptom checklist was used to assess patients’ symptoms, the St.Mary’ s Hospital Sleep Questionnaire ( SMH) was used to evaluate the sleep quality of patients.Patients’ symptoms and sleep quality were compared at the second day after admission and the first day after intervention.Results The scores of symptom checklist and SMH were not significant (P>0.05).After the intervention, the total scores of somatization and SMH were (1.36 ±0.20) and (18.09 ±3.58) in the observation group.Those scores of the control group were (1.42 ±0.33) and (17.69 ±2.48).There were no significant differences between the two groups ( t =0.368, 0.985, respectively;P>0.05).Other aspects of the observation group were significantly better than those in the control group (t=2.896-4.023,P<0.05).The self-assessment lists and SMH of the observation group before and after the intervention had significant differences (t=3.012-7.362,P<0.05).After the intervention, the total scores of somatization and SMH of the control group were significantly improved ( t =3.026, -4.331, respectively;P<0.05).The rest of the aspects had no significant differences (t=0.639-0.942,P>0.05). Based on the five row emotional care programme, 112 patients in the observation group were satisfied and 2 patients were not satisfied.Those numbers of the control group were 91 and 23.There was a significant difference between the two groups (χ2 =19.726,P<0.01).Conclusions The five row emotional nursing program for patients suffering from gastrointestinal operation have a certain effect on negative emotional, and can improve the sleep quality and treatment satisfaction of the patients.