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

Objective To evaluate the efficacy and safety of peroral endoscopic myotomy (POEM) for achalasia.Methods A total of 40 achalasia patients who underwent POEM at our hospital were enrolled.The outcomes of Eckardt score,Barium contrast imaging,esophageal manometry as well as esophagogastroscopy were assessed before and at 6th day,1 month,3 months and 6 months after POEM respectively.Results All 40 patients successfully underwent POEM,with the mean operation time 57.2 ± 18.4 minutes.lntraoperative mediastinal and subcutaneous emphysema occurred on two patients.All patients had significant symptom relief after POEM (Eckardt score ≤ 3).The patients had a mean follow-up of 13.3 months.Two patients had symptom relapse,and treatment success rate (Eckardt score ≤3) was 90％ in 6-month follow up.According to high-resolution manometry (HRM),the resting lower esophageal sphincter (LES) pressures were 30.6 and 15.8 mmHg (P =0.001),and intergrated relaxation pressure(IRPs) were 28.1 and 12.2 mmHg (P =0.000) before and after POEM,respectively.The diameter of the esophageal lumen was 4.2 cm and 3.1 cm before and after POEM (P＜0.001).Conclusion POEM is safe and effective in a short term with less complications.Further follow-up studies are needed to evaluate long-term outcomes.

Objective To investigate the protective effects of rhein lysinate (RHL)on the blood vessel damage induced by oxidative stress in the mice,and to explore its mechanism.Methods The mouse models of oxidative damage were established by intraperitoneal injection of paraquat.30 C57 mice were randomly divided into control, paraquat model,and RHL prevention groups.The mice in RHL prevention group were given RHL by gavage for one week before performing model.The mice in other two groups were given equal volume of distilled water.For making model,paraquat was intraperitoneally injected in the mice in paraquat model and RHL prevention groups once a week for two weeks.The activities of superoxide dismutase (SOD)and glutathione peroxidase (GSH-Px) and the content of serum malonaldehyde (MDA) of the mice were detected 2 weeks after modeling. The pathological profile of blood vessel was observed by hematoxylin and eosin (HE)staining and the level of reactive oxygen species was observed by DCFH-DA staining.The expressions of genes related to blood vessel damage were detected by Western blotting method.Results Compared with control group,the activities of SOD and GSH-Px were decreased and the content of MDA was increased in paraquat model group (P < 0.05 ). Compared with paraquat model group,the activities of SOD and GSH-Px were increased and the content of MDA was decreased in RHL prevention group (P <0.05).The pathological examination indicated the structure of blood vessel of the mice was damaged and the level of reactive oxygen species of blood vessel was increased (P <0.05)in paraquat model group.The pathological changes were significantly improved and the level of reactive oxygen species of blood vessel of the mice was decreased (P < 0.05 )in RHL prevention group. The Western blotting analysis showed that compared with control group,the expression levels of nitric oxide endothelial synthase (eNOS)and caspase-3 of the mice in paraquat model group were decreased (P < 0.05),however the expression level of cleaved fragment of caspase-3 was increased (P < 0.05).Compared with paraquat model group,the expression levels of eNOS and caspase-3 of the mice in RHL prevention group were increased (P < 0.05 )and the expression level of cleaved fragment of caspase-3 was decreased (P <0.05).Conclusion Paraquat could induce vascular cell damage in vivo through increasing the levels of reactive oxygen species, and RHL could antagonize the effects of paraquat by scavenging reactive oxygen species, and up-regulating the eNOS expression and reducing the expression of the cleaved fragment of caspase-3.

Objectives To investigate the relationship of sex difference with serum bisphenol-A (BP-A),adiponectin and metabolic syndrome (MetS)in elderly patients with isolated systolic hypertension(EISH).Methods A retrospective study of the clinical data was conducted in 540 subjects from the Cardiology and Geriatric Department in the Affiliated Hospital of Shanxi Medical University,Changzhi Municipal People,s Hospital and the Department of Cardiology of Shanxi Medical University,First Clinic Hospital from January 2010 to December 2013.Elderly patients with EISH were divided into male group(n=270)and female group(n=270).Meanwhile 560 older health persons were severed as controls,including 300 females and 260 males.The changes of BP-A and adiponectin (Ad) concentration were measured.The blood lipid,insulin resistance index (HOMA-IR),blood pressure,body mass index,heart rate variability and ultrasonic change of heart and blood vessel were tested regularly.Results The level of serum BP-A[(0.89±0.10)ng/L vs.(0.57±0.04)ng/L]and [(0.64±0.10)ng/L vs.(0.55 ± 0.08)ng/L] were higher in male EISH vs in male control,and in female EISH than in female control (F =23.76,23.86,all P ＜ 0.01),respectively.The levels of adiponectin were lower in male EISH vs control[(4.9±1.4)ng/L vs.(10.5±2.7)ng/L and in female EISH vs control(6.0±1.3) ng/L vs.(11.5±3.3)ng/L),F=13.10,16.20,all P＜0.01.Root mean sequare of the successive normal sinus RR interval difference(rMSSD)were lower in male/ female EISH than control groups(F=13.10、13.70,P ＜0.01).Serum BP-A level was positively correlated with the bocly mass index and systolic pressure (r =0.38,0.54,P ＜ 0.01),and was negatively correlated with serum Ad and rMSSD(r=-0.46,-0.42,P＜0.01).Conclusions Obvious gender difference in changes of serum BP-A exists in older patients with EISH.Network cytokines may take part in the pathophysiological process of the obesity related hypertension.

Objective To explore the effects of experiential teaching model on student nurses in the stomatology department. Methods A total of 71 student nurses who practiced in the affiliated hospital of a medical university from June 2016 to September 2017 were selected by purposive sampling. Totally 33 student nurses who practiced between June and December 2016 were divided into the control group, and another 38 student nurses who practiced between January and June 2017 were divided into the treatment group. Student nurses in the treatment group received experiential teaching, while students nurses in the control group received conventional teaching of the department. The Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV) was used to compare the critical thinking ability between the two groups. Results The treatment showed higher total scores and scores in the dimensions of truth-seeking, open-mindedness, analyticity, systematicity and curiosity than the control group (P＜0.05) when leaving the department. There was no statistical difference in the scores of self-confidence and cognitive maturity between the two groups (P＞0.05). Conclusions Experiential teaching can enhance the critical thinking ability of student nurses in the stomatology department, which may be put into use in clinical teaching in the future.

Objective?To explore the safety of hydrophilic fiber containing silver dressings used on the wound of the patient with pressure sore. Methods?From January 2014 to January 2017, 60 elderly patients with pressure sore from inpatient and outpatient of Geriatrics Department of Shenzhen People's Hospital were selected as the research object. They were divided randomly into control group and experimental group, 30 patients for each group. Patients in the experimental group used hydrophilic fiber containing silver dressings on half of the area of the wound. Patients in the control group used hydrophilic fiber containing silver dressings on the whole area of the wound. All the treatment lasted for 4 weeks. Silver concentration of serum, serum creatinine and alanine aminotransferase value were detected in two groups of patients. Data were analyzed by SPSS 17.0 statistical software. Results?After the use of hydrophilic fibers containing silver dressing, the silver concentration of serum in the two groups increased, the value reached a peak in the third week and a downtrend in the fourth week; There were no significant differences in silver concentration of serum between the two groups in the first 3 weeks (P＞ 0.05), but the difference was statistically significant only in the fourth week (P＜ 0.05). There were no significant differences between the serum creatinine and alanine transaminase in the two groups (P＞0.05). Conclusions?The usage of hydrophilic fibers containing silver dressing cannot directly affect serum creatinine and alanine transaminase within four weeks.

Objective:To reveal the differentially expressed genes and long non-coding RNAs (lncRNAs) by sequencing the transcriptome of bovine alveolar macrophages (BAM) infected with Bacillus Calmette-Guérin (BCG) and analyzing their bioinformations, and to provide theoretical foundation for the research on immune regulation mechanism of anti-infection of Mycobacteriumtuberculosisof macrophages.Methods:The BAM were collected by pulmonary lavage and centrifugation and cultured and divided into infected group and uninfected group.After infection for 12hin infected group, the expression profiles of mRNA and lncRNA in infected group and uninfected group were detected by RNA-Seq, and bioinformatics analysis was carried out.Results:compared with uninfected group, there were 119differentially expressed lncRNAs and 1111differentially expressed mRNA in infected group (P＜0.05) .Gene Ontology functional enrichment analysis showed that the most significant enrichment was immune response (GO:0006955, P＜0.05) , including 125genes, in which 63 were up-regulated and 62 were downregulated, and the expressions of proinflammatory factors interleukin-1 (IL-6) , interleukin-7 (IL-7) , and interleukin-23A (IL-23A) were up-regulated.Cis target gene prediction and KEGG pathway analysis showed that the differentially expressed lncRNAs were involved in the regulation of transforming growth factor-β (TGF-β) signaling pathway and ATP-binding cassette transporter (ABC transporter) signaling pathway (P＜0.05) .Conclusion:The host cells are stimulated to produce a strong immune response after the BAM are infected by BCG and results in the changes of lncRNA and mRNA expression profiles.

Objective:To study the characteristics of clinical, laboratory, imaging, genetic and differential diagnosis of McLeod syndrome.Methods:The clinical characteristics of 2 cases of McLeod syndrome confirmed by gene detection in Qilu Hospital (Qingdao) on June 27, 2018 and in Qilu Hospital of Shandong University on September 11, 2019 were analyzed retrospectively. And the characteristics of patients of McLeod syndrome reported in China were analyzed in combination with literature review.Results:Both of the 2 patients were adult male, aged 57 and 61 years, respectively, with a slowly progressive course, beginning with gradually involuntary movement of trunk and extremities, involving involuntary biting of the tongue and dysphagia. Two patients had mild cognitive impairment; one patient had emotional agitation. Imaging study showed atrophy of caput nuclei caudate. Neuroelectrophysiological examination of case 1 showed sensory axon neuropathy in both upper limbs with severe damage to the left ulnar nerve. Creatine kinase (CK) was mildly elevated in 2 patients. The peripheral blood smear of 1 patient showed increased acanthocytes, accounting for 13%, the other patient showed no increased acanthocyte. McLeod syndrome related gene was tested in the 2 patients, case 1 with deletion mutation of exon 2 of XK gene, and case 2 with hemizygotic mutation of XK gene c.898delC p.L300 *. Conclusions:The clinical manifestations of McLeod syndrome are various and the differential diagnosis is crucial. For elderly male with cephalic facial chorea, elevated CK level and neuromuscular diseases, the possibility of McLeod syndrome should be screened.

Objective:To evaluate and summarize the best evidence for exercise scheme after bariatric and metabolic surgery in obese patients at home and abroad.Methods:We used "obesity" " bariatric and metabolic surgery" "sleeve gastrectomy" "gastric bypass surgery" "banding surgery" "exercise" "physical activity" "exercise therapy" "guideline" "expert consensus" "systematic review" "Meta-analysis" and "evidence summary" as keywords, and searched databases such as UpToDate, Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI) , Wanfang Data, and the guide network and professional association platforms by computer. Literature retrieved included guidelines, expert consensus, best clinical practice, clinical decision-making, systematic reviews, and the search time limit was from the database establishment to July 18, 2020. Two researchers evaluated the quality of literature and extracted evidence, and the evidence was revised and perfected through expert consultation.Results:A total of 4 systematic reviews and Meta-analysis articles, 2 clinical decision-making articles, 4 guidelines, and 1 expert consensus were included. The evidence was collected from 7 aspects, namely the importance of exercise, pre-exercise evaluation, exercise style, exercise intensity and duration, exercise safety, exercise follow-up, exercise effect evaluation, and finally 33 best evidences were summed up.Conclusions:Evidence of exercise scheme after bariatric and metabolic surgery in obese patients is comprehensive. Medical institutions and clinical medical and nursing staff can combine the institutional environment to transform and apply the evidence.

Objective:To develop the Economic Toxicity Scale for Kidney Transplantation Patients, and to test the reliability and validity of the scale.Methods:Drawing upon Coleman′s social capital theory and the six subfields associated with economic toxicity put forward by European scholars, the initial version of the scale was developed via expert correspondence consultation and a preliminary survey. This was accomplished by building upon existing literature and conducting semi-structured interviews. A total of 261 cases of kidney transplantation patients from March to October 2022 admitted to the First Affiliated Hospital of Shandong First Medical University were investigated for reliability and validity test.Results:The Economic Toxicity Scale for Kidney Transplantation Patients included 6 dimensions, 31 entries. The total scale had a Cronbach alpha coefficient of 0.910 and the subscale had Cronbach alpha coefficient ranging from 0.798 to 0.943. The retest reliability coefficient for the total scale was 0.948, while the six dimensions ranged from 0.732 to 0.942.Conclusions:The scale demonstrates strong reliability and validity, making it a reliable tool for objectively evaluating the economic toxicity of kidney transplantation patients.