Objective To investigate the appropriate range of gestational weight gain in pregnant women with abnormal glucose metabolism.Methods A retrospective study was conducted on 661 term singleton pregnant women with gestational abnormal glucose metabolism,who delivered in the Department of Obstetrics and Gynecology of Peking University First Hospital from Jan.2005 to Dec.2007,by reviewing the medical records.All sujects were divided into 4 groups according to their body mass index (BMI) before pregnancy:group Ⅰ (n=40):BMI<18.5;group Ⅱ (n=400):BMI18.5-23.9;group Ⅲ (n=162):BMI 24.0-27.9;group Ⅳ (n=59):BMI≥28.0.The weight gain among different groups and that between women who delivered normal birth weight infant and maerosomia were analyzed.The weight gain of pregnant women who delivered babies weighing 3000～3500 g in each group was determined as the appropriate weight gain for that group.Results The same results were achieved that the weight gain in pregnant women who delivered macrosomia was significantly higher than those who delivered normal birth weight newborns in each group,ie,the weight gains for women who had macrosomia and normal birth weight infants were (17.0±5.2) kg and (14.1±4.7) kg in group Ⅱ,(16.8±7.3) kg and (11.9±5.1) kg in group Ⅲ and (18.3±6.7) kg and (11.2±5.4) kg in group Ⅳ,respectively (P<0.05).The appropriate ranges of weight gain for each group were (15.6±3.3) kg,(14.0-18.0) kg for group Ⅰ,(13.9±4.6) kg,(11.0-16.5) kg for group ]],(11.5±5.2)kg,(9.0-15.0) kgforgroup Ⅲ,(10.1±2.9) kg,(7.0-12.7) kg forgroup Ⅳ.Conclusions Appropriate weight gain based on prepregnant BMI,together with glucose monitoring in women with gestational abnormal glucose metabolism,is helpful for fetal weight control.

Objective To investigate the influencing factors of neonatal birth body mass in women with abnormal glucose metabolism during pregnancy. Methods A study was conducted on 1157 singleton gravidas, who were diagnosed and treated for abnormal glucose metabolism and delivered in the Department of Obstetrics and Gynecology, First Hospital, Peking University from January 2005 to December 2009, by reviewing the medical records. Based on the pre-pregnant body mass index, the selected cases were divided into 4 groups: low body mass group [ body mass index (BMI) ＜ 18.5 kg/m2, n =53], ideal body mass group ( BMI 18.5 - 23.9 kg/m2, n = 647 ), over body mass group ( BMI 24.0 - 27.9 kg/m2, n = 323 ),and obese group (BMI≥28.0 kg/m2, n = 134). 1157 newborns were divided by birth body mass into 3 groups: normal birth body mass group (body mass 2500 -4000 g, n =987), of which 545 cases of birth body mass 3000 -3500 g for the appropriate newborns, macrosomia group (body mass≥4000 g, n = 112);low birth body mass group (body mass ＜ 2500 g, n = 58 ). The following information was collected,including pre-pregnancy body mass, height, gestational age of diagnosis and body mass gain after diagnosis,maternal serum level of cholesterol, history of adverse pregnancy, and family history of diabetes, gestational age, delivering body mass, neonatal birth body mass. The influence of pre-pregnant BMI, body mass gain during pregnancy, gestational age of diagnosis, body mass gain after diagnosis, maternal serum level of cholesterol, family history of diabetes on the newborns' birth body mass was analyzed. The appropriate ranges of gestational body mass gain were calculated in women with abnormal glucose metabolism. Results ( 1 )The average neonatal birth body mass for each group respectively were (3142 ±333) g for low body mass group, (3339 ±476) g for the ideal body mass group, (3381 ±581) g for over body mass group, and (3368 ± 644) g for obese group. The neonatal birth body mass was increasing with maternal pre-pregnant BMI, and average birth body mass of the newborns in low body mass group was lower than other 3 groups,respectively, the difference was statistically significant ( P ＜ 0.05 ). The difference was not statistically significant ( P ＞ 0.05 ), when it was compared among the obese group, ideal weight group and over body mass group. (2)The body mass gain during pregnancy in women delivered normal birth weight newborn and delivered macrosomia for each group respectively were ( 13.5 ±4.5 ) and ( 17.1±5.4) kg for the ideal body mass group, ( 11.6 ± 4.9 ) and ( 15.3 ± 6.4 ) kg for the over body mass group, ( 10.3 ± 5.0) and ( 14.7 ±7.4) kg for the obese group. The difference was statistically significant in 3 groups (P ＜ 0.05 ). The difference of body mass gain during pregnancy in women delivered normal birth weight newborn and delivered macrosomia for low body mass group could not be compared statistically, because of only 1 case delivered macrosomia. (3)The gestational age of diagnosis in women who delivered normal birth weight newborn and macrosomia for the ideal body mass group respectively were ( 27.8 ± 5.8) and ( 29.8 ± 5.3 ) weeks, the difference was statistically significant ( P ＜0.05 ). The gestational age of diagnosis in gravidas who delivered normal birth weight newborn and macrosomia for the over body mass group respectively were ( 26.7 ± 6.8)and (30.2 ± 4.1 ) weeks, the difference was statistically significant ( P ＜ 0.05 ). The gestational age of diagnosis in women who delivered normal birth weight newborn for obese group was (26.2 ± 7.5 )weeks, less than that of pregnant women who delivered macrosomia [ ( 25.7 ± 9.3 ) weeks ], but the difference was not statistically significant (P ＞ 0.05 ). The difference of the diagnosed gestational age for low body mass group could not be compared statistically, because of only 1 case delivered macrosomia. (4)Tbe serum triglyceride (TG) levels of pregnant women who delivered macrosomia was (3.1 ± 1.5) mmol/L, higher than that of pregnant women who delivered normal birth weight newborn [ (2.7 ± 1.2) mmol/L], and the difference was statistically significant (P ＜ 0.01 ). The serum high density lipoprotein cholesterol (HDL-C) levels of pregnant women who delivered macrosomia was ( 1.4 ± 0.3 ) mmol/L, lower than that of pregnant women who delivered normal birth weight newborn [( 1.7 ±0.9) mmol/L], and the difference was statistically significant (P＜0.01). The serum low-density lipoprotein cholesterol (LDL-C) and cholesterol level of pregnant women who delivered macrosomia respectively was ( 2.8 ± 0.8 ) and ( 5.4 ± 1.1 ) mmol/L, less than those of pregnant women who delivered normal birth weight newborn [ (3.0 ±0.9) mmol/L and (5.6 ±1.1) mmol/L], but the difference was not statistically significant (P ＞0.05). (5)The final regression model of variables into the top three were pre-pregnant BMI, body mass gain during pregnancy and maternal serum level of HDL-C, when analyzing the related factors of affecting neonatal birth body mass with multiple logistic regression analysis such as age, history of adverse pregnancy, family history of diabetes, prepregnancy BMI, body mass gain during pregnancy and after diagnosis of abnormal glucose metabolism,maternal serum level of cholesterol, abnormal glucose metabolism categories, gestational age and other factors ( P ＜ 0.01 ). Conclusion Pre-pregnant BMI, body mass gain during pregnancy and maternal serum level of HDL-C may affect the neonatal birth body mass whose mothers were complicated with abnormal glucose metabolism during pregnancy.

The impelling mode of morality-oriented nursing education unites moral affection and moral volition by impelling the need for nursing morality, and enables nurses to play an active role in the nursing work. This mode also indicates that nursing morality is a humanistic and valuable scientific career, and of great importance for guaranteeing the human wellbeing. Therefore, the establishment of morality-oriented nursing is a necessity for the specialization of nursing career.

Objective To investigate the relationship between serum prealbumin (PA) and inflammation in acute myocardial infarction (AMI) patients. Methods A prospective observational study was conducted. AMI patients hospitalized in the cardiovascular department of the General Hospital of Chinese People's Armed Police Forces from June 2014 to June 2016 were enrolled in the study. At the same time, healthy cases were enrolled as control. Venous blood was taken from patients at admission. Serum PA was detected by immune projection turbidimetry method and high-sensitivity C-reactive protein (hs-CRP) was measured by latex enhanced immune turbidimetry. High-sensitivity cardiac troponin T (hs-cTnT), and interleukin (IL-6, IL-8) was measured by electrochemical luminescence method. Creatine kinase-MB isoenzyme (CK-MB) was detected by rate method. PA, inflammatory factor and myocardial enzyme were compared between two groups. The correlation between PA and inflammatory factors was analyzed by Pearson linear correlation; The diagnostic value of PA was analyzed by receiver operating characteristic (ROC) curve. Results 173 AMI patients and 86 healthy controls were enrolled in the study. There were no significant differences in gender, age, history of smoking, hypertension and diabetes. Compared with the control, the levels of serum PA in AMI patients was lower [PA (g/L): 0.215±0.056 vs. 0.280±0.057], hs-CRP, IL-6, IL-8, hs-cTnT and CK-MB were higher [hs-CRP (mg/L): 6.63±3.52 vs. 2.25±1.45, IL-6 (ng/L): 38.03±22.43 vs. 6.13±3.38, IL-8 (ng/L): 295.61±98.70 vs. 17.24±7.31, hs-cTnT (μg/L): 4.789±2.874 vs. 0.009±0.008, CK-MB (U/L): 244.48±165.54 vs. 12.20±5.24], the difference was statistical significant (all P < 0.01). It was shown by Pearson correlation analysis that the levels of PA were negatively related to hs-CRP, IL-6 and IL-8 (r = -0.562, -0.591, -0.548, all P <0.05). The PA level had no correlation with hs-cTnT and CK-MB (r = -0.018, -0.149, both P > 0.05). It was shown by ROC curve analysis that area under ROC curve (AUC) of PA for diagnosis of AMI was 0.783±0.039, and the 95% confidence interval (95%CI) was 0.706-0.860 (P < 0.05). When the cut-off value was 0.190 g/L, the sensitivity was 29.63%, and the specificity was 62.22%. Conclusion PA may be involved in the inflammatory process of AMI and had a diagnostic value for AMI.

Objective To analyze the single resistance and multiple resistance situation of of Helicobacter pylori (Hp) in Qingd‐ao area to commonly used antibacterial drugs and to investigate the mutation characteristics of drug‐related resistant genes .Methods Hp was isolated from the mucosal samples of gastric antrum .The agar diffusion test was used to determine the susceptibility of Hp to clarithromycin ,levofloxacin and metronidazole .The 23s rRNA of clarithromycin resistance gene ,gyrA of levofloxacin resistance gene and rdxA of metronidazole resistance gene were amplified by using PCR ,after the PCR products sequencing ,the sequence com‐parative analysis was performed by the ClustalW2 software .Results The drug susceptibility test results found that the single re‐sistance rates of 134 strains of clinically isolated Hp to clarithromycin ,levofloxacin and metronidazole were 40 .3% ,34 .3% and 43 .3% ,respectively .Only 17 .9% of Hp strains were susceptible to these 3 kinds of antibacterial drug ;the multi‐drug resistance rate was 29 .9% ,triple drug resistance rate was 9 .0% ;furthermore ,the double resistance rate of levofloxacin plus metronidazole was significantly lower than that of clarithromycin plus levofloxacin ,the difference was statistically significant(3 .0% vs .10 .4% ,χ2 = 5 .96 ,P=0 .015) .The drug resistance genes sequence analyses showed that the commonest mutation locus was A2143G (77 . 8% ) ,the commonest mode of gyrA gene mutation was N87K(78 .3% ) ,and which of rdxA gene was nucleotide insertion into loci 20/32 ,generating the frameshift mutation with the mutation rate of 44 .8% .Conclusion The multi‐drug resistance rate of Hp is high in Qingdao area .The effective antibacterial drugs should be selected according to the drug susceptibility test results .Levofloxa‐cin could serve as the first line drug for the eradication therapy scheme in this area .

Objective:To develop an effective therapeutic double HBV DNA vaccine with two eukaryotic expressing motif,namely pS2.S and pIIF,a fusion ORF of hIL-2/hIFN-?.Methods:Two genes were amplified,which separately encoded HBV preS2.S middle envelope protein as a vaccine and human IL-2/IFN-? fusion protein as an adjuvant by PCR technique from plasmids pcDNA3.1/preS2.S and pcDNA3.1/hIL-2/IFN-?.Then the genes subcloned into eukaryotic vector pVAX1.The new plasmid was analysed by restriction endonuclease and DNA sequencing.The constructed plasmids were transfected into COS-7 cells in vitro with LipofectamineTM 2000.The expressing products in supernatants were quantified by ELISA.Space structure of fusion hIL-2/IFN-? expressed by the adjuvant plasmid was simulated by CE software.The double plasmid association were injected into BALB/c mice by in situ electroporation method,and specific humoral and cellular immune responses were examined.Results:The gene segments and inserting direction of pVAX1-S2.S(pS2.S)and pVAX1-IL-2IFN-?(pIIF)were both correct by genetic analysises.At 48 h after transfection,HBsAg and the cytokines of IL-2 and IFN-? were respectively 45.1 ng/ml,10.03 ng/ml and 11.5 ng/ml by ELISA.The activity domains of the two cycokines in fusion protein were entirely exposed on surface by CE software.Experiments were pefrormed in mice by injection of plasmid pS2.S.Protective antibodies of anti-HBs were produced in terms of dose-dependment pattern for the efficacy.Co-injection of plasmid pS2.S together with adjuvant pIIF resulted in more evident immune responses and dose of the plasmid pS2.S needed was diminished.There was strongly specific humoral and cell immunity by pS2.S and pIIF co-injection with EP technique.Conclusion:The double plasmids pS2.S and pIIF of anti-HBV are constructed succeedly and induce strongly specific immune activity in vitro and vivo.

PurposeVon Hippel-Lindau (VHL) syndrome is a rare autosomal dominant diseases involved multiple organs. This paper aims to explore the clinical and imaging features of VHL syndrome for the improvement of early diagnosis and treatment of this disease.Materials and Methods The clinical and imaging data, as well as their history of 5 patients with VHL syndrome were retrospectively studied. Follow-up was performed and the related literature was also reviewed.Results Among the 5 patients, 4 were found with angioreticulomas. One out of four patients simultaneously suffered from multiple angioreticulomas in brainstem, and another one had multiple cervical cord angioreticulomas. The typical MRI showed multiple cystic and solid mass with mixed intense signals, and the enhanced MRI displayed obvious enhancement in the solid part of the mass. Three patients were diagnosed with renal clear cell carcinomas. The typical CT scan showed equidensity or slightly low density signals, and the enhanced CT scan noted heterogeneous enhancement. Besides, bilateral epididymis cystadenoma occurred in one case. The ultrasonography presented heterogeneous echo and rich blood vessels. The follow-ups had been conducted till January 2015. According to the Glasgow outcome scale, three patients were in good conditions, while the other two died from renal clear cell carcinomas.Conclusion Patients with VHL syndrome usually have an unsatisfactory prognosis and most may die from renal carcinoma. Genetic test and investigation of family history should be performed as early as possible on patients with highly suspected or confirmed VHL Early treatment, life-long follow-up and periodic imaging examinations may be helpful in the prognosis.

Objective:To observe the effect of early goal directed sedation (EGDS) on cerebral oxygen metabolism in patients with acute brain injury.Methods:A prospective cohort study was conducted. A total of 108 patients with acute brain injury admitted to the intensive care unit (ICU) of the Third Medical Center of the PLA General Hospital from January 2015 to December 2019 were enrolled. According to the patient's condition, dexmedetomidine contraindication and tolerance, and combined with the wishes of patients' families, they were divided into EGDS group and on-demand sedation group. Routine treatments such as surgery, mechanical ventilation, dehydration and reduction of intracranial pressure with mannitol, hemostasis or antiplatelets therapy were given according to the patient's condition. All patients were continuously given sufentanil by intravenous infusion for analgesia. Patients in the EGDS group were sedated by continuously intravenous infusion of dexmedetomidine (0.2-0.7 μg·kg -1·min -1) for 72 consecutive hours. Patients in the on-demand sedation group received intravenous bolus of propofol (0.5-1.0 mg/kg) when treatments were interfered due to agitation. Hemodynamic indexes [heart rate (HR), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), intracranial pressure (ICP)], sedation indexes [bispectral index (BIS)], severity indexes [acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, Glasgow coma score (GCS)] and cerebral oxygen metabolism indexes [jugular venous blood lactate (Lac), jugular venous oxygen saturation (SjvO 2), cerebral arterial oxygen content (CaO 2), cerebral extraction rate of oxygen (CERO 2), cerebral arteriovenous blood oxygen content difference (a-vDO 2)] were compared between the two groups before sedation and at 24, 48 and 72 hours of sedation. Results:① Among the 108 patients, 3 patients with cerebral hemorrhage received secondary surgery or had worsening of cerebral hernia were excluded. 105 patients were enrolled in the study, including 54 patients in the EGDS group and 51 patients in the on-demand sedation group. There were no statistically significant differences in gender, age, type of craniocerebral injury, GCS score, proportion of mechanical ventilation and operation ratio between the two groups. ② Compared with before sedation, Lac, CERO 2 and a-vDO 2 of both groups gradually reduced over time of sedation while SjvO 2 and CaO 2 were gradually higher. Those changes were more quickly in the EGDS group, Lac, SjO 2, CERO 2 and a-vDO 2 significantly improved at 24 hours of sedation compared with those before sedation. Above indexes at 72 hours of sedation in the EGDS group were obviously better than those in the on-demand sedation group [Lac (mmol/L): 1.81±0.31 vs. 2.19±0.12, SjvO 2: 0.714±0.125 vs. 0.683±0.132, CaO 2 (mL/L): 201.21±15.25 vs. 179.65±14.07, CERO 2: (27.87±3.66)% vs. (33.00±2.58)%, a-vDO 2 (mL/L): 44.32±5.68 vs. 48.57±8.22, all P < 0.05]. ③ Compared with before sedation, HR, MAP and ICP decreased in the two groups over time while CPP, BIS and GCS score showed increasing trend, especially more quickly in the EGDS group, HR at 24 hours of sedation, MAP, CPP, BIS and GCS score at 48 hours significantly improved as compared with those before sedation. Hemodynamics and sedation related parameters and GCS score at 72 hours of sedation in the EGDS group were significantly better than those in the on-demand sedation group [HR (bpm): 70.69±7.80 vs. 79.85±9.77, MAP (mmHg, 1 mmHg = 0.133 kPa): 84.23±8.76 vs. 89.97±9.48, ICP (mmHg): 14.23±8.76 vs. 15.97±9.48, BIS: 60.56±24.58 vs. 56.86±33.44, GCS score: 8.06±3.63 vs. 7.86±2.98, all P < 0.05]. The APACHE Ⅱ scores were significantly reduced at 72 hours of sedation in both groups as compared with those before sedation, while there was no statistical difference between the two groups. Conclusion:Compared with the on-demand sedation, EGDS could reduce cerebral oxygen metabolism, improve the coma degree, and reduce the severity of the disease in patients with acute brain injury.

Objective To discuss training of the nurses in outpatient blood collection room with the digital training modular of blood sample collection to improve the quality of blood sample collection. Methods Nurses were trained with the digital training modular by multimedia,group discussion to impmve the quality of blood sample collection continuously. Results The unqualified blood sample rate in the same season after training were statistically different compared with that before training. Conclu-sions Training the nurses in outpatient blood collection room with the digital traimg modular of blood sample collection have actual direction value to improve the quality of blood sample collection.

Objective To evaluate the clinical value of pro-gastrin-releasing peptide (ProGRP) for small cell lung cancer ( SCLC ).Methods Serum levels of ProGRP and neuron-specific enolase (NSE) were measured by both chemiluminescent immunoassay and electrochemiluminescent immunoassay in 46 patients with SCLC (26 patients with limited disease,20 patients with extensive disease ),51 patients with non-small cell lung cancer (NSCLC),45 patients with benign pulmonary diseases and 56 healthy subjects.Patients were recruited by the Affiliated Hospital of Medical College,Qingdao University,from September 2010 to April 2011.The receiver operating characteristic curves (ROC) was used to set the cutoff value of ProGRP and NSE and the areas under ROC ( ROC-AUC).The sensitivity and specificity of ProGRP and NSE were analyzed for diagnosing SCLC.Results Serum levels of ProGRP in healthy subjects,benign pulmonary diseases,NSCLC and SCLC groups were 22.9 ( 19.5 - 28.7 ),23.7 ( 20.0 - 27.8 ),28.9 (23.8-34.7) and 370.9( 129.4- 1951.6) ng/L respectively; the serum levels of NSE were 14.1 (12.5- 15.7),13.3(10.3- 15.3),16.8(11.7-22.1) and 39.9(16.1-93.9) μg/L,respectively.The Kruskal-Wallis H test showed significantly difference amoun groups of ProGRP and NSE (H =92.116 and 55.481,P ＜0.001 ).The serum levels of ProGRP in limited disease SCLC (LD-SCLC) group[ 156.2(65.4-547.5 ) ng/L]were also significantly higher than those in the healthy group,benign pulmonary diseases group and NSCLC group ( U =57,70 and 144,P ＜ 0.001 ).In extensive disease SCLC (ED-SCLC) group,the ProGRP and NSE results[ 1933.1 (325.9 -4512.1) ng/L and 61.0(35.4- 115.5 ) μg/L ]were higher than those in the LD-SCLC group ProGRP,NSE [ 24.3 ( 15.1 - 16.3 ) μg/L,U =119 and 153,P ＜ 0.05 ].Using healthy subjects group as control,the largest Youden index point of ROC was used to set the cut-off value of ProGRP and NSE (34.0 ng/L and 20.2 μg/L).The ROC-AUC of ProGRP (0.96 ) was statistically higher than that of NSE ( 0.86 ) in the SCLC group ( Z =2.57,P ＜0.05).The ROC-AUC results between combining detection of ProGRP and NSE (0.96 ) and ProGRP itself (0.96) were not significant difference ( Z =0.21,P ＞ 0.05 ).The sensitivity of ProGRP ( 89.1％ ) was statistically higher than that of NSE in the SCLC group (71.7％,x2 =4.90,P ＜0.05 ) ; the specificity of ProGRP (98.2％) compared with NSE did not have statistical significance (96.4％,x2 =0.00,P ＞0.05 ).The combining detection of ProGRP and NSE had no influence on the sensitivity and specificity compared with ProGRP itself (91.3％ vs 89.1％,94.6％ vs 98.2％,x2 were all 0.00,P ＞ 0.05 ).Using benign pulmonary diseases group as control,the largest Youden index point of ROC was used to set the cutoff value of ProGRP and NSE (49.5 ng/L and 23.1 μg/L).The ROC-AUC of ProGRP (0.95) was statistically higher than that of NSE (0.87) in the SCLC group (Z =1.99,P ＜0.05 ).The ROC-AUC of combining detection of ProGRP and NSE ( 0.95 ) and ProGRP itself ( 0.95 ) were not difference significantly ( Z =0.02,P ＞ 0.05 ).The sensitivity of ProGRP (84.8％ ) was statistically higher than that of NSE in the SCLC group (69.6％,x2 =4.00,P ＜0.05);the specificity of it (97.8％) was equal to that of NSE (97.8％,x2 =0.50,P ＞0.05 ).The combining detection of ProGRP and NSE had no obviously influence on the sensitivity and specificity compared with ProGRP itself ( 87.0％ vs 84.8％,95.6％ vs 97.8％,x2 were all 0.00,P ＞0.05 ).Using NSCLC group as control,the largest Youden index point of ROC was to set the cut-off value of ProGRP and NSE (49.1 ng/L and 23.0 μg/L).The ROC-AUC of ProGRP ( 0.90) was statistically higher than that of NSE (0.76) in the SCLC group (Z=2.90,P＜0.05).The ROC-AUC of combining detection of ProGRP and NSE (0.90 ) and ProGRP itself (0.90 ) were not difference significantly ( Z =0.00,P ＞ 0.05 ).The sensitivity of ProGRP ( 84.8％ ) was higher than that of NSE in the SCLC group ( 69.6％,x2 =4.00,P ＜ 0.05 ) ; the specificity of it ( 96.1％ ) was also higher than that of NSE (80.4％,x2 =6.13,P ＜ 0.05 ).The combining detection of ProGRP and NSE had no obviously influence on the sensitivity and specificity compared with ProGRP itself ( 87.0％ vs 84.8％,95.6％ vs 96.1％,x2 were all 0.00,P ＞ 0.05 ).Conclusion ProGRP has a higher diagnostic value than NSE in SCLC.