PurposeTo evaluate and describe fetal cardiac development and hemodynamics high risk pregnancy by using ultrasound technique. Methods Two-hundred and thirty-three pregnancies were prospectively studied by using the detailed fetal echocardiographic procedure( fetus gestational age from 19 weeks to 39 weeks). Cardiac chamber size, internal diameter of great arteries were documented together with the presence of inflow and outflow wave patterns. In utero diagnoses of variety of congenital heart defects were also conducted. ResultsCardiac chamber size and internal diameter of great arteries showed a positive correlation with the increasing of gestational age. Left and right ventricles were demonstrated the same size during whole fetal observational period. Blood flow through mitral valve and tricuspid valve were typically 'M' type. By comparing 'e' wave and 'a' wave, this inflow blood velocity pattern was dominant by 'a' wave, though the ratio of a/e gradually decreased during the fetal development period. Blood velocity in aorta and pulmonary artery remained steady along with the gestational age. The detection rate of verity types of congenital heart diseases in this sample population was 5.7% (13 cases) ,the major problem was the complex heart malformation. The occurrence of fetal cardiac arrhythmia was 14 cases (16 % ), with the majority of atrial premature beat. Conclusions Fetal echocardiography can be used to evaluate and monitor the change of cardiac anatomy, structure and hemodymanics during the different gestational age. This has provided a new approach to the further understanding of fetal cardiac development, and is importantto the screening of congenital heart disease during pregnancy.

Objective A retrospective study was undertaken to evaluate the outcomes of the newborns with pulmonary atresia with intact ventricular septum(PAIVS),in order to delineate strategies for the optimal management of PAIVS. Methods From July 2003 to July 2008,17 neonates with PAIVS underwent surgical treatment.The mean age at operation was(1 5.6±8.6)d and the mean weight was(3.54±0.44)kg.Initial surgical treatment included:Blalock-Taussig shunt (BT shunt)in 2 cases,closed pulmonary valvotomy and BT shunt in 1 case,right ventricular outlet tract reconstruction(RVOTR)in 2 cases,RVOTR and BT shunt in 11 cases. Results The mean duration of mechanical ventilation and intensive care unit stay were(35.5±35.1)h and(8.7±5.9)d,respectively.Two early deaths were reported inside the hospital(2/17,11.8%).Multivariable analysis demonstrated that mechanical ventilation before surgery was the risk factor for in-hospital mortality(r=1.02,P<0.01).The rest 15 cases were followed up with the average time of 19 months(2 months to 5 years)and no death was reported. Conclusions Neonates with PAIVS should be operated early.Individualized treatment strategy and regular follow-up are helpful to achieve better short-term outcome.

Objective To explore the effect and safety of the operationive treatment of calculus incarceration in neck of gallbladder.Methods We analyzed retrospectively the clinical data of 26 cases with calculus in carceration In neck of Gallbladder.Results All 26 cases patients were found to have serious cholecystitis and unclear anatomic site in Calot's trangle.Six patients'operative way had to transform from laparoscopiccholecystectomy to cholecystectomy.Endogenous membrane of gallbladder were excised retrogradely in the operation.In operative process,there were no injury in extrahepatic bile duct,intestinal canal and vascular.The all patients were recovery and discharge after operation.Conclusion It is one kind of good choice to open the gallbladder,aspirate the bile and extract the stones.And then performing endogenous membrane retrograde cholecystectomy.For treatment of the Calot's trangle areas,blunt dissection may used.It is dangerous that using sharp dissection and electrosurgical knife.

The purpose of this study is to investigate the transdermal delivery characteristics of Gentiana macrophylla complex components system through different parts of the skin under micro-needles conditions. Two-chamber diffusion cells were used, different parts of isolated skin and micro-needle pretreated isolated mouse skin were applied separately, high performance liquid chromatography (HPLC) similarity evaluation methods were used to evaluate transdermal delivery characteristics of Gentiana macrophylla complex components system on receiving pool and the permeation rate and penetration amount of Gentiopicroside at different parts of mouse skin. In the 24 h, the similarity between receiving fluid which was on passive transdermal delivery and micro-needle transdermal delivery conditions and original fluid were ranged from 83.0% to 98.9%; By the micro-needle pretreatment with different parts of the mouse skin, the time that Gentiana macrophylla complex components system though abdominal skin to the receiving fluid which reached 90% similarity compared with that of original fluid was 4 h, which was 18 h at back skin and 12 h at neck skin separately. Micro-needles can be used as the ideal ingredients for traditional Chinese medicine complex transdermal delivery; transdermal absorption time delay could be greatly reduced and its bioavailability was improved. The permeation rate and similarity to original liquid of Chinese medicine complex components increased significantly in the abdominal skin relative to the neck and back skin under micro-needle conditions.

Objective To construct a core response competence index system for infectious disease emergencies,and to provide content framework for training program.Methods A draft of index system was developed based on literature review and theory study.Delphi technique was employed to revise the draft.Analytical Hierarchy Process and average distribution method were used to measure the weight of each index.Results Response rate of the two round consultations were 100％ and 77.8％,respectively.experts' authority coefficients were 0.88 and 0.87.Kendall's coefficients of concordance were 0.274 and 0.258,and both were statistically significant (P＜0.001).The final index system comprised 3 first-level indexes,11 second-level indexes,and 38 third-level indexes.Conclusion The index system could be used to evaluate response competence of medical staff towards infectious disease emergencies,and served as the content framework of future training program.

Objective:To develop a systematic and comprehensive training program focusing on infectious disease emergencies, which is suitable for continuing education of medical staff.Methods:The emergency competence index system constructed in previous study was used as the content framework. The training method was selected based on the core concept of "Lindeman's View of Adult Education". The training form was designed based on the results of the questionnaire survey. The expert group meeting was used to demonstrate and revise the concrete training items.Results:The finally formed Training Program on Infectious Diseases Emergencies for Medical Staff adopted a "small-group" training format and modular design, including a total of 3 modules and 9 items, and the training program database included portable training manuals, skills videos, scenario cases scripts, and assessment papers, etc.Conclusion:The developed training program could be applied to regular continuing education or intensive training of response team for certain infectious disease emergencies, so as to improve their response competence.

Objective: To investigate the serum angiopoietin-Ⅱ (Ang Ⅱ) levels in acute pancreatitis (AP) patients and the relationship between AngⅡ levels and the disease severity of AP based on the new Atlanta classification criteria. Methods: Seventy-seven patients with AP who were treated in the Affiliated Baiyun Hospital of Guizhou Medical University were included in this prospective study. According to the revised Atlanta classification, the modified Mashall scoring system was used to divided patients into AP with the persistent organ failure(POF) group and without POF group, and the CECT was used to divided patients into AP with pancreatic necrosis(PN) group and without PN group. The levels of AP 72 h after admission of two groups were compared with t test, and Spearman analysis was used to analyze the correlation between common severity indicators and Ang Ⅱ. The receiver operating characteristic (ROC) was performed to analyze the area under curve(AUC), sensitivity and specificity of Ang Ⅱ in predicting POF and PN. Results: According to the modified Mashall scoring system, there were 18 patients (23.38%) in POF group and 59 patients (76.62%) in without POF group. According to CECT, 22 patients (28.57%)were in PN group and 55 patients(71.43%) in without PN group. The Ang Ⅱ of the POF and PN groups was significantly higher than those without POF and PN groups (P=0.001, 0.011) on day 1 on admission. The cut-off value was 126.44 μg/L, and the AUC, sensitivity and specificity for predicting POF were 0.739, 83.3% and 68.4%, which was significantly better than that of traditional predictive indicators, such as C-reaction protein (CRP), procalcitonin (PCT), blood urea nitrogen (BUN), bedside index for severity in AP (BISAP) score and Ranson score. When the cut-off value was 130.90 μg/L, the AUC, sensitivity and specificity for predicting PN were 0.703, 77.3% and 73.6%, respectively, which was significantly better than that of all traditional single indicator. The predicted value was less than PCT and CRP 2 or 3 day after admission. In addition, the Ang Ⅱlevel 1 day after admission was closely related to the Ranson score, BISAP score, and PCT level which was commonly used indicators of AP severity. Conclusions Under the new Atlanta classification criteria, Ang Ⅱ is superior to the traditional predictive indicators commonly used for predicting POF, and is a better single biochemical indicator for predicting PN in clinic.