Objective To investigate the effect of programed training in the treatment of patients with chronic schizophrenia.Methods 88 patients with chronic schizophrenia were randomly divided into families involved in the training group and control group 44 cases,the training group for eight weeks of programmed training,and then all were followed up for 44 weeks.Positive and negative syndrome scale (PANSS),insight and treatment attitude questionnaire(ITAQ),Morningside Rehabilitation Status Scale(MRSS) were selected to assess.Results Total score of PANSS,negative symptoms and general psychopathology in The training group sub-section 20,32,44 weekend were cignificartly lower than in the control group(t =2.42 ～ 11.19,all P ＜0.01) ;positive symptoms points in 44 weekend the difference was significant(t =3.19,P ＜ 0.01) ; training group ITAQ score the weekend of the first 20,32,44 were significantly higher(t =3.13 ～ 8.32,all P ＜ 0.01) ;training group MRSS assessment dependent activities,the lack of capacity,the average social skills and the current symptoms and abnormal behavior in the 20 weeks were significantly lower than the control group.(t =1.67 ～4.31 ;2.37 ＞ t ＞ 1.664,P ＜ 0.05 ;t ＞ 2.374,P ＜ 0.01) ;relapse rate after 1 year of follow-up two groups by the x2 test (x2 =0.87 ;P ＜ 0.05) have significant differences.Conclusion The programmable training can significantly improve the effect of rehabilitation of patients with chronic schizophrenia,reduce the recurrence rate of chronic schizophrenia.

Objective To investigate the categories of fetal anomalies detected by ultrasound scan in the third trimester.Methods From January 1,2012 to December 31,2013,492 singleton fetuses were found to have structural abnormalities on the first,second or third trimester ultrasound scan in the Peking University First Hospital,only 50 (10.2％) fetuses were detected on the third trimester (≥ 28 weeks of gestation) with no abnormalities detected on the first and second trimester scan,were enrolled.The categories of the fetal structural abnormalities were analyzed.Results The age of the mothers of the 50 fetuses with structural abnormalities was (35.7± 5.2) years (26-43 years) with an average gestation of (32.4±2.8) weeks (28.6-36.8 weeks).These abnormalities were seen in the central nervous system (42％,21/50),digestive system (28％,14/50),urinary system (16％,8/50),cardiovascular system (8％,4/50),respiratory system (4％,2/50) and facial structures (2％,1/50).Intrauterine death occurred in one case and 49 mothers had a live birth.After birth,14 neonates were normal,five needed further treatment,three cases were complicated by other abnormalities,23 had no dysfunction but need follow-up and four were lost to follow-up.Six of the 20 (30％) fetuses with central nervous system abnormalities and 2/4 fetuses with cardiovascular system abnormalities had an adverse prognosis,while 1/12 and 2/7 fetuses with digestive and urinary system abnormalities had an adverse prognosis.Conclusions The central nervous system and cardiovascular system should be examined in priority during the third trimester ultrasound scan.

There is an independent-regulated renin-angiotensin system(RAS)in kidney.Most of patients with hypertension or kidney diseases present increased renal RAS activity,which maintains body water and sodium balance,but contributes to the occurrence of hypertension and renal damage progression.The article reviewes some recent basic and clinical researches,focusing on the renal RAS activation mechanisms,consequences and clinical significance of the intervention of RAS blockers,which may help us recognize local RAS function of kidney,explore the treatment strategies to control hypertension and slow chronic kidney disease progression.

Objective To investigate prenatal diagnosis and prognosis of fetus with hyperechogenic kidney.Methods Clinical data of 65 cases prenatally diagnosed with fetal hyperechogenic kidney in Peking University First Hospital between July,2009 and May,2015 were retrospectively analyzed.Results of fetal ultrasound screening and pregnancy outcomes were analyzed and Growth and development status of those babies were followed up until December,2015.Independent-sample-t,Chi-square or Fisher's exact test was applied for statistical analysis.Results Among the 65 cases,including 48(73.8％) bilateral and 17 (26.2％) unilateral,34 cases (52.3％) were diagnosed as non-isolated and 31 cases (47.7％) as isolated fetal hyperechogenic kidney.The primary associated malformations with non-isolated fetal hyperechogenic kidney included cardiac abnormality (14 cases,41.2％),urinary system abnormality (12 cases,35.2％),skeletal system abnormality (nine cases,26.5％),central nervous system abnormality (eight cases,23.5％) and Meckel-Gruber sydrome (one case,2.9％).Amniotic volume,the size and numbers of affected kidney between non-isolated and isolated groups showed no significant differences (all P＞0.05).Twenty out of the 65 cases (30.8％) received fetal karyotyping and one received non-invasive prenatal testing,and no abnormality was detected.Three cases received cord blood array comparative genomic hybridization with negative results.Pathogenic genes were found in two cases who received targeted exome capture with high throughput sequencing,including a TTC21B mutation in cord blood in one case and a HNF1β deletion mutation in peripheral blood after birth in the other.There were 23 (35.4％) terminations of pregnancy and 42 (64.6％) live births among which three died after birth.The rate of live birth was significantly higher in the isolated group than in the non-isolated group[87.1％(27/31) vs 44.1％(15/34),x2=13.101,P＜0.01].Of the fifteen live births in the non-isolated group,there were fourteen survived symptomfree except that one lost to follow-up.Of the 27 live births in the isolated group,follow up study revealed 23 symptom-free survivors,one lost,two neonatal deaths (one died of volvulus neonatorum,and the other due to unknown causes) and one death of renal and liver function failures at the age of two-and-a-half.ConclusionsFetal hyperechogenic kidney is an important prenatal ultrasound marker for congenital renal anomalies,and the prognosis of non-isolated fetal hyperechogenic kidney is poor.The current rate of abnormal karyotype in fetus with hyperechogenic kidney is very low.However,the rate of prenatal genes screening should be encouraged.

Objective To evaluate the effect of 6% hydroxyethyl starch 130∕0. 4 on acute kidney injury in elderly patients in a prospective, multicenter, randomized, double?blind, controlled clinical tri?al. Methods A total of 120 patients of both sexes, aged 65-82 yr, weighing 56-83 kg, of American So?ciety of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective orthopaedics and hernia surgery, were divided into either hydroxyethyl starch group ( group HES) or lactated Ringer′s solution group ( group LR) , with 60 patients in each group. Hydroxyethyl starch and lactated Ringer′s solution were infused intra?venously at a rate of 7. 5 ml∕kg during 1st hour of surgery in HES and LR groups, respectively. Lactated Ringer′s solution was then infused at a rate of 5 ml∕kg starting from 2nd hour of surgery until the end of sur?gery in both groups. Before surgery, at the end of surgery and at 1, 3 and 5 days after surgery, blood sam?ples and urine specimens were collected for determination of the concentrations of neutrophil gelatinase?asso?ciated lipocalin, interleukin?18 (IL?18), plasma creatinine, urine β2 microglobulin and urine albumin.
The estimated glomerular filtration rate was calculated. Results The level of urine IL?18 was significantly higher at each time point after surgery than before surgery and immediately after the end of surgery ( P<0.05) . There were no significant differences between the two groups in the levels of urine IL?18, plasma creatinine, plasma and urine neutrophil gelatinase?associated lipocalin, plasma IL?18, urineβ2 microglob?ulin and urine albumin and estimated glomerular filtration rate at each time point ( P>0.05) . Conclusion Compared with lactated Ringer′s solution, 6% hydroxyethyl starch 130∕0.4 does not aggravate acute kidney injury in elderly patients.

ObjectiveTo investigate the intervention effects of fluoxetine on hypothalamic-pituitary-thyroid (HPT) axis function changes in post-stroke depression (PSD) patients.MethodsMild to moderate stroke patients were enrolled and blood T3,T4,FT3,FT4 and TSH were measured at day 0,1,7,14,21 and 3 months.At day 7,thyroid hormone releasing hormone (TRH) stimulation test were performed.After evaluated with the anxiety scale screening using the HAMD scale assessment at day 21,the subjects were divided into simple stroke subgroup ( ＜8 points,25 cases) and PSD sub-group ( ≥ 8 points,18 cases),with 16 healthy age and sex matched individuals as control group.In the 2nd stage,TRH stimulation test were performed in PSD patients before and after 7 days of fluoxetine administration.ResultsCompared with control group,stroke patients presented lower FT3 (P ＜0.05 ) and higher serum TSH (P ＜ 0.05) at day 0,1,7,14.Furthermore,PSD patients presented lower FT3,TSH levels and higher FT4 levels than simple stroke patients did(P＜0.05).At day 21 and month 3,T3,T4,FT3,FT4 and TSH levels in stroke patients were not different from those in control group(P ＞ 0.05).TRH test showed that the responses in PSD patients were lower than those in simple stroke patients( (2.65 ±0.42)μIU/ml vs (5.31 ±0.68 ) μIU/ml,P ＜ 0.05 ).Correlation analysis showed HAMD scores correlated with TSH level changes and TSH0 ～30 in PSD subgroup closely( r=0.35,0.25,P＜0.01 ).In the 2nd stage,TRH test showed that PSD patients who took fluoxetine presented a lower TSH level change than PSD patients who did not( (4.61 ± 2.02) μIU/ml vs (7.05 ± 2.12) μIU/ml,P ＜ 0.05 ).ConclusionPSD patients present a long and severe HPT axis function inhibition,which may due to TRH deficiency,and fluoxetine may improve this abnormality.

Objective:To investigate the influence of peer education based on WeChat support on the social support, mental flexibility and rehabilitation self-efficacy of patients after laparoscopic radical prostatectomy.Methods:A total of 82 patients after laparoscopic radical prostatectomy who were admitted from January 2018 to December 2019 were selected as the research objects. According to the operation time, they were divided into the treatment group (January 2019-December 2019) with 43 cases and the control group (January 2018-December 2018) with 39 cases. The control group was given regular health education, and the treatment group jointly applied peer education based on WeChat support. Followed up for 2 months, the two groups of patients were evaluated the degree of social support, psychological flexibility, and rehabilitation self-efficacy by Social Support Rating Scale, Connor-Davidson Resilience Scale, General Self-Efficacy Scale and compared.Results:There was no significant difference in the degree of social support, psychological flexibility, and rehabilitation self-efficacy before intervention between the two groups( P>0.05). The objective support, support utilization, and social support scores in the treatment group after intervention were (9.12±1.12), (10.45 ± 0.75), (32.49 ± 4.56) points, and the control group were (7.45 ± 1.36), (8.74 ± 1.43), (29.84 ± 4.45) points, and the differences were statistically significant ( t values were 6.091, 6.681, 2.658, P<0.01). The scores of toughness, self-improvement, optimism, and mental resilience in the treatment group after intervention were (28.21 ± 4.25), (20.32 ± 3.54), (9.36 ± 1.12), and (57.89 ± 7.21) points, and the control group were (24.36 ± 4.34), (17.14 ± 3.21), (7.84 ± 1.23), (49.34 ± 6.55) points, and the differences were statistically significant( t values were 4.056-5.857, P<0.01). The scores of physical exercise self-efficacy, coping self-efficacy, and rehabilitation self-efficacy in the treatment group after intervention were (43.43 ± 5.38), (54.45 ± 6.32), (97.88 ± 7.45) points, and the control group were (37.45 ± 5.42), (48.65 ± 6.45), (86.10 ± 9.12) points, and the differences were statistically significant ( t values were 5.009, 4.110, 6.430, P<0.01). Conclusions:Peer education based on WeChat support helps to enhance the degree of social support for patients after laparoscopic prostate cancer surgery, improve the level of mental flexibility, and promote the development of rehabilitation self-efficacy.

Objective To study the value of cervical length(CL) by transvaginal sonography in the mid-trimester and late-trimester for the prediction of preterm delivery.Methods The CL was measured by transvaginal sonography for 5277 pregnant women between 22-24 weeks and 28-32 weeks gestation,who were prenatal cared and delivered at the First Hospital of Peking University from June 2008 to November 2009.The pregnancy outcomes were followed,and the relationship between CL and preterm delivery and preterm premature rupture of membrane was studied.Results ( 1 ) The incidence of preterm delivery was 5.4％ (289/5370) total,among of them the incidence of therapeutic preterm delivery was 1.7％ (93/5370),spontaneously preterm delivery was 1.2％ (62/5370),and preterm premature rupture of membrane was 2.5 ％ (134/5370).There are 4 cases (4/5370) who occured late abortion.(2) Excluding the 93 women who had therapeutic preterm delivery,the mean CL of 22-24 weeks was ( 38.8±4.0) mm.The relative risk for preterm delivery when the CL＜30 mm was 5.2,when CL＜25 mm,the relative risk was 11.1,and when CL ＜15 mm the relative risk for preterm delivery was 13.8.The average CL during 28-32 weeks of gestation was ( 34.6±4.8) mm,was significantly shorter than that of 22-24 weeks ( P＜0.05 ).During this period the relative risk for preterm delivery when the CL＜30 mm was 6.9,when CL＜25 mm,the relative risk was 11.1,and when CL＜15 mm the relative risk for preterm delivery was 20.0.(3) A CL＜30 mm as the cutoff value for predicting preterm delivery during 22-24 weeks of gestation has only a 3％ sensitivity and 19％ positive predictive value,but had a 99％ specificity and 96％ negative predictive value.The sensitivity,positive predictive value,specificity and negative predictive value for a CL ＜ 30 mm as the cut-off value for predicting preterm delivery during 28-32 weeks of gestation was 33％,21％,95 ％ and 97 ％ respectively.(4) The total number of preterm premature rupture of membrane pregnant women was 134 (2.5％ ),who had a mean CL of (38.4 ±4.7) mm during 22-24 weeks of gestation,was similar with the women without preterm premature rupture of membrane ( PPROM),but during 28-32 weeks of gestation the women who occured PPROM had a mean cervical length of ( 30.6 ± 8.1 ) mm,and was significantly shorter than that of women without PPROM ( 34.7 + 4.6 ) mm.Conclusions ( 1 ) CL in 28-32 weeks of gestation issignificantly shorter than that of in the mid-gestation,but more than 90％ of women has a CL≥30 mm.(2)The shorter the CL is,the greater the relative risk of preterm delivery.According to different CL for clinical consulting objective relative risk could be provide.(3) The CL during 28-32 weeks of gestation can also predict preterm delivery,the sensitivity is obviously better than that of 22-24 weeks of gestation.(4) The CL during 28-32 weeks of gestation is valuable for predicting of PPROM.

ObjectiveTo investigate the change of cervical length (CL) during uncomplicated pregnancy by transvaginal ultrasound and its correlated factors.MethodsData of five hundred and ninety-five normal singleton pregnant women who received vaginal ultrasound examination on CL in their 11-13+6gestational weeks ( Ⅰstage),20-24 gestational weeks ( Ⅱ stage),28-32 gestational weeks (Ⅲ stage) and ≥36 gestational weeks (Ⅳ stage) were collected and retrospectively analyzed.Related factors were recorded at the same time.Repeated measurement data analysis of variance,t-test and Spearman correlation analysis were applied for statistical analysis.Results(1) The mean values of CL at Ⅰ,Ⅱ,Ⅲ and Ⅳ stage were (38.85±3.11) mm,(38.92±4.10) mm,(36.43±4.69) mm and (30.63±6.11) mm,respectively.There were statistical differences between the CL of any two stages (P＜0.01),except for that between Ⅰ and Ⅱ stage.The median values of CL change rates were:Ⅱ-Ⅰ stage0.00％; Ⅲ-Ⅰ stage -5.36％; Ⅳ-Ⅰ stage -20.00％.(2) The CL of pregnant women who were older than 35 was longer than that of those younger than 35 at any stage [ Ⅰ stage:(39.36±3.18) mm　vs (38.77±3.10) mm;Ⅱ stage:(39.89±4.61) mm vs (38.88±4.00) mm;Ⅲ stage:(37.29±4.79) mm vs (36.31 ±4.67) mm;Ⅳ stage:(32.25± 5.95) mm vs (30.38±6.10) mm],while significant difference was found only at Ⅳ stage (t=-2.56,P=0.01).The CL of multiparas was longer than that of primiparas [ Ⅰ stage:(38.95±2.59) mm vs (38.76±3.14) mm;Ⅱ stage:(39.54±3.62) mm vs (38.82±4.11) mm;Ⅲ stage:(37.37±4.21) mm vs (36.34±4.70) mm;Ⅳ stage:(31.77±6.05) mm vs (30.59±6.11) mm],while there was no statistical significance within any stage ( P＞ 0.05). ConclusionsCervix shortens gradually after 28 gestational weeks.Sequential measurement of CL during routine ultrasonic inspection might be helpful in predicting preterm labor.