The establishment of open-loop psychiatric ward is an innovation for mental disease treatment,while new legal and ethical issues become evident.For instance,psychiatric patients with no guardians or agents can not normally sign the informed consent form at hospitalization.It is extremely difficult to make a definite diagnosis in some cases.Informed consent form is refused by certain guardians due to the misunderstanding of psychiatric diseases.This paper explores those legal and ethical issues arising in the medical treatment in open-loop psychiatric ward,and comes up with relevant countermeasures.

Objective To investigate relationship between infection rate of Mycoplasma pneumoniae(MP) in children with corresponding gender, age and season. Methods Mycoplasma pneumoniae IgM (MP-IgM) antibody level in serum was measured utilizing method of passive particle agglutination. Results From 2007 to 2009, MP-IgM antibodies among total 1701 children with pneumoniae were detected in the study, of which 569 cases showed MP-IgM antibodies positive (569/1701,33.5%). The MP-IgM positive rate in male and female patients were 30.1% and 37. 8% respectively and the difference was statistically significant (P ＜ 0. 01). The MP-IgM positive rates in 0 ～ 1year-old group,2 ～ 3 year-old group ,4 ～ 6 year-old group and 7 ～ 14 year-old group were 5.8% ,35.3% ,43.3% and 52.9%, respectively. The disparities of MP-IgM positive rate between the groups was statistically significant (P ＜0.01,P ＜ 0.01 and P ＜ 0.05, respectively). The differences of MP-IgM positive rates during the peroid of 2007,2008and 2009 were statistically significant(P ＜ 0.01), but no difference was significantly exhibited during the peroid of 2008 verse 2009 (P ＞ 0.05). As for onset distribution of season, in year 2007, MP infection rates between the individual seasons were not statistically different. Conclusion MP infection was mainly prevailed in those whose ages were over three years old. MP infection was inclined to occur in female children than in male and the prevalent season was the Spring.

Objective To explore the factors relating to serum lutein level in elderly patients with early age-related macular degeneration (AMD).Methods 102 early AMD patients diagnosed by international diagnostic criteria were selected.The level of serum lutein was measured by HPLC,and dietary intake was estimated by food-frequency questionnaire (FFQ).The factors relating to serum lutein level were analyzed by Pearson correlation and multiple regression analysis models.Results Serum lutein level was higher in female AMD patients than in male AMD patients [(0.33±0.31) μmol/L vs.(0.21 ±0.19) μmol/L,t=2.21,P＜0.05].Serum lutein level was positively correlated with dietary lutein (r=0.49,P＜ 0.001),but not correlated with age,BMI,and other nutrient intake after adjustment for caloric intake.Dietary lutein was mainly from corn,spinach,leeks,eggs,chrysanthemum,pumpkin,broccoli,lettuce,asparagus and peas.Intakes of spinach,pumpkin,asparagus were significantly associated with serum lutein level.Conclusions Elderly patients with AMD should increase the intakes of lutein-rich vegetables to increase the serum lutein level.

Objective:To evaluate the effects of humanistic care on medication compliance and social function of schizophrenic patients. Methods:76 patients with schizophrenia were randomly divided into two groups within two days of hospital admission. The observational group was applied humanistic care but the control group with rou-tine care. All the information related to the present study was collected using unified language. At the time of ad-mission, day 1, day 14, day 28 and day 56 after the intervention, the effect of humanistic care was evaluated by medication compliance, Brief Psychiatric Rating Scale ( BPRS) , Personal and Social Performance Scale ( PSP) and Family Concern Index Questionnaire ( APGAR) . Results:The patient′s medication compliance rate in the obser-vational group was higher than those in the control group, especially, at the time of day 56, the patients in the ob-servational group ( full compliance : 66%, partial compliance: 44%) was significantly better than those in the control group ( full compliance 19%, partial compliance 66%, incompliance 15%) . There were no statistical difference in the two groups of the BPRS scores on day 1 and day 14 of admission, however, the scores of the pa-tients in the observational group was significantly lower than those in the control group on day 28 and day 56 . As for PSP, the result was similar to BPRS on day 1 and day 14, while the PSP score of the patients in the observational group was significantly higher than those in the control group on day 28 and day 56. In terms of APGAR, the score of the patients in the observational group was significantly higher than those in the control study except day 1 of ad-mission. Conclusion:Humanistic care has positive effects on medication compliance and social function of schizo-phrenic patients especially after hospital discharge. The implementation of humanistic care would guide patients to maintain the capacity of life, labor and social communication, enhance the patient's sense of control over life, and improve their confidence to overcome the disease. With humanistic care, patients are more willing to cooperate with treatment, and further to reduce the recurrence and degradation of social function.

Objective To explore the factors that affect the prognosis of extensive small cell lung cancer by analyzing the association between lab-oratory indicators before treatment of extensive small cell lung cancer patients and the initial evaluation results with disease progression and overall survival. Methods This study retrospectively analyzed 96 cases of hospitalized patients in the medical oncology department of The First Hospital of China Medical University from March 2008 to September 2014. Kaplan-Meier method and Cox proportional hazards models were adopted to ana-lyze the relevant factors affecting the prognosis of extensive small cell lung cancer. P<0.05 was considered statistically significant. Results There was no obvious correlation between HB level before treatment with PFS of patients(P=0.179),but there was obvious significant correlation be-tween HB level and OS of patients(P=0.041). Our results showed that the TBIL level of patients before chemotherapy was significantly associated with the PFS(P=0.039)and OS(P=0.026)of patients. Conclusion HB and TBIL levels are the influencing factors that affect the prognosis and survival of patients with extensive small cell lung cancer.

This study was aimed to reveal current achievements and the future trend about Chinese materia medica (CMM) processing, which pointed future research direction for scholars.“CMM processing” was used as the subject term in document retrieval to the Web of Science (WoS) and CNKI. The CitespaceII and Ucinet & Netdraw were used to build mapping knowledge domains to acceptable both English and Chinese literature data. The results showed that the mapping knowledge for“CMM processing” for co-citation, source journal, author, key words and so on were established. It was concluded that the rapid present period of Chinese literature on CMM processing was earlier for around 15 years than English literature. And the total amount of English documents was much less than Chinese documents. Combing the developing process of CMM, it revealed its current achievements and future trend, which pointed future research direction for scholars, and moreover it put forward new thinking and method to summarize or expand traditional medicine and related research fields.

Objective To determine whether neuron?specific enolase(NSE)affects the prognosis of extensive small cell lung cancer by analyz?ing the association between NSE before treatment and disease progression and overall survival of patients. Methods This study retrospectively an?alyzed 83 inpatients in the medical oncology department of the First Affiliated Hospital of China Medical University from March 2008 to September 2014. The Kaplan?Meier method and Cox proportional hazards models were used to analyze relevant factors affecting the prognosis of extensive small cell lung cancer;statistical significance was determined for a P value less than 0.05. Results The lactate dehydrogenase(LDH)level be?fore treatment was significantly associated with the progression?free survival(PFS)(P=0.001)and overall survival(OS)(P=0.036). The NSE level before treatment was also significantly associated with the PFS(P=0.007)and OS(P=0.013). Conclusion LDH and NSE affect progno?sis and survival of patients with extensive small cell lung cancer.

Objective To establish a gestational diabetes rat model by feeding the rats with high-fat diet.Methods A total of 55 female SD rats were divided into four groups:NV group,NP group,FV group and FP group.Three months after normal feeding,the female rats in NP and FP group were put into the same cage with the male rats at the ratio of 2∶1 and were given high-fat diet or normal diet as usual.Before pregnancy and day 1,7,14,20 in pregnancy,fasting plasma glucose and body weight of rats were detected.The fasting serum insulin and serum c-peptide levels were monitored by enzyme immunoassay and insulin resistance index was calculated.At late pregnancy,glucose tolerance and the indicator of fat were tested.Liver and pancreas were dyed to be observed under microscope.FResultS Body weights of the rats raised with high-fat diet were significantly higher than those of control group and body weight during pregnancy significantly increased (P＜0.05).Fasting glucose,fasting insulin and serum C-peptide in FP group were signifieantly higher than those in NP group and insulin resistance was evident (P＜0.05).The area under curve of GTT in FP group was significantly larger (P＜0.05).The levels of serum lipids in FP group were higher than those in normal group.CorncluSiornS The gestational diabetes rat model induced by high-fat diet can be successfully established.The model presents major pathophysiological manifestations of GDM and can be used as a good model of GDM in relevant research.

Objective:To analyze the duration of the second stage of labor without epidural anesthesia and its association with pregnancy outcome.Methods:This retrospective study involved 12 789 women who delivered without epidural anesthesia in the First Affiliated Hospital of Kunming Medical University from January 1, 2014 to December 31, 2017. These subjects were divided into primipara group (9 517 cases) and multipara group (3 272 cases). Demographic characteristics, maternal and neonatal outcomes and the duration of the second stage of labor were compared between the two groups using two independent samples t-test, Mann-Whitney U test and Chi-square test (Fisher's exact test). Differences in the maternal and neonatal outcomes were also analyzed among different subgroups in primiparae [length of second stage: <1 h group ( n=6 265), ≥1-2 h group ( n=2 305), ≥2-3 h group ( n=831) and ≥3 h group ( n=116)] and multiparae [length of second stage <1 h group ( n=3 144), ≥1-2 h group ( n=102) and ≥2 h group ( n=26)]. The association between second stage length and pregnancy outcomes was analyzed with Cramer's V. After adjusted for maternal age, gestational weeks at delivery, body mass index before pregnancy, complications during pregnancy and neonatal birth weight, the relationship between the duration of the second stage and adverse outcomes was analyzed by binary logistic regression analysis. Results:The 95 th percentile of the second-stage labor duration was 143 min for primiparae and 52 min for multiparae. The rates of vaginal delivery, forceps delivery, cesarean section in the second stage, episiotomy, third- or fourth-degree perineal laceration, postpartum hemorrhage, grade Ⅱ postpartum hemorrhage, transfusion, umbilical arterial blood gas pH<7.15 and transferring to neonatal intensive care unit (NICU) were all correlated with the duration of second stage in primiparae (Cramer's V values: 0.22, 0.23, 0.03, 0.22, 0.05, 0.10, 0.03, 0.03, 0.03 and 0.07, respectively, all P<0.05), and so did those of vaginal delivery, forceps delivery, episiotomy, postpartum hemorrhage, grade Ⅱ postpartum hemorrhage, transfusion and transferring to NICU in multiparae (Cramer's V values: 0.18, 0.19, 0.28, 0.14, 0.09, 0.13 and 0.06, respectively, all P<0.05). Logistic analysis showed that in primiparae, the duration of second stage >1 h was an independent risk factor for episiotomy, third- or fourth-degree perineum laceration, forceps delivery, postpartum hemorrhage, admission to NICU and umbilical arterial blood gas pH<7.15 [adjusted OR (95% CI): 2.080 (1.907-2.268), 1.773 (1.080-2.911), 1.625 (1.420-1.859), 1.365 (1.231- 1.514), 1.305 (1.165-1.462) and 1.246 (1.081-1.436), respectively], while second stage length >2 h was the independent risk factor for episiotomy, forceps delivery, third- or fourth-degree perineum laceration, postpartum hemorrhage, grade Ⅱ postpartum hemorrhage, blood transfusion, admission to NICU and umbilical arterial blood gas pH<7.15 [adjusted OR (95% CI): 4.844 (4.132-5.678), 4.223 (3.571-4.993), 3.289 (1.806-5.989), 1.952 (1.675-2.274), 1.781 (1.057-3.001), 1.654 (1.025-2.668), 1.682 (1.421-1.991) and 1.298 (1.039-1.620), respectively]. In multiparae, the length of second stage >1 h was an independent risk factor for episiotomy, blood transfusion, forceps delivery, postpartum hemorrhage and admission to NICU [adjusted OR (95% CI): 8.796 (5.717-13.534), 7.469 (2.874-19.411), 6.135 (3.217-11.699), 2.697 (1.624-4.477) and 1.814 (1.063-3.097), respectively], while the duration of second stage >2 h was the independent risk factor for episiotomy, third- or fourth-degree perineum laceration, blood transfusion, grade Ⅱ postpartum hemorrhage, forceps delivery and postpartum hemorrhage [adjusted OR (95% CI): 38.868 (14.948-101.063), 28.046 (2.780-282.490), 20.076 (5.384-74.866), 16.327 (3.406-78.274), 14.337 (5.351-38.411) and 9.036 (3.880-21.011), respectively]. Conclusions:The duration of the second stage of labor without epidural anesthesia is between that reported by Friedman and by Zhang. A prolonged second stage of labor may increase the risk of adverse pregnancy outcomes.

Objective:To analyze common pathogenic gene mutations of arrhythmogenic right ventricular cardiomyopathy (ARVC) in Yunnan unexplained sudden death (hereinafter referred to as Yunnan sudden death) cases, and explore the etiological relationship between Yunnan sudden death and ARVC.Methods:Four typical Yunnan sudden death affected counties (cities) were selected as investigation sites. Cryopreserved autopsy cardiac cavity blood samples were collected from Yunnan sudden death cases ( n = 3), and peripheral venous blood samples were harvested from their relatives (first, second, third and immediate degree of kinship, n = 67) and control population ( n = 49). The DNA of blood samples was extracted for amplification and sequencing of 97 exons of 5 common ARVC desmosomal protein [desmoplakin (DSP), desmocollin-2 (DSC2), desmoglein-2 (DSG2), plakophilin-2 (PKP2) and junction plakoglobin (JUP)] genes, and genetic lineage of Yunnan sudden death cases was investigated. Results:A total of 17 gene mutation sites were discovered in Yunnan sudden death cases and their relatives, with 6, 5, 4, 1 and 1 in the DSP, DSC2, DSG2, PKP2 and JUP genes, which were not found in the control population. Among them, 9 were newly discovered mutation sites and 8 were reported mutation sites. The DSP gene exon 24 c.8472 G>C, a pure contractual sense mutation, was common in the relatives of 4 cases in the same family surveyed; and one immediate relative carried a deletion mutation at c.2368 - 2370 of exon 15 of DSC2 gene.Conclusion:Yunnan sudden death cases and their relatives carry mutations in the ARVC desmosomal protein DSP, DSC2, DSG2, PKP2, and JUP genes, and the onset of some Yunnan sudden death may be associated with mutations in the ARVC desmosomal protein genes.