Objective To establish the reference intervals of thyroid hormone levels fro the women in early ,middle and late preg‐nancy in the local area .Methods Through the strict screening for routine diagnosis of pregnant women who went to the hospital , we choose 420 women with 6-37 weeks of pregnancy and 120 non pregnancy women(control group) .Chemiluminescence was used to detect thyroid stimulating hormone(TSH) ,free thyroxine(FT4 ) ,total thyroxine(TT4 ) ,free triiodothyronine(FT3) ,total triiodo‐thyronine(TT3 ) for the pregnant women in early pregnancy(0-12 weeks) ,mid‐pregnancy(13-27 weeks) ,and late pregnancy(28-40 weeks) and women in control group .Using those data ,we established reference intervals of thyroid hormone and use bilateral limits P2 .5 - P97 .5 to represent .Results The differences of serum TSH ,FT4 ,TT4 ,TT3 concentration between pregnant group and control group were statistically significant(P<0 .05);while the difference of serum FT3 concentration between pregnant group and control group was not statistically significant(P=0 .79) .The concentration of TSH was not statistically significantly different in the mid‐pregnancy compared with late pregnancy(P=0 .933) ,the reference interval can be merged as 0 .56-3 .94μIU/mL .Conclu‐sion The establishment of normal reference interval of thyroid hormone concentration in different period of pregnancy respectively is conducive to the diagnosis and treatment of thyroid disease in pregnancy .

AIM:This study continuously monitors the hemodynamic changes in conscious and anesthetic rats during rapid ascent to high altitude to investigate whether there is difference between the 2 conditions and discuss the rela-ted underlying mechanism.METHODS: Sprague-Dawley rats were randomly divided into conscious group, anesthetic group, anesthetic-5000-control ( A-5000-control) group, anesthetic-5000-aminoguanidine ( A-5000-AG) group, conscious-5000-control ( C-5000-control ) group and conscious-5000-aminoguanidine ( C-5000-AG ) group.The rats in anesthetic group and conscious group were kept in a hypobaric chamber, in which the simulated altitude was increased from 2 260 m to 5 000 m at 2 m/s, and the rats in other 4 groups were at 5 000 m.The system arterial pressure ( Psa) , central venous pressure ( CVP) , heart rate ( HR) and breathing rate ( BR) were directly and continuously displayed and digitally recorded by a high-performance data acquisition (PowerLab 16/35, AD Instruments) at 200 Hz.RESULTS: The HR and BR in the conscious rats were higher and MAP was lower than those in the anesthetic rats obviously.A significant decrease in mean arterial pressure ( MAP) in conscious and anesthetic groups was observed following the increase in the altitude levels, and the net decrease in MAP in conscious group was significantly greater.Additionally, HR in the conscious rats was sig-nificantly lower at 5 000 m than that of the initial level.The rats in C-5000-AG group and A-5000-AG group showed a sig-nificant increase in the arterial pressure after the intravenous injection of AG, a selective inhibitor of inducible nitric oxide synthase ( iNOS) , and no marked change of HR and BR was found.CONCLUSION: Blood pressure and HR decrease during rapid ascent to high altitude, while the change of BR is not obvious.The mechanisms of self-safety would be trig-gered in the early stage of hypoxia, which activates iNOS and then leads to a larger number of nitric oxide.Plentiful NO di-astolizes the vessels to improve the ventilation-perfusion mismatch and lower the blood pressure.When the altitude arise to 5 000 m, even more earlier, a decompensatory stage may occur in the body, leading to decreased HR and blood pressure further more than those in the anesthetic rats.Due to the effects of pentobarbital sodium, the depression of blood pressure requires a lag period and the net decrease in MAP is less than that in the conscious rats.Therefore, hemodynamic changes during rapid ascent to high altitude in conscious rats are more comprehensive and authentic.

Objective To study the clinical efficacy and safety of iguratimod in the treatment of active rheumatoid arthritis. Methods Ninety patients with rheumatoid arthritis were randomly divided into three groups, with 30 cases in each group. Group A: oral administration of iguratimod, 25 mg two times a day, and oral administration of methotrexate, 10 mg once a week. Group B:oral administration of iguratimod, 25 mg two times a ady. Group C: oral administration of methotrexate, 15 mg once a week. According to the American College of Rheumatology criteria for judging 20%, 50%and 70%(ACR20, ACR 50 and ACR 70) improvement of swollen and tender joint was judged according to the American College Of Rheumatology criteria, and the adverse reactions were observed. Results After the treatment in group A and group B ACR20, ACR50 and ACR70 were higher than those in group C [76.67%(23/30) and 60.00% (18/30) than 40.00% (12/30), 50.00% (15/30) and 33.33% (10/30) than 20.00% (6/30), 23.33%(7/30) and 13.33%(4/30) than 6.67%(2/30)], and in group A was higher than that in group B. The differences were statistically significant (P<0.05). The adverse reaction rate in group A and group B was significantly lower than that in group C:16.67%(5/30) and 13.33%(4/30) than 30.00%(9/30), and the difference was statistically significant (P<0.05); the adverse reaction occurred rate in group A and group B, had no significant difference (P>0.05). Conclusions Monotherapy with iguratimod in the treatment of active rheumatoid arthritis is superior to methotrexate, and has fewer side effects. The combined application of the two drugs is more effective, and can reduce the dose of methotrexate and reduce the incidence of side effects, which is worthy of clinical application.

Objective To explore the influence of Explain-Simulate-Practice-Communication-Support ( ESPCS) nursing on self-management and quality of life in coronary heart disease ( CHD ) patients. Methods We chosen 200 CHD patients from January to December in 2013 and divided them into observation group and control group according to random number table method, 100 cases in each group. The patients of the control group received routine nursing, while the patients of the observation group underwent EPSCS nursing intervention on the basis of conventional nursing. After the intervention, the self management behavior and quality of life were surveyed. Results After the intervention, the patients of the observation group acquired the scores of (43. 5 ± 6. 1), (51. 2 ± 3. 5), (21. 1 ± 3. 2) for daily life management, disease medical management, and emotion management respectively, while the scores of the control group were (39. 6 ± 5. 8), (45. 6 ± 3. 9), and (18. 2 ± 2. 9), the differences were statistically significant ( t = -3. 462, -6. 247,-2. 958,respectively;P<0. 05). Scores of physical function and physical role had no statistical significance between the two groups (P>0. 05), but scores of the rest other six dimensional in the observation group were significantly higher than those of the control group, the difference was statistically significant (P <0. 05). Conclusions ESPCS nursing intervention can improve the ability of CHD patients on self-management and rehabilitation training persistence, and improve the quality of life.

Objective:To explore the current status of self-perceived burden among patients with chronic wound and influencing factors and to analyze its influencing factors.Methods:From July 2018 to August 2019, we selected 113 patients with chronic wounds treated in Wound Clinic of the First Affiliated Hospital of Harbin Medical University as research objects. All patients were investigated with the General Information Scale, Self-perceived Burden Scale (SPBS) , Sense of Coherence-13 (SOC-13) , Social Support Rating Scale (SSRS) .Results:A total of 113 questionnaires were distributed in this study, and a total of 102 valid questionnaires were returned. Among patients with chronic wounds, the score of SPBS was (28.37±10.10) at a mild level. The total score and dimensions scores of SPBS of patients with chronic wounds had negative correlations with the total score of SOC-13, the total score and dimension scores of SSRS with statistical differences ( P<0.05) . Multiple linear regression analysis showed that the influencing factors of self-perceived burden were the age, occupation, social support and sense of coherence also with statistical differences ( P<0.05) . Conclusions:The self-perceived burden of patients with chronic wound is at a mild level. Clinical medical and nursing staff should carry out targeted nursing measures according to patients' self-perceived burden to reduce the self-perceived burden of patients so as to reducing the impact of psychological factors on wound healing.

Objective This study was to understand the status of pollution on drinking water, by volatile organic compounds(VOCs),among rural residents living in the basin of Huaihe River. Relationship between the morbidity,morbidity of cancers and VOCs were also explored. Methods 28 villages were chosen from Xuyi,Jinhu,Chuzhou along the Huaihe River,with water samples collected from ditch pond water,shallow wells,deep wells in November-December 2010. VOCs indicators were evaluated according to the Standard Quality GB 5749-2006 for Drinking Water. Results Methylene chloride,chloroform,benzene and carbon tetrachloride were all detected in 76 water samples. The rates of chloroform,benzene,carbon tetrachloride which exceeding the quality standards were 3.95%,21.05% and 22.37%,but no significant differences were found among these three water resources in chloroform,benzene or carbon tetrachloride. Results from the correlation analysis showed that benzene had positive correlation with tumor deaths(r=0.24,P<0.05). Results from the risk assessment on health showed that some chloroform,benzene,carbon tetrachloride products which were related to the risks of cancers were exceeding the acceptable ranges of risk,with the rates as 28.95%,22.37% and 64.47% but with no significant differences among the three water resources(P>0.05). Conclusion Drinking waters for rural residents along the Huaihe River were polluted while VOCs might have related to tumor incidence with potential impact and risk to the health of local residents.

Objective To investigate the effects of phased written health education in heart stent surgery patients. Methods A total of 200 cases with heart stent surgery were randomly divided into two groups based on the random number table, 100 cases in each group. The patients of control group used conventional methods of coronary stent nursing care, while the patients of observation group received a phased written health education on the basis of routine care. We contrasted compliance behavior in the two groups of patients, as well as side effects, and treatment satisfaction. Results The compliance behavior of observation group were significantly better than that of the control group (P<0. 05). The incidence of adverse reactions in the patients of observation group was significantly lower than that of the control group (P<0. 05). Similarly, the satisfaction of observation group were better than that in the control group (P<0. 05). Conclusions Phased written health education is an effective health education, which can enhance compliance behavior and patient′s satisfaction with care.

Objective:To investigate the post-traumatic stress response in women with unintended pregnancy termination and analyze its related factors.Methods:Totally 388 women with unintended pregnancy termination from two public hospitals in Fujian were selected as the research subjects.They were assessed with the Impact of E-vent Scale-Revised(IES-R),Hospital Anxiety and Depression Scale(HADS),Connor-Davidson Resilience Scale(CD-RISC)and Perinatal Grief Scale(PGS).The total score of IES-R ≥35 was positive for post-traumatic stress disorder screening.Results:The total score of IES-R was(20.6±12.4),and the positive rate of post-traumatic stress disorder screening was 16.5％.Multiple linear regression analysis showed that the IES-R total scores were higher in those who thought pregnancy timing was appropriate than those who thought pregnancy timing was wrong(β=0.13),and lower in women with moderate pain during termination than in those with severe pain(β=-0.09).The IES-R total scores were positively correlated with gestational weeks,depression scores of the HADS and grief scores of the PGS(β=0.18,0.27,0.16),and negatively correlated with optimism scores of the CD-RISC(β=-0.12).Conclusion:The post-traumatic stress response of unintended termination of pregnancy is at a moder-ate level.Post-traumatic stress symptoms are more likely to occur in women who thought pregnancy timing is ap-propriate,and those with severe pain during pregnancy termination,large gestational weeks,high level of depression during pregnancy,and high level of grief after pregnancy termination.

Objective To investigate the novice nurses'psychological experience of caring hospitalized children with pain .Methods Fifteen pediatric novice nurses were in-depth interviewed .The interview results were transcribed and analyzed on the bases of relevant theories .Results Novice nurses felt confident and had self-identity when pain of hospitalized children was expected , otherwise, they felt fearful, helpless, unconfident and even losing their sense of self . Conclusions More attention should be paid to the novice nurses'psychological experience of caring hospitalized children with pain .Effective interventions should be adopted to develop the novice nurses'ability of pain care and assure the quality , efficiency and safety of nursing .

Objective:To analyze the neurocognitive abnormalities and related emotional and behavioral problems in 410 adolescent patients with Turner syndrome (TS) managed in Henan Children′s Hospital in the past 5 years, and to explore the relationship between neurocognitive abnormalities and chromosome karyotype, pubertal development, hormone replacement therapy.Methods:A retrospective case series study.A total of 410 adolescent patients who were diagnosed with TS by karyotype or fluorescence in situ hybridization in the outpatient or inpatient Department of Endocrinology, Genetics and Metabolism at Henan Children′s Hospital from June 2018 to June 2023 were selected and divided into 2 groups according to age: < 12 years old and 12-18 years old.Neurocognitive assessments were performed based on the results of the Wechsler Intelligence Scale (4 th edition) for children and behavior scales for children, SPSS 22.0 software was used for data processing and statistical analysis, and chi-square test was used to analyze the correlation between chromosome karyotype, intelligence development level, pubertal development status, hormone therapy status and the occurrence of neuropsychiatric diseases. Results:Among the 410 TS patients, 207 cases had the karyotype of 45, X0/46, XX, accounting for 50.49%, 94 cases had the monosomic karyotype of 45, X0, accounting for 22.93%.Forty-six patients completed the Wechsler intelligence test, with the intelligence quotient (IQ) score ranging from 70 to 105, with high verbal comprehension and perceptual reasoning scores and low processing speed and working memory scores on all assessments.Fifty-two patients completed the hyperactivity scale assessment, and 43 cases had a predisposition to attention deficit hyperactivity disorder (ADHD).There were no significant differences in total IQ, perceptual reasoning and processing speed among the children with karyotype 45, X0, chimeric, and X chromosome structural abnormalities ( H=3.161, 1.955, 5.890, all P>0.05), while there were significant differences in verbal comprehension and working memory among the three groups ( H=7.697, 9.694, all P<0.05).Among TS patients 12-18 years old, 68 cases completed the depression scale self-assessment, of which 23 cases had depressive tendencies.There was no correlation between depressive tendency and chromosome karyotype, pubertal development and hormone replacement therapy ( P>0.05). Conclusions:TS patients generally have low intelligence levels and tend to have ADHD in childhood.TS patients in the pubertal development have a high incidence of depression.Pubertal development status and hormone replacement therapy show no correlation with the occurrence of neuropsychiatric diseases in TS patients.