Objective To explore the relation between single umbilical artery with other malformations and pregnancy outcome,and to provide evidence for pregnancy counseling and diagnosis.Methods The outcomes of 92 fetuses with single umbilical artery diagnosed and delivered in Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University from September 2007 to July 2009 were followed up and retrospectively analyzed with Chi-square test.Results Among 25 292 pregnant women,92 cases were finally diagnosed as single umbilical artery giving the incidence of 0.36％,among which 57.6％ (53/92) of newborns survived without malformations,15.2％(14/92) survived with malformations and 27.2％ (25/92) died during perinatal period.There were 36 fetuses (39.1％,36/92) with single umbilical artery complicated with other malformations,among which 29 had single malformation (80.6 ％ ),and seven ( 19.4 ％ ) had multiple malformations.The incidence of heart defects was the highest among the complicated malformations,and then followed by central nervous system,digestive system,motor system and urinary system.Thirty-three fetuses with single umbilical artery accepted karyotype analysis.Chromosome abnormality was diagnosed in three subjects (9.1％,3/33).Twenty-three fetus (25.0％,23/92) associated with small for gestational age,and among which 18 fetuses (78.3％,18/23) died with a higher mortality than that (4.0％,24/597) of small for gestational age patients without single umbilical artery (x2=181.71,P＜0.01).Conclusions Single umbilical artery is likely to be complicated with congenital anomalies.After single umbilical artery was diagnosed by routine ultrasound,fetal ultrasonography,echocardiography and amniocentesis for karyotype analysis is suggested.Fetal growth restriction is an important indicator of fetal adverse outcomes.

OBJECTIVE To evaluate the prevention of antibiotic-associated diarrhea(AAD) in surgical critical illness patients and strengthen the usage of antibacterials to AAD in hospital.METHODS Using prediction and retrospection to analyze the factors of AAD.RESULTS The main factors for AAD are changing antibiotics frequently,the age of patient,complicated disease of patient.CONCLUSIONS Rational use and rigorous control of antibiotics are the keys to prevent AAD in hospital.

Reactive oxygen species(ROS) resulting from oxidative stress plays a significant role in the pathogenesis of diabetic nephropathy.It induces cell apoptosis and accelerates the development and progression of diabetic nephropathy through mitochondrial activation,DNA oxidative injury and influence on gene expression.Reducing ROS formation and blocking the pathway of cell apoptosis activated by ROS may become a new target in the treatment of diabetic nephropathy.

Objective To investigate whether R-848 could inhibit IgE production of mice immunized with OVA plus ALUM in vivo.Methods BALB/c mice were immunized s.c on the back with PBS,OVA,OVA plus R-848,OVA plus CpG,OVA plus ALUM,and OVA plus ALUM in R-848 or CpG every two weeks for three times.The blood from the mice was harvested after the last immunization,and the concentration of OVA specific or total IgE,IgG1 and IgG2a in the sera was determined;the splenocytes from the immunized mice were harvested and cultured with or without OVA for 3 days,and the concentration of IL-4 and IFNγ in the supernatants was determined.Results Firstly,we investigated that R-848 as Th1 adjuvant could enhance the production of OVA specific IgG2a in mice immunized with OVA.Secondly,further study showed that R-848 could inhibit the production of OVA specific IgE and total IgE,and promote the production of OVA specific IgG2a in the sera of mice immunized with OVA plus ALUM.Moreover,the results of ELISA showed that R-848 inhibiting IgE production was related to its reducing IL-4 production and enhancing IFNγ production.Conclusion R-848 could inhibit IgE production of mice immunized with OVA plus ALUM in vivo.

Objective To develop clinical dual-qualification nursing teachers stressors scale. Methods Based on literature review, semi-structured interview and the Delphi, first of all, the item pool was made up, then the pre-test scale was formatted. 167 dual-qualification nursing teachers participated in this investigation.Finally, the official scale was formed after measuring its reliability and validity. Results The scale was made up of six dimensions and 25 items. The Cronbach's α was 0.652 ～ 0.903, and the intraclass correlation coefficient was 0.716 ～ 0.921. Conclusion The process of this scale is scientific, rational, rigorous. The scale has good psychometric characteristics and can be used for the stress assessment of dual-qualification nursing teachers.

Objective To investigate the clinical effect of pegylated interferon(IFN)on chronic hepatitis C and its effect on cellular immune function.Methods A total of 92 patients with chronic hepatitis C were enrolled in our hospital from June 2013 to October 2016.They were randomly divided into study group and control group by single and double numbers(admission order),with 46 cases in each group.The control group was treated with recombinant human interferon alpha-2b on the basis of conventional treatment.The study group was treated with pegylated interferon alpha-2a on the basis of conventional treatment.Results After treatment, the rates of RVR, EVR, ETVR and SVR in the study group(52.17%, 71.74%, 76.09% and 54.35%, respectively)were significantly higher than those in the control group(34.78%, 50%, 58.70%, 39.13%, respectively), The difference was statistically significant(P<0.05).There were no significant difference in the cellular immune function index between the two groups before treatment;After treatment,the CD3+, CD4+, CD4+/CD8+ and other immune function indexes of the study group were significantly higher than those before treatment, while the results of CD8+ were significantly lower than before treatment(P<0.05);There was no significant difference in the cellular immune function in the control group compared with before, and the difference of the cellular immune function between the 2 groups after treatment was statistically significant(P<0.05).Conclusion Pegylated interferon(IFN)on the basis of routine treatment can improve the virologic response and cellular immune function in patients with chronic hepatitis C.

Objective To explore the treatment and nursing intervention in heart failure, the use of cedilanid therapy. Methods In 40 cases of heart failure patients using conventional methods of intervention, and classified as the control group, the other 40 patients in the control group using Western intervention on LAN, and classified as the observation group, two groups the patients in our hospital from January 2017 to March 2015. Results The two groups of patients have found efficiency, patients in the observation group were significantly higher, the observation of patients was 92.5%, the control group was 72.5%; the two groups of patients with heart rate, blood pressure were not significantly different in the treatment before and after intervention in observation group were improved after grouping obviously better than that shows obvious differences (P<0.05). The two groups had no obvious adverse reactions. Conclusion Cediland analysis shows that in the treatment of heart failure and intervention effect, can improve the clinical situation of patients, improve the clinical treatment effect, and no significant adverse reactions, worthy of clinical reference.

Objective To study the clinical manifestations and pathological features of distal myopathies, we investigated 71 distal myopathy patients collected in the past 16 years.Methods Clinical manifestations and pathological features of biopsied muscle specimens were summarized and analysed retrospectively. Results Twenty-six of the 71 patients were of Nonaka type, 38 of Miyoshi type, 2 of tibial muscular dystrophy (TMD) type, 4 of Welander type, and 1 of oculophayngodistal myopathy (OPDM) type. Nonaka type is a sporadic or autosomal recessively inherited disorder with preferential involvement of the anterior tibial muscles. In the 26 patients with Nonaka myopathy, the onset age ranged from 8 to 39 years, averaging 24 years, and the disease was rather rapidly progressive. Sternocleidomastoid, biceps brachii muscle, pectoralis major muscle and quadriceps femoris were also involved as the disease advanced. The serum CK was slightly elevated or normal. Muscle biopsies showed rimmed vacuoles markedly without obvious dystrophic features. 15-20-nm cytoplasmic and nuclear filaments were usually seen on electron microscope. The patients with Miyoshi type were characterized clinically by sporadic or autosomal recessive inheritance, preferential gastrocnemius muscle involvement, and dystrophic muscle pathology. Rimmed vacuoles were occasionally seen. Average age of onset was 23 years (range of 8-41 years). As the disease advanced, patients with Miyoshi myopathy occasionally showed apparent proximal muscle involvement. Serum CK was markedly elevated, ranging from 3-180 times than the normal. Welander type was found in four cases. Onset age was from 30 to 46 years. Weakness always began in the finger and wrist extensors. As the disease progressed, symptoms were spreading to the distal lower extremities slowly. The serum CK level was normal or only slightly elevated. Muscle biopsies showed dystrophic features, with rimmed vacuoles occasionally. The oneset ages of two patients with TMD were from 41 to 42 years. Weakness was confined mainly to the anterior tibial muscle. Muscle biopsies revealed fibre necrosis and regeneration. Rimmed vacuoles were present significantly. OPDM was found in a 38-year-old-onset patient with autosomal dominant inheritance and characterized by the weakness of distal lower extremity and development of extraocular muscles, vocal cord and pharyngeal muscle weakness. Muscle biopsies showed rimmed vacuoles without fibre necrosis.Conclusion Five types of distal myopathies were present in China, and Miyoshi and Nonaka myopathies were more common. The clinical and pathological findings of Chinese distal myopthies should be basically similar to those reported by other countries.

As a result of accuracy of staging and decreased patient morbidity,sentinel lymph node biopsy for breast cancer was quickly accepted into clinical practice.Many controversies remain in the methods and indications of sentinel lymph node biopsy.In this article,we attempt to highlight the clinical studies regarding the biopsy techniques,pathologic evaluation,indication for lymphatic mapping and eliminating axillary lymph dissection by sentinel lymph node biopsy.It is demonstrated that radioisotope and blue dye techniques are complementary.Preoperative lymphoscintigraphy is most useful for detecting an internal mammary SLN,but the practicability of internal mammary SLN biopsy is still in the investigative stage.As for intraoperative diagnosis of sentinel lymph node,imprint cytology is a quick,economic and tissue-preserving method,but not very effective in the identification of micrometastasis;axillary lymph node dissection is preferable for patients with micrometastasis.Sentinel lymph node biopsy is indicated for ductal carcinoma in situ,with prophylactic mastectomy,breast cancer patients with previous reduction mammoplasty and breast implants.Currently,NSABP B32,Z0010 and Z0011,large,prospective randomized trials are in progress to evaluate unresolved issues of SLN biopsy.Although data from these trials is not available,SLN biopsy has been widely adopted in the clinic.Consistency of technique as well as case selection has attained great significance.