ObjectiveThis paper discusses the instructional design of ＂General survey of medical culture＂,to provide the basis for the implementation of the teaching.MethodsThe first round of our teaching situation was concluded,to improve the teaching objectives,content,methods and the content and methods of teaching evaluation.Results The course is a new medical humanities curriculum to improve medical knowledge of the human spirit of nursing students,training the cultural literacy,but the teaching content should be combined with professional features,and teaching evaluation methods should be improved.ConclusionsRigorous designed curriculum,flexible and diverse teaching methods and forms of assessment and suggestions from the students are conducive to the improvement of the course.

Objective To investigate the expression of autoantibodies to the angiotensin Ⅱ type Ⅰreceptor (AT1-AA) and endothelin-1 (ET-1) in pregnant women's blood and explore their correlation with the pathogenesis of preeclampsia.Methods Ninety pregnant women who delivered from June 2011 to December 2011 in the First Affiliated Hospital of Zhengzhou University were chosen as the study objects.They were divided into mild preeclampsia group (n =30),severe preeclampsia group (n =30) and normal group (control group,n =30).The levels of AT1-AA and ET1 in maternal peripheral blood and umbilical cord blood were detected by ELISA,and the mRNA expression levels of AT1-AA and ET1 in placenta tissues were determined by reverse transcription (RT) PCR.Moreover,the correlation clinical indexes were detected and analysed.Results (1) The levels of AT1-AA and ET1 in maternal peripheral blood of preeclampsia [mild group:(114 ± 19) ng/L and (31 ± 9) ng/L,severe group:(145 ± 15) ng/L and (38 ± 10) ng/L] were both significantly higher than that of control group [(59 ± 5) ng/L,(17 ±4) ng/L].In addition,compared with mild group,the levels of AT1-AA and ET1 in severe group were significantly higher (P ＜0.05).(2) The levels of AT1-AA and ET1 in umbilical cord blood of preeclampsia [mild group:(105 ± 14) ng/L and (35 ±6) ng/L,severe group:(118 ± 14) ng/L and (40 ±5) ng/L] were significantly higher than that of control group [(61 ± 12) ng/L,(24 ± 5) ng/L].In addition,compared with mild group,the levels of AT1-AA and ET1 in severe group were significantly higher (P ＜0.05).(3) The mRNA expression levels of AT1-AA and ET1 in placenta tissues of mild group (0.313 ± 0.039,0.296 ±0.028) and severe group (0.568 ±0.052,0.577 ±0.046) were significantly higher than that in control group (0.198 ± 0.017,0.137 ± 0.012),and the levels in severe group were significantly higher than that in mild group (P ＜0.05).(4) There was an evident positive correlation between AT1-AA and ET1 levels of preeclampsia women's peripheral blood,umbilical cord blood and placenta (P ＜ 0.05).(5) The level of AT1-AA in umbilical cord blood of preeelampsia pregnant women was positively correlated with S/D value of umbilical artery (P ＜ 0.05),and negatively correlated with the weight of the birth and the placental (P ＜ 0.05).Conclusion The AT1-AA in the blood of pregnant women plays an important role in promoting the generation and development of preeclampsia by increasing the ET1 secretion.

Objective To investigate the role of S100 calcium binding protein A12 (S100A12) in the pathogenesis of preeclampsia. Methods Sixty patients with preeclampsia were recruited from March 2013 to December 2013 in the First Affiliated Hospital of Zhengzhou University. Among them, thirty cases were defined as the mild preeclampsia group and thirty cases were defined as the severe preeclampsia group. The other thirty healthy pregnant women were recruited in the healthy pregnant women group. The levels of S100A12 protein in maternal peripheral blood were detected by enzyme-linked immunosorbent assay (ELISA). Immunohistochemistry of streptavidin peroxidase biotin (SP) method was used to measure the protein expression of S100A12. The trophoblast cells were cultured in vitro with plasma from the three groups, and a blank control group was set up as well. Transwell was used to detect the cytotrophoblast invasion ability. Western blot was used to measure the protein expression level of receptor for advanced glycation end products (RAGE). Results (1) The levels of S100A12 in maternal peripheral blood of patients with preeclampisa [mild group:(30.8 ± 2.7)μg/L, severe group:(49.3 ± 4.1)μg/L] were significantly higher than that of the control group [(15.8 ± 1.4) μg/L]. In addition, compared with the mild preeclampsia group, the level of S100A12 in the severe preeclampsia group was significantly higher (P<0.05). (2)Positive immunostaining of S100A12 was observed in the cytoplasm of cytotrophoblast, decidual cells and the placentas from the three groups. The positive rate in the mild preeclampisa group was 77%(23/30);in the severe preeclampsia group it was 93%(28/30);and in the healthy pregnant women group it was 23%(7/30). The positive rates of placenta in the mild and severe preeclampsia groups were significantly higher than that in the healthy pregnant women group (P<0.05). In addition, compared with the mild preeclampsia group, the positive rate of immunostaining of S100A12 in the severe group was significantly higher (P<0.05).(3) Cytotrophoblast invasion ability and the expression of RAGE in the mild preeclampsia group were 29.1±3.2 and 0.479 ± 0.038, respectively;in the severe preeclampsia group they were 16.8 ± 2.5 and 0.652 ± 0.059;in the healthy pregnant women group they were 38.6 ± 24.3 and 0.327 ± 0.024; and in the blank control group they were 42.6 ± 5.6 and 0.194 ± 0.011. Cytotrophoblast invasion ability and the expression of RAGE protein in the mild and severe preeclampsia groups were significantly higher than those in the healthy pregnant women group and the control group(P<0.05). Conclusions The expression of S100A12 increased in materal peripheral blood and placenta, and the receptor protein of S100A12 RAGE also had high expression. It suggested that the S100A12 may have some effect on the pathogenesis of preeclampsia.

Objective To explore the joints and tendons characteristic features of high frequency ultrasound in asymptomatic hyperuricemia(AH) and to assess its value in AH diagnosis.Methods One hundred asymptomatic individuals with hyperuricemia (AH group) and 75 normouricemic subjects (control group) were examined by high frequency and color Doppler ultrasound.The joints,tendons and soft tissue of the knees,ankles and first metatarsal-phalangeal joints in two groups were examined.The correlations of serum urate(SU) level with double contour sign,bone erosion and articular cavity effusion were analysed.Results Hyperechoic deposition on the sulface of the articular hyaline cartilage (double contour sign) were found in the knees (35),ankles (17) and the first metatarsophalangeal joints (MTPJs,48) from the asymptomatic individuals with hyperuricemia,in contrast to none in the control group (P ＜0.05).Similar results were found in two groups of the bone erosion (30,25,20 vs 4,6,3,P ＜0.05),the effusion (28,36,41 vs 6,8,9,P ＜0.05) and the hyperechoic spots (19,18,22 vs 0,0,0,P ＜0.05).Patellar enthesopathy (4.5％ vs 0.6％,P ＜0.05) as well as achilles enthesopathy(8％ vs 0,P ＜0.05) and achilles tophi (6％ vs 0.6％,P ＜ 0.05) were more frequent in asymptomatic hyperuricemic than that of normouricemic individuals.No correlations between SU concentration and the presence of the double contour sign,the bone erosion and effusion were found (P ＞0.05).Conclusions There were some similar specific sonographic findings of gouty arthritis in the asymptomatic individuals with hyperuricemia.Also,these findings support high frequency ultrasound as a useful tool to detect anatomical damage in the joints,synovial tissue and tendons of asymptomatic individuals with hyperuricemia.

Objective To discuss the effect of self-clotting cutter radiofrequency ablation in curing the hysteromyoma. Methods 96 patients with hysteromyoma were selected. Their hysteromyomas were cured by self-clotting cutter radiofrequency ablation through virgina under the direction of B-ultrasound. Then they were followed up for one month, three months and six months after the operation. Results Six months after the treatment,42.71% of the patients were eumenorrhea,44.79% of the patients' menstrual bleeding volumes were few, 12.5% has no change. The cure rate of anaemia was 100%. 1 month,3 months ,6 months after the treatment, the bulks of uterus and myoma were reduced,and the myoma reduced most after six months. 35.42% of the patients were cured,47.92% had remarkable effect, 15.6% had effect, 1.04% had no effect. Total effective rate was 98.72%. Conclusion The clinical effect of self-clotting cutter radiofrequency ablation in curing the hysteromyoma was satisfactory. It was a minimally invasive technique which could keep the integrality of uterus and it was rapid recovery,effective and safe,and easy to operate.

Objective To explore the differences in disease location,pathological feature,disease severity,extraintestinal manifestations and drug treatment between inflammatory bowel disease (IBD) patients with comorbid autoimmune disease (AD) and simple IBD patients.Methods From January 2009 to December 2014,the clinical data of 54 IBD patients with comorbid AD and at the same period 74 simple hospitalized IBD patients were retrospectively analyzed.According to IBD type and whether combined with AD,patients were divided into Crohn's disease (CD)+AD group (n=16),CD group (n=26),ulcerative colitis (UC)+AD group (n=38) and UC group (n=48).Chi square test was performed to compare the differences in disease severity,location,extraintestinal manifestations and drug treatment between IBD patients with and without AD.Results There was no statistically significant difference in location among four groups (all P＞0.05).The most common concomitant AD of IBD was rheumatoid arthritis (20.4％,11/54) and ankylosing spondylitis (13.0％,7/54).The proportion of mild active patients of CD+ AD group was lower than that of CD group (2/16 vs 53.8％ (14/26),x2 =7.180,P=0.007),while the proportion of severe active patients was significantly higher that of CD group (6/16 vs 0,x2 =8.519,P=0.004).There was no statistically significant difference in moderate active patients between the two groups (P=0.808).Main type of patients of UC+ AD group (76.3 ％,29/38) and UC group (68.8 ％,33/48) were moderate active patients.There was no statistically significant difference in disease stage and location (all P＞0.05).The incidence of extraintestinal manifestations of IBD+AD group (55.6 ％,30/ 54) was significantly higher than that of IBD group (9.5 ％,7/74,x2 =32.279,P＜0.01),and the main manifestation was arthritis (37.0％ (20/54) vs 5.4％ (4/74),x2=20.504,P＜0.01).The rate of glucocorticoid and immunosuppressant application in IBD+AD group was higher than that of IBD group (40.7％ (22/54) vs 17.6％(13/74),x2 =8.438,P=0.004;20.4％(11/54) vs 0,x2=14.000,P＜ 0.01).Conclusions The condition of patients with IBD and comorbid AD is more severe,and the incidence of extraintestinal manifestations is higher.Early treated with glucocorticoid and immunosuppressant could effectively achieve remission.

Objective To explore the neurasthenia situation of the population attending the postgraduate exam in medical class and its influencing factors .Methods The random cluster sampling method was adopted .The influencing factors were per‐formed the χ2 test and Logistic regression analysis .Results According to the inclusion criteria and exclusion criteria ,36 positive ca‐ses were screened out ,accounting for 8 .89% of participants ,which was higher than the value of the general population ;the statisti‐cally significant differences were noted in the factors of the confidence of attending the postgraduate exam ,stress ,adjusting ability , interpersonal situation ,reading duration ,sleep ,nutrition and dietary (P<0 .05) .Conclusion Attending the postgraduate exam such highly intensitive mental activity is the important reason causing neurasthenia among the population attending the postgraduate ex‐am ,which mainly display in the aspects of stress size ,bearing ability facing stress and regulation .

Objective To investigate the therapeutic effect of uteroplasty aided with temporary balloon occlusion of abdominal aorta in treating pernicious placenta previa combined with placenta percreta.Methods Sixty-two third-trimester gravidas who were diagnosed as pernicious placenta previa combined with placenta percreta by prenatal ultrasound and magnetic resonance imaging (MRI) in the First Affiliated Hospital of Zhengzhou University from January 1,2013 to May 31,2016 were enrolled in this study.All of them received cesarean section and then underwent uteroplasty following temporary balloon occlusion of abdominal aorta.Efficacy of that treatment was evaluated from the perspectives of blood loss,operation time,complications and postoperative recovery.All data were analyzed by descriptive analysis.Results All of the 62 cases were diagnosed with placenta percreta during operation including 10 cases (16.1％) with perimetrium invasion,46 cases (74.2％) with invasion to the muscular layer of bladder and six cases (9.7％) with bladder invasion.The average blood loss of all cases during and within 24 hours after operation was (1 377.3±605.2) ml and (140.6±66.3) ml,respectively.The average operation time was (72.3 ±24.5) min and the average length of postoperative hospital stay was (5.8± 1.6) d.The six cases of placenta percreta with bladder invasion received bladder repair.Sixty-one cases had their uterus preserved and the other one case had a sub-total hysterectomy due to amniotic fluid embolism.One woman developed phlebothrombosis in her lower limbs after operation.No intestinal or ureteral injury,puerperal infection,uterine ischemia necrosis or death was reported.In addition to three cases lost to follow-up,the other 59 patients were followed up to May 31,2017.Results of physical examination indicated that the 59 cases had normal uterine involution after operation.Menses returned in 58 of the 59 cases without any difference from before,and did not return in one case due to breastfeeding.Conclusion Uteroplasty aided with temporary balloon occlusion of abdominal aorta is a safe and effective uterus-preserving surgery for patients with pernicious placenta previa combined with placenta percreta.

Objective To study the operative technique and effect of temporary balloon occlusion of the abdominal aorta for preventing intraoperative bleeding during cesarean for patients with pernicious placenta previa and placenta accreta. Methods Retrospective analysis was conducted on the intraoperative situation of forty-one cases and information of follow-up twenty-nine cases, which were pernicious placenta previa and placenta accreta and delivered in the First Affiliated Hospital of Zhengzhou University from May 1, 2013 to June 30, 2014. Diagnosis was confirmed by line of color Doppler ultrasound and MRI for all patients before operations. An interventional physician performed right femoral artery puncture and preset the abdominal aortic balloon catheter in the digital subtraction angiography operation room before cesarean. At the same time of fetal delivery, 10 ml normal saline was injected into the balloon immediately, which results in filling of the balloon and blocking of the aorta. According to the area and depth of placenta implantation and implantation or penetration of the posterior bladder wall, placenta separation, partial resection of the uterine wall and partial bladder resection and repair were performed correspondingly. Meanwhile, saline in the balloon was pumped out gradually until empty. Condition of placenta implantation, blood loss and blood transfusion volume during the operation, intraoperative and postoperative complications, the duration and dose of fetal radiation exposure, and Apgar score of neonates were analyzed. Results Among the 41 cases, penetrative placenta and implanted placenta were observed in five cases and 36 cases, respectively. The latter 36 cases including 28 cases of bladder posterior wall accreta and eight cases of bladder posterior wall penetration. For all cases, the average operation time was (68.5±15.3) min, the mean blood loss in the operation was (1 058±960) ml, among which eight received blood transfusion with an average of (600±400) ml, and the mean hospital stay was (8.2±2.3) d. Uteruses were reserved in all cases. The mean duration and dose of fetal radiation exposure was (8.1±3.6) s and (5.2±2.9) mGy, and the Apgar score of neonates was 8.7±0.5 at 1 min and 9.5±0.3 at 5 min, respectively. The patients were followed up until October 31, 2014. Among them, six were lost, six were still in puerperium, 18 were breast-feeding, and the menses of 11 had returned. Conclusion Preset abdominal aortic balloon catheter in pernicious placenta previa and placenta accrete patients might effectively reduce the blood loss during cesarean section as well as the risk of hysterectomy through temporary occlusion of the abdominal aorta.

Objective To explore the relationship among clinicians' work pressure,perceived social support and compassion fatigue,and to provide a new prospective for the localization studying of intervention and treatment to compassion fatigue.Methods Data of scale for occupational stressors on clinician,perceived social support scale and professional quality of life scale were collected from a sample of 533 clinicians and analyzed with structural equation modeling to study the relationship among clinicians' work pressure,perceived social support and compassion fatigue.Results (1)Work pressure(2.40±0.45),burnout (2.14±0.54) and secondary traumatic stress(1.93±0.60) scores of the clinicians with high perceived social support were significantly lower than that of the clinicians with low perceived social support (2.78±3.67,2.73± 0.59,2.32±0.71;t=7.68,-9.44,8.77,5.07;P＜0.01).Compassion satisfaction scores (4.15±0.63) of the clinicians with high perceived social support were significantly higher than that of the clinicians with low perceived social support (3.40±0.71,t =-9.44,P＜0.01).(2) According to relevant results,work pressure was significantly negative correlation with both perceived social support (r=-0.34,P＜0.01) and compassion satisfaction (r=-0.44,P＜0.01),and significantly positive correlation with both burnout (r=0.69,P＜0.01) and secondary traumatic stress(r=0.53,P＜0.01);while perceived social support was significantly positive correlation with compassion satisfaction (r=0.42,P＜0.01),and significantly negative correlation with burnout (r=-0.40,P＜0.01) and secondary traumatic stress(r=-0.26,P＜0.01).(3) According to the results of structural equation modeling,perceived social support played a partly mediating role in the effect of work pressure toward compassion satisfaction and fatigue with the intermediary effect of 55.4％ and 12.5％.Conclusion Perceived social support plays a mediation role between work pressure and compassion fatigue for clinicians,and better social support of the clinician is beneficial to clinicians mental health level.