Objective To explore the job tasks and qualifications of midwives in China for the next five years.Methods Anonymous surveys were sent by email to 80 professionals to learn the job tasks and qualifications of midwives in China using the Delphi method.The recipients include senior midwives, nursing administrators and nursing educators,senior obstetricians and gynecology department chiefs,as well as health administrators.Results Learnt in the survey were the qualifications and job tasks of professional midwives in China for the next five years.The system concludes 77 job tasks of midwives, among which 31 items are supposed to be completed independently.Conclusion China should develop the midwife system as soon as possible,strengthen the midwife training and education,develop the midwife access system and the corresponding laws and regulations for midwives,standardize midwife management,clear the midwife qualifications and job tasks,formulate normative midwife promotion system,and realize the midwifery scientific management.

BACKGROUND: Apoptosis of cardiomyocytes is speeded up during ischemic reperfused injury. Acupuncture on the points of hand- Jueyin meridian can inhibit the progression of reperfused injury and reduce apoptosis of cardiomyocytes so as to provide the protection on the heart.OBJECTIVE: To observe the effects of acupuncture on the points of hand-Jueyin meridian on apoptosis of cardiomyocytes during ischemic reperfused injury.DESIGN: Randomized controlled experiment based on the experimental animals.SETTING: Department of acupuncture and massage in a university of traditional Chinese medicine.MATERIALS: The experiment was performed in Central Laboratory of Shandong University of Traditional Chinese Medicine from April to December 2001. Forty Wistar male rats were employed, and were randomized into 5 groups, named as blank group, model group, "Neiguan(PC 6)" group,"Ximen(PC 4)" group and "Zhigou(TE 6)" group.METHODS: After electric acupuncture on the points of pericardium meridian for 20 minutes, the ligature was done on the anterior-descending branch of the left coronary artery for 40 minutes. Electrocardiogram (ECG) monitoring was followed. The ligature was released after electric acupuncture on the points for another 20 minutes and perfusion was restored for 60 minutes. Afterward, the heart was extracted, the cellular suspension was prepared and the determination with flow-type cell apparatus was applied.MAIN OUTCOME MEASURES: Effects of acupuncture on the changes in apoptosis rate of cardiomyocytes.RESULTS: In the model group, the typical apoptosis peak presented, the apoptosis rate was remarkably increased. The comparison between the points of pericardium meridian groups and the model group indicated very significant difference(P < 0.01) .The apoptosis rates in "Neiguan(PC 6)" group, "Ximen(PC 4)" group and "Zhigou(TE 6)" group as well as the model groupwere(4.29±0.76)%, (5. 17±0.88)%, (13.96 ±2.77)% and (16.01 ± 1.04)% respectively.CONCLUSION: Acupuncture on the points of hand-Jueyin meridian inhibits myocardial apoptosis effectively so as to reduce myocardial injury caused by cell apoptosis.

BACKGROUND:Patients with Parkinson disease (PD) are always supplied exogenous dopamine so as to balance a disproportion of neurotransmitter.However,a long-term administration may easily cause drug resistance;therefore,it is not able to solve nerve injuries at all.A lot of researches suggest that ganglioside can promote neural axon growth,improve neurotrophy,and resist cellular toxicity mediated by glutamic acid (GA).OBJECTIVE:To probe into the duration and effect of oraL administration of ganglioside on improving clinical symptoms of PD patients.DESIGN:Retrospective case analysis.SETTING:Department of Internal Medicine.Shanghai Electric Power Hospital;Departments of Neurosurgery and Internal Medicine,the First Affiliated Hospital of Kunming Medical College.PARTICIPANTS:A total of 6 344 PD patients were selected from Heilongjiang,Hebei,Shandong,Henan, Beijing,Jiangsu,Gansu,Qinghai.Guizhou,Fujian,Hunan,Shanxi, Hubei,Sichuan,Chongqing,Jiangxi, Shanghai and Yunnan from January 2001 to January 2005.All patients met the diagnostic and typing criteria of PD in Practical Neurology.They orally took≥10 mg/d ganglioside for more than 1 month,and all of them were provided the consent.METHODS:Patients who were treated with oral ganglioside accepted neural functional rehabilitation. Every oral solution of ganglioside contained 0.25 g/L ganglioside [including monosialoteterahexosyl ganglioside 1 (21%),diplo-sialoteterahexosyl ganglioside 1a(40%),diplo-sialoteterahexosyl ganglioside 1 b(16%),and tri-sialoteterahexosyl ganglioside 1b(19%)],and patients fastingly took two ampoules in every morning and 2 in every evening before sleeping, or took 4 ampoules in every evening before sleeping. Every 3 months was regarded as a course, and patients were always treated for two or three courses;especially,patients having a long-term duration were treated for above 4 courses.Regular follow-up was performed during the administration to observe the improvements of PD patients on the aspects of chatter, myotone, bradypraxia,posture irregularity, etc. Effective evaluation: Iilness improvements of PD patients who orally took ganglioside were observed within 3,6,9 months and 1 year.Excellent effective: Chatter and myotone disappeared after gradually stopping administration of dopamine preparation;improvement: Symptoms mentioned above were relieved after gradually reducing administration of dopamine preparation (effect=apparent effect+improvement);inefficacy:Symptoms mentioned above were not changed.MAIN OUTCOME MEASURES:Effect at various time Points of administration.RESULTS:Among 5 937 patients who met the inclusion criteria,all of them were involved in the final analysis without any loss.① Improvement of clinical symptoms at various time points of administration:There were 669 PD patients with the effective improvements within 1-3 months.941 within 4-6 months and 1713 within 7-12 months.The total effective rate was 56%.② Therapeutic effective rate of PD patients at various administrating times:The therapeutic effective rates of patients who received administration from 1 to 3 months,from 4 to 6 months and from 7 to 12 months were 30%,57%and 84%respectively.The rate was higher of patients administrated from 4 to 6 months than.of those from 1 co 3 months(P<0.05),and also higher of those from 7 to 12 months than of those from 4 tp 6 months and from 1 to 3 months (P<0.05,P<0.01).CONCLUSION:Ganglioside can effectively improve clinical symptoms,such as chatter,myotone,bradypraxia,posture irregularity,etc.In addition,it has a better effect during a long-term administration.

ObjectiveTo explore the predictive effect of serum TC/HDL-C ratio on ischemic and hemorrhagic stroke incidence in middle aged Chinese population.MethodsA prospective study was conducted based on the PRC-USA Collaborative Study on Cardiovascular and Cardiopulmonary Epidemiology. A total of 10 121 individuals (4921 men and 5200 women), aged 35—59 years were selected from 4 cohorts, in Beijing and Guangzhou, urban and rural. The average following up time was 15.9 years. During the follow-up period, 277 ischemic and 125 hemorrhagic stroke cases were diagnosed.ResultsThe age adjusted incidence rate of ischemic stroke was 144.1,169.4,166.7,226.9 and 282.2 in the group of TC/HDL-C ratio

Objective To analyze the efficacy and safety of glimepiride treatment as initial monotherapy in newly diagnosed patients with type 2 diabetes mellitus (T2DM).Methods This was a subgroup analysis of the GREAT study,which investigated the efficacy and safety of glimepiride as initial monotherapy in Chinese patients with T2DM.This analysis was performed in 209 patients with disease duration less than 6 months and never received any anti-diabetic drugs.The change of HbA1C,fasting plasm glucose (FPG),2 h postprandial blood glucose (2hPPG),homeostasis model assessment for β-cell function index (HOMA-β),homeostasis model assessment for insulin-resistance index(HOMA-IR),the percentage of patients with HbA1C ＜ 7.0％ at endpoint and the incidence of hypoglycemia were evaluated after 16-weeks treatment.Results After 16-weeks glimepiride treatment,HbA1C value reduced significantly from baseline to endpoint,the reduction was statistically significant (9.21％ ± 1.65％ to 6.69％±0.83％,P＜0.001),69.7％ of the patients achieved HbA1C ＜7.0％ at study endpoint.Glimepiride-treated patients also achieved a significant improvement in FPG [from (10.15 ± 2.13) mmol/L to (7.23 ± 1.50) mmol/L,P＜0.001] and 2hPPG [from (17.21 ±4.14) mmol/L to (11.62 ± 3.34) mmol/L].HOMA-β was improved from 17.21± 15.19 [11.62 (2.90,115.8)] to 41.13 ± 44.12 [28.00 (5.1,360.00)],and HOMA-IR was reduced from 2.32± 1.90 [1.76 (0.60,12.80)] to 2.07 ± 1.74 [1.63 (0.4,12.3)].The incidence of all reported symptomatic hypoglycemia was 18.2％,and the incidence of confirmed hypoglycemia was 3.8％.Conclusion This analysis showed that glimepiride treatment as an initial mono-therapy could effectively improve blood glucose control in newly diagnosed patients with T2DM,and the treatment may improve islet β cell function,and the safety profile is reasonably good.

Objective:To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI), and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods:A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth, VPI were divided into non BPD group and BPD group, and the risk factors of BPD in VPI were analyzed.Results:A total of 2 514 cases of VPI including 1 364 cases without BPD and 1 150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight, the higher the incidence of BPD( P<0.001). Compared with non BPD group, the average birth age, weight and cesarean section rate in BPD group were lower, and the incidence of male infants, small for gestational age and 5-minute apgar score≤7 were higher( P<0.01). In BPD group, the incidences of neonatal respiratory distress syndrome(NRDS), hemodynamically significant patent ductus arteriosus, retinopathy of prematurity, feeding intolerance, extrauterine growth restriction, grade Ⅲ~Ⅳ intracranial hemorrhage, anemia, early-onset and late-onset sepsis, nosocomial infection, parenteral nutrition-associated cholestasis were higher( P<0.05), the use of pulmonary surfactant(PS), postnatal hormone exposure, anemia and blood transfusion were also higher, and the time of invasive and non-invasive mechanical ventilation, oxygen use and total hospital stay were longer( P<0.001). The time of starting enteral nutrition, cumulative fasting days, days of reaching total enteral nutrition, days of continuous parenteral nutrition, days of reaching 110 kcal/(kg·d) total calorie, days of reaching 110 kcal/(kg·d) oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group( P<0.001). The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group( P<0.001). Multivariate Logistic regression analysis showed that NRDS, invasive mechanical ventilation, age of reaching total enteral nutrition, anemia and blood transfusion were the independent risk factors for BPD in VPI, and older gestational age was the protective factor for BPD. Conclusion:Strengthening perinatal management, avoiding premature delivery and severe NRDS, shortening the time of invasive mechanical ventilation, paying attention to enteral nutrition management, reaching whole intestinal feeding as soon as possible, and strictly mastering the indications of blood transfusion are very important to reduce the incidence of BPD in VPI.