Neonatal jaundice or hyperbilirubinemia is a common occurrence in newborns.Most cases of neonatal jaundice have a benign course.Hyperbilirubinemia can be best understood as a balance between the production and elimination of bilirubin,with a multitude of factors and conditions affecting each of these processes.When an imbalance results because of an increase in circulating bilirubin ( or the bilirubin load)to significantly high levels( severe hyperbilirubinemia),it may cause permanent neurologic sequelae( kernicterus),which is preventable if the hyperbilirubinemia is identified early and treated appropriately.Phototherapy for jaundice is a common treatment in neonatal medicine and is used to prevent the neurotoxic effects of bilirubin.Phototherapy for hyperbilirubinemia should be based primarily on total serum bilirubin levels of the infant's age in hours and other factors that affect the risk of bilirubin encephalopathy.

Objective To learn about the mastery level of midwives and obstetric nurses about fetal monitoring knowledge.Methods 77 midwives and obstetric nurses attending a fetal monitoring education programme in Huaxi Second Hospital of Sichuan University were investigated by using a self-made questionnaire.Results Some respondents lacked of systematic training in fetal monitoring knowledge,and they could not accurately answer the purpose or contents of fetal monitoring,as well as the basic elements and related knowledge about fetal electronic monitoring.Most of the respondents focused on fetal monitoring in clinical practice,but neglected the corresponding frontier progresses.Conclusions The training and education on fetal monitoring knowledge should be strengthened to improve obstetric quality because of the unsatisfactory survey results in midwives and obstetric nurses.

Objective To determine the range of total serum bilirubin(TSB) of healthy term newborns during the first post natal week in Huainan region of Anhui province and provide the theoretical basis for the neonatal jaundice intervention in this region.Methods The bilirubin analyzer for capillary blood was used to measure TSB level of 1257 healthy term newborns during the first post natal week,P25,P50,P75 and P95 were recorded at every time point,the peak serum bilirubin(PSB) and the time it appeared was observed.50 blood samples were randomly selected and the TSB level was measured by the routine laboratory method,at the same time,the serum bilirubin level was measured by bilirubin analyzer for capillary blood.Then,the linear correlation coefficient of capillary blood bilirubin level and TSB level was calculated and statistically analyzed,and at last got the linear regression model.The newborns'skin xanthochromia coverage scales and TSB levels were recorded in order to get the corresponding TSB level in terms of xanthochromia coverage.Results In this study,the serum bilirubin P25,P50,P75 and P95 of 1 257healthy term newborns were 58.64μmol/L,72.51μmol/L L,102.44μmol/L,120.35 μmol/L,respectively in the first day,2nd day 105.41μmol/L,119.72μmol/L,150.18μmol/L,185.30μmol/L,3rd day 128.85μmol/L,157.951μmol/L,191.22μmol/L,227.61μmol/L,4th day 160.24μmol/L,191.40μmol/L,216.65μmol/L,277.49μmol/L,5th day 164.26μmol/L,179.51 μmol/L,209.88μmol/L,263.74μmol/L,6th day 131.87mol/L,172.73μmol/L,195.57μmol./L,231.26μmol/L,and the 7th day 118.94μmol/L,157.57μmol/L,204.83μmol/L,223.84μmol/L,with PSB 294.46μmoL/L appeared at the fourth day.The correlafionship was existed between the capillary blood bilirubin measurement and the routine laboratory method (r =0.948,t =21.067).The TSB level was (1 12.3 ± 6.2) μmol/Lwhen the xanthochromiawas on thehead,(165.1 ± 2 6.7) μmol/Lon the chest,(214.0 ±30.8) μmol/L on the belly,(268.5 ± 28.2) μmol/L on the knee or elbow,and ＞ 271.7μ mol/L on the palm or sole of the foot.Conclusion The TSB variation rang is 120.35 ～ 223.84μmol/L within 7 days after their birth in Huainan region of Anhui province,capillary blood bilirubin is reliable in measuring serum bilirubin level of newborns ; visual assessment of xanthochromia coverage is also an easy and feasible way of estimating serum bilirubin level initially.

[Summary] Glucagon-like peptide-1 ( GLP-1 ) as a new treatment of type 2 diabetes, not only has hypoglycemic effect, but also plays an important role in the regulation of lipid metabolism. GLP-1 plays a unique role in regulating lipid metabolism via lipid absorption and transport, fat formation and decomposition, hepatic lipid metabolism, and cholesterol transport.

Objective To explore which operation and the accuracy of the detection method is better by exploring the correlation among three bilirubin detection methods.Methods 50 hospitalized neonates within 7 days after birth with visual jaundice were randomly selected.The total serum bilirubin level was measured by the routine laboratory method.At the same time,the serum bilirubin level was measured by bilirubin analyzer for capillary blood and transcutaneous bilirubin(TcB) measurement,then calculated the linear correlation coefficient of TcB level and TSB level,capillary blood bilirubin level and TSB level respectively to analyze their statistical significance,and get the linear regression model at last.Results Close correlation is existed between the capillary blood bilirubin measurement and the routine laboratory method,also the transcutaneous bilirubin measurement and the routine laboratory method.Moreover,the former is better than the later.Conclusion Capillary blood bilirubin is reliable in measuring serum bilirubin level of newborns.

Scenario-based teaching method can be applied in clinical skills training of obstetrics and gynecology,which increases practice opportunities of interns by imitating the real clinical work.For professional examination teaching,teachers and simulation models as simulated patients help interns improve inspection skills and provide error feedback timely; for emergency and severe diseases teaching,real cases combined simulation models,medical equipment,and multi-professional collaboration develop the clinical problem-solving competence of interns; for doctor-patient communication teaching,the communication skills of interns can be improved by scenario database which has been constructed by teachers; and for clinical skills test,the clinical practice quality of interns can be reflected accurately by integrating various clinical skill tests.Scenario-based teaching requires a large amount of scenario materials,as well as highly qualified teachers who can control the teaching process effectively.

Objective: To investigate the factors that affect the outcome of pregnancies complicated with critically heart disease admitted to obstetric Intensive Care Unit (ICU). Methods: A retrospective study was conducted for 188 pregnant and postpartum patientscomplicated with heart disease who were admitted to the ICU in West China Second University Hospital from July 2009 to March 2013. Results: During the 4 years, there were 619 cases of pregnancy complicated with heart disease hospitalization. Among them, 188 (30.37%) patients complicated with severe heart disease were admitted to the ICU, accounting for 39.17% of the total ICU admission (480); the mean maternal age was (28.45±6.08) years old and the mean gestational time was (36.03±4.19) weeks. 23 (12.23%) patients received regular antenatal care in our hospital. 61 (32.45%) patients never received antenatal care before hospitalization. Among them, 5 patients were dead. hTe ratio for diagnosis of heart disease before pregnancy, during pregnancy and atfer admission were 39.89%, 25.54% and 34.57%, respectively; the most common heart diseases during pregnancy were congenital cardiac disease (80, 42.55%) and rheumatic heart disease (45, 23.94%) followed by arrhythmias (20, 10.64%). The most common complication were pulmonary arterial hypertension (51, 27.13%), arrhythmias (47, 25.00%) and severe heart failure (30, 15.96%); the cardiac function of 164 (87.23%) patients was at stage I–II and 5 (2.66% ) patients died when discharged from hospital. 151 (80.32%) patients received multidisciplinary consultation and 34 (18.09%) used central venous catheterization to control central venous pressure (CVP). 21 (11.17%) patients required mechanical ventilation. 11 (5.85%) patients required emergency life support (cardiopulmonary resuscitation 9 + electric deifbrillation 3). Conclusion: Pregnancy complicated with heart disease is the leading reason for admission to ICU. hTe congenital cardiac disease, rheumatic heart disease and arrhythmias are the main heart diseases during pregnancy. Multidisciplinary cooperation and intensive care are the key measures to improve the outcomes of patients with critically illness. It is very important for reduction of the maternal mortality rate through strengthening preconception care and antenatal care.

Objective To investigate the curative effect of cephalosporins in the treatment of neonatal infectious pneumonia and the effect on intestinal microflora.MethodsA total of 124 cases of neonatal pneumonia in our hospital were divided into the cephalosporin group (40cases), the piperacillin group (38 cases) and the combined treatment group (46 cases), and 40 healthy neonates were selected as healthy group.The clinical efficacy was compared.The intestinal bacterial genus of the four groups was examined on the 5th day after treatment, including Enterobacter, Bacteroides, Enterococcus, Bifidobacterium and Lactobacillus.ResultsThe cure rates of the cephalosporin group, the piperacillin group and the combined group were 82.5%, 81.57% and 89.13%, respectively.The healing time of the above three groups was (5.3±0.2) d, (5.5±0.3) d and (5.2±0.3) d, respectively.Enterobacteriaceae, Bacteroides, Enterococcus and Lactobacillus were significantly more in the above three groups than the healthy group, and Bifidobacterium was fewer than healthy group (P<0.05).There was no significant difference between the cephalosporin group and piperacillin group.ConclusionThe curative effect of cephalosporins is similar to other antibiotics in the treatment of neonatal infectious pneumonia.The former can effectively relieve alteration of intestinal flora, combined with other drugs.Irrational use of antibiotics woll increase alteration of intestinal flora.

Objective:To Study the equity of Chinese health systems performance and provide evidence for strengthening health system.Methods:Based on WHO health systems performance evaluation framework,the provincial data of expanded pilots under the national health service investigation and relative concentration index (RCI) were used to study the inequality of Chinese health systems performance from regions,income and education,etc.Results:The RCI values were lower than 0.1 on health status and satisfaction dimensions.The RCI of financial risks protection was higher than 0.2,which was at a respective higher level.Conclusion:The health performance of people with lower education and wealth were fragility and these people usually with health shocks.Therefore,the national and regional government should pay more attention on vulnerable group and provide more healthcare management and security support.

Objective To investigate the relevant factors of early stage hyponatremia in patients with complete cervical spinal cord injury (CSCI). Methods A retrospective study was conducted in consecutive 49 individuals with complete CSCI from January 2010 to December 2015.The diagnostic criteria for hyponatremia was two consecutive tests (interval <24 h) of serum sodium <135 mmol/L.Twenty-six patients with hyponatremia were classified as hyponatremia group , and the other 23 patients without hyponatremia were classified as control group .Ten factors were included in the univariate analysis: age, gender, the highest level of CSCI , the degree of CSCI , the blood albumin when transferred to ICU , the serum sodium when transferred to ICU , the use of glucocorticoid , the incidence of neurogenic shock , the average daily urine output , and the average daily liquid balance .The variables with significance (P<0.05) in the univariate analysis then entered stepwise logistic regression analysis .The optimal critical point of the continuous variables with statistical significance in the univariate analysis was determined by drawing the receiver operator characteristic curve . Results There were differences in two variables between the two groups ( P<0.05 ) .The incidence of neurogenic shock before the occurrence of hyponatremia was 57.7% ( 15/26 ) in the patients with hyponatremia and 26.1% ( 6/23 ) in the patients without hyponatremia(χ2 =6.516,P=0.011).The average daily urine output was (2225 ±389) ml in the patients with hyponatremia and (1936 ±289) ml in the patients without hyponatremia (t=2.924,P=0.005).The stepwise logistic regression analysis indicated that these two factors may be the independent relevant factors (OR =13.708 and 0.996, P =0.004 and 0.002, respectively).The receiver operator characteristic curve demonstrated the average daily urine output more than 2331 ml was the optimal critical point . Conclusion The neurogenic shock and the average daily urine volume more than 2331 ml are the independent relevant factors of early stage hyponatremia in patients with complete CSCI .