Objective To evaluate the detection rate of congenital heart defect (CHD) during the first trimester screening for chromosomal abnormalities,the role of ultrasound soft markers including increased nuchal translucency (NT),tricuspid regurgitation (TR) and abnormal ductus venosus (DV) flow in the screening for cardiac anomalies was also investigated.Methods From January 2009 to January 2012,4 673 fetuses were scanned at 11-14 weeks at Department of Fetal Medicine,the First Affiliated Hospital of Jinan University.The ultrasound findings and follow up outcomes were recorded,False-positive rate of different first-trimester ultrasound markers for the detection of CHD was calculated,sensitivity of the markers for all major CHD was calculated as well.Results There was a significant association between major CHD and first trimester ultrasound markers.(1) Overall findings:among the 4 673 fetuses,31 fetuses were diagnosed CHD prenatally,17,12 and 2 of which were detected in the first,second and third trimester,respectively.In 22 of the 31 CHD cases,invasive procedure was performed,fetal karyotype was abnormal in 12 cases,including triosmy 21 (5 cases),trisomy 18 (2 cases),trisomy 13 (2 cases),Turner syndrome (2 cases) and pericentric inversion of chromosome 9 (1 cases).(2) NT measurement and prenatal detected CHD:in 4 673 cases,NT measurement between 95th-99th percentile were present in 206 (4.41％),5 cases were diagnosed CHD prenatally,in 4 of 5 cases were detected in first trimester; NT measurement ＜ 95th percentile were present in 4 430(94.80％),16 cases were diagnosed CHD prenatally,in 5 of 16 cases were detected in first trimester; NT measurement ＞ 99th percentile (＞ 3.5 mm) were present in 37 (0.79％,37/4 673),10 cases were diagnosed CHD prenatally,in 8 of 10 cases were detected in first trimester.(3) TR and inverted a-wave at the DV and prenatal detected CHD:among 4 673 cases,TR or inverted a-wave at the DV were present in 51 (1.09％),98 (2.10％) respectively.TR was present in 8 of 31 CHD cases,inverted a-wave at the DV was present in 7 of 31 CHD cases.(4)Sensitivity of different first trimester ultrasound markers for detection of major CHD cases:in 31 CHD cases diagnosed prenatally,23 eased were defined as major CHD.Sensitivity of at least one of the ultrasound narkers,NT measurement between 95th-99th percentile,＞ 99th percentile(＞ 3.5 mm),TR or inverted a-wave at the DV for detection of major CHD eases was 74％ (17/23),22％ (5/23),39％ (9/23),35％ (8/23),30％ (7/23),respectively.(5) Specificity of different first trimester ultrasound markers for detection of CHD cases:specificity of NT measurement between 95th-99th percentile,＞ 99th percentile(＞ 3.5 mm),TR or inverted a-wave at the DV for detection of major CHD cases was 4.30％ (201/4 673),0.58％ (27/4 673),0.92％ (43/4 673),1.94％ (91/4 673).Conclusions Routine first trimester soft markers for chromosomal abnormalities screening combined with cardiac assessment can detect quite a number of major heart defects.Increased NT,TR and abnormal DV flow can be important indicators for echocardiography,which is favorable to early prenatal diagnosis of CHD.

Objective To investigate the effects of ketamine on Na+ -K+ -ATPase and Ca2+ -ATPase activity Of cerebro cortex and thalamus in rats. Methods Thirty-two SD rats of both sexes weighing 200-300 g were randomly divided into 4 Groups: 1 control group; 2 anesthesia group; 3 recovery group 1 and 4 recovery group II . In control group normal saline 10 ml?kg-1 was administered intraperitoneally (ip) while in the 3 ketamine groups ketamine 100mg?kg-1 was administered ip. The animals were killed by decapitation when righting reflex was lost (group 2) or recovered (group 3) or when the animals were fully awake (group 4). Brain was immediately removed on ice. Bilateral cortex and thalamus were isolated homogenized and centrifuged. Na+ -K+ -ATPase and Ca2+-ATPase activity were assessed by spectrophotometric analysis. Results The Na+-K+-ATPase and Ca2+ -ATPase activity of cerebrocortex decreased by 32.8% and 26.2% and of thalamus decreased by 31.4% and 24.5% respectively in group 2 as compared with those in group 1. The Na+-K+-ATPase and Ca 2+-ATPase activity of the cerebrocortex and thalamus were recovered in group 3 and 4. Conclusions The Na+ -K+ -ATPase and Ca2+ -ATPase may play an important role in the mechanism of ketamine anesthesia.

Objective To compare the security between the sevoflurane anesthesia via laryngeal mask airway (LMA) composited nerve block in groin area and ketamine anesthesia in the pediatric hemioplasty.Methods 80 children (aged 2 -6,weight 10 -25kg,ASAⅠ -Ⅱ)with high ligation of hernia sac were divided into two groups according to the random number table method:group S -sevoflurane combined with inguinal region block under laryngeal airway ventilation;group K -ketamine combined with caudal block.Group S was inhalated with 6% -8% sevoflurane for foundation anesthesia,and then followed with vein induction:fentanyl 2μg/kg and propofol 2mg/kg.The laryngeal mask was placed when the temporomandibular joint was relaxed.Inguinal region was blocked by the surgeon after disinfect and spread towels.Anesthesia was maintained by 3% to 4% sevoflurane with mechanical ventilation interop-eration.Group K was adopted the intramuscular ketamine (5mg/kg)for basic anesthesia and then used modified sacral canal blocking.Ketamine 1mg/kg was administered before skin incision.Additional ketamine 0.5mg/kg was intravenously injected when it was appeared with body move,choking cough,etc.The values of MAP and HR in the two groups were recorded respectively at the time point of 1min before skin cutting (T0 ),1min after skin cutting (T1 ),5min after skin cutting (T2 ),the end of operation (T3 )and awaken time (T4 ).The body movement was observed intraoperation,the number of SpO2≤95% and awaken restlessness,the recovery time and residence time in anesthesia recovery room were recorded.Results The values of MAP in group S at time points of T1 ,T2 ,T3 were (77.6 ±6.2)mmHg,(77.8 ±6.4)mmHg,(76.5 ±4.7)mmHg respectively,and the values of MAP in group K at time points of T1 ,T2 ,T3 were (86.9 ±8.1)mmHg,(88.1 ±5.3)mmHg,(86.4 ±6.5)mmHg respectively.The t values at time points of T1 ,T2 ,T3 were 5.766,7.893,7.806 respectively when the group S compared with group K(P <0.0001),the group S was superior to group K.The values of HR in group S at time points of T1 ,T2 ,T3 were (121.3 ± 9.6)times/min,(121.9 ±8.4)times/min,(120.3 ±7.8)times/min respectively,and the values of HR in group K at time points of T1 ,T2 ,T3 were (138.6 ±9.4)times/min,(136.5 ±7.5)times/min,(128.7 ±6.9)times/min respec-tively.The t values at time points of T1 ,T2 ,T3 were 8.144,8.200,5.101 respectively(P <0.0001),the group S was superior to group K.The MAP and HR were more smoothly in group S than in group K.The recovery time in group S and K was (7.5 ±3.4)min and (16.7 ±5.5)min respectively(t =8.99,P <0.0001),it was shorter in group S than in group K.The residence time in anesthesia recovery room was (15.4 ±4.2)min and (23.7 ±6.3)min respectively (t =6.93,P <0.0001),it was shorter in group S than in group K.Intraoperative body movements was 3 cases and 15 cases respectively in group S and group K(χ2 =10.32,P <0.001);Cases of SpO2 ≤95% was 4 and 12 respec-tively in group S and group K(χ2 =10.32,P <0.001),the occurrence of body movements and SpO2 ≤95% cases was lower in group S than in group K.Conclusion The sevoflurane anesthesia via LMA composited nerve block in groin area has the advantages of faster induction,faster recovery,the hemodynamics was more stable,adverse reactions was fewer and so on,it can be safely used in pediatric anesthesia.

Objective To investigate the impact of acupoint massage on the vital signs of patients with angina pectoris in coronary artery heart disease (CHD) during the operation. Methods Using non-concurrent cohort controlled design, 38 cases who with angina pectoris in CHD received interventional therapy, from June to September in 2015, in the therapy rooms of our hospital were selected as control group and received routine nursing. 38 cases who with angina pectoris in CHD received interventional therapy, from October 2015 to January 2016, in the therapy rooms of our hospital were selected as intervention group and received acupoint massage based on routine nursing. Heart rate and blood pressure of patients in two groups were monitored and recorded during the operation. Results Compared with control group, systolic blood pressure of patients in intervention group decreased obviously (143.26±17.67 vs. 153.18 ± 19.35) mmHg (1mmHg=0.133 kPa), diastolic blood pressure decreased obviously (83.16 ± 12.29 vs. 93.82 ± 16.54), and heart rate decreased obviously (71.89 ± 13.90 vs. 79.05 ± 12.63) mmHg (t=2.33, 3.19, 2.35, P<0.05 or 0.01). Conclusions Acupoint massage can effectively reduce heart rate and blood pressure of patients with angina pectoris in CHD during the operation, relieve patients' anxiety, and help for smoothing operation, shortening operation time and reducing operation risk.

With the development of technology, the new technologies contact with the medical profession increasingly close. Mobible nursing information system (MNIS) is a new technology product of the combination of the nursing profession, which will digitize the introduction of paperless care industry, providing convenient for clinical work, real-time technical service is an important tool for clinical work. The application of MNIS have played an important role in confined the nursing profession, disease management and pharmaceutical management, more users discover problem from different professional perspective, thus the MNIS should be improved for all-round care. This article is consist of the domestic and care information systems development, application and effect, as well as its application in the clinical factors of its research progress in clinical application were reviewed to provide a basis for the development of leadership and decision-making about MNIS, and thus, enhance the mobile application of the effectiveness of care information systems and promoting their improvement.

Objective To optimize the prescription ofBaichanting Tablets by the central composite design-response surface methodology.Methods The doses of MCC, cCMC-Na, SiO2, and magnesium stearate were set as investigation factors; disintegration time and moisture rate were set as indexes. Linear equation quadratic polynomial described mathematic relationship of disintegration time and moisture rate with other four influence factors. Response surface was described according to the optimal mathematic models; the optimal prescription was chosen; predictive analysis was conducted.ResultsThe relationship of disintegration time and moisture rate with other four influence factors could not be described by linear equation. When quadratic polynomial matching was used, correlation coefficients were 0.837 9 and 0.923 1, with relatively high reliability. Optimal prescription contained 30.6%MCC, 10%cCMC-Na, 0.30%SiO2, and 0.10% magnesium stearate. The theoretical value and predicted value deviations of the disintegration time limit and moisture absorption rate were within 5%.Conclusion The predictability of the established model is good. Application of central composite design-response surface methodology can precisely optimize the prescription ofBaichanting Tablets.

Objective To investigate the expression of P2X receptors in CA1 subfield of rat hippocampus and the effect of hypoxia on the expression. Methods We set up the hypoxia animal model of high altitude and observed the expression of P2X receptors by using immunohistochemical staining before and after hypoxia. Results Immunohistochemistry showed that there were several sub-type of P2X receptors expressed in hippocampus CA1 neurons. After long term hypoxia, the expression of these receptors was increased. Conclusion there were abundant of P2X receptors expressed on the hippocampus CA1 neurons. Hypoxia affects the expression P2X receptors.

PurposeTo analyze the sonographic and the histological features of special types of breast malignant tumors in order to explore preoperative ultrasound diagnosis. Materials and Methods Seven cases of special types of breast malignant tumors confirmed by pathology were retrospectively investigated by ultrasound. The sonographic and histological features of the lesions were reviewed. The ultrasonogram manifestations of the breast anatomy and the lesions were observed and recorded.Results Among 7 cases, there were 2 cases of papillary carcinoma, 3 cases of mucinous carcinoma, and 2 cases of lymphoma. Microscopically, the papillary carcinoma had clear boundaries with infringing mesenchyme, and the tissues were papillary and dense. The mucinous carcinoma had cancer cells floated in mucus lake. The primary breast lymphoma was diffused large B-cell type with focal lesion. For sonography type of breast, there were 3 cases of fatty types, 1 case of fibroglandular-1 and 3 cases of fibroglandular-2. The papillary carcinoma was hypoechoic in 2 cases, one of them was expansive growth with large size. Two cases of mucinous carcinoma were hypoechoic without accompanying sound attenuation in 1 case and with accompanying acoustic shadow due to calcification in the other case. Lymphoma was apparent anechoic and cystoid.Conclusion Special types of breast malignancies have different sonographic features and histological features from the common invasive ductal carcinoma. It has high clinical significance to enhance the understanding of rare malignant breast tumors.

Objective Through the analysis of the status quo of the research on neonatal pressure sore in the relevant nursing research, we can understand the strategy and the problems of the prevention of neonatal pressure sore, which provides reference for future research. Methods This article used bibliometric analysis method to construct literature reading and reviewing database,screening articles in the Chinese biological medical disc (CBMdisc), China Journal Full-text Database (CJFD), China Science Periodical Database(CSPD)and China Science and Technology Journal Database(CSTJ), according to the criteria of inclusion and exclusion. Results A total of 74 articles were integrated into the literature, the first published in China in 2006, after the overall trend of growth, especially since 2011 began to significantly increase. Of which 29 (39.2%) of the literature published in 13 kinds of professional nursing journals. The total number of citations was 1.84, the cohort rate was 39.19%, the total number of citations was 54, and the number of citations per article was 0.73. The total number of citations was 447, and the average number of citations was 6.04. Literature research types are subdivided into 10 categories, of which experienced literature was the most (23.0%). Literature research concentrated on the use of chemical or physical methods to prevent neonatal pressure sores. Conclusions Neonatal pressure sore is paid more and more attention by the nurses, and the policy support for it is acceptable, but the related research needs to be further strengthened in the breadth, depth and comprehensive aspects. It is necessary for us to use scientific research methods, combining with the culture of pediatric and the characteristics of pediatric management in our country, to construct the best practice manual for preventing neonatal pressure sore in China.

Objective To investigate the influence of ocular residual astigmatism (ORA) on the correction of astigmatism by FS-LASIK with vector analysis.Methods The records of 182 patients who had accept FS-LASIK between January,2016 and April,2016 were retrosepectively reviewed.The patients whose ORA ≥ refractive cylinder were assigned to high ocular residual astigmatism group (HORA group),ORA ＜ refractive cylinder were assigned to low ocular residual astigmatism group (LORA group).All of the patients were followed 6 months or more.The visual acuity,error ratio and correction ratio were compared between HORA group and LORA group.Results The preoperative ORA of all patients was (0.61 ± 0.27) D,in which ＞ 0.75 D were 58 cases (31.9％),and the HORA group was more than the LORA group (P ＜ 0.05).At postoperative 6 months,there was no statistically significant difference in vision acuity between the HORA group (1.06 ± 0.15) and LORA group (1.08 ± 0.15) (t =0.97,P =0.35).There was statistically significant difference in the error ratio between the HORA group (58.11 ± 63.23) ％ and LORA group (26.12 ± 35.37) ％ (t =3.43,P ＜ 0.05).There was statistically significant difference in the correction ratio between the HORA group (146.45 ± 86.63) ％ and LORA group (122.56 ± 36.31) ％ (t =2.81,P ＜ 0.05).Conclusion The error ratio and correction ratio of astigmatic correction by FSLASIK is significantly higher in eyes with high ORA than in eyes with low ORA.Vector analysis should been carried out before the FS-LASIK.