Objective To investigate the clinical effect of McDonald cervical cerclage and the affecting factors. Methods Between January 2002 to December 2013 in Peking University First Hospital we performed McDonald cervical cerclage for 116 single pregnant women. They were defined as the successful group who deliveried the live babies after 28 weeks after the cerclage and the failure group who deliveried in the second trimester. According to the surgical indications they were divided into preventive cerclage group and therapeutic cerclage group. Then we analyzed the curative effect and the affecting factors in the groups. Results (1) In the 116 cases, 12 cases (10.3%) failed, and 104 cases (89.7%) succeeded. In the successful group, 37 cases (35.6%,37/104) deliveried pretermly and 67 cases (64.4%) deliveried termly. And there were 56 cases of vaginal delivery (53.8%), and 48 cases (46.2%) of cesarean section. (2) Among the 116 cases, 48 cases (41.4%) were included in prophylactic cerclage group, the gestational age was (16.3± 2.2) weeks, 68 (58.6%) cases were included in therapeutic group, the gestational age was (24.0±2.2) weeks. The operation time was (22±9) minutes in preventive group and (24±13) minutes in therapeutic group,there was no statistical difference between the two groups (P>0.05). Live-birth rate between preventive cerclage group and therapeutic cerclage group was no statistically significant difference (P>0.05). The term birth rate (72.9%, 35/48) in preventive group was higher than that in therapeutic group (47.1%, 32/68), the difference was statistically significant (P<0.01). Neonatal hospitalization rate was lower in preventive group (14.6%, 7/48) than therapeutic group (36.8%, 25/68) , the difference was statistically significant (P< 0.01). (3) In the failure group placental pathology was examed in 7 cases. The placental tissue showed a large number of neutrophils infiltrating in 6 cases (6/7). In the successful group, 27 pregnant women deliveried between 28 to 33+6 weeks (26.0%,27/104), 10 pregnant women deliveried between 34 to 36+6 weeks 10 cases (9.6%, 10/104), 67 cases deliveried after 37 weeks (64.4%, 67/104). A lot of factors including maternal age, the previous cervix operation history, perioperative application of progesterone, operation time and preoperative invasive procedure were compared between the successful group and the failure group. Only maternal age and preoperative invasive proedcure were statistically significant (P<0.05) and the others had no statistical significance (P>0.05). (4) There were 68 cases in the therapeutic group, 7 cases failed, and 61 cases succeeded;the preoperative cervical os in failure group [ (21 ± 20) mm] was wider than that in successful group [(14±5) mm], the difference was statistically significant (P<0.05);and preoperative vaginal ultrasound measurement of cervical canal length were (18 ± 8) mm versus (19 ± 10) mm, there was no statistically significant difference (P>0.05). Conclusions The McDonald cervical cerclage for cervical incompetence is a simple, safe and high successful rate of intervention measures. The term labor rate of prophylactic cervical cerclage was higher than that of the therapeutic cerclage. Older maternal age and preoperative invasive procedure may be the risk factors for cerclage. The infection may play an important factor leading to the failure of McDonald cervical cerclage.

Objective To investigate the effect of emergency nursing pathway in emergency treatment of patients with questionable sources. Methods A clinical nursing pathway for the treatment for patients with questionable sources was formulated. From February to December 2014, 78 patients with questionable sources treated by clinical nursing pathway were selected as the observation group. From January to November 2013, 75 patients with questionable sources treated by routine nursing care methods were selected as the control group. Differences were compared in duration of staying in the emergency department, nursing complication and fees paid rate between the two groups. Results For the average duration of staying in the emergency department, the observation group was lower than that in the control group [19.35%(9.08) vs. 19.90%(25.20), P< 0.05)]. For the nursing complication rate, the observation group was significantly lower than that of the control group [1.28%(1/78) vs.10.67%(8/75), P<0.05]. For the fees paid rate, the observation group was significantly higher than that in the control group [64.10%(50/78) vs. 33.33%(25/75), P<0.01]. Conclusions By the emergency nursing pathway, emergent patients with questionable sources will be treated with satisfactory result in the shortest time.

Objective To observe the influence of renal sympathetic denervation (RSD) on renal interstitial fibrosis and transforming growth factor beta 1(TGF-β1) and microRNA-21 (miR-21) in rats with unilateral ureteral obstruction(UUO).Methods 40 male Wistar rats were randomly divided into UUO group (A group,n=10),sham UUO group (B group,n=10),RSD+UUO group (C group,n=1O) and RSD + sham UUO group (D group,n=10).Rats in A group and C group underwent unilateral ureteral ligation,while those in B group and D group underwent sham operation.Rats in C group and D group were followed by RSD.Rats were sacrificed at 21 days after the operation to evaluate the fibrosis by Masson staining.Immunohistochemical staining and Western blotting were used to detect the expressions of collagen I (COL-Ⅰ),collagen Ⅲ (COL-Ⅲ) and TGF-β1 in four groups.The expression of miR-21 was detected by fluorescence in situ hybridization (FISH) and quantitative real-time PCR (RT-qPCR).Results A large amount of collagen deposition was observed in the renal interstitial area in A and C group compared to either B or D group (P ＜ 0.05),but the change in C group was decreased significantly than that in A group (P ＜ 0.05).Similarly,the expressions of COL-Ⅰ,COL-Ⅲ,TGF-β1and miR-21 were obviously higher in A and C group compared to either B or D group (P ＜ 0.05),but those change in C group were decreased significantly than those in A group (P ＜ 0.05).The above indexes were not significantly different between B group and D group (P ＞ 0.05).Conclusion RSD may relieve the renal interstitial fibrosis in UUO rats,and down-regulate the expression of TGF-β1 and miR-21.

Objective: To investigate the clinicopathologic features of micronodular thymoma with lymphoid stroma(MNT). Methods: Five cases of MNT diagnosed from January 2007 to December 2016 in Henan Provincial People′s Hospital were collected.Hematoxylin-Eosin staining and immunohistochemistry were used to evaluate the histological and immunophenotypic characteristics in 5 MNT cases. Epstein-Barr virus (EBV) status was detected by in situ hybridization for EBV-encoded small RNA (EBER). Polymerase chain reaction was used to detect the rearrangement of immunoglobulin genes. Results: Five cases were MNT, including 3 male and 2 female patients, mean aged 59 years (from 43 to 63 years). All patients had ananterior mediastinal mass, with no myasthenia gravis and autoimmune diseases, and underwent surgical resection.Half to ten years follow-up showed no recurrence.Grossly, the tumors were solid in 4 cases, and cystic and solid in 1 case; the border was clear. Histologically, the tumors presented as a distribution of micronodules separated by abundant lymphoid stroma with prominent germinal centers. The nodules were composed of neoplastic spindle, oval cells containing bland, oval nuclei.Immunohistochemical study showed strong positivity of the tumor cells for CKpan, CK19, CK5/6 and p63. Stains for EMA, CD117, calretinin, TTF1 were negative in the tumor cells.Scattered CD3, CD1a, and TdT positive immature T lymphocytes were noted in and around tumor nodules. Many lymphocytes in the stroma, including germinal centers, were positive for CD20.The bcl-2 was also detected in lymphocytes in the stroma, mantle and marginal zone of lymphoid follicles, and in part of tumor cells. Tumor cells and lymphocytes were negative for EBER. Immunoglobulin genes rearrangement analysis showed that B lymphocytes were polyclonal. Conclusions MNT is a rare thymoma, which occurs in the elderly and has no obvious symptom. After complete resection, the prognosis is very good. The diagnosis should be based on a combination of clinicopathologic features, and other types of thymoma should be excluded.

Objective To explore the most suitable appliance for patients′ orotracheal intubation applied by nurses in emergency ICU. Methods A total of 90 EICU patients who admitted to our hospital from January 2013 to September 2013 were randomly divided into three groups, named A, B and C, 30 cases in each group. Appliances for patients in group A were traditional forceps and tweezers; implement for group B was disposable long cotton swabs;the tools for group C were soft bristled toothbrush for children oral cavity nursing. The three groups were observed for the patients′ degree of subjective comfort, oral cleanliness, ventilator-associated pneumonia rates and also nurses′operation time. Results Patients in group C (20 cases) and group A (10cases) and group B (15 cases) felt oral comfort (H=9. 840,P<0. 05). Patients in group C had oral cavity residual (5 cases), oral lesions (3 cases), the incidence of VAP (3 cases), which all were lower than that of the group A and B (χ2 =7. 479,4. 812,7. 422,P<0. 05);in the group C, nurses used total (11. 53 ± 1. 26) min operation time lower than that in group A and group B (F=22. 250,P<0. 05). Conclusions The application of children′s soft bristled toothbrush is the most suitable appliance of oral nursing for patients with orotracheal intubation, and it can clean oral cavity effectively and operate conveniently.

Objective To explore the current status of the stress and coping styles of emergency room nurses in Class Ⅲ Grade A hospitals, to discuss the correlation between stress and coping styles, and to provide a basis for formulating targeted training plans. Methods Totally 178 emergency room nurses from 9 Class ⅢGrade A hospitals in Hebei Province were randomly selected as the study subject from April to May 2016 and investigated with the General Information Questionnaire, Nurse's Working Stress Source Scale and Coping Style Questionnaire. Results The total average stress score of the nurses was (1.88±0.56); and the scores for each dimension of coping styles were: (0.84±0.12) for problem-solving, (0.71±0.20) for fantasy, (0.68±0.22) for rationalization, (0.67±0.24) for avoidance, (0.67±0.14) for asking for help, and (0.60±0.29) for self-accusation. Nursing and working stress was positively correlated with the coping styles such as fantasy and rationalization (P<0.05), and negatively correlated with self-accusation (P<0.05). Conclusions Emergency room nurses' stress generally remains at a medium and high level. Therefore, nursing managers should formulate proper nursing management measures and take necessary measures to alleviate nurses' stress.

Objective:To explore experiential teaching to physical restraint training for intensive care nurses and its effects in reducing restraint actions.Methods:903 inpatients in ICU from January 2017 to October 2018 in a ClassⅢ Grade A hospital in Shijiazhuang were selected as the subjects by convenient sampling. 491 patients from January to October 2017 were set as the control group, and 412 patients who implemented the experiential teaching method from January to October 2018 were set as the test group. The control group was given routine restraint nursing, and the test group was given reduced restraint nursing. The physical restraint rates, qualified rates of physical restraint, writing quality of physical restraint nursing documents and patient satisfaction scores were compared between the two groups.Results:The restraint rate of patients in the test group was 62.14% (256/412) , which was lower than that 71.69% (352/491) in the control group, the qualified rate of restraint in the test group was 89.06% (228/256) , which was higher than that 80.68% (284/352) in the control group, the differences between the two groups were statistically significant ( P<0.05) . Quality score of writting quality of physical restraint nursing documents in the test group was (98.32±2.22) , and the patients satisfaction score was (98.11±2.53) , which were higher than those in the control group, there were statistically significant differences between the two groups ( P<0.05) . Conclusions:Reduced restraint nursing based on experiential teaching reduces the physical restraint rate of ICU patients, improves the quality of physical restraint and patient's satisfaction of nursing, and it is worthy of clinical promotion.

Immunoscenescence plays a key role in the initiation and development of tumors. Furthermore, immunoscenescence also impacts drug delivery and cancer therapeutic efficacy. To reduce the impact of immunosenescence on anti-tumor therapy, this experimental plan aimed to use neutrophils with tumor tropism properties to deliver sialic acid (SA)-modified liposomes into the tumor, kill tumor cells via SA-mediated photochemotherapy, enhance infiltration of neutrophils into the tumor, induce immunogenic death of tumor cells with chemotherapy, enhance infiltration of CD8⁺ T cells into the tumor-draining lymph nodes and tumors of immunosenescent mice, and achieve SA-mediated photochemotherapy. We found that CD8⁺ T cell and neutrophil levels in 16-month-old mice were significantly lower than those in 2- and 8-month-old mice; 16-month-old mice exhibited immunosenescence. The anti-tumor efficacy of SA-mediated non-photochemotherapy declined in 16-month-old mice, and tumors recurred after scabbing. SA-mediated photochemotherapy enhanced tumor infiltration by CD8⁺ T cells and neutrophils, induced crusting and regression of tumors in 8-month-old mice, inhibited metastasis and recurrence of tumors and eliminated the immunosenescence-induced decline in antitumor therapeutic efficacy in 16-month-old mice via the light-heat-chemical-immunity conversion.