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.

[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.

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.

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 survey and analyze characteristics of brucellosis epidemic in Dalian City for the purpose of setting up prevention and control measures for the disease. Methods In 2007, the basic situation of people of 7-60 years old and in close contact with livestock was surveyed in Dalian according to the "Surveillance standard for brucellosis"(GB 16885-1997). Blood was collected in brucellosis suspicious or high-risk groups for the laboratory examination, using rose bengal test for qualitative detection and test-tube agglutination test(SAT) method for quantitative detection of serum antibodies; At the same time, brucellosis cases found in the routine monitoring and confirmed in and this survey in the department of endemic disease prevention in the center for disease control and prevention of Dalian City underwent questionnaire surveys. Results All 1563 people were epidemiologically surveyed of brucellosis, 1310 were male, 253 female,livestock care givers accounted for 56.05% (876/1563). 240 blood samples were serologically surveyed, the detection rate was 3.75%(9/240). This survey confirmed 2 cases of brucellosis patients, 3 cases confirmed in routine monitoring. 3 cases were infected via contacting infected brucellosis cows, and the 2 cases were imported. Conclusions To strengthen the quarantine of livestock and timely treat the infected livestock should be the key of control of brucellosis. At the same time, professionals of livestock should be educated to protect themselves.

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 investigate the clinical characteristics of intrahepatic cholestasis of pregnancy(ICP) Methods Totally 1241 cases of ICP during the 10 years from Jan 1991 to Dec 2000 in our hospital were retrospectively reviewed Results Forty four (3 5%) patients were multiple gestation One hundred and one (8 1%) patients had pregnancy induced hypertension ICP recurred in 30 2% multipara (38/126) On average, it occurred at gestational week of 32 6 Pruritus was the first symptom in 1201(96 8%)patients while 8 (0 6%) patients had jaundice and 28 (2 3%) patients had abnormal liver function at the onset Serum total bile acid (TBA), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were usually mild or moderately elevated, while some patients had normal TBA(17 7%), ALT(15 6%), or AST(17 1%) level The albumin/globulin ratio was reversed in 35 (3 2%) patients Conclusion ICP tends to recur in subsequent pregnancy It is more likely to develop in multiple gestation Pruritus is the most common and prominent manifestation Elevated TBA and ALT or AST level is helpful for diagnosis It should be noted that the above manifestations might not be typical in some patients