Objective To explore the puerperal mode of muliparas re-pregnancy, accumulate the clinical experience. Methods 490 multiparas' puerperal mode were analyzed as study group,and compared with 1600 prima-ry pregnancy at the same stage; compared the puerperal mode, the cesarean section rate and the rate of maerosoma. Results Re-pregnancy mtthiparas' vaginal delivery 385 examples, CS 105 examples,CS rate 21.4%, meanwhile the primary pregnancy's vaginal delivery 1200 examples,CS 400 examples,CS rate 25% ,no statistical difference(P>0.05). CS rate was directly proportional to the away time from last delivery. Conclusion CS rate had no remarkable difference between multiparas and primary pregnancy. Mainly CS indication is fetal distress, CS rate directly response to the time interval to last delivery. Macrosoma rate is high in muhiparas by well-fed. Multiparas had low CS rate with macrosoma.

Objective To investigate the significance of miR-103 as noninvasive biomarker for diagnosis of nonalcoholic fatty liver disease (NAFLD).Methods The serum samples were collected from healthy subjects and NALFD patients to detect biochemical parameters.NucleoZOL method was used to isolate serum miRNA.SYBR Green qPCR was used for relatively quantitative analysis of miR103a-2.The correlations between miR-103a-2 and biochemical parameters were analyzed by Spearman method.Results Compared with healthy control group,the levels of total cholesterol (TC),triacylglyceride (TG),alanine aminotransferase (ALT) and glutamyl transpeptidase (γ-GGT) were all significantly increased in NAFLD group (P ＜ 0.01).Compared with the NAFLD group accompanying ortholiposis,the levels of TC,TG and low density lipoprotein-cholesterol (LDL-C) were all significantly increased in the NAFLD group accompanying dyslipidemia (P ＜0.01).Compared with the healthy control group,the level of serum miR-103a-2 increased in both NAFLD with ortholiposis group (P ＜ 0.05) and NAFLD with dyslipidemia group (P ＜ 0.01).The level of serum miR-103a-2 was positively correlated with serum TC (r =0.495,P =0.001).Conclusion Serum miR-103a-2 may be a more sensitive parameter for noninvasive screening of NAFLD than the parameters of blood lipid.

This study run through the process of developing behavioral medicine discipline in a general hospital with action research method,based on the balanced scorecard (BSC) framework.The four perspectives of the behavioral medicine BSC covered the main areas in hospital discipline development,including patients and community,healthy financial disciplines,clinical service process and efficiency,and research,innovation and growth.By the implementation of the discipline BSC,this hospital clarified its discipline development strategy,provided a communication platform,determined the objective and monitored the discipline effectively,and provided a mode which can integrate the discipline development and providing clinical services.The hospital set up the first neurology behavioral medicine clinic in Jinan Region though the exploration of the path and methods for developing behavioral medicine discipline,which had practical guiding significance for behavioral medicine development and services.

Objective To compare the curative effects of CT-guided ethanol injection and lauromacrogol injection into the sac cavity in treating ovarian endometriosis cysts. Methods A total of 86 patients with ovarian endometriosis cyst were enrolled in this study. The patients were divided into ethanol group (n=44) and lauromacrogol group (n=42). Under CT guidance, injections of ethanol or lauromacrogol into the sac cavity of ovarian endometriosis cysts were respectively performed for the patients of both groups. The patients were followed up for six months, and the curative effects and the complications were analyzed. Results Six months after the treatment, the cure rates of ethanol group and lauromacrogol group were 95.50%and 92.86%respectively, and no statistically significant difference in cure rate existed between the two groups (P>0.05). The preoperative serum CA125 levels of the ethanol group and lauromacrogol group were (48.42±23.68)μg/L and(49.21±22.83) μg/L respectively, and the post operative ones were (23.56±5.89) μg/L and (25.49± 6.10) μg/L respectively; the differences between the preoperative data and the postoperative data were statistically significant in both groups (P<0.05), although the differences in serum CA125 levels between the two groups were not significant (P>0.05). The incidence of postoperative complications in the lauromacrogol group was obviously lower than that in the ethanol group (P<0.05). The cure time in the ethanol group was shorter than that in the lauromacrogol group, although the difference was not significant after six months. Conclusion For the treatment of ovarian endometriosis cysts, CT-guided lauromacrogol injection into the sac cavity has reliable curative effect. Compared to ethanol injection, injection of lauromacrogol is safer and has fewer adverse reactions. Therefore, this technique should be recommended in clinical practice. Serum CA125 can be used as an indicator for the evaluation of curative effect.

Objective To observe the effect of transcutanous acupoint electrical stimulation(TAES)and dexmedetomidine on postoperative cogni?tive dysfunction in female patients underwent laparoscopic surgery. Methods Nighty patients scheduled for laparoscopic surgery were recruited in this study and randomly divided into control group(group C,n=30),TAES group(group T,n=30)and dexmedetomidine group(group D,n=30). In group T,patients received TAES treatment 30 min before the anesthesia until the end of the surgery at Neiguan(PC 6)and Zusanli(ST 36). The frequency was 2/100 Hz. In group D,patients were intravenously administrated with dexmedetomidine(0.5μg/kg)before the induction. All the patients were given routine general anesthesia. Drugs induced were sulfentanyl,etomidate and cisatracurium. Sevoflurane was given to main?tain the bispectral index(BIS)between 40 and 55. The time of extubation and in PACU was recorded. The serum S100βlevel was assessed at pre?operation(T0),the end of operation(T1)and 24 h after operation(T2). Mini?mental state examination(MMSE)was adopted to evaluate and re?cord the changes in cognitive function 1 day before operation and 24 h after operation. Results The incidence rate of POCD in group T and group D were lower than that in group C(all P<0.05). The level of S100βin group T and group D was lower than those in group C at T1 and T2 separately (all P<0.05). The time of extubation and time in PACU in group D were longer than those in group C and group T(all P<0.05),and the incidence of bradycadia in group D was higher than that in the other groups(all P<0.05). Conclusion TAES and dexmedetomidine reduce the incidence of cognitive dysfunction,decrease the release of S100βprotein. However,dexmedetomidine increases bradycadia,and prolongs extubation time and stay time in PACU. Hence,TAES deserve to be recommended practically.

Objective To investigate the effects of HMME mediated photodynamic therapy (PDT) on apoptosis of murine hepatoma cell line MM45T-Li.MethodsThe photodynamic treatment on MM45T-Li cells was performed in vitro using HMME as photosensitizer and 630 nm laser as light source.The ceils were incubated with HMME of 2.5,5,10 and 20 μg/ml for 4 h respectively,and then irradiated with laser at different dosages.The dark toxicity of HMME and the activity of cells after PDT were evaluated by MTT assay.The effect of PDT on apoptosis were observed by Hoechst fluorescent staining analysis.ResultsMTT assay showed that there were no significant effects on cell growth in each concentration group of HMME when the cells were not exposed to light.The inhibition ratio of cells increased with laser dosage at HMME concentration of 10 and 20 μg/ml.Chromatin condensation,nuclear pyknosis and karyorrhexis were observed after PDT by Hoechst fluorescent staining analysis.The apoptosis rate increased in groups of 5.4 J/cm2 and 7.2 J/cm2 compared with that of control (P＜0.05).Conclusion HMME mediated PDT can efficiently induce the apoptosis of MM45T-Li cells.

Objective To evaluate the effects of spinal segmental stabilization exercises (SSE)at home on the quality of life for community dwelling elderly patients with lower back pain.Methods Eighty elderly patients with lower back pain were divided into two groups according to the random number method:the experimental group,which received intervention for three months,and the control group,which received no intervention.Evaluation was conducted using the Oswestry Disability Index (ODI) and the WHO Quality of Life-BREF (WHOQOL BREF).Results The ODI and WHOQOL-BREF scores for the control group were (0.32 ± 0.09) and (87.65 ± 8.63),respectively,before treatment,and (0.32± 0.07) and (87.98 ±8.15),respectively,three months after treatment; the scores for the experimental group were (0.32 ± 0.09) and (87.97 ± 8.71),respectively,before treatment,and (0.27 ± 0.09) and (92.30 ± 9.64),respectively,three months after treatment.No statistically significant difference was found in ODI and WHOQOL-BREF scores in the control group before and three months after treatment (t=0.311 and-0.672,respectively; P ＞0.05 for both),while statistically significant differences were detected before and three months after treatment (t =0.311 and-0.672,respectively; P＜ 0.05 for both).Differences in ODI and WHOQOL-BREF scores were also found between the experimental group and the control group three months after treatment (t=8.500 and-4.526,respectively; P＜0.05 for both).Conclusions Spinal segmental stabilization exercises can effectively relieve symptoms,improve body functions and uplift the quality of life for community-dwelling elderly patients with lower back pain.As a beneficial physical therapy option,SSE can be promoted in residential communities.

Objective To survey the satisfaction degree of the postgraduates in professional degree with The Joining Together of Double-Track education model in the current stage of professional degree graduate education and standardized training of residents in China. Methods According to various factors, such as the current situation of postgraduates in medical universities, we sought the opinions of relevant experts to design questionnaire. Meanwhile, to enhance the reliability of the questionnaire and the survey, we chose the postgraduates of Shengjing Hospital of China Medical University first to do the pre-survey, and according to the feedback, we adjusted part of the aspects, thus formed a formal questionnaire, which included the satisfaction with training of clinical practice ability, training of research ability, and tutors' assessment etc. Finally, the Chinese New Youth Forum online released the questionnaires, selecting the postgraduates in professional degree who were participating in, or had participated in the completion of the standardized training as the participants, which took place between March 2016 and May 2016. SPSS 16.0 was used for statistical analysis. The evaluation results of different majors were tested by Kruskal-Wallis rank sum test. Results According to the results of the survey, the aspects in the clinical resident standard-ized training that the 1000 postgraduates were more satisfied with were as follows: training time [42.8%(n=428)], training center [41.8% (n=418)], training of clinical practice ability [41.6% (n=416)], tutors [40.2%(n=402)], economic income [38.8%(n=388)], department arrangements [38.4% (n=384)], training of research ability [37.5%(n=375)]. There is a significant difference in the satisfaction degree of different pro-fessional graduate students in theJoining Together of Double-Trackeducation model (P<0.05). ConclusionThe Joining Together of Double-Track education model should be compatible with the training objectives of postgraduates in professional degree. Much more attention should be paid to the post-graduates, satisfac-tion degree with the clinical resident standardized training, as well as the requirements during the training period, improve the evaluation of graduate students' ability of scientific research, econo-mic income and so on, so as to improve the training system for the postgraduates.

Objective To investigate clinical features of chronic actinic dermatitis (CAD) in Kunming of Yunnan Province.Methods From October 2008 to October 2013,CAD in-patients in our hospital were selected and their general conditions,outcomes of photo-sensitive test and photo-patch test were analyzed in details.Results (1) Among 169 CAD patients,gender ratio (male:female) was 8.9:1.The lesions were mainly distributed on the exposed areas.(2) Photo-sensitive tests of 93 patients showed that the average value of UVA-MPPDwas 7.39 JPcm2 and that of UVB-MED was 20.91 mJPcm2.(3) The results of photo-patch test in 83 patients showed that 48 patients (67.8％) had positive reactions in patch test,and the most common contactant was balsam peru.Fifty-eight patients (69.9％) had positive reactions in photo-patch test indicating that the most common contactant in photo-patch test was balsam peru.Conclusions CAD appears mostly in the middle aged and the aged males and the lesions are mainly distributed on exposed areas.The most common contactants in photo-patch test are balsam peru and perfumed compounds.

Objective To investigate and compare the killing effect of photodynamic therapy (PDT)induced by hematoporphyrin derivative (HpD),hematoporphyrin monomethyl ether (HMME) and photocarcinorin (PsD007) on human leukemia cells K562 in vitro.Methods Human leukemia cells were cultured with serial concentrations of photosensitizers followed by irradiation of different dosage of laser light,then MTT colorimetric assay was applied to measure the relative survival rate of PDT for the cells.Results Significant difference in the inhibitory between the PDT group and control group was observed (P＜0.05).The survival rate of PDT for the cells elevated along with the increase in the concentration of sensitizer and dose of laser light.When the photosensitizer concentration was bigger (25 μg/ml) or the energy density was bigger (7.2 J/cm2),the effect of PsD007 was better than HMME,and they were significantly better than HpD (P＜0.05).Conclusion PDT has significant killing effect on human leukemia cells K562,and its relative inhibitory rate appears to be correlated with the dose of sensitizer and laser light irritation.The effect of PDT is related to the photosensitizers.The effect of HpD-PDT is not as effective as PsD007 and HMME.On the conditions of higher energy density and larger photosensitizer concentration,the effect of PsD007-PDT is better than HMME-PDT.