Objective To explore the effect of misoprustol on restoration of gastroinete stinal function after cesarean section.Methods 100 patients after cesarean section were randomly divided into two groups:50 patients were treated by dropping rectum with misoprostol 200μg.The other 50 patients were the control group.To compare the two groups of the time of wind breaking,the time of lactation and postpartum hemorrhage.Results The duration of there recovery time of the gastrointestinal functionin and lactation of misoprostol group was shorrer than that in the control group(P＜0.05).Quicker involution of uterus and less quantity of red lochia were compared with the control group(P＜0.05).Conclusion Misoprostol used after cesarean section can accelerate lactation and wind breaking and the involution of uterus.It would he used clinically for its safety,eonvenieney and without evident side effects.

Objective To study the relationship between the pregnant women with HBsAg and the gestational diabetes mellkus.Methods Clinical data of 94 cases with pregnant women with HBsAg-positive in our hospital were analyzed retrospectively.119 cases with pregnant women with HbsAg-negative were selected at random according to their personal preference and were compared.The prevalence rate of the gestational diabetes mellitus and itS related factors were compared between the 2 groups.Results 32 cases were diagnosed the gestational diabetes mellitus in pregnant women with HBsAg-positive,according to 34.0%,13 cases were diagnosed the gestational diabetes mellitus in control group,according to 10.9%.It was significant difference in 2 groups(P＜0.05).Compared wlth the control group,there were significant difference in the occurrence of thrombocytopenia,post partum hemorrhage(P＜0.05).Compared with the control group,there were no significant changes in the ratio of cesarean section,BMI,occurrence of fetal macrosomia.Conclusion The prevalence rate of the gestational diabetes mellitus and post partum hemorrhage and thrombocytopenia in pregnant women with HBsAg-positive group was significantly higher than in the HBsAg-positive group.

Squamous cell carcinoma is the second most common non -melanoma skin cancer and its morbidity is increasing in recent years .Because of the complicated pathogenesis and non -specific clinical mani-festation of squamous cell carcinoma ,misdiagnosis occurs frequently .Although squamous cell carcinoma usually grows very slowly ,the invasion and metastasis of special types occurs early .With the deep knowledge of squamous cell carcinoma,people get more and more research results in diagnosis ,treatment and prevention .This paper de-scribes the epidemiology ,etiology ,clinical manifestation ,pathology ,clinical staging ,treatment and prognosis .

Objective To explore the relationship between organizational justice and turnover intention among nurses of tertiary hospitals and to provide implications for human resource management.Methods Totally 511 nurses were recruited from four tertiary hospitals of Jinan City and investigated with Organizational Justice Questionnaire and Turnover Intention Scale.Results The average scores of turnover intention and organizational justice were (2.46±0.61) and (3.55±0.62),respectively.Distributive justice and informational justice were significant predictors of turnover intention.Conclusions The turnover intention of nurses in tertiary hospitals is high.It is beneficial for mitigating nurses' tumover intention to improve their organizational justice,apply post management and performance appraisal model.

Keratoacanthoma ( KA) is an epithelial neoplasm occurring in sun -exposed skin of the elder-ly.Two striking features of KA are its clinical behavior with spontaneous regression after rapid growth and its nos -ological position on the border between benignity and malignancy .The regression of KA may be associated with the hair follicle cycle,apoptosis and immune function of organism .This article summarizes physiological mecha-nisms such as Wnt/retinoic acid signalling cross -talk,the function of p53,bcl-2,bcl-xL and bak in apopto-sis,and the mechanism of action of several immune -related cells,that drives KA regression .It can provide theo-retical basis for us to select the method as well as time of the treatment in KA .

Objective To systematically evaluate the effectiveness of diabetes self-management education through telemedicine on glycosylated hemoglobin (HbA1c). Methods Randomized clinical trials (RCTs) that assessed the effectiveness of remote diabetes self-management education in patients with diabetes were systematically reviewed using multiple electronic databases. The searching time was from database establishment to May 2015. These articles were analyzed after evaluation of their quality. Results Eight RCTs were included involving 2 047 patients.The results of Meta-analysis showed the effectiveness of remote DMSE on reduction of HbA1c of patients with type 2 diabetes was more significant than that of the control group [WMD=-0.50,95%CI (-0.88,-0.12),P < 0.05],while failing to support the effectiveness of remote DMSE on patients with type 1 diabetes [WMD=0.62, 95%CI(-0.19,1.43), P>0.05]. Conclusions Remote DMSE is effective to improve the glycemic control in patients with type 2 diabetes,while the effect on patients with type 1 diabetes is still not certain. Large-scale and multi-centered RCTs are needed to confirm its effectiveness.

Objective To analyze the causes of misdiagnosis and mistreatment of Dravet syndrome. Methods Patients with Dravet syndrome diagnosed according to clinical features and SCN1A gene mutation detection were recruited within recent 3 years. The patients were grouped into correct diagnosis-treatment group and misdiagnosis-mistreatment group according to whether the patients had ever been misdiagnosed and mistreated by sodium channel blockers. The clinical features were compared between two groups. Results Thirty-five cases with Dravet syndrome were collected and the rate of misdiagnosis reached 40%, Nine cases were misdiagnosed as symptomatic focal epilepsy, 4 as Lennox-Gastaut syndrome and 1 as Doose syndrome. The average age of onset in misdiagnosis-mistreatment group was (5.50 ± 3.56) months,and the age of confirmed diagnosis was (83.57 ± 105.62) months. The percentage of abnormal EEG, onset seizure with partial seizure, the seizure frequency within the first year from onset, onset with afebrile seizure, patients with status epilepticus or cluster seizures was higher in misdiagnosis-mistreatment group but it showed no significant statistical significance when compared with that of correct diagnosis-treatment group. The percentage of patients with mental retardation and focal neurological signs was significantly higher in misdiagnosis-mistreatment group (P=0.005 and 0.002, respectively). Conclusions Dravet syndrome is frequently misdiagnosed as symptomatic focal epilepsy. The appearance of focal neurological signs and mental retardation before confirmed diagnosis are important factors for misdiagnosis. Gene mutation screening will be helpful for differential diagnosis of Dravet syndrome.

Objective We tried to explore the relationship between work engagement and organizational citizenship behavior among nurses in tertiary hospitals in order to provide evidence for implementing targeted interventions to promote nurses' organizational citizenship behavior and job performance from a perspective of positive psychology.Methods Totally 511 nurses from four tertiary hospitals of Jinan city were enrolled using multistage sampling.Data were collected with Utrecht Work Engagement Scale (UWES-9) and Chinese Organizational Citizenship Behavior Scale.Data analysis included descriptive analysis,Pearson correlation analysis and stepwise multiple regression analysis.Results The average scores of work engagement and organizational citizenship behavior were (3.82 ± 1.08) and (5.89 ± 0.66),respectively.Work engagement accounted for 25.4％ of the variance in identification with the company,14.6％ of the variance in altruism and 18.7％ of the variance in conscientiousness.Conclusions Work engagement is a significant predictor of organizational citizenship behavior.Nurse managers are suggested to take actions in aspects of professional practice environment,resources allocation and staff training so as to enhance nurses' work engagement and subsequent their organizational citizenship behavior.

Objectives To report the first case of multiple trichodis coma in China.A 31-year-old man presented with multiple,broomcorn grain to r ed bean-sized,skin-colored,firm papules on the right lower extremity for 15 years,and similar lesions on the left knee and lower leg for about one year.T he lesions were asymptomatic.Methods and Results Histopathology showed acanth osis of epidermis,proliferation of fine reticulate collagen fibers and depositi on of focal mucinous proteins in upper dermis.Small blood vessels and nerve fib ers were increased,and proliferation of elastic fibers was localized in the hai r follicles and around some rete ridges.Proliferated hair follicles were seen i n the margins of the lesions and extended down in a collar-like pattern.Ultra structurally,Merkel cell-axon complex was located in the overlying basal lami na of the epidermis.Myelinated nerve fibers were seen in the upper dermis.Bloo d vessel alterations were found under electron microscopy,some basal laminae of blood vessels exhibited laminated structure,proliferation of fibrous component,and thickened wall of blood vessels were observed.Conclusions The disease is rare.It is a hamartoma originated from hair disk.

Objective To explore the expressions and significances of p 53、bcl-2、Ki-67 and apopto-sis in keratoacanthoma(KA)and well differentiated squamous cell carcinoma (WDSCC).Methods The expres-sions of p53、bcl-2、Ki-67 were detected by immunohistochemical technique in 44 cases of KA and 20 cases of WDSCC.Apoptosis was identified by using terminal deoxynucleotidyl transfers ( TdT) -mediated dUTP -biotin nick and labelling(TUNEL)method.Results The positive expressive rates of p53 in proliferative、mature and re-gressive of KA were 22.23%、26.18% and 6.52%, which was lower than the positive rate of WDSCC (41.82%).Significant differences were found between every period of KA with WDSCC in p 53 expression;The intensity of expression and pattern were similar in KA of Ki -67 and p53.There were a positive correlation be-tween p53 and Ki-67 expression rate(r=0.986,P<0.001).The bcl-2 staining showed weak expression in 1 case in WDSCC and 2 cases in KA ,but only a few positive tumor cells was limited to basal cell layer in KA .The average apoptosis rate in KA was 21.72%,which was apparently higher than in WDSCC (9.925%).There were a negative correlation between the apoptosis rate and proliferation rate of Ki -67(r=-0.824,P<0.001).Con-clusion The proliferation and apoptosis in KA can coexist .However ,the apoptosis will occupy a dominance posi-tion in regressive phase ,which results in the regression of tumor .The expressions of p53、Ki-67 and apoptosis would be a certain significance in differentiated KA and WDSCC .