ObjectiveTo investigate the significance of hearing screening combined with gene screening for neonates with high-risk of hearing impairment.MethodsNeonates admitted to the Neonatal Department of Guangdong Women and Children Hospital between July 2013 and June 2014 were enrolled in this study. They were divided into high-risk group (with high-risk for hearing impairment) (n=3 129), and control group (n=5 106). Neonate hearing screening was carried out using otoacoustic emission and automated auditory brainstem response. Blood samples were collected using a standard protocol for detecting the mutations of four common deafness genes, includingGJB2,GJB3,SLC26A4 and mitochondrial 12s rRNA.Chi-square test was used to compare the differences of the pass rate of hearing screening and positive rate of gene mutations between the two groups.ResultsThe rates of failure on otoacoustic emission, automated auditory brainstem response or both in the high-risk group were 11.92% (373/3 129), 10.32% (323/3 129) and 4.83% (151/3 129), respectively, higher than those in the control group [5.03%(257/5 106), 6.56%(335/5 106) and 2.02% (103/5 106)] (χ2=130.265, 37.354 and 51.196, allP=0.000). In the high-risk group, the overall positive rate of gene mutations was 5.63% (176/3 129), and theGJB2 andSLC26A4 gene mutation rates were 3.04% (95/3 129) and 2.40% (75/3 129)], all higher than the control group [3.15% (161/5 106), 2.04% (104/5 106) and 1.06% (54/5106)] (χ2=30.301, 8.216 and 22.517, allP<0.01). But the mitochondria 12S rRNA gene andGJB3 gene mutation rates were the same in high-risk group and control group [0.19% (6/3 129) vs 0.06% (3/5 106); 0.03% (1/3 129) vs 0.00%(0/5 106), bothP>0.05]. The rates of failure on otoacoustic emission and automated auditory brainstem response of the neonates with deafness gene mutations were 9.50% (32/337) and 10.39% (35/337), respectively, higher than the neonates without [1.14% (90/7 898) and 1.29% (102/7 898)] (χ2=154.621 and 163.399, both P=0.000).ConclusionCombined hearing screening is of clinical significance for neonates with high-risk of hearing impairment.

Objective To investigate the effect of emergency case video segmentally introduction combining with simulation in cultivation of undergraduate nursing students′skills of trauma management. Methods A group of 55 undergraduate nursing students, recruited in the control group from September 2013 to April 2014, were instructed by traditional teaching method, the trauma management skill was delivered by lecture, video and group based practice. Another 50 undergraduate nursing students, recruited in the observation group from September 2014 to April 2015, were located in the simulation group, while the key point of trauma management was segmentally introduced by emergency case video, the skill of trauma management was delivered by lecture and video, a multiple injury case scenario was used for group practice. The score of the practice test and the evaluation of the teaching were compared among the two groups. Results The students in observation group demonstrated more skilled trauma management compared with that in the control group (90.42±8.50 vs. 84.68±8.77, t=3.56, P<0.05). The students in observation group presented significantly higher satisfaction with the teaching, improving study interesting 93.33%(56/60), promoting the theory knowledge deepen 91.67%(55/60), improving the ability of thinking and observation 95.00% (57/60/) , improving the ability of analyzing and solving problems 100.00% (60/60), enhancing the ability of independent learning 96.67%(58/60), while in the control group, they were 76.36%(42/55), 69.09%(38/55), 65.45%(36/55), 69.09%(38/55) and 80.00%(44/55), the differences between the two groups were significant (χ2 =2.30-4.40, P < 0.05). Conclusions Application of emergency case video segmentally introduction combining with simulation provided more opportunity to the undergraduate nursing students to apply relevant knowledge in analyzing and dealing with trauma cases, which contributes to the improvement of undergraduate nursing students′ skills of trauma management.

Objective:To analyze the job preference of doctors at township health center ( THC) and provide references for formulating effective policy. Methods:238 cases of doctors were sampled from Shandong, Anhui and Shaanxi provinces. Using a discrete choice experiment, we analyzed the data with a conditional logit model. Results:The most important job attribution was salary, followed by education for children, permanent post, work location, training opportunity, and years before promotion. The OR value of the monthly income of 8 000 yuan is 7. 0 compared to 2 000 yuan. Doctors will pay 3 857 yuan and 3 294 yuan respectively for better education for children and perma-nent posts. Monthly income increasing to 8 000 yuan will reduce the quitting rate from 35% to 8%, and providing better education for children and permanent posts will reduce 5%. The permanent posts at township health center and non-permanent posts in county hospital have the same appeal to the doctor. Conclusion:When choosing a job, doc-tors at THCs valued salary the most. Improving the education level for children can be beneficial for attracting and re-taining doctors at THCs. A permanent post is more attractive to doctors than non-permanent posts at THCs.

Objective:To conduct a systematic review on the implementation effects of National Essential Medi-cine System ( NEMS) since the new health care reform and provide some suggestions to further improve the NEMS. Methods:Databases and relevant international organization reports were searched to collect studies related to the im-plementation of NEMS in China. The database search occurred from January 2009 to December 2014. Results:A to-tal of 1 292 studies were finally included, encompassing 1,277 Chinese papers, 12 English papers, and 3 WHO/HAI reports. A lot of researches have been done on NEMS, but the techniques of NEMS evaluation are not perfect. The sample representativeness is poor, and the longitudinal follow-up studies of the microscopic view is insufficient. . Evi-dence-based evaluation research using big data has just started. Conclusions: The research on NEMS should be strengthened. The NEMS evaluation should not only be based on national conditions, but it should also be in combi-nation with an international, multidimensional evaluation framework in terms of availability, affordability and rational drug use, so as to provide evidences to perfect the NEMS.

The contents about the central action mechanisms of needling Zusanli (ST 36) were sorted by summarizing the relevant literatures published in the past 10 years, and it was found that: by comparing acupuncture at Zusanli (ST 36), other acupoints or sham points, most studies showed that Zusanli (ST 36) had relatively specific characteristics in the brain function response; studies on the central action mechanisms of Zusanli (ST 36) were mainly focused on sequelae of cerebral apoplexy, pain, gastrointestinal diseases, weight loss and drug addiction withdrawal and so on; acupuncture manipulations, stimulation methods, individual differences, stimulation quantity, and stimulation duration, etc. could also induce different brain function responses; acupuncture at Zusanli (ST 36) had an after-working effect, also called long-term effect, but with poor repeatability. So, it was suggested that the future studies should focus on the factors that affect the clinical efficacies and experimental results, including the compatibility effects of the acupoints, reproducibility of research results, sample size, acupuncture methods, long-term effects and disease entities.

Objective To study the relationship between vitamin D deficiency and severe bronchial pneumonia in children. Methods A total of 58 children with severe pneumonia complicated by a lack of vi-tamin D from January 2011 to December 2013 were enrolled in this study,the serum 25-( OH) D3 was detec-ted by the high performance liquid chromatography-tandem mass spectrometry. All the children were random-ly divided into two groups,the vitamin D treatment group( observation group) and without vitamin D treat-ment group(control group),control group received conventional treatment,and the observation group re-ceived vitamin D based on the same treatment with the control group. Results The serum 25-( OH) D3 of the observation group increased significantly( P<0. 01 ) . ( 2 ) The symptoms such as cough, asthma, fever and pulmonary rales in the observation group disappeared more quickly than that of the control group,and the av-erage cure days of heart failure,respiratory failure and encephalopathy as well as the average length of stay in the observation group were less than those of control group,and there were significant differences between two groups(P<0. 01). (3) The total efficiency of the observation group and control group was 96. 42% and 73. 33% respectively,and there was significant difference between two groups(χ2 =6. 693,P<0. 01). (4) Blood oxygen pressure and oxygen saturation of the observer group were significantly improved,CO2 partial pressure decreased obviously, the differences were statistically significant between two groups ( P <0. 01 ) . Conclusion During the treatment periods in children with severe pneumonia,vitamin D supplements could relieve symptoms promptly,shorten the duration,improve the 25-( OH) D3 levels,and vitamin D deficiency may also be the underlying cause of severe pneumonia in children.

OBJECTIVE: To study the effects of serum derived from rats treated with electroacupuncture at stomach meridian acupoints on the expressions of epidermal growth factor receptor (EGFR) signaling substances phospholipase C gamma-1 (PLC gamma-1), protein kinase C (PKC) and c-myc in gastric mucosal cells. METHODS: Sixty rats were randomly divided into normal group, stomach meridian group, gallbladder meridian group, stomach meridian plus PD153035 group and gallbladder meridian plus PD153035 group. Water-immersion and restrained stress methods were adopted for inducing gastric mucosal injury in the rats. Gastric mucosal cells were separated by using pronase digestion method, and incubated by PD153035, a EGFR inhibitor, and 100 ml/L serum. The expression of PLC gamma-1 in the gastric mucosal cells was tested by enzyme linked-immunosorbent assay (ELISA), while the expression of PKC by isotope incorporate assay and the expression of c-myc by reverse transcription polymerase chain reaction assay (RT-PCR). RESULTS: In gastric mucosal cells, weak expressions of PLC gamma-1, PKC and c-myc were seen in the normal group, and relatively strong expressions of PLC gamma-1, PKC and c-myc were seen in the stomach meridian group and the gallbladder meridian group, among which, the expressions of PLC gamma-1, PKC and c-myc in the stomach meridian group were the strongest, and there was a significant difference between the stomach meridian group and the gallbladder meridian group (P<0.01). Relative weak expressions of PLC gamma-1, PKC and c-myc were seen in the stomach meridian plus PD153035 group and the gallbladder meridian plus PD153035 group, and there was a significant difference between the stomach meridian group and the stomach meridian plus PD153035 group (P<0.01). CONCLUSIONS: The serum derived from the rats treated with electroacupuncture at stomach meridian acupoints can activate the EGFR singling pathway, and this provides an evidence for the theory of "relative particularity between meridians and viscera" in traditional Chinese medicine.

Objective To investigate MRI features of metanephric adenoma(MA). Methods The retrospective analysis was performed on 6 adult patients that were scanned by regular, DWI and dynamic-enhancement MRI two weeks before surgery and diagnosed with MA pathologically after surgery. MRI features of lesions were observed. The signal intensities of lesions and contralateral normal renal cortex and medulla were respectively measured in plain scan, cortex, parenchyma and delayed phase. The enhancement magnitudes were calculated and the ADC values of lesions were measured. The differences of the signal intensity and enhancement magnitude were assessed by paired-sample t test among renal cotex, medulla and lesions. Results All lesions in MA were single and solid masses. Four cases occurred in the right kidney and two cases in the left kidney. The maximum diameters of the lesions ranged from 21 to 79 mm and the mean value was(41 ± 20)mm. Five cases were round or oval, while one case was irregular. The signal intensity in five cases was slightly lower in T2WI than the renal parenchyma, while one case was slightly higher than the renal parenchyma. The hyperintentsity of DWI and hypointensity of ADC were seen in all cases. The mean ADC value was(0.759 ± 0.211) × 10-3mm2/s. Hemorrhage were seen in two cases. Necrosis was present in one case and the capsules were seen in two cases. No scar, fat and swollen lymph nodes was seen in all cases . There was no statistical significance of the signal intensity between lesions measure in the plain scan and normal renal parenchyma(P>0.05). After adminstrating contrast materials, all lesions shown persistently mild to moderate enhancement . The siganl intensities of lesions measured in three phases after enhancement were signifcantly lower than those of the renal cortex(P<0.05). No significant differences of the signal intensity measured in cortex and medulla phase between lesions and normal renal medulla was present(P>0.05). But the signal intensities of leisons in delayed phases were significantly lower than thoseof renal medulla(P<0.05). Except from the difference of enhanced magnitude in cortex phase between lesions and normal medulla, significant differences were present between leisons and normal renal parenchyma(P<0.05). Conclusion MRI manifestations of MA show certain distinction, including, dominantly solid lesions, relatively lower signal intensity of lesions than that of renal cortex, slowly persistent enhancement, high signal on DWI and low signal on ADC.

?AlM:To compare the anti-inflammatory effects with lotrprednol-tobramycin and tobramysin-dexamethasone eyedrops after phacoemulsification combined intraocular lens implantation.
? METHODS: ln this prospective, comparative, randomized controlled trial, patients with senile cataract who underwent phacoemulsification combined intraocular lens implantation in our hospital from January 2014 to October 2014 were enrolled, which were randomly divided into two groups. Patients were given lotrprednol -tobramycin ( LE/T group ) and dexamethasone-tobramysin ( D/T group ) eyedrops respectively. Preoperative and postoperative intraocular pressure, malnutrition inflammation score, bruggrmann comfort scale were observed.
?RESULTS:A total of 143 eyes of 143 cases were enrolled, of them 81 cases were in the LE/T group and 62 in the D/T group. There were no statistically significant differences between the two groups in malnutrition inflammation score and bruggrmann comfort scale. The average intraocular pressure was 16. 5±3. 1mmHg in D/T group after 14d postoperation, which was obviously higher than LE/T group ( 14. 7± 3. 7mmHg, P = 0. 004 ). After 14d postoperation, the intraocular pressure of 2 cases were > 21mmHg, which were back to normal after drug withdrawal.
? CONCLUSlON: The anti - inflammatory effects lotrprednol-tobramycin and tobramysin-dexamethasone eyedrops are similar after phacoemulsification. However, lotrprednol-tobramycin has little influence in intraocular pressure, and more safety.

[Objective] To explore the risk factors for mortality of bloodstream infections in the patients with hematologic diseases,so as to provide evidence for reasonable and effective application of treatments.[Methods] The clinical data of 242 cases of bloodstream infections who were hospitalized from Jan 2012 to Jun 2016 were analyzed retrospectively,then the analysis was performed for risk factors.The statistical analysis was processed by SPSS 19.0.[Results] A total of 266 strains of pathogens were isolated,including 99 strains of gram-positive bacteria,accounting for 37.2％,and 164 strains of gram-negative bacteria,accounting for 61.7％.Multivariate analysis showed that the significant independent risk factors for mortality were active states of hematologic diseases (P =0.007,OR =5.622,95％ CI 1.586 ～ 19.924),presentation with septic shock(P =0.007,OR =4.978,95％ CI 1.560 ～15.884),cardiac insufficiency (P =0.001,OR =11.878,95％ CI 2.760 ～ 51.120),level of albumin less than 35 g/L (P =0.036,OR =3.468,95％ CI 1.087 ～ 11.066),polymicrobial infection (P =0.010,OR =6.024,95％ CI 1.540 ～ 23.563),and Staphylococcus haemolyticus (P =0.001,OR =19.308,95％ CI 3.392 ～ 109.888)/Enterococcus (P =0.002,OR =15.266,95％ CI 2.817 ～82.728) infection.The survival curves show that the inappropriate initial antimicrobial therapy group or presentation with any one of the independent risk factors had a lower probability of survival than the control group.[Conclusions] Bloodstream infections in patients may cause high mortality rate,so it is necessary that we use antibiotic reasonably and spare no effort to reduce the mortality rate by appropriate application of antimicrobial therapy and effective intervention of the risk factors.