Objective To investigate the effects of comprehensive pelvic floor rehabilitation program on pelvic floor muscle strength, female sexual function index (FSFI) score and sexual satisfaction scale for women (SSS-W) score in patients with perimenopausal female sexual dysfunction. Methods The clinical data of 120 patients with perimenopausal female sexual dysfunction were retrospectively analyzed, and all the patients were treated with estrogen and progesterone replacement therapy. Among the patients, 80 patients were treated with Kegel training program (control group), and 80 patients were treated with Kegel training program combined with comprehensive pelvic floor rehabilitation program (treatment group). The pelvic floor muscle strength, FSFI score, SSS-W score, incidence of algopareunia and sexual life frequency were compared between 2 groups. Results The pelvic floor muscle strength after treatment in treatment group was significantly better than that in control group. The Ⅲ,ⅣandⅤgrade of pelvic floor muscle strength in treatment group was in 5, 42 and 33 cases, and that in control group was in 21, 47 and 12 cases, and there was statistical difference (P<0.05). The FSFI scores and SSS-W scores after treatment in treatment group were significantly higher than those in control group:(32.24 ± 3.70) scores vs. (28.51 ± 2.95) scores and (139.80 ± 16.17) scores vs. (122.33 ± 13.75) scores, and there were statistical differences (P<0.05). The incidence of algopareunia after treatment in treatment group was significantly lower than that in control group:10.00%(8/80) vs. 55.00%(44/80), and there was statistical difference (P<0.05). The sexual life frequency after treatment in treatment group was significantly better than that in control group, the 0, 1, 2 and≥3 times/month of sexual life frequency in treatment group was in 0, 8, 20 and 52 cases, and that in control group was in 5, 34, 24 and 17 cases, and there was statistical difference (P<0.05). Conclusions Comprehensive pelvic floor rehabilitation program in patients with perimenopausal female sexual dysfunction can efficiently promote the recovery process of pelvic floor muscle strength, improve FSFI score and SSS-W score, and increase the degree of sexual satisfaction.

Through the doctor group, the questionnaire survey to understand what the doctor online habits situ-ation of network communication, doctors and patients, the effect of the real network environment for medical diag-nosis and treatment, news media under the network environment on the influence of the doctor and the doctor group about web development comprehensive view of the impact of the doctor-patient relationship.Points out that the current network environment brings to the doctor-patient relationship: the influence of the Internet become some doctors information update and the accumulated knowledge source, network has become an important platform inter-action some doctors and patients, doctors need to deal with an increasing number of network patients, the doctor-shave reactive shifts to the media negative reports.

Objective To investigate the levels of cancer related fatigue (CRF) and the correlations between CRF and serum inflammatory factors and hypothalamus-pituitary-adrenal (HPA) axis in patients with gastrointestinal cancer.Methods The CRF level was assessed by brief fatigue inventory (BFI).The level of C-reactive protein (CRP) was measured by immunoturbidimetry, and the level of cortisol was measured by electrochemiluminesence.The levels of interleukin (IL)-6, IL-1β, tumor necrosis factor-α (TNF-α), adrenocorticotropic hormone (ACTH) and norepinephrine (NE) were measured by enzyme-linked immunosorbent assay (ELISA).Results The average total score of CRF was 3.15±1.93, and the degree was mild to moderate, which was positively correlated with the CRP (r=0.321, P=0.000), TNF-α (r=0.265, P=0.000), NE (r=0.174, P=0.015) and ACTH (r=0.257, P=0.000), but was not correlated with the cortisol (r=0.033, P=0.652).Eastern Cooperative Oncology Group (ECOG) score (t=8.081, P=0.000), education (t=-4.244, P=0.000), treatment (t=4.563, P=0.000), time from diagnosis to sampling (t=3.453, P=0.001) and CRP (t=2.837, P=0.006) were important factors of CRF.Conclusion The CRF status is common in gastrointestinal cancer patients.The CRF is correlated with the NE and ACTH of HPA axis.Medical staff should pay attention to the inflammatory factors and hormone levels to improve the fatigue status and the quality of patients.

Objective The study aimed to explore the relationship between organizational commit ment,leader-member exchange and nurses' organizational citizenship behavior based on an empirical study.Methods A total of 264 nurses recruited from four general hospitals were investigated with the Organizational Commitment Scale,Leader-Member Exchange Scale,and Organizational Citizenship Behavior Scale.Results Affective organizational commitment and leader-member exchange correlated with every factor of organizational citizenship behavior.Both affective organizational commitment and leader-member exchange predicted the variance of identification with organization 0.29,altruism toward colleagues 0.06,interpersonal harmony 0.09,protecting organizational resources 0.12,and conscientiousness 0.28.Conclusions Affective organizational commitment and leader-member exchange had a positive influence on nurses' organizational citizenship behavior,thus,hospital managers should strengthen nurses' affective organizational commitment and leader-member exchange to promote their organizational citizenship behaviors.

Objective To assess the value of four different techniques of detecting the Mycobacterium tuberculosis (MTB) in bronchoalveolar lavage fluid (BALF) in the diagnosis of tracheobronchial tuberculosis. Methods A total of 98 patients diagnosed as tracheobronchial tuberculosis were selected from May 1,2013 to June 30,2016. The clinical data was analyzed retrospectively,and the positive rates of MTB of the 960 cultrue, the direct smears , the modified Ziehl?Neelsen stain method and Xpert MTB/RIF assay were compared. Results The positive rates of the 960 cultrue,the direct smears,the modified Ziehl?Neelsen stain method and Xpert MTB/RIF assay were 20.4%(20/98),15.3%(15/98),70.4%(69/98) and 74.5%(73/98),respectively. Among the four techniques ,the positive rates of the modified Ziehl?Neelsen stain method and Xpert MTB/RIF assay were significantly higher than those of the 960 cultrue and the direct smears(P<0.05,respectively). However,no significant difference was found between the modified Ziehl?Neelsen stain method and the Xpert MTB/RIF assay (P > 0.05). Conclusions The modified Ziehl?Neelsen stain method and Xpert MTB/RIF assay for detecting the MTB in BALF have high clinical value in the diagnosis of tracheobronchial tuberculosis.

Objective To evaluate the effects of music on improving psychosomatic distress in severe patients. Methods The data were collected via China national knowledge infrastructure ( From January 1979 to December 2014), Vip journal integration platform (From January 1989 to December 2014) and Wanfang data ( From January 1982 to December 2014 ) , conducted by two researchers separately. The inclusive literatures were related to the intervention effects of music on anxiety and depression in severe patients, and the data were analyzed by Meta-analysis. The searching strategies determined by the first author; the third party would be involved into the determination in case of the divergence emerged. Results The researchers invited 11 literatures into the study and randomly compared them. Meta-analysis demonstrated that music had protective function on anxiety and the WMD(weighted mean difference)values for SAS, VAS and TAI were: -10. 13 (95%CI:-14. 56, -5. 69),-0. 73 (95%CI: -1. 21, -0. 24) and -3. 71 (95%CI: -5. 18, -2. 25);the WMD values for SDS and for UCLA were -0. 05 (95%CI: -0. 08, -0. 03) and -6. 24 (95%CI: -8. 62,-3. 87), suggested that music had protective effects on depression and on loneliness;the WMD values for sleeping time and awakening time were 1. 09 (95%CI:0. 72, 1. 45) and -0. 93 (95%CI: -1. 49,-0. 36), suggested that music could significantly increase the sleeping time and reduce the awakening time in order to cope with sleep disorder;the WMD value for blood pressure was -5. 41 (95%CI: -20. 08, 9. 27), suggested that the protective effects of music on blood pressure was uncertain;the WMD value for heart rate was -12. 35 (95%CI:-14. 68,-10. 01), suggested that music could protectively reduce the heart rate. Conclusions Music should be highly recommended for it plays a significant role in dealing with psychosomatic distress such as anxiety, depression, lonely and sleep insufficiency.

OBJECTIVETo explore the subcellular localization of ataxin-3 and the effect of polyglutamine (polyQ) expansion mutation on the morphology of mitochondrion, golgi apparatus and endoplasmic reticulum.

METHODSTransient transfection was employed to build cell models expressing wild-type or mutant ataxin-3 proteins. Indirect immunofluorescence was applied to identify markers of organelle membrane. The results were observed under a laser scanning confocal microscope.

RESULTSNo co-localization was observed for ataxin-3 protein and mitochondrial marker TOM20, but the percentage of cells with mitochondrial fragmentation has increased in cells expressing mutant ataxin-3 (P<0.05). No co-localization was observed for ataxin-3 protein and golgi marker GM130, and mutant ataxin-3 did not cause golgi fragmentation. Wide type and polyQ-expanded ataxin-3 both showed partial co-localization with ER marker calnexin. The latter showed more overlap with calnexin, and the overlapping signals were mostly located in the places where aggregates were situated.

CONCLUSIONPolyQ-expanded ataxin-3 protein may indirectly affect the integrity of mitochondria, but may cause no effect on the structure and functions of golgi apparatus. Endoplasmic reticulum may be another place where extended ataxin-3 protein can induce cytotoxicity in addition to the nucleus.

Ataxin-3 ; Cytoplasm ; genetics ; metabolism ; Endoplasmic Reticulum ; genetics ; metabolism ; HeLa Cells ; Humans ; Machado-Joseph Disease ; genetics ; metabolism ; Mitochondria ; genetics ; metabolism ; Nerve Tissue Proteins ; genetics ; metabolism ; Nuclear Proteins ; genetics ; metabolism ; Protein Transport ; Repressor Proteins ; genetics ; metabolism

Objective To analyze the patients′ psychological resilience level of postpartum pelvic floor dysfunction and to explore the influencing factors, in order to provide the scientific basis for patients′psychological intervention. Methods A cross-sectional survey was conducted on 208 patients of postpartum pelvic floor dysfunction by using the Connor-Davidson Resilience scale(CD-RISC), Positive and Negative Affective scales(PANAS) and Medical Coping Modes questionnaire(MCMQ, which includes "confrontation","acceptance-resignation"and"avoidance"). Results The score of psychological resilience of 208 patients was (53.64 ± 12.29)points, differences in age, family monthly income, living locations, delivery methods and delivery times reached a statistically significant level(F=15.287,5.731,t=-2.571,-15.911,-2.922,all P<0.05). Patients′psychological resilience level had significant positive correlation with positive emotions(P<0.01)and"confrontation",and it had negative correlation with"acceptance-resignation"(P<0.01).Age,living locations, delivery methods, positive emotions and "acceptance- resignation" are the forecast factors of psychological resilience, which can explain 69.6% of total variation. Conclusions Patients of postpartum pelvic floor dysfunction have low levels of psychological resilience, which associated with positive emotions and medical coping modes. Therefore, nursing staffs should pay attentions to the patients′ psychological status, develop individualized psychological guidelines,implement psychological intervention and health education,in order to improve the level of patients′resilience and improve their living quality.

Objective To evaluate the targeted surveillance of health care-associated infections in ICU. Methods PubMed, EMBASE ( Excerpt Medica Database ) , China Biology Medicine disc, China National Knowledge Infrastructure, Vip Journal Integration Platform and Wanfang Data were searched from 2009 to 2013 by two researchers. Full-text studies on targeted surveillance of healthcare-associated infections in ICUs were included. Studies were evacuated using STROBE and GRADE. Random effects meta-analyses were used to generate summary estimates of infection rates. Results Totals of 21 studies met eligibility criteria, which were all Chinese research papers. Taking the infection rate as an example, 74 600 cases were observed within which 7 318 cases were infected. Pooled meta-analyses of eligible studies revealed that adjusted infection rate:infection rate, case infection rate, daily infection rate, case daily infection rate were 3. 27%, 4. 92%, 4. 58‰, 6. 49‰, respectively. The infection rates were 23. 12‰ in ventilator associated pneumonia, 5. 26‰ in catheter-related bloodstream infections, and 2. 38‰ in catheter-associated urinary tract infections. The lower respiratory tract, the blood, and the urinary tract were the main infection sites, accounting for 58. 07%, 18. 16%, and 15. 35%, respectively. A. baumanii, P. Aeruginosa, fungi, S. aureus, K. pneumoniae, E. coli were the main pathogens, accounting for 20. 54%, 14. 28%, 14. 35%, 11. 62%, 10. 92% and 6. 86%, respectively. Conclusions The burden of health-care-associated infection in ICU is high. Our findings indicate a need to improve surveillance and infection-control practices.

Objective To observe the effect of early enteral nutrition (EEN) on nutritional indicators and clinical outcomes in patients with severe heart failure undergoing mechanical ventilation. Methods Thirty-four patients with severe heart failure (grade Ⅲ-Ⅳ of cardiac function) and pulmonary infections undergoing mechanical ventilation admitted to intensive care unit (ICU) of Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from May 2017 to April 2018 were enrolled. They were randomly divided into EEN group and delayed enteral nutrition (DEN) group. Both groups were given routine treatment, including mechanical ventilation, improvement of cardiac function, anti-infection, protection of vital organ function, regulation of blood sugar and adjustment of electrolyte and acid-base balance. The patients in EEN group received enteral nutrition (EN) within 48 hours after ICU admission, and in DEN group, EN was started after the patients had spent the early stage of stress and had stable vital signs (48 hours after ICU admission). The changes in serum B-type natriuretic peptide (BNP), C-reactive protein (CRP), nutritional indicators and liver function indicators at ICU admission and 7 days after treatment were compared between the two groups. The time needed for patients to reach EN target, duration of mechanical ventilation, length of ICU stay, and the 28-day mortality were recorded, and complications were observed. Results There was no significant difference in serum BNP, CRP, nutritional indicators or liver function indicators at ICU admission between the two groups. After treatment for 7 days, BNP and CRP in both groups were decreased significantly as compared with those at ICU admission [BNP (ng/L): 592.1±370.9 vs. 2 517.7±1 163.4 in EEN group, 621.9±418.8 vs. 2 251.5±1 006.8 in DEN group; CRP (mg/L): 46.0±19.6 vs. 59.8±22.5 in EEN group, 40.5±18.8 vs. 61.2±24.6 in DEN group, all P < 0.05], pre-albumin (PA) and transferrin (TF) were significantly increased [PA (g/L): 0.18±0.05 vs. 0.15±0.06 in EEN group, 0.17±0.04 vs. 0.12±0.06 in DEN group; TF (g/L): 1.6±0.4 vs. 1.5±0.4 in EEN group, 1.7±0.5 vs. 1.4±0.5 in DEN group, all P < 0.05]. However, there was no significant difference in the above indicators after treatment between the two groups (all P > 0.05). There was no significant change in liver function after treatment in both groups. The EN treatment was successfully completed in both groups. Some patients developed abdominal distension and diarrhea in varying degrees, which were alleviated by slowing down the infusion rate, supplemented by gastrointestinal motility drugs and intestinal flora adjustment drugs. The time needed to reach EN target in EEN group was significantly earlier than that in DEN group (hours: 42.4±10.2 vs. 53.8±17.1, P < 0.05), the duration of mechanical ventilation (days: 14.2±8.7 vs. 13.4±7.9), the length of ICU stay (days: 17.8±6.7 vs. 18.3±5.6) and 28-day mortality [5.9% (1/17) vs. 11.8% (2/17)] showed no significant difference as compared with those in DEN group (all P > 0.05), and it did not increase the incidence of aspiration pneumonia [23.5% (4/17) vs. 17.7% (3/17), P > 0.05]. Conclusion EEN could help to achieve nutritional goals as soon as possible, improve the nutritional status of the body, and provide conditions and basis for further treatment of severe heart failure patients.