Objective To investigate the efficacy and safety of percutaneous induced thrombosis closure on small patent ductus arteriosus (PDA) solely under echocardiography guidance.Methods From June 2013 to September 2016,276 PDA patients were treated by femoral artery retrograde approach under echocardiography guidance.Twenty-five patients (14 boys,11 girls) among them with small PDA received percutaneous induced thrombosis closure because the delivery sheath could not pass PDA,with mean age (3.7 ± 1.6) years,mean body weight (16.6 ±5.4) kg and the mean diameter of the most narrow PDA was (1.3 ± 0.4) mm.All patients were assessed by transthoracic echocardiography,chest radiography and electrocardiography preoperatively.The intraoperative and postoperative effects were evaluated by echocardiography.Outpatient assessment was performed at 1,3,6 and 12 months after operation with electrocardiography and echocardiography,and yearly thereafter.Results Twenty-five patients were successfully treated with percutaneous induced thrombosis closure solely under echocardiography guidance.The mean operation time was (35.2 ± 6.1) minutes.The immediate residual shunt rates and 24 hours after operation were 28.0％ (7/25 cases) and 16.0％ (4/25 cases),respectively.All patients recovered and were discharged from hospital.The average hospitalization stay was (3.0 ± 0.6) days.The mean follow-up was (16.8 ± 12.3) months,residual shunt was observed in 2 patients (8.0％),and it decreased from 1.5 mm and 2.0 mm preoperatively to 0.8 mm and 1.0 mm postoperatively,respectively.All patients survived without peripheral vascular injury,cardiac perforation,PDA rupture or thrombembolia.Conclusions Percutaneous induced thrombosis closure of small PDA solely under echocardiography guidance is safe and effective.It can avoid occluder implantation and radiation injury.However,the residual shunt after operation needs following up closely.

Objective:To examine the distribution of syphilis antibody in pregnant women and newborns and to explore how to optimize the existing syphilis screening process by setting the diagnostic gray area.Methods:The results of syphilis testing obtained from 119 531 pregnant women and 21 275 newborns from 2015 to 2018 by automatic chemiluminescent immunoassay (CLIA) and the re-examination results determined by Treponema pallidum particle agglutination (TPPA) and the rapid plasma reagin test (RPR) were retrospective analyzed. Data analysis was performed by Chi-square, Fisher′s exact test and Chi-square test for trend. Results:The positive rates of Syphilis specific antibody (TPAb) in clinical specimens from pregnant women and newborns were 0.69% (825/119 531) and 1.24%(264/21 275). The total re-examination positive rates were 0.32% (380/119 531) and 0.90%(191/21 275), and the suspicious syphilis prevalence rates in these specimens were 0.13% (161/119 531) and 0.31%(67/21 275), respectively. The suspicious syphilis prevalence rates in specimens of pregnant women from 2015 to 2018 and newborns increased year by year (χ 2=9.860, P=0.002; χ 2=5.311, P=0.021). With the elevation of the optical density value of samples to cut-off ratio (S/CO) value, positive coincidence rate of TPPA and TPAb in pregnant women and newborns increased significantly (χ 2=614.833, P<0.001; P<0.001). When the S/CO value in newborns exceeded 7.00 or the S/CO value in pregnant women exceeded 15.00, the effectiveness of TPAb results is equivalent to TPPA. The prevalence of suspected syphilis in pregnant women and newborns also increased with the increase of S/CO value (χ 2=323.059, P<0.001; P<0.001). When the S/CO value in newborns bellowed 3.00 or the S/CO value in pregnant women bellowed 5.00, the prevalence rate of suspected syphilis was 0%, which could preliminarily exclude syphilis infection. Conclusions:The prevalence rates of suspected syphilis in pregnant women was increasing during the recent years. It is necessary to further strengthen syphilis screening and intervention treatment in early pregnancy to improve the rate of eugenics. Being a primary screening method for syphilis in pregnant women and newborns, CLIA has high false positive rate. According to the gray area established in this study, the syphilis screening process can be optimized to prevent missed detection, which may reduce the false positive rate and avoid clinical misdiagnosis.

Objective To study application effect of clinical nursing pathway on health ed-ucation in patients with laparoscopic cholecystectomy.Methods A total of 98 patients with laparo-scopic cholecystectomy were randomly divided into control group and pathway group,with 49 pa-tients in each group.Patients in the pathway group received health education according to clinical nursing pathway table while patients in the control group received traditional health education.Re-sults The command condition of health knowledge,compliance of patients and satisfaction to-wards nursing in the observation group were higher than that in the control group (P <0.05). Conclusion Clinical nursing pathway could effectively improve health education in a standardized and scientific way,enhance patients′compliance and maintain harmonious relationship between nurses and patients.

Objective To study application effect of clinical nursing pathway on health ed-ucation in patients with laparoscopic cholecystectomy.Methods A total of 98 patients with laparo-scopic cholecystectomy were randomly divided into control group and pathway group,with 49 pa-tients in each group.Patients in the pathway group received health education according to clinical nursing pathway table while patients in the control group received traditional health education.Re-sults The command condition of health knowledge,compliance of patients and satisfaction to-wards nursing in the observation group were higher than that in the control group (P <0.05). Conclusion Clinical nursing pathway could effectively improve health education in a standardized and scientific way,enhance patients′compliance and maintain harmonious relationship between nurses and patients.

Objective    To assess the efficacy and safety of percutaneous closure of patent ductus arteriosus (PDA) solely under echocardiography guidance. Methods    We retrospectively analyzed the clinical data of 200 patients who received the percutaneous closure of PDA under echocardiography guidance in Fuwai Hospital from August 2013 to April 2016. According the different approach, they were divided into 2 groups: a femoral artery approach group (n=143) and a femoral vein approach group (n=57). In the femoral artery approach group, there were 42 males and 101 females aged 3.20±5.63 years. In the femoral vein group, there were 10 males and 47 females aged 7.30±11.36 years. All Patients were treated by percutaneous PDA closure solely under echocardiography guidance. The follow-up was performed at one month after the operation by echocardiography, chest radiograph and electrocardiogram. Results    All 200 patients were successfully treated with percutaneous closure of PDA. The patients’ gender, in-hospital stay, rates of occluder  detachment were similar between the two groups (P>0.05). Compared with the femoral vein approach group, the femoral artery approach group had a younger age (3.20±5.63 years vs. 7.30±11.36 years, P<0.001), less body weight (14.25±11.54 kg vs. 24.25±19.14 kg, P<0.001) and shorter diameter of PDA (3.06±0.79 mm vs. 5.93±0.68 mm, P<0.001) and PDA occluders (5.43±1.00 mm vs. 12.14±0.54 mm, P<0.001), but had higher hospitalization expenses (32 108.2±3 100.2 yuan vs. 25 120.7±3 534.1 yuan, P<0.001). In the femoral vein approach group, one patient was closed under radiation guidance because guide wires could not pass through PDA. One patient in the femoral artery approach group suffered from occluder detachment at one day after operation and was cured by transthoracic minimally invasive PDA occlusion. There were no complications of occluder detachment, residual shunt, pericardial effusion or left pulmonary stenosis during the follow-up. Conclusion    Echocardiography-guided percutaneous PDA closure is safe and effective, while the proper interventional approach should be chosen by the anatomical features of PDA.