Objective To derive hematopoietic stem cells with functional properties of hematopoietic reconstitution from murine embryonic stem (ES) cells. Methods ES-D3 cells by formation of the day-4 embryoid bodies (4dEBs) were induced into hematopoietic stem cells by co-culture with murine bone marrow endothelial cell-conditional medium (mBMEC-CM) and the fetal liver stromal cell-conditional medium (FLSC-CM). This experiment was designed to 4 groups (mBMEC-CM + FLSC-CM group, mBMEC-CM group, FLSC-CM group, and the control group). Results The total cell numbers, CD34 + cell numbers, and colony numbers formed in the mBMEC-CM + FLSC-CM group were the highest among the 4 groups. The cells in the mBMEC-CM + FLSC-CM group resumed the hematopoietic system of the mice after being transplanted with the inducing cells. Conclusion The culture condition combing mBMEC-CM with FLSC-CM can promote murine ES cells differentiating into hematopoietic stem cells with functional properties of hematopoietic reconstitution.

Objective To explore the effect of group-responsibility system nursing round on improving the critical thinking ability of nurses. Methods We improved the model and optimized the process of nursing round. The model of nursing round was improved from a responsibility-nurse to group-responsibility system. At the same time, the whole process of nursing round was cooperatively completed by group members and guided by N3 nurses including diagnosing through interrogation, nursing physical examination, reporting with multimedia, putting forward nursing problems, nursing intervention, summarizing briefly and so on. Besides, we increased the special lecture on diseases by N3 nurses, evaluations by quality control group and examinations by the head nurse. And then, the score of the Chinese version of critical thinking disposition inventory ( CTDI-CV ) was compared before and after implementation. Results One year after implementing group-responsibility system nursing round, the total score of critical thinking ability increased from (270±1.95) to (301±2.01). Before and after implementation, the difference was statistically significant (t=2.911,P<0.05). The score of peculiarity from 7 aspects in the CTDI-CV after implementation was higher than that before implementation with significant differences except for the peculiarity of looking for the truth and cognitive maturity (P<0.05).Conclusions The improved nursing round increases the thirst for knowledge, self-confidence and improves the ability to analyze problems, critical thinking ability of nurses.

Objective? To explore the effect of applying the combination of the observation-teaching-discussion(OTD) modal with case instruction in the nutritional nurse training. Methods? By convenient sampling, a total of 62 participants were selected from the nutritional nursing team in Shaanxi Provincial People's Hospital from January to December in 2017. The participants were divided into two groups: observation group(n=31) and control group(n=31) based on the random grouping method. In the control group, the traditional teaching approach was applied while the combination teaching modal of OTD and case instruction was used in the observation group. The theoretical and clinical practise assessment, Competency Inventory for Registered Nurse, and the Inpatient Satisfaction Questionnaire on Nursing Service were used to evaluate the effect of the intervention. Results? After 12 months of intervention, the nurses in the observation group scores higher than the control group in terms of the total score of competency inventory,the testing dimensions of critical thinking, scientific research competence, clinical nursing competence, leadership, professional development, education and counselling with statistically significant difference (P＜0.05). The nurses also achieved higher score in the theoretical and clinical practise assessment as well as the patients' satisfaction degree than the control group with statistically significant differences (P＜0.05). Conclusions? The combination teaching modal of OTD and case instruction can effectively improve the nutritional nurses' core competence, professional skills and patients' satisfaction degree.

Objective To evaluate the impact of the professional knowledge and skills of hospital attendants on the quality of hospital care and its training effect. Methods200 accompanists from a Class ⅢGrade A hospital in Xi'an from January 2017 to December 2018 were selected as the subjects by convenient sampling. 100 accompanists from January to December 2018 were used as observation groups to develop their professional knowledge and skills training; 100 accompanists who did not carry out professional knowledge and skills training during from January to December 2017 were the control group. The professional knowledge and skills, quality of care were compared between the two groups before and after training. ResultsThe scores of basic care, daily life care, psychological care, functional rehabilitation, cleansing care, and communication in the observation group were higher than those in the control group, and the differences between the two groups were statistically significant (P＜ 0.05). After training, the patients' health education awareness rate, complication rate, safety incident rate, and satisfaction were better than before training, and the differences were statistically significant (P＜0.05). ConclusionsDue to the limitation of professional knowledge and skill level, the comprehensive quality of hospital accompanists needs to be improved. Strengthening the training of accompanists can not only improve the comprehensive quality of the accompanists themselves, but also improve the quality of hospital care, which is beneficial to the health and rapidity of the medical care industry.

OBJECTIVES: The incidence of infertility is increasing, more than 30% of them having related abnormal tubal patency. Four-dimensional (4D) hysterosalpingo-contrast sonography (HyCoSy) overcomes the shortcomings of 3D HyCoSy in the diagnosis of tubal patency, showing high specificity and accuracy. In addition, 4D HyCoSy discards iodine allergy and X-ray radiation and possesses easy-operating, contributing to good acceptance in clinical practice. However, there is no research to explore the imaging standards related to the possibility of natural pregnancy after 4D HyCoSy. If a predictive model of postoperative natural pregnancy was established using the analysis of clinical data combined with imaging characteristics of 4D HyCoSy of patients with tubal factor infertility, clinical decision-making can be wisely guided in the future. This study aims to establish a predictive model of natural pregnancy after 4D HyCoSy based on clinical data and imaging characteristics of patients with tubal factor in fertility. METHODS: A retrospective study was conducted for patients who were diagnosed with tubal factor infertility in Hunan Guangxiu Hospital from February 2017 to May 2018. The patients ought to possess complete 4D HyCoSy imaging data and at least one-side-unobstructed fallopian tube. General clinical data and imaging data were collected. Pregnancy outcome was followed up till 3 months after 4D HyCoSy. According to pregnancy outcome, patients were divided into a pregnancy group and a non-pregnancy group. Binary logistic regression was used to analyze the correlation between various variables and natural pregnancy after 4D HyCoSy. The variables with significant difference (P<0.05) in single-factor logistic regression were included in the natural pregnancy probability prediction model. The classification accuracy was further verified with 10-fold cross-validation. RESULTS: A total of 1 085 patients with clinically suspected tubal factor infertility who met the requirements and followed the doctors' prescription were collected. Clinical characteristics (age and duration of infertility) and 4D HyCoSy imaging characteristics (thickness of endometrium from the 3rd to the 7th day after the end of menstruation, visualization of the left fallopian tube, the diffusion of contrast agent around the left ovary, and the diffusion of contrast agent around the right ovary) were independent predictors for natural pregnancy 3 months after 4D HyCoSy. A natural pregnancy probability prediction model was established with the area under the curve (AUC) verified by the 10-fold cross-validation all greater than 0.75, and the best AUC was 0.868. The Q value obtained by the prediction model was the probability of natural pregnancy, and the cutoff value was 0.5. When the Q value was greater than 0.5, it was recommended to attempt natural pregnancy for 3 months, and when the Q value was less than 0.5, in vitro fertilization was adviced. CONCLUSIONS A predictive model for the evaluating probability of natural pregnancy in women with tubal factor infertility after 4D HyCoSy is successfully established based on the analysis for clinical data and imaging characteristics. This model shows a great potential in assisting clinical decision making.
Humans ; Female ; Pregnancy ; Contrast Media ; Retrospective Studies

OBJECTIVE: To summarize the genetic characteristics of 671 Chinese pedigrees affected with Duchenne/Becker muscular dystrophy (DMD/BMD). METHODS: Clinical data of the pedigrees were collected. Multiplex PCR, multiple ligation dependent probe amplification (MLPA), next generation sequencing (NGS), Sanger sequencing and long read sequencing were used to detect the variant of DMD gene in the probands and their mothers, and prenatal diagnosis was provided for high risk pregnant women. RESULTS: Among 178 pedigrees analyzed by multiplex PCR, 44 variants of the DMD gene were detected, with the genetic diagnosis attained in 110 pedigrees. Among 493 pedigrees analyzed by MLPA in combination with NGS or Sanger sequencing, 294 pathogenic/possible pathogenic variants were identified, among which 45 were unreported previously, and the genetic diagnosis attained in 484 pedigrees. Structural variants of the DMD gene were identified in two pedigrees by long-read sequencing. Among 444 probands, 341 have inherited the DMD gene variant from their mothers (76.8%). Among 390 women with a high-risk, 339 have opted to have natural pregnancy and 51 chose preimplantation genetic testing for monogenetic disease (PGT-M). The detection rate of neonatal patients and carriers following natural pregnancy was significantly higher than that for PGT-M. CONCLUSION Combined application of MLPA, NGS, Sanger sequencing and long-read sequencing is an effective strategy to detect DMD/BMD. PGT-M can effectively reduce the risk of fetuses. Above finding has expanded the spectrum of DMD gene variants and provided a basis for reproductive intervention for pregnancies with a high risk for DMD/BMD.
China ; Dystrophin/genetics* ; Exons ; Female ; Genetic Testing ; Humans ; Infant, Newborn ; Multiplex Polymerase Chain Reaction ; Muscular Dystrophy, Duchenne/genetics* ; Mutation ; Pedigree ; Pregnancy ; Prenatal Diagnosis

OBJECTIVE: To explore the genetic basis for 7 families with gonadal mosaicism for Duchenne muscular dystrophy (DMD). METHODS: For the 7 families presented at the CITIC Xiangya Reproductive and Genetic Hospital from September 2014 to March 2022, clinical data were collected. Preimplantation genetic testing for monogenic disorders (PGT-M) was carried out for the mother of the proband from family 6. Peripheral venous blood samples of the probands, their mothers and other patients from the families, amniotic fluid samples from families 1 ~ 4 and biopsied cells of embryos cultured in vitro from family 6 were collected for the extraction of genomic DNA. Multiplex ligation-dependent probe amplification (MLPA) was carried out for the DMD gene, and short tandem repeat (STR)/single nucleotide polymorphism (SNP)-based haplotypes were constructed for the probands, other patients, fetuses and embryos. RESULTS: The results of MLPA showed that the probands and the fetuses/probands' brothers in families 1 ~ 4, 5, 7 had carried the same DMD gene variants, whilst the probands' mothers were all normal. The proband in family 6 carried the same DMD gene variant with only 1 embryo (9 in total) cultured in vitro, and the DMD gene of the proband's mother and the fetus obtained through the PGT-M were normal. STR-based haplotype analysis showed that the probands and the fetuses/probands' brothers in families 1 ~ 3 and 5 have inherited the same maternal X chromosome. SNP-based haplotype analysis showed that the proband from family 6 has inherited the same maternal X chromosome with only 1 embryo (9 in total) cultured in vitro. The fetuses in families 1 and 6 (via PGT-M) were both confirmed to be healthy by follow up, whilst the mothers from families 2 and 3 had chosen induced labor. CONCLUSION Haplotype analysis based on STR/SNP is an effective method for judging gonad mosaicism. Gonad mosaicisms should be suspected for women who have given births to children with DMD gene variants but with a normal peripheral blood genotype. Prenatal diagnosis and reproductive intervention may be adapted to reduce the births of further affected children in such families.
Male ; Pregnancy ; Child ; Humans ; Female ; Muscular Dystrophy, Duchenne/diagnosis* ; Dystrophin/genetics* ; Mosaicism ; Exons ; Prenatal Diagnosis/methods* ; Nucleotides