Objective To explore the effect of flushing uterine cavity with metronidazole solution at different temperatures on postpartums with high risk of infections during cesarean section.Methods One hundred and two puerperas with high risks of infections undergoing caesarean section were randomized according to random sampling into three groups equally.Groups A,B and C were treated with uterine cavity flushing with metronidazole solution at three temperatures of 22~24℃,39~40℃and 37.5~37.8℃respectively.Comparisons were done between the three groups in terms of vaginal bleeding 2h after operation,heart rates 15 min before operation and 15 min after operation and the temperatures.Results The differences in temperature and heart rate 15 min after operation were significantly different arnong the groups(P<0.05).The temperature and heart rates of group A were higher and faster than the other two groups(both P<0.05)but no differences between group B and group C(P>0.05).In group A,the temperature and heart rate after operation were significantly lower and faster than those before operation(P<0.05),while there were no differences within group B and C respectively (P>0.05).The vaginal bleeding volume 2 h after operation in groups A and B was significantly more than group C(P<0.05)and that of group B was significantly smaller than group A(P<0.05).Conclusion Uterine cavity flushing using metronidazole at the temperature of 37.5~37.8℃after cesarean section can reduce postpartum hemorrhage and relieve patient’s discomfort.

Objective To discuss the effect of residual renal function on prognosis of maintenance dialysis in patients with end-stage renal disease ( ESRD) .Methods 90 cases of patients of maintenance hemodialysis were selected and divided into group A and group B based on different eGFR levels at the beginning of dialysis, 51 cases in group A of eGFR≤5 mL/( min· 1.73 m2 ) , while 39 cases in group B of eGFR>5 mL/( min· 1.73 m2 ).The renal function of two groups were observed,all patients underwent a five-year clinical follow-up and mortality rates, hemoglobin (Hb), serum albumin ( Alb) , C reactive protein ( CRP) of patients in both groups were observed.Results The renal function of urea nitrogen, serum creatinine, blood uric acid, urinary protein and urine creatinine in group B before dialysis was better than those in group A (all P<0.05).The Hb and Alb levels of group A were significantly lower than those of group B, while the CRP levels was significantly higher than that of group B (all P<0.05).The mortality rate of group A was 43.14%,compared with 20.51% of group B,and there was no significant difference.The two main reasons of death was cardiovascular and pulmonary infection, accounted for 50.00% and 33.33%, respectively.Conclusion Residual renal function of patients with ESRD before dialysis has important clinical significance for prognosis judgment.When eGFR level is lower before dialysis, the mortality rate of patients is higher in five years, prone to cardiovascular and cerebrovascular, with poor nutritional status, which is more vulnerable to infection.

To explore the binocular disparity information for children with a normal vision based on computer-assisted evaluation system.We examined the random dot zero-order disparity,line zero-order disparity,2nd-order disparity and random dot motion parallax for 97 children with normal vision.And 94 children reached 100″ vision disparity both in random dot zero-order disparity and line zero-order disparity (pass rate of 96.9％) ; all 94 cases passed the 2nd-order disparity and random dot motion parallax.Thus children with a normal vision develop their stereopsis.

Objective To evaluate the clinical efficacy and safety of adapalene0.1%gel with individ-ualized treatment regimen for acne vulgaris(ITRAV).Methods Eighty-one patients with acne vulgaris of mild to moderate severity were treated with adapalene0.1%gel topically1to3times daily for6to8weeks according to the severity of the disease.Clinical responses were recorded and photographed weekly in30pa-tients randomly selected from the81patients,and treatment regimens were adjusted accordingly.Results It was shown that cure rates were44.4%and73.4%,in81recruited cases and30selected cases,respectively.Seborrhea decreased remarkably(83.3%)in the treatment.Side effects took place in39.5%of patients with-out interruption of the treatment.Conclusions ITRAV with adapalene0.1%gel has been proved to have an excellent response.Reasonably increasing the daily dosage could improve the cure rates.The cutaneous tolera-bility of the drug was generally good.Seborrhea could be reduced considerably during the treatment

Objective To observe the effect of enhanced external counterpulsation (EECP) on diabetic retinopathy (DR). Methods 179 patients who accepted EECP combined with medication were as group A and the other 190 patients who accepted medication only were as group B. Their visual acuity, fundus fluorescein angiography (FFA) and optical hemodynamics were compared. Results There was significant improvement in group A with visual acuity, FFA and optical hemodynamics (P<0.05), and the incidence of improvement was more in group A than in group B (P<0.05). Conclusion EECP is effective on diabetic retinopathy.

Liver diseases in pregnancy comprise both gestational liver disorders and acute and chronic hepatic disorders occurring coincidentally in pregnancy.Whether pregnancy-related or not,liver diseases in pregnancy are associated with a significant risk of maternal and fetal morbidity and mortality.Thus,the European Association for the Study of the Liver invited a panel of experts to develop clinical practice guidelines aimed at providing recommendations,based on the best available evidence,for the management of liver diseases in pregnancy for hepatologists,gastroenter-ologists,obstetric physicians,general physicians,training specialists and other healthcare professionals who provide care for this patient population.

Acute-on-chronic liver failure(ACLF),which was first described in 2013,is a severe form of acutely decompensated cirrhosis characterized by the existence of organ system failure(s)and a high risk of short-term mortality.ACLF is caused by an excessive systemic inflammatory response triggered by precipitants that are clinically apparent(e.g.,confirmed microbial infection with sepsis,severe alcohol-related hepatitis)or not.Since the description of ACLF,some important studies have suggested that patients with ACLF may benefit from liver transplantation and should therefore be urgently stabilized for transplantation by receiving appropriate etiological treatment and comprehensive management,including support of organ systems in the intensive care unit(ICU).The goal of the present clinical practice guidelines is to provide the most reliable evidence available to assist the clinical decision-making process in the management of patients with ACLF,to make triage decisions(ICU vs.no ICU),to identify and manage acute precipitants,to identify organ systems that require support or replacement,to define potential criteria for futility of intensive care,and it also provides suggestions for identifying potential indications for liver transplantation.

Objective: Depression was common during coronavirus disease-2019 (COVID-19) pandemic, while the association of perceived stress with depression among vaccinated healthcare workers has not been investigated. This study aimed to address this issue. Methods: We included a total of 898 fully vaccinated healthcare workers during the outbreak of severe acute respiratory syndrome coronavirus 2 Delta variant in Nanjing, 2021. Depression was ascertained by Patient Health Questionnaire-9, with a cut-off score of ≥5 indicative of mild-to-severe depression. Perceived stress, resilience, and compassion fatigue were assessed by Perceived Stress Scale-10, Resilience Scale-25, and Professional Quality of Life Scale version-5, respectively. Logistic regression analyses were used to estimate the odds ratio (OR) and 95% confidence interval (CI), along with subgroup and mediation analyses. Results: The prevalence of mild-to-severe depression was 41.1% in vaccinated healthcare workers. The odd of mild-to-severe depression was increased with higher perceived stress. Compared with vaccinated healthcare workers with the lowest tertile of perceived stress, those with the highest tertile had increased odds of mild-to-severe depression by 120% (OR 2.20, 95% CI 1.46 to 3.31) after multivariable-adjustment. However, perceived stress was not associated with mild-to-severe depression in vaccinated healthcare workers with strong resilience, but was in those with weak resilience (pinteraction=0.004). Further analysis showed that compassion fatigue mediated the relationship between perceived stress and mild-to-severe depression, with a mediating effect of 49.7%. Conclusion Perceived stress was related to an increased odd of mild-to-severe depression in vaccinated healthcare workers during COVID-19 pandemic, and this relationship might be explained by compassion fatigue.

Hemorrhage and thrombosis prevention and treatment in patients with cirrhosis faces certain clinical difficulties. Therefore, this guideline is formulated to provide practical guidance on controversial topics, such as the current perspectives on hemostasis in liver disease, whether invasive procedures need to correct thrombocytopenia and coagulation abnormalities, and the necessity of thromboprophylaxis in hospitalized patients with abnormal coagulation. Many of the recommendations in the guidelines are not useful measures; however, they were stem under the oversight of an expert panel, and are widely used in clinical practice. Here, we compile and summarize the recommendations on the above topics in order to share them with readers.

This Practice Guidance intends to coalesce best practice recommendations for the identification of portal hypertension （PH）， for prevention of initial hepatic decompensation， for the management of acute variceal hemorrhage （AVH）， and for reduction of the risk of recurrent variceal hemorrhage in chronic liver disease. The most significant changes in the current Guidance relate to recognition of the concept of compensated advanced chronic liver disease， codification of methodology to use noninvasive assessments to identify clinically significant PH （CSPH）， and endorsement of a change in paradigm with the recommendation of early utilization of nonselective beta-blocker therapy when CSPH is identified. The updated guidance further explores potential future pharmacotherapy options for PH， clarifies the role of preemptive transjugular intrahepatic portosystemic shunt in AVH， discusses more recent data related to the management of cardiofundal varices， and addresses new topics such as portal hypertensive gastropathy and endoscopy prior to transesophageal echocardiography and antineoplastic therapy.