Objective To investigate the clinical features,critical laboratory parameters,and fetal monitoring methods in intrahepatic cholestasis of pregnancy(ICP).Methods A retrospective analysis of 21 cases of ICP suffered with fetal death in Women's hospital.School of Medicine.Zhejiang University from January 1999 to December 2010 were discussed.Results(1)The average age of ICP patients suffered with fetal death were(30.2±4.6)years old.Among them,4 cases were older than 35 years,six cases were multipara.oneo of them suffered stillbirth 2 year before.Twenty cases were singleton pregnancies and 1 cage was twin pregnancy.(2)All 21 cases of fetal death occurred in the third trimester,12 cases occurred before 37 weeks,9 cases after 37 weeks.Nine cases were diagnosed by ultrasound in outpatient clinics,fetal heart beat disappeared in 9 patients after admission because of ICP, two disappeared after labor, one during anesthesia before emergent surgery. Perinatal mortality rate of ICP was 0. 148% (21/14 184), and fetal death occurred from 29 to 41 weeks with an average gestational age of ( 33.8 ± 4. 2 ) weeks, ( 3 ) Puritus occurred in all 21 cases while 11 of them had pruritus all over the body. Ten pregnant women felt the fetal movement decreased or disappeared before diagnosis of fetal death. The glycocholic acid levels increased in all of the 21 cases. Among them, glycocholic acid levels in 11 cases were (21.49 -64. 48) μmol/L, while in 10 cases were ≥64. 48 μmol/L Serum bile acid levels elevated in 16 cases which had been analyzed ( the other 5 cases had not been checked ), and the highest level reached 270 μmol/L Serum alanine aminotransferase and aspartate aminotransferase were increased in 14 cases. Seven cases had their total bilirubin ＞21 μmoL/L, and 12 cases had their direct bilirubin levels significantly elevated. Among the 21 cases of ICP, 15 cases were in severe status, while the other 6 cases were mild. (4) Nine patients had no antepartum surveillance since fetal death were diagnosed before admission. The results of antepartum surveillance were as follows: 2 cases had nonreassuring nonstress test (NST), one had mild "V" type deceleration. Absence of diastolic flow in umbilical artery were found in 3 cases, and low fetal biophysical score was got in one case. ( 5 ) All 21 patients had vaginal delivery. Six of them delivered after natural contraction, and the remaining 14 cases delivered after oral intake of mifepristone and amniotic injection of ethacridine, or oxytocin induced labor within 48 hours, only one case delivered after additional dinoprostone suppositories. The appearance of fetus, placentas and membranes were normal, the lengths of umbilical cord were average. Four cases were found with cords binding the necks or the bodies. Eighteen cases had grade Ⅲ amniotic fluid with meconium-stained, and 2 cases complicated by oligohydramnios. Ten cases had their fetuses and placentas examined by pathologist. Among them, one case had multiple malformations, no more obvious pathological abnormalities were found in other fetuses. Pathologic examination showed that fibrin deposited around chorion and deciduas basalis, large vessels accompanied by calcification, degeneration,hemorrhagic infarction, and increased focal syncytial nodules could be seen in all of the ten placentas. Conclusions Fetal death in pregnant women with ICP of ten occurs after the contractions, Severe ICP may be a key factor that involved in the occurrence of fetal death. Up to now, there is no valid indicators in fetal monitoring, which can predict fetal death. Extensive assessment of the severity and careful antepartum surveillance should be achieved before timely termination of pregnancy.

Antineoplastic Agents ; pharmacology ; Apoptosis ; drug effects ; Cell Cycle ; drug effects ; Cell Proliferation ; drug effects ; Deoxyadenosines ; pharmacology ; HeLa Cells ; Humans

Objective To explore the dynamic changes of D-dimers during pregnancy and early puerperium (within 3 days postpartum). Methods A retrospective study was performed among 8 367 healthy women who had term singleton delivery in Women′s Hospital, School of Medicine, Zhejiang University from January 2007 to December 2014. D-dimers concentrations during pregnancy and early puerprium of all the cases were collected. Data of 21 065 D-dimers tests were assigned to 5 groups according to the time of sampling, including early pregnancy (≤12 gestation weeks), middle pregnancy (12-28 gestation weeks), late pregnancy (>28 gestation weeks), 1 postpartum (within 48 hours postpartum) and 2 postpartum (48-72 hours postpartum). The D-dimers concentrations in different groups were compared. The effect of delivery mode on D-dimers of early pureperium was analyzed. The correlation between D-dimers and the thromboembolic disease was also explored. In this study, Student′s t-test and Wilcoxon rank sum test were used for statistical analysis. D-dimers concentration≤0.5 mg/L was used as the normal range. Results (1) D-dimers concentrations during pregnancy were higher than the non-pregnant women (P<0.01), but there was no statistical difference between early pregnancy and late pregnancy (P=0.820). D-dimers concentration in the 1 postpartum group was higher than that of early pregnancy group or late pregnancy group (P<0.01). But in the 2 postpartum group, it was lower than early pregnancy, late pregnancy and 1 postpartum groups. (2)D-dimers in cesarean section cases was significantly higher than in vaginal delivery cases in each period of pregnancy and early pueprium.(3)The 95%CI of D-dimers in early pregnancy, late pregnancy, 48 hours after vaginal delivery, 48-72 hours after vaginal delivery, ≤48 hours after cesarean section, 48-72 hours after cesarean section were 0.58-8.28, 0.47-11.52, 1.04-9.59, 0.87-5.22, 1.07-11.58 and 1.00-6.23 mg/L, respectively.(4)In 6 cases with thromboembolic disease, D-dimers was 6.89-19.89 mg/L, with the mean value of 13.66 mg/L. It was significantly higher than normal range. In 3 cases, all after cesarean section, with lower extremity vein thrombosis within 48 hours postpartum, the D-dimers concentrations, 9.77, 8.65 and 6.89 mg/L respectively, were in the 95%CI of the study population after cesarean section. Conclusions D-dimers concentration of 0.5 mg/L is not suitable for venous thromboembolism screening during pregnancy. D-dimers concentration in pregnancy and early puerprium is higher than non-pregnancy. It increases in the very early period postpartum and decreases with time. D-dimers should not be a routine screening test to exclude thromboembolic disease in pregnant women without high risk factors and clinical manifestation of thromboembolic disease.

In view of the existing situation of our hospital's information security system,this paper gives a reasonable analysis,including the risk analysis on the computer room' surroundings,basic facilities,applied stage,business system and security management. In addition,this paper suggests the countermeasures in technology and management to remove the hidden danger in the hospital's information security system.

AIM:To determine notoginsenoside R_1 and ginsenoside Rg_1, Rb_1 in Zidan Huoxue Tablet by HPLC linear gradient elution (total saponins of Radix et Rhizoma Notoginseng). METHODS: Using HPLC method with Hypersil ODS2 C_ 18 column. A mobile phase consisted of acetonitrile-water 0-20 min (20∶80), 20-21 min(40-20∶60-80), 21-30 min(20∶80) gradient elution. The column temperature was at room temperature. The detection wavelength was at 203 nm. RESULTS: The linear ranges of R1, Rg1, Rb1 were 0.52-2.6 ?g (r= 0.999 9 ), 2.106 -10.53 ?g (r= 0.999 6 ) and 2.946-14.73 ?g (r= 0.999 6 ), respectively. The average recoveryies were 99.3% (RSD=1.1%), 100.0%(RSD=0.5%) and 99.7%(RSD=0.9%), respectively. CONCLUSION: The method is selective and reproducible for determination of notoginsenoside R_1 and ginsenoside Rg_1, Rb_1 in Zidan Huoxue Tablet.

Shenzhen Eye Hospital took the lead to launch the time interval outpatient clinic appointment registration,for easing the difficulty of seeing doctors and shortening outpatient waiting time.With 30min as a registration interval,the hospital calls into play a variety of means to provide this service to outpatients.This service benefits the outpatients with comfortable hospital environment and promotes hospital efficiency.On this basis,the paper probed into existing problems in the appointment system and proposed improvement suggestions.

Objective To analyze the unreasonable elements in prescriptions from outpatient department through the intervention of unreasonable prescriptions;To provide evidence for reasonable usage of medicine in outpatient department.Methods Prescriptions were examined by senior pharmacists. If they found any unreasonable elements, they would consult doctors, and record all the unreasonable elements in the prescriptions to avoid unreasonable prescriptions. A total of 663 unreasonable prescriptions from Jan. 2011 to May 2013 were analyzed.Results A total of 709 unreasonable elements were found in these prescriptions. The man elements were following three types:overdose of toxic decoction pieces (73.76%), incompatible prescriptions without signature (12.13%), wrong inputting of prescription and decoction (7.76%).Conclusion With early intervention in prescriptions, the quality of prescriptions and the safety and effectiveness of medication can be improved.

Objective:To analysis the effects of alprostadil and yishen huashi particles on blood glucose,blood lipid,renal function and urinary podocyte proteins of patients with diabetic nephropathy.Methods:98 patients with diabetic nephropathy were selected and randomly divided into the control group and the experimental group with 49 cases in each group.The patients in the control group were treated with alprostadil,while the patients in the experimental group were treated with yishenhuashui particles on the basis of the control group.Then the curative effect,the levels of glycosylated hemoglobin (HbAlc),blood glucose (FPG),2 h postprandial blood glucose (2h PG),triglycerides (TG),total cholesterol (TC),high-density lipoprotein (HDL-C),low density lipoprotein (LDL-C),blood urea nitrogen (BUN),creatinine (Cr),β2 microglobulin (β2-MG),bladder inhibition (Cys-C) and urinary podocyte proteins (PCX) in the two groups were observed and compared between the two groups before and after the treatment.Results:The total effective rate of experimental group was higher than control group (P＜0.05).After treatment,there was no statistically significant difference about the HbA1c,FPG and 2 HPG between the two groups (P＞0.05).After the treatment,the levels ofTG,TC,LDL-C,BUN,Cr,β2 MG,Cys C,PCX and urinary nephrin/urine Cr of the experimental group were lower than those of the control group (P＜0.05).The HDL-C of experimental group was higher than that of the control group (P＜0.05).Conclusion:The curative is effect of alprostadil and yishen huashi particles in treatment diabetic nephropathy patients,can conducive to the improvement of blood glucose,blood lipid,renal function,reduce the concentration of urinary podocyte related proteins.

Objective To investigate the clinical effects on the hypernatremia in elderly patients with ARDS treated by continu-ous veno-venous hemofiltration(CVVH) .Methods Eighteen cases of elderly patients with ARDS and hypernatremia were treated by CVVH ,the serum sodium concentration was observed and the displacement fluid composition was adjusted dynamically by serum sodium concentration ,the changes of kidney function ,gas index ,plasma osmotic pressure and APACHE Ⅱ score were recorded and analyzed .Results After treatment ,the plasma osmotic pressure of patients declined [(318 .5 ± 20 .2)mmol/L vs .(294 .4 ± 15 .1) mmol/L ,P<0 .01] .After treatment ,the oxygenation index rised [(157 .4 ± 34 .2) vs .(178 .4 ± 40 .4) ,P< 0 .05] ,APACHE Ⅱscore declined[(20 .8 ± 9 .4) vs .(14 .5 ± 8 .8) ,P<0 .05] ,and the comparison of after and before treatment was statistically signifi-cant .Conclusion Therapy method of elderly patients with ARDS and hypernatremia treated by CVVH can correct hypernatremia , improve oxygenation index and APACHE Ⅱ score effectively .