Objective To explore the application effect of action-oriented teaching method in senior midwifery practice teaching.Methods Selecting 30 students from class 1,grade 2011 of the midwifery professional for the experimental group,another 30 students from class 2 for the control group.We selected four core contents for the experimental teaching refbrm such as obstetric abdominal examination,external pelvimetry measurement,prenatal vulva washing disinfection and sterile towel covering before the delivery.The experimental group was taught by action-oriented teaching,in accordance with the procedures:putting forward the projects or work task,set goals and grouping,making work plans,implementing and evaluating.The control group was taught by traditional teaching.We used questionnaire smvey and skills examination to evaluate the teaching effects and conducted teaching satisfaction scores and scores for t test to two groups of students.Results (1)Questionnaires:The resuhs of the 18 issues on the teaching effect evaluation,professional technology level and nursing soft skills,etc.showed that the experimental group's evaluation of the action-oriented teaching is higher than the control group's evaluation of the traditional teaching(P＜0.05),action-oriented teaching is more helptul to improving the professional skill and nursing soft skills(P＜0.05).@The scores of skill examination:The skills scores of the experimental group(80.01 ± 9.36) were significantly higher than those of the control group(71.32 ± 8.85)(t=3.70,P=0.000).The difference was statistically significant (t=3.70,P=0.00).Conclusions Action-oriented teaching helps to raise practice teaching effecr,train students' clinical work ability and nursing soft skills.It is suitable for practice teaching of senior midwifery.

Objective To carry out a meta-analysis on the published data to evaluate therapeutic effects of intact canal wall mastoidectomy and open mastoidectomy for cholesteatoma otitis media .Methods A comprehensive search was performed in VIP (1989-2015) ,WANFANG (1999-2015) ,CNKI (1994-2015) and CAJD databases to collect the randomized controlled trials (RCTs) on the intact canal wall mastoidectomy and open mastoidectomy treat cholesteatoma otitis media ,and to analyze the RCTs in meta -analysis method .Results 1 069 patients were analyzed in the 18 RCTs which met the inclusion criteria .Patients were followed up from 3 months to 7 years .The meta-analysis results suggested that ,compared with the open mastoidectomy group ,the patients had less operative time (test for overall effect :Z=15 .54 ,MD= -18 .36 ,95% CI(-24 .54 ,-12 .18) , P<0 .000 01) ,less dry ear time (test for overall effect :Z=8 .64 ,MD= -13 .90 ,95% CI(-17 .05 ,-10 .75) , P<0 .000 01) ,less complica‐tions (test for overall effect :Z=7 .63 ,OR=0 .19 ,95% CI(0 .12 ,0 .29) , P<0 .000 01) ,and more patients with decreased pure tone air conduction thresholds >10 dB (test for overall effect:Z=2 .83 ,OR=2 .47 ,95% CI(1 .32 , 4 .61) ,P=0 .005) ,more patients with air-bone gaps <20 dB(Z=3 .05 ,OR=1 .60 ,95% CI(1 .18 ,2 .17) ,P=0 .002) ,but the recurrent rate is not different significantly (test for overall effect :Z= 1 .92 ,OR =1 .87 ,95% CI (0 .99 ,3 .53) ,P=0 .05) .Conclusion The illness is suitable to be treated by using the two surgical ways while the intact canal wall mastoidectomy treatment takes less operative time ,dry ear time and complications ,and improve hearing more significantly than the open mastoidectomy ,but the recurrent rate is not different significantly for trea‐ting cholesteatoma otitis media .

Objective To observe the effects of Bushen Huoxue Formula on free radical metabolism and p16 protein expression in heart of aged rats; To discuss its protective mechanism to the heart of aged rats.Methods One hundred were divided into young control group, the natural aging group,Bushen HuoxueFormula high-, medium- and low-dose groups, with 20 rats in each group. Each medication group was given relevant medicine for gavage, once a day for 16 weeks. 1 hour after the last administration, after the rats were sacrificed, serum and heart were taken. The contents of NO and MDA and activities of CAT and SOD in serum and myocardial,β-galactosidase enzyme and p16 protein expression in myocardial tissue were detected.ResultsCompared with the natural aging group, NO content and SOD activity in the serum of rats inBushen Huoxue Formula high-dose group increased significantly (P<0.05) and MDA content in allBushen Huoxue Formula groups decreased (P<0.01); NO content, CAT and SOD activity in the myocardial tissue of rats inBushen HuoxueFormula high-dose group increased significantly, and MDA content decreased significantly (P<0.05). CAT activity in allBushen HuoxueFormula groups increased (P<0.05,P<0.01).β-galactosidase enzyme and p16 protein expression in myocardial tissue in allBushen Huoxue Formula groups decreased.Conclusion Bushen Huoxue Formula can in hibit the aging of myocardial-aged rats, and the mechanism might be related to its anti-oxidative damage and inhibition of tumor suppressor gene p16 expression.

AIM:To investigate the effect of compound of cordyceps sinensis(CS) and tripterygium hypoglaucum on survival time of the heterologous human-pig graft skin.METHODS: CS solution were used to hatch the skin graft and CS was used locally.Ciclosporin A(CsA) and normal saline solution(NS) were used in control.Besides,skin HE staining was detected and CD4,CD8,IL-2 and IL-10 were also examined before and after operation.RESULTS: The survival time of the graft skin treated with CS was(21.20?3.19) days,while the control group treated with NS was(10.17?1.94) days(P

OBJECTIVE To survey the patient with pulmonary infection induced by extended-spectrum ?-lactamases-producing bacteria and their Enterobacteriaceae clinical characteristics, drug-resistance and countermeasure. METHODS Isolation, cultivation, identification, drug-sensitivity tests and confirmation of ESBLs-producing bacteria were done for the bacteria of sputum specimens collected from our hospital from Feb 2001 to Sept 2004. Susceptibility testing was performed by disk diffusion(K-B)method. RESULTS Totally 541 strains of Enterobacteriaceae were cultivated altogether and ESBLs-producing bacteria were 135 strains. The ESBLs- producing strains were sensitive to imipenem, and the resistance rates to it were 0.00% . The resistance rates of ESBLs-producing strains to cefoperazone/sulbactam and piperacillin/tazobactam were 31.11% and 44.44%, respectively . The multi-drug-resistance (MDR) rate of ESBLs-producing strains was higher than that of strains no producing ESBLs (P

Objective To explore the effects of compound Danshen dripping pills on the expression levels of micro RNA-1 (miR-1) and inflammatory factors in serum of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods A total of 180 AMI patients admitted to Mindong Hospital of Ningde City from March 2017 to October 2018 were divided into a compound Danshen dripping pills group and a conventional western medicine treatment group, 90 cases in each group. According to the disease situations of all the patients, they needed to undergo PCI treatment, after the intervention, in the conventional western medicine treatment group, aspirin enteric-coated tablet (metformin hydrochlorid) was given as the basic anti-coagulation medicine and in the compound Danshen dripping pill group, on the basic treatment, 10 Danshenn pills each time, 3 times a day, were orally applied. Both groups were evaluated for efficacy after 2 months of continuous treatment. Echocardiography was used to detect the patients' cardiac functions; the changes of the expression levels of serum miR-1, interleukins (IL-1, IL-6), tumor necrosis factor-α (TNF-α), and myocardial troponin I (cTnI) and creatine kinase isoenzyme (CK-MB) in the two groups before and after treatment were observed. Results After treatment in both groups, the left ventricular ejection fraction (LVEF) and cardiac output index (CI) were significantly higher than those before treatment, while the expression of miR-1 and serum IL-1, IL-6, TNF-α, cTnI and CK-MB were lower than those before treatment, the LVEF and CI in the compound Danshen dripping pill treatment group were obviously higher than those in the conventional western medicine treatment group [LVEF: 0.60±0.08 vs. 0.56±0.08, CI (L·min-1·m-2): 6.02±0.34 vs. 4.91±1.50, both P < 0.05], the expression level of miR-1 and serum IL-1, IL-6, TNF-α, cTnI and CK-MB in the compound Danshen dripping pill group were lower than those in the conventional western medicine treatment group [miR-1 (2-ΔΔCt): 0.69±0.17 vs. 0.85±0.22, IL-1 (μg/L): 59.20±18.67 vs. 68.31±23.69, IL-6 (μg/L): 20.36±1.87 vs. 25.38±2.39, TNF-α (μg/L): 28.65±1.63 vs. 31.86±2.92, cTnI (μg/L):3.12±0.88 vs. 4.03±0.97, CK-MB (U/L): 29.18±10.52 vs. 34.28±10.21, all P < 0.05]. Conclusion Compound Danshen dripping pills can reduce serum the expression levels of miR-1 and inflammatory cytokines in patients with AMI after PCI.

Objective To investigate the protective effect of dexamethasone on stress response induced by intraute-rine balloon aortic valvuloplasty (IUBAV) in a fetal lamb model. Methods Twenty-four near term twin pregnant goats were randomly assigned to control group (n=12) and dexamethasone group (intracardiac injection of dexamethasone) (n=12). Ultrasound guided IUBAV model was established. According to the combination of treatment and operation, 48 fetal lambs were divided into four groups. The following parameters were dynamically monitored by ultrasound, which were fetal and neonatal heart rate (HR), cardiac rhythm, aortic resistance index (RI) and pulsatility index (PI). On established IUBAV model, blood samples and liver tissue specimens were taken from fetal/neonatal goats for detection of blood glucose (Glu), lactate acid (LA), plasma epinephrine (E), norepinephrine (NE), cortisol (Cort), hepatic glycogen staining. Results IUBAV resulted in increased values of Glu, LA, E, NE and Cort levels, and decreased pH value, there were significant differences between pre-and 3h-post procedure (P<0.05), and significant differences were also existed in these values between pre-and 3d-post procedure (P<0.05). After administrating dexamethasone, the changes of Glu, LA, E, NE, Cort and pH levels were suppressed effectively. Fetal hepatic glycogen was consumed in large amounts due to IUBAV while recovered 3 days after IUBAV by glycogen staining. After administrating dexamethasone, hepatic glycogen consumption related to IUBAV was obviously inhibited. After IUBAV, fetal aortic RI was increased, and there was significant differences compared with pre-procedure (P<0.05). Up to 3d-post procedure, the values of RI recovered to some extent, but statistical difference was exist-ed compared with pre-procedure (P<0.05). After administrating of dexamethasone, increased aortic RI was effectively sup-pressed. Conclusions IUBAV could lead to reversible stress response and increased aortic RI in a fetal lamb model which could be alleviated by dexamethasone.

Objective? To investigate the status quo of depression and cognitive function of the elderly in aged care institutions in the urban area of Hangzhou, analyze the influencing factors of cognitive function and its correlation with depression, so as to provide reference for the design of later intervention measures. Methods? A total of 130 elderly people from 3 aged care institution of 3 districts of Hangzhou were recruited by convenience sampling method from March to May 2018. Montreal Cognitive Assessment and the Chinese version of Geriatric Depression Scale were applied to assess the cognitive function and depression symptoms of the elderly in aged care institutions. Logistic regression analysis was used to explore the influencing factors of cognitive function, and Pearson correlation analysis was applied to analyze the correlation between depression and cognitive function in elderly people in aged care institutions. Results? The incidence of depression in the elderly was 24.62% (32/130) and the incidence of mild cognitive impairment was 89.23% (116/130). The results of Logistic regression analysis showed that gender (OR=5.379,95%CI: 1.152-25.109), age (OR=1.129,95%CI:1.008-1.266) and educational level (OR=0.353,95%CI: 0.193-0.645) entered the model. Pearson correlation analysis showed that there was no significant correlation between depression level and cognitive function in the elderly in aged care institutions (P＞ 0.05). Conclusions? Depression and cognitive status of the elderly people in aged care institutions are in urgent need of attention. It is suggested that an intervention that focuses on reducing the incidence of depression and cognitive impairment should be provided to improve the quality of life of the elderly people.

Objective: To investigate the design of free perforator flap, and the efficacy of utilizing perforator flaps for Ⅳ degree Ischia-sacral ulcer treatment. Methods: From January 2010 to October 2016, 18 patients with Ⅳ degree ischia-sacral ulcer were treated. The surface area of the sacral tail ranged from 4 cm×5 cm to 8 cm ×12 cm.Doppler sonography was used to detect potential perforator.All defects were repaired with free perforator flaps, designed based on the size and shape of the wound. The flap size ranged from 6 cm×11 cm to 9 cm×15 cm. Results: One perforator flap went dehiscence after surgery, repaired by V-Y flap. All the rest of perforator flaps survived well, after 3-24 months follow-up. Flap texture and appearance was good, no ulcer reoccurred. Conclusions The free perforator flap is a simple technique.It does not need to tracethe trunk of vessels, and it does not cause major morbidities to the buttocks. Therefore, it is one of the ideal ways to repair Ⅳ degree Ischia-sacral ulcer.

Objective: To investigate the feasibility and efficacy of free lobulated lateral circumflex femoral artery perforator flap for foot and ankle defect at non-weight bearing area. Methods: From January 2008 to June 2016, 28 cases with foot and ankle skin and soft tissue defects at non-weight bearing area were treated, including 16 cases with traffic accident, 8 cases with machine injury, and 4 cases with falling injury. There were 10 cases with Achilles tendon exposure, 16 cases with dorsalis pedis tendons exposure and 12 cases with bone exposure. The defect size ranged from 10 cm×8 cm to 16 cm×13 cm. Doppler ultrasound detector was used to select two perforators of lateral femoral circumflex artery. The lobulated perforator flap was designed and harvested as one flap. After clip test was performed to make sure the blood supply of flap, the flap was segmented and repositioned to cover the wound. The width of lobulated flaps was less than 8cm, in order to close the defect at donor sites directly. Postoperative rountine anti-inflammatory, anticoagulant, anticonvulsive treatment and function exercise were adopted. The patients were followed up for 6-28 months. Results: The flap size ranged from 9.0 cm×4.5 cm to 17.0 cm×7.0 cm. Partial necrosis happened at the end of one flap lobe due to pressure, which healed after dressing. All the other 27 flaps survived completely with satisfactory cosmetic and functional result. The wounds at donor sites all healed primarily. Conclusions Free lobulated lateral circumflex femoral artery perforator flap is one of the ideal flaps with high survival rate and low complication for foot and ankle defect at non-weight bearing area.