Atrial fibrillation (AF) is an independent risk factors for stroke.The stroke outcome in patients with AF is poor.The mortality and morbidity were also higher.As for the higher risk of stroke in patients with AF,the application of anticoagulant drugs is needed.Apixaban is an emerging oral direct Ⅹ a factor inhibitor in recent years.Compared to the traditional anticoagulants,such as warfarin,apixaban shows certain advantages in the prevention of stroke and systemic embolism in patients with AF.

Objective To systematically assess the clinical efficacy and safety of apixaban versus enoxaparin in the prevention of venous thromboembolism (VTE) after major orthopedic surgery.Methods Based on the principles and methods of Cochrane systematic review,the Cochrane Library,PubMed,EMBASE,Chinese Bio-medicine Database,China Journal Full-text Database,VIP Database were searched from their establishment to March 2012 in whatever languages.Related journals were handsearched as well.Randomized controlled trials (RCTs) of comparing apixaban and enoxaparin in the prevention of venous thromboembolism after major orthopedic operation were included.Cochrane Collaboration' s tool was used for assessing risk of bias in the included trials.Cochrane Collaboration' s software RevMan 5.1 was used for statistical analysis.Results Four RCTs totaling 12 897 patients were included.Apixaban treatment showed significant differences in aspects of total VTE and all-cause mortality [relative risk (RR) =0.63,95％ CI(0.41,0.96)],major VTE [RR =0.59,95％ CI(0.19,0.98)] and symptomatic deep vein thrombosis (DVT) [RR =0.50,95％ CI(0.26,0.97)] when compared with enoxaparin,but the difference in fatal pulmonary embolism was insignificant[RR =1.57,95％ CI(0.41,5.99)].For patients undergoing total knee arthroplasty,apixaban was associated with significantly fewer major bleeding events[RR =0.55,95％ CI(0.32,0.96)] and fewer total bleeding events[RR =0.79,95％ CI(0.66,0.95)] than enoxaparin.For patients undergoing total hip replacement,however,the two treatments revealed no statistically significant differences.With regard to the incidence of drug-related serious adverse events,the two treatments displayed no significant difference[RR =0.97,95％ CI(0.59,1.58)].Conclusion Apixaban is effective in the prevention of VTE after major orthopedic surgery and can significantly reduce the risk of postoperative VTE.

Objective:To analyze the immune function regulation and clinical effect of dust mite drops desensitization treatment on children with allergic rhinitis.Methods:80 patients with allergic rhinitis and adenoid hypertrophy treated in our department from January 2012 to June 2014 were selected and randomly divided into experimental group and control group.Control group was treated with ebastine and levocabastine treatment, the experimental group was treated with sublingual containing Dermatophagoides Farinae Drops on the basis of control group.The level of IL-2,IL-6,house dust mite specific IgE (sIgE),dust mite IgE (T-IgE),house dust mite specific IgG4 ( sIgE in) ,blood addicted eosinophile cells ( EOS) ,and induced sputum EOS level were compared between the two groups before treatment and after 2 years treatment.Results:The level of IL-2 in the two groups was significantly higher than that before treatment,the level of IL-6 was significantly lower than that before treatment ( P<0.05 ) .After treatment, the level of IL-2 in the experimental group was significantly higher than that in the control group, the level of IL-6 was significantly lower than that in the control group( P<0.05 ).After treatment, the level of sIgE, T-IgE, blood EOS and induced sputum EOS in the two groups were significantly lower than before treatment,the level of sIgG4 were significantly higher than those before treatment (P<0.05).After the treatment,the level of sIgE, T-IgE, blood EOS and induced sputum EOS in experimental group were significantly lower than control group,and the level of sIgG4 was significantly higher than that in control group ( P<0.05).After treatment,the asthma symptom scores and nasal symptom scores of the two groups were significantly lower than before treatment (P<0.05),and those index of experimental group after treatment were significantly lower than control group ( P<0.05 ).Conclusion: Combine the basis of conventional therapy plus with Dermatophagoides Farinae Drops in the treatment of allergic rhinitis and adenoid hypertrophy children can effectively regulate the immune function of the patients,has good clinical efficacy.

OBJECTIVE: Explore the model of universal NICU newborns' hearing screening in high-risk neonates, preliminary understanding factor of hearing damage. METHOD: Transient evoked otoacoustic emissions (TEOAE) and automatic auditory brainstem response (AABR) were used to detect newborns' hearing in 13 315 objects, that is newborns' hearing screening in NICU with TEOAE test who not pass, 42 days after will use AABR rescreening. Children's Hearing Center of Guangxi Child Health Hospital will diagnose the newborns that did not pass in 3 months. RESULT: In these 13 315 newborns, 5 151 subjects who did not pass the initial screening, 1910 subjects who also did not pass after 42 days, 1167 subjects cannot pass the rescreening after 3 months, 642 subjects were diagnosed congenital hearing impairment by Brainstem Auditory Evoked Potential Test, the rate is 4.82%. CONCLUSION TEOAE and AABR are the suitable model of universal newborns' hearing screening in high-risk neonates.
Evoked Potentials, Auditory, Brain Stem ; Female ; Follow-Up Studies ; Hearing Tests ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Male ; Neonatal Screening

To effectively introduce and utilize global advanced educational resources, the implementation of Chinese-foreign joint education program in medical universities and the establishment of an internal quality assurance system with Chinese characteristics and substantially equivalent to international standards of medical education is crucial for improving the quality of Chinese medical talent cultivation and achieving high-quality development of education opening up to the outside world in the new era. Using the Chinese-Foreign Joint Education Program jointly run by Chongqing Medical University and University of Leicester as an example, this paper proposes a plan for the development of an internal quality assurance system with three core indicators of management mechanism, team building, and student services. This plan provides experience and a reference for domestic universities to carry out cross-border medical education and improve the quality and efficiency of Chinese-foreign joint education programs.

Liver-qi stagnation and spleen deficiency syndrome can be seen in a variety of clinical diseases,such as chronic hepatitis,liver cirrhosis,chronic gastritis,peptic ulcer,irritable bowel syndrome (IBS),p.sychosis and so on.Disease characteristics determine the symptom characteristic and criterion of syndrome differentiation and treatment.Therefore,different diseases with liver-qistagnation and spleen deficiency syndrome have different clinical manifestation and diagnostic criteria.This paper summarized the modern biological basis of liver-qistagnation and spleen deficiency syndrome from the nervous system,endocrine system,digestive system,circulatory system,immune system and metabolic system,in order to provide reference for researches on modern biology basis of liver-qistagnation and spleen deficiency syndrome.

Objective　To observe the incidence of white matter hyperintensities （WMHs） and the distribution of right to left shunt （RLS） in migraine patients，and to explore whether WMHs is related to RLS. Methods　106 patients with migraine were selected as the research objects. The basic data and clinical information of migraine were collected. The WMHs were evaluated by cranial MRI. The RLS was diagnosed and graded by transcranial Doppler （TCD） bubbles test. The correlation between WMHs and RLS was analyzed. Results　Among 106 migraine patients，33 （31.1%） were in WMHs+ group and 73 （68.9%） in WMHs- group. The total positive rate of RLS was 48.1% （51/106）. The distribution of different shunt levels was as follows：grade Ⅰ shunt in 27 cases （25.5%），grade Ⅱ shunt in 4 cases （3.8%），grade Ⅲ shunt in 6 cases （5.6%），grade Ⅳ shunt in 14 cases （13.2%）. In "WMHs+" group，there were 5 cases of grade Ⅰ shunt，1 case of grade Ⅱ shunt，3 cases of grade Ⅲ shunt and 10 cases of grade Ⅳ shunt；in "WMHs-" group，there were 22 cases of grade Ⅰ shunt，3 cases of grade Ⅱ shunt，3 cases of grade Ⅲ shunt and 4 cases of grade Ⅳ shunt. Compared with "WMHs+" group and "WMHs-" group，there was no statistical difference in the overall positive rate of bubbles test between the two groups （P>0.05，χ2=1.719），but the large shunt rate of "WMHs+" group was significantly higher than that of "WMHs-" group （P<0.01，χ2=13.188）. Conclusion　There is no significant correlation between WMHs and RLS in migraine patients，but large RLSs will increase the risk of WMHs in migraine patients.

Objective:To investigate the nutritional status of rectal cancer patients with permanent enterostomy.Methods:From January 2019 to May 2021, the convenient sampling was used to select 180 rectal cancer patients with permanent enterostomy who were reexamined in the Outpatient Department of the First Affiliated Hospital with Nanjing Medical University as the research objects. The general information questionnaire, Patient Generated-Subjective Global Assessment (PG-SGA) and Chinese version of Ostomates' Adjustment Inventory-20 (OAI-20) were used for investigation. Pearson correlation analysis was used to explore the correlation between nutritional status and stoma adaptation level. A total of 180 questionnaires were distributed and 173 valid questionnaires were recovered, with an effective recovery rate of 96.11%.Results:The total score of PG-SGA and OAI-20 were respectively (7.85±3.23) and (41.89±2.48) among 173 rectal cancer patients with permanent enterostomy and 138 patients were malnourished and 35 patients were well nourished. There were statistically significant differences in age, stoma complications, history of chemotherapy and stoma adaptation between the malnutrition group and the well-nutrition group ( P<0.05) . Pearson correlation analysis showed that the total score of OAI-20 was negatively correlated with the total score of PG-SGA in rectal cancer patients with permanent enterostomy ( r=-0.723, P<0.01) . Conclusions:The nutritional status of rectal cancer patients with permanent enterostomy is poor, and the nutritional status is related to the level of stoma adaptation.