Objective:To investigate the clinical value and age stratification significance of anti-mullerian hormone (AMH) combined with sex hormone in the diagnosis of patients with polycystic ovary syndrome (PCOS).Methods:The clinical data of 164 patients with PCOS(PCOS group) and 120 healthy women(control group) were retrospectively chosen from January 2015 to December 2018.The age, sex hormone index levels and AMH levels of the two groups were compared.The clinical efficacy of single index and combined index detection in the diagnosis of PCOS were analyzed.The correlation between AMH level and age, sex hormone index was evaluated and the influence of age stratification on the diagnosis of PCOS was observed.Results:The levels of AMH, T, LH and LH/FSH ratio in the PCOS group were (62.90±5.19)pmol/L, (1.36±0.55)nmol/L, (12.86±2.4)IU/L, (2.27±0.86), respectively, which were significantly higher than those in the control group [(27.22±3.72)pmol/L, (0.87±0.30)nmol/L, (6.41±1.18)IU/L, (1.15±0.53)] ( t=7.38, 3.76, 5.15, 3.89, all P<0.05). The sensitivity of AMH in the diagnosis of PCOS was significantly higher than LH and LH/FSH(χ 2=5.72, 14.10, all P<0.05). The sensitivity of AMH+ T, AMH+ LH and AMH+ T+ LH were 89.02%, 87.80%, 95.12%, respectively, which were significantly higher than AMH alone (80.49%)(χ 2=5.67, 4.33, 10.94, all P<0.05). There was no significant ststistically difference among AMH, T, LH and LH/FSH in the diagnosis of PCOS(χ 2=0.38, P>0.05). There was no significant ststistically difference in the specificity of AMH alone, AMH+ T, AMH+ LH, AMH+ LH/FSH and combination of AMH+ T+ LH in the diagnosis of PCOS(χ 2=0.45, P>0.05). The AUC of AMH in diagnosis of PCOS was 0.86, which was significantly higher than T, LH and LH/FSH(0.714, 0.765, 0.783)( Z=2.09, 2.43, 2.20, all P<0.05). Spearman correlation analysis showed that there was positive correlation between AMH level and T, LH, LH/FSH in PCOS group ( r=0.27, 0.25, 0.33, all P<0.05). There was negative correlation between AMH level and age in healthy group( P>0.05). The critical value of AMH in diagnosis of PCOS was decreased with the increase of age.The sensitivity, specificity and ROC-AUC of AMH in 25-29 years old group and 30-37 years old group were higher than whole population( r=-0.33, P<0.05). Conclusion:The combination of AMH+ T, AMH+ LH or AMH+ T+ LH can improve the diagnosis sensitivity of PCOS, but the specificity is similar to AMH alone; then age stratification for the AMH critical value can increase the diagnosis accuracy of PCOS.

Objective:To investigate the application effect of rapid leg circumference positioning measuring device in critical ill patients.Methods:From August 2021 to November 2021, selected 50 patients in ICU of Hangzhou First People′s Hospital. Two methods to measure the leg circumference of the same patient at the same time were used. The traditional method used a tape measure to measure the leg circumference, while the improved method used the rapid positioning and measuring device of leg circumference to measure the leg circumference. the average total positioning time, average total measurement time, average measurement difference and nurses′ satisfaction were compared.Results:The total positioning time and total measurement time of the improved method were respectively (15.2 ± 3.3) s and (34.0 ± 3.9) s, which were shorter than the traditional method (29.0 ± 3.1) s, (79.1 ± 4.9) s, the differences were statistically significant ( t=50.93, 21.43, P<0.05). The measured data difference between 15 cm above patella and 10 cm below patella of the improved method was (1.27 ± 0.67) mm, (0.93 ± 0.31) mm, which were less than the traditional method (8.82 ± 3.28) mm and (7.94 ± 2.11) mm, the differences were statistically significant ( t=28.66, 23.42, P<0.05). Nurses′satisfaction in the improved method was 96.0% (48/50), which was higher than 36% (18/50) in the traditional method, and the difference was statistically significant ( Z=5.78, P<0.05). Conclusions:The leg circumference measurement device designed in this study can effectively save the leg circumference measurement time, quickly and accurately, increase the comfort of patients and improve the satisfaction of patients and nursing staff. It is worthy of clinical application.

Ventilator-associated pneumonia (VAP) is one of the most common infectious diseases in patients undergoing mechanical ventilation in intensive care unit (ICU). Although the use of closed sputum suction tube for sputum suction is the most common nursing measure for patients with tracheal intubation in ICU, and it is also an important measure to reduce the occurrence of VAP, the existing clinical technology still needs to use external flushing solution for humidification and flushing. In the process of use, the flushing operation has the risk that the amount of flushing fluid cannot be controlled, resulting in a large amount of flushing fluid entering the patient's airway, causing the patient to suffocate. The sputum attached to the wall of the sputum suction tube cannot be completely flushed, and the prolonged retention of the sputum leads to the proliferation of colonized bacteria, aggravating the infection of patients. Repeated pipe flushing not only increases consumables, but also increases the workload of medical staff. For this reason, the author has designed a fully enclosed sputum suction tube flushing device, which has obtained the National Utility Model Patent of China (patent number: CN 2019 2 1198740.5). This device is an integrated design, and the materials used for sputum suction, humidification and flushing are fully enclosed, without air exposure, and can be operated strictly without bacteria. Pulse flushing with syringe can clean the sputum attached to the inner wall and reduce the incidence of VAP. The volume of flushing fluid can be effectively controlled during use to ensure patient safety and reduce waste. It is worth popularizing and applying in clinical practice to optimize the operation steps and reduce the workload of medical staff.

Patients in the intensive care unit (ICU) often need to have various catheters placed on their bodies due to their severe condition. In order to prevent the occurrence of unplanned extubation, patients' hands should be restrained appropriately. The current restraint gloves used in clinical practice have problems such as improper restraint, easy falling off of oxygen saturation monitoring probes, and pressure injury of hands. Therefore, department of critical care medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine designed a wrist restraint glove suitable for restless patients, and obtained the national utility model patent (ZL 2020 2 1612453.7). The device is composed of restraint gloves and restraint rings, which can not only restrain patients, but also continuously monitor the changes of blood oxygen saturation in patients with restfulness. This device is convenient to use, low cost, comfortable to wear, and can prevent the occurrence of device-related pressure injuries, which is suitable for clinical application.
Humans ; Wrist ; Intensive Care Units ; Critical Care ; Hand ; Upper Extremity ; Restraint, Physical

Deep venipuncture catheterization is a routine and basic operation in the treatment of critically ill patients, and it is the most effective way to quickly correct the shock. Clinical B-ultrasound guided deep vein catheters can improve the success rate of puncture, but in the process of operation, the short axis needs to be replaced by the long axis. In the replacement process, the stability of the novice is insufficient, the positioning is difficult, and the operation time is too long. If only short axis puncture is used, it is impossible to know whether the current position of the puncture needle, and the puncture may be too deep and stray into the artery. The accuracy of the 45 degree angle of the injection point requires a very experienced operator. In view of the above shortcomings, doctors in the department of critical care medicine of Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine designed a B-ultrasound puncture equipment, which has obtained the National Invention Patent of China (ZL 2016 1 0571557.X). The device is composed of B-ultrasound probe fixing frame, sliding scale plate, simulation slide rule, puncture needle, sliding device. By sliding device the angle of the pinhole channel, it is conducive to the accurate positioning of the puncture target, optimizing the operation procedure, improving the puncture speed and accuracy, effectively reducing the occurrence of puncture complications, ensuring patient safety, reducing unnecessary waste of human and material resources. It can reduce the workload of medical staff and is worthy of clinical practice.
Humans ; Catheterization, Central Venous/methods* ; Ultrasonography, Interventional/methods* ; Ultrasonography ; Punctures/methods* ; Needles

Objective To explore the feasibility of smart-planes fetal heart ( S-planes FH ) in the display of the fetal ventricular outflow views ,and to compare diameters of fetal aorta ( AO) and pulmonary artery (PA) measured using two-dimensional echocardiography(2DE) and S-planes FH . Methods One hundred and eighty-five fetuses with gestational age of 17 - 36 weeks were enrolled . Each fetus had undergone conventional 2DE examination and the three-dimensional fetal cardiac volume datasets were obtained . The volume datasets were analyzed offline using S-planes FH . The diameters of AO and PA were measured by 2DE and S-planes FH ,respectively . Pearson correlation analysis was used to evaluate the correlation between the two methods for measuring the diameters of AO and PA . The consistency of the two methods was verified by Bland-Altman analysis . Results Fetal ventricular outflow views were successfully obtained using S-planes FH in 173 ( 93 .5％ ) cases of 185 fetuses whose ventricular outflow views were satisfactorily obtained by fetal 2DE . There were close correlations between the two methods in measuring the diameters of AO and PA ( r = 0 .84 , P = 0 .04; r = 0 .81 , P = 0 .00 ) . Bland-Altman analysis showed a close consistency between the two methods ,and their 95％ confidence intervals were ( -1 .17 ,1 .00) and ( -1 .79 ,1 .02) ,respectively . Conclusions There is a close consistency between S-planes FH and 2DE in measuring fetal AO and PA . S-planes FH may have potential for the evaluation of fetal ventricular outflow .