Objective To discuss the feasibility and the security of implementing the abodomen-type horizon- tal margin improvement in-fascia womb excision method to the womb benign pathological change.Methods Among the womb bening pathological change patients who were treated in our hospital from October 2000 to October 2004. 80 examples were implemented the abdomen-type horizontal margin improvement in-fasica womb excision method as the research group and 90 examples were implemented the traditional vertical margin womb excision method as the comparison group.The patients' age,sickness type,the womb size and the pelvic cavity adhesion of the tub groups had no significant difference.The surgery time,the bleeding quantity in the course of the operation,the margin ache situation,the exhaust time and getting sick rate after the surgery,the exhaust time and getting sick rate after the surgery,the hospitalization time and sex life situation after the surgery,and so on were analyzed.Results The re- search group's bleeding quantity in the course of the operation,the margin ache,the exhaust time and getting sick rate after the operation were obviously lower than those of the comparison group(P＜0.05),moneover,it was not found out that the vagina remnant end was exceptional,and the vagina wall was nelaxing or escaping or hanging,the degnce of satisfaction to the sex life obviously surpasses that of the comparison group(P＜0.05).Conclusion The abdomen-type horizontal margin inprovement in-fascia womb excision method is safe and feasible to the womb benign pathological change.

Objective To highlight the role of physician's experience in physical examination for the early diagnosis of breast cancer.Methods Data of physical examination of mammary glands in 1785 female were analyzed and compare with the uhrasonography and mammngraphy results.Results Of the 31 breast cancers confirmed by pathologic examination after operation,2 cases were bilateral breast cancers and 1 was nonpalpable.9 of 41 cases which suspected by inspection were confirmed as breast cancers.The significant difference was found comparing with control group by X2 test (X2=100.5,P＜0.05).The 34 breast cancers were found in 2089 focus in palpation and there were 6 minimal cancers (diameter≤1.0 cm) among them.Some cancers were found in special location with no malignant clinical manifestation.The rate of missed diagnosis of ultrasonography and rnammography is 16.1% and 19.4%,respectively.Conclusions Physical examination plays an important role in the early detection of breast cancer and physician's experience is a major determinant for avoiding misdiagnosis.

Objective To investigate the cognition and participation on organ donation in ICU medical staff and analyze the influencing factors, thus to provide reference for the development organ donation promotion measures. Methods 265 ICU medical staff were chosen by convenient sampling method from 10 three-level hospitals in Chongqing and were investigated with a self-designed questionnaire about the cognition, willingness and its influencing factors towards organ donation. Results ICU medical staff′s understanding of brain death, significance, basic conditions and concepts of organ donation were 67.2% (178/265), 61.1% (162/265), 60.0% (159/265), 55.8% (148/265) respectively, but understanding of Principles , registration methods, laws and regulations, and procedures of organ donation were 24.5%(65/265), 12.1%(32/265), 7.9%(21/265), 4.5%(12/265) respectively. 47.5%(126/265) ICU medical staff were willing to donate their own organs, 35.8%(95/265) were consented to relative′s organ donation and 4.5% (12/265) were organ donation applications. 89.1% (236/265) were affected by traditional ethical concepts, 70.2%(186/265) were for the publicity not enough, 51.7%(137/265) did not know about the procedures of organ donation, 37.0%(98/265) were for too much troubled procedures, and 43.8%(116/265) were for the ineffective work of relevant organizations. Conclusions Lacking in-depth understanding of organ donation and low willingness to donate organs in ICU medical staff in Chongqing. Mainly associated with the effect of traditional concept and lack of propaganda to the donation.

Objective To explore the impulsivity and aggressivity,and its treatment outcomes of the inpatients with intemet addiction disorder (IAD) by intergration interview. Methods Barratt Impulsiveness Scale ( BIS), Buss Aggressive Scale (BAS) were used to assess the impulsiveness and aggressivity in 58 IAD patients, at the first week and after the point of intergration interview 3 months,54 normal subjects in the control group were conducted by BIS and BAS only when they were recruited. Results ①The intemet addiction group had significantly higher scores on the BIS and BAS total scores than the control group at the first week ( BIS score 99.3 ±15. 1vs 75.0 ± 15.4, t=8.47, P＜0. 01; BAS score 78.3 ±24.4 vs 54.8 ± 17.7, t=5.87 , P＜0. 01 ). IAD group had lower scores on the total scores of BIS-Ⅱ and BAS after intergration interview than before, but the subscales and total scores were higher than those in the control group ( BIS score 86.3 ± 16.6 vs 75.0 ± 15.4, t =4.98, P ＜ 0.01 ;BAS score 66.2 ± 22.6 vs 54.8 ± 17.7, t = 3.65, P ＜ 0. 01 ). ②Total score of SCL-90 in IAD group were significantly correlated with the BAS total score ( r=0. 376, P＜0. 01 ) ,and the decreased SCL-90 total score was also related with the decreased BAS score ( r= 0.508, P＜ 0. 01 ). Conclusion This study suggests that IAD group exhibit more impulsivity and aggressivity than those in the control group. After interview, their impulsivity and aggressivity are significantly decreased, but are still higher than those in the normal control group.

Objective To explore the effect of security,self-acceptance,self-concept,intemet addiction,anxiety,depression on the suicidal ideation of internet addiction patients.Methods The safety,self-acceptance,self-concept,internet addiction,anxiety and depression of 220 internet addiction patients were assessed using the corresponding scale tools.Suicidal ideation was used as the dependent variable,and each influencing factor was used as the independent variable.Correlation analysis,multiple stepwise regression analysis and path analysis were utilized to analyze the predisposing factors.Results The suicidal ideation (12.65 ±5.72) was positively correlated with internet addiction assessment (73.35± 15.83),depression self-evaluation (56.33± 13.75) and anxiety self-assessment (48.93± 17.20) (r=0.250,0.636,0.531,P＜ 0.01),while negatively correlated with security (50.26± 12.33),self-acceptance (38.29±7.15),and self-concept (56.47± 17.92) (r=-0.390,-0.297,-0.298,P＜ 0.01).Sequentially depression (β =0.571,P＜ 0.01),anxiety (β =0.173,P=0.003) were entered into the multiple regression equation.Path analysis based on the structural equation model showed that suicidal ideation had a direct effect with depression and anxiety,with effect values of 0.583 and 0.176.There were indirect effects of self-concept,self-acceptance,sense of security,and internet addiction assessment.The effect values were-0.137,-0.117,-0.281,and 0.034.The total effect of suicidal ideation and self-concept,self-acceptance,sense of security,internet addiction,depression self-assessment,and anxiety self-assessment were-0.137,-0.117,-0.281,0.034,0.583 and 0.176 respectively.Conclusions The influence of security,self-acceptance,and self-concept on suicidal ideation is produced through the mediating effects of depression and anxiety,and it has a negative predictive effect.There is no direct causal relationship between internet addiction and suicidal ideation.

Objective To investigate the construction of outpatient quality care services and the needs of patient for outpatient service,and to explore the relevance of the two projects.Methods A total of 152 cases of outpatient department registered nurse of Beijing Union Hospital and 281 cases of hospitalized patients on May,2017 were selected,and then developed the Content Questionnaire on Quality Nursing Work of Outpatient Nurse and the Questionnaire on Outpatient Needs Status to carry out investigation.Results This kind of hospital patients with college or university in 216 cases(76.9%,216/281),personal monthly income of 5.0-10.0 thousand accounted for 44.8%(126/281);outpatient nurses aged ≥46 in 83 cases(54.6%,83/152),the working time≥20 years in 120 cases(78.9%,120/152),college degree or above in 137 cases(90.1%,137/152),97 nurses(63.8%,97/152)in charge.The clinic nursing work relates to the rate of above 85%for disease treatment and consultation,health education,guidance service,self-service system services,on-site inspection,consulting room environment,and the cost of nurses working hours and the most frequent content for the on-site inspection and diagnosis of diseases,counseling,health education,medical order service.The order of patients' needs from high to low was disease and consultation,health education,guidance service,order service,on-site inspection,self-service system,registration service,waiting environment and consulting room environment.There was no correlation between the patient's needs and the rate of nursing,the length of work,and the frequency of work(P＞0.05).There were significant differences in the demand for health education on each department(F =3.047,P ＜0.05),education level,medical order service and on-site inspections have significant difference on demand(F=3.809,3.409,P＜0.05),family income,sources of patients were not statistically significant in the comparison(P＞0.05).The outpatient quality care services had lower improved demand(≤26%),and the first six item that needed to improve are disease and medical consultation,self-service system,treatment order service,waiting environment,health education,guidance services.Conclusions In view of the characteristics of outpatient medical staff and patients in large general hospitals,we will improve the quality of outpatient service and meet the needs of patient outpatient service,which will help to deepen the medical reform and improve the quality of medical service.

Objective To investigate the current status of self-management in patients after mechanical heart valve replacement(MHVR) and the influential factors. Methods The convenience sampling method was used to obtain the sample in Chongqing Province, and 400 participants after MHVR at a month in 3 top three hospitals were recruited (Department of Cardiothoracic Surgery, the First Hospital of Chongqing Medical University. The Second Clinical Medical College of Third Military Medical University. The Third Clinical Medical College of Third Military Medical University). Self-Management Scale for patients after Mechanical Heart Valve Replacement edited by ourselves were used to collect the data. Results The score of patients were 79-119 (96.81 ± 7.86) points. The influential factors were sex, age, education level and the resident manner. Conclusions The self-management level of patients after MHVR is not so bad, the male, advanced age, live with distant relatives or housemaid, low education level's patients' self-management ability are low, the medical workers should strenghen health education in these patients.

Objective To analyze the expression of miR-4524a-3p in peripheral blood mononuclear cells(PBMCs)and major immune cell subsets of patients with systemic lupus erythematosus(SLE),and evaluate its clinical application.Methods Peripheral blood samples were collected from SLE patients and healthy controls,followed by isolation of PBMCs,CD3+T lymphocytes,CD19+B lymphocytes,and CD14+monocytes using human peripheral blood lymphocyte isolation solution(Ficoll)and immunomagnetic bead cell sorting.The expression level of miR-4524a-3p was quantified using fluorescence quantitative PCR.Pearson's linear correlation analysis was per-formed to assess the relationship between miR-4524a-3p expression and the disease activity score in SLE patients(SLEDAI).Additionally,the diagnostic efficacy of miR-4524a-3p for SLE was evaluated by constructing a receiver operating characteristic curve(ROC).Results The expression of miR-4524a-3p was significantly decreased in PBMCs(P<0.05),CD3+T cells(P<0.001),and CD14+monocytes(P<0.001)from patients with SLE compared to healthy controls.Furthermore,it exhibited a negative correlation with SLEDAI score(r=-0.406,P<0.01).Notably,the expression level of miR-4524a-3p was significantly lower in patients with moderate or severe active stage than those in mild and inactive stages(P<0.01).In addition,the SLE subgroup with lupus nephritis and joint involvement displayed lower levels of miR-4524a-3p compared to the subgroup without such manifestations(P<0.01).Importantly,ROC analysis demonstrated that miR-4524a-3p holds promising diagnostic value for SLE.Conclusion The expression of miR-4524a-3p was significantly diminished in CD3+T cells and CD14+monocytes derived from patients with SLE,exhibiting a close association with disease activity and demonstrating potential clinical diagnostic value for SLE.

OBJECTIVE: To compare the clinical application and health economic values of non-invasive prenatal testing (NIPT) and second trimester serum screening (STSS). METHODS: A retrospective analysis was carried out on 54 026 singleton pregnant women undergoing NIPT and STSS from March 1, 2018 to December 31, 2019 in Changsha Maternal and Child Health Care Hospital. For pregnant women with high-risk results of NIPT, prenatal diagnosis and follow-up of pregnancy outcomes were conducted. The data was grouped to 4 screening models, and their cost-benefit was analyzed. RESULTS: The sensitivity, specificity and positive predictive value of NIPT were all higher than STSS. Screening models 1 to 4 have prevented the birth of 71, 29, 52 and 54 patients with Down syndrome, respectively. The safety index of screening models 1 to 4 were 0.0036, 0.3944, 02215 and 0.1281, respectively. When the price of NIPT was decreased to 600 RMB, the cost-benefit of the screening models 1 to 4 was 0.46, 0.65, 0.44 and 0.40 million RMB, respectively. CONCLUSION NIPT has a better detection performance than STSS. When the price of NIPT is 600 RMB, screening model 1 has the best screening effect and the highest accuracy, safety index and health economical value.
Child ; China ; Cost-Benefit Analysis ; Down Syndrome/diagnosis* ; Female ; Humans ; Pregnancy ; Prenatal Diagnosis/methods* ; Retrospective Studies

OBJECTIVETo determine whether lysosome-associated protein transmembrane-4 beta (LAPTM4B) over-expression is associated with the proliferation and invasion in colorectal cancer (CRC).

METHODSThirty pairs of CRC tissues, containing carcinoma and adjacent tissues, were used for the examination of LAPTM4B mRNA expression by real-time quantitative PCR (qPCR) assays. Then immunohistochemistry was performed to examine LAPTM4B protein expression in 6 pairs of CRC tissues. Over-expression LAPTM4B and low-expression LAPTM4B cell models were constructed with HCT116 CRC cell lines. CCK8 assay was used to detect the proliferation and Transwell assay was used to detect the invasion of the model cells.

RESULTSqPCR and immunohistochemistry results showed that LAPTM4B expression levels in CRC were higher compared to adjacent tissues (all P<0.01). CCK8 and Transwell assays results showed that LAPTM4B promoted proliferation and invasion of HCT116 cell lines model cells (all P<0.01).

CONCLUSIONLAPTM4B promotes the proliferation and invasion in CRC patients, and may be used as an important potential marker.