Objective To investigate the changes of serum leptin levels and the influential factors in maintenance peritoneal dialysis patients.Methods Seventy-six peritoneal dialysis patients were chosen at the time before,and 3 months,6 months,12 months,18 months and 24 months after they began the peritoneal dialysis therapy,to examine body mass index (BMI),triceps skinfold thickness (TSF),abdominal circumference,homeostasis model assessment of insulin resistance (HOMA-IR),the plasma lipid profile,and leptin in the same situation.Results For 24 months,these patients showed higher serum leptin level than the values before commencing peritoneal dialysis treatment (P ＜ 0.01).The level of leptin was positively correlated with the BMI(r =0.412,P ＜ 0.01),TSF(r =0.308,P ＜ 0.01),abdominal circumference(r =0.284,P ＜ 0.01),HOMA-IR(r =0.184,P ＜ 0.01) and TG(r =0.288,P ＜ 0.01),negatively corelated with the high-density lipoprotein cholesterol(HDL-C)(r =-0.285,P ＜ 0.01).Multiple logistic regression analysis showed that BMI (β =0.339,P ＜ 0.01),TGβ =0.157,P ＜ 0.01) and HDL (β =-0.126,P ＜ 0.05)were significant predictive factors for the changes of serum leptin levels.Conclusion Leptin maybe involve in the occurrence and the development of cardiovascular events like other metabolic parameters in peritoneal dialysis therapy.

Objective To be good for the different working age midwives to carry out the same evaluation of the pregnant woman,we build and use the Episiotomy Evaluation Form for reducing the rate of episiotomy with ensuring the safety of mother and baby.Methods Consult relevant literature,combine clinical practice,discuss,report to the hospital ethics committee many times and at last it was made after approval.The details included:perineal lesions,perineum elasticity,perineal length,maternal coordination,gestational age,age,fetal distress degree,amniotic fluid situation,the weight of fetus estimated,the second time of labor and so on,to score by 0,1,3,5,20.A total of 600 patients with low risk of natural childbirth were randomly divided into observation group and control group according to method of random number table with 300 cases each.The observation group was graded according to the perineal incision evaluation and we operated according to its use method.The control group was judged according to the experience of midwife and subjective cognition.At last compared the effects on the mother and baby.Results The rates of lateral episiotomy and Ⅰ degree laceration were 15.00％ (45/300) and 63.00％ (189/300) in the observation group and 48.33％ (145/300) and 21.67％ (65/300) in the control group,respectively.The difference between the two groups was statistically significant (x2=16.238,21.507,P ＜ 0.05).There was no statistical difference in the perineal intact rate,median perineal incision rate,perineal Ⅱ degree laceration rate,severe perineal laceration,second stage of labor,postpartum hemorrhage 2 hours,neonatal asphyxia rate,incidence of neonatal birth injury (brachial plexus injury,clavicle fracture,etc.) and pelvic floor muscle strength of 42 days after delivery between the two groups (P ＞ 0.05).Conclusions By using the episiotomy evaluation form,we can improve the accuracy and homogeneity of the midwife's assessment about the episiotomy which is benefit to reduce rate of episiotomy.It is worth promoting in clinical practice but we should ensure the safety of maternal and child.

Hiatal hernia (HH) is a prevalent medical condition characterized by the protrusion of abdominal contents into the thoracic cavity through an enlarged diaphragmatic esophageal hiatus. The most common clinical manifestations of HH include acid reflux, heartburn, belching, coughing, and chest pain. Currently, there is a lack of standardized comprehensive treatment protocols for different types of HH, presenting significant challenges in their clinical management. In light of this, individualized treatment approaches should be followed by surgical practitioners when dealing with HH, in order to formulate the most appropriate clinical treatment plan tailored to each patient′s specific circumstances.