Objective To build occupational management skills training mode for the community patients with psychosis in recovery stage by using action research method. Methods Action research method was applied to mental rehabilitation patients in Sunshine Psychiatric Garden of Shanghai to manage vocational rehabilitation support. By literature verification and empirical experience, the key problems were found out, and goals were established. Then management skills according to planning, action, observation, reflection and correction were implemented. This circle were spiraled for 2-3 times stages, and verification and evaluation before and after action practice based on Negative Symptom Rating scale (SANS) and Social Disability Screening Scale (SDSS). Results The community mental vocational rehabilitation was built with action research and based on the evidence of foreign psychic rehabilitation supportive individual placement and support. The mode should consider the professional characteristics of technical, social and economic. Also, it should contain professional ability, social skills and job adaptability training and performance evaluation, and offer salary allowance. The factors of SANS in 21 patients after practice were significantly improved (P < 0.01), and most of the factors in the SDSS were significantly improved (P < 0.01). Conclusions Community psychic vocational rehabilitation using action research method is a kind of advanced nursing practice, and also a process of evidence-based practice, which can provide a systematic, specific, practical work method for community mental rehabilitation institutions to force vocational rehabilitation training.

Objective To study the clinical effect of Fuyankangfupian in the treatment of patients with miscarriage caused by chronic endometritis and its influence on the inflammatory factor.Methods A total of 80 patients with miscarriage caused by chronic endometritis were enrolled in this study.The subjects were randomly divided into control group (n =40) and observation group (n =40).The control group was treated with conventional treatment,the experiment group was treated with Fuyankangfupian combined with conventional treatment.The clinical indicators,the visual analogue scale (VAS),serum levels of TNF-α,hs-CRP and IL-2 of the two groups before and after treatment were recorded and compared.Results After treatment,the abdominal pain time [(2.96 ± 0.88) d],bleeding time [(4.51 ± 1.12) d] and blood loss [(102.16 ± 21.82) mL] of the observation group were significantly lower than those of the control group[(6.83 ± 1.32)d,(7.14 ± 1.50)d,(174.28 ±33.35) mL,t =15.428,8.885,11.445,all P ＜ 0.05].The VAS scores in the control group and observation group after treatment were (4.57 ± 0.79) points,(2.12 ± 0.41) points,respectively,which were significantly lower than those before treatment[(8.68 ± 1.40) points,(8.72 ± 1.38) points,t =16.170,28.995,all P ＜ 0.05],which of the observation group was significantly lower than that of the control group (t =17.409,P ＜ 0.05).After treatment,the serum levels of TNF-α and hs-CRP in the control group and observation group were (2.61 ± 0.20) pg/mL,(6.40 ± 1.36) mg/L and (1.13 ± 0.12) pg/mL,(3.01 ± 1.02) mg/L,respectively,which were significantly lower than those before treatment[(3.95 ±0.31) pg/mL,(11.35 ± 3.14) mg/L and (4.02 ± 0.35) pg/mL,(11.52 ± 3.20) mg/L,t =22.972,9.149,49.400,16.025,all P ＜0.05],while the serum levels of IL-2 of the two groups after treatment were (4.13 ± 0.75) μg/mL,(7.12 ±0.91) μg/mL,which were significantly higher than before treatment[(1.98 ±0.51) μg/mL,(1.87 ± 0.60) μg/mL,t =14.993,30.462,all P ＜ 0.05].The serum levels of TNF-α and hs-CRP of the observation group were significantlylower than those of the control group (t =40.132,12.612,all P ＜ 0.05),serum level of IL-2 of the observation group was significantly higher than that of control group (t =16.036,P ＜ 0.05).Conclusion Fuyankangfupian can significantly reduce the abdominal pain,bleeding time and blood loss,ease abdominal pain and inflammation of the patients with miscarriage caused by chronic endometritis,it is worthy clinical application.

Objective: To summarize surgical result of single ventricle with total anomalous pulmonary venous connection (TAPVC) in relevant patients.
Methods:A total of 25 patients of single ventricle with TAPVC treated in our hospital from 2008-09 to 2016-03 were summarized. The patients were between 5 days to 14 years of age with body weight at (3.3-49.5) kg. There were 22 patients with supracardiac type TAPVC, 1 with infracardiac type TAPVC and 2 with mixed type TAPVC;in addition,17 cases having complete atrio-ventricular canal defect, 2 having tricuspid atresia, 4 having more than moderate atrio-ventricular valve regurgitation, 5 having pulmonary atresia and 9having pulmonary venous obstruction.
Results:There were 5/25 (20%) patients died at the early stage for low cardiac output syndrome. Followed-up study was conducted in 20 survivals for (1-65) months and 7 patients had re-surgery including 5 with modified Fontan operation, 1 with atrio-ventricular valve replacement due to severe atrio-ventricular valve regurgitation, 1 with pulmonary venous stenosis repair+atrio-ventricular valve replacement due to pulmonary venousobstruction and severe atrio-ventricular valve regurgitation. 3 patients died during followed-up period because of low cardiac output syndrome, protein lost intestine disease and neurological injury respectively. The rest survivals had good general condition, no residualpulmonary venous obstruction was found.
Conclusion: The patients of single ventricle with TAPVC were frequently associated with right atrial isomerism and complex cardiac anomaly;surgical treatment still having the high mortality.

Objective To observe the fundus imaging characteristics of different stages of syphilitic posterior uveitis. Methods Retrospective cases series. Forty-six eyes of 32 patients with syphilitic posterior uveitis were included. There were 14 patients (16 eyes) and 18 patients (30 eyes) were assigned to acute stage group (with the course<2 months) and chronic stage group (with the course≥2 months) respectively. All eyes received the examination of indirect ophthalmoscopy, color fundus photography, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). All patients received regular anti-syphilitic treatment. Color fundus photography and OCT were followed after treatment. The fundus imaging characteristics of different stages of syphilitic posterior uveitis were observed. Results Indirect ophthalmoscopy and fundus color photography showed that in the acute stage group, there were 3/16 eyes with optic disc edema;4/16 eyes with a yellowish, placoid lesion involving the macular. There were only some pigment alterations on the fundus after treatment. In the chronic stage group, there were 4/30 eyes with optic disc hyperemia, 3/30 eyes with cystoid macular edema. After treatment, the optic hyperemia vanished gradually, but there were still some pigment alterations. The FFA images of two groups showed various vascular leakages. In the chronic stage group, patients also showed hyper-fluorescence with cystoid macular edema. The patients with course 2–3 years have more transmitted fluorescence on FFA. OCT showed that all eyes in the acute stage group had lost the ellipsoid zone, with irregular granular reflectivity of the retinal pigment epithelium (RPE) layer, 6 eyes with subretinal fluid in the macular. After treatment, the ellipsoid zone and RPE layer structure recovered gradually. In the chronic stage group, all eyes showed widespread loss of the ellipsoid zone, pigment migration and (or) cystoid macular edema. After treatment, the ellipsoid zone showed partial recovery. The outer ellipsoid zone was still discontinuous in patients with long duration. Conclusions Syphilitic posterior uveitis patients generally had normal fundus, but some cases had a yellowish, placoid lesion involving the macular. FFA showed various vascular leakages, and the chronic stage group showed more transmitted fluorescence. The major OCT change was loss of the ellipsoid zone or with subretinal fluid. After treatment, fundus showed no abnormal manifestations except some pigment alterations;the ellipsoid zone structure recovered gradually in acute stage eyes, partially recovered in chronic stage eyes.

Objective: To investigate the proportion of physical examinations among patients with severe mental disorders and its influencing factors in Shaoxing City, Zhejiang Province, so as to provide the evidence for improving the proportion of physical examinations among patients with severe mental disorders. Methods : The epidemiological and clinical features of patients with severe mental disorders included in community management in Shaoxing City in 2022 were collected from Zhejiang Provincial Severe Mental Disorder Management Information System, including demographics, disease diagnosis and treatment, physical examination, and rescue and assistance. Factors affecting the physical examination were identified among patients with severe mental disorders using a multivariable logistic regression model. Results: A total of 25 468 patients with severe mental disorders were enrolled in Shaoxing City in 2022, including 12 151 males and 13 317 females, with a male to female ratio of 0.91∶1, and the participants had a mean age of (54.34±14.71) years. Schizophrenia was the predominant type of severe mental disorders (15 419 cases, 60.54%), and 21 374 subjects participating in the physical examinations in 2022 (83.92%). Multivariable logistic regression analysis showed that female (OR=0.901, 95%CI: 0.832-0.975), urban areas (OR=0.506, 95%CI: 0.468-0.547), mental disorders due to epilepsy (OR=1.779, 95%CI: 1.104-2.866), hospitalized treatment (6 to 10 times, OR=0.523, 95%CI: 0.401-0.681; 11 times and more, OR=0.177, 95%CI: 0.108-0.288), special diseases in outpatient (OR=1.738, 95%CI: 1.597-1.891), receiving medical assistance (OR=2.851, 95%CI: 2.616-3.107), targets of the community care and assistance groups (OR=1.653, 95%CI: 1.471-1.857) and guardian (spouse, OR=1.777, 95%CI: 1.513-2.086; children, OR=1.277, 95%CI: 1.069-1.526; parents, OR=1.342, 95%CI: 1.143-1.576) were statistically associated with the proportion of physical examinations. Conclusions The proportion of health examinations was 83.92% among patients with severe mental disorders in Shaoxing City in 2022. Gender, residence, guardian, disease diagnosis, times of hospitalized treatment, medical assistance, special diseases in outpatients and target of community care and assistance groups were factors affecting health examinations among patients with severe mental disorders.

Objective To further investigate direct effects of dipeptidyl peptidase-4(DPP4) on calcification and to identify responsible signaling pathways in human vascular smooth muscle cells (HVSMC). Methods The effect of DPP-4 on calcification of HVSMC was observed by alizarin red, and Western blot was used to detect whether DPP4 induced calcification-related protein expressions through extracellular signal-regulated kinases 1/2 (ERK1/2) pathway. Results The Alizarin red staining results showed that calcified nodules in DPP4 group were significantly increased as compared with control group, similar to calcification group.The protein expressions of osteoprotegerin (OPG), osteopontin (OPN), Runt-related transcription factor 2 (RUNX2), and bone morphogenetic protein 2 (BMP2) were stimulated by DPP4 in a concentration- and time-dependent manner. The phosphorylation level of ERK1/2 was significantly increased after DPP4 incubation for 15 min (P<0.05). PD98059, an ERK1/2 inhibitor, significantly lowered DPP4-stimulated expressions of calcification-related proteins (P<0.05). Conclusion DPP4 may promote the calcification of HVSMC through ERK1/2 signaling pathways.

Objective In patients with pulmonary atresia and intact ventricular septum ( PAIVS) without right ventricular-dependent coronaries, catheter techniques including the use of a sniff wire, lasers, and radiofrequency have been the most widely used initial therapy. However, percutaneous perforation and balloon valvuloplasty were associated with higher rate of procedural failure and serious complications. Methods We report our experience with a hybrid approach for pulmonary atresia with intact ventricular septum, combining surgery and interventional catheterization techniques. Between March 2005 and March 2010, hybrid procedure was carried out successfully in 30 newboms and infants with favorable anatomy. The age ranged from 1 day to 48 months with a mean of (4.59 ±3.21) months. The heart was exposed through median sternotomy. A pursestring suture was placed in the right ventricular outflow tract 2 cm away from the pulmonary trunk. Then a 16-gauge intravenous catheter was punctured through the right ventrical and perforated the atretic PV with the guidance of echocardiography. A guide wire was then inserted into the sheath and used to guide the balloon across the PV. Sequential dilations were performed until a full opening of the PV with the guidance of epicardial echocardiography. In patients ＜ 3 months PDA ligation was performed followed by modified Blalock-Taussig (B-T) shunt. In patients ＞ 3 months PDA ligation was not performed. A modified B-T shunt was inserted if severe systemic oxygen desaturation occurred after PDA ligation. Bidirectional Glenn shunt was performed for severe hypoplasia. Hybrid procedure was achieved in all patients. The simultaneous procedures included 25 cases of PDA ligation. 6 newborns underwent modified B-T shunt placement (3.5 to 5 mm) after pulmonary valvuloplasty and PDA ligation, and 2 patients ＞ 1 month underwent modified B-T shunt. Another 2 patients were selected for univentricular palliative surgery because of a diminutive monopartite right ventricle and bidirectional Glenn procedure was performed. No pericardial effusion or cardiac tamponade was observed in all patients. Another case without PDA ligation underwent a modified B-T shunt because of hypoxemia three days after hybrid procedure, and the rest patients were discharged without any further surgical intervention.During the follow-up period of 1.5 to 62.0 months, 5 patients died. 25 (83.3%) survived and were all in New York Heart Association functional class 1. Peripheral oxygen saturation increased from 0.73 ± 0.08 to 0.94 ± 0.04 (P ＜ 0.05). One patient remains in a single-ventricle pathway, whereas 24 patients achieved a two-ventricle circulation. Results Conclusion Perventricular balloon pulmonary valvuloplasty using a hybrid approach is a safe and feasible procedure for patients with PAIVS.

Objective:Analyze the perioperative data of children undergoing cardiopulmonary bypass(CPB) for congenital heart disease under the management of ultra-fast track anesthesia(UFTA), the factors of CPB are discussed.Methods:1 034 children who underwent CPB from May 2018 to August 2019 were analyzed retrospectively. According to the success of anesthesia, they were divided into two groups: UFTA group and UFTA failure group. Propensity score matching was used to screen the children with preoperative baseline data matching. Finally 346 cases in each group. The possible CPB factors of the two groups were analyzed by single factor analysis, and the statistically significant factors were analyzed by logistic regression analysis. Results:Univariate analysis showed that the CPB and aortic occlusion time, the lowest temperature and lowest hematocrit in CPB, the dosage of crystalloid and suspended erythrocytes, the second or more times of CPB, and the blood lactate after CPB were the factors influencing the ultra-fast track anesthesia. Logistic regression analysis showed that the time of CPB and aortic occlusion, the value of blood lactate, the dosage of suspended erythrocytes, and the second or more times of CPB were the independent influencing factors of ultra-fast track anesthesia. In the UFTA failure group, the postoperative hospitalization time, the length of stay in the ICU and the hospitalization cost were all higher than those in the ultra-fast track group. Conclusion:CPB time, aortic occlusion time, blood lactate after CPB, the dosage of suspended erythrocytes, secondary or multiple CPB were independent risk factors for UFTA.UFTA is beneficial to shorten the postoperative hospital stay, the ICU stay and the cost of hospitalization.

The drafting of Zhejiang Mental Health Regulation has started since the promulgation of the Mental Health Law of the People's Republic of China in the year of 2013. Based on the preliminary investigation and the practice of mental health work in Zhejiang Province,this paper introduces the contents and characteristics of the regulation from six aspects,which are the legislative purpose and scope of application, the responsibilities of the government and departments, the construction of mental health service system,management of mental health services and consulting institutions,prevention,treatment and rehabilitation of mental disorders, and measures necessary to implement the regulation.

OBJECTIVE: To explore the effects of three dentine desensitizers on the surface morphology of freshly exposed dentin and to evaluate their occlusion effects on dentinal tubules using scanning electron microscope (SEM). METHODS: A total of 16 isolated human premolar samples, which were prepared to expose dentine, were randomly divided into a control group (n=4), a Hybrid Coat group (n=4), a Prime & Bond NT group (n=4), and a anti-sensitivity toothpaste group (n=4). After treatment with dentine desensitizers, one half of the samples in each group were vertically cleaved. Finally, the surfaces and cross sections of the samples were observed by SEM. RESULTS: The exposed tubule was almost occluded in the Hybrid Coat group and the Prime & Bond NT group, while only the majority of tubules could be sealed in the anti-sensitivity toothpaste group. The cross-section images showed that sediments were visible in all groups except the control group. CONCLUSION Hybrid Coat and Prime & Bond NT are able to effectively seal tubules, while the effect of anti-sensitivity toothpaste is slightly poor.
Dentin ; ultrastructure ; Dentin Desensitizing Agents ; pharmacology ; Dentin Permeability ; drug effects ; Humans ; Microscopy, Electron, Scanning ; Polymethacrylic Acids ; pharmacology ; Toothpastes ; pharmacology