Objective To explore the relation between single umbilical artery with other malformations and pregnancy outcome,and to provide evidence for pregnancy counseling and diagnosis.Methods The outcomes of 92 fetuses with single umbilical artery diagnosed and delivered in Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University from September 2007 to July 2009 were followed up and retrospectively analyzed with Chi-square test.Results Among 25 292 pregnant women,92 cases were finally diagnosed as single umbilical artery giving the incidence of 0.36％,among which 57.6％ (53/92) of newborns survived without malformations,15.2％(14/92) survived with malformations and 27.2％ (25/92) died during perinatal period.There were 36 fetuses (39.1％,36/92) with single umbilical artery complicated with other malformations,among which 29 had single malformation (80.6 ％ ),and seven ( 19.4 ％ ) had multiple malformations.The incidence of heart defects was the highest among the complicated malformations,and then followed by central nervous system,digestive system,motor system and urinary system.Thirty-three fetuses with single umbilical artery accepted karyotype analysis.Chromosome abnormality was diagnosed in three subjects (9.1％,3/33).Twenty-three fetus (25.0％,23/92) associated with small for gestational age,and among which 18 fetuses (78.3％,18/23) died with a higher mortality than that (4.0％,24/597) of small for gestational age patients without single umbilical artery (x2=181.71,P＜0.01).Conclusions Single umbilical artery is likely to be complicated with congenital anomalies.After single umbilical artery was diagnosed by routine ultrasound,fetal ultrasonography,echocardiography and amniocentesis for karyotype analysis is suggested.Fetal growth restriction is an important indicator of fetal adverse outcomes.

Purpose：To determine the treatments and prognostic predictors of malignant melanoma of the head and neck. Methods：Surgical treatment and outcome was analyzed for 28 patients with malignant melanoma of the head and neck at department of the head and neck of our hospital (1984-1994). Results：23 patients underwent local excised as the first treatment, and local recurrence was demonstrated in 8 (34.8%). Margin of resection of primary melanoma was divided into narrow excision (≤2 cm) and wide excision (＞2 cm), and 5-year survival was 58% and 40%(P＜0.01). According to surgical methods, 5-year survival of WE, WE/END and WE/TLND were 80%, 80% and 39%. Conclusions：An excision with 2 cm margin is safe procedure for primary tumor of malignant melanoma of the head and neck. Neck dissection may not be practiced until neck lymph node is positive. Neck dissections differ from the positions of the primary tumors, and the flaps must be raised preferably superficial to the platysma.

Pharmaceutical therapy,including anti-vascular endothelial growth factor treatment and intravitreal corticosteroids,is the most common treatment for branch retinal vein occlusion (BRVO) and its complications,however there are confusing ideas about the protocol,patient selection,timing and endpoint of this treatment.The disease is easy to relapse with these drugs therapy.Collateral vessel formation was found in patients receiving intravitreal injection of ranibizumab or triamcinolone for BRVO and secondary macular edema.The mechanism of collateral vessel formation has not been carefully investigated.In the past thrombolysis,arteriovenous fasciostomy and laser choroidal retinal vascular anastomosis were used to reconstruct the retinal circulation,but their rationality,effectiveness and safety need to be further were studied.In recent years,because of the key technology is still immature,the artificial vascular bypass surgery experiment is not yet practical,but provides us a new idea worth looking forward to for the treatment of BRVO.

As a result of accuracy of staging and decreased patient morbidity,sentinel lymph node biopsy for breast cancer was quickly accepted into clinical practice.Many controversies remain in the methods and indications of sentinel lymph node biopsy.In this article,we attempt to highlight the clinical studies regarding the biopsy techniques,pathologic evaluation,indication for lymphatic mapping and eliminating axillary lymph dissection by sentinel lymph node biopsy.It is demonstrated that radioisotope and blue dye techniques are complementary.Preoperative lymphoscintigraphy is most useful for detecting an internal mammary SLN,but the practicability of internal mammary SLN biopsy is still in the investigative stage.As for intraoperative diagnosis of sentinel lymph node,imprint cytology is a quick,economic and tissue-preserving method,but not very effective in the identification of micrometastasis;axillary lymph node dissection is preferable for patients with micrometastasis.Sentinel lymph node biopsy is indicated for ductal carcinoma in situ,with prophylactic mastectomy,breast cancer patients with previous reduction mammoplasty and breast implants.Currently,NSABP B32,Z0010 and Z0011,large,prospective randomized trials are in progress to evaluate unresolved issues of SLN biopsy.Although data from these trials is not available,SLN biopsy has been widely adopted in the clinic.Consistency of technique as well as case selection has attained great significance.

Objective To develop clinical dual-qualification nursing teachers stressors scale. Methods Based on literature review, semi-structured interview and the Delphi, first of all, the item pool was made up, then the pre-test scale was formatted. 167 dual-qualification nursing teachers participated in this investigation.Finally, the official scale was formed after measuring its reliability and validity. Results The scale was made up of six dimensions and 25 items. The Cronbach's α was 0.652 ～ 0.903, and the intraclass correlation coefficient was 0.716 ～ 0.921. Conclusion The process of this scale is scientific, rational, rigorous. The scale has good psychometric characteristics and can be used for the stress assessment of dual-qualification nursing teachers.

From the Government’s fully guarantee stage to the stage of independent organization of medicine, then to the market-oriented reforms and the new health care reform exploration stages, the public hospitals reform fol-lows different institutional logics, but the institutional dilemma have emerged at all stages including the little coupling between the institutional arrangements and environment, the public welfare and benefit wandering, the management system instability, and the breakdown of the financial investment and control costs mechanisms. The Government should elaborate conditions for the spontaneous public hospitals reform on the institutional environment in order to em-bed intrinsic motivation of the induced institutional change into the imposed institutional change. There should be positive interaction between the government and the market in order to form a reasonable and orderly competitive land-scape to the market of medical services. Payment should be reformed which has significant influence on internal medi-cal service system incentives.

Reactive oxygen species(ROS) resulting from oxidative stress plays a significant role in the pathogenesis of diabetic nephropathy.It induces cell apoptosis and accelerates the development and progression of diabetic nephropathy through mitochondrial activation,DNA oxidative injury and influence on gene expression.Reducing ROS formation and blocking the pathway of cell apoptosis activated by ROS may become a new target in the treatment of diabetic nephropathy.

OBJECTIVE To evaluate the prevention of antibiotic-associated diarrhea(AAD) in surgical critical illness patients and strengthen the usage of antibacterials to AAD in hospital.METHODS Using prediction and retrospection to analyze the factors of AAD.RESULTS The main factors for AAD are changing antibiotics frequently,the age of patient,complicated disease of patient.CONCLUSIONS Rational use and rigorous control of antibiotics are the keys to prevent AAD in hospital.

Objective: To study psychosocial factors and immunity of patients with generalized anxiety disorder Method: 30 patients with generalized anxiety disorder (GAD), 25 patients with neurotic depression and 32 normal controls were collected and assessed with LES (life event scale), SCSQ (simplified coping style questionnaire) and EPQ (Eysenck personality questionnaire) The blood level of IL-2, and rates of NK cell and CD3+ cell of them were also measured Result: The number of negative life events and LEU of negative life events of GAD group were higher that of normal controls, but lower than that of neurotic depression group Their total life events were also more than that of normal controls They had less positive coping than normal controls, more negative coping than both normal controls and patients with neurotic depression Their N score of EPQ was higher than that of normal control and had no significant different to that of patients with neurotic depression They also had higher levels of IL-2 than that of the other two groups There was no significant difference in rates of NK cell and CD3+ cell among all three groups The level of IL-2 was negatively correlated to the number of total life events and L score of EPQ, positively correlated to the rate of NK cell Conclusion: Patients with GAD have psychosocial stress in their life, they incline to negative coping, having unstable mood and impaired immune function Psychosocial stress has influence on immunity

Objective To investigate the clinical effect of pegylated interferon(IFN)on chronic hepatitis C and its effect on cellular immune function.Methods A total of 92 patients with chronic hepatitis C were enrolled in our hospital from June 2013 to October 2016.They were randomly divided into study group and control group by single and double numbers(admission order),with 46 cases in each group.The control group was treated with recombinant human interferon alpha-2b on the basis of conventional treatment.The study group was treated with pegylated interferon alpha-2a on the basis of conventional treatment.Results After treatment, the rates of RVR, EVR, ETVR and SVR in the study group(52.17%, 71.74%, 76.09% and 54.35%, respectively)were significantly higher than those in the control group(34.78%, 50%, 58.70%, 39.13%, respectively), The difference was statistically significant(P<0.05).There were no significant difference in the cellular immune function index between the two groups before treatment;After treatment,the CD3+, CD4+, CD4+/CD8+ and other immune function indexes of the study group were significantly higher than those before treatment, while the results of CD8+ were significantly lower than before treatment(P<0.05);There was no significant difference in the cellular immune function in the control group compared with before, and the difference of the cellular immune function between the 2 groups after treatment was statistically significant(P<0.05).Conclusion Pegylated interferon(IFN)on the basis of routine treatment can improve the virologic response and cellular immune function in patients with chronic hepatitis C.