Objective To explore the application effect of action-oriented teaching method in senior midwifery practice teaching.Methods Selecting 30 students from class 1,grade 2011 of the midwifery professional for the experimental group,another 30 students from class 2 for the control group.We selected four core contents for the experimental teaching refbrm such as obstetric abdominal examination,external pelvimetry measurement,prenatal vulva washing disinfection and sterile towel covering before the delivery.The experimental group was taught by action-oriented teaching,in accordance with the procedures:putting forward the projects or work task,set goals and grouping,making work plans,implementing and evaluating.The control group was taught by traditional teaching.We used questionnaire smvey and skills examination to evaluate the teaching effects and conducted teaching satisfaction scores and scores for t test to two groups of students.Results (1)Questionnaires:The resuhs of the 18 issues on the teaching effect evaluation,professional technology level and nursing soft skills,etc.showed that the experimental group's evaluation of the action-oriented teaching is higher than the control group's evaluation of the traditional teaching(P＜0.05),action-oriented teaching is more helptul to improving the professional skill and nursing soft skills(P＜0.05).@The scores of skill examination:The skills scores of the experimental group(80.01 ± 9.36) were significantly higher than those of the control group(71.32 ± 8.85)(t=3.70,P=0.000).The difference was statistically significant (t=3.70,P=0.00).Conclusions Action-oriented teaching helps to raise practice teaching effecr,train students' clinical work ability and nursing soft skills.It is suitable for practice teaching of senior midwifery.

Peking University Third Hospital is one of the first hospitals for experiments in clinical pathway selected by the Ministry of Health,which keeps optimizing the clinical pathway management mechanism and function of information system in its 4-year practice.This article described the combination strategy of clinical pathway management and information system applications,in terms of reasonable design of the management plan,standardized clinical pathway,strengthened execution control and improvement of the quality control.The purpose is to balance the relationship between clinical pathway management norms and user-friendliness of the system,enhance rationality and feasibility,improve efficiency and provide high-quality service to ensure medical safety.

Objective To explore the clinical value of two dimensional and color Doppler echocardiography in diagnosis of infants with coarctation of the aorta(CoA),and to analyse the cause of missed diagnosis and misdiagnosis.Methods The echocardiographic characteristics of 87 infants with CoA were analyzed retrospectively,and the results were compared with surgical findings.Results Seventy-five patients were correctly diagnosed,while 9 patients were missed and 3 patients were misdiagnosed.Discrete coarctation was found in 67 cases,whereas tubular coarctation was detected in 8 cases of CoA.Conclusions Mastering the echocardiographic characteristics of infants with CoA and carefully scanning the sternum nest section,combined with two dimensional and color Doppler echocardiography,could avoid missed diagnosis and misdiagnosis.

Objective To explore the clinical value of Doppler flow spectrums of umbilical artery and ductus venosus in fetus with arrhythmia by Doppler ultrasound in evaluating the fetal prognosis.Methods Umbilical artery and ductus venosus flow spectrums were obtained in a total of 796 pregnancies with gestation age between 16-41 weeks who were found abnormal heart rhythm by maternity auscultation,fetal electronic monitoring or ultrasound.All these fetuses were followed up by electrocardiography and echocardiography examination until the end of pregnancy and the pregnancy outcomes were recorded.Results Among 796 fetuses,136 cases of fetal arrhythmia were detected.There were 18 cases appeared with umbilical artery absent or reversed end-diastolic flow,and 9 cases with absent or reversed wave A.Among 18 fetuses with arrhythmia whose blood flow spectrums of umbilical artery were abnormal,twelve were compared with congenital heart disease.The proportion of fetal bradycardia associated with abnormal flow spectrums and congenital heart disease were higher than other types of arrhythmias.Conclusions Pregnancy outcome of the fetus with arrhythmias who appeared with normal umbilical artery and ductus venosus will be good,and conversely is poor.So Doppler flow spectrums of the fetal umbilical artery and ductus venosus is one of the important indicators in early intervention.

Objective: To analyze the plague monitoring results in Ulanqab City of Inner Mongolia in 2018, to master the changes in rat density and the prevalence of plague in rats, and provide a basis for scientific prevention and control of plague. Methods: According to "The Plague Monitoring Scheme of Inner Mongolia", we surveyed Siziwang Banner, Chahar Right Back Banner, Huade County, and Shangdu County of Ulanqab City from April to November 2018 to monitor the plague. Rat density was surveyed using a one-day bow clamp method; small rodent was surveyed using a 5 m clamping method. Rodents were obtained by sample method, 5 m clamping method, daily method, collecting dead animals and the like, and fleas were picked up from the captured rats and rat nest. The rodents and fleas were carried out pathogen detection, the serum of rodents was tested by indirect hemagglutination test. Laboratory test results were analyzed based on the "Diagnostic Criteria for Plague" (WS 279-2008). Results: Totally 1 463 mice were captured overlapping a monitored area of 416 hm², the average rat density was 3.52 per hectare; the number of Meriones unguiculatus was 1 235, and the rat density was 2.97 per hectare. Totally 1 603 mice were grooming, 404 mice with fleas, the flea infected rate was 25.20%, the number of fleas were 1 348, and the flea index was 0.84. A total of 22 mouse nests were dug, 17 nests with fleas, the flea infected rate was 77.27%, the number of fleas were 131, and the flea index was 5.95. Totally 1 603 rodents were checked by etiology, the results showed that 7 plague rats were all Meriones unguiculatus. Totally 1 479 fleas of 581 groups were cultured, 14 fleas of 5 groups were detected, 3 fleas of 1 group in Siziwang Banner, and 11 fleas of 4 groups in Huade County. Totally 243 samples of murine animal serum were tested and the results were all negative. Conclusions The epidemic of plague in Ulanqab City is in an active state, so monitoring should be strengthened in this area to prevent the prevalence of human plague.

Objective: To study the mechanism of Heshi-Gejiugao on the nerve endocrine immune network in the treatment of perimenopausal syndrome. Methods: A total of 100 patients with perimenopausal syndrome were randomly divided into treatment group and control group, 50 cases in each group. The control group was only given general treatment, while the treatment group was treated with Heshi-Gejiugao on the basis of general treatment for 30 days. The clinical efficacy, Kupperman score, nerve, endocrine and immune related indexes of the two groups before and after treatment were observed. Results: The total effective rate was 96.0% (48/50) in the treatment group and 50.0% (25/50) in the control group. There was significant difference between the two groups (χ²=37.639, P<0.01). The Kupperman score (17.52 ± 2.73 vs. 24.22 ± 6.87, t=6.409) in the treatment group was significantly lower than that in the control group (P<0.01). After treatment, NE (1 878.08 ± 931.57 ng/m vs. 1 278.43 ± 866.32 ng/ml, t=3.331), DA (1 568.56 ± 597.15 ng/ml vs. 1 183.62 ± 798.72 ng/ml, t=2.729) in the treatment group were significantly higher than those in the control group (P<0.05); E₂ (42.12 ± 9.77 pg/ml vs. 35.91 ± 12.55 pg/ml, t=2.761), FSH (62.70 ± 15.96 mIU/ml vs. 72.67 ± 30.18 mIU/ml, t=2.065), LH (33.88 ± 12.18 mIU/ml vs. 42.93 ± 9.83 mIU/ml, t=4.089) were significantly lower than those of the control group (P<0.05). CD3⁺ (1 087.34/μl ± 432.19/μl vs. 918.27/μl ± 199.72/μl, t=2.511), CD4⁺ (738.16/μl ± 326.75/μl vs. 588.43/μl ± 212.55/μl, t=2.716) and CD4/CD8 (1.87 ± 0.56 vs. 1.16 ± 0.55), t=6.483) were significantly higher than those of the control group (P<0.05); CD8⁺ (788.32/μl ± 214.56/μl vs. 976.37/μl ± 318.62/μl, t=3.462) was significantly lower than that of the control group (P<0.05). Conclusions Heshi-Gejiugao can reduce the symptoms and improve the quality of life by regulating the multi target and multi direction of the neuroendocrine immune network of perimenopausal patients.

Furthering healthcare reform calls for public hospitals to curb unreasonable growth of medical expenses,reduce drug proportion,and lower the costs of medical materials consumed per 100 RMB medical income.In view of the hospital,the authors established a data-based monitoring system for key indicators of medical consumables,formulated an evaluation scheme of rational use,and implemented the corresponding control measures,which provide a reference for scientific control of clinical rational use of the medical consumables.

OBJECTIVE: To investigate the efficacy and safety of Yisui Shengxue Granule (YSSXG), a compound traditional Chinese herbal medicine, in treating beta-thalassemia. METHODS: A randomized single-blinded trial was designed. Sixty patients with beta-thalassemia were divided into two groups: 30 patients in YSSXG-treated group and 30 in placebo parallel-control group. The patients in the two groups were assigned to receive either YSSXG or placebo for three months. The patients' symptoms and their blood indexes such as hemoglobin (Hb), red blood cell (RBC), reticulocytes (Ret) and fetal hemoglobin (HBF) were examined before and after the treatment. Meanwhile, the liver and spleen were examined with B-mode ultrasound. RESULTS: In the YSSXG-treated group, the blood indexes (Hb, RBC, Ret and HBF) and the symptoms of the patients were improved after three-month treatment, with statistical significance compared to those before treatment (P<0.01); hepatauxe and splenomegaly were also relieved (P<0.05) and no adverse reactions were monitored. In the placebo parallel-control group, no significant improvement of the blood indexes and symptoms, as well as the hepatauxe and splenomegaly had been found (P>0.05). CONCLUSION: YSSXG demonstrates obvious clinical efficacy and no adverse reactions in treating beta-thalassemia.

Objective To explore the ultrasonographic features ,diagnostic clues and methods of fetal aortic arch anomalies ,and to improve the diagnosis rate of prenatal ultrasonography for fetal aortic arch anomalies . Methods Fetuses with aortic arch anomalies diagnosed by prenatal ultrasound were selected as the study objects . The prenatal ultrasonographic features of the three views of the aortic arch were carefully observed . The three views included the followings :the transverse view ( the view of three vessels and trachea) ,the sagittal view ( the longitudinal view of the aortic arch) ,and the coronal view ( the coronal view of the descending aorta) . The prenatal diagnostic clues and diagnostic techniques of aortic arch anomalies were summarized and analyzed . Results Eighty-one cases with aortic arch anomalies were followed up . Fifteen cases were left-sided aortic arch and left-sided ductus arteriosus with aberrant right subclavian artery ,22 cases with right aortic arch and left-sided ductus arteriosus with aberrant left subclavian artery ,4 cases were mirror right aortic arch and left-sided ductus arteriosus ,2 cases were mirror right aortic arch and right-sided ductus arteriosus ,11 cases were double aortic arch ,23 cases were coarctation of the aorta ,and 4 cases were interruption of aortic arch . Among them ,27 cases were complicated with other cardiac and extra-cardiac malformations and 13 cases with chromosomal abnormalities . Prenatal ultrasonographic clues for diagnosis of coarctation of the aorta included the three vessels and trachea view showing small diameter and disproportion to the diameter of the ductus arteriosus . And the longitudinal view of the aortic arch was helpful for showing the position and the extent of coarctation of the aorta . Prenatal ultrasonographic clues for diagnosis of interruption of aortic arch were that the three vessels and trachea view and the longitudinal view of the aortic arch showed the interruption between aortic arch and descending aorta . And the abnormal combination cases of the aortic arch segments also had their corresponding diagnostic clues . These clues included that the three vessels and trachea view showed abnormal position ,arrangement and running of the branches of the aortic arch . And the coronal view of the descending aorta also showed abnormal changes in the branches of aortic arch . Conclusions Various types of congenital aortic arch anomalies have characteristic ultrasonography and their corresponding diagnostic clues and methods . The combined use of the three views of the aortic arch is effective in prenatal diagnosis for aortic arch anomalies .

Objective To investigate the prenatal ultrasonographic features of fetal total anomalous pulmonary venous connection (TAPVC).Methods Forty-one cases who received prenatal ultrasound examination and then were diagnosed with TAPVC by postnatal surgery at the Third Affiliated Hospital of Zhengzhou University from June 2013 to June 2018 were enrolled.Echocardiography findings of all cases were analyzed retrospectively,and the prenatal imaging features were summarized.Results Among all cases,21 were confirmed as supracardiac type,14 as intracardiac type,four as infracardiac type and two as mixed type after surgery.The echocardiographic features of TAPVC were as follows:all 41 cases showed smooth posterior wall of left atrium without visible part of pulmonary venous connected to the left atrium in the-four chamber view;in 33 cases,the space between left atrium and descending aorta was widened and the pulmonary venous confluence was observed in the four-chamber view;ten cases showed a dilated coronary sinus in the four-chamber view and 27 cases showed vertical vein in the three vessels and trachea or the upper abdomen view.None of the 41 cases was complicated by other structural intracardiac abnormalities.However,seven cases were complicated by obstruction of blood flow,and the blood flow velocity measured by Doppler ultrasound was 0.76 m/s to 1.25 m/s.Conclusions Blood flow in pulmonary veins should be carefully observed in prenatal ultrasonography,and anomalous pulmonary venous connection should be considered when pulmonary veins do not connect to the left atrium.