BACKGROUND: Logistic analysis of multi-ordered response-variable is used to probe into from another view the interrelationship between lead content in fetus faeces and neurobehavioral development under exposure to low-level lead in uterus.OBJECTIVE: To probe into multi-factors of neurobehavioral development in neonates and the sensibility.DESIGN: The total score of neurobehavior in neonates was taken as dependent variable and 24 indexes were as independent variables, such as induced factors, lead in umbilicus blood and lead in fetus faeces in questionnaire. Logistic progressive regression of multi-ordered response-variables was used in analysis and corresponding factors were screened at level of P=0.10.SETTING: Wuhan University of Science and Technology, Laboratory Room of Occupation Disease and Epidemic disease in Tongji Medical College of Huazhong University of Science and Technology and Occupation Hospital of China First Metallurgical Construction General Company.PARTICIPANTS: Totally 103 full-month borne and healthy neonates were randomized in Department of Gynecology of one occupation hospital in Qingshan District of New-type Industry Area of Huanhan City from January to October 1999 as the objects. The relatives agreed with topic research and questionnaire investigation and they provided neonatal faeces and received neonatal tests on time.off the umbilicus and preserved in freezing in refrigerator at -4 ℃. The faeces in 24 hours after birth was collected and the lead contents of umbilicus blood and faeces were assayed with graphite furnace atomic absorpBehavioral Neurological Assessment (NBNA) was used in examination on the 3rd day after delivery. Simultaneously, the self-designed questionnaire was adopted in the investigation for parturients. The questionnaire involved other possible factors of neonatal neurobehavioral development, including dependent variables, concerning to states of family, society, environment and health that affected neurological development in neonates and lead contents in umbilicus blood and faeces. Scores of neonatal neurobehavior were taken as response variables. Finally, the corresponding factors were screened.MAIN OUTCOME MEASURES: To screen the factors of neurobehavioral development of neonates.RESULTS: Totally 103 cases entered result analysis. Six factors were selected in the model, named pregnant weeks, the month of drug administration in pregnancy, hemoglobin, emotions in pregnancy, lead level in fetus faeces and drug administration.CONCLUSION: Neonatal neurobehavioral development was related to multiple factors. Good nutrient in pregnancy, long pregnant weeks and good emotions in pregnancy benefit neurobehavioral development of neonates. Drug administration during pregnancy is disadvantageous in neonatal neurobehavioral development, especially the medication at the early phase of pregnancy. The increased lead content in neonatal faeces does not benefit neonatal neurobehavioral development.

BACKGROUND: In the past, a lot of researches used one-time lead level in umbilical cord blood at birth for investigations,however, one-time lead level in umbilical cord blood at birth can not represent lead caused cumu lative injury to neonatal nervous system during the whole period of preg nancy. Lead in meconium is mainly from digestive juice secreted by fetal alimentary tract, exfoliative epithelia from neonatal intestinal tract and am niotic fluid and sebum cutaneum swallowed by fetus, which is excreted from the very start of pregnancy to 24 hours after birth of neonates and re flects the lead deposit in neonatal intestinal tract during the whole period of pregnancy. OBJECTIVE: To explore the relationship between neurobehavioral devel opment in neonates with intrauterine exposure to lead at low level and the lead level in umbilical cord blood (CBPb) and meconium (MPb). DESIGN: Take lead levels in umbilical cord blood and meconium as neonatal intrauterine exposure indicators and scores of neonatal neurobe havioral development as effect indicators, and descriptive analysis is used to evaluate the correlativity. SETTING: Wuhan University of Science and Technology; Laboratory of Occupation Disease and Epidemiology, Tongji Medical College, Huazhong University of Science and Technology; Wuhan First Metallurgical Con struction Company Hospital for Workers and Staff. PARTICIPANTS: A total of 103 cases of full-term and healthy neonates were selected as objects of observation. The neonates were born in Depart ment of Gynecology and Obstetrics, Wuhan First Metallurgical Constrction Company Hospital, Qingshan District of New Industrial District of Wuhan from January to October 1999. Their parents were agreed to participate in the study and filled in the questionnaire, and provided neonatal meconium and performed neonatal tests on schedule. METHODS: ① Collection and assay of sample: 5 mL umbilical cord blood were collected and reserved in refrigerator at -4 ℃. Meconium with in 24 hours after birth, with dry weight between 5 to 10 g was collected, the lead levels in umbilical cord blood and meconium were assayed with the method of graphite furnace atomic absorption spectroscopy. ② Group ing: The neonates were divided into two groups with high and low-exposure to lead based on the cutoff value of CBPb of 0.483 μmol/L and MPb of 127.78 mg/kg. ③ Neonatal neurobehavioral development examination: Neonatal neurobehavioral development examination method was used for examination 3 days before delivery. Meanwhile, self-designed questionnaire was used to conduct a survey in puerperas. MAIN OUTCOME MEASURES: ① Lead levels in neonatal umbilical cord blood and meconium. ② Scores of neurobehavioral development of neonates with different lead levels of umbilical cord blood and meconium. RESULTS: All the 103 cases of neonates entered results analysis. ①There was significant difference only in scores of neonatal behavioral neurological assessment (NBNA) and biological visual and auditory orientation reaction (BVAOR)between groups with high and low-exposure to lead in umbilical cord blood (P ＜ 0.05). However, there was no rank correlativity between lead level in umbilical cord blood and scores of NBNA,non-biological auditory orientation reaction (NBAOR), non-biological visual orientation reaction (NBVOR) and biological visual and auditory orientation reaction (NBVOR). ②here was significant difference in scores of NBNA,NBAOR, NBVOR and BVAOR between groups with high and low-exposure to lead in meconium (P ＜ 0.05-0.01). The lead level in meconium clearly correlated reversely with scores of NBNA, NBVOR and BVAOR.CONCLUSION: Lead level in meconium is more sensitively related to the scores of neonatal neurobehavioral development, which could be used as indicator for lead deposit in the fetal body during the period of pregnancy.

The study used questionnaires to investigate clinical TCM master degree students who enrolled in the year of 2011 and 2012 about the implementation effect of training plan before and after standardization of resident training. The results showed that a lot of students in the year 2011 and 2012 were satisfied with their training plan and training mode. However, the ability of clinical skills and academic research improved much higher after standardization of resident training among the students in 2012. The study showed that our education training plan met the training goal and reflected achievements in the cultivation of medical master degree of TCM. The training plan and training mode were higher satisfied for the students in the year 2011 and 2012. The conception of tutor, training target, the relationship between clinical skills and scientific research should be improved in future.

OBJECTIVEDiscrete potentials (DPs) have been recorded and targeted as the site of ablation of the outflow tract arrhythmias. The aim of the present study was to investigate the significance of DPs with respect to mapping and ablation for idiopathic outflow tract premature ventricular contractions (PVCs) or ventricular tachycardias (VTs).

METHODSSeventeen out of 24 consecutive patients with idiopathic right or left ventricular outflow tract PVCs/VTs who underwent radiofrequency catheter ablation between September 2012 and December 2013 in our department were included. Intracardiac electrograms during the mapping and ablation were analyzed.

RESULTSDuring sinus rhythm, sharp high-frequency DPs that displayed double or multiple components were recorded following or buried in the local ventricular electrograms in all of the 17 patients, peak amplitude was (0.51 ± 0.21) mV. The same potential was recorded prior to the local ventricular potential of the PVCs/VTs. Spontaneous reversal of the relationship of the DPs to the local ventricular electrogram was noted during the arrhythmias. The DPs were related to a region of low voltage showed by intracardiac high-density contact mapping. At the sites with DPs, unipolar and bipolar ventricular voltage of sinus beats were lower compared with the adjacent regions without DPs (unipolar: (6.1 ± 1.8) mV vs. (8.3 ± 2.3) mV, P < 0.05; bipolar: (0.62 ± 0.45) mV vs. (1.03 ± 0.60) mV, P < 0.05). The targeted DPs were still present in 12 patients after successful elimination of the ectopies. Discrete potentials were not present in seven controls.

CONCLUSIONSDiscrete potentials and related low-voltage regions were common in idiopathic outflow tract ventricular arrhythmias. Discrete potential- and substrate-guided ablation strategy could help to reduce the recurrence of idiopathic outflow tract arrhythmias.

Objective To investigate the effect of Buyang Huanwu Decoction on blood-brain barrier of focal cerebral ischemia rats, and explore the mechanism of the decoction. Methods The model of focal cerebral ischemia was made by thread embolism method. SD rats were divided randomly into sham-operated group, model group and Buyang Huanwu Decoction group. Buyang Huanwu Decoction group was given Buyang Huanwu Decoction by gavage, the sham-operated group and model group were given normal saline of the same quantity 24 h after modeling. The nervous function deficit scores was evaluated, brain tissues and serum were taken from the rats after treating for seven days, infarct volume was detected by TTC staining, and pathological changes of microvessel were observed microscopically in HE stained sections. And the protein level of MMP-9, MMP-2, VEGF in brain tissue and the serum levels of vWF in serum of every groups were measured by ELISA. Results Compared with model group, Buyang Huanwu Decoction significantly improved the neurological behavior performance, decreased the cerebral infarct volume, alleviated the pathological changes and decreased the protein level of MMP-9, MMP-2, VEGF, vWF. Conclusion Buyang Huanwu Decoction has the protective effect on blood-brain barrier in the model rats of focal cerebral ischemia. The mechanism may be related with restrainning the expression of MMP-9, MMP-2, VEGF, vWF.

Objective To investigate the effects of baicalin on serum progesterone and related hormones in female normal and cerebral ischemia rats; To explore whether baicalin plays a role in cerebral protection of neurological functions by regulating progesterone levels.Methods With vaginal smear method, the adult estrus female SD rats were selected and divided into normal group, baicalin normal group, and molding groups. The left side of the middle cerebral artery of rats in the molding groups was blocked to establish the permanent middle cerebral artery occlusion (pMCAO). After modeling, the rats were randomly divided into model group, baicalin treatment group, progesterone treatment group and progesterone inhibitor group. The baicalin normal group and baicalin treatment group were given intraperitoneal injection of baicalin solution; the normal group and model group were given normal saline of the same quantity; progesterone treatment group was given intramuscular injection of progesterone; progesterone inhibitor group was given intraperitoneal injection of baicalin solution and intragastric administration of mifepristone solution.The neurological function deficit scores were evaluated and rat forelimb holding power was detected by Grip Strength Meter respectively at different time points. Serum was taken from the rats and the progesterone and related hormones levels in the serum of every group were measured by ELISA. Results Compared with normal group, neurological functions of rats in molding groups were damaged, and neural functional behavior scores of different time points were the most strongly increased (P<0.001), and rat forelimb holding power was the most strongly reduced (P<0.001). 5 days after treating, baicalin showed the trend of improvement of neurological functions (P>0.05) and more significant improvement of the forelimb holding power (P<0.01); 10 days after modeling, baicalin treatment group significantly increased neural functional behavior scorce (P<0.001) and the most significantly improved the forelimb holding power (P<0.001). Compared with baicalin treatment group, the progesterone inhibitor group had a significant inhibitory effect on neural functional recovery (P<0.05) 10 days after modeling, and the group also had a significant inhibitory effect on the recovery of holding power (P<0.05) 5 days and 10 days after treating. At the same time, compared with the model group, progesterone level in baicalin treatment group increased significantly (P<0.05), and FSH and LH decreased (P>0.05).Conclusion After applying mifepristone to block progesterone, baicalin neurologic protection is significantly inhibited. The results demonstrated that baicalin may play a role in cerebral protection via up-regulating serum progesterone level.

Objective To determine the risk factors for postoperative respiratory complications and establish a preoperative risk scoring system.Methods Patients,aged ≥ 18 yr,scheduled for elective surgery or undergoing emergency operation under total intravenous anesthesia or field block anesthesia,were studied.The general data of patients,preoperative SpO2,and conditions of respiratory infection,anemia or cough tests within 1 month before surgery were recorded.The operative sites (thorax,upper abdomen,other sites),duration of operation,type of surgery (emergency operation/elective operation),and methods of anesthesia (general anesthesia/field block) were also recorded.According to the development of respiratory complications within 1-7 days after operation,the patients were divided into either postoperative respiratory complication group or non-postoperative respiratory complication group.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to pick out the risk factors for postoperative respiratory complications and to establish a preoperative risk scoring system.Results Two thousand and thirty-seven patients completed the study.A total of 493 patients developed postoperative pulmonary complications,and the incidence was 24.20％.Statistical analysis showed that the risk factors associated with postoperative respiratory complications included age ＞ 50 yr,preoperative SpO2 ≤90％,high ASA physical status,duration of smoking ＞ 1 yr,positive cough tests,respiratory infections at one month before operation,preoperative anemia,upper abdominal and intrathoracic operations,duration of operation ＞ 2 h.A preoperative risk scoring system was established for postoperative respiratory complications based on 6 independent risk factors:preoperative SpO2,anemia,respiratory infections,age,duration of operation and operative sites.The incidence of postoperative respiratory complications was 61.9 ％,52.8 ％ and 17.2 ％ in high-risk,medium-risk and low-risk groups,respectively,and there was significant difference between the three groups (P ＜ 0.01).Area under the ROC curve was 90％ for subsamples and 87％ for the validation subsamples.Conclusion Age ＞ 50 yr,high ASA physical status,duration of smoking ＞ 1 yr,positive cough tests,preoperative SpO2 ≤90％,anemia,respiratory infections at one month before operation,duration of operation ＞ 2 h,upper abdominal and intrathoracic operations are risk factors for postoperative respiratory complications.A preoperative risk scoring system is successfully established for postoperative respiratory complications based on preoperative SpO2,anemia,respiratory infections,age,duration of operation and operative sites.

Perioperative pressure injury accounts for a large proportion of hospital-acquired pressure injury. However, most of them can be effectively prevented by taking measures. Hospital-acquired pressure injury has become one of the ten safety goals to prevent and reduce accidental injury. Chain management is a scientific management mode, emphasizing horizontal and continuous management. This paper summarizes the application progress of chain management in perioperative pressure injury from its concept, application mode, effect, existing problems and enlightenment. It suggests that we should pay more attention to the handover between ward and operating room and the collaboration between nurses and physicians, then establish a standardized prevention program of perioperative pressure injury to improve nursing care.

Objective To investigate the productive effects of baicalin on the male rats with ischemic brain injury and its effects on serum progesterone level in rats; To explore the possible mechanism of baicalin in brain protection. Methods Adult SD male rats were used to create a permanent left middle cerebral artery occlusion model. The rats were evenly divided into model group, baicalin group, inhibitor group, and sham-operation group (without inserted into the intraluminal thread) according to the neurological function scores. At different time points after modeling, the neurological function scores and the grip strength of double foreleg were measured, and the reduction rate of grip strength was calculated. Serum progesterone and adrenocorticotrophic hormone (ACTH) were detected by ELISA. Results Compared with the sham-operation group, the neurological function of rats in the model group was impaired, the grip strength of double foreleg was significantly reduced. 7 days after treatment, compared with the model group, the neurological function score of baicalin group was lowered, grip strength of double foreleg was recovered, reduction rate of grip strength was reduced (P<0.05); compared with the baicalin group, protective effects of baicalin on neurological function was lowered in inhibitor group (P<0.05). 7 days after treatment, compared with the model group, the serum progesterone level in baicalin group was significantly higher (P<0.01), and ACTH level showed an increasing trend; compared with the baicalin group, serum progesterone and ACTH levels in the inhibitor group decreased (P<0.05). Conclusion The protective effects of baicalin on the male rats with ischemic brain injury may be related to the regulation of progesterone.

Objective To study the therapeutic effects of Xileisan Pessary on rats with cervicitis based on the idea of treating different diseases with the same therapy. Methods Vagina perfusion of hydroxybenzene mucilage was used to establish rat cervicitis models. Rats were randomly divided into normal group, model group, positive medicine group, low-, medium-, and high-dose Xileisan Pessary groups. Rats with cervicitis were treated with Xileisan Pessary from the next day after modeling for 10 days. The amount of neutrophilic granulocytes and leukocytes were detected by blood routine analysis meter; cervial histopathologic examination was conducted by HE staining. Results Compared with normal group, the numbers of granulocyte and leucocyte increased significantly in the model group (P<0.01). Compared with the model group, the numbers of granulocyte and leucocyte in the low-dose Xileisan Pessary group showed a decreasing trend (P<0.05, P<0.01); cervical inflammation mucosal epithelium and tissue necrosis were signally alleviated; granulocyte in the medium-dose Xileisan Pessary group showed a decreasing trend (P>0.05);the content of leucocyte hardly changed;granulocyte in the high-dose Xileisan Pessary group increased observably (P<0.01); the number of leucocyte showed an increasing trend (P>0.05), and the numbers of granulocyte and leucocyte in positive medicine group decreased observably (P<0.01), and cervical inflammation mucosal epithelium and tissue necrosis were also signally alleviated. Conclusion Xileisan Perssary can relieve the inflammation of cervix and repair injured mucosa. It has the function of treating different diseases with the same therapy.