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Objective To develop a three-stage standardized and systematic training program framework and indicator systems for clinical midwives.Methods Based upon literature review,Delphi technique was used to formulate index system and indicators for midwives' training program through tworound expert consultation among 29 experts.Results After two-round expert consultation,the response rates were 96.7％ and 100.0％,respectively.Experts' authority coefficient was 0.874.The training program framework consisted of a three-level index system.Average importance scores of the three-level indexes were 4.10 to 4.97,4.07 to 4.97,and 4.00 to 5.00,respectively.And their variance coefficients were 0.037 to 0.119,0.037 to 0.130,and 0 to 0.141,respectively.Then a progressive and integrated three-year standardized training framework and index system for clinical midwives was finally formed,which totally contained 5 first-level indicators or training modules,including professional competence and safety awareness,specialized and basic knowledge,specialized practical skills,emergency management,and basic capacity for teaching and research.Conclusions The three-level framework and indicators for clinical midwives' training program has been proved to be acceptable,reliable and scientific,thus providing a theoretical and referential basis for training clinical midwives and improving teaching quality.

OBJECTIVE: To determine the value of contrast-enhanced ultrasound in the diagnosis of benign and malignant hepatic tumors. METHODS: A total of 83 patients with 123 focal liver lesions (FLLs) underwent contrast enhanced ultrasound (CEUS) examination. The contrast enhanced characterization of FLLs were compared. RESULTS: All the 103 lesions in hepatocallular carcinoma improved quickly in the arterial phase or portal phase. Altogether 98 lesions (95%) washed out during the late phase but the rest 5 lesions (5%) did not. Of the 69 lesions of hepatocellular carcinoma, 53(77%) enhanced global in the arterial phase or portal phase, and the rest 16 (23%) showed inhomogeneous enhancement but no enhancement in the central area during arterial phase or portal phase. A total of 66(96%) presented wash-out during the late phase, and 3(4%) had no wash-out. Of the 34 lesions of metastatic hepatic carcinoma, 24(71%)presented inhomogeneous enhancement in the arterial phase or portal phase, 10(29%) enhanced globally in the arterial phase or portal phase, 32 (94%) presented wash-out during the late phase, and 2(6%) had no wash-out in the late phase. Of the 20 lesions of benign hepatic tumor, 18(90%) presented inhomogeneous enhancement slowly in the arterial phase or portal phase, 14 (70%) slightly enhanced, and 20 (100%) presented no wash-out in the the late phase. CONCLUSION CEUS can improve the accuracy of diagnosis of benign and malignant hepatic tumors.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular ; diagnostic imaging ; pathology ; Contrast Media ; Diagnosis, Differential ; Female ; Hemangioma ; diagnostic imaging ; pathology ; Humans ; Image Enhancement ; Liver Neoplasms ; diagnostic imaging ; pathology ; secondary ; Male ; Middle Aged ; Ultrasonography

ObjectiveTo analyze the surgical treatment of visceral artery aneurysm (VAAs).MethodClinical data of 19 patients surgically treated for visceral artery aneurysm in our hospital from Feb 2002 to Jun 2010 were reviewed. There were 7 cases of splenic, 1 of right hepatic, 1 of left gastric,3 of pancreaticoduodenal,2 of gastroduodenal, 1 of superior mesenteric, 1 of middle colic, 1 of left colic and 2 of renal artery aneurysms. Rupture of the aneurysm occurred in 12 patients. Transcatheter arterial embolization was performed in 13 cases, other 6 cases received open surgical treatment.ResultsFour patients suffered from recurrent bleeding after first embolization, 2 of those received surgery to stop bleeding, another 2 were successfully managed by second embolization.Bleeding were rapidly controlled in 8 ruptured patients associated with shock. Duodenum incomplete obstruction developed in 1 patient after pancreaticoduodenal artery embolization, another 2 patients suffered from partial splenic infarction after splenic artery operation. 18 cases were followed-up from 2 to 103 months without aneurysm recurrence.ConclusionsEndovascular embolization and open surgery for VAAs are safe and effective, endovascular intervention and embolization is especially life saving for ruptured pseudo-aneurysm cases.

Objective To investigate the effect and safety of autologons bone margow-mononuclear cell (BM-MNC)transplantation after the bone marrow stimulation in patients with thromboangiitis obliterans (TAO).Methods The bone marrows of 12 patients were stimulated by an injection of the recombinant human granuloeyte-macmphage colony-stimulatory factor(GCSF)for 3-5 days.150-200 ml bone marrow was drown from the iliac spine and the autologous BM-MNC were obtained in each patients.Fifteen lower limbs of 12 patients received implantation of the autologous BM-MNC by an intramuscular iniecdon.A series of subjective indexes(including improvement of pain and cold sensation)and objeetive indexes [including increase of ankle braehial index(ABI),transcutaneons oxygen pressure(TcPO2)and improvement of foot skin ulcer] were used to evaluate the effects.Results The outcomes were evaluated after 2 months of transplantation.The pain-relief rate and the cold feeling improvement rate were 86.7%(13/15)and 93.3%(14/15)respectively.The ABI were 0.38 ±0.05 vs.0.61 ±0.14(P<0.05)before transplantation and 2 months after transplantation respectively.increased in 66.7%(10/15)limbs.The TcPO2 of the ischemic legs increased from(27.47±2.85)mm Hg to(43.53 ±8.38)mm Hg(t=-7.03,P<0.05)after the transplantation,and the improvement rate of TcPO2 was 93.3%(14/15).Skin ulcers in improved in 8/9 limbs.Twelve patients were followed up for all average period of 10 months.The patients'symptoms improved in 80.0%(12/15)limbs,as to the objective index the ABI was0.57±0.13,TcPO2 was(42.07 ±7.81)mm Hg,which improved significandy compared to before treatment(t=-5.33,-7.80,Ps<0.05).skin ulcer healing rate was 66.7%(6/9).The ischemic symptoms in 2 patients were not relieved.There WBS no mortality and high level amputation in all subjects.The complications,such as proliferative retinopathy,malitpmnt tumor,myocardial infarction,stroke or hemangioma were not found in any patients.Conclusion In patients with TAO,intramuscular transplantation of autologous BM-MNC after the bone marrow stimulation has advantages of less bone marrow aspiration,more mononuclear cell content and relatively high safety.It may be a new and effective method to alleviate symptoms and accelerate the healing of skin ulcer.

This article describes softwares and their functions in each phase of 3D printing process in medical device production, and gives the advices on supervision. For software with specific medical purposes, the registration of the software should be carried out. The softwares used in the printing process need to be verified according to the corresponding risk.
Equipment and Supplies ; Printing, Three-Dimensional ; Software

OBJECTIVETo research the intestinal absorption characteristics of paeoniflorin in extractive Radix Paeoniae Alba in the different intestinal segment, and the interaction with P-glycoprotein.

METHODPaeoniflorin, a representative component in extractive Radix Paeoniae Alba, on the intestinal absorption was studied in vitro using everted gut sacs model and detected by HPLC method. The absorption characteristics was evaluated by the absorption parameter.

RESULTThe absorption of paeoniflorin was linearity at different intestine segment and dose, and the square of regrees correlation coefficient exceed 0.9 (R2 > 0.9), which consistent with zero order rate process. The Kalpha of paeoniflorin showed a dose-dependent increase along with the raised dose of extractive Radix Paeoniae Alba, indicated it was a mechanism of passive absorption. The absorption rate was jejunum > ileum > colon. Verapamil (100 micromol x L(-1)), a inhibitor of the P-glycoprotein, can remarkable increase the absorption of the paeoniflorin in ileum (P < 0.05). After administer the extractive Radix Paeoniae Alba for 5 days, the extraction of Rho123 is significantly increase in ileum (P < 0.01).

CONCLUSIONThe intestinal absorption of paeoniflorin is zero order rate process and passive absorption. Paeoniflorin is a substrate of P-glycoprotein, and extractive Radix Paeoniae Alba could induce the expression of the P-glycoprotein.

ATP-Binding Cassette, Sub-Family B, Member 1 ; antagonists & inhibitors ; metabolism ; Animals ; Benzoates ; isolation & purification ; metabolism ; pharmacokinetics ; pharmacology ; Bridged-Ring Compounds ; isolation & purification ; metabolism ; pharmacokinetics ; pharmacology ; Dose-Response Relationship, Drug ; Drugs, Chinese Herbal ; isolation & purification ; metabolism ; pharmacokinetics ; pharmacology ; Gastrointestinal Tract ; drug effects ; metabolism ; Glucosides ; isolation & purification ; metabolism ; pharmacokinetics ; pharmacology ; Intestinal Absorption ; drug effects ; Male ; Monoterpenes ; Paeonia ; chemistry ; Rats ; Rats, Wistar ; Verapamil ; pharmacology

Objective: To investigate the effect and mechanism of helix B surface peptide (HBSP) on myocardial ischemia reperfusion injury (MIRI) in experimental mice.
Methods: The MIRI model was established by ligation of anterior descending coronary artery of the mice for 45 min and followed by corresponding treatment at 5 min before reperfusion. A total of 64 male ICR mice were randomly assigned to 4 group:①Sham group,②MIRI group, the mice received normal saline at 5 min before reperfusion,③HBSP group, MIRI mice received HBSP at 5 min before reperfusion and④HBSP+PD98059 group, MIRI mice received PD98059 (a speciifc blocker of ERK1/2) at 20 min before reperfusion and followed by HBSP at 5 min before reperfusion.n=16 in each group, all animals were treated for 2 hours. The area of myocardial infarction (MI) was detected by TTC-EB double staining method, the myocardial apoptosis rate was examined by TUNEL method, the levels of protein expression of ERK1/2 and phosphorylation of ERK1/2 were measured by Western blot analysis.
Results: Compared with MIRI group, HBSP group presented decreased MI area, decreased myocardial apoptosis rate and increased phopsphorylation level of ERK1/2, allP<0.05. Compared with HBSP group, HBSP+PD98059 group showed decreased phopsphorylation level of ERK1/2, increased myocardial apoptosis rate and increased MI area, allP<0.05.
Conclusion: HBSP may reduce the MI area via inhibiting myocardial apoptosis and therefore, protecting the experimental mice from MIRI; the mechanism might be related to the activation of ERK1/2 pathway.

Objective To explore the safety and feasibility of calf arterial stent angioplasty to treat severe lower limb ischemia. Methods Clinical data of 13 patients in our hospital during recent 3 years were retrospectively analysed and all these patients were followed up after discharge.Of these patients there were 10 males and 3 females; mean age was (73 ±7) years; mean disease course was (8 ±4) months.Severe claudication was reported in 5 patients,rest pain in 4 patients,toe ulcer in 2 patients,gangrene in 2 patients.Stent was placed in the tibioperoneal trunk artery in 5 patients ; in the proximal part of peroneal artery in 3 patients; in the tibioperoneal trunk and proximal peroneal artery in 2 patients; in the anterior tibial artery in 2 patients; in the posterior tibial artery in one patient.Simultaneous endovascular treatment of femoral/popliteal arterial disease was done in 11 patients. Results All the procedures were successful and the treated arteries kept patent on discharge of patients.Claudication distance increased to be above 500 meter in 5 patients; rest pain relieved in 4 patients ; toes ulcer reduced in 2 patients,feet gangrene kept dry till discharge in 2 patients.Postoperative ABI increased in all patients.Patients were followed-up of mean (6.9 ± 2.2) months.One patient with previous toe gangrene underwent amputation due to recurrent pain while the stent in anterior tibial artery kept patent after 6 months discharge.In the other patient gangrene toe had fallen off and the wound healed.Two patients with toe ulcer had a total recovery and patients with previous rest pain had no recurrent symptoms. Conclusions Below knee arterial stent angioplasty is a safe and effective method in the treatment of severe lower limb ischemia.

Objective To establish WeChat official account-based platform for evidence dissemination,and to evaluate the effects of the platform.Methods The WeChat official account-based platform for evidence dissemination was established,and big data analysis and sampling survey were adopted to analyze information and its communication effects published from December,2014 to September,2016.Results Totally 22 369 followers used the platform and conducted 404 232 hits on its pages in total.The most frequent searches were Evidence and Knowledge of evidence-based nursing.The WeChat Communication Index was 433.07.The overall evaluation score was 4.34± 0.67.Conclusion WeChat official account-based platform for evidence dissemination can promote the accessibility of evidence and receives high evaluation score from followers.