Objective To evaluate the correlations of emphysema and airway wall thickness to chronic obstructive pulmonary disease(COPD) of airflow limitation by quantitative CT.Methods 40 COPD patients and other 40 normal controls underwent pulmonary function tests and following MSCT exams with inspiration.The square root of wall area of an airway with an internal area of 8 mm2 (Ai8) and the percentage of low attenuation volume(LAV%) of the whole lung and each lobes at the threshold of-950 HU were measured by a software of Thoracic VCAR.The Ai8 between the observation group and the control one was compared using SPSS2.2.The contributions of LAV% and Ai8 to predictions of FEV1/FVC and FEV1% were also evaluated.Results There was a significantly statistical difference in the Ai8 between the observation group and the control one.There were correlations between airflow limitation markers and all of LAV% as well as Ai8 (P<0.05 for all standardized coefficients).Only the Ai8 of right inferior lobar made a significant contribution to airflow limitation in the whole lung bronchus, and the LAV% of each lobes made a stronger contribution to airflow limitation than the Ai8 of right inferior lobe.Conclusion There is a significantly statistical difference in the Ai8 between the observation group and the control one.The LAV% may make a greater contribution to airflow limitation than Ai8 in COPD group.The influential factors of airflow limitation in order were LAV%, Ai8 of right inferior lobe and Ai8 of the other lobes.

Objective To develop an indicator system for evaluating midwifery quality. Methods Guided by the latest evidence-based framework of midwifery quality,based on indicator selection principle,the indicator system for evaluating midwifery quality was preliminarily developed by literature review,expert meeting,theoretical analysis and expert consultation,for further validation through large-scale Delphi method. Results The indicator pool for mid-wifery quality evaluation was identified by literature review,including indicator name and definition of special indi-cator. The indicator system was finalized through comprehensive analysis and selection,and consisted of 45 indica-tors. The expert consultation questionnaire response rate was 100%,the rate of experts who provided written sug-gestions was 81.3%,the authority coefficient was 0.92,the coefficients of variation of indicators ranged from 0 to 0.29. Conclusion The preliminarily developed indicator system for midwifery quality evaluation guided by the lat-est evidence-based framework of midwifery quality was scientific,oriented and accessible,which could be further ex-amined through large-scale Delphi method.

Objective To explore the diagnostic value of intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI)in diagnosis of different pathological types of lung cancer.Methods 45 patients were performed traditional MR and multi-b value DWI scan by GE discovery 750 MR.The values of Slow-ADC,Fast-ADC and ffast measured on a AW4.5 workstation were analyzed between the different pathological types of lung cancers.The correlations between these IVIM-DWI parameters and the serum tumor markers of lung cancer were analyzed.The diagnostic efficiency of these parameters were evaluated by receiver operator characteristic curve (ROC).Results 27 cases NSCLC(13 cases squamous carcinoma;14 cases adenocarcinoma )and 18 cases SCLC were finally included in this study.There were significant differences in Slow-ADC values between SCLC group and NSCLC group (P =0.00),the adenocarcinoma group (P=0.03),the squamous carcinoma group(P=0.01).There were no significant difference in Fast-ADC as well as ffast value between any two groups.The AUC of Slow-ADC value was 0.874.There existed negative correlation between squamous cell carcinoma antigen(SCC-Ag)of squamous carcinoma group and Slow-ADC(r=-0.730).Conclusion The Slow-ADC of IVIM-DWI parameters is useful in differential diagnosis of NSCLC and SCLC,which has the largest diagnostic efficiency.The correlation between SCC-Ag and Slow-ADC value has a certain meaning in diagnosing different pathological types of lung cancers.

Objective To analyze the published articles on the etiology of rheumatoid arthritis (RA) and catch the recent research hot topics.Methods Literature searching on the etiology of RA was conducted through PubMed database of US Congress Library of Medicine published in past five years.Bibliographic Item CO-Occurrence Matrix Builder (BICOMB) to bibliometric analysis and statistical product and service solutions (SPSS) 19.0 were used for cluster analysis and plotting strategic coordinate figure.Results Four research hot topics were identified by analyzing the keywords:① Therapeutic and adverse effects of antirheumatic agents;② Genetics and complications of RA;③ Immunity of autoantigens and autoantibodies in RA;④ Immune cells and microRNAs in RA.Conclusion Researches on RA etiology have developed steadily,with different current status and developing tendency,which provides reference for related studies.

Twelve novel 2-phenyl -tetrahydrothiopyrano［4, 3-d］pyrimidine derivatives were synthesized from 4-hydroxy-benzonitrile by etherification, hydrolysis, acylation and addition reactions, etc. The inhibitory activities against xanthine oxidase were evaluated in vitro. Results showed that compounds 8a-8h exhibited varying inhibitory potencies on xanthine oxidase at 100 μmol/L, significantly better than those of compounds 6a-6d, indicating that carboxy-substituted pyrimidine is beneficial to the inhibitory activity. Among compounds 8a-8h, 8f with isopropionic acid-substituted pyrimidine and ethyl-substituted phenol showed the best inhibition with IC50 of 76. 0 μmol/L.

Objective To develop a quality evaluation indicator system of midwifery care in line with the modern service concept in Shanghai area under the background of over-medicalization trend of midwifery services, and to guide the improvement direction of midwifery quality. Methods Guided by the evidence-based framework of midwifery quality and indicator selection principles, the indicators for evaluating midwifery quality were preliminarily selected by literature review and theoretical analysis. Two rounds of Delphi survey among 53 experts from Shanghai were conducted to decide the final quality evaluation indicator system of midwifery care. Analytic hierarchy process ( AHP) and the importance′ sum average method were adopted to calculate weights coefficients of the indicators. Results 45 indicators for evaluating midwifery quality were preliminarily selected. The response rate of two rounds of Delphi survey were 76% and 100% , the authority coefficients were 0.90 and 0.89, expert opinion coordinate coefficients were 0.190 and 0.257, respectively. The final version of the indicator system consists of 11 structure quality indicators, 13 process quality indicators and 19 outcome quality indicators. The weight values of the three first-level indicators were 0.195 8, 0.310 8 and 0.493 4 respectively. The weight values of the 43 second-level indicators ranged from 0. 016 1 to 0. 028 6. Conclusions The quality evaluation indicator system of midwifery care developed fits evidence-based midwifery philosophy. It provides a scientific tool for midwifery quality evaluation in Shanghai, which can guide the improvement of midwifery quality.

Objective To investigate the operative efficacy of pellucid septostomy in patients with septum pellucidum cysts and refractory epilepsy.Methods Nine patients with septum pellucidurn cysts and refractory epilepsy,admitted to our hospital from January 2012 to September 2017,chosen;diagnosis by MR imaging was performed in all patients and no other obvious epilepsy lesions were noted.All patients underwent bilateral endoscopic fenestration (pellucid septostomy) by right frontal approach.Follow-up was performed for 6-72 months.Results All patients took antiepileptic regularly.No overall tonic-clonic seizure was noted in 6-72 months of follow-up.Shrunk septum pellucidum cysts were noted in MR imaging.Conclusion Patients with septum pellucidum cysts and refractory epilepsy could be cured by pellucid septostomy.

Objective:To early identify and manage secondary malposition of peripherally inserted central catheter (PICC), and to reduce other PICC related complications.Methods:A total of 8 509 patients were included form January 2017 to December 2018 in intravenous therapy department in the Second Affiliated Hospital of Medical College of Zhejiang University. PICC was implanted and the original tip location was in the superior vena cava (SVC). The function and complications of the catheter were evaluated during the indwelling process. X-ray was taken for every abnormal patient to confirm the route and tip position of the catheter. Tip malposition were adjusted by external manipulation (pulling out part of the catheter, changing body position, external percussion, rapid flushing with 0.9% sodium chloride) when patients’ situation were allowed.Results:A total of 31 cases of PICC secondary malposition were early identified, 27 of them were treated with external manual reduction. Totally 19 cases succeeded, and 8 cases failed. The success rate was 70.4%. There was no other complication during the process. 3 cases were found venous thrombosis, and 1 case was unable to do external manipulation due to his poor situation.Conclusion:X-ray is a simple and easy method to identify secondary malposition of PICC. Using external manipulation to adjust the tip position back to SVC is effective, and the complications are few, which is worthy of clinical application.

The clinical data of 15 patients with duodenal trauma who were admitted to Shanxi Bethune Hospital from January 2012 to June 2019 were retrospectively analyzed. There were 13 patients with blunt injury and 2 with penetrating injury. The surgical procedure was selected by patient′s condition and extent of injury combined with the clinical symptoms, imaging examination and the Organ Injury Scale grading system of the American Association for the Surgery of Trauma (AAST-OIS). All patients were followed up through outpatient examination and telephone interview till February 2020. Ten patients were diagnosed as duodenal trauma by CT scan before operation, and 5 patients were diagnosed during the operation. According to the AAST-OIS, 1 patient was with grade Ⅰ injury, 6 in grade Ⅱ, 5 in grade Ⅲ, 2 in grade Ⅳ and 1 in grade Ⅴ. All 15 patients received surgical treatment, including 1 with simple suture, 5 with break suture and duodenal diverticularization, 6 with break suture and biliary drainage (3 with hepatocystic duct drainage and 3 with cholecystostomy), 2 with pancreaticoduodenectomy. Postoperative complications occurred in 3 patients with Clavien system classification of Ⅲ b, Ⅱ and Ⅱ. One patient with duodenal stricture and severe abdominal infection was cured after gastrectomy and Billroth Ⅱ gastrojejunostomy 6 months after operation, and 2 cases with duodenal fistula were cured after conservative treatment. One patient who underwent pancreaticoduodenectomy was followed up for 6 months in the outpatient department, and 14 patients were followed up for 6-24 months. For emergency abdominal trauma patients with suspected duodenal injury, surgical exploration should be carried out actively. The site and range of intestinal wall injury should be considered in order to select a reasonable operation. Effective duodenal decompression and complete peritoneal drainage are important for the success of surgery. Early postoperative enteral nutrition support is one of the key measures for successful wound healing.

Objective: To detect the effect of the ball compressor method to prevent jugular vein malposition in peripherally inserted central catheter insertion (PICC). Methods: Convenient sampling method was used to recruit 1 358 patients with PICC insertions during October 2017 to September 2018 in Second affiliated hospital Zhejiang University, school of medicine. 681 were included in experimental group, and 677 patients were included in control group. The control group used traditional turning head to the PICC insertion side or fingers compression to block the entrance of jugular vein to prevent jugular vein malposition in control group. While in experimental group, rugby- shape ball compression were used to block jugular vein to reduce jugular vein malposition. The rate of jugular vein malposition in the first try of catheterization was calculated in both groups. Results: The rate of jugular vein malposition in the first try of catheterization was 19.1%(130/681) in experimental group and 23.5% (159/677) in control group respectively. There is statistically significant difference between two groups (χ²=3.917, P=0.047 8). Conclusion Rugby- shape ball compression could reduce jugular vein malposition in the first try of catheterization effectively.