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 investigate the rule of lymphatic formation and the relationship between lymphatic formation and clinical pathological factors in supraglottic carcinoma. METHOD: Immunohistochemistry method and automatic image analysis technique were applied to observe the lymphatic quantity and state in central carcinoma tissue, join tissue and normal larynx mucosa of supraglottic carcinoma. Analyze the rule and the correlation between lymphatic formation and T stage, differentiation, lymph metastasis. RESULT: The lumen-lymphatic formation was not seen in central carcinoma tissue. There are little lymphatic in normal larynx mucosa whereas many lymphatic formation in join area. The lymphatic density in join tissue is correlated with T stage, differentiation and lymph metastasis: T(1-2) lower than T(3-4) and the difference is significant (P<0.01); The difference between high and middle differentiation is insignificant (P=0.212); High-middle differentiation lower than low differentiation and the difference is significant; No lower than N+ and the difference is significant (P<0.01). CONCLUSION In join area, there are lymphatic formation both in carcinoma area and para-tumor area. Tumor cell can go to lymph nodes via this pathway. This conclusion provides theoretical basis for clinical utility of the anti-tumor medicines which inhibitable lymphatic formation. It can help surgeons forecast prognosis and select more effective treatment method to observe join lymphatic vessel quantity.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; pathology ; Female ; Humans ; Laryngeal Neoplasms ; pathology ; Lymph Nodes ; pathology ; Lymphangiogenesis ; Lymphatic Metastasis ; Lymphatic Vessels ; pathology ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis

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 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 analyze the trend and epidemiological features of human brucellosis from 2010 to 2016 in Weinan,Shaanxi Province,and to provide scientific data for effective control of human brucellosis.Methods The data were obtained from the China Disease Surveillance Information Management System and the brucellosis monitoring and epidemic survey of Weinan City from 2010 to 2016.The "three distribution" of brucellosis,the positive rate of serological test of the key group and the infecting route of the epidemic were analyzed using descriptive epidemiology method.Results A total of 1 624 brucellosis cases were reported in Weinan City from 2010 to 2016 and none death case occurred.The morbidity rose from 1.96/100 000 in 2010 to 11.16/100 000 in 2014.The morbidity fallen from 5.46/100 000 in 2015 to 3.33/100 000 in 2016.The reported cases distributed in 10 counties of Weinan and mainly concentrated in Dali County (682 cases),Chengcheng County (269 cases) and Pucheng County (225 cases),accounting for 72.41％ (1 176/1 624).There were brucellosis occurring in all months of the year.The age group distributed mainly from 40 to 64 years old which accounted for 63.67％ (1 034/1 624) of the total reported cases.The peasants accounted for 91.75％ (1 490/1 624) in all cases.Men were significantly higher than women and the morbidity ratio of male to female was 3.28 ∶ 1.00 (1 245 ∶ 379).A total of 15 126 key occupational persons were tested and the positive rate of serology was 2.21％ (335/15 126) annually.The feeding and delivery process were the main ways of infection.Conclusions The brucellosis epidemic in Weinan shows a trend from rise to decline.The middle-aged male peasants account for major population in all cases and the ways of infection are diversified.

Transverse sinus is an important pathway of intracranial venous reflux,which is also crucial for maintaining cerebral circulation and stabilizing intracranial pressure.Transverse sinus stenosis(TSS)is the most common variation of transverse sinus,which might lead to changes in sinus hemodynamics and pressure and closely related to idiopathic intracranial hypertension,pulsatile tinnitus and chronic headache.The progresses in imaging researches of transverse sinus stenosis were reviewed in this article.

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.

OBJECTIVE：To study the improvement eff ects and its mech anism of Guiyuan decoction formula granules （GDFG） on model mice with decreased ovarian reserve （DOR）. METHODS ：Totally 42 female ICR mice whith with normal estrous cycle were randomly divided into control group ，model group ，estradiol valerate group （positive control ，0.15 mg/kg）and GDFG low-dose，medium-dose and high-dose groups （0.75，1.49，2.98 g/kg），with 7 mice in each group. Except for control group ，other groups were given cisplatin （3 mg/kg）intraperitoneally to establish DOR model. After modeling ，administration groups were given relevant medicine intragastrically；model group and control group were given normal saline intragastrically ，once a day ，for consecutive 4 weeks. After last administration ，ELISA assay was used to measure the serum levels of anti-Müllerian hormone （AMH）and follicle-stimulating hormone （FSH）in mice. Histopathological morphology of ovarian was observed by HE staining. Protein distribution of AMH receptor Ⅱ（AMHRⅡ）and Smad 4 in ovarian tissue were observed by immunohistochemistry. Protein expression of AMHR Ⅱ and Smad 4 were detected by Western blot assay. RESULTS ：Compared with control group ，theserum level of AMH ，the expression of AMHR Ⅱ and Smad 4 protein in ovarian tissue in model group were significantly decreased （P＜0.01），while the FSH level in serum was significantly increased （P＜0.01）；follicles were crumpled and lost nucleus ，ovarian interstitial were fibrosis ，luteum were loose ； AMHRⅡ and Smad 4 protein in ovarian tissue were mainly distributed in the follicle membrane and ovarian interstitial. Compared with model group ，the serum level of AMH ，the expression of AMHR Ⅱ and Smad 4 protein in ovarian tissue was increased significantly in GDFG groups （P＜0.01），while the serum level of FSH was decreased significantly （P＜0.05 or P＜0.01）；in ovarian tissue ，follicles at all levels could be found and follicle morphology was improved ，and no obvious nuclear loss and cumulus formation were found ；AMHRⅡ and Smad 4 protein were mainly distributed in the follicular nucleus （except for GDFG high-dose group) and the granular cell membrane （mainly distributed in the sinus follicles of GDFG medium-dose group ）；they were slightly distributed around the mature follicular nucleus or in corpus luteum. CONCLUSIONS ：GDFG can improve ovarian function of DOR model mice. The mechanism may be related with promoting serum level of AMH ，protein expression of AMHR Ⅱ and Smad 4，improving the distribution of AMHR Ⅱ and Smad 4 protein in ovarian granulosa cell membrane and follicular nucleus ， reducing FSH levels.