Background::The potential impact of β cell function and insulin sensitivity on adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM) remains uncertain. We aimed to investigate the association between β cell dysfunction, insulin resistance, and the composite adverse pregnancy outcomes.Methods::This observational study included 482 women diagnosed with GDM during pregnancy. Quantitative metrics on β cell function and insulin sensitivity during pregnancy were calculated using traditional equations. The association of β cell dysfunction and insulin resistance with the risk of the composite adverse pregnancy outcomes was investigated using multivariable-adjusted logistic regression models.Results::Multivariable-adjusted odds ratios (ORs) of adverse pregnancy outcomes across quartiles of homeostatic model assessment for insulin resistance (HOMA-IR) were 1.00, 0.95, 1.34, and 2.25, respectively ( P for trend = 0.011). When HOMA-IR was considered as a continuous variable, the multivariable-adjusted OR of adverse pregnancy outcomes was 1.34 (95% confidence interval 1.16-1.56) for each 1-unit increase in HOMA-IR. Multivariable-adjusted ORs of adverse pregnancy outcomes across quartiles of homeostatic model assessment for β cell function (HOMA-β) were 1.00, 0.51, 0.60, and 0.53, respectively ( P for trend = 0.068). When HOMA-β was considered as a continuous variable, the multivariable-adjusted OR of adverse pregnancy outcomes was 0.57 (95% CI 0.24-0.90) for each 1-unit increase in HOMA-β. However, other quantitative metrics were not associated with the composite adverse pregnancy outcomes. Conclusions::We demonstrated a significant association of β cell function and insulin sensitivity with the risk of adverse pregnancy outcomes. We have provided additional evidence on the early identification of adverse pregnancy outcomes besides the glycemic values.

Objective:To investigate the clinical efficacy of gastroscopic 'sandwich’ injection and sequential laparoscopic splenectomy combined with pericardial devascularization in the treatment of gastric variceal bleeding.Methods:The retrospective cohort study was conducted. The clinical data of 52 patients with cirrhotic portal hypertension combined with gastric variceal bleeding who were admitted to Affiliated Hospital of Jiaxing University between March 2011 and October 2019 were collected. There were 33 males and 19 females, aged (63±9)years, with a range of 41-83 years. Of the 52 patients, 31 undergoing gastroscopic 'sandwich’ injection and sequential laparoscopic splenectomy combined with pericardial devascularization and 21 undergoing laparoscopic splenectomy combined with pericardial devascularization were allocated into sequential group and laparoscopic group, respectively. Observation indicators: (1) surgical situations; (2) complications; (3) changes in gastric varices after treatment; (4) follow-up. Follow-up was performed using telephone interview combined with outpatient examination to detect survival of patients up to December 2019. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed by the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was analyzed by the Mann-Whitney U test. Count data were expressed as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Ordinal data was analyzed by nonparametric rank sum test. Results:(1) Surgical situations: patients of sequential group and laparoscopic group underwent surgery successfully. The operation time and volume of intraoperative blood loss of the sequential group were (112±16)minutes and (57±11)mL, respectively, versus (103±14)minutes and (55±9)mL of the laparoscopic group, showing no significant difference in the above indicators between the two groups ( t=0.963, 1.052, P>0.05). (2) Complications: 11 patients in the sequential group had postoperative complications including 1 case with perioperative bleeding, 2 cases with postoperative gastrointestinal rebleeding, 4 cases with ascites, 4 cases with portal vein thrombosis. There was no death in the sequential group. Sixteen patients in the laparoscopic group had postoperative complications including 2 cases with perioperative bleeding, 6 cases with postoperative gastrointestinal rebleeding, 4 cases with ascites, 4 cases with portal vein thrombosis. Three patients died in the laparoscopic group. There was no significant difference in the cases with perioperative bleeding or cases with ascites between the two groups ( P>0.05) and no significant difference in the cases with portal vein thrombosis or death between the two groups ( χ2=0.082, 0.082, P>0.05). There was a significant difference in the cases with postoperative gastrointestinal rebleeding between the two groups ( P<0.05). Cases with postoperative gastrointestinal rebleeding, cases with ascites, cases with portal vein thrombosis in the sequential group were cured after the treatment of gastroscopy, low salt diet combined with diuretic or low dose warfarin, respectively. Of the 6 patients with postoperative gastrointestinal rebleeding in the laparoscopic group, 3 were cured after the treatment of gastroscopy and 3 died due to failure to rescue in time. Cases with ascites and cases with portal vein thrombosis in the laparoscopic group were cured after the treatment of low salt diet plus diuretic or low dose warfarin, respectively. (3) Changes in gastric varices after treatment: at postoperative 6 months, 31 patients in the sequential group were diagnosed with negative gastric varices; 15 of 21 patients in the laparoscopic group were diagnosed with negative gastric varices, 3 cases were diagnosed with obvious gastric varices and 3 cases were diagnosed with severe gastric varices. There was a significant difference in the cases with gastric varices between the two groups ( Z=-3.128, P<0.05). At postoperative 12 months, 29 patients in the sequential group and 13 patients in the laparoscopic group were diagnosed with negative gastric variceal. There were 2 patients in the sequential group diagnosed with obvious gastric varices, and 8 patients in the laparoscopic group diagnosed with gastric varices including 3 cases with obvious gastric varices and 5 cases with severe gastric varices. There was a significant difference in the cases with gastric varices between the two groups ( Z=-2.933, P<0.05). Cases with obvious gastric varices in the sequential group were cured after the treatment of gastroscopy. Cases with obvious or severe gastric varices in the laparoscopic group were cured after the treatment of gastroscopy except 1 died due to massive gastrointestinal hemorrhage. (4) Follow-up: 52 patients were followed up for 1-8 years, with a median time of 4 years. All the 31 patients in the sequential group and 18 ptients in the laparoscopic group survived. Conclusion:Gastroscopic 'sandwich’ injection and sequential laparoscopic splenectomy combined with pericardial devascularization in the treatment of gastric variceal bleeding has low recurrence rate of varicosity and low incidence of rebleeding.

Objective:To construct a close-loop path management model for aspiration risk screening of patients in Department of Neurosurgery, and verify its application effect in the nursing of inpatients in department of neurosurgery.Methods:Through literature retrieval and expert consultation, the close-loop path management model of aspiration risk screening was constructed. The convenient sampling method was adopted to select inpatients in the Neurosurgery Department of a ClassⅢ Grade A hospital in Jiangmen of Guangdong Province from January to December 2019. The patients admitted from January to June 2019 were set as the control group and received routine aspiration assessment and management while the patients admitted from July to December 2019 were set as the observation group and received close-loop management of aspiration risk screening. The incidences of aspiration and aspiration pneumonia were compared between the two groups.Results:In the control group, there were 506 patients, of whom 92 (18.18%) had aspiration. In the observation group, there were 543 patients, of whom 74 (13.63%) had aspiration. There was a statistically significant difference in the incidence of aspiration between the two groups (χ 2=4.078, P=0.043) . The incidence of aspiration pneumonia was 8.10% (41/506) in the control group and 5.52% (30/543) in the observation group. There was no statistically significant difference between the two groups (χ 2=2.758, P=0.097) . Conclusions:The close-loop management of aspiration risk screening standardizes the process of aspiration risk screening, guarantees the implementation of dynamic assessment and effectively reduces the incidence of aspiration, which can provide a reference for improving the management level of prevention and treatment of aspiration.

Preventing and mitigating major risk exposure is an important task for modern countries to maintain sustained and healthy economic development and overall social stability. In this manuscript, the authors introduced Israel′s current medical and health care risk prevention system, including the regional health emergency response coordination mechanism, hospital′s external emergency rescue capacity building and hospital′s internal security system. Israel′s risk prevention system has been tested by wars and terrorist attacks, as well as many infectious diseases outbreaks. Thus the authors expected that its successful experiences can be introduced as a reference for improving China′s medical and health care risk prevention system.

Objective To compare the complications and outcomes of urgent?start peritoneal dialysis (PD) and hemodialysis (HD) in end?stage renal disease (ESRD) patients, and explore the safety and effectiveness of PD which was as an urgent?start dialysis modality in ESRD patients. Methods All patients for urgent?start dialysis, who initiated dialysis without a long?term dialysis access or had the long?term dialysis access under 30 days in Renji Hospital from January 1st 2013 to December 31st 2014, were enrolled. According to the dialysis modalities, patients were divided into PD group and HD group. Participants were followed up until death, transferred to other centers, lost of follow up or January 1st 2016. Dialysis?related complications within 30 days of implantation, complications of reimplantation and the occurrence of bacteremia between two groups were compared, and their survival rates were tested by Kaplan?Meier curves. Results Among 178 patients in this study, there were 96 (53.9%) patients in PD group and 82 (46.1%) patients in HD group. Compared with those of HD group, patients of PD group presented more cardiovascular disease [21(21.9%) vs 8(9.8%), P=0.029], higher serum potassium [(4.5±0.8) mmol/L vs (4.3±0.8) mmol/L, P=0.038], but less heart failure (NYHA Ⅲ?Ⅳ) [26(30.2%) vs 40 (48.8%), P=0.014], lower brain natriuretic peptide (BNP) [328.5 (129.5, 776.8) ng/L vs 503.5(206.0, 1430.0) ng/L, P=0.008], higher hemoglobin [(81.5 ± 17.7) g/L vs (75.3 ± 22.5) g/L, P=0.039], higher serum albumin (33.5±5.7) g/L vs (31.3±6.7) g/L, P=0.022] and higher serum pre?albumin (304.5±78.0) mg/L vs (257.0 ± 86.1) mg/L, P<0.001]. PD group presented less dialysis?related complications [5 (5.2%) vs 20(24.4%), P<0.001], less dialysis?related complications requiring reimplantation [1(1.0%) vs 20(24.4%), P<0.001] and less bacteraemia [3(3.1%) vs 11(13.4%), P=0.011]. The 3?, 6?and 12?month patient survival rates of PD and HD group were 97.9% vs 98.4%, 97.9% vs 98.4%, and 92.1%vs 93.0% respectively, and no significant difference was found (Log ? rank=0.004, P=0.947). Conclusions Patients with urgent?start PD have less complications within 30 days of implantation and occurrence of bacteremia than patients with urgent?start HD, and the same survival rates. PD may be a feasible and safe urgent?start dialysis modality for ESRD patients.

Objective:To establish a method for the determination of zolpidemtartrate in human plasma by SPE-HPLC. Methods:The samples were extracted by solid phase with a Hypersil BDS C18 column and determined by an internal standard method. The mobile phase was methanol:acetonitrile:water (45 ∶45 ∶110), the flow rate was 1. 0 ml·min-1, the column temperature was 35℃, and the detection wavelength was 254nm. Results:The linear relationship of zolpidemtartrate was within the range of 0. 511 5-4. 092 0 μg· ml-1 . The relative recovery was greater than 90%. The intra-and inter-day RSDs were all less than 10%. Conclusion:The method is quite simple, quick and accurate with little interference, which is suitable for the clinical determination of zolpidemtartrate.

The paper described the professional approach of Shanghai Hospital Development Center(SHDC)in developing a professional team of public hospital directors by such means as operation and management-autonomy,fixed tenures system,performance appraisal,part-time job control and income distribution. Recommendations raised include an organic unity of management functions of investors and power of management of the directors to motivate them in their management;building a comprehensive investor management system and strict cadre management mechanism to enhance supervision of the directors.

OBJECTIVE:To discuss the mode and feasibility of informatization and automation construction in the inpatient pharmacy. METHODS:The practice of informatization and automation construction of inpatient pharmacy in our hospital was intro-duced,as well as the change of drug dispensing model. The influence of them on drug dispensing process was analyzed. RESULTS&CONCLUSIONS:2 automatic single dose tablets dispense packing machines,2 rapid dispensing machines and 2 automatic injec-tion chests are introduced in automatic inpatient pharmacy of our hospital. The informatization construction contain the establish-ment of inpatient pharmacy database,drug dispensing and recheck,the application of code,etc. Due to the implementation of auto-matic drug dispensing information system,drug dispensing mode have changed,i.g. drug dispensing by area instead of wards;in-jection and large volume transfusion are dispensed by wards;oral preparation and discharge medication are dispensed by prescrip-tion;dispensed drugs are distributed to wards with professional logistics. The implementation of informatization and automation of inpatient pharmacy in our hospital improve pharmaceutical administration and pharmaceutical care,and add automatic expiry date management and code tracking to guarantee the accuracy,timeliness and high efficiency of drug dispensing.

Objective To investigate the role of IL-28B gene on the antiviral curative effect in the patients with chronic hepatitis B.Methods 205 HBeAg-positive patients treated with the antiviral therapy of pegylation interferon(PEG-IFN)were detected the IL-28B rs12980275 and rs12979860 genotypes by TapManSNP genotyping assay and the relationship between the IL-28B genotypes and HbeAg seroconversion at end of treatment was analyzed.Results Among 205 cases,6 cases of genotype were uncertainty,the frequencies of IL-28B genotypes in other 199 cases were 77%,19%,5% for AA,AG,GG genotypes at rs12980275 and 76%,20%, 4%,for CC/CT/TT genotypes at rs12979860 respectively.The IL-28B polymorphisms were significantly correlated with the HbeAg seroconversion at the end of PEG-IFN treatment (P =0.001).In rs12979860 genotype,by the HBV genotyp,age,HBV lev-el,ALT and the combined therapy,the odds ratio (OR)of AA versus AG/GG was adjusted to 3.16 by HbeAg seroconversion.The similar result also obtained for the rs12980275 genotype.The IL-28B genotype was also associated with the HBsAg clearance.Con-clusion The IL-28B gene polymorphism is associated with the antiviral curative effect in the patients with HBeAg positive chronic hepatitis B.

Objective: To establish an HPLC method for the simultaneous determination of chloromycetin and metronidazole in chlortalidone and metronidazole spirits. Method:The HPLC method was performed on an NOV-pak C18 (150 mm × 4. 6 mm, 5 μm) column and the mobile phase consisted of methanol and water (75∶25). The flow rate was 1. 0 ml·ml-1, the detection wavelength was 297nm, the temperature of column was 30℃ and the sample size was 20 μl. Result: The calibration curve of metronidazole was linear within the range of 5-80μg·ml-1(r=0. 999 7), and the average recovery was 100. 83% with RSD of 1. 82%(n=6). The cal-ibration curve of chlortalidone was linear within the range of 50-800μg·ml-1(r=0.999 7), and the average recovery was 100.2%with RSD of 0. 55%(n=6). Conclusion: The method is simple, rapid, accurate and reproducible, and can be used in the quality control of chlortalidone and metronidazole spirits.