Objective::To build a reference fetal growth chart for the Chinese population based on fetal ultrasound measurements.Methods::This was a multicenter, population-based retrospective cohort study. Longitudinal ultrasound measurement data were collected from 24 hospitals in 18 provinces of China from 1 st September through 31 st October of 2019. The estimated fetal weight (EFW) was calculated based on head circumference, abdominal circumference, and femur length using Hadlock formula 3. Fetal growth curves were estimated using a two-level linear regression model with cubic splines. All participants were divided into two groups: the northern group ( n = 5829) and the southern group ( n = 3246) based on the geographical division of China and male fetus group ( n = 4775) and female fetus group ( n = 4300) based on fetal gender. The EFW was compared by fetal gender and geographical group. All statistical models were adjusted for maternal sociodemographic characteristics. Results::A total of 9075 participants with 31,700 ultrasound measurement records were included in this study. Male fetuses demonstrated significantly larger EFW compared to female ones starting at 16 weeks of gestation and extending to delivery (global test P < 0.01). The overall geographic difference in EFW was significant (global test P = 0.03), and week-specific comparisons showed that the northern group had a greater EFW starting at 15 weeks of gestation and extending to 29 weeks of gestation, although this difference did not extend to the time of delivery. The Z-score of EFW confirmed that our Chinese fetal growth charts differed from previously published standards. Conclusion::This study provides EFW and ultrasound biometric reference measurements for Chinese fetuses and reveals differences from other fetal growth charts. The chart is worth promoting in more regions of China but should be tested prudently before use.

Objective::To build a reference fetal growth chart for the Chinese population based on fetal ultrasound measurements.Methods::This was a multicenter, population-based retrospective cohort study. Longitudinal ultrasound measurement data were collected from 24 hospitals in 18 provinces of China from 1 st September through 31 st October of 2019. The estimated fetal weight (EFW) was calculated based on head circumference, abdominal circumference, and femur length using Hadlock formula 3. Fetal growth curves were estimated using a two-level linear regression model with cubic splines. All participants were divided into two groups: the northern group ( n = 5829) and the southern group ( n = 3246) based on the geographical division of China and male fetus group ( n = 4775) and female fetus group ( n = 4300) based on fetal gender. The EFW was compared by fetal gender and geographical group. All statistical models were adjusted for maternal sociodemographic characteristics. Results::A total of 9075 participants with 31,700 ultrasound measurement records were included in this study. Male fetuses demonstrated significantly larger EFW compared to female ones starting at 16 weeks of gestation and extending to delivery (global test P < 0.01). The overall geographic difference in EFW was significant (global test P = 0.03), and week-specific comparisons showed that the northern group had a greater EFW starting at 15 weeks of gestation and extending to 29 weeks of gestation, although this difference did not extend to the time of delivery. The Z-score of EFW confirmed that our Chinese fetal growth charts differed from previously published standards. Conclusion::This study provides EFW and ultrasound biometric reference measurements for Chinese fetuses and reveals differences from other fetal growth charts. The chart is worth promoting in more regions of China but should be tested prudently before use.

Objective:To design a new medication guidance tool for clinical intravenous therapy and nursing safety which covers all-dimensional information of intravenous therapy and nursing needs, and observe its application effects.Methods:(1) The treatment plans of common and frequently-occurring diseases in the priority departments of Class Ⅲ general hospitals in Jilin Province from January 2016 to December 2017 were retrospectively investigated and summarized to determine the index framework of intravenous therapy guidance tools. (2) The status quo survey, expert meeting and literature search were used to determine the content of the guidance tool and the drug information. (3) The expert consensus was used to determine the presentation of the guidance tool. (4) Totally 127 nurses in the departments were selected by convenient sampling for a non-contemporaneous controlled trial to compare the effects of the guidance tool after one month of application and nursing staff's level of knowledge about the risk of intravenous therapy.Results:(1) A guidance tool with 8 specialties, 73 treatment plans, and 326 commonly used drug information presented with specialties as an index and visualized signs was designed and developed, which covers relevant information such as requirements for infusion device materials, selection of infusion device, and requirements for inter-group tube flushing and sealing. (2) From May to June 2019, the nurses were tested before and after use, who were required to complete the specialist drug knowledge questionnaire within the specified time. The accuracy of the three dimensions of the physical and chemical properties of drugs, pharmacological effects, and safe use was 89.76%, 90.55%, and 95.27%, respectively, which were higher than that before use, and the difference was statistically significant ( P<0.05) . Conclusions:Based on the needs of clinical intravenous therapy and nursing safety medication, the novel guidance tool for intravenous therapy and safe medication nursing is designed and completed, which can effectively improve the nurses' ability to safely use intravenous medications and work efficiency and is worth promoting in clinical practice.

Objective? To observe the effects of continuous quality improvement on the incidence rate of ventilator-associated pneumonia (VAP) in intensive care unit (ICU). Methods? Totally 158 patients using ventilators in ICU of Hangzhou Red Cross Hospital between January and June 2016 were selected as the control group using convenient sampling, and another 165 patients using ventilators between January and June 2017 were selected as the observation group. Patients in the control group received conventional nursing care, while patients in the observation group received Plan-Do-Check-Act (PDCA) Cycle Management with the quality of standardized nursing process, standardized upper respiratory tract management and hand hygiene continuously improved. Incidence rate of ventilator-associated pneumonia(VAP), rate of pass in oral nursing care and hand hygiene compliance in medical and nursing workers were compared between the two groups before and after improvement. SPSS 17.0 was used for statistical analysis. Results? The incidence rate of VAP during the first half of 2017 totaled 5.07‰, a decrease of 6.42‰ compared with the first half of 2016. There was statistically significant difference in the incidence rate of VAP between the two groups (P＜0.01); the rate of pass in oral nursing care after improvement (93.17%) was statistically higher than that before improvement (57.31%) (P＜ 0.01); and the hand hygiene compliance after improvement (93.67%) was statistically higher than that before improvement (67.33%) (P＜ 0.01). Conclusions? Continuous quality improvement can reduce the incidence rate of VAP in ICU, which is operable and worth promoting in clinical practice.

OBJECTIVE Aimed to observe the changes of acetylated histone H2B in the marginal cells of stria vascularis and spiral ganglion cells from the noise-induced hearing loss model (NIHL). METHODS Fifty guinea pigs were randomly divided into control and noise-exposure group. Auditory brainstem response threshold shift was examined before noise exposure and at 1h after noise exposure (122 dB SPL, 3 h). Immunofluorescence staining and western blot were used to observe the expression of acetyl-histone H2B both in the marginal cells of stria vascularis and spiral ganglion cells of modiolus 2 h after noise expose in two groups. RESULTS There was no significant difference in hearing threshold of 4, 8, 16, 32 kHz for the two groups before noise exposure. The hearing threshold was beyond 90dB (the maximum output) at 4,8,16 and 32 kHz 1h after noise exposure. The expression of acetylated histone H2B significantly decreased with immunofluorescence staining in the marginal cells after noise stimulation. Accordingly, the protein level of acetylated histone H2B in the lateral wall of cochlear decreased obviously in the noise group compared to the control, the ratios of H2B-AcK5/p-actin were 0. 3471 ±0. 0843 and 0. 6114 ±0. 0207 respectively(t=5. 268,P＜0. 01). There was no obvious difference for the expression of acetylated histone H2B in the modiolar tissue between two groups, the ratio of H2B-AcK5/p-actin was 0. 4993 ± 0. 0994 for the noise group and 0. 5139±0. 0132 for the controI (P＞0. 05). CONCLUSION Noise exposure significantly decreased histone acetylation expression in the nuclei of strial marginal cells, whereas the level in the spiral ganglion cells remained stable. Histone acetylation imbalance in the marginal cells of stria vascularis may contributed to the occurrence ofNIHL.

Objective : To investigate the short-term clinical effect of semiconductor laser exposure combined with total glucosides of paeony (TGP) capsules for the treatment of erosive oral lichen planus (OLP). Methods: Sixty-four patients with erosive oral lichen planus were randomly divided into two groups: the experimental group and the control group. Patients in the control group were treated with TGP capsules, while patients in the experimental group were treated with TGP capsules and semiconductor laser irradiation. The clinical effects were evaluated 3 months after treatment. The data were analyzed using the SPSS 17.0 software package. Results : Three months after treatment, the effective rate in the experimental group was 90.6%, which was significantly higher than that in the control group (59.4%, χ 2=5.62, P < 0.05). The physical condition and visual analogue scale (VAS) scores in the experimental group were 2.17 ± 1.49 and 1.25 ± 1.29, respectively. The physical condition and VAS scores in the control group were 3.55 ± 1.41 and 2.09 ± 1.24, respectively. The physical condition and VAS scores in both groups were significantly higher after treatment than before (P < 0.05). Three months after treatment, the physical condition score (t=3.805) and VAS score (t=2.655) in the experimental group were significant higher than those in the control group (P < 0.05). Conclusion Semiconductor laser irradiation combined with TGP capsules can improve the short-term clinical efficacy in the treatment of erosive OLP.

Objective To investigate changes in serum levels of antinuclear antibody(ANA), anti?double?stranded DNA(dsDNA)antibody and anti?extractable nuclear antigen(ENA)antibody before and after anti?tumor necrosis factor?α(TNF?α)therapy in psoriatic patients. Methods Clinical data obtained from 32 patients with psoriasis were analyzed retrospectively. Of the 32 patients, 13 received intravenous injection of 5 mg/Kg infliximab at week 0, 2, 6 for 3 sessions, then once every 8 weeks(infliximab group), while other 19 received subcutaneous injection of 25 mg etanercept twice every week(etanercept group). The treatments in the 2 groups both lasted more than 3 months. Serum levels of ANA, anti?dsDNA antibody and anti?ENA antibody and changes of clinical symptoms were detected and observed respectively before each treatment in the infliximab group, as well as every 3- 6 months in the etanercept group. The 75%reduction in psoriasis area and severity index(PASI75)and disease activity score of 28 joints(DAS28) were used to evaluate clinical efficacy. Serum levels of ANA, anti?dsDNA antibody and anti?ENA antibody were measured by indirect immunofluorescence(IIF)assay, Western blot analysis combined with enzyme?linked immunosorbent assay(ELISA), and Western blot analysis, respectively. Results After 3?month treatment, the 32 patients achieved clinical remission to different extents. Of 32 patients receiving anti?TNF?αtherapy, 7(21.9%)developed new autoantibodies. Concretely speaking, 4 patients in the infliximab group developed autoantibodies in 8.3 ± 5.1 months, including 3 cases positive for ANA and 3 for anti?ENA antibody. Three patients in the etanercept group developed autoantibodies in 9.0 ± 3.0 months, including 3 cases positive for ANA and 1 for anti?ENA antibody. Conclusion Partial patients with psoriasis may develop autoantibodies after anti?TNF?αtherapy.

Objective:To analyze the value of low dose enteral nutrition (EN) in treatment of septic shock combined with acute gastrointestinal injury Ⅲ (AGI Ⅲ).Methods:Clinical data of septic shock patients combined with AGI Ⅲ admitted at our hospital were analyzed.Patients were divided into two groups according to the nutrition therapy they received:treatment group (EN,n =41) and control group (no EN,n =46).The mortality and ICU hospital stays were collected.The intestinal barrier,inflammatory cytokines,and oxidative stress were evaluated before and after EN treatment.Results:For patients in the treatment group,the dosages of EN ranged from 200 to 410 kcal/d,with the median dose of 350 kcal/d.No significant differences were found on death rates between the two groups (24.4％vs 32.6％,P =0.398).Patients in the treatment group had shorter ICU hospital stays than those of the control group (11.8 ± 3.7 vs 16.2 ± 5.3,P ＜0.01).After one week EN treatment,patients in the treatment group had lower levels of CRP,IL-6,TNF-α,diamine oxidase,endotoxin and D-lactate than those of the control group (P ＜ 0.05).Conclusion:For septic shock patients combined with AGI Ⅲ,low dose EN can improve the intestinal barrier function and systemic inflammatory responses.

Objective To study the changes of acetyl-histone H2B in the cochlear hair cells of the guinea pig model of noise-induced hearing loss (NIHL).Methods Sixty guinea pigs were randomly divided into control and noise-exposure group.Thirty guinea pigs in the noise-exposure group were exposed to narrowband noise at 122 dB SPL for 3 hours , while thirty guinea pigs in the control group were not exposed to noise.Auditory thresholds were assessed by auditory brainstem response (ABR), prior to noise in two groups and 3, 7,14 and 21 days after noise exposure in the noise group.Then we investigated the expression of acetyl-histone H2B levels in the sensory cells of basilar membrane after noise expose by immunofluorescence staining and western blot.Results Compared with pre-exposure hearing, ABR thresholds were increased at 1h, 3, 7, 14 and 21 days after noise exposure, and recovered gradually with time and reached a permanent threshold shift at 14 days.The expression of acetyl-histone H2B was down-regulated in the hair cells and Hensen''s cells of the guinea pig cochlea after the noise expose , The ratio of H2B-AcK5 / β-actin was 0.6179±0.1260 in the control group and 0.3102±0.0839 in the noise group, and the difference was statistically significant (P<0.01).Conclusion Noise decreased the inner ear sensory cells histone acetylation level and histone acetylation imbalance may be involved in the occurrence of NIHL.