Objective:To study the effects of plan-do-check-action (PDCA) cycle in quality improvement of neonatal resuscitation.Methods:From 2016 to 2020, the clinical data of neonates born in our hospital were analyzed. Neonates born during 2016 to 2017 were pre-PDCA group and neonates born during 2018 to 2020 were post-PDCA group. PDCA quality improvement included step-by-step, high-frequency and low-dose training, strengthening teamwork and adding equipment.Results:A total of 7 728 live-birth neonates were delivered before PDCA with 319 cases (4.1%) of asphyxia. 10 174 live-birth neonates were delivered after PDCA with 422 cases (4.1%) of asphyxia. The asphyxia rates showed no significant difference between the two groups ( P>0.05). The incidences of severe asphyxia before and after PDCA were both 0.8% without significant difference ( P>0.05). The success rates of resuscitation for severe asphyxia before and after PDCA was 27.9% and 44.9%, respectively, and the differences were statistically significant ( P<0.05). The mortality rates within 7 d before and after PDCA were 0.5‰ and 0.1‰ respectively, without significant differences ( P>0.05). Conclusions:The implementation of PDCA cycle and step-by-step, high-frequency, low-dose neonatal resuscitation training can effectively improve the success rate of resuscitation in newborns with severe asphyxia.

The clinical data of a child with chemical pneumonia caused by kerosene in Hainan Maternal and Children′s Medical Center in June 2019 were retrospectively analyzed.The patient was a 2 years and 1 month old boy with a history of kerosene inhalation and fever.The clinical features included low breath sounds in the left lung and dry and wet rales in both lungs.The white blood cells (WBC) level, C-reactive protein (CRP) level, and erythrocyte se-dimentation rate (ESR) were significantly increased.Chest CT showed inhalation pneumonia.Chest ultrasound suggested medium pleural effusion on the left side.The patient was given antibiotics, nebulization and other treatment.On the 12 th day of the course of the disease, his temperature returned to normal, and breath sounds on the left side were stronger than before.The WBC level, CRP level and ESR were improved according to the re-check results, but pulmonary ventilation was still obstructed mildly to moderately.Fourteen days after hospital discharge, the patient coughed less.Reexamination of chest CT prompted the lesions were further absorbed, but the mild to moderate obstructive lesions were still observed.With the reduction of kerosene use in daily life, kerosene-induced chemical pneumonia is rare, but due to its diverse and complex clinical manifestations and slow absorption of pulmonary inflammation, attention should be paid to its progression into chronic cough.

Objective To investigate the therapeutic effect of goal-directed fluid therapy on perioperative volume therapy in patients with placenta previa during perioperative period. Methods Eighty patients undergoing cesarean section were randomly divided into 2 groups(n=40 in each group):the conventional therapy group(N group)and the target management of resuscitation group(G group). Patients in G group were connected the Flo-Trac/Vigileo monitoring system to obtain the information of△SV and CI which were used to guide goal-directed flu-id therapy. Hemodynamics,blood coagulation indexes and lactic acid content in different periods of operation were recorded. Results Compared with N group,colloid infusion volume,HR,△SV,the amount of phenylephrine, PT,APTT and TT were decreased,but urine volume,CVP,CI and MBP of each time point and FIB were mark-edly increased(P < 0.05,respectively). Conclusion The application of FloTrac/Vigileo monitoring system for goal-directed fluid therapy,real-time monitor and effectively maintain hemodynamics in patients with dangerous placenta previa during perioperative period,which can improve the postoperative coagulation function and is better than the conventional rehydration capacity.

Objective:To establish a method for the determination of fenofibrate in fenofibrate capsules .Methods: HPLC was performed on a Dikma Diamonsil C18column (150 mm ×4.6 mm, 5 μm).The mobile phase was acetonitrile-water (7030, adjusting pH to 2.5 with phosphoric acid) and the detection wavelength was 286 nm.The flow rate was 1.0 ml· min-1 and the column tempera-ture was 30 ℃.The injection volume was 20 μl.Results:The linear range of fenofibrate was 10.07-60.42 μg· ml-1(r=0.9996) and the average recovery was 99.26%(RSD=0.5%,n=6).Conclusion:The method is simple, accurate and special, which can be used for the quality control of fenofibrate capsules .

Objective To investigate the expression of growth arrest-specific protein 6 (Gas6) in the placenta and decidua tissues and its relationship with the pathogenesis of preeclampsia. Methods All the patients were recruited in Qilu Hospital of Shangdong University from October 2013 to June 2014. Among them, thirty-two women with early-onset severe preeclampsia who received cesarean section were assigned to the preeclampsia group, and thirty healthy pregnant women who received cesarean section were defined as the control group. Blood glucose, blood lipids, platelet count, D-dimer levels and other clinical indicators of the two groups were detected. Immunohistochemistry of SP was conducted to identify the localization of Gas6 protein in the placenta and decidua tissues. And reverse transcription (RT)-PCR was performed for quantitative analysis of Gas6 RNA expression in placentas. The correlations between placental Gas6 mRNA levels with clinical indicators were analyzed. Results (1) The gestational age at delivery, blood pressure, serum albumin, platelet count and birth weight of fetuses showed statistically significant differences between the two groups(P<0.05). (2) The Gas6 protein expressed in the cytoplasm and nucleus of the syncytiotrophoblasts and decidual cells in the placenta and decidual tissues of the two groups. (3) The Gas6 mRNA expression elevated significantly in the placenta of preeclampsia group (0.60 ± 0.38) when compared to that of the control group (0.34±0.22;P<0.05). (4) The expression of Gas6 mRNA was positively related with body mass index, diastolic blood pressure, systolic blood pressure, free fatty acids and creatinine (P<0.05), while it was negatively associated with serum albumin(P<0.05). Conclusion The high expression of Gas6 in the placenta and decidua tissues may be related to the pathogenesis of severe preeclampsia.

Objective To investigate the expression of interleukin-37 (IL-37) in placenta tissue and its relationship with the pathogenesis of severe preeclampsia. Methods All the patients were recruited in Qilu Hospital of Shangdong University from November 2012 to November 2013. Among them, thirty patients with severe preeclampsia were assigned to the preeclampsia group, and thirty-one healthy pregnant women were assigned to the control group. Immunohistochemistry of SP was used to detect the IL-37 protein expression in placenta tissue of the two groups. The expression level of IL-37 in placenta tissue of the two groups was detected by western blot. Besides, reverse transcription(RT)-PCR was used to detect the expression of IL-37 mRNA. The correlation between the expression of IL-37 mRNA and the delivery gestational age, body mass index(BMI)was analyzed. Results (1) IL-37 were detected in the placenta of both the preeclampsia group and the control group, and the expression site mainly located in the syncytiotrophoblast, with a small amount in cytotrophoblast.(2)The expression levels of IL-37 protein in the preeclampsia group and the control group were 0.59 ± 0.39 and 0.88 ± 0.22, respectively. The IL-37 mRNA levels in the preeclampsia group and the control group were 0.55 ± 0.17 and 1.11 ± 0.21, respectively. Both decreased significantly when compared to the control group (P<0.05). (3) Significant correlation between the expression of IL-37 mRNA and the delivery gestational weeks(r=0.209, P>0.05) was seen neither in the preeclampsia group nor in the control group(r=-0.053, P>0.05). In the severe preeclampsia group, the pregnant women′s BMI had no significant correlation with IL-37 mRNA expression of placenta tissue(r=0.102, P>0.05), neither did the control group(r=-0.115, P>0.05). Conclusion IL-37 expression is significantly lower in severe preeclampsia placenta tissue than that in the normal pregnant women, which may play a protective role in the course of severe preeclampsia.

Objective:To prepare Jieheling dispersible tablets and establish the dissolution determination method. Methods:The dissolution of fischeriana B in the tablets was determined by HPLC. The column was Kromasil C18(250 mm ×4.6 mm,5μm)with ace-tonitrile-water (40∶60) as the mobile phase at a flow rate of 1. 0 ml·min-1 . The detection wavelength was at 290nm. The column temperature was 30℃ and the sample size was 100 μl. Results: The linear range of fischeriana B was 0. 005-0. 057 μg ( r =0. 999 6). The average recovery was between 95% and 105%. Phosphate solution with pH of 6. 8 was used as the dissolution medi-um. Conclusion:The method is simple, accurate and specific, and can be used in the quality control of Jieheling dispersible tablets.

Objective To investigate the influence of tethered cord syndrome (TCS) on the up-per urinary tract and its etiology. Methods Forty patients with TCS diagnosed by spinal MRI were enrolled in this study. There were 21 males and 19 females with mean age of 23 years old. The course of disease ranged from 1 to 40 years. Urinalysis, mid-stream urine culture, serum creatinine(SCr), urinary system ultrasound, IVU, eystography and urodynamic study were carried out on all patients. Results Urinary tract infection was found in 17 patients and increased level of SCr was found in 6 pa-tients (251.64±98.5μmol/L). Of the 29 patients who underwent urinary system ultrasound examina-tion, 12 cases had hydronephroais and dilated upper ureter. Of the 30 patients who underwent IVU, 10(33.3%) had ureterectasia and hydronephrosis, 22 cases had bladder turriform or Christmas tree like deformity with diverticulum and trabeculum. Of the 22 patients accepted cystography, 17 cases had vesieoureteral reflux on 27 sides. Post-void residual (PVR) was evaluated in 35 patients and found increased in 31 cases. Cystometry had been done in 33 patients. The mean value of maximal detrusor pressure (Pdetmax) during filling phase was 41.2±20.9 cm H2O. The detrusor compliance was 22.35±18.8 ml/cm H2O. During voiding phase, detrusor-sphincter dyssynergia(DSD)was observed in 16 patients, detrusor areflexia was observed in 16 patients and detrusor underactivity was observed in 13 patients. Resting urethral pressure profilemetry was measured in 16 patients. Maximal urethral closure pressure (MUCP) was 76.1±33.1 cm H2O. The upper urinary tract deterioration was de-fined as increased SCr, hydronephrosis or vesicoureteral reflux. There were 20 patients diagnosed as upper urinary tract deterioration. The compliance of the upper urinary tract deteriorating group and the no-deteriorating group was 9.4±7.8 vs 19.3±15.8 ml/cm H2O, Pdetmax was 43.1±21.2 vs 24.0±11.9 cm H2O, PVR 189.0±138.0 vs 47.8±36.8 ml, MUCP 86.2±32.4 vs 46.8 5±20.8 cm H2O, incidence of damaged detrusor 100.0% vs 69.2% and DSD 65.0% vs 23.1%, respectively. There were significant differences between the 2 groups(P<0.05). And when comparing the VUR group with no VUR group, the incidence of urinary tract infection was 94.1%(16/17) vs 20.0%(1/ 5) (P=0.003). And when comparing urinary tract infection group with no infection group, the inci-dence of upper urinary tract deterioration was 88.2% (15/17) vs 21.7%(5/23)(P=0.000). Condn-sion Low compliance bladder, high Pdetmax during filling phase, increased PVR, high MUCP, damage of detrusor contractive function and DSD are the risk factors for upper urinary tract deteriora-tion in the TCS patients.

Electives,as an important component of medical education,are useful for students in expanding knowledge scope,improving knowledge structure and increasing overall capacity.Adjusting course resources,strengthening education administration and conducting course evaluation can achieve the establishment of electives system in medical colleges and universities.As a result,the electives system will contribute to the formation of inter-disciplinary medical talents.