Objective:To analyze the influence of epidural labor analgesia on neonatal breast-seeking behavior and first breastfeeding.Methods:This study was an observational study. According to the cross-sectional study formula and inclusion and exclusion criteria, 150 cases of puerperas and their full-term infants who underwent vaginal delivery in the Affiliated Hospital of Southwest Medical University from March to September 2020 were included as the research objects, and the time of breast searching behavior in newborn crawling was observed and recorded. According to whether epidural analgesia was used or not, the patients were divided into analgesic group and non-analgesic group (the specific names of the two groups), and the outcome variables were analyzed.Results:There were 81 cases of successful breast crawl, 69 cases of failure, including 94 cases of epidural analgesia, 56 cases of non-epidural analgesia. Epidural analgesia had no effect on breast crawl and the time of breast searching behavior ( P>0.05). For puerperas with epidural analgesia, the total score of Breastfeeding Assessment Tool (IBFAT) and the scores of its four dimensions such as feeding time, foraging, sucking and nipple holding behavior were 9(7, 10), 3(2, 3), 2(2, 3), 2(1, 2), 2(1, 2), which lower than those non-epidural analgesia puerperas, which were 10(8, 10), 3(3, 3), 3(2, 3), 2(2, 2), 2(1, 2), the differences were statistically significant ( Z values were -6.36- -4.32, all P<0.05). Conclusions:When epidural analgesia is used clinically, medical staff need to seize the best time of drug use, pay attention to continuous monitoring of drug use duration and dosage, while exerting drug analgesia effect, it is also necessary to minimize adverse outcomes and reduce the impact of analgesics on breastfeeding.

Objective:To understand and analyze the current situation of core competence of graduate midwives in standardized training in Sichuan Province, so as to provide a reference for the training of midwives in Sichuan Province.Methods:A total of 102 midwives who participated in standardized training and graduated from July 2016 to June 2018 in Sichuan Province were investigated by using general information questionnaire (including 14 items of general information, occupational literacy and hospital conditions) and Midwives Core Competence Scale (including 54 items and 6 dimensions). Among 109 questionnaires distributed, 102 valid questionnaires were collected. SPSS 21.0 was used to analyze the results by single factor analysis and multiple linear regression analysis.Results:The average total score of the core competency scale in this study was (203.470±32.398). The scores of postpartum health care and prenatal health care were relatively high, while the score of public health care was relatively low. Multivariate regression analysis showed that whether the maternal and infant health certificates were obtained during the training period, and whether there was a training system for midwives alone and arrangements of department rotation were the influencing factors of the core competence of the graduate midwives ( P<0.05). Conclusion:The core competence of midwives in standardized training in Sichuan province is at the middle level. The standardized training of midwives is at the initial stage and lack of systematic management. Hence, it is urgent to build a unified and standardized training system.

OBJECTIVE： To analyze the development status of neuropsychotropic therapeutic drug monitoring （TDM）， and to provide reference for improving the quality of TDM in neuropsychiatry department. METHODS： The laboratory data of neuropsychotropic TDM external quality assessment （EQA） were collected from Website of Clinical Laboratory Center of Ministry of Health （http：//www.clinet.com.cn） during 2008-2017， and then analyzed statistically in respects of TDM project， the number of involved laboratory， monitoring method， etc. RESULTS： By the end of 2017， the Clinical Laboratory Center of the Ministry of Health had conducted 5 neuropsychiatric TDM projects involving 4 drugs， including 3 items of serum TDM （carbamazepine， valproic acid， phenytoin）， lithium ion monitoring （lithium carbonate） in biochemical routine and newly added pharmacokinetic laboratory biological sample monitoring （carbamazepine） in 2014. From 2008 to 2017， the number of involved laboratories increased from 209 to 603， with carbamazepine （serum， plasma） and valproic acid showing good annual growth trend， exceeding 200 and phenytoin 107， but only 27 in lithium carbonate until 2017. Among all monitoring methods of involved laboratories， the number of laboratories which adopted fluorescence polarization immunoassay （FPIA） decreased year by year. By the end of 2017， there were fewer than 10 laboratories. The number of laboratories using acridinium direct chemiluminescence， enzyme-multiplied immunoassay technique （EMIT）， and high performance liquid chromatography （HPLC） had steadily increased. By the end of  2017， acridinium direct chemiluminescence was the most used in laboratory， followed by EMIT and HPLC. CONCLUSIONS： Due to the increasing number of participating laboratories， it can be seen that the consciousness of quality control of laboratory personnel is increasing day by day； but the complexity of TDM monitoring methods limits the types of drugs used in external quality evaluation. It is suggested to formulate guidelines， quality control standards and operation rules as soon as possible， so as to ensure the accuracy of test results.

Objective To explore the correlation between the occurrence of pulmonary infection after thoracotomy and preoperative pulmonary function indexes in patients with esophageal cancer,and to provide clinical theoretical basis for reducing the incidence of pulmonary infection after thoracotomy.Methods The clinical data of 80 patients with esophageal cancer who underwent thoracotomy from May 2017 to May 2018 in Qinhuangdao Military Industrial Hospital of Hebei Province were retrospectively analyzed.The patients were divided into infected group and uninfected group according to whether pulmonary infection occurred after operation.The preoperative maximal voluntary ventilation (MVV),MVV as a percentage of predicted value (MVV％pred),forced vital capacity (FVC),FVC as a percentage of predicted value (FVC％ pred),forced expiratory volume in one second (FEV1),FEV1 as a percentage of predicted value (FEV1％ pred),peak expiratory flow (PEF),PEF as a percentage of predicted value (PEF％ pred) of the two groups were compared and analyzed.Logistic regression was used to analyze the correlation between pulmonary function indexes and postoperative pulmonary infection.Results Postoperative pulmonary infection occurred in 24 out of 80 patients (30.00％).There was no correlation between gender (t =1.755,P =0.086),nationality (t =2.125,P =0.073) and the severity of pulmonary infection after operation.Age (t =4.084,P =0.024),smoking history (t =5.881,P =0.001),operation duration (t =3.583,P =0.041),intraoperative bleeding volume (t =5.115,P =0.003) and combined basic diseases (t =4.574,P =0.018) were significantly correlated with the severity of pulmonary infection after operation.MVV (x2 =4.242,P =0.039),MVV％ pred (x2 =4.405,P =0.036),FVC (x2 =17.500,P ＜0.001),FVC％pred (x2 =12.382,P ＜0.001),FEV1 (x2 =12.070,P =0.001) were associated with pulmonary infection.FVC (OR =9.102,95％ CI:2.691-28.213,P =0.027),FEV1 (OR =21.621,95％ CI:8.956-81.145,P =0.002) and MVV％ pred (OR =5.648,95％ CI:2.979-15.248,P =0.001) were high risk factors for pulmonary infection.Conclusion Partial pulmonary function indexes are significantly associated with postoperative pulmonary infection.It is necessary to strengthen the detection and improvement of preoperative pulmonary function in order to reduce the incidence of pulmonary infection.

Objective To investigate the pressure of male nurses in women and children′s Hospital and analyze it, so as to provide decision support for nursing administrators. Methods Used general information questionnaire, Perceptual Stress Scale, China Nurses'Pressure Source Scale (CPSS) in Sichuan,Chongqing,Yunnan,Guizhou,Tibet and other places of the maternal and child hospital male nurses, and analyzed the results. Results According to the CPSS scoring standard,63 in 101 subjects(62.4%)male nurses were in the state of stress, and the average score of stress was 26.0 ± 7.4. Binary Logistic regression showed that the main factors of male nurses′pressure were the lack of support from parents and family,low income, less promotion opportunities and non-nursing work. Conclusion The pressure situation of male nurses in maternity and child care hospitalis affected by family, work, society and so on. Managers should timely relieve the stress for male nurses and maintain the stability of male nurses′team.

Objective To study correlation between biochemical markers of bone metabolism and postmenopausal osteoporot-ic vertebral fractures.Methods The clinical data of 100 cases with postmenopausal osteoporotic were study retrospectively.Fifty patients were postmenopausal osteoporotic,the rests were postmenopausal osteoporotic vertebral fractures.Lumbar spine,hip BMD,serum P1NP,β-CTX,N-MID,25-(OH)VitD and Ca2 + were recorded.Results There was a significant difference among ser-um P1NP,β-CTX and 25-(OH)VitD(P <0.05 ).There was positive correlation between postmenopausal osteoporotic vertebral fracture with serum P1NP (P <0.05),and negative correlation with serum 25-(OH)VitD (P <0.05),but had no correlation with serumβ-CTX (P >0.05).Conclusion Serum P1NP and 25-(OH)VitD could predict risk of postmenopausal osteoporotic vertebral fractures.Biochemical markers of bone metabolism combined with BMD could reduce postmenopausal osteoporosis fractures.

BACKGROUND: Total hip arthroplasty is an effective measure to treat hip involvement in ankylosing spondylitis.Ankylosing spondylitis patients have different degrees of anemia after total hip arthroplasty. The hidden blood loss accounts for a large proportion of perioperative blood loss in total hip arthroplasty, and can affect the recovery of joint function.OBJECTIVE: To investigate risk factors of hidden blood loss after total hip arthroplasty in patients with hip involvement in ankylosing spondylitis.METHODS: We studied a consecutive series of 70 hips in 60 patients with ankylosing spondylitis hip involvement who were converted to cementless total hip arthroplasty. The average age of surgery was 35.12 years. The hidden blood loss was calculated according to Cross formula linear equation. The effects of operation time, erythrocyte sedimentation rate,C-reactive protein, body mass index, Bath ankylosing spondylitis radiology index, allogenic blood transfusion, and osteoporosis on hidden blood loss after total hip arthroplasty in patients with ankylosing spondylitis were analyzed. The patients were divided into the high blood loss group (≥ 480 mL) and the low blood loss group (< 480 mL) according to the high blood loss. Risk factors of high hidden blood loss after total hip arthroplasty in patients with ankylosing spondylitis were analyzed by single factor analysis and multivariate Logistic regression analysis (SPSS 17.0).RESULTS AND CONCLUSION: (1) The hidden blood loss after primary total hip arthroplasty in patients with ankylosing spondylitis was (737.76±419.18) mL, and the total blood loss was (1312.83±487.41) mL, and the percentage of hidden blood loss was 51.48%. The high blood loss group included 41 hips, and the low blood loss group included 29 hips; and the ratio was 41:29. (2) Single factor analysis showed that the operation time, Bath ankylosing spondylitis radiology index and osteoporosis, allogenic blood transfusion, decrease of hemoglobin were significantly associated with high hidden blood loss. (3) Multivariate Logistic regression analysis showed that Bath ankylosing spondylitis radiology index,allogeneic blood transfusion, and decrease of hemoglobin were significantly associated with high hidden blood loss. (4)Hidden blood loss is an important portion of total blood loss after primary total hip arthroplasty in patients with ankylosing spondylitis. Bath ankylosing spondylitis radiology index, allogeneic blood transfusion and decrease of hemoglobin are risk factors for high hidden blood loss.

BACKGROUND: Heterotopic ossification (HO) is common following primary total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS), which may cause certain influence on functional recovery.OBJECTIVE: To explore the risk factors for HO after primary THA in AS patients.METHODS: The clinical and radiological data from 87 patients (132 hips) with AS undergoing primary THA between June 2011 and December 2015 were retrospectively analyzed, and followed up for more than 6 months. The radiological information included preoperative and postoperative hip anteroposterior and lateral radiographs. The presence of HO surrounding the prosthesis was evaluated on the radiographs at the last follow-up and graded according to the Brooker classification. Risk factors for HO were divided into invariable factors (age, sex, course and with or without ankylosed hip) and variable factors (preoperative C-reactive protein level, preoperative erythrocyte sedimentation rate, intraoperative blood loss, operation time, prosthesis types and anesthesia methods) to determine the pertinent risk factors.RESULTS AND CONCLUSION: (1) Totally 43 hips (32.6%) were found to have developed into HO. (2) Invariable risk factors including male (P=0.029), preoperative ankylosed hip (P < 0.001), and course (P=0.029) increased the prevalence of HO. Among the variable risk factors, prolonged operation time (P=0.031) and general anesthesia (P=0.003)were associated with the increased occurrence of HO. Age, preoperative C-reactive protein level and erythrocyte sedimentation rate, intraoperative blood loss, and prosthesis types had no obvious correlation with HO. (3) These results suggest that to prevent the formation of HO following THA in AS, efforts to reduce the operation time and avoid general anesthesia should be considered.

BACKGROUND:Tranexamic acid is extensively used in the primary total knee replacement, but there are many different methods. OBJECTIVE:To explore the efficacy and safety of the intra-articular injection of tranexamic acid with pressurization in reducing the blood loss of primary total knee replacement. METHODS:Total y 56 patients undergoing unilateral total knee arthroplasty were enrol ed and randomly divided into two groups. Patients were given the intra-articular injection of 100 mL of saline solution dissolving 2.0 g of tranexamic acid with large pad pressure bandaging the knee, and 4-hour drainage tube close, and then underwent negative pressure suction (experimental group);differently, the controls were given the normal pad bandage group. The drainage tube was removed within 48 hours after replacement. The patient blood routine examination was performed at the 3rd day, and at the same time, the volume of drainage was recorded;and the color Doppler ultrasound in ipsilateral lower extremity veins was conducted to observe the incidence of thrombosis at 4-5 days. RESULTS AND CONCLUSION:(1) The total blood loss, postoperative dominant blood loss, and hidden blood loss in the experimental group were significantly less than those in the control group (P<0.05). (2) No significant difference was found in the incidence of postoperative thrombosis between two groups (P>0.05). (3) These results indicate that the intra-articular injection of tranexamic acid with pressurization can significantly reduce the postoperative blood loss in the primary total knee arthroplasty, without increasing the risk of deep vein thrombosis.

BACKGROUND:Jumonji domain-containing histone demethylase (JMJD) can promote osteoblast differentiation, and estrogen-related receptor alpha (ERRα) can promote osteoblast differentiation and increase bone formation. However, little is reported on the association between postmenopausal osteoporosis andJMJD and ERRα. OBJECTIVE: To study the changes in the JMJD2 family expression in patients with postmenopausal osteoporosis. METHODS: Postmenopausal patients with osteoarthritis of the hip scheduled for total hip arthroplasty, aged 50-70 years, were enroled, including 10 postmenopausal osteoporosis patients (experimental group) and 10 patients with no postmenopausal osteoporosis (control group). During the arthroplasty, the cancelous bone specimens from the femoral head were colected. Then, immunohistochemistry and western blot assay were used to detect expression of histone demethylase (JMJD2A, JMJD2B), histone methylation (H3K9me3, H3K36me3) and ERRα. RESULTS AND CONCLUSION:In the experimental group, the expressions of JMJD2A, JMJD2B and ERRαwere from weakly positive to positive; these expressions were significantly lower in the experimental group than the control group (P < 0.05). The expressions of H3K9me3 and H3K36me3 were significantly higher in the experimental group than the control group (P < 0.05). These findings indicate that the expression of JMJD2A and JMJD2B is consistent with the expression of ERRα in the patients with postmenopausal osteoporosis, and JMJD is likely to serve as an antagonistic enzyme of osteoporosis.