Objective:To investigate the current situation of the use of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension, which should aid the development of TIPS in China.Methods:The China Portal Hypertension Alliance (CHESS) initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research. The survey included the following: the number of surgical cases, main indications, the development of Early-TIPS, TIPS for portal vein cavernous transformation, collateral circulation embolization, intraoperative portal pressure gradient measurement, commonly used stent types, conventional anticoagulation and time, postoperative follow-up, obstacles, and the application of domestic instruments.Results:According to the survey, a total of 13 527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021, and 94.1% of the hospital had the habit of routine follow-up after TIPS. Most hospitals believed that the main indications of TIPS were the control of acute bleeding (42.6%) and the prevention of rebleeding (40.7%). 48.1% of the teams carried out early or priority TIPS, 53.0% of the teams carried out TIPS for the cavernous transformation of the portal vein, and 81.0% chose routine embolization of collateral circulation during operation. Most of them used coils and biological glue as embolic materials, and 78.5% of the team routinely performed intraoperative portal pressure gradient measurements. In selecting TIPS stents, 57.1% of the hospitals woulel choose Viator-specific stents, 57.2% woulel choose conventional anticoagulation after TIPS, and the duration of anticoagulation was between 3-6 months (55.4%). The limitation of TIPS surgery was mainly due to cost (72.3%) and insufficient understanding of doctors in related departments (77.4%). Most teams accepted the domestic instruments used in TIPS (92.7%).Conclusions:This survey shows that TIPS treatment is an essential part of treating portal hypertension in China. The total number of TIPS cases is far from that of patients with portal hypertension. In the future, it is still necessary to popularize TIPS technology and further standardize surgical indications, routine operations, and instrument application.

With the improvement of the quality of obstetric medical care, postpartum hemorrhage, the leading cause of maternal death, has received high attention. And pregnancy associated venous thromboembolism (PA-VTE) has gradually become one of the leading causes of maternal death. The clinical characteristics of PA-VTE and the particularity of treatment determine the importance of early assessment and prevention. This article reviews the risk factors and current assessment status of PA-VTE, in order to provide references for clinical risk assessment and prevention of VTE in pregnant women.

Objective: To study the frequency of clinical nuclear medicine procedures and the distribution of examinees in Jiangxi povince, and to estimate the annual frequency of clinical nuclear medicine procedures in Jiangxi in 2017. Methods: A survey was made with questionnaires on all medical institutions carrying out clinical nuclear medicine practices in the province. Results: Except for positron emission tomography (PET) examinations, the frequency of nuclear medicine procedures for females was much higher than that for males. The total frequency of nuclear medicine procedures was 0.67 examinations per 1 000 population in 2017, and the frequencies for diagnosis and treatment were 0.58 and 0.09 examinations per 1 000 population, respectively. Conclusions The frequency of clinical nuclear medicine procedures in Jiangxi increased rapidly after the "Ninth Five-Year Plan" period. It is necessary to further standardize the diagnosis and treatment of nuclear medicine procedures, to enhance the awareness of radiation protection of nuclear medicine staff and to promote the healthy and orderly development of nuclear medicine.

Objective To investigate the status and analyze the influencing factors of structural empowerment and psychological empowerment of midwives in Suzhou.Methods Using convenience sampling,totally 309 midwives from fifteen hospitals in Suzhou were investigated with the Conditions of Work Effectiveness Questionnaire-Ⅱ (CWEQ-Ⅱ) and Psychological Empowerment Scale (PES).Results The scores of structural and psychological empowerment of midwives were (18.07±3.12) and (14.82±2.01).There was a significantly positive correlation between midwives' structural and psychological empowerment (r=0.396,P＜0.01).Hospital level and whether participate in midwifery standardization training had an impact on structural empowerment score(P＜0.05).Age,parental status,job title,salary,delivery room working hours,number of night shifts per month,and whether or not participate in teaching had an impact on psychological empowerment score(P＜0.05).Conclusion Midwives' structural and psychological empowerments are at a moderate level.Administrators should take targeted intervention to create an empowerment-allowing working environment for midwives,stabilize midwives work force,strengthen midwifery discipline construction and make full specialized features of midwives.

Objective To investigate the expression of fibroblast growth factor 4 (FGF4) in serum of active rheumatoid arthritis (RA) and its role in RA synoviocyte proliferation. Methods The serum level of FGF4 were detected by protein arrays in 20 patients with RA, and 20 age and gender matched healthy controls. FLSs were isolated from RA synovium,and were co-cultured with recombinant human FGF4 (rhFGF4). Cell proliferation was quantified by Cell Counting Kit-8 assay and cell cycle distribution was evaluated by flow-cytometry. The protein levels of cyclin D1, phospho-Akt (p-Akt) and phospho-p38 (p-p38) were measured by western blot. Results The serum expression of FGF4 in RA group was higher than that in control group (P=0.041). After being treated with different concentrations of rhFGF4 (12.5, 25, 50, and 100 ng/ml), RA-FLS showed significant increase in cell proliferation, with different rates of [(121 ±8)％], [(126 ±12)％], [(129 ± 12)％], a nd [(134 ±14)％] respectively, comparing with that of the controls [(100 ±0)％, (P12.5=0.049, P25=0.009, P50=0.004, P100=0.001).]. Among them, the percentage of G2/M+S phase cells were [(12.6±3.6)％], [(15.3±4.5)％], [(17.1±5.1)％], [(19.6±4.1)％] respectively, and except the lowest rhFGF4 concentration treatment group of 12.5 ng/ml, G2/M+S phase cells in other groups was significantly increased compared with the controls [(5.4±2.4)％] (P12.5=0.159, P25=0.042, P50=0.018, P100=0.005). And the protein expression of cyclin D1 was up-regulated after being treated with 50 ng/ml and 100 ng/ml rhFGF4 (P50=0.035, P100=0.027). FGF4 transiently increased the expression of p-Akt and p-p38 protein at the concentration of 50 ng/ml. Comparisons of data between groups were performed by independent sample Student's t-test. Statistical significant differences among groups were tested by one-way analysis of variance (ANOVA) or the Kruskal-Wallis test. The Dunnett's t-test was used for multiple comparisons. A P-value of <0.05 was considered statistically significant. Conclusion Our results suggest that FGF4 is highly expressed in the serum of active RA patients. FGF4 may promote the proliferation of RA-FLS via modulating PI3K/Akt and p38-MAPK signaling pathways, which subsequently contributs to synovial hyperplasia.

Objective To explore the application effect of objective structured clinical examination (OSCE) in the clinical practical examination for national midwifery standardized training and its significance for the training work.Methods A total of 89 candidates participated in 2016 national midwifery exam were recruited and investigated by self-designed questionnaire included general information, evaluation of measurement and effect of OSCE, and self evaluation.Results Candidates gave a high degree of evaluation and approval on OSCE, and it also had a positive guiding significance for further improving the midwifery training scheme.Conclusions The application of OSCE is in accordance with the practice demand for midwifery talents, thus it has popular value in the midwifery training and exams.

Objective To investigate the effect of meridian-unblocking and mind-regulating acupuncture pretreatment on neurobehavioral functions and cerebral water content and explore its mechanism for modulating miRNA664 and MMP9 expressions in cerebral ischemia/reperfusion rats.Methods One hundred and thirty Wistar rats were randomized into group A (electroacupuncture pretreatment) of 30 rats, group B (moxibustion pretreatment) of 30 rats, group C (aspirin pretreatment) of 30 rats, group D (model) of 30 rats and group E (blank control) of 10 rats. Group A received electroacupuncture; group B, suspended moxibustion with moxa sticks; group C, an oral gavage of aspirin 10 mg/kg. A model of cerebral ischemia/reperfusion was made in every group after seven days. Rat neurobehavioral functions were observed and cerebral water content and relative miRNA664 and MMP9 expressions in the cortical region were determined at 24 hours after reperfusion.Results There was a statistically significant difference in the neurobehavioral score between group A, B, C or D and group E (P<0.01), between group A or B and group C (P<0.01) and between groups A and B (P<0.01). There were statistically significant differences in cerebral water content and relative miRNA664 and MMP9 expressions between group A, B, C or D and group E (P<0.01,P<0.05), between group A, B or C and group D (P<0.01), between group A or B and group C (P<0.01,P<0.05) and between groups A and B (P<0.01,P<0.05).Conclusions Meridian-unblocking and mind-regulating acupuncture pretreatment can effectively decrease the neurobehavioral score and cerebral water content and reduce relative MMP9 expression through modulating miRNA664 expression in cerebral ischemia/reperfusion rats. One of the mechanisms of Du meridian-unblocking and mind-regulating acupuncture pretreatment for protecting the brain may be reducing relative MMP9 expression, inducing tolerance to cerebral ischemia and relieving cerebral edema by the modulation of miRNA664 expression.

Objective To determine the immunogenic and adhesive abilities of a segment (P1C protein) that located at the carboxy terminal region of P1 protein (1125 to 1395 amino acids).Methods A recombinant prokaryotic vector (pGEX6p-2/p1c) was constructed for P1C protein expression in E.coli BL21DE3.The expressed target recombinant protein (rP1C) was identified using SDS-PAGE and Western blot assay,and then extracted by GST-based affinity chromatography.The purified rP1C was used to immunize BALB/c mice to obtain rP1C-antiserum and titer of the antiserum was determined by ELISA.Immunoreactivity of the rP1C to the sera form M.pneumoniae-infected patients was detected using Western blot assay,while activity of the rP1C adhering to HeLa cells as well as adhesion blockage of the rP1C antiserum were detected using indirect immunofluorescence assays.Results The constructed prokaryotic expression system could efficiently express soluble rP1C with a relative molecular weight of 66×103.The antiserum from rP1Cimmunized mice showed an ELISA titer as high as 1:64 000.Both the M.pneumoniae-infected patients' sera and the mouse antiserum against rP1C could recognize as well as combine with the rP1C.rP1C could adhere to HeLa cells and the adhesion could be blocked by the mouse antiserum with an antiserum concentration-dependent manner.Conclusion P1C,a segment of M.pneumoniae P1 protein,possesses powerful immunogenicity and immunoreactivity and cell-adhered activity,indicating the protein segment can be used as an antigen candidate for developing vaccines and serological diagnostic methods of M.pneumoniae-induced diseases.

Objective To investigate the short- and long-term complications after endoscopic Oddi's sphincterotomy (EST) upon endoscopic retrograde cholangiopancreatography (ERCP) procedure and determine whether the size of EST correlates to the occurrence of EST complications.Methods 95 cases receiving EST in the process of ERCP in our hospital were studied and followed up. The patients were divided into large, moderate and small incision groups according to the size of EST and the states of short-term and long-term EST complications were statistically analyzed.Results The incidence of short-term complications of EST was 18. 94% (18/95). They included bleeding in the process of ERCP in 11 cases, delayed bleeding in 3, acute pancreatitis in 1, acute cholangitis in 2 and duodenal perforation in 1. All these patients but 1 with duodenal perforation were discharged after undergoing symptomatic treatments. Eleven out of the 95 patients had long-term complications (11.57 % ). These included biliary system infection in 5 cases, recurrent calculus of bile duct in 3, papilla stricture in 1 and chronic relapsing pancreatitis in 2. All 11 patients recovered after therapeutic ERCP again or symptomatic drug treatments. There was no significant difference in incidence of short-term (χ2 =2.433, P=0.296) or long-term complications (χ2 = 1.151, P=0.562) among the 3 groups. Furthermore, there was no statistical correlation between the incision size of Oddi and complications including operative bleeding (P=0.109), short-term complications (P=0.124) and longterm complications(P=0.402). Conclusion There are many short-term and long-term complications after EST, but there is no correlation between the complications and the incision size of Oddi. The occurring rate of complications might be reduced through accurate direction of papilla incision, avoidance from injury of blood vessel, keeping bile drainage unobstructed and protection of the function of Oddi sphincter as far as possible in the process of ERCP.