Objective:To understand the current situation of nurses in 52 hospitals in China on mastery of knowledge about skin injury in the elderly based on the background of mixed-mode homogenization training.Methods:Using the convenient sampling method, a total of 1 067 nurses from 52 hospitals in China were selected as the research objects in January 2021. A self-designed questionnaire on knowledge of skin injury in the elderly was used to investigate the nurses through the questionnaire star and univariate analysis was used to analyze the influencing factors. A total of 1 067 questionnaires were distributed and 1 067 valid questionnaires were recovered, and the effective recovery rate was 100%.Results:The knowledge scores of pressure injury, incontinence-associated dermatitis, skin tear and xerosis cutis among 1067 nurses were (95.66±7.37) , (95.65±9.15) , (91.37±15.45) and (87.67±15.91) , respectively. The results of univariate analysis showed that hospital grade was the influencing factor of nurses' knowledge score of pressure injury, skin tear and incontinence-associated dermatitis ( P<0.05) , educational background was the influencing factor of nurses' knowledge score of skin tear ( P<0.05) , professional title was the influencing factor of nurses' knowledge scores of pressure injury, incontinence-associated dermatitis and xerosis cutis ( P<0.05) . Conclusions:Hospitals at all levels need to strengthen the theoretical and practical knowledge training for nurses on skin xerosis and skin tear in the elderly, especially for nurses with primary titles and lower education in grassroots hospitals.

Objective To investigate the correlation between KLF14 gene rs4731702 locus polymorphism and gestational diabe-tes mellitus (GDM) and relation between its different genotypes with BMI and insulin resistance.Methods This study adopted the case-control method.One hundred pregnant women of GDM (GDM group) and one hundred healthy pregnant women (normal con-trol group) were randomly selected as the research subjects and performed the physical examination ,biochemical indicators detec-tion.HOMA-IR and HOMA-β were calculated.The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was adopted.The genotyping of KLF14 gene rs4731702 locus in the two groups was performed.The genotypes and allele gene frequency were compared between the two groups and the GDM association analysis was conducted.Results The C alleles fre-quency and CC genotype frequency of KLF14 gene rs4731702 locus in the GDM group was significantly higher than that in the con-trol group ,the difference was statistically significant (P< 0.05).The patients with genotype CC in the GDM group had higher BMI ,FPG ,TG ,HbA1c and HOMA-IR as compared with those carrying genotype CT and TT ,the difference was statistically signif-icant(P<0.05).Also they had lower FINS ,HDL and HOMA-βas compared with carriers of genotype CT and TT ,the difference was statistically significant(P<0.05).The multivariate analysis showed that the genotype CC of KLF14 gene rs4731702 locus was closely related with GDM (P=0.005 ,RR=25.128).Conclusion The genotype CC of KLF14 gene rs4731702 locus plays a role in the pathogenesis process of GDM ,may be susceptibility genes for GDM ,which is also related to the abnormal lipid metabolism ,islet dysfunction and obesity.The polymorphism study of KLF14 gene rs4731702 locus helps to reveal the relation between lipid metabo-lism abnormality and insulin resistance with GDM onset.

Objectives To explore the influence of standardized treatment and technical flow improvement on the diagnosis and treatment of congenital diaphragmatic hernia (CDH) after prenatal diagnosis. Methods The clinical data of neonates diagnosed with CDH who were hospitalized in neonatal intensive care unit from January 2005 to August 2016 was analyzed retrospectively. Based on the start time of standardized treatment implementation, 93 cases of CDH hospitalized from January 2010 to August 2016 were divided into the intervention group while 15 cases of CDH hospitalized from January 2005 to December 2009 were divided into the control group. The survival rate and complications of clinical outcomes between two groups were compared. Results There was no significant difference in sex, gestational age, birth weight, Apgar score, and CDH position between two groups (P >0.05). The total survival rate was 81.7％ in the intervention group and 53.3％ in the control group, and there was statistical difference (P<0.05). The difference of mechanical ventilation mode and pneumothorax rate between two groups also had statistical difference (P >0.05). The median operation time in the control group was 4.5 h and the intervention group was 49.5 h. The postoperative survival rate was 61.5％ in the control group and 90.5％ in the intervention group, and the differences between two groups were significant (P >0.05). The first blood gas analysis of deaths cases in both groups showed that there were significant differences in pH and PCO2 values (P >0.05). Conclusions Optimization of the clinical management during perioperative period can improve the survival rate of CDH and reduce complications. However, the dead cases in the intervention group had more severe pulmonary hypoplasia.

Objective To discuss prenatal ultrasound features and fetal outcomes of meconium peritonitis.Methods This is a retrospective study of all cases of fetal meconium peritonitis (n=26) registered in the Department of Obstetrics,Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from April 1,2004 to December 31,2014.Prenatal ultrasound features,surgical findings and fetal outcomes were discussed.Variance analysis,Chi-square test or Fisher's exact test were applied for statistics.Results Among the 26 cases,25(96.2％) were diagnosed prenatally,24 (92.3％) underwent neonatal surgery,and 24 (92.3％) survived.Prenatal ultrasound findings included bowel dilatation (88.5％,23/26),intra-abdominal calcification (42.3％,11/26),fetal ascites (30.8％,8/26),intra-abdominal pseudocysts (15.4％,4/26) and polyhydramnios(50.0％,13/26).Surgical findings confirmed the diagnosis of meconium peritonitis was due to jejunal atresia[16.7％(4/24)],ileal atresia[75％(18/24)],and atresia of jejunal and ileal junction [8.3％(2/24)],respectively.However,no statistical significance was shown in the incidence of bowel dilatation,intra-abdominal calcification,fetal ascites,pseudocysts and polyhydramnios among the three groups of different etiology (all P＞0.05).Conclusions The prenatal ultrasound features of meconium peritonitis may vary a lot.But bowel dilatation combined with intra-abdominal calcification,fetal ascites or pseudocysts prompts the diagnosis of meconium peritonitis.Early surgical intervention in neonatal period could reduce the neonatal mortality remarkably,thus comprehensive and standardized perinatal management are necessary to improve fetal outcomes.

Objective To analysis the causes and preventive measures of acquired pressure ulcers in hospitalized patients, and to provide evidences and references for strengthening hospital management of pressure ulcers.Methods We took a retrospective study to collect relevant information of 201 patients with hospital-acquired pressure ulcers from January 2012 to December 2014, and conducted a descriptive statistical analysis on the cause of the developed, high-risk departments and high-risk areas, then came up with preventive suggestions.Results The high incidence of 201 hospital-acquired pressure ulcers was oncology department, which accounted for 33.83%;the most common part was the sacrococcygeal region, which accounted for 59.2%;stage II was the most common stage of pressure ulcer, which accounted for 76. 12%; 64. 67% of the pressure ulcers happens within the first two weeks in hospital. Braden scoring less than 12 points that accounted for 58. 21%;anemia accounted for 72. 14%; hypoalbuminemia accounted for 75. 62%; forced postures caused by pain or hydrothorax and ascite accounted for 26.87%; medical equipment pressure accounted for 10.95%. The use of vacuum pad accounted for 87.56%;turning over once every 2 hours accounted for 41.79%. Skin nursing according to the guide accounted for 62. 19%; nutritional support through the mouth or vein accounted for 38.81%. Reporting to the nursing department timely after the occurrence accounted for 95.52%; found in ward rounds accounted for 1.99%; reported by patients or their families accounted for 1.49%; failure to report and found in the medical records accounted for 1.00%,the patient or family members to report accounted for 1.49%. Conclusions Cancer patients are high-risk groups of nosocomial pressure ulcers. The sacrococcygeal region is the high-risk area;stage II is the most common stage, and most of them happens within the first 2 weeks in hospital. Main reasons are hypoalbuminemia, anemia, forced postures, unable to turn over periodically, and the preventive care implementation is not enough. For cancer patients, preventive care is recommended, especially those patients with cancer pain, malnutrition and forced postures.

Objective To determine the perinatal outcomes and its risk factors of fetuses prenatally diagnosed with the double bubble sign on ultrasound scanning.Methods The clinical data of 57 cases of fetal double bubble sign which was prenatally diagnosed by ultrasound in Xin Hua Hospital from January 1,2000 to December 31,2013 were retrospectively analyzed.The neonates survived not less than 42 days were as surviving group,and who survived lower than 42 days were as dead group.The t test,x2 test and Logistic regression were used for statistical analysis of the data.Results Of 57 fetuses with the double bubble sign,the incidence of polyhydramnios,intrauterine fetal death and associated anomalies was 88％ (50/57),4％ (2/57) and 23％ (13/57),respectively.Induced labor to terminate the pregnancy was occurred in eight cases,the other 49 cases had live births but ten neonates abandoned therapy.Thirty-nine live babies accepted surgical treatment with one dead,and the other 38 neonates survived not less than 42 days.The overall 42-day survival rate was 67％ (38/57) and the surgical survival rate was 97％ (38/39).Compared with surviving neonates,the neonates who died had lower gestational age [(35.8±3.0) vs (38.1 ± 1.9) weeks,t=2.859,P＜0.01] and birth weight [(2 229±567) vs (2 830±558) g,t=3.136,P＜0.01],and a higher incidence of prenatally diagnosed structural anomalies [3/11 vs 3％ (1/38),P＜0.05] and karyotype anomalies detected after birth [3/11 vs 3％ (1/38),P＜0.05].Logistic regression analysis showed that the fetuses with the double bubble sign and fetal growth restriction had a higher risk of complications (OR=9.893,95％CI:1.758 55.661,P=0.009).Conclusions Fetuses with double bubble sign have adverse outcome if they complicating preterm delivery,low birth weight,prenatally diagnosed structural anomalies and karyotype anomalies.

Objective To explore the prenatal diagnosis and factors influencing prognosis of congenital diaphragmatic hernia (CDH).Methods Fifty seven cases of CDH prenatally diagnosed by ultrasound in the Department of Obstetrics,Xinhua Hospital from January 1,2006 to March 31,2013 were retrospectively reviewed.Prognosis and risk factors were analyzed by ultrasound characteristics and newborn status.Statistical analysis was performed using t test,x2 test and Logistic regression.Results Forty-five (79％)of all cases were left-side CDH and the rest 12 (21％)were right-side.Fourteen fetuses were aborted.Thirty three were delivered and treated surgically,twenty-three infants survived after surgery and ten died,with an overall survival rate of 40％ (23/57).The other ten cases were delivered,but died of no treated surgically.The birth weight of the surviving neonates was heavier than that of those who died [(3 173 ±348) vs (2 846±568)g,t=2.238,P=0.033].The gcstational age at diagnosis of the aborted fetuses was younger than that of the surviving neonates [(24.0 ± 4.1) vs (30.0± 6.0) weeks,t=3.181,P=0.003].Twenty-one (91％,21/23) of the surviving neonates had a lung-to-head ratio (LHR) ≥ 1.4.A linear trend test showed a negative correlation between LHR and adverse outcome (x2=9.223,P=0.002) with a correlation coefficient-0.730 (P=0.000).LHR＜1.4 (OR=35.867,95％CI:1.861-691.341,P=0.018) and polyhydramnios (OR=9.285,95％CI:1.102-78.212,P=0.040) were risk factors for neonatal death.Right-side CDH (OR=0.158,95％CI:0.009-2.824,P=0.210),liver herniation into the thorax (OR=1.730,95％CI:0.144 20.707,P=0.665) and birth weight (OR=l.002,95％CI:0.999-1.005,P=0.135) were not risk factors.Conclusions The survival rate of CDH is still low.Gestational age on diagnosis,presence of polyhydramnios and LHR＜ 1.4 predict an adverse outcome.

For the case study group,52 pregnant women diagnosed as abnormal glucose metabolism and requiring in-hospital glucose control were selected for continuous glucose monitoring.And another 49 pregnant women with known glucose levels through serial glucose monitoring at the same period were taken as case control group.We divided the case study group into A1,A2 and B based on White's typing.In case study group,the glucose levels peaked at 8 to 10 am and dropped to the lowest levels at 10 pm to 6 am on the next day.The glucose of A2 group was markedly higher than that of A1 group.The highest postprandial glucose of case study group happens at (1.6 ± 0.5) h after breakfast,(1.6 ± 1.2) h after lunch and (1.6 ± 0.8) h after dinner.The blood glucose wavy coefficient of patients of A1 and A2 groups had significant statistical difference.The newborn weight of case study group was lower than that of case control group.

Objective To investigate the different expression of NF-κB p65 Protein in placental tissues between premature delivery and term delivery and to explore the significance of nuclear factor kB (NF-κB) protein expression in preterm delivery. Methods Fifty premature delivery pregnant women and thirty term delivery pregnant women ( were enrolled in this study. According to the way of delivery , the patients were divided into two groups. The expression of NF-κB p65 protein was analyzed by using immunohistochemistry method in the placental tissues. Results In the term delivery, NF-κB p65 was mainly negative or weak positive expressed in the cytoplasm of cells in the placental tissues. There was no demonstrable difference in immunostaining of the NF-kB p65 subunit in the placental tissues including chorion, umbilical cord and fetal membranes before and after labor ( P ＞ 0.05 ). In the premature delivery, NF-κB p65 was strongly expressed in the cytoplasm and nuclear of cells. The expression of NF-κB p65 protein in chorion and fetal membranes from premature delivery( 18% ,56% ) was significantly higher than that from normal pregnant women (6.7% ,13.3%, P ＜0.01 ). But no significant change was found for NF-κB p65 expression in umbilical cord in pregnant women with or without premature delivery ( P ＞ 0.05 ). And in fetal membranes and deciduas, there was a significant increase in the staining of immunoreactive NF-κB p65 in preterm(52.9% ,58.8% ) by caesarean section compared to tissues obtained from term delivery( 13.3%,6.7%, P ＜0.01 ). In chorion and fetal membranes, there was significant increases in the staining of immunoreactive NF-κB p65 in preterm ( 24.2%, 57.6% ) by vaginal dehvery compared to tissues obtained term delivery (6.7%, 13.3%, P ＜0.01 ). Conclusion In this study, the expression of NF-κB p65 did not show significant change in term delivery before and after labor. NF-κB p65 in premature delivery was higher than term delivery, and it had no relationship with the delivery ways.

Objective To measure the blood levels of mercury and arsenic of mother and umbilical cord, and analyze the relationship between these levels and outcome of pregnancy and complications. To explore the influential factors in order to guide a good birth and good care in pregnancy and lying-in women.Methods A total of 400 cases who were hospitalized in Xinhua hospital from March 2009 to August 2009 were included in this study. The blood levels of arsenic of mother and umbilical cord were determined by microwave digestion method and inductively coupled plasma emission mass spectroscopy method ( ICP-MS),while mercury determination was made using flame atomic absorption spectrophotometer (AAS). In addition, pregnant women were required to fill the questionnaire including their living environments, life styles,diet habits and etc. Results The newborn cord blood levels of mercury and arsenic were positively related to those of their mothers( r =0.88,0.91 respectively, P ＜0.05). The adverse pregnancy rates and complications rates in blood elevated mercury and arsenic groups were significantly higher than in the normal groups( x2 =7.07, 9. 94 respectively, P ＜ 0.01 ). Multiple regression analysis showed that the newborn blood mercury levels were significantly correlated to sea-fish eating, fruits supplement and ventilation during pregnancy. The former was a risk factor( Wald χ2 =8.28, P ＜0.01 ) and the later two were protective factors( Wald χ2 = 9.02, 6.05 respectively, P ＜ 0.05 ). Multiple regression analysis also showed that the newborn blood arsenic levels were significantly correlated to eating canned food, using cosmetics and education degree. Eating canned food and using cosmetics were risk factors(Wald χ2 =7.35, 10.38 respectively,P ＜ 0.05 ) while high education degree was protective factor( Wald χ2 = 8.87, P ＜ 0.05 ). Conclusion The newborn cord blood levels of mercury and arsenic were related to those of their mothers, environmental factors and health care during pregnancy. Health education and care during pregnancy were effective approaches for preventing mercury and arsenic poisoning.