Objective:To evaluate the effect of umbilical cord milking (UCM) on neonatal outcomes after cesarean section.Methods:Chinese and English databases (including CNKI, Wanfang, China Biology Medicine Disc, VIP, Yiigle, PubMed, Embase, CINAHL, Web of Science, the Cochrane Library, and Google Scholar) and ClinicalTrials.gov were retrieved from the inception to July 2023. Randomized controlled trials regarding UCM in neonates from different races who were born by cesarean section were included. The outcomes were postnatal hemoglobin level, hematocrit value, peak serum bilirubin level, phototherapy, cord blood pH value, intraventricular hemorrhage, death, polycythemia, neonatal necrotizing enterocolitis, and Apgar score. The risk of bias among the included studies was confined to low or possible risk according to the Cochrane Risk of Bias Assessment Tool 2.0. RevMan5.3 was used for meta-analysis, and subgroup analysis was performed among neonates with different gestational ages. The certainty of evidence was evaluated using the grades of recommendations assessment, development, and evaluation (GRADE) framework.Results:A total of 11 articles involving 2 347 neonates (1 322 full-term and 1 025 preterm infants) were included. Meta-analysis results showed that: (1) Compared with the immediate cord clamping, UCM increased the hemoglobin level within 24 h and 48-72 h after birth ( MD=1.40, 95% CI: 1.11-1.70, Z=9.32; MD=0.86, 95% CI: 0.69-1.02, Z=10.02, both P<0.01), hematocrit value within 24 h and 48-72 h after birth ( MD=2.73, 95% CI: 0.18-5.29, Z=2.09, P=0.04; MD=3.57, 95% CI: 2.29-4.85, Z=5.46, P<0.01). However, no significant differences were found in the peak bilirubin level, phototherapy, cord blood pH, and Apgar score at 1 and 5 min (all P>0.05). (2) Compared with delayed cord clamping, UCM increased the hemoglobin level ( MD=0.83, 95% CI: 0.75-0.91, Z=20.11, P<0.01) and hematocrit value ( MD=2.34, 95% CI: 1.25-3.43, Z=4.20, P<0.01) within 24 h after birth, but not in the hematocrit value at 48-72 h after birth ( MD=－0.38, 95% CI:－2.27-1.52, Z=0.39, P=0.70) or the peak bilirubin level ( MD=－0.65, 95% CI:－2.16-1.04, Z=0.69, P=0.49). Sensitivity analysis showed that for full-term neonates born by cesarean section, the peak bilirubin level in the UCM group was significantly lower than that in the delayed cord clamping group ( MD=－1.30, 95% CI:－2.26-0.34, Z=2.66, P<0.01). Still, the incidence of phototherapy, intraventricular hemorrhage (grade Ⅰ-Ⅳ), death, polycythemia, neonatal necrotizing enterocolitis, and Apgar score at 1 min and 5 min showed no statistical differences (all P>0.05). Conclusions:UCM could increase the short-term postnatal hemoglobin and hematocrit levels in neonates born by cesarean section, which might prevent neonatal anemia in the short term without increasing the adverse neonatal outcomes. Little effects were observed on the peak bilirubin level, phototherapy, polycythemia, etc. More high-quality and large-sample randomized controlled trials are needed in the future.

Objective:To establish a scientific and comprehensive evaluation index system for teaching ability of dental specialist nurses, providing a basis for the selection and assessment of dental nursing instructors.Methods:Based on literature analysis, semi-structured interviews, and group discussions, preliminary evaluation indicators were formulated. From February to April 2023, the Delphi method was used to conduct two rounds of consultation with 27 experts from six provinces and municipalities in China to determine the evaluation index system for the teaching ability of dental specialist nurses. The analytic hierarchy process (AHP) was used to determine the weights of each indicator and its combined weight.Results:The authority coefficient of 27 experts was 0.895. In the two rounds of expert consultation, the effective response rates of the questionnaire were all 100% (27/27), and the Kendall harmony coefficients of various indicators were 0.179 to 0.240 and 0.200 to 0.261 respectively ( P<0.01). The final evaluation index system for teaching ability of dental specialist nurses was formed, including six primary indicators, 15 secondary indicators, and 71 tertiary indicators. Conclusions:The evaluation index system for teaching ability of dental specialist nurses has a reasonable structure, a scientific and rigorous construction process, and can provide a theoretical basis for the allocation of dental specialist human resources and nursing training assessment.

OBJECTIVE To provide reference for the construction of remote inspection mode of pharmaceutical production in China. METHODS By combing the guidance documents of remote inspection and related pilots issued abroad， the experience of constructing remote inspection mode of pharmaceutical production was summarized. RESULTS & CONCLUSIONS Typical foreign countries and regions have carried out remote inspection pilots all over the world， and clearly defined the application situation， implementation process， inspection techniques and related points for attention of remote inspection of pharmaceutical production. In terms of application， the European Union pointed out four specific applicable situations， including travel restrictions， while the United States stipulated that remote inspection was applicable to pre-approved inspection and so on. In terms of the implementation process， the United States developed a four-step method of remote inspection， while the European Union has defined the specific implementation process of remote inspection in more detail. In comparison， Japan paid more attention to the remote inspection process of production documents. In terms of inspection techniques， the European Union used 360° cameras， Matterport 3D technology and document review software to realize the remote inspection of production sites and production documents. In terms of attention points for remote inspection， the United States required that access rights should be set for information sharing to avoid information disclosure. Both the European Union and the United States required inspectors to be trained and equipment inspected before remote inspection. It is suggested that China should formulate unified guidelines for remote inspection of pharmaceutical production， clarify the applicable situations， and formulate the implementation process of remote inspection of pharmaceutical production with reference to the opinions of drug manufacturers. In addition， intelligent remote inspection technology can be used in combination with the information construction level of drug manufacturers， and remote inspection training program can be formulated to cultivate professional remote inspection team.

Objective:To construct the index system for nurses' job competency in children's dental general anesthesia treatment, so as to provide a reference for formulating job admission assessment standards and nurses training strategies.Methods:Research was carried out from July to November 2021. Taking the "job competency model for specialist nurses-iceberg model" as the theoretical framework, the first draft of the indicators was initially prepared by the method of literature review and behavioral event interview. Through the Delphi method, 26 stomatology experts at home and abroad were inquired by letters. Combined with the analytic hierarchy process, the evaluation indicators and weights of the index system for nurses' job competency in children's dental general anesthesia treatment were determined.Results:In the first round, 26 experts completed the letter inquiries, and in the second round, 24 experts completed the letter inquiries, the effective recovery rates of the questionnaires were 100.00% and 92.31%, respectively, the expert authority coefficients were 0.844 and 0.856, and the Kendall harmony coefficients were 0.242 and 0.289, respectively. Finally, the index system for nurses' job competency in children's dental general anesthesia treatment was formed, including 4 first-level indicators, 11 second-level indicators, and 58 third-level indicators.Conclusions:The index system for nurses' job competency in children's dental general anesthesia treatment is scientific, reliable, and in line with clinical practice. It can provide quantitative standards for the comprehensive training of children's dental general anesthesia treatment with nurses and job admission assessment, so as to promote the effectiveness of quality of nursing and safety management.

Objective:To explore the clinical effects of traditional Chinese medicine (TCM) dialectical feeding in patients with oral lichen planus of spleen and stomach damp-heat type.Methods:From January 2017 to December 2018, we selected 98 patients with oral lichen planus of spleen and stomach damp-heat type who visited the Oral Mucosal Diagnosis and Treatment Center of Integrated Traditional Chinese and Western Medicine in Qingdao Stomatological Hospital, the Affiliated Hospital of Qingdao University. Patients were divided into experimental group and control group by random number table method, each with 49 cases. Two groups adopted the same treatment methods of Chinese and Western medicine, and control group carried out conventional nursing, and experimental group conducted TCM dialectical feeding based on conventional nursing. Both groups had continuous intervention for 8 weeks. The physical sign scores, Visual Analogue Scale (VAS) scores, Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores of patients of the two groups were compared before and after treatment.Results:The physical sign scores of the two groups at the fourth and eighth week of intervention were lower than those at the initial diagnosis, and the difference was statistically significant ( P<0.05) . After 8 weeks of intervention, the physical sign score of experimental group was lower than that of control group, and the difference was statistically significant ( P<0.05) . The VAS scores of the two groups at the the fourth and eighth week of intervention were lower than those at the initial diagnosis with a statistical difference ( P<0.05) . After 4 and 8 weeks of intervention, the VAS scores of experimental group were lower than those of control group, and the difference was statistically significant ( P<0.05) . After intervention, the SAS and SDS scores of the two groups were reduced, and that of experimental group was lower than that of control group also with a statistical difference ( P<0.05) . Conclusions:The use of TCM dialectical feeding nursing guidance for patients with spleen and stomach damp-heat type oral lichen planus can improve the patient's disease condition and pain symptoms, and relieve the patient's negative emotion.

More and more studies have been focusing on marginal donor livers, such as steatotic liver grafts, to alleviate donor shortage and reduce mortality from waiting lists. Poor tolerance of streatotic liver grafts often leads to primary graft nonfunction, early dysfunction, and postoperative vascular and biliary complications. Some studies have shown that moderate and severe macrosteatosis livers can be used for transplantation with rigorous selection of recipients. In this paper, techniques such as venous systemic oxygenated persufflation, hypothermic oxygenated perfusion, subnormothermic machine perfusion, normothermic machine perfusion, improved liver quality, and steatotic liver grafts transplantation were discussed.

Objective:To explore the current situation of demoralization syndrome among young and middle-aged female breast cancer patients with radiochemotherapy after radical resection and to analyze its influencing factors.Methods:From January 2019 to September 2019, this study selected 204 young and middle-aged female breast cancer patients of Breast Surgery at a ClassⅢ Grade A hospital in Jilin Province as subjects by convenience sampling. All patients were investigated with the General Information Scale, Demoralization Scale-Mandarin Version (DS-MV) , Medical Coping Modes Questionnaire (MCMQ) and the Social Support Rate Scale (SSRS) . A total of 204 questionnaires were sent out and 192 valid questionnaires were collected.Results:Among 192 young and middle-aged female breast cancer patients, the score of DS-MV was (33.72±14.23) ; the total score of MCMQ was (42.49±8.83) , scores of confronce, avoidance and resignation dimension were (19.12±4.10) , (14.28±3.26) and (9.39±3.48) respectively; the total score of SSRS was (35.39±6.23) . Multiple linear regression analysis showed that the influencing factors of demoralization of breast cancer patients included the age, education level, time after surgery, confronce coping, resignation coping and social support.Conclusions:Demoralization of young and middle-aged female breast cancer patients with radiochemotherapy after radical resection has a high level. Medical staff should provide targeted intervention for patients with young age, low level of education, short time after surgery, facing disease with the resignation coping style and low level of social support so as to improve their physical and mental health.

Objective: To investigate the effect of PM2.5 exposure on the thyroid function in male SD rats. Methods: Adult Sprague-Dawley rats were divided into " filtered air" (FA) and " PM2.5" groups. These rats exposed to the 2 kinds of air for 12 weeks were killed and their plasma and thyroid tissues were taken for investigation. The morphological status and pathological changes of thyroid tissue were observed after H&E staining. The levels of triiodothyronine (T₃), free triiodothyronine (FT₃), thyroxine(T₄), free thyroxine (FT₄), anti-thyroglobulin antibody (TGAb), anti-thyroid peroxidase antibody (TPOAb), thyrotropin (TSH), tumor necrosis factor α (TNF-α), and interleukin-6 (IL-6) in rats were measured by ELISA. Results: The results showed that there was no significant difference in body weight between two groups after 12 weeks of exposure to either filtered air or PM2.5. No pathological changes and significant differences were observed in the thyroid tissues of two groups after HE staining. There were no significant differences in plasma levels of T₄, T₃, FT₃, TNF-α, and IL-6 between two groups. However, compared with rats exposed to filtered air, rats exposed to PM2.5 had significantly lower plasma FT₄[(3.81±1.23) vs (6.02±2.40)pmol/L, P<0.01] and higher TSH [(5.63±1.74) vs (4.29±1.37) mU/L, P<0.05] levels. Conclusion The exposure to PM2.5 for a period of 12 weeks may lead to the decrease of FT₄ and increase of TSH in rats.

OBJECTIVE: To determine the incidence of surgical site infection (SSI) after abdominal surgery and to further evaluate the related risk factors of SSI in China. METHODS: The multicenter cross-sectional study collected clinical data of all adult patients who underwent abdominal surgery from May 1, 2018 to May 31, 2018 in 30 domestic hospitals, including basic information, perioperative parameters, and incisional microbial culture results. The primary outcome was the incidence of SSI within postoperative 30 days. SSI was classified into superficial incision infection, deep incision infection, and organ/gap infection according to the US Centers for Disease Control and Prevention (CDC) criteria. The secondary outcome variables were ICU stay, postoperative hospital stay, total hospital stay, 30-day mortality and treatment costs. Multivariate logistic regression was used to analyze the risk factors of SSI. RESULTS: A total of 1666 patients were enrolled in the study, including 263 cases of East War Zone Hospital of PLA, 140 cases of Affiliated Hospital of Qingdao University, 108 cases of The First Affiliated Hospital of Nanchang University, 87 cases of Central War Zone Hospital of PLA, 77 cases of West China Hospital, 74 cases of Guangdong General Hospital, 71 cases of Chenzhou First People's Hospital, 71 cases of Zigong First People's Hospital, 64 cases of Zhangjiagang First People's Hospital, 56 cases of Nanyang City Central Hospital, 56 cases of Lanzhou General Hospital of Lanzhou Military Command, 56 cases of Shandong Provincial Hospital, 52 cases of Shangqiu First People's Hospital, 52 cases of People's Hospital of Xinjiang Uygur Autonomous Region, 48 cases of The Second Xiangya Hospital of Central South University, 48 cases of Chinese PLA General Hospital, 44 cases of Affiliated Hospital of Xuzhou Medical University, 38 cases of Hunan Province People's Hospital, 36 cases of Dongguan Kanghua Hospital, 30 cases of Shaoxing Central Hospital, 30 cases of Northern Jiangsu People's Hospital, 29 vases of The First Affiliated Hospital of Zhengzhou University, 27 cases of General Hospital of Tianjin Medical University, 22 cases of Zigong Fourth People's Hospital, 21 cases of The Second Hospital of University of South China, 18 cases of Tongji Hospital, 15 cases of Nanchong Central Hospital, 12 cases of The 901th Hospital of PLA, 11 cases of Hunan Cancer Hospital, 10 cases of Lanzhou University Second Hospital. There were 1019 males and 647 females with mean age of (56.5±15.3) years old. SSI occurred in 80 patients (4.8%) after operation, including 39 cases of superficial incision infection, 16 cases of deep incision infection, and 25 cases of organ/interstitial infection. Escherichia coli was the main pathogen of SSI, and the positive rate was 32.5% (26/80). Compared with patients without SSI, those with SSI had significantly higher ICU occupancy rate [38.8%(31/80) vs. 13.9%(220/1586), P<0.001], postoperative hospital stay (median 17 days vs. 7 days, P<0.001) and total hospital stay (median 22 days vs. 13 days, P<0.001), and significantly higher cost of treatment (median 75 000 yuan vs. 44 000 yuan, P<0.001). Multivariate analysis showed that male rise(OR=2.110, 95%CI:1.175-3.791, P=0.012), preoperative blood glucose level rise(OR=1.100, 95%CI: 1.012-1.197, P=0.026), operative time (OR=1.006, 95%CI:1.003-1.009, P<0.001) and surgical incision grade (clean-contaminated incision:OR=10.207, 95%CI:1.369-76.120, P=0.023; contaminated incision: OR=10.617, 95%CI:1.298-86.865, P=0.028; infection incision: OR=20.173, 95%CI:1.768-230.121, P=0.016) were risk factors for SSI; and laparoscopic surgery (OR=0.348, 95%CI:0.192-0.631, P=0.001) and mechanical bowel preparation(OR=0.441,95%CI:0.221-0.879, P=0.020) were protective factors for SSI. CONCLUSIONS The incidence of postoperative SSI in patients with abdominal surgery in China is 4.8%. SSI can significantly increase the medical burden of patients. Preoperative control of blood glucose and mechanical bowel preparation are important measures to prevent SSI.
Abdomen ; surgery ; Adult ; Aged ; China ; Cross-Sectional Studies ; Female ; General Surgery ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Operative Time ; Postoperative Complications ; prevention & control ; Preoperative Period ; Retrospective Studies ; Risk Factors ; Surgical Wound Infection ; prevention & control

Di-(2-ethylhexyl) phthalate (DEHP) is an ubiquitous environmental contaminant because of its extensive use in plastics and its persistence. As an environmental endocrine disruptor, it is suspected to interfere with neurodevelopment in people. However, evidence of the effects of maternal DEHP exposure on cerebellar development in offspring is scarce. The objective of this study was to investigate maternal exposure to DEHP and its effect on apoptosis of cerebellar granule cells (CGCs) and related mechanisms. Pregnant Wistar rats were administrated DEHP (0, 30, 300 and 750 mg/kg/d) by gavage from gestational day (GD) 0 to postnatal day (PN) 21. Primary CGCs were also exposed to mono-(2-ethylhexyl) phthalate (MEHP), the main metabolite of DEHP, for 24 h with concentrations of 0, 25, 100 and 250 µM. The CGCs of male offspring from 300 and 750 mg/kg/d DEHP exposure groups showed significantly increased apoptosis. In addition, the PI3K/AKT signaling pathway was inhibited in the male offspring of the 300 and 750 mg/kg/d DEHP exposure groups. However, effects on female pups were not obvious. Apoptosis was also elevated and the PI3K/AKT signaling pathway was inhibited after primary CGCs were exposed to MEHP. Furthermore, apoptosis was reduced after treatment with the PI3K/AKT signaling pathway activator, insulin-like growth factor (IGF) 1, and increased after treatment with LY294002, an inhibitor of the PI3K/AKT signaling pathway. These results suggested that maternal DEHP exposure induced apoptosis in the CGCs of male pups via the PI3K/AKT signaling pathway, and the apoptosis could be rescued by IGF1 and aggravated by LY294002.
Apoptosis* ; Diethylhexyl Phthalate ; Female ; Humans ; Male ; Maternal Exposure ; Plastics ; Rats, Wistar