The nursing care of a case of Sheehan syndrome with infection and combined with diabetic ketoacidosis was summarized.To improve prognosis of the disease and guarantee patient's safety,key points of nursing care are as following:sufficient early liquid resuscitation and target-oriented management of blood glucose to correct internal environment disorder;dynamic monitoring of condition,implementing hormone replacement therapy by stages to prevent pituitary crises;to measure the mental state and implement cluster intervention measures to prevent infection worsening;regular follow-up and disease education to improve patients'disease self-management ability.After positive treatment and careful nursing care,no serious complications occurred,blood glucose was controlled well,and the case was in stable conditions and was discharged.

Objective:To assess the efficiency of modified enrichment method for cell-free fetal DNA (cffDNA) through purified superparamagnetic beads during non-invasive prenatal testing (NIPT).Methods:A total of 26 252 pregnant women undergoing NIPT at the Maternal and Child Health Care Hospital of Haidian District from December 2017 to September 2022 were recruited and randomly assigned into the conventional group ( n = 10 573) and the modified enrichment group ( n = 15 679), who were then subjected to the screening and enrichment of the cffDNA using a conventional and modified technique, respectively. High-risk pregnant women detected by NIPT were subjected to invasive prenatal diagnosis. All women were followed up for their pregnancy outcomes, and the detection efficacy of the two methods was compared in terms of fragment size, concentration of cffDNA, duplicate detection rate, and indices of clinical laboratory tests. Results:The fragment size of the main peak of the cell-free DNA library of the modified enrichment group was significantly lower than that of the conventional group [267 (264, 269) bp vs. 294 (292, 296) bp, P<0.01], while the concentration of cffDNA was significantly higher [21.86% (17.61%, 26.36%) vs. 9.08% (6.87%, 11.87%), P<0.01]. In addition, the duplicate detection rate (0.740% vs. 2.02%, χ2=83.90, P<0.01) and detection failure rate (0.006% vs. 0.057%, P<0.05) in the modified enrichment group were significantly lower than those of the conventional group. The combined positive predictive value (PPV) in both high-risk (64.3% vs. 76.1%) and low-risk (35.3% vs. 45.5%) pregnant women from the modified enrichment group was slightly lower than those from the conventional group, though no significant difference was detected. There was one false negative case for trisomy 21 among the high-risk pregnant women from the conventional group, and no false negative case was found in the modified enrichment group. Conclusion:The modified technique to screen and enrich the cffDNA has significantly enhanced the relative concentration of cffDNA and reduced the failure and duplication detection rate of NIPT, which has significantly reduced the incidence of false negative cases due to the low concentration of cffDNA, and greatly increased the overall detection efficacy of NIPT.

Objective:To evaluate the value of modified magnetic bead screening for enrichment of cell-free fetal DNA (cffDNA) in non-invasive prenatal testing (NIPT).Methods:This study retrospectively recruited 31 cases with low concentration of cffDNA (<6.00%), Z value in the gray zone (3.00-4.00) at the first detection, or false-positive (confirmed by invasive prenatal diagnosis) or false-negative (confirmed by postnatal chromosome test) results among 11 000 pregnant women who underwent routine NIPT in Beijing Haidian District Maternal and Child Health Care Hospital from October 2017 to December 2019. Plasma samples collected for the first-time routine NIPT were used to enrich cffDNA using modified magnetic beads for NIPT (modified NIPT). Wilcoxon rank sum test was used to compare the modified NIPT with the routine NIPT in detecting the cffDNA concentrations of male fetuses.Results:Among the 31 pregnant women, there were 13 cases with low cffDNA concentration in routine NIPT, 11 having false-positive results in the routine NIPT (three for trisomy 13, four for trisomy 18 and four for trisomy 21, all were confirmed by invasive prenatal diagnosis), six with gray-zone Z values in the first-time NIPT (retesting indicating low risk) and one having false negative result for trisomy 21 (confirmed by postnatal chromosome test). Cell-free DNA (cfDNA) fragments less than 150 bp were effectively enriched using the modified magnetic bead screening and the concentration of cffDNA was increased from 4.43% (2.45%-17.61%) in routine NIPT to 13.46% (7.75%-36.64%) in the modified NIPT ( Z=-14.22, P<0.01). Results of the modified NIPT indicated that 13 cases with low cffDNA concentration of routine NIPT were successfully detected as low risk, as well as the risks in the six cases with gray-zone Z value and six of the 11 false-positive cases in the routine NIPT were low, which were consistent with the retest results of the routine NIPT, while high risk was found in one false-negative case. Conclusions:The modified NIPT could reduce the false positive rate by lowering the failure rate caused by low concentration of cffDNA and is able to identify false-negative cases. Compared with the routine NIPT, it shows a higher success rate and a lower false positive rate.

The observation and nursing care of a case of fulminant type 1 diabetes mellitus related to immune checkpoint inhibitor were summarized.To improve prognosis of the disease and guarantee patients'safety,key points of nursing are as following:sufficient early liquid resuscitation to improve renal perfusion;dynamic monitoring and summary of blood glucose changes,implementing a target-oriented blood glucose management program;providing nutritional support;regularly follow-up and health education.After positive rescue and careful nursing,no serious complications occurred;blood glucose was controlled well;nutritional status was improved;the patient was in stable conditions and was discharged.Telephone follow-up of the patient for 3 months showed stable blood glucose and good condition.

Objective:To study the effect of changing operator on the detection rate of colorectal polyps during surgery in patients who had been diagnosed with colorectal polyps by electronic colonoscopy for the first time.Methods:From June 2016 to June 2019, the patients who had been diagnosed with colorectal polyps by electronic colonoscopy for the first time, they were performed by electronic colonoscopy for the second time after 3 months by 5 doctors in the No.946 Hospital of PLA who had engaged in endoscopic work longer and been with rich experience. The results of the electronic colonoscopy were recorded and compared.Results:Fived hundred and seventy-six patients were found have colorectal polyps through electronic colonoscopy for the first time. Among them, 423 patients came to the hospital within 3 months and were eligibled for the research. The detection rate of newly detected polyps by the same operator was 22.7%(96/423), after changing the operator, the detection rate became 24.3% (103/423), but there was no significant difference ( P>0.05). The detection rates of newly detected polyps were respectively 20.8% (220/1 059) and 25.9%(294/1 133), the proportion of newly detected polyps with diameter ≤ 5 mm was respectively 73.6%(162/220) and 82.0%(241/294), the ratio of flat polyps to total newly detected polyps was 71.8%(158/220) and 79.9%(235/294), and there were significant differences ( P<0.05). The proportion of polyps in sigmoid colon was respectively 35.0% (77/220) and 39.1%(115/294), and there was no significant difference ( P>0.05). Conclusions:For patients with colorectal polyps detected by electronic colonoscopy, the operator should be changed during surgery, so that more missed polyps can be detected during surgery, especially flat polyps with diameter ≤ 5 mm. The operator should be changed to improve the detection rate and reduce the probability of missed diagnosis.

This study explores the construction and application of online platform for medical continuing education based on libraries and academic conferences. With the consent of the experts participating in the conference, the contents of the conferences are recorded and made into learning videos for continuing education. By constructing network servers, cloud services, and other platforms, the online continuing education can be realized, and such procedures as giving credits also can be completed. And combined with other professional continuing education platforms, a complete continuing education system can be constructed. We have initially designed out the construction mode of medical continuing education platform. The construction of medical continuing education platform has enhanced the class or position of the symposium organization institutions, facilitated the continuing education of professionals and technical personnel, with good social and economic effects, which is worthy of promotion.

Objective:To analyze the reform of improving the teaching effects of nursing college students' practical training.Methods:Cluster sampling method was used to select 396 nursing college students in a higher nursing school as the research objects, with 197 in experimental group and 199 in control group. Self-directed learning was adopted in practical teaching of surgical nursing in the students in experimental group, and traditional surgery teaching was adopted in control group. Self-rating scale of self-directed learning (SRSSDL) was used every 3 months during the period. The students' self-directed learning ability was measured dynamically, and the scores of practical examination and course satisfaction were compared between the two groups. The data were statistically analyzed by repeated measures analysis of variance and independent sample t-test using SPSS 17.0.Results:The scores of repeated measurement of SRSSDL in the experimental group were higher than those in the control group ( F=16.237, P=0.016). Except for the common surgical instruments module ( P=0.056), the scores of practical training examination in the experimental group were higher than those in the control group, and the differences were statistically significant ( P<0.01 for the operating room nursing module, P=0.005 for the wound nursing module, P<0.01 for the enterostomy nursing module). The students' satisfaction with the overall curriculum in the experimental group was higher than that in the control group. Conclusion:Self-directed learning in the teaching of nursing practice can effectively enhance comprehensive ability and quality of students based on self-directed learning ability, and improve the teaching effect of practical training courses.

Chronic pancreatitis is a focal or diffuse chronic inflammation and fibrosis of pancreatic tissue, which is progressive, persistent and irreversible.Chronic pancreatitis in children has its own characteristics of early onset and frequent occurrence, which greatly affects the nutritional status and quality of life of children.Recently, diagnosis and treatment of this severe inflammation gradually improved with a burgeoning technique: endoscopic retrograde cholangiopancreatography (ERCP), especially in the treatment of pediatric chronic pancreatitis.The detection rate of the disease has been increasing year by year.As an effective and safe procedure for the treatment of chronic pancreatitis in children, ERCP has replaced traditional surgery and become the first-line treatment method for pediatric chronic pancreatitis.

Objective: To screen for hotspot gene mutations associated with genetic deafness in Chinese pregnant women, and to perform risk assessment and prenatal diagnosis in high-risk families. Methods: Between November 2012 and October 2017, 26 117 pregnant women were screened by molecular hybridization microarray for 9 hot-spot mutations in 4 hereditary deafness related genes (GJB2 c. 35 del G, c. 176_191 del 16 bp, c. 235 del G, c. 299_300 del AT, GJB3 c. 538 C>T, SLC26A4 c. 2168 A>G, IVS 7-2 A>G, mitochondrial DNA 12S rRNA m. 1494 C>T, m. 1555 A>G). Genotype analysis was carried out in husbands of women carrying mutations, and prenatal diagnosis was carried out in the fetuses with high risk of deafness. Results: Among all women tested, 1 208(4.63%) were carriers of genetic deafness mutations, 7 with hearing impairment were affected by homozygous or compound heterozygous mutations, 51 were mitochondrial gene mutation carriers, 103 were carriers of GJB3 c. 538 C>T heterozygous mutation, 1 026 were carriers of GJB2 or SLC26A4 heterozygous mutations, and 21 carried heterozygous mutations in two genes simultaneously. In 394 families, the husbands accepted gene sequence testing, and 27 in which were determined as carriers of mutations in identical genes as their wives. Among which, 18 families received prenatal diagnosis, and 5 fetuses were diagnosed as hereditary deafness. In 9 families who did not receive prenatal diagnosis, 1 neonate was diagnosed as compound heterozygote after delivery. Conclusion In order to prevent birth defects with congenital hearing problems, it is effective to provide screening for hotspot mutations in pregnant women and to perform prenatal diagnosis on high risk pregnancies.

Objective To investigate the safety and effectiveness of ultrasound-guided paravertebral anaes-thesia combined with propofol in the thoracoscopic sympathectomy. Methods Total 63 male and 59 female patients with hyperhidrosis were recruited. The patients were equally divided into two groups:group A and C. Patients in group A received ultrasound-guided paravertebral anaesthesia combined with propofol. Patients in group C received general intravenous anesthesia with endotracheal intubation. The heart rate (HR),mean arterial pres-sure(MAP)and the oxygen saturation(SpO2)at the time of entering the operating room(T0),completing anesthe-sia(T1),incising the skin(T2),cutting the T4 sympathetic trunk(T3),completing the operation were record-ed. The awake time after operation ,VAS score after operation and postoperative throat discomfort were also record-ed. Results The two groups successfully completed the surgery. There were no significant differences of the HR , MAP and SpO2 at T0-T4 between the two groups. There were significant differences of the awake time after opera-tion,postoperative feeding time and hospitalization expenses. The VAS score after operation of group A were better than group C(P<0.05)at T2 h,T4 h,T8 h,and T12 h. There was no significant difference of VAS score at T24 h between the two groups. Conclusion Ultrasound-guided paravertebral anaesthesia combined with propofol can pro-vide a safe and effective approach for patients receiving the thoracoscopic sympathectomy.