Epidural labor analgesia aims to provide effective medical services to alleviate labor pain in parturients, while adhering to the principles of voluntary participation and clinical safety. In 2018, Peking Union Medical College Hospital(PUMCH)became one of the first pilot units for labor analgesia in China, and has achieved satisfactory results in high-quality development of labor analgesia. This article mainly introduces the achievements and experience of labor analgesia at PUMCH, including: (1) prioritizing maternal and infant safety, arranging personnel rationally, and developing standardized treatment processes through multidisciplinary collaboration to ensure safe and comfortable childbirth; (2) leveraging the hospital's comprehensive capabilities in emergency treatment, and improving collaborative rescue plans for critically ill parturients and newborns; (3) implementing advanced teaching methods to effectively train and conduct simulated drills for labor analgesia and rescue of critically ill parturients; (4) conducting patient education and informative lectures to help parturients acquire a scientific understanding of labor analgesia. We hope that this experience can provide reference and inspiration for other hospitals.

Type 2 diabetes mellitus,a common metabolic disease,has become a global public health challenge due to its high morbidity and disability.With the rise of mobile healthcare,the advancement of emer-ging technologies such as artificial intelligence,and the popularization of the concept of personalized health,the field of smart wearable devices is growing rapidly.Wearable devices are categorized into two types:medical and fitness wearable devices,which have been applied in the monitoring and regulation of blood glucose and the mod-ulation of healthy lifestyles of patients with type 2 diabetes mellitus.This article summarizes the research progress in the application of wearable devices in patients with type 2 diabetes mellitus in the past 8 years,with a view to promoting the application of wearable devices and realizing the whole life-cycle health management of patients with type 2 diabetes mellitus.

Objective:This paper tried to have a dialogue with ChatGPT about ethics review, to understand the degree of intelligence of this application in the field of ethical management, and to analyze its possible impact on the future ethics review work.Methods:The research team sorted out 43 questions, then the research team member at abroad accomplish the dialogue with ChatGPT in both Chinese and English. Feedback answers were summarized and analyzed to explore their advantages and problems.Results:Most of the ChatGPT′s answers of this test were reasonable, with obvious advantages in response speed, and the rigor and friendliness were relatively good. However, there were also problems in consistency, comprehensiveness and expertise, the accuracy and computing power also still have a lot of space for improvement.Conclusions:It is too early for AI to replace professionals, but we should fully develop and utilize the advantages of AI to help professionals get rid of inefficient labor and play a better role.

Objective:To retrieve, evaluate, and summarize the best evidence for postoperative hypothermia rewarming in adults with severe burns.Methods:Foreign language databases including Cochrane Library, Joanna Briggs Institute Evidence- Based Health Care Center Database, PubMed, Ovid- Medline, BMJ Best Practice, and Web of Science were retrieved with the search terms of " severe burn/major burn/severe degree burn" , " hypothermia/warming intervention/hypothermia/temperature/body temperature change" , and " postoperative /perioperative/peri-operative/post-operative" and Chinese databases including Chinese Journal Full- Text Database, Wanfang Database, and VIP Database were retrieved with the search terms of "手术/术后/术中" , "低温/低体温" , and "烧伤" to obtain all the publicly published evidence for postoperative hypothermia rewarming in adults with severe burns from the establishment of each database to April 2018, including systematic evaluations, guidelines, expert consensus, evidence summary, and original research closely related to the evidence. The literatures were screened and evaluated for their quality, the evidences were extracted from them, evaluated, classified in order to summarize the best evidences. Results:A total of 8 literatures were included, including one systematic evaluation, three guidelines, one expert consensus, and three evidence summaries. Finally, the best evidences in 8 aspects including the body temperature monitoring site, body temperature monitoring frequency, surface heating, in vivo heating, rewarming start, multi-strategy rewarming, equipment, and personnel training were summarized.Conclusions:Based in the evidence-based nursing method, this study retrieves and evaluates the literature, summarizes the evidence analysis and evaluation, and obtains the best evidences of postoperative hypothermia rewarming in adult patients with severe burns, which provides a strong reference for the clinical implementation of rewarming.

Objective To observe the application effects of the nursing procedure based on the instruction in incontinent patients with cerebral apoplexy. Methods A total of 82 cases were selected from the incontinent patients with cerebral apoplexy between March 2014 to February 2015, implementing incontinence nursing procedures to them, and observing the average duration of hospitalization, healing time, the length of nursing care, the incidence rate of incontinence-association dermatitis( IAD) and HAPU. The results were used to compare with the 91 cases in one year ago, which the time before the implementation of the incontinence nursing procedure. Results After the implementation of the incontinence nursing procedure, the patients′ s average duration of hospitalization, healing time, the length of nursing care, and the incidence rate of IAD and HAPU had shown as (11. 57 ± 4. 22) d,(3. 12 ± 1. 25) d,(1. 55 ± 1. 03) h, 10. 98% and 0, which were statistically significant from the results before the nursing procedures implementation (P<0. 05). Conclusions The nursing procedures based on the instructions can shorten the hospitalization duration, the length of healing time and nursing time, and decrease the incidence rate of IAD and HPAU.

Objective To explore the effect of preventing skin tears with prevention protocol based on guideline. Methods According to International Guideline of Prevention Skin Tears to discuss and make prevention protocol, including prediction risk people, prevention fall and fall from bed with auxiliary means, wearing long sleeves clothes, using emollient on skin twice a day, providing nutrients and water, prevention friction and shear force with movement skills, totally six comprehensive measures. Wound care team trained backbone nurses the measures and backbone nurses trained clinical nurses. Before and after intervention 5 month and 17 month, every patient with age more than 18 years and hospitalized more than 24 hours was checked skin from head to toes in order to observe and compare skin tears incidence and practicable rate of prevention measures by cross-sectional survey.Results Before intervention, skin tears incidence was 0.77%(12/1 558), and skin tears incidence after intervention 5 month and 17 month was 0.16%(3/1 777) and 0.22%(4/1 825) ( P<0.05) . Practicable rate of 6 measures in patients with risk and with skin tears after intervention 5 month and 17 month was increased than that before intervention which was unsatisfactory (P>0.05).Conclusions Preven-tion skin tears protocol can reduce skin tears incidence, but practicable rate need be improved. In future nurses training, guidance and management bedside should be strengthened in order to enhance practicable rate of prevention measures.

Objective To evaluate the causes of medical-devices-related pressure ulcer in intensive care unit ( ICU) and to come up with the countermeasures .Methods Patients were recruited between April 2011 and April 2012.A team of five nurses was in charge with the data collection , consultation of the nursing record and investigation of the possible reasons of medical-devices-related pressure ulcer .Results Among a total of 2 240 ICU patients, thirty-seven patients (1.65%) had medical-devices-related pressure ulcer, within which eighteen ( 48.65%) pressure ulcer was related to mechanical ventilation device and nine ( 24.32%) pressure ulcer was because of the orthopedic fixation devices .Medical devices which induced to pressure ulcer in the first three were mask and strap , orthotics and t shoes , endotracheal intubation and fixed belt .After the intervention treatment was given according to the pressure ulcer care guidelines , twenty-eight patients was healed , with healing time 4-12 d, six cases died , and three cases was in automatic discharge .Conclusions The use of ventilation devices and orthopedic fixation are the major causes of pressure ulcer .The key point to prevent pressure ulcer is to decompress tissue and skin , and strengthen the care for pressing areas .

Objective To detect the expression of osteopontin (OPN) in cervical local tissues of patients with chronic cervicitis, cervical intraepithelial neoplasia (CIN), cervical cancer. To investigate the possibility that OPN is used as tumor marker of cervical cancer. Methods The expression of OPN in 25 cases of chronic cervicitis, 18 cases of CIN and 21 cases of cervical cancer was detected by immuohistochemistry SP method. Results The positive expression rates of OPN in the chronic cervicitis, CIN and the cervical cancer had a rising trend (48 %, 77.78 % and 80.95 %, respectively) and their differences had statistical significant (P <0.05). The OPN expression level in cervical cancer had no statistical correlation with age, tumor size, clinical stage and other clinical pathological features (P >0.05). Although OPN expression level in cervical cancer wasn' t related with tumor clinical stage, positive expression rates of OPN had a gradually increased trend along with the clinical stage. Conclusion High expression of OPN is found in cervical cancer and may be related to the occurrence and development of cervical cancer.

OBJECTIVETo investigate the role of calcineurin (CaN) in the lung fibroblast proliferation and collagen synthesis induced by basic fibroblast growth factor (bFGF).

METHODSWe used Western blot and immunohistochemical methods for investigating the content and distribution of calcineurin in the lung tissue. Calcineurin activity in different tissues was measured using (32)P-labelled substrate. In the primary culture of lung fibroblasts, (3)H-thymidine ((3)H-TdR) and (3)H-proline incorporation methods were used to study the effect of cyclosporin A (CsA), an inhibitor of calcineurin, on the lung fibroblast DNA and collagen synthesis stimulated by bFGF.

RESULTSWe found that calcineurin was expressed in lung tissue and has phosphatase activity (7.1 +/- 2.0 pmol Pi/mg pr/min). CsA (10(-8) - 10(-6) mol/L) inhibited lung fibroblast (3)H-TdR incorporation induced by bFGF in a dose-dependent manner, with the inhibitory rates by 20%, 46% and 66% (P < 0.01). CsA (10(-7) - 10(-6) mol/L) inhibited (3)H-proline incorporation in lung fibroblasts stimulated by bFGF, with the inhibitory rates by 21% and 37% (P < 0.01). In a culture medium, CsA (10(-8) - 10(-6) mol/L) inhibited (3)H-proline secretion induced by bFGF in a dose-dependent manner, with the inhibitory rates by 19%, 29% (P < 0.05) and 56% (P < 0.01). CsA (10(-7) mol/L) could inhibit calcineurin activity by 44% in lung fibroblasts (P < 0.01).

CONCLUSIONSCalcineurin is expressed in lung tissue and has phosphatase activity. It is involved in the bFGF stimulated lung fibroblast DNA and collagen synthesis.

Animals ; Calcineurin ; analysis ; physiology ; Cell Division ; Cell Survival ; drug effects ; Collagen ; biosynthesis ; Fibroblast Growth Factor 2 ; pharmacology ; Fibroblasts ; drug effects ; physiology ; Lung ; cytology ; drug effects ; metabolism ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo evaluate the safety and effectiveness of direct gastroscopy for detecting gastric cancer.

METHODSClinical screening by direct gastroscopy was performed for gastric cancer (GC) from September 1985 to July 1998. 3048 elderly people were screened. Their age ranged from 60 to 93 years, and 2034 of the 3084 were followed up.

RESULTSNinety-two patients with gastric cancer were discovered by gastroscopy, representing 3.02% of the screened population. The rate of early gastric cancer (EGC) was 63.04% (58/92) of all gastric cancers detected. The rate was up to 79.59% (39/49) on follow-up, and was 74.14% (43/51) in asymptomatic patients with gastric cancer. The excision rate was 88.89% for patients with gastric cancer, and 100% for patients with early gastric cancer. The 5-year survival rate was 91.89% for patients with gastric cancer, and 96.30% for patients with early gastric cancer.

CONCLUSIONClinical screening and follow-up by direct gastroscopy in persons over 60 years of age are a safe and effective method for raising the 5-year survival and detection rate of gastric cancer, especially early gastric cancer.

Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Gastroscopy ; Humans ; Male ; Middle Aged ; Prognosis ; Stomach Neoplasms ; diagnosis ; mortality ; Survival Rate