Objective:To analyze the clinical applicability of the sixth edition of nursing measures classification in children's general surgery, to provide a basis for standardizing clinical nursing terms and to promote the clinical use of standardized terminology of nursing measures.Methods:The research method of this study was mapping method. The electronic nursing records of the general surgery of Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine from October 1st to December 31st, 2018, including the records of care records for free entry and the records of nursing measures related to medical orders were selected. The degree of matching between electronic care records and classification of nursing measures (sixth edition of nursing measures classification) was compared with conceptual consistency. Difficulties and time-consuming analysis of the characteristics of the standardized care measures obtained by matching.Results:A total of 4 560 independent electronic care records mapped 86 treatments in seven areas. Among them, 98.84% (4 507/4 560) of the nursing records were completely matched with the nursing measures, 0.83% (38/4 560) of the nursing records were partially matched with the nursing measures, and 0.33% (15/4 560) of the nursing records did not match the nursing measures. Difficulty and time-consuming were expressed as standard deviation, which were 2.20±0.45 and 2.03±1.25 respectively.Conclusions:The classification of nursing measures can be used to describe the daily behavioral activities of the children's general surgery nurses, and can also solve the standardization problem of the nursing records in the presentation, and is suitable as a standardized nursing language for the nursing records of children's general surgery.

Objective:To analyze the applicability of the 6th edition of nursing interventions classification in Pediatric Respiratory Medicine Department, so as to provide a basis for standardizing clinical nursing terms and promoting the clinical use of standardized nursing terminology.Methods:The research method of this research was mapping method. The electronic nursing records of Department of Respiratory Medicine in a ClassⅢGrade A children's specialty hospital from September 1 to November 30, 2018 were collected, including the nursing interventions recorded by free text and records of nursing interventions related to medical orders. The matching degree between electronic nursing records and standardized nursing interventions (the 6th edition of nursing interventions classification) was compared by concept consistency. Characteristics of standardized nursing interventions matched were analyzed by analyzing difficulty and time-consuming.Results:Totally, there were 84 standardized nursing interventions mapped from 3 258 independent electronic nursing statements, which involved 7 domains. Of the 3 258 statements, 3 183 (97.70%) were labelled as "perfect match", 55 (1.69%) as "partial match", and 20 (0.61%) as "not match at all". The average difficulty and time spent for the standardized nursing interventions were 1.76 and 2.02.Conclusions:Nursing interventions classification can be used to describe the daily behavior and activities of nurses in Pediatric Respiratory Medicine Department, and it can also solve the problem of standardization shown in nursing records. The results of this study can be used in the performance analysis of nursing staff with combination of difficulty and time-consuming empowerment in the future.

Objective To observe the clinical efficacy of acupuncture combined with auricular therapy and three-step analgesic ladder in the treatment of cancer pain.Methods 120 patients with cancer pain were randomly divided into the treatment group and control group,60 cases in each group.Both groups were treated with the basic therapy of three-step analgesic ladder.Additionally,the treatment group was treated with acupuncture combined with auricular therapy,and the control group was treated with sham acupuncture and auricular therapy,with a course of 21 days.The usage and side reactions of analgesics in three-step ladder were observed,and the visual analogue scale (VAS) score,Zubrod performance status (ZPS) score and the levels of natural killer (NK) cells and T cells (CD3 +,CD4 +,CD8 +,CD4 +/CD8 +)were compared.Results ①Finally 114 patients completed the whole trial,58 cases in the treatment group and 56 cases in the control group.②After treatment,there was statistically significant difference on VAS score between the two groups,and the VAS score of the treatment group was obviously lower than that of the control group(P ＜ 0.05).③At the end of the treatment,58.62％ patients in the treatment group effectively reduced the analgesic usage or used the analgesics in lower ladder,while 17.86％ patients in the control group did.There was statistically significant difference on the effective rate of drug reduction between the two groups (P ＜ 0.05).④At the end of the treatment,the decrease on side reactions of analgesics was observed in 34.48 ％ patients in the treatment group and 21.43％ patients in the control group.There was statistically significant difference on the effective rate of side effects reduction between the two groups,and the effective rate of the treatment group was obviously higher than that of the control group (P ＜ 0.05).⑤After treatment,there was statistically significant difference on ZPS score between the two groups,and the ZPS score of the treatment group was obviously lower than that of the control group (P ＜ 0.05).⑥After treatment,there were statistically significant differences on the levels of CD3 +,CD4 + and CD4 + / CD8 + between the two groups,and the improvement in the treatment group was significantly better than that in the control group(P ＜ 0.05).Conclusion Acupuncture combined with auricular therapy and three-step analgesic ladder can be used in the treatment of cancer pain,which can significantly alleviate the cancer pain and improve the quality of life and cellular immune function of patients.It also can reduce the analgesics usage and side reactions caused by analgesics to some extent.

目的:探讨卵泡液中双酚A(bisphenol A,BPA)在多囊卵巢综合征(PCOS)发病中的作用.方法:于取卵日收集行体外受精/卵胞质内单精子显微注射(IVF/ICSI)的PCOS患者和非PCOS患者的卵泡液,检测患者卵泡液BPA水平和卵泡液性激素水平,并进一步与患者血清抗苗勒氏管激素(AMH)及临床结局等因素行相关性分析.结果:PCOS患者和非PCOS患者的卵泡液BPA水平(446.57±63.57 ng/L vs 336.29±59.02 ng/L,P＜0.001)、血清AMH水平(12.09±4.78 μg/L vs 5.69±2.98 μg/L,P＜0.001)、卵泡液FSH(5.58±1.66 IU/L vs 3.95±1.54 IU/L,P=0.008)、LH(4.54±2.97 IU/L vs 0.96±1.10 IU/L,P＜0.001)和T(54.68±34.34 nmol/L vs 32.48±16.68 nmol/L,P=0.035)组间比较有统计学差异.相关性分析显示,卵泡液中BPA水平与血清AMH水平呈显著正相关(r=0.577,P=0.001).结论:卵巢局部的BPA暴露可能参与了PCOS疾病的发生、发展.

Hypereosinophilic dermatitis refers to a spectrum of disease with unknown etiology and with hypereosinophilia-related tissue damage in skin, but without involvement of the other organs. In recent years, the incidence of the disease seems to be increased, while there remains some dififculties in diagnosing and treating the disease. Here, we summarize the updated pathogenesis of this disorder, which may help to develop effective treatment strategies.

目的:探讨严重少弱畸形精子尤其是不活动及畸形精子对卵胞质内单精子注射(ICSI)治疗结局的影响.方法:回顾性分析ICSI病例,选择同一患者累积治疗周期中因各种原因既使用夫精又使用供精的58例患者,其中每例患者的夫精部分(严重少弱畸形精子)列入A组和供精部分(正常精子)列入B组,比较A、B组的受精率、卵裂率、优质胚胎率、临床妊娠率及流产率的差异.结果:B组的受精率、卵裂率、优质胚胎率、临床妊娠率均高于A组,流产率低于A组,其中优质胚胎率、临床妊娠率A、B组间差异均有统计学意义(P＜0.05).结论:严重少弱畸形精子,尤其是不活动和畸形精子行ICSI治疗的优质胚胎率和临床妊娠率均明显下降,同时还增加流产及出生缺陷的风险.

OBJECTIVE:To study the regulation of microRNA 199a (miR-199a) on adhesion, migration and invasion ability of human eutopic endometrial stromal cells (ESC) from patients with endometriosis.METHODS:ESC were transfected with miR-199a mimics or negative control (NC) RNA by lipofectamine 2000. The adhesion, migration and invasion ability of ESC were detected by cell adhesion assay, scratch assay, cell migration assay and matrigel invasion assay, respectively. Luciferase reporter assay was used to evaluate whether IKKβ was the target gene of miR-199a. The expression of ikappa B kinase beta (IKKβ), inhibitory kappa B alpha (IκB-α), phospho-IκB-α(p-IκB-α) and nuclear factor-kappa B (NF-κB) protein were measured by western blot.RESULTS:(1) Adhesion potential: the adhesion inhibitory rates were (14 ± 4)% in miR-199a group and 0 in control group, which showed significant difference (P < 0.01). (2) Migration and invasion: in the scratch assay, ESC transfected with miR-199a exhibited a lower scratch closure rate than that of controls. In migration and invasion assays, the migration and invasion ability of miR-199a group were significantly decreased compared with those of NC group [130 ± 31 vs. 247 ± 36 (P < 0.01); 63 ± 15 vs. 133 ± 17 (P < 0.01), respectively]. (3) The luciferase activity of miR-199a group was significantly lowered than that of control group [0.160 ± 0.006 vs. 0.383 ± 0.083 (P < 0.01)]. The protein levels of IKKβ, p-IκB-α, IκB-α and NF-κB of 0.350 ± 0.195, 0.443 ± 0.076, 1.970 ± 0.486 and 0.454 ± 0.147 in miR-199a group were significantly different compared with the NC group in which the protein levels were set at 1.000 (P < 0.01).CONCLUSIONS:miR-199a can inhibit the adhesion, migration and invasion of the ESC. IKKβ is the target gene of miR-199a in ESC. One of the mechanisms of the inhibition effect is probably that miR-199a inhibits the activation of NF-κB signaling pathway by targeting IKKβ gene.

Backgroud:The efficacy of trastuzumab for treating human epidermal growth factor receptor 2(HER2)-positive gastric cancer(GC)has been confirmed by phaseⅢclinical trial.Investigation on correlation of HER2 score with clinical outcome will be helpful for determining which patient might be benefit from trastuzumab therapy.Aims:To study the correlation of HER2 gene amplification and protein expression with clinicopathological characteristics and prognosis of GC.Methods:One hundred and seventy-seven GC specimens were collected.HER2 gene amplification and protein expression were determined by using the Food and Drug Administration(FDA)-approved kits for fluorescence in situ hybridization(FISH)and immunohistochemistry(IHC),and were scored according to the consensus panel recommendations on HER2 scoring for GC.The difference in HER2 positivity rate among GC with different clinicopathological characteristics was analyzed,and the correlation between HER2 and prognosis was estimated by Kaplan-Meier survival curve.Results:Thirty-one cases of GC(17.5%)were positive for HER2.The positivity rates in intestinal type GC and well-differentiated GC were higher than those in diffuse/mixed type GC and poorly-differentiated GC,respectively(28.1% vs.12.5%,P=0.0109;37.0%vs.10.7%,P<0.0001),but were not correlated with gender,age,tumor location and TNM stage.The overall survival was not significantly different between HER2-positive and HER2-negative GC,but in well-differentiated cases,the survival of HER2-positive GC was worse than that of HER2-negative GC(P=0.0084). Conclusions:Patients with intestinal type GC and well-differentiated GC may be the potential responders to trastuzumab therapy.HER2 can not yet be served as an independent predictor for prognosis of GC.

The assisted reproductive techniques in China have witnessed rapid development in the past two decades.However,it also brings up issues of ethics and laws,especially the urgent regulation and reinforcement of the procedure of informed consent.This article begins with an explanation of the procedure of informed consent.Then it discusses the decision of the content,major and difficult points of informed consent in assisted reproductive technology services based on the practice in this field.Finally,it discusses the challenges to informed consent.To well enforce an informed consent process,we should first ensure the contents are reasonable and just;second,clinicians should have a scientific understanding of the importance of informed consent and establish normative procedure of informed consent;third,we must work according to relative ethic demands.Last but not least,respecting patients is the key to the principle of ethics.

Objectives: To evaluate the effect of medical interventions on the sonographic appearance of endometrium in the infertile women with endometrial abnormalities and the clinical outcome of controlled ovarian stimulation cycles.Methods: Transvaginal ultrasonography was performed in follicular phase in natural period.30 of 60 infertile patients found with abnormal endometrial echoes were treated with hysteroscopy assisted dilation curettage(HADC group),another 30 with dilation curettage(DC group).The controls were 50 infertile women without identifiable endometrial abnormalities.The controlled ovarian hyperstimulation cycles were performed after treatment.Results: In HADC group and in DC group,the rate of type A endometrial echoes was significantly increased in controlled ovarian hyperstimulation cycles than in nature cycles,and the rate of type B,type C echoes was significantly decreased(P0.05).But compared with that in control group,the rate of type A endometrial echoes was significantly lower in HADC group and in DC group,and the rate of type B,type C echoes was significantly higher(P0.05).The clinic pregnancy rate in HADC group(56.7%) was statistically higher than that in DC group(43.3%) and in control group(40.0%)(P0.05).There was no significance difference between DC group and control group(P0.05). Conclusion: It is suggested that dilation curettage,especially hysteroscopy assisted dilation curettage,may be benefit to improve intrauterine disorder and increase clinic pregnancy rate.

Objective: To explore the value and moleculor mechanism of local injury therapy in improving the endometrial receptivity. Methods: There were 120 infertile patients who had 140 IVF cycles, in which 60 of them were in the local injury group (group A) and the other 60 women were in control group (group B). Scanning electron microscopy and immunohistochemistry were used to screen for the expression of pinopode, LIF and ostepontin (OPN) in the endometrium of two groups. Twenty non-pregnant women (group B2) from group B were taken to undergo local injury therapy and proceed with IVF treatment. The influence of the expression of pinopode, LIF and osteopontin before and after local injury therapy were also compared. Results: The expression of implantation related factors in group A and group B of the IVF patients were following: pinopode abundance 63.33% vs 36.67%, LIF 6.07 ± 1.33 vs 4.94 ± 2.26, OPN 6.36 ± 1.49 vs 5.28 ± 2.06. They showed more expression of pinopode and higher level of LIF, OPN in the endometrium of group A than in group B (P<0.05). The single embryo implantaion rate in group A was 27.78%, which was much higher than that in group B (14.29%, P<0.05). The expression of pinopode, LIF and OPN in group B2 before and after local injury treatment were following: pinopode abundance 10% vs 50%,LIF 4.50 ± 0.82 vs 6.33 ± 1.25, OPN 5.06 ± 0.98 vs 6.83 ± 1.46, respectively (P<0.05). A total of 140 IVF cycles were divided into the pregnancy group (62 IVF cycles) and the non-pregnancy group (78 IVF cycles) according to the outcomes of IVF-ET/ICSI. The implantation related factors expressed in the pregnancy group and the non-pregnancy group were following: pinopode abundance 54.84% vs 25.64%, LIF 6.94 ±1.03 vs 4.24±1.84, OPN 7.31±0.85 vs 4.52±1.65, respectively. These were also higher expression of the implantation related factors in the pregnancy group than in the non-pregnancy group (P<0.05). And they were correlative each other. Conclusion: Pinopode, LIF and OPN are important related factors in the implantation window. The abundant expression of pinopode and higher level of LIF, OPN in the endometrium may be closely related to the endometrial receptivity to implantation. Further more, the local injury may increase these implantation related factors and thus inhence the rate of IVF pregnancy.

In the artical,the connotation ofthe origin of congenital constitution had been discussed through the embryo stage of the vitality.It was considered the zygote's forming and growth depends on kidney essence quality,and the prosperity and decline of kidney-qi plays an important role in maintaining and keeping the normal embryo in its position,meanwhile discriminating and eliminating the abnormal embryo.It is an instinct of survival of the fittest the female parents by discriminating and eliminating its abnormal embryo,which is formed in the long period of evolution and has the hereditary feature.Therefore,not all of the abortions belong to morbid states,sometimes are because of the female parent eliminating her unnormal embryos to guarantee the descendant's quality.

Objective: To analyze the value of basal follicle stimulating hormone-to-luteinizing hormone((bFSH/LH))(ratio) in the assessment of ovarian response to gonadotrophin stimulation.Methods: One hundred and thirty-four patients underwent IVF-ET or ICSI using a short protocol for superovulation.We studied their age,basal FSH/LH ratio and some indexes which can represent ovarian response.Statistical evaluation was performed using logistic regression analysis and ROC curve was used to determine odds ratios(OR) and FSH/LH cutoffs.Results: In the patients with basal FSH less than 8 IU/L,three odds ratios between the ovarian(response) index and their age,basal FSH,basal FSH/LH were of no significant difference and basal(FSH/LH) cutoff was 3.7.But among the patients with basal FSH ≥8 IU/L,there were differences of these three OR and basal FSH/LH cutoff was 3.3.The highest OR was found between basal FSH/LH(ratio) and ovarian response indexes,while the lowest was between basal FSH and those ovarian(response indexes.)Conclusion: Among the patients who has lower ovary reserve(basal FSH≥8 IU/L),the basal(FSH/LH) ratio has a superior significance to age and basal FSH on evaluating ovarian response.