Objective To study the effects of ropivacaine on the duration of labor and mode of delivery in the primigravidas using patient-controlled epidural analgesia (PCEA). Methods Retrospective analysis was performed. The 190 healthy, full-term, and single-fetus parturient primigravidas who received PCEA with 0.1% ropivacaine+fentanyl (1 ?g/ml ) were in the epidural analgesia group. Another 222 primigravidas who didnot receive PCEA were in the control group. The duration of labor and modes of delivery, and the neonatal Apgar scores in both two groups were recorded and evaluated. Results Those in the epidural analgesia group experienced a significantly longer first stage [(426?161) minutes], longer second stage [(54?27) minutes] and longer full duration of delivery [(489?166) minutes] than those in the control one [(409?170) minutes, (364?167) minutes and (37?22) minutes]. The rate of using pitocin in the epidural analgesia group (30.2 %) was significantly higher than that in the control group (4.1%). The cesarean section rate in epidural analgesia group (20.0 %) was lower than that in the control one (28.4%); while the rate of instrumental delivery in the epidural analgesia group (20.0%) was significantly higher than that in the control one (6.3%). In summary, there were significant differences between two groups in the duration of labor, the rate of using pitocin, the rate of instrumental delivery and the rate of cesarean section. But there were no differences found for those newborn who had Apgar scores less than 7 at the point of both one and five minutes (7.9% and 4.5%, 2.6% and 0.5% respectively). Conclusion Epidural ropivacaine labor analgesia lengthens the duration of labor and increases the rate of instrumental delivery, but it has no significant negative effects on the neonates.

Objective To explore the association between urinary lactate/creatinine ratio and neonatal asphyxia,and to clarify the application value of urinary lactate/creatinine ratio in forecasting the hypoxie-ischemic encephalopathy (HIE)in neonates.Methods Using case-control study design method,40 cases of neonatal asphyxia infants were selected as asphyctic group and 40 healthy infants were used as control group.The urinary lactate/creatinine ratio in the first day after birth, urinary N-Acetyl-β-D-glucosaminidase (NAG)/creatinine and the score of Apgar of 80 infants were detected.The relationship between the urinary lactate/creatinine ratio,urinary NAG/creatinine ratio, as well as the score of Apgar and HIE were analyzed and compared in asphyctic group and control group.Results The Apgar scores at 1 and 5 min in asphyctic group were significantly lower than those in control group (P<0.01). The urinary lactate/creatinine ratio and urinary NAG/creatinine ratio in asphyctic group 1 d after birth were significantly higher than those in control group(P<0.01).There was significantly negative correlation between the urinary lactate/creatinine ratio and the 1-min and 5-min Apgar scores(r=-0.636,P<0.001;r=-0.883,P<0.01),but there was a significantly positive correlation between the urinary lactate/creatinine ratio and urinary NAG/creatinine ratio(r=0.433,P<0.01).Conclusion The urinary lactate/creatinine ratio may have decisive roles in prognosis evaluation of neonatal asphyxia,and so as the important foundation for the prediction of HIE.

Objective To evaluate the effects of drotaverine hydrochloride versus scopolamine in re-ducing duodenal motility and in facilitating cannulation during endoscopic retrograde cholangiopancreatogra-phy (ERCP). Methods Randomized controlled trial of 650 participants from 4 endoscopic centers assigned to receive scopolamine 20 mg or drotaverine hydrochloride 40 mg intravenously 15 minutes before ERCP. Pa-rameters including duodenal motility grades, success rates of deep cannulation, ERCP-related complications and adverse effects were recorded. Results The data of 638 patients (319 in each group) were valid. There were no significant differences in duodenal motility grades (1.17 ±0. 82 vs. 1.13 ± 0.89, P =0. 705), success rate of deep cannulation (90. 9% vs. 91.8%, P =0. 672) and incidence of ERCP-related complications (11.3% vs. 11.0%, P =0. 900) between 2 groups. However, the incidence of tachycardia (heart rate > 120 bpm) during ERCP was lower in drotaverine group than in scopolamine group (2. 2% vs. 6. 9%, P = 0. 004). There was no significant difference in other adverse effects (nausea, vomiting) between 2 groups. Conclusion Drotaverine hydrochloride may provide a reasonable alternative as antimotility agent before ERCP.

Objective:To explore the cause and treatment of chylothorax after surgery for congenital heart disease(CHD) in newborns.Methods:A retrospective analysis was made to the clinical data of 49 newborns with chylothorax after surgery for CHD within the period from January 2009 to December 2019. These newborns were aged from from 1 day to 28 days with the weight from 2.0 kg to 4.1 kg. The complete transposition of great arteries was performed in 13 cases, coarctation of the aorta/ interruption of the aortic arch in 13 case, right ventricular outflow tract reconstruction/ Blalock-Taussing shunt in 9 cases, total anomalous pulmonary venous connection in 8 cases, ventricular septal defect repair and atrial septal defect repair in 4 cases, ligation of patent ductus arteriosus in 1 case and persisten truncus arteriosus in 1 case. Chylothorax occurred in the right in 19 cases, left side in 20 cases, bilateral in 9 cases and the pericardium in 1 case. The diagnosis was made at the time from 1 day to 22 days after the surgery with an average of 8 days.Results:43 patients were cured(87.75%), 41 cases(83.67%) were cured with diet and support therapy, the course lasted from 4 days to 65 days with an average of 11 days; 1 cases, because of the poor effect of diet and support therapy, was given pleural injection of high-sugar combined with octreotide treatment; 1 case received thoracic duct ligation as the conservative therapy was ineffective; 6 cases of death due to heart failure/ severe pulmonary hypertension after operation, and parents gave up.Conclusion:Individualization conservative therapy is the first choice for chylothorax, while timely surgery can raise the survival rate and save the hospitalization time and the cost.

Objective: To investigate the efficacy and safety of using pegylated recombinant human granulocyte-colonystimulating factor (PEG-rhG-CSF) in preventing neutropenia in multiple chemotherapy cycles. Methods: A multicenter, prospective, open-label, singlearmstudy was designed. Patients with malignant tumors, such as lung, ovarian, and colorectal cancers, who received multiple cycles of chemotherapy with the prophylactic use of PEG-rhG-CSF for 2-4 consecutive cycles participated in the study. Results: After the prophylactic use of PEG-rhG-CSF, the incidence of grade IV neutropenia decreased from 4.76% (13/273) in the first cycle to 1.83% (5/273), 1.15% (2/174), and 2.08% (2/96) in subsequent cycles. Meanwhile, the incidence of grade III neutropenia decreased from 11.36% (31/ 273) in the first cycle to 6.23% (17/273), 2.87% (5/174), and 3.13% (3/96) in subsequent cycles. The incidence of febrile neutropenia (FN) during the first cycle was 0.73% (2/273). The duration of FN was 2 days in one case and 5 days in another case. FN was not observed during the second, third, or fourth cycle. After the secondary prophylactic use of PEG-rhG-CSF, the incidence of grade IV neutropenia decreased from 25% (7/28) to 3.57% (1/28), 0% (0/28), and 6.67% (1/15) in subsequent cycles. Meanwhile, the incidence of grade III neutropenia decreased from 71.43% (20/28) to 10.71% (3/28), 14.29% (4/28), and 0% (0/15) in subsequent cycles. The proportion of patients who received antibiotic therapy during the entire chemotherapy period was 10.48% (44/420). Conclusion: The application of PEG-rhG-CSF once per chemotherapy cycle can effectively reduce the occurrence of neutropenia in patients under multiple cycles of chemotherapy treatment with good safety.