Objective To investigate the relation of changes of fetal bile acid and morphologic ultrastructure of human placental syncytial cells in intrahepatic cholestasis of pregnancy (ICP). Methods(Total bile acid of cord venous blood was measured by cycle enzyme method between intrahepatic cholestasis of pregnancy and control groups after birth. The ultrastructure of human placental syncytial cell was analyzed by morphologic study in two groups. Results (1) The total bile acid of cord venous blood in ICP group was significantly higher than in control group[(8.6?3.2) ?mol/L vs (4.6?1.5)?mol/L ](P0.05). The average volume, surface area density and volume density of mitochondrion in ICP group [respectively (0.0200?0.0020) ?m~3,(0.600?0.010) ?m~2/?m~3,(0.0800?0.0090)?m~3/?m~3] were significantly enlarged than in control group [respectively (0.0100?0.0050)?m~3, (0.500?0.030) ?m~2/?m~3,(0.0500?0.0020) ?m~3/?m~3](P0.05). Conclusion In ICP, high levels of bile acids may impair cellular organelle, resulting in abnormality of physiological function of syncytial cells, and affecting the synthesis and transportation functions of placenta.

Objective To study the clinical significance of dexamethasone (DT) in the combined spinal and epidural anesthesia for delivery of elderly parturient women. Methods 134 elderly parturient women were selected as the research object, and randomly divided into two groups. 69 cases in DT group received intramuscular injection of dexamethasone and combined anesthesia, while 65 cases in INN group received intramuscular injection of tramadol (INN) and combined spinal and epidural anesthesia. The anesthetic effect of the two groups were observed. Results After treatment, the interleukin (IL-6), myeloperoxidase (MPO), tumor necrosis factor-α (TNF-α) and methane dicarboxylic aldehyde (MDA) in DT group were significantly higher than INN group (P<0.05). The five kinds of immunoglobulins levels (IgA, IgD, IgE, IgG and IgM) in DT group were higher than those in INN group (P<0.05). The heart rate (HR) in DT group was lower and mean arterial pressure (MAP) was higher than that in INN group(P<0.05). There was 1 cases of macrosomia, 2 cases of premature delivery in DT group, the adverse pregnancy outcomes was 4.35%(3/69). there was 1 cases of macrosomia, 1 cases of congenital deformity, 1 cases of premature delivery and 1 case of postterm delivery in DT group, the adverse pregnancy outcomes was 5.80%(4/69), with no significant difference between two groups. Conclusion Dexamethasone combined with anesthesia is very effective for delivery of elderly parturient women which shows very good anti-inflammatory and immunoregulation.

Objective The objective of this study was to observed the effect of target control intravenous (TCI) anesthesia and intravenous inhalational anesthesia in the postoperative cognitive function in elderly patients with intracranial tumor at different time points.Methods Seventy patients were divided into the experimental and control groups according to the different methods of intraoperative anesthesia.The experimental group was selected to treat with propofol combined with remifentanil TCI anesthesia,and the control group was treated with intravenous anesthetics combined with inhalation isoflurance.Recovery time of respiration,time of opening eyes,extuation time,orientation recovery time,OAAS score before and after operation,and cognitive function (MMSE)were observed in two groups.Results They were no differences in the recovery time of respiration,time of opening eyes and extubation time in two groups (P ＞ 0.05).The orientation recovery time in the experimental group was 20.4 ± 5.8 min and 23.2 ± 4.3 min in the control group.They had significantly different between experimental and control groups (P ＜ 0.05).The time of extubation,leaving the operating room and after 1 h of extubation,OAAS point for the experimental group was 3.3 ± 0.5,4.2 ± 0.4,4.6 ± 0.6 min,respectively,and 2.3 ± 0.2,3.3± 0.4,3.9 ± 0.3 in the control group,respectively.They were significantly different between the experimental and control groups(P ＜ 0.05).Prior to treatment,there was no significant difference in MMSE score between the two groups(P ＞0.05).MMSE score was 25.0 ±0.4 and 27.9 ± 1.1 in the experimental group after treatment for 24 h and 48 h,respectively.MMSE score in the control group was 23.2 ±0.9 and 25.8 ± 1.3 after treatment for 24 and 48 h,respectively.There had a significant different from two groups (P ＜ 0.05).Conclusion For elderly patients with intracranial tumor surgery,TCI anesthesia with propofol and remifentanil is stable and awake,and the effect on postoperative cognitive function is relatively small.

BACKGROUND: As indicated by clinical research, if cerebral infarction could be effectively treated at early stage, especially normal specific therapy provided within 6 hours or even earlier after attack, the prognosis would be significantly better than delayed therapy. However, it is still unclear that whether the changes of cellular apoptosis-inducing or -inhibiting indicators could be used as criteria in the judgment of prognosis.OBJECTIVE: To test the content of cell apoptotic factor and to investigate the prognosis in hospitalized patients with cerebral infarction who received treatment at different time for further verification of the therapeutic timing for the disease.DESIGN: A same term randomized controlled study based on patients.SETTING: Department of neurology of a general hospital of a military area command of Chinese PLA.PARTICIPANTS: Totally 144 male patients admitted in the Second Department of Neurology, General Hospital of Jinan Military Area Command of Chinese PLA between 2000 and 2002 were divided into four groups including 6 hours, 24 hours, 72 hours and 96 hours group according to different time of therapy provided.METHODS: Oral administration of 400 mg Lumbrokinase, 2 tablets of heparin sodium, 60 mg of nimodipine, and 100 mg of vitamin E, three times a day. 150 mL of normal saline(NS) containing 52.5 mg of Ginkgo biloba L extractive(Jin Na Duo) and 150 mL of NS containing 10 mL of Cerebroprotein Hydeolysate were used through intravenous drop once a day. Ten days were set as one therapeutic course and 2 courses were given. 200 g/L of mannite was given to dehydrate for patients with large area infarction(＞ 7 cm2) . Platelet membrane Fas, Apo2.7 and Bcl-2 percentage and prognostic assessment were tested in patients of four groups before and after therapy.MAIN OUTCOME MEASURES: Peripheral platelet membrane Fas,Apo2.7 and Bcl-2 percentage in patients of different group and prognosis evaluation.RESULTS: Percentage of platelet membrane Fas, Apo2.7 and Bcl-2 of 6 hours group was significantly higher or lower after therapy than before therapy ( P ＜ 0.05 ), and moreover, the difference with other groups was significant( P ＜ 0.05), As revealed in the analysis of prognosis, the effectiveness of patients who received therapy within 6 hours was significantly better than that of 96 hours group and the mortality reduced significantly.CONCLUSION: Normal hospitalizing therapy provided within 6 hours after attack could surely improve the prognosis and reduce the disability rate, and the abnormity and extent in Fas, Apo2.7 and Bcl-2 are closely correlated with prognosis.

Objective To investigate the effects of different target effect-site concentrations (Ces) of remifentanil on the sedative effect of propofol. Methods Fifty ASA Ⅰ or Ⅱ patients aged 20-55 yr weighing 48-86 kg with body mass index ＜ 30 kg/m2 were randomly divided into 5 groups ( n = 10 each) . Anesthesia was induced with TCI of remifentanil (Ce = 0, 2, 4, 6 and 8 ng/ml in groups R0-R4 respectively) and propofol. The initial Ce of propofol was 2.0 μg/ml in the 5 groups, and then the Ce of propofol increased by 0.5 μg/ml every 1 min until BIS value decreased to 50. BIS value and Ce of propofol were recorded as the patient lost consciousness. The effect-site concentration and consumption of propofol and the time required were recorded when BIS value decreased to 50.Results BIS value was significantly increased, while the effect-site concentration of propofol was significantly decreased as the patient lost consciousness, and the effect-site concentration and consumption of propofol were significantly decreased and the time required was shortened when BIS value decreased to 50 in R2-R4 groups compared with group R0 (P ＜ 0.05 or 0.01) . Conclusion The sedative effect of propofol can be enhanced when the Ce of remifentanil reaches 4 ng/ml, and the effects are comparable when the Ce of remifentanil reaches 4, 6 and 8 ng/ml.

Objective To evaluate ultrasonic measurement of fetal thigh soft tissue thickness in the estimation of fetal weight . Methods Fetal biparietal (BPD), head cirumference (HC), abdominal cirumference (AC) , femur length (FL) and fetal thigh soft tissue thickness (TSTT) were measured by ultrasonography in 196 pregnant women during five days before dilivery and the relation with neonatal birth weight were analyzed.Results There was significantly correlation between TSTT and neonatal weight (r=0.865) , and it was better to estimate fetal weight with TSTT than with the other parameters. The prospective study showed that the predictive value of fetal TSTT was 80 1%.Conclusions The ultrasonic measurement of fetal TSTT is a simple and valuable index in estimation of fetal weight. [

Objective To conduct in‐depth job analysis and needs assessment on advanced midwifery practitioner (AMP) set up at a tertiary hospital .Methods The appraisal structure was designed by the needs assessment framework .Information on AMP′s job needs was collected via in‐depth interviews ,field notes and midwives′diaries .Colaizzi analysis method was used to sort out and analyze all the data .Results Seven themes through AMP′s job needs assessment were presented in the form of6W1H ,including :(1) who was AMP ;(2) whom did AMP serve;(3) what was AMP′s job content ;(4) what scope did AMP work in ;(5) how was the AMP′s practice model ;(6) where was the practical site;(7) why was the job post launched .Conclusions AMP practice at current stage is in its embryonic form of exploration but with huge potential demand ,which still needs to be improved using the needs assessment framework so that a scientific and standard job description can be formed to guide the AMP clinical practice .

Objective To investigate the impact of previous cystectomy for ovary benign cyst on ovarian reserve and pregnancy outcome in in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles. Methods Totally 622 infertility patients were retrospectively investigated who underwent first IVF/ICSI-ET cycle in Reproductive Hospital Affiliated to Shandong University from January 2013 to June 2014. There were 153 cases who had been removed ovarian cyst by cystectomy surgeries recruited as study group, in which 44 cases of ovarian endometriosis cyst, 35 cases of benign ovarian teratomas, 67 cases of simple ovarian cyst and 7 cases of ovarian mucinous cystadenoma. In contrast, 469 infertility patients with tubal-factor infertility or male factor were included as control group. The age-matched women in the control group had no ovarian surgery previously. The indicators of ovarian reserve and pregnancy outcome were analyzed between two groups. The influence of different types of ovarian cysts on ovarian reserve and pregnancy outcome in IVF/ICSI-ET cycles were also studied, ovarian endometriosis cyst was studied as Group A, and Group B consisted of benign ovarian teratomas, simple ovarian cyst and mucinous cystadenoma. Results (1) The significantly lower serum antimullerian hormone (AMH) level (median: 1.92 versus 2.90 mg/L), antral follicle count (AFC; median: 12.0 versus 13.0), retrieved oocytes (12 ± 5 versus 13 ± 6) and the number of embryo cryopreserved (median:1.0 versus 3.0) were found in study group compared with control group (all P<0.05). There was no statistical difference between two group for the following parameters, such as basal FSH level, the total dosage of gonadotropin duration and the total dosage of gonadotropin (all P>0.05). A better clinical pregnancy rate was achieved in control group (61.6%, 241/391) than that in study group (61.4%, 81/132), but no significant difference was existed (P=0.96). (2) Compared to Group B, Group A had fewer AFC, lower serum AMH level, retrieved oocytes and the number of embryo cryopreserved (11±4 versus 13±5;1.65 versus 2.15 mg/L;9±4 versus 13±5;0 versus 2.0;all P<0.01). There was a lower clinical pregnancy rate in Group A than that in Group B [50.0% (19/38) versus 66.0%(62/94)], accompanying with higher abortion rate [3/19 versus 9.7%(6/62)], but no differences were observed (all P>0.05). Conclusions Ovarian reserve declines after the cystectomy for ovarian benign cysts and the cystectomy has a negative impact on IVF/ICSI-ET cycle, resulting in a decrease of the number of retrieved oocytes and the number of embryo cryopreserved, but do not influence clinical pregnancy outcome. Ovarian reserve is impaired more seriously by cystectomy for ovarian endometriosis cyst than other ovarian benign cyst.

Adenocarcinoma ; metabolism ; pathology ; Adenocarcinoma, Follicular ; metabolism ; pathology ; surgery ; Bronchial Neoplasms ; metabolism ; secondary ; surgery ; Carcinoid Tumor ; metabolism ; pathology ; DNA-Binding Proteins ; metabolism ; Diagnosis, Differential ; Female ; Humans ; Middle Aged ; Thyroglobulin ; metabolism ; Thyroid Neoplasms ; metabolism ; pathology ; surgery ; Transcription Factors

Objective: To explore the spatial distribution pattern and characteristics of myopia prevalence for Chinese children and adolescents aged 7-18 years old from 2005 to 2014, and to provide scientific basis for regional myopia prevention and control. Methods: Using data from the National Survey on the Constitution and Health of Chinese Students from 2005 to 2014,children and adolescents aged 7-18 yeaer old with Han and Tibetan ethnicity were included into analysis by using the Arc-GIS 10.2 software. Results: From 2005 to 2014, the overall Moran’s index were 0.13,0.02,-0.06(P>0.05), there was no spatial autocorrelation. Local autocorrelation analysis showed that Shandong, Jiangsu, Shanghai, and Zhejiang Province were "high" aggregation areas, while Hainan and Guangxi Province were "low" aggregation areas. Conclusion The myopia prevalence of children and adolescents in 31 provinces, municipalities, and autonomous regions shows significant local spatial autocorrelation, most of which are positive correlation; the number of high-high aggregation gradually decreases, while the number of low-low and low-high aggregation gradually increases.