Objective To know the awareness level of patient-controlled epidual analgesia in labor related knowledge,and to provide evidence for health education,develop a comprehensive intervention program to reduce the rate of cesarean section.Methods Investigation on knowledge of patient controlled epidural analgesia during labor for a total of 400 pregnant women on Maternal and Child Health Hospital of Taiyuan City,MCH Hospital of Shanxi Province by questionnaire.Compared different characteristics of the pregnant women's scores about control epidural analgesia childbirth knowledge by nonparametric test,knowledge score of multi-factor analysis by multiple linear regression analysis.Results The maximum score of pregnant women-controlled epidural analgesia delivery knowledge was 13,the minimum score was 0,the median score was 4,range interquartile was 5.Different pregnant women with different age,education level,number of weeks of gestation,pregnancy,family income,and condition of parnatal care had different scores of knowledge of patient-controlled epidural analgesia,the difference was significant,P＜0.05.Multiple linear regression analysis showed that:pregnant women's education,gestational age,the average monthly household income can be explained by maternal knowledge score of 61.4％ of the variation.Conclusions The level of pregnant women-controlled epidural analgesia childbirth knowledge is low,we need to strengthen the natural childbirth education,and take a variety of modes of propaganda and increase their level of knowledge,enhance confidence of natural childbirth in pregnant women,so as to achieve the purpose of reducing cesarean section rate.

Aim To investigate the direct effects and mechanism of carvedilol on HERG channel stably expressing in human embryonic kidney-293(HEK293) cells.Methods Whole-cell patch-clamp technique was used to record HERG current and kinetic curves in single cells.Western blot methods were used to investigate the expression of HERG channel in different concentration of carvedilol.Result Carvedilol decreased HERG current in a concentration-dependent manner with an IC50 539.6 nmol?L-1,Hillslope-0.64.The time constants of onset of inactivation and deactivation were accelerated.Other kinetcs(activation,inactivation,recovery from inactivation)had no significant changes.Based on western result,carvedilol had no effect on the generation and trafficking of HERG protein.Conclusion Carvedilol inhibits the transfected HERG channels by influencing the open state which is the probable anti-arrhythmic mechanism.There is no relationship between carvedilol and HERG channel expression.

Objective To evaluate the value of CT virtual endoscopy(CTVE)for microsurgery of pituitary microadenomas via transsphenoidal approach.Methods In 18 patients with pituitary micmadenomas underwent microsurgery via transsphenoidal approach,the presurgical CT data was transfered to work station,the anatomies of the sphenoid sinus were then reconstructed by CTVE.The CTVE images were used to make the preoperative planning and indentify sphenoid sinus, sellar floor,and the position of the tumor during surgery.The CTVE images and the views from intraoperative microscope were compared. Results CTVE could display the anotomoties of sphenoid sinus in a three-dimentional mode.The display rates of superfical antomies such as sphenoid septa,sellar floor,carotid prominence,optic prominence and opticocarotid recess were 344.4%,100%,41.7%,36.1%and 58.3%respectively and the visual fields of these anatomic landmarks were larger than the views from the intraoperative microscope. CTVE could depcit the anatomies of the enhanced carotid ateries and pituitary tissue and some optic canals underlying the sellae by transparent function or heighten the threshold.The sites of the tumor could be marked correctly on CTVE images.CTVE could simulate the operative approach and some operating procedures properatively. Conclusion CTVE can display the anatomies of sphenoid sinus in a three-dimensional mode. In transsphenoidal treatment of pituitary microadenoma,CTVE can help to make preoperative planning,locate the intraoperative structures and make a precise bone window during surgery.

To explore the role of β-endorphin (β-EP) in the pathogenesis of the acute encephaledema, the levels of β-EP in both of plasma and CSF were determined by radioimmunoassay in 69 children with infection of central nervous system consisting of 39 cases with encephaledema and 30 cases without encephaledema, respectively. Another 19 cases without intracranial infection were as the control group. The results showed that the levels of plasma and CSF β-EP in the encephaledema group (50.74 ng/L±26.60ng/L，62.72ng/L±39.23ng/L) were significantly higher than those in without encephaledema group (32.78 ng/L±21.2ng/L，34.13ng/L±30.26ng/L)and the normal group (14.83ng/L±6.55ng/L，9.77ng/L±6.33ng/L)，respectively (P＜0.01).It is concluded that β-EP plays an important role in the occurrence and development of encephaledema in children with the infection of central nervous system.

Objective To evaluate the effect of enteral immune nutrition on the occurrence of acute kidney injury(AKI) in sepsis patients. Methods A retrospective study was conducted, 80 patients with sepsis admitted and treated in the intensive care unit (ICU) of Quzhou People's Hospital from January 2015 to December 2016 were enrolled, and according to different treatment programs, they were divided into an immune nutrition group and a standard nutrition group, each group 40 cases. The two groups received an equal amount of calories and nitrogen in enteral nutrition (EN). After treatment, the changes of serum total protein (TP), albumin (Alb), prealbumin (PA), hemoglobin (Hb), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin (IL-6, IL-10), infection site, length of stay in ICU, mortality in ICU, AKI incidence, AKI staging, etc in the two groups were observed. Results ① After treatment, the nutritional indicators TP, Alb, PA, Hb levels were significantly increased, the serum inflammatory factors CRP, TNF-α, IL-6 were obviously decreased and IL-10 was markedly increased in the two groups compared with those before treatment (all P < 0.05), the changes in the immune nutrition group were more obvious than those in the standard nutrition group [TP (g/L): 60.84±5.90 vs. 58.32±6.11, Alb (g/L): 33.95±3.83 vs. 31.79±3.44, PA (g/L): 0.24±0.04 vs. 0.21±0.03, Hb (g/L): 117.47±16.15 vs. 112.50±15.71, CRP (mg/L): 53.04±23.76 vs. 82.33±37.09, TNF-α (ng/L): 20.29±17.74 vs. 29.63±18.43, IL-6 (ng/L): 50.74±28.55 vs. 80.32±31.67, IL-10 (ng/L): 41.09±24.65 vs. 40.86±24.73]; ② The length of stay in ICU (days: 10.54±4.33 vs. 14.80±5.19), ICU mortality [15.00% (6/40) vs. 32.50% (13/40)] and the incidence of AKI [22.50% (9/40) vs. 47.50% (19/40)] of immune nutrition group were significantly lower than those of standard nutrition group (all P < 0.05); There were 9 cases of AKI mainly at stage I andⅡ (8 cases) in the immune nutrition group, while in the standard nutrition group there were 19 cases with AKI mainly at stageⅢ (11 cases). Conclusion The enteral immune nutrition can effectively reduce the incidence of AKI in sepsis patients, and the mechanism may be related to the immune nutritional preparation can inhibit the expressions of pro-inflammatory factors such as TNF-α, IL-6, etc.

Objective To explore the influence factors on hepatitis B virus (HBV) relapse after nucleos(t)ide analogues (NA) withdrawal in the chronic hepatitis B (CHB) patients who met NA cessation criteria. Methods Eighty-one consecutive CHB patients were treated with NA, 38 with lamivudine (LAM), 25 with adefovir dipivoxil (ADV), 12 with entecavir (ETV), 6 with LAM +ADV. Among recruited patients, 40 were hepatitis B virus e antigen (HBeAg) positive, 41 were HBeAg negative, 67 of them were initial treatment, 14 were retreatment due to resistance to NA at baseline. The treatment was discontinued after meeting China therapeutic end-point criteria. HBV DNA, HBV serological markers, alanine aminotransferase (ALT) were measured respectively at baseline, every month before virological response, every 3 months after virological response, every month within first 6 months and every 2 months over 6 months after drugs withdrawal. Twelve probable influence factors on relapse which were sex, age, HBV family history, baseline HBV DNA,baseline HBeAg status, baseline ALT, virological response time, total duration of treatment, duration of additional treatment, the level of hepatitis B virus surface antigen (HBsAg) at cessation therapy,initial treatment or retreatment, drug category were analyzed with univariate, multivariate Cox regression modle and stratified analysis. The cumulative relapse was calculated by the Kaplan-Meier method. Results A total of 36 patients (44. 4%) relapsed within 1 year. Initial treatment or retreatment, HBV family history, virological response time, the level of HBsAg at cessation therapy were independent risk factors. The relapse rate of retreatment was higher than that of initial treatment (78.6% vs 37. 3% , χ2 = 7. 983, P = 0. 005) , those of patients with HBV family history higher than without family history (64. 5% vs 15.0%, χ2 =12. 096,P = 0.002), those of patients obtained virological response within 3 months lower than after 3 months(34. 0% vs 64. 3% , χ2 =6. 823,P=0. 009) , those of patients with HBsAg≤150 μg/L at cessation therapy lower than >150 μg/L(27. 6% vs 53. 8%, χ2=5. 199,P=0. 023). Conclusions Retreatment, HBV family history, later virological response and higher HBsAg level at cessation therapy are risk factors of relapse after NA withdrawal. Such patients should be treated with prolonged duration after meeting end-point criteria to strengthen the efficacy.

Objective To evaluate the efficacy and drug resistance profiles of nucleosides (NA) retreatment in NA experienced chronic hepatitis B (CHB) patients. Methods Totally 104 NA experienced CHB subjects were enrolled in this study.All these subjects had received at least 3 months NA monotherapy and stopped the treatment,and then received NA retreatment for at least one year.The subjects were divided into three groups according to the following criteria:reached the therapy endpoint of China guideline when they stopped NA-naive treatment (group A,n =39); did not reach the therapy endpoint when they stopped NA-naive treatment but hepatitis B virus (HBV) DNA＜1.0× 103 copy/mL (group B,n=33); and with HBV DNA＞1.0× 103 copy/mL (group C,n=32).The efficacy and drug resistance profiles of retreatment were compared among three groups. The effects of baseline alanine aminotransferase (ALT) levels,HBV DNA levels and HBeAg titers on the retreatment efficacies were analyzed. The mutations of HBV P gene were detected by nested polymerase chain reaction (PCR) and direct sequencing.The data were analyzd by Wilcoxon test and x2 test.Results The time to ALT normalization in patients with baseline ALT＜ 1.3 × upper limit normal (ULN) was shorter than that in patients with ALT≥1.3×ULN (2 months vs 4 months; Z=2.281,P=0.023).The time to virological response in patients with baseline HBV DNA＜5 lg copy/mL was shorter than that in patients with HBV DNA≥5 lg copy/mL (1 month vs 2 months; Z=2.054,P =0.040). The time to virological response and ALT normalization in baseline HBeAg negative were both shorter than those in patients with baseline HBeAg positive patents ( 1 month vs 3 months and 2 months vs 4.5 months,respectively; Z=2.580 and 2.304,respectively; both P＜0.05). The subjects in group A achieved virological response and HBeAg seroconversion after retreatment earlier compared to previous NA-naive therapy ([1.61 ± 1.76] months vs [3.48±4.066]months and [3.38 ± 3.34] months vs [9.92-11.22] months,respectively; Z=-2.854 and-1.094,respectively; both P＜0.05).The cumulative HBeAg seroconversion rate in group A was higher compared to those in group B and group C (80.0％ vs 36.8％ and 37.5％,respectively; x2 =4.368 and 5.100,respectively; both P＜0.05).Thirteen patients developed clinical resistance and four of them developed genotypic resistance proved by PCR direct sequencing.Among the patients retreated with the same regimen as previous in the C group,the cumulative resistance rate was highest compared to group A and B (44％ vs 9％ and 0,respectively; x2 =5.019 and 6.588,respectively;both P＜0.05).No resistance was detected in the 14 patients retreated with combined NA treatment without cross resistance.Conclusions For NA experienced CHB patients who fulfill the indication of antiviral therapy,the retreatment should be started as earlier as possible. Retreatment with NA combination without cross resistance can prevent (reduce) the risk of developing drug resistance.

Objective To analyze the burden of pneumoconiosis in China through comparison with the United States, Germany and the world based on GBD 2017 data, and to provide references for direction and reform measures for the Pneumoconiosis Prevention and Control Battle and the Occupational Health Protection Action in China. Methods The indexes of disease burden for pneumoconiosis in China, the United States, Germany and the Global level from 1990 to 2017 on the basis of GBD 2017 was obtained, and epidemiological characteristics and trends of pneumoconiosis were analyzed to compare the differences in the disease burden of pneumoconiosis. The main reasons for pneumoconiosis were analyzed, and the strategies for the improvement of prevention and control policies were discussed. Results From 1990 to 2017, the prevalence of pneumoconiosis in China rose from 12.96/100 000 to 20.45/100 000, an increase of 57.79%. The years lived with disability rose from 1.95/100 000 to 3.05/100 000, with an increase of 56.41%. In 2017, the YLL/DALY of China's pneumoconiosis was 82.60%, and the years of life lost caused by premature death was still the main component of China's pneumoconiosis disease burden. In 2017, the standardized DALY rate and standardized YLL rate of occupational exposure to silicon in China accounted for 66.19% and 72.62% of the total burden of environmental occupational factors, respectively, which were higher than the United States (30.24%, 35.06%) and Germany (52.17%, 52.65%) ), as well as the world (50.95%, 54.80%). From 1990 to 2017, the standardized DALY rate of pneumoconiosis in China, the United States, Germany, and the world all showed a downward trend, with a decrease of 51.99%, 37.69%, 58.33%, and 48.20%, respectively. However, in 2017, the standardized DALY rate of China (12.57/100 000) was still higher than the United States (4.10/100 000), Germany (3.45/100 000), and the world (6.32/100 000). Conclusion Until at least 2017, the disease burden of pneumoconiosis in China was still higher than that of the United States, Germany and the world. It is necessary to learn from the experience of countries with better prevention and control effects, strengthen laws and regulations, and focus on dust control to prevent pneumoconiosis.

Objective: : To observe the short-term efficacy and toxicity of apatinib monotherapy as well as docetaxel plus cisplatin in advanced gastric cancer. Method: : According to inclusion and exclusion criteria, 108 patients with advanced gastric cancer in the 105th Hospital of PLA were selected. According to random table grouping method, there were 54 cases in group A and 54 cases in group B. Patients in group A received continuous oral administration of apatinib alone, while group B received docetaxel plus cisplatin chemotherapy, with 3 weeks as a cycle and 4 cycles for a course. The efficacy and side effects were evaluated 3 months later. Results: : In groupA, there were 4 cases of CR, 25 cases of PR, 18 cases of SD and 7 cases of PD; the ORR was 53.7% and DCR was 87%. In group B, there were 2 cases of CR, 19 cases of PR, 21 cases of SD and 12 cases of PD; the ORR was 38.9% and DCR was 77.8%. The ORR and DCR in group A were significantly better than those in group B (P<0.05). The main adverse reactions were gastrointestinal reaction, myelosuppression, hypertension and hand-foot syndrome, all of which were grade 1 to 2; The incidence of bone marrow suppression and gastrointestinal reaction in group A was lower than that in group B (P<0.05), while the incidence of hand-foot syndrome and hypertension in group B was lower than that in group A (P<0.01). Conclusion： ：The short-term efficacy of targeted therapy of apatinib alone was better than that of docetaxel combined with cisplatin chemotherapy, and the toxicity and side effects of both regimens were controllable;Apatinib can be used as the primary regimen for the treatment of advanced gastric cancer.