Actins ; metabolism ; Female ; Heart Atria ; pathology ; Heart Neoplasms ; secondary ; surgery ; Humans ; Iliac Vein ; pathology ; surgery ; Leiomyomatosis ; metabolism ; pathology ; surgery ; Middle Aged ; Uterine Neoplasms ; metabolism ; pathology ; surgery ; Vascular Neoplasms ; metabolism ; pathology ; surgery ; Veins ; pathology ; surgery ; Vena Cava, Inferior ; pathology

Objective By analyzing the cesarean delivery rate (CDR) and the indications of cesarean section in Jiangsu Province from 2012 to 2014, to find the strategy to reduce CDR.Methods Data of 40 hospitals whose number of delivery was over 2 400 per year from the database of the Quality Control Center of Gynecology and Obstetrics of Jiangsu Province from 2012 to 2014 were selected.The cohort was divided into two groups, one was specialized hospital including 11 maternal and child health hospitals and the other included 29 general hospitals.After analyzing the current status of cesarean section of the whole province, the average CDR and the distribution of the first indications of cesarean section in two groups were compared using Chi-square test.Results The average CDRs at year 2012, 2013 and 2014 were 53.8％(96 347/178 970), 51.8％ (97 509/188 142) and 48.8％(106 323/217 877), which had a trend of decrease (x2=1 026.2, P ＜ 0.01).CDR without medical indications for each year were 15.7％ (28 098/178 970), 15.5％ (29 162/188 142) and 12.8％ (27 888/217 877).The rate had decreased apparently from both 2012 and 2013 to 2014 (x2=217.6, P ＜ 0.01;x2=341.3, P ＜ 0.01).The CDRs of specialized hospitals for year 2012, 2013 and 2014 were 51.2％ (45 496/ 88 916), 50.6％ (45 853/90 607) and 49％ (55 404/113 105), while the CDRs of general hospitals for each year were 56.6％(50 851/90 054), 53.0％(51 656/97 535) and 48.6％(50 919/104 772).Both showed significant decreasing trend (x2=105.8 and 1 215.7, both P ＜ 0.01).The average CDR of general hospitals was obviously higher than that of specialized hospitals in 2012 and 2013 (x2=505.6 and 104.3, both P ＜ 0.01).However, the difference disappeared in 2014 (x2=3.2, P ＞ 0.05).The three main first indications of cesarean section were associated and postoperative pregnancy complications, and no medical indications.Interestingly, from 2012 to 2014, the CDR for scarred uterus in specialized hospitals raised from 5.4％ to 20.3％, and that in general hospitals increased from 6.7％ to 21.6％, which became the first.Conclusions The average CDR in Jiangsu Province tends to decrease each year, so does the CDR without medical indications.The first indication of cesarean section is associated or postoperative pregnancy complications, while scarred uterus becomes the most common in cesarean section.

Adenocarcinoma ; metabolism ; pathology ; Aged ; Ampulla of Vater ; pathology ; Carcinoid Tumor ; pathology ; Carcinoma, Hepatocellular ; metabolism ; pathology ; Diagnosis, Differential ; Duodenal Neoplasms ; metabolism ; pathology ; Endodermal Sinus Tumor ; pathology ; Humans ; Male ; alpha-Fetoproteins ; metabolism

OBJECTIVEThe purpose of this article was to observe the effect of Vitapex Paste in apexilication.

METHODS64 younger permanent teeth with underdeveloped apex and necrotic pulp were randomly selected. After root canals were prepared and sterilized, Vitapex paste was used in the apexification. All the teeth were observed for three years.

RESULTS24 teeth (37.5%) were successful, 37 teeth (57.81%) were progressive, 3 teeth (4.69%) were failed. Altogether 61 teeth were effective, the effective rate was 95.31%.

CONCLUSIONVitapex paste was effective for the younger permanent teeth in the apexification.

Adolescent ; Calcium Hydroxide ; therapeutic use ; Child ; Drug Combinations ; Female ; Follow-Up Studies ; Humans ; Male ; Root Canal Filling Materials ; therapeutic use ; Silicones ; therapeutic use ; Tooth Apex ; drug effects ; growth & development

Objective: To quantitatively evaluate the abnormal tense of parasympathetic nerve via measuring the heart rate deceleration capacity (DC) and heart rate variability (HRV) in patients with vasovagal syncope (VVS).
Methods: Our research included 2 groups: VVS group,n=28 patients with positive head-up tilt test treated in our hospital from 2013-06 to 2014-08 and Control group,n=30 patients without cardiovascular disorders. The DC and HRV were examined and compared between 2 groups.
Results:① The overall deceleration capacity (ODC) (9.4 ± 2.9) ms and daytime deceleration capacity (DDC) (8.9 ± 2.9) ms in VVS group were higher than those in Control group (7.5 ± 2.5) ms and (7.5 ± 2.5) ms respectively,P<0.05.② More patients in VVS group presented daytime-to-nighttime deceleration capacity ratio (DNratio) >1 than those in Control group (9/28, 32.1% vs 2/30, 6.7%),P=0.019.③ The SDNN (139.8 ± 34.0) ms, SDSD (29.9 ± 15.7) ms and rMSSD (40.9 ± 18.8) ms in VVS group were higher than those in Control group, (115.5 ± 29.4) ms, (21.8 ± 6.6) ms and (28.9 ± 8.4) ms respectively,P<0.05.④ Multivariate Logistic regression analysis indicated that ODC was positively related to vasovagal syncope occurrence (OR=2.045, 95% CI: 1.100-3.801,P=0.024).
Conclusion: VVS patients have abnormally increased indexes of DC and HRV, HDC is the predictor for vasovagal syncope occurrence.

Objective Preoperative autologous blood donation ( PABD) may reduce the need for allogeneic blood , but it may also cause a short massive blood loss in pregnant women , and its fetal and maternal safety has to be adequately assessed .This study was to evaluate the feasibility and safety of PABD for pregnant women and their fetuses . Methods A prospective observational study was conducted among the women who met the inclusion criteria and gave birth in Nanjing Drum Tower Hospital between January and December 2013 .According to the clinical validation of risk stratification criteria for peripartum hemorrhage of California 2013 , the ca-ses were classified into a low-, a medium-, and a high-risk group.Data on blood donation procedures , obstetric outcomes, and blood transfusions were collected after delivery for analysis . Results Totally, 92 pregnant women accomplished 115 blood donations .The median volumes of the donated blood were 300, 300, and 400 mL in the low-, medium-, and high-risk groups, respectively ( P>0.001).There were no significant changes in HR , SBP and SpO2 during the blood donation procedures (P>0.05) except for the fall of diastolic blood pressure by an average of 3.4 mmHg (P<0.05) at 5 minutes after blood collection, which was restored to normal later.Non-reassuring fetal heart rate patterns were not found in any of the cases .The levels of HB and HCT were remarkably lower af-ter donation than before it (P<0.05) but restored to normal before delivery in the PABD cases who donated once only (P>0.05), which were similar to those in the cases who donated twice , with no significant differences before and after the donation (P>0.05). Homologous blood transfusion was performed for 5 cases (17.9%) in the high-risk group, with the volume of blood loss >2000 mL in all the cases.All the newborns survived without asphyxia and there was no perinatal death . Conclusion PABD can provide timely autologous whole blood donation for pregnant women .Under strict management , PABD is feasible and safe for pregnant patients who are at a high risk for massive blood loss during delivery or have a rare type of blood no readily available .

Objective To explore the effect of omni-directional health education on self-management level and blood glucose control in patients with type 2 diabetes mellitus. Methods A total of 100 diabetic patients admitted to the department of neurology of Taizhou Central Hospital from January to December 2016 were randomly divided into an observation group and a control group, 50 cases in each group. All patients were given conventional medication according to their systemic conditions, the control group used conventional nursing care, while the observation group was supplemented with omni-directional health education (including diet control therapy, exercise therapy, blood glucose control, hypoglycemic drug use and observation, foot care, blood glucose self monitoring) on the basis of routine nursing;the course of treatment was 2 weeks in the two groups. The differences in self-management level and the effect of blood glucose control were compared between the two groups. Results On the return visits, the self-management scores were significantly higher in both groups than those before education (the control group was 35.2±9.2 vs. 30.1±5.2, the observation group was 78.6±11.5 vs. 29.8±5.4, all P < 0.05), fasting blood glucose [FBG (mmol/L): the control group was 8.8±2.5 vs. 14.8±2.9, the observation group was 6.1±1.6 vs. 15.1±2.7, both P < 0.05) and 2 hours postprandial blood glucose [2 h PBG (mmol/L): the control group was 12.5±3.4 vs. 22.5±3.8, the observation group was 9.1±2.2 vs. 21.9±3.6) were obviously lower than those before education (all P < 0.05), the degrees of improvement of the observation group were more significant than those of the control group [self management score: 78.6±11.5 vs. 35.2±9.2, FBG (mmol/L): 6.1±1.6 vs. 8.8±2.5, 2 hours PBG (mmol/L): 9.1±2.2 vs. 12.5±3.4, all P < 0.05]. Conclusion Omni-directional health education can improve the self-management level of diabetic patients, and the patient's blood glucose control is relatively better.

OBJECTIVETo investigate the impact of proportional assist ventilation (PAV) on tolerance and breathlessness in ventilated chronic obstructive pulmonary disease (COPD), and to describe the patient-ventilator interaction, hemodynamic state, breathing pattern and work of breath during PAV and pressure support ventilation (PSV).

METHODSTen intubated COPD patients on weaning from mechanical ventilation were studied. Elastance and resistance were measured by both the inspiratory-hold technique during a brief period of volume control ventilation and runaway technique during PAV. Each assistance level of PAV (80%, 60% and 40%) and PSV was selected randomly. Patients' response, hemodynamics, blood gas and lung mechanics were monitored.

RESULTSTidal volume and respiratory rate didn't change in a consistent manner as the level of assist was decreased (P > 0.05). With the level of assist increasing, peak inspiratory pressure was increasing significantly (P < 0.05), while patients' work of breath had the tendency to decrease (P < 0.05). A significant difference in the Borg Category Scale was observed between PAV and PSV (0.50 [1.50] vs. 0.75 [2.00], P < 0.05) at the same degree of respiratory muscle unloading. PaCO(2) was significantly higher on PAV (54 [23] mm Hg) than on PSV (48 [23] mm Hg) (P < 0.05). Peak inspiratory pressure on PAV was significantly lower than on PSV (16 +/- 4 cm H(2)O vs. 21 +/- 3 cm H(2)O, respectively, P < 0.05). Hemodynamics and oxygenation remained unchanged.

CONCLUSIONSPAV is a feasible method for supporting ventilator-dependent patients and was well tolerated. It can improve the breathing pattern and reduce inspiratory effort. At the same degree of respiratory muscle unloading, PAV can be implemented at much lower peak inspiratory pressure than PSV. It can also apply proportional pressure support according to the patients' ventilatory demand.

Aged ; Blood Gas Analysis ; Female ; Hemodynamics ; Humans ; Male ; Positive-Pressure Respiration ; Pulmonary Disease, Chronic Obstructive ; complications ; Pulmonary Gas Exchange ; Pulmonary Ventilation ; Respiration, Artificial ; methods ; Respiratory Insufficiency ; etiology ; physiopathology ; therapy

OBJECTIVELeptin (LEP) is mainly produced by white adipose tissue and participates in the energy metabolism and regulation of growth. Cooperating with the other metabolic hormones, it plays an important role in the developments of fetus and neonates. This study was designed to test the serum levels of LEP, neuropeptide Y (NPY), insulin (INS) and insulin-like growth factor-1 (IGF-1) and measure the body mass index (BMI) and head circumference (HC) at different days of life of premature infants with or without serious diseases and to find the changes of serum levels of LEP as well as NPY, INS and IGF-1, the relationship between those hormones and the changes of body weight and the influences of diseases on the levels of those hormones in premature infants.

METHODThe clinical data as well as weights, lengths, HC of 40 sick premature infants (sick group) and 30 premature infants without any diseases (control group) were collected and the serum levels of LEP, NPY, INS and IGF-1 were determined by using radioimmunoassay (RIA) at d 1, d 7 and d 12 of life. BMI was calculated by weight (kg)/length (m)(2). SPSS13.0 was used to analyze the data

RESULT(1) In sick group the serum LEP levels were 0.74 +/- 0.21, 0.60 +/- 0.18, 0.82 +/- 0.12 (mg/L) (P < 0.01), the BMI were 9.81 +/- 1.24, 8.36 +/- 0.87, 9.08 +/- 1.12 (kg/m(2)) (P < 0.01) on d 1, d 7 and d 12, respectively. In control group serum LEP levels were 0.78 +/- 0.17, 0.71 +/- 0.17, 0.88 +/- 0.58 (mg/L) (P < 0.01), the BMI were 10.03 +/- 1.04, 9.35 +/- 0.80, 11.06 +/- 0.82 (kg/m(2)), on d 1, d 7 and d 12, respectively (P < 0.01). In both groups, serum LEP levels as well as the BMI decreased on d 7 and reincreased on d 12. The differences of serum LEP levels and BMI between sick group and control group at d1 were not significant (P > 0.05); compared with control group, the serum LEP levels and BMI on d 7 and d 12 in sick group were lower and the differences were significant. (2) There were positive correlations between serum LEP levels and BMI in sick group as well as in control group. (3) In sick group, the serum NPY levels at d 1, d 7, d 12 were 55.33 +/- 9.38, 46.64 +/- 6.17, 75.13 +/- 9.12 (ng/L) (P < 0.01), INS were 10.07 +/- 2.63, 7.71 +/- 2.77, 10.37 +/- 2.29 (mU/L) (P < 0.01), IGF-1 were 38.66 +/- 11.42, 31.98 +/- 7.34, 41.84 +/- 8.05 (mg/L) (P < 0.01), respectively. In control group, the serum NPY levels at d1, d 7 and d 12 were 57.77 +/- 7.15, 48.49 +/- 8.81, 81.36 +/- 8.51 (ng/L) (P < 0.01), INS were 11.55 +/- 1.99, 8.28 +/- 2.87, 15.42 +/- 3.80 (mU/L) (P < 0.01), IGF-1 were 37.76 +/- 7.07, 34.33 +/- 8.97, 50.19 +/- 8.38 (mg/L) (P < 0.01), respectively. In both groups, serum levels of NPY, INS and IGF-1 had positive correlations with serum LEP levels as well as BMI on the corresponding days and decreased on d 7 and reincreased on d 12.

CONCLUSION(1) The serum LEP levels decreased on 7 d of life and reincreased on 12 d of life, which corresponded to the changes of the physical development of premature infants. (2) The serum LEP levels in sick premature infants decreased definitely as compared with control group, which suggested that diseases had negative influences on the LEP levels and the physical developments were slowed down in sick premature infants. (3) The serum levels of NPY, INS and IGF-1 had positive correlations with LEP levels as well as BMI at the early period of life, which suggested that NPY, INS and IGF-1, cooperating with LEP, might take part in the regulation of development of premature infants.

Case-Control Studies ; Female ; Human Growth Hormone ; Humans ; Infant, Newborn ; Infant, Premature ; Insulin ; blood ; Insulin-Like Growth Factor I ; metabolism ; Leptin ; blood ; Male ; Neuropeptide Y ; blood

Objective:To explore the of short-term psychodynamic psychotherapy on anxiety and depression of gout patients and its influence on well-being index, family function and compliance.Methods:60 gout patients were selected from June 2018 to December 2019 in the outpatient department of rheumatism and immunity department of Dongguan Kanghua Hospital by prospective case-control study. They were randomly divided into control group and treatment group, 30 cases respectively. Both groups were given gout related clinical treatment and routine nursing, and the treatment group was given short-term dynamic orientation psychotherapy. The treatment compliance, the psychological status, well-being index and blood uric acid (UA) level of the two groups were compared before intervention, immediately after intervention and 3 months after intervention.Results:The scores of Patient Health Questionnaire-9 (PHQ-9) and the generalized anxiety disorder 7-item scale (GAD-7) in the two groups were gradually decreased immediately and 3 months after intervention ( P<0.05), and the scores of well-being index were gradually increased ( P<0.05); Compared with the control group, the scores of PHQ-9 and GAD-7 in the treatment group decreased more significantly ( P<0.05), and the score of well-being index increased more significantly ( P<0.05); The scores of communication, behavior control and total function of family function in the treatment group decreased gradually immediately after intervention and 3 months after intervention ( P<0.05), and were significantly lower than those in the control group ( P<0.05); The level of serum UA in the two groups decreased gradually immediately after intervention and 3 months after intervention ( P<0.05), but there was no significant difference in UA level at each time point between the two groups. The treatment compliance of the treatment group was significantly better than that of the control group ( P<0.05). Conclusions:The short-term dynamic orientation psychotherapy for gout patients has obvious effect in improving the state of anxiety and depression, improving the index of well-being, family function and treatment compliance.