Objective To observe and research the influence of vaginal delivery and cesarean section by two kinds of mode of delivery on maternal infant outcome of re-pregnancy after cesarean section.Methods 258 patients with re-pregnancy after cesarean section were selected,they were divided into vaginal delivery group(73 cases) and cesarean section group(185 cases) according to the different delivery mode.The maternal puerperal infection rate,24h postpartum hemorrhage volume,days,cost of hospitalization,lochia time and neonatal in hospital of both two groups were compared.Results The success rate of vaginal delivery was 69.52％,the rate of cesarean section was 71.71％.In vaginal delivery group,maternal puerperal infection rate,24 h postpartum hemorrhage volume,length of hospital stay,cost of hospitalization,lochia time were 1.73 ％,(201.54 ± 107.54) mL,(3.41 ± 0.09) d,(1 540.12 ±117.21),(21.36 ± 13.12) d,which were significantly better than the second cesarean section group [8.11％,(354.64 ± 215.54) mL,(7.45 ± 0.32) d,(4 932.62 ± 786.35),(27.11 ± 17.04) d],the differences were statistically significant (x2 =4.08,t =4.75,7.24,8.91,3.98,all P ＜ 0.05).Delivery of two kinds of mode of delivery of the newborn had no significant differences in birth weight,Apgar score,the rate of infection,intracranial hemorrhage rate and the asphyxia rate(t =0.15,0.09,0.46,0.00,x2 =0.03,all P＞0.05).Conclusion Re-pregnancy after cesarean section is not the choice of cesarean section delivery clinical indications of operation,when the pregnant women with indications of trial production,in strict monitoring downlink vaginal delivery.

Objective　To investigate the changes in the e xpressions of P53 mRNA and Bcl-2 mRNA in spermatogenic cells in rats after expo sure to ultrasound to elucidate the possible mechanisms underlying the apoptosis induced by ultrasound at genetic trascription level. Methods　Thirty-two healthy male SD rats,（30±2） days old and (70±5) grams body weight, were randomized into 4 groups (n=8) according to the time of exposure to ultrasound,including control group without exposure,gr oups of 10 minutes, 20 minutes and 30 minutes with exposure to ultrasound for 10 ,20 and 30 min,respectively. Samples were taken 24 hours after exposure to ultra sound,then 4% paraformal-dehyde fixed,paraffin-embedded and sectioned into 4 μm sections (slides were pretreated with APES and poly-lysine). P53 and Bcl-2 in situ hybridization kits were purchased from Wuhan Boshida Bio-engineering C o.Results　There was no significant difference in the expressions o f P53 mRNA or Bcl-2 mRNA in sperematogenic cells in rats between the control gr oup and 10 minutes group. The expressions of P53 mRNA in groups over 10 minutes were up-regulated and that of Bcl-2 mRNA were down-regulated. P53 mRNA in s permatogenic cells in rats was increased from (44.13±5.05)% in control group to (60.47±6.57)% in group 30 minutes. Bcl-2 mRNA was decreased f rom (40.29±9.10)% in control group to (31.01±5.67)% in group 3 0 minutes. Conclusions　Exposure to ultrasound over 10 minutes can induce up -regulatory expressions of P53 mRNA and down-regulatory expressions of Bcl-2 mRNA in spermatogenic cells in rats.

Objective To observe the effects of rehabilitation intervention on the quality of life (QOL) of patients after coronary artery bypass grafting. Methods Fifty-eight hospital patients in need of coronary artery by-pass grafting (CABG) were randomly assigned to a cardiac rehabilitation group ( rehab ; n = 31 ) or a routine care group (control; n = 27 ). In the rehab group, patients received progressively increasing movement and appropriate psychological intervention. Changes in the medical outcome study short form (SF-36) scores and 6 min walk dis-tances (6MWDs)as well as the length of post-operative stays in hospital were observed in both groups. Results Compared with the control group, patients in the rehab group scored significantly higher on the SF-36. Their physical functioning, general health, vitality, role-emotion and mental health scores improved significantly, their final 6MWDs were longer, and they had significantly shorter average hospital stays after the operation. Conclusions Rehabilita-tion training can improve QOL for patients after coronary artery bypass grafting.

Objective To observe the effects of rehabilitation on the quality of life and capacity of aerobic exercise in patients after coronary artery bypass graft. Methods 58 patients after coronary artery bypass graft were divided into rehabilitation group (n=31) and control group (n=27). Patients in the control group received routine drug treatment out of hospital, while the rehabilitation group was guided regularly for rehabilitation. All patients were surveyed with the MOS item short form health survey (SF-36) and 6 min walking test on the 15th and the 90th day after operation. Results Compared with the control group，the scores of all the items of SF-36 in rehabilitation group improved (P<0.01) except in body pain. The result of 6MWT was also higher in rehabilitation group than in controls(P<0.01). Conclusion Rehabilitation can improve capacity of aerobic exercise and the quality of life of patients after coronary artery bypass grafting.

Objective To evaluate the effects of the range and the frequency of the compression load on the accuracy for discerning target stiffness differences in ultrasound elastography.Methods Quantitative ultrasound elastography was achieved by integrating two compression force sensors,a laptop computer and a clinical ultrasound elastographic system.The force sensors and the ultrasound probe were assembled in a 3D printed mounting bracket for continuous monitoring of compression loads during ultrasound elastography. Both the force measurements and the elastographic maps were acquired and displayed on the laptop computer in real time.Four targets of the same diameter(10.4 mm),the same depth (3 cm) and different stiffness levels (8,14,45 and 80 kPa) were examined by a HITACHI preirus,L74M linear-array transducer.Each target was evaluated 45 times with two different method(i.e.,freehand elastography and quantitative elastography),yielding 1 80 evaluations.The data were divided into the following three groups:group Ⅰ(80 kPa vs 45,14 and 8 kPa),group Ⅱ(80,45kPa vs 14,8 kPa)and group Ⅲ(80,45 and 14 kPa vs 8 kPa).Area under ROC curves(AUC)were calculated for different stiffness levels.Results In group Ⅲ, quantitative elastography yielded an greater AUC level than that of freehand elastography(P =0.0379).In group Ⅰ and group Ⅱ,two methods yielded the similar AUC levels (P = 1 .000).However,quantitative elastography was able to discern 8 kPa and 14 kPa targets (P <0.001),while freehand elastography was hard to differentiate them(P =0.258).Conclusions In comparison with freehand elastography,quantitative ultrasound elastography is able to improve the accuracy for discerning different target stiffnesses.

Objective To evaluate the effect of Budesonide combined with Poractant Alfa(pulmonary surfactants,PS) on preventing the bronchopulmonary dysplasia (BPD) in preterm infants.Methods One hundred and twenty preterm infants 6 hours after birth(gestational ages≤32 weeks and birth weights ≤1500 g)admitted to the Department of Newborn Medicine,the Affiliated Hospital of Southeast Medical University from October 2013 to February 2015 were randomly divided into 4 group(30 cases in each group).Group A was a control group,group B was neonatal respiratory distress syndrome(NRDS) group,group C was NRDS with PS group,and group D was NRDS with PS and Budesonide group.Thirty-two-week preterms without other diseases and without uptaking oxygen within 48 h were assigned as group A.Group B were treated by continuous uptaking oxygen with continuous positive airway pressure(CPAP) (oxygen uptaken lasting more than 48 h and oxygen concentrations more than 40％).Group C were treated with 100 mg/kg PS within 48 h on the basis of group B.Group D were treated with 0.25 mg/kg Budesonide suspension for inhalation on the basis of group C.The pH value,partial pressure of oxygen [pa(O2)],partial pressure of carbon dioxide [pa(CO2)] in the blood gas analysis were all detected in all groups before treatment,1,6,12,24 and 48 hours after using drug,respectively.All groups were also observed for whether to use respirator assisted ventilation,the duration of high oxygen use,the total time of uptaking oxygen,the rate of using PS again,the rate of BPD,the total hospitalization days and the adverse effects.The adverse effects included high blood pressure,high blood sugar,necrotizing enterocolitis and the incidence of nosocomial infection.Results Compared with group B,the pH value at 1 and 6 hours after using drugs,the pa(O2) and pa(CO2) at 1,6 and 12 hours after using drugs were improved obviously in the group C,and the differences were statistically significant (all P＜0.01).Compared with group B,the above indicators were improved more obvious in group D,and the differences were statistically significant (all P＜0.01).Moreover,compared with the group B,the oxygen inhalation duration,the rate of having a respirator assisted ventilation and using PS again,and the incidence of BPD were obviously decreased in other groups,the differences were statistically significant (all P＜0.05).The incidence of BPD in group D was less than that of group C,and the differences were statistically significant (3.33％ vs 10.00％,x2=4.00,P=0.046).The total oxygen time and the rate of adverse effects of each group were similar.The differences were not statistically significant (all P＞0.05).Conclusions Budesonide combined with Poractant Alfa can prevent BPD in preterm infants.Its effect is better than the simple use of Poractant Alfa,and the rate of adverse effects are not increased significantly.

Objective To evaluate the effect of ulinastatin on acute kidney injury in the pediatric patients undergoing living-donor liver transplantation (LDLT).Methods Forty pediatric patients with congenital biliary atresia,aged 5-14 months,weighing 5.5-10.0 kg,of American Society of Anesthesiologists physical status Ⅲ or Ⅳ,scheduled for elective LDLT,were divided into either control group (group C,n=20) or ulinastatin group (group U,n=20) using a random number table.Ulinastatin 20 000 U/kg was diluted to 10 000 U/ml in normal saline and then intravenously infused in 2 parts (1/2 was given immediately before skin incision;1/2 at 5 min before portal vein declamping) in group U.The equal volume of normal saline was given instead of ulinastatin at the same time points in group C.Immediately before skin incision (To,baseline),at 30 min of anhepatic period (T1),at 1 h of neohepatic period (T2),at the end of surgery (T3) and at 24 h after surgery (T4),blood samples from the central vein and urine specimens were collected for determination of creatinine (Cr) and blood urea nitrogen (BUN) concentrations in serum (by colorimetric assay) and β2-microglobulin (β2-MG) concentrations in serum and urine (using immunoturbidimetric method).The urine volume,requirement for dopamine and diuretics and occurrence of adverse cardiovascular events (hypotension,myocardial ischemia,ventricular premature beat)were recorded during surgery.The changing rates of Cr,BUN and β2-MG concentrations in serum and β2-MG concentrations in urine were calculated at T1-4.Results Compared with group C,the urine volume was significantly increased,Cr and β2-MG concentrations in serum,β2-MG concentrations in urine and the changing rates were decreased at T2-4,serum BUN concentrations and the changing rates were decreased at T3,4 (P＜0.05 or 0.01),and no significant changes were found in the incidence of adverse cardiovascular events or requirement for dopamine and diureitcs in group C (P＞0.05).Conclusion Ulinastatin can attenuate acute kidney injury in the pediatric patients undergoing LDLT.

Objective To evaluate the role of necroptosis in intestinal injury induced by autologous orthotopic liver transplantation ( AOLT) in rats. Methods Twenty-four SPF adult male Sprague-Dawley rats, aged 10-12 weeks, weighing 250-280 g, were divided into 3 groups ( n=8 each) using a random number table method: sham operation group ( group S) , AOLT group ( group T) and necroptosis inhibitor necrostatin-1 group ( group N) . Necrostatin-11. 0 mg∕kg and the equal volume of dimethyl sulfoxide ( DM-SO) were intraperitoneally injected at 30 min before surgery in N and T groups, respectively. Blood samples were collected from the inferior vena cava at 6 h after opening the portal vein ( at 6 h after the end of surgery in group S) for determination of serum diamine oxidase ( DAO) , D-lactic acid ( D-LA) and intestinal fatty acid binding protein ( I-FABP ) concentrations by enzyme-linked immunosorbent assay. Rats were sacrificed after blood sampling, and the intestine was removed for examination of the pathological changes ( with a light microscope ) and for determination of malondialdehyde ( MDA ) contents and superoxide dismutase ( SOD) activities ( using a spectrophotometer) , and the expression of receptor-interacting protein kinase-1 ( RIPK1) , RIPK3 and mixed lineage kinase domain-like protein ( MLKL) in intestinal tissues ( by Western blot) . Intestinal damage was assessed and scored using Chiu' s scoring system. Results Compared with group S, the serum DAO, D-LA and I-FABP concentrations, MDA content and Chiu's score were signifi-cantly increased, SOD activity was decreased, and the expression of RIPK1, RIPK3 and MLKL was up-regulated in group T ( P<0. 05) . Compared with group T, the serum DAO, D-LA and I-FABP concentra-tions, MDA content and Chiu's score were significantly decreased, the SOD activity was increased, and the expression of RIPK1, RIPK3 and MLKL was down-regulated in group N ( P<0. 05) . Conclusion Ne-croptosis is involved in the pathophysiological process of intestinal injury induced by AOLT in rats.

Objective To investigate the changes of hemodynamics and cardiac function in pediatric living donor liver transplantation (LDLT).Methods 50 cases of pediatric living donor liver transplantation in our hospital from January 2016 to January 2017 were collected.The hemodynamics was monitored by Mostcare with the radial artery.Acquisition of heart rate (HR),mean arterial pressure (MAP),peripheral vascular resistance index (SVR/SVRI),stroke volume / stroke index (SV/SVI),cardiac output (CO/CI),cardiac index / stroke volume variability (SVV),dp/dtmax (cardiac contractility),cardiac cycle efficiency (CCE) at the moment of the start of operation(T0),before occlusion of the inferior vena cava (T1),immediately after occlusion of the inferior vena cava (T2),anhepatic phase 30 min (T3),immediately after reperfusion(T4),neohepatic phase 5 min (T5),30 min (T6) and 60 min (T7).Results There were no significantly hemodynamic fluctuations before occlusion of the portal vein.At T3,the increased of MAP,CI,SVRI (T3 vs T0,P＜0.05),while CCE decreased significantly (T3 vs T0,P＜0.05);MAP,SVRI,lower HR,CI and dp/dtmax have different degrees of liver T4,but the change was not significant.SVV fluctuated in the anhepatic phase at 11％ ～ 15％,maintained in the new liver stage at 12％ ～ 15％,but fluctuated slightly.Conclusion Mostcare can be used to monitor the hemodynamic and cardiac function changes in pediatric living donor liver transplantation,but the reasons for the change of the monitoring indicators and the significance of guiding the perioperative treatment need to be further studied.