Objective To evaluate the effect of the two methods of delivery,hands-on vs.handspoised,on maternal and neonatal outcomes and health service utility during vaginal delivery.Methods 218 primiparous pregnant women admitted from January to May 2013 were randomly assigned to the control group,who adopted two hands-on or traditional method (108 cases) and the intervention group who chose hand-poised method (110 cases).The delivery outcomes and medical resource utilization were compared between two groups.Results The rate of perineal trauma,postpartum hemorrhage and edema was significantly lower in the intervention group compared with that of the control group.No significant difference in neonatal outcome was observed between the two groups.The second stage duration of the intervention group was longer but the whole hospital duration and costs was significantly lower than those of the control group.Conclusions Our data suggest that a policy of hands-poised care is a safe and effective birthing alternative and could improve delivery outcome and reduce hospitalization days and costs.

Objective To evaluate whether the size,number or location of fibroids affect therapeutic efficacy of uterine artery embolization (UAE).Methods 84 patients with symptomatic uterine fibroids who had received uterine fibroid embolization with the use of polyvinyl alcohol(PVA)or gelfoam sponge particles(GSP).According to the lesion's size,number or location,all patients were divided into different groups and following -up as outpatients. Patient's symptomatic improvement and imaging following -up was assessed after UAE.Results A technically suc-cessful embolization was done in all patients.Postoperative 12 -month following -up was performed in 77 cases.No major life -threatening complications were found and the clinical symptoms were improved after UAE.In the different groups,the uterine size and the leiomyoma size after UAE were markedly decreased(t =5.842,P <0.05).Further comparison showed that the mean reduction in fibroids volume after UAE was not significant between the two groups, so was the mean reduction in uterine volume.Solitary leiomyoma group showed no significant difference in volume reduction rate of fibroids and uterine after UAE as compared with multiple leiomyoma group.Changes were not signifi-cantly in Submucosal uterine fibroids,Subserosal uterine fibroids,Intramural uterine fibroids.Conclusion UAE is an effective treatment for uterine fibroids.In this study,the size,number,and location of fibroids did not affect therapeutic efficacy or the complication rate of UAE.

Objective To investigate the effect of vitamin D (VD) on gastric cancer and its underlying mechanisms by detecting serum VD levels in gastric cancer patients and the expression of vitamin D receptor (VDR) in gastric tumor.Methods Serum VD levels was detected by enzyme linked immunosorbent assay,VRD expression of tumor tissue and normal mucosa were detected by immunohistochemistry.At the same time,relationships of VDR expression and the prognosis of the patients were analyzed.Results The serum levels of VD of gastric cancer patients were lower than that of healthy people (P＜0.05),and they were negatively related to the degree of cell differentiation significantly (P＜0.001).VDR expression in gastric tumor tissue significantly decreased compared to that of the normal mucosa (P＜0.05).A significant correlation was found between the VDR expression and the differentiation grade of the carcinoma,with well differentiated carcinoma having the highest level of VDR expression (P＜0.05).For patients with gastric cancer,those with positive VDR expression had significant longer progression-free survival (PFS) and overall survival (OS) than the patients with negative VDR expression (P＜0.05).Conclusions VD may be a protecting factor of gastric cancer.VDR can be regarded as a marker of differentiation of gastric cancer and served as an effective prognostic factor in patients with postoperative gastric cancer.

Objective To evaluate the effect of verapamil on the expression of K+-Cl-cotransporter 2 (KCC2) in spinal dorsal horns during remifentanil-induced hyperalgesia in a rat model of incisional pain.Methods Thirty-two pathogen-free healthy adult male Sprague-Dawley rats,aged 6-7 weeks,weighing 250-300 g,were divided into 4 groups (n=8 each) using a random number table:control group (group C),incisional pain group (group Ⅰ),incisional pain plus remifentanil plus verapamil group (group I+R+ V) and incisional pain plus remifentanil group (group I+R).Normal saline was subcutaneously infused in group C.A 1 cm long incision was made in the plantar surface of the right hindpaw in anesthetized rats in group Ⅰ.Verapamil 5 mg/kg was intraperitoneally injected at 10 min before establishment of the incisional pain model in group I+R+V.In I+R and I+R+V groups,the model of incisional pain was established,and remifentanil was subcutaneously infused for 30 min at a rate of 80 μg · kg-1 · h-1 simultaneously.The mechanical paw withdrawal threshold (MWT) to yon Frey filament stimulation was measured at 1 day before establishment of the model (T0) and 2,6,24 and 48 h after establishment of the model (T1-4).The rats were sacrificed after measurement of MWT at T4,and the lumbar enlargement segments of the spinal cord were harvested for determination of the expression of KCC2 by immunofluorescence.Results Compared with group C,the MWT was significantly decreased at T1-4,and the expression of KCC2 was down-regulated in the other groups (P＜0.05).Compared with group Ⅰ,the MWT was significantly decreased at T1-4,and the expression of KCC2 was down-regulated in group I+R (P＜0.05).Compared with group I+R,the MWT was significantly increased at T1-4,and the expression of KCC2 was up-regulated in group I+R+V (P＜0.05).Conclusion The mechanism by which verapamil reduces remifentanil-induced hyperalgesia is related to up-regulation of the expression of KCC2 in spinal dorsal horns in a rat mnodel of incisional pain.

Objective To explore the effect of nursing support on negative emotion and quality of life in patients with brain tumor. Methods A total of 139 cases of brain tumor in Shandong Provincial Cancer Hospital of Shandong University from September 2014 to February 2016 by convenient sampling , according to the random number table, they were divided into the control group and the intervention group. The patients in the control group were given routine discharge follow-up, while the patients in the intervention group were given emote team nursing support on the basis of the control group. We used anxiety self rating scale (SAS), depression self rating scale (SDS) and quality of life assessment scale (QLICP-BN) evaluation two groups of patients with anxiety, depression and quality of life level in the patients when they were discharged from hospital and discharged after 1 month, 3 months. Results Comparing the two groups of patients with anxiety and depression level and quality of life in the hospital, there was no statistically significant difference (t=0.187,0.174, P > 0.05);1 month after discharge, the scores of SAS and SDS respectively (62.97 ± 485), (63.83 ± 5.24) points in the intervention group, the scores of SAS and SDS respectively (64.58 ± 5.15), (65.17 ± 5.11) points in the control group, the difference is statistically significant (t=2.753, 2.321, P<0.05);3 month after discharge, the scores of SAS and SDS respectively(61.04±4.13),(62.25±3.95)points in the intervention group, the scores of SAS and SDS respectively(63.91 ± 4.73),(64.83 ± 4.29)points in the control group, the difference is statistically significant (t=4.621,5.196, P < 0.01); 1month, 3 months after discharge, the total quality of life scores respectively (65.28 ± 12.53), (68.71 ± 12.78) points in the intervention group, the total quality of life scores respectively (62.07 ± 11.27), (63.86 ± 12.13) points in the control group, the difference is statistically significant (t=2.439, 3.803, P < 0.01). The intervention effects and time effects of anxiety, depression and quality of life were statistically significant (W Mauchly's were 0.823, 0.782, 0.757, P <0.05). Conclusions Remote team nursing support can effectively reduce the negative emotions of patients with brain tumor, improve the quality of life, can be used in the department to promote the quality of clinical care.

Objective To set up the different alcohol-associated dementia (AAD) models in vitro and provide methods for researching the mechanism of AAD.Methods Hippocampal neurons got from fetal rats were primary cultured for 6 days and identified.Then,the cells were treated with different doses of ethanol (25-100 mol/L) for 24 h.The cell viability was analyzed with MTT assay.The staining with Hoechst33342 was used to observe the cell apoptosis.In addition,hippocampi of newbom rats 7-10 days after birth were taken out and cut to 300 μm thickness of slices; the morphological changes of the brain slices were observed with HE staining at different time points after ethanol administration.Results Primary-cultured hippocampal neurons highly expressed neuron-specific enolase (NSE) and lowly expressed glial fibrillary acidic protein (GFAP).And the cell viability was significantly decreased by ethanol administration (50-100 mol/L,24 h) in a dose-dependent manner.Increased apoptosis cells were detected when cells were treated with 50 mol/L concentration of ethanol for 24 h.For hippocampal slices,acute ethanol administration (50 mol/L,30 min) induced significant cell apoptosis and chronic ethanol administration (50 mol/L,24 h) resulted in the serious damage of hippocampal morphology.Conclusions The models that primary-cultured hippocampal neuron apoptosis induced by chronic ethanol administration is suitable for researching the mechanism of AAD.Hippocampal slices are more sensitive for ethanol toxic effects and may be used for the research of acute alcohol toxicity.

OBJECTIVESTo study the diagnosis and treatment of thymoma and to assess prognosis factors.

METHODSThe clinical data on 116 patients with thymoma were collected. A retrospective analysis was performed by comparison of their survival rates computed by the actuarial method and rate of recurrence and metastasis.

RESULTSChest radiograph was used chiefly for the preoperative diagnosis of thymoma; myasthenia gravis (MG) (25.0%, 29/116) was the most common paraneoplastic disease. An extensive and radical resection was carried out to reduce the recurrence rate of thymoma with stage I and stage II (chi(2) = 4.941 P = 0.0219). The survival time was prolonged by postoperative radiotherapy and chemotherapy. A strong correlation was noted between the clinical stage and histologic subtype of M-H classification, by which the invasive behavior of thymoma was predicted (r = 0.385, P = 0.007). The 3-, 5-, and 10-year survival rates were 81.2%, 67.9% and 40.5%, respectively. Statistical analysis showed a significant negative correlation between stage and survival rate (r = -0.897, P = 0.0000).

CONCLUSIONThe prognosis of thymoma depends mainly on the histologic subtype, clinical stage and multimodality treatment rather than paraneoplastic diseases.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Myasthenia Gravis ; etiology ; Prognosis ; Radiography ; Retrospective Studies ; Thymoma ; complications ; diagnosis ; diagnostic imaging ; therapy

BACKGROUNDAccording to the international standard in TNM staging of pulmonary carcinoma, pulmonary carcinoma complicated with diffuse pleural metastasis and malignant pleural effusion belongs to IIIB stage. In the past, non-operative therapy was employed, but both the therapeutic efficacy and the quality of life of patients were poor. The purpose of this study is to find out a complex treatment for this disease.

METHODSTotal pleuro-pneumonectomy was performed in 55 cases of patients with pulmonary carcinoma complicated with diffuse pleural metastasis and malignant pleural effusion from December 1978 to February 2003. The patients were followed up postoperatively, and the quality of life and survival period of them were observed.

RESULTSIn all the cases, only 2 patients died of operation. Satisfactory recovery and remarkable relief of symptoms such as short breath, dyspnea and chest pain were found in all the other patients. After a follow-up period of 1-25 years, local recurrence was found in 6 cases (11.3%), and distant metastasis in 42 cases (79.2%). A total of 48 patients died of tumor, with survival period ranging from 5-40 months (average survival period: 15 months; median survival period: 14 months), and 5 patients were still alive in good health.

CONCLUSIONS(1) Patients appropriated for operation should be carefully selected in case that postoperative complications influence their smooth recovery; (2) Tumor tissues should be removed as clear as possible; (3) During the operation, close attention should be paid to the protection of incisions; (4) Removal of the tumor tissues can reduce the tumor load, effectively clean the immunosuppressive factors in malignant pleural effusion, and break the immunity block status, which provides basis for the following comprehensive therapy; (5) The quality of life of the patients can be improved and the median survival period can be prolonged by the operation; (6) The long-term survival rate of patients is still unsatisfactory.

OBJECTIVETo study the diagnosis and treatment of thymoma and to assess its prognostic factors.

METHODSThe clinical data of 116 patients with thymoma were collected. A retrospective analysis was performed, by comparing the survival rate calculated by the Kaplan-Meier method with the rate of recurrence or metastasis.

RESULTSThe standard posteroanterior and lateral chest radiographs were reliable means of detection of most thymomas. Myasthenia gravis was the most commonly paraneoplastic disease (25.0%, 29/116). The extensive radical resection was beneficial for reducing the rate of recurrence of stage I or stage II thymomas (chi(2) = 4.941, P = 0.0219). The survival time could be prolonged by postoperative radiotherapy and chemotherapy. There was a strong correlation between the clinical stage and the histological classification (according to MH classification), through which the invasive behavior of thymoma could be predicted (chi(2) = 19.76, P = 0.007, RR = 1.47). The 3- 5- and 10-year survival rates were 81.2%, 67.9%, and 40.5%, respectively. Statistical analysis showed a significant negative correlation between the stage and the survival rate (chi(2) = 29.73, P = 0.0000, RR = 0.15).

CONCLUSIONThe prognosis of thymoma depends mainly on the histological classification, clinical stage and multimodality treatment rather than on the paraneoplastic diseases.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Myasthenia Gravis ; etiology ; Prognosis ; Retrospective Studies ; Thymoma ; diagnosis ; mortality ; therapy ; Thymus Neoplasms ; diagnosis ; mortality ; therapy

Objective:To compare the clinical efficacy and safety of continuous dosing or alternate-day dosing of apatinib combined with SOX regimen as first-line treatment for patients with advanced gastric cancer.Methods:A total of 52 patients with human epidermal growth factor receptor 2 (HER2) negative and inoperable locally advanced or advanced gastric cancer who were pathologically diagnosed from January 2018 to January 2021 in the Second Affiliated Hospital of Shandong First Medical University were collected. The patients were divided into continuous dosing group and alternate-day dosing group by random number table method. The continuous dosing group received apatinib (250 mg, once a day) combined with SOX regimen (S-1+oxaliplatin); the alternate-day dosing group received apatinib (250 mg, once every other day) combined with SOX regimen. Twenty-one days were a cycle, and the efficacy was evaluated after 2 cycles. After 4-6 cycles, patients with stable disease received apatinib and S-1 for maintenance therapy. The therapeutic effects and adverse reactions of the two groups were compared.Results:The curative effect could be evaluated in 51 patients, including 26 in the continuous dosing group and 25 in the alternate-day dosing group. The disease control rates in the continuous dosing group and the alternate-day dosing group were 84.6% (22/26) and 76.0% (19/25) ( χ2 = 0.60, P = 0.499), and the median progression-free survival time was 7.50 months (95% CI 6.17-8.83 months) and 8.30 months (95% CI 6.99-9.61 months) ( χ2 = 0.71, P = 0.401), and the median overall survival time was 15.50 months (95% CI 11.30-19.69 months) and 15.60 months (95% CI 13.63-17.57 months) ( χ2 = 1.82, P = 0.177). The main adverse reactions in the two groups were leukopenia, thrombocytopenia, hypertension, nausea, vomiting, fatigue, hand-foot syndrome, proteinuria, liver and kidney damage. The incidence rates of ≥grade 3 adverse reactions in the continuous dosing group and the alternate-day dosing group were 42.3% (11/26) and 12.0% (3/25), and the difference was statistically significant ( χ2 = 4.46, P = 0.035). Conclusions:The efficacy of continuous dosing or alternate-day dosing of apatinib combined with SOX regimen as first-line treatment for advanced gastric cancer is similar, but the incidence of ≥grade 3 adverse reactions in alternate-day dosing group is lower, which improves the compliance and tolerance of patients.