Objective To investigate the influence of the different second stage of labor duration on the maternal and neo‐natal outcomes .Methods Data were retrospectively analyzed from 201 nulliparous women delivering a singleton infant in cephalic presentation without labor analgesia hospitalized in our hospital between January 2012 and May 2015 ,whose second stage pro‐gressed beyond 2 hours .They were divided into observation group and control group according to different second stage of labor du‐ration ,and cases with a second stage of labor duration of three hours were in the observation group (163 cases) ,and those within two hours were in the control group (38 cases) .Results Whether the limit of the second stage of labor duration of 2 hours ,or 3 hours ,the risk of postpartum hemorrhage ,postpartum fever ,urinary retention and neonatal asphyxia ,admission to the neonatology department in two groups were not significantly different(P>0 .05) .However ,there was significance difference in the rate of soft birth canal laceration(72 cases in the observation group) ,poor wound healing (0 case in the observation group and 3 cases in the control group ,P<0 .05) .Conclusion a second stage of labor duration of 3 hours could reduce the rate of cesarean section ,and with no increase in severe adverse maternal and neonatal outcomes .

OBJECTIVE:To observe the application of sevoflurane combined with different dose of fentanyl in general anesthesia-inducing endotracheal intubation in adults. METHODS:60 selective patients were randomly divided into three groups(n=20). In haled 8% sevoflurane inductal anesthesia with tidal volume method. When the patients breathing and his own,and loss of eyelvaisah i .rve.f lTehxe, SgBroPu,p DⅠBwP earne dg iHvRen in2 e?agc?hk ggr-o1 ufpe nwtaenrye l dveitae cit.evd., agt rtoimupe Ⅱof 3lo s?sg-? okf-g -ey1 efleanstha nryelf lvexia ain.vd. baenfdo rger oinudpu Ⅲcti o4n ?agn?esktgh-e1s ifae(ntTan0)y,l before intubation(T1),at the moment of intubation(T2),at 1 min after intubation(T3),3 min after intubation(T4),5 min after intubation(T5)and 10 min after intubation(T6). RESULTS:Compared with at T0,SBP,DBP and HR in three groups were significantly decreased at T1(P0.05). SBP, fDeBntPa naynld i sH eRff einc tigvreo utop iⅢnd uwceer ea ndeescthreeassiae di nm aadrukletd elyn daot trTa(2chPe

0.05).CONCLUSION:Neuromuscular blockade induced by single i.v.of Cisatracurium showed no gender difference.

Objective To summarize the experiences of microsurgery for treatment of middle cerebral artery aneurysms (MCAA). Methods The clinical data of 35 patients with MCAA treated by microsurgery in General Hospital of PLA from 2004 to 2008 were retrospectively reviewed. Of them there were 20 males and 15 females, aged 18 to 72 years with a mean of 40 years. Of the 35 patients, subarachnoid hemorrhage occurred formerly in 22, intracerebral hemorrhage occurred in 11 and subdural hematoma in one patient. The MCAA located in the middle cerebral artery trunk in 10 patients, at the bifurcation in 20 patients (including one patient with 2 MCAAs), and in the distal segment in 5 patients. MCAA located on the left side in 13 and on right side in 22 patients. There were 7 patients with giant aneurysms, 11 with large aneurysms and 17 with small aneurysms. Microneurosurgery was performed in all cases, and different approaches were taken according to the locations of aneurysms. Superior temporal gyrus approach was conducted in 3 patients with giant intracerebral hematoma. Bypass of superficial temporal artery to middle cerebral artery was performed before occlusion of the afferent artery in one patient with giant aneurysm. Bypass with saphenous vein to middle cerebral artery was performed in another patient with giant aneurysm. Results The giant and large MCAAs consisted of 51.4% of all cases. Excellent outcomes were achieved in 20 patients, no marked change in 12 patients, and post-operative complications were observed in 3 patients. No perioperative death occurred. Conclusions Giant and large aneurysms are more common in middle cerebral artery aneurysms. Proper surgical approaches based on different situations during operation should be considered to achieve satisfactory outcome.

We describe an interactive viewer for the All-Species Living Tree (LVTree). The viewer incorporates treeing and lineage information from the ARB-SILVA website. It allows collapsing the tree branches at different taxonomic ranks and expanding the collapsed branches as well, keeping the overall topology of the tree unchanged. It also enables the user to observe the consequence of trial lineage modifications by re-collapsing the tree. The system reports taxon statistics at all ranks automatically after each collapsing and re-collapsing. These features greatly facilitate the compar-ison of the 16S rRNA sequence phylogeny with prokaryotic taxonomy in a taxon by taxon manner. In view of the fact that the present prokaryotic systematics is largely based on 16S rRNA sequence analysis, the current viewer may help reveal discrepancies between phylogeny and taxonomy. As an application, we show that in the latest release of LVTree, based on 11,939 rRNA sequences, as few as 24 lineage modifications are enough to bring all but two phyla (Proteobacteria and Firmicutes) to monophyletic clusters.

Objective To evaluate the diagnostic performance of Xpert MTB/RIF for the diagnosis of tuberculous meningitis (TBM).Methods This was a prospective, single center clinical trial.A total of 116 consecutive patients with suspected meningitis who were admitted to Xijing Hospital from October 2013 to June 2015 were recruited.Mycobacterium tuberculosis ( MTB) and rifampicin ( RIF) resistance mutations in 1 ml cerebrospinal fluid ( CSF) were detected with Xpert MTB/RIF and the remaining sample was tested by Ziehl-Neelsen staining , MGIT960 liquid culture and other laboratory tests .And the enrolled patients were grouped according to the 2010 South African expert consensus .The diagnostic performance of Xpert MTB/RIF was evaluated by comparing against clinical score >5 points and MGIT960 liquid culture as reference standards respectively .The comparison was performed using a χ2 test or Fisher′s exact test for categorical variables and a nonparametric rank sum test for continuous variables .Results Among the enrolled 116 subjects, 23 subjects were diagnosed as definite-TBM by MGIT960 liquid culture, 16 subjects were classified as probable TBM , 27 subjects were classified as possible TBM , and 50 subjects were classified as non-TBM.When clinical score >5 points was used as a reference standard , the sensitivity of Xpert MTB/RIF (39.4%) was comparable with that of MGIT960 liquid culture (34.8%) (χ2 =0.292, P=0.589), and significantly better than that of Ziehl-Neelsen staining (9.9%) (χ2 =16.500, 12.771, P<0.001). No significant differences were found among the specificities of Xpert MTB /RIF, MGIT960 liquid culture and Ziehl-Neelsen staining ( 98.0%, 100.0% vs 98.0%, χ2 =1.014, P=0.602 ) .When tested against MGIT960 liquid culture as a reference standard , the sensitivity of Xpert MTB/RIF was 91.3%. Conclusions Xpert MTB/RIF is a rapid and specific method to detect MTB and RIF resistance in CSF .It exhibits a good rule in value for the diagnosis of TBM and a comparable sensitivity with MGIT 960 liquid culture, thus it can be used as the initial method for the diagnosis of tuberculous meningitis .

Objective:To explore the effect of "Internet +" blood glucose management model in patients with gestational diabetes mellitus (GDM) .Methods:From January 2020 to March 2021, convenience sampling was used to select 95 GDM patients who were treated in the Outpatient Department of Lu'an People's Hospital of Anhui Province as the research object. According to the random number table method, the patients were divided into the control group ( n=47) and the intervention group ( n=48) . The control group received routine nursing, and the intervention group was given the "Internet +" blood glucose management model on the basis of routine nursing. The scores of the Diabetes Management Self-Efficacy Scale (DMSES) , GDM Self-management Behavior Scale and blood glucose control, including fasting blood glucose, 2-hour postprandial blood glucose (2hPG) , and glycosylated hemoglobin (HbA1c) , were compared before and after management, and the pregnancy outcomes were calculated. Results:After management, the DMSES and GDM self-management behavior scores of the intervention group were higher than those of the control group, and the 2 hPG, fasting blood glucose and HbA1c were lower than those of the control group, and the differences were statistically significant ( P<0.05) . The incidences of cesarean section, abnormal amniotic fluid volume and neonatal hypoglycemia in the intervention group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The "Internet +" blood glucose management model can improve the self-efficacy of GDM patients, strengthen self-management behaviors, effectively control blood glucose, and improve maternal and infant pregnancy outcomes.

Objective:To explore the effect of "Internet +" blood glucose management model in patients with gestational diabetes mellitus (GDM) .Methods:From January 2020 to March 2021, convenience sampling was used to select 95 GDM patients who were treated in the Outpatient Department of Lu'an People's Hospital of Anhui Province as the research object. According to the random number table method, the patients were divided into the control group ( n=47) and the intervention group ( n=48) . The control group received routine nursing, and the intervention group was given the "Internet +" blood glucose management model on the basis of routine nursing. The scores of the Diabetes Management Self-Efficacy Scale (DMSES) , GDM Self-management Behavior Scale and blood glucose control, including fasting blood glucose, 2-hour postprandial blood glucose (2hPG) , and glycosylated hemoglobin (HbA1c) , were compared before and after management, and the pregnancy outcomes were calculated. Results:After management, the DMSES and GDM self-management behavior scores of the intervention group were higher than those of the control group, and the 2 hPG, fasting blood glucose and HbA1c were lower than those of the control group, and the differences were statistically significant ( P<0.05) . The incidences of cesarean section, abnormal amniotic fluid volume and neonatal hypoglycemia in the intervention group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The "Internet +" blood glucose management model can improve the self-efficacy of GDM patients, strengthen self-management behaviors, effectively control blood glucose, and improve maternal and infant pregnancy outcomes.

Objective To investigate the effects of intrathecal administration of Maresin 1 on pain behavior and glial cells activation in spinal dorsal horn of mice with bone cancer pain(BCP).Methods Experiment Ⅰ,twenty-eight clean male C57BL/6 mice,aged 4-6 weeks,weighing 18-22 g,were ran-domly divided into two groups:sham 1 group(group S1)and BCP 1 group(group B1),14 mice in each group.BCP model was established in group B1 by injecting PBS 20 μl containing 2 × 105 lewis lung carcino-ma cells into the intramedullary space.Group S,received PBS 20 μl without tumor cells.Six mice in each group were randomly selected to determine the mechanical withdrawal threshold(MWT)and thermal with-drawal latency(TWL)1 day before implantation,3,7,14,21 days after implantation.Four mice were randomly sacrificed on days 7,14 and 21 in group S,and group B1.The expressions of spinal glial fibrillary acidic protein(GFAP)and ionized calcium-binding adapter molecule 1(Iba1)were detected by Western blot.Experiment Ⅱ,thirty-six clean male C57BL/6 mice were randomly divided into three groups:sham 2 group(group S2),BCP 2 group(group B2),and Maresin 1 group(group M),12 mice in each group.BCP models were established in groups B2 and M while group S2 received PBS 20 μl without tumor cells.Maresin 1 50 ng/5 μl were intrathecally injected from days 14 to 16 after tumor cells implantation.Six mice in each group were randomly selected to determine the MWT and TWL on days 14 to 18 after implantation.Mice were sacrificed on day 18 after pain behavior tests.The expressions of spinal GFAP and Iba1 were de-tected by Western blot and immunofluorescence staining.The levels of spinal IL-1 β,IL-6,and TNF-α were detected by ELISA.Results Experiment Ⅰ:compared with group S1,the MWT and TWL were significantly lower on days 7,10,14,and 21 after implantation in group B,(P＜0.05),the expressions of spinal GFAP and Iba1 were upregulated on days 7,14,and 21 after implantation in group B1(P＜0.05).Experiment Ⅱ:compared with group S2,the levels of spinal GFAP,Iba1,IL-1β,IL-6,and TNF-α were increased on day 18 after implantation in group B2(P＜0.05).Compared with group B2,the MWT and TWL were significantly higher on days 15-18 after implantation while levels of spinal GFAP,Iba1,IL-1β,IL-6,and TNF-α on day 18 were decreased in group M(P＜0.05).Conclusion Intrathecal administra-tion of Maresin 1 attenuates BCP maybe by inhibiting the glial cells activation and neuroinflammation in the spinal cord.

Objective To observe the effect of low-dose remifentanil combined with propofol on the blood pressure(BP),heart rate(HR)and neonatal Apgar score in parturients undergoing cesarean section. Methods Forty-two parturients undergoing cesarean section were placed in two groups:low-dose remifentanil combined with propofol general anesthesia group(group GA,n=20)and neuraxial anesthesia group(group RA, n=22).BP and HR at the basis line(T0),pre-incision(T1),instant incision(T2),1 min(T3),3 min(T4),5 min(T5)after incision,cutting the umbilical cord(T6)were recorded,and neonatal Apgar scores at 1 min and 5 min after birth were also recorded. Results In group GA,the systolic blood pressure(SBP)and the diastolic blood pressure(DBP)remained unchanged at any time(P > 0.05). Compared with T0,HRs at T1~ T4were de-creased significantly(P<0.05).In group RA,compared with T0,the levels of SBP,DBP,HR at T1~T4were de-creased significantly(P<0.05).The levels of SBP and DBP at T1~T4in group GA were significantly higher than those in group RA(P<0.05),but there was no significant difference in HR between the two groups(P>0.05). The number of cases of ephedrine in group RA was significantly larger than that in the group GA(P<0.05).Neo-natal Apgar scores at 1 min and 5 min after birth were similar between the two groups(P > 0.05). Conclusion The application of low-doseremifentanil and propofol can be safely used in cesarean section,for the stability of par-turient BP and HR and no risk of neonatal respiratory depression.