Acute traumatic coagulopathy (ATC) is one of coagulopathy induced by severe trauma in the early phase of trauma.It is always with high morbidity,mortality and multiple organ failure.Early diagnosis and treatment is the main content of trauma surgery in the department of emergency and the key to reduce mortality.Thrombelastography (TEG) can comprehensively assess the different stages of coagulation,early diagnose disturbance of blood coagulation and guide the goal-directed therapy with low complications,mortality and medical costs.TEG has been widely used in the operation of cardiac surgery,liver transplantation and trauma surgery to monitor coagulation and guide therapy.This paper mainly reviews the clinical value of thrombelastography in diagnosis and treatment of acute traumatic coagulopathy.

Objective To study the influence on primipara's second stage of labor with the methods of Changqiang-pressing and Vaginal-pressing. Methods 180 primipara in the second stage of labor were randomly divided into 3 groups of 60 each, in which Changqiang-pressing, Vaginal-pressing and general guidance (the control group) were used respectively. The duration of uterine contraction and second stage of labor, vaginal bleeding amount in 2 hours after delivery, mode of delivery, perineal injury and birth case would be evaluated. Results The results in both Changqiang-pressing group and Vaginal-pressing group were statistically significant when compared with the control group, but there was no significant difference between Changqiang-pressing group and Vaginal-pressing group. Conclusions Using Changqiang-pressing and Vaginal-pressing can promote the progress of the second stage of labor for primipara, reduce the rate of cesarean section and neonatal asphyxia, and improve the quality of obstetric department.

Objective To investigate the effect of massaging Changqiang acupuncture point during the second labor course of primiparas. Methods 124 primiparas were randomized into the observation group(63 cases)and the control group (61 cases). In the observation group, after entering the second stage of labor, Changqiang point was massaged upwards by using index finger and middle finger, and at the same time primiparas were guided to hold breath to coordinate with uterine contraction to make effort to the anus point which was massaged. While the control group were directed with routine way of correctly using abdominal pressure during process of uterine contraction in the second stage of labor. Results The lasting time of uterine contraction was significantly longer in the observation group than in the control group, the time of second stage of labor was shorter, and the amount of postpartum hemorrhage in the observation group was less than those in the control group. Conclusions Application of massaging Changqiang acupuncture point could prolonge the time of uterine contraction, advance the progress of second stage of labor, and decreased the amount of postpartum hemorrhage.

Objective:To compare the immediate therapeutic effect and safety between esmolol and lanatoside in con-trolling ventricular rate for patients with rapid atrial fibrillation.Methods:A total of 72 patients with rapid atrial fi-brillation (ventricular rate ≥120 beats/min)were randomly and equally divided into esmolol group and lanatoside group.Esmolol group received first dosage of 0.5 mg/kg intravenously for 1 min,then were observed for 5 min,if ventricular rate still >100 beats/min or decreased <20%,the 0.5 mg/kg esmolol was appended,meanwhile main-tained by 0.05mg·kg-1 ·min-1 via micro pump at first,maintenance dose can increase to a maximum 0.3mg· kg-1 ·min-1;lanatoside group received first dosage of 0.4mg or 0.2mg slow intravenous injection,if ventricular rate still >100 beats/min or decreased<20%,the another 0.2mg was appended.The onset time and adverse reac-tions were recorded after administration.Results:Compared with lanatoside group,there was significant reduction in mean onset time [(39.2±8.7)min vs.(5.6±3.1)min]in esmolol group,P<0.01;compared with before adminis-tration,there was significant decrease in ventricular rate in two groups after administration,P<0.05 or<0.01. On 2h af-ter administration,compared with lanatoside group,there was significant increase in decreasing range of ventricular rate (29% vs.39%)in esmolol group,P<0.05. The total effective rate and adverse reaction rate was no significant difference (P>0.05)between two groups.Conclusion:Intravenous using esmolol is efficient and safe,and it can be regarded as pre-ferred therapy to control ventricular rate in patients with rapid atrial fibrillation.

Objective To explore the correlation and difference between thromboelastography (TEG) and conventional coagulation tests (CCTs) in critically ill patients of emergency department,so as to provide valuable information for TEG clinical application.Methods TEG and CCTs data of critically ill patients admitted from August 2015 to September 2016 in emergency department of Xijing Hospital were prospectively collected and retrospectively analyzed.The correlational analyses of analogue parameters of TEG and CCTs were carried out to investigate their clinical significance.ROC curve was used to explore the sensitivity and specificity of R for diagnosis of abnormal PT and APTT.Then comparisons of sensitivity of detecting abnormalities of clotting factors among R,PT and APTT were made.The changes of α and MA in patients with abnormal platelet count or fibrinogen concentration were respectively counted so as to evaluate the ability of oα and MA to reflect abnormal platelet count or fibrinogen concentration.The results of TEG and CCTs were comprehensively analyzed to find out the capability of TEG and CCTs in reflecting the overall blood coagulation status.The differece in blood transfusion rate was compared between TEG and CCTs in trauma patients.The chi-square test of matched fourfold table was used to test the significance and there was statistical significance when P ＜ 0.05.Results (1) R correlated weakly with PT and APTT,MA correlated moderately with FIB and PLT;K and α angle correlated moderately with PLT and weakly with FIB.For the TEG parameter,there was no correlation between R and MA.R correlated moderately with K,α,and K correlated strongly with α angle,MA,and α correlated strongly with MA.(2) For detecting PT ＞ 15.1 s,the sensitivity of R (＞ 10 min) was 32％ (95％ CI:0.20-0.47) and specificity was 90％ (95％CI:0.84-0.94).For detecting APTT ＞41.8 s,the sensitivity of R (＞ 10 min) was 39％ (95％ CI:0.25-0.54) and specificity was 91％ (95 ％ CI:0.85-0.95).(3) There was a low sensitivity for MA and α to detect PLT count or FIB concentration abnormality.(4) TEG was able to detect a few abnormal blood coagulation which CCTs could not detect.(5) TEG-guided transfusion reduced plasma transfusion ratein trauma patients.Conclusions There is a moderate or even weak correlation between TEG and CCTs parameters,R has a low sensitivity to detect abnormal blood coagulation factor than PT,APTT.TEG is mainly able to reflect functional abnormality of PLT and FIB rather than to reflect their quantitative changes.TEG is able to detect a few abnormal blood coagulation which CCTs are not able to detect.The use of TEG can reduces plasma transfusion rate in trauma patients.TEG has certain advantages over CCTs but is not able to completely replace CCTs.Individual component change and overall blood coagulation status can be assessed in their combination,suggesting more helpful for clinical diagnosis and treatment.

Objective: To understand the infection status, characteristics and drug resistance of non-O157 Shiga toxin-producing E. coli (STEC) in animal feces in Shandong Province. Methods: From 2015 to 2016, convient sampling method was used to collect 1 022 fresh feces of animals in Weishan county and Laizhou city, and 24 non-O157 STEC were isolated. The serotypes of non-O157 STEC strains were confirmed through serum agglutination test. The susceptibility was explored through the antimicrobial sensitivity experiments. ESBLs activity was confirmed by double-disc diffusion. PCR method was used to detect the resistance genes. PFGE typing was operated to assess the relatedness and variability of the strains. The multi-locus sequence typing (MLST) was adopted to get the allelic profile and ST sequence of strains. Analysis was made on the evolutionary relationship between different ST groups was made through CLC Sequence Viewer and Counting Express. Results: A total of 24 non-O157 STEC were isolated from animal feces. 23 strains were from pig feces, and 1 strain was from cow feces, and the serotypes were more dispersed. All of the 24 strains carried stx2 genes. The highest resistance rate was sulfamethoxazole(22 strains), the mount of cotrimoxazole and nalidixic acid was 18 strains, chloramphenicol was 13 strains, tetracycline was 19, and there was a phenomenon of multiple drug resistance. The drug resistance spectrum was sulfamethoxazole tetracycline-compound novammin-naphthidine-chloramphenicol. All strains were sensitive to cefepime and imipenem. The ESBLs confirmatory test showed that 4 strains of non O157 STEC produced beta lactamase. PCR detected 7 resistance genes, and 4 tetracycline resistance genes (Tet A, Tet B, tetC and tetD) were detected. The beta lactamase resistance genes (blaSHV-1, bla CTX-M, bla TEM) were all negative. 24 strains were divided into 15 PFGE types, and their clustering results were more dispersed and no dominant PFGE type. There were 11 kinds of MLST types, most of them are ST540 and ST5133 types, each of which was 4 strains, and clustered into 1 MLST genomes. Conclusion The serotypes of non-O157 STEC in animal feces O157 STEC were dispersed, and the resistant rate to common antibiotic was high. MLST typing results presents obvious polymorphism. Surveillance and manage ment of these strains should be strengthened.

Objective:To explore the short-term outcomes of reconstruction of tumorous critical bone defects at femoral shaft with a 3D printed ultra-short stem with a porous structure.Methods:From September 2016 to June 2018, 8 patients underwent reconstruction of critical bone defects with a 3D printed ultra-short stem with a porous structure after resection of femoral shaft malignant tumor at Department of Orthopaedics, West China Hospital. There were 4 males and 4 females, with an average age of 36.9 years (from 11 to 61 years). Their preoperative Enneking staging was stage Ⅱb in all. There were 3 osteosarcomas, 2 Ewing sarcomas, 2 chondrosarcomas and one periosteal osteosarcoma. Preoperative CT/MRI image fusion technology was used to define the surgical boundary, design the guide plate and prosthesis, and perform surgical simulation. Tomosynthesis-shimadzu Metal Artefact Reduction technology was used to evaluate osseointegration. Complications and bone oncology prognosis of the patients were documented. The lower limb function of the patients was evaluated using Musculoskeletal Tumor Society (MSTS) 1993 scoring and knee range of motion.Results:The overall follow-up time ranged from 36 to 50 months, averaging 42.8 months. During operation one patient sustained a periprosthesis fracture, the union of which was followed up after wire assisted fixation. There was no local tumor recurrence, lung metastasis or death. The last follow-up revealed good osseointegration and basically isometric lower extremities in all cases. There was no such a complication as aseptic loosening of the prosthesis, deep infection or prosthesis fracture during the follow-up period. At the last follow-up in the 8 patients, the flexion range of the knee joint was 116.2°±9.1°, significantly improved compared with that before operation (98.8°±10.9°), and the MSTS score was (26.2±2.1) points, also significantly improved compared with that before operation [(21.6±1.8) points] ( P<0.05). Conclusions:Reconstruction with a 3D printed ultra-short stem with a porous structure is an accurate operation for femoral shaft tumorous bone defects. With careful preoperative design, intraoperative manipulation and strict postoperative follow-up management, this operation can lead to fine early curative outcomes for long shaft critical bone defects.

Objective:To investigate the current status of maternal body image during pregnancy, mother-infant attachment and postpartum depression and explore the mediating effect of mother-infant attachment on maternal body image during pregnancy and postpartum depression, in order to effectively reduce the incidence of postpartum depression and provide reference and guidance for alleviating depressive symptoms.Methods:A total of 362 pregnant women admitted to obstetric wards in Women′s Hospital of Nanjing Medical University were selected for a cross-sectional investigation by applying the Edinburgh Postnatal Depression Scale, the Body Image in Pregnancy Scale and the Maternal Postnatal Attachment Scale by convenient sampling from July to September 2022. Model 4 in the SPSS macro program PROCESS was used to test the mediating effect of maternal infant attachment between body image and postpartum depression.Results:Totally 362 valid questionnaires were retrieved including 194 individuals aged ≤30 years old and 168 individuals aged >30 years old. The scores of maternal body image during pregnancy, mother-infant attachment and postpartum depression were (89.24 ± 15.56), (71.40 ± 8.05), 7.50 (4.00, 11.00) points.Conclusions:Body image during pregnancy can not only directly predict postpartum depression, but also indirectly predict postpartum depression through the mediating effect of mother-infant attachment. In order to prevent or reduce the occurrence of postpartum depression, nursing staff should carry out intervention research based on influencing the path of postpartum depression from the perspective of positive psychology.

Objective To evaluate the risk factors and sonographic findings of pregnancies complicated by placenta increta or placenta percreta. Methods Totally, 2219 cases were retrospectively analyzed from 20 tertiary hospitals in China from January 2011 to December 2015. The data were collected based on the original case records. All cases were divided into two groups, the placenta increta (PI) group (79.1％, 1755/2219) and the placenta percreta (PP) group (20.9％, 464/2219), according to the degree of placental implantation. The risk factors and sonographic findings of placenta increta or percreta were analyzed by uni-factor and logistic regression statistic methods. Results The risk factors associated with the degree of placental implantation were age, gravida, previous abortion or miscarriage, previous cesarean sections, and placenta previa (all P<0.05), especially, previous cesarean sections (χ2=157.961) and placenta previa (χ2=91.759). Sonographic findings could be used to predict the degree of placental invasion especially the boundaries between placenta and uterine serosa, the boundary between placenta and myometrium, the disruption of the placental-uterine wall interface and loss of the normal retroplacental hypoechoic zone(all P<0.01). Conclusions Previous cesarean sections and placenta previa are the main independent risk factors associated with the degree of placenta implantation. Ultrasound could be used to make a prenatal suggestive diagnosis of placenta accreta spectrum disorders.

Objective To investigate high risk human papillomavirus(HR-HPV)prevalence among married women in Beijing and to study the high risk flactors.nethods During March 2007 to September 2008.a total of 6185 married women sampled from 137 communities in 12 districts were screened bv HR-HPV DNA test and cytogical test.The interview was carried out with unified questionnaires.The databage was set up and twice entered in EpiDam 3.0.After checked up,the data were analyzed in SPSS 15.0.Results (1) The HR-HPV infection rate was 9.89%.The HR-HPV infection rate of the city zone,the suburb and the exurb were 9.34%,10.51% and 9.51% (P>0.05).The HR-HPV infection rate of the native and the oudander were 9.53%,11.30% (P<0.05).(2) The age distribution of HR-HPV infection was that the rate was around 10% among 25 to 44 age groups,which was the highest(11.21%) in 30 to 34 age group;then the rate was descended as the age raising,the rate of 50 to 54 age group was the lowest(7.78%).(3) Multiple logistic regression showed that the related risk factors of HR-HPV infection mainly included 1000 RMB and above of family income per person per month.possessing more than 1 sexual partner of her husband,outlander and hish levels of education.(4) The prevalence of cervical intraepithelial neoplasia(CIN)in HR-HPV positive group wag significantly higher than that in HR-HPV negative group(29.76% vs 3.32%,P<0.01).Conclusions(1)The HR-HPV infection rate among aged 25 to 54 years was 9.9% and there was no significant difference in area distribution.(2)The hish risk population which should strengthen screening was the married bearing-age women with high level of family income,outlander,high levels of education and her husband possessing more than 1 sexual partner.(3)HR-HPV infection is the main risk factor for CIN and cervical cancer.while does not provide a causal relationship with them.The high risk population should be checked regularly to understand the development of HR-HPV infection and CIN incidence.