Objective To investigate the effect of epidural anesthesia for painless labor on the birth process and newborn,and to provide a reference for the implementation of painless labor.Methods From January 2013 to January 2015 in our hospital,102 pregnant women were randomly divided into observation group and control group, 51 cases in each group.The observation group used sufentanil combined with ropivacaine for labor analgesia,and the control group received conventional natural childbirth measures for labor.Compared the two groups of maternal analge-sia effect,duration,the rate of vaginal delivery and postpartum 2 hours the amount of bleeding,and compared the two groups of fetal distress and neonatal asphyxia incidence.Results The maternal effect rate and total efficiency in the observation group were 62.75%,96.08%,which were significantly higher than those of the control group (P <0.05).In the observation group,the first birth process was (251.82 ±93.64)min,the second stage of labor was (54.72 ±2.561)min,which were significantly less than those of the control group (P <0.05 );birth rate of the observation group was 74.51%,postpartum 2 hours bleeding (227.52 ±31.73)mL,fetal distress occurred rate was 1.96%,newborn asphyxia occurrence rate was 1.96%,and compared with the control group,the differences were not statistically significant (P >0.05).Conclusion Epidural block anesthesia of painless labor can effectively relieve the pain of delivery,reduce maternal labor and the second stage of history,and has good safety of mother to child,it is worth popularization and application.

Acupuncture Therapy ; Adrenal Insufficiency ; therapy ; Adult ; Humans ; Male

Objective To investigate the effect of Yiqi Yangyin Huoxue Decoction combined with Western medicine therapy , while on this basis the observation group was combined with the on serum CRP ,TNF‐α,blood lipid and hemorheology levels in cor‐onary heart disease angina pectoris .Methods Totally 114 patients with coronary heart disease(CHD) angina pectoris were random‐ly divided into observation group (n=57) and control group (n=57) according to the random number table method .The control group was treated with Western medicine treatment ,while on this basis the observation group was combined with the therapy of Yiqi Yangyin Huoxue Decoction .The treatment cource was 4 weeks in the two groups .Serum CRP ,TNF‐α,blood lipids ,hemorheol‐ogy levels ,frequency and duration of angina pectoris attack ,efficacy of angina pectoris and ECG and adverse reactions were contras‐tively analyzed in the two groups .Results The levels of serum CRP and TNF‐αafter treatment in the two groups were decreased (P<0 .05);sthe serum levels of CRP and TNF‐α after treatment in the observation group were lower than those in the control group(P<0 .05);the TG ,TC and LDL‐C levels after treatment in the two groups were decreased (P<0 .05);the TC ,LDL‐C and TG levels after treatment in the observation group were lower than those in the control group (P<0 .05);fibrinogen ,plasma vis‐cosity and whole blood viscosityafter treatment in the two groups were decreased (P<0 .05);the fibrinogen ,plasma viscosity and whole blood viscosity after treatment in the observation group were lower than those in the control group (P<0 .05);the angina pectoris attack frequency after treatment in the two groups were reduced (P<0 .05) ,the duration was shortend (P<0 .05);but the angina pectoris attack frequency after treatment in the observation group was lower than that in the control group (P<0 .05) ,the duration was shorter than that in the control group (P<0 .05);the total effective rate of angina pectoris and ECG in the observa‐tion group was higher than that in the control group (P<0 .05) .The two groups had no serious adverse reactions during the treat‐ment process .Conclusion Yiqi Yangyin Huoxue Decoction combined with Western medicine can reduce serum CRP ,TNF‐α,blood lipid and hemorheologic levels in CHD angina pectoris ,and has remarkable curative effect with safety and reliability .

Objective To study the clinical value of combined detection of D-dimer,PT,FIB and Cyc-C in the patients with nephrotic syndrome(NS) complicating thromboembolism.Methods Sixty-five patients with clinically diagnosed NS(observation group) in the Huangshi Municipal Central Hospital from April 2013 to March 2016 were selected and divided into the non-thromboembolism group(group A,45 cases) and thromboembolism group(group B,20 cases).Contemporaneous 43 individuals undergoing physical examination served as the control group(group C).The levels of Cys-C and 24 h urine protein were tested by the electrochemical luminescence method;meanwhile PT,FIB and D-dimmer levels were detected by the nephelometry method.Their changes in the patients with NS complicating thromboembolism were observed.Results The levels of Cys-C,24 h urine protein and D-dimer in the observation group were significantly higher than those in the control group (P＜0.01).The difference of PT and FIB levels were not statistically significant(P＞0.05);the D-dimer and Cys-C levels in the observation B group was significantly higher than that in the observation A group(P＜0.05),moreover the D-dimer level was positively correlated with Cys-C.Conclusion D-dimer and Cys-C can be used as the predictive factors of thromboembolism occurrence in NS patients.

Objective To evaluate the effect of mouse nerve growth factor on fracture healing.Methods Cochrane library, Pubmed, EMbase, CNKI,VIP,Wanfang Data and CBM were searched for the randomized controlled trials(RCTs)of mouse nerve growth factor on fracture healing from the date of establishment of the databases to May 2014.Three independent rese archers evaluated the included studies using GRADE,according to recommend classification method of GRADE system by three researchers,crtical evaluated and data extracted of the quality of the included studies,which conform to the quality standard of RCT was analyzed by Meta analysis.The extracted data were analyzed by RevMan 5.0 and GRAED proiler.Results A total 5 trials were discovered and all of these were in Chinese.Compared with conventional treatment was improved a lot[MD =-8.74,95%CI( -9.79,-7.68),P<0.0001].However, adverse drug reaction in patients with mouse nerve growth factor were increased[OR =14.66,95%CI(1.89, 113.99),P=0.01].The both outcomes were low quality in the GRADE system.Conclusion Mouse nerve growth factor can improve fracture healing and the side effects will also increase.

10.3969/j.issn.1000-8179.2013.12.004

Objective To systematically review articles about therapeutic drug monitoring of vancomycin in Chinese adults, so as to provide a reference of vancomycin trough concentrations for clinical evidence-based medicine.Methods Literature concerning vancomycin therapeutic drug monitoring were electronically retrieved in, CBM, Wanfang data, CNKI and Vip.Furthermore, the articles written in English by Chinese author in PubMed, EMbase were included.All the data were searched from inception of the database or network to Aug.2014.Two reviews independently screened literature according to the inclusion and exclusion criteria, and assessed the quality of literature using the Combieg and NOS.Analyzing the types of studies, the number of therapeutic monitoring of vancomycin, trough serum concentration, clinical outcome and renal function.Results A total of 35 studies including 32 cross-sectional studies and 3 cohort studies were included, all studies were observational studies.3099 patients with 5206 blood concentrations monitoring results were eligible for final analyses in all 32 cross-sectional studies.The rates of trough serum concentration in 5-15 mg/L was 53.6%.Compared with the trough concentrations between 5 and 15 mg/L, clinical cure rate was no significant difference in the trough concentrations of over 15μg/mL.However, the incidence rate was significantly reduced in renal toxicity in 5-15 mg/L trough serum concentration.Conclusions For adults, trough serum concentration of vancomycin should adopt the 5-15 mg/L in China.However, considering lack of high-level evidence, so it needs to be studied further.

ObjectiveTo evaluate long-term outcome of laryngeal reinnervation using the main branch of the ansa cervicalis for the treatment of unilateral vocal fold paralysis (UVFP) caused by thyroid surgery. MethodsFrom Oct.1990 to Jan.2010,a total of 325 UVFP patients who underwent main branch of ansa cervicalis-to-recurrent laryngeal nerve (RLN) anastomosis were enrolled in the study.We retrospectively analyzed the efficacy of the reinnervation surgery using videostroboscopy,vocal function assessment (acoustic analysis,perceptual evaluation and maximum phonation time ),and laryngeal electromyography. ResultsVideostroboscopy showed that the glottic closure,vocal fold edge,vocal fold position,phase symmetry and regularity were significantly improved postoperatively. The vocal function parameters (GRBAS scale,jitter,shimmer,noise to harmonics ratio and maximum phonation time) were also significantly improved postoperatively ( P ＜ 0.01 ),as compared to corresponding preoperative values.Voice recovered to a normal level in 93.5％(304/325)patients,and the effective rate was 98.8％ (321/325). Postoperative laryngeal electromyography confirmed successful reinnervation of laryngeal muscle. CondusionsLaryngeal reinnervation using the main branch of ansa cervicalis is a feasible and effective approach for treatment of UVFP patients caused by thyroid surgery,with satisfactory long-term results.

Objective In this study,we investigated the hair cell apoptosis and the molecular mechanisms in age-related hearing IOSS mouse cochlea.Methods All animals were assessed by ABR and DPOAE analysis in both ears.TUNEL(Terminal dexynucleotidyl transferase(TdT)mediated dUTP Nick End Labeling)and PI were used to identify DNA fiagments and caspase-3 activities in hair cells.Results The results showed that the nmf308 mice had progressive hair cell loss along with age.The cochlear OHCs were reduced 5%～10% at 1 month and 100% at 3 month in the basal region.Substantial amounts of TUNEL-postive OHCs nuclei were observed at age of 1 month,and activated caspase-3 labeling OHCs were most obviously observed at age of 2 months.Conclusion These results suggest that DNA single strand break is attributed primarily to apoptosis of cochlear lesion,and activation of caspase-3 at leter stage leads to the hair cell apoptiovs of nuclear condensation in age-related hearing loss mouse cochlea.

Objective To study direct economic loss of healthcare-associated infection (HAI)in hospitalized children with acute respiratory infection (ARI),and the influence in satisfaction degree of children’relatives.Methods Clinical data of 1 039 children with ARI in a pediatrics ward between April 1,2012 to March 31,2013 were analyzed retrospective-ly.50 patients with HAI were in case group and 50 patients without HAI were in control group.The difference in medical cost and the degree of satisfaction of children’s relatives were compared between two groups.Results Medical cost of pa-tients in case group was significantly higher than control group([P 25 - P 75 :￥3 095.54 - ￥4 779.48]vs [P 25 -P 75 :￥1 744.14-￥2 382.07],Z =5.89,P <0.01).The expenses in medicine,laboratory examination,diagnosis and treatment,and nursing in case group were all higher than control group,there were significant differences between two groups(all P <0.01 );Hospitalization day of case group was significantly longer than control group ([P 25 -P 75 :9 d-15 d]vs[P 25 -P 75 :6 d-8 d],Z =5.79,P <0.01 ).Satisfaction degree of patients’relatives in case group was significantly lower than control group (Z =8.22,P <0.01).Conclusion HAI occurred in ARI children can increase medical cost,prolong length of hospital stay and decrease satisfaction degree of patients’relatives.