Objective To analyze the clinical effects of continuous epidural anesthesia and psychological intervention in painless labor. Methods From June 2016 to December 2016110 cases of maternal treatment in Ningbo city town of dragon longsai hospital as the research object, randomly divided into control group and observation group, control group of women to provide continuous epidural anesthesia, the observation group in continuous epidural anesthesia combined with psychological intervention measures. Results The two groups of pregnant women at different time scales VAS score, duration and other indicators, the data into the SPSS software, given the corresponding analysis and draw conclusions. Results The two groups of pain VAS score had no significant difference, the observation group each time after analgesia VAS score decreased than the control group(P<0.05); the first stage of the observation group was shorter than the control group (P<0.05), there was no significant difference between the 2 groups of second, third labor time. Conclusion Conclusion Epidural anesthesia and psychological intervention combined with painless labor have good analgesic effect and shorten the first stage of labor. .

Aim To observe the effect of sodium nitrop russide (SNP)on glial fibrillary acidic protein(GFAP) synthesis in the gerbil hippocampus. Method lmmunofluorescent histochemical staining method was used. Result SNP increased GFAP synthesis in rediatum layer,molecular layer and dentate gyrus.There were not GFAP positive cells in rediatum layer and mol ecular layer.Number of GFAP positive cells related to dose of SNP.Conclu sion SNP increased GFAP synthesis.

Objective To describe the CSP genotypic profile in clinical isolates of Aspergillus fumigates from different regions of China,and to investigate if there is a difference in antifungal susceptibility among A.fumigates of different CSP genotypes and from different regions.Methods Totally,112 A.fumigates strains clinically isolated from Fujian,Shanghai,Hebei and Beijing were included in this study,and identified according to macro-and micro-morphological characters,growth temperature and β-tubulin sequence.Classic A.fumigatus strains were typed according to CSP gene sequence.The minimal inhibitory concentrations (MICs) of voriconazole,itraconazole and amphotericin B to A.fumigates were determined in accordance with the National Committee for Clinical Laboratory Standards (NCCLS) M38-A protocol.Results All the strains were identified as classic A.fumigates,and fall into 11 CSP genotypes.The most common genotypes were t04A (n =32),t03 (n =17) and t01 (n =24) in all the strains,tl0,t04A and t01 in Fujian,t04A and t01 in Shanghai,t01,t03 and t04A in Hebei,t02,t04A,t01and t03 in Beijing.One A.fumigatus strain was identified as a new CSP type t25 in Fujian,which showed no obvious difference in morphology,growth rate or appropriate growth temperature from the other CSP genotypes of A.fumigatus strains.No statistical difference was found in the susceptibility to amphotericin B,itraconazole or fluconazole among different genotypes of A.fumigates,whereas the MICs of itraconazole were significantly lower in A.fumigates isolates from Fujian than in those from the other three regions.Conclusions The CSP genotypic profile of A.fumigates varies in clinical isolates from different regions.No significant difference is observed in the susceptibility to amphotericin B,itraconazole or fluconazole among different CSP genotypes of A.fumigates,but the susceptibility to itraconazole is somewhat different between A.fumigates strains from different regions.

Objective To evaluate the feasibility of endovascular repair for retrograde type A aortic dissection.Method 35 patients of retrograde type A aortic dissection admitted to Peking University People's Hospital from December 2001 to March 2014 were treated with endovascular repair.There were 33 males and 2 females with mean age of 46 ± 9 years.29 were on acute stage,2 on subacute stage and 4 on chronic stage.The entry tear was in the descending thoracic aorta in 32 cases,between the left subclavian artery and the left common carotid artery in one,and between the left common carotid artery and the innominate artery in two.Results Entry closure was achieved in all patients with a covered stent.2 patients died in 30 days postoperatively (5.7％).1 patient with two chimney developed acute renal artery embolized which was infused by false lumin (2.9％).One patient developed transient paraparesis after graft deployment(2.9％).During the follow-up period,the aortic remodeling is perfect,no entry tear was noted in the ascending thoracic aorta.All the endografts for preserving supra-aortic branches were patent.Conclusions The endovascular repair for retrograde type A aortic dissection is feasible and effective.

A vascular closure device (VCD) is a medical apparatus which is used for stopping bleeding at the puncture point after percutaneous vascular puncturing management. According to its principles , these devices can be categorized into active closure device, compression-assisted device and local hemostatic plaster. The use of these devices can shorten the time of hemostasis, the time of limb immobilization, and the time of hospitalization; it can also reduce the damage to the patient, improve patient’s comfort, and reduce the work load of the medical staff as well. But each VCD has its own applicable scope and learning curve , thus it might cause serious complications when it is improperly used. Therefore , in using VCD the interventional physicians should be familiar with the characteristics of each special VCD and have enough knowledge concerning the treatment of the common complications. This paper aims to make a comprehensive review of the closure device manufacturer data and the relevant literatures recently published so as to make a brief introduction of the principle, characteristics, scope of application and practical tips of several common vascular closure devices.

Objective To evaluate the application of percutaneous suture-mediated closure device (Perclose ProGlide) in patients undergoing percutaneous endovascular aortic procedures.Method From Apr 2011 to Jun 2012,23 patients underwent percutaneous endovascular aortic procedures.The stent delivery system used included one 24Fr,twelve 22Fr,two 20Fr,one 18Fr,two 16Fr,four 14Fr,one 10Fr and four 6Fr.The success rate,complications and the technical feasibility was analyzed.Result The success rate was 93.3％ (28/30),in which two patients were converted to open surgery because of severe stenosis and bleeding of femoral artery.There was no hemorrhage,hematoma,false aneurysm,thrombosis,and serious artery stenosis during the follow-up period ( 8 ± 4 months).Conclusions Percutaneous suture techniques is safe and effective in patients undergoing percutaneous endovascular aortic procedures.Percutaneous suture techniques can be safely used to the branch of aortic arch.

Objective To sum up our clinical experience in interventional treatment of 143 cases of Budd-Chiari syndrome. Methods This study included 92 males and 51 females, aged from 6 to 65 years old with an average of 34.8 years. The pathologic types were composed of complete occlusion of inferior vena cava (IVC) (71), IVC stenosis (36), IVC membrane occlusion with a hole (29), membrane occlusion of hepatic vein (HV) (3), IVC thrombosis (4), and IVC lesions forementioned combined with HV occlusion (14). Therapeutic methods included that I: Percutaneous transinferior vena cava membranotomy and occlusion dilatation (PTA) (77); II: IVC PTA with stent (62); III: Percutaneous transhepatic vein recanalization (3); IV: IVC thrombolysis through a catheter (4); V: Additional operation after intervention (16). Results The range of reduced IVC pressure was (3 ～ 29) cmH 2O with the mean pressure being 12.1 cmH 2O. Complications occurred in 8 cases, including pulmonary embolism (PE), stent migration and HV occlusion after IVC stent (2 cases respectively), cardiac tamponade and hemothorax (1 case repectively). 2 cases died of PE and 3 cases died of hepatic coma after meso-caval shunt,the death rate being 3 5% . A follow-up study showed the recurrence rates were 10.4% in IVC PTA cases and 1.6% in IVC PTA with stent cases respectively, and no recurrence was found in other cases. Conclusions ① PTA is the first choice for localized lesions without fresh thrombus. ② For those with elastic recoil or recurrence, stent is suggested. ③ For those with both IVC lesions and HV occlusion, the additional operation to reduce portal hypertension is needed after IVC intervention.

Objective:To report a rare type of aortic arch aneurysm. Methods: Three cases of aortic arch aneurysm derived from the fourth aortic arch were retrospectively analyzed. The pathogenesis and treatment of this type of aortic arch aneurysm were investigated. Results:Most of the aneurysm body was located in the Z2 zone, which was the stem from the fourth aortic arch in the embryonic development period. All of the 3 cases could not be explained by common etiology. We speculated that the cause might be developmental anomaly of the fourth aortic arch. All the 3 aortic arch aneurysms were totally ex-cluded with a covered stent. The technical success rate was 100%. Endoleak of typeⅠwas seen in one case, which was resolved in a later open surgery. During the follow-up, no type of complications was found. Conclusion:To the best of our knowledge, this is the first report of this type of aortic arch aneurysm. The cause may be developmental anomaly of the fourth aortic arch. Endovascular treatment of this type of aortic arch aneurysm is feasible.

Objective To investigate risk factors of the prognosis of patients with severe fever with thrombocytopenia syndrome (SFTS).Methods From May 2012 to July 2014,17 cases of severe fever with thrombocytopenia syndrome in Renmin Hospital of Wuhan University were treated.Clinical data including history of epidemiology,clinical manifestations,complications,physical examination and laboratory test results on admission and the third day after admission were retrospectively analyzed and compared with the death group and recovery group by application of Spearman correlation analysis.Results Elderly male patients with neuropsychiatric symptoms,or abnormal liver function,or abnormal blood clotting function had higher risk of the poor prognosis.In SFTS patients,AST,ALT was significantly increased,AST 539 U/L (229.73,545.4) U/L (r =0.597,P =0.015) was a risk factor affecting prognosis.Elevated blood ammonia indicated serious liver dysfunction and neurological dysfunction which were manifested as irritability,delirium,and trembling limbs.In SFTS patients,platelets were significantly decreased accompanied with mouth ulcers / bleeding gums,gastrointestinal bleeding.PLT 24.88 × 10 9/L-1 (12.75,35.00) ×10 9/L-1 (r=0.557,P=0.005) or APTT 86.06 s (66.88,114.18) (r=0.798,P=0.001) or D-dimmer 9.79 mg / L (4.09,16.51) mg/L (r =0.597,P =0.015) are risk factors affecting poor prognosis.Conclusions On the third days after admission,AST,WBC,PLT,APTT,Ddimmer are risk factors for prognosis of patients with severe fever with thrombocytopenia syndrome infected by a novel bunyavirus.

Objective To evaluate iliac artery rupture during endovascular treatment of aorto-iliac disease and treatment with covered stent.Methods From November 2008 to August 2014,iliac artery rupture happened in 8 patients of 225 patients of aorto-iliac artery disease admitted to our hospital.Clinical data of the 8 patients were analyzed retrospectively.Four were of intraoperative rupture and four were of delayed rupture.The aorto-iliac diease of all the 8 patients were TSAC D.Direct placement of a covered stent was performed in all the cases,except for one patient who refused further treatment.Results All of the procedures finally achieved technical success and all patients become hemodynamically stable.One patient was complicated with heart failure who died of multiple organ dysfunction syndrome.Another one died of aspiration.5 patients were followed up from 9-52 moths,average 9-52 moths without recurrence.Conclusions Iliac artery rupture is a serious and life-threatening complication in the endovascular treatment of aorto-iliac disease.Covered stent provided a safe and effective treatment for iliac perforations.