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 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 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 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 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 evaluate the use of covered stent in endovascular treatment for aortoiliac occlusive disease.Method In this study45 cases [8 women,37 men; age range,38-94 years; mean age,(61 ± 12) years] of aortoiliac occlusive disease were reviewed,28 with intermittent claudication,11 with rest pain,6 with toe gangrene,including 22 unilateral iliac artery occlusions,8 unilateral occlusions combined with contralateral stenosis and 15 aorto-bilateral iliac artery occlusions.4 cases received catheter thrombolysis therapy for 3 days before stenting and the others received directly covered stent placement.Result Procedures were successful in all cases completed including 19 cases with one side covered stent and 26 cases with kissing covered stent.Limb ischemia was significantly relieved in all patients,only one case amputated because of infection.The mean follow-up period was (12 ±4) months (6 to 21 months).All stents were patent except one occlusion at 14 months due to bad outflow.The primary patency was 97.8％.Conclusions Covered stent can bring a satisfied results and outcomes in endovascular treatment of aortoiliac occlusive disease.

AIM: To evaluate the different conditions inducing mouse embryonic stem cells (ESC) in vitro to differentiate into cardiomyocytes. METHODS: BRL conditioned medium was used to promote the growth of ESC and maintain them in an undifferentiated state. During the inducing process, retinoic acid (RA), DMSO, activin-A and TGF-? 1 were used as inducing reagents, and made up six kinds of differentiating medium. Then a three-step method inducing ESC cultured in hanging drops, in suspension and in plating was used to induce the differentiation of ESC. RESULTS: ESC were induced in vitro to differentiate into cardiomyocytes. Of all groups, the highest differentiating rate was observed in the group induced by activin-A (20 ?g/L) and TGF-? 1 (2 ?g/L). CONCLUSION: The inducing conditions including activin-A (20 ?g/L) and TGF-? 1 (2 ?g/L) is very valuable in inducing ESC differentiation into cardiomyocytes. [

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.