Objective　To investigate the dynamic changes of psychological states and the results of delivery in pregnant women,simultaneously,study the effective way to reduce the rate of cesarean section.Methods　Through applying the self-compiled test paper,the self-evaluating state table(SCL-90)and the table of overall feeling of happiness,we assessed the psychological states of 89 pregnant women.The results were recorded at 35 and 38 weeks of gestation and 72 hours postpartum.Results　48 delivered vaginally(53.93%).4 were managed by cesarean section(46.07%),including 12 non-indicated cesarean section(29.27%).The mark of anxiety,terror and depression factors increased in the group of non-indicated cesarean section before and after dilivery compared with the group of vaginal delivery and indicated cesarean section.There was remarkable difference(P＜0.01).The value of overall feeling of happiness in the group of non-indicated cesarean section was less than that in the group of vaginal delivery.The difference was extremely significant(P＜0.001).The rdevant analysis showed that the feeling of happiness,the desire of labor and educational level were related negatively to the level of symptom during pregnancy(P＜0.01).The mode of delivery was related positively to the psychological state of pregnant women(P＜0.01).Conclusion　Non-indicated cesarean section is mainly interrelated to anxiety,terror and depression that proceed gradually during pregnancy and delivery.So it is suggested that the aimed psychological education be beneficial to decrease the rate of cesarean section.

Objective To investigate risk factors decreasing cannulation success rate of trainees receiving hands-on ERCP training and to improve thelevel of ERCP training.Methods Clinical data of 1 193 ERCP cases involved in training in Xijing Hospital of Digestive Disease from December 2012 to December 2014 were retrospectively analyzed.Multivariate logistic regression analysis was performed to investigate the risk factors influencing cannulation success rate of trainees.Results There were 1 165 and 28 patients undergoing common biliary duct (CBD) cannulation and pancreatic duct(PD) cannulation respectively.The success rate of CBD cannulation by trainees was 58.5％(681/1 165)and the overall success rate was 97.9％(1 140/1 165).PD cannulation success rate by trainees was 39.3％ (11/28) and the overall success rate was 89.3％ (25/28).The overall complication incidence was 8.0％ (96/1 193)and the incidence of post-ERCP pancreatitis was 4.4％(53/1 193).Multivariate logistic regression analysis showed that the selective cannulation by trainees was more likely to fail in patients with malignant biliary stricture(OR =0.44,95％CI:0.28-0.67,P＜0.01),benign or undetermined biliary stricture(OR =0.32,95％ CI:0.17-0.60,P＜ 0.01),suspected sphincter of Oddi dysfunction(SOD) (OR =0.28,95％ CI:0.16-0.47,P＜ 0.01),coexisting hypertension (OR =0.65,95 ％ CI:0.44-0.96,P＜0.05),RDW ≥ 48 fL (OR =0.69,95％ CI:0.51-0.92,P＜ 0.05),PLT＜ 100 × 109/L (OR=1.68,95％CI:1.05-2.71,P＜0.05).Conclusion Biliary stricture,suspected sphincter of Oddi dysfunction,coexisting hypertension,abnormal RDW and PLT were independent risk factors influencing cannulation success rate by trainees during hands-on ERCP training.

Objective To analyze the risk factors of post-ERCP pancreatitis (PEP) and to evaluate the relationship between cannulation time and PEP.Methods The data of cannulation time in 1 625 patients who underwent ERCP from 2010 to 2012 were retrospectively studied.The risk factors associated with PEP were analyzed by univariate and multivariate Logistic regression analysis.The effect of different cannulation time on PEP was evaluated.Results The incidence of overall PEP was 4.6％ (75/1 625) including 4.1％ (67/1 625)of mild and 0.5％ (8/1 625)of moderate-to-severe.Univariate analysis revealed that diabetes mellitus (P =0.02),choledocholithiasis (P =0.02),malignant biliary stenosis (P =0.007),duodenal stenosis (P =0.029),precut (P＜0.01),cannulation time ≥ 8 min (P＜0.01),blood platelet count ≥ 180× 109/L(P =0.089),alkaline phosphatase ≥ 120 U/L (P =0.083) and total bilirubin ≥ 17.1 μmol/L (P =0.094)were associated with PEP.Multivariate analysis revealed that precut (OR=1.93,95％CI:1.10-3.39,P=0.022),cannulation time ≥8 min (OR =3.50,95％CI:2.00-6.13,P＜0.01) and duodenum stenosis (OR=2.92,95％CI:1.08-7.86,P=0.034) were independent risk factors of PEP.Within 30 min of cannulation,longer cannulation time was accompanied with higher PEP rate.Conclusion The cannulation time is an independent risk factor of PEP.Overall PEP is increased when cannulation time is more than 8 min.

Objective To study and summary the treatment of talus fracture. Methods Fifteen patients with talus fracture were treated by limited cut off reduction by leverage and hollow lag screw under C arm X-Ray machine January 2008 to November 2014, of whom there were 11 males and 4 females, aged 15-61 years old. Seven patients sufferred from talus fracture because of traffic accidents, 4 patients because of falls, 2 patients because of crush injury, and 2 patients because of sprains. Hawkins typing:Ⅰtype in 1 patient, Ⅱ type in 6 patients, Ⅲ type in 6 patients of Ⅲ type, and Ⅳ type in 2 patients. Results Followed up for 6 months to 4 years (mean 1.5 years), fracture healed better. Hawkins grading standard:9 patients showed excellent (1 patient ofⅠtype, 5 patients ofⅡtype, 3 patients ofⅢtype), and two patients showed good (Ⅲtype). The excellent and good rate was 11/15. Necrosis of talus occurred in one patient, and degenerative joint disease occured in one patient. Conclusions Minimally invasive internal fixation with hollow lag screw under C arm X-Ray machine in the treatment of talus fracture has a small injury to the periosteum and the blood supply of small soft tissue. It can fix reliably and can pressurize the fracture fragments, and is conducive to fracture healing.

Objective:To explore the effects of conflicting stimuli generated by different chromatic lights on visual display terminal (VDT) on accommodative response and microfluctuation of myopes and emmetropes, and to investigate the possible relationship between chromatic light, accommodation and the development and progression of myopia.Methods:A non-randomized controlled trial was conducted.Forty-one subjects aged 22 to 30 years old were enrolled, including 19 emmetropes in emmetropic group and 22 myopes in myopic group.The subjects had the normal color vision and no ocular organic diseases.The interventions were screens of different colors.There were 7 chromatic light conditions, including 3 monochromatic lights (red, green, blue), 3 bichromatic lights (red+ green, red+ blue, green+ blue) and 1 polychromatic light (white=red+ green+ blue). Subjects were asked to look at a black E target on a VDT at a distance of 33 cm for more than 20 seconds.The background color of the VDT was changed randomly in the 7 chromatic light conditions.The accommodative responses were recorded with the Grand Seiko WAM-5500 automatic infrared refractor every 0.2 seconds and the accommodative microfluctuation was calculated as the standard deviation of the accommodative response.Accommodative response and accommodative microfluctuation under different chromatic light conditions were compared.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine (No.2019-1564). Written informed consent was obtained from each subject.Results:No statistically significant difference was found in the accommodative response between the two groups ( Fgroup=2.626, P=0.113). There was a statistically significant difference under different chromatic light conditions between the two groups ( Flight=39.070, P<0.01). There were similar trends in the effects of various color lights in both groups, with the largest accommodative response under monochromatic red light, followed by the bichromatic light containing red light, and then the smallest accommodative response under monochromatic blue light, and the differences were statistically significant (all at P<0.05). The accommodative microfluctuations under red, green, blue, red+ blue, red+ green, blue+ green and white light conditions were (0.142±0.033), (0.128±0.038), (0.131±0.043), (0.139±0.039), (0.127±0.034), (0.131±0.043) and (0.139±0.042)D in emmetropic group, and (0.178±0.043), (0.164±0.043), (0.159±0.039), (0.174±0.042), (0.166±0.036), (0.159±0.031) and (0.174±0.035)D in myopic group, respectively, showing statistically significant differences between them ( Fgroup=12.146, P<0.01; Flight=2.782, P<0.05). The accommodative microfluctuations under the 7 light conditions were higher in myopic group than in emmetropic group, and the differences were statistically significant (all at P<0.05). In myopes, the accommodative microfluctuation was the largest under red light, which was significantly larger than that under blue light, and was the smallest under blue+ green light (all at P<0.05). There was no significant difference in the accommodative microfluctuation between bichromatic light and its two monochromatic lights, or between the polychromatic light (white light) and its three monochromatic lights (all at P>0.05). There was no significant effect of various chromatic lights on the accommodative microfluctuation in emmetropic group (all at P>0.05). Conclusions:The accommodative microfluctuation is greater in myopes than in emmetropes.The stimuli produced by long-wavelength light cause larger accommodative microfluctuation, while conflicting stimuli generated by different chromatic lights do not increase accommodative microfluctuation.