Objective To study the perinatal outcomes of pregnant women when their total stage of labor over 24 hours after the application of new partogram.Methods A retrospective case-control study was conducted on 3 991 pregnant women who received routine prenatal care and intrapartum management according to new partogram and delivered at full-term with alive babies at Beijing Obstetrics and Gynecology Hospital from October 1,2014 to January 31,2015.Among these 3 991 women,85 delivered after 24-hours' labor and all were nulliparas,while five of the 85 converted to cesarean section (CS group) and 80 delivered vaginally (study group).Another 160 primigravidas were randomly selected from those vaginal deliveries with the total stage of labor less than 24 h as control group.The general conditions,maternal and fetal perinatal outcomes were compared between the study and control group and between the study and CS group.The duration of labor was compared among different groups of women in the study group.Independent sample t-test,Rank-sum test,Chi-square test or Fisher's exact test were applied for statistics.Results The durations of first stage,second stage,third stage and total stage of labor were all longer in the study group than in the control [25.7(23.8-26.8) vs 10.4(5.9-13.9) h,1.4(0.6-1.8) vs 0.8(0.4-1.0) h,0.14(0.08-0.17) vs 0.11(0.07-0.13) h,27.2(24.9-26.8) vs 10.4(5.9 14.0) h,Z=12.525,4.359,3.528 and 12.588,all P＜0.01].The proportions of intrapartum interventions and application of labor analgesia were both higher in the study group than in the control [97.5％(78/80) vs 32.5％(52/160),42.5％(34/80) vs 11.9％(19/160),x2=90.764 and 29.071,both P＜0.01].Higher incidences of intrapartum fever [18.8％(15/80) vs 5.6％(9/160),x2=10.208],episiotomy [50.0％(40/80) vs 25.6％(41/160),22=14.172],assisted vaginal delivery [26.3％(21/80) vs 10.0％(16/160),x2=10.800],postpartum hemorrhage [32.5％(26/80) vs 8.1％(13/160),x2=23.284],and cervical laceration [15.0％(12/80) vs 3.1％(5/160),~=11.427] were shown in the study group than in the control (all P＜0.01).There was no statistically significant difference was found in the rate of fetal distress,neonatal asphyxia and neonatal intensive care unit (NICU) admission between the study and control group (all P＞0.05) except for newborns' birth weight [(3 542±388) vs (3 431 ±368) g,t=2.162,P=0.032].However,the incidences of postpartum hemorrhage,intrapartum fever and neonatal admission to NICU were comparable between the study (n=20) and CS group (both P＞0.05).Within the study group,the durations of second stage of labor in women with postpartum hemorrhage,assisted vaginal delivery and episiotomy were significantly longer than those without [1.8(0.9-3.1) vs 1.2(0.5-1.5) h,2.0(0.8-3.4) vs 1.2(0.5-1.6) h,1.7(0.6-2.6) vs 1.1(0.5-1.5) h,Z=2.168,2.756 and 1.891,all P＜0.05].Conclusions After the application of new partogram,vaginal delivery remains possible for pregnant women whose total stage of labor over 24 hours without increase of neonatal morbidity.However,the incidences of postpartum hemorrhage,episiotomy and assisted vaginal delivery may rise up.

Abdominal aortic aneurysm (AAA) is a common fatal aortic disease.The rupture of AAA is the procession affected by multiple factors.Besides physiological,pathological and biochemical changes,morphological and biomechanical alteration can also influence this procession.The progress of rupture risk evaluation through morphological and biomechanical characteristics of AAA were reviewed in this article.

Objective To investigate relationships between serum asymmetric dimethylarginine (ADMA) and transient ischemic attack (TIA).Methods Forty hcalthy controls and 40 patients with TIA were enrolled in the present study.ABCD2 score was used to evaluate risk for future stroke.Serum ADMA levels were measured with ELISA analysis.Results Serum level of ADMA was higher in TIA group than that in control group [(0.52 ± 0.06) mmol/L vs (0.23 ± 0.04) mmol/L,P ＜ 0.05].In TIA subgroup,19 cases(47.5％)developed cerebral infarction and 23 cases(57.5％)had no stroke history.There is positive correlation between serum ADMA levels and ABCD2 score in both cerebral infarction subjects (r =0.560,P =0.013),and no stroke history cases(r =0.602,P =0.002).TIA subjects were,then,divided in to two groups based on ABCD2 score as 0-3 group and ≥ 4 group.In general linear model analysis,ADMA level was associated with ABCD2 score (F =4.39,P =0.043) after adjusted for age and gender.This situation hold true for subjects within cerebral infarction group (F =7.327,P =0.017) or non-previous stroke group(F =12.300,P =0.002).No association could bc found between ADMA level and ABCD2 score grouping in subjects with non-infarct (F =0.523,P =0.675) or stroke history (F =0.274,P =0.609).Conclusions Elevated ADMA is associated with occurrence of TIA.Endothelial dysfunction may play an important role in the pathogenesis of TIA.

Objective To investigate the electromyographic changes in the anterior temporal and masseter muscles of patients with long-term unilateral mandibular first molar loss. Methods Eighteen patients with one-year or more than one-year loss of unilateral mandibular first molar were selected as experimental group,and eighteen volunteers from similar places,had similar dietary habits in the same age and gender with normal occlusion were recruited as control group. Surface electromyography was used for the evaluation of the electrical activities of bilateral anterior temporal and masseter muscles in mandibular postural position ( MPP ) , maximal clenching in intercuspal position ( ICP) and masticating situations. The data were analyzed using SPSS 17. 0 software package to compare the differ-ences among groups. Results The average electrical activities of anterior temporal and masseter muscles in MPP of experimental group were significantly higher than the contral group,and the missing side was higher than the non-missing side ( P <0. 05 ) . The average electrical activities of anterior temporal and masseter muscles in maximal clenching and masticating were significantly lower than the control group,especially in the masticating situation( P<0. 05 ) . The asymmetry index of anterior temporal muscles and masseter muscles in MPP and maximal clenching were significantly different(P<0. 05). Conclusion Long-term loss of unilateral mandibular first molar can affect the electrical activities of the anterior temporal muscles and masseter muscles in the experimental group,especially for the missing side and in the masticating situation. These results also suggest that it might be one of the potential factors on mastication system disorders.

ObjectiveTo explore the effect of peridural injection on acute herniation of intervertebral disc.Methods60 cases of acute herniation of intervertebral disc were divided into two groups,including 30 cases of the peridural injection treatment group and 30 cases of the traditional treatment group. The clinical symptoms and signs were assessed before and after treatment.ResultsThe peridural injection restrained pain rapidly and shorten the period of treatment. The eminent rate was 83.4%. The index and rate in improvement and efficiency of peridural injection group were higher than that of traditional group. The course of treatment in hospital in peridural injection group was shorter than that in traditional group.ConclusionsThe peridural injection has preferable clinical curative effect in herniation of intervertebral disc.

Acute respiratory distress syndrome is an acute,progressive and inflammatory process of lung injury.The disease is very serious with the neonatal mortality as high as 30％-60％.In recent years,with the development of the study on the mechanisms of newborns with acute respiratory distress syndrome,a lot of new viewpoints on diagnosis and treatments have been explored.This review focuses on the recent advances on new mechanisms,diagnosis and therapy strategies of acute respiratory distress syndrome.

Objective To investigate the clinical and electrophysiological characteristics of upper motor neuron-dominant amyotrophic lateral sclerosis (UMN-D ALS ).Methods The clinical and electrophysiological characteristics were analyzed retrospectively in 76 patients with UMN-D ALS and 19 patients with primary lateral sclerosis (PLS).Electrophysiological study included the examination of median nerve,ulnar nerve,tibial nerve,peroneal nerve and sural nerve except for the electromyogram of bulbar region,cervical region,thoracic region and lumbosacral region.Results The diagnosis in 8 PLS patients were changed to UMN-D ALS after detailed review.In UMN-D ALS patients,there were more females in age group of older than 40 (male:female =1∶1.37) and 32 patients (38.1％) had onset with bulbar dysfunction.UMN-D ALS patients showed electromyograph evidence of denervation at 30 months (median)after onset,and clinical lower motor neuron (LMN) signs 6 months later.Seventy-seven patients (91.6％)developed LMN sign by 4 years from symptom onset.ALS functional rating score-revised changed from 40 ±3 to 32 ±4 in 4 years in U MN-D ALS patients (t =1.83,P ＜ 0.05 ).The amplitude of motor unit action potential (MUAP) on the first interosseus dorsalis was higher (( 1003.7 ± 25.2) μV vs (353.5 ±21.5) μV,t=2.34,P ＜0.05) and the duration of MUAP was longer ((19.8 ±2.3) ms vs (9.6 ±1.3) ms,t =1.85,P ＜0.05 ) in UMN-D ALS patients than in PLS patients.Conclusions UMN-D ALS occurs more in female cases,with more bulbar onset and with faster progression than PLS does.It also presents focal denervation in electromyograph.

Objective To identify the patterns of population distribution and the relationship of copper-zinc superoxide dismutase 1 (SOD1) mutations and clinical phenotypes in Chinese patients with familial amyotrophic lateral sclerosis (FALS).Methods The clinical data of 43 FALS families from 2008 to 2011 were collected,SOD1 gene mutations in the probands were screened with PCR and direct sequencing,and the correlations of genotype-phenotype were analyzed.Results All 43 FALS families were autosomal dominant inheritance.The male to female ratio for probands was 1∶0.6,and the average onset age was (48.1 ± 11.8) years.Upper limb onset accounted for 53.5％,lower limb onset 41.9％,and bulbar onset 4.6％.Nine mutation types including 8 missense mutations and 1 deletion mutation were detected in 10 probands.The detection rate of SOD1 mutations in this cohort was 23.3％.Conclusions The study reported the correlations of genotype-phenotype of SOD1 in a larger group of Chinese FALS patients.Two novel mutations were found including one deletion mutation.SOD1 mutations increased from 11 to 19 in Chinese FALS.For SOD1 patients,lower motor neuron signs usually predominated.Most clinical phenotypes of one mutation varied greatly in different families even in the same family.

Objective To analyze the phenotype and genatics in a Chinese family with early-onset familial Alzheimer's disease(EOFAD). Methods Peripheral blood were collected in available members in the family and genomic DNA was extracted. PCR-sequencing of exon 16 and exon 17 of the amyloid precursor protein(APP) gene, presenilin 1 (PSEN1), and presenilin 2 (PSEN2) was performed. Results At age 40, two EOFAD patients (siblings) in the family developed an insidious onset of difficulties in memory. One ( Ⅱ3 in the pedigree) showed blinking. The other ( Ⅱ 5 ) showed irritability and bradykinesia.Progressive diffuse coritcal atrophy in bilateral temporal cortex was observed. Moderate diffuse cerebral dysfunction was observed in Ⅱ3 by the electroencephalogram study and neuropsychological assessments.Sequencing revealed that both patients were heterozygous for a mutation c. 2343 G ＞ A in exon 17 of APP,causing the amino acid substitution Val715Met. Four members ( Ⅱ1, Ⅱ 3, Ⅱ 5 and Ⅲ1 ) were homozygous for ApoE ε4 allele. Ⅱ9 was ε2/ε4. Conclusions This study identified a mutation, Val715Met in the APP gene in Chinese patients with EOFAD. We suggest screening for APP gene mutations in Chinese patients with EOFAD.

Objective To investigate the clinical epidemiological characteristics of gastric carcinoma detected by endoscopy in Gansu province.Methods Data of patients with gastric carcinoma,which was detected by endoscopy and confirmed pathologically from January 1977 to December 2006 in 163 hospitals of Gansu province,were reviewed.The endoscopic findings,clinical manifestations and epidemiological features were retrospectively analyzed.Results A total of 34,116 patients were diagnosed as gastric carcinoma with the overall screening rate as 5.30%,which was decreasing in the recent years.The rate of cardiac and noncardiac cancer was 18.5%and 81.5%,respectively,and the rate of cardiac cancer raised from 16.1%to 20.0%in the last decade.The tumor was most likely detected in antrum(38.63%).The male/female ratio of gastric cancer is 3.56:1.The screening rate of gastric carcinoma was the highest in Wuwei district (8.19%).The poorly differentiated adenocarcinoma accounted for 49.64%in all patients.Conclusion Gastric carcinoma occurs most frequently in Wuwei district of Gansu province and was mostly detected in gastric antrum.The most common pathological type is poorly differentiated adenocarcinoma.In the past three decades,the detection rate of gastric cancer is decreasing,SO is that of cardiac cancer,and that of the early gastric cancer is relatively low.