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.

Objective To determine the diagnostic value and necessity of excretory phase of CT urogrphy (CTU). Methods One hundred and one cases with 197 sides of cohort CTU studies were enrolled from PACS system retrospectively, and 44 cases had the records of radiation dosage. Three different seniority senior radiologists reviewed the images and diagnosed 2 times blindly with the clinical information. At the first time, plane scan, contrast enhanced renal cortical phase and renal parenchymal phase images (Diag. A) were reviewed. At the second time, with 3 kinds of images mentioned above plus excretive phase images (Diag. B) were reviewed, with interval of 3 months between the two reviews. With Diag. B as reference standard, accordance rate of diagnoses of Diag. A was calculated. The difference of the 3 rediologists's accordance rates were analyzed with Chi-square test, and the lesions with accordance rate ≤80% were recorded. The cases of 197 urinary tracts were divided into 4 groups: lesions of renal pelvic and ureter, lesions of bladder, lesions of kidney and extra-urinary tract, without lesion. The filling of contrast media in the urinary tract was recorded with 5-scale scoring system. The differences of the urinary tract filling among the 4 groups were analyzed with Kruskal-Wallis test. The effective radiation dosages of CTU with and without excretory phase scan were recorded and calculated, and the difference was analyzed with t test. Result The diagnostic accordance rate of CTU with and without excretory phase of the 3 radiologists was 95.4%(188/197), 93.9%(185/197), 92.4%(182/197)respectively(χ2=1.60, P>0.05). Lesions with diagnostic rate≤80%were parapelvic cyst and caliceal diverticulum. The median score of urinary tracts filling in the lesions of renal pelvic and ureter, lesions of bladder, lesions of kidney and extra-urinary tract, without lesion group were 2, 3, 3, 4, and the differences were significant (HC=31.7, P<0.05). The effective radiation dosages of CTU with and without excretory phase scan were (32.36±11.04)mSv and (41.47±14.27) mSv respectively (t=3.35, P<0.01). Conclusions No significant effect of excretive phase imaging is found on the diagnosis of most urinary system diseases. Poor contrast filling and high rate of failure of filling of the urinary tract with intra luminal pathologies, and increase of the radiation dosage make the excretory phase scan in CTU less useful and it should be used carefully and selectively.

Objective To study the features of ventilation function in patients with flail arm syndrome (FAS).Methods The clinical data of 351 patients with sporadic amyotrophic lateral sclcrosis (ALS) fron 2009 to 2013 were retrospectively reviewed.Among them,329 were classical ALS and 22 were FAS.The differences of forced vital capacity (FVC) between FAS and classical ALS were analyzed.Results The percent predicted FVC (FVC％pred) values were (88.0 ±9.5)％ in FAS and (84.3 ± 16.8)％ in classical ALS including 4 and 128 patients with abnormal FVC％ pred (＜80％) in FAS and classical ALS,respectively.The FVC％ pred levels were significantly higher in FAS subjects [(88.0 ± 9.5) ％] than in classical ALS subjects of bulb [(80.0 ± 14.8) ％] or those of upper limb [(80.8 ± 16.0) ％] onset with duration over 12 months (All P ＜ 0.05).The proportion of subjects with FVC％pred ＜ 80％ was statistically lower in FAS [18.2％ (4/22)] than in both classical ALS of upper limb onset [42.8％ (80/187);P=0.037] and classical ALS with duration over one year [48.5％ (48/99);P =0.009].Conclusions Impaired ventilation function occurs less and later in FAS than that in classical ALS of upper limb onset with duration over one year,suggesting later and less requirement for non-invasive positive pressure ventilation treatment for FAS patients.Differentiation of FAS subjects from ALS helps assess prognosis and make treatment plan for these patients.

Objective To investigate the expression and significance of Th9, Th17 and CD4+CD25+Foxp3+regulatory T (Treg) cells as well as the related cytokines (IL-9, IL-17, TGF-β) in peripheral blood of patients with adult primary immune thrombocytopenia ( ITP) . Methods Peripheral blood samples were collected from 47 patients with ITP and 39 age-and sex-matched healthy subjects. The percentages of Th9, Th17 and CD4+CD25+Foxp3+Treg cells in peripheral blood samples were detected with flow cytometry. The levels of IL-9, IL-17 and TGF-βin serum samples were detected by enzyme linked immunosorbent assay ( ELISA) . Results Compared with healthy subjects, the percentages of Th9 and Thl7 cells and the concen-trations of IL-9 and IL-17 in patients with ITP were significantly increased [(1. 27±0. 31)% vs (0. 71± 0. 26)%, P<0. 05;(2. 01±0. 42)% vs (0. 97±0. 32)%, P<0. 05. (26. 52±7. 48) ng/L vs (16. 16± 5. 27) ng/L, P<0. 05;(10. 97±3. 94) ng/L vs (7. 14±2. 73) ng/L, P<0. 05]. The percentages of CD4+CD25+Foxp3+ Treg cells and the concentrations of TGF-β in patients with ITP were lower than those in healthy subjects [(4. 69±0. 85)% vs (7. 16±1. 92)%, P<0. 05. (3. 76±1. 28) μg/L vs (6. 41±1. 83)μg/L, P<0. 05]. Moreover, the blood platelet counts in patients with ITP were negatively correlated with the percentages of Th9 and Th17 cells and the concentrations of IL-9 and IL-17 (γs=-0. 349, P=0. 037;γs=-0. 392, P=0. 031;γs=-0. 436, P=0. 014;γs=-0. 401, P=0. 027), but were positively correlated with the percentages of CD4+CD25+Foxp3+ Treg cells and the concentrations of TGF-β (γs=0. 411, P=0. 024;γs=0. 407, P=0. 026). Conclusion The imbalanced distribution of Th9, Th17 and Treg cells and the abnormal expression of related cytokines (IL-9, IL-17 and TGF-β) in patients with ITP might be the possible immunological pathogenesis of ITP.

AIM:To explore whether histamine can regulate the expression of early growth response factor-1 (Egr-1) in the cerebral cortex astrocytes.METHODS:Normal wild-type (WT) mice, histidine decarboxylase knockout ( HDC-KO) mice and histamine treated HDC-KO mice were sacrificed for extracting the total RNA of the cerebral cortex. Primary cultured rat cortical astrocytes were treated with histamine at concentrations of 10 -8 , 10 -7 , 10 -6 , 10 -5 or 10 -4 mol/L for 15, 30, 60, 120 or 240 min.H1 or H2 receptor antagonists were pretreated for 15 min before histamine treat-ment.After histamine treatment, the cell total RNA or protein was extracted.The expression of Egr-1 at mRNA and protein levels was determined by real-time PCR and Western blot.RESULTS:The mRNA level of Egr-1 in cerebral cortex of HDC-KO mice was significantly lower than that in WT mice, while exogenous histamine induced the mRNA expression of Egr-1 in HDC-KO mice.In cultured astrocytes, histamine induced the mRNA expression of Egr-1.The maximum increase in the mRNA level of Egr-1 was produced by histamine at concentration of 10 -5 mol/L.In addition, histamine-induced Egr-1 mRNA accumulation peaked at 30 min after commencing stimulation, while histamine significantly increased Egr-1 protein expression at 60 min.Furthermore, histamine-induced Egr-1 expression was inhibited by H1 receptor antagonist but not H2 receptor antagonist.CONCLUSION:Histamine up-regulates the Egr-1 expression in cerebral cortex and cultured astrocytes, which may attribute to H1 receptor activation.

Objective To observe the therapeutic effect between less invasive stabilization system (LISS) plate and anatomical plate internal fixation for the treatment of tibial plateau fractures. Methods The clinical data of 58 patients with tibial plateau fractures were retrospectively analyzed. The patients were divided into LISS plate group and anatomical plate group according to the internal fixation method with 29 cases each. The operative time, blood loss, incision length, fracture healing time, postoperative weight-bearing time, postoperative complications and therapeutic effect (according to Rasmussen knee joint function score scale) were compared between 2 groups. Results The operative time, incision length, blood loss and incidence of postoperative complications in LISS plate group were significantly lower than those in anatomical plate group:(68.5 ± 7.1) min vs. (92.3 ± 9.4) min, (5.8 ± 1.4) cm vs. (8.6 ± 2.1) cm, (208.5 ± 27.8) ml vs. (329.7 ± 25.2) ml and 17.2%(5/29) vs. 41.4%(12/29), and the excellent rate was significantly higher than that in anatomical plate group: 86.2% 25/29) vs. 62.1%(18/29), and there were statistical differences (P<0.05);there were no statistical differences in fracture healing time and postoperative weight-bearing time between 2 groups (P>0.05). Conclusions Both of LISS plate and anatomical plate internal fixation for the treatment of tibial plateau fractures have good clinical efficacy, but the LISS plate has advantages of shorter operation time, less tissue trauma, less blood loss, quicker fracture healing and less postoperative adverse reaction.