Objective:To investigate the influence of free position delivery on maternal labor pain, labor control, maternal and infant outcomes and pelvic floor muscle function.Methods:Forty-eight pregnant women who took delivery in free position in the Third People′s Hospital of Bengbu from April to December 2018 were selected as the study group, and 48 pregnant women who took sitting position delivery at the same period were selected as the control group at a 1∶1 ratio. The pregnancy outcomes of the two groups were compared. The duration of labor time and the amount of bleeding were observed. Simplified McGill Pain Questionnaire (SF-MPQ) and labor agentry cale (LAS) were used to evaluate the pain and the labor control of mothers 2 h after delivery. The neonatal asphyxia was evaluated by neonatal Apgar score. The Hamilton anxiety scale (HAMA) and the Hamilton depression scale (HAMD) were used to evaluate the anxiety and depression status of mothers in the two groups 6 weeks after the delivery. The pelvic floor muscle function of the pregnant women in the two groups was compared 6 weeks after the delivery.Results:The rate of maternal transfer to cesarean section in the study group was lower than that in the control group [4.17%(2/48) vs. 16.67%(8/48)] , and the difference was statistically significant ( χ2 = 4.019, P = 0.045). The time of the first and the second stage of labor, the total duration of labor, and the amount of bleeding in the study group were lower than those in the control group [(472.69 ± 55.24) min vs. (515.25 ± 67.26) min, (43.26 ± 5.23) min vs. (52.34 ± 5.56) min, (535.24 ± 38.22) min vs. (582.68 ± 40.16) min, (179.12 ± 25.65) ml vs. (195.34 ± 24.31) ml], and the differences were statistically significant ( P<0.05). There was no statistically significant difference in the time of the third stage of labor between the two groups ( P>0.05). After the delivery, the scores of verbal response scale (VRS), visual analogue scale (VAS), present pain intensity scale (PPI) and HAMA, HAMD in the study group were lower than those of the control group [(6.24 ± 1.21) scores vs. (7.68 ± 1.32) scores, (21.25 ± 2.98) scores vs.(27.95 ± 3.75) scores, (2.78 ± 0.29) scores vs. (3.49 ± 0.85) scores, (6.35 ± 0.18) scores vs. (7.54 ± 0.16) scores, (4.38 ± 0.12)scores vs.(5.54 ± 0.25) scores], the score LAS in the study group was higher than that of the control group [(175.18 ± 15.64) scores vs. (122.65 ± 14.85) scores], and the differences were statistically significant ( P<0.05). The Apgar scores of neonates in the study group was higher than that of the control group at 1 min and 5 min after the delivery, but there was no statistically significant difference ( P>0.05). There was no statistically significant difference in abnormal pelvic floor muscle strength, muscle strength fatigue and abnormal vaginal pressure between the two groups ( P>0.05). The incidence of adverse outcomes in the study group was lower than that in the control group [13.04%(6/46) vs. 35.00%(14/40)] ( P<0.05). Conclusions:Free posture delivery can reduce the rate of transfer to cesarean section, shorten the delivery process, and reduce the amount of bleeding. It also can alleviate the anxiety, pain of mothers, increase the labor control, and reduce the incidence of adverse labor outcomes, but its impact on maternal pelvic floor muscle function needs to be further explored.

ObjectiveTo evaluate endovascular stenting for TASC TASC Ⅱ C/D femoropopliteal arterial disease.MethodsBetween January 2008 and June 2011,Endovascular treatments of 51 limbs TASC Ⅱ C/D femoropopliteal artery occlusions in 46 patients(27 male and 19 female) were retrospectively reviewed.Mean age was (70 ± 8 ) years ( range,52 years to 88 years).Severe intermittent claudication,rest pain,minor tissue defect and foot ulceration or gangrene were in 29 limbs,12 limbs,6 limbs and 4 limbs,respectively. Technical success rate,ankle brachial index (ABI),complication rate, and cumulative primary patency rate were evaluated. ResultsTechnical success rate was 90.2％.93 stents were placed in 46 limbs of the 42 patients.Postoperative ABI was increased in all patients.42 patients(46 lower limbs) were followed up for a mean period of 14.6 months.Primary,assisted-primary,and cumulative patency rates at 6 months were 81.0％,88.1％ and 90.5％.Primary,assisted-primary,and cumulative patency rates at 12 months were 66.7％,71.8％ and 79.5％ respectively. ConclusionsEndovascular treatment of TASC Ⅱ C/D femoropopliteal arterial lesions is microinvasive,safe and effective.

Objectives To evaluate the safety and efficacy of endovascular angioplasty for extracranial vertebral artery ( VA ) stenosis caused by atherosclerosis. Methods We analyzed retrospectively data of the 24 patients with extracranial vertebral artery stenosis who had been placed endovascular angioplasty from April 2006 to March 2010. According to Mori classification, there were 21 type A and 3 type B among all cases.The artery stenosis rate was 60％ -95％ , the average was 79％ ± 10％. Results Twenty-four balloon mounted stents were placed, the successful rate was 100％. Postoperatively the stenosis rate decreased to 4％ ± 6％. Patients were followed up from 3 to 36 months, the average was 22 months. Symptomes disappeared in 15 out of 17 patients. Postoperative restenosis on the treatment site with transient brain ischemia occurred in one patient. The symptoms in another patient of multiple cerebral infarction with ataxia and episodic vertigo were not relieved, although the patient didn't suffer from apoplectic seizure after the intervention. Postoperative color Doppler ultrasound revealed an over 50％ residual stenosis in 5 patients. The postoperative restenosis rate was 20. 8％. According to Malek scoring, 22 patients were scored 1 point, 1 patient scored 2 and one scored 4. Conclusions Endovascular angioplasty with stent placement is a safe and effective treatment. The restenosis rate could be futher reduced by technology improvement.

Objectives To compare Doppler noninvasive vascular testing and computed tomographic angiography(CTA) with vascular angiography in the assessment of arteriosclerotic occlusion of the lower limbs. Methods In this study 97 lower extremities in 64 patients suffering from arteriosclerotic occlusion underwent both Doppler and CTA plus angiography. Angiogram results were taken as golden standard.The sensitivity and specificity of Doppler was calculated,the diagnostic accuracy of Doppler scanning and CTA plus angiography was calculated and compared.The statistic analysis was performed using x2 test in SPSS 16.0 format. Results Compared with CTA,Doppler scanning is equally accurate at the segments of iliac artery,common femoral artery,superficial femoral artery,dorsal pedis artery and posterior tibial artery (P ＞ 0.05).At segment of popliteal artery,Doppler scanning yields more accurate results (P ＜0.05 ). Conclusions Being noninvasive convenient and of good accuracy,Doppler examination has a role for the diagnosis of arteriosclerotic occlusion of the lower limbs.

Objective To evaluate the safety and efficacy of endovascular intervention to revise peripheral bypass problems through prosthetic approach.Methods Among 17 cases undergoing graft bypass anastomotic stenosis and graft thrombosis was identifled in 16 cases(inflow or outflow obstructive lesions in 10),inflow obstructive lessions in 1(without anastomotic and graft thrombosis).All revision procedures were taken under local anesthesia,16 patients were treated by means of surgical thrombectomy followed by endovascular intervention through prosthesis itself in addition to one who had no thrombectomy.The graft patency and clinical outcome were observed.Resuits Thirteen stents were implanted in 13patients with distal anastomotic stenosis and 1 with proximal anastomotic stenosis including 10 stentings/PTAs in iliac popliteal,posterior tibial or anterior tibial arteries.One stent was implanted in 1 patient with common femoral stenosis.Stenting were not used(abandoned)in 2 patients,of which one underwent a foot amputation and calf gangrene occurred a week later,and the other had a redo of grafting.Follow-up time is 1-35 months.with an average of 12±4 months.One had a below-knee amputation two months after intervention,the other had symptoms recurred and treated with a redo 3 months afterwards.the third died of myocardial infarction six months later.Grafts remained patent in the rest 13 patients at follow-up.Conclusions Endovascular intervention through prosthesis is a safe and effective method,which offers an alternative means to treat anastomotic stenosis.inflow or outflow obstructive lesions.

This article retrospectively analyzed the clinical data of 8 patients with vesicovaginal fistula after radiotherapy for cervical cancer admitted in our hospital from January 2015 to October 2021. All of them underwent cystostomy under local anesthesia. A single J tube of bilateral ureters was retained under cystoscope, and the single J tube was introduced into the fistula bag through the cystostomy opening. All patients wore diapers for a long time before operation, and used urine pads 0-2 pieces/day after operation. QOL score was 5.3±0.5 points before operation, and 2.5±0.5 points after operation. The patient's body odor basically disappeared. The vesicovaginal fistula can be repaired by surgery, but for patients who cannot be operated or failed repeatedly due to various reasons, a single J tube of bilateral ureters can be drawn out through the cystostomy opening, which can improve the quality of life of patients through minor trauma.

Background: Chronic exposure to elevated levels of saturated fatty acids results in pancreatic β-cell senescence. However, targets and effective agents for preventing stearic acid-induced β-cell senescence are still lacking. Although melatonin administration can protect β-cells against lipotoxicity through anti-senescence processes, the precise underlying mechanisms still need to be explored. Therefore, we investigated the anti-senescence effect of melatonin on stearic acid-treated mouse β-cells and elucidated the possible role of microRNAs in this process. Methods: β-Cell senescence was identified by measuring the expression of senescence-related genes and senescence-associated β-galactosidase staining. Gain- and loss-of-function approaches were used to investigate the involvement of microRNAs in stearic acid-evoked β-cell senescence and dysfunction. Bioinformatics analyses and luciferase reporter activity assays were applied to predict the direct targets of microRNAs. Results: Long-term exposure to a high concentration of stearic acid-induced senescence and upregulated miR-146a-5p and miR- 8114 expression in both mouse islets and β-TC6 cell lines. Melatonin effectively suppressed this process and reduced the levels of these two miRNAs. A remarkable reversibility of stearic acid-induced β-cell senescence and dysfunction was observed after silencing miR-146a-5p and miR-8114. Moreover, V-maf musculoaponeurotic fibrosarcoma oncogene homolog A (Mafa) was verified as a direct target of miR-146a-5p and miR-8114. Melatonin also significantly ameliorated senescence and dysfunction in miR-146a-5pand miR-8114-transfected β-cells. Conclusion These data demonstrate that melatonin protects against stearic acid-induced β-cell senescence by inhibiting miR-146a- 5p and miR-8114 and upregulating Mafa expression. This not only provides novel targets for preventing stearic acid-induced β-cell dysfunction, but also points to melatonin as a promising drug to combat type 2 diabetes progression.