Objective To study the pain relief effectiveness of the combined spinal epidural analgesia(CSEA) and the inhalation of nitrous oxide, and the influences on the mothers and infants Methods The 300 cases of pregnant women were randomly divided into 3 groups: CSEA group,nitrous oxide group and control group The nitrous oxide group was that pregnant women inhaled nitrous oxide premixed with oxygen (50%∶50%),the pregnant women of the CSEA group were injected fentanyl and bupivacaine in the subarachnoid and epidural space,analgesic was not used in the control group The degree of labor pain, duration of the labor,way of delivery, bleeding volume, rate of anoxia of newborn,blood gas analysis to maternal radius artery and fetal umbilical blood among 3 groups were observed Results The effect for analgesia labor of the CSEA group was much better than that of the nitrous oxide group ( P 0 05) In the second stage of labor,the 3 groups were alike to each other The bleeding volume of caesarean section (373?77) ml in the nitrous oxide group was much more than the other 2 groups, there was no difference between the CSEA group (259?78) ml and the control group (239?89) ml The rate of obstetric forceps of CSEA group was higher than the control group ( P

Objective To compare the consistency of the results of clinical specimens between Tecan Freedom Evolyzer-2200 automated enzyme immunoassay analyzer and manual ELISA method,so as to explore more scientific and reliable test method.Methods Ninety samples were randomly selected from clinical and physical examination,the IMARK2 microplate reader and the instrument operating manual sample measurement was used to test hepatitis A,hepatitis B 5,hepatitis C,hepatitis E 2,TP and HIV,and the results were given correlation and linear regression analysis.Results For the test items of HBsAg,HBsAb,HBeAg,TP,HIV,the correlation coefficient was r2＞ 0.9,the data showed a good correlation,and for HAV-IgM,HBeAb,HBcAb,HCV,HEV-IgM,HEV-IgG,the correlation coefficient was 0.9＞ r 2 ＞ 0.6.Compared with manual method,the total coincidence rate of automated enzyme immunoassay analyzer was 96.9％ in 11 indexes of 90 samples.Conclusions Automatic and manual ELISA method has a good correlation.Automatic ELISA also greatly reduce the labor burden of laboratory personnel,improve efficiency,should be strengthened in clinical practice.

Objective To investigate the ultrasonic atomization anesthesia time guided needle aspiration biopsy for endobronchial ultrasound (EBUS-TBNA) effect of anesthesia in patients. Methods A total of 60 patients of EBUS-TBNA were divided into A group, B group and C group by random digits table method, each group of 20 cases. Three groups of patients were treated with topical anesthesia with 2%lidocaine aerosol inhalation, atomizing inhalation time:A group 20 min;B group 25 min;C group 30 min. Fiberoptic bronchoscopy was performed in accordance with operating procedures after anesthesia. The changes of vital signs were observed. The patients were investigated by questionnaire. Results A, B, C three groups of the highest blood pressure were (141.90±3.24), (132.30±3.06), (131.15±3.42) mmHg (1 mmHg=0.133 kPa), heart rate was (98.25 ± 3.39), (90.50 ± 3.85), (92.20 ± 5.12) beats/min, breath respectively was (20.45±1.43), (19.15±1.23), (19.00±1.38) beats/min, blood oxygen saturation was 0.9150± 0.0248, 0.9750±0.0128, 0.9735±0.0114, the B and C group was more stable than the A group (P<0.05), B, C two groups were not statistically significant (P>0.05). A, B, C three groups of patients with bronchoscopy insert a successful number of cases were 55%(11/20), 90%(18/20), 90%(18/20), A group was lower than B, C two group (χ2=6.144, P<0.05). The subjective comfort of the three groups were (28.40± 1.82), (37.10 ± 2.02), (36.15 ± 1.42)points, A group and B, C two groups were statistically significant (P<0.05), B, C two groups were not statistically significant (P>0.05). There was significant difference in the effect of anesthesia among three groups (Z=2.105, P<0.05). Conclusions Using 2%lidocaine ultrasonic atomization inhalation anesthesia for patients with local anesthesia, the effect of anesthesia is 25 min and the patient′s tolerance is the best.

Objective To establish a real‐time fluorescent polymerase chain reaction and detect 16S rRNA gene of Legionella strains isolated from sputum specimens of patients with pulmonary infection by using this method .Methods 16s rRNA gene of Le‐gionella was used to design primers and probes .The reaction system and reaction conditions were optimized and the specificity ,sen‐sitivity and repeatability of this method were verified by detecting Legionella pneumophila ,non‐Legionella pneumophila and other bacteria .A total of 557 sputum specimens of patients with pulmonary infection were detected ,and PCR‐digestion identification method was carried out as control .Otherwise ,sequences of 16S rRNA were verified in patients with positive detection results .Re‐sults The results showed that all reference strains of Legionella were positive ,while all of other bacteria were negative ,and the sensitivity was 102 CFU/mL .Among sputum specimens collected from 577 cases of patients with pulmonary infection ,the positive rate of Legionella detected by using real‐time fluorescent PCR and PCR‐digestion identification method was 23 .1% and 19 .9% re‐spectively ,while the positive rate was 17 .2% by verifying the sequences of 16s rRNA .There were no statistically significant differ‐ences of positive rate among the three methods(P>0 .05) .Conclusion The real‐time fluorescent PCR is fast and convenient in de‐tection of Legionella strains isolated from sputum specimens of patients ,which could be an assisted method for clinically diagnosing Legionella infection .

Objective: Expression of Bcl\|2 and Bax oncoproteins was tested in laryngeal squamous cell carcinoma (LSCC) in order to find the relationship between the two genes and LSCC, and to explrore their clinical significance by retrospectively study of pathological and clinical doouments. Methods: Immunohistochemical S\|P method was emioyed in testing the expression of Bcl\|2 and Bax oncoproteins in 74 patients with LSCC, 24 laryngeal atypical hyperplasis (LAH) and 24 laryngeal normal membrane (LNM). Results: Bcl\|2 oncoprotein was mainly expressed in cytoplasm of epithelium cells and a small part of cell membrances were stained, appearing brow or yellow, granular distribution.There were no expression in the cell nuclear and stroma. Bax oncoprotein was expressed in cytoplasm and cell membrane and there were a little expression in stroma, appearing light brown and yellow, granular distribution. Bax was less stained than Bcl\|2. The positive expression percentages of Bcl\|2 oncoprotein in LSCC, LAH, LNM tissues were 59.46%,66.67% and 20.83% respectively. The Bcl\|2 expressions in LSCC, LAH tissues were significantly higher than that in LNM (P＜0.05); The positive expression percentages of Bax oncoprotein in these three groups were 56.76%, 50.0% and 66.67% respectively which were no significant difference. The results of Spearman correlated analysis showed that expression of Bcl\|2 and Bax oncoproteins had no obvious correlations with pathological grade, clinical stage and metastasis of lymph node. Both were correlated only with smoking. Conclusions: The imbalance of Bcl\|2/Bax mainly induced by the high expression of Bcl\|2 oncoprotein played an important role in the development of LSCC and LAH, Bcl\|2 may act as a reference index in judging the biological speciality of LSCC; Expressions of Bcl\|2 and Bax oncoprotein had obvious corelation with smoking in LSCC, indicating Bcl\|2 and Bax genes may be a target of carcinogenic substance in tobacco; Expression of Bcl\|2 oncoprotein was blocked may be an important part in studying gene therapy for the future.

Objective To investigate the effects of the transient receptor potential V6 (TRPV6) gene silencing on the proliferation and apoptosis of trophoblasts HTR-8/SVneo cells.Methods siRNA sequences targeting the TRPV6 gene were constructed and then transfected into HTR-8/SVneo cells mediated by liposome.The cells were divided three groups,including blank control (add the reagent of transfenction),negative control groups (transfecting nonspecific siRNA) and experimental groups (transfecting TRPV6-siRNA).Those cells in every group were collected at 24,48,72 hours after transfecting.The expression levels of TRPV6 mRNA were detected by reverse transcription (RT) PCR at different times after transfecting.The effects of siRNA on the proliferation and apoptosis of the cells were assayed by methyl thiagolyl tetragolium (MTT) and flow cytometry at different times after transfecting.Results siRNA TRPV6 transfection could inhibit the expression of TRPV6 mRNA in the HTR-8/SVneo cells.The expression was decreased with the extension of time,by 0.72 ± 0.02,0.54 ± 0.02 and 0.29 ± 0.01 after 12,48 and 72 hours of siRNA transfection as compared with the blank control and the negative control groups (P ＜0.01).The rates of proliferation inhibition were (19.29 ± 1.23) ％,(32.12 ± 1.35) ％ and (46.51 ±1.42) ％ at 24,48 and 72 hours respectively when compared with the blank control (2.12 ± 0.03)％,(2.42 ± 0.02) ％,(3.13 ± 0.04) ％ and the negative control groups (2.37 ± 0.01) ％,(2.61 ± 0.05) ％,(2.93 ± 0.03) ％ (P ＜ 0.01).The apoptosis rates of HTR-8/SVneo cells was 16.21％ at 48 hours after transfected with siRNA TRPV6,which were significantly higher than 3.27％ in the blank control and 5.34％ in the negative control groups (P ＜ 0.05).Conclusion Silenceing of TRPV6 genen could inhibit the proliferation and increase the apoptosis of extravillous trophoblas of human placenta.

The rapidly aging society gives rise to sizable demands for chronic disease nursing care. With IT development as backup, the hospital has developed a platform for regional collaborative nursing informationization within a medical alliance and a health management platform for home care of the elderlies. This practice can build an extended nursing care model, featuring the three main service lines of " hospital-family, hospital-medical alliance and hospital-community hospital-family". The model provides diversified, personalized, disease specific, informationization and multi-disciplinary coverage for nursing care, providing the primary level with high quality nursing resources.Medical alliances and corresponding communities share information, for a full-range, full region and full timeframe coverage of nursing health supervision and scientific guidance, thus effectively minimizing the rate of revisit to upper-level hospitals by patients and implementing the hierarchical medical system.

Objective: To investigate the effect and mechanism of hydroxyfasudi (HF), a specific Rho kinase inhibitor, on lipopolysaccharide(LPS)induced endothelial dysfunction. Methods: A total of 24 male Sprague Dawley rats were randomly divided into control group(n=6), HF group(n=6), LPS group(n=6) and LPS + HF group(n=6) with random number table method. There was no special treatment in control group. HF (30 mg/kg) was injected intraperitoneally in HF group. LPS (1 mg/kg) were injected intravenously in LPS group. In LPS+ HF group, HF (30 mg/kg) was injected intraperitoneally, followed by intravenous LPS injection (1 mg/kg) 30 minutes later. All rats were sacrificed after 8 hours, and aortic tissue was extracted. RT-PCR was performed to detect mRNA levels of Rho-associated coiled-coil protein kinase (ROCK)1, connexin (Cx)43 and caveolin (Cav)1. The protein levers of ROCK1, Cx43 and Cav-1 were assessed by Western blot and immunohistochemical staining respectively. Results: (1) RT-PCR experiments showed that mRNA levels of ROCK1(2.67±0.03 vs. 1.00±0.04), Cx43(1.73±0.03 vs. 1.00±0.08), and Cav1(1.85±0.04 vs. 1.0±0.03) in LPS group were significantly higher than in control group(all P<0.05). mRNA levels of ROCK1(0.38±0.02), Cx43(0.58±0.02), and Cav1(0.27±0.01) in LPS + HF group were significantly lower than in LPS group(all P<0.05). (2)Western blot analysis showed that protein levels of ROCK1(3.46±0.82 vs. 2.19±0.56), Cx43(0.33±0.09 vs.0.11±0.06), and Cav1(3.45±0.74 vs. 2.25±0.91) in LPS group were significantly higher than in control group(all P<0.05). Protein levels of ROCK1(1.09±0.52), Cx43(0.01±0.06), and Cav1(2.06±0.40) in LPS + HF group were significantly lower than in LPS group(all P<0.05). (3) Immunohistochemical staining showed that protein levels of ROCK1(84.1±0.9比53.7±2.9), Cx43(99.1±2.1 vs. 46.2±0.8), and Cav1(167.0±6.4 vs. 84.9±1.0) in LPS group were significantly higher than in control group(all P<0.05). Protein levels of ROCK1(30.4±0.6), Cx43(21.4±1.3), and Cav1(55.8±2.8) in LPS + HF group were significantly lower than in LPS group(all P<0.05). Conclusion HF attenuates LPS induced endothelial dysfunction probably via suppressing the expression of ROCK1, Cx43 and Cav1.

Objective To investigate the current situation of social support for patients with coronary heart disease intervention in different hospitals in Dalian, to analyze the influence of different demographic characteristics on patients' social support, to provide reference for the rehabilitation and management of patients undergoing coronary intervention surgery. Methods From November 15th to 16th, 2017, a cross-sectional unified investigation was carried out in 20 hospitals of different levels in Dalian, patients' general information questionnaire, Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Self-management Behavior Scale (SSRS) and Social Support Rating Scale (SSRS) were adopted. Results The total score of social support was 29.57 ± 12.01 in patients with coronary artery disease and interventional therapy in different hospitals in Dalian area. The scores of social support in patients with different residence area and residence condition were statistically significant (F=1.769, 6.150, P<0.01). The influencing factors of patients'social support were living condition, depression and self-management (r=-0.243,-0.129, 0.255, P<0.05). Conclusion Social support for patients with coronary artery disease intervention in different hospitals in Dalian is at a moderate level. And affected by living conditions, depression, self- management and other factors. Medical staff should formulate corresponding intervention measures to improve their social support level and improve the quality of life of patients.

Objective:To explore the effect of staged intervention based on the theory of planned behavior (TPB) on breastfeeding self-efficacy and exclusive breastfeeding among women with gestational diabetes mellitus (GDM) .Methods:From January to May 2019, continuous sampling was used to select 380 delivery women who were diagnosed with GDM in Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University and met the inclusion and exclusion criteria as the research object. According to the random number table method, the delivery women were divided into the control group and the intervention group, 190 cases in each group. The delivery women in the control group received routine breastfeeding health education, while the delivery women in the intervention group implemented the TPB-based staged intervention on the basis of routine breastfeeding health education. The exclusive breastfeeding rate, knowledge and self-efficacy were compared between the two groups. As of four months postpartum, 169 delivery women were included in the intervention group and 157 delivery women in the control group.Results:The exclusive breastfeeding rate of delivery women in the intervention group at four months postpartum was 63.3% (107/169) , which was higher than that [47.1% (74/157) ] in the control group, with a statistically significant difference ( P<0.05) . The breastfeeding knowledge scores of the intervention group and the control group were (15.01±2.04) and (13.05±2.78) respectively, and the difference was statistically significant ( P<0.01) . The GDM breastfeeding knowledge scores were (8.86±1.85) and (4.80±2.76) , and the difference was statistically significant ( P<0.01) . There were significant differences in breastfeeding self-efficacy scores between the two groups at 38 to 40 weeks before delivery, three days, 42 days, and four months after delivery ( P<0.01) . There were significant differences in the exclusive breastfeeding rates between the two groups of GDM women at different time points ( P<0.05) . Conclusions:The staged intervention based on TPB can improve the effect of breastfeeding in GDM women, enhance maternal knowledge and self-efficacy, and increase the rate of exclusive breastfeeding.