目的观察旋转振动扫痰仪预防长期卧床老年患者坠积性肺炎的临床效果。方法将182例老年脑卒中偏瘫患者(年龄56～91岁)分为治疗组(117例)和对照组(65例)。治疗组采用旋转振动扫痰仪治疗,每次10min,1～2次/d;对照组采用传统护理方法预防坠积性肺炎。结果对照组发生坠积性肺炎5例,治疗组无1例发生,治疗组治疗效果优于对照组(P<0.05)。结论旋转振动扫痰仪对预防长期卧床老年患者坠积性肺炎有良好效果。

Objective To investigate the incidence and pregnant outcome on vaginal birth after cesarean (VBAC). Methods From January 2005 to December 2015, clinical data of 507 cases with VBAC in West China Second Hospital were studied retrospectively. There were 370 cases of VBAC from January 2013 to December 2015 as study group (VBAC group), in contrast, 740 cases of elective repeat cesarean section (ERCS group) and 740 primiparas of vaginal delivery without history of cesarean section as control groups, the pregnancy outcome were analyzed between the study group and control groups respectively. Results (1) There were 76 547 total births from January 2005 to December 2015. Among these, 10 178 (13.296%, 10 178/76 547) patients had a single prior low transverse cesarean section, of which 4.981%(507/10 178) had VBAC. The incidence of VBAC was rising from 1.020%-3.704%during 2005-2012 to 6.028%-7.662% during 2013-2015. The rate of scared uterus during 2013-2015 was 18.269% (5 539/30 319), of which 9.26%(513/5 539) chose trial of labor after cesarean section (TOLAC). Successful VBAC occurred in 72.12%(370/513) of patients with TOLAC, and 27.88%(143/513) delivered by emergency cesarean. (2) The following parameters of the successful group and the unsuccessful VBAC group were compared, maternal age (29±4) versus (34±4) years, body mass index at prenatal visit (22.2±1.4) versus (22.6±1.4) kg/m2, gestational age (38.7±0.9) versus (39.6±1.3) weeks, birth weight (3 326±317) versus (3 404±285) g, and the rate of induction of labor 0 (0/370) and 6.29%(9/143), there were significant differences (all P<0.01). There was no statistical difference between two group for lower uterine segment (P=0.947). (3) The duration of labor of VBAC group and 740 primiparas of vaginal delivery without history of cesarean section was compared, (10.3± 1.8) versus (11.5 ± 2.0) hours, there was significant difference (P<0.01). There were no statistical difference between two groups for the following parameters, including postpartum hemorrhage, hospitalization duration, the ratio of 5-minute Apgar score≥8, neonatal admission rate (all P>0.05). (4) The postpartum hemorrhage and hospitalization duration in VBAC group incidence were respectively (194±34) ml and (2.32±0.49) days, and the indexes of the ERCS group were respectively (419 ± 57) ml and (4.14 ± 0.78) days, there were significant differences (all P<0.01). There were no statistical difference between two groups for the ratio of 5-minute Apgar score≥8 and neonatal admission rate (all P>0.05). Conclusions The majority of patients choose ERCS rather than TOLAC. It′s important to assess the indications and contraindications of patients for the successful VBAC, and to monitor maternal and fetal conditions during the delivery process. The premise of TOLAC is a comprehensive understanding of closely monitoring the progress of delivery. Compared with the ERCS, VBAC could reduce patients′ postpartum hemorrhage and hospitalization duration, improve the outcomes of pregnancy, and the cesarean section rate could be reduced.

Objective To explore the effects of low serum-albumin on maternal and neonatal outcomes in severe pre-eclampsia. Methods Two hundred and thirty-three women with severe preeclampsia admitted to our hospital from Jan. 2000 to Mar. 2006 were retrospectively investigated and were divided into two groups according to the serum-albumin level: low serum-albumin group (Group A, n= 133) and normal serum-albumin group (Group B, n=90). Maternal and fetal outcomes were compared between the two groups. Results The proportion of women with abnormal retention of fluid (6.8%, vs 0), elevated liver enzymes (60.9% vs 38.9%) renal involvement (30.1% vs 11.1%) and complications (23.3% vs 11.1%) (placental abruption and postpartum hemorrhage) in group A were significantly higher than those in group B (all P<0. 05). Birth weight in group A was lower than that in group B[(2192. 78±795. 31) g vs (2454. 92±776. 24) g, P<0. 05] and neonatal mortality in group A was higher (26.0%vs 13. 6%, P<0. 05). Conclusions Severe pre-eclampsia with low serum-albumin is associated with severe maternal and neonatal outcomes. Appropriate termination of pregnancy should be considered following adequate and careful assessment of maternal and fetal well-being in order to improve perinatal outcomes.

Objective To investigate the effects of different glucose concentration on EGR2 protein expression in Schwann cells . Methods Schwann cells were cultured in different glucose concentrations ,and they were divided into two groups ,normal glucose concentration (5 .5 mmol/L ,N group) and high glucose concentration(25 mmol/L ,H group) .Immunocytochemistry and Western blot were used to study EGR2 expression .Results The expression of EGR2 protein was higher in H group than that in N group the difference was statistically significont (P<0 .05) .Conclusion High glucose can lead to EGR2 protein upregulate in Schwann cells ,and EGR2 maybe one of the reasons of diabetic neuropathy .

Objective To explore the clinical characteristics and pregnancy outcomes of twin pregnancies complicated with severe preeclampsia.Methods The pregnant outcomes of 131 twin pregnancies (twin group) and 572 singleton pregnancies (singleton group),all complicated with severe preeclampsia,were analyzed retrospectively.All patients were treated in the Department of Obstetrics and Gynecology,West China Second University Hospital,Sichuan University from June 2007 to June 2011.The patients' age,onset of disease,gestational weeks at delivery,mean duration of expectant treatment,blood pressure,laboratory parameters and incidence of pregnancy complications,including placental abruption,heart failure,pulmonary edema,postpartum hemorrhage,uteroplacental apoplexy,eclampsia,HELLP syndrome (hemolysis,elevated liver enzymes and low platelets syndrome),hypoproteinemia,retinopathy,intracranial hemorrhage and renal insufficiency,were compared between the two groups.Perinatal outcomes such as premature delivery,perinatal mortality,neonatal intensive care unit (NICU) hospitalization,fetal distress,hypoxic-ischemic encephalopathy (HIE),asphyxia neonatorum,neonatal pneumonia,hyperbilirubinemia and neonatal hypoglycemia of two groups were also compared.Chi-square test,Fisher's exact test or t-test were used for statistical analysis.Results The severe preeclampsia incidence of twin pregnancies (5.03％,131/2604) was higher than that (1.94％,572/29 452) of singleton pregnancy (x2=106.40,P＜0.001).The onset time [(33.6±1.8) weeks] and gestations at delivery [(34.6±2.9) weeks] in twin group were earlier than those in singleton group [(34.4± 2.0) weeks,t=2.364,P＜0.05; (35.6±3.2) weeks,t=3.902,P＜0.05].The duration of expectant treatment of twin group [(6.4±0.3) d] were shorter than that of singleton group [(7.4± 0.5) d,t=5.314,P＜0.01].The incidence of placental abruption [9.9％ (13/131) vs 4.2％ (24/572),x2=7.013,P＜0.01],heart failure [11.5％ (15/131) vs 3.2％ (18/572),x2=16.430,P＜0.01],pulmonary edema [4.6％ (6/131) vs 0.9％ (5/572),x2=9.505,P＜0.01],postpartum hemorrhage [16.0％ (21/131) vs 7.0％ (40/572),x2 =10.990,P ＜ 0.01] and uteroplacental apoplexy [5.3％ (7/131) vs 0.5％ (3/572),x2 =17.650,P＜0.01] of twin group were higher than those of singleton group,respectively.The incidence of premature delivery [77.1％ (202/262) vs 29.9％ (171/572),x2=162.000,P＜0.05],NICU hospitalization [76.2％ (205/262) vs 58.4％(332/572),x2 =31.980,P＜0.05] and HIE [8.4％ (22/262) vs 4.7％ (27/572),x2 =4.392,P＜0.05] of twin group were higher than those of singleton group,respectively.Conclusions Twin pregnancy women are more likely to be complicated with severe preeclampsia and more vulnerable to suffer from severe complications,resulting in poor perinatal outcomes.More attentions should be paid on the management of twin pregnancy.Once hypertensive disorders complicating pregnancy is diagnosed,active management should be provided and timing of termination should be considered.

AIM: To investigate the role of brainstem auditory evoked potential(BAEP) in the early diagnosis of diabetic central neuropathy (DCN) and to probe into the relationship between plasma nitric oxide (NO) and DCN. METHODS: Experimental diabetes(ED) rat model was used. BAEP and plasma NO were measured dynamically after ED modeling. RESULTS: The peak latency (PL) of Ⅰ, Ⅲ, Ⅳ and V and the interpeak latency (IPL) of I-III and III-V of BAEP in ED group prolonged after 4 weeks of ED modeling (P

AIM: To investigate the role of brainstem auditory evoked potential(BAEP) in the early diagnosis of diabetic central neuropathy (DCN) and to probe into the relationship between plasma nitric oxide (NO) and DCN. METHODS: Experimental diabetes(ED) rat model was used. BAEP and plasma NO were measured dynamically after ED modeling. RESULTS: The peak latency (PL) of Ⅰ, Ⅲ, Ⅳ and V and the interpeak latency (IPL) of I-III and III-V of BAEP in ED group prolonged after 4 weeks of ED modeling (P＜0.05). All PL and IPL of BAEP prolonged after 6 weeks、8 weeks and 10 weeks (P＜0.01). The plasma NO increased to the top in ED group at 2 weeks and then decreased gradually. There was negative correlation between plasma NO and PL and IPL of BAEP. CONCLUSION: BAEP was sensitive and valuable in the early diagnosis of DCN. Reduction of plasma NO may play a role in the pathogenesis of DCN.

Objective To find out the bacterial species in the vagina of postpartum women and the possible influencing factors on colonization. Methods From Jun. 2007 to Oct. 2007, 560 postparmm women from 7 hospitals in China were enrolled. Questionnaire survey, gynecological examination and Nngent score of vaginal smear and microbial spectrum study of the vaginal flora were completed. Results (1 ) According to the Nngent score, 48 out of the 560 women were normal (8.6%), 337 at the borderline (60. 2% ) and 175 (31.2%) were complicated with bacterial vaginosis (BV). Among the 560 women, Bacterium lacticum were identified in 74 cases (13. 2% ), but not in the rest 486 cases (86. 8% ). Gardnerella and bacteroids were detected in 322 women (57. 5% ) and small flectobacillus in 214 women (38. 2% ) out of the 560 subjects. (2) Influencing factors on vaginal microflora: among the 266 women who had normal vaginal delivery, 23 (9. 4% ) showed normal vaginal microflora, 148 (55.6% ) at borderline and BV was diagnosed in 93 women (35.0%). The corresponding figures among the 294 women who underwent cesarean section were 23 (7. 8% ), 189 (64. 3% ) and 82(27.9% ), respectively. However, the incidence of BV had no statistical difference between these two groups (P = 0. 204). In the 233 women who received episiotomy, 22 (9. 4% ) showed normal vaginal microflora, 135 (57.9%) at borderline and 76 presented with BV (32. 6% ), the corresponding figures among the 327 women without episiotomy were 26 (8. 0% ), 202 (61.8%) and 99 (30. 2% ), respectively. The incidence of BV did not show any statistical difference between the above two groups (P = 0. 790 ). (3 ) Prenatal vaginitis were reported in 46 women, among which 5 (10.9%) with normal vaginal flora, 26 (56.5%) at borderline and 15 (32.6%) with BV, and again in the 514 women without prenatal vaginits, the above figures changed to 43 (8.4%) , 311 (60. 5% ) and 160 (31.1%). No significant difference was found in the incidence of BV between the two groups (P =0. 962). The rate of BV in women without sex, with sex occasionally and with sex frequently during pregnancy was 27.5% (78/284), 35.6% (96/270) and 1/6, respectively (P = O. 185), and the numbers in women who had breast-feeding, bottle feeding and mixed feeding were 31.0% (67/216), 39.3% (35/89) and 28.6% (73/255), respectively (P=0.573). Conclusions The amount of Lactobacillus in vagina of postpartum women is greatly reduced leading to dysbacteria. The incidence of BV is not affected by vaginal delivery, episiotomy, vaginitis, prenatal intercourse and the way of feeding, but is higher in postpartum women.

Objective To explore the effects of the new melatonin nonselective agonists Neu-P11 on intraocular pressure (IOP) and glial fibrillary acid protein (GFAP) expression in the retina of acute high IOP rat.Methods Twenty-four male Sprague-Dawley rats were randomly divided into 4 groups (6 cases in each group):Normal IOP with local treatment (NIL) group,high IOP with local treatment (HIL) group,HILwith melatonin treatment (HIL-M) group,HIL with Neu-P11 treatment (HIL-N) group.10 μL normal saline was instilled in NIL group and HIL group,while 10 μL 100 μmol · L-1 Mel/Neu-P11 treated in HIL-M group and HIL-N group.After 2 hours of rest,rats were placed in the Trendelenburg position duration 45 minutes.And then,IOP was measured every hour for 6 hours,and repeated it for a week.The excessive sodium pentobarbital was injected to SD rats at the end of the experiment.The rat eyeballs were took out to perform HE and immunohistochemical staining to detect retina GFAP protein expression.Results After a week,IOP in HIL group was (41.26 ± 1.73) mmHg (1 kPa =7.5 mmHg),NIL group was (13.61 ± 0.55) mmHg,which mean the Trendelenburg could induce high IOP in SD rats.Compared with the NIL group,the retinal becoming thick,the level of organization was not clear and the expression of GFAP protein was quite high in HIL group.At the same time,the GFAP protein expression and IOP were significantly weakened in HIL-M group and HIL-N group compared with HIL group.Conclusion Neu-P1 1 can reduce IOP,inhibit the activation of gliocyte,and decrease the expression of GFAP to protect the retina.

Aim To explore the effect of Neu-P11,a novel melatonin agonist with similar function of melatonin,on IOP of acute high IOP animals and the related mechanism.Methods The experiment used the Trendelenburg position(head low feet high position of 80°)to establish acute high IOP model.Rats were placed in the Trendelenburg position and used Tonopen XL contact tonometer to measure IOP(every 5 minutes measured once IOP,and the maximum value in 20 minutes)in 8 :00～9 :00 am.And then,thirty Sprague-Dawley rats(8 week-old)were divided into five groups: normal IOP+normal saline,high IOP+normal saline,high IOP+10 mg·kg-1 Mel,high IOP+20 mg·kg-1 Neu-P11,high IOP+50 mg·kg-1 Neu-P11.Put in a flat to rest 2 h,animals were placed in Trendelenburg position again and then,IOP was measured every hour in the flat by 6 hours.After excessive sodium pentobarbital administration continuous for 1 week,the serum was collected and stored for subsequent detection at the end of the experiment.The level of MDA,SOD and GSH-Px enzyme activity of the rat serum was tested by kit accordingly.HE staining method was used to identify the SD rat retinal morphological changes.Results Trendelenburg position could induce IOP of model group rats,which was increased by 202.9％(P<0.01)and the content of MDA,reduced the activity of SOD and GSH-Px enzyme,retinal thickening was observed and its level was not clear.Neu-P11/Mel could significantly improve oxidative stress level and retinal edema in rats.Conclusion Neu-P11 could reduce IOP of the acute high IOP animals,which might be involved in the lower level of oxidative stress in the body.