Objective To evaluate factors associated with labor pain and delivery outcomes.Methods From Jul.to Dec.2009,111 normal singleton cephalic presentation pregnancies (including 5 elderly parturient) who delivered at the Department of Obstetrics and Gynecology,Second Affiliated Hospital,Zhejiang Chinese Medical University were enrolled in this study to evaluate the relationship between factors of labor pain and delivery outcomes.The labor pain of latent phase and active phase were scored by the visual analogue scale (VAS).Factors associated with pain included the age of parturient,the number of gravidity and parity,occupation,education profile,dwell location,etc.The questionnaire was designed by ourselves.Childbirth awareness,psychological preparation of delivery,emotional controllability,couple relationship,the relationship of parturient and mother-in-law,the relationship of parturient and parents,family economic status,use of sedative during the labor process and delivery outcomes were collected and analyzed.Results (1)Factors associated with pain:in the latent phase,the rate of moderate labour pain of 1/5 in women with more than 35 years old was statistically lower than 76.4％ ( 81/106 ) in suitable age group (P＜0.05 ).The women with a good understanding about delivery had a statistically lower rate of moderate pain of 64.7％( 44/68 ) than 88.4％ ( 38/43 ) of those having a poor understanding( P＜0.05 ).The women who had a better couple relationship had a significandy higher rate of moderate pain of 77.2％ (78/101) than 4/10 of those who had a general couple relationship ( P＜0.05 ).There was significant difference in rate of moderate pain between pluripara group ( 50.0％,11/22) and primipara group(79.8％,71/89;P＜0.01 ).In the active phase,women with tense,scared or a poor emotion control expressed significantly severe labour pain(59.0％,36/61 ) than 35.6％ ( 16/45 ) in well-prepared group.The rate of severe labour pain in good control of emotion group of 44.8％ (43/96) was a statistically lower than 9/10 in poor control group.There was a statistically lower severe labour pain in women given by sedatives ( 29.2％,7/24 ) than 54.9％ (45/82) in women without sedatives treatment (P ＜ 0.05).(2) Delivery outcomes:in latent phase,the rates of fetal distress and cesarean section were 36.6％ (30/82) and 39.0％ (32/82) in moderate pain group,which were significantly higher than 13.8％ (4/29) and 17.2％ (5/29) in mild pain group.In active phase,the rate of fetal distress,cesarean section and postpartum hemorrhage were 36.5％ ( 19/52),40.4％ (21/52) and 13.5％ (7/52) in severe pain group,which were significantly higher than [18.5％ (10/54) ;20.4％ (11/54) ;0] in moderate pain group (P＜0.05).Conclusions Women with poor understanding of delivery,tense,scared,poor emotion control,young age and uniparous have severe labour pain.Sedative use could alleviate pain in active phase.Women with mild labour pain have good delivery outcomes.

Objective To examine the effects of genetic polymorphisms in GSTM1, GSTT1 and GSTP1 (rs1695) genes on hematologic toxicities of breast cancer patients receiving Anthracycline/Paclitaxel- based chemotherapy. Methods Multiply PCR technique and High Resolution Melting method were used to examine these 3 genes polymorphsim in female breast cancers (n=252). Results The GSTP1(rs1695) AG/GG genotype was a risk factor forⅢ-Ⅳdegree of neu-trophil toxicity when patients received Paclitaxel-based chemotherapy and Anthracycline-Paclitaxel-based chemotherapy (OR=6.111, 95%CI 1.526-24.469, P<0.05 and OR=9.257, 95%CI 2.903-29.522, P<0.01). There were no statistic differ-ence onⅢ-Ⅳdegree hematologic toxicities rates between GSTM1(+) and GSTM1(-), GSTT1(+) and GSTT1(-) patients after they receiced Paclitaxel-based chemotherapy and Anthracycline-Paclitaxel-based chemotherapy( P>0.05);There was no statistic difference onⅢ-Ⅳdegree hematologic toxicities rates between GSTM1(+) and GSTM1(-), GSTT1(+) and GSTT1(-), GSTP1AA and GSTP1AG/GG patients after they receiced Anthracycline-based chemotherapy (P>0.05). Conclusion The genetic polymorphisms in GSTP1(rs1695) can be used as a gene marker for forecasting the chemotherapy, inducing neutrope-nia toxicities in breast cancer patients receiving Paclitaxel-based chemotherapy.

Child ; Humans ; Lymphoma, Follicular ; diagnosis

Objective To observe the level of supportive care need and quality of life in patients postoperation for breast cancer and ac-cepting chemotherapy, and the relationship between them. Methods From September, 2015 to June, 2016, 235 patients with breast cancer af-ter surgery were conveniently sampled, and investigated with the general situation questionnaire, Supportive Care Need Survey Short-form (SCNS-SF34) and Functional Assessment of Cancer Therapy-Breast (FACT-B). Results A total of 230 patients were analyzed. Patients self-reported to need supportive care in all dimensions of SCNS-SF34, and the most frequency was in the health information (31.30％). The score of FACT-B was (93.25±23.53), that needed further improvement. The needs of supportive care in each dimension negatively correlat-ed with the scores of FACT-B in the dimensions (|r|>0.168, P<0.05) except society/family and function. Conclusion The patients with breast cancer need variety of supportive care, which may impact their quality of life.

Objective_To investigate the effects of hypoxia-inducible factor-1 alpha ( HIF-1α) inhibitor YC-1 on hy-poxia induced human pulmonary artery smooth muscle cells ( HPASMCs) proliferation, apoptosis and the expression of P53, and to explore the molecular mechanism in the processes.Methods_HPASMCs were cultured in DMEM me-dium supplemented with 10%FBS in vitro.Then divided them into four groups:normoxia, hypoxia and hypoxia+YC-1(0.01 and 0.05 mmol/L).Cell proliferation was measured by CCK-8 and apoptosis was detected by flow cytom-etry.The expressions of HIF-1αand P53 were tested by Western blot, and the mRNA expression of P53 was tested by RT-PCR.Results_Hypoxia can promote the proliferation of HPASMCs.Treatment of HPASMCs with different concentrations of YC-1 intervention for 24h obviously dropped proliferation rate (P<0.05), and the apoptosis rate increased significantly (P<0.05).YC-1 can also down-regulate the expression of HIF-1αand up-regulate the ex-pression of P53 significantly ( P<0.05 ) .Conclusions_YC-1 can inhibit hypoxia-induced HPASMCs proliferation and promote apoptosis, the mechanism is potentially related to the up-regulation of P53 expression.

Objective To evaluate the imaging findings of thoracic Castleman's disease (CD)to improve the diagnostic accuracy. Methods The imaging findings of 14 cases of thoracic CD confirmed by pathology were analyzed retrospectively.Plain and dynamic contrast-enhanced CT scans were performed in all patients before surgery.Results Among the 14 cases,10 cases were hyaline vascular type (HVT)and other 4 cases were plasma cell type (PCT).HVT-CD showed well-define,homogeneous soft-tissue lesion with different sizes of lymph nodes around the lesions in 2 cases,mottled calcification in 2 cases and coarse calcification in 1 case.Dynamic enhanced CT showed HVT-CD had obvious enhancement in arterial phase,and sustained enhancement in venous phase and delayed phase.PCT-CD all showed enlarged lymph nodes in the mediastinum and bilateral axillary,associated with interstitial pneumonia,pulmonary nodules,ground glass opacity and pleural effusion,with marked and sustained enhancement 1 case.Conclusion Thoracic HVT-CD presents equal density on CT plain scan,and obvious and durative enhanement on multiphase contrast-enhanced CT,which can be accompanied by lymphnodes around the lesions and intratumoral calcification.With the above imaging findings,we should consider the possibility of HVT-CD.CT features of PCT-CD are non-specific,a comprehensive evaluation of the clinical data should be combined,but the obviously enhanced PCT-CD can be diagnosed.

Objective:To explore the etiology, pathogenesis, clinical features, diagnosis and treatment of hepatic sinus obstruction syndrome(HSOS)after orthotopic liver transplantation(OLT).Methods:Clinical data were reviewed for 3 HSOS patients after OLT.Baseline profiles, primary disease, onset, clinical manifestations, abdominal imaging and pathological changes were recorded for summarizing the key points of diagnosis, treatment and outcomes of HSOS after OLT.Results:HSOS was an extremely rare complication after OLT with an incidence of 2%(2/117)and a median onset of 15(13-50)days.The major clinical manifestations were hepatic pain, abdominal distension, poor appetite, fatigue, jaundice, oliguria, peritoneal effusion and pleural effusion.Some of them were complicated with acute renal insufficiency.Abdominal ultrasonography revealed that blood stream of hepatic and portal veins was smooth but rather slow and hepatic parenchyma showed uneven echo changes.Abdominal enhanced computed tomography(CT)demonstrated " mosaic" and " map-like" uneven enhancement in portal vein and balance phases.The pathological manifestations of liver biopsy included obvious dilation and congestion of hepatic sinuses, swelling and necrosis of hepatic cells, thickening of hepatic venules and luminal stenosis or occlusion.All of them received immunosuppressants.Tacrolimus was switched to sirolimus, low molecular weight heparin or plus rivaroxaban anticoagulant thrombolytic therapy, methylprednisolone regulatory immunotherapy, albumin supplementation, diuresis, hepatic protection and fluid replacement.Afterward clinical symptoms of 2 patients improved, became cured and discharged.One case died from gastrointestinal hemorrhage and acute renal failure secondary to multiple organ failure.Conclusions:HSOS is an extremely rare but severe complication after OLT.Early diagnosis and fine-tuning of treatment protocols can avoid poor prognosis such as liver and kidney failure and significantly improve patient survival.

Under the diagnosis-related groups(DRG) prospective payment system, innovative health technologies with high costs and risks may be limited to some extent. How to balance the increase of health care cost and the development of innovative health technology is a difficult problem to be solved in the current reform. By studying the relatively mature payment systems of innovative health technologies in the world, the authors found that countries generally adopted additional payment or compensation to encourage the development of new technologies. But at the same time, a relatively perfect health technology assessment and payment management mechanism had been established to ensure the standardized operation of payment plan. These international advanced experience and practice could provide references for China′s innovative health technology payment strategy under the DRG payment system. It is suggested to establish a scientific and reasonable assessment mechanism of innovative health technology, create a special access channel for innovative health technology with limited short-term evidence, and gradually form a long-term incentive mechanism of innovative health technology in DRG payment system.

Objective: To investigate the current status and influencing factors of basis of the replacement of short peripheral intravenous catheters for clinical nurses and explore the obstruction of the latest guide promoted in practice. Methods: The qualitative research method was adopted, and semistructured interviews were used to interview 11 clinical nurses. Data were analyzed by the method of category analysis. Results: Although the clinical nurses mainly used the national standards to do practical operation, they preferred to carry out catheter replacement according to clinical indications. The difference between the latest guide and the national standards was the main obstruction in the practical promotion of the latest guide. Conclusions The removal of short peripheral intravenous catheters according to clinical indications is more suitable for clinical practice. Further improving the standards of intravenous therapy in China has become a fundamental measure to solve the contradictions of work of clinical nurses, improve patients′ medical experience and save medical resources.

OBJECTIVE To estab lish the pre paration method of clopidogrel active thiol metabolite （CATM），and to provide reference for the synthesis of cis-CATM. METHODS CATM was prepared ，separated and purified with isolated rat liver perfusion and ChromCore 120 C18 preparative column ，using（S）-2-oxo-clopidogrel as substrate. The target compounds were identified by mass spectrometry and nuclear magnetic resonance spectroscopy. The retention time of the active configuration of CATM in the human body （cis-CATM）were compared to confirm the proportion of active configuration in the target product. RESULTS The conversion rate of the target product was 11.71％. The target products were identified as CATM by MS and 1H-NMR. Peak 2-peak 5 of CATM were four stereoisomers. The retention time of them were 21.3，22.3，26.5，27.3 min. The peak area ratios of them were 7.13％，7.23％，63.52％，14.97％，respectively. Based on that retention time of the active configuration of CATM in human body was 26.3 min，the active cis-stereoisomer in the target product CATM accounted for 63.52％. CONCLUSIONS This method is low-cost ，simple，and can prepare CATM with higher active configuration.