BackgroundHepatolithiasis frequently presents with recurring cholangitis and complications. Oddi sphincter-preserved cholangioplasty with hepatico-subcutaneous stoma (OSPCHS), introduced in 1993, has shown favorable long-term results. Endoscopic sphincterotomy (EST) is commonly used, but its impact on OSPCHS outcomes remains unclear.MethodsFrom January 1993 to June 2021, 254 patients with hepatolithiasis underwent OSPCHS. A total of 31 patients had prior EST (group with EST, n = 31), while 223 did not (group without EST, n = 223). Perioperative and long-term outcomes were compared, and risk factors for stone and cholangitis recurrence were analyzed using a Cox regression model.ResultsThe immediate and final stone clearance rates were 67.3% and 81.9%, respectively. Patients with prior EST had higher rates of stone recurrence (57.7% vs. 35.7%, p = .031), shorter stone-free duration (median: 51.5 vs. 112.0 months, p = .001), higher cholangitis recurrence (45.2% vs. 25.6%, p = .023), and shorter cholangitis-free duration (median: 71.0 vs. 134.0 months, p = .006). Multivariable analysis identified bilateral intrahepatic stones (HR: 1.815, p = .010) and prior EST (HR: 3.157, p = .000) as independent risk factors for stone recurrence, whereas combined hepatectomy was a protective factor (HR: 0.448, p = .001). For cholangitis recurrence, male gender (HR: 2.308, p = .001) and EST (HR: 2.241, p = .009) were independent risk factors, while complete stone clearance reduced recurrence risk (HR: 0.423, p = .002).ConclusionPrior EST adversely affects the long-term outcomes of OSPCHS. Therefore, in the management of hepatolithiasis, emphasis should be placed on preserving the Oddi sphincter.

Objective: To investigate the relationship between the gingival crevicular fluid Omentin-1, matrix metalloproteinase-9（MMP-9）, osteopterin（OPG）/receptor activator of nuclear factor-κBligand（RANKL） ratio and periodontal indicators, oxidative stress and nucleotide binding oligomerization domain-like receptor protein 3（NLRP3） inflammasome in type 2 diabetes mellitus（T2DM） with chronic periodontitis（CP）. Methods: 73 patients with T2DM（T2DM group）, 77 patients with CP（CP group）, and 83 patients with T2DM with CP（T2DM with CP group） who were admitted to Beijing Rehabilitation Hospital affiliated to Capital Medical University from June2020 to June 2022 were selected. The Omentin-1, MMP-9 and OPG/RANKL ratio in gingival creval fluid of all patients were detected,and their correlations with periodontal indicators, oxidative stress and NLRP3 inflammator-related molecule messenger RNA（m RNA）expression were analyzed. Results: The gingival crevicular fluid Omentin-1, OPG/RANKL ratio, total antioxidant capacity（TAC） and superoxide dismutase（SOD） in the T2DM with CP group were lower than those in the T2DM group and CP group（P＜0.05）. The MMP-9,malonaldehyde（MDA）, NLRP3mRNA, apoptosis-related speck-like protein（ASC） m RNA, cysteine protease-1（caspase-1） m RNA expressions, and bleeding index（SBI）, plaque index（PLI）, periodontal pocket probing depth（PD） and attachment loss（AL） were higher than those in the T2DM group and CP group（P＜0.05）. The gingival crevicular fluid Omentin-1 and OPG/RANKL ratio in patients with T2DM with CP were positively correlated with TAC and SOD（P＜0.05）, they were negatively correlated with the MDA, NLRP3mRNA,ASC m RNA, caspase-1mRNA expressions, and PLI, SBI, AL, PD（P＜0.05）, and MMP-9 was negatively correlated with TAC and SOD（P＜0.05）, it was positively correlated with the MDA, NLRP3mRNA, ASC m RNA, Caspase-1 m RNA expressions, and PLI, SBI, AL, PD（P＜0.05）. Conclusion: The gingival crevicular fluid Omentin-1 level, OPG/RANKL ratio in patients with T2DM with CP are decreased,and MMP-9 level are increased, which are associated with aggravated periodontal tissue destruction, oxidative stress and activation of NLRP3 inflammatorome.

目的 探讨龈沟液中白细胞介素-1β(IL-1β)、超敏C反应蛋白(hs-CRP)、内毒素(LPS)水平与牙周牙髓联合病变病情程度、治疗效果的关系.方法 选取首都医科大学附属北京康复医院2020年1月至2021年8月收治的牙周牙髓联合病变患者96例作为研究对象,根据临床附着水平(CAL)分为轻度25例、中度41例、重度30例,比较不同病情程度患者龈沟液IL-1β、hs-CRP、LPS水平,采用单因素、多因素分析牙周牙髓联合病变患者疗效的影响因素,受试者工作特征(ROC)曲线探讨龈沟液IL-1β、hs-CRP、LPS对疗效的预测价值.结果 龈沟液IL-1β、hs-CRP、LPS水平随病情程度增加呈升高趋势,重度患者>中度患者>轻度患者,比较差异有统计学意义(P<0.05);单因素分析:不同疗效患者病程、病情程度、治疗2、4周后显效者龈沟液IL-1β、hs-CRP、LPS水平比较,差异有统计学意义(P<0.05);多因素分析:病程>3年、病情程度为重度、治疗2周后、治疗4周后龈沟液IL-1β、hs-CRP、LPS水平是牙周牙髓联合病变患者疗效的独立危险因素(P<0.05);ROC曲线分析治疗2周后、治疗4周后龈沟液IL-1β、hs-CRP、LPS均具有一定预测价值,治疗4周后龈沟液IL-1β、hs-CRP、LPS联合预测AUC(0.933)>治疗2周后(0.882),敏感度为84.81％,特异度为94.12％.结论 龈沟液IL-1β、hs-CRP、LPS水平随牙周牙髓联合病变病情加重而升高,是影响牙周牙髓联合病变患者疗效的独立危险因素,三者联合检测在疗效评估中具有较高预测价值.

目的 研究PBL和CBL混合趣味性教学在区县级医院心电图教学中应用有效性.方法 选取2019级、2020级在首都医科大学延庆教学医院学习的首都医科大学三年制临床医学专业(山区定向、乡村医生)77名医学生为研究对象,2019级34名医学生作为传统模式教学组,2020级43名医学生为混合模式教学组.采取笔试方式对学生的理论知识、心电图阅读分析、临床技能和综合能力进行测试,并发放调查问卷,采用个人评分的方式对两种教学方法进行评估.结果 混合模式教学组医学生心电图理论课考核成绩高于传统模式教学组(P<0.05),但混合模式教学组医学生心电图综合考核成绩相较于传统模式教学组未体现出显著优势(P=0.05);教学评价方面发现混合模式教学组在提高学生理解记忆加深程度、学习兴趣提高程度、自学认知度、临床思维能力提高程度等能力方面明显优于传统模式教学组(P<0.05).结论 PBL和CBL混合趣味性教学在区县级医院心电图教学中应用效果确切,可激发学习兴趣,加深对心电图理解记忆程度,提高医学生学习心电图的积极性,促进心电图理论和综合应用能力的提升,利于医学生临床思维能力的发展,具有显著的应用有效性.

目的 研究下调长链非编码RNA(lncRNA)人类白细胞抗原复合体18(HCG18)靶向调控miR-34a影响口腔鳞癌细胞增殖、侵袭以及迁移的分子机制.方法 Realtime PCR方法测定HCG18在口腔鳞癌CAL27、SCC4、HB96细胞和正常口腔黏膜NOK细胞中的表达变化.在口腔鳞癌SCC4细胞中转染HCG18 shRNA,Realtime PCR方法测定下调效果,MTT测定各细胞增殖变化,Transwell小室测定各细胞侵袭和迁移能力变化,Western blot测定各细胞中N-cadherin、E-cadherin蛋白表达变化.生物信息学软件发现HCG18与miR-34a可能互为靶向关系,利用荧光素酶系统鉴定二者靶向关系.将miR-34a inhibitor、inhibitor control和HCG18 shRNA分别共转染到口腔鳞癌SCC4细胞中,利用上述方法测定各细胞增殖、迁移和侵袭能力变化.结果 HCG18在口腔鳞癌CAL27、SCC4、HB96细胞中的表达水平高于正常口腔黏膜NOK细胞,并且口腔鳞癌SCC4细胞中HCG18表达水平最高,差异有统计学意义(P<0.05).转染HCG18 shRNA可以下调口腔鳞癌SCC4细胞中HCG18表达水平,降低细胞增殖、迁移和侵袭能力,促进细胞中E-cadherin蛋白表达,抑制细胞中N-cadherin蛋白表达.HCG18靶向负调控miR-34a的表达.与共转染inhibitor control和HCG18 shRNA后的细胞相比,共转染miR-34a inhibitor和HCG18 shRNA后的细胞增殖、迁移和侵袭能力升高,差异有统计学意义(P<0.05).结论 下调HCG18靶向调控miR-34a抑制口腔鳞癌SCC4细胞增殖、侵袭以及迁移.

目的 探讨麻醉方法对烟雾病患者脑血管搭桥手术术后早期认知功能的影响.方法 选择2015-05至2016-03在天坛医院治疗的74例烟雾病患者,分为全静脉麻醉组(total intravenous anesthesia,T组)和吸入麻醉组(inhalation anesthe-sia,I组),全部患者择期行血管搭桥手术,术中实施全身麻醉,所有患者在术前及术后7 d分别接受简易精神状况量表(MMSE)和蒙特利尔认知功能量表(MoCA)检测,评估术后早期认知功能.结果 与术前相比,两组患者术后7 d MMSE评分各项均无统计学差异.两组患者MoCA评分中记忆力一项有明显改善,差异有统计学意义(P<0.05),其余各项均无统计学差异.两组患者之间评分比较无统计学差异.结论 脑血管搭桥手术对患者早期记忆功能有明显改善;全静脉麻醉和吸入麻醉对脑血管搭桥手术术后早期认知功能的影响无明显差异.

目的 检测炎性人牙周膜成纤维细胞(hPDLF)及细胞自噬后miR-200b的表达,验证miR-200b在自噬中的作用及与ATG12的靶向关系,探讨miR-200b及细胞自噬对牙周炎的调控.方法 检测LPS、雷帕霉素及3-甲基腺嘌呤(3-MA)处理后的hPDLF细胞中miR-200b的表达,ELISA检测炎性因子IL-6、IL-12及TNF-α的表达,Western blot检测LC3 Ⅱ/LC3I的蛋白表达,RT-qPCR、Western blot检测ATG12表达量,双荧光素酶验证miR-200b与ATG12的靶向关系.结果 LPS可上调hPDLF中miR-200b的表达(P＜0.05),且LPS与miR-200b均可使炎性因子IL-6、IL-12及TNF-α的表达升高,后者上调更为明显;雷帕霉素及miR-200b均可使LC3Ⅱ/LC3 I蛋白升高;miR-200b与ATG12存在靶向调控作用关系.结论 miR-200b通过靶向下调ATG12基因的表达调控hPDLF细胞自噬,促进牙周炎的炎性反应.

Introduction: To investigate the feasibility and safety of laparoscopic hepatectomy combined with choledochoscopy without T-tube drainage in the treatment of intrahepatic and common bile duct stones. Method: From January 2014 to May 2018, 18 patients with hepatolithiasis in the left intrahepatic duct and common bile duct stones underwent laparoscopic hepatectomy combined with choledochoscopy and stone extraction. Of which 12 patients have left lateral heatic calculi, 6 patients have left hepaic calculi, all patients were complicated with common bile duct stones.After laparoscopic hepatectomy ,common bile duct stones were removed under video-assisted choledochoscopy through the left hepatic duct without choledochotomy and T-tube drainage. Result: Twelve patients underwent successfully laparoscopic left lateral lobectomy,six patients underwent successfully laparoscopic left hemihepatectomy, all 18 patients with common bile duct stones were explored by choledochoscope through hepatic cross section.5 patients were used laser lithotripsy due to incarceration of common bile duct stones. The mean operation time was 148 min (range ,108∼212 min), the mean intraoperative blood loss was 160ml (range,80∼320ml).There was one case of bile leakage, which was resolved by conservative treatment.The mean postoperative hospital stay was 5 days(range,3-9 days).Over follow-up of 6 months to 60 months,mean 26 months,no residual or recurrent stone formation were found. Conclusion: Laparoscopic hepatectomy combined with choledochoscopy without T-tube drainage for the treatment of intrahepatic and common bile duct stones is safe and effective in selected patients. This procedure has advantages of reapid rehabilitation and short postoperative hospital stay.

Objective To evaluate the effects of the second phase of Neonatal Resuscitation Program (NRP) in China. Methods A mail survey and an onsite assessment were conducted to collect data. (1) Mail survey: Different levels of domestic hospitals (except those in Tibet, Hong Kong, Macao and Taiwan) were randomly selected to collect information on in-hospital NRP training, resuscitation equipments, incidence of birth asphyxia and neonatal mortality caused by birth asphyxia from year 2010 to 2014. (2) Onsite assessment: One provincial level, two prefecture level and two county level hospitals or healthcare institutions were randomly selected in four provinces. A questionnaire survey was conducted among randomly selected health workers including midwives, obstetricians and pediatricians. Megacode performance of those health workers was evaluated. Trend Chi-square test was used for statistical analysis. Results (1) Questionnaires were gathered from 347 hospitals via the mail survey with a response rate of 74.6% (347/465). In the 347 hospitals, 97.5% (10410/10674) of the obstetricians, paediatricians, and midwives received in-hospital training, and 72.7% (7765/10674) of them received training from county or above level. (2) In the onsite assessment of the four provinces, 205 health workers were randomly selected and completed the questionnaire survey. Among them, 85.4%(175/205) received training more than three times, 52.7% (108/205) received over two days of training in the previous training workshops, but only 62.0% (127/205) could share one set of training manikin with less than eight trainees in training workshops. Megacode performance of 96 health workers was evaluated. The results showed that all of the health workers were qualified in terms of total score and achieved an average score of over 1.5 in the performance of every primary resuscitation skill. Health workers attained relatively high scores in performing initial steps in resuscitation and tracheal intubation, and in identifying the indication of chest compression and epinephrine administration. However, their average scores in preparation for resuscitation, positive pressure ventilation and teamwork were relatively low. (3) Over 90% of the 347 hospitals had basic resuscitation equipment such as neonatal bag and mask, devices for tracheal intubation and radiation warmer. But fewer were equipped with umbilical venous catheter, T-piece or oxygen-air blender, especially at the county level hospitals. The incidence of neonatal asphyxia decreased from 2.33%(7810/335190) in 2010 to 1.79%(9227/515481) in 2014. The mortality from asphyxia at birth decreased from 2.41 to 1.64 per 10000 live births [(81/335190) and (85/515481)]. Trend analysis revealed that the incidence of neonatal asphyxia (χ2trend=20.56, P<0.01) and the mortality at birth (χ2trend=77.34, P<0.01) declined over time. Conclusions The second phase of NRP has promoted the generalization of the neonatal resuscitation technology and resulted in decreased incidence of asphyxia and asphyxial mortality. Future programs should focus on measures to improve practical skills and teamwork, to increase the allocation of resuscitation equipment and to strengthen trainings among obstetricians and midwives.

For tooth segmentation problem on the three-dimensional computed tomography(CT)volume data,this paper proposes a regional adaptive deformable model for tooth structure measurement of CT images.The proposed method combines the automatic thresholding segmentation,CV active contour model,and graph-cut.Firstly,we achieved the segmentation and location of dental crowns by automatic thresholding segmentation.And then by using the above segmentation result as the initial contour,we utilized active contour method to slice gradually the segment of remaining tooth.By incorporating active contour and graph-cut then,we realized the accurate segmentation for tooth root,which is the most difficult to be segmented.The experimental results showed that the proposed tooth structure measurement accurately and automatically segmented dental crowns from CT data,and then rapidly and accurately segmented the tooth neck and tooth root.The structure of tooth could be effectively segmented from CT data by using the proposed method.Experimental results indicated that the proposed method was rather robust and accurate,and could effectively assist the doctor for diagnosis in clinical treatment.

AIM:To evaluate the long-term outcomes of Oddi sphincter preserved cholangioplasty with hepatico-subcutaneous stoma (OSPCHS) and risk factors for recurrence in hepatolithiasis.METHODS:From March 1993 to December 2012, 202 consecutive patients with hepatolithiasis underwent OSPCHS at our department. The Oddi sphincter preserved procedure consisted of common hepatic duct exploration, stone extraction, hilar bile duct plasty, establishment of subcutaneous stoma to the bile duct. Patients with recurrent stones can undergo stone extraction and/or biliary drainage via the subcutaneous stoma which can be incised under local anesthesia. The long-term results were reviewed. Cox regression model was employed to analyze the risk factors for stone recurrence.RESULTS:Ninety-seven (48.0%) OSPCHS patients underwent hepatic resection concomitantly. The rate of surgical complications was 10.4%. There was no perioperative death. The immediate stone clearance rate was 72.8%. Postoperative cholangioscopic lithotomy raised the clearance rate to 97.0%. With a median follow-up period of 78.5 mo (range: 2-233 mo), 24.8% of patients had recurrent stones, 2.5% had late development of cholangiocarcinoma, and the mortality rate was 5.4%. Removal of recurrent stones and/or drainage of inflammatory bile via subcutaneous stoma were conducted in 44 (21.8%) patients. The clearance rate of recurrent stones was 84.0% after subsequent choledochoscopic lithotripsy via subcutaneous stoma. Cox regression analysis showed that residual stone was an independent prognostic factor for stone recurrence.CONCLUSION:In selected patients with hepatolithiasis, OSPCHS achieves excellent long-term outcomes, and residual stone is an independent prognostic factor for stone recurrence.

目的：分析临床病例教学法在心血管内科教学中的应用效果。方法：于临床传统教学过程中适当穿插心血管内科病例，引导学生运用自身所学知识自我解决存在问题。结果：通过将病例教学法用于心血管内科教学过程中，可启发学生思维，活学活用。同时，还可提高学生学习积极性，提高教学效果。结论：病例教学是临床较为有效的教学方法，可在体现现代化教育的同时，顺应医学实践目的。

可摘局部义齿（ RPD）修复是临床常见的牙列缺损的治疗方法，其对口腔微生态系统及牙周组织健康的影响是近年来研究的重点。研究表明，RPD修复对口腔微生态系统带来了严重的负面影响，可引起牙周炎、牙龈炎、龋齿发病率的增高〔1〕；但也有研究表明，只要保证长期口腔清洁、注意口腔卫生，长期佩戴RPD仅会引起轻度炎症，相反，RPD修复可改善患者的生理功能及心理社会功能〔2〕。为了探讨老年人RPD修复对口腔微生态系统的影响，本研究对老年人牙列缺损患者进行RPD修复前后的口腔微生态系统变化进行统计分析。

目的 研究颌骨囊肿的手术治疗效果,观察其手术后的感染发生情况,以及预防控制措施,为提高该类疾病的临床治疗效果和防止并发症提供帮助.方法 选择首都医科大学附属北京世纪坛医院口腔科2009年1月～2013年5月收治的颌骨囊肿患者70例,观察其手术治疗效果,并分析影响患者术后并发感染的危险因素,总结相关控制及预防措施.结果 所有70例颌骨囊肿手术患者中,4例老年患者因囊肿过大行开窗减压治疗;2例术后复发,再次手术后痊愈;8例术后并发感染,后经冲洗及碘仿填塞换药后痊愈.感染患者与非感染患者各项生理指标比较包括白细胞计数(WBC)、C反应蛋白(CRP)、中性粒细胞比例(NEUT％)等,差异均有统计学(P＜0.05).不同手术时间及是否抗生素使用、无菌操作、伤口清创是手术感染的临床影响因素.结论 颌骨囊肿手术治疗有感染风险,但可以通过术前充分准备,术中冲洗干净,合理使用抗生素,严格无菌操作,以及充分清创来降低其感染率,从而减轻患者痛苦.

在口腔正畸的治疗过程中，牙根吸收是常见的治疗风险，对牙根吸收的研究，要求研究者准确观察牙根形态改变，并精确测量牙根长度。约41.6%患者在正畸治疗后出现程度不等的牙根吸收[1]。随着研究手段的发展，螺旋CT也引发了正畸学者的兴趣，而其线距测量的精确性能否满足对牙根吸收的研究要求，本文通过拔牙矫治正畸患者牙齿的螺旋CT测量与游标卡尺实测的比较进行了分析，报告如下。

OBJECTIVE To explore the clinical efficacy of difference types of mouthwashes in prevention of oral infections after tooth extraction so as to provide guidance for the clinical treatment.METHODS Totally 192 patients,who underwent the tooth extraction in the department of stomatology and used mouthwashes from Mar 2012 to Jun 2013,were enrolled in the study and randomly divided into four groups,with 48 cases in each,then the incidence of oral infections was observed,the clinical efficacy of the povidone iodine mouthwash,compound chlorhexidine mouthwash,hydrogen peroxide mouthwash,or saline in prevention of the infections was evaluated, and the bacterial colony counts were recorded before the tooth extraction and 1 week after the tooth extraction. RESULTS Of the 192 patients who underwent the tooth extraction,the oral infections occurred in 14 cases with the infection rate of 7.29%.The contrast study indicated that all the four kinds of mouthwashes had the inhibitory effect on bacteria and varied in the antibacterial effect,with statistical significance(P0.05);the inhibitory effect of the povidone iodine mouthwash was better than that of other three groups;the incidence of oral infections was 0 after the use of the povidone iodine mouthwash,and the bacterial colony counts were only(2.01±1.32)CFU/ml, with statistical significance(P0.05).CONCLUSION The povidone iodine mouthwash has broader antibacterial spectrum and can achieve more significant inhibitory effect,which has good clinical efficacy in prevention of oral infections after the tooth extraction.It is suggested that the mouthwashes should be reasonably used during the oral nursing so as to improve the level of oral care and reduce the incidence of oral infections.

AIM: To evaluate the clinical effects of nitrous oxide inhalation on dental anxiety during extraction of impacted mandibular wisdom teeth. METHODS: 70 patients with impacted mandibular wisdom tooth extraction were included in this study. The patients were divided into the nitrous-oxide inhalation group( n = 30) and local anesthesia group( n = 40). Blood pressure,heart rate,breathing and variation of calm situation,degree of anxiety,pain score were recorded before,during and after tooth extraction. The parameters were statistically analysed by t- test. RESULTS: All teeth were successfully extracted and with no serious complications. Nitrous oxide inhalation group showed much less changes in heart rate and blood pressure; much lower dental anxiety score,VAS pain score and postoperative forgetfulness than local anesthesia group( P 0. 05). CONCLUSION: Nitrous oxide inhalation is effective in alleviating dental anxiety during impacted wisdom tooth extraction.

PURPOSE To evaluate the effectiveness and safety of nitrous oxide/oxygen inhalation sedation in the treatment of acute pulpitis. METHODS The study population comprised 72 patients of acute pulpitis treated from September 2012 to March 2013. They were randomly divided into 2 groups, which included experimental group (37 cases) and control group (35 cases). Venham clinical anxiety, cooperative behavior level and WHO clinical pain level evaluation were conducted for the patients. Wilcoxon and Chi-square test were used respectively for statistical analysis with SPSS 14.0 software package. RESULTS In the experimental group, 86.5% cases behaved comfortable, while in the control group the rate was only 42.9%. 94.6% of the patients in the experimental group felt painless after therapy. The proportion of that in the control group was 68.6%. There was significant difference between the 2 groups (P<0.01). CONCLUSIONS The technique of nitrous oxide/oxygen inhalation sedation provides a safe and effective way to release pain and anxiety during treatment of acute pulpitis, while the long-term clinical result still needs further investigation.

OBJECTIVE:To evaluate an intervention package promoting effective neonatal resuscitation training at county level hospitals across China.METHODS:The intervention package was implemented across 4 counties and included expert seminars, training workshops, establishment of hospital-based resuscitation teams, and supervision of training by national and provincial instructors. Upon completing the activities, a survey was conducted in all county hospitals in the 4 intervention counties and 4 randomly selected control counties. Data on healthcare providers' knowledge and self-confidence, and incidence of deaths from birth asphyxia from 2009 to 2011 in all hospitals were collected and compared between the two groups.RESULTS:Eleven intervention and eleven control hospitals participated in the evaluation, with 97 and 87 health providers, respectively, completing the questionnaire survey. Over 90% of intervention hospitals had implemented neonatal resuscitation related practice protocols, while in control hospitals the proportion was less than 55%. The average knowledge scores of health providers in the intervention and control counties taking a written exam were 9.2±1.2 and 8.4±1.5, respectively (P<0.001) out of maximum possible score of 10, and the average self-confidence scores were 57.3±2.5 and 54.1±8.2, respectively (P<0.001). Incidence of birth asphyxia (defined as 1-min Apgar score≤7) decreased from 8.8% to 6.0% (P<0.001) in the intervention counties, and asphyxia-related deaths in the delivery room decreased from 27.6 to 5.0 per 100,000 (P=0.076). There was no difference over time in asphyxia rates for the control counties.CONCLUSIONS:The intervention has not only improved skills of health providers, decreased the mortality and morbidity of birth asphyxia, but also resulted in effective implementation of guidelines and protocols within hospitals.

Objective To explore the feasibility and safety of dexmedetomidine sedation in interventional neuroradiology operations.Methods Eighty-five cases ASA grade Ⅱ-Ⅲ grade patients undergoing cerebral angiography according to age divided into two groups:old group(more than 60 years old,35 cases) and young group (18-59 years old,50 cases).The loading dose of dexmedetomidine were dexmedetomidine 0.5 μ g/kg in old group and 1.0 μ g/kg in young group,respectively.The loading dose was administered for 10 min followed by continuous infusion dexmedetomidine 0.5 μ g/ (kg· h).Blood pressure,heart rate (HR),peripheral oxygen saturation (SpO2) and respiratory rate (RR),Ramsay score and bispectral index(BIS) were monitored and recorded during the study.Results The BIS,Ramsay score after administration 10,15,30,45 min in two groups was significantly longer than that before administration [old group:84 ±22,83 ±22,85 ± 15,75 ±23 vs.94 ±5; (2.0 ±0.4),(2.3 ±0.6),(2.8 ±0.7),(3.0 ±0.7)scores vs.(1.7 ± 0.5) scores; young group:91 ± 8,89 ± 11,86 ± 12,81 ± 13 vs.96 ± 2; (1.9 ± 0.6),(2.3 ±0.7),(2.7 ± 0.9),(3.0 ± 0.9) scores vs.(1.6 ± 0.5) scores,P ＜ 0.05].The systolic blood pressure,diastolic blood pressure,mean arterial pressure (MAP) after administration 10,15,30,45 min in two groups was significantly longer than that before administration [old group:(152 ± 23),(144 ± 23),(140 ± 21),(135 ±21) mm Hg(1 mm Hg =0.133 kPa) vs.(165 ± 25) mm Hg; (87 ± 11),(83 ± 11),(78 ± 8),(75 ± 8) mm Hg vs.(89± 13)mm Hg;(106±14),(100±13),(99±12),(95±12)mm Hg vs.(113±16)mm Hg;young group:(131 ± 24),(127 ± 23),(124 ± 25),(124 ± 26) mm Hg vs.(142 ± 23) mm Hg; (81 ± 13),(79±13),(77±13),(76±13)mmHgvs.(86± 14) mmHg;(97±16),(94±16),(91±19),(92±20) mm Hg vs.(104 ± 19) mm Hg,P ＜0.05],but the decreases in blood pressure were ＜20％ from baseline.The HR,RR and SpO2 was no significant difference (P ＞ 0.05).Conclusions Continuous infusion of dexmedetomidine sedation during cerebral angiography has little effect on hemodynamics,no significant respiratory depression,is safe and effective.