Light spectra influence barley development, causing a diverse range of responses among cultivars that are poorly understood. Here, we exposed three barley genotypes with different light sensitivities to two light sources: fluorescent bulbs, over-representing green and red wavebands, and metal halide lamps, with a more balanced spectrum. We used RNA sequencing to spot the main genes and pathways involved in the different responses, and RT-qPCR to validate the expression values. Different grades of sensitivity to light spectra were associated with transcriptional reprogramming, plastid signals, and photosynthesis. The genotypes were especially divergent in the expression of genes regulated by transcription factors from MADS-box, WRKY, and NAC families, and in specific photoreceptors such as phytochromes and cryptochromes. Variations in light spectra also affected the expression of circadian clock, flowering time, and frost tolerance genes, among others, resembling plant responses to temperature. The relation between PPD-H1, HvVRN1, and HvFT1 might explain genotypic differences. Light-sensitive genotypes experienced a partial reversion of the vernalization process and senescence-related stress under the less favorable light quality conditions. The observed light-quality sensitivities reveal a complex mechanism of adaptation to regions with specific light quality features and/or possible regulation of light spectra in plant development during early spring.

Aim: We aim to investigate the endoscopic and CT scan findings of pediatric patients with Henoch-Schonlein purpura (HSP). Methods: The endoscopic and CT findings of the patients were observed. Endoscopy was carried out using the Olympus GIF XQ 230 electronic gastroscope. Laboratory tests were carried out to investigate the expression of potential markers in these patients. In total, 4 females and 2 males were included in this study, with the median age of 7.5 yrs. All the 6 patients underwent endoscopic examination. Results: One showed hyperemia and erosion in the gastric antrum, together with punctiform hyperemia in the gastric balloon and bile regurgitation. One showed erosion in the gastric fundus, body and angle, as well as hyperemia and edema in the descendant duodenum, together with massive erosion and ulcer. One showed hyperemia and erosion in the gastric antrum combined with ecchymosis in the descending part of stomach. One showed ecchymosis in the descendant duodenum, and a tendency of hemorrhage. One showed massive ecchymosis in the descendant part and horizontal part of the duodenum. The other one showed hyperemia in the descendant duodenum. Endoscopic findings of HSP consisted of mucous hyperemia and edema, together with local erosion and irregular ulcer. Some patients at the acute stage presented hemorrhagic spots and capillary hemorrhage, which usually involved the duodenum, gastric antrum and body. Conclusion: CT findings of the HSP were edema and thickening in the small intestinal wall, hydrops in the intestinal cavity and intestinal obstruction.

Black women are four times more likely to die than White women in pregnancy in the U.K. Black women are more prone to Hypertensive Disorders in Pregnancy (HDP). Outside of pregnancy, there are race based differences in the management of hypertension as Calcium-Channel Blockers (CCB) are more effective in reducing blood pressure in Black patients. It is unclear whether these differences in anti-hypertensive management extend to the management of hypertension in pregnancy. Objectives The primary objective was to address this gap in evidence by undertaking a systematic review of all randomised control trials investigating pharmacological management of HDP to assess whether CCBs are the most effective anti-hypertensive agent in Black pregnant women. Search Strategy The following electronic databases were searched: PubMed, MEDLINE and Embase. We used MeSH and free text terms in conjunction to increase sensitivity to potentially relevant studies. Selection Criteria Inclusion criteria: (1) study involved treatment of HDP; (2) study was of a randomised control trial design; (3) one of the treatment arms involved CCBs and (4) English full-text. Data collection and Analysis Information regarding baseline participant data, type of anti-hypertensive, and clinical outcomes was extracted from each study. Main results This current review highlighted one randomised control trial, which stratified HDP outcomes by ethnicity. Conclusions There is a lack of evidence to draw conclusions as to whether CCBs are the most effective anti-hypertensive agent for Black patients with HDP. Funding None Keywords Hypertension; pregnancy; pre-eclampsia; ethnicity; anti-hypertensive; Calcium-Channel Blocker; race; Black; maternal mortality; maternal morbidity

A stable core-shell structure Au12@Au30 has been investigated by first-principles calculations. The Au12@Au30 with Ih symmetry is composed of an icosahedron core and an icosidodecahedron shell. There is no imaginary frequency in the normal vibrational modes. And combining molecular dynamics NVT simulations the dynamic stability of the structure is proved. The orbital bonding analysis shows that there are multi-center bonds, twenty6-centerσ bonds and one12-centerσ bond in this structure, which are the potential reasons for the structural stability. Both the PDOS and the Hirshfeld charge population analysis show that this system is non-magnetic. The HOMO frontier molecular orbital reveals obvious s-d hybridization characteristics. In this core-shell nanostructure, there are a large number of 1-center valence lone electron pairs with the characteristics of d-like orbitals. This proposed structure Au12@Au30 makes the size of core-shell clusters more enriched and may be used in catalysis and medicine fields.

Objective To determine the prevalence of gestational diabetes in women with obstetric cholestasis. Design Systematic review and meta-analysis of data published since 2010. Selection Observation studies with quantifiable data. Sample A total of 16748 patients with obstetric cholestasis from 21 studies were included. Methods A pre-defined protocol with extensive literature search plus other sources to obtain all possible articles was followed. All articles were evaluated and included in the study with specified criteria for the risk of bias using the Newcastle Ottawa Score. A meta-analysis was performed with MOOSE specifications met. Main Outcome measure Prevalence of gestational diabetes in the obstetric cholestasis population. Results The prevalence of gestational diabetes in the obstetric cholestasis population was 13.9% (20 studies analysed). Gestational diabetes was seen more in the obstetric cholestasis group compared to the non-obstetric group (OR 2.129, 95%CI, 1.697 to 2.670,10 studies). Severe cholestasis has more gestational diabetes cases (OR 2.168, 95% CI, 1.429 to 3.289, 4 studies) compared to mild cholestasis. Conclusion There is a significant co-relation of gestational diabetes among the diagnosed obstetric cholestasis population. With a diagnosis of obstetric cholestasis is made, it is necessary to test for undiagnosed gestational diabetes further. This approach may reduce the risk of stillbirth in severe obstetric cholestasis cases. PROSPERO Registration number CRD42021223886

In this paper, we are concerned with a kinds of tempered fractional differential equation Riemann-Stieltjes integral boundary values problem involving p−Laplacian operator. By means of the sum-type mixed monotone operators fixed point theorem based on the cone Ph, not only the local existence of unique positive solution is obtained, but also two successively monotone iterative sequences are constructed for approximating the unique positive solution. Finally, we present an example to illustrate our main results.

Introduction: The laryngeal mask airway (LMA) is an airway management device commonly used during general anesthetics. In this study, a nationwide comprehensive legal database was searched for all medical malpractice cases involving an LMA and analyzed according to the clinical context in which the LMA was implicated. Methods: Cases were identified using Westlaw Edge, a legal database covering 8 million United States federal and over 100 million state dockets. All cases containing the search terms “anesthesiology” and “malpractice” were retrieved, and results were then narrowed to those cases containing “laryngeal mask airway” within their text. Cases were excluded if they did not allege malpractice by an anesthesiologist or the listing was a duplicate case listing. Results: Of the over 500 cases identified, 9 remained for analysis after application of inclusion and exclusion criteria. Three of the cases (33%) involved use of the LMA as a rescue airway device when endotracheal intubation was unsuccessful. Two (22%) alleged aspiration of gastric contents during a general anesthetic with an LMA, and another two (22%) described inadequate ventilation with an LMA that necessitated progression to endotracheal intubation. Discussion: This study helps to better elucidate the role of the LMA in anesthesiology practice by describing related malpractice case outcomes. It is clear from this case series that entry of a defendant verdict does not necessarily indicate that the circumstances surrounding LMA use in that case were congruent with standard of care, as multiple other elements are required to prove medical malpractice. Nevertheless, the analysis of malpractice cases involving LMAs can provide useful clinical insight.

Introduction: Atrial tachycardias (AT) can present multiple sites of origin or circuits which complicates mapping, requiring creation of separate activation maps per site. Objective: To evaluate the Intra-Cardiac Pattern Matching (ICPM) software that automatically detects and assigns different arrhythmia sources to separate 3D activation maps in a porcine model. Methods: To simulate different ATs, continuous pacing at same cycle length was performed from 2-3 right atrial (RA) sites (2 screw-in leads and mapping catheter) for 60-90 seconds before alternating. RA was continuously mapped with a 48-electrode high-density mapping catheter (Octaray). The operator manually switched and added points to the respective maps when the AT changed. Conversely, the ICPM algorithm (Carto Mapping system) automatically assigned each beat to its respective map. Pacing electrodes were repositioned to create a second set of maps. Offline analysis (manual and automatic maps) was performed comparing local activation times (LAT) and mesh coloring values of adjacent points (<5 mm apart). Differences <10 msec were considered a match. Results: Twenty-three different pacing sites were analyzed in 6 swine with 1 manual/1 automatic map per site (46 maps); and 40,176 points were compared (manual and automatic). Individual LATs for manual and automatic maps were compared and matched 91.2% of the time (variance of <10 ms). Mesh coloring values matched using the same criteria. Conclusion: The ICPM algorithm accurately identified changing atrial activation sites and assigned points to appropriate maps >90% of the time compared to manual acquisition.

The current research addresses hydrodynamic and thermal solutions of the incompressible fluid flowing through uniformly co-rotating disks of finite radii. The narrow gap between the disks necessitates the consideration of slip flow in the radial direction, rather than the classical no-slip model. Perturbation approach is adopted and full analytical approximations from the Navier-Stokes and energy equations are derived up to the second-order, otherwise numerical effort is required for higher level truncations, owing to the lengthy and complex expressions. In the absence of slip, the momentum solutions are shown to match perfectly with those available in the literature. The convergence of series solutions with slip is then demonstrated through some selection of parameter set. The main conclusion is that slip and Reynolds number lead to reduction in the momentum and thermal layers, with more cooled disk surfa

Posteroseptal accessory pathways located in the CS diverticulum are rare and unique forms of accessory pathways which are difficult to precisely locate and ablate. The ablation of this type of accessory pathway could also be associated with collateral injury to the neighbouring coronary arteries. We present a case of Wolff--Parkinson--White syndrome due to a CS diverticulum accessory pathway with previous failed ablation attempt who was safely and successfully ablated. We demonstrated that using the advanced 3-D cardiac mapping system could guide clinicians to precisely locate and safely ablate these difficult pathways.

Objective: Preoperative testing for COVID-19 has become widely established to avoid inadvertent surgery on patients with COVID-19 and prevent hospital outbreaks, however, there is limited evidence underpinning new protocols. We wished to study the effectiveness of preoperative COVID-19 testing during and after the first wave of the pandemic in Ireland. Design Prospective cohort study. Setting: 2 university hospitals in the Republic of Ireland. Participants: Patients undergoing otolaryngology surgery and the otolaryngologists performing surgery. Main outcome measure: Incidence of COVID-19 within 30 days of surgery. Results: 173 patients (56% male) were recruited. 123 (71%) patients “cocooned” for 14 days prior to surgery. All patients completed a questionnaire prior to hospital admission. 156 patients (90%) had reverse transcriptase-polymerase chain reaction (RTPCR) nasopharyngeal swabs, 14 patients (8%) had CT thorax. No cases of COVID-19 were detected among patients followed up at 30 days. Two surgeons developed COVID-19 early during the study period not considered to be related directly to contact within the hospital. Conclusion: Current pre-operative testing protocols consisting primarily of questionnaires and RT-PCR resulted in zero cases of COVID reported in this cohort. It is possible that COVID-19 restrictions and high proportion of patients cocooning preoperatively were factors in ensuring a low rate of COVID-19 postoperatively. Ongoing data collection is required to confirm these findings in the setting of further disease surges.

Sexual selection theory states that males compete for mate monopolization and larger males can sire more offspring than smaller males, thereby resulting in the evolution of sexual size dimorphism. Female grouping facilitates mate monopolization and increases intensity of sexual selection. Sexual selection should be particularly intense in mammals because females have the most parental investment due to gestation and lactation, making them a limiting resource for which males compete. Nevertheless, I found evidence suggesting a minor role of sexual selection in mammals. I found low values of the standardised variances in male reproductive success, Im, and Nonacs’s B indices. Phylogenetic confirmatory path analyses indicated that sexual dimorphism evolved after the evolution of large body size, regardless of the evolution of polygyny and breeding groups. Results are explained by a ‘gender neutral’ model, in which all individuals in a population are initially subjected to the same pressures of natural selection.

Background: Preeclampsia constitutes a major health problem with substantial maternal and perinatal morbidity and mortality. Purpose: The aim of this study was to detect the diagnostic efficacy of fetal Doppler in predicting adverse outcomes in severe late onset preeclampsia (LOP). Methods: A prospective study was conducted among childbearing women who presented with severe LOP and matched controls. Umbilical artery (UA) and middle cerebral artery (MCA) Doppler indices including pulsatility index (PI), resistance index (RI), systolic/diastolic ratio (S/D) and cerebroplacental ratio (CPR) were measured. Results: All UA indices were significantly higher in the case group compared to the controls (p  0.001). UA PI and RI were significantly correlated with all neonatal adverse outcomes except cord pH status (p  0.05). Abnormal CPR was the most sensitive index that positively correlated with intrauterine growth retardation (IUGR), low 5- minute Apgar score and neonatal intensive care unit admission (79 %, 72.8 % and 73.3 %, respectively). In the same context, Abnormal UA PI and RI represented the most specific tool for predicting IUGR, low 1- and 5- minutes Apgar score with PPV values were 52 %, 87 % and 57 %, respectively. Discussion: Doppler flow ultrasound has emerged as a non-invasive tool for fetomaternal surveillance in high risk pregnancies and prediction of adverse-pregnancy outcomes particularly in a limited-resource settings. Conclusion: In severe LOP, UA Doppler remains the preferential indicator for adverse birth outcomes with CPR is the best index that could be solely used for predicting such outcome.

Background To evaluate the diagnostic utility of gas under the diaphragm on abdominal radiograph for patients with a perforated appendix. Methods A prospective, observational study at General Surgery Department, Jinnah Postgraduate Medical Centre, Karachi, Pakistan was conducted between 2018 to 2020. All patients with suspected appendicitis, irrespective of gender were included in the study. Patients with age younger than 12 years or older than 60 years were excluded from the study. Findings from the imagings for each patient were noted. The plain radiograph was looking for “Gas under diaphragm”. All imaging was performed by a radiologist with experience of five years or more. All data were entered into a statistical package for social sciences (SPSS version 24). Results The appendix diameter was highly significantly associated with the risk of perforation in patients with appendicitis (p<0.001). Similarly, the patients with a perforated appendix have a significantly higher white blood cell count compared to those without perforation (15.6 ± 5.1 versus 13.2 ± 4.4; p-value = 0.002). It was found that out of the 76 patients with perforated appendicitis pneumoperitoneum was positive in 6 (7.8%) patients while out of those with a non-perforated appendix, 8 (10.5%) had gas under the diaphragm. Conclusion Gas under the diaphragm on a plain radiograph was detected in only a few cases with perforated appendicitis. Nevertheless, if positive, it warrants immediate abdominal surgery and requires comprehensive investigation.

Drought is one of the major abiotic stress factors limiting wheat production worldwide, thus threatening food security. The dissection of the genetic footprint of drought stress response offers strong opportunities toward understanding and improving drought tolerance in wheat. In this study, we investigated the genotypic variability for drought response among 200 diverse wheat cultivars (genotypes) using agronomic, developmental, and grain quality traits, and conducted genome-wide association studies (GWAS) to uncover the genetic architectures of these important traits. Results indicated significant effects of genotype, water regime and their interactions for all agronomic traits. Grain yield was the most drought-responsive trait and was highly correlated with kernels number per meter square. GWAS revealed 17 and 20 QTL regions under rainfed and drought conditions, respectively, and identified one LD block on chromosome 3A and two others on 5D associated with breeding progress. The major haplotypes of these LD blocks have been positively selected through breeding and are associated with higher starch accumulation and grain yield under drought conditions. Upon validation, the identified QTL regions caring favorable alleles for high starch and yield will shed light on mechanisms of tolerance to drought and can be used to develop drought resistant cultivars.

Background: Sawtooth oak is a potent cause of tree pollinosis in Korea. However, molecular characteristics of the major allergen have not been elucidated. Objective: The study was to perform biochemical and allergenic characterization from sawtooth oak. Methods: Native Que ac 1 was purified and analyzed by 2D gel electrophoresis and LC-coupled ESI-MS/MS analysis. Polymorphisms of Que ac 1 were examined by RT-PCR, and a recombinant allergen of the major isoform was produced. IgE reactivities of the native and recombinant allergens were compared by ELISA. Results: At least 12 isoforms of Que ac 1 were identified by proteomic analysis, and 22 isoforms including two isoallergens were identified by RT-PCR. A major isoform Que ac 1.0101 (13.3%, 10/75) shared the lowest homology to Bet v 1 (58.1%) and the highest homology to Que r 1 (83.0%). Recombinant Que ac 1.0101, which exhibited a similar CD spectrum with native Que ac 1, was recognized by serum IgE from 91.3% of Korean oak pollinosis patients. Recombinant Que ac 1 inhibited 67.2% of IgE reactivity to sawtooth pollen extract, but native Que ac 1 and recombinant Bet v 1 inhibited 88.7% and 57.6% of the IgE reactivity, respectively. No difference in allergen potential was shown between Que ac 1 and Bet v 1 by basophil mediator release assay. Conclusion: Molecular properties of the major allergen Que ac 1 were characterized. Que ac 1 seems to be an allergen of regional importance homologous to Bet v 1 and may be useful for better diagnostics of pollinosis.

One of the important ways to improve photosynthetic capacity in C3 crops, such as rice and wheat, is to transfer efficient C4 characters to them. Here, cytosolic carbonic anhydrase (βCA3) of the C4 Flaveria bidentis (Fb), having low Km for CO2, was overexpressed under the control of 35S promoter in Arabidopsis thaliana, a C3 plant, to enhance its photosynthetic efficiency. Overexpression of CA resulted in higher [HCO3-] in the cytosol of the overexpressors, and increased endogenous phosphoenolpyruvate carboxylase activity generating oxaloacetate that feeds into the tricarboxylic acid cycle. This provided more carbon skeleton for increased synthesis of amino acids and proteins. Further, transgenic expression of FbβCA3 in Arabidopsis led to pleiotropic expression of several genes/proteins involved in chlorophyll biosynthesis and photosynthesis leading to higher chlorophyll content and photosynthetic capacity in the transformants. Due to the presence of higher CO2 in the chloroplast, pleiotropic effect overexpressors had enhanced CO2 assimilation, starch content, and plant dry weight. In addition, transgenic plants had lower stomatal conductance, reduced transpiration rate and higher water use efficiency. These results, taken together, show that expression of C4 CA in the cytosol of a C3 plant can indeed improve its photosynthetic capacity with enhanced water use efficiency.

Objective To generate a comprehensive transcriptomic profile of cellular signifures and transcriptomes of human placenta in GDM by single-cell RNA-sequencing (scRNA-seq), and built a comprehensive cell atlas. We hope to reveal the molecular mechanism of pregnancy risk for GDM women. Design Scientific study. Setting University Hospital and laboratories. Population or Sample Pregnant women Methods 20 GDM women and 20 normal pregnant women were recruited in present study. ScRNA-seq were loaded on the Chromium Single Cell Controller Instrument (10×Genomics) to generate single cell gel beads in emulsions (GEMs). Results A total of 27,220 cells from placenta samples were obtained. First, with the cell-type-specific marker genes, we annotated 15 cell clusters into more than 9 different cell types. Second, beside the classcial markers, we also found some novel markers for distinguishing three kinds of trophoblast and subtypes, which cloud be confirmed by immunohistochemistry imaging. Third, we demonstrated the specific placental function in GDM by the bioinformatics analysis of differentially expressed genes, such as estrogen signaling pathway, natural killer cell mediated cytotoxicity down- regulated. Fourth, there are abundant ligand-receptor interactions between trophoblast and immune cells in the maternal fetal interface microenvironment, such as VEGFB-FLT1, MIF-EGFR, RPS19-C5AR1, SPP1-CD44These dysfunctional ligand-receptor interactions may play the important roles in the development of GDM. Conclusion This study provided the first cell-type-specific transcriptomic alterations GDM placenta from single cell level, exploded the cell identities and cell-type-specific marker genes in the human placenta. In addition, it demonstrated the features of placental function and cell interactions for GDM.

Although non-genetic inheritance is thought to play an important role in plant ecology and evolution, evidence for adaptive transgenerational responses is scarce. Here, we investigated the consequences of copper excess on offspring defense and fitness in the duckweed Spirodela polyrhiza across multiple generations. We found that descendants of large monoclonal populations (>10,000 individuals) that grew for 30 generations under copper excess exhibited negative fitness during the first few generations and positive fitness in consecutive generations under recurring stress. Similarly, propagating individual plants for 5 or 10 generations under copper excess decreased plant fitness when 5 generations and improved fitness when 10 generations passed between initial and recurring stress. Fitness benefits under recurring stress were partially associated with avoidance of excessive copper but not increased flavonoid accumulation. Taken together, these data demonstrate time-dependent adaptive transgenerational responses under recurring stress, which highlights the importance of non-genetic inheritance for plant ecology and evolution.

Many physical factors affecting gestational weight gain have been studied, the psychosocial aspect of this needs to be looked under the microscope, especially in low socio-economic countries. A scoping review of the articles published in the last five years exhibits that perinatal outcomes like gestational weight are influenced by certain psychosocial factors, including but not limited to intimate partner violence, lack of social support and recognition, financial distress, household food insecurity, chronic stress and depression related to pregnancy, eating pathologies and low self-esteem. Employing a multi-disciplinary approach can help us mitigate undesirable outcomes of inadequate and excessive weight gain.

The gold standard technique for treatment of vault prolapse is a laparoscopic sacro colpopexy, which requires advanced surgical skill in endoscopy. We present a new surgical technique for treatment of vault prolapse namely “laparoscopic assisted abdominal colpopexy “. This technique involves skills of a vaginal surgery and basic skill of laparoscopy to give an option for treatment of vault prolapse at lesser equipped centers. Technique involves suspension of vaginal vault by fixing mersilene tape vaginally and guiding It under laparoscopic vision extraperitoneally to anchor it to inturned part of inguinal ligament near the anterior superior ischial spine.

Introduction: COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2 increasingly involves people worldwide. Probiotics can improve immune system functions via different mechanisms. We proposed that Synbiotic Lactocare® may also reduce SARS-Cov2 infection in high risk medical staff working in COVID-19 hospital wards. Method: In a randomized, controlled trial, 60 hospital staff without any history of clinical or laboratory evidence of SARS-Cov2 infection were received either once daily oral synbiotic capsule (Lactocare®) that contains 1 billion CFU/Cap of L. (Lactobacillus) casei, L. rhamnosus, Streptococcus thermophilus, Bifidobacterium breve, L. acidophilus, Bifidobacterium infantis, L. bulgaricus, and Fructooligosacharide (Zist Takhmir, Tehran, Iran) or placebo with the same appearance for 30 days. They were followed for two months. Result: During the two month period of this study, SARS-COV-2 RT-PCR test results were positive in three participants (9.67%) in placebo group compared to zero positive test in synbiotic group. The differences were not statistically significant (p= 0.238). During the study, two persons (7 %) of placebo group had respiratory complaint such as cough, rhinorrhea and/or dyspnea, compared with one in synbiotic group (p= 0.492). Conclusion: This study showed that overall frequency of SARS-COC2 infection in participants receiving synbiotic and those receiving placebo did not differ significantly. However, 3 hospital staff in placebo group compared to no one in synbiotic group had SARS-COV2 infection. Further studies with greater power and alternative probiotic strains and mixture are warranted to determine whether Synbiotic can prevent COVID-19 in at-risk hospital staff. Keywords: COVID-19, Synbiotic, prevention, Lactocare, SARS-Cov2

Aims: This study determined the effect of subcutaneous (SC) low molecular weight heparin (LMWH) injection in three different areas (abdomen, leg, and upper arm) after coolant spray application on pain, hematoma, and ecchymosis formation. Methods: The sample of this randomized controlled study consisted of 50 patients that were administered SC LMWH once a day. The SC injection occurred after applying coolant spray to the arm, leg, or abdominal region. The sample of this randomized controlled study consisted of 50 patients that were administered SC LMWH once a day. The SC injection occurred after applying coolant spray to the arm, leg, or abdominal region. Results: The study determined that there was no statistically significant difference in pain severity, hematoma, and ecchymoses between the regions of SC injection after coolant spray was applied (p>0.05). However, the highest average pain intensity directly and 15 minutes after the SC injection was in the leg region. Conclusion: SC injection after coolant spray application in three different regions led to the biggest hematoma in the abdominal region, the biggest ecchymosis in the arm region, and the lowest pain severity in the abdominal and arm regions. Key words: Coolant spray, ecchymosis, hematoma, pain, subcutaneous injection (SC).

Objective To construct an evaluation indicator system for the assessment of nursing care quality of labor analgesia, and to provide a reference for the working standards of management and evaluation of the nursing care quality. Method Based on the related literature, and referring to “Obstetric Analgesia and Anesthesia Practice Guide(2017)” and “Expert Consensus on Labor Analgesia(2018) ”, we draw up a consultation questionnaire of evaluation indicator system for labor analgesia. A two-round experts consultation involved 31 experts. Result Two rounds of experts consultation were conducted with expert positive response rate 96.67% and 96.66% respectively, degree of expert authority 0.88 and 0.87 respectively, and the Kendall’s W coefficients 0.19 and 0.17 respectively (all p<0.01).The evaluation indicator system of labor analgesia comprises 3 levels, including 6 first-level indicators,31 second-level indicators, and 45 third-level indicators. Conclution The evaluation indictor system of nursing services quality for labor analgesia is scientific, practical and maneuverable. It can provide standards for nursing services of labor analgesia ,and can be used as a basis for evaluating the nursing quality of labor analgesia.