ABSTRACT
Objective:To investigate the safety, efficacy and application indication of intra-operative cell salvage (IOCS) in cesarean section.Methods:A total of 1 265 pregnant women who received IOCS blood transfusion during cesarean section in 11 tertiary A hospitals from August 2016 to January 2019 were collected and divided into <1 500 ml group (796 cases) and ≥1 500 ml group (469 cases) according to the amount of blood loss during cesarean section. The general clinical data, ultrasonic imaging data, perinatal and puerperium indicators were analyzed retrospectively. The risk factors of intraoperative blood loss ≥1 500 mL using IOCS transfusion were analyzed by logistic multivariate regression.Results:(1) A total of 848 001 ml of blood was recovered and a total of 418 649 ml of blood was transfused in 1 265 pregnant women who received IOCS transfusions, which was equivalent to 23 258 U red blood cell suspension, greatly saving medical resources. The intraoperative blood loss in <1 500 ml group and ≥1 500 ml group was 800 ml (300-1 453 ml) and 2 335 ml (1 500-20 000 ml), respectively. No amniotic fluid embolism, severe adverse reactions, shock and death occurred in the two groups. (3) Multivariate regression analysis showed that age ≥35 years ( OR=1.5, 95% CI: 1.1-1.9), prenatal hemoglobin level <110 g/L ( OR=1.7, 95% CI: 1.3-2.2), history of uterine surgery ( OR=1.8, 95% CI: 1.3-2.6), placenta previa ( OR=1.9, 95% CI: 1.1-3.1), placenta accreta ( OR=2.6, 95% CI: 1.8-3.9), blood pool in the placenta ( OR=1.6, 95% CI: 1.1-2.3), abnormal posterior placenta muscle wall ( OR=1.8, 95% CI: 1.2-2.6), placenta projecting to the anterior uterine wall ( OR=3.0, 95% CI: 1.3-7.0) were risk factors for blood loss ≥1 500 ml in obstetric transfusion using IOCS technique, with statistical significance (all P<0.05). Conclusion:IOCS is safe and effective in cesarean section, which could save the medical resources and reduces medical expenses, however, it is necessary to strictly master the application indication.
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Objective:To investigate the clinical characteristics and pregnancy outcomes of fetal umbilical artery embolism.Methods:This retrospective case series recruited 18 cases of fetal umbilical artery embolism delivered at Xiamen Maternal and Child Healthcare Hospital from January 2018 to February 2020. Maternal age, complications, umbilical artery condition revealed by prenatal ultrasound, delivery mode, perinatal outcomes, and placental pathological examinations were analyzed using descriptive statistical methods.Results:(1) The total prenatal detection rate of umbilical artery embolism was 0.062% (18/29 130). The average maternal age was (30.1±6.1) years old. Four of the 18 cases aged other 35 and one was younger than 18 years old; 17 cases were singleton pregnancy, and the other one was a dichorionic diamniotic twin pregnancy. The mean gestational age was (35.1±2.6) weeks when an abnormal umbilical artery was first indicated by ultrasound, including 16 with a single umbilical artery shown in the third trimester and two with suspected umbilical artery embolism. The main complications were followed as gestational diabetes mellitus (8/18), fetal growth restriction (4/18), and abnormal umbilical cord insertion (3/18). (2) Cesarean section was performed for 16 cases, resulting in live births, while the other two cases had intrauterine death. Among the 16 neonates, nine were premature infants, and seven were full-term infants, with an average birth weight of (2 434±816) g; four were small for gestational age, and neonatal asphyxia occurred in three cases. Eleven were admitted to the neonatal intensive care unit, including five with brain injury. (3) Placental pathological examinations showed embolism in one of the two umbilical arteries in 17 cases and the umbilical vein in one case. Excessive torsion of the umbilical cord was observed in 11 cases and the umbilical cord's abnormal insertion in three cases. One case refused placental pathological examination.Conclusions:Umbilical artery embolism should be considered when a single umbilical artery is indicated by ultrasound in the third trimester. The time of delivery should be based on the risk of premature birth and unexpected adverse events. A cesarean section is suggested.
ABSTRACT
Background and purpose:The gastric cancer is the highest incidence of malignant tumors in the world. The main treatment methods for gastric cancer are operation and chemotherapy. But the effect is not good. With the rapid development of economy and molecular biology, early diagnosis and molecular targeted therapy for gastric cancer has become a research hotspot. The oncogene overexpression and the anti-oncogene lower expression are closely related with gastric cancer.CDC4/FBXW7 is an anti-oncogene, butc-Myc is an oncogene. The previous research showed that CDC4 affected the expression of many oncogenes, such as Cyclin E. This study aimed to investigate the expression of CDC4 and c-Myc in gastric cancer and to elucidate the potential relationship between their expressions and clinical pathological characteristics.Methods:Semi-quantitative reverse transcription polymerase chain reaction (sRT-PCR), immunohistochemistry and Western blot method were used to determine the mRNA and protein expressions of CDC4 and c-Myc in 40 specimens of gastric carcinoma tissues, corresponding adjacent tissues and normal mucosal tissues. The expressions of CDC4 and c-Myc and the clinical pathological characteristics were analyzed.Results:The protein expressions of CDC4 in gastric cancer tissues were signiifcantly lower than those in adjacent tissues and normal mucosal tissues (P<0.05), whereas the protein expression of c-Myc in gastric cancer tissues was signiifcantly higher than that in adjacent tissues and normal mucosal tissues (P<0.05). The protein and mRNA expression of CDC4 and c-Myc were correlated with differentiation, TNM stage, lymph node metastasis, inifltration, but not with patients’ gender, age and site of cancer (P<0.05). There was a signiifcant negative correlation between CDC4 and c-Myc at the mRNA and protein expression levels (P<0.05).Conclusion:The lower expression of CDC4 is correlated with differentiation, TNM stage, lymph node metastasis and inifltration. c-Myc overexpression is likely to be the CDC4 loss. It suggests that the loss of CDC4 may be a valuable marker for assessing the diagnosis and treatment and the prognosis of gastric cancer.