Relationship between prenatal D-dimer level and postpartum hemorrhage in patients with preeclampsia / 中国医师杂志

Objective:To investigate the relationship between prenatal D-dimer level and preeclampsia complicated with postpartum hemorrhage (PPH).Methods:The clinical data of 340 preeclampsia pregnant women in Hechi People′s Hospital from January 2016 to December 2020 were retrospectively analyzed. According to whether PPH occurred, they were divided into preeclampsia complicated with PPH group (PPH group, 57 cases) and uncomplicated PPH group(non PPH group, 283 cases). The general clinical data, blood routine and coagulation function parameters before delivery of the two groups were analyzed, and the differences between the two groups were compared. Logistic regression analysis was used to investigate the relationship between prenatal D-dimer level and preeclampsia complicated with PPH. Meanwhile, the influence of D-dimer level on the occurrence of PPH in preeclampsia patients was quantified. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of D-dimer level on preeclampsia complicated with PPH.Results:Compared with non-PPH group, PPH group had higher white blood cell counting and D-dimer levels ( P<0.05), and lower levels of platelet count and fibrinogen (all P<0.05); there were no significant difference in the levels of hemoglobin and activated partial thrombin time (APTT) between the two groups (all P>0.05). Multivariate logistic regression analysis showed that elevated D-dimer level was an independent risk factor for PPH in preeclampsia patients ( OR=1.150, 95% CI: 1.076-1.230, P<0.001). When D-dimer≥2.16 μg/ml, the risk of PPH in preeclampsia patients increased by 2.804 times ( OR=3.904, 95% CI: 1.705-8.939, P=0.001). In patients who delivered three times or more, D-dimer predicted the occurrence of PPH with an AUC of 0.851, specificity of 60.78%, and sensitivity of 100%. Conclusions:Elevate D-dimer level is an independent risk factor for preeclampsia complicated with PPH. When the D-dimer level increased by 1 unit, the risk of PPH in preeclampsia patients increased by 0.15 times. D-dimer has a high predictive value for the occurrence of PPH in preeclampsia patients who delivered three times or more.

Analysis of the influencing factors of cervical dilatation balloon in the induced labor in primipara / 中国医师杂志

Objective:To investigate the influencing factors and to build a model for predicting successful labor induction with cervical ripening balloon (CRB) in primipara.Methods:312 cases of primipara in late trimester of pregnancy induced by CRB between January 2018 and April 2019 in the First Affiliated Hospital of Shenzhen University were reviewed retrospectively. Factors including gravidity, age, body height, body weight, body mass index (BMI), the cervical Bishop score, neonatal birth weight, pregnant complication and other factors were collected to analyze the effect on successful labor induction.Results:Pregnancy times, cervical Bishop score and height in primipara were positively correlated with the success rate of induced labor, while BMI and neonatal weight were negatively correlated with the success rate of induced labor. The area under receiver operating characteristic (ROC) curve was 0.849 and diagnostic threshold was 0.725, with a sensitivity of 80.7% and a specificity of 75.7%.Conclusions:Among the primipara, the gravidity and cervical Bishop score are the most significant factors influencing the successful labor induction. These factors can be used as the predictive indexes for the outcome of labor induction along with pregnancy times, height, BMI and neonatal birth weight, which is beneficial to reduce the artificial interventions and improve the success rate of labor induction.

Correlation between vitamin A and E concentrations during pregnancy and preeclampsia / 中国医师杂志

Objective To investigate the relationship between vitamin A and vitamin E concentra-tions and preeclampsia. Methods A total of 160 pregnant women who were finished normal perinatal care and tested for serum vitamin A and vitamin E concentrations in the First Affiliated Hospital of Shenzhen Uni-versity (Shenzhen Second People's Hospital) from March 1, 2018 to February 28, 2019, including 80 pre-eclampsia cases and 80 healthy control cases were enrolled in the study. The concentrations of serum vita-mins A and E in early pregnancy ( <14 weeks) and late pregnancy (≥34 weeks) were determined by high performance liquid chromatography tandem mass spectrometry. The collected clinical and test data were sta-tistically analyzed. Results ⑴There was no significant difference in vitamin A concentration between pre-eclampsia group and control group during early pregnancy (P=0. 360) and there was no significant differ-ence in vitamin A concentration between preeclampsia group and control group during late pregnancy ( P=0. 450). ⑵ The concentration of vitamin E in early pregnant women in preeclampsia group was [(9. 51 ± 2. 82)mg/L], which was lower than that in healthy control group [(11. 19 ± 3. 04)mg/L], with significant statistically difference (t=8. 85, P=0. 01); the vitamin E concentration in late pregnant women in pre-eclampsia group was [(13. 52 ± 4. 40)mg/L], which was lower than that in healthy control group [(16. 20 ± 5. 00)mg/L], with significant statistically difference (t=10. 9, P=0. 01). ⑶Logistic regression anal-ysis showed that there was a correlation between vitamin E concentration in early pregnancy and late preg-nancy and preeclampsia. Conclusions There was no significant correlation between vitamin A concentra-tion and preeclampsia. Vitamin E may be involved in the pathogenesis of pre-eclampsia.

Value of dynamic contrast-enhanced CT combined with MRI in differential diagnosis of adrenal adenoma and metastatic tumor / 中国医师杂志

Objective To investigate the clinical significance of dynamic contrast-enhanced computed tomography (CT) combined with magnetic resonance imaging (MRI) in differential diagnosis of adrenal adenoma and metastasis.Methods 120 patients with adrenal adenoma who were examined by enhanced MRI and enhanced CT before operation were collected.According to the pathological examination after operation,they were divided into adrenal adenoma group (86 cases) and adrenal metastasis group (34 cases).The difference of time-density curve between the two groups was compared,and the diagnostic criteria were evaluated by using receiver operating characteristic (ROC) curve.Results Dynamic CT and dynamic MRI were mainly type A,followed by type C,B,D and E.Dynamic CT and dynamic MRI were mainly type B,followed by type D/E,type A and type C.There were significant differences in type A,B,C,E dynamic CT and dynamic MRI between the two groups (P ＜ 0.05);there was no significant difference in type D dynamic CT and dynamic MRI between the two groups (P ＞ 0.05).The AZ value of adrenal adenomas ranged from 0.714 to 0.825 and that of adrenal metastasis ranged from 0.872 to 0.965 at 3-30 minutes delay.Conclusions Dynamic contrast-enhanced CT combined with MRI in patients with adrenal adenoma and metastasis has a time-density difference,5min has high discriminant value in time lapse.

Value of dynamic contrast-enhanced CT combined with MRI in differential diagnosis of adrenal adenoma and metastatic tumor / 中国医师杂志

Objective@#To investigate the clinical significance of dynamic contrast-enhanced computed tomography (CT) combined with magnetic resonance imaging (MRI) in differential diagnosis of adrenal adenoma and metastasis.@*Methods@#120 patients with adrenal adenoma who were examined by enhanced MRI and enhanced CT before operation were collected. According to the pathological examination after operation, they were divided into adrenal adenoma group (86 cases) and adrenal metastasis group (34 cases). The difference of time-density curve between the two groups was compared, and the diagnostic criteria were evaluated by using receiver operating characteristic (ROC) curve.@*Results@#Dynamic CT and dynamic MRI were mainly type A, followed by type C, B, D and E. Dynamic CT and dynamic MRI were mainly type B, followed by type D/E, type A and type C. There were significant differences in type A, B, C, E dynamic CT and dynamic MRI between the two groups (P<0.05); there was no significant difference in type D dynamic CT and dynamic MRI between the two groups (P>0.05). The AZ value of adrenal adenomas ranged from 0.714 to 0.825 and that of adrenal metastasis ranged from 0.872 to 0.965 at 3-30 minutes delay.@*Conclusions@#Dynamic contrast-enhanced CT combined with MRI in patients with adrenal adenoma and metastasis has a time-density difference, 5min has high discriminant value in time lapse.

Endovascular recanalization with a direct aspiration first-pass thrombectomy technique for acute cerebral artery occlusion / 中华神经科杂志

Objective To investigate the feasibility, safety and technical superiority of mechanical thrombectomy using a direct aspiration first-pass thrombectomy (ADAPT) in treatment of patients with acute cerebral artery occlusion. Methods A retrospective study was conducted on all patients with acute ischemic stroke treated with mechanical thrombectomy in our institution from January 2013 to August 2016.Patients using ADAPT or stent retriever as a first-line endovascular procedure were compared for clinical characteristics, procedural variables and clinical outcomes. The technical superiority of ADAPT was analyzed in depth. Results During observation period, a total of 91 cases were performed endovascular treatment with mechanical thrombectomy. ADAPT was designed in 46 cases as a first-line endovascular procedure and was utilized in 38 cases (82.6%;ADAPT group), while primary stent retriever thrombectomy was performed in 21 patients(stent group). There was no significant difference in baseline clinical or radiographic factors between ADAPT and stent groups. Although rates of good neurological outcome (modified Rankin Scale(mRS) score≤2) at 90 days were similar between the ADAPT and stent groups (61%(23/38) vs 48%(10/21), P=0.247), National Institute of Health Stroke Scale (NIHSS) score at seven days (6.0(2.0, 9.3) vs 9.0(5.5, 18.5),Z=-2.031,P=0.021) and full recovery rate of neurological outcome (mRS score=0, 37%(14/38) vs 10%(2/21), P=0.022) were significantly better in the ADAPT group than in the stent group. There were no significant differences in rates of embolus to new territory (21%(8/38) vs 29%(6/21), P=0.365), Thrombolysis In Cerebral Infarction (TICI) 2b/3 grade revascularization (84%(32/38) vs 81%(17/21), P=0.507) and symptomatic intracerebral hemorrhage (0%(0/38) vs 10%(2/21), P=0.123) between the ADAPT and the stent groups, but the figures were better in the ADAPT group. Conclusions Mechanical thrombectomy using ADAPT is feasible and safe compared with stent retriever, with higher full recovery rate of neurological outcome and better NIHSS score.It is a method worthy of further exploration for endovascular mechanical recanalization.

Clinical significance of secondary results from non-invasive prenatal testing / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To assess the accuracy of copy number variations (CNVs) detection by non-invasive prenatal testing (NIPT) in addition to its routine targets and clinical significance of such CNVs for the reduction of fetuses born with chromosomal microdeletion/duplication syndromes.</p><p><b>METHODS</b>From October 2014 to October 2015, 14 235 pregnant women volunteered to participate in the study. Fifteen cases detected with chromosomal CNVs by the NIPT decided to undergo prenatal diagnostic procedures including amniocentesis, G-banded karyotyping and chromosomal microarray analysis (CMA). All such cases were routinely followed up after birth.</p><p><b>RESULTS</b>Among the 14 235 subjects underwent NIPT, 18 cases were detected with Down syndrome, 4 with trisomy 18, and 2 with trisomy 13, in addition with 24 cases of CNVs. For the latter, 15 (including 11 cases with microdeletions and 4 cases with microduplications) participated in further prenatal diagnosis. In 13 cases (86.7%), the results of CMA were consistent with those of NIPT. On the other hand, only 7 out of the 15 cases showed a positive result with karyotyping, suggesting a rather high rate of missed diagnosis (46.2%). Of note, karyotyping has identified partial inversion of chromosome 9 in one case.</p><p><b>CONCLUSION</b>As a screening tool, NIPT has a high accuracy for the detection of CNVs. However, as this method is still under improvement, it is more of a reminder rather than a diagnostic tool with full capability.</p>

Performance verification and evaluation of Stago STA-R automatic blood coagulation analyzer / 国际检验医学杂志

Objective To conduct the performance verification of the Stago STA-R automatic blood coagulation analysis system once every year to evaluate the analysis system for ensuring its accuracy and reliability .Methods According to the related docu-ments of the Clinical and Laboratory Standards Institute (CLSI) ,5 items of prothrombin time (PT ) ,activated partial clotting en-zyme live time (APTT) ,thrombin time (TT) ,fibrinogen (Fib) and antithrombin Ⅲ (ATⅢ) were selected to conduct the verifica-tion and preliminary evaluation on the accuracy ,imprecision ,carry-over rate ,linearity range and reference interval of the instrument analysis system .Results The relative bias(SE% ) of accuracy in each item was less than 5% .The intra-batch and inter-batch im-precisions (CV) were less than 3% and 5% respectively .The carry-over rates were within 4% .The linearity of Fib and AT Ⅲ was very well ,r2 were 0 .9980 and 0 .9979 respectively .Validated reference interval was consistent with quotative reference range . Conclusion The Stago STA-R automatic blood coagulation analysis system has good analytical performance ,can provide accurate and reliable test results for clinical doctors .

The perioperative risk factors of postoperative complications after posterior lumbar fusion operation: a retrospective analysis of 654 cases / 中华骨科杂志

Objective To analyze the perioperative risk factors of postoperative complications after posterior lumbar fusion operation.Methods The clinical data of 654 patients with posterior lumbar fusion during 2010 and 2014 were retrospectively analyzed.Using x2 test and one-way ANOVA,the predicted risk factors were screened for further Logistic regression.Results The total complication rate was 11.6％ among all 654 patients.The major complications included cardiac infarction,deep infection,sepsis,neurological impairment,and secondary operation.And the minor complications included wound dehiscence,urinary tract infection,pulmonary infection,gastrointestinal bleeding,CSF leakage and others.According to x2 test and one-way ANOVA,renal function insufficiency,preoperative neurological injury,ASA higher than Ⅲ level,intraoperative blood loss,long operation length,and usage of autogenous bone were screened as risk factors of complications.Renal function insufficiency,preoperative neurological injury,intraoperative blood loss,and long operation length were screened as risk factors of minor complications.And male,renal function insufficiency,preoperative neurological injury,intervertebral fusion,and posteriolateral fusion were screened as risk factors of major complications.However,according to Logistic regression,the independent risk factor of complications were preoperative neurological injury and long operation length;independent risk factors of minor complications were renal function insufficiency,preoperative neurological injury and long operation length;and independent risk factor of major complications was preoperative neurological injury.Conclusion Preoperative neurological injury,renal function insufficiency and long operation length are proved to be the risk factors of postoperative complication in lumbar fusion surgery.

Regulatory effect of transforming growth factor-β on activation of hepatic stellate cells / 临床肝胆病杂志

In the process of liver fibrosis, transforming growth factor β (TGFβ) is considered an important regulatory factor for the activation of hepatic stellate cells (HSCs) and extracellular matrix production. Therefore, the therapeutic strategies targeted at the activation of HSCs and liver fibrosis induced by TGFβ are worthy of further research. This article reviews the role of TGFβ in the activation of HSCs, the regulatory effect of TGFβ, and the therapeutic strategies targeted at the activation of HSCs induced by TGFβ, so as to provide a theoretical basis and new thoughts for the clinical treatment of liver fibrosis.

Expression and identification of VEGF165 in bone marrow mesenchymal stem cells of rhesus / 天津医药

Objective To detect the transferred vascular endothelial growth factor (VEGF)165 gene expression in rhesus autologous bone marrow mesenchymal stem cells (MSCs), and to explore the functional viability of transgenic MSCs. Methods MSCs from rhesus bone were isolated by Ficoll, which were used to detect the phenotype. After the culturing, the expression vector pcDNA-eGFP-VEGF165 was transfected into bone marrow MSCs. Fluorescence microscope and flow cytometry were used to detect the enhanced green fluorescent protein (eGFP) expression. At the same time, the phenotype in transfected MSCs was also indentified. The VEGF165 expression level was detected by RT-PCR. Results The highly purified MSCs were collected successfully. The transfected MSCs and daughter cells showed expressions of eGFP and VEGF165, which also remained the characteristics of MSCs. Conclusion The VEGF165 gene that is transfected into MSCs can maintain characteristics of MSCs, and stably express foreign genes.

Liver resection for patients with hepatocellular carcinoma and portal hypertension / 中国癌症杂志

Background and purpose: The proportion of hepatocellular carcinoma (HCC) patients with cirrhosis and portal hypertension (PHT) is high. PHT may increase the risk of hemorrhage and liver failure. The aim of this study was to evaluate the safety and efifcacy of liver resection (LR) for patients with HCC and PHT. Methods:From 2006 to 2010, a total of 564 HCC patients with Child-Pugh A liver function and with (78) or without PHT (486) were retrospective analyzed. Complications after surgry, 30 and 90-day mortality, overall survival (OS), and recurrence rates were compared between the two groups. Propensity score analysis was also conducted to reduce confounding bias between the groups. Moreover, subgroup analysis based on tumor stage and the range of resection was carried out. Results:The complications after surgry, 30 and 90-day mortality of patients with PHT were signiifcantly higher than those without PHT, before and after propensity analysis (P0.05). Conclusion: PHT is not the contraindication of LR for patients with HCC. Those with early stage HCC and who underwent minor hepatectomy are the best candidates to LR therapy.

Influence factors for neurodevelopmental impairment of infants with tetralogy of Fallot / 中华胸心血管外科杂志

Objective To analyze the risk factors for neurodevelopmental impairment of infants with tetralogy of Fallot (TOF).Methods Neurodevelopment of infants aged 0-3 years and undergoiong tetralogy of Fallot surgic operations in NanJing Children Hospital between October 2010 and October 2011 were assessed with Bayley Scales of Infant Development test (BSID).On the basis of assessment results,infants with 90 piont or more were devided into the normal group,and the rest less than 90 point were devided into the abnormal group.Compare the difference of birh weight,age,weight transcutaneous oxygen saturation (SPO2),hematokrit (HCT),McGoon index and left ventricular end-diastolic capacity index(LVEDI) at surgery between the two groups with t-test.And to identify risk factors for neurodevelopmental impairment of infants with tetralogy of Fallot with multivariate linear regression analysis.P ＜ 0.05 was statistically significant.Results All of 83 infants with 55 males and 28 females were admitted into this prospective study.There was no statistical significance in mental development index (MDI) and psychological development index (PDI) between the sexes.For MDI:normal 67 (80.7％),abnormal 16 (18.3％).With t-test,McGoon index,left ventricular end-diastolic capacity index and birth weight had significant difference between the two groups (P ＜ 0.05).Multivariate linear regression analysis showed that McGoon index,left ventricular end-diastolic capacity index and age at surgry were risk factors for MDI decrease,beta was 21.41,0.59 and-0.31,respectively (P＜ 0.05).Age at surgry was connected with MDI nagetively,McGoon index affected mostly.For PDI:normal 61 (73.5％),abnormal 22(26.5％).With t-test,MaGoon index and left ventricular end-diastolic capacity index had statistical significance between the two groups(P ＜ 0.05).Multivariate linear regression analysis showed that McGoon index and left ventricular end-diastolic capacity index were risk factors for PDI decrease,beta was 23.88 and 0.49,respectively (P =0.000).McGoon index influenced greatly.Conclusion McGoon index,left ventricular end-diastolic capacity index and age at surgry are influence factors for MDI decrease.McGoon index,left ventricular end-diastolic capacity index are risk factors for PDI decrease.McGoon index affects neurodevelopment of infants with tetralogy of Fallot mostly.

Expression and significance of phosphorylation-mammalian target of rapamycin in endometrial carcinoma / 中国医师进修杂志

Objective To investigate the expression of phosphorylation-mammalian target of rapamycin (p-mTOR) in endometrial carcinoma. Methods The expressions of p-mTOR protein in tissues from 45 cases of endometrial adenocarcinoma, 7 endometrial atypical hyperplasia, and 6 normal endometrium were detected by immunohistochemistry SP method. Results The expression of p-mTOR protein maily restricted to cytoplasm. Compared with normal endometrium, the expression of p-mTOR protein in the cases of endometrial atypical hyperplasia and endometrial adenocarcinoma was significantly up-regulation(2.36 ± 0.76vs 6.21 ± 1.19, 15.82 ± 2.64)( F = 11.37, P ＜ 0.05 ). There was significant difference of p-mTOR protein in different histology class in endometrial adenocarcinoma (F = 8.27, P ＜ 0.05), but there was no significant difference of p-mTOR protein in different pathological grade in endometrial adenocarcinoma (P ＞0.05).Conclusion The expression of p-mTOR protein may participate in the occurrence and development of endometrial carcinoma.