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Objective:To analyze the predictive factors of postpartum SUI, and establish and validate nomogram model.Methods:A total of 272 patient from Affiliated Jinhua Hospital, Zhejiang University School of Medicine were reviewed, and the general clinical data and ultrasound parameters were analyzed. The median age (range) was 32 (28-38) years. Vaginal delivery was recorded in 191(70.0%), while cesarean section was performed in 81(30.0%) cases. The average body mass index (BMI) was (23.0±2.9) kg/m 2. The median bladder neck mobility was 2.5cm and rate of bladder neck funnel was 25%. Patients were divided into two groups: Group SUI(n=98) and Group NSUI (without SUI, n=174). The independent predicting SUI were analyzed by univariate and multivariate logistic regression analysis. Two predictive models were constructed with the important general clinical data and ultrasound parameters, then receiver operating characteristic (ROC) curve analyses were conducted to evaluate the predictive power of two models. At last, the nomogram was established for the better model. Results:The results of multivariate analysis showed that age( OR=1.08, P=0.011), delivery method( OR=9.26, P<0.01), body mass index( OR=1.15, P=0.023), bladder neck distance ( OR=1.73, P=0.047) and bladder neck funneling( OR=18.44, P<0.01) were independent predictors for SUI. Two predictive models were used with independent predictors of SUI. The area under the receiver operating characteristic(ROC)curve of validation group was 0.88. The area under the ROC curve of general clinic factors was 0.77. The difference between the two model and other indicators was statistically significant( P<0.001). The nomogram model was well calibrated, with the mean absolute error of 1.9%. Conclusions:Age, delivery method, BMI, bladder neck mobility and bladder neck funneling were independent predictors for SUI. The nomogram model for predicting SUI has a good statistical significance.
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OBJECTIVE@#To establish a prognostic model for preterm birth in women after cervical conization, and to evaluate its effectiveness.@*METHODS@#Seventy three women after cervical conization in Women's Hospital of Zhejiang University were included for this retrospective study. The influencing factors of preterm delivery were analyzed by Logistic regression analysis and a prognostic model was created. Receiver operating characteristic (ROC) curve was used for evaluation of the predictive ability of the model. Forty five women who underwent cervical conization were included for testing the validity of the model.@*RESULTS@#For women after cervical conization, mother's age (=1.20, 95%:1.01-1.43, <0.05) and cervical length during middle pregnancy (=0.06, 95%:0.01-0.21,<0.01) were independent predictors for preterm birth. The regression model was Logit ()=1.408-2.903×cervical length+0.186×age. The areas under the ROC curve (AUC) of the training dataset was 0.93 (95%:0.87-0.99). The sensitivity, specificity, Youden index, positive predictive value (PPV), negative predictive value (NPV) and accuracy with the cutoff value of -1.512 were 91.7%, 81.5%, 0.732, 68.8%, 95.7% and 84.5% respectively. The AUC of the testing dataset was 0.94 (95%:0.86-1.00). The sensitivity, specificity, Youden index, PPV, NPV and accuracy with the cutoff value of -0.099 were 92.9%, 90.3%, 0.832, 81.3%, 96.5% and 91.1%, respectively.@*CONCLUSIONS@#The model based on the age and cervical length during middle pregnancy can effectively predict preterm delivery in pregnant women after cervical conization.
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Female , Humans , Pregnancy , Cervix Uteri , General Surgery , Conization , Models, Biological , Premature Birth , Diagnosis , Prognosis , ROC Curve , Retrospective StudiesABSTRACT
Objective To investigate the prenatal diagnosis and postnatal clinical outcomes of fetal congenital choledochal cyst (CCC) to improve the recognition and treatment of fetal CCC.Methods Clinical data of 23 cases of fetal CCC which were diagnosed during routine prenatal ultrasonic examination in Jinhua Municipal Central Hospital from June 2009 to May 2015 were retrospectively analyzzed. Maternal age, gestational age at diagnosis of CCC, location and size of cyst, postnatal examination, age at operation and follow-up outcomes were recorded and statistically analyzed by Wilcoxon rank-sum test.Results (1) Among the 23 cases, six (26%) were terminated and the rest 17 continued their pregnancies (74%). (2) Results of the prenatal ultrasonography of the 23 cases indicated that hepatic portal cysts were closely related to hepatic portal veins or arteries. Six of the cysts communicated with gall bladder and eight connected to intrahepatic bile duct. The maximum diameter of the cysts in the 23 cases was 16.0-31.0 mm, averagely (24.7±3.7) mm. The maximum diameter of cysts diagnosed in the third trimester was significantly larger than that in the second trimester [ 27.0 (22.0-31.0) vs 23.0 (21.0-25.0) mm,Z=-2.134,P<0.05]. (3) Among the 17 cases of continued pregnancy, one underwent cesarean section at 35+ weeks of gestation and 16 delivered at term with the average gestational age at delivery of (38.2±1.1) weeks. All neonates were re-examined by abdominal ultrasound at 1-2 postnatal weeks and confimed prenatal diagnosed of CCC. (4) The 17 neonates were re-examined by abdominal ultrasound during the second postnatal week and the results showed that cyst size remained the same in four, decreased in one and gradually increased with the gestational age in 12 neonates. Among the 16 cases of confirmed CCC, 12 received surgery, including 11 (Ⅰa, 6;Ⅰc, 3;Ⅳb, 2) within one year-old and one (Ⅰc) around 18 months old. The prognosis was uneventful. Four out of the 16 cases rejected surgical operation and were followed up in outpatient. One neonate was diagnosed with congenital biliary atresia and transferred to Children's Hospital for operation.Conclusions When fetal abdominal cyst presented with hepatic portal cyst which communicates with gallbladder or intra-hepatic duct in ultrasonography, a congenital choledochal cyst should be taken into consideration by excluding the possibility of biliary atresia in the first place. Surgery for CCC infants without symptoms or signs is suggested to be performed around three months after birth. The postoperative prognosis of CCC is favorable, so termination is not recommended for gravidas with fetal CCC in prenatal consultation.
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Objective Malrotation of intestine with midgut volvulus is a special disease in newbo-rns.It is important of early diagnosis to avoid the risk of intestinal infarct and necrosis.We intended to ex-plore the value of early ultrasonographic diagnosis in malrotation of intestine with midgut volvulus,comparing with upper gastrointestinal imaging.Methods Ultrasonographic features and upper gastrointestinal imaging of 48surgically confirmed malrotation of intestine with midgut volvulus between January 2011and December 2014were retrospectively analyzed.Results All patients were comfirmed by operaion.The rotational degree of midgut volvulus were 90to 720°.In 43of 48patients (89.58%)of malrotation of intestine with midgut volvulus were diagnosed by ultrasonography.The typical ultrasonographic features were called “whirlpool sign”,which was the superior mesenteric vein and the mesentery around the superior mesenteric artery.In 35 of 48(72.92%)patients with malrotation were confirmed by the upper gastrointestinal imaging.The typical sign of the upper gastrointestinal imaging was the helical form of the distal duodenum and proximal jejunum located at middle abdomen.Compared with upper gastrointestinal radiographic examination,ultrasonographic examination had more sensitivity in diagnosis of malrotation of intestine with midgut volvulus (P﹤0.05). Conclusion Ultrasonographic examination have more sensitivity in diagnosis.Noninvasiveness,absence of X-rays,and low costs could make ultrasonographic examination a useful screening test in patients with sus-pected malrotation of intestine with midgut volvulus.“Whirlpool sign”could be considered a specific ultra-sonographic sign in diagnosis of midgut volvulus,which could provide reference for the clinical treatment of malrotation of intestine with midgut volvulus.
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Objective To determine whether intravenously transplanted bone marrow stromal cells (BMSCs) could promote recovery of lower urinary tract function in rats with spinal cord transaction.Method The BMSCs were harvested from rats and labeled with 5-bromo-2'-deoxyuridine (BrdU) (30 g/mL) in vitro for 3 days for intravenous transplantation.The BMSCs of 5th passage were characterized by flow cytometry of CD45 and CD90.Twenty-four male Sprague-Dawley rats were divided randomly into three goups.Sixteen rats received a spinal cord transection and a transplantation of cell culture medium (OP-controls,n =8) or BMSCs (n =8).Eight rats were justly given T8-T9 laminectomy (CNS-intact group,n =8).Urodynamic tests,HE staining and immunohistochemistry of the spinal cord with anti-BrdU at 28th day after transplantation were performed.Result The cultured BMSCs of 5th passage expressed 5.94％ of CD45 and 99.4％ of CD90 on flow cytometry.BMSC rats showed significant decrease in residual urine volume (0.85 ± 0.16 mL vs.1.54 ± 0.66 mL,P＜ 0.05),leak point pressure (33.85 ± 3.73 mmHg vs.40.83 ± 3.85 mmHg,P＜0.01),episodes of non-inhibitory contraction (NVC) (2.17 ± 1.12 vs.9.71 ± 3.84,P＜0.01) and increase in voiding efficiency (26.37 ± 6.97％ vs.2.68 ± 1.47,P＜0.01) compared to OP-control rats.In OP-control rats,only tonic EUS activity was remained and busting EUS activity was abolished during bladder filling.While,the tonic EUS activity and busting EUS activity were remained in BMSCs rats.Otherwise,the silent period between EUS bursts was shorter in BMSCs rats (68.86 ± 13.78 ms,P＜ 0.05) and OP-control rats (33.4 ms) than CNS-intact rats (132.79 ± 17.11 ms).Cells derived from BMSCs,identified by 5-BrdU immunoreactivity,survived and were distributed at the damaged tissue (T10),lumbar and sacral spinal cord.Conclusion Intravenously transplanted BMSCs survived in the injured spinal cord,lumbar and sacral cord for rebuilding new voiding reflex and inhibiting afferent sprouting leading to baldder dysfunction.So they had beneficial effects on the recovery of lower urinary tract function in rats with spinal cord transection.