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Objective:To explore the value of jellyfish sign, an abnormal ultrasonographic sign, in predicting adverse perinatal outcomes of women with complete placenta previa combined with placenta accreta spectrum disorders (PAS).Methods:This retrospective study analyzed the ultrasound images of 72 singleton gravidas, diagnosed with complete placenta previa combined with PAS, who underwent cesarean section at the First Affiliated Hospital of Nanjing Medical University between January 2020 and February 2023. Based on the presence and absence of the jellyfish sign in ultrasound images, these gravidas were divided into the jellyfish-sign group (15 cases, 20.8%) and the non-jellyfish-sign group (57 cases, 79.2%). The clinical data and perinatal outcomes of the two groups were analyzed. The adverse perinatal outcomes encompassed conditions such as abdominal aorta balloon block, uterine artery embolism, hysterectomy, postpartum hemorrhage, and neonatal intensive care unit (NICU) admission of their neonates. Statistical analysis was performed using two independent samples t-test, the Mann-Whitney U test and the Chi-square (or Fisher's exact) test. Results:(1) The jellyfish-sign group exhibited a higher parity [(1.6±0.7) times vs (1.2±0.6) times, t=2.01] and higher prenatal scores of placenta accreta [(12.3±1.5) scores vs (8.6±2.9) scores, t=6.59] than those in the non-jellyfish-sign group (both P<0.05). Among the 57 cases in the non-jellyfish-sign group, there were 14 cases of placenta creta (24.6%), 40 cases of placenta increta (70.2%), and three cases of placenta percreta (5.3%). Among the 15 cases in the jellyfish-sign group, nine cases were diagnosed with placenta increta, six with placenta percreta, and none with placenta creta. The difference in distribution between the two groups was statistically significant (Fisher's exact test, P<0.001). (2) Intraoperative blood loss [(for those who accepted abdominal aorta balloon block, 1 973±1 057) ml vs (1 211±576) ml, t=2.55], red blood cells transfused [4.0 U (2.0-23.0 U) vs 2.5 U (0.0-11.0 U), Z=－2.53], postoperative hospitalization time [(9.7±2.4) vs (7.5±2.2) d, t=3.36], the incidence of abdominal aorta balloon block [15/15 vs 38.6% (22/57), χ2=17.92], uterine artery embolism [for those who accepted abdominal aorta balloon block, 3/15 vs 1.8% (1/57), Fisher's exact test], and requiring blood transfusion [15/15 vs 63.2% (36/57), Fisher's exact test] were higher in the jellyfish-sign group than those in the non-jellyfish-sign group. However, the non-jellyfish-sign group had lower gestational age at delivery [(33.6±1.5) weeks vs (35.2±1.8) weeks, t=－3.24], and lower neonatal Apgar score at 1 min and 5 min [1 min: 8 scores (3-10 scores) vs 9 scores (4-10 scores), Z=－2.46; 5 min: 9 scores (7-10 scores) vs 10 scores (6-10 scores), Z=－2.02] (all P<0.05). There were no significant differences in emergency surgery rate, 24 h postoperative blood loss, neonatal birth weight, and proportion of NICU admission between the two groups. Additionally, no cases of hysterectomy or death were observed in the two groups. Conclusions:Ultrasound examination revealing jellyfish signs in patients with complete placenta previa and PAS is associated with an increased likelihood of adverse perinatal outcomes. Consequently, the management of these patients should be given greater attention.
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Objective To compare dexmedetomidine administered via different routes for epidural anesthesia during second cesarean section.Methods Sixty parturients who were at full term with a singleton fetus,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 22-38 yr,weighing 58-84 kg,undergoing a second caesarean section under epidural anesthesia,were divided into 3 groups (n=20 each) using a random number table:Ⅳ infusion of dexmedetomidine conbined with epidural injection of ropivacaine group (VDER group),epidural injection of a mixture of ropivacaine and dexmedetomidine group (ERD group) and epidural injection of ropivacaine group (ER group).The epidural puncture was performed at L2,3.After identification of the epidural space and a negative aspiration test for blood or cerebrospinal fluid,the mixture of 0.75％ ropivacaine 15 ml and 0.9％ normal saline 2 ml was injected epidurally,and dexmedetomidine 1 μg/kg was intravenously infused for 10 min at the same time in VDER group;the mixture of 0.75％ ropivacaine 15 ml and 1 μg/kg dexmedetomidine 2 ml was injected epidurally in ERD group;the mixture of 0.75％ ropivacaine 15 ml and 0.9％ normal saline 2 ml was injected epidurally in ER group.The onset time of epidural block,maximum level ofepidural block,time to reach the maximum epidural block and time of sensory block were recorded.Ramsay sedation scores were assessed at 30 miu after the end of epidural administration,and intraoperative traction reaction was also assessed.The development of hypotension,bradycardia,respiratory depressim and shivering was observed.The number of patients in whom remifentanil was used before delivery and Apgar scores at 1 and 5 min after birth were recorded.Results Compared with VDER group and ER group,the onset time and time to reach the maximum epidural block were significantly shortened,and the time of sensory block was prolonged in ERD group (P＜0.05).Compared with ER group,the rate of satisfactory sedation was significantly increased,the number of patients in whom remifentanil was used before delivery was decreased,the degree of intraoperative traction reaclion was mitigated,and the incidence of respiratory depression and shivering was decreased (P＜0.05),and no significant change was found in Apgar scores at 1 and 5 min after birth in VDER and ERD groups (P＞0.05).Conclusion Both Ⅳ and epidural dexmedetomidine can enhance the efficacy of epidural anesthesia during second cesarean section,producing no adverse effects on neonates;epidural injection of a mixture of ropivacaine and dexmedetomidine provides faster onset and prolonged time of sensory block,which is helpful for postoperative analgesia.
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Objective To evaluate the relationship between pathogenesis of preeclampsia (PE) and the ultrastructure change of the endoplasmic reticulum in trophocyte, mRNA and protein expression levels of endoplasmic reticulum molecular chaperone glucose-regulated protein 78 (GRP78), glucose-regulated protein 94 (GRP94), endoplasmic reticulum apoptosis factor cysteine protease protein 12 (caspase-12).Methods Sixty-five pregnant women who were hospitalized in the First Affiliated Hospital of Nanjing Medical University from July 2008 to January 2010, were selected as the subject. Thirty pregnancy women diagnosed with PE were divided into PE group and 35 normal pregnant women were used as control group.Electron Microscopy was used to measure ultrastructure change of the endoplasmic reticulum in placenta trophocyte. Reverse transcription(RT) PCR and western blot were used to investigute the expression levels of GRP78, GRP94, caspase-12 mRNA and protein in placenta. Results (1) In control group the volume of endoplasmic reticulum does not increase; no swelling and no expansion of endoplasmic reticulum was found.In PE group the edema number of endoplasmic reticulum was reduced; the volume of endoplasmic reticulum increased; expansion and vacuolation of cavity and degranulation of the endoplasmic reticulum was observed significantly. (2) The mRNA and protein expression levels of GRP78 in placenta of PE group (2.59 ± 0. 09 and 0. 81 ±0. 31) were significantly higher than those in placenta of control group (1. 16 ±0. 07 and 0. 40 ± 0. 10, P <0. 01). (3) The mRNA and protein expression levels of GRP94 in placenta of PE group (1.31 ± 0. 91 and 0. 55 ±0. 24) were significantly higher than those in placenta of control group (0. 63 ±0. 57 and 0. 22 ±0. 09, P < 0. 01). (4) The mRNA and protein expression levels of caspase-12 in placenta of PE group (4. 03 ± 0. 65 and 1.56 ± 0. 17) were significantly higher than those in placenta of control group (1.85 ± 0. 85 and 0. 91 ± 0. 69, P < 0. 01). Conclusion The obvious expansion of endoplasmic reticulum in trophocyte and the increased expression levels of GRP78, GRP94 and caspase-12 indicate that endoplasmic reticulum stress-mediated apoptosis may be involved in the pathophysiological processes of PE.
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Objective To investigate the changes of the serum level of IL-6 and IL-10 as well as their significance after coronary artery stent implantation. Methods The study involved 30 patients who underwent coronary artery stent implantation. Blood stamples were taken from the femoral arteries before and 24h after successful coronary stenting. Serum concentration of interleukin-6 (IL-6) and interleukin-10 (IL-10) were measured and complications as well as the occurance of restenosis were observed after the procedure. Results The concentration of IL-6 in femoral aterial blood was significantly higher after 24 hours of stent-implantation (214.6?118.0 ng/L vs 175.8?81.8 ng/L, P 0.05, and the ratio of IL-6/IL-10 increased (3.2?1.9 vs 2.3?1.0, P