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Objective:To observe the clinical outcomes of continued pregnancy in pregnant women with cesarean scar pregnancy (CSP).Methods:A retrospective analysis was performed on the pregnancy outcomes of 55 pregnant women who were diagnosed with CSP at the Second Affiliated Hospital of Army Medical University during the first trimester of pregnancy from August 1st, 2018 to October 31st, 2021 and strongly requested to continue the pregnancy.Results:Of the 55 pregnant women, 15 terminated the pregnancy in the first trimester, 1 underwent hysterotomy at 23 weeks of gestation due to cervical dilation, and 39 (71%, 39/55) continued pregnancy to the third trimester achieving live births via cesarean section. The gestational age of the 39 pregnant women delivered by cesarean section was 35 +6 weeks (range: 28 +5-39 +2 weeks), of whom 7 cases at 28 +5-33 +6 weeks, 20 cases at 34-36 +6 weeks, and 12 cases at 37-39 +2 weeks. The results of pathological examination were normal placenta in 3 cases (8%, 3/39), placenta creta in 4 cases (10%, 4/39), placenta increta in 9 cases (23%, 9/39) and placenta percreta in 23 cases (59%, 23/39). Among the 36 pregnant women who were pathologically confirmed as placenta accreta spectrum disorders (PAS) after surgery, the last prenatal ultrasonography showed placenta previa in 27 cases (75%, 27/36) and not observed placenta previa in 9 cases. The median intraoperative blood loss, autologous blood transfusion, and allogeneic suspended red blood cell infusion of 39 pregnant women during cesarean section were 1 000 ml (300-3 500 ml), 300 ml (0-2 000 ml) and 400 ml (0-2 400 ml), respectively. The uterine preservation rate was 100% (39/39), and only 1 case received cystostomy due to intracystic hemorrhage. The birth weight of the newborn was 2 580 g (1 350-3 800 g), and 1 case of mild asphyxia. Conclusions:Pregnant women with CSP who continue pregnancy under close monitoring after adequate ultrasound evaluation and doctor-patient communication could achieve better maternal and infant outcomes, but pregnant women with CSP are highly likely to continue pregnancy and develop into PAS. Effective hemostasis means and multidisciplinary team cooperation are needed in perinatal period for ensuring maternal and fetal safety.
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In order to train professionals in medical laboratory technology who are directly engaged in medical examination and medical laboratory work and who have strong practical ability and can adapt to the development of precision medicine, the reform of precise teaching for experiment is implemented. Through the precise stratification of experimental projects and knowledge points, the design of precise teaching activity and the construction of precise evaluation system for experiments, guided by precision medicine during the experimental process, the standardization and precision training of basic skills for students are strengthened in clinical laboratory test. The students can more well adapt to the needs of society for technical and innovative talent in the new period. The precise teaching for experiment will become one of the main characteristics of medical laboratory technology education in our school.
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Objective@#To improve clinical management of maternal and neonatal listeriosis through analyzing the clinical characteristics and antibiotic treatment.@*Methods@#A retrospective analysis of 26 cases of listeriosis, including their demographic and clinical features, was conducted, involving 16 pregnant women from Civil Aviation General Hospital, Xiamen Humanity Hospital, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing Tiantan Hospital, Tangshan Maternal and Child Health Hospital, the Fourth Hospital of Tianshui City from October, 2011 to May, 2018, and 10 newborns from the Fourth Hospital of Tianshui City, Tangshan Maternal and Child Health Hospital, Zhengzhou Children's Hospital from February, 2016 to April 2018. Descriptive methods were used for data analysis.@*Results@#(1) Among the 16 gravidas, one, five and 10 developed the infection in the 1st, 2nd and 3rd trimester of pregnancy, respectively, and eight had pregnancy complications. Furthermore, all of them developed fever [(38.9±0.5) ℃]. Symptoms such as cough, nasal congestion, runny nose, sore throat, dizziness, headache and other flu-like symptoms were observed in six cases. Gastrointestinal symptoms and flu-like symptoms were presented in four. Fetal distress, tachycardia and decreased fetal movement occurred in 11 cases. Elevated C-reactive protein and white blood cell count were detected in 16 and 14, respectively. Eight underwent placental pathological examination which shown various degrees of pathological changes, including neutrophil infiltration, acute chorioamnionitis and inflammatory necrosis. The main empirical antibiotic treatment for the 16 patients was cephalosporins and only four covered Listeria monocytogenes. Only two delivered at term, while the others (14/16) ended in miscarriage, premature delivery or stillbirth. (2) Among the 10 newborns with listeriosis, there were eight early-onset infections and two late-onset infections. All of them were febrile [(38.6±0.6)℃]. Six had cyanosis, groaning, foaming and three concave sign; five showed shortness of breath; meningitis and skin rash were found in one, respectively. All had elevated white blood cell and C-reactive protein. Six received antibiotics covering Listeria monocytogenes during the initial empirical treatment. Four were treated with cephalosporins alone, one of which died after the treatment was withdrawn. One was cured by initial treatment with meropenem alone, while eight recovered after adjustment of treatment with ampicillin, penicillin, meropenem, vancomycin alone, or meropenem combined with ampicillin or vancomycin. (3) The isolates that were susceptible to penicillin, ampicillin and meropenem accounted for 96.1% (25/26) all together and 88.5% (23/26) were susceptible to compound sulfamethoxazole.@*Conclusions@#There is no specific clinical manifestations of maternal or neonatal listeriosis. Maternal listeriosis is often characterized by acute onset and high incidence of adverse pregnancy outcomes.
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Objective To improve clinical management of maternal and neonatal listeriosis through analyzing the clinical characteristics and antibiotic treatment.Methods A retrospective analysis of 26 cases of listeriosis,including their demographic and clinical features,was conducted,involving 16 pregnant women from Civil Aviation General Hospital,Xiamen Humanity Hospital,Tongzhou Maternal and Child Health Hospital of Beijing,Beijing Tiantan Hospital,Tangshan Maternal and Child Health Hospital,the Fourth Hospital of Tianshui City from October,2011 to May,2018,and 10 newborns from the Fourth Hospital of Tianshui City,Tangshan Maternal and Child Health Hospital,Zhengzhou Children's Hospital from February,2016 to April 2018.Descriptive methods were used for data analysis.Results (1) Among the 16 gravidas,one,five and 10 developed the infection in the 1st,2nd and 3rd trimester of pregnancy,respectively,and eight had pregnancy complications.Furthermore,all of them developed fever [(38.9± 0.5) ℃].Symptoms such as cough,nasal congestion,runny nose,sore throat,dizziness,headache and other flu-like symptoms were observed in six cases.Gastrointestinal symptoms and flu-like symptoms were presented in four.Fetal distress,tachycardia and decreased fetal movement occurred in 11 cases.Elevated C-reactive protein and white blood cell count were detected in 16 and 14,respectively.Eight underwent placental pathological examination which shown various degrees of pathological changes,including neutrophil infiltration,acute chorioamnionitis and inflammatory necrosis.The main empirical antibiotic treatment for the 16 patients was cephalosporins and only four covered Listeria monocytogenes.Only two delivered at term,while the others (14/16) ended in miscarriage,premature delivery or stillbirth.(2) Among the 10 newborns with listeriosis,there were eight early-onset infections and two late-onset infections.All of them were febrile [(38.6±0.6)℃].Six had cyanosis,groaning,foaming and three concave sign;five showed shortness of breath;meningitis and skin rash were found in one,respectively.All had elevated white blood cell and C-reactive protein.Six received antibiotics covering Listeria monocytogenes during the initial empirical treatment.Four were treated with cephalosporins alone,one of which died after the treatment was withdrawn.One was cured by initial treatment with meropenem alone,while eight recovered after adjustment of treatment with ampicillin,penicillin,meropenem,vancomycin alone,or meropenem combined with ampicillin or vancomycin.(3) The isolates that were susceptible to penicillin,ampicillin and meropenem accounted for 96.1％ (25/26) all together and 88.5％ (23/26) were susceptible to compound sulfamethoxazole.Conclusions There is no specific clinical manifestations of maternal or neonatal listeriosis.Maternal listeriosis is often characterized by acute onset and high incidence of adverse pregnancy outcomes.
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OBJECTIVE: To explore the correlation between obstructive sleep apnea-hypopnea syndrome (OSAHA) and elderly (≥80 year-old) hypertension (HP), and the effects of levamlodipine on antihypertensive effect of elderly patients with HP complicated with OSAHA. METHODS: A total of 90 elderly HP patients were analyzed retrospectively and divided into HP group (30 cases) and HP+OSAHA group (60 cases) according to whether accompanied by OSAHA or not. The latter was divided into HP complicated with mild OSAHA group (20 cases, HP+OSAHA1 group), hypertension complicated with medium OSAHA group (21 cases, HP + OSAHA2 group), HP complicated with severe OSAHA group (19 cases, HP + OSAHA3 group) according the severity of OSAHA. All patients were given Levamlodipine besylate tablet 2. 5 mg taken at a draught, qd, in the morning, for 4 weeks, while continuous positive pressure veritilation was given to treat the obstructive apnea in OSAHA patients. Neck circumference, BMI, apnea hypoventilation index (AHI), Sa02, SBP and DBP (daytime, evening and 24 h) were observed in each group 4 weeks later. The correlation of AHI and Sa02 with SBP and DBP was analyzed by Spearman rank correlation. RESULTS: Neck circumference, BMI, AHI, daytime SBP, evening and 24 h SBP and DBP of HP + OSAHA group were significantly higher than those of HP, while SaO2 of HP + OSAHA group was significantly lower than that of HP group. Neck circumference and BMI of HP+OSAHA2 group and HP+OSAHA3 group were significantly higher than those of HP group; the HP+ OSAHA3 group were higher than the HP+OSAHA2 group. SaO2 of HP+OSAHA2 group and HP+OSAHA3 group were significantly lower than that of HP group; the HP+OSAHA3 group was lower than the HP+OSAHA2 group. AHI, evening and 24 h SBP and DBP of HP+OSAHA group were significantly higher than 6those of HP group; the descending order was as follows: HP+OSAHA3 group>HP+OSAHA2 group>HP+OSAHA1 group. Daytime SBP of HP+OSAHA3 group was significantly higher than that of HP group, with statistical significance (P<0. 001); there was no statistical significance in daytime DBP among those groups (P>0. 05). Results of Spearman rank correlation analysis showed that evening and 24 h SBP and DBP were positively correlated with AHI (P<0. 001) and negatively correlated with SaO2 (P<0. 001). CONCLUSIONS: OSAHA can induce the significant increase of blood pressure in elderly HP patients. Levamlodipine has different influences antihypertensive effect of elderly patients with HP complicated with OSAHA. The drug should be adjusted according to the patient's condition.
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Objective:To investigate the effects of pristimerin therapy on the functions of Th17 and Treg cells in patients with allergic asthma,and expore the function of immune factors in therapy on allergic asthma. Methods:Extracted mononuclear cells in pe-ripheral blood of patients with allergic asthma,and given pristimerin intervention in vitro. Then used fluorescence-activated cell sorting analysis to detect the contect of Th17 and Treg,enzyme-linked immunosorbent assay to detect cytokine production of IL-17 and TGF-β, and Real-time PCR to detect the contect of RORγT and Foxp3. Results: Compared with the control group, experimental group had reduced expression of CD4+IL-17+T cells ( Th17 cells) ,and increased expression of CD4+CD25+Foxp3+T cells ( Treg cells) ,which all had the statistical significance (P<0. 05);displayed decreased level of IL-17,and increased level of TGF-β,which all had the statistical significance (P<0. 05);had reduced expression of RORγT,and increased expression of Foxp3,which all had the statistical significance (P<0. 05). Conclusion: Pristimerin therapy can remit the unbalance of Th17/Treg in vitro,hinting this drug may regulate allergic asthma by influencing immunologic balance,which offers the theoretical support for pristimerin in clinical application.
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OBJECTIVE:To investigate therapeutic efficacy and safety of levamlodipine and telmisartan combined with hydro-chlorothiazide in the treatment of anti-dipper hypertension. METHODS:Totally 150 patients with anti-dipper hypertension were ran-domly divided into group A,B,C,with 50 cases in each group. Group A was given Telmisartan tablet 40 mg+Hydrochlorothiazide tablet 10 mg,once a day,in the morning. Group B was given Levamlodipine tablet 5 mg,once a day,in the night. Group C was given Telmisartan tablet(usage and dosage same as group A)+Hydrochlorothiazide tablet(usage and dosage same as group A)+Le-vamlodipine tablet(usage and dosage same as group B). Treatment courses of 3 groups lasted for 8 weeks. The changes of electro-lyte and 24 h ambulatory blood pressure were observed and compared among 3 groups before and after treatment. The incidence of adverse reactions was recorded. RESULTS:There was no statistical significance in the electrolyte indexes in 3 groups before and af-ter treatment(P>0.05). Before treatment,there was no statistical significance in 24 h blood pressure among 3 groups(P>0.05). Af-ter treatment,the 24 h blood pressure of the patients in the 3 groups after treatment was lower than before treatment,and group C was lower than that of the group A and group B(P0.05). CONCLUSIONS:Levamlodipine and telmisartan combined with hydrochlorothiazide show good therapeutic efficacy for anti-dipper hypertension,and can reduce 24 h blood pressure and effectively reverse anti-dipper rhythm with good safety.
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In order to adapt to the training target of medical laboratory technology professionals under the condition of five to four educational system,we reformed the experimental teaching of medical laboratory technology.The experiment teaching was divided three phases (traditional classroom teaching + simulated clinical laboratory training + clinical laboratory teaching).Classroom teaching focused on the cultivation of students' basic skills test;simulation laboratory training focused on strengthening the students' operating skills and basic post ability and professional quality;hospital laboratory teaching focused on strengthening the students' ability of medical laboratory management,test comprehensive analysis and scientific research.The reform practice of two sessions of the students showed that the students' examination skills and comprehensive quality improved significantly,which could better adapt to the social demand for technical personnel.
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With increasing use of carbapenem antibiotics , carbapenems-resistant gram-negative bacteria are spreading, and carbapenemase-producing is the main mechanism of carbapenems resistance . Rapid and accurate identification of carbapenemase and its type is of great importance to timely and effective treatment and control of infections .Chromogenic /Fluorogenic culture media, modified Hodge test and double disk synergy test are traditional methods for carbapenemase detection , but all are time-consuming. Biochemical method is more time efficient and with high sensitivity and specificity , but cannot be used to identify subtypes.Now matrix-assisted laser desorption ionization -time-of-flight mass spectrometry (MALDI-TOF MS) has been successfully applied in the identification of species , subtypes and detection of drug -resistant genes.And among various carbapenemase gene detection techniques , next generation sequencing (NGS) can also be used for the detection of integrons , transposons and plasmids, which is important in both epidemiology and resistant mechanism studies .This article reviews the advantages and disadvantages of various methods for phenotype and gene detection of carbapenemase .
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Objective To study the possibility of direct identification of pathogens from positive blood cul-tures by methods of separation gel tube -centrifugation.Methods 216 cases of positive blood culture were collected from 2015.7 to 2015.12.The bacterias were purified from blood culture bottle by separation gel tube.After washing 2 times,identified by MALDI -TOF MS.At the same time,traditional culture,smears and identification were done. Compared the results of identification by two methods.Results 216 cases of positive blood culture were single bacte-rial infection.By Gram stain,89 strains were Gram positive,119 strains were Gram negative and 8 strains were fungal spores.190 cases of positive blood culture were identified by MALDI -TOF MS,it concluded 67 Gram positive strains,111 Gram negative strains,4 anaerobe strains and 8 fungus.Compared with traditional culture,the coincidence rate reached up to 87.9%,Gram positive strains 78.8%,Gram negative strains 93.2%,anaerobe strains 100.0%and fungus 100.0%.Conclusion It takes less than 30 minutes purified from blood culture bottle by separation gel tube.And the time of identification is shorter than traditional culture.This method is good for clinical diagnosis and treatment.
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Objective To compare serum protein fingerprint among Uygur patients with thyroid cancer and benign thyroid nodules, and Han patients with thyroid cancer, and to screen ethnic-specific protein markers of thyroid cancer. Methods Using the technology of two-dimensional polyacrylamide gel electrophoresis (2D-PAGE), the protein expression profiles of Uygur and Han patients with thyroid cancer and Uygur patients with thyroid nodules were established and compared by image analysis software between two groups. Liquid chromatography-mass spectrometry/mass spectrometry coupling techniques ( LC-MS/MS) were used to identify differential protein. The protein′s name, cellular localization and functional classification were searched in Swissport database. Results There are 11 differentially expressed proteins by comparison of sera in Uygur patients with benign thyroid nodules and thyroid cancer, in which complement C3 and C4b levels were down-regulated in the serums of Uygur patients with benign thyroid nodules, and 9 proteins such as heme-binding proteins etc were up-regulated. There are 7 differentially expressed proteins by comparison of serums in Uygur and Han patients with thyroid cancer, in which transferrin level was up-regulated in the serum of Uygur patients with thyroid cancer, and 6 proteins such as cytokeratin-1 etc were down-regulated in serum of Uygur patients with thyroid cancer. Conclusion Combined screening of multiple labelled proteins including heme-binding protein,α2-macroglobulin, and transferrin protein etc may provide the basis for the diagnosis of thyroid cancer in Uygurs and Hans.
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Objective To investigate the relation between the characteristics of body fat distribution and the cardiovascular risk factors in some patients with type 2 diabetes mellitus (T2DM)in Xinjiang region.Methods The percentage of body fat (PBF)and visceral fat area(VA)were determined in 155 cases of T2DM by using the Inbody 720 body composition analyzer.At the same time triglycerides(TG),total cholesterol(TC),high density lipoprotein(HDL-C),low density lipoprotein(LDL-C),blood pressure(BP), glycosylated hemoglobin HbA1c,body weight(W),body height,waist circumference ratio(WC)and hip circumference(HC)were also determined.The body mass index(BMI)and the waist to hip ratio was calculated.Results In both men and women,BMI in the subjects with visceral fat obesity(VFO)was higher than that with subcutaneous fat obesity(SFO).In males,TG in VFO was signif-icantly higher than that in SFO.PBF,TC and LDL-C in the female T2DM patients were significantly higher than those in the male T2DM patients.VA and PBF in the minority male patients were significantly higher than those in the Han nationality male patients (P <0.05).After correcting the age,course of disease and BMI,WHR in the female patients was positively correlated with DBP and PBF was positively correlated with LDL-C.In the male patients,there were correlations between BMI with SBP,between VA with DBP,and between VA with PBF and HDL-C;in the female patients,there were correlations between BMI with SBP and be-tween WHR with DBP.Conclusion The body fat distribution in the patients with T2DM in Xinjiang region is dominated by VFO. The cardiovascular risk factors are not only associated with the increase of body fat content,but more closely associated with VFO, moreover the differences in genders and nationalities exist.
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Objective To investigate the correlation between methylation status of UNC 5C gene promoter with colorectal cancer UNC5C .Methods 54 cases of sporadic colorectal cancer and related normal mucosal tissue ,as well as 6 colon cancer cell lines and fiber cell lines(FCL) in the oncology department of the Kailuan General Hospital from February 2010 to March 2013 were selected as the research objects and performed the mRNA and methylation analysis for exploring the correlation between the netrin‐1 receptor UNC5C defects with colorectal cancer disease .Results mRNA of UNC5A and UNC5B was expressed in the detected colorectal cancer cell lines .Except FCL for UNC5C ,all of the cancer cell lines had no mRNA expression .In colorectal cancer tissue , UNC5C methylation was significantly higher than that in the normal mucosa ,the difference was statistically significant (P<0 .05) . The methylation levels of UNC5C gene in the stage Ⅰ to Ⅱ ,and the stage Ⅲ to Ⅳwere significantly higher than non‐methylation levels ,the differences were statistically significant (P<0 .05) .The correlation analysis by the Spearman method showed that the UNC5C defects was positively correlated with colorectal cancer disease (r= 0 .856 ,P< 0 .05) .Conclusion Netrin‐1 receptor UNC5C defect has certain correlation with colorectal cancer disease .
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Objective To analyze the correlation between body mass index(BMI)and percentage body fat(PBF)in people of dif-ferent nationality and gender,and assess the value of BMI and PBF in the diagnosis of obesity.Methods A total of 925 healthy a-dults who underwent physical examination in the hospital were enrolled in the study,bioelectrical impedance measurement was used to measure the weight,PBF,then analyze the correlation between BMI and PBF in people of different nationality and gender.Results In the normal and overweight population classified by BMI,;In underweight,overweight and obesity people,PBF of Han women were higher than that of Uighur women(P <0.05 ).In people of different gender and ethnic group,PBF was positively correlated with BMI(P <0.05).Using BMI≥28 kg/m2 as gold standard for the diagnosis of obesity,PBF have good sensitivity and low speci-ficity for the diagnosis of obesity in both of the two ethnic groups.Conclusion Compared with Uygur,Han have higher PBF at the same level of BMI.There is a malconformation between BMI and PBF.Evaluation of obesity could not simply rely on BMI,and should be analyzed combined with PBF.
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The assessment method for pharmacology courses in top-up program of Yanjing medical college was reformed supported by the principal foundation from China capital medical university.The reform specified the assessment content and examination syllabus,formed the multilayer assessing methods and assessing modes and assessed objectively through questionnaires and investigations.The results showed that the students were satisfied with the assessment mode,degree of standardization and the implementation effect. Pharmacology teaching was effectively assessed by the new method and students′ comprehensive ability was improved.
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Objective The aim of this study is to provide guidance on rehabilitation nursing via observing the effect of comprehensive relaxation training on perioperative psychological stress in patients with coronary intervention treatment. Methods In this study, eighty patients ready to receive coronary intervention were randomly divided into the experimental group and the control group (40 patients in each). The control group were treated with routine percutaneous coronary intervention care, and the experimental group received both comprehensive relaxation training and routine care. The anxiety state and subjective feelings on comprehensive relaxation training in both groups were dynamically investigated via State-Trait Anxiety Inventory questionnaire and subjective feeling questionnaire from pre-operation to 7 days after operation. Results Anxiety levels between two groups showed the similar trend, and there was statistically significance between two groupsin the state anxiety level. The subjective feeling in the experimental group improved. Conclusions The psychological stress in patients receiving coronary intervention surgery maintains at high level form pre-operation to 24h post operation, and comprehensive relaxation training can significantly reduce the level of state anxiety. These patients consider that this simple training shows obvious relaxing effect.