Risk factor assessment and adverse outcome prediction of placenta accreta in pregnant women after cesarean section complicated with placenta previa: a national multicenter retrospective study / 中华妇产科杂志

Objective:To study the risk factors of adverse pregnancy outcomes for the diagnosis and treatment of pregnancy after cesarean section complicated with placenta previa.Methods:A national multicenter retrospective study was conducted to select a total of 747 pregnant women with the third trimester singleton pregnancy after cesarean section complicated with placenta previa from 12 tertiary hospitals in January 1st to December 31st, 2018. The risk factors of severe adverse outcomes [hysterectomy, intraoperative blood loss ≥1 000 ml, intraoperative diagnosis of placenta accreta spectrum disorders (PAS)] in pregnant women with second pregnancy complicated with placenta previa after cesarean section were investigated by logistic regression analysis. The roles of prenatal ultrasonography and magnetic resonance imaging (MRI) in the prediction of PAS and severe adverse outcomes were observed. According to whether vascular intervention was performed (uterine artery embolization or abdominal aortic balloon occlusion), the pregnant women were divided into the blocked group and the unblocked group, and the maternal and infant perinatal outcomes between the two groups were compared.Results:(1) General information: the hysterectomy rate of 747 pregnant women with second pregnancy complicated with placenta previa after cesarean section was 10.4% (78/747), the intraoperative blood loss ≥1 000 ml in 55.8% (417/747), and PAS was confirmed in 47.5% (355/747). The incidence of uterine rupture was 0.8% (6/747). (2) Analysis of risk factors for severe adverse outcomes: based on binary unconditioned logistic regression univariate and multivariate analysis, the risk factors for hysterectomy were the mode of vascular embolization and intraoperative blood loss. The probability of hysterectomy with uterine artery embolization was 5.319 times higher than that with abdominal aortic balloon occlusion (95% CI: 1.346-21.018). The risk factors of intraoperative blood loss ≥1 000 ml were the number of cesarean section delivery, ultrasonography indicated PAS and suspected PAS, intraoperative PAS and complete placenta previa. The risk factors for intraoperative PAS were uterine scar thickness, ultrasonography indicated PAS and suspected PAS, MRI indicated PAS and suspected PAS, and complete placenta previa. (3) The roles of ultrasonography and MRI in predicting PAS: the sensitivity and specificity of ultrasonography in predicting PAS were 47.5% and 88.4%; the kappa value was 0.279 ( P<0.001), with fair agreement. The sensitivity and specificity of MRI to predict PAS were 79.2% and 97.8%, respectively. The kappa value was 0.702 ( P<0.001), indicating a good agreement. The intraoperative blood loss and hysterectomy rate of pregnant women with PAS indicated by ultrasonography and MRI were significantly higher than those with PAS only by ultrasonography or MRI. (4) Influence of vascular occlusion on pregnancy outcome: there were no significant differences in intraoperative blood loss and incidence of intraoperative bleeding ≥1 000 ml between the blocked group and the unblocked group (all P>0.05). There was no significant difference in intraoperative blood loss between the pregnant women with abdominal aortic balloon occlusion, uterine artery embolization and those without occlusion ( P=0.409). The hysterectomy rate of pregnant women with uterine artery embolization was significantly higher than those with abdominal aortic balloon occlusion [39.3% (22/56) vs 10.0% (5/50), P=0.001]. Conclusions:In the third trimester of pregnancy with placenta previa after cesarean section, MRI examination has better consistency in predicting PAS than ultrasonography examination. Ultrasonography examination combined with MRI examination could effectively predict the hysterectomy rate and intraoperative blood loss. Vascular occlusion could not reduce the amount of intraoperative blood loss. The hysterectomy rate of pregnant women with uterine artery embolization is higher than those with abdominal aortic balloon occlusion.

Daratumumab for the treatment of primary systemic amyloidosis: a multicenter retrospective analysis / 中华内科杂志

Objective:To analyze the efficacy and safety of Daratumumab for the treatment of primary AL light chain systemic amyloidosis.Methods:Twenty one patients who were diagnosed as primary AL light chain systemic amyloidosis and treated with Daratumumab from 7 centers were retrospectively analyzed. Daratumumab was administrated as first line therapy in seven patients and 14 patients with relapsed settings. Hematological response, safety and survival were analyzed.Results:All 7 patients achieved very good partial response (VGPR) or better with first-line application of daratumumab. Three patients died, and the other four achieved organ remission. Among 14 relapsed patients, 2 patients had a difference of free light chain (dFLC) less than 20 mg/L before treatment, and 9 with a dFLC of more than 50 mg/L. All patients reached partial response (PR) or better, including 4 patients with complete response (CR), 3 with VGPR and 2 with PR. The response rate was 100% in 3 patients with dFLC 20-50 mg/L at baseline. The organ remission rate was 50% in patients with heart involvement and 58.3% in patients with kidney impairment. The overall median follow-up period was 5.3 months, and 11 months in surviving patients. One patient died of severe infection and disseminated intravascular coagulation (DIC) with stable amyloidosis. One patient switched to other regimens because dFLC elevated but did not fulfill progressive disease after 2 year application. As to safety, no grade 3/4 infusion reaction developed, and grade 1 infusion reaction occurred in 3 cases during the first infusion. Lymphocytopenia was seen in 75% patients including grade 3 or more in 30% patients.Conclusion:Daratumumab is effective to eliminate serum free light chain in both newly diagnosed and relapsed patients with systemic amyloidosis.

Evaluation of the diagnosis and treatment of cesarean scar pregnancy induced in the second trimester: a national multicenter retrospective study / 中华妇产科杂志

Objective:To study the risk factors of adverse pregnancy outcomes for induced abortion of cesarean scar pregnancy in midtrimester.Methods:A national multicenter retrospective study was conducted. A total of 154 singletons pregnant women with cesarean scar pregnancy during the second trimester induced abortion by various reasons in 12 tertiary A hospitals were selected, their pregnant outcomes were observed and the risk factors of serious adverse outcomes were analyzed with univariate and multivariate logstic regression; the role of ultrasound and MRI in predicting placenta accreta and severe adverse outcomes was evaluated, the effectiveness of uterine artery embolization (UAE) in preventing hemorrhage in pregnant women with and without placenta accreta was compared.Results:Among 154 subjects, the rate of placenta accreta was 42.2% (65/154), the rate of postpartum hemorrhage≥1 000 ml was 39.0% (60/154), the rate of hysterectomy was 14.9% (23/154), the rate of uterine rupture was 0.6% (1/154). The risk factor of postpartum hemorrhage≥1 000 ml and hysterectomy was placenta accreta ( P<0.01). For each increase in the number of parity, the risk of placenta accreta increased 2.385 times (95% CI: 1.046-5.439; P=0.039); and the risk of placenta accreta decreased with increasing ultrasound measurement of scar myometrium thickness ( OR=0.033, 95% CI: 0.001-0.762; P=0.033). The amount of postpartum hemorrhage and hysterectomy rate in the group with placenta accreta diagnosed by ultrasound combined with MRI were not significantly different from those in the group with placenta accreta diagnosed by ultrasound only or MRI only (all P>0.05). For pregnant women with placenta accreta, there were no significant difference in the amount of bleeding and hysterectomy rate between the UAE group [median: 1 300 ml; 34% (16/47)] and the non-embolization group (all P>0.05); in pregnant women without placenta accreta, the amount of bleeding in the UAE group was lower than that in the non-embolization group (median: 100 vs 600 ml; P<0.01), but there was no significant difference in hysterectomy rate [2% (1/56) vs 9% (3/33); P>0.05]. Conclusions:(1) Placenta accreta is the only risk factor of postpartum hemorrhage≥1 000 ml with hysterectomy for induced abortion of cesarean scar pregnancy in midtrimester; multi-parity and ultrasound measurement of scar myometrium thickness are risk factors for placenta accreta. (2) The technique of using ultrasound and MRI in predicting placenta accreta of cesarean scar pregnancy needs to be improved. (3) It is necessary to discuss of UAE in preventing postpartum hemorrhage for induced abortion of cesarean scar pregnancy in midtrimester.

Lenalidomide plus dexamethasone for proliferative glomerulonephritis with monoclonal immunoglobulin deposits / 中华肾脏病杂志

Objective:To evaluate the efficacy and safety of lenalidomide plus dexamethasone (LD) in patients with proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID).Methods:The clinicopathological data of PGNMID patients who were treated with LD protocol from January 2010 to October 2019 were retrospectively analyzed.Results:All of 6 patients received LD treatment for≥3 months after renal biopsy in Jinling Hospital. During the follow-up period of 6 to 19 months, 3 patients achieved renal remission, and the renal remission rate was 50%(3/6). Light microscopy showed membranoproliferative glomerulonephritis and immunofluorescence showed single kappa type IgG3 was deposited in the mesangial region and the vascular loop. Before taking LD scheme, the median urinary protein were 7.76(1.27, 14.57) g/24 h, the median serum creatinine was 118.5(70.7, 289.1) μmol/L, and the median albumin was 34.5(22.4, 37.5) g/L. The concentration of serum free kappa and lambda light chain was increased in 5 patients, but the serum free light chain ratio was normal. Hypocomplementemia was detected in two cases. Six patients underwent bone marrow flow cytometry, and 2 patients had elevated monoclonal plasma cells, accounting for 0.7% and 0.5%, respectively. Immunofixation electrophoresis suggested that 1 patient had positive serum M protein for kappa type IgG3. At the last follow-up, median urine protein was 3.33(0.33, 11.23) g/24 h, median serum creatinine was 108.7(80.4, 160.9) μmol/L, and median albumin was 35.9(24.5, 45.6) g/L. The concentration of serum free light chain in 4 patients from 5 patients with elevated serum free light chain was lower than that before taking the drug. Decreased level of serum complement in two cases returned to normal after treatment. The M spike did not turn negative during the follow-up in one patient. Adverse events included anemia, neutropenia, limb numbness and upper respiratory tract infection.Conclusion:This study reports for the first time that LD protocol may be effective in treating PGNMID, but more attention should be paid to the hematological adverse events of lenalidomide.

Female reproductive system dysplasia: a clinical study of 924 cases / 中华妇产科杂志

Objective To explore the relationship between different types of female reproductive system dysplasia and age of visit, clinical manifestations, common types of combined malformations and endometriosis. Methods The patient′s medical records in the Second Hospital of Hebei Medical University from December 2002 to June 2016 were collected and retrospectively analyzed. Results Among 924 cases of genital tract dysplasia, uterine dysplasia (65.3%, 824/1 261) was the most common, followed by vaginal dysplasia (28.3%, 357/1 261), hymen atresia and urogenital fistula (3.7%, 47/1 261), and cervical dysplasia (2.6%, 33/1 261). (1) The youngest age was in patients with hymen atresia and urogenital fistula, with a median of 14.5 years old, while the older age were in patients with uterine, vaginal and cervical dysplasia, with median age of 25.0, 24.0 and 23.0 years old, respectively. (2) The clinical manifestations were lack of specificity, mainly abnormal findings of physical examination or accessory examination, primary amenorrhea, lower abdominal pain, infertility, adverse pregnancy history. (3) About other systemic malformations, urological malformations were the most common (4.8%, 44/924), followed by spinal malformations (0.5%, 5/924), inguinal hernia (0.4%, 4/924), heart malformations (0.2%, 2/924), cleft lip and palate (0.2%, 2/924). Oblique vaginal septal syndrome and MRKH syndrome were the most likely to be associated with other system malformations. (4) About combination with endometriosis, there was no significant difference between obstructive genital tract malformations (2.3%, 9/385) and non obstructive genital tract malformations (1.7%, 9/539; P=0.469). Conclusions Female reproductive system dysplasia is the most common in uterine dysplasia, followed by vaginal dysplasia, hymen atresia and urogenital fistula, and cervical dysplasia. The age of visit is generally older, often found by abnormal findings of physical examination or accessory examination, primary amenorrhea, lower abdominal pain, infertility, adverse pregnancy history;and could be combined with a variety of other system malformations, most seen by urinary system malformations,there is also the risk of endometriosis.

Prevalence and associated factors of female urinary incontinence in Hebei province / 中华妇产科杂志

Objective To estimate the prevalence and associated factors of adult female urinary incontinence in Hebei province. Methods Stratified and multistage sampling method was used, between January 2016 to May 2016, to investigate the target population in Hebei province. While, logistic regression was used to analyse datas. Results A population-based survey was conducted in 2 450 women in Hebei province, there were 2 408 effective questionnaires after deleting 48 invalid questionnaires. According to the results, the average age of subjects was (56±15) years old, and the urinary incontinence prevalence of adult female in Hebei province was 27.70%(667/2 408). Stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence were diagnosed as 23.13%(557/2 408), 1.58%(38/2 408) and 2.99%(72/2 408), respectively. There were only 2.85% (19/667) urinary incontinence patients seeking medical help. The results of logistic regression analysis showed that age, daily water intake, pulmonary diseases, urinary tract infection, hypertension, chronic low back pain, dysmenorrhea, vaginitis, abortion, mode of delivery, postpartum infection were statistically significant (all P≤0.05). Among these factors, cesarean section was the protective factor for urinary incontinence (OR=0.365, 95%CI: 0.195-0.685, P<0.01). Conclusions The prevalence of urinary incontinence in adult female in Hebei province is high, and there are few patients seeking medical help. It is a common disorder in women and is associated with many factors;among these factors, cesarean section is the protective factor for urinary incontinence.

Research on warning indexes for percutaneous nephroscope complicated septic shock and multiple organ dysfunction syndrome and prevention countermeasures / 中国生化药物杂志

Objective To evaluate early warning indexes of percutaneous nephroscope complicated with septic shock and multiple organ dysfunction syndrome and prevention countermeasures.Methods Thirty patients with PCNL complicated with septic shock and MODS were selected from January 2004 to December 2014, and 35 patients suffering from MODS after PCNL were divided into the control groups, and the levels of platelet (PLT), D-dimer (DD), serum albumin (ALB), cholinesterase (CHE) and troponin T (TNT) of patients in two groups were detected.Results PLT, CHE and ALB of patients in observation group were (103.25 ±35.27) ×109/L, (2313.38 ±231.65) U/L and (22.43 ±5.38)g/L, respectively, being significantly lower than those of patients in control group, and TNT and DD were (0.67 ±0.17) ng/mL and (2.56 ±0.93) mg/L, respectively, being significantly higher than those of patients in control group, the differences were statistically significant (P<0.05).PLT, CHE and ALB of death patients in observation group were (87.32 ±21.27) ×109/L, (2109.26 ±219.41) U/L and (19.38 ±4.28) g/L, respectively, being significantly lower than those of survived patients, TNT and DD were (0.78 ±0.13) ng/mL and (3.04 ±0.77) mg/L, respectively, being significantly higher than those of survived patients, the differences were statistically significant (P<0.05).The fatality rate of patients with two organ dysfunctions more than 41.67%.The fatality rate of patients with three organ dysfunctions was 44.44%.The fatality rate of patients with organ dysfunctions more than 4 was 100%. Conclusions for Platelets, D-dimer, serum albumin, cholinesterase and calcium muscular,organ dysfunction number may serve as early warning indexes of patients with postoperative percutaneous nephroscope complicated septic shock and multiple organ dysfunction syndromes.

Expression of protein gene product 9.5, vasoactive intestinal peptide and neuropeptide Y in the mucosa of the neovagina after sigmoid colon vaginoplasty / 中华妇产科杂志

Objective To investigate re-innervation in the neovaginal mucosa of patients underwent sigmoid colon vaginoplasty in treatment of Mayer-Rokitansky-Kistner-Hauser Syndrome (MRKHS).Methods Biopsies in the upper third of the posterior neovagina were taken in 20 patients treated by sigmoid colon vaginoplasty at 1, 2 and 3 years after surgery, respectively. Protein gene product 9. 5 ( PGP 9. 5 ),vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY) were detected by immunohistochemical method and compared with those in intact sigmoid colon mucosa. Results ( 1 ) Density of nerve fiber:abundant distribution of PGP 9. 5 nerve fibers were observed in the mucosal muscle layer, submucosa, and smooth muscle layer of the neovagina. The nerve fibers of VIP and NPY immunoreactivity were mainly distributed around blood vessels and in the smooth muscles. In the neovagina, the density of nerve fibers of PGP 9. 5 of 17 ± 6 were much more than VIP of 2. 9 ± 1.0 and NPY of 2. 5 ± 0. 8 significantly ( P ＜ 0. 05 ).( 2 ) Expression of PGP 9. 5 in neovagina: at 1 year after surgery, PGP 9. 5 positive expression of 14 ± 4 was significantly lower in the neovagina than 28 ± 7 in the intact sigmoid colon( P ＜ 0. 05 ). However, after 2 to 3 years, its expression displayed an upgrade tendency in the neovagina and was significantly higher at the 3 year postoperatively than that at the 1 years postoperatively ( 22 ± 7 vs. 14 ± 4, P ＜ 0. 05 ). The changes were much more obvious in submucosa. (3) The expression of VIP and NPY in neovagina: at 1 year after surgery, VIP and NPY positive nerve fibers were also decreased in the neovagina when compared with those in the intact sigmoid colon ( 2. 3 ± 0. 7 vs. 5.3 ± 1.4, P ＜ 0. 05; 2.5 ± 1. 1 vs. 5.5 ± 1.1, P ＜ 0. 05 ) . At 2 to 3 years after surgery, the positive VIP fiber showed initially decreased and subsequently increased tendency. The density of VIP of 3.7 ± 0. 7 in the neovagina at 3 years postoperatively was higher than 2. 3 ±0. 7 at 1 years postoperatively (P ＜ 0. 05 ). No significant up-regulation was observed in NPY-positive expression in the neovagina within 3 years after operation. Conclusions Distribution of sensory PGP 9. 5,VIP and NPY immunoreactive nerve fibers was similar to the pattern observed within the intact sigmoid colon wall. The number of nerve fibers in the neovagina decreased after surgery and then increased subsequently within 3 years after surgery.

Expression of occludin and zona occluden-1 and their morphologic changes in vagina mucosal cells in patients undergoing vaginal construction by using sigmoid colon / 中华妇产科杂志

quamous metaplasia occurred, the expression of occludin and ZO-1 in cells were similar to those in control group, which might play a role in the defense function of neovaginal mucosa.

Effects of riboflavin and ascorbic acid on apoptosis and proliferative inhibition of mouse thymocytes induced by deoxynivalenol in vivo / 中国病理生理杂志

AIM: To explore the effects of riboflavin and ascorbic acid on the apoptosis induced by deoxynivalenol(DON) in mouse thymocytes. METHODS: The effects of riboflavin and ascorbic acid on the apoptosis and proliferation inhibition of thymocytes induced by DON in KM mice were studied with animal experiment, DNA agarose gel electrophoresis and flow cytometric DNA content analysis. RESULTS: Apoptosis rate of thymocytes in DON (4 mg/kg) treated group was 13 73%?1 53% The percentages of apoptosis in riboflavin (1 25 mg/kg-10 mg/kg) and ascorbic acid (25 mg/kg-100 mg/kg) pretreated thymocytes groups were significantly lower than that in DON group ( P

Effects of deoxynivalenol on apoptosis and proliferation of mouse thymocytes in vivo / 中国病理生理杂志

AIM: To explore the effect of deoxynivalenol on apoptosis and proliferation of mouse thymocytes in vivo. METHODS: Effect of deoxynivalenol at different concentrations on apoptosis and proliferation of mouse thymocytes in vivo were studied with animal experiment, electron microscopic observation, DNA agarose gel electrophoresis and flow cytometric analyses. RESULTS: FCM analysis showed that the apoptosis rates of the thymocytes in DON groups (0 5 mg/kg, 1 mg/kg, 2 mg/kg, 4 mg/kg and 8 mg/kg) were significantly higher than that in control ( P

Experience of bench preparation of donor liver in liver transplantation / 中国普通外科杂志

Objective To study the method of preparation of donor liver in liver transplantation. Methods The methods and skills of donor liver preparation and the anomaly artery reconstruction of graft in 64 cases of orthotopic liver transplantation (OLT) were retrospectively analyzed. Results All allografts had preparation and were suitable for clinical transplantation. Thirteen cases with hepatic artery anatomy variation were found. Among the 13 cases, 5 cases were reconstructed. Splenic artery (3/5) and gastro-duodenal artery (2/5) were typically used for anastomosis of the variant hepatic arteries. No complications resulted from donor liver preparation. Conclusions Correct preparation of the donor hepatic artery and biliary tracts, can decrease the incidence of hepatic artery and biliary tract complications after liver transplantation, and is the key to ensure successful donor liver preparation.

Effects of sterigmatocystin on interferon-? secretion of human peripheral blood mononuclear cells in vitro / 中国病理生理杂志

AIM: To explore the putative effects of sterigmatocystin (ST) on human help T lymphocyte(Th1)function. METHODS: The effects of ST on interferon-?(IFN-?)secretion of human peripheral blood mononuclear cells(HPBMc) in vitro were determined with ELISA method. RESULTS: The effects of ST on IFN-? secretion of HPBMc in vitro were closely dependent on ST concentrations. ST at relatively lower concentrations (0.03125-0.12500 mg/L) showed inhibiting effects on IFN-? secretion. While, stimulating effects could be found when ST concentration was above 0.25mg/L. The highest level was seen in ST 1 mg/L group ( P