Surgical treatment of multiple magnet ingestion by children: A single-center experience from China.

BACKGROUND: The incidence of magnet ingestion in children has escalated concurrent with the rise in popularity of magnetic playthings, bearing the capacity to induce substantial morbidity. AIM: The objective of this study was to encapsulate our accumulated expertise in handling pediatric cases featuring multiple magnetic foreign bodies within the gastrointestinal tract sometimes necessitating surgical intervention, as well as to formulate a clinical management algorithm. METHODS: This was a retrospective review of patients with multiple magnetic foreign bodies in the digestive tract, admitted to Shenzhen Children's Hospital, between January 2018 and December 2022. RESULTS: A total of 100 cases were included in this study, including 66 males and 34 females. The main clinical manifestation ns were abdominal pain and vomiting. All patients had abdominal x-ray, all of which indicated foreign bodies in the digestive tract. 33 patients had to undergo a surgical intervention. Among these cases, the gastrointestinal complications occurred in 31 patients, including gastric rupture (n = 9), intestinal obstruction (n = 11) and intestinal perforation (n = 30). Postoperative intestinal obstruction occurred in 6 children. There was no statistical significant difference in age and gender between the Surgical group and Non-surgical group, but the Surgical group had a higher number of magnets ([7.5(2-44) vs 4(2-20)], p = 0.009), a longer interval between time of misingestion to clinical visit ([48(7.2-480) vs 5(2-336)]hours, p < 0.001), and a longer length of hospital stay ([10(6-19) vs 2(1-8)]days, p < 0.001). CONCLUSIONS: Multiple magnet ingestion in children can lead to serious complications and carry severe risks. Timely diagnosis and effective treatment are crucial for managing such patients.

Random Forest Model for Labor Induction in Pregnant Women With Hypertensive Disorders Using a Cervical Double Balloon.

Context: Women with hypertensive disorders of pregnancy often need to have labor induced. The use of cervical double balloons to trigger cervical ripening, combined with the use of oxytocin, has been widely used for labor induction in recent years. In the evaluation of factors affecting the success rate of labor induction, previous predictive models have been limited to use of linear correlation, which simplifies the complex relationship between a large number of variables. Objective: The study intended to retrospectively analyze the factors influencing the outcomes of cervical dilatation using a cervical double balloon in the induction of labor for pregnant women with hypertensive disorders and to establish a predictive model based on the random forest (RF) method that is able to manage multifeatured data, provide fast training speeds, offer high predictive accuracy, and analyze the impact of various features. Design: The research team performed a retrospective analysis of data. Setting: The study took place at the Fujian Provincial Maternity and Child Health Hospital at the Affiliated Hospital of Fujian Medical University in Fuzhou, China. Participants: Participants were 201 women in late pregnancy who came to the hospital for delivery between January 2014 and December 2018, who had hypertensive disorders of pregnancy, and for whom doctors induced labor using a cervical double balloon. Intervention: The research team divided participants into an intervention group, who had a successful induced labor, and a control group, who had a failed induced labor. Outcome Measures: The research team analyzed the medical records of the groups using the RF method of ensemble learning and the multifactor logical regression method. The team used the receiver operating characteristic curve (ROC) to evaluate the working efficiency of the two models. The RF prediction model examined the factors influencing induced labor: the pregnancy method, the ultrasound EFW, the amniotic fluid index (AFI), the serum LDH level of the pregnant women, the placental volume, the cervical Bishop score before use of the balloon, the duration of the balloon's use, and the hours of use of oxytocin after balloon removal. Results: The success rate for induced labor with use of a cervical double balloon for women with hypertensive disorders during pregnancy was 77.18%. The incidence of postpartum hemorrhage was 4.7% and of fetal distress was 12.7%. The most important 10 features were: (1) hours of oxytocin use, (2) fetal weight, (3) placental volume, (4) AFI, (5) LDH, (6) BMI, (7) the Bishop score before use of the COOK balloon, (8) duration of the balloon's use, (9) pregnancy method, and (10) weight gain during pregnancy. The area under the ROC curve for successful induction for the RF model was 0.983. The multivariate logistic regression model based on RF showed that multiple births, high cervical Bishop scores before labor induction, less time for use of oxytocin after balloon removal, and a small placental volume were independent risk factors, with the area under the ROC curve for successful induction being 0.918. Conclusions: Medical practitioners can use the cervical double balloon effectively for the induction of labor for women with hypertensive disorders during the third trimester of pregnancy, and the prediction model for induction of labor based on RF had a good working efficiency.

Prediction of pre-eclampsia complicated by fetal growth restriction and its perinatal outcome based on an artificial neural network model.

Objective: Pre-eclampsia (PE) complicated by fetal growth restriction (FGR) increases both perinatal mortality and the incidence of preterm birth and neonatal asphyxia. Because ultrasound measurements are bone markers, soft tissues, such as fetal fat and muscle, are ignored, and the selection of section surface and the influence of fetal position can lead to estimation errors. The early detection of FGR is not easy, resulting in a relative delay in intervention. It is assumed that FGR complicated with PE can be predicted by laboratory and clinical indicators. The present study adopts an artificial neural network (ANN) to assess the effect and predictive value of changes in maternal peripheral blood parameters and clinical indicators on the perinatal outcomes in patients with PE complicated by FGR. Methods: This study used a retrospective case-control approach. The correlation between maternal peripheral blood parameters and perinatal outcomes in pregnant patients with PE complicated by FGR was retrospectively analyzed, and an ANN was constructed to assess the value of the changes in maternal blood parameters in predicting the occurrence of PE complicated by FGR and adverse perinatal outcomes. Results: A total of 15 factors-maternal age, pre-pregnancy body mass index, inflammatory markers (neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio), coagulation parameters (prothrombin time and thrombin time), lipid parameters (high-density lipoprotein, low-density lipoprotein, and triglyceride counts), platelet parameters (mean platelet volume and plateletcrit), uric acid, lactate dehydrogenase, and total bile acids-were correlated with PE complicated by FGR. A total of six ANNs were constructed with the adoption of these parameters. The accuracy, sensitivity, and specificity of predicting the occurrence of the following diseases and adverse outcomes were respectively as follows: 84.3%, 97.7%, and 78% for PE complicated by FGR; 76.3%, 97.3%, and 68% for provider-initiated preterm births,; 81.9%, 97.2%, and 51% for predicting the severity of FGR; 80.3%, 92.9%, and 79% for premature rupture of membranes; 80.1%, 92.3%, and 79% for postpartum hemorrhage; and 77.6%, 92.3%, and 76% for fetal distress. Conclusion: An ANN model based on maternal peripheral blood parameters has a good predictive value for the occurrence of PE complicated by FGR and its adverse perinatal outcomes, such as the severity of FGR and preterm births in these patients.

Strategical district cooling system operation in hub airport terminals, a research focusing on COVID-19 pandemic impact.

Part load ratio is often observed in real operations of airport terminal cooling system. This phenomenon is more obvious during the COVID-19 pandemic, as sudden flight restrictions impacting cooling demand are widely adopted in hub airport terminals. This research aims to propose optimal strategies of multi-chiller in airport terminals based on cooling load characteristics modeling, to tackle the aforementioned issues. Numerical experiments based on a real-world Chinese airport terminal are conducted to validate the proposed method. The results show that an average cooling load drop of 30% is observed from scenario of normal flight before COVID-19 to scenario of COVID-19 Period flight, and the average cooling load drop reaches to 44% from scenario of busy flight before COVID-19 to scenario of COVID-19 Period flight. The results also reflect that cooling load presents synchronous trend with passenger flow, but presents asynchronous trend with outdoor temperature. The influence of outdoor temperature on cooling demand delays due to building envelops. It indicates that simple superimposition according to passenger flow change for chiller operation number is reliable, efficient and effective, but is not suitable for outdoor temperature change. The findings are helpful to develop optimal strategies for further real-time control of multi-chiller.

A Clinical Analysis of the Diagnosis and Treatment of Fetal Sacrococcygeal Teratomas.

OBJECTIVE: The present study aims to discuss the clinical features, treatment, and prognosis of fetal sacrococcygeal teratomas (SCTs) to improve the standard of diagnosis and treatment. METHODS: The clinical data of 15 pregnant females with fetal SCT, admitted to Fujian  Maternity and Child Health Hospital from January 2013 to January 2020, were retrospectively analyzed with respect to clinical characteristics, imaging features, complications, treatment options, and pregnancy outcomes. RESULTS: The 15 cases of fetal SCT were all detected by color ultrasonography. There were two cases of cystic tumors and 13 cases of solid cystic tumors. In terms of tumor blood supply, there was one case without blood flow signal, eight cases with little blood flow signal, and six cases with abundant blood flow. At the time of delivery, there were two cases with a tumor diameter less than 5 cm, five cases with a diameter of 5-10 cm, and eight cases with a diameter of more than 10 cm. In terms of tumor shape and location, there were two cases of type I, ten cases of type II, and three cases of type III. There were six cases with an increased fetal heart to chest ratio, four cases of fetal edema, three cases of placental edema, four cases of excessive amniotic fluid, one case of insufficient amniotic fluid, three cases of fetal distress, one case of stillbirth, two cases of gestational diabetes mellitus, two cases of mirror syndrome, and two cases of postpartum hemorrhage. According to the pathological diagnosis, there were seven cases of mature teratoma, seven cases of immature teratoma, and one case of mixed germ cell tumor. There were six cases of induced delivery, nine cases of cesarean section, one case of premature birth, and two cases of mild neonatal asphyxia. CONCLUSION: Fetal SCT was generally diagnosed by prenatal ultrasonography. The tumor blood supply, growth rate, size, nature of the tumor, clinical type, pathology, and maternal-fetal complications are all closely correlated with the prognosis. The timing and manner of the termination of pregnancy should be determined on the basis of the pregnant female, the fetus, and the tumor.