Multi-slice spiral computed tomography in diagnosing unstable pelvic fractures in elderly and effect of less invasive stabilization.

BACKGROUND: Older people are more likely to experience pelvic fractures than younger people. Multi-slice spiral computed tomography (CT) uses three-dimensional (3D) reconstruction technology to generate 3D images that can clearly demonstrate the 3D space of fractures and detect fractures at a higher rate. AIM: To investigate the clinical value of multi-slice spiral CT 3D reconstruction in the diagnosis of unstable pelvic fractures in the elderly as well as the effect of less invasive stabilization. METHODS: A total of 86 patients with unstable pelvic fractures treated between March 2016 and March 2019 underwent femoral supracondylar bone traction before surgery. Pelvic radiography and multi-row spiral CT were performed successively once the patient's vital signs and hemodynamic indices were stable. Secondary processing of the original data was performed to obtain 3D reconstruction images and determine the vertical displacement of the pelvis. After basic or complete reduction, minimally invasive internal fixation using hollow lag screws was performed. The detection rates of fracture location and classification by X-ray and CT reconstruction were compared. Patients were divided into two groups according to the presence or absence of preoperative 3D reconstruction to compare postoperative reduction, wound healing time, fracture healing time, hospitalization time, visual analog scale (VAS) score, poor internal fixation, and functional recovery. RESULTS: The diagnostic coincidence rates of X-rays for pubic symphysis, ilium wing, sacroiliac periarticular, and sacral fractures were lower than those of CT reconstruction. The coincidence rate of CT reconstruction in the clinical classification of pelvic fractures was 100%, whereas 11 cases were misdiagnosed by X-ray; the total coincidence rate was 87.21%. The total excellent and good rates of postoperative reduction were significantly higher in the study group than in the control group (P < 0.05). The wound healing, fracture healing, and hospitalization times were significantly shorter in the study group than in the control group (P < 0.05). The VAS scores decreased in both groups postoperatively and were lower in the study group than in the control group (P < 0.05). The total incidence of poor postoperative internal fixation was significantly lower in the study group than in the control group (P < 0.05). The overall rate of postoperative functional recovery was significantly higher in the study group than in the control group (P < 0.05). CONCLUSION: Multi-slice spiral CT has high guiding significance for the diagnosis, classification, and treatment of unstable pelvic fractures in the elderly. Preoperative 3D reconstruction can effectively shorten the operation time and promote fracture healing, while minimally invasive internal fixation can effectively reduce pain and promote functional recovery of fracture sites, making it worthy of clinical application.

The low fetal fraction at the first trimester is associated with adverse pregnancy outcomes in IVF singleton pregnancies with single embryo transfer from frozen cycles.

PURPOSE: To study the associations between fetal fraction at the first trimester and subsequent adverse pregnancy outcomes (APOs) in IVF singleton pregnancies with single embryo transfer from frozen cycles. METHODS: This is a single-center retrospective cohort study on IVF singleton pregnancies with single embryo transfer from frozen cycles. A total of 8457 women were collected between March 2015 and September 2018 from the Center for Reproductive Medicine, Shandong University, China. Participants underwent cell-free DNA (cfDNA) sequencing at 11-13 weeks' gestation. Multivariable logistic regressions were performed with the risk of APOs based on various predictor variables. RESULTS: A total of 8457 women were included in the analysis of which 1563 (18.48%) women developed one or more APOs. The hypertensive disorders of pregnancy (HDP) (N = 515), gestational diabetes mellitus (GDM) (N = 684), preterm birth (PTB) (N = 567), and low birth weight (LBW) (N = 306) groups had lower fetal fraction compared with the no pregnancy complication (NPC) group (all p values < 0.05). Based on the multivariable logistic regression results, the optimal cutoff values of fetal fraction were 9.30%, 12.54%, 9.10%, 12.65%, and 13.83% for at least one APO, HDP, GDM, PTB, and LBW, respectively. After adjustment for potential maternal confounders, women in the low fetal fraction (LFF) group had a higher risk for the APOs compared with high fetal fraction (HFF) group. CONCLUSIONS: The fetal fraction in HDP, GDM, PTB, and LBW groups were lower than NPC group in IVF singleton pregnancies with single embryo transfer from frozen cycles in China.

Pregnancy Outcome Difference between Fresh and Frozen Embryos in Women without Polycystic Ovary Syndrome: a Systematic Review and Meta-Analysis.

The purpose of this study is to identify that the advantages of frozen embryos are not evident in ovulatory women or women with non-polycystic ovary syndrome (non-PCOS) by meta-analysis. An exhaustive literature search of PubMed (MEDLINE), Embase, and Cochrane Library databases was performed until March 20, 2020 (limited to articles published in English). We included randomized clinical trials comparing the results of frozen and fresh embryo transfers. The primary outcomes were live birth rate and birth weight. The fixed effect model was used when a significant heterogeneity was observed. Otherwise, a random effect model was used. In 511 identified studies, 4 were eligible and were included in this review. There was no difference in live birth rate, singleton birth weight, clinical pregnancy, ongoing pregnancy, gestational diabetes, and gestational hypertension between frozen and fresh embryos. In frozen embryos, the relative risk of moderate or severe ovarian hyperstimulation syndrome (OHSS) was lower, the incidence rate of pre-eclampsia higher, and the standardized mean difference of twin birth weight higher than in fresh embryos. There is no significant difference between frozen embryo transfer (FET) and fresh embryo transfer in ovulatory women or women with non-PCOS. We recommend that the transfer depends on the actual situation in the patient in clinical practice, rather than the "freeze all" policy and thawing FET.