Analysis of perinatal outcomes for emergency cervical cerclage in singleton pregnancies at 24-28 weeks of gestation.

BACKGROUND: Cervical cerclage is the only effective treatment for cervical insufficiency, effectively preventing late miscarriage and preterm birth. The effectiveness and safety of emergency cervical cerclage (ECC) as an emergency treatment when the cervix is already dilated or when there is protrusion of the fetal membranes into the vagina remain controversial, especially in pregnancies at 24-28 weeks when the fetus is viable. There is still no consensus on whether emergency cervical cerclage should be performed in such cases. PURPOSE: To investigate the effectiveness and safety of emergency cervical cerclage in singleton pregnant women at 24-28 weeks of gestation. METHODS: This study employed a single-center prospective cohort design, enrolling singleton pregnant women at 24-28 weeks of gestation with ultrasound or physical examination indicating cervical dilation or even membrane protrusion. Emergency cervical cerclage was compared with conservative treatment. The primary endpoints included a comprehensive assessment of perinatal pregnancy loss, significant neonatal morbidity, and adverse neonatal outcomes. Secondary endpoints included prolonged gestational age, preterm birth, neonatal hospitalization rate, premature rupture of membranes, and intrauterine infection/chorioamnionitis. RESULTS: From June 2021 to March 2023, a total of 133 pregnant women participated in this study, with 125 completing the trial, and were allocated to either the Emergency Cervical Cerclage (ECC) group (72 cases) or the conservative treatment group (53 cases) based on informed consent from the pregnant women. The rate of adverse neonatal outcomes was 8.33% in the ECC group and 26.42% in the conservative treatment (CT) group, with a statistically significant difference (P = 0.06). There were no significant differences between the two groups in terms of perinatal pregnancy loss and significant neonatal morbidity. The conservative treatment group had a mean prolonged gestational age of 63.0 (23.0, 79.5) days, while the ECC group had 84.0 (72.5, 89.0) days, with a statistically significant difference between the two groups (P < 0.001). Compared with CT group, the ECC group showed a significantly reduced incidence of preterm birth before 28 weeks, 32 weeks, and 34 weeks, with statistical significance (P = 0.046, 0.007, 0.001), as well as a significantly decreased neonatal hospitalization rate (P = 0.013, 0.031). Additionally, ECC treatment did not increase the risk of preterm premature rupture of membranes or intrauterine infection/chorioamnionitis, with no statistically significant differences (P = 0.406, 0.397). CONCLUSION: In singleton pregnant women with cervical insufficiency at 24-28 weeks of gestation, emergency cervical cerclage can reduce adverse neonatal pregnancy outcomes, effectively prolong gestational age, decrease preterm births before 28 weeks, 32 weeks, and 34 weeks, lower neonatal hospitalization rates, and does not increase the risk of preterm premature rupture of membranes or intrauterine infection/chorioamnionitis.

Sodium tetraborate simultaneously enhances the degradation of acetaminophen and reduces the formation potential of chlorinated by-products with heat-activated peroxymonosulfate oxidation.

In this study, sodium tetraborate (Na2B4O7) was introduced to enhance the degradation of acetaminophen (ACT) in heat-activated peroxymonosulfate (PMS) process. The elimination of ACT in Na2B4O7/heat/PMS process followed the pseudo-first order kinetics. The corresponding kobs value with 10 mM Na2B4O7 was 33.1 times higher than that in heat/PMS process. 1O2 and HO· were identified as primary reactive species via quenching experiments and electron paramagnetic resonance technology. B(OH)4-, the hydrolysis product of Na2B4O7, reacted with PMS to generate HOOB(OH)3-. 1O2 was generated by the self-decomposition of PMS using B(OH)4- as catalyst, while HO· was produced via the breakage of peroxide bond of PMS and HOOB(OH)3-under high temperature. ACT was degraded by reactive species via the pathways of -NH- bond breakage, -OH replacement, -NH2 oxidation and benzene ring cleavage. Nine transformation intermediates were detected by LC/Q-TOF/MS, and the toxicity of reaction solution decreased significantly with the elimination of ACT. Increasing Na2B4O7 dosage, PMS concentration, initial pH and reaction temperature were conducive to ACT elimination. Humic acid, Cl- and CO32- inhibited the degradation of ACT heavily, while SO42- and NO3- had the negligible effects. Moreover, B(OH)4- could react with free chlorine to the inert B(OH)3OCl- and further significantly suppress the formation of chlorinated by-products for the treatment of Cl--containing water in Na2B4O7/heat/PMS process. This study provided an effective way to enhance the oxidation capacity of heat/PMS process and suppress the formation of chlorinated by-products in chloride-containing water, and the findings had important implications for using borate buffer in the studies of PMS-based advanced oxidation processes.

Multi-wavelength spectrophotometric determination of peracetic acid and the coexistent hydrogen peroxide via oxidative coloration of ABTS with the assistance of Fe2+ and KI.

In this study, a multi-wavelength spectrophotometric method for simultaneous determination of peracetic acid (PAA) and coexistent hydrogen peroxide (H2O2) was presented. This method was based on the oxidation of 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonate) (ABTS) with the assistance of Fe2+/KI to produce a stable green radical (ABTS●+), which could be determined at four characteristic peaks (i.e., 415 nm, 650 nm, 732 nm, and 820 nm). The absorbances of ABTS●+ at four peaks were well linear (R2 > 0.999) with concentrations of both total peroxides (PAA + H2O2) and PAA in the range of 0-40 µM under optimized conditions. The sensitivities for determining total peroxides at 415 nm, 650 nm, 732 nm and 820 nm were determined to be 4.248 × 104 M-1 cm-1, 1.682 × 104 M-1 cm-1, 2.132 × 104 M-1 cm-1, and 1.928 × 104 M-1 cm-1, respectively. For determining PAA, the corresponding sensitivities were 4.622 × 104 M-1 cm-1, 1.895 × 104 M-1 cm-1, 2.394 × 104 M-1 cm-1 and 2.153 × 104 M-1 cm-1, respectively. The concentration of coexistent H2O2 was gained by deducting PAA concentration from total peroxides concentration. The ABTS method was accurate enough to determine PAA concentration in natural water samples. Moreover, the ABTS method was successfully used to determine the changes of PAA and coexistent H2O2 and to distinguish their role on naproxen degradation in heat-activated PAA process. Overall, the ABTS method could be used as an alternative method for the convenient, rapid and sensitive determination of PAA and the coexistent H2O2 in water samples.

Hydroxylamine enhanced Fe(II)-activated peracetic acid process for diclofenac degradation: Efficiency, mechanism and effects of various parameters.

In this study, a commonly used reducing agent, hydroxylamine (HA), was introduced into Fe(II)/PAA process to improve its oxidation capacity. The HA/Fe(II)/PAA process possessed high oxidation performance for diclofenac degradation even with trace Fe(II) dosage (i.e., 1 µM) at pH of 3.0 to 6.0. Based on electron paramagnetic resonance technology, methyl phenyl sulfoxide (PMSO)-based probe experiments and alcohol quenching experiments, FeIVO2+ and carbon-centered radicals (R-O•) were considered as the primary reactive species responsible for diclofenac elimination. HA accelerated the redox cycle of Fe(III)/Fe(II) and itself was gradually decomposed to N2, N2O, NO2- and NO3-, and the environmentally friendly gas of N2 was considered as the major decomposition product of HA. Four possible degradation pathways of diclofenac were proposed based on seven detected intermediate products. Both elevated dosages of Fe(II) and PAA promoted diclofenac removal. Cl-, HCO3- and SO42- had negligible impacts on diclofenac degradation, while humic acid exhibited an inhibitory effect. The oxidation capacity of HA/Fe(II)/PAA process in natural water matrices and its application to degrade various micropollutants were also investigated. This study proposed a promising strategy for improving the Fe(II)/PAA process and highlighted its potential application in water treatment.

Image Features of Magnetic Resonance Imaging under the Deep Learning Algorithm in the Diagnosis and Nursing of Malignant Tumors.

In order to explore the effect of convolutional neural network (CNN) algorithm based on deep learning on magnetic resonance imaging (MRI) images of brain tumor patients and evaluate the practical value of MRI image features based on deep learning algorithm in the clinical diagnosis and nursing of malignant tumors, in this study, a brain tumor MRI image model based on the CNN algorithm was constructed, and 80 patients with brain tumors were selected as the research objects. They were divided into an experimental group (CNN algorithm) and a control group (traditional algorithm). The patients were nursed in the whole process. The macroscopic characteristics and imaging index of the MRI image and anxiety of patients in two groups were compared and analyzed. In addition, the image quality after nursing was checked. The results of the study revealed that the MRI characteristics of brain tumors based on CNN algorithm were clearer and more accurate in the fluid-attenuated inversion recovery (FLAIR), MRI T1, T1c, and T2; in terms of accuracy, sensitivity, and specificity, the mean value was 0.83, 0.84, and 0.83, which had obvious advantages compared with the traditional algorithm (P < 0.05). The patients in the nursing group showed lower depression scores and better MRI images in contrast to the control group (P < 0.05). Therefore, the deep learning algorithm can further accurately analyze the MRI image characteristics of brain tumor patients on the basis of conventional algorithms, showing high sensitivity and specificity, which improved the application value of MRI image characteristics in the diagnosis of malignant tumors. In addition, effective nursing for patients undergoing analysis and diagnosis on brain tumor MRI image characteristics can alleviate the patient's anxiety and ensure that high-quality MRI images were obtained after the examination.