Objective To evaluate the influence of ultrasound-mediated contrast agent microbubbles carrying kallidinogenase targeted therapy on neurogenesis and angiogenesis after experimental acute cerebral infarction.Methods Kallidinogenase-loaded microbubbles were prepared using mechanical shaking method.Middle cerebral artery occlusion (MCAO) model was established in male Wistar rats by sutureoccluded method.MCAO rats (n =120) were randomly divided into 5 groups:ultrasound-mediated kallidinogenase-loaded microbubbles group (group 1),ultrasound-mediated microbubbles group (group 2),ultrasound-mediated saline group (group 3),kallidinogenase group (group 4),saline group (group 5).Medication was given through tail vein daily for 2-6 consecutive days starting 24 h after MCAO.Ultrasound groups (groups 1,2 and 3) were given 2 MHz pulse ultrasonic irradiation on the ischemia lateral skull for 10 min after injection.Cell proliferation was examined using 5'-bromo-2'-deoxyuridine (BrdU,50 mg/kg).Infarction volume and neurological function were evaluated on the 3rd,7th day after MCAO respectively.Doublecortin (DCX) + cells in the subventricular zone and laminin + in the peri-infarction region were observed at the same time.Results The number of DCX + cells in the subventricular zone (under 20 × ocular) of groups 1-5 was 251.8 ± 13.1,125.7 ± 11.6,130.2 ± 13.7,234.5 ± 12.4 and 123.7 ± 10.0 respectively.The percentage of laminin + cells in the peri-infarction region (× 10 objective) of groups 1-5 was 10.0％ ± 0.8％,5.2％ ± 0.7％,5.0％ ± 1.0％,8.0％ ± 1.8％ and 5.0％ ± 0.9％ respectively.The number of DCX + cells in the subventricular zone and laminin + cells in the peri-infarction region of the group 1 and the group 4 was significantly more on the 7th day after MCAO compared with those of the other three groups (DCX:t values of group 1 vs groups 2,3,5 were 17.88,17.17 and 18.16,all P ＜ 0.01 ; t values of group 4 vs groups 2,3,5 were 15.42,14.78 and 15.70,all P ＜0.01.Laminin:t values of group 1 vs groups 2,3,5 were 7.01,6.71 and 7.11,all P ＜ 0.01 ; t values of group 4 vs groups 2,3,5 were 4.23,3.94 and 4.33,all P ＜0.01).Moreover,the number of DCX+ cells in the subventricular zone (t =2.46,P ＜ 0.05) and laminin + cells in the peri-infarction region (t =2.78,P ＜ 0.05) of the group 1 was much more than those of the group 4.Neurologic scores on the 7th day of groups 1-5 were 1.00 (0.75,1.25),2.0 (2.00,3.00),2.0 (1.00,2.00),1.5 (0.75,2.00),2.0 (2.00,2.50).Compared with other four groups,group 1 showed better functional improvement after stroke (U values of group 1 vs groups 2-5 were 2.0,4.0,7.5 and 2.5,all P ＜ 0.05).While there was no significant difference in infarction volume among five groups at all the time points after MCAO.Conclusions Our study demonstrates ultrasound-mediated kallidinogenase-loaded contrast agent microbubbles targeted therapy promotes neuroblasts proliferation and vascular regeneration compared with mediated and non-medicine-loaded microbubbles therapy,which attributes to functional improvement after MCAO.Therefore,ultrasound-mediated ultrasound contrast agent microbubbles carrying drugs targeted therapy may have a perspective on ischemic stroke.

Objective To probe into the application of PureceptionTM gradient centrifugation technique for sperm separation in artificial insemination by husband (AIH) .Methods Prepare the semen by PureceptionTM gradient centrifugation technique ,and used for 1360 AIH cycles in 672 infertile couples .Results After preparing the semen by PureceptionTM gradient centrifugation technique ,the sperm concentration was increased from (54 .86 ± 26 .03) × 106/mL to (63 .89 ± 34 .40) × 106/mL ,the rate of PR sperm was increased from (32 .47 ± 9 .31)% to (69 .78 ± 5 .10) ,the differences were both statistically significant (P<0 .05) .the recovery rate of PR sperm was (34 .08 ± 3 .95)% .672 infertile couples received 1360 AIH cycles ,and the clinical pregnance rate was 16 .62% (226/1360) .According to the sperm concentration before preparing the semen ,the cycles were divided into 3 groups :≥15 × 106/mL (GroupⅠ) ,(≥10 ,<15)× 106/mL (GroupⅡ ) and <10 × 106/mL (Group Ⅲ ) ,the clinical pregnancy rates were 17 .13% ,16 .05% and 4 .26% ,respectively ,Group Ⅲ was significantly lower than the other two groups (P<0 .05);According to the rate of PR sperm ,the cycles were divided into 3 groups:≥32% (Group A) ,(≥10 ,<32)% (Group B) and <10% (Group C) , the clinical pregnancy rates were 17 .53% ,16 .55% and 4 .65% ,respectively ,Group C was significantly lower than the other two groups (P<0 .05) .According to the number of PR sperm after preparing the semen ,the cycles were divided into 2 groups:≥10 × 106 and <10 × 106 ,the clinical pregnancy rates were 17 .33% and 10 .22% ,the difference was statistically significant (P<0 .05) . Conclusion PureceptionTM gradient centrifugation technique is a better way for sperm separation ,and the clinical pregnance rate is satisfactory when it is used in AIH .When the sperm concentration is ≥10 × 106/mL and the rate of PR sperm is ≥10% before pre‐paring the semen ,and the number of PR sperm is ≥10 × 106 after preparing the semen ,patients will get a more ideal pregnancy rate .

Objective：To explore the difference in creative thinking and the related factors between deaf children and normal children.Methods：Observation group(n=122)with the hearing disability students were selected from 4 special education schools.Control group(n=122)was come from 2 ordinary primary schools and 2 ordinary middle schools.The two groups were given both the New Creativity Test and the Combined Raven's Test.Results：(1)Deaf children got lower scores than normal children in verbal fluency[(7.76±0.75)vs.(12.98±0.59),P<0.001],verbal flexibility[(4.28±0.33)vs.(7.87±0.28),P<0.001],verbal originality [(7.16±0.89)vs.(11.35±0.72),P<0.001],figural flexibility[(9.69±0.35)vs.(11.10±0.31),P=0.003]and IQ[(101.05±1.196)vs.(105.01±1.102),P=0.030].Deaf children got higher scores than normal children in figural elaboration[(3.24±0.40)vs.(1.96±0.22),P=0.006].There was no significant difference in fluency and originality of figural task between the two groups.(2)Deaf children's scores of verbal fluency and verbal originality were positively correlated with their age(β=0.310,0.301;Ps<0.01).Deaf children's scores of verbal flexibility were positively correlated with length of bilingual education(β=0.308,P<0.001).Deaf children's scores of figural fluency,figural flexibility,figural originalityand figural elaboration were correlated positively with their age of sign language(β=0.321,0.308,0.228,0.456;Ps<0.05).Conclusions:(1)Deaf children are lower than normal children in verbal fluency,verbal flexibility,verbal originality,figural flexibility,and are higher in figural elaboration.There is no difference in figural fluency and originality between them.(2)Sign language is a major related factor to deaf children's figural creative thinking.

OBJECTIVE To investigate the significance of CNS in clinical infections.METHODS A total of 114 CNS strains isolated from our hospital were identified by conventional procedures and the icaD gene was amplified by PCR.RESULTS Of all CNS strains,the highest isolated rate was S.epidermidis(41.2%).CNS isolated from deep venous catheters,wound secretions and blood had a higher rate of carrying ica operon,accounted for 44.4%,42.1% and 36.8%,respectively,whereas 24.0% in respiratory secretions and 14.1% in urine.Among the ica operon positive CNS strains,the percentages of S.epidermidis and S.haemolyticus were 42.6% and 19.0%.CONCLUSIONS There is a wide range of CNS species carrying ica operon,especially in S.epidermidis.CNS isolated from different specimens might have different significances.It should be cautious to assess the results of isolated CNS from respiratory and urine specimens.The CNS isolates from blood specimens might be contaminated.The PCR method for the ica operon is simple and easy.

Objective:To observe the clinical effect of prolonged photodynamic therapy (PDT) irradiation time combined with intravitreal injection of ranibizumab in the treatment of circumscribed choroidal hemangioma (CCH).Methods:A retrospective clinical study. From March 2012 to March 2018, 51 eyes of 51 patients diagnosed in Shenzhen Eye Hospital were included in the study. Among the patients, the tumor of 36 eyes were located in macular area, of 15 eyes were located outside macular area (near center or around optic disc). All patients underwent BCVA, color fundus photography, FFA, ocular B-scan ultrasonography and OCT examinations. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. OCT showed 48 eyes with macular serous retinal detachment. of 36 eyes with tumor located in macular area, the logMAR BCVA was 0.05±0.05, the tumor thickness was 4.5± 2.2 mm, the diameter of tumor was 9.7±3.6 mm. Of 15 eyes with tumor located outside macular area, the logMAR BCVA was 0.32±0.15, the tumor thickness was 3.8±1.4 mm, the diameter of tumor was 7.7± 1.9 mm. PDT was performed for all eyes with the irradiation time of 123 s. After 48 h, all patients received intravitreal injections of 0.5 mg ranibizumab (0.05 ml). At 1, 3 and 6 months after treatment, the same equipment and methods before treatment were used for related examination. BCVA, subretinal effusion (SRF), tumor leakage and size changes were observed. BCVA, tumor thickness and diameter before and after treatment were compared by t test. Results:At 6 months after treatment, the tumor was becoming smaller without scar formation. FFA showed that the blood vessels in the tumor were sparse compared with those before treatment, and the fluorescence leakage domain was reduced. OCT showed 43 eyes of macular serous detachment were treated after the combined treatment. The logMAR BCVA were 0.16±0.15 and 0.55±0.21 of the eyes with tumor located in or outside macular area, respectively. The difference of logMAR BCVA between before and after treatment was significant ( t=-2.511, -2.676; P=0.036, 0.040). Both the tumor thickness ( t=3.416, 3.055; P=0.011, 0.028) and diameter ( t=4.385, 4.171; P=0.002, 0.009) of CCH patients were significantly reduced compared with that before treatment. Conclusion:The tumor of CCH can be reduced by prolonged PDT irradiation time combined with intravitreal injection of ranibizumab.

Objective:To investigate the effect of lifestyle intervention on the clinical outcomes of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) in overweight or obese patients with polycystic ovary syndrome (PCOS).Methods:This study was a non-randomized controlled trial. A total of 126 overweight or obese PCOS patients who received IVF/ICSI treatment for infertility in Shaoguan Maternal and Child Health Hospital from January 2021 to December 2022 were selected by semi-random sampling method. The patients were divided into the experimental group (39 cases) and the control group (87 cases) according to whether they received the comprehensive lifestyle intervention. The experimental group maintained a healthy lifestyle and emotional control, accepted balanced diet, performed aerobic exercise and resistance exercise regularly and quantitatively, the data changes related to body mass index were collected regularly. The control group implemented a weight loss regimen on their own, following a low-calorie diet and exercise interventions. After 2 to 3 months, both groups of patients entered the test tube cycle (the intervention duration for each patient was up to the effect and their willingness to weight loss). The baseline data, cycle characteristics and pregnancy outcomes were compared between the two groups with t test and Chi-square. And the effects of lifestyle interventions on the clinical outcomes of IVF/ICSI in overweight or obese PCOS patients were also analyzed. Results:Before the intervention, the serum level of anti-muller hormone (AMH) in the experimental group was significantly higher than that in the control group [(5.62±2.98) vs (4.47±2.64) μg/L]( P<0.05). But there were no significant differences in age, infertility years, basal follicle maturation hormone (FSH), antral follicle count (AFC), primary infertility ratio, ICSI ratio, body mass index, proportion of obese patients, abdominal circumference, waist-to-hip ratio, visceral fat area and body fat percentage between the two groups (all P>0.05). After intervention, the body mass index, proportion of obese patients, abdominal circumference, visceral fat area and body fat percentage in experimental group were all significantly lower than those before intervention [(26.56±2.92) vs (29.21±3.37) kg/m2, 25.64% vs 64.10%, (89.92±7.16) vs (95.27±7.38) cm, (78.46±15.92) vs (95.46±17.21) cm2, 33.71%±2.46% vs 36.27%±3.02%] (all P<0.05). After intervention, the visceral fat area in the control group was significantly lower than that before the intervention [(92.08±19.38) vs (98.84±19.65) cm2] ( P<0.05), and there was no significant differences in the other indexes (all P>0.05). After intervention, the total amount of gonadotropin (Gn) in experimental group was significantly lower than that in control group [(2 488.23±711.30) vs (2 935.67±854.78) U] ( t=2.301, P<0.05). Conclusion:A 2-3 month lifestyle intervention can significantly reduce the body mass index, waist circumference, visceral fat area, and body fat percentage of overweight or obese PCOS patients, as well as decrease the total amount of Gn used for ovulation induction. However, it does not show a significant improvement in clinical outcomes.

Objective To explore the mutation characteristics of DMD gene in patients with Duchenne or Becker muscular dystrophy and female carriers, to provide effective prenatal diagnosis. Methods Samples were collected from 94 male patients clinically diagnosed with Duchenne or Becker muscular dystrophy and 121 corresponding female relatives from Qingdao Women and Children′s Hospital from June 2011 to October 2018. Multiplex ligation-dependent probe amplification (MLPA) was used to detect their DMD gene, and 23 high risk pregnants were performed prenatal diagnosis. Any candidate of DMD gene single-exon deletion was validated by further PCR amplification. The sample with whole DMD gene deletion was confirmed by chromosomal microarray analysis (CMA) to detect copy number variations and break site. Results Among 94 clinical Duchenne or Becker muscular dystrophy patients, 66(70.2%, 66/94) were detected gene mutation; 56 cases were exon deletion mutation and 10 cases were duplication mutation. In 121 female relatives, 48 cases (39.7%, 48/121) were diagnosed as carriers. The mutation carrying rate, was 64.5% (40/62) identified in 62 mothers of Duchenne or Becker muscular dystrophy patients. Five Duchenne or Becker muscular dystrophy fetuses and 5 carrier fetuses were prenatally diagnosed in 23 high risk pregnants. Two children with the entire DMD gene deletion were identified more deletions at Xp21, with deletions of 6.66 Mb and 10.64 Mb respectively. Conclusions MLPA may be an important method to detect DMD gene mutation of deletion and duplication. Therefore, the diagnosis of probands, female carriers and making an effective prenatal diagnosis are essential to reduce the birth of children with Duchenne or Becker muscular dystrophy.

Objective:To explore the value of karyotyping and chromosomal microarray analysis (CMA) in the prenatal diagnosis of balanced translocation/inversion carriers.Methods:This was a retrospective study involving 117 balanced translocation/inversion carrier couples. Among them, 90 women had a history of spontaneous abortion(≥2 times), stillbirth, fetal multiple malformations, or giving birth to children with chromosome abnormality disease and the peripheral blood karyotyping and fluorescence in situ hybridization testing confirmed that one partner was balanced translocation/inversion carrier. The present pregnancies of these cases were spontaneous and lasted until 18-25 weeks. The other 27 cases were confirmed by chromosome examination at the present pregnancy after the indication of fetal structural abnormalities by fetal karyotyping due to advanced maternal age and abnormal ultrasound and prenatal screening results. The results of karyotyping and CMA by amniocentesis during 18 to 25 gestational weeks were all summarized and described. Results:The successful rate of both methods was 100.0% (117/117). Unbalanced and balanced translocation/inversion were detected in seven (6.0%) and 39 (33.3%) fetuses by karyotyping, respectively. CMA revealed 14 fetuses with pathogenic copy number variation (CNV) and one with variants of uncertain significance(VUS), with an anomaly detection rate of 12.8% (15/117). Among the 15 cases with CNV, 13 were related to the parental translocation/inversion, one with de novo mutation (22q11.2 microdeletion syndrome), and one Duchenne muscular dystrophy mutation carrier. Based on the results of karyotype and CMA, there were 12 fetuses with unbalanced chromosomal fragments (10.3%), 37 fetuses with balanced translocation/inversion (31.6%), and 68 fetuses with normal chromosomes (58.1%). Conclusions:The combination of karyotyping and CMA can provide more accurate prenatal genetic diagnosis when one of a couple carries balanced chromosomal translocations/inversion.

Objective:To determine a relationship between ultrasound shear wave elastography (SWE) and pathological lessions of renal tissues in children with chronic kidney disease (CKD).Methods:It was a cross-sectional observational study, involving children admitted to the Department of Pediatrics of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January to December 2021 with definite pathological diagnosis through kidney biopsy. The SWE was used to determine the Young's modulus (elastic modulus) of the cortex and medulla of the upper, middle, and lower poles of the kidney. The renal histopathology was classified or graded. The statistical method was used to analyze the relationship between Young's modulus of the inferior polar cortex (YM cor) and medulla (YM med) of the right kidney and renal pathology. Results:The study included 110 children with definite pathological diagnosis through renal biopsy, aged (10.1±3.4) years old (2-17 years old), with 55 males (50.0%). The body mass index was (20.6±2.4) kg/m 2, and mean arterial pressure was (95±24) mmHg. There were 94 patients (85.4%) with CKD stage 1, 8 patients (7.3%) with CKD stage 2, and 8 patients (7.3%) with CKD stage 3. There was no significant difference of YM cor and YM med in the upper and middle poles of the right kidneys, and YM med in the lower poles of right kidneys in CKD patients with different stages (all P>0.05). Both YM cor [(15.75±3.36) kPa] and YM med [(13.50±2.43) kPa] of CKD stage 3 patients were significantly higher than those of CKD stage 1 patients [(12.94±2.45) kPa, (11.88±2.23) kPa](both P<0.05). There was no significant difference of YM cor and YM med in the lower poles of right kidneys between stage 1 and stage 2 CKD patients (both P>0.05). YM cor[(17.93±3.23) kPa] and YM med [(15.50±1.48) kPa] in patients with crescentic glomerulonephritis were higher than those in patients with focal segmental glomerulosclerosis [(12.71±2.42) kPa, (11.57±2.63) kPa] and mesangial proliferative glomerulonephritis [(12.73±2.04) kPa, (11.48±2.10) kPa](all P<0.05). There was no significant difference of YM cor and YM med between focal segmental glomerulosclerosis and mesangial proliferative glomerulonephritis (both P>0.05). YM cor [(16.30±2.63) kPa] and YM med [(15.54±1.59) kPa] of Lee's Ⅳ grade of IgA nephropathy were higher than those of Lee's Ⅲ grade [(13.32±2.70) kPa, (12.57±2.50) kPa](both P<0.05), while the International Study of Kidney Disease in Children grade of purpura nephritis had no significant correlation with YM cor and YM med (both P>0.05). YM cor [(15.41±2.37) kPa] and YM med [(13.82±2.59) kPa] of interstitial fibrosis/tubular atrophy (T1/T2) group of IgA nephropathy mixed with purpura nephritis were significantly higher than those of T0 group's [(12.99±2.40) kPa, (11.79±2.05) kPa] (both P<0.05). Moreover, crescent formation (C1) group had a higher YM cor [(14.21±2.77) kPa] and YM med [(12.80±2.47) kPa] than those in C0 group [(12.73±2.15) kPa, (11.59±1.97) kPa] (both P<0.05), while YM cor and YM med were unrelated to the mesangial hypercellularity (M), endocapillary cellularity (E), segmental sclerosis or adhesion (S) indicators (all P>0.05). In lupus nephritis patients, YM cor ( r=0.744, P=0.035) and YM med ( r=0.728, P=0.009) were favorably linked with the chronic index, but not with the activity index (both P>0.05). Conclusions:Renal interstitial fibrosis/tubular atrophy and crescentic development are connected with YM cor and YM med at the lower pole of the kidney as measured by SWE. SWE can be used to assess the chronic renal lesions in children with CKD in the early and middle stages. It may develop into a new noninvasive way to assess renal pathology.

Objective:To investigate the effects of placenta previa on the surgical and pregnancy outcomes in patients with total/subtotal or segmental hysterectomy attributed to placenta accreta spectrum disorders (PAS).Methods:This study retrospectively enrolled 510 patients who gave birth and underwent total/subtotal hysterectomy or segmental hysterectomy (local implantation site) due to PAS at the third Affiliated Hospital of Guangzhou Medical University from January 1, 2017, to December 31, 2022. These subjects were divided into the placenta previa group (427 cases) and non-placenta previa group (83 cases). According to the type of hysterectomy, they were further divided into the total/subtotal hysterectomy and placenta previa subgroup (221 cases), total/subtotal hysterectomy and non-placenta previa subgroup (23 cases), segmental hysterectomy and placenta previa subgroup (206 cases), and segmental hysterectomy and non-placenta previa subgroup (60 cases). Nonparametric test or Chi-square test were used to compare the differences in the clinical features, surgical and pregnancy outcomes between different groups. Binary logistic regression was used to analyze the effects of placenta previa on the risk of additional surgical procedures and adverse maternal outcomes. Results:(1) Compared with the non-placenta previa group, the hemorrhage volume within 24 h postpartum [1 541 ml (1 036-2 368 ml) vs 1 111 ml (695-2 000 ml), Z=－3.91] and the proportion of women requiring additional surgical procedures [84.8% (362/427) vs 69.9% (58/83), χ2=10.61], with total/subtotal hysterectomy [51.8% (221/427) vs 27.7% (23/83), χ2=16.10], cystoscopy and/or ureteral stenting [60.7% (259/427) vs 31.3% (26/83), χ2=24.25], total adverse pregnancy outcomes [86.9% (371/427) vs 65.1% (54/83), χ2=17.75], hemorrhage volume>1 500 ml within 24 h postpartum [54.1% (231/427) vs 33.7% (28/83), χ2=29.94], transfusion of blood products [75.9% (324/427) vs 47.0% (39/83), χ2=28.27] were all higher in the placenta previa group (all P<0.05). Binary logistic regression analysis found that for PAS patients with hysterectomy, regardless of the hysterectomy type (total/subtotal/segmental), placenta previa was risk factor for requiring additional surgical procedures ( aOR=3.26, 95% CI: 1.85-5.72) and adverse pregnancy outcomes ( aOR=5.59, 95% CI: 2.01-6.42), even if adjusting for the confounding factors such as maternal age, number of previous cesarean sections, parity, gestational weight gain, twin pregnancy, and the use of assisted reproductive technology. (2) In patients with total/subtotal hysterectomy, the proportion of women requiring additional surgical procedures was higher in those with placenta previa [82.8% (183/221) vs 56.5% (13/23), χ2=9.11] than those without placenta previa, especially the proportion of cystoscopy and/or ureteral stenting [67.9% (150/221) vs 34.8% (8/23), χ2=9.99] (both P<0.05). However, no significant difference was found in adverse pregnancy outcomes [89.6% (198/221) vs 87.0% (20/23), χ2<0.01, P=0.972] between the two groups. In patients with segmental hysterectomy, higher proportions of women requiring additional surgery [86.9% (179/206) vs 75.0% (45/60), χ2=4.94], with adverse pregnancy outcomes [84.0% (173/206) vs 56.7% (34/60), χ2=25.31], cystoscopy and/or ureteral stenting [52.9% (109/206) vs 30.0% (18/60), χ2=9.78], vascular occlusion [94.2% (194/206) vs 71.7% (43/60), χ2=24.23], hemorrhage volume>1 500 ml within 24 h postpartum [46.6% (96/206) vs 23.3% (14/60), χ2=10.37], and transfusion of blood products [68.9% (142/206) vs 33.3% (20/60), χ2=24.73] were found in the placenta previa group (all P<0.05). Furthermore, patients with placenta previa had more hemorrhage volume within 24 h postpartum [1 368 ml (970-2 026 ml) vs 995 ml (654-1 352 ml), Z=－3.66, P<0.001] in the segmental hysterectomy subgroup. After adjusting for the confounding factors such as age, number of previous cesarean sections, parity, gestational weight gain, twin pregnancy, and the use of assisted reproductive technology, binary logistic regression analysis found that placenta previa did not increase the risk of additional surgical operations ( aOR=2.71, 95% CI: 0.99-7.42) and adverse pregnancy outcomes ( aOR=2.14, 95% CI: 0.54-8.42) in patients with total/subtotal hysterectomy but were risk factors of the two outcomes for those with segmental hysterectomy ( aOR=4.67, 95% CI: 2.15-10.10; aOR=3.80, 95% CI: 1.86-7.77). Conclusions:Placenta previa increases the risk of additional surgical procedures and adverse pregnancy outcomes in patients with total/subtotal or segmental hysterectomy caused by PAS. Appropriate preparation is required after the clinical diagnosis of PAS with placenta previa.