Objective To investigate the predictive value of labor progress angle (AOP), fetal head descent distance (HPD) and their change rates in the outcome of vaginal trial of cesarean scar uterus. Methods A total of 170 pregnant women who underwent vaginal trial production of scar uterus after cesarean section were selected as study subjects, and were divided into successful group and failed group based on the trial production outcomes. Advanced oxidation processes (AOP) and head-perineum distance (HPD) were measured by ultrasound during the active phase of the first stage of labor when the cervix dilated to 4 cm and at 1 hour after the cervix dilated to 4 cm, respectively. The AOP change rate and HPD change rate after 1 hour of progress were calculated. The receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of AOP, HPD and their change rates in the outcome of vaginal trial production of scar uterus after cesarean section. Delong test was used to compare the differences in area under curves (AUCs). Results Among 170 pregnant women with scarred uterus after cesarean section who were pregnant again, 139 cases (success group) were succeed in transvaginal delivery, while 31 cases failed trial delivery, and transferred to cesarean section (failure group). The AOP of the successful group was significantly larger than that of the failed group when the cervix was opened to 4 cm, and the HPD was significantly shorter than that of the failure group (P < 0.05). The AOP change rate and the change rate of HPD of the successful group were significantly higher than that of the failed group when the cervix dilated to 4 cm and at 1 hour (P < 0.05). The AUC of AOP and HPD in predicting the outcome of vaginal trial delivery of scar uterus after cesarean section were 0.846 and 0.812 respectively, and AUC predicted jointly by AOP and HPD showed no significant differences compared with AUC predicted separately (P>0.05). The AUC of the change rate of AOP and HPD in predicting the outcome of vaginal trial delivery of scarred uterus after cesarean section was 0.899 and 0.852 respectively, and the combined prediction of AOP change rate and HPD change rate had a higher AUC value than the AUC predicted separately. Its AUC value was higher than that of AOP combined with HPD (P < 0.05). Conclusion The AOP, HPD and their change rates when the uterine orifice expands to 4 cm in the active phase of the first stage of labor have predictive value for the outcome of vaginal trial production of scarred uterus after cesarean section.

Humans ; Cost-Benefit Analysis ; HIV Infections/drug therapy* ; Cost-Effectiveness Analysis ; Decision Trees

OBJECTIVE: To evaluate the efficacy and safety of hydroxychloroquine (HCQ) in the treatment of patients with moderate coronavirus disease 2019 (COVID-19). METHODS: We prospectively enrolled 30 treatment-naïve patients with confirmed COVID-19 after informed consent at Shanghai Public Health Clinical Center. The patients were randomized 1：1 to HCQ group and the control group. Patients in HCQ group were given HCQ 400 mg per day for 5 days plus conventional treatments, while those in the control group were given conventional treatment only. The primary endpoint was negative conversion rate of SARS-CoV-2 nucleic acid in respiratory pharyngeal swab on days 7 after randomization. This study has been approved by the Ethics Committee of Shanghai Public Health Clinical Center and registered online (NCT04261517). RESULTS: One patient in HCQ group developed to severe during the treatment. On day 7, nucleic acid of throat swabs was negative in 13 (86.7%) cases in the HCQ group and 14 (93.3%) cases in the control group (>0.05). The median duration from hospitalization to virus nucleic acid negative conservation was 4 (1,9) days in HCQ group, which is comparable to that in the control group [2 (1,4) days, Z=1.27, >0.05]. The median time for body temperature normalization in HCQ group was 1 (0,2) day after hospitalization, which was also comparable to that in the control group [1 (0,3) day]. Radiological progression was shown on CT images in 5 cases (33.3%) of the HCQ group and 7 cases (46.7%) of the control group, and all patients showed improvement in follow-up examinations. Four cases (26.7%) of the HCQ group and 3 cases (20%) of the control group had transient diarrhea and abnormal liver function (>0.05). CONCLUSIONS The prognosis of COVID-19 moderate patients is good. Larger sample size study are needed to investigate the effects of HCQ in the treatment of COVID-19. Subsequent research should determine better endpoint and fully consider the feasibility of experiments such as sample size.
Betacoronavirus ; isolation & purification ; China ; Coronavirus Infections ; diagnostic imaging ; drug therapy ; Humans ; Hydroxychloroquine ; therapeutic use ; Pandemics ; Pilot Projects ; Pneumonia, Viral ; diagnostic imaging ; drug therapy ; RNA, Viral ; isolation & purification ; Treatment Outcome

Objective? To translate the attitudes towards vital signs monitoring scale (V-scale) and to test the reliability and validity of it. Methods? We carried out translation, back-translation and culture adaptation to confirm the Chinese version scale. From March to August 2018, we investigated 420 nurses of general wards from three Class Ⅲ Grade A general hospitals in Beijing with the Chinese version of V-scale. The reliability and validity of the scale was evaluated by exploratory factor analysis, confirmatory factor analysis and internal consistency test. Results? The Chinese version of V-scale had 16 items with 0.93 for the content validity. A total of 5 common factors (workload, operation skill, communication, key indicators and knowledge) were extracted by exploratory factor analysis with 65.724% for the total variance contribution. Confirmatory factor analysis showed that the scale was with the good level of fit indices in each item, and adaptation test values all reached the standard level. The Cronbach's α coefficient of the total scale was 0.761 and Cronbach's α coefficients of all dimensions ranged from 0.579 to 0.809. The retest reliability of the scale was 0.778. Conclusions? The Chinese version of V-scale has the good reliability and validity which could be used to assess ward nurses' attitudes towards vital signs monitoring to identify disease progression in China.

Objective To explore the best time window of intake and output volume observation after partial nephrectomy and its predictive value for acute renal injury. Methods The information of totally 134 renal cancer patients with regular subsequent visits after partial nephrectomy in Peking Union Medical College Hospital from December 2014 to December 2015 were collected. The intake and urine volume per hour was recorded. The receiver operating characteristic (ROC) curve was used to explore the best time wind of intake and output volume observation and its predictive value for acute renal injury in patients with partial nephrectomy. Results Acute renal injury was found in 19.4% of the 134 patients. The differences between intake and output volumes 10, 14, 16 and 18 h postoperatively in the acute renal injury group were bigger than those in the non acute renal injury group (P＜0.05). According to the multiple regression analysis, the intake and output volume 10 h postoperatively and the time of warm ischemia were the independent risk factors to postoperative renal injury (P＜0.05). The intake and output volume 10 h postoperatively had predictive power to acute renal injury, whose area under the ROC was 0.747 (95%CI:0.592-0.903, P＜0.05). Conclusions The intake and output volume 10 h postoperatively may be the best time window for observing the intake and output volume in patients with acute renal injury after partial nephrectomy.

Objective To explore the clinical value of transgastric natural orifice transluminal endoscopic surgery(NOTES)in diagnosing unexplained ascites.Methods The clinical data in 12 cases of unexplained ascites diagnosed by adopting transgastric approach NOTES and performed abdominal exploration and peritoneal biopsy in our hospital from November 2015 to July 2016 were retrospectively analyzed.The operative risk and clinical application value were evaluated by statistically analyzing the postoperative complications occurrence and the diagnosis rate of disease.Results The definite diagnosis rate reached 100％ verified by pathology after abdominal exploration and peritoneal biopsy,in which 8 cases(66.7％)were tuberculous peritonitis,2 cases(16.7％)were liver cirrhosis,1 case(8.3％)was peritoneal mesothelioma,1 cases(8.3％)was peritoneal metastatic carcinoma;2 cases appeared abdominal pain after operation,including 1 case of neutrophil ratio increase,symptoms and persistent time of abnormal laboratory indexes did not exceed 24 h,the incidence rate was 8.3％;no complications of abdominal cavity infection,incision bleeding and puncture site fistula occurred.Conclusion The transgastric NOTES for conducting abdominal exploration and peritoneal biopsy in the diagnosis of unexplained ascites has the advantages of small trauma,less complications and rapid postoperative recovery,possesses an important clinical application value.

Background: Aberrant Bcl-2 transcription is closely related with nodal diffuse large B-cell lymphoma (DLBCL), however, the relationship between Bcl-2 and primary gastrointestinal DLBCL (PGI-DLBCL) was not fully studied.Aims: To investigate the relationship between Bcl-2 gene amplification and protein expression and clinicopathological characteristics, immunophenotype and prognosis of PGI-DLBCL.Methods: Clinical data was collected from 136 PGI-DLBCL patients receiving surgical treatment, and a telephone interview was conducted for survival information.Bcl-2 gene amplification and protein expression in tumor tissue were determined by fluorescence in situ hybridization and immuno-histochemistry, respectively, and relationships between Bcl-2 and clinicopathological characteristics, immunophenotype and prognosis of PGI-DLBCL were analyzed.Results: Among 136 PGI-DLBCL patients, 33 (24.3%) showing gene amplification and 90 (66.2%) showing protein expression of Bcl-2;gene amplification was correlated with primary tumor location, Ann Arbor stage, serum lactate dehydrogenase level, B symptom and International Prognostic Index (IPI) score (P<0.05), while protein expression was correlated with primary tumor location and immunophenotype (P<0.05).5-year overall survival (OS) in patients positive for Bcl-2 gene amplification and patients with non-GCB immunophenotype and positive for Bcl-2 protein expression were inferior to those negative ones (41.5%vs.71.5%, P<0.05;54.6% vs.84.6%, P<0.05).In Bcl-2 gene amplification or protein expression positive patients, 5-year OS of CHOP chemotherapy was inferior to that of rituximab combined with CHOP chemotherapy (48.6%vs.80.3%, P<0.05;66.4%vs.83.4%, P<0.05).Conclusions: Detection of Bcl-2 gene amplification is useful for prediction of prognosis in PGI-DLBCL.Both patients with Bcl-2 gene amplification and non-GCB patients with Bcl-2 protein expression have a poorer prognosis.Rituximab may improve the prognosis in patients with Bcl-2 gene amplification or protein expression.

Objective To study the correlation between homocysteine levels and MTHFR C677T gene polymorphism of cerebral infarction.Methods Four hundred and fifty patients with cerebral infarction in our hospital were selected as the study group from February 2012 to August 2015,including 181 diabetes patients and 269 non-diabetic patients.Also 285 cases of physical examination healthy people in the outpatient department were selected as the control group.The MTHFR C677T polymorphism and the correlation between genotype and Hcy levels were analyzed by pyrosequencing.Results The difference of distributions of MTHFR genotype between the study group and the control group was statistically significant (P ＜ 0.05).The frequency of the T gene in the study group was significantly higher than the control group,the difference was statistically significant (x2 =13.67,P =0.00).The Hcy concentrations of the study group was significantly higher than the control group,and the difference was statistically significant (t =12.71,P =0.00).The Hcy levels of different MTHFR genotype in the cerebral infarction patients were statistically significant (F =17.68,P =0.00).Hcy levels in non-diabetic patients with cerebral infarction was significantly higher than in diabetic patients with cerebral infarction,and the difference was statistically significant (t =2.97,P =0.00).Hcy concentrations of TT genotype of non-diabetic group was significantly higher than the TT genotype of the diabetic group,CC type Hcy concentration significantly lower than the diabetic group,and the differences were statistically significant (t =5.67,2.18;P =0.00,0.03).In cerebral infarction patients both with non-diabetic and diabetic,the Hcy levels of MTHFR gene TT genotype were significantly higher than those of CC and CT genotype,and the differences were statistically significant (P ＜ 0.05),and the differences of Hcy levels between the genotype of CT and CC was not statistically significant (P ＞ 0.05).Conclusion The T allele frequency of MTHFR C677T in the cerebral infarction patients is much higher than healthy people.MTHFR TT genotype is related to serum Hcy levels.Maybe it is a risk factor for cerebral infarction.

Objective To summarize the stomach via laparoscopic and natural orifice transluminal endoscopic surgery (NOTES) Clinical application of abdominal exploration and peritoneal biopsy unexplained ascites. Methods A retrospective analysis of our hospital clinical datum of unexplained ascites patients, 20 cases were undergone single port laparoscopic operation from January 2014 to October 2015 and 11 cases were undergone NOTES from May 2015 to July 2016. Operation time, hospitalization expenses, intraoperative bleeding, postoperative hospital stay, postoperative abdominal pain score, fever and leukocyte on the 3rd postoperation were compared in tow groups. Results Laparoscopy group 20 cases, 11 cases diagnosed as tuberculous ascites, 8 cases malignant ascites, 1 case was still unknown;NOTES group 11 cases, 9 cases diagnosed as tuberculous ascites, 1 case malignant ascites and 1 case liver cirrhosis. In two groups, 30 cases were accurate diagnosed (96.8%), tuberculous ascites 20 cases (64.5%), malignant ascites nine cases (29.0%). Laparoscopy group compared with NOTES group, operation time was longer and hospitalization expenses was more, there were statistical signiifcant differences (P<0.05);postoperative hospital stays were higher (P < 0.05); intraoperative bleeding, postoperative abdominal pain score, fever and leukocyte on the 3rd postoperation were no statistical difference (P>0.05). Conclusion The two methods were able to quickly and accurately diagnose ascites reason, in order to facilitate treatment and surgical trauma, less serious complications. Comparison of laparoscopy, NOTES may be more advantageous in ascites diagnosis.

This study was aimed to observe the effect of Bai-Zhu Huang-Qi (BZHQ) decoction ethyl acetate extract on NOD like receptor family,pyrin domain-containing 3 (NLRP3) inflammasome in macrophages.The U937 cells were pretreated with phorbol 12-myristate 13-acetate (PMA,10 ng· mL-1) for 48 hours to induce macrophages.Effects on cell viability by different doses of BZHQ decoction ethyl acetate extract (0,3.125,6.25,12.5,25,50,100 μg· mL-1) were observed to select the appropriate concentration.Contents of NLRP3 and caspase-1 in cells were detected by real-time PCR and western blot.The concentration of interleukin-1β (IL-1β) in cell supernatant was detected by enzyme linked immunosorbent assay (ELISA).The cell counting kit-8 (CCK-8) assay showed that when the drug concentration was lower than 25 μg· mL-1,there was no impact on cell viability;when the drug concentration was higher than 50 μg· mL-1,there was inhibition on cell viability (P ＜ 0.05).The concentration of 25 μg· mL-1 was used to conduct the following experiment.Compared to the blank group,the expression of NLRP3 and caspase-l in cells of the LPS group were significantly increased (P ＜ 0.01).The concentration of IL-1β in cell supernatant was also significantly increased (P ＜ 0.01).After treated with BZHQ decoction ethyl acetate extract,levels of NLRP3,caspase-1 and IL-1β were significantly decreased (P ＜ 0.05).It was concluded that BZHQ decoction ethyl acetate extract can inhibit the production of NLRP3 inflammasome in LPS-stimulated macrophages.