Objective To explore the correlation between pre-pregnancy body mass index (BMI) and the risk of difficult airway during labor and delivery through grading changes of Mallampati test (MT). Methods A total of 354 primiparous women who delivered at Obstetrics and Gynecology Hospital of Fudan University from October 2020 to April 2021 were enrolled and categorized into low BMI, normal BMI, and high BMI groups based on pre-pregnancy BMI. Changes in MT grading were analyzed during early labor, postpartum (20 minutes to 1 hour after placental delivery), and 48 hours postpartum. A multifactor logistic regression model was used to analyze the factors increased MT grading postpartum. Results Among the 354 participants, 97 (27.4%) exhibited increased MT grading postpartum, with the proportion of women classified as MT grade 3-4 rising from 39 (11.0%) during early labor to 77 (21.8%) postpartum. By 48 hours postpartum, the number of women with MT grade 3-4 decreased to 21 (5.9%). Multifactor logistic regression analysis showed that low pre-pregnancy BMI (vs high BMI: OR＝2.15, 95%CI 1.02-4.53, P＝0.045) and snoring history during pregnancy (OR＝2.32, 95% CI 1.38-3.90, P＝0.001) were independent risk factors for postpartum MT grading elevation. Conclusions MT grading might increase postpartum in parturients, with low pre-pregnancy BMI and prenatal snoring history identified as significant risk factors for elevated MT grading after delivery.

Objective:To develop an artificial intelligence (AI)-based automatic scoring model for magnetic resonance imaging-detected extramural vascular invasion (AI-mrEMVI) and evaluate its performance and prognostic value in patients with rectal cancer.Methods:In this multicenter retrospective cohort study, a total of 2 501 rectal cancer patients from seven centers between November 2012 and December 2020 were included and divided into completely independent training ( n=1 830) and validation ( n=671) cohorts. A nnUNet-based AI-mrEMVI scoring model was constructed. Manual mrEMVI scores assigned by two radiologists served as the reference standard for accessing the accuracy of the AI-mrEMVI scoring. Kaplan-Meier survival analysis and Cox regression were used to evaluate the prognostic stratification ability of the AI-mrEMVI scores. The concordance index (C-index) was calculated to evaluate prognostic performance. Results:In the validation cohort, the manual mrEMVI scores were 0-2 in 425 patients (63.3%), 3 in 89 (13.4%), and 4 in 157 (23.4%). The AI-mrEMVI model identified 0-2 in 375 patients (55.9%), 3 in 95 (14.2%), and 4 in 201 (30.0%), with an overall accuracy of 81.1% (544/671, 95% CI 77.9%-84.0%). The 3-year disease-free survival (DFS) rates for patients with AI-mrEMVI scores of 0-2, 3, and 4 were 85.2%, 70.0%, and 58.2%, respectively, and the 5-year overall survival (OS) rates were 87.2%, 81.6%, and 62.6%, respectively (DFS: χ2=48.74, P<0.001; OS: χ2=30.04, P<0.001). Multivariable Cox regression showed that for DFS, AI-mrEMVI scores of 3 and 4 were associated with hazard ratios ( HR) of 1.75 (95% CI 1.11-2.77, P=0.016) and 2.65 (95% CI 1.86-3.78, P<0.001), respectively. For OS, an AI-mrEMVI score of 4 was associated with an HR of 2.56 (95% CI 1.62-4.03, P<0.001). The C-index values of the AI-mrEMVI scoring model for predicting DFS and OS were 0.647 (95% CI 0.608-0.686) and 0.650 (95% CI 0.598-0.702), respectively. Conclusion:The proposed AI-mrEMVI automatic scoring model demonstrated high diagnostic accuracy and performed favorably in predicting DFS and OS prognostic risk in patients with rectal cancer.

Objective:To investigate the difference in brain activity intensity between methamphetamine (MA) dependent patients (MA group) and healthy controls (control group) using fractional amplitude of low-frequency fluctuation (fALFF), and to establish a classification model between these two groups using support vector machine (SVM).Methods:From February 2014 to October 2019, a total of 46 male MA-dependent patients and 46 male healthy controls were recruited from the Affiliated Kangning Hospital of Ningbo University. The study collected resting-state functional magnetic resonance imaging (rs-fMRI) data and analyzed the differences in brain functional activity between the two groups. This analysis was conducted using both static and dynamic fractional amplitude of low-frequency fluctuations (d-fALFF). Additionally, the study examined the correlation between fALFF/d-fALFF values in specific brain regions and the total scores, as well as each factor score, of the Brief Psychiatric Rating Scale (BPRS). Furthermore, the relationship between fALFF/d-fALFF values and the age of first use and total dose of MA in the MA group was investigated. Finally, the fALFF map and d-fALFF map of brain regions with significant differences between groups were used as features for constructing classification.Results:Compared to the healthy control group, those dependent on MA showed significantly increased fALFF mainly in the nucleus accumbens, caudate nucleus, thalamus, and amygdala nucleus( t=-5.21--2.72, all P<0.05). The MA group exhibited decreased fALFF in the superior frontal gyrus, middle frontal gyrus, orbital gyrus, and cingulate gyrus( t=3.59-5.00, all P<0.05). Most of the brain regions with decreased d-fALFF overlapped with those exhibiting decreased fALFF( t=3.33-4.87, all P<0.05). The results of the correlation analysis showed that the fALFF value of the right nucleus accumbens was positively correlated with the age of first use of MA ( r=0.537, P<0.001). There is no significant relationship between the abnormal fALFF and d-fALFF values in the MA group and the total scores and each factor scores of BPRS, as well as the total dose of MA taken (after removing outliers). Based on fALFF and d-fALFF values, the SVM classifier achieved accuracies of 90.33%±6.89% and 71.56%±7.80%, respectively. Conclusions:There are significant abnormalities in the low-frequency fluctuation of the resting brain in patients dependent on MA. These abnormalities reflect the rigidity of prefrontal cortex activity, functional impairment, and dysfunction of the anti-reward system. These factors may be one of the causes for MA dependent behavior and repeated episodes. In addition, the fALFF values may be helpful for distinguishing MA dependent individuals from the control group.

Objective To investigate the perioperative outcomes and postoperative pregnancy outcomes of patients with intrauterine adhesions(IUA)treated by see-and-treat hysteroscopy and traditional hysteroscopy in transcervical resection of adhesions(TCRA).Methods A retrospective cohort study was performed on 485 patients with moderate-to-severe IUA who met the inclusion criteria and admitted in our hospital from January 2019 to December 2021.According to surgical approaches,the patients were assigned into a see-and-treat mode group and a traditional mode group.After clinical diagnosis(ultrasound and symptoms)of IUA,the patients from the former group received direct hysteroscopic adhesion separation surgery,and those of the latter group were diagnosed by outpatient hysteroscopy first and then hysteroscopic adhesion separation surgery.The perioperative indicators,postoperative three-dimensional transvaginal ultrasound(3D-TVUS)examination related characteristics,postoperative menstrual recovery,postoperative pregnancy outcomes,obstetric related complications,and neonatal outcomes were collected and compared between the 2 groups.Results Among the enrolled 485 patients,there were 277 in the see-and-treat group and 208 in the traditional group.The success rate of surgical treatment was 89.89%in the see-and-treat group and 92.79%in the traditional group,but no statistical difference was seen between them(Chi-square=1.234,P=0.267).3D-TVUS examination displayed that the see-and-treat mode group obtained better improvement of endometrial morphology,uterine morphology and menstruation after operation than the traditional group(P<0.001).The postoperative pregnancy rate was slightly higher in the see-and-treat group than the traditional mode group(58.84%vs 58.17%,P=0.882).However,the see-and-treat mode showed obvious advantage in the postoperative natural pregnancy rate,with a rate of 90.80%,obviously higher than that in the traditional mode group(81.82%,P=0.026).The live birth rate was 70.55%in the see-and-treat mode group,excluding 1 case with ongoing pregnancy in the second trimester and 1 case with ongoing pregnancy in the third trimester,and the rate was 74.38%in the traditional group,excluding 3 cases with ongoing pregnancy in the third trimester,but there was no statistical difference between the 2 groups(P=0.303).In terms of obstetric-related complications,there were 0 cases of blood transfusion during delivery hospitalization in the see-and-treat group,while there were 7 cases in the traditional group(P=0.003).In neonatal outcomes,the rate of transfer to the pediatric department was 10.43%in the see-and-treat mode group and 22.22%in the traditional mode group(P=0.021).For health economics,the see-and-treat hysteroscopy group demonstrated a significant advantage over the traditional hysteroscopy group(P<0.001).There was no significant difference in pain scores between the 2 groups.Conclusion The see-and-treat approach is a safe,feasible,and highly efficient strategy for integrating the diagnosis and treatment of IUA,enabling maximal minimization of surgical trauma while optimizing time and cost efficiency.

Objective To investigate the incidence of intraoperative hypothermia(IH)and rewarming efficacy in elderly patients with different traditional Chinese medicine(TCM)constitutions undergoing general anesthesia.Methods A total of 500 elderly patients undergoing general anesthesia at the First Affiliated Hospital of Guangzhou University of Chinese Medicine from June 2022 to November 2022 were enrolled.The patients were divided into IH group and non-IH group depending on the occurrence of IH.Baseline data of the patients were collected,and univariate and multivariate logistic regression analyses were performed to identify risk factors for IH.A risk prediction model was constructed after value-assignment of influencing factors and its diagnostic efficiency was assessed by receiver operating characteristic(ROC)curve.External validation of the model was conducted in 50 elderly patients undergoing general anesthesia at the same period.From December 2022 to February 2023,80 elderly patients undergoing general anesthesia and complicated with IH were randomized into a control group(routine measures for keeping warm)and an observation group(keeping warm with forced-air-warming blanket)to compare the rewarming efficacy.Results(1)Among 500 elderly patients undergoing general anesthesia,180 cases developed IH,with an incidence of 36.0%.(2)Except for age,sex,type of surgery,American Society of Anesthesiologists(ASA)classification,type of anesthesia,and total fluid output volume,statistically significant differences were presented in body mass index(BMI),TCM constitution type,surgical complexity grading,preoperative core body temperature,operating room temperature,rewarming strategy,surgical duration,anesthesia duration,total fluid intake volume,intraoperative irrigation volume,and intraoperative blood transfusion between the two groups(P＜0.05 or P＜0.01).(3)Multivariate logistic regression analysis identified BMI,TCM constitution type,surgical complexity grading,preoperative core body temperature,operating room temperature,rewarming strategy,anesthesia duration,total fluid intake volume,and intraoperative irrigation volume as independent influencing factors for the occurrence of IH in elderly patients undergoing general anesthesia.ROC curve analysis demonstrated that the area under the curve(AUC)of the constructed risk prediction model was 0.816,with a sensitivity of 74.40%and a specificity of 77.50%.(4)In an external validation cohort of 50 elderly patients undergoing general anesthesia(19 IH cases versus 31 non-IH cases),the constructed risk prediction model exhibited a sensitivity of 73.68%and a specificity of 77.42%.(5)The observation group exhibited lower tympanic temperature upon post-anesthesia care unit(PACU)admission,shorter rewarming time and PACU stay duration,faster rewarming rate,and lower incidence of shivering than the control group,the differences being statistically significant(P＜0.05 or P＜0.01).Conclusion IH is common in elderly patients undergoing general anesthesia,particularly in those under the conditions of low BMI,qi/yang/blood deficiency constitutions,major surgery,low preoperative core body temperature,low operating room temperature,passive rewarming,prolonged anesthesia,high fluid intake volume,and high and intraoperative irrigation volume.The constructed risk prediction model demonstrates favorable diagnostic performance.Proactive use of forced-air-warming blankets effectively improves rewarming outcomes in elderly patients undergoing general anesthesia and complicated with IH.

This study analyzed the clinical and laboratory data of 3 children diagnosed with mitochondrial disease-associated primary adrenal insufficiency (PAI) at the Guangzhou Women and Children′s Medical Center, Guangzhou Medical University from October 2018 to November 2023.All patients were normal at birth but gradually developed symptoms and were diagnosed with PAI between the ages of 1 year and 1 month and 7 years and 3 months.The children presented typical clinical symptoms of PAI, including skin and mucosal hyperpigmentation (3 cases), electrolyte disturbances (3 cases), and hypoglycemia (2 cases), as well as multisystem abnormalities related to mitochondrial disease, including recurrent infections, growth retardation, cachexia, and hyperlactatemia.Genetic testing revealed significant single deletions in mitochondrial DNA in all patients: Patient 1: m.11219_15954del, Patient 2: m.8483_13459del, and Patient 3: m.8649_16084del.Treatment with Hydrocortisone acetate replacement therapy improved the electrolyte disturbances and hypoglycemia, but issues with recurrent infections, growth retardation, and cachexia persisted.This study suggests that in clinical practice, the possibility of mitochondrial disease should be highly suspected when PAI patients present with multisystem abnormalities, especially in conjunction with hyperlactatemia.

Objective:To develop an artificial intelligence (AI)-based automatic scoring model for magnetic resonance imaging-detected extramural vascular invasion (AI-mrEMVI) and evaluate its performance and prognostic value in patients with rectal cancer.Methods:In this multicenter retrospective cohort study, a total of 2 501 rectal cancer patients from seven centers between November 2012 and December 2020 were included and divided into completely independent training ( n=1 830) and validation ( n=671) cohorts. A nnUNet-based AI-mrEMVI scoring model was constructed. Manual mrEMVI scores assigned by two radiologists served as the reference standard for accessing the accuracy of the AI-mrEMVI scoring. Kaplan-Meier survival analysis and Cox regression were used to evaluate the prognostic stratification ability of the AI-mrEMVI scores. The concordance index (C-index) was calculated to evaluate prognostic performance. Results:In the validation cohort, the manual mrEMVI scores were 0-2 in 425 patients (63.3%), 3 in 89 (13.4%), and 4 in 157 (23.4%). The AI-mrEMVI model identified 0-2 in 375 patients (55.9%), 3 in 95 (14.2%), and 4 in 201 (30.0%), with an overall accuracy of 81.1% (544/671, 95% CI 77.9%-84.0%). The 3-year disease-free survival (DFS) rates for patients with AI-mrEMVI scores of 0-2, 3, and 4 were 85.2%, 70.0%, and 58.2%, respectively, and the 5-year overall survival (OS) rates were 87.2%, 81.6%, and 62.6%, respectively (DFS: χ2=48.74, P<0.001; OS: χ2=30.04, P<0.001). Multivariable Cox regression showed that for DFS, AI-mrEMVI scores of 3 and 4 were associated with hazard ratios ( HR) of 1.75 (95% CI 1.11-2.77, P=0.016) and 2.65 (95% CI 1.86-3.78, P<0.001), respectively. For OS, an AI-mrEMVI score of 4 was associated with an HR of 2.56 (95% CI 1.62-4.03, P<0.001). The C-index values of the AI-mrEMVI scoring model for predicting DFS and OS were 0.647 (95% CI 0.608-0.686) and 0.650 (95% CI 0.598-0.702), respectively. Conclusion:The proposed AI-mrEMVI automatic scoring model demonstrated high diagnostic accuracy and performed favorably in predicting DFS and OS prognostic risk in patients with rectal cancer.

This study analyzed the clinical and laboratory data of 3 children diagnosed with mitochondrial disease-associated primary adrenal insufficiency (PAI) at the Guangzhou Women and Children′s Medical Center, Guangzhou Medical University from October 2018 to November 2023.All patients were normal at birth but gradually developed symptoms and were diagnosed with PAI between the ages of 1 year and 1 month and 7 years and 3 months.The children presented typical clinical symptoms of PAI, including skin and mucosal hyperpigmentation (3 cases), electrolyte disturbances (3 cases), and hypoglycemia (2 cases), as well as multisystem abnormalities related to mitochondrial disease, including recurrent infections, growth retardation, cachexia, and hyperlactatemia.Genetic testing revealed significant single deletions in mitochondrial DNA in all patients: Patient 1: m.11219_15954del, Patient 2: m.8483_13459del, and Patient 3: m.8649_16084del.Treatment with Hydrocortisone acetate replacement therapy improved the electrolyte disturbances and hypoglycemia, but issues with recurrent infections, growth retardation, and cachexia persisted.This study suggests that in clinical practice, the possibility of mitochondrial disease should be highly suspected when PAI patients present with multisystem abnormalities, especially in conjunction with hyperlactatemia.

Objective:To investigate the difference in brain activity intensity between methamphetamine (MA) dependent patients (MA group) and healthy controls (control group) using fractional amplitude of low-frequency fluctuation (fALFF), and to establish a classification model between these two groups using support vector machine (SVM).Methods:From February 2014 to October 2019, a total of 46 male MA-dependent patients and 46 male healthy controls were recruited from the Affiliated Kangning Hospital of Ningbo University. The study collected resting-state functional magnetic resonance imaging (rs-fMRI) data and analyzed the differences in brain functional activity between the two groups. This analysis was conducted using both static and dynamic fractional amplitude of low-frequency fluctuations (d-fALFF). Additionally, the study examined the correlation between fALFF/d-fALFF values in specific brain regions and the total scores, as well as each factor score, of the Brief Psychiatric Rating Scale (BPRS). Furthermore, the relationship between fALFF/d-fALFF values and the age of first use and total dose of MA in the MA group was investigated. Finally, the fALFF map and d-fALFF map of brain regions with significant differences between groups were used as features for constructing classification.Results:Compared to the healthy control group, those dependent on MA showed significantly increased fALFF mainly in the nucleus accumbens, caudate nucleus, thalamus, and amygdala nucleus( t=-5.21--2.72, all P<0.05). The MA group exhibited decreased fALFF in the superior frontal gyrus, middle frontal gyrus, orbital gyrus, and cingulate gyrus( t=3.59-5.00, all P<0.05). Most of the brain regions with decreased d-fALFF overlapped with those exhibiting decreased fALFF( t=3.33-4.87, all P<0.05). The results of the correlation analysis showed that the fALFF value of the right nucleus accumbens was positively correlated with the age of first use of MA ( r=0.537, P<0.001). There is no significant relationship between the abnormal fALFF and d-fALFF values in the MA group and the total scores and each factor scores of BPRS, as well as the total dose of MA taken (after removing outliers). Based on fALFF and d-fALFF values, the SVM classifier achieved accuracies of 90.33%±6.89% and 71.56%±7.80%, respectively. Conclusions:There are significant abnormalities in the low-frequency fluctuation of the resting brain in patients dependent on MA. These abnormalities reflect the rigidity of prefrontal cortex activity, functional impairment, and dysfunction of the anti-reward system. These factors may be one of the causes for MA dependent behavior and repeated episodes. In addition, the fALFF values may be helpful for distinguishing MA dependent individuals from the control group.

Purpose Hydrogen proton magnetic resonance imaging was used to study the brain metabolism of menstrual-related migraine(MRM)in different states,and to investigate its correlation with clinical features and estrogen and progesterone.Materials and Methods We recruited 36 patients with MRM diagnosed by neurology outpatient experts of the First Affiliated Hospital of Henan University of Science and Technology from April 2019 to August 2022,and also recruited 29 normal women with age-and education-matched.Proton magnetic resonance spectroscopy was used to assess neurochemical brain changes during interictal period(late follicular phase)and ictal period(perimenstrual phase)in them.The point resolved spectroscopic sequence was used to focus on the bilateral medial prefrontal cortex(mPFC)and bilateral thalamus.Sex hormone levels were collected on the same day of MRI acquisition.The ratios of NAA/Cr,GABA/Cr,Glx/Cr and Cho/Cr were observed.Metabolite changes and hormone levels were investigated among two groups.Furthermore,metabolite changes were investigated in a longitudinal design during the interictal period and ictal period.Results There were no significant differences in the levels of estrogen and progesterone both in the late follicular and perimenstrual periods.There were no significant differences in decline rate of them in perimenstrual periods between patients and normal people(P>0.05).During interictal period,the ratio of Cho/Cr in the region of left mPFC was lower significantly in the MRM group than that of control group(U=-2.957,P=0.003)and showed a significant negative correlation with attack frequency(r=-0.398,P=0.018).During ictal period,the women with MRM had significantly lower the ratio of GABA/Cr in the left mPFC and higher the ratio of Glx/Cr in the left thalamus compared to those of controls(U=-2.015,P=0.044;t=2.213,P=0.033).We found no significant correlations between these results and magraine characteristics(P>0.05).In addition,we found the ratio of GABA/Cr did not change(P>0.05),the ratio of Glx/Cr and Cho/Cr in right thalamus increased from interictal towards the ictal state for MRM patients(t=-2.181,P=0.038;Z=-2.414,P=0.016).Conclusion The present study suggests the existence of distinct cerebral metabolism states between MRM and control,and there are dynamic changes in cerebral metabolism with headache attacks.However,there is no significant difference in estrogen and progesterone from normal women,and its neural mechanism still needs to be further studied.