Objective:To explore the treatment methods and prognosis of pregnancy-related uterine arteriovenous malformation (UAVM).Methods:A retrospective analysis was conducted on clinical data from 81 patients with UAVM treated at Peking Union Medical College Hospital between March 2019 and March 2024. Clinical manifestations, diagnostic approaches, treatment strategies and prognosis were evaluated.Results:(1) General Information: the age of patients with UAVM was (32.7±4.6) years, with median gravidity and parity of 1 (quartile range: 1, 2) and 0 (0, 1), respectively. Pregnancy termination methods included surgical abortion or curettage in 46 cases (57%, 46/81), medical induction in 17 cases (21%, 17/81), spontaneous abortion in 16 cases (20%, 16/81), vaginal delivery in 1 case (1%, 1/81), and laparoscopic pregnancy tissue removal in 1 case (1%, 1/81). (2) Clinical manifestations: clinical presentations comprised vaginal bleeding in 59 cases [73%, 59/81; median blood loss: 740 ml (440, 1 360 ml)], massive hemorrhage in 9 cases (11%, 9/81, and bleeding combined with lower abdominal pain in 8 cases (10%, 8/81). Ultrasonography revealed intrauterine masses in 65 cases [80%, 65/81; median size: 2.5 cm (1.8, 4.2 cm)]. Elevated serum human chorionic gonadotrophin-β subunit (β-hCG) levels were observed in in 55 cases [85%, 55/65; median: 62.6 U/L (14.9, 300.1 U/L)]. The median time to UAVM diagnosis via ultrasound was 30.0 days (16.0, 52.0 days) after pregnancy termination, with median peak systolic velocity (PSV) and resistance index of 59.8 cm/s (45.0, 79.6 cm/s) and 0.39 (0.36, 0.43), respectively. (3) Treatment and prognosis: treatment modalities included expectant management in 49 cases (36%, 29/81), medication in 13 cases (16%, 13/81), lesion resection in 31 cases (38%, 31/81), and uterine artery angiography in 8 cases (10%, 8/81; 5 confirmed as arteriovenous fistula). The median time of PSV returning to normal after treatment was 53.8 days (36.0, 93.4 days). The average time for β-hCG returning to normal was (60.4±20.4) days. The median return time of menses was 59.0 days (43.0, 75.4 days).Conclusions:Pregnancy-related UAVM carries a high risk of life-threatening hemorrhage, necessitating management in centers equipped for emergency uterine artery embolization. Informed consent must emphasize disease progression risks and prognosis. Treatment stratification should integrate clinical parameters and imaging features.

Objective To analyze the molecular epidemiology of Candida tropicalis(C.tropicalis)isolates from bloodstream infections,and to investigate preliminarily the underlying mechanisms of fluconazole resistance.Methods Clinical C.tropicalis isolates were collected from bloodstream infections at West China Hospital,Sichuan University and other hospitals in Sichuan Province.All the collected isolates were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry,and the antifungal susceptibility test was performed by the broth microdilution method.Multilocus sequence typing(MLST)was conducted using the first generation sequencing technique.Genes associated with drug-resistance were sequenced and the mutation sites were identified.The relative expression levels of genes associated with drug-resistance were analyzed using reverse transcription-quantitative polymerase chain reaction(RT-qPCR).Results A total of 39 C.tropicalis isolates from bloodstream infections were collected.The MLST phylogenetic tree showed that most of the strains clustered in the phylogenetic tree shared identical or similar minimal inhibitory concentrations(MICs).All MLST types were not matched with the isolates in the PubMLST database,representing new diploid sequence types(DSTs).A total of 3 sense mutations,including Ser154Phe,Tyr132Phe,and Tyr257His were identified in ERG11,and were present only in drug-resistant strains.UPC2 contained 4 sense mutations,including Ala251Thr,Gln289Leu,Ser279Glu,and Gln313His,which were also present only in drug-resistant strains.Ser279Glu and Gln313His were previously unreported.There were two sense mutations in ERG3,namely Ser112Gly and Ala48Ser,both being previously unreported,and Ser112Gly was found only in drug-resistant strains.The expression levels of ERG11(14.48 vs 7.109,P=0.003)and UPC2(1.922 vs 0.832,P=0.04)in non-sensitive group(MIC>2 mg/L)were higher than those in sensitive group(MIC≤2 mg/L),and the difference was statistically significant.Conclusion There may be a unique genetic relationship among C.tropicalis isolates from Sichuan province,and the MICs of fluconazole against C.tropicalis are associated with molecular typing.ERG11 mutations were the major mechanism underlying fluconazole resistance in C.tropicalis isolates.The upregulation of ERG11 and UPC2 was associated with fluconazole resistance in C.tropicalis.

Objective To analyze the virulence genes and antibiotics resistance of Escherichia coli(E.coli)isolates cause urinary tract infection(USI)in children,and further understand the epidemiological characteristics of E.coli isolates in children with USI.Methods Children with urinary system infection admitted to Quanzhou Maternity and Child Health Care Hospital&Children's Hospital from January to December 2021 were collected.E.coli was isolated from urine,and the drug sensitivity of the E.coli to 15 commonly used clinical antibiotics was detected by instruments.Among them,33 strains of E.coli that showed Extended-spectrum beta-lactamase(ESBL)production were increased,genomic DNA was extracted,and the whole genome sequence of the strains was analyzed by high-throughput sequencing technology.Results In the gene sequence analysis of 33 strains of E.coli,86 virulence genes were obtained,and the bacterial structural virulence genes accounted for the most(43/86),including capsular,fimbriae and cell-membrane system,followed by functional virulence genes and toxigenic genes,while fimH,fdeC and terC virulence genes had the highest detection rates.In the analysis of drug resistance,Cefazolin(96.97%)was the most resistant,and carbapenems were also found to be resistant.In addition,39 inactivation genes,18 target alteration genes and 51 e?ux system genes were obtained.The most information related to antibiotic e?ux(1 273/1 815),mainly RND and MFS superfamily e?ux pumps.There were 19～43 drug resistance genes in each E.coli genome.A variety of β-lactamase resistance genes were found,in which CTX-M/EC/TEM gene family dominated.Conclusion In the urine isolation of ESBL-producing E.coli in USI children,the β-lactamase should continue to be monitored.Virulence genes fimH,fdeC,terC and acrAB/emrAB/mdtABC-TolC e?ux pump gene detected higherratio,should be more attention.

Objective To explore the clinical efficacy of ultra-micro 8.0 mm single-port thoracoscopic nerve resection through areola incision in the treatment of primary palmar hyperhidrosis(PPH).Methods 84 patients with PPH from January 2018 to January 2022,were divided into the observed group[(inframammary approach,IMA)group,n=42]and control group[axillary approach(AA)group,n=42].The observed group was treated with ultra-micro 8.0 mm IMA single-port endoscopic thoracic sympathectomy(ETS),the control group used the traditional AA single-port ETS.The visual analogue scale(VAS)score,serum C-reactive protein(CRP),cortisol(Cor),interleukin-6(IL-6)levels,the postoperative cosmetic effect and compensatory hyperhidrosis of the two groups were compared.Results The VAS scores of 2,12 and 24 h after surgery in the observation group were significantly lower than those of the control group,the differences were statistically significant(P<0.05);At 12 and 24 h postoperation,the levels of CPR,Cor,and IL-6 levels in both groups of patients were significantly higher than preoperation,but those in the observation group were significantly lower than those of the control group,the differences were statistically significant(P<0.05);The total satisfaction rate of postoperative incision in the observation group was significantly higher than that of the control group,the difference was statistically significant(P<0.05);There was no statistically significant difference of the incidence of compensatory hyperhidrosis between the two groups(P>0.05).Conclusion The clinical efficacy of ultra-micro 8.0 mm IMA single-port ETS through areola incision in the treatment of PPH is good.Compared with the traditional axillary single-port thoracoscopic method,it has the advantages of small trauma,less bleeding,less patient pain,high safety and high patient satisfaction.It is worthy of clinical promotion and application.

Objective:To evaluate the safety,efficacy,and prognosis of interventional treatment for pregnan-cy-related uterine arteriovenous malformations(UAVM).Methods:A retrospective analysis was conducted of the clinical data from 8 patients with pregnancy-associated UAVM who underwent interventional therapy after initial di-agnosis by ultrasound at Peking Union Medical College Hospital between February 1,2016,and January 4,2024.Results:All 8 patients underwent ultrasound examination,and color Doppler imaging revealed abundant blood flow signals within the lesions,presenting a high-velocity and low-resistance blood flow spectrum.The median age of patients was 29 years,with termination of pregnancy occurring at 7-38 weeks of gestation.Clinical manifesta-tions included persistent irregular vaginal bleeding in 2 cases(25.0％),"on-off"hemorrhage in 2 cases(25.0％),acute massive vaginal bleeding(≥400 ml per episode)in 5 cases(62.5％),abdominal pain in 3 ca-ses(37.5％),secondary anemia in 4 cases(50.0％),and persistent elevation of serum β-hCG in 2 cases(25.0％).All 8 patients underwent uterine artery angiography.Postoperatively,5 cases were diagnosed with preg-nancy-related UAVM,with 1 case also complicated by a right ovarian arteriovenous fistula.The remaining 3 cases revealed only abnormal vascular clusters without early venous opacification.Bilateral uterine artery embolization(UAE)was performed in 4 cases,unilateral UAE(all right-sided)in 2 cases,and no UAE was performed in 2 ca-ses.Hysteroscopic lesion resection or curettage was performed in 3 cases,with 2 cases receiving adjuvant gona-dotropin-releasing hormone agonist(GnRH-a)therapy postoperatively.All 5 patients ultimately diagnosed with UAVM achieved hemostasis within 24 hours after UAE,with mild post-embolization syndrome observed in 1 case.During follow-up,only the patient with the concomitant ovarian arteriovenous fistula experienced recurrent sudden vaginal bleeding and subsequently underwent laparoscopic uterine lesion resection following GnRH-a therapy.Conclusions:UAE is the treatment of choice for pregnancy-related UAVM patients with complex or severe bleed-ing initially diagnosed by ultrasound.However,management should be tailored based on imaging and clinical fea-tures to balance therapeutic efficacy with fertility preservation.

Objective:To evaluate the safety,efficacy,and prognosis of interventional treatment for pregnan-cy-related uterine arteriovenous malformations(UAVM).Methods:A retrospective analysis was conducted of the clinical data from 8 patients with pregnancy-associated UAVM who underwent interventional therapy after initial di-agnosis by ultrasound at Peking Union Medical College Hospital between February 1,2016,and January 4,2024.Results:All 8 patients underwent ultrasound examination,and color Doppler imaging revealed abundant blood flow signals within the lesions,presenting a high-velocity and low-resistance blood flow spectrum.The median age of patients was 29 years,with termination of pregnancy occurring at 7-38 weeks of gestation.Clinical manifesta-tions included persistent irregular vaginal bleeding in 2 cases(25.0％),"on-off"hemorrhage in 2 cases(25.0％),acute massive vaginal bleeding(≥400 ml per episode)in 5 cases(62.5％),abdominal pain in 3 ca-ses(37.5％),secondary anemia in 4 cases(50.0％),and persistent elevation of serum β-hCG in 2 cases(25.0％).All 8 patients underwent uterine artery angiography.Postoperatively,5 cases were diagnosed with preg-nancy-related UAVM,with 1 case also complicated by a right ovarian arteriovenous fistula.The remaining 3 cases revealed only abnormal vascular clusters without early venous opacification.Bilateral uterine artery embolization(UAE)was performed in 4 cases,unilateral UAE(all right-sided)in 2 cases,and no UAE was performed in 2 ca-ses.Hysteroscopic lesion resection or curettage was performed in 3 cases,with 2 cases receiving adjuvant gona-dotropin-releasing hormone agonist(GnRH-a)therapy postoperatively.All 5 patients ultimately diagnosed with UAVM achieved hemostasis within 24 hours after UAE,with mild post-embolization syndrome observed in 1 case.During follow-up,only the patient with the concomitant ovarian arteriovenous fistula experienced recurrent sudden vaginal bleeding and subsequently underwent laparoscopic uterine lesion resection following GnRH-a therapy.Conclusions:UAE is the treatment of choice for pregnancy-related UAVM patients with complex or severe bleed-ing initially diagnosed by ultrasound.However,management should be tailored based on imaging and clinical fea-tures to balance therapeutic efficacy with fertility preservation.

Objective To analyze the virulence genes and antibiotics resistance of Escherichia coli(E.coli)isolates cause urinary tract infection(USI)in children,and further understand the epidemiological characteristics of E.coli isolates in children with USI.Methods Children with urinary system infection admitted to Quanzhou Maternity and Child Health Care Hospital&Children's Hospital from January to December 2021 were collected.E.coli was isolated from urine,and the drug sensitivity of the E.coli to 15 commonly used clinical antibiotics was detected by instruments.Among them,33 strains of E.coli that showed Extended-spectrum beta-lactamase(ESBL)production were increased,genomic DNA was extracted,and the whole genome sequence of the strains was analyzed by high-throughput sequencing technology.Results In the gene sequence analysis of 33 strains of E.coli,86 virulence genes were obtained,and the bacterial structural virulence genes accounted for the most(43/86),including capsular,fimbriae and cell-membrane system,followed by functional virulence genes and toxigenic genes,while fimH,fdeC and terC virulence genes had the highest detection rates.In the analysis of drug resistance,Cefazolin(96.97%)was the most resistant,and carbapenems were also found to be resistant.In addition,39 inactivation genes,18 target alteration genes and 51 e?ux system genes were obtained.The most information related to antibiotic e?ux(1 273/1 815),mainly RND and MFS superfamily e?ux pumps.There were 19～43 drug resistance genes in each E.coli genome.A variety of β-lactamase resistance genes were found,in which CTX-M/EC/TEM gene family dominated.Conclusion In the urine isolation of ESBL-producing E.coli in USI children,the β-lactamase should continue to be monitored.Virulence genes fimH,fdeC,terC and acrAB/emrAB/mdtABC-TolC e?ux pump gene detected higherratio,should be more attention.

Objective:To explore the treatment methods and prognosis of pregnancy-related uterine arteriovenous malformation (UAVM).Methods:A retrospective analysis was conducted on clinical data from 81 patients with UAVM treated at Peking Union Medical College Hospital between March 2019 and March 2024. Clinical manifestations, diagnostic approaches, treatment strategies and prognosis were evaluated.Results:(1) General Information: the age of patients with UAVM was (32.7±4.6) years, with median gravidity and parity of 1 (quartile range: 1, 2) and 0 (0, 1), respectively. Pregnancy termination methods included surgical abortion or curettage in 46 cases (57%, 46/81), medical induction in 17 cases (21%, 17/81), spontaneous abortion in 16 cases (20%, 16/81), vaginal delivery in 1 case (1%, 1/81), and laparoscopic pregnancy tissue removal in 1 case (1%, 1/81). (2) Clinical manifestations: clinical presentations comprised vaginal bleeding in 59 cases [73%, 59/81; median blood loss: 740 ml (440, 1 360 ml)], massive hemorrhage in 9 cases (11%, 9/81, and bleeding combined with lower abdominal pain in 8 cases (10%, 8/81). Ultrasonography revealed intrauterine masses in 65 cases [80%, 65/81; median size: 2.5 cm (1.8, 4.2 cm)]. Elevated serum human chorionic gonadotrophin-β subunit (β-hCG) levels were observed in in 55 cases [85%, 55/65; median: 62.6 U/L (14.9, 300.1 U/L)]. The median time to UAVM diagnosis via ultrasound was 30.0 days (16.0, 52.0 days) after pregnancy termination, with median peak systolic velocity (PSV) and resistance index of 59.8 cm/s (45.0, 79.6 cm/s) and 0.39 (0.36, 0.43), respectively. (3) Treatment and prognosis: treatment modalities included expectant management in 49 cases (36%, 29/81), medication in 13 cases (16%, 13/81), lesion resection in 31 cases (38%, 31/81), and uterine artery angiography in 8 cases (10%, 8/81; 5 confirmed as arteriovenous fistula). The median time of PSV returning to normal after treatment was 53.8 days (36.0, 93.4 days). The average time for β-hCG returning to normal was (60.4±20.4) days. The median return time of menses was 59.0 days (43.0, 75.4 days).Conclusions:Pregnancy-related UAVM carries a high risk of life-threatening hemorrhage, necessitating management in centers equipped for emergency uterine artery embolization. Informed consent must emphasize disease progression risks and prognosis. Treatment stratification should integrate clinical parameters and imaging features.

Objective To explore the clinical efficacy of ultra-micro 8.0 mm single-port thoracoscopic nerve resection through areola incision in the treatment of primary palmar hyperhidrosis(PPH).Methods 84 patients with PPH from January 2018 to January 2022,were divided into the observed group[(inframammary approach,IMA)group,n=42]and control group[axillary approach(AA)group,n=42].The observed group was treated with ultra-micro 8.0 mm IMA single-port endoscopic thoracic sympathectomy(ETS),the control group used the traditional AA single-port ETS.The visual analogue scale(VAS)score,serum C-reactive protein(CRP),cortisol(Cor),interleukin-6(IL-6)levels,the postoperative cosmetic effect and compensatory hyperhidrosis of the two groups were compared.Results The VAS scores of 2,12 and 24 h after surgery in the observation group were significantly lower than those of the control group,the differences were statistically significant(P<0.05);At 12 and 24 h postoperation,the levels of CPR,Cor,and IL-6 levels in both groups of patients were significantly higher than preoperation,but those in the observation group were significantly lower than those of the control group,the differences were statistically significant(P<0.05);The total satisfaction rate of postoperative incision in the observation group was significantly higher than that of the control group,the difference was statistically significant(P<0.05);There was no statistically significant difference of the incidence of compensatory hyperhidrosis between the two groups(P>0.05).Conclusion The clinical efficacy of ultra-micro 8.0 mm IMA single-port ETS through areola incision in the treatment of PPH is good.Compared with the traditional axillary single-port thoracoscopic method,it has the advantages of small trauma,less bleeding,less patient pain,high safety and high patient satisfaction.It is worthy of clinical promotion and application.

Objective To investigate the effect of dapagliflozin on myocardial work and energy metabolism in patients with heart failure with reduced ejection fraction(HFrEF)without type 2 diabetes mellitus(T2DM).Methods Patients with HFrEF without T2DM who visited Wuzhou People's Hospital from January 2021 to January 2022 were randomly divided into conventional group and dapagliflozin group(conventional treatment+dapagliflozin).After treatment(12 months),myocardial work[global work index(GWI),global constructed work(GCW),global wasted work(GW),and global work efficiency(GWE)],energy metabolism[(free fatty acids(FFA)and β-hydroxybutyric acid(β-HB)],traditional cardiac function[left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),and left ventricular ejection fraction(LVEF)],clinical efficacy,prognosis[mortality,rehospitalization,and incidence of major adverse cardiovascular events(MACE)]and adverse reactions were compared between the two groups.Results A total of 128 patients with HFrEF without T2DM were enrolled,including 63 patients in the dapagliflozin group and 65 patients in the conventional group.After treatment,the LVEDD,LVESD,GWW,NT-pro BNP in the dapagliflozin group was significantly lower than that in the conventional group(P＜0.05),while the LVEF,GWI,GCW,GWE,β-HB acid and FFA were significantly higher than those in the conventional group(P＜0.05).The total effective rate and hypoglycemia rates in the dapagliflozin group were significantly higher than those in the conventional group(P＜0.05),and the rehospitalization rate and MACE rate were significantly lower than those in the conventional group(P＜0.05).There were no significant differences in mortality,renal adverse events,urinary tract infections and gastrointestinal symptoms between the two groups(P＞0.05).Conclusion Dapagliflozin has significant clinical efficacy in patients with HFrEF without T2DM,which can increase the serum levels of FFA and ketones,improve effective work,and reduce ineffective work,but it is necessary to be vigilant against hypoglycemia.