Objective:To explore the application value of improved " Triple-P" surgery in uterine preservation surgery for patients with placenta previa and placental implantation.Methods:A retrospective analysis was conducted on the clinical data of 100 patients with placental implantation admitted to Nanfang Hospital of Southern Medical University from January 2018 to January 2023. All patients underwent modified " Triple-P" surgery, which focused on bladder management, uterine incision selection, tourniquet ligation of the lower segment of the uterus to stop bleeding, complete removal of the placenta, removal of the anterior wall of the uterus at the site of placental implantation, and uterine shaping and suturing. Clinical data such as the patient′s general condition, intraoperative and postoperative conditions were analyzed.Results:The age of 100 postpartum women with placental implantation was (31.2±5.1)years old, with (3.7±1.5) pregnancies, (1.6±0.6) deliveries, and (36.2±1.7)weeks of termination of pregnancy. All patients had a clear preoperative diagnosis. 76 cases (76%) had a history of 1 cesarean section, 18 cases (18%) had a history of 2 cesarean sections, and 6 cases (6%) had a history of ≥3 cesarean sections. As the number of cesarean sections increased, the proportion of placental penetration (placental implantation reaching the serosal layer or invading the surrounding organs of the uterus) significantly increased (all P<0.05). The patient had a 24-hour blood loss of (1 230±340)ml, including postpartum hemorrhage of (237±132)ml, intraoperative blood transfusion of (986.3±463.8)ml, and surgery time of (73.6±12.7)minutes. 56 patients (56%) were transferred to the intensive care unit (ICU), and the postoperative hospital stay was (5.8±1.7)days. Four cases (4%, 4/100) underwent hysterectomy, all with penetrating placental implantation. All surgical incisions of the pregnant women healed as scheduled and were discharged after recovery. The birth weight of the newborn was (2 870±340)g, and there was no occurrence of neonatal asphyxia. The 24-hour blood loss, intraoperative blood transfusion, surgical time, proportion of transfer to ICU, and proportion of hysterectomy in patients with placental penetration were all higher than those in patients with placental implantation, with statistically significant differences (all P<0.05). Conclusions:The improved " Triple-P" surgery has a clear hemostatic effect, which can effectively reduce intraoperative bleeding and preserve reproductive function. It has strong operability and low requirements, and can be further promoted in clinical practice.

Objective:To investigate the prediction of National Institute of Healthy (NIH) risk stratification of gastrointestinal stromal tumor(GIST) based on clinical ultrasound model, ultrasonographic radiomics model and combined model by oral contrast enhanced ultrasonography.Methods:The clinical and ultrasound imaging data of 204 gastric GIST patients attending Tianjin Medical University Cancer Institute and Hospital from June 2021 to June 2022 were retrospectively analyzed, among whom a total of 101 patients with high and moderate NIH risk stratification GIST confirmed by postoperative pathology were included in the high risk group, and a total of 103 patients with low and extremely low NIH risk stratification GIST were in the low risk group. The ultrasound images of the largest diameter of the GIST were manually segmented by ITK-SNAP software, and Pyradiomics (v3.0.1) module in Python 3.8.7 was applied to extract ultrasonographic radiomics features from the ROI segmented images. The patients were randomly divided into training and validation sets in the ratio of 7∶3. The XGBoost of Sklearn module was applied to construct the clinical ultrasound imaging model, ultrasonographic radiomics model, and combined model. Then the area under ROC curve (AUC), sensitivity, specificity, and accuracy were evaluated; the predictive ability of the three models was compared by Delong test. Calibration Curve was applied to evaluate the model performance, and the clinical Decision Curve Analysis was applied to determine the net benefit to patients.Results:A total of 578 ultrasonographic radiomics features were extracted from ROI, and 8 ultrasonographic radiomics features were finally retained for modeling after regression and dimensionality reduction. Finally, test results showed that AUC, sensitivity, specificity and accuracy of clinical ultrasound imaging model, ultrasonographic radiomics model and combined model were 0.75, 69.3%, 68.9%, 69.1%; 0.87, 79.2%, 81.6%, 80.4%; 0.91, 80.2%, 83.5%, 81.9%, respectively. Delong test showed that the difference of AUC between ultrasonographic radiomics model and clinical ultrasound imaging model was statistically significant ( Z=2.698, P<0.001), and the combined model was significantly better than clinical ultrasound imaging model ( Z=4.062, P<0.001) and ultrasonographic radiomics model ( Z=2.225, P=0.026). Calibration Curve showed the high performance of combined model, and Decision Curve Analysis showed the superior clinical usefulness of combined model. Conclusions:It is feasible to construct an ultrasonographic radiomics model for GIST NIH risk stratification based on oral contrast enhanced ultrasonography images, and the combined model has more advantageous diagnostic performance, which can identify high risk NIH GIST objectively and stably for clinical purposes.

Objective:To demonstrate the selection of breast implant during an immediate breast reconstruction post-mastectomy and analyze the indication of this technique. Methods:From June 2007 to June 2012, a total of 121 patients with breast cancer received immediate breast reconstruction with breast implants. Among the 121 patients, 89 patients had simple mastectomy, while the rest under-went modified radical mastectomy in the Department of Breast Neoplasm, Nanchang No.3 Hospital. The volumes of the resected breast tissues were measured using Archimedes principle. The diameters of the tissues were also determined. Proper breast implants were se-lected according to the measured data. Results: Postoperative complications, such as implant exposure, flap necrosis, and infection, were not found. Follow-up period ranged from 6 months to 12 months. Patients answered a questionnaire that displayed their degree of satisfaction for the breast operation outcome. Results show that 89.3%of the patients (108/121) were very satisfied, 9%were (11/121) satisfied, and 1.7%(2/121) were unsatisfied. Conclusion:Immediate breast reconstruction with breast implant post-mastectomy is an ideal method for rebuilding the breast. This technique is advantageous because it prevents damage to the donor site and retains the maxi-mal elasticity of the skin for breast reconstruction. Accurate parameters of breast implants, which are important to achieve good surgical results, could be obtained using Archimedes principle.