Objective: To evaluate the application of blood conservation measures in obstetric patients with different red blood cell transfusion volumes and to assess the impact of different transfusion volumes on postpartum outcomes. Methods: A retrospective investigation was conducted on 448 obstetric patients who received blood transfusions at the Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from January 2016 to December 2022. Patients were divided into four groups (1-2 units group, 3-4 units group, 5-6 units group, and >6 units group) based on the volumes of red blood cells (RBCs) transfused during and within 7 days after delivery. The maternal physiological indicators, pre- and postpartum laboratory test indicators, obstetric complications, application of blood conservation measures, use of blood products, and postpartum outcomes were reviewed. The clinical characteristics, application of blood conservation measures, and their impact on postpartum outcomes were compared among different transfusion groups. Results: There were statistically significant differences in the multivariate logistic analysis of history of previous cesarean section (OR=1.781), eclampsia/pre-eclampsia/(OR=1.972) and postpartum blood loss>1 000 mL（OR=1.699）(P<0.05) among different transfusion groups. In terms of blood conservation measures, the more RBCs transfused, the higher the rate of mothers receiving blood conservation measures such as balloon occlusion, arterial ligation, autologous blood transfusion with a cell saver, and hysterectomy. With the increase in the volume of RBCs transfusion, the demand for fresh frozen plasma（FFP）, cryoprecipitate, and platelet transfusions also increased. The hospitalization days for the four groups of parturients were 6.0 (4.0-9.0), 7.5 (5.0-14.8), 7.0 (4.5-13.0) and 11.0 (9.0-20.5), respectively (P<0.05) and the rates of ICU transfer were 2.0% (5/250), 9.4% (12/128),18.2% (6/33) and 51.4% (19/37), respectively (P<0.05). Both increased significantly with the increase in the volume of RBCs transfusion, and the differences between groups were statistically significant. Conclusion: Parturients who received higher volume of RBCs had multiple risks factors for bleeding before childbirth, had higher postpartum blood loss, and had a higher rate of application of various blood conservation measures. In addition, an increase in the volume of RBCs transfusion may have adverse effects on postpartum recovery.

OBJECTIVE: To investigate the feasibility and clinical outcomes of emergency reconstruction of traumatic dynamic muscle defects using functional superficial vastus lateralis chimeric perforator flap based on descending branch of lateral femoral circumflex artery. METHODS: A retrospective analysis was conducted of 10 patients with traumatic dynamic muscle defects treated between March 2020 and April 2024. There were 8 males and 2 females, aged 23-52 years (mean, 36.7 years). Injuries included 7 cases of Gustilo type ⅢB forearm trauma (2 with flexor muscle group defects, 3 with extensor muscle group defects, and 2 with combined flexor and extensor muscle group defects), 1 case of right first metacarpal defect with concomitant thenar muscle and skin defect, 1 case of complete transection of the right upper arm musclecutaneous nerve extracted from the biceps brachii muscle, and 1 case of Gustilo type ⅢC lower-limb trauma with extensor hallucis longus and toe extensor defects. Soft tissue defects ranged from 10 cm×8 cm to 36 cm×11 cm. Preoperative musculoskeletal ultrasound of the contralateral side was used to measure cross-sectional area, length, and pennation angle of the target muscles. Based on these parameters, anterolateral thigh flaps combined with one or two superficial vastus lateralis muscle segments were designed and transplanted to the recipient sites. The grafts were used to cover wounds, reconstruct major missing muscle groups, and were fixed in place. Vascular and neural anastomoses were performed simultaneously with repair of bone and soft tissue injuries to restore limb perfusion and function. Postoperative evaluation included musculoskeletal ultrasound, electrophysiology, and dynamic assessment of muscle strength during follow-up. RESULTS: All transplanted muscles and flaps survived primarily without vascular or neural complications. All the 10 patients were followed up 10-38 months, with an average of 22.8 months. The muscle strength recovery reached M₅ in 6 cases, M₄ in 3 cases, and M3+ in 1 case. Patients achieving M₄ or above regained their original work capacity; limb contours were symmetrical, with no joint deformities, and patients achieved effective ranges of motion; functional recovery included the ability to push or lift weights of 2-30 kg, perform opposition, and achieve grasping function. All flaps were soft and lustrous, and the protective sensation restored in all patients. There was no discomfort in the donor site and knee joint. Musculoskeletal ultrasound showed that the average cross-sectional area of the transplanted muscles increased by 4%-66% in 10 cases at 1 month after operation, and the ratio of the average cross-sectional area of the transplanted muscles in contraction and relaxation was 1.37±0.16 in 7 cases at 6 months after operation. Electrophysiological examination showed that motor potential could be detected in 8 cases at 2 months after operation, and then the amplitude increased gradually, and 2 cases were not detected. CONCLUSION Emergency reconstruction of traumatic dynamic muscle defects using functional superficial vastus lateralis chimeric perforator flap based on descending branch of lateral femoral circumflex artery achieves near-normal muscle strength recovery and effective joint motion. This technique allows for reconstruction of one or two major muscle groups as clinically required.
Humans ; Male ; Adult ; Female ; Perforator Flap/blood supply* ; Plastic Surgery Procedures/methods* ; Retrospective Studies ; Soft Tissue Injuries/surgery* ; Middle Aged ; Quadriceps Muscle/transplantation* ; Femoral Artery/surgery* ; Young Adult ; Muscle, Skeletal/surgery* ; Treatment Outcome ; Forearm Injuries/surgery*

Objective: To investigate the current status and influencing factors of sleep disorders among pregnant women, so as to provide insights into health management during pregnancy. Methods: Pregnant women who underwent prenatal checkups at Hangzhou Obstetrics and Gynecology Hospital from January to October 2023 were selected as subjects, and general data including age, pregnancy period and exercise were collected through questionnaire surveys. Sleep quality, pregnancy stress, anxiety and depression were evaluated using Pittsburgh Sleep Quality Index, Pregnancy Stress Rating Scale, Pregnancy-related Anxiety Scale and Edinburgh Postnatal Depression Scale, respectively. Factors affecting sleep disorders among pregnant women were analyzed using a multivariable logistic regression model. Results: A total of 386 pregnant women was surveyed, with a mean age of (30.28±4.65) years, including 20.47% in the first trimester, 47.93% in the second trimester and 31.61% in the third trimester. Women with anxiety and depression accounted for 14.51% and 21.76%, respectively. Pregnancy stress was mainly moderate, accounting for 51.04%. There were 106 pregnant women with sleep disorders, accounting for 27.46%. Mutivariable logistic regression analysis showed that age (≥35 years, OR=1.656, 95%CI: 1.094-2.503), pregnancy period (third pregnancy, OR=2.097, 95%CI: 1.213-3.621), regular exercise in the past 6 months (OR=0.376, 95%CI: 0.210-0.670), anxiety (OR=2.794, 95%CI: 1.545-5.048), depression (OR=3.501, 95%CI: 1.877-6.529) and pregnancy stress (moderate, OR=1.355, 95%CI: 1.018-1.801; severe, OR=2.538, 95%CI: 1.417-4.540) were the factors affecting sleep disorders among pregnant women. Conclusions Sleep disorders of pregnant women is influenced by age, pregnancy period, pregnancy stress, anxiety, depression and exercise. It is necessary to identify high-risk individuals with sleep disorders early, and to provide psychological intervention and prenatal health guidance.

Objective:To investigate the correlations between perfused lung volumes, visual scores (using perfusion SPECT/CT) and right-heart catheter (RHC) hemodynamic parameters in patients with chronic thromboembolic pulmonary hypertension (CTEPH).Methods:A total of 51 consecutive CTEPH patients (17 males, 34 females, age (59±12) years) in the First Affiliated Hospital of Guangzhou Medical University between March 2015 and July 2019 were retrospectively analyzed. All patients underwent lung perfusion SPECT/CT imaging and RHC examinations. Perfused lung volumes were determined using threshold-based (15%-85%) segmentation. Visual semiquantitative scoring in each lung segment was performed using Begic method. RHC hemodynamic parameters including pulmonary artery systolic pressure (PASP), pulmonary arterial diastolic pressure (PADP), mean pulmonary artery pressure (mPAP), pulmonary arteriolar wedge pressure (PAWP), pulmonary vessel resistance (PVR), cardiac output (CO), cardiac index (CI) were recorded. Spearman correlation analysis was used to evaluate the correlations between perfused lung volumes, visual scores and hemodynamic parameters.Results:There were significant correlations between perfused lung volumes (30%-70% threshold) and mPAP ( rs values: from -0.414 to -0.302, all P<0.05). Among them, perfused lung volumes under the threshold of 40% and 45% were moderately correlated with mPAP ( rs values: -0.414, -0.412, both P<0.05). Perfused lung volume (40% threshold) was moderately negatively correlated with PASP, PADP ( rs values: -0.402, -0.440, both P<0.05), and slightly negatively correlated with PVR ( rs=-0.352, P<0.05). Visual scores were slightly positively correlated with the PADP ( rs=0.311, P<0.05), while there was no correlation between visual scores and other RHC hemodynamic parameters ( rs values: from -0.201 to 0.275, all P>0.05). Conclusion:Perfused lung volumes based on threshold-based segmentation in lung perfusion SPECT/CT imaging can accurately reflect hemodynamic status and may provide useful information for severity assessment of CTEPH.

Objective:To explore the relationship between residual collateral vessels in uterine arterial embolization (UAE) and the risk of bleeding during the operation of curettage for cesarean scar pregnancy.Methods:A total of 499 patients who underwent preventive UAE before curettage for scar pregnancy in Shandong Provincial Hospital from January 2012 to June 2019 were included. Clinical data of the patients were retrospectively collected and analyzed. In patients with uterine collateral circulation, collateral vessels were embolized as much as possible. Angiography was performed after UAE. All the cases were divided into 3 grades according to residual staining in middle and lower part of corpus uteri as follows, grade A: no or mild staining, grade B: moderate staining, grade C: intense staining. Blood loss of the patients during curettage was recorded, and the incidence rate of minor hemorrhage (<50 ml) and massive hemorrhage (>500 ml) of the 3 grades were calculated respectively. The results of three grades groups were compared with those of control group (patients without collateral circulation) by using Chi-square test or Fischer exact probability.Results:According to angiogram acquired after UAE, collateral vessels were found in 53 patients, with 25 cases in grade A group, 15 cases in grade B group, and 13 cases in grade C group, respectively. Thirty-six patients underwent transcatheter embolization of collateral vessels. The incidence rate of minor hemorrhage in type B and C [60.0% (9/15), 46.2% (6/13)] was lower than that in control group (87.9%, 392/446), with significant difference found (χ2=9.972, P=0.002, χ2=19.090, P<0.001). Significant difference was found in the incidence rate of massive haemorrhage between group C (23.1%, 3/13) and control group (2.2%, 9/446) (χ2=14.480, P=0.001). Conclusion:As for cesarean scar pregnancy cases with uterine collateral vessels, embolization of collateral vessels may reduce the amounts of bleeding during curettage. Residual staining of middle and lower part of corpus uteri may be helpful in predicting the risk of massive haemorrhage during curettage.

Nonalcoholic fatty liver disease (NAFLD) is characterized by hepatic steatosis caused by nonalcoholic factors, and its pathogenesis, progression, treatment, and prevention have attracted more and more attention. At present, an increasing number of studies have been conducted on the association of intestinal microecology with various metabolic diseases such as obesity, diabetes, and cardiovascular diseases. Recent studies have found that butyrate, a metabolite of intestinal flora, is closely associated with NAFLD and can affect the development and progression of NAFLD through various mechanisms, such as alleviating inflammatory response, inhibiting insulin resistance, and reducing oxidative stress of liver mitochondria. Exploration of the association between butyrate and NAFLD is expected to provide a new approach for the prevention and treatment of NAFLD.

Objective To investigate the influencing factors of portal vein tumor thrombus in patients with primary liver cancer(PLC).Methods A total of 483 patients with PLC in the Second People's Hospital of Fuyang from January 2012 to December 2016 were included in this retrospective study.Univariate analysis and multi-variate logistic regression analysis were employed to analyze the association between portal vein tumor thrombus and routine clinical parameters.Results The univariate analysis showed that alanine aminotransferase,aspartate aminotransferase,total bilirubin,γ-glutamyltranspeptidase,alkaline phosphatase,alpha-fetoprotein,the size and the number of tumors,ascites and center location of cancer performed a close relationship with the formation of portal vein tumor thrombus in patients with PLC,and the differences were statistically significant(P values were 0.010,0.000,0.010,0.000,0.001,0.000,0.000,0.004 and 0.010).Multivariate logistic regression analysis showed that potential significant predictors of portal vein tumor thrombus in patients with PLC were alpha-fetoprotein and ascites,and the differences were statistically significant(P values were 0.000 and 0.040).Conclusion PLC patients with high level of alpha-fetoprotein and ascites are easier to induce the formation of portal vein tumor thrombus.

Adult ; Cytomegalovirus ; Cytomegalovirus Infections ; Humans ; Liver Failure

OBJECTIVETo study the effect of interleukin-1β (IL-1β) on the expressions activin A, follistatin, and cripto in cultured human endometrial stromal cells (HESCs) form patients with endometriosis.

METHODSCultured HESCs were stimulated with 250, 500, and 750pg/ml IL-1β, and the mRNA and protein expressions of activin A, follistatin, and cripto were assayed using real-time reverse transcriptase-polymerase chain reaction and enzyme-linked immunosorbent assay.

RESULTSIL-1β treatment caused significant dose-dependent increments of the mRNA and protein expressions of activin A and follistatin and of the mRNA expression of cripto in cultured HESCs.

CONCLUSIONIL-1β can affect the expressions of activin A, follistatin and cripto in HESCs from patients with endometriosis.

Activins ; metabolism ; Cells, Cultured ; Endometriosis ; metabolism ; Endometrium ; cytology ; Female ; Humans ; Interleukin-1beta ; pharmacology ; Stromal Cells ; drug effects ; metabolism

Objective To study the effect of interleukin-1β(IL-1β) on the expressions activin A, follistatin, and cripto in cultured human endometrial stromal cells (HESCs) form patients with endometriosis. Methods Cultured HESCs were stimulated with 250, 500, and 750 pg/ml IL-1β, and the mRNA and protein expressions of activin A, follistatin, and cripto were assayed using real-time reverse transcriptase-polymerase chain reaction and enzyme-linked immunosorbent assay. Results IL-1βtreatment caused significant dose-dependent increments of the mRNA and protein expressions of activin A and follistatin and of the mRNA expression of cripto in cultured HESCs. Conclusion IL-1βcan affect the expressions of activin A, follistatin and cripto in HESCs from patients with endometriosis.