Objective:To evaluate the clinical feasibility and safety of uterine suture with tourniquet binding during cesarean delivery for placenta previa with placenta accreta spectrum (PAS) grades 2-3a.Methods:This retrospective cohort study included 62 patients with placenta previa and PAS grades 2-3a who underwent cesarean section at the First Affiliated Hospital of Kangda College of Nanjing Medical University (the First People's Hospital of Lianyungang) from June 2018 to June 2023. Participants were divided into two groups according to vascular occlusion method: 31 patients receiving uterine suture with aortic balloon and/or uterine artery embolization comprised the intervention group, while 31 patients undergoing uterine suture with rubber tourniquet binding constituted the tourniquet group. Clinical characteristics and outcomes were compared, including operative duration, 24-hour postoperative blood loss, postoperative hospitalization, costs (hospitalization and 24-hour transfusion), early complications (late postpartum hemorrhage, fever, disseminated intravascular coagulation, organ injury), and late complications (menstrual changes, pelvic pain, urinary tract infections within 6-12 months). Statistical analyses employed two independent t-tests, Mann-Whitney U tests, and Chi square tests. Results:(1) Baseline characteristics, including maternal age, gestational weeks at delivery, gravidity and parity, number of previous cesarean deliveries, hemoglobin levels within 24 hours before surgery, neonatal birth weight, or proportion of emergency surgeries, showed no significant differences between the two groups (all P>0.05). (2) The tourniquet group demonstrated shorter operative duration [(118.3±38.2) vs. (180.7±66.6) min, t=3.87, P<0.001] and postoperative hospitalization [(5.9±1.7) vs. (7.6±2.2) d, t=3.04, P=0.002], with lower hospitalization costs [20 000 (15 000-23 000) vs. 44 000 (34 000-52 000) CNY, Z=5.92, P<0.001] and 24-hour transfusion costs [1 300.0 (1 207.5-2 400.0) vs. 2 828.0 (1 634.5-5 657.7) CNY, Z=2.90, P=0.004]. Early complication rates were significantly reduced [6.5% (2/31) vs. 35.5% (11/31), χ2=7.88, P=0.005], while 24-hour blood loss [1 574.2 (900.0-2 000.0) vs. 1 990.3 (1 000.0-2 500.0) ml, Z=1.37, P=0.172] and late complication rates [25.8% (8/31) vs. 32.3% (10/31), χ2=0.48, P=0.399] showed no significant differences. Conclusion:For placenta previa with PAS grades 2-3a, tourniquet-binding uterine suture effectively controls hemorrhage, reduces operative time, hospitalization duration, and costs, representing a safe and efficient surgical approach.

Objective:To develop a deep learning-based system for real-time recognition and classification of portal hypertensive gastropathy (PHG) and evaluate its ability to assist junior endoscopists.Methods:A total of 2 848 gastroscopy images from 832 patients with liver cirrhosis were selected from Digestive Endoscopy Center databases of Renmin Hospital of Wuhan University, Wuhan Hospital of Traditional Chinese and Western Medicine, and the Second Hospital of Jingzhou from January 2015 to October 2023. This system referred to 3 endoscopic features of Baveno Ⅱ scoring system. Three models were developed respectively for gastric antral vascular ectasia (GAVE), mosaic-like pattern (MLP), and red marks (RM). The specific classification references were as follows: (1) GAVE model: 0 no, 1 yes; (2) MLP model: 0 no, 1 mild, 2 severe; (3) RM model: 0 no, 1 isolated, 2 fused. The classification results for endoscopic characteristics of PHG of 3 endoscopy experts were taken as the gold standard. The yolov8-m model was used for training. The training dataset, validation dataset, and test dataset were allocated at a ratio of 8∶1∶1. The test dataset was used to evaluate the performance of models and their auxiliary effects on endoscopists. The accuracy, recall, precision, specificity and Kappa coefficient were calculated. Results:The accuracy, recall, specificity of GAVE model were 96.0% (48/50), 87.5% (7/8) and 97.6% (41/42). There was no significant difference between its accuracy and the gold standard ( χ2=316.226, P=1.000). The precision of GAVE1 and GAVE0 were 87.5% (7/8) and 97.6% (41/42) respectively. The accuracy of MLP model was 84.1% (132/157), and there was no significant difference compared with the gold standard ( χ2=3.286, P=0.193). The precision and recall of MLP2 were 88.2% (15/17) and 75.0% (15/20). The precision and recall of MLP1 were 77.9% (60/77) and 88.2% (60/68). The precision and recall of MLP0 were 90.5% (57/63) and 82.6% (57/69). The accuracy of RM model was 87.9% (123/140), and there was no significant difference compared with the gold standard ( χ2=2.891, P=0.409). The precision and recall of RM2 were 94.7% (18/19) and 78.3% (18/23). The precision and recall of RM1 were 72.2% (26/36) and 81.3% (26/32). The precision and recall of RM0 were 92.9% (79/85) and 92.9% (79/85). The mean accuracy of the three junior endoscopists, with and without the assistance of the GAVE model, MLP model, and RM model, respectively increased from 95.3% to 99.3%, from 83.9% to 91.9%, and from 81.9% to 83.1%. The overall consistency analysis of the 3 junior endoscopists with the gold standard indicated that the consistency of the GAVE model before and after assistance was extremely strong (both an overall Kappa of 1.000); the consistency before assistance of the MLP model was moderate (with an overall Kappa of 0.601), which increased to extremely strong after assistance (with an overall Kappa of 0.964); and the consistency of the RM model before and after assistance was also relatively strong (with an overall Kappa of 0.792 before and 0.798 after). Conclusion:The deep learning system accurately identifies and classifies PHG features and significantly enhances diagnostic performance of junior endoscopists.

Objective:To develop a deep learning-based system for real-time recognition and classification of portal hypertensive gastropathy (PHG) and evaluate its ability to assist junior endoscopists.Methods:A total of 2 848 gastroscopy images from 832 patients with liver cirrhosis were selected from Digestive Endoscopy Center databases of Renmin Hospital of Wuhan University, Wuhan Hospital of Traditional Chinese and Western Medicine, and the Second Hospital of Jingzhou from January 2015 to October 2023. This system referred to 3 endoscopic features of Baveno Ⅱ scoring system. Three models were developed respectively for gastric antral vascular ectasia (GAVE), mosaic-like pattern (MLP), and red marks (RM). The specific classification references were as follows: (1) GAVE model: 0 no, 1 yes; (2) MLP model: 0 no, 1 mild, 2 severe; (3) RM model: 0 no, 1 isolated, 2 fused. The classification results for endoscopic characteristics of PHG of 3 endoscopy experts were taken as the gold standard. The yolov8-m model was used for training. The training dataset, validation dataset, and test dataset were allocated at a ratio of 8∶1∶1. The test dataset was used to evaluate the performance of models and their auxiliary effects on endoscopists. The accuracy, recall, precision, specificity and Kappa coefficient were calculated. Results:The accuracy, recall, specificity of GAVE model were 96.0% (48/50), 87.5% (7/8) and 97.6% (41/42). There was no significant difference between its accuracy and the gold standard ( χ2=316.226, P=1.000). The precision of GAVE1 and GAVE0 were 87.5% (7/8) and 97.6% (41/42) respectively. The accuracy of MLP model was 84.1% (132/157), and there was no significant difference compared with the gold standard ( χ2=3.286, P=0.193). The precision and recall of MLP2 were 88.2% (15/17) and 75.0% (15/20). The precision and recall of MLP1 were 77.9% (60/77) and 88.2% (60/68). The precision and recall of MLP0 were 90.5% (57/63) and 82.6% (57/69). The accuracy of RM model was 87.9% (123/140), and there was no significant difference compared with the gold standard ( χ2=2.891, P=0.409). The precision and recall of RM2 were 94.7% (18/19) and 78.3% (18/23). The precision and recall of RM1 were 72.2% (26/36) and 81.3% (26/32). The precision and recall of RM0 were 92.9% (79/85) and 92.9% (79/85). The mean accuracy of the three junior endoscopists, with and without the assistance of the GAVE model, MLP model, and RM model, respectively increased from 95.3% to 99.3%, from 83.9% to 91.9%, and from 81.9% to 83.1%. The overall consistency analysis of the 3 junior endoscopists with the gold standard indicated that the consistency of the GAVE model before and after assistance was extremely strong (both an overall Kappa of 1.000); the consistency before assistance of the MLP model was moderate (with an overall Kappa of 0.601), which increased to extremely strong after assistance (with an overall Kappa of 0.964); and the consistency of the RM model before and after assistance was also relatively strong (with an overall Kappa of 0.792 before and 0.798 after). Conclusion:The deep learning system accurately identifies and classifies PHG features and significantly enhances diagnostic performance of junior endoscopists.

Objective:To evaluate the clinical feasibility and safety of uterine suture with tourniquet binding during cesarean delivery for placenta previa with placenta accreta spectrum (PAS) grades 2-3a.Methods:This retrospective cohort study included 62 patients with placenta previa and PAS grades 2-3a who underwent cesarean section at the First Affiliated Hospital of Kangda College of Nanjing Medical University (the First People's Hospital of Lianyungang) from June 2018 to June 2023. Participants were divided into two groups according to vascular occlusion method: 31 patients receiving uterine suture with aortic balloon and/or uterine artery embolization comprised the intervention group, while 31 patients undergoing uterine suture with rubber tourniquet binding constituted the tourniquet group. Clinical characteristics and outcomes were compared, including operative duration, 24-hour postoperative blood loss, postoperative hospitalization, costs (hospitalization and 24-hour transfusion), early complications (late postpartum hemorrhage, fever, disseminated intravascular coagulation, organ injury), and late complications (menstrual changes, pelvic pain, urinary tract infections within 6-12 months). Statistical analyses employed two independent t-tests, Mann-Whitney U tests, and Chi square tests. Results:(1) Baseline characteristics, including maternal age, gestational weeks at delivery, gravidity and parity, number of previous cesarean deliveries, hemoglobin levels within 24 hours before surgery, neonatal birth weight, or proportion of emergency surgeries, showed no significant differences between the two groups (all P>0.05). (2) The tourniquet group demonstrated shorter operative duration [(118.3±38.2) vs. (180.7±66.6) min, t=3.87, P<0.001] and postoperative hospitalization [(5.9±1.7) vs. (7.6±2.2) d, t=3.04, P=0.002], with lower hospitalization costs [20 000 (15 000-23 000) vs. 44 000 (34 000-52 000) CNY, Z=5.92, P<0.001] and 24-hour transfusion costs [1 300.0 (1 207.5-2 400.0) vs. 2 828.0 (1 634.5-5 657.7) CNY, Z=2.90, P=0.004]. Early complication rates were significantly reduced [6.5% (2/31) vs. 35.5% (11/31), χ2=7.88, P=0.005], while 24-hour blood loss [1 574.2 (900.0-2 000.0) vs. 1 990.3 (1 000.0-2 500.0) ml, Z=1.37, P=0.172] and late complication rates [25.8% (8/31) vs. 32.3% (10/31), χ2=0.48, P=0.399] showed no significant differences. Conclusion:For placenta previa with PAS grades 2-3a, tourniquet-binding uterine suture effectively controls hemorrhage, reduces operative time, hospitalization duration, and costs, representing a safe and efficient surgical approach.

Aim To investigate the effect of salvianolic acid B (Sal B)on c-Jun N-terminal kinase (JNK)ac-tivation and apoptosis of INS-1 cells induced by inter-mittent high glucose.Methods INS-1 cells were pre-incubated with Sal B for 24 h,followed by exposure to intermittent high glucose (IHG,11.1 mmol·L-1 12 h,33. 3 mmol·L-1 12 h)for 72 h.Cell viability was assessed by MTT assay and cell apoptosis was evalua-ted by flow cytometry.Glucose induced insulin secre-tion capacity and intracellular reactive oxygen species (ROS)contents were measured by enzyme linked im-munosorbent assay (ELISA)and a fluorescent probe DCFH-DA,respectively.Levels of JNK activation and PDX-1 protein expression were determined by Western blot analysis.Results Sal B significantly alleviated IHG-induced cell injury and apoptosis,with glucose induced insulin secretion capacity improved evidently (P<0.05 or P<0.01).Preincubation with Sal B no-tably decreased intracellular ROS and JNK activation in INS-1 cells,while the level of PDX-1 protein was in-creased markedly (P<0.05 or P<0.01 ).Conclu-sion Sal B is capable of ameliorating IHG-induced cell injury and apoptosis in INS-1 cells,which might be derived from suppression of JNK activation and up-regulation of PDX-1 protein expression.

From November 2003 to May 2010, intrathecal drug delivery system (IDDS) was implanted in 18 patients with chronic intractable pain. Analgesia was provided with morphine. Thirteen patients suffered from late stage cancer and 5 from diseases other than cancer. VAS score was used to measure intensity of pain in all 18patients. QLQ-C30 score was used to evaluate quality of life in cancer patients. The patients were followed up for 3-62 months in 5 non-cancer patients. All 13 cancer patients died at 57 days-10 months after operation. VAS scores were significantly decreased and QLQ-C30 scores increased by intrathecal administration of morphine. Side effects developed in all patients to some extent including nausea, vomiting, constipation, urinary retention, pruritus and over-sedation and vanished in a week. Intrathecal catheter was cut while being pulled out of the needle in 1 patient. Two patients developed low intracranial pressure after operation. Cerebrospinal fluid leakage occurred in 1 patient. One patient developed neuropathic pain in the posterolateral side of right leg.

Seventy-four patients aged 26-63 yr who had suffered cervicogenic headache for 3 months-21 yr were treated with puked radiofrequency applied to C2 dorsal root ganglion, which is located in the middle of the posterior side of lateral atlantoaxial joint. A trochar was introduced percutaneously under the guidance of X-ray aiming at the target point. As it was inserted through the deep fascia, the stylet was withdrawn and a 10 cm long 22 gauge curved blunt electrode was inserted into the trochar and advanced until the patients felt radiating pain from the point of puncture to occiput. Lateral radiograph was obtained to verify the placement of electrode. The tip of the electrode was usually located in front of spinal canal at the atlantoaxial joint level. Sensory stimulation was performed with 50 Hz and 0.1-0.5 V and the patients could feel radiating pain at occiput. Motor stimulation was performed with 2 Hz and 0.4-1.0 V and regular pulsation of the patient's muscle of occiput could occur. Pulsed radiofrequency was applied at 42 ℃7 for 240 s and was performed twice on each side. VAS scores and disturbances of daily activity, mood and sleep were recorded before operation and at 1 week and 1, 3, 6, 12 and 18 months after pulsed radiofrequency treatment. Complications and recurrence within 12 and 18 months were recorded. Follow-up was lost in 22 patients. VAS scores and disturbances of daily activity, mood and sleep significantly decreased after procedure. All of the patients responded without complications like infection, spinal cord and vertebral artery injury. Some patients had transient occipital neuralgia which was usually relieved within 24 h. The recurrence rate in 12 and 18 months after operation was 19% and 31% respectively.