Objective To examine the correlation between fetal rectal ampulla diameter and gestational age,and to establish reference value ranges for low-risk fetuses between 18 and 40 weeks of gestation in Yibin region.Methods A total of 1,103 low-risk singleton pregnant women between 18 and 40 weeks of gestation were recruited from five hospitals in Yibin City(the Second People's Hospital,the First People's Hospital,the Fifth People's Hospital,the Maternal and Child Health Hospital of Yibin City,and the Maternal and Child Health Hospital of Cuiping District)for routine level Ⅰ,Ⅱ,and Ⅲ prenatal ultrasound screening from October 2022 to March 2024.Fetal rectal ampulla diameters,including anteroposterior diameter,transverse diameter,and area,were measured using prenatal ultrasound.The normality of these measurements was assessed using the Shapiro-Wilk test.Scatter plots depicting the relationship between fetal rectal ampulla diameter parameters and gestational age were generated using the"Overlap Scatter Plot"function in SPSS.Percentiles were calculated using the"Explore"function in SPSS,with reference value ranges described by P5,P10,P50,P90,and P95.Results The visual-ization rate of the fetal rectal ampulla diameter was 55%at 18～20 weeks of gestation,100%at 21～37 weeks,and 96%at greater than 37 weeks.The fetal rectal ampulla diameter exhibited a significant positive correlation with gestational age(r=0.925～0.949,P<0.01).Conclusions Prenatal ultrasound measurement of fetal rectal ampulla diameter demonstrates a robust correlation with gestational age.The reference intervals for the rectal ampulla diameter of low-risk fetuses between 18 and 40 weeks of gestation,established in this study,may offer valuable theoretical guidance for prenatal diagnosis of fetal rectal and anal abnormalities in Yibin region.

Objective To examine the correlation between fetal rectal ampulla diameter and gestational age,and to establish reference value ranges for low-risk fetuses between 18 and 40 weeks of gestation in Yibin region.Methods A total of 1,103 low-risk singleton pregnant women between 18 and 40 weeks of gestation were recruited from five hospitals in Yibin City(the Second People's Hospital,the First People's Hospital,the Fifth People's Hospital,the Maternal and Child Health Hospital of Yibin City,and the Maternal and Child Health Hospital of Cuiping District)for routine level Ⅰ,Ⅱ,and Ⅲ prenatal ultrasound screening from October 2022 to March 2024.Fetal rectal ampulla diameters,including anteroposterior diameter,transverse diameter,and area,were measured using prenatal ultrasound.The normality of these measurements was assessed using the Shapiro-Wilk test.Scatter plots depicting the relationship between fetal rectal ampulla diameter parameters and gestational age were generated using the"Overlap Scatter Plot"function in SPSS.Percentiles were calculated using the"Explore"function in SPSS,with reference value ranges described by P5,P10,P50,P90,and P95.Results The visual-ization rate of the fetal rectal ampulla diameter was 55%at 18～20 weeks of gestation,100%at 21～37 weeks,and 96%at greater than 37 weeks.The fetal rectal ampulla diameter exhibited a significant positive correlation with gestational age(r=0.925～0.949,P<0.01).Conclusions Prenatal ultrasound measurement of fetal rectal ampulla diameter demonstrates a robust correlation with gestational age.The reference intervals for the rectal ampulla diameter of low-risk fetuses between 18 and 40 weeks of gestation,established in this study,may offer valuable theoretical guidance for prenatal diagnosis of fetal rectal and anal abnormalities in Yibin region.

Objective:To investigate the independent risk factors for postoperative severe pulmonary infection (SPI) in patients with severe traumatic brain injury (sTBI) and evaluate their predictive value.Methods:A retrospective cohort study was conducted to analyze the clinical data of 163 sTBI patients admitted to Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from April 2021 and March 2023, including 101 males and 62 females, aged 20-80 years [53.0(46.0, 59.0)years]. The surgical procedures involved decompressive craniectomy, subdural hematoma removal, epidural hematoma removal, and intracranial hematoma removal. The patients were divided into SPI group ( n=62) and non-SPI group ( n=101) according to whether they had SPI postoperatively. The following data of the two groups were collected, including gender, age, preoperative Glasgow coma scale (GCS), elevated blood glucose, abnormal liver function, abnormal renal function, hemoglobin level, anemia, albumin level, hypoproteinemia, white blood cell count, neutrophil count, lymphocyte count, platelet count, neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI) and serum lactate dehydrogenase (LDH) level. All the hematological tests were performed on venous blood samples collected preoperatively before anti-inflammatory treatment. Independent risk factors for predicting the postoperative occurrence of SPI in sTBI patients were identified through univariate analysis and multivariable stepwise regression analysis. The predictive value of separate indicator or indicators combined was assessed by calculating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Results:Univariate analysis demonstrated that preoperative GCS, albumin level, lymphocyte count, NLR, PNI and serum LDH level in both groups were significantly correlated with the postoperative occurrence of SPI ( P<0.05), while gender, age, elevated blood glucose, abnormal liver function, abnormal renal function, hemoglobin level, anemia, hypoproteinemia, white blood cell count, neutrophil count, platelet count, dNLR and PLR were not correlated with the postoperative occurrence of SPI in sTBI patients ( P>0.05). Multivariable stepwise regression analysis revealed that low lymphocyte count (95% CI -0.337, -0.013, P<0.05), high NLR (95% CI -0.023, -0.005, P<0.01), low PNI (95% CI 0.007, 0.026, P<0.01), and high serum LDH (95% CI -0.002, -0.001, P<0.01) were independent risk factors for SPI in sTBI patients ( P<0.05). ROC curve analysis indicated that low lymphocyte count, high NLR, low PNI and high serum LDH level could predict SPI in sTBI patients postoperatively, with the combination of PNI and serum LDH showing the highest predictive ability (AUC=0.78, 95% CI 0.70, 0.85). Conclusion:Low lymphocyte count, high NLR, low PNI, and high serum LDH level are independent risk factors for postoperative SPI in patients with sTBI, and the combination of PNI and serum LDH possesses a high predictive value for postoperative SPI in sTBI patients.

Objective To investigate the clinical outcomes of cranioplasty with polyether ether ketone(PEEK)or titanium after large craniectomy in patients.Methods Clinical data of 150 patients undergoing skull repair due to large frontotemporal skull defect in our hospital from April 2018 to June 2022 were retrospectively analyzed,and they were divided into titanium mesh group and PEEK group according to different repair materials.The conditions of surgical site infection,bleeding,subcutaneous effusion,seizure,implant rupture or exposure in the two groups were compared.Results In the PEEK group,96.3％of patients needed to implant the repair material under the temporal muscle,which was significantly higher than that in the titanium mesh group(78.1％)(P＜0.05).There were no significant differences in postoperative complications including infection,bleeding,seizure,implant rupture or leakage between the two groups(P＞0.05).However,the incidence of postoperative subcutaneous effusion in PEEK group was higher than that in titanium mesh group(14.8％VS4.2％,P＜0.05),and the difference was statistically significant.Conclusion Both titanium and PEEK can be used in cranioplasty for patients with large frontotemporal cranial defects.Subcutaneous effusion is common in patients underwent cranioplasty with PEEK postoperatively,which needs to be paid more attention.

Objective: To analyze pre- and post-operation electrocardiograms (ECGs) features of patients underwent orthotopic heart transplantation (OHT), and provide evidences for identifying and analyzing post OHT ECGs. Methods: Nine hundreds and ninty-eight pre- and post- OHT standard 12-leads ECGs from 110 consecutive patients, who underwent OHT in our hospital from May 2008 to May 2014, were analyzed. Results: The mean heart rate(HR)was (86.9±16.4) beats per minute before OHT, and (100.0±0.4) beats per minute after OHT. P wave′s amplitude, duration, amplitude multiplied by duration of donor heart in lead Ⅱ were (0.124±0.069)mV, (111.1±17.2)ms, (14.34±9.51)mV·ms before OHT; (0.054±0.037)mV, (86.9±27.0)ms, (5.02±4.03)mV·ms at 1 month after OHT; (0.073±0.049)mV, (93.9±17.5) ms, (7.00±4.81)mV·ms at 6 years after OHT. ECGs rotation occurred in 83.64%(92/110) patients after OHT, and prevalence of clockwise rotation was 76.36%(84/110). Sinus tachycardia was evidenced in 99.09%(109/110) patients after OHT, and incomplete right bundle branch block was present in 60.91%(67/110) patients after OHT. Pseudo complete atrioventricular block mostly occurred at 2 days after OHT. Prevalence of double sinus rhythm was 27.95%(263/941) post OHT, 40% of them occurred between the 1st and the 2nd month post OHT; the atrial rate of recipient hearts was (104.0±10.2) beats per minucte between the 3rd and the 6th month post OHT, and was (95.3±4.2) beats per minucte between the 4th year and the 5th year. P wave′s amplitude, duration, amplitude multiplied by duration of recipient heart in lead Ⅱ were (0.066±0.055) mV, (52.8±34.7) ms, (4.67±4.95) mV·ms at 1 month after OHT, (0.043±0.040)mV, (44.4±40.5) ms , (3.11±3.61) mV·ms between the 1st year and 2nd year after OHT. The absolute value of P-wave(originating from the donor heart) terminal force in chest leads increased in 48.99%(461/941) patients post OHT, the P-wave terminal force of V₁ , V₂ and V₃ were -0.044(-0.066, -0.028), -0.060(-0.087, -0.038), -0.035(-0.056, 0) mm·s. Notched P wave in chest leads was presented in 10.31%(97/941) patients post OHT. PR segment depression in chest leads occurred in 60.24%(100/166) patients between the 3rd month and the 6th month, the incidence of PR segment depression in V₁ , V₂ and V₃ was 21.04%(198/941), 37.41%(352/941) and 28.69%(270/941), respectively. Conclusions OHT is related to significantly changed ECGs. The mean HR increased significantly after OHT, then decreased gradually after half a year to one year, but it was still higher than preoperative mean HR after five or six years; the P waves of donor heart were usually inconspicuous or small in first month after OHT, and they became bigger after 2 months, and their duration and amplitude then became relatively steady afterwards. ECGs rotation, especially the clockwise rotation, was common post OHT. A variety of arrhythmias originating from the donor heart including sinus tachycardia and incomplete right bundle branch block could be found. Pseudo complete atrioventricular block could also be found in the early phase after OHT. With the extension of time, the incidence of double sinus rhythm reduced gradually. The atrial rate and P wave of recipient heart presented with a tendency to become lower. The absolute value of P-waves(originating from the donor heart) terminal force in chest leads (mainly V₁, V₂ and V₃) increased, notched P waves in chest leads (mainly V₁, V₂) and PR segments depression in chest leads (mainly V₂, V₃ and V₄) also belong to typical post OHT ECGs features.

Objective: To explore the relationship between expression of tumor necrosis factor-α( TNF-α) and electrophysiological heterogeneity in isolated heart tissues and isolated rat ventricular myocytes.The arrhythmogenic mechanisms of TNF-αwere further studied.Methods:Langendorff perfused heart tissues models were used to verify the arrhythmogenic effects of TNF-α.The monophasic action potentials( MAPs) of the endocardium and epicardium from the isolated heart tissues were recorded by elec-trophysiological experiments.The isolated rat ventricular myocytes were obtained by enzymatic dissociation.K+currents(Ito,IK1)were recorded by using whole cell patch clamp technique.Results: Compared to the control group, the difference in MAPD between endocardium and epicardium dramatically increased with TNF-α( P<0.05 ) .TNF-αcould cause MAP duration ( MAPD ) prolongation, and a single dose of TNF-αdifferentially affected the MAPs of endocardium and epicardium of isolated heart tissues.Compared to the control group,the K+currents(Ito,IK1)were dose-dependently decreased with TNF-αin rat ventricular myocytes(P<0.05).However, etanercept had no effects on the MAPD in the absence of TNF-α.Conclusion:TNF-α-induced heterogeneity of MAPD between the endo-cardium and epicardium may provide the substrate for the onset of ventricular arrhythmias during acute myocardial infarction.The effect might be associated with TNF-αcontribute to re-entrant ventricular arrhythmias which resulted from decreased K+currents(Ito,IK1).

Objective To explore the cause of bile acid-induced lung injury through investigating the cell apoptosis and the expressions of Capsase-3 in A549 cell of umbilical artery serum in neonates delivered by women with intrahepatic cholestasis of pregnancy.Methods A549 cell was used as target cell.The cultural cells in orifice were divided into control group and intrahepatic cholestasis of pregnancy-serum attacking group.The cells of control group were cultivated with normal nutritive medium.The umbilical arterial blood was cowered from the placental end of pregnant women with intrahepatic cholestasis after the baby had been delivered.Then the serum was gathered,and the cells of the intrahepatic cholestasis of pregnancy-serum attacking group were attacked by intrahepatic cholestasis of pregnancyserum.After 24 hours,lactate dehydrogenase leakage rate,expression of Caspase-3 and the apoptosis rate of the cells in the 2 groups were detected,respectively.Results The expression of Caspase-3 in A549 cells was observed in the light microscope,and Caspase-3 expre-ssion in the cytoplasm was brown.The lactate dehydrogenase leakage rate [(34.68 ±0.77) ％],the integrate optical density value (981.77 ± 55.21) of the expression of Caspase-3 and the rate of apoptosis [(27.86 ± 0.53) ％] of cells in intrahepatic cholestasis of pregnancy group were significantly higher than those of the cells in control group[(17.39±0.66)％,(540.63 ±38.41),(6.99 ±0.11)％] (t =-45.70,-15.96,-134.41,all P ＜ 0.05).Conclusions Umbilical artery serum in neonates delivered by women with intrahepatic cholestasis of pregnancy can induce apoptosis of A549 cells by up-regulating the expression of Caspase-3,and this was the potential machine of bile acid-induced lung injury in newborn infants.