Objective:To evaluate the safety and complications of external cephalic version(ECV)for term breech presentation and to explore factors influencing the occurrence of ECV-related complications.Methods:Pregnant women with term breech presentation who underwent ECV(ECV group,n=751)and those who under-went direct cesarean section(CS)without ECV(CS group,n=706)at Guangzhou Women and Children's Medi-cal Center of Guangzhou Medical University,from January 1,2018,to July 31,2024,were enrolled.Differences in maternal clinical characteristics and neonatal outcomes were compared between the two groups.The ECV group was further divided into a successful ECV subgroup(n=537)and a failed ECV subgroup(n=214)to compare complication rates.Based on the presence or absence of complications,the ECV group was divided into a compli-cation subgroup(n=86)and a no-complication subgroup(n=665).Univariate analysis was performed on the clinical data of these subgroups.Statistically significant factors identified in the univariate analysis were subse-quently included in a multivariate Logistic regression analysis to identify high-risk factors for ECV complications.Results:①Among the 751 women undergoing ECV,the success rate was 71.50％(537/751).The vaginal deliv-ery rate following successful ECV was 57.26％(430/751).The overall complication rate was 11.45％(86/751),with a perinatal mortality rate of 0.13％(1/751).②There were no significant differences with regard to severe neonatal asphyxia and neonatal intensive care admission rate between ECV group and CS group(P＞0.05).③The total complication rate,incidence of cesarean delivery(CS)within 24 h,and incidence of uterine contrac-tions were significantly higher in the failed ECV group compared to the successful ECV group(P＜0.05).Howev-er,there was no statistically significant difference in the incidence of severe complications(fetal demise,placental abruption,emergency CS)between the two groups(P＞0.05).④Univariate and multivariate Logistic regression analyses revealed that three factors were associated with a reduced risk of ECV complications(P＜0.05):a high-er amniotic fluid index(AFI),non-engagement of the presenting part,and a palpable fetal head.Conversely,the use of anesthesia and the use of nifedipine as the tocolytic were associated with an increased risk of ECV compli-cations(P＜0.05).Conclusions:ECV does not increase the adverse outcomes of full-term neonates with breech presentation.But failed ECV can increase complications.Higher amniotic fluid index,not engaged of fetal presen-tation,touchable of fetal head and appropriate tocolytic agent application can reduce the complications while anes-thesia during ECV procedure can increase the complications of ECV.

Objective To explore the clinical characteristics of Zoletil 50 poisoning.Methods The clinical data of 33 patients with Zoletil 50 poisoning admitted to our hospital recently were retrospectively analyzed.Results Thirty-two cases were male and 1 case was female in all the 33 patients.Five cases had previous exposure to psychoactive substances such as nitrous oxide,methamphetamine and ketamine,and 19 cases had a history of smoking or drinking alcohol.Limb shaking was in 33 cases(100％),blurred and yellowed vision was in 18 cases(54.55％),unresponsiveness and hypomnesia were in 17 cases(51.52％),hallucination was in 17 cases(51.52％),irritability and panic were in 16 cases(48.48％),insomnia was in 13 cases(39.39％),unfavorable speech was in 9 cases(27.27％),dizziness and lightheadedness were in 8 cases(24.24％),delusion was in 6 cases(18.18％),nausea and vomiting were in 6 cases(18.18％),frequent urination and difficulty in urination were in 5 cases(15.15％),diarrhea and bloating were in 4 cases(12.12％),itchy skin and the abnormal sensation were in 3 cases(9.09％).There was 1 case(3.03％)of epileptic seizure and 1 case(3.03％)of chills.Ataxia was in 29 cases(96.99％),cognitive dysfunction was in 17 cases(51.52％),abnormal tendon reflex was in 13 cases(39.39％),dysarthria was in 9 cases(27.27％),nystagmus was in 6 cases(18.18％),delirium was in 3 cases(9.09％),and vision loss was in 2 cases(6.06％).Auxiliary examinations suggested neutrophil abnormalities in 19 cases(57.58％),elevated transaminases in 21 cases(63.64％),elevated uric acid in 13 cases(39.39％),increased urinary crystals in 8 cases(24.24％),elevated lipids in 11 cases(33.33％),elevated homocysteine in 5 cases(15.15％),and abnormal thyroid hormone abnormalities in 11 cases(33.33％).EEG showed sinus bradycardia in 4 cases(12.12％).Among the 16 patients who underwent EEG examination,there were 2 cases of mild and moderate abnormalities.Among the 6 patients with evoked potentials,there were 5 cases of optic nerve and auditory nerve abnormalities.There were 3 cases of peripheral nerve abnormalities in 7 cases who underwent EMG.Among the 16 patients who underwent cranial MRI examination,there were 3 cases of cortical atrophy,2 cases of white matter degeneration,and 1 case of cerebellar atrophy.Spinal cord MRI showed spinal cord abnormal signal in 1 case.In the treatment,B vitamins were supplemented to control limb shaking,improve sleep,relieve anxiety,control mental symptoms,improve cognition and other symptomatic and supportive therapy.Symptoms were relieved in 29 cases;1 case was discharged automatically;1 case relapsed during treatment,and no significant improvement was observed;2 cases died.Conclusions The specific mechanism of Zoletil 50 poisoning has not been fully clarified,and the main clinical manifestations are significant limb shaking,blurred vision,slow reaction,hallucinations,insomnia,etc.,which can be fatal in severe cases.At present,symptomatic supportive treatment can only mildly relieve the symptoms.

Objective:To evaluate the safety and complications of external cephalic version(ECV)for term breech presentation and to explore factors influencing the occurrence of ECV-related complications.Methods:Pregnant women with term breech presentation who underwent ECV(ECV group,n=751)and those who under-went direct cesarean section(CS)without ECV(CS group,n=706)at Guangzhou Women and Children's Medi-cal Center of Guangzhou Medical University,from January 1,2018,to July 31,2024,were enrolled.Differences in maternal clinical characteristics and neonatal outcomes were compared between the two groups.The ECV group was further divided into a successful ECV subgroup(n=537)and a failed ECV subgroup(n=214)to compare complication rates.Based on the presence or absence of complications,the ECV group was divided into a compli-cation subgroup(n=86)and a no-complication subgroup(n=665).Univariate analysis was performed on the clinical data of these subgroups.Statistically significant factors identified in the univariate analysis were subse-quently included in a multivariate Logistic regression analysis to identify high-risk factors for ECV complications.Results:①Among the 751 women undergoing ECV,the success rate was 71.50％(537/751).The vaginal deliv-ery rate following successful ECV was 57.26％(430/751).The overall complication rate was 11.45％(86/751),with a perinatal mortality rate of 0.13％(1/751).②There were no significant differences with regard to severe neonatal asphyxia and neonatal intensive care admission rate between ECV group and CS group(P＞0.05).③The total complication rate,incidence of cesarean delivery(CS)within 24 h,and incidence of uterine contrac-tions were significantly higher in the failed ECV group compared to the successful ECV group(P＜0.05).Howev-er,there was no statistically significant difference in the incidence of severe complications(fetal demise,placental abruption,emergency CS)between the two groups(P＞0.05).④Univariate and multivariate Logistic regression analyses revealed that three factors were associated with a reduced risk of ECV complications(P＜0.05):a high-er amniotic fluid index(AFI),non-engagement of the presenting part,and a palpable fetal head.Conversely,the use of anesthesia and the use of nifedipine as the tocolytic were associated with an increased risk of ECV compli-cations(P＜0.05).Conclusions:ECV does not increase the adverse outcomes of full-term neonates with breech presentation.But failed ECV can increase complications.Higher amniotic fluid index,not engaged of fetal presen-tation,touchable of fetal head and appropriate tocolytic agent application can reduce the complications while anes-thesia during ECV procedure can increase the complications of ECV.

Objective To explore the clinical characteristics of Zoletil 50 poisoning.Methods The clinical data of 33 patients with Zoletil 50 poisoning admitted to our hospital recently were retrospectively analyzed.Results Thirty-two cases were male and 1 case was female in all the 33 patients.Five cases had previous exposure to psychoactive substances such as nitrous oxide,methamphetamine and ketamine,and 19 cases had a history of smoking or drinking alcohol.Limb shaking was in 33 cases(100％),blurred and yellowed vision was in 18 cases(54.55％),unresponsiveness and hypomnesia were in 17 cases(51.52％),hallucination was in 17 cases(51.52％),irritability and panic were in 16 cases(48.48％),insomnia was in 13 cases(39.39％),unfavorable speech was in 9 cases(27.27％),dizziness and lightheadedness were in 8 cases(24.24％),delusion was in 6 cases(18.18％),nausea and vomiting were in 6 cases(18.18％),frequent urination and difficulty in urination were in 5 cases(15.15％),diarrhea and bloating were in 4 cases(12.12％),itchy skin and the abnormal sensation were in 3 cases(9.09％).There was 1 case(3.03％)of epileptic seizure and 1 case(3.03％)of chills.Ataxia was in 29 cases(96.99％),cognitive dysfunction was in 17 cases(51.52％),abnormal tendon reflex was in 13 cases(39.39％),dysarthria was in 9 cases(27.27％),nystagmus was in 6 cases(18.18％),delirium was in 3 cases(9.09％),and vision loss was in 2 cases(6.06％).Auxiliary examinations suggested neutrophil abnormalities in 19 cases(57.58％),elevated transaminases in 21 cases(63.64％),elevated uric acid in 13 cases(39.39％),increased urinary crystals in 8 cases(24.24％),elevated lipids in 11 cases(33.33％),elevated homocysteine in 5 cases(15.15％),and abnormal thyroid hormone abnormalities in 11 cases(33.33％).EEG showed sinus bradycardia in 4 cases(12.12％).Among the 16 patients who underwent EEG examination,there were 2 cases of mild and moderate abnormalities.Among the 6 patients with evoked potentials,there were 5 cases of optic nerve and auditory nerve abnormalities.There were 3 cases of peripheral nerve abnormalities in 7 cases who underwent EMG.Among the 16 patients who underwent cranial MRI examination,there were 3 cases of cortical atrophy,2 cases of white matter degeneration,and 1 case of cerebellar atrophy.Spinal cord MRI showed spinal cord abnormal signal in 1 case.In the treatment,B vitamins were supplemented to control limb shaking,improve sleep,relieve anxiety,control mental symptoms,improve cognition and other symptomatic and supportive therapy.Symptoms were relieved in 29 cases;1 case was discharged automatically;1 case relapsed during treatment,and no significant improvement was observed;2 cases died.Conclusions The specific mechanism of Zoletil 50 poisoning has not been fully clarified,and the main clinical manifestations are significant limb shaking,blurred vision,slow reaction,hallucinations,insomnia,etc.,which can be fatal in severe cases.At present,symptomatic supportive treatment can only mildly relieve the symptoms.

Aim To investigate the effects of dopamine(DA)on insulin secretion from rat islets and the possible mechanism.Methods Pancreatic islets were obtained from the pancreatic of male SD rats by collagenase P digestion and histopaque-1077 density gradient separation.Insulin secretion experiment was used to observe the change of insulin release after DA treatments.As to study the potential mechanisms of the effects of DA,patch-clamp experiment and calcuim image technique were applied to test the depolarization-evoked Ca2+ currents,action potential duration and intracellular Ca2+ concentration.Results In 2.8 mmol·L-1 glucose,DA had no effect on insulin secretion;in 16.7 mmol·L-1 glucose,dopamine inhibited insulin secretion in a dose-dependent manner.DA inhibited the inward calcium current,shorten the action potential duration,and reduced the intracellular Ca2+ concentration.Conclusion DA inhibits insulin secretion maybe by decreasing the inward calcium current leading to shorten the action potential duration and reduce the intracellular Ca2+ concentration.