Objective:To explore the relationship between amniotic fluid and peripheral blood inflammatory factors and the pregnancy outcomes after emergency cervical cerclage, and to identify effective indicators for predicting adverse pregnancy outcomes after the procedure.Methods:A case-control study was conducted, including pregnant women who were hospitalized at Sun Yat-sen Memorial Hospital, from January 1, 2013, to July 31, 2019, and underwent emergency cervical cerclage due to cervical dilatation at gestational age between 16 and 28 weeks. A total of 85 pregnant women who underwent amniocentesis for the detection of amniotic fluid inflammatory factors during the perioperative period were included. Based on whether their baby was perinatal death, the participants were divided into the case group (28 cases with perinatal death) and the control group (57 cases with live births). Univariate logistic regression analysis was performed to identify risk factors associated with adverse pregnancy outcomes, followed by multivariate logistic regression analysis to establish a regression model and nomogram.Results:(1) The levels of tumor necrosis factor α (TNF-α), interleukin (IL)-1β, IL-6, IL-8, IL-10 in the amniotic fluid during the perioperative period and postoperative serum C-reactive protein (CRP) were significantly higher in the case group compared to the control group (all P<0.05). The case group underwent emergency cervical cerclage at an earlier gestational age compared to the control group, and their cervical dilation was greater than that of the control group (all P<0.05). However, there were no significant differences in the white blood cell counts, neutrophil percentage, and the level of preoperative CRP in the peripheral blood of pregnant women during the perioperative period (all P>0.05). (2) Univariate logistic regression analysis showed that the levels of amniotic fluid WBC, TNF-α, IL-1β, IL-2 receptor (IL-2R), IL-6, IL-8, IL-10, postoperative CRP in the peripheral blood, gestational age at cerclage and cervical dilation were associated with adverse pregnancy outcomes (all P<0.05). Multivariate regression analysis indicated that only the levels of amniotic fluid WBC and TNF-α were independent risk factors for perinatal death. (3) Based on clinical practice, a multivariate logistic regression model was constructed including the levels of amniotic fluid TNF-α, WBC, gestational age at cervical cerclage, and cervical dilation. A nomogram and calibration curve were plotted, which suggested its good predictive value for adverse pregnancy outcomes. Conclusions:During the perioperative period of emergency cervical cerclage, the levels of amniotic fluid WBC, TNF-α, IL-1β, IL-2R, IL-6, IL-8, IL-10 are associated with adverse pregnancy outcomes, with amniotic fluid WBC and TNF-α showing the closest relationship. However, there is no significant correlation between maternal peripheral hemogram during the perioperative period and adverse pregnancy outcomes. A model constructed by amniotic fluid TNF-α, WBC, cervical cerclage gestational age, and cervical dilation has a good predictive effect on adverse pregnancy outcomes.

Objective:To retrospectively construct competency-based portfolios for medical students to analyze the factors influencing competency self-assessment, and to explore an approach to efficient portfolio construction.Methods:The participants were randomly selected among medical graduates of 2015 in Shantou University Medical College. Through records collection and an online questionnaire survey, portfolios were built for the participants based on their development data during eight years from college entrance, college education, to post-graduation medical education. The correlation between variables was determined using Kendall's tau-b correlation coefficients. The inter-group differences were analyzed using the Mann-Whitney U test. Results:A total of 126 usable questionnaires for effective developmental portfolios were collected. There were a total of 208 indicators collected, including 79 questionnaire indicators (including 36 for competency self-assessment). The reliability coefficient (Cronbach's α) of the questionnaire was 0.984. The factors related to competency self-assessment were identified. Conclusion:This study provides a basis for the implementation of portfolio assessment, which can promote students' self-assessment and competency development. Optimizing the indicator system, building an online platform, increasing participants' participation motivation, and emphasizing self-reflection and feedback will help improve the efficiency of developmental portfolio construction and its performance.

Objective To investigate the diagnostic value of contrast-enhanced CT and MR diffusion-weighted imaging (DWI) in differentiating autoimmune pancreatitis (AIP) from pancreatic carcinoma (PC).Methods Twelve patients with AIP (AIP groups) and 15 patients with PC (PC groups) were included in this study.Contrast-enhanced CT and DWI were performed in all patients.The manifestations of the pancreatic lesions,pancreatic duct and bile duct were observed.The CT attenuation values and the apparent diffusion coefficient (ADC) values of the lesions were calculated.Frequencies of the CT manifestations,and the mean CT attenuation values,and the ADC values were compared between the two groups.Results Most of the AIP showed diffuse enlargement,sausage shape,peripancreatic capsule,penetrating sign of pancreatic duct and thickness of the bile duct.The frequencies of the findings mentioned above were significantly different between AIP and PC (P＜0.05).The CT attenuation values of the lesions,and the rate of lesions' CT attenuation values to livers' in 3 phases of contrast enhanced CT were significantly different between AIP and PC (P＜0.05).The ADC values of AIP were significantly lower than that of PC (P＜0.05).Conclusion The changes of morphology of pancreas,pancreatic and bile duct may facilitate in differentiating AIP from PC.Quantitative analysis of CT attenuation values and ADC values measured on MR images may be helpful in differentiating AIP from PC.

Objective To analyze the clinical features and prognosis of CD34-positive and CD34-negative adult patients with acute T-lymphoblastic leukemia (T-ALL),and to explore the value of CD34 expression for prognosis of patients with T-ALL.Methods 75 adult patients diagnosed with T-ALL from January 2012 to July 2015 in the Department of Hematology,the First Affiliated Hospital of Zhengzhou University,were analyzed retrospectively.According to the expression of CD34,the patients were divided into CD34-positive group and CD34-negative group,and then the clinical characteristics and prognosis of both groups were analyzed.Results In 75 patients,CD34-positive group had 24 (32.0 ％) patients and CD34-negative group had 51 (68.0 ％) patients.Between the two groups,there was no significant difference in these factors,such as sex,age,infiltration of liver,spleen and lymph nodes,thrombocytopenia,high white blood cell count,abnormal karyotype,complete remission within 4 weeks and central nervous system leukemia (CNSL).The proportions of patients with hemoglobin (Hb) ＜ 90 g/L and expression of myeloid lineage marker were higher in the CD34-positive group than those in the CD34-negative group (x2 =5.888,P=0.015;x2 =10.758,P =0.001,respectively).There were only 18 patients treated with hematopoietic stem cell transplantation (HSCT),57 patients were not.In patients without HSCT,the median survival time in the CD34-positive group and CD34-negative group was significant different (5 months vs.32 months,x2 =9.172,P =0.002).Conclusions CD34 expression in adult patients with T-ALL appears to be associated with Hb ＜ 90 g/L and the expression of myeloid lineage markers.For the patients without HSCT,CD34 is likely negatively related with the prognosis.

Objective To investigate the feasibility and safety of modified percutaneous left atrial appendage occlusion (PLAAO) under transthoracic echocardiographic (TTE) guidance without general anesthesia instead of transesophageal echocardiographic guidance.Methods A total of 14 patients who met the inclusion criteria underwent modified PLAAO guided by TTE instead of TEE without general anesthesia.Regular clinical follow-up observations of PLAAO-related major adverse events were done in the perioperative period.Results All patients were successfully implanted with left atrial appendage occluder device (Watchman) without device-related serious complications.Immediately occlusion success rate was 100％.No major adverse events occurred during hospitalization and follow-up.The mean operation time was 108 ± 22 min(range 75-150 min)and the mean radiation exposure time was 15.8 ± 7.6 min(range 8-32 min).Conclusion Modified PLAAO guided by TTE instead of TEE without general anesthesia may be safe and effective.This method simplifies the operation process and is favorable for PLAAO application.But this modified PLAAO is still needed to be validated in more patients.

Objective To observe the therapeutic effect of titanium plate and Kirschner wire system for treatment of calcaneal fracture.Methods The data of 189 patients with calcaneal fracture treated with operation were retrospectively studied,of which 102 patients of calcaneal fracture were treated with titanium plate fixation (titanium plate group),87 patients were treated with Kirschner wire system (Kirschner wire group).The operative time,blood loss,postoperative complication,healing time,before and after treatment Bohler angle,Gissane angle and middle calcaneal width,and Maryland foot function score were observed.Results The patients of the 2 groups were observed with 12-36 (24.0 ± 9.5) months follow-up.The operative time and blood loss in Kirschner wire group were significantly lower than those in titanium plate group [(42.3 ± 12.5) min vs.(67.5 ± 23.1) min and (137.7 ± 42.8) ml vs.(245.0 ± 55.6) ml],there were statistical differences (P ＜ 0.05).The Bohler angle,Gissane angle and middle calcaneal width in the 2 groups after treatment were significantly better than those before treatment [titanium plate group:(32.80 ± 6.35)° vs.(7.81 ± 8.75)°,(130.42 ±6.93)° vs.(175.80 ± 6.05)°,(30.77 ± 3.56) mm vs.(42.60 ±5.24) mm; Kirschner wire group:(30.11 ±4.91)° vs.(9.54 ±8.90)°,(132.89 ±9.54)° vs.(173.11 ±9.05)°,(32.00 ± 4.18) mm vs.(42.78 ± 4.96) mm],there were statistical differences (P＜ 0.05).The excellent rate of Maryland foot function score after treatment in titanium plate group was significantly higher than that in Kirschner wire group [92.2％ (94/102) vs.81.6％ (71/87)],there was statistical difference (P ＜ 0.05).Therewere 6 cases appeared infection of incisional wound in titanium plate group,there was no complication in Kirschner wire group,there was statistical difference (P ＜ 0.05).Conclusions Titanium plate and Kirschner wire system are the commonly used methods in treatment of calcaneal fractures,each has its advantages and disadvantages,titanium plate has long time operation,much blood loss and prone to infection,but the excellent rate is higher.Also note that the incision location,restoration and reconstruction of calcaneal anatomy subtalar joint.

A new head and neck location frame for positron emission tomography (PET) and computed tomography (CT) cross-modality medical image fusion in radiotherapy was developed. The solid mark bars of N form in the old designed CT location frame were replaced by closed hollow pipes which could be filled with different developer solutions before CT or PET scan, respectively. Nine points of external marker used for registration and fusion were obtained in CT images and PET images, respectively. The locations of the two sets of nine points showed the method of registration to be effective and accurate in achieving the PET and CT image fusion. This method, based on its characteristics of simple structure and easy-to-use, can be of wide application in clinical setting.
Head ; anatomy & histology ; diagnostic imaging ; Humans ; Image Interpretation, Computer-Assisted ; instrumentation ; methods ; Multimodal Imaging ; methods ; Neck ; anatomy & histology ; diagnostic imaging ; Positron-Emission Tomography ; methods ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; instrumentation ; methods ; Tomography, X-Ray Computed ; methods

Objective To investigate the effectiveness and safety of transcatheter radiofrequency ablation guided by a three-dimensional mapping system (Ensite or Carto) for the treatment of complex cardiac arrhythmias. Methods A cohort of 123 consecutive hospitalized inpatients during the period from February 2006 to December 2008 were selected for this study. These patients suffered from various arrhythmias, including paroxysmal atrial fibrillation (n=58). Persistent or permanent atrial fibrillation (n=10), atrial flutter (n=13), atrial tachycardia (n=12) and ventricular tachycardia or frequent ventricular premature beats (n=30). Transcatheter radiofrequency ablation for arrhythmias was performed under the guidance of an EnSite3 000/NavX or Array mapping system in 80 cases, and under the guidance of a CARTO mapping system in the remaining 43 cases. Results Successful ablation of arrhythmias was obtained by single operation in 106 cases(86.18%). Including 59 cases with atrial fibriUation,11 cases with atrial flutter, 10 cases with atrial tachycardia, and 26 cases with ventricular tachycardia or premature ventricular beat. Ablation procedure was carried out and was successful in 10 cases with a successful rate of 94.31%, including 5 cases with atrial fibrillation. 1 case with recurred atrial flutter, 1 case with recurrent atrial tachycardia, and 3 cases with ventricular tachycardia or premature ventricular beat. After operation, complications occurred in 6 cases, including cardiac tamponade in 4 cases, distal embolism of the left anterior descending coronary artery in 1 case, and pulmonary embolism in 1 case. Conclusion Three-dimensional mapping system can clearly and stereoscopically display the cardiac structures. Therefore, this technique is of great value in guiding the transcatheter radiofrequency ablation for complex arrhythmias, in improving the success rate of ablation and in increasing the safety of the procedure.

Objective To observe curative effect and clinical outcome in 30 recipients undergoing allogcneic peripheral blood stem cell transplantation (PBSCT) combined with bone marrow transplantation (BMT). Methods 30 patients with a median age of 32.6 years underwent allo-HSCT, of which 11 patients with AML, 14 patients with ALL, and 5 patients with CML They all have a HLA-identical sibling. PBSCswere mobilized with G-CSF. Three hundreds milliliter bone marrow blood was transplanted to the patients on the day that the PBSC was transplanted. Amended Bu/Cy was used as the conditioning regimen. MTXcombined with CsA and MMF was used as GVHD prophylaxis. Results A median number of mononuclear cells of (5.13±2.6)x10~8/kg recipient's weight was collccted from peripheral blood, and (1.3±0.6)x10~8/kgrecipient' s weight from bone marrow blood. Engraftment of neutrophils and platelets was achieved at a median of (12.1±3.25) days and (14±5.33) clays respectively. Ⅰ - Ⅱ acute GVHD occurred in 40.0 % cases,Ⅲ - Ⅳ acute GVHD occurred in 3.3 % cases, and chronic GVHD developed in 43.3 % cases. Severe cGVHD developed in 3.3% cases. The 2 years disease free survival rate (DFS) by the day of transplantation was 72.0 %. Conclusion PBSCT combined with BMT was effective to cure leukemia. The results also suggested that PBSC recipients had an lower incidence of aGVHD and cGVHD as compared with previous reports.