Objective:To investigate the clinical effect of cervical cerclage at different gestational weeks in twin pregnancy with cervical length (CL)≤15 mm.Methods:This was a retrospective cohort study. Eighty-three twin pregnant women with CL≤15 mm detected by transvaginal ultrasound at 16-27 +6 weeks of gestation in Fujian Maternity and Child Health Hospital from January 2017 to December 2023 were enrolled. According to different treatment methods, they were divided into cervical cerclage group (47 cases) and conservative treatment group (36 cases), and stratified according to the gestational age of CL≤15 mm diagnosis (<26 weeks, ≥26 weeks). The differences in pregnancy outcomes between the two groups were compared. Multivariate logistic regression was used to analyze the effect of cervical cerclage on preterm birth in twin pregnant women with different CL≤15 mm diagnosis weeks. Results:(1) The gestational age at delivery and prolonged gestational age in the cervical cerclage group were longer than those in the conservative treatment group (median gestational age at delivery: 35.3 vs 33.0 weeks; median prolonged gestational age: 10.4 vs 7.2 weeks), and preterm birth rates before 34, 32 and 28 weeks were lower than those in the conservative treatment group [34 weeks: 23% (11/47) vs 53% (19/36); 32 weeks: 15% (7/47) vs 39% (14/36); 28 weeks: 4% (2/47) vs 25% (9/36)], the differences were statistically significant (all P<0.05). There were no significant differences in the rates of preterm birth before 37 weeks of gestation and preterm premature rupture of membranes between the two groups (all P>0.05). (2) When gestational age at CL≤15 mm diagnosis was <26 weeks, pregnancy outcomes in the cervical cerclage group were better than those in the conservative treatment group, including gestational age at delivery (median: 35.4 vs 31.3 weeks) and prolonged gestational age (median: 11.1 vs 5.6 weeks), neonatal birth weight [(2 246±519) vs (1 594±691) g], incidence of adverse neonatal outcomes [19% (13/68) vs 56% (19/34)], and proportion of live births [100% (68/68) vs 82% (28/34)], respectively; the differences were statistically significant (all P<0.05). When the gestational age of CL≤15 mm diagnosis was ≥26 weeks, there were no statistically significant difference in pregnancy outcomes between the two groups (all P>0.05). (3) Multivariate logistic regression analysis showed that when the gestational age of CL≤15 mm diagnosis was <26 weeks, cervical cerclage reduced the risk of preterm birth before 34 weeks (a OR=0.10, 95% CI: 0.02-0.51; P<0.05), 32 weeks (a OR=0.11, 95% CI: 0.02-0.58; P<0.05) and 28 weeks (a OR=0.04, 95% CI: 0.01-0.65; P<0.05). When the gestational age of CL≤15 mm diagnosis was ≥26 weeks, cervical cerclage did not reduce the risk of preterm birth before 34, 32 and 28 weeks of gestation (all P>0.05). Conclusions:Cervical cerclage might reduce the risk of preterm birth and improve neonatal outcomes in twin pregnancies with CL≤15 mm before 26 weeks. However, cerclage showed no advantage over conservative treatment in twin pregnancies with CL≤15 mm over 26 weeks.

Objective:To investigate the clinical effect of cervical cerclage at different gestational weeks in twin pregnancy with cervical length (CL)≤15 mm.Methods:This was a retrospective cohort study. Eighty-three twin pregnant women with CL≤15 mm detected by transvaginal ultrasound at 16-27 +6 weeks of gestation in Fujian Maternity and Child Health Hospital from January 2017 to December 2023 were enrolled. According to different treatment methods, they were divided into cervical cerclage group (47 cases) and conservative treatment group (36 cases), and stratified according to the gestational age of CL≤15 mm diagnosis (<26 weeks, ≥26 weeks). The differences in pregnancy outcomes between the two groups were compared. Multivariate logistic regression was used to analyze the effect of cervical cerclage on preterm birth in twin pregnant women with different CL≤15 mm diagnosis weeks. Results:(1) The gestational age at delivery and prolonged gestational age in the cervical cerclage group were longer than those in the conservative treatment group (median gestational age at delivery: 35.3 vs 33.0 weeks; median prolonged gestational age: 10.4 vs 7.2 weeks), and preterm birth rates before 34, 32 and 28 weeks were lower than those in the conservative treatment group [34 weeks: 23% (11/47) vs 53% (19/36); 32 weeks: 15% (7/47) vs 39% (14/36); 28 weeks: 4% (2/47) vs 25% (9/36)], the differences were statistically significant (all P<0.05). There were no significant differences in the rates of preterm birth before 37 weeks of gestation and preterm premature rupture of membranes between the two groups (all P>0.05). (2) When gestational age at CL≤15 mm diagnosis was <26 weeks, pregnancy outcomes in the cervical cerclage group were better than those in the conservative treatment group, including gestational age at delivery (median: 35.4 vs 31.3 weeks) and prolonged gestational age (median: 11.1 vs 5.6 weeks), neonatal birth weight [(2 246±519) vs (1 594±691) g], incidence of adverse neonatal outcomes [19% (13/68) vs 56% (19/34)], and proportion of live births [100% (68/68) vs 82% (28/34)], respectively; the differences were statistically significant (all P<0.05). When the gestational age of CL≤15 mm diagnosis was ≥26 weeks, there were no statistically significant difference in pregnancy outcomes between the two groups (all P>0.05). (3) Multivariate logistic regression analysis showed that when the gestational age of CL≤15 mm diagnosis was <26 weeks, cervical cerclage reduced the risk of preterm birth before 34 weeks (a OR=0.10, 95% CI: 0.02-0.51; P<0.05), 32 weeks (a OR=0.11, 95% CI: 0.02-0.58; P<0.05) and 28 weeks (a OR=0.04, 95% CI: 0.01-0.65; P<0.05). When the gestational age of CL≤15 mm diagnosis was ≥26 weeks, cervical cerclage did not reduce the risk of preterm birth before 34, 32 and 28 weeks of gestation (all P>0.05). Conclusions:Cervical cerclage might reduce the risk of preterm birth and improve neonatal outcomes in twin pregnancies with CL≤15 mm before 26 weeks. However, cerclage showed no advantage over conservative treatment in twin pregnancies with CL≤15 mm over 26 weeks.

Objective:To compare the effect of two vs one stitch on outcomes in women with cervical incompetence who undergo emergency transvaginal cervical cerclage.Methods:A retrospective study was conducted on 38 cases of cervical incompetence patients who underwent emergency cervical cerclage at Fujian Maternity and Child Health Hospital from January 2018 to December 2022. These subjects were divided into two groups: one stitch group (loop continuous suture and knot at cervical-vaginal junction level) and two stitches group (the first loop was closed with a single suture set, and the second loop was closed below the first loop near the cervical outlet) with 19 cases in each group. Two independent samples t or t'-test, rank-sum test, Chi-square test and Fisher's exact test were used to compare the differences in perinatal outcomes between the two groups. Kaplan-Meier survival analysis was performed to evaluate the efficacy of the prolongation of gestational age after emergency transvaginal cervical cerclage. Results:There was no statistically significant difference in the gestational age at cervical cerclage between the two stitches and the one stitch group [24.9 weeks (23.9-25.9 weeks) vs 23.6 weeks (22.6-24.9 weeks), Z=－1.61, P=0.108]. The average gestational age at delivery [(33.1±4.8) vs (28.6±4.3) weeks, t=－3.10] and the prolongation of gestational age after cerclage[(8.5±4.6) vs (5.0±2.6) weeks, t=－2.90] were significantly greater in the two stitches group compared to those in the one stitch group, while the rates of preterm birth before 32 weeks (6/19 vs 16/19, χ2=10.80), 34 weeks (8/19 vs 17/19, χ2=9.47), and 37 weeks (14/19 vs 19/19, Fisher's exact test) were lower (all P<0.05). The Kaplan-Meier survival analysis demonstrated that the two stitches group had significantly higher efficacy in prolonging gestational age compared to the one stitch group [log-rank test χ2 (1)=13.10, P<0.05]. Although there was no statistically significant difference in the neonatal mortality between the two groups (2/19 vs 4/19, Fisher's exact test, P=0.660), survival neonates in the two stitches group had significantly higher birth weight [2 370.0 g (1 775.0-2 710.0 g) vs 1 300.0 g (1 210.0-1 660.0 g), Z=－3.14], lower admission rate to the neonatal intensive care unit (9/17 vs 15/15, Fisher's exact test), lower incidence of stage Ⅲ necrotizing enterocolitis (0/17 vs 5/15, Fisher's exact test), moderate-severe respiratory distress syndrome (5/17 vs 10/15, χ2=4.44), and grade Ⅲ-Ⅳ intraventricular hemorrhage (0/17 vs 7/15, Fisher's exact test) compared to those in the one stitch group (all P<0.05). Conclusion:Compared with emergency cervical cerclage with one stitch, the procedure with two stitches can prolong the gestational age and improve the neonatal prognosis more effectively.

Objective:To explore the clinical efficacy of ultrasound-indicated cervical cerclage in twin pregnancies.Methods:This retrospective cohort study included 96 asymptomatic twin pregnancies with cervix length (CL)≤2.5 cm at 16-27 +6 weeks indicated by transvaginal ultrasound from January 2013 to May 2022 in Fujian Maternity and Child Health Hospital. They received either cervical cerclage (cerclage group, n=45) or conservative treatment (conservative group, n=51). The subgroup analysis was further performed after stratifying the subjects into the CL≤1.0 cm subgroup, the CL>1.0-≤1.5 cm subgroup, and the CL>1.5 cm subgroup. Two independent samples t-test, Mann-Whitney U test, and Chi-square test were used to compare the differences in the pregnancy and perinatal outcomes between different groups. Multivariate logistic regression was used to analyze the impact of cervical cerclage on pregnancy outcomes of women with different CLs. Results:The average gestational age at delivery and the prolonged gestation were significantly greater in the cerclage group than those in the conservative group [35.9 (34.9-37.0) weeks vs 34.9 (29.1-36.1) weeks; 10.7 (9.6-13.1) weeks vs 8.7 (4.8-11.0) weeks, Z=－2.59 and -3.63, both P<0.05]. The incidences of preterm birth before 34 weeks and 28 weeks, chorioamnionitis, and preterm premature rupture of membrane were lower in the cerclage group than those in the conservative group [17.8% (8/45) vs 45.1% (23/51), χ2=8.16; 2.2% (1/45) vs 15.7% (8/51), Fisher' exact test; 8.9% (4/45) vs 25.5% (13/51), χ2=4.52; 15.6% (7/45) vs 33.3% (17/51), χ2=4.03; all P<0.05]. There were no statistically significant differences in the proportion of postpartum hemorrhage and live births between the two groups (both P>0.05). In the women with CL≤1.0 cm, the cerclage group had a greater gestational age at delivery [36.0 (34.8-37.3) weeks vs 34.9 (28.6-35.4) weeks, Z=－2.61, P=0.009], greater prolonged gestation [12.3 (9.7-13.9) weeks vs 7.3 (3.4-9.1) weeks, Z=－3.34, P=0.001], higher birthweight [2 430.0 (2 173.8-2 646.3) g vs 1 900.0 (1 372.5-2 435.0) g, Z=－3.06, P=0.002], lower incidence of adverse neonatal outcomes [16.7% (6/36) vs 36.7% (11/30), χ2=4.22, P=0.048] compared with the conservative group. Multivariate Logistic regression analysis showed that cerclage reduced the risks of preterm birth before 34 and 32 weeks [ aOR (95% CI)=0.083 (0.009-0.790) and 0.092 (0.009-0.939), both P<0.05]. However, cerclage did not reduce the risk of preterm birth in women with CL>1.5 cm or CL>1.0-≤1.5 cm (both P>0.05). Conclusion:Ultrasound- indicated cervical cerclage can reduce the risk of preterm birth before 34 and 32 weeks, prolong pregnancy, and improve perinatal outcomes in asymptomatic twin pregnancies with CL≤1.0 cm.

Objective:To investigate the incidence and risk factors associated with preterm premature rupture of membranes (PPROM) following transvaginal cervical cerclage.Methods:This retrospective cohort study involved 170 singleton pregnancies with cervical incompetence who underwent vaginal cervical cerclage at Fujian Maternity and Child Health Hospital from January 2021 to January 2022. Based on the onset of PPROM after cervical cerclage, the patients were divided into the PPROM group ( n=28) and the non-PPROM group ( n=142). Independent samples t-test, rank-sum test, Chi-square test, or Fisher's exact test were used to compare the general condition, pre- and postoperative data, pregnancy complications or comorbidities between the two groups, with a significance level at α=0.1. Multiple logistic regression analysis was conducted to identify the risk factors for PPROM after cerclage surgery. Results:The overall incidence of PPROM after vaginal cervical cerclage was 16.5% (28/170). Logistic regression analysis showed that a history of cervical conization ( OR=11.966, 95% CI:1.695-84.468), the use of Mersilene RS22 tape as the suture material ( OR=3.318, 95% CI:1.064-9.252), cervical length<2.5 cm after cerclage ( OR=3.486, 95% CI:1.116-10.888), and Mycoplasma genitalium- positive results for cervical secretion culture after surgery ( OR=4.856, 95% CI:1.487-15.861) were the independent risk factors for PPROM after cervical cerclage (all P<0.05). Conclusions:The incidence of PPROM following vaginal cervical cerclage is relatively high and can have unfavorable effects on pregnancy outcomes. Factors such as a history of cervical conization, the use of Mersilene RS22 tape for cerclage, cervical length<2.5 cm after cerclage, and Mycoplasma genitalium-positive results for cervical secretion culture after surgery may increase the risk of PPROM after cerclage.

Alcoholic liver disease(ALD)is the most frequent liver disease worldwide,resulting in severe harm to personal health and posing a serious burden to public health.Based on the reported antioxidant and anti-inflammatory capacities of scutellarin(SCU),this study investigated its protective role in male BALB/c mice with acute alcoholic liver injury after oral administration(10,25,and 50 mg/kg).The results indicated that SCU could lessen serum alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels and improve the histopathological changes in acute alcoholic liver;it reduced alcohol-induced malondialdehyde(MDA)content and increased glutathione peroxidase(GSH-Px),catalase(CAT),and superoxide dismutase(SOD)activity.Furthermore,SCU decreased tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and IL-1β messenger RNA(mRNA)expression levels,weakened inducible nitric oxide synthase(iNOS)activity,and inhibited nucleotide-binding oligomerization domain(NOD)-like receptor protein 3(NLRP3)inflammasome activation.Mechanistically,SCU suppressed cytochrome P450 family 2 subfamily E member 1(CYP2E1)upregulation triggered by alcohol,increased the expression of oxidative stress-related nuclear factor erythroid 2-related factor 2(Nrf2)and heme oxygenase-1(HO-1)pathways,and suppressed the inflammation-related degradation of inhibitor of nuclear factor-κB(NF-κB)-α(IκBα)as well as activation of NF-κB by mediating the protein kinase B(AKT)and p38 mitogen-activated protein kinase(MAPK)pathways.These findings demonstrate that SCU protects against acute alcoholic liver injury via inhibiting oxidative stress by regulating the Nrf2/HO-1 pathway and suppressing inflammation by regulating the AKT,p38 MAPK/NF-κB pathways.

Sophorae Flavescentis Radix,derived from the root of Sophora flavescens in the Leguminosae family,has been widely used in the medicine,agriculture,animal husbandry,and daily chemical industry. A pharmacophore model-based method for rapid discovery of tyrosinase inhibitors( TIs) from S. flavescens was established by molecular docking under Lipinski rules,and verified by enzyme assays. Briefly,the chemical constituent database of S. flavescens( CDSF) was established based on the previous papers. Theoptimal pharmacophore model( OPM) was constructed by DS 2019 on the basis of known active TIs. Eighty-three hits predominated by flavonoids having higher fitting scores with OPM than the positive control were screened out,and subjected to molecular docking based on the three-dimensional structure of tyrosinase crystal protein. The potential TIs such as kurarinone and nor-kurarinone were rapidly discovered from the compounds with higher docking scores than the positive control under the Lipinski rules. The results were verified by the in vitro enzyme assays. The inhibition activities of tyrosinase from non-medicinal parts of S. flavescens were also tested to explore the relationship between the inhibition activity and chemical compositions. This study is expected to provide data support for the comprehensive application and development of S. flavescens and also a new method for the rapid discovery of active substances or functional constituents in the complex systems.
Animals ; Flavonoids ; Molecular Docking Simulation ; Monophenol Monooxygenase ; Plant Extracts/pharmacology* ; Plant Roots ; Sophora

To define the composition of relevant substances in Breviscapine for Injection, in order to improve the quality control of impurity, and ensure the clinical safety. The analysis and structural identification of relevant substances in different specifications and batches of Breviscapine for Injection powders were carried out by HPLC and UPLC-QTOF-MS. Three primary relevant substances, namely 5,6,7,3',4'-pentahydroxyflavone-7-O-glucuronide(3), 3,5,6,7,4'-pentahydroxyflavone-3-O-glucuronide(4) and scutellarein(10), as well as three minor impurities, namely 6-hydroxyapigenin-6-O-glucosyl-7-O-glucuronide(1), methoxylscutellarin(6) and apigenin-7-O-glucuronide(7) were structurally identified by matching retention time, UV spectra, and mass spectra with authentic compounds and MS fragmentation rules. The main relevant substances(3) and(4) were separated and purified by semi-preparative HPLC, and their structures were further confirmed by NMR data. The study defined relevant substances of Breviscapine for Injection, and provided reference for improving the quality control level of single impurity in breviscapine preparation.
Apigenin/analysis* ; Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal/standards* ; Flavonoids/chemistry* ; Glucuronides/analysis* ; Injections ; Magnetic Resonance Spectroscopy ; Mass Spectrometry ; Quality Control

Background: Little study has investigated the differences between Talatomyces marneffei (T. marneffei) respiratory infection and tuberculosis and the prognostic factors of such infection. This study investigated the characteristics and prognostic factors of T. marneffei infections with respiratory lesions and the causes of misdiagnosis. Methods: Clinical characteristics and prognoses of patients with T. marneffei infections with respiratory system lesion were investigated. T. marneffei diagnosis followed isolation from clinical specimens using standard culture, cytology, and histopathology. Survival curves were estimated by using Kaplan-Meier analysis, with log-rank test to compare differences in survival rates between groups. Univariate and multivariate Cox regression analyses were also performed to assess significant differences in clinical characteristics of overall survival. Results: Of 126 patients diagnosed with T. marneffei infections, 63 (50.0%) had T. marneffei respiratory system infections; 38.1% (24/63) were misdiagnosed as having tuberculosis. Human immunodeficiency virus (HIV) infection, CD4/CD8 < 0.5, percentage of CD4⁺ T cells <42.8%, and length of time from onset to confirmation of diagnosis >105 days were potential risk factors for poor prognoses. Length of time from onset to confirmation of diagnosis persisted as an independent predictor of all-cause mortality in multivariate analysis (odds ratio: 0.083, 95.0% confidence interval: 0.021–0.326, P < 0.001). However, the size of the lung lesions, dyspnea, thoracalgia, mediastinal lymphadenopathy, and pleural effusion did not significantly predict overall survival. There was no significant difference in prognosis according to the type of treatment. Conclusions T. marneffei infections involving the respiratory system are common. The critical determinants of prognosis are HIV infection, CD4/CD8, percentage of CD4⁺ T cells, type of treatment, and the time range from onset to confirmation of diagnosis. Rapid and accurate diagnosis is crucial for improving prognosis.

Objective: To explore the effect of Feng-liao-chang-wei-kang (FLCWK) on acute and chronic gastroenteritis, synergistic effect on the growth inhibitory effect with 5-fluorouracil (5-FU) on colorectal cancer and its underlying mechanisms. Methods: In the in vitro study, HT-29 cells were divided into 5-FU alone, FLCWK alone and coadministration groups. The MTT assay was used to analyze the proliferation of HT-29 cells at 24 h. Flow cytometry was used to observe the apoptosis, cycle of colorectal cancer HT-29 cells at 24 h. In the in vivo experiment, The subcutaneous transplantation tumor model of colorectal cancer HT-29-Luc was established with nude mice. All mice were randomly divided into 5-FU alone, FLCWK alone and coadministration groups according to body weight. During administration, the Interactive Video Information System small animal live imaging system was used to monitor the growth of subcutaneous transplantation in nude mice. The model of colitis-associated colorectal cancer (CACC) was established with BALB/c mice. BALB/c mice were randomly divided into the normal control group, the model control group, and the FLCWK group. At the end of the administration, the pathological status was detected by HE staining. Cell apoptosis of tumor tissue tumor and colon tissues were observed by TUNEL staining and TUNEL green fluorescence. The protein expression of Caspase 3, p-STAT3, Bcl-2, Bax and P-gp in tumor tissues tumor and colon tissues were tested by using immunohistochemical assay. Results: FLCWK and 5-FU coadministration suppressed HT-29 cell viability and induced S phase arrest and apoptosis compared to treatment with 5-FU alone. Furthermore, compared to treatment with 5-FU alone, coadministration of FLCWK and 5-FU obviously reduced tumor volume and weight and induced apoptosis through decreasing p-STAT3 and P-gp and increasing Caspase 3 protein expression in a murine xenograft tumor model. Moreover, the result revealed decreased number and size of tumors following FLCWK protective administration, downregulated p-STAT3 and Bcl-2 levels and upregulated Bax and Caspase 3 expression in mice with CACC. Conclusions: FLCWK has synergistic effects with 5-FU on colorectal cancer by suppressing the STAT3 pathway and downregulating P-gp expression. Furthermore, FLCWK administration suppresses CACC tumorigenesis by inhibiting the STAT3 pathway.