Objective:To explore the factors influencing the success of external cephalic version(ECV)and to construct a nomogram prediction model.Methods:The clinical and imaging data of 269 pregnant women who un-derwent ECV by two obstetricians in the Department of Obstetrics,Women and Children's Hospital,School of Medicine,Xiamen University,from 1 July 2018 to 31 July 2023 were collected,and 215 cases were selected as the training set and 54 cases as the validation set.According to the ECV outcome,the patients were divided into the success group(160 cases)and the failure group(55 cases)in the training set.A multifactorial Logistic regression analysis was performed to establish an ECV success rate prediction model and draw a nomogram.The perform-ance and accuracy of the model was evaluated and verified using the receiver operating characteristic(ROC)curve,calibration curve and the clinical decision curve(DCA).Results:ECV was performed in 269 pregnant women,with a total success rate of 75.46%,and the success rate of menstruating mothers(81.11%)was higher than that of primigravid women(64.04%),with a statistically significant difference(P<0.05).Multifactorial Logistic regression analysis showed that amniotic fluid index(AFI),placenta position,palpability of the fetal head,direction of the fetal back,and whether the fetal presentation engages the pelvis were independent factors affecting the success of ECV(P<0.05).The above five factors were used to construct a nomogram model with the area under the ROC curve(AUC)was 0.906,and the AUC for the validation set of this model was 0.831.Conclusions:The nomogram model for predicting the success rate of external cephalic version constructed has good accuracy and high clinical application value.

Objective:To explore the factors influencing the success of external cephalic version(ECV)and to construct a nomogram prediction model.Methods:The clinical and imaging data of 269 pregnant women who un-derwent ECV by two obstetricians in the Department of Obstetrics,Women and Children's Hospital,School of Medicine,Xiamen University,from 1 July 2018 to 31 July 2023 were collected,and 215 cases were selected as the training set and 54 cases as the validation set.According to the ECV outcome,the patients were divided into the success group(160 cases)and the failure group(55 cases)in the training set.A multifactorial Logistic regression analysis was performed to establish an ECV success rate prediction model and draw a nomogram.The perform-ance and accuracy of the model was evaluated and verified using the receiver operating characteristic(ROC)curve,calibration curve and the clinical decision curve(DCA).Results:ECV was performed in 269 pregnant women,with a total success rate of 75.46%,and the success rate of menstruating mothers(81.11%)was higher than that of primigravid women(64.04%),with a statistically significant difference(P<0.05).Multifactorial Logistic regression analysis showed that amniotic fluid index(AFI),placenta position,palpability of the fetal head,direction of the fetal back,and whether the fetal presentation engages the pelvis were independent factors affecting the success of ECV(P<0.05).The above five factors were used to construct a nomogram model with the area under the ROC curve(AUC)was 0.906,and the AUC for the validation set of this model was 0.831.Conclusions:The nomogram model for predicting the success rate of external cephalic version constructed has good accuracy and high clinical application value.

Objective:To study the risk factors of adverse pregnancy outcomes for the diagnosis and treatment of pregnancy after cesarean section complicated with placenta previa.Methods:A national multicenter retrospective study was conducted to select a total of 747 pregnant women with the third trimester singleton pregnancy after cesarean section complicated with placenta previa from 12 tertiary hospitals in January 1st to December 31st, 2018. The risk factors of severe adverse outcomes [hysterectomy, intraoperative blood loss ≥1 000 ml, intraoperative diagnosis of placenta accreta spectrum disorders (PAS)] in pregnant women with second pregnancy complicated with placenta previa after cesarean section were investigated by logistic regression analysis. The roles of prenatal ultrasonography and magnetic resonance imaging (MRI) in the prediction of PAS and severe adverse outcomes were observed. According to whether vascular intervention was performed (uterine artery embolization or abdominal aortic balloon occlusion), the pregnant women were divided into the blocked group and the unblocked group, and the maternal and infant perinatal outcomes between the two groups were compared.Results:(1) General information: the hysterectomy rate of 747 pregnant women with second pregnancy complicated with placenta previa after cesarean section was 10.4% (78/747), the intraoperative blood loss ≥1 000 ml in 55.8% (417/747), and PAS was confirmed in 47.5% (355/747). The incidence of uterine rupture was 0.8% (6/747). (2) Analysis of risk factors for severe adverse outcomes: based on binary unconditioned logistic regression univariate and multivariate analysis, the risk factors for hysterectomy were the mode of vascular embolization and intraoperative blood loss. The probability of hysterectomy with uterine artery embolization was 5.319 times higher than that with abdominal aortic balloon occlusion (95% CI: 1.346-21.018). The risk factors of intraoperative blood loss ≥1 000 ml were the number of cesarean section delivery, ultrasonography indicated PAS and suspected PAS, intraoperative PAS and complete placenta previa. The risk factors for intraoperative PAS were uterine scar thickness, ultrasonography indicated PAS and suspected PAS, MRI indicated PAS and suspected PAS, and complete placenta previa. (3) The roles of ultrasonography and MRI in predicting PAS: the sensitivity and specificity of ultrasonography in predicting PAS were 47.5% and 88.4%; the kappa value was 0.279 ( P<0.001), with fair agreement. The sensitivity and specificity of MRI to predict PAS were 79.2% and 97.8%, respectively. The kappa value was 0.702 ( P<0.001), indicating a good agreement. The intraoperative blood loss and hysterectomy rate of pregnant women with PAS indicated by ultrasonography and MRI were significantly higher than those with PAS only by ultrasonography or MRI. (4) Influence of vascular occlusion on pregnancy outcome: there were no significant differences in intraoperative blood loss and incidence of intraoperative bleeding ≥1 000 ml between the blocked group and the unblocked group (all P>0.05). There was no significant difference in intraoperative blood loss between the pregnant women with abdominal aortic balloon occlusion, uterine artery embolization and those without occlusion ( P=0.409). The hysterectomy rate of pregnant women with uterine artery embolization was significantly higher than those with abdominal aortic balloon occlusion [39.3% (22/56) vs 10.0% (5/50), P=0.001]. Conclusions:In the third trimester of pregnancy with placenta previa after cesarean section, MRI examination has better consistency in predicting PAS than ultrasonography examination. Ultrasonography examination combined with MRI examination could effectively predict the hysterectomy rate and intraoperative blood loss. Vascular occlusion could not reduce the amount of intraoperative blood loss. The hysterectomy rate of pregnant women with uterine artery embolization is higher than those with abdominal aortic balloon occlusion.

Objective:To evaluate the efficacy of quantitative fecal immunochemical test (fecal immunochemical test, FIT) in the screening of colorectal cancer and precancerous lesions.Methods:47 243 patients who underwent quantitative FIT screening for colorectal cancer in the Health Management Department of Shenzhen People′s Hospital from January 2019 to October 2020 were enrolled as subjects. Colonoscopy was recommended for patients with positive quantitative FIT. A follow-up was done after one year to compare the results of the quantitative FIT positive group and the negative group after colonoscopy. Data were adjusted by propensity score matching method and a receiver operating characteristic curve ( ROC) was established to evaluate the diagnostic effect of quantitative FIT combined with colonoscopy on colorectal cancer and precancerous lesions. Results:A hemoglobin concentration>100 μg/L was set as a positive threshold. There were 2 472 positive cases of quantitative FIT, and the positive rate was 5.23%. After one-year follow-up, 284 patients had completed colonoscopy; the colonoscopy compliance was 11.49%. Of the negative population, 1 493 patients selected colonoscopy within one year. Compared with the results of gold standard colonoscopy, the sensitivity and specificity of quantitative FIT for screening for advanced adenoma and cancer were 26.53% and 86.54%, respectively. The sensitivity for colorectal cancer screening was 94.44% and screening for advanced adenoma was 22.77%. After propensity score matching, there were 256 FIT positive patients and 705 FIT negative patients. Colorectal cancer was the outcome variable, while FIT combined with colonoscopy, age combined with colonoscopy, and FIT combined with age combined with colonoscopy were the diagnostic indicators. The areas under the curve were 0.841(95% CI:0.778-0.904), 0.677(95% CI: 0.535-0.820), and 0.882(95% CI:0.807-0.958), respectively. Conclusion:Quantitative FIT has a high susceptibility to opportunistic screening for colorectal cancer, and a low sensitivity to advanced adenoma. At the same time, quantitative FIT combined with colonoscopy has a good diagnostic accuracy for colorectal cancer, which is better than the effect of using age as a cut-off point for colonoscopy. Quantitative FIT combined with age and colonoscopy has the best effect on screening for colorectal cancer. Quantitative FIT has a high sensitivity to colorectal cancer and a low sensitivity to advanced adenoma.

Objective:To evaluate the effect of combined teaching of optical laryngoscope and general laryngoscope on anesthesia undergraduate practice.Methods:A total of 40 anesthesia undergraduate students were randomly divided into group A (using the optical laryngocope only in the first month and the general laryngoscope only in the second month, n=20), and group B (using the general laryngocope only in the first month and the optical laryngoscope only in the second month, n=20). The teaching effect was evaluated through the first month and the second month of tracheal intubation assessment and questionnaire survey results. SPSS 23.0 was used for t test and chi-square test. Results:In the first month, the success rate was 90% in group A and 60% in group B, which showed that the success rate of group B was lower, with significant differences ( P < 0.05). The time for tracheal intubation in group A was (61.8±5.0) s, and that in the group B was (83.0±4.9) s, showing that the time of group B was longer, with significant differences ( P < 0.05). The complications in group A was 5%, and that in group B was 14%, showing that the group B had more cases of implications, with significant differences ( P < 0.05). In the second month, there was no significant difference in the one-time success rate, the time for tracheal intubation, and complications between the two groups ( P > 0.05). There was no significant difference in one-time success rate and complications between groups. Both groups showed that the time for general laryngoscope intubation was longer, with significant differences ( P < 0.05). All of the students believed that applying optical laryngoscope teaching was beneficial and could enhance the interest of learning, and the combination of the two methods was better. Conclusion:Using the optical laryngoscope first and then the general laryngoscope teaching is more beneficial for students to master the two methods of tracheal intubation, improve the success rate, reduce complications, and cultivates their self-confidence.

Objective:To study the risk factors of adverse pregnancy outcomes for induced abortion of cesarean scar pregnancy in midtrimester.Methods:A national multicenter retrospective study was conducted. A total of 154 singletons pregnant women with cesarean scar pregnancy during the second trimester induced abortion by various reasons in 12 tertiary A hospitals were selected, their pregnant outcomes were observed and the risk factors of serious adverse outcomes were analyzed with univariate and multivariate logstic regression; the role of ultrasound and MRI in predicting placenta accreta and severe adverse outcomes was evaluated, the effectiveness of uterine artery embolization (UAE) in preventing hemorrhage in pregnant women with and without placenta accreta was compared.Results:Among 154 subjects, the rate of placenta accreta was 42.2% (65/154), the rate of postpartum hemorrhage≥1 000 ml was 39.0% (60/154), the rate of hysterectomy was 14.9% (23/154), the rate of uterine rupture was 0.6% (1/154). The risk factor of postpartum hemorrhage≥1 000 ml and hysterectomy was placenta accreta ( P<0.01). For each increase in the number of parity, the risk of placenta accreta increased 2.385 times (95% CI: 1.046-5.439; P=0.039); and the risk of placenta accreta decreased with increasing ultrasound measurement of scar myometrium thickness ( OR=0.033, 95% CI: 0.001-0.762; P=0.033). The amount of postpartum hemorrhage and hysterectomy rate in the group with placenta accreta diagnosed by ultrasound combined with MRI were not significantly different from those in the group with placenta accreta diagnosed by ultrasound only or MRI only (all P>0.05). For pregnant women with placenta accreta, there were no significant difference in the amount of bleeding and hysterectomy rate between the UAE group [median: 1 300 ml; 34% (16/47)] and the non-embolization group (all P>0.05); in pregnant women without placenta accreta, the amount of bleeding in the UAE group was lower than that in the non-embolization group (median: 100 vs 600 ml; P<0.01), but there was no significant difference in hysterectomy rate [2% (1/56) vs 9% (3/33); P>0.05]. Conclusions:(1) Placenta accreta is the only risk factor of postpartum hemorrhage≥1 000 ml with hysterectomy for induced abortion of cesarean scar pregnancy in midtrimester; multi-parity and ultrasound measurement of scar myometrium thickness are risk factors for placenta accreta. (2) The technique of using ultrasound and MRI in predicting placenta accreta of cesarean scar pregnancy needs to be improved. (3) It is necessary to discuss of UAE in preventing postpartum hemorrhage for induced abortion of cesarean scar pregnancy in midtrimester.

Objective:To investigate the microRNA (miRNA) expression features in ectopic endometrial tissues of endometriosis (EMS) patients.Methods:From April 2018 to October 2019, ectopic endometrial tissues from EMS patients and eutopic endometrial tissues from control women who received treatment in the Department of Obstetrics and Gynecology of The First Affiliated Hospital of Xiamen University were used in subsequent experiments. Differentially expressed miRNAs were screened out in ectopic endometrial tissues by detecting miRNA sequence from Illumina. The potential roles of these differentially expressed miRNAs and their potential targeted genes in pathogenesis of EMS were analyzed by bioinformatics, and the differential expression levels of 6 miRNAs (miR-98-5p, miR-495-3p, let-7c-5p, miR-200b-3p, miR-200c-3p, miR-148b-3p) were validated by quantitative real-time polymerase chain reaction (qRT-PCR) and subsequently used to build the miRNA-gene regulatory network, then we verified its potential target gene.Results:The microarray results showed that 69 miRNAs might be differentially expressed in ectopic endometrial tissues compared with those in eutopic endometrial tissues (fold change>1.5, P<0.05), including 22 up-regulated miRNAs and 47 down-regulated miRNAs. Gene ontology (GO) analysis showed that the target genes of these differentially expressed miRNAs mainly participated in the protein modification, regulation of development, cell metabolism and morphological structure. KEGG pathway analysis showed that these targeted genes were involved in protein function, autophagy, AGE-RAGE and MAPK signaling pathways. The expression levels of miR-98-5p, let-7c-5p, miR-200b-3p and miR-200c-3p were validated to be significantly altered in ectopic endometrial tissues. The miRNA-gene co-expression network revealed the correlation between the 4 miRNAs and their predicted target genes. qRT-PCR validated results showed that the expression of miR-200b-3p and miR-200c-3p were significantly negatively correlated with ZEB2, while miR-98-5p was negatively correlated with PGRMC1, miR-98-5p and let-7c-5p were positively correlated with ADIPOR2. Conclusion:MiR-98-5p, let-7c-5p, miR-200b-3p and miR-200c-3p were significantly differentially expressed in the ectopic endometrial tissues of EMS patients, which may be involved in the development of EMS.

Objective:To investigate the microRNA (miRNA) expression features in ectopic endometrial tissues of endometriosis (EMS) patients.Methods:From April 2018 to October 2019, ectopic endometrial tissues from EMS patients and eutopic endometrial tissues from control women who received treatment in the Department of Obstetrics and Gynecology of The First Affiliated Hospital of Xiamen University were used in subsequent experiments. Differentially expressed miRNAs were screened out in ectopic endometrial tissues by detecting miRNA sequence from Illumina. The potential roles of these differentially expressed miRNAs and their potential targeted genes in pathogenesis of EMS were analyzed by bioinformatics, and the differential expression levels of 6 miRNAs (miR-98-5p, miR-495-3p, let-7c-5p, miR-200b-3p, miR-200c-3p, miR-148b-3p) were validated by quantitative real-time polymerase chain reaction (qRT-PCR) and subsequently used to build the miRNA-gene regulatory network, then we verified its potential target gene.Results:The microarray results showed that 69 miRNAs might be differentially expressed in ectopic endometrial tissues compared with those in eutopic endometrial tissues (fold change>1.5, P<0.05), including 22 up-regulated miRNAs and 47 down-regulated miRNAs. Gene ontology (GO) analysis showed that the target genes of these differentially expressed miRNAs mainly participated in the protein modification, regulation of development, cell metabolism and morphological structure. KEGG pathway analysis showed that these targeted genes were involved in protein function, autophagy, AGE-RAGE and MAPK signaling pathways. The expression levels of miR-98-5p, let-7c-5p, miR-200b-3p and miR-200c-3p were validated to be significantly altered in ectopic endometrial tissues. The miRNA-gene co-expression network revealed the correlation between the 4 miRNAs and their predicted target genes. qRT-PCR validated results showed that the expression of miR-200b-3p and miR-200c-3p were significantly negatively correlated with ZEB2, while miR-98-5p was negatively correlated with PGRMC1, miR-98-5p and let-7c-5p were positively correlated with ADIPOR2. Conclusion:MiR-98-5p, let-7c-5p, miR-200b-3p and miR-200c-3p were significantly differentially expressed in the ectopic endometrial tissues of EMS patients, which may be involved in the development of EMS.

Objective:To explore the effect of Iowa evidence practice mode-based management program on the swallowing function in stroke patients.Methods:A total of 88 stroke patients in affiliated hospital of North Sichuan Medical College from April 2017 to April 2018 were recruited in the present study. Patients were randomly divided into experimental group (44 cases) and control group (44 cases) according to the random number table. The control group received routine nursing, while the Iowa evidence practice mode-based management program was carried our in the experimental group. After 30 days of intervention, the swallowing function was assessed by water swallow test, quality of life was evaluated by Short form of 36, the incidence of aspiration pneumonia was also compared between groups.Results:After intervention, the grade 1 patients in water swallow test were up to 29.3%(12/41) in the experimental group, and 18.6%(8/43) in the control group, the water swallow test was better in the experimental group compared to the control group ( Z value was 2.332, P<0.05). After intervention, the scores of vitality, social functioning, role-emotional, mental health were significantly increased in the experimental group compared to the control group (61.39±13.07, 60.44±10.89, 62.07±14.82, 64.78±15.24, 446.15±42.06 vs. 53.19±14.77, 50.09±13.15, 53.91±16.72, 57.81±16.34, 410.98±35.81), the difference was statistically significant ( t value was 2.018-4.133, P<0.01 or 0.05). The incidence of aspiration pneumonia was significantly decreased in the experimental group (2.4%,1/41) compared to the control group (16.3%,7/43), the difference was statistically significant ( χ2 value was 4.666, P<0.05). Conclusions:Iowa evidence practice mode-based management program can promote the swallowing function of stroke patients, as well as promote improve quality of life and decrease the incidence of aspiration pneumonia. It serves as an instruction for clinical intervention.

Objective:To analyze the clinical features of cystic fibrosis (CF) associated allergic bronchopulmonary aspergillosis (ABPA) in children.Methods:A retrospective study was performed in 22 children who were diagnosed with CF associated ABPA in Beijing Children′s Hospital affiliated to Capital Medical University from March 2010 to March 2020. The clinical features, imaging characteristics, laboratory results and the prognosis were reviewed.Results:A total of 22 cases met the diagnostic criterion, including 12 males and 10 females. The age of diagnosis was (10.4±2.8) years and the age of onset was (5.5±4.4) years. Clinical manifestations included cough and expectoration (22 cases), recurrent wheezing (15 cases), hemoptysis (7 cases), failure to thrive (12 cases), pancreatitis (10 cases), hepatomegaly (7 cases), splenomegaly (4 cases) and steatorrhea (4 cases). CT scans of all the patients showed pulmonary infiltrates and central bronchiectasis, combined with mucoid impaction in 17 cases and high density mucus plug in 12 cases. Eosinophilia was found in 18 patients. Total IgE and serum levels of A. fumigatus-specific IgE were elevated in all 22 patients. Positive culture of sputum or bronchoalvedar lauage fluid for fungus were in 15 cases, with single Aspergillus infection in 8 cases and mixed Aspergillus infection in 3 cases. The predominant bacteria found in the airways were Pseudomonas aeruginosa (17 cases), followed by staphylococcas. aureus (6 cases) and stenotrophomonas. maltophilia (5 cases). Pulmonary function revealed obstructive ventilation dysfunction in 4 cases, mixed dysfunction in 11 cases, and small airway dysfunction in 4 cases. Regarding the treatment, 3 were treated only with systemic corticosteroid, while the remaining 19 cases also received antifungal agents.The follow up continued for 1-7 years, and 6 maintained remission, 10 had recurrent episodes, 1 died, and 5 lost to follow up. Conclusions:CF associated ABPA is extremely rare in China. The overlapping clinical, radiographic, and immunologic features of these two diseases make the diagnosis challenging. Systemic corticosteroids are considered the first-line therapy for these patients, and adjuvant antifungal agents may be helpful. Recurrence rate in our center is high.