Objective:To combine and improve two kinds of classical transvaginal cervical cerclage,and to provide a new reference for the clinical treatment of patients with cervical insufficiency(CIC).Methods:Retro-spective analysis was performed on the clinical data of 117 patients who underwent transvaginal cervical cerclage due to CIC from January 1,2018 to August 31,2023 in the Second Affiliated Hospital of Kunming Medical Univer-sity.According to different surgical methods,the patients were divided into the modified cerclage group(40 ca-ses),the McDonald cerclage group(40 cases)and the Shirodkar cerclage group(37 cases).Intraoperative and postoperative conditions and pregnancy outcomes were compared.Univariate and multivariate Logistic regression analysis was performed to analyze the related factors of preterm birth after modified cervical cerclage and the oth-er two groups of classical cervical cerclage.Results:①Compared with the McDonald cerclage group,the modified cerclage group had longer effective cervical length,longer delivery and gestational weeks,higher term delivery rate,and shorter post-operative contraction inhibitor time,with statistical significance(P＜0.05).Compared with the Shirodkar cerclage group,the operation time of patients in the modified cerclage was significantly shortened,the amount of intraoperative blood loss was reduced,the use time of postoperative contraction inhibitors was shortened,and the rate of postoperative wire-cutting was decreased,with statistical significance(P＜0.05).②Multivariate Logistic regression analysis of preterm birth showed that the longer the length of the cervix and the later gestational age when the modified cervical cerclage was performed with reference to McDonald's cerclage,the longer the length of the cervix after surgery,the later the gestational age when the suture was removed.The risk of preterm birth was reduced(OR＜1,P＜0.05),while preoperative BMI≥24 kg/m2 was associated with an increased risk of preterm birth(OR＞1,P＜0.05).Using Shirodkar's cerclage as reference,the risk of preterm delivery was consistent between the two types of cervix(P＞0.05).Longer cervical length and later gestational age after suture removal reduced the risk of preterm delivery(OR＜1,P＜0.05).Conclusions:The modified transvaginal cervical cerclage is simple and safe in clinical application,it has certain advantages in improving ad-verse pregnancy outcomes of pregnant women,which provides a new reference for the treatment of pregnant women with CIC.Due to the small number of cases included in the study,comprehensive evaluation by clinicians is still needed for clinical application.

Objective:To combine and improve two kinds of classical transvaginal cervical cerclage,and to provide a new reference for the clinical treatment of patients with cervical insufficiency(CIC).Methods:Retro-spective analysis was performed on the clinical data of 117 patients who underwent transvaginal cervical cerclage due to CIC from January 1,2018 to August 31,2023 in the Second Affiliated Hospital of Kunming Medical Univer-sity.According to different surgical methods,the patients were divided into the modified cerclage group(40 ca-ses),the McDonald cerclage group(40 cases)and the Shirodkar cerclage group(37 cases).Intraoperative and postoperative conditions and pregnancy outcomes were compared.Univariate and multivariate Logistic regression analysis was performed to analyze the related factors of preterm birth after modified cervical cerclage and the oth-er two groups of classical cervical cerclage.Results:①Compared with the McDonald cerclage group,the modified cerclage group had longer effective cervical length,longer delivery and gestational weeks,higher term delivery rate,and shorter post-operative contraction inhibitor time,with statistical significance(P＜0.05).Compared with the Shirodkar cerclage group,the operation time of patients in the modified cerclage was significantly shortened,the amount of intraoperative blood loss was reduced,the use time of postoperative contraction inhibitors was shortened,and the rate of postoperative wire-cutting was decreased,with statistical significance(P＜0.05).②Multivariate Logistic regression analysis of preterm birth showed that the longer the length of the cervix and the later gestational age when the modified cervical cerclage was performed with reference to McDonald's cerclage,the longer the length of the cervix after surgery,the later the gestational age when the suture was removed.The risk of preterm birth was reduced(OR＜1,P＜0.05),while preoperative BMI≥24 kg/m2 was associated with an increased risk of preterm birth(OR＞1,P＜0.05).Using Shirodkar's cerclage as reference,the risk of preterm delivery was consistent between the two types of cervix(P＞0.05).Longer cervical length and later gestational age after suture removal reduced the risk of preterm delivery(OR＜1,P＜0.05).Conclusions:The modified transvaginal cervical cerclage is simple and safe in clinical application,it has certain advantages in improving ad-verse pregnancy outcomes of pregnant women,which provides a new reference for the treatment of pregnant women with CIC.Due to the small number of cases included in the study,comprehensive evaluation by clinicians is still needed for clinical application.

Objective:To combine and improve two kinds of classical transvaginal cervical cerclage,and to provide a new reference for the clinical treatment of patients with cervical insufficiency(CIC).Methods:Retro-spective analysis was performed on the clinical data of 117 patients who underwent transvaginal cervical cerclage due to CIC from January 1,2018 to August 31,2023 in the Second Affiliated Hospital of Kunming Medical Univer-sity.According to different surgical methods,the patients were divided into the modified cerclage group(40 ca-ses),the McDonald cerclage group(40 cases)and the Shirodkar cerclage group(37 cases).Intraoperative and postoperative conditions and pregnancy outcomes were compared.Univariate and multivariate Logistic regression analysis was performed to analyze the related factors of preterm birth after modified cervical cerclage and the oth-er two groups of classical cervical cerclage.Results:①Compared with the McDonald cerclage group,the modified cerclage group had longer effective cervical length,longer delivery and gestational weeks,higher term delivery rate,and shorter post-operative contraction inhibitor time,with statistical significance(P＜0.05).Compared with the Shirodkar cerclage group,the operation time of patients in the modified cerclage was significantly shortened,the amount of intraoperative blood loss was reduced,the use time of postoperative contraction inhibitors was shortened,and the rate of postoperative wire-cutting was decreased,with statistical significance(P＜0.05).②Multivariate Logistic regression analysis of preterm birth showed that the longer the length of the cervix and the later gestational age when the modified cervical cerclage was performed with reference to McDonald's cerclage,the longer the length of the cervix after surgery,the later the gestational age when the suture was removed.The risk of preterm birth was reduced(OR＜1,P＜0.05),while preoperative BMI≥24 kg/m2 was associated with an increased risk of preterm birth(OR＞1,P＜0.05).Using Shirodkar's cerclage as reference,the risk of preterm delivery was consistent between the two types of cervix(P＞0.05).Longer cervical length and later gestational age after suture removal reduced the risk of preterm delivery(OR＜1,P＜0.05).Conclusions:The modified transvaginal cervical cerclage is simple and safe in clinical application,it has certain advantages in improving ad-verse pregnancy outcomes of pregnant women,which provides a new reference for the treatment of pregnant women with CIC.Due to the small number of cases included in the study,comprehensive evaluation by clinicians is still needed for clinical application.

Objective:To combine and improve two kinds of classical transvaginal cervical cerclage,and to provide a new reference for the clinical treatment of patients with cervical insufficiency(CIC).Methods:Retro-spective analysis was performed on the clinical data of 117 patients who underwent transvaginal cervical cerclage due to CIC from January 1,2018 to August 31,2023 in the Second Affiliated Hospital of Kunming Medical Univer-sity.According to different surgical methods,the patients were divided into the modified cerclage group(40 ca-ses),the McDonald cerclage group(40 cases)and the Shirodkar cerclage group(37 cases).Intraoperative and postoperative conditions and pregnancy outcomes were compared.Univariate and multivariate Logistic regression analysis was performed to analyze the related factors of preterm birth after modified cervical cerclage and the oth-er two groups of classical cervical cerclage.Results:①Compared with the McDonald cerclage group,the modified cerclage group had longer effective cervical length,longer delivery and gestational weeks,higher term delivery rate,and shorter post-operative contraction inhibitor time,with statistical significance(P＜0.05).Compared with the Shirodkar cerclage group,the operation time of patients in the modified cerclage was significantly shortened,the amount of intraoperative blood loss was reduced,the use time of postoperative contraction inhibitors was shortened,and the rate of postoperative wire-cutting was decreased,with statistical significance(P＜0.05).②Multivariate Logistic regression analysis of preterm birth showed that the longer the length of the cervix and the later gestational age when the modified cervical cerclage was performed with reference to McDonald's cerclage,the longer the length of the cervix after surgery,the later the gestational age when the suture was removed.The risk of preterm birth was reduced(OR＜1,P＜0.05),while preoperative BMI≥24 kg/m2 was associated with an increased risk of preterm birth(OR＞1,P＜0.05).Using Shirodkar's cerclage as reference,the risk of preterm delivery was consistent between the two types of cervix(P＞0.05).Longer cervical length and later gestational age after suture removal reduced the risk of preterm delivery(OR＜1,P＜0.05).Conclusions:The modified transvaginal cervical cerclage is simple and safe in clinical application,it has certain advantages in improving ad-verse pregnancy outcomes of pregnant women,which provides a new reference for the treatment of pregnant women with CIC.Due to the small number of cases included in the study,comprehensive evaluation by clinicians is still needed for clinical application.

Objective:To combine and improve two kinds of classical transvaginal cervical cerclage,and to provide a new reference for the clinical treatment of patients with cervical insufficiency(CIC).Methods:Retro-spective analysis was performed on the clinical data of 117 patients who underwent transvaginal cervical cerclage due to CIC from January 1,2018 to August 31,2023 in the Second Affiliated Hospital of Kunming Medical Univer-sity.According to different surgical methods,the patients were divided into the modified cerclage group(40 ca-ses),the McDonald cerclage group(40 cases)and the Shirodkar cerclage group(37 cases).Intraoperative and postoperative conditions and pregnancy outcomes were compared.Univariate and multivariate Logistic regression analysis was performed to analyze the related factors of preterm birth after modified cervical cerclage and the oth-er two groups of classical cervical cerclage.Results:①Compared with the McDonald cerclage group,the modified cerclage group had longer effective cervical length,longer delivery and gestational weeks,higher term delivery rate,and shorter post-operative contraction inhibitor time,with statistical significance(P＜0.05).Compared with the Shirodkar cerclage group,the operation time of patients in the modified cerclage was significantly shortened,the amount of intraoperative blood loss was reduced,the use time of postoperative contraction inhibitors was shortened,and the rate of postoperative wire-cutting was decreased,with statistical significance(P＜0.05).②Multivariate Logistic regression analysis of preterm birth showed that the longer the length of the cervix and the later gestational age when the modified cervical cerclage was performed with reference to McDonald's cerclage,the longer the length of the cervix after surgery,the later the gestational age when the suture was removed.The risk of preterm birth was reduced(OR＜1,P＜0.05),while preoperative BMI≥24 kg/m2 was associated with an increased risk of preterm birth(OR＞1,P＜0.05).Using Shirodkar's cerclage as reference,the risk of preterm delivery was consistent between the two types of cervix(P＞0.05).Longer cervical length and later gestational age after suture removal reduced the risk of preterm delivery(OR＜1,P＜0.05).Conclusions:The modified transvaginal cervical cerclage is simple and safe in clinical application,it has certain advantages in improving ad-verse pregnancy outcomes of pregnant women,which provides a new reference for the treatment of pregnant women with CIC.Due to the small number of cases included in the study,comprehensive evaluation by clinicians is still needed for clinical application.

Objective:To combine and improve two kinds of classical transvaginal cervical cerclage,and to provide a new reference for the clinical treatment of patients with cervical insufficiency(CIC).Methods:Retro-spective analysis was performed on the clinical data of 117 patients who underwent transvaginal cervical cerclage due to CIC from January 1,2018 to August 31,2023 in the Second Affiliated Hospital of Kunming Medical Univer-sity.According to different surgical methods,the patients were divided into the modified cerclage group(40 ca-ses),the McDonald cerclage group(40 cases)and the Shirodkar cerclage group(37 cases).Intraoperative and postoperative conditions and pregnancy outcomes were compared.Univariate and multivariate Logistic regression analysis was performed to analyze the related factors of preterm birth after modified cervical cerclage and the oth-er two groups of classical cervical cerclage.Results:①Compared with the McDonald cerclage group,the modified cerclage group had longer effective cervical length,longer delivery and gestational weeks,higher term delivery rate,and shorter post-operative contraction inhibitor time,with statistical significance(P＜0.05).Compared with the Shirodkar cerclage group,the operation time of patients in the modified cerclage was significantly shortened,the amount of intraoperative blood loss was reduced,the use time of postoperative contraction inhibitors was shortened,and the rate of postoperative wire-cutting was decreased,with statistical significance(P＜0.05).②Multivariate Logistic regression analysis of preterm birth showed that the longer the length of the cervix and the later gestational age when the modified cervical cerclage was performed with reference to McDonald's cerclage,the longer the length of the cervix after surgery,the later the gestational age when the suture was removed.The risk of preterm birth was reduced(OR＜1,P＜0.05),while preoperative BMI≥24 kg/m2 was associated with an increased risk of preterm birth(OR＞1,P＜0.05).Using Shirodkar's cerclage as reference,the risk of preterm delivery was consistent between the two types of cervix(P＞0.05).Longer cervical length and later gestational age after suture removal reduced the risk of preterm delivery(OR＜1,P＜0.05).Conclusions:The modified transvaginal cervical cerclage is simple and safe in clinical application,it has certain advantages in improving ad-verse pregnancy outcomes of pregnant women,which provides a new reference for the treatment of pregnant women with CIC.Due to the small number of cases included in the study,comprehensive evaluation by clinicians is still needed for clinical application.

Objective:To combine and improve two kinds of classical transvaginal cervical cerclage,and to provide a new reference for the clinical treatment of patients with cervical insufficiency(CIC).Methods:Retro-spective analysis was performed on the clinical data of 117 patients who underwent transvaginal cervical cerclage due to CIC from January 1,2018 to August 31,2023 in the Second Affiliated Hospital of Kunming Medical Univer-sity.According to different surgical methods,the patients were divided into the modified cerclage group(40 ca-ses),the McDonald cerclage group(40 cases)and the Shirodkar cerclage group(37 cases).Intraoperative and postoperative conditions and pregnancy outcomes were compared.Univariate and multivariate Logistic regression analysis was performed to analyze the related factors of preterm birth after modified cervical cerclage and the oth-er two groups of classical cervical cerclage.Results:①Compared with the McDonald cerclage group,the modified cerclage group had longer effective cervical length,longer delivery and gestational weeks,higher term delivery rate,and shorter post-operative contraction inhibitor time,with statistical significance(P＜0.05).Compared with the Shirodkar cerclage group,the operation time of patients in the modified cerclage was significantly shortened,the amount of intraoperative blood loss was reduced,the use time of postoperative contraction inhibitors was shortened,and the rate of postoperative wire-cutting was decreased,with statistical significance(P＜0.05).②Multivariate Logistic regression analysis of preterm birth showed that the longer the length of the cervix and the later gestational age when the modified cervical cerclage was performed with reference to McDonald's cerclage,the longer the length of the cervix after surgery,the later the gestational age when the suture was removed.The risk of preterm birth was reduced(OR＜1,P＜0.05),while preoperative BMI≥24 kg/m2 was associated with an increased risk of preterm birth(OR＞1,P＜0.05).Using Shirodkar's cerclage as reference,the risk of preterm delivery was consistent between the two types of cervix(P＞0.05).Longer cervical length and later gestational age after suture removal reduced the risk of preterm delivery(OR＜1,P＜0.05).Conclusions:The modified transvaginal cervical cerclage is simple and safe in clinical application,it has certain advantages in improving ad-verse pregnancy outcomes of pregnant women,which provides a new reference for the treatment of pregnant women with CIC.Due to the small number of cases included in the study,comprehensive evaluation by clinicians is still needed for clinical application.

Objective:To combine and improve two kinds of classical transvaginal cervical cerclage,and to provide a new reference for the clinical treatment of patients with cervical insufficiency(CIC).Methods:Retro-spective analysis was performed on the clinical data of 117 patients who underwent transvaginal cervical cerclage due to CIC from January 1,2018 to August 31,2023 in the Second Affiliated Hospital of Kunming Medical Univer-sity.According to different surgical methods,the patients were divided into the modified cerclage group(40 ca-ses),the McDonald cerclage group(40 cases)and the Shirodkar cerclage group(37 cases).Intraoperative and postoperative conditions and pregnancy outcomes were compared.Univariate and multivariate Logistic regression analysis was performed to analyze the related factors of preterm birth after modified cervical cerclage and the oth-er two groups of classical cervical cerclage.Results:①Compared with the McDonald cerclage group,the modified cerclage group had longer effective cervical length,longer delivery and gestational weeks,higher term delivery rate,and shorter post-operative contraction inhibitor time,with statistical significance(P＜0.05).Compared with the Shirodkar cerclage group,the operation time of patients in the modified cerclage was significantly shortened,the amount of intraoperative blood loss was reduced,the use time of postoperative contraction inhibitors was shortened,and the rate of postoperative wire-cutting was decreased,with statistical significance(P＜0.05).②Multivariate Logistic regression analysis of preterm birth showed that the longer the length of the cervix and the later gestational age when the modified cervical cerclage was performed with reference to McDonald's cerclage,the longer the length of the cervix after surgery,the later the gestational age when the suture was removed.The risk of preterm birth was reduced(OR＜1,P＜0.05),while preoperative BMI≥24 kg/m2 was associated with an increased risk of preterm birth(OR＞1,P＜0.05).Using Shirodkar's cerclage as reference,the risk of preterm delivery was consistent between the two types of cervix(P＞0.05).Longer cervical length and later gestational age after suture removal reduced the risk of preterm delivery(OR＜1,P＜0.05).Conclusions:The modified transvaginal cervical cerclage is simple and safe in clinical application,it has certain advantages in improving ad-verse pregnancy outcomes of pregnant women,which provides a new reference for the treatment of pregnant women with CIC.Due to the small number of cases included in the study,comprehensive evaluation by clinicians is still needed for clinical application.

Objective:To explore the quality evaluation index system of Internet plus nursing service suitable for China's national conditions, aiming to provide a basis for the quality evaluation and monitoring of Internet plus nursing service.Methods:Based on the "structure-process-result" proposed by Donabedian as the theoretical framework, combined with literature retrieval, qualitative interview, group discussion, and referring to the relevant systems and policies of advanced regions in China, the quality evaluation index item pool and initial questionnaire were preliminarily constructed. In the first and second rounds of questionnaires, Delphi method was used to select indicators. In the third round of questionnaires, the expert importance assignment method was used to clarify the weights of the indicators.Results:The 3 rounds of expert positive coefficients were respectively 92%, 100% and 100%, the expert authority coefficients were respectively 0.870, 0.870 and 0.877 and Kendall's W coefficients were 0.101, 0.105 and 0.119. Finally, an Internet plus nursing service quality evaluation index system with 3 first-level indicators, 19 second-level indicators and 176 third-level indicators was formed. Conclusions:For quality evaluation index system of Internet plus nursing service based on quality three-dimensional theory, the expert opinions are relatively concentrated and results are relatively, which can provide a basis for the establishment of quality evaluation standards of Internet plus nursing service for medical institutions and guide and promote the healthy development of Internet plus nursing service in China.

PURPOSE: This study aims to investigate the feasibility of contouring target volume according to residual tumor and decreasing the dose to the tumor regression field after induction chemotherapy (IC) in locoregionally advanced nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: From August 2009 to August 2013, patients with stage III–IVB NPC were treated with IC and concurrent chemoradiotherapy. Gross tumor volume of nasopharynx (GTVnx)–residual and gross tumor volume of cervical lymph node (GTVnd)–residual were contoured according to post-IC residual primary tumor and any N+ disease, respectively. The tumor regression field was included in CTVnx1/CTVnd1 and prescribed a dose of 60 Gy. Outcomes and toxicities of all patients were evaluated. RESULTS: A total of 57 patients were enrolled. At a median follow-up of 68 months, three cases displayed locoregional recurrence and one case showed both distant metastasis and locoregional recurrence. All locoregional recurrences were in the GTVnx-residual/GTVnd-residual and in-field. The 5-year overall, locoregional relapse-free, distant metastasis-free, and progression-free survival rates were 82.2%, 87.7%, 85.8% and 80.3%, respectively. CONCLUSION: After IC, contouring of GTVnx-residual/GTVnd-residual as residual tumor volume and distribution 60 Gy ofradiation dose to the tumorregression field may be feasible and need further investigation.
Chemoradiotherapy ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Induction Chemotherapy ; Lymph Nodes ; Nasopharynx ; Neoplasm Metastasis ; Neoplasm, Residual ; Radiotherapy, Intensity-Modulated ; Recurrence ; Tumor Burden