Objective:To explore the treatment methods and prognosis of pregnancy-related uterine arteriovenous malformation (UAVM).Methods:A retrospective analysis was conducted on clinical data from 81 patients with UAVM treated at Peking Union Medical College Hospital between March 2019 and March 2024. Clinical manifestations, diagnostic approaches, treatment strategies and prognosis were evaluated.Results:(1) General Information: the age of patients with UAVM was (32.7±4.6) years, with median gravidity and parity of 1 (quartile range: 1, 2) and 0 (0, 1), respectively. Pregnancy termination methods included surgical abortion or curettage in 46 cases (57%, 46/81), medical induction in 17 cases (21%, 17/81), spontaneous abortion in 16 cases (20%, 16/81), vaginal delivery in 1 case (1%, 1/81), and laparoscopic pregnancy tissue removal in 1 case (1%, 1/81). (2) Clinical manifestations: clinical presentations comprised vaginal bleeding in 59 cases [73%, 59/81; median blood loss: 740 ml (440, 1 360 ml)], massive hemorrhage in 9 cases (11%, 9/81, and bleeding combined with lower abdominal pain in 8 cases (10%, 8/81). Ultrasonography revealed intrauterine masses in 65 cases [80%, 65/81; median size: 2.5 cm (1.8, 4.2 cm)]. Elevated serum human chorionic gonadotrophin-β subunit (β-hCG) levels were observed in in 55 cases [85%, 55/65; median: 62.6 U/L (14.9, 300.1 U/L)]. The median time to UAVM diagnosis via ultrasound was 30.0 days (16.0, 52.0 days) after pregnancy termination, with median peak systolic velocity (PSV) and resistance index of 59.8 cm/s (45.0, 79.6 cm/s) and 0.39 (0.36, 0.43), respectively. (3) Treatment and prognosis: treatment modalities included expectant management in 49 cases (36%, 29/81), medication in 13 cases (16%, 13/81), lesion resection in 31 cases (38%, 31/81), and uterine artery angiography in 8 cases (10%, 8/81; 5 confirmed as arteriovenous fistula). The median time of PSV returning to normal after treatment was 53.8 days (36.0, 93.4 days). The average time for β-hCG returning to normal was (60.4±20.4) days. The median return time of menses was 59.0 days (43.0, 75.4 days).Conclusions:Pregnancy-related UAVM carries a high risk of life-threatening hemorrhage, necessitating management in centers equipped for emergency uterine artery embolization. Informed consent must emphasize disease progression risks and prognosis. Treatment stratification should integrate clinical parameters and imaging features.

Objective:To evaluate the safety,efficacy,and prognosis of interventional treatment for pregnan-cy-related uterine arteriovenous malformations(UAVM).Methods:A retrospective analysis was conducted of the clinical data from 8 patients with pregnancy-associated UAVM who underwent interventional therapy after initial di-agnosis by ultrasound at Peking Union Medical College Hospital between February 1,2016,and January 4,2024.Results:All 8 patients underwent ultrasound examination,and color Doppler imaging revealed abundant blood flow signals within the lesions,presenting a high-velocity and low-resistance blood flow spectrum.The median age of patients was 29 years,with termination of pregnancy occurring at 7-38 weeks of gestation.Clinical manifesta-tions included persistent irregular vaginal bleeding in 2 cases(25.0％),"on-off"hemorrhage in 2 cases(25.0％),acute massive vaginal bleeding(≥400 ml per episode)in 5 cases(62.5％),abdominal pain in 3 ca-ses(37.5％),secondary anemia in 4 cases(50.0％),and persistent elevation of serum β-hCG in 2 cases(25.0％).All 8 patients underwent uterine artery angiography.Postoperatively,5 cases were diagnosed with preg-nancy-related UAVM,with 1 case also complicated by a right ovarian arteriovenous fistula.The remaining 3 cases revealed only abnormal vascular clusters without early venous opacification.Bilateral uterine artery embolization(UAE)was performed in 4 cases,unilateral UAE(all right-sided)in 2 cases,and no UAE was performed in 2 ca-ses.Hysteroscopic lesion resection or curettage was performed in 3 cases,with 2 cases receiving adjuvant gona-dotropin-releasing hormone agonist(GnRH-a)therapy postoperatively.All 5 patients ultimately diagnosed with UAVM achieved hemostasis within 24 hours after UAE,with mild post-embolization syndrome observed in 1 case.During follow-up,only the patient with the concomitant ovarian arteriovenous fistula experienced recurrent sudden vaginal bleeding and subsequently underwent laparoscopic uterine lesion resection following GnRH-a therapy.Conclusions:UAE is the treatment of choice for pregnancy-related UAVM patients with complex or severe bleed-ing initially diagnosed by ultrasound.However,management should be tailored based on imaging and clinical fea-tures to balance therapeutic efficacy with fertility preservation.

Objective:To evaluate the safety,efficacy,and prognosis of interventional treatment for pregnan-cy-related uterine arteriovenous malformations(UAVM).Methods:A retrospective analysis was conducted of the clinical data from 8 patients with pregnancy-associated UAVM who underwent interventional therapy after initial di-agnosis by ultrasound at Peking Union Medical College Hospital between February 1,2016,and January 4,2024.Results:All 8 patients underwent ultrasound examination,and color Doppler imaging revealed abundant blood flow signals within the lesions,presenting a high-velocity and low-resistance blood flow spectrum.The median age of patients was 29 years,with termination of pregnancy occurring at 7-38 weeks of gestation.Clinical manifesta-tions included persistent irregular vaginal bleeding in 2 cases(25.0％),"on-off"hemorrhage in 2 cases(25.0％),acute massive vaginal bleeding(≥400 ml per episode)in 5 cases(62.5％),abdominal pain in 3 ca-ses(37.5％),secondary anemia in 4 cases(50.0％),and persistent elevation of serum β-hCG in 2 cases(25.0％).All 8 patients underwent uterine artery angiography.Postoperatively,5 cases were diagnosed with preg-nancy-related UAVM,with 1 case also complicated by a right ovarian arteriovenous fistula.The remaining 3 cases revealed only abnormal vascular clusters without early venous opacification.Bilateral uterine artery embolization(UAE)was performed in 4 cases,unilateral UAE(all right-sided)in 2 cases,and no UAE was performed in 2 ca-ses.Hysteroscopic lesion resection or curettage was performed in 3 cases,with 2 cases receiving adjuvant gona-dotropin-releasing hormone agonist(GnRH-a)therapy postoperatively.All 5 patients ultimately diagnosed with UAVM achieved hemostasis within 24 hours after UAE,with mild post-embolization syndrome observed in 1 case.During follow-up,only the patient with the concomitant ovarian arteriovenous fistula experienced recurrent sudden vaginal bleeding and subsequently underwent laparoscopic uterine lesion resection following GnRH-a therapy.Conclusions:UAE is the treatment of choice for pregnancy-related UAVM patients with complex or severe bleed-ing initially diagnosed by ultrasound.However,management should be tailored based on imaging and clinical fea-tures to balance therapeutic efficacy with fertility preservation.

Objective:To explore the treatment methods and prognosis of pregnancy-related uterine arteriovenous malformation (UAVM).Methods:A retrospective analysis was conducted on clinical data from 81 patients with UAVM treated at Peking Union Medical College Hospital between March 2019 and March 2024. Clinical manifestations, diagnostic approaches, treatment strategies and prognosis were evaluated.Results:(1) General Information: the age of patients with UAVM was (32.7±4.6) years, with median gravidity and parity of 1 (quartile range: 1, 2) and 0 (0, 1), respectively. Pregnancy termination methods included surgical abortion or curettage in 46 cases (57%, 46/81), medical induction in 17 cases (21%, 17/81), spontaneous abortion in 16 cases (20%, 16/81), vaginal delivery in 1 case (1%, 1/81), and laparoscopic pregnancy tissue removal in 1 case (1%, 1/81). (2) Clinical manifestations: clinical presentations comprised vaginal bleeding in 59 cases [73%, 59/81; median blood loss: 740 ml (440, 1 360 ml)], massive hemorrhage in 9 cases (11%, 9/81, and bleeding combined with lower abdominal pain in 8 cases (10%, 8/81). Ultrasonography revealed intrauterine masses in 65 cases [80%, 65/81; median size: 2.5 cm (1.8, 4.2 cm)]. Elevated serum human chorionic gonadotrophin-β subunit (β-hCG) levels were observed in in 55 cases [85%, 55/65; median: 62.6 U/L (14.9, 300.1 U/L)]. The median time to UAVM diagnosis via ultrasound was 30.0 days (16.0, 52.0 days) after pregnancy termination, with median peak systolic velocity (PSV) and resistance index of 59.8 cm/s (45.0, 79.6 cm/s) and 0.39 (0.36, 0.43), respectively. (3) Treatment and prognosis: treatment modalities included expectant management in 49 cases (36%, 29/81), medication in 13 cases (16%, 13/81), lesion resection in 31 cases (38%, 31/81), and uterine artery angiography in 8 cases (10%, 8/81; 5 confirmed as arteriovenous fistula). The median time of PSV returning to normal after treatment was 53.8 days (36.0, 93.4 days). The average time for β-hCG returning to normal was (60.4±20.4) days. The median return time of menses was 59.0 days (43.0, 75.4 days).Conclusions:Pregnancy-related UAVM carries a high risk of life-threatening hemorrhage, necessitating management in centers equipped for emergency uterine artery embolization. Informed consent must emphasize disease progression risks and prognosis. Treatment stratification should integrate clinical parameters and imaging features.

Objective:To investigate the light exposure in neonatal intensive care unit (NICU), and to explore the effect of light management on the growth and development of premature infants.Methods:This study adopted a quasi-experimental research method. Sixty-three premature infants hospitalized in NICU of Obstetrics and Gynecology Hospital Affiliated to Jiangnan University from January to December 2021 were selected by convenience sampling as the control group, and conventional premature infant care measures were implemented, while 60 hospitalized premature infants from January to December 2022 were selected as the observation group, and NICU light management strategies were implemented. The light intensity, bad light exposure, the growth of body mass, body length, hospitalization days of premature infants during hospitalization, and the feeding of premature infants during hospitalization were compared between the two groups.Results:Sixty-three patients were enrolled in the control group, including 28 males and 35 females with a gestational age of (32. 13 ± 1.94) weeks, while 60 patients were enrolled in the observation group, including 32 males and 28 females with a gestational age of (31. 79 ± 1.83) weeks. The daytime and nighttime illuminations in the observation group were (413.79 ± 181.95) and (18.95 ± 12.43) lux, which were better than those in the control group (145.12 ± 99.56) and (53.25 ± 38.34) lux, respectively. The rate of bad light exposure in the observation group was 18.2% (183/1 008). The difference was statistically significant ( t=-29.08, 11.55, χ2=126.99, all P<0.05). In the observation group, the body mass, weekly length gain, hospitalization days, milk intake and age at full feeding on the 7th and 14th day of birth were (1.74 ± 0.32) kg, (1.88 ± 0.32) kg, (1.63 ± 0.60) cm, (26.92 ± 12.32) d, (125.60 ± 69.43) ml/d, (239.33 ± 92.83) ml/d, (15.07 ± 10.01) d, and (1.58 ± 0.31) kg, (1.73 ± 0.31) kg, (1.39 ± 0.48) cm, (32.00 ± 14.00) d, (100.83 ± 68.54) ml/d, (195.05 ± 111.22) ml/d, (18.95 ± 10.76) d in the control group. There were significant differences between the two groups ( t values were -2.89 to 2.13, all P<0.05). Conclusions:The implementation of light management strategy in NICU can effectively reduce the bad light exposure of premature infants, promote their growth and development and shorten the length of hospital stay, which is worthy of clinical application.

Objective:To evaluate the characteristics, clinical management and clinical outcomes of type 2 intestinal failure (IF).Methods:A descriptive case-control study was carried out. The inclusion criteria were as follows: (1) the diagnosis of IF was performed according to the European Society for Parenteral and Enteral Nutrition (ESPEN) consensus statement. (2) using a requirement for parenteral nutrition (PN) of 28 days or more as surrogate marker. (3) a multidisciplinary team (MDT) included surgeons, nutritionist, pharmacist, stoma therapists, and critical care physicians. (4) complete laboratory data. Patients with type 1 and type 3 IF and those who do not cooperate with follow-up. All the data of 67 type II IF were collected from the database in Sir Run Run Shaw Hospital from Jan 2016 to Dec 2023. The pathophysiology, clinical management, and outcomes of type II IF were analyzed.Results:A total of 67 type II IF were included. The median age was 54 (15-83) with 43 males and 24 females. The body mass index was (17.5±3.8) kg/m 2, the incidence of malnutrition was 67.2% (45/67), the incidence of sarcopenia was 74.6% (50/67), the median number of previous surgeries was 2.0 (1-13), and the median duration time of PN was 2.1 (1-12) months. The underlying disease of type 2 IF included 36 Crohn`s disease, 2 ulcerative colitis, 3 radiation enteritis, 2 intestinal Behcet's disease, 4 mesenteric infarction, 1 aggressive fibromatosis, 5 abdominal cocoon syndrome, 5 gastrointestinal perforation, 1 hernia, 4 intestinal dysmotility, and 4 other reasons (gastrointestinal tumor, trauma, and non-Hodgkin's lymphoma). According to the pathophysiology of IF, there were 33 intestinal fistula, 12 intestinal dysmotility, 6 mechanical obstruction, 13 short bowel syndrome, and 3 extensive small bowel mucosal disease. After treatment with MDT, 67 patients with type 2 IF received nutritional support therapy for intestinal rehabilitation treatment, of which 36 patients recovered with oral diet or enteral nutrition, 31 patients underwent reconstructive surgery after intestinal rehabilitation treatment failure. The median duration time of reconstructive surgery was 2.7 (1-9) months. 24 patients recovered intestinal autonomy after surgery, with 7 deaths, including 6 deaths due to abdominal infections and 1 case of intestinal dysmotility with abiotrophy and liver failure. Conclusion:Standardized multidisciplinary treatment plays an important role in type II intestinal failure, and it promotes patients with intestinal failure regain enteral autonomy.

Objective To investigate the effect of dapagliflozin on myocardial work and energy metabolism in patients with heart failure with reduced ejection fraction(HFrEF)without type 2 diabetes mellitus(T2DM).Methods Patients with HFrEF without T2DM who visited Wuzhou People's Hospital from January 2021 to January 2022 were randomly divided into conventional group and dapagliflozin group(conventional treatment+dapagliflozin).After treatment(12 months),myocardial work[global work index(GWI),global constructed work(GCW),global wasted work(GW),and global work efficiency(GWE)],energy metabolism[(free fatty acids(FFA)and β-hydroxybutyric acid(β-HB)],traditional cardiac function[left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),and left ventricular ejection fraction(LVEF)],clinical efficacy,prognosis[mortality,rehospitalization,and incidence of major adverse cardiovascular events(MACE)]and adverse reactions were compared between the two groups.Results A total of 128 patients with HFrEF without T2DM were enrolled,including 63 patients in the dapagliflozin group and 65 patients in the conventional group.After treatment,the LVEDD,LVESD,GWW,NT-pro BNP in the dapagliflozin group was significantly lower than that in the conventional group(P＜0.05),while the LVEF,GWI,GCW,GWE,β-HB acid and FFA were significantly higher than those in the conventional group(P＜0.05).The total effective rate and hypoglycemia rates in the dapagliflozin group were significantly higher than those in the conventional group(P＜0.05),and the rehospitalization rate and MACE rate were significantly lower than those in the conventional group(P＜0.05).There were no significant differences in mortality,renal adverse events,urinary tract infections and gastrointestinal symptoms between the two groups(P＞0.05).Conclusion Dapagliflozin has significant clinical efficacy in patients with HFrEF without T2DM,which can increase the serum levels of FFA and ketones,improve effective work,and reduce ineffective work,but it is necessary to be vigilant against hypoglycemia.

Objective:To evaluate the characteristics, clinical management and clinical outcomes of type 2 intestinal failure (IF).Methods:A descriptive case-control study was carried out. The inclusion criteria were as follows: (1) the diagnosis of IF was performed according to the European Society for Parenteral and Enteral Nutrition (ESPEN) consensus statement. (2) using a requirement for parenteral nutrition (PN) of 28 days or more as surrogate marker. (3) a multidisciplinary team (MDT) included surgeons, nutritionist, pharmacist, stoma therapists, and critical care physicians. (4) complete laboratory data. Patients with type 1 and type 3 IF and those who do not cooperate with follow-up. All the data of 67 type II IF were collected from the database in Sir Run Run Shaw Hospital from Jan 2016 to Dec 2023. The pathophysiology, clinical management, and outcomes of type II IF were analyzed.Results:A total of 67 type II IF were included. The median age was 54 (15-83) with 43 males and 24 females. The body mass index was (17.5±3.8) kg/m 2, the incidence of malnutrition was 67.2% (45/67), the incidence of sarcopenia was 74.6% (50/67), the median number of previous surgeries was 2.0 (1-13), and the median duration time of PN was 2.1 (1-12) months. The underlying disease of type 2 IF included 36 Crohn`s disease, 2 ulcerative colitis, 3 radiation enteritis, 2 intestinal Behcet's disease, 4 mesenteric infarction, 1 aggressive fibromatosis, 5 abdominal cocoon syndrome, 5 gastrointestinal perforation, 1 hernia, 4 intestinal dysmotility, and 4 other reasons (gastrointestinal tumor, trauma, and non-Hodgkin's lymphoma). According to the pathophysiology of IF, there were 33 intestinal fistula, 12 intestinal dysmotility, 6 mechanical obstruction, 13 short bowel syndrome, and 3 extensive small bowel mucosal disease. After treatment with MDT, 67 patients with type 2 IF received nutritional support therapy for intestinal rehabilitation treatment, of which 36 patients recovered with oral diet or enteral nutrition, 31 patients underwent reconstructive surgery after intestinal rehabilitation treatment failure. The median duration time of reconstructive surgery was 2.7 (1-9) months. 24 patients recovered intestinal autonomy after surgery, with 7 deaths, including 6 deaths due to abdominal infections and 1 case of intestinal dysmotility with abiotrophy and liver failure. Conclusion:Standardized multidisciplinary treatment plays an important role in type II intestinal failure, and it promotes patients with intestinal failure regain enteral autonomy.

Objective:To analyze the relationship between mesenteric fat or creeping fat and bowel stricture or penetrating disease of Crohn's disease (CD).Methods:Clinical data of 101 CD patients undergoing bowel surgery at Department of General Surgery in our hospital between Mar 2021 and Dec 2021 were retrospectively analyzed. The characteristics of mesenteric fat, creeping fat, luminal cross-section diameter, and the intestinal stricture index were analyzed. The Spearman correlation analysis was used to evaluate the correlation between disease behavior and mesenteric fat score or creeping fat score.Results:Totally 101 CD patients were enrolled, with 68 stricturing diseases and 33 penetrating diseases. CD patients with stricturing diseases had higher score of mesenteric disease activity index (4.6±1.9 vs. 3.7±2.0, t=2.212, P=0.029) and creeping fat index (4.2±2.0 vs. 2.9±1.6, t=3.154, P=0.002) than those in patients with penetrating diseases. The mesenteric fat and creeping fat score positively correlated with the intestinal stricture index, C-reactive protein, and fecal calprotectin, and negatively correlated with minimum luminal cross-section diameter. Conclusion:The higher score of mesenteric fat and creeping fat were observed in CD patients with stricturing disease, which were associated with intestinal stricture index and inflammation status.

Objectives:To assess bowel function and quality of life in patients with ulcerative colitis (UC)after ileal pouch anal anastomosis (IPAA).Methods:Clinical data of 37 UC patients after IPAA between 2014 and 2017 were retrospectively analyzed at Sir Run Run Shaw Hospital School of Medicine Zhejiang University. The IBDQ and Bowel Function questionnaire were used for analyzing correlation between clinical variables and quality of life or bowel function.Results:Laparoscopic operation was performed in 12 cases at stage 2 and 25 cases at stage 3. Postoperative defecation of stage 3 patients were better than that of stage 2 ( t=6.72, P<0.05). The number of daily defecation in age >45-year-old group was more than that in <45-year-old ( t=3.49, P<0.05), and the rate of evening stool seepage in the older group was higher than in the younger group( t=5.28, P<0.05). The total score of intestinal symptoms of IBDQ in patients of pouchitis was lower than that without pouchitis ( r=0.330, P<0.05). The total score in age >45 in terms of systemic symptoms ( r=0.349, P<0.05) and emotional function ( r=0.379, P<0.05) was higher than age <45. Conclusions:Outcomes of UC patients after IPAA are satisfactory, bowel function and quality of life is related with age, and stage of IPAA affect postoperative defecation.