With the adjustment of China's fertility policies, the proportion of advanced maternal age pregnancies has increased, making early identification of critical conditions in this population essential for successful treatment. This article systematically reviews the development of obstetric early warning management systems and advances in machine learning-based artificial intelligence for risk assessment in high-risk pregnant women. As artificial intelligence technology continues to evolve, future developments will include intelligent electronic medical record systems for high-risk pregnant women, generate clinical decision support solutions for early warning management, and establish coordinated critical care systems for severely ill pregnant women.

Objective:This study aims to investigate the feasibility and safety of implanting leadless pacemakers in the low septum and its impact on cardiac electrical synchronization.Methods:A total of 36 patients who received leadless pacemaker implantation at Fuwai Central China Cardiovascular Hospital from January 2021 to August 2023 were included in this study.According to implantation sites of leadless pacemakers,patients were divided into mid-septal group(n=16)and low-septal group(n=20).The clinical characteristics and cardiac electrical synchronization were compared between the two groups.Results:There were 21 male patients,mean age was(68±13)years old.There was no statistical difference in the type of brady-arrhythmia between the two groups(P=0.73).There were 61 implant attempts in these 36 patients,and there was no significant difference in the number of attempts,procedure time,and pacemaker parameters between the two groups,but the average procedure time tended to be shorter in the low-septal group([84±37]minutes vs.[105±35]minutes,P=0.09).In terms of electrical synchronization,there was no statistical difference in QRS duration between the low-septal group and the mid-septal group([162.0±21.1]ms vs.[174.0±14.8]ms,P=0.20).There were no vascular puncture complications,cardiac perforation,or pericardial tamponade during the procedure.There were no complications and readmissions related to the leadless pacemaker during follow-up period.Conclusions:Our results show that the implantation of a leadless pacemaker in the low ventricular septum is safe and effective,has a similar impact on cardiac electrical synchronization as mid-septal pacing.

Objective:This study aims to investigate the feasibility and safety of implanting leadless pacemakers in the low septum and its impact on cardiac electrical synchronization.Methods:A total of 36 patients who received leadless pacemaker implantation at Fuwai Central China Cardiovascular Hospital from January 2021 to August 2023 were included in this study.According to implantation sites of leadless pacemakers,patients were divided into mid-septal group(n=16)and low-septal group(n=20).The clinical characteristics and cardiac electrical synchronization were compared between the two groups.Results:There were 21 male patients,mean age was(68±13)years old.There was no statistical difference in the type of brady-arrhythmia between the two groups(P=0.73).There were 61 implant attempts in these 36 patients,and there was no significant difference in the number of attempts,procedure time,and pacemaker parameters between the two groups,but the average procedure time tended to be shorter in the low-septal group([84±37]minutes vs.[105±35]minutes,P=0.09).In terms of electrical synchronization,there was no statistical difference in QRS duration between the low-septal group and the mid-septal group([162.0±21.1]ms vs.[174.0±14.8]ms,P=0.20).There were no vascular puncture complications,cardiac perforation,or pericardial tamponade during the procedure.There were no complications and readmissions related to the leadless pacemaker during follow-up period.Conclusions:Our results show that the implantation of a leadless pacemaker in the low ventricular septum is safe and effective,has a similar impact on cardiac electrical synchronization as mid-septal pacing.

With the adjustment of China's fertility policies, the proportion of advanced maternal age pregnancies has increased, making early identification of critical conditions in this population essential for successful treatment. This article systematically reviews the development of obstetric early warning management systems and advances in machine learning-based artificial intelligence for risk assessment in high-risk pregnant women. As artificial intelligence technology continues to evolve, future developments will include intelligent electronic medical record systems for high-risk pregnant women, generate clinical decision support solutions for early warning management, and establish coordinated critical care systems for severely ill pregnant women.

Objective To discuss the effect of simultaneous coronary angiography plus percutaneous coronary intervention(PCI)and selective PCI on the surgical success rate in treating coronary chronic total occlusion(CTO).Methods The clinical data of a total of 147 consecutive patients with coronary CTO,who received PCI treatment at the Jinhua Municipal Central Hospital of China between January 1,2020 and December 31,2022,were retrospectively analyzed.According to whether the patient received PCI immediately after coronary angiography or not,the patients were divided into simultaneous PCI group(n=64)and selective PCI group(n=83).The clinical data and surgical success rate were compared between the two groups.Multivariate logistic regression analysis was used to determine the factors affecting the success of the PCI surgery for coronary CTO.Results The lesion's length of coronary CTO in the simultaneous PCI group was 35 mm,which was obviously shorter than 50 mm in the selective PCI group(P=0.022).No statistically significant differences in the other angiographic findings existed between the two groups(all P＞0.05).The surgical success rate in the simultaneous PCI group was 78.1%,which was remarkably lower than 88.0%in the selective PCI group(P=0.034).Multivariate logistic regression analysis revealed that simultaneous PCI(OR=4.617,95%CI=1.900-11.221,P=0.001),no stump lesion(OR=4.381,95%CI=1.821-10.452,P=0.001),occlusion length≥20 mm(OR=2.462,95%CI=1.030-5.887,P=0.043),and surgical complications(OR=8.688,95%CI=1.573-47.971,P=0.013)were the independent factors influencing the success of PCI surgery for coronary CTO.Conclusion For the treatment of coronary CTO,the simultaneous coronary angiography and PCI treatment may increase the risk of surgical failure.(J Intervent Radiol,2024,32:52-56)

Objective:To explore the necessity of supplementary operation after primary cervical conization for cervical lesions and the choosing method of reoperation, so as to provide clinical data for further stratification treatment after primary conization.Methods:A prospective study was performed in 116 patients with complete data due to cervical biopsy diagnosis of cervical lesions who first received cervical conization, and received supplementary surgeries within 6 months at Wenzhou People Hospital from March 2016 to March 2018, and 17 cases who received radical resection diagnosed grade Ⅰa1 with vascular infiltration or above were excluded. The patients were divided into residual and non-residual according to residual disease of supplementary surgical specimens. The residual rates of clinical and pathological factors (including incision margin, gland involvement, curettage of cervical canal) were analyzed by univariate analysis. The factors of P ≤ 0.10 were further analyzed by progressive Logistic regression. The clinical and pathological data of 41 patients undergoing repeated conization were analyzed. The follow-up data were analyzed and summarized. Results:Univariate analysis showed that the residual rate of disease in the patients with positive margin, endocervical cone margin involvement and other positive margin was 55.36% (31/56), 63.64% (14/22) and 50.00% (17/34), respectively, higher than that of the patients with negative margin 30.00% (18/60) with statistical significance ( P<0.05). There was no significant difference in pregnancy (≥ 3), parity (≥ 2), symptomatic cases between the two groups, but all P < 0.10. Multivariate analysis showed that both endocervical cone margin involvement and vaginal incision margin were independent risk factors for residual disease, and OR was 4.083 (95% CI 1.459 to 11.430, P = 0.007) and 2.333 (95% CI 0.978 to 5.569, P = 0.056); 19 cases (46.34%) of cervical lesions and 11 cases (26.83%) of high-grade cervical lesions were found in 41 cases after repeated conization. 2 cases (4.88%) of positive margin of incision were supplemented with total hysterectomy; the incidence of intraoperative massive bleeding was 4.88% (2/41). The incidence of massive hemorrhage after operation was 2.43% (1/41). Conclusions:Margin involvement and vaginal incision margin might predict the occurrence of residual disease. Additional surgery should be considered in these cases. Repeat conization can remove residual cervical lesions with minimal trauma and can be used as the preferred treatment.

Objective To observe the effect of Danqi Shuxin Capsule on patients with coronary heart disease complicated with hypercholesterolemia.Methods 140 cases of patients patients with coronary heart disease complicated with hypercholesterolemia from February 2016 to October 2016 in our hospital were selected, according to different treatment divided into observation group and control group,the control group treated with Rosuvastatin Calcium,the observation group treated with Danqi Shuxin capsule on the basis of the control group , observation and compared the change of hs-CRP, Hcy, TNF-α, blood lipid, blood sugar levels between two groups.Results After treatment,the levels of hs-CRP,Hcy and TNF-αin the two groups were significantly decreased (P<0.05),and the levels of hs-CRP, Hcy and TNF-αin the observation group were significantly lower than those in the control group (P<0.05).Compared with before treatment, the levels of TC, TG and LDL-C in the two groups were significantly decreased, HDL-C levels were significantly increased,the difference was statistically significant (P<0.05); the levels of TC, TG and LDL-C in the observation group were significantly lower than those in the control group (P<0.05).There was no significant change in FPG levels before and after treatment. Conclusion Danqi Shuxin capsule can effectively reduce the hs-CRP and Hcy levels in CHD patients with hypercholesterolemia , improve blood lipid levels, while reduce the level of inflammatory factors.

Objective To investigate the clinical effect of nicorandil for treatment of patients with acute respiratory distress syndrome (ARDS).Methods A prospective randomized controlled trial was conducted. A total of 40 cases of patients with ARDS admitted to Department of Critical Care Medicine of Guizhou Provincial People's Hospital from October 2012 to October 2014 were enrolled, and they were randomly divided into two groups, 20 cases in each group. The two groups were treated with routine western medicine after admission. On this basis, the observation group was given nicorandil 10 mg, while the control group was given warm boiled water 10 mL, through gastric tubes 3 times a day, the therapeutic course being consecutive 5 days in both groups. The length of stay in intensive care unit (ICU), duration of mechanical ventilation after treatment, oxygenation index (OI), alveolo-arterial oxygen partial pressure difference (PA-aO2), positive end-expiratory pressure (PEEP), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, Glasgow coma score (GCS) before and after treatment, the predicted death rate (PDR) and 28-day mortality were compared between the two groups. The predicitive factors for 28-day mortality were screened by binary logistic analysis.Results The length of stay in ICU and duration of mechanical ventilation of control group were longer than those of observation group, but the difference was not statistically significant [ICU length of stay (day): 14.55±12.71 vs. 9.15±6.00, duration of mechanical ventilation (day): 13.25±12.27 vs. 7.75±5.32, bothP > 0.05]. After treatment, the GCS was higher than that before treatment in control group and observation group (11.95±3.98 vs. 10.75±4.89, 12.95±3.67 vs. 12.20±4.56), while APACHE Ⅱ score, PDR and PEEP were all lower than those before treatment [APACHE Ⅱ: 21.05±8.58 vs. 24.90±5.63, 18.70±11.21 vs. 26.65±7.67; PDR: (47.71±29.49)% vs. (61.00±23.29)%, (36.79±18.49)% vs. (56.12±18.16)%; PEEP (cmH2O, 1 cmH2O = 0.098 kPa): 4.40±3.14 vs. 5.75±2.59, 3.80±2.55 vs. 7.55±3.32], but there were no statistically significant differences between the two groups before and after treatment (allP > 0.05). After treatment, the OI was significantly higher and the PA-aO2 was significantly lower than those before treatment in the two groups, and the degrees of improvement of the observation group were more remarkable than those of the control group [OI (mmHg, 1 mmHg = 0.133 kPa): 224.72±85.12 vs. 141.37±45.82, PA-aO2 (mmHg): 132.60±46.64 vs. 204.30±121.2, bothP < 0.05]. The 28-day mortality of observation group was lower than that of control group, but no statistically significant difference was seen [15% (3/20) vs. 25% (5/20),χ2 = 0.156,P > 0.05). Binary logistic regression analyses showed that the PA-aO2 [odds ratio (OR) = 0.958,P = 0.013, 95% confidence interval (95%CI) = 0.927 - 0.991], APACHE Ⅱ score (OR = 0.882,P = 0.010, 95CI = 0.803 - 0.970), GCS (OR = 1.399, P = 0.004, 95%CI = 1.111 - 1.761) and PDR (OR = 0.907,P = 0.002, 95%CI = 0.853 - 0.965) after treatment were the independent predictors of 28-day mortality.Conclusion Nicorandil can significantly improve oxygenation, but cannot reduce 28-day mortality in patients with ARDS.

Objective To investigate the effect and safety of primary percutaneous coronary intervention (PCI) of acute ST-segment elevation myocardial infarction (STEMI) in elderly patients.Methods 103 consecutive patients with STEMI treated by primary PCI were divided into two groups according to the age:the elderly group [aged≥65 years,with a mean age of (75.7 ±6.2) years(n =49],the non-elderly group [aged＜65 years,with a mean age of (43.0±8.6) years(n =54].Clinical characteristics,complications related to PCI procedure and success rate were analyzed,and major cardiovascular events (MACE) were followed up for(5.7 ± 1.2) months.Results The proportion of female,patients with Killip ≥ Ⅲ,three vessels disease and higher level of serum brain natriuretic peptide were higher in elderly group than in non-elderly group (all P＜0.05).No significant difference was observed between the two groups in success rate and complications of PCI procedure (both P＞0.05).Patients were followed up for (5.7± 1.2) months.The in-hospital and one-month mortalities were higher in elderly group than in non-elderly group [8.2％ (4 cases)vs.0％ (0 case),10.2％(5 cases) vs.0 ％ (0 case),respectively,all P＜0.05].There was no significant difference in six-month mortality and MACE between the two groups.Multivariate logistic regression analysis showed that Killip ≥ Ⅲ was related with the increase of one-month mortality in patients with STEMI undergoing primary PCI,whereas age was not.Conclusions Primary PCI is effective and safe in elderly patients with STEMI.

Cancer related anemia( CRA)is one of the ancer complications. The incidence rate of CRA is more than 70% in patients after receiving chemotherapy,radiation therapy,or both. CRA has severe clinical symptoms which significantly attenuate effectiveness of cancer treatment and the quality of patients' life. The current treatments for CRA,such as transfusion,recombinant EPO therapy,iron supplement and so on,could correct CRA in some sense. However,the present accepted therapeutic approaches could not be satisfied since there are complexity and diversity factors accounting for CRA. More effective and safety treatments of CRA are required in the near future.