Objective:To explore the feasibility of measuring the angle of progress(AOP)and the fetal head-perineum distance(HPD)by ultrasound to predict the duration of the second stage of labor.Methods:A to-tal of 135 full-term singleton primiparas who gave birth through vagina in Shandong Provincial Hospital Affiliated to Shandong First Medical University from September 2022 to June 2024 were selected.They all received medication for labor analgesia during labor,and the fetal position was determined as occipital anterior position by ultrasound when the cervix was fully dilated.AOP and HPD were measured during the contraction interval.All parturients were divided into group A(duration of the second stage of labor≤60 min),group B(60 min＜duration of the sec-ond stage of labor≤120 min)and group C(duration of the second stage of labor＞120 min).The differences of AOP and HPD among these groups were compared,and their predictive efficacy for vaginal delivery within 60min and 120min was evaluated.Results:①The AOP in group A was higher than that in group B.The HPD in group A was lower than that in group B.The differences were statistically significant(P＜0.01).The AOP in group B was higher than that in group C.The HPD in group B was lower than that in group C.The differences were statistically significant(P＜0.05).②The area under the ROC curve for AOP and HPD to predict a vaginal delivery within 60 min was 0.872 and 0.914,and the optimal cut-off value was 126.25°and 4.52 cm,respectively(P＜0.01).③The area under the ROC curve for AOP and HPD to predict a vaginal delivery within 120 min was 0.901 and 0.801,and the optimal cut-off value was 116.40°and 4.69 cm,respectively(P＜0.01).Conclusions:It is feasible to pre-dict the duration of the second stage of labor duration by measuring AOP and HPD using intrapartum ultrasound.

Objective:To explore the feasibility of measuring the angle of progress(AOP)and the fetal head-perineum distance(HPD)by ultrasound to predict the duration of the second stage of labor.Methods:A to-tal of 135 full-term singleton primiparas who gave birth through vagina in Shandong Provincial Hospital Affiliated to Shandong First Medical University from September 2022 to June 2024 were selected.They all received medication for labor analgesia during labor,and the fetal position was determined as occipital anterior position by ultrasound when the cervix was fully dilated.AOP and HPD were measured during the contraction interval.All parturients were divided into group A(duration of the second stage of labor≤60 min),group B(60 min＜duration of the sec-ond stage of labor≤120 min)and group C(duration of the second stage of labor＞120 min).The differences of AOP and HPD among these groups were compared,and their predictive efficacy for vaginal delivery within 60min and 120min was evaluated.Results:①The AOP in group A was higher than that in group B.The HPD in group A was lower than that in group B.The differences were statistically significant(P＜0.01).The AOP in group B was higher than that in group C.The HPD in group B was lower than that in group C.The differences were statistically significant(P＜0.05).②The area under the ROC curve for AOP and HPD to predict a vaginal delivery within 60 min was 0.872 and 0.914,and the optimal cut-off value was 126.25°and 4.52 cm,respectively(P＜0.01).③The area under the ROC curve for AOP and HPD to predict a vaginal delivery within 120 min was 0.901 and 0.801,and the optimal cut-off value was 116.40°and 4.69 cm,respectively(P＜0.01).Conclusions:It is feasible to pre-dict the duration of the second stage of labor duration by measuring AOP and HPD using intrapartum ultrasound.

Cholangiocarcinoma originates from bile duct epithelial cells. It has an insidious onset, a high degree of malignancy, a poor prognosis and a high recurrence rate. Exosomes are nanoscale vesicles with a bilayer membrane structure, containing abundant biomolecules such as DNA, RNA, proteins and lipids. Exosomes are important carriers for the exchange of substances and information between cells and are involved in a variety of pathophysiological processes. In addition, exosomes have great potential in the diagnosis and treatment of various diseases. This article reviews the role of exosomes in the occurrence and development of cholangiocarcinoma and their potential value in the diagnosis and treatment of cholangiocarcinoma.

This article reported a pregnant woman admitted to the hospital due to "25 +2 weeks of amenorrhea and a 1-day history of shortened cervical canal accompanied by vaginal bleeding". The patient with pregestational diabetes mellitus and suboptimal glycemic control required prolonged hospitalization for tocolytic therapy due to shortened cervical length. She developed a cough at 31 weeks and 4 days of gestation, followed by right-sided intercostal pain and hypotension after coughing at 31 weeks and 6 days of gestation. Bedside chest ultrasound showed a small anechoic fluid collection (approximately 1.1 cm in width) in the right pleural cavity. The emergency cesarean section was performed at 31 weeks and 4 days of gestation. However, the intraoperative bleeding and other conditions were inconsistent with the obstetric clinical presentations of blood loss. Subsequent repeated ultrasound and CT examinations confirmed the diagnosis of pulmonary sequestration and right-sided progressive hemopneumothorax. On the same day, an emergency right lower lobectomy was performed, achieving stable postoperative recovery. Both mother and infant had favorable outcomes. Hemopneumothorax complicated by pulmonary sequestration is uncommon, and its occurrence during pregnancy is exceedingly rare. Multidisciplinary consultations, aggressive, rapid, and accurate diagnosis, and combined treatment are critical to ensuring maternal-fetal survival. Hemopneumothorax caused by the rupture of pulmonary sequestration during pregnancy represents a life-threatening condition. Emergency thoracotomy can timely clarify the cause, arrest bleeding, relieve compression, and resect the lesion, thereby reducing mortality and the complications risk.

This article reported a pregnant woman admitted to the hospital due to "25 +2 weeks of amenorrhea and a 1-day history of shortened cervical canal accompanied by vaginal bleeding". The patient with pregestational diabetes mellitus and suboptimal glycemic control required prolonged hospitalization for tocolytic therapy due to shortened cervical length. She developed a cough at 31 weeks and 4 days of gestation, followed by right-sided intercostal pain and hypotension after coughing at 31 weeks and 6 days of gestation. Bedside chest ultrasound showed a small anechoic fluid collection (approximately 1.1 cm in width) in the right pleural cavity. The emergency cesarean section was performed at 31 weeks and 4 days of gestation. However, the intraoperative bleeding and other conditions were inconsistent with the obstetric clinical presentations of blood loss. Subsequent repeated ultrasound and CT examinations confirmed the diagnosis of pulmonary sequestration and right-sided progressive hemopneumothorax. On the same day, an emergency right lower lobectomy was performed, achieving stable postoperative recovery. Both mother and infant had favorable outcomes. Hemopneumothorax complicated by pulmonary sequestration is uncommon, and its occurrence during pregnancy is exceedingly rare. Multidisciplinary consultations, aggressive, rapid, and accurate diagnosis, and combined treatment are critical to ensuring maternal-fetal survival. Hemopneumothorax caused by the rupture of pulmonary sequestration during pregnancy represents a life-threatening condition. Emergency thoracotomy can timely clarify the cause, arrest bleeding, relieve compression, and resect the lesion, thereby reducing mortality and the complications risk.

To formulate an expert consensus on the principles of preoperative hair removal and provide scientific guidance for standardized removal of hair before surgical procedures so as to reduce the incidence of surgical site infections.METHODS Led by the Hospital Management Institute of National Health Commission of the People's Republic of China,this consensus was reached with the joint efforts from the expects of relevant fields such as surgeries,interventional therapies,nursing,and infection prevention and control.The consensus facilitates the classification and evaluation of literatures by following the evidence grade formulated by Oxford Evidence-based Medicine Center and focuses on the association of preoperative hair removal with surgical site infection,it reaches the evidence grade of expert consensus and recommendation intensity by integrating with discussions on meetings and clinical experience of the expects from relevant fields.RESULTS A total of 6 items of consensus were reached by summarizing the latest evidence on the aspects including the indications for preoperative hair removal,tools,range,timing and places.CONCLUSION The consensus,to some extent,make supplements to and complete the exiting regulations and standards.It provides guidance for the medical institutions to carry out the preoperative hair removal.

To formulate an expert consensus on the principles of preoperative hair removal and provide scientific guidance for standardized removal of hair before surgical procedures so as to reduce the incidence of surgical site infections.METHODS Led by the Hospital Management Institute of National Health Commission of the People's Republic of China,this consensus was reached with the joint efforts from the expects of relevant fields such as surgeries,interventional therapies,nursing,and infection prevention and control.The consensus facilitates the classification and evaluation of literatures by following the evidence grade formulated by Oxford Evidence-based Medicine Center and focuses on the association of preoperative hair removal with surgical site infection,it reaches the evidence grade of expert consensus and recommendation intensity by integrating with discussions on meetings and clinical experience of the expects from relevant fields.RESULTS A total of 6 items of consensus were reached by summarizing the latest evidence on the aspects including the indications for preoperative hair removal,tools,range,timing and places.CONCLUSION The consensus,to some extent,make supplements to and complete the exiting regulations and standards.It provides guidance for the medical institutions to carry out the preoperative hair removal.

Cholangiocarcinoma originates from bile duct epithelial cells. It has an insidious onset, a high degree of malignancy, a poor prognosis and a high recurrence rate. Exosomes are nanoscale vesicles with a bilayer membrane structure, containing abundant biomolecules such as DNA, RNA, proteins and lipids. Exosomes are important carriers for the exchange of substances and information between cells and are involved in a variety of pathophysiological processes. In addition, exosomes have great potential in the diagnosis and treatment of various diseases. This article reviews the role of exosomes in the occurrence and development of cholangiocarcinoma and their potential value in the diagnosis and treatment of cholangiocarcinoma.

With the development of perinatal medicine in China for more than 30 years, great progress has been made in the fight against infectious diseases associated with pregnancy, including better knowledge, improved clinical treatment, and more effective preventive measures. This article reviews and prospects the prevention and treatment of infectious diseases in pregnancy in China from the four aspects: mother-to-child transmission of acquired immune deficiency syndrome, syphilis, and hepatitis B; toxoplasma, others, rubella virus, cytomegalovirus, and herpes simplex virus infection; influenza and novel coronavirus infection; and sepsis.

Sepsis and septic shock are obstetric emergencies, which bring clinical issues for obstetricians to pay attention to, such as early identification and emergency intervention before transferring the patients to intensive care. Physiological changes during pregnancy and puerperium result in difficulty in identifying the clinical features of sepsis. Simple bedside screening tools can be used for early identification and screening for possible sepsis. If initial sepsis screening is positive with suspected or evidence of infection, regardless of the presence of fever, further evaluation of organ damage is required for the diagnosis of sepsis. Bundle therapy should be initiated within 1 h after the identification of sepsis: For pregnant women or puerpera with suspected or confirmed sepsis, bacterial culture (blood, urine, respiratory tract, and other body fluids) and serum lactate level detection should be conducted promptly, moreover, empirical broad-spectrum antibiotics given within 1 h are recommended; For patients with sepsis complicated by hypotension or organ hypoperfusion, it is recommended to administer 1-2 L crystal solution as soon as possible for liquid resuscitation; For those with persistent hypotension and/or organ hypoperfusion despite fluid resuscitation, vasopressors are recommended to maintain mean arterial pressure ≥65 mmHg (1 mmHg=0.133 kPa), with norepinephrine as the first-line vasopressor. When sepsis is suspected or confirmed, the focus of infection should be actively sought to effectively control the source. Termination of pregnancy should be considered individually and comprehensively on the basis of obstetric indications, gestational age, and maternal and fetal conditions, but not depend on sepsis alone. If intrauterine infection is confirmed, pregnancy should be terminated immediately. Cesarean delivery usually requires general anesthesia for pregnant women with sepsis and intraspinal anesthesia is relatively contraindicated. The diagnosis and treatment of sepsis in pregnancy and puerperium should be individualized in accordance with the corresponding guidelines.