Objective Based on the clinical data and imaging manifestations of patients with ischemic stroke to establish a simple clinical prediction model that is used for identifying intracranial atherosclerotic stenosis-acute large vessel occlusion(ICAS-LVO in posterior circulation before surgery.Methods The clinical data of patients with acute large vessel occlusion(LVO in the posterior circulation,who received endovascular intervention at the First Affiliated Hospital of Nanjing Medical University of China from January 2019 to September 2022,were retrospectively analyzed.According to the intraoperative angiographic findings,the patients were divided into ICAS-LVO group and non-ICAS-LVO group.Univariate analysis and multivariate logistic regression analysis were used to analyze the patient's demographic characteristics,clinical history,imaging findings,and laboratory results,based on which a clinical prediction model for ICAS-LVO was established,and according to the relevant parameters a nomogram prediction model was plotted.Results A total of 110 patients with LVO in the posterior circulation who received endovascular treatment were included in the final analysis.In 51 patients(49.6％)the cause of vascular occlusion was the atherosclerotic stenosis of the intracranial arteries.Compared with non-ICAS-LVO group,in ICAS-LVO group the patients were younger,the incidence of atrial fibrillation was lower,and the level of plasma D-dimer was lower.Three factors,including atrial fibrillation,occlusion site and collateral circulation status,were finally screened out to establish the prediction model for ICAS-LVO.This model demonstrated acceptable calibration(Hosmer-Lemeshow test,P=0.562)and good discrimination ability(AUC=0.956;95％CI:0.906-0.986).Conclusion The clinical prediction model for ICAS-LVO,which is established on the three predictive factors(absence of atrial fibrillation,occlusion located at the V4 segment of the vertebral artery or at the proximal to mid segment of the basilar artery,and a favorable collateral circulation),carries high sensitivity and accuracy.This model can help neurointervention physicians to make early identification of ICAS-LVO and to promptly formulate vascular recanalization treatment strategies.

Female ; Infant, Newborn ; Humans ; Pregnancy ; Premature Birth ; Retrospective Studies ; Risk Factors ; Cerclage, Cervical ; Cervix Uteri

Objective:To investigate the impact of post-cesarean scar defects and scar diverticulum on the clinical outcomes of in vitro fertilization-embryo transfer (IVF-ET). Methods:A total of 523 cases, who had a previous delivery, underwent frozen-thawed single blastocyst transfer cycles during January 1 st, 2014 to January 31 st, 2018 in Shanghai Ji Ai Genetics and IVF Institute. Of which, 256 patients who had undergone cesarean section （C-S） surgery prior, along with 267 patients with a history of one vaginal delivery as control group, were admitted into this study. In addition, C-S group was further divided into 3 subgroups according to the different healing conditions of the uterine incision detected by ultrasound, namely, no severe defect subgroup, scar defects subgroup and diverticulum subgroup. The impact of patients with or without C-S history, patients with or without scar defects and diverticulum on the clinical outcomes of FET cycle was analyzed. Results:There was no difference in age, body mass index (BMI) and thickness of endometrium at the day of progesterone conversion between patients with one vaginal delivery (VD group) and patients with C-S history (C-S group). C-S group showed a significant decrease in implantation rate (48.05%), clinical pregnancy rate (46.48%) and live birth rate (38.28%) compared with VD group (58.05%, P=0.023; 56.93%, P=0.014; 51.31%, P=0.022). There was a significant rise in preterm delivery rate （13.26% vs. 1.46%, P<0.001）, and average gestational age at the time of delivery was decreased [(38.12±1.76) weeks vs. (39.02±1.37) weeks, P<0.001], and neonatal birth weight was also significantly lower in C-S group [(3 372.14±374.25) g vs. (3 438.82±337.30) g, P=0.023]. Further analysis was done to address whether C-S severe defects with diverticulum had an impact on the clinical outcomes. Compared with the vaginal delivery group, the implantation rate, the clinical pregnancy rate, the live birth rate, and the gestational age at the time of delivery in severe scar defects subgroup were significantly reduced ( P=0.021, P=0.026, P=0.005 and P=0.009); and in the scar diverticulum subgroup they were more affected ( P=0.004, P=0.003, P=0.004 and P<0.001), the differences were statistically significant. Conclusion:A history of C-S, particularly a poor healing of incision with scar defects and diverticulum, has a significantly negative impact on the clinical outcomes of IVF-ET as well as a negative impact on gestational age at delivery, and increases the risk of premature birth and lower birth weight newborns.

Objective:To investigate the impact of post-cesarean scar defects and scar diverticulum on the clinical outcomes of in vitro fertilization-embryo transfer (IVF-ET). Methods:A total of 523 cases, who had a previous delivery, underwent frozen-thawed single blastocyst transfer cycles during January 1 st, 2014 to January 31 st, 2018 in Shanghai Ji Ai Genetics and IVF Institute. Of which, 256 patients who had undergone cesarean section （C-S） surgery prior, along with 267 patients with a history of one vaginal delivery as control group, were admitted into this study. In addition, C-S group was further divided into 3 subgroups according to the different healing conditions of the uterine incision detected by ultrasound, namely, no severe defect subgroup, scar defects subgroup and diverticulum subgroup. The impact of patients with or without C-S history, patients with or without scar defects and diverticulum on the clinical outcomes of FET cycle was analyzed. Results:There was no difference in age, body mass index (BMI) and thickness of endometrium at the day of progesterone conversion between patients with one vaginal delivery (VD group) and patients with C-S history (C-S group). C-S group showed a significant decrease in implantation rate (48.05%), clinical pregnancy rate (46.48%) and live birth rate (38.28%) compared with VD group (58.05%, P=0.023; 56.93%, P=0.014; 51.31%, P=0.022). There was a significant rise in preterm delivery rate （13.26% vs. 1.46%, P<0.001）, and average gestational age at the time of delivery was decreased [(38.12±1.76) weeks vs. (39.02±1.37) weeks, P<0.001], and neonatal birth weight was also significantly lower in C-S group [(3 372.14±374.25) g vs. (3 438.82±337.30) g, P=0.023]. Further analysis was done to address whether C-S severe defects with diverticulum had an impact on the clinical outcomes. Compared with the vaginal delivery group, the implantation rate, the clinical pregnancy rate, the live birth rate, and the gestational age at the time of delivery in severe scar defects subgroup were significantly reduced ( P=0.021, P=0.026, P=0.005 and P=0.009); and in the scar diverticulum subgroup they were more affected ( P=0.004, P=0.003, P=0.004 and P<0.001), the differences were statistically significant. Conclusion:A history of C-S, particularly a poor healing of incision with scar defects and diverticulum, has a significantly negative impact on the clinical outcomes of IVF-ET as well as a negative impact on gestational age at delivery, and increases the risk of premature birth and lower birth weight newborns.

OBJECTIVE:To evaluate the improvement and rectification effects about prescription checking and intervention skills of pharmacists. METHODS:By retrospective investigation,2417 outpatient prescriptions and 1698 outpatient prescriptions were respectively selected from some one hospital during Oct.-Dec. 2015 (before improvement and rectification) and Jan.-Mar. 2016 (after improvement and rectification). According to standards,guidelines and references as Prescription Administrative Poli-cy,Prescription Review Management Standard(trial)and drug instructions,irrational drug use and prescription checking and inter-vention skills of pharmacists were compared before and after the implementation of rectification measures as optimizing hospital in-formation system,improving comprehensive skills of pharmacists,strengthening pharmacists'concept,establishing feedback mech-anism. RESULTS:After the implementation of rectification measures,unsuitable indications,clinical diagnosis inconsistent with medication,antibiotics use without indications,unsuitable usage and dosage,unsuitable drug combination and irrational drug use were all decreased,but repeated drug use was increased,without statistical significance (P>0.05). The number of non-standard prescriptions and unsuitable prescriptions checked by pharmacists were decreased,without statistical significance(P>0.05). The in-cidence of checking missing,excessive checking and checking error were all increased from 2.40%,0.99%,3.39% before im-provement and rectification to 0.47%,0.29%,0.77%,with statistical significance(P<0.05). CONCLUSIONS:The improvement and rectification measures of the hospital can improve comprehensive prescription checking and intervention skills of pharmacists. Ir-rational drug use should be further standardized.

Objective To assess the value of ultrasonography in the diagnosis of ovarian pregnancy (OP). Methods The characteristics of transvaginal ultrasound and color Doppler flow imaging of 38 cases of OP were reviewed, whose diagnoses were confirmed by operations and pathologic findings. Results Twenty eight cases(~73.7 %) were correctly diagnosed by ultrasound, nine cases(~23.7 %) were misdiagnosed either as lutein cysts or as tubal pregnancy, one case(~2.6 %) was missed by ultrasound examination. According to ultrasound findings, 24 cases(~63.2 %) were diagnosed as type of gestational sac, 14(~36.8 %) cases as type of complex mass. Conclusions Ultrasonography plays an important role in diagnosing OP, especially in earlier OP of the gestational sac type.