Objective To compare the safety and efficacy of curettage and their combination with uterine artery embolization(UAE)in the treatment of cesarean scar pregnancy(CSP)patients with a low score(≤4)in the ultrasound quantification scoring system.Methods Based on our inclusion and exclusion criteria of this randomized controlled study,the women with CSP who had an ultrasonic quantitative score≤4 and were treated in our department from May 2020 to August 2023 were enrolled,and then randomly divided into a curettage group(n=48)and a UAE combination group(n=47)in a ratio of 1∶1.General information,intraoperative conditions,and use of rescue measures within 3 months after operation were collected in the 2 groups of patients.All the patients were followed up until October 2024 to observe the pregnancy outcomes and determine the impact on the menstrual volume after the resumption of normal menstruation.Results The patients from the both groups completed the follow-up.Except for the maximum gestational sac diameter,there were no significant differences in other baseline data between the 2 groups,and the curettage group had notably more patients having a gestational sac diameter≤25 mm than the combination group[37(77.1%)vs 27(57.4%),P<0.05].No statistical differences were observed between the 2 groups in the intraoperative bleeding volume and use of rescue measures within 3 months after surgery.The combination group had obviously more patients with reduced menstrual volume after the resumption of normal menstruation than the dilation and curettage group[30(63.8%)vs 13(27.1%),P<0.001].There were no statistically differences in pregnancy outcomes and the number of days to resume menstruation between the 2 groups.Conclusion For CSP patients with a score of≤4 in the ultrasound quantification scoring system,curettage show no significant difference in therapeutic effectiveness,and even have better efficacy and safety when compared with curettage combined with UAE.

Objective To develop a prediction model for placenta previa in early pregnancy by analyzing embryo implantation sites and related clinical factors,in order to provide an objective basis for early risk identification.Methods A retrospective cohort study was conducted on 232 singleton pregnant women delivering in our hospital between September 2020 and March 2024.According to the final pre-delivery ultrasound findings,they were divided into placenta previa group(n=78)and a non-placenta previa group(n=154).Their ultrasound parameters[distance from lower gestational sac margin to cervical os,implantation site(lower/middle-upper uterine segment),and implantation position(anterior/posterior wall)],and clinical data[age,gravidity(categorized as<2 or≥2 pregnancies),parity(<2 or≥2 deliveries),and history of intrauterine procedures were collected through electronic medical records.Univariate analysis was used to screen potential predictors(P<0.1),and multivariate logistic regression analysis was employed to identify the predictors(P<0.05)for placenta previa.Then a nomogram prediction model was constructed,which was internally validated with Bootstrap(1 000 bootstrap resamples)and assessed for discrimination with area under the receiver operating characteristic curve(AUC)and for calibration with Hosmer-Lemeshow goodness-of-fit test.Results The placenta previa group showed significantly advanced age(≥35 years),lower education level(≤high school),multigravidity(≥2 pregnancies),multiparity(≥2 deliveries),more intrauterine procedures,distance of gestational sac-to-cervical os<5.5 mm,and larger proportion of lower uterine segment implantation than the non-placenta previa group(all P<0.1).But there were no statistical differences between the 2 groups in proportion of posterior wall implantation,history of cesarean section or assisted reproductive technology(ART).Multivariate logistic regression analysis confirmed lower uterine segment implantation(OR=40.40,95%CI:14.68～136.19,P<0.001),posterior wall implantation(OR=2.73,95%CI:1.27～6.28,P=0.013),and intrauterine procedures(OR=3.48,95%CI:1.65～7.70,P=0.001)as independent risk factors.The model based on these predictors demonstrated excellent discrimination(AUC value=0.84,95%CI:0.79～0.90)and calibration(Hosmer-Lemeshow test Chi-square=3.455,P=0.750).Conclusion Lower uterine segment/posterior wall implantation and intrauterine procedures are independent risk factors for placenta previa.Our nomogram model based on these factors shows good predictive efficiency,and can provide reference for early recognition of pregnant woman with high-risk placenta previa.

Objective To investigate the effect of precision nutrition management on the weight gain and pregnancy outcome in the patients with rapid gestational weight gain (GWG).Methods A total of 121 pregnant women with regular antenatal check-up and rapid GWG in this hospital from July 2022 to May 2023 were selected as the study subjects and divided into the observation group (n=58) and control group (n=63) by the random number table method.The two groups all received the conventional antenatal check-up,health-care and health education.The observation group simultaneously received the precision nutrition intervention for 4 weeks,in which one extra meal was replaced with 30 g of low glycaemic index nutritional formula pow-der.The diet situation and physical activity levels in the observation group were investigated before interven-tion and during the intervention period.The baseline information,post-intervention body weight,delivery body weight and pregnant maternal and neonate outcomes were collected in the two groups.Results Compared with before intervention,whole grains and miscellaneous beans[0(0,30.0)g/d vs.0(0,2.5)g/d],fish and shrimp[65.0(0,130.0)g/d vs.0(0,100.0)g/d],vegetables[(310.5±98.9)g/d vs.(248.2±117.9)g/d],iron[20.30(18.70,23.90)mg/d vs.18.75(14.80,22.80)mg/d]intake and weekly activity time[350(280,420) min vs.210(150,280)min]during the intervention period in the observation group were increased,fruits[179.0(145.0,238.0)g/d vs.200.0(179.0,366.0)g/d],total energy[1702(1608,1837)kcal/d vs.2055 (1848,2327)kcal/d],saturated fatty acids[11.50(8.20,15.80)g/d vs.15.75(12.30,19.00)g/d]intake and proportion of fat calories[(31.71±5.22)％ vs.(35.12±6.17)％]were decreased,the differences were statis-tically significant (P<0.05).Compared with the control group,the intervention period[0.45(0.29,0.63)kg/week vs.0.63(0.50,0.88)kg/week]and the weekly weight gain in 4 weeks after the intervention[0.50 (0.34,0.64)kg/week vs.0.70(0.50,0.93)kg/week],GWG excess ratio (60.3％ vs.77.8％) in the observa-tion group were lower,and the differences were statistically significant (P<0.05).Compared with the control group,complicating anemia during pregnancy (15.5％ vs.31.7％),macrosomia (5.2％ vs.17.2％),incidence rate of adverse delivery outcomes (1.7％ vs.12.7％) and neonatal birth weight[(3292.2±420.9)g vs. (3497.6±454.7)g]in the observation group were lower,and the natural labor process was shorter[5.17 (3.33,9.15)h vs.10.00(6.37,18.00)h],the differences were statistically significant (P<0.05).Conclusion Preci-sion nutrition management could effectively control rapid GWG and the increasing velocity of gestational weight.

Objective:To observe the clinical outcomes of continued pregnancy in pregnant women with cesarean scar pregnancy (CSP).Methods:A retrospective analysis was performed on the pregnancy outcomes of 55 pregnant women who were diagnosed with CSP at the Second Affiliated Hospital of Army Medical University during the first trimester of pregnancy from August 1st, 2018 to October 31st, 2021 and strongly requested to continue the pregnancy.Results:Of the 55 pregnant women, 15 terminated the pregnancy in the first trimester, 1 underwent hysterotomy at 23 weeks of gestation due to cervical dilation, and 39 (71%, 39/55) continued pregnancy to the third trimester achieving live births via cesarean section. The gestational age of the 39 pregnant women delivered by cesarean section was 35 +6 weeks (range: 28 +5-39 +2 weeks), of whom 7 cases at 28 +5-33 +6 weeks, 20 cases at 34-36 +6 weeks, and 12 cases at 37-39 +2 weeks. The results of pathological examination were normal placenta in 3 cases (8%, 3/39), placenta creta in 4 cases (10%, 4/39), placenta increta in 9 cases (23%, 9/39) and placenta percreta in 23 cases (59%, 23/39). Among the 36 pregnant women who were pathologically confirmed as placenta accreta spectrum disorders (PAS) after surgery, the last prenatal ultrasonography showed placenta previa in 27 cases (75%, 27/36) and not observed placenta previa in 9 cases. The median intraoperative blood loss, autologous blood transfusion, and allogeneic suspended red blood cell infusion of 39 pregnant women during cesarean section were 1 000 ml (300-3 500 ml), 300 ml (0-2 000 ml) and 400 ml (0-2 400 ml), respectively. The uterine preservation rate was 100% (39/39), and only 1 case received cystostomy due to intracystic hemorrhage. The birth weight of the newborn was 2 580 g (1 350-3 800 g), and 1 case of mild asphyxia. Conclusions:Pregnant women with CSP who continue pregnancy under close monitoring after adequate ultrasound evaluation and doctor-patient communication could achieve better maternal and infant outcomes, but pregnant women with CSP are highly likely to continue pregnancy and develop into PAS. Effective hemostasis means and multidisciplinary team cooperation are needed in perinatal period for ensuring maternal and fetal safety.

OBJECTIVE: To investigate the efficacy and safety of the bladder training in male patients before urinary catheter removal after mid-low rectal cancer surgery. METHODS: This was a prospective, open, randomized controlled study. INCLUSION CRITERIA: male patients; pathologically diagnosed as mid-low rectal adenocarcinoma; distance from tumor lower edge to anal margin ≤10 cm; standard radical surgery for rectal cancer, including intestinal resection and regional lymph node dissection. EXCLUSION CRITERIA: previous history of benign prostatic hyperplasia or history of prostate surgery; bladder dysfunction such as dysuria and urinary retention before surgery; local resection of rectal tumor or extended resection. According to the above criteria, 92 patients who underwent colorectal surgery at the Union Hospital of Fujian Medical University from June to December 2016 were prospectively included. The patients were randomly divided into bladder training group (n=43) and bladder non-training group (n=49) according to the random number table method. The study was approved by the Ethics Committee of the Union Hospital of Fujian Medical University (ethical approval number: 2016KY005) and registered with the China Clinical Trial Registration Center (ChiCTR) (registration No.ChiCTR-IOR-16007995). The implementation of patient's treatment measures, the data collection and analysis were based on the three-blind principle, using envelopes for distribution concealment. In the bladder training group, bladder training was routinely performed from the first day after operation to catheter removal, and in bladder non-training group the catheter was kept open till its removal. The catheter was removed in the early morning at the 5th day after surgery, and the spontaneous urine output was recorded and the residual urine volume of the bladder was measured after the first urination. The international prostate symptom score (IPSS) was applied to evaluate the patient's urinary function before and after surgery. RESULTS: The age of whole group was (58.6±10.9) years old, the body mass index was (22.4±2.7) kg/m , and the distance from tumor lower edge to anal margin was (6.5±1.9) cm. The baseline data, such as age, body mass index, distance from tumor lower edge to anal margin, preoperative IPSS score, preoperative bladder residual urine volume, neoadjuvant radiotherapy and chemotherapy, preventive ileostomy and surgical procedure were not significantly different between two groups (all P>0.05). There was no significant difference in IPSS scores evaluated at the second day (3.6±4.0 vs. 3.5±3.4, t=0.128, P=0.899) and one month (3.7±2.9 vs. 3.0±3.1, t=1.113, P=0.269) after catheter removal between the bladder training group and bladder non-training group. No significant difference in the postoperative residual urine volume of bladder (media 44 ml vs. 24 ml, Z=-1.466, P=0.143), the first spontaneous urination volume (median 200 ml vs. 150 ml, Z=-1.228, P=0.219) after catheter removal, and postoperative hospital stay [(8.2±4.5) days vs. (9.1±5.5) days, t=-0.805, P=0.423] was found. Urinary infection rate was 20.9%(9/43) in the training group, which was even higher than 8.2%(4/49) in the non-training group, but the difference was not significant(χ²=3.077, P=0.079). No patient needed re-catheterization in either group. CONCLUSIONS The routine bladder training after mid-low rectal cancer surgery does not improve the urinary function, and can not reduce the residual urine volume of bladder after catheter removal. This routine clinical practice is not helpful for the bladder function recovery after rectal cancer surgery.
Aged ; China ; Humans ; Laparoscopy ; Male ; Middle Aged ; Prospective Studies ; Recovery of Function ; Rectal Neoplasms ; surgery ; therapy ; Treatment Outcome ; Urinary Bladder ; surgery ; Urinary Retention ; therapy

0.05). Conclusion Fetal ovary allotransplant can survive in spayed adult female rats, develop and restore the function of secreting sex hormones.

OBJECTIVE:To study the therapeutic effect of yixinkangtai capsul e with nilestriol on perimenopausal syn?drome.METHODS:68female patients suffering from perimenopausal syndrome were randomly divided into united therapy group(yixinkangtai capsule+nilestriol)and the control group(nilestriol),the effective rates and the amelioration of clinical symptoms of the2groups were observed and compared.RESULTS:The total effective rate of the united therapy group was88.24%,which is significantly higher than the control group(61.76%)(P