OBJECTIVE: To explore the factors for the failure of non-invasive prenatal testing (NIPT) through multifactorial unconditional Logistic regression analysis. METHODS: A total of 3 410 pregnant women who had visited Dalian Women and Children Medical Group from July 2019 to June 2020 were selected as the study subjects and divided into first success NIPT group (n = 3 350) and first failed group (n = 60). Clinical data including age, weight, body mass index (BMI), gestational week, type of pregnancy (singleton/twin), history of delivery, heparin treatment, and conception method [natural conception/assisted reproductive technology (ART)] were collected. Independent sample t-test and Chi-square test were carried out for comparing the two groups, and multi-factorial unconditional Logistic regression analysis was carried out to explore the factors for the failure of NIPT, and receiver operating characteristic curve (ROC) analysis was used to evaluate the diagnosis and predictive effects. RESULTS: Among the 3 410 pregnant women, 3 350 were assigned to the first success NIPT group, and 60 were assigned to the first failed group, and the first-time failure rate was 1.76% (60/3 410). No significant difference was found in age, weight, BMI and method of conception between the two groups (P > 0.05). Compared with first success group, first failed group had lower sampling gestational weeks, lower proportion of women with previous history of delivery, and higher proportion of twin pregnancies and heparin treatment (P < 0.05). Multi-factorial unconditional Logistic regression analysis indicated that sampling gestational week (OR = 0.931, 95%CI: 0.845 ~ 1.026, P < 0.001) and history of heparin use (OR = 8.771, 95%CI: 2.708 ~ 28.409, P < 0.001) are independent factors for first failed NIPT. One-way unconditional Logistic regression analysis for sampling gestational weeks indicated that the regression equation for NIPT screening failure was Logit (P) = -9.867 + 0.319 × sampling gestational week, with the area under the ROC curve being 0.742, a Jordan index of 0.427, and a cutoff value of 16.36 weeks. CONCLUSION Gestational week and heparin treatment are independent factors for the first failed NIPT. A regression equation has been established and determined the optimal sampling gestational week to be 16.36 weeks, which may provide a reference for the timing of NIPT screening.
Child ; Pregnancy ; Female ; Humans ; Logistic Models ; Prenatal Diagnosis/methods* ; Pregnancy, Twin ; Reproductive Techniques, Assisted

Objective:To explore the risk factors of poor renal prognosis in patients with coronary artery bypass surgery (CABG)-associated acute kidney injury (AKI), and establish a preliminary clinical risk prediction model for chronic kidney disease (CKD) progression in CABG-associated AKI patients, and evaluate its predictive efficacy.Methods:It was a retrospective, observational cohort study. The study subjects were patients who underwent CABG at Central China Fuwai Hospital from January 1, 2018 to December 31, 2020, with a baseline estimated glomerular filtration rate (eGFR)>60 ml·min -1·(1.73 m 2) -1 and postoperative complication of AKI. The patients were followed up for 90 days after discharge from hospital. The endpoint event was defined as progression to CKD after 90 days of the occurrence of CABG-associated AKI. The patients were divided into CKD group and non-CKD group based on whether they experienced endpoint events. The baseline clinical data were compared between the two groups. The logistic regression model was used to analyze the risk factors of endpoint event. The receiver-operating characteristic curve was drawn to evaluate the performance of the clinical risk prediction model for predicting poor renal prognosis in CABG-associated AKI patients. Results:A total of 124 CABG-associated AKI patients were enrolled in the study, including 95 males and 29 females, aged (62.57±9.61) years old. Thirty-eight patients (30.8%) progressed to new-onset CKD 90 days after CABG-associated AKI. Compared with non-CKD group, CKD group had lower preoperative hemoglobin ( t=2.778, P=0.006) and baseline eGFR ( t=3.603, P<0.001), higher proportion of women ( χ2=10.714, P=0.001), and higher preoperative blood NT-proBNP ( Z=-2.150, P=0.030) and discharged serum creatinine ( Z=-5.290, P<0.001). The multivariate logistic regression analysis results revealed that female ( OR=5.179, 95% CI 1.535-17.477, P=0.008), high preoperative blood NT-proBNP ( OR=1.049, 95% CI 1.004-1.095, P=0.032), low baseline eGFR ( OR=0.928, 95% CI 0.889-0.968, P=0.001), and high serum creatinine at discharge ( OR=1.019, 95% CI 1.009-1.029, P<0.001) were independent influencing factors of CABG-associated AKI to CKD. The clinical risk prediction model including female, preoperative blood NT-proBNP, preoperative baseline eGFR, and serum creatinine at discharge produced a moderate performance for predicting CABG-associated AKI to CKD ( AUC=0.872, 95% CI 0.806-0.939, P<0.001). Conclusion:Patients with CABG-associated AKI are at high risks for new-onset CKD. Female, preoperative high NT-proBNP, preoperative low baseline eGFR and high serum creatinine at discharge can help identify patients with a high risk of CABG-associated AKI to CKD.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

Objective:To explore the application value of non-invasive prenatal testing (NIPT) technology in twin pregnancy.Methods:A total of 339 twin pregnant women who underwent NIPT at Dalian Municipal Women and Children′s Medical Center(Group), Dalian Jinpu New District Maternity and Child Health Hospital, and Dalian Lvshunkou District People′s Hospital from July 1, 2019 to June 30, 2021 were continuously retrospectively included. The clinical characteristics and test results of pregnant women with high-risk and low-risk were analyzed.Results:Among 339 pregnant women, 336 were successfully tested, with a success rate of 99.12%(336/339); 6 pregnant women were at high risk of NIPT, with a positive screening rate of 1.77%(6/339), including 1 case of high risk of trisomy 13, 2 cases of high risk of trisomy 18, and 3 cases of high risk of Trisomy 21; the results of amniocentesis for 2 high-risk pregnant women were not abnormal.Conclusions:NIPT technology is non-invasive, safe and efficient, and is suitable for large-scale prenatal screening. However, the detection accuracy of pregnant women with twin pregnancy needs to be improved.

Objective:By using array-based comparative genomic hybridzation (CGH), the karyotype of spontaneous abortion was detected to analyze the genetic background difference between initial abortion and recurrent abortion.Methods:From July 2016 to September 2019, patients diagnosed as spontaneous abortion in Dalian Women′s and Children′s Medical Center were collected continuously. The abortion tissue microarray was used to analyze.Results:A total of 618 cases were collected, 345 of whom met the inclusion criteria, 133 cases (38.55%) in spontaneous abortion group and 212 cases (61.45%) in recurrent abortion group. A total of 237 cases of abnormal chromosome were detected, among whom the incidence of trisomy 22 (10.14%), trisomy 16 (9.86%) and monosomy 19 (7.25%) was high. The abnormal rate of chromosome karyotype was lower in recurrent abortion group, but there was no significant statistical difference ( P>0.05). After analyzing different age and gestational age, there was no significant statistical difference between haplotype and trisomy ( P>0.05). Conclusions:Some abnormal karyotypes are more common in abortion tissues. In recurrent abortion, the abnormal rate of chromosome karyotype is lower, but there is no significant difference in genetic background between spontaneous abortion and recurrent abortion.

Objective:To investigate the clinical significance of seminal plasma polymorphonuclear neutrophil elastase(PMNE) concentration and semen quality in male infertility.Methods:Semen samples of 941 patients admitted to the andrology department from June 2017 to December 2018 in Dalian Municipal Women and Children′s Medical Center were selected. According to the World Health Organization (WHO) fifth edition standards, the positive group had a leukocyte content ≥ 1 × 10 9/L, and the negative group had a leukocyte content < 1 × 10 9/L; the samples were divided into the inflammatory group and the non-inflammatory group with the PMNE concentration of 600 μg/L as the cut-off point, and the relationship between the PMNE, semen parameters and mycoplasma positive rate was analyzed; the samples were divided into sterile group and normal group according to WHO standard, and the relationships among semen routine parameters, PMNE concentration and mycoplasma positive rate were analyzed. Results:PMNE in the positive group was significantly higher than that in the negative group [(1823.29 ± 557.64) × 10 9/L vs. (480.60 ± 195.36) × 10 9/L], and PMNE concentration was positively correlated with leukocyte content ( P<0.05); the semen quality of the inflammatory group decreased, and the positive rate of mycoplasma was higher than that of the non-inflammatory group [(23.7%(71/299) vs. 11.5%(74/642)] ( P<0.05). The semen quality of the sterile group decreased, and the PMNE and mycoplasma positive rate were both higher than that in the normal group [(1 230.89 ± 489.09) × 10 9/L) vs. (596.78 ± 159.25) × 10 9/L, 34.7%(90/259) vs. 8.1%(55/682)]( P<0.05). Conclusions:There is a good correlation between the concentration of PMNE and the leukocyte content, which can be used as an index to evaluate the male reproductive system infection. The concentration of PMNE is closely related to semen quality, which has clinical value in the diagnosis of male infertility.

Objective: To prepare anti-serum against α-toxin in guinea pigs and purify anti-rHla IgG and identify it by SDS-PAGE observe the expression of Hla on the surface of yeast cells by ELISA and immunofluorescence confocal microscopy. Methods: Guinea pigs were immunized with recombinant α-toxins to obtain anti-α-toxin serum and total IgG which contains anti-rHla IgG. The purity of IgG was Identified and evaluated with non-reducing SDS-PAGE. The expression of Hla was evaluated with whole cell ELISA and immunofluorescence confocal. Results: The anti-α-toxin antibody of guinea pig was successfully obtained. Anti-α-toxin antibodies was captured by the protein A on the pre-packed column. The concentration of IgG in the unpurified serum was low, the α-rHla content in the flow-out peak was even lower, and the elution fraction contains IgG (α-rHla) with purity of about 85%. Through ELISA, transformant-1 and transformant-2 was identified to be positive with rHla on the surface, compared with that in the negative control. After stain with the purified anti-α-toxin IgG, the 1 yeast transformant showed green fluorescence under immunofluorescence confocal microscope. By contrast, without inducing, the 1 yeast transformant was negative with fluorescence. Conclusions The results show that Staphylococcus aureus Hla is successfully displayed on the surface of yeast, and this research could be further applied in the identification of clinical samples or pre-clinical research. This study provides two reliable methods for the development of yeast-display vaccine.

Objective To test the inhibitory effect of Corynebacterium cell wall extract on bladder cancer cells. Methods The bladder RNA was extracted from bladder cancer rats, and concentration and purity of RNA was detected. The extracted RNA was reversely transcribed into cDNA, then the primers were designed and the Grim19 gene, β-actin gene, Stat3 gene was amplified. Finaly the PCR product was subjected to agarose gel electrophoresis. Results OD260 was 0.07, and OD260/OD280 was 2.03 in the group of Corynebacterium parvm extract(3-5# ); OD260 was 0.12, and OD260/OD280 was 2.07 in the group of MNU( 6-5#);OD260 was 0.08, and OD260/OD280 was 2.07 in the group of physiological saline(7-5#) . The results of agarose gelelectrophoresis showed that Grim19 gene and Stat3 gene was expressed highly in the bladder of rats from the group of CP cell wall extract (3-5# ). Grim19 gene was expressed lowly, while Stat3 gene was expressed highly in the bladder of rats from the group of MNU (6-5#). Grim19 gene and Stat3 gene was expressed normally in the bladder of rats from physiological saline(7-5). Conclusions The expression situation of antitumor gene Grim19 and tumor gene Stat3 in the bladder of rats was inhibited by the cell wall extract of Corynebacterium parvm, which indicates that the cell wall extract of Corynebacterium parvm has inhibitory effect on bladder cancer cells.

Objective To determine the influence of abiraterone acetate (AA) on neuroendocrine differentiation (NED) in metastatic castration-resistant prostate cancer (mCRPC) and the prognostic predicting value of the serum NED markers in mCRPC patients treated with AA.Methods We conducted an analysis in 115 chemotherapy-naive mCRPC patients who were treated with chemotherapy in Renji hospital from 2013 to 2017.The median age was 70,ranged from 65 to 76 years old.The median CgA,NSE and PSA levels were 101.1 ng/ml (78.5-150.0 ng/ml),13.4 ng/ml (10.5-17.6 ng/ml) and 38.8 ng/ml (11.2-123.2 ng/ml),respectively.Among them,48 cases were classified as the group without AA treatment.The other 67 cases were classified as group after AA failure.In group without AA treatment,the median CgA,NSE and PSA levels were 109.1 ng/ml(80-151.5 ng/ml);13.8 ng/ml(10.8-18.2 ng/ml) and 39.2 ng/ml (8.6-200 ng/ml),respectively.In group after AA failure,the median CgA,NSE and PSA levels were 105.4 ng/ml(78.8-175.5 ng/ml),13.8 ng/ml(10.8-17.6 ng/ml) and 39.0 ng/ml(8.4-219.8 ng/ml),respectively.In the group with serial evaluation of NED markers during AA treatment,the median serum CgA,NSE levels at baseline were 115.9 ng/ml(90.1-201.5 ng/ml),13.3 ng/ml (10.4-18.1 ng/ml),respectively.The endpoints were PSA PFS(progression-free survival) and radiographic PFS (rPFS).Results In 34 patients with serial evaluation,serum NED markers level in 19 patients increased after the failure of AA treatment.Median serum CgA and NSE levels were 115.9 ng/ml(90.1-201.5 ng/ml)and 13.25 ng/ml (10.37-18.14 ng/ml) at baseline.Median serum CgA and NSE levels were 129.6ng/ml (75.5-230.5 ng/ml) and 14.7 ng/ml (11.8-19.1 ng/ml) after 6 months treatment,respectively.The median serum CgA and NSE levels were 130.4 ng/ml (95.7-205.7 ng/ml) and 15.2 ng/ml(12.4-18.7 ng/ml) at the time of failure of AA treatment,respectively.There was no significant difference of NED markers between baseline and failure of AA treatment (P =0.243).In logistic univariate analysis,AA treatment and its duration were not independent factors influencing NED(P =0.30;P =0.52).Compared with the NED markers elevation group in the first 6 months of AA treatment and baseline supranormal NED markers group,the NED markers decline group(PSA PFS(17.1 vs.10.4 months,P ＜ 0.001) and rPFS (17.0 vs.10.4 months,P =0.003)) and baseline normal NED markers group(PSA PFS(14.1 vs.9.5 months,P =0.001) and rPFS(16.4 vs.10.5 months,P ＜ 0.001)) has a longer median PSA PFS and rPFS respectively.In multivariate Cox analysis,baseline NED markers level and NED markers variation during the first 6 months of AA treatment remained significant predictors of rPFS(P ＜ 0.05),and PSA-PFS (P ＜ 0.05).Conclusions We found there was heterogeneity in changes of NED markers in different mCRPC patients during AA treatment,and AA might not significantly lead to progression of NED of mCRPC in general.Serial CgA and NSE evaluation might help clinicians guide clinical treatment of mCRPC patients.Serum NED markers elevation during the first 6 months of AA treatment and elevated baseline NED markers levels indicated poor prognosis in mCRPC treated with AA.

Objective To evaluate the predictive value of CT scan in the outcome of renal function after decompression procedures in patients with acute obstructive renal failure.Methods Retrospective analysis of clinical information of 76 patients with acute obstructive renal failure between January 2012 and August 2017 was performed.Clinical information included age,cause of obstruction,type of decompression procedures,total renal area and dominant side renal area measured by CT scan,serum creatinine(SCr) level before operation,SCr level in 3 months after decompression.Patients were divided into 2 groups according to creatinine clearance rate (CCr) in 3 months after decompression,including normal renal function group (26 cases,CCr ≥50 ml/min) and decompensated renal function group (50 cases,CCr ＜ 50 ml/min).The CCr of normal renal function group was (65.3 ± 12.8)ml/min,while the decompensated renal function group was (28.9 ± 11.9)ml/min.The average age of normal renal function group was 48.3 years old,the median value of serum creatinine before operation was 633μmol/L,while the average age of decompensated group was 63.8 years old,the median value of preoperative creatinine was 583 μmol/L.Renal area was measured in CT scan image which was performed when acute obstructive renal failure was diagnosed.Univariate analysis and logistic regression multivariate analysis was used to analyze these parameters.Receiver operating characteristic curve (ROC) was used to evaluate the performance of CT scan for renal function prediction.Results There were significant differences in the renal area between the normal renal function and decompensated renal function group,the total renal area were (3 765.5 ± 628.6) mm2 (range 2 375.3-4 853.6 mm2) and (2 493.0 ± 830.6) mm2 (range 476.9-4 225.1 mm2) respectively (P ＜ 0.001),while the dominant side renal area were (2 283.5 ± 430.2) mm2 (range 1 654.6-3 383.3 mm2) and (1 655.5 ± 496.2) mm2 (range 476.94-2 816.0 mm2) respectively (P ＜ 0.001).The integration area under the ROC curve of the total renal area to predict the outcome of renal function was 0.89.Conclusions The renal area measured in CT scan image might be useful for the early prediction of renal function outcome in patients with acute obstructive renal failure.