Objective To investigate the induction factors of hypotension during cesarean section for perilous placenta previa under combined spinal-epidural anesthesia (CSEA) and to construct a nomogram prediction model. Methods A total of 130 parturients who underwent cesarean section for perilous placenta previa under CSEA from January 2020 to December 2023 in Yulin Maternity and Child Healthcare Hospital were selected as study subjects. A self-designed general information questionnaire was used to investigate the basic information and the occurrence of hypotension of the subjects. According to the occurrence of intraoperative hypotension, the patients were divided into hypotension group (47 cases) and non-hypotension group (83 cases). Univariate analysis was performed on the general information of the two groups, and multivariate Logistic regression analysis was used to explore the induction factors of intraoperative hypotension. Results Univariate analysis showed that there were statistically significant differences in body mass index, anesthesia level, presence of multiple pregnancy, preoperative systolic blood pressure, operative time, and the occurrence of Bezold-Jarisch reflex between the two groups (P < 0.05). Multivariate Logistic regression analysis revealed that body mass index≥ 24 kg/m², anesthesia level was in the eighth thoracic vertebra(T8) or above, multiple pregnancy, preoperative systolic blood pressure < 90 mmHg, operative time >1.5 h, and the occurrence of Bezold-Jarisch reflex were independent risk factors for hypotension during cesarean section for perilous placenta previa under CSEA (P < 0.05). A regression equation for the induction factors of hypotension during cesarean section for perilous placenta previa under CSEA was constructed: Logit(P)=-23.211+1.079×(body mass index ≥ 24 kg/m²)+1.101×anesthesia level (≥T8)+3.193×multiple pregnancy+2.214×preoperative systolic blood pressure (< 90 mmHg)+4.606×operative time (>1.5 h)+2.011×occurrence of Bezold-Jarisch reflex. The nomogram showed high discrimination and accuracy for patients with preoperative systolic blood pressure < 90 mmHg. After 1, 000 times of Bootstrap resampling for the nomogram model, a calibration curve was obtained, and the consistency index was calculated as 0.850, indicating good calibration of the nomogram model. The receiver operating characteristic (ROC) curve was plotted, with an area under the curve of 0.896 and 95% confidence interval of 0.802 to 0.956, suggesting good predictive performance. Conclusion Body mass index ≥24 kg/m², anesthesia level ≥ T8, multiple pregnancy, preoperative systolic blood pressure < 90 mmHg, operative time >1.5 h, and the occurrence of Bezold-Jarisch reflex are induction factors for hypotension during cesarean section for perilous placenta previa under CSEA.

Objective:This study aims to analyze the characteristics and basic principles of emergency surgery risks and anesthesia care of medical support at the landing site for China’s taikonauts of the Shenzhou-12, and to summarize China’s experience in medical support at the landing site for manned spaceflight, and ensure supports in special environments such as an emergency return of manned spaceflight.Methods:This study was carried out through literature research on relevant reports on the emergency surgery risks and aids of domestic and foreign astronauts at the landing sites, and summaries of the experience in medical support for taikonauts of spacecrafts from Shenzhou-5 to Shenzhou-11 at the landing sites. At the same time, according to the characteristics of Shenzhou-12 such as the long on-orbit time, the adjustment in the landing area, the optimization of the mission mode, and new search and rescue power, a series of organization, pre-arranged planning, equipment allocation, and effective anesthesia treatment plan were proposed and inspected in practice.Results:Based on the original anesthesia care plan of medical support, the first-aid carrier was adjusted and modified, the first-aid procedure was optimized, a new generation of supraglottic airway opening tool, video laryngoscope, portable ultrasound, and other devices were added, and the anesthesia care plan at the landing site for manned spaceflight was formulated to provide strong support for the medical care of taikonauts that had stayed in the outer space for a long time.Conclusions:Upon the targeted improvement and process optimization, the anesthesia care plan of medical support for taikonauts of Shenzhen-12 in the landing area fully meets the anesthesia requirement of medical support in special environments such as the emergency return of the taikonauts that have stayed in the outer space for a long time under the new orbital altitude.

Objective:To summarize and share the experience of one-stage feminization surgery in children with congenital adrenal hyperplasia (CAH).Methods:The clinical data of CAH female children in the Department of Pediatric Urology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from January 2018 to December 2020 were retrospectively analyzed. According to the Prader classification standard, the external genital virilism of children was graded. The cases of Prader grades Ⅱ to Ⅳ were underwent clitoroplasty and labiaplasty, while the cases of Prader Ⅱ and Ⅳ grades were required further vaginoplasty.Partial urogenital sinus mobilization(PUM) or total urogenital sinus mobilization(TUM )was performed according to the length of the urethrovaginal junction to the vulvar opening during the procedure. The postoperative follow-up was included the recovery of the external genitalia wound, the child’s ability to control urination, and the family members’ satisfaction with the child’s external genitalia appearance. Six months after the operation, the satisfaction with the appearance of the external genitalia was evaluated in the outpatient clinic, including four aspects: clitoris, labia majora, labia minora, and vaginal appearance.Results:A total of 18 female children were enrolled, ranging in age from 2 to 9 years old, with an average age of 4.5 years. There were 5 cases of Prader grade Ⅱ, 9 cases of grade Ⅲ, and 4 cases of grade Ⅳ. Ten cases (9 cases of Prader grade Ⅲ and 1 case of grade Ⅳ) underwent PUM, and 3 cases of Prader grade Ⅳ underwent TUM. All patients were followed up for 6-12 months after the operation, and all the wounds of the external genitalia of the children were healed in one stage. The satisfaction of family members to the appearance of external genitalia of children: 15 cases were satisfied, 3 cases were not satisfied; 3 patients were found to have overactive bladder two weeks after the operation, and no special treatment was given, the symptoms disappeared three months after the procedure, and the other children had no abnormal urination control ability. Six months after the process, the external genitalia was evaluated in the physician’s clinic: 17 cases were satisfied, and one was dissatisfied.Conclusions:The surgical method can be selected for better results according to the degree of external genitalia virilism and the common channel length in CAH female children.

Objective:To summarize and share the experience of one-stage feminization surgery in children with congenital adrenal hyperplasia (CAH).Methods:The clinical data of CAH female children in the Department of Pediatric Urology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from January 2018 to December 2020 were retrospectively analyzed. According to the Prader classification standard, the external genital virilism of children was graded. The cases of Prader grades Ⅱ to Ⅳ were underwent clitoroplasty and labiaplasty, while the cases of Prader Ⅱ and Ⅳ grades were required further vaginoplasty.Partial urogenital sinus mobilization(PUM) or total urogenital sinus mobilization(TUM )was performed according to the length of the urethrovaginal junction to the vulvar opening during the procedure. The postoperative follow-up was included the recovery of the external genitalia wound, the child’s ability to control urination, and the family members’ satisfaction with the child’s external genitalia appearance. Six months after the operation, the satisfaction with the appearance of the external genitalia was evaluated in the outpatient clinic, including four aspects: clitoris, labia majora, labia minora, and vaginal appearance.Results:A total of 18 female children were enrolled, ranging in age from 2 to 9 years old, with an average age of 4.5 years. There were 5 cases of Prader grade Ⅱ, 9 cases of grade Ⅲ, and 4 cases of grade Ⅳ. Ten cases (9 cases of Prader grade Ⅲ and 1 case of grade Ⅳ) underwent PUM, and 3 cases of Prader grade Ⅳ underwent TUM. All patients were followed up for 6-12 months after the operation, and all the wounds of the external genitalia of the children were healed in one stage. The satisfaction of family members to the appearance of external genitalia of children: 15 cases were satisfied, 3 cases were not satisfied; 3 patients were found to have overactive bladder two weeks after the operation, and no special treatment was given, the symptoms disappeared three months after the procedure, and the other children had no abnormal urination control ability. Six months after the process, the external genitalia was evaluated in the physician’s clinic: 17 cases were satisfied, and one was dissatisfied.Conclusions:The surgical method can be selected for better results according to the degree of external genitalia virilism and the common channel length in CAH female children.

Objective:To summarize and share the experience of one-stage feminization surgery in children with congenital adrenal hyperplasia (CAH).Methods:The clinical data of CAH female children in the Department of Pediatric Urology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from January 2018 to December 2020 were retrospectively analyzed. According to the Prader classification standard, the external genital virilism of children was graded. The cases of Prader grades Ⅱ to Ⅳ were underwent clitoroplasty and labiaplasty, while the cases of Prader Ⅱ and Ⅳ grades were required further vaginoplasty.Partial urogenital sinus mobilization(PUM) or total urogenital sinus mobilization(TUM )was performed according to the length of the urethrovaginal junction to the vulvar opening during the procedure. The postoperative follow-up was included the recovery of the external genitalia wound, the child’s ability to control urination, and the family members’ satisfaction with the child’s external genitalia appearance. Six months after the operation, the satisfaction with the appearance of the external genitalia was evaluated in the outpatient clinic, including four aspects: clitoris, labia majora, labia minora, and vaginal appearance.Results:A total of 18 female children were enrolled, ranging in age from 2 to 9 years old, with an average age of 4.5 years. There were 5 cases of Prader grade Ⅱ, 9 cases of grade Ⅲ, and 4 cases of grade Ⅳ. Ten cases (9 cases of Prader grade Ⅲ and 1 case of grade Ⅳ) underwent PUM, and 3 cases of Prader grade Ⅳ underwent TUM. All patients were followed up for 6-12 months after the operation, and all the wounds of the external genitalia of the children were healed in one stage. The satisfaction of family members to the appearance of external genitalia of children: 15 cases were satisfied, 3 cases were not satisfied; 3 patients were found to have overactive bladder two weeks after the operation, and no special treatment was given, the symptoms disappeared three months after the procedure, and the other children had no abnormal urination control ability. Six months after the process, the external genitalia was evaluated in the physician’s clinic: 17 cases were satisfied, and one was dissatisfied.Conclusions:The surgical method can be selected for better results according to the degree of external genitalia virilism and the common channel length in CAH female children.

Objective:To summarize and share the experience of one-stage feminization surgery in children with congenital adrenal hyperplasia (CAH).Methods:The clinical data of CAH female children in the Department of Pediatric Urology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from January 2018 to December 2020 were retrospectively analyzed. According to the Prader classification standard, the external genital virilism of children was graded. The cases of Prader grades Ⅱ to Ⅳ were underwent clitoroplasty and labiaplasty, while the cases of Prader Ⅱ and Ⅳ grades were required further vaginoplasty.Partial urogenital sinus mobilization(PUM) or total urogenital sinus mobilization(TUM )was performed according to the length of the urethrovaginal junction to the vulvar opening during the procedure. The postoperative follow-up was included the recovery of the external genitalia wound, the child’s ability to control urination, and the family members’ satisfaction with the child’s external genitalia appearance. Six months after the operation, the satisfaction with the appearance of the external genitalia was evaluated in the outpatient clinic, including four aspects: clitoris, labia majora, labia minora, and vaginal appearance.Results:A total of 18 female children were enrolled, ranging in age from 2 to 9 years old, with an average age of 4.5 years. There were 5 cases of Prader grade Ⅱ, 9 cases of grade Ⅲ, and 4 cases of grade Ⅳ. Ten cases (9 cases of Prader grade Ⅲ and 1 case of grade Ⅳ) underwent PUM, and 3 cases of Prader grade Ⅳ underwent TUM. All patients were followed up for 6-12 months after the operation, and all the wounds of the external genitalia of the children were healed in one stage. The satisfaction of family members to the appearance of external genitalia of children: 15 cases were satisfied, 3 cases were not satisfied; 3 patients were found to have overactive bladder two weeks after the operation, and no special treatment was given, the symptoms disappeared three months after the procedure, and the other children had no abnormal urination control ability. Six months after the process, the external genitalia was evaluated in the physician’s clinic: 17 cases were satisfied, and one was dissatisfied.Conclusions:The surgical method can be selected for better results according to the degree of external genitalia virilism and the common channel length in CAH female children.

OBJECTIVE: To investigate the effect of corticosteroids therapy on the inflammatory response in a critically ill coronavirus disease 2019 (COVID-19) patient. METHODS: A 55-year old female patient with critical ill COVID-19 was admitted in Taizhou Hospital on January 19, 2020. The patient was treated with methylprednisolone 80 mg on the 2nd day after admission. Thereafter, the dose was adjusted in a timely manner and the therapy lasted for 13 days. The peripheral lymphocyte subsets (CD3T, CD4 T, CD8 T, NK cells, B cells), as well as serum levels of lymphocyte factors (IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ) were dynamically monitored. RESULTS: On D1 of admission, the numbers of peripheral blood CD3 T, CD4 T, CD8 T, and NK cells were significantly lower than the normal range. With the improvement of the disease, the numbers of CD3 T, CD8 T and CD4 T cells gradually recovered and showed a linear growth trend (linear fitting equation: =18.59+109.4, <0.05). On D2 of admission, the patient's IL-6 and IL-10 levels were significantly higher than normal values, IFN-γ was at a normal high value, and then rapidly decreased; IL-2, IL-4, and TNF-α were all in the normal range. On the D6 and D7, the IL-6 and IL-10 decreased to the normal range for the first time. On the D18, the sputum virus nucleic acid test was negative for the first time, and the fecal virus nucleic acid test was still positive; on the D20 the sputum and fecal virus nucleic acid test were both negative. On D34, the patient recovered and was discharged. At the discharge the muscle strength score of the patient was 44 and the daily life ability evaluation was 90. CONCLUSIONS In the absence of effective antiviral drugs, early use of appropriate doses of corticosteroids in critically ill patient with COVID-19 can quickly alleviate inflammatory response and improve clinical symptoms, however, it may reduce the number of T cells, and to adjust the dose in time is necessary.
Betacoronavirus ; isolation & purification ; Cell Count ; Coronavirus Infections ; diagnosis ; drug therapy ; immunology ; physiopathology ; Critical Illness ; Cytokines ; blood ; Female ; Humans ; Methylprednisolone ; administration & dosage ; adverse effects ; Middle Aged ; Pandemics ; Pneumonia, Viral ; diagnosis ; drug therapy ; immunology ; physiopathology ; T-Lymphocyte Subsets ; drug effects ; Treatment Outcome

Further healthcare system reform calls for desirable pathway design. This paper introduced the logical framework of the new healthcare system reform pathway design and typical practical experience in Hangzhou.Known for " Internet+Smart healthcare" forerunner, Hangzhou has pioneered the reform of public hospitals and the construction of smart handy service for the public.With the aim of fully protecting the health rights and interests of urban and rural residents, comprehensive policy has been taken to deepen the reform of public hospitals; with the comprehensive promotion of contracted services and the primary level sharing of resources as a carrier, we will build a hierarchical medical service system of vertical linkage.We will also innovate and practice the governing philosophy of " Medicine has its limitations but we have the courage to overcome, service is boundaryless and we must pursue excellence".Promotion of party building in the industry also ranks high.Deepening the reform of " one visit for all" in the field of medical and health services as a measure to enhance people′s sense of gain; The " public-private partnership" to encourage the development of the social governance system and legalization in healthcare proves successful at this stage. However, there are still many challenges in the information security maintenance of smart healthcare, the balance of stakeholder interests in public hospitals, the all-round advancement of hierarchical medical service, standardizing and streamlining the reform of " one visit for all".

OBJECTIVE: To delineate cytogenetic and molecular abnormalities of a fetus carrying a de novo 46,X,der(X),t(X;Y)(p22.3;p11.2). METHODS: G-banded karyotyping and next-generation sequencing (NGS) were used to analyze the fetus, his father and sister. Single nucleotide polymorphism-based arrays (SNP-array), multiple PCR and fluorescence in situ hybridization (FISH) were utilized to verify the result. RESULTS: G-banded karyotyping at 320 bands showed that the fetus had a normal karyotype, while NGS has identified a 3.58 Mb microdeletion at Xp22.33 and a Y chromosomal segment of about 10 Mb at Yp11.32p11.2. With the sequencing results, high-resolution karyotyping at 550-750 bands level has determined the fetus to be 46,X,der(X)t(X;Y)(p22.3;p11.2). The result was confirmed by PCR amplification of the SRY gene, FISH and SNP-array assays. The karyotypes of his father and sister were both normal. His sister also showed no amplification of the SRY gene, and her NGS results were normal too, suggesting that the karyotype of the fetus was de novo. CONCLUSION Combined karyotyping, NGS, SNP-array, PCR and FISH assay can facilitate diagnosis of XX disorder of sex development.
Chromosomes, Human, X ; genetics ; Disorders of Sex Development ; genetics ; Female ; Fetus ; Humans ; In Situ Hybridization, Fluorescence ; Karyotyping ; Male ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Translocation, Genetic

Objective To investigate the clinical and imaging characteristics of phosphaturic mesenchymal tumor and improve the clinical diagnosis. Methods From November 2014 to September 2017, 22 patients with pathologically confirmed diagnosis as phosphaturic mesenchymal tumor (PMT) were retrospectively analyzed, including 12 males and 10 females, age ranged from 30-72 years, mean (47 ± 11) years old. The clinical data, laboratory tests [serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone and 1, 25- (OH) 2 D] and imaging examinations (X-ray, CT, MRI, nuclide) were collected and explored. Sixteen patients underwent SPECT scan and seven underwent PET/CT scan. Twenty patients had X-ray, eighteen patients had CT and 12 patients had MRI with enhancement. Results All patients suffered from diffuse pain for one to fifteen years, especially in lower back and lower extremities. All patients were found with low serum phosphorus, normal serum calcium. Twenty-one patients were found with elevated alkaline phosphatase, 16 with increased parathyroid hormone and 15 with decreased 1, 25 - (OH) 2 D. Thirteen lesions were located in the medullary cavity, seven in the soft tissue and two in the sinuses. Nineteen cases showed varying degrees of trabecular bone sparse, osteoporosis and osteomalacia on X-ray;There were 15 cases of multiple pseudo-fractures, including four cases of pelvic fracture complicated with femoral fracture, six cases of single fracture of pelvis, four cases of femur and one case of fibula. And seven cases showed multiple vertebral compression fractures. Thirteen lesions showed soft-tissue density and four in the medullary cavity showed high density on CT scan. The lesions presented low signal intensity on T1WI,high or low signal intensity on T2WI FLAIR and obviously enhanced in 12 patients who underwent MRI enhancement. Conclusion For patients with decreased serum phosphorus, elevated alkaline phosphatase, bone softening and fracture, octreotide or other nuclides should be primary imaging modality for confirming the location of the lesion. CT and MRI can further evaluate the nature of the lesion and improve diagnostic accuracy.