Background: Complete uterine rupture can lead to serious adverse maternal and child outcomes. Uterine rupture is rare, and it can occur in an intact uterus. Methods: We identified patients with intact uterus who encountered uterine rupture between 2010 and 2020 from the medical records of 10 hospitals in Sichuan Province. Results: In total, 37 cases of uterine rupture in intact uteri were identified. Eight ruptures (8/37, 21.6%) occurred before spontaneous labor, 11 ruptures (11/37, 29.7%) occurred during spontaneous labor, and 18 ruptures (18/37, 48.6%) occurred during induced labor. The clinical manifestations of the patients were abdominal pain in 20 cases (20/37, 54.1%), vaginal bleeding in three cases (3/37, 8.1%), and abdominal pain and vaginal bleeding in eight cases (8/37, 21.6%). The rate of hysterectomy/death was significantly higher in patients with more than three previous vaginal deliveries (p = 0.005). In addition, the rate of hysterectomy/death in the spontaneous labor group was significantly higher than that in the induced labor group (p = 0.011). The fetal survival rate in patients with uterine rupture at the uterine horn was significantly higher than that in patients with uterine rupture at the lower uterine segment (p = 0.007). Conclusions: Uterine rupture in an intact uterus was associated with a high hysterectomy rate and high fetal/neonatal mortality rate. For pregnant women with sudden abdominal pain and abnormal fetal heart rate, we should be alert to the possibility of uterine rupture. Induction and augmentation of labor need to be performed with caution to avoid this potential obstetric emergency.
Objective: To explore the clinical value of expanded carrier screening (ECS) for monogenic diseases in Chinese pregnant individuals. Methods: The clinical data of pregnant individuals with ECS for 334 single-gene recessive (AR or X-linked) diseases (434 pregnant woman and 315 spouses) at West China Second University Hospital of Sichuan University from May 2021 to February 2024 were retrospectively collected, including the general information, gestational age, carrier rate, detection of pathogenic/likely pathogenic (P/LP) variation with Human Gene Mutation Database (HGMD), and detection rate of at-risk couple (ARC). The diagnostic gestational weeks for ARC with concurrent screening and sequential screening mode were compared. Results: This study included 749 individuals (434 females and 315 males) with a median (Q1, Q3) age of 31 (28, 34) years. The carrier rate for carrying at least one P/LP variant was 65.6% (491/749). When only the P/LP variation included in HGMD was reported, detection rate of ARC was 8.3% (26/315). The actual detection rate of ARC (including P/LP variation in HGMD and not in HGMD) increased to 9.5 % (30/315). A total of 86 genes overlapped with the T3 screening genes recommended by American College of Medical Genetics and Genomics (ACMG-T3), and the detection rate of ARC was 7.0% (22/315). Compared with ACMG-T3, 334 gene screening packages covered an additional 248 genes, and the detection rate of ARC was 2.5% (8/315). The gestational age of ARC at prenatal diagnosis with concurrent screening was significantly earlier than that of sequential screening [(19.7±3.3) weeks vs (22.2±2.2) weeks, P=0.049]. Conclusion: Concurrent screening for monogenic disease carriers of multiple diseases during pregnancy will evidently advance the timing of diagnosis.
Highly pathogenic avian influenza viruses (HPAIV), such as H5N1, H5N6, and H7N9, have been reported to frequently infect humans, but acute encephalitis caused by HPAIV in humans has been rarely reported. We report the first critical case of acute encephalitis with mild pneumonia caused by the H5N6 virus. On January 25 of 2022, a 6-year-old girl with severe neurological symptoms was admitted to our hospital and rapidly developed into seizures and coma. Brain imaging showed abnormalities. Electroencephalogram (EEG) presented abnormal slow waves. Cerebrospinal fluid (CSF) contained elevated protein (1.64 g/L) and white cells (546 × 106/L). Laboratory investigations revealed abnormally elevated transaminases, lactate dehydrogenase, and cytokines in serum. A novel reassortant H5N6 virus was identified from the patient’s serum, CSF, and tracheal aspirate specimens. Phylogenic analysis indicated that this virus was a novel reassortant avian-origin influenza A (H5N6) virus that belonged to clade 2.3.4.4b. This patient was diagnosed with acute encephalitis and discharged from the hospital accompanied by a language barrier. An epidemiological investigation confirmed that wild waterfowls were the direct source of infection in this case. Our study highlights the urgent need to pay attention to acute encephalitis caused by HPAIV.
Microvascular decompression (MVD) surgery is recognized as an effective treatment for hemifacial spasm (HFS). In MVD surgery, biocompatible materials are usually implanted in situ at the neurovascular conflict site in contact with the offending vessel and the facial root entry/exit zone (REZ). Another procedure of implanting the materials between the responsible vessel and the supraolivary fossa without REZ contact has also been applied. However, it is unclear whether there are any differences between these 2 procedures (REZ-contact procedure vs. REZ-non-contact procedure). Therefore, the aim of the present study was to investigate the effect of the placement of implants (contacting or not contacting the facial REZ) on surgical operations and outcomes.A historical control study was performed. Clinical data of HFS patients who underwent MVD between December 2016 and November 2018 were reviewed and categorized into 1 group with the REZ-contact procedure or another group with the REZ-non-contact procedure according to the decompression strategy they received. Clinical demographics, postoperative outcomes, and complications were collected and compared between the two groups.Not all patients are suitable for REZ-non-contact decompression. A total of 205 patients were enrolled: 112 in the REZ-contact group and 93 in the REZ-non-contact group. In the early postoperative period, the complete cure rate in the REZ-non-contact group was significantly higher than that in the REZ-contact group. The reappearance and partial relief rates in the REZ-contact group were significantly higher than those in the REZ-non-contact group. The incidence of short-term neurological complications, especially hearing loss and transient facial palsy, was lower in the REZ-non-contact group (P=0.043). But for long-term follow-up of >1 year, there was no significant difference between the two groups in either curative effects or neurological complications. The operating time for REZ-non-contact decompression was relatively longer than for REZ-contact decompression (P=0.000). An unexpected subdural hemorrhage occurred in the REZ-non-contact group.REZ-non-contact decompression procedure showed superiority only in short-term postoperative outcomes. Given its limitations and potential risks, the REZ-non-contact procedure can be used as an alternative individualized strategy in MVD, and there is no need to pursue REZ-non-contact during the decompression.
Objective
To investigate the change tendency of platelet(PLT) count in healthy pregnant women, and study the correlation between platelet count and postpartum hemorrhage, and perinatal outcomes.
Methods
From July 2006 to June 2007, the clinical data of 2 655 healthy pregnant women who delivered in the West China Second University Hospital, Sichuan University were investigated retrospectively.
Results
① The reference value of platelet count >80×109/L for the healthy pregnant women. The platelet count decreased during normal pregnancy. ② The incidence of gestational thrombocytopenia (GT) of healthy pregnant women before delivering was 22.29%. ③ There were no significant correlation between platelet count and the gravidity, parity, age, and occupation (P>0.05). ④ There were no significant difference between groups compared with volume of bleeding during caesarean section and vaginal delivery(P>0.05). Platelet transfusion could decrease bleeding volume during caesarean section. ⑤ There were no significant correlation between platelet count and perinatal outcomes(P>0.05).
Conclusion
The incidence of gestational thrombocytopenia is high. But there are no significant correlation between platelet count and perinatal outcomes. Platelet transfusion can reduce bleeding volume in caesarean section.
Key words:
pregnancy; platelet count; gestational thrombocytopenia
Tuberculosis (TB) is a major public health concern worldwide, and spreads more easily in densely populated areas such as school campuses.The aim of this study was to determine the prevalence of positive TB skin tests among freshmen, i.e. newly-enrolled college students, in Zhengzhou City, China.We reviewed the data of purified protein derivative (PPD) skin tests in 656,212 freshmen in 2004-2013.A positive test showed a diameter of swelling ≥ 5 mm. The PPD positive rate was 40.69 %, with a prevalence of 146.29 per 100,000. During the 10-year study period, the rate of students with positive PPD test increased from 34.19 % in 2004 to 40.69 % in 2013. The positive PPD rate was significantly higher in males than in females (41.68 % vs 39.61 %, P<0.0001), and in rural compared with urban areas (42.04 % vs 38.03 %, P<0.0001).These findings indicated a high prevalence of PPD positivity among participants during the study period, with an increasing trend. Therefore, this population needs to be targeted by TB prevention and control programs.
IN THE CRYSTAL STRUCTURE OF THE TITLE COMPOUND [SYSTEMATIC NAME: 6,7-dimeth-oxy-12-methyl-16,18-dioxa-12-aza-tetra-cyclo-[12.7.0.0(4,9).0(15,19)]henicosa-1(21),4,6,8,14,19-hexaen-3-ol], C(21)H(25)NO(5), the benzene rings exhibits a dihedral angle of 14.95 (4)°. In the crystal, mol-ecules are linked by pairs of O-H⋯O hydrogen bonding into inversion dimers. These dimers are further connected by C-H⋯O inter-actions.
Objective
To investigate the epidemiological features of influenza outbreaks in Yangzhou from 2013 to 2017.
Methods
Data of the 26 influenza outbreaks reported in Yangzhou from January 2013 to December 2017 were collected from China Influenza Surveillance Information System and Management System of Public Health Emergencies, including outbreak investigation reports, pathogenic test results and virus isolation results. A total of 771 cases were reported. Fluorescent RT-PCR was adopted for detection of influenza virus nuclear acids and for virus genotyping. Descriptive epidemiological analysis was conducted to analyze subtypes of influenza virus as well as the time, spatial and crowd distribution of the outbreaks.
Results
Of the 26 influenza outbreaks, 11.5% (3/26) of the outbreaks were caused by influenza A (H1N1), 19.2% (5/26) by influenza A (H3N2), 30.8% (8/26) by influenza B Victoria (BV), 30.8% (8/26) by influenza B Yamagata (BY). The proportions of outbreaks caused by influenza, A (H1N1) mixed BY and BY mixed A (H1N1) were both 3.8% (1/26). Tweenty-three out of 26 influenza outbreaks occurred in primary schools (88.5%), while two outbreaks were in middle schools (7.7%) and 1 in a kindergarden (3.8%). Most outbreaks occured in winter and spring. Outbreaks from February to March accounted for 38.5% (10/26) and those from October to December accounted for 61.5% (16/26).
Conclusions
In Yangzhou area, different predominant strains alternately caused local influenza outbreaks during 2013 and 2017, with winter and spring as peak seasons and the primary and secondary schools as main places.
Key words:
Influenza; Disease outbreaks; Epidemiologic studies
Highly pathogenic avian influenza viruses (HPAIV), such as H5N1, H5N6, and H7N9, have been reported to frequently infect humans, but acute encephalitis caused by HPAIV in humans has been rarely reported. We report the first critical case of acute encephalitis with mild pneumonia caused by the H5N6 virus. On January 25 of 2022, a 6-year-old girl with severe neurological symptoms was admitted to our hospital and rapidly developed into seizures and coma. Brain imaging showed abnormalities. Electroencephalogram (EEG) presented abnormal slow waves. Cerebrospinal fluid (CSF) contained elevated protein (1.64 g/L) and white cells (546 × 106/L). Laboratory investigations revealed abnormally elevated transaminases, lactate dehydrogenase, and cytokines in serum. A novel reassortant H5N6 virus was identified from the patient's serum, CSF, and tracheal aspirate specimens. Phylogenic analysis indicated that this virus was a novel reassortant avian-origin influenza A (H5N6) virus that belonged to clade 2.3.4.4b. This patient was diagnosed with acute encephalitis and discharged from the hospital accompanied by a language barrier. An epidemiological investigation confirmed that wild waterfowls were the direct source of infection in this case. Our study highlights the urgent need to pay attention to acute encephalitis caused by HPAIV.
'/%3e%3cuse xlink:href='%23a' transform='rotate(23.036 .093 25.536)'/%3e%3cuse xlink:href='%23a' transform='rotate(45.87 1.273 16.18)'/%3e%3cuse xlink:href='%23a' transform='rotate(69.945 .996 12.078)'/%3e%3cuse xlink:href='%23a' transform='rotate(20.66 -19.689 31.932)'/%3e%3c/svg%3e)