AIM: To determine predictors of clinically relevant pancreatic fistulas (CRPF) by measuring drain fluid amylase (DFA) in the early postoperative period.
Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification o...Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification of risk factors and a proper physical examination are beneficial;however,ultrasound is the gold standard for the diagnosis of malpresentations.External cephalic version(ECV)refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation.This procedure is performed manually through the mother’s abdomen by a trained health care provider,to reduce the likelihood of a cesarean section.Studies have reported a version success rate of above 50%by ECV.The main objective of this review is to present a broad perspective on fetal malpresentation,ECV,and delivery of a breech fetus.The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them.After discussing breech prevalence,risk factors,diagnosis,and management,an updated review of ECV is presented.Moreover,ECV indications/contraindications,alternatives,clinical techniques on how to perform ECV and breech vaginal delivery,and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.展开更多
Objective: dystocia can be divided into many types, and cephalic dystocia is common. This kind of dystocia is mainly due to the orientation of fetal head in the natural delivery process, and it can also be caused by v...Objective: dystocia can be divided into many types, and cephalic dystocia is common. This kind of dystocia is mainly due to the orientation of fetal head in the natural delivery process, and it can also be caused by various factors, such as birth canal environment, fetal shape, abnormal productivity, poor mental state of parturient, etc. In clinical cases of dystocia, cephalic dystocia accounts for a relatively large proportion, which is a relatively common abnormal delivery phenomenon. It is also an undetermined clinical manifestation, accounting for more than 65% of the total incidence of dystocia. The symptoms of cephalic dystocia can only be determined during trial production. If the symptoms can't be diagnosed early, or can't be effectively solved at the first time, it will bring serious threats to the health and life safety of parturient and baby. Therefore, early detection, early treatment and intervention are necessary for cephalic dystocia. This paper explores the clinical features and pregnancy outcomes of this kind of pregnant women. Methods: the cephalic dystocia is very harmful to the health of the mother and baby. In order to reduce the cesarean section rate and avoid all kinds of complications of the mother and baby in the delivery process, this time, some typical cephalic dystocia cases were selected from the department for clinical research, and 354 cases were established, and the causes of cephalic dystocia, clinical features of pregnant women and delivery outcomes were investigated. Results: the parturient went to the hospital to wait for delivery. Before delivery, the clinical physical examination was conducted to determine the fetal status and physical indexes of the parturient. The test result showed that the head position was dystocia. According to the dystocia of the parturient, the corresponding countermeasures were formulated. Through clinical intervention of cephalic dystocia, there were 223 parturients who chose vaginal delivery and 131 parturients who finished delivery by cesarean section. Conclusion: this study fully shows that early clinical diagnosis should be made for parturient with cephalic dystocia, and effective intervention can reduce the occurrence of cephalic dystocia, avoid unpredictable damage to mother and baby, and improve pregnancy outcome.展开更多
Purpose:Hidden blood loss(HBL)during the perioperative period significantly impacts postoperative recovery and complications,yet it is frequently disregarded.This study aimed to investigate the effects of tip-apex dis...Purpose:Hidden blood loss(HBL)during the perioperative period significantly impacts postoperative recovery and complications,yet it is frequently disregarded.This study aimed to investigate the effects of tip-apex distance(TAD)and calcar-referenced tip-apex distance(calTAD)on HBL in the treatment of intertrochanteric fractures utilizing proximal femoral nail antirotation(PFNA).The study also seeks to evaluate the possible decrease in HBL subsequent to PFNA treatment by optimizing nail positioning.Method:A historical cohort study was conducted from January 2020 to December 2022.Patients diagnosed with unilateral acute closed femoral intertrochanteric fracture and who underwent PFNA internal fixation surgery met the inclusion criteria,and were grouped according to the value of calTAD and TAD.The participants were divided into low TAD group(TAD<20 mm)and high TAD group(TAD≥20 mm);low calTAD group(calTAD<7.625 mm)and high calTAD group(calTAD≥7.625 mm),respectively.The primary outcome measures were intraoperative blood loss(including HBL,overt blood loss,and total blood loss).Continuous data were analyzed using an independent samplet-test or Mann-WhitneyU test,and categorical data were analyzed using the Pearson Chi-square test.Univariate analysis was used to evaluate the association between various indicators and perioperative HBL.A stepwise multiple linear regression analysis model was used to determine the independent factors affecting perioperative HBL.Ap value less than 0.05 was considered statistically significant.Results:A total of 131 patients were initially included,of which 80 were assigned to the calTAD group(with 61 in the high calTAD group and 19 in the low calTAD group),and 80 were assigned to the TAD group(with 34 in the high TAD group and 46 in the low TAD group).The average HBL for the low TAD group was 772.85 mL,whereas for the high TAD group it was 919.68 mL(p>0.05).The average HBL for the low calTAD group was 611.42 mL,whereas for the high calTAD group it was 904.97 mL(p<0.05).Subsequent analysis revealed that the patient''s height,preoperative hemoglobin levels,changes in hemoglobin and hematocrit levels from pre-to post-surgery,and calTAD are independent risk factors influencing HBL.Conclusion:In summary,our investigation revealed a significant correlation between the positioning of nails in PFNA and HBL during the perioperative period.By optimizing the placement of the cephalic nail,specifically by ensuring a calTAD of less than 7.625 mm,a significant decrease in HBL can be attained.Additionally,we identified that height,preoperative hemoglobin,differences in preoperative and postoperative hemoglobin and hematocrit,and the positioning of the cephalic nail were independent risk factors for HBL.展开更多
Objective:Various techniques are proposed for changing fetal presentation.We aimed to assess the effect of BL67 point stimulation on correcting breech presentation and natural delivery in women at 36-38 gestational we...Objective:Various techniques are proposed for changing fetal presentation.We aimed to assess the effect of BL67 point stimulation on correcting breech presentation and natural delivery in women at 36-38 gestational weeks.Methods:A parallel single blinded randomized clinical trial was conducted on 72 eligible pregnant women with breech presentation at the 36 weeks of pregnancy.The subjects were divided into two groups-intervention(n=36)and control groups(n=36)by block randomization method.The intervention group stimulated the BL67 point by self-administration for 20 min once a day for 2 weeks.Finally,the appearance of cephalic presentation and rate of vaginal delivery was compared between the groups(n1=n2=32)using the Chi-square test and multivariate logistic regression.Results:The correction of breech to cephalic presentation occurred in 53.1% of patients in the intervention group.The adjusted relative risk(RR)for fetal correction from breech to cephalic was 1.80(RR=1.80,95%confidence interval[CI],1.13-5.17).It was shown that the stimulation of the BL67 point increased the correction of breech to cephalic presentation.In addition,the rate of vaginal delivery increased by>4-fold(RR=4.16,95%CI,2.54-6.82)by correction to cephalic presentation.Moreover,65.6%of mothers in intervention group and 90.6%in the control group underwent cesarean section.Conclusions:The stimulation of the BL67 point is a safe,inexpensive,and effective method that can be self-administered at home for fetal correction from breech to cephalic presentation in women with breech presentations during 36-38 gestational weeks.This promotes uncomplicated natural childbirth.展开更多
We report the extraordinarily preserved euarthropod Sidneyia minor sp.nov.from the Cambrian Stage 3 Xiaoshiba Lagerst?tte in Yunnan,South China.So far this is the earliest occurrence of the genus.As with other species...We report the extraordinarily preserved euarthropod Sidneyia minor sp.nov.from the Cambrian Stage 3 Xiaoshiba Lagerst?tte in Yunnan,South China.So far this is the earliest occurrence of the genus.As with other species of Sidneyia,the new taxon shares similar features such as a crescent-shaped head shield with paired lateral notches for stalked eyes,but more significantly and new,is the presence of three pairs of post-antennal appendages beneath the head shield identified by micro-CT methods.We conclude that Sidneyia is a sister group to other members of Vicissicaudata within the diverse radiation of Artiopoda.展开更多
Social parasitic Hymenopterans have evolved morphological, chemical, and behavioral adaptations to overcome the sophisticated recognition and defense systems of their social host to invade host nests and exploit their...Social parasitic Hymenopterans have evolved morphological, chemical, and behavioral adaptations to overcome the sophisticated recognition and defense systems of their social host to invade host nests and exploit their worker force. In bumblebees, so- cial parasitism appeared in at least 3 subgenera independently： in the subgenus Psithyrus consisting entirely of parasitic species, in the subgenus Alpinobombus with Bombus hy- perboreus, and in the subgenus Thoracobombus with B. inexspectatus. Cuckoo bumblebee males utilize species-specific cephalic labial gland secretions for mating purposes that can impact their inquiline strategy. We performed cephalic labial gland secretions in B. hyperboreus, B. inexspectatus and their hosts. Males of both parasitic species exhibited high species specific levels of cephalic gland secretions, including different main com- pounds. Our results showed no chemical mimicry in the cephalic gland secretions between inquilines and their host and we did not identify the repellent compounds already known in other cuckoo bumblebees.展开更多
Cephalic index(CI)is the percentage of biparietal diameter to the occipitofrontal diameter of the skull and can be used in forensic investigations in cases of disputed identity where only fragments of the head/skull a...Cephalic index(CI)is the percentage of biparietal diameter to the occipitofrontal diameter of the skull and can be used in forensic investigations in cases of disputed identity where only fragments of the head/skull are available.The sella turcica houses the pituitary gland whose hormones regulate the functions of many other glands and systems of the body.Abnormal sizes of sella turcica could indicate sella/pituitary pathology with health implications.This study aimed to assess CI,head shapes and sella turcica dimensions and morphology of the Yoruba tribe of Nigeria.The objectives are:to relate CI and head shapes with sella turcica dimensions and morphology,to use CI and head shape to identify and distinguish the Yoruba tribe from other tribes,to use CI and head shape to distinguish between genders.Skull/head and sella turcica dimensions were measured on 321 retrospectively enlisted normal cranial Computed Tomography(CT)images of Yoruba subjects,mean age 55(SD±17)years,in a Tertiary Hospital in South-West Nigeria between January 2020 and April 2021,and then CI calculated.Data was analyzed using IBM SPSS 27(IBM Corp.Armonk,NY,USA,2019).Predominant head shape of the studied group was dolichocephalic.Mean CI was 70.0±3.7 and showed no statistically significant difference between gender(P=0.097).Mean sella length,depth;and anteroposterior diameter was 1.22±0.24 cm,0.80±0.15 cm,1.34±0.25 cm respectively.Mean sella length and depth showed significant difference between gender(P=0.0001;P=0.032)respectively.Head shape has no association with sella dimensions and morphology.Head shape and CI may stratify populations in forensic practice and surgical planning.展开更多
文摘AIM: To determine predictors of clinically relevant pancreatic fistulas (CRPF) by measuring drain fluid amylase (DFA) in the early postoperative period.
文摘Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification of risk factors and a proper physical examination are beneficial;however,ultrasound is the gold standard for the diagnosis of malpresentations.External cephalic version(ECV)refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation.This procedure is performed manually through the mother’s abdomen by a trained health care provider,to reduce the likelihood of a cesarean section.Studies have reported a version success rate of above 50%by ECV.The main objective of this review is to present a broad perspective on fetal malpresentation,ECV,and delivery of a breech fetus.The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them.After discussing breech prevalence,risk factors,diagnosis,and management,an updated review of ECV is presented.Moreover,ECV indications/contraindications,alternatives,clinical techniques on how to perform ECV and breech vaginal delivery,and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.
文摘Objective: dystocia can be divided into many types, and cephalic dystocia is common. This kind of dystocia is mainly due to the orientation of fetal head in the natural delivery process, and it can also be caused by various factors, such as birth canal environment, fetal shape, abnormal productivity, poor mental state of parturient, etc. In clinical cases of dystocia, cephalic dystocia accounts for a relatively large proportion, which is a relatively common abnormal delivery phenomenon. It is also an undetermined clinical manifestation, accounting for more than 65% of the total incidence of dystocia. The symptoms of cephalic dystocia can only be determined during trial production. If the symptoms can't be diagnosed early, or can't be effectively solved at the first time, it will bring serious threats to the health and life safety of parturient and baby. Therefore, early detection, early treatment and intervention are necessary for cephalic dystocia. This paper explores the clinical features and pregnancy outcomes of this kind of pregnant women. Methods: the cephalic dystocia is very harmful to the health of the mother and baby. In order to reduce the cesarean section rate and avoid all kinds of complications of the mother and baby in the delivery process, this time, some typical cephalic dystocia cases were selected from the department for clinical research, and 354 cases were established, and the causes of cephalic dystocia, clinical features of pregnant women and delivery outcomes were investigated. Results: the parturient went to the hospital to wait for delivery. Before delivery, the clinical physical examination was conducted to determine the fetal status and physical indexes of the parturient. The test result showed that the head position was dystocia. According to the dystocia of the parturient, the corresponding countermeasures were formulated. Through clinical intervention of cephalic dystocia, there were 223 parturients who chose vaginal delivery and 131 parturients who finished delivery by cesarean section. Conclusion: this study fully shows that early clinical diagnosis should be made for parturient with cephalic dystocia, and effective intervention can reduce the occurrence of cephalic dystocia, avoid unpredictable damage to mother and baby, and improve pregnancy outcome.
文摘Purpose:Hidden blood loss(HBL)during the perioperative period significantly impacts postoperative recovery and complications,yet it is frequently disregarded.This study aimed to investigate the effects of tip-apex distance(TAD)and calcar-referenced tip-apex distance(calTAD)on HBL in the treatment of intertrochanteric fractures utilizing proximal femoral nail antirotation(PFNA).The study also seeks to evaluate the possible decrease in HBL subsequent to PFNA treatment by optimizing nail positioning.Method:A historical cohort study was conducted from January 2020 to December 2022.Patients diagnosed with unilateral acute closed femoral intertrochanteric fracture and who underwent PFNA internal fixation surgery met the inclusion criteria,and were grouped according to the value of calTAD and TAD.The participants were divided into low TAD group(TAD<20 mm)and high TAD group(TAD≥20 mm);low calTAD group(calTAD<7.625 mm)and high calTAD group(calTAD≥7.625 mm),respectively.The primary outcome measures were intraoperative blood loss(including HBL,overt blood loss,and total blood loss).Continuous data were analyzed using an independent samplet-test or Mann-WhitneyU test,and categorical data were analyzed using the Pearson Chi-square test.Univariate analysis was used to evaluate the association between various indicators and perioperative HBL.A stepwise multiple linear regression analysis model was used to determine the independent factors affecting perioperative HBL.Ap value less than 0.05 was considered statistically significant.Results:A total of 131 patients were initially included,of which 80 were assigned to the calTAD group(with 61 in the high calTAD group and 19 in the low calTAD group),and 80 were assigned to the TAD group(with 34 in the high TAD group and 46 in the low TAD group).The average HBL for the low TAD group was 772.85 mL,whereas for the high TAD group it was 919.68 mL(p>0.05).The average HBL for the low calTAD group was 611.42 mL,whereas for the high calTAD group it was 904.97 mL(p<0.05).Subsequent analysis revealed that the patient''s height,preoperative hemoglobin levels,changes in hemoglobin and hematocrit levels from pre-to post-surgery,and calTAD are independent risk factors influencing HBL.Conclusion:In summary,our investigation revealed a significant correlation between the positioning of nails in PFNA and HBL during the perioperative period.By optimizing the placement of the cephalic nail,specifically by ensuring a calTAD of less than 7.625 mm,a significant decrease in HBL can be attained.Additionally,we identified that height,preoperative hemoglobin,differences in preoperative and postoperative hemoglobin and hematocrit,and the positioning of the cephalic nail were independent risk factors for HBL.
基金Qom University of Medical Sciences,Iran by grant number of 96894.
文摘Objective:Various techniques are proposed for changing fetal presentation.We aimed to assess the effect of BL67 point stimulation on correcting breech presentation and natural delivery in women at 36-38 gestational weeks.Methods:A parallel single blinded randomized clinical trial was conducted on 72 eligible pregnant women with breech presentation at the 36 weeks of pregnancy.The subjects were divided into two groups-intervention(n=36)and control groups(n=36)by block randomization method.The intervention group stimulated the BL67 point by self-administration for 20 min once a day for 2 weeks.Finally,the appearance of cephalic presentation and rate of vaginal delivery was compared between the groups(n1=n2=32)using the Chi-square test and multivariate logistic regression.Results:The correction of breech to cephalic presentation occurred in 53.1% of patients in the intervention group.The adjusted relative risk(RR)for fetal correction from breech to cephalic was 1.80(RR=1.80,95%confidence interval[CI],1.13-5.17).It was shown that the stimulation of the BL67 point increased the correction of breech to cephalic presentation.In addition,the rate of vaginal delivery increased by>4-fold(RR=4.16,95%CI,2.54-6.82)by correction to cephalic presentation.Moreover,65.6%of mothers in intervention group and 90.6%in the control group underwent cesarean section.Conclusions:The stimulation of the BL67 point is a safe,inexpensive,and effective method that can be self-administered at home for fetal correction from breech to cephalic presentation in women with breech presentations during 36-38 gestational weeks.This promotes uncomplicated natural childbirth.
基金supported by the National Natural Science Foundation of China (Grant Nos. 41730318, 42162002 and 42202003)the Innovative Research Fund of Yuxi Normal University (Grant No. 202111390020)。
文摘We report the extraordinarily preserved euarthropod Sidneyia minor sp.nov.from the Cambrian Stage 3 Xiaoshiba Lagerst?tte in Yunnan,South China.So far this is the earliest occurrence of the genus.As with other species of Sidneyia,the new taxon shares similar features such as a crescent-shaped head shield with paired lateral notches for stalked eyes,but more significantly and new,is the presence of three pairs of post-antennal appendages beneath the head shield identified by micro-CT methods.We conclude that Sidneyia is a sister group to other members of Vicissicaudata within the diverse radiation of Artiopoda.
文摘Social parasitic Hymenopterans have evolved morphological, chemical, and behavioral adaptations to overcome the sophisticated recognition and defense systems of their social host to invade host nests and exploit their worker force. In bumblebees, so- cial parasitism appeared in at least 3 subgenera independently： in the subgenus Psithyrus consisting entirely of parasitic species, in the subgenus Alpinobombus with Bombus hy- perboreus, and in the subgenus Thoracobombus with B. inexspectatus. Cuckoo bumblebee males utilize species-specific cephalic labial gland secretions for mating purposes that can impact their inquiline strategy. We performed cephalic labial gland secretions in B. hyperboreus, B. inexspectatus and their hosts. Males of both parasitic species exhibited high species specific levels of cephalic gland secretions, including different main com- pounds. Our results showed no chemical mimicry in the cephalic gland secretions between inquilines and their host and we did not identify the repellent compounds already known in other cuckoo bumblebees.
文摘Cephalic index(CI)is the percentage of biparietal diameter to the occipitofrontal diameter of the skull and can be used in forensic investigations in cases of disputed identity where only fragments of the head/skull are available.The sella turcica houses the pituitary gland whose hormones regulate the functions of many other glands and systems of the body.Abnormal sizes of sella turcica could indicate sella/pituitary pathology with health implications.This study aimed to assess CI,head shapes and sella turcica dimensions and morphology of the Yoruba tribe of Nigeria.The objectives are:to relate CI and head shapes with sella turcica dimensions and morphology,to use CI and head shape to identify and distinguish the Yoruba tribe from other tribes,to use CI and head shape to distinguish between genders.Skull/head and sella turcica dimensions were measured on 321 retrospectively enlisted normal cranial Computed Tomography(CT)images of Yoruba subjects,mean age 55(SD±17)years,in a Tertiary Hospital in South-West Nigeria between January 2020 and April 2021,and then CI calculated.Data was analyzed using IBM SPSS 27(IBM Corp.Armonk,NY,USA,2019).Predominant head shape of the studied group was dolichocephalic.Mean CI was 70.0±3.7 and showed no statistically significant difference between gender(P=0.097).Mean sella length,depth;and anteroposterior diameter was 1.22±0.24 cm,0.80±0.15 cm,1.34±0.25 cm respectively.Mean sella length and depth showed significant difference between gender(P=0.0001;P=0.032)respectively.Head shape has no association with sella dimensions and morphology.Head shape and CI may stratify populations in forensic practice and surgical planning.
