Development and validation of models for predicting preterm birth and gestational latency following emergency cervical cerclage: A multicenter cohort study.

INTRODUCTION: Emergency cervical cerclage is a recognized method for preventing mid-trimester pregnancy loss and premature birth; however, its benefits remain controversial. This study aimed to establish preoperative models predicting preterm birth and gestational latency following emergency cervical cerclage in singleton pregnant patients with a high risk of preterm birth. MATERIAL AND METHODS: We retrospectively reviewed data from patients who received emergency cerclage between 2015 and 2023 in three institutions. Patients were grouped into a derivation cohort (n = 141) and an independent validation cohort (n = 61). Univariate and multivariate logistic and Cox regression analyses were used to identify independent predictive variables and establish the models. Harrell's C-index, time-dependent receiver operating characteristic curves and areas under the curves, calibration curve, and decision curve analyses were performed to assess the models. RESULTS: The models incorporated gestational weeks at cerclage placement, history of prior second-trimester loss and/or preterm birth, cervical dilation, and preoperative C-reactive protein level. The C-index of the model for predicting preterm birth before 28 weeks was 0.87 (95% CI: 0.82-0.93) in the derivation cohort and 0.82 (95% CI: 0.71-0.92) in the independent validation cohort; The C-index of the model for predicting gestational latency was 0.70 (95% CI: 0.66-0.75) and 0.78 (95% CI: 0.71-0.84), respectively. In the derivation set, the areas under the curves were 0.84, 0.81, and 0.84 for predicting 1-, 3- and 5-week pregnancy prolongation, respectively. The corresponding values for the external validation were 0.78, 0.78, and 0.79, respectively. Calibration curves showed a good homogeneity between the observed and predicted ongoing pregnant probabilities. Decision curve analyses revealed satisfactory clinical usefulness. CONCLUSIONS: These novel models provide reliable and valuable prognostic predictions for patients undergoing emergency cerclage. The models can assist clinicians and patients in making personalized clinical decisions before opting for the cervical cerclage.

Measurement of postpartum blood loss using a new two-set liquid collection bag for vaginal delivery: A prospective, randomized, case control study.

BACKGROUND: Postpartum hemorrhage (PPH) is a major obstetric complication, and the real-time measurement of blood loss is important in the management and treatment of PPH. We designed a new two-set liquid collection bag (TSLCB) for measuring postpartum blood loss in vaginal delivery. The aim of this study was to evaluate the effectiveness of the TSLCB in separating the blood from the amniotic fluid during vaginal delivery and in determining the accuracy of the measured postpartum blood loss. METHODS: A prospective, randomized, case control study was conducted in the Women's Hospital, Zhejiang University School of Medicine, from March 2018 to April 2018. Sixty single pregnant women with spontaneous labor at 37-41 weeks without maternal complications were randomly divided into the experimental and control groups. The TSLCB was used to evaluate separately the amount of blood and amniotic fluid. For the control group, visual estimation and traditional plastic blood-collecting consumables were used to estimate the amount of postpartum blood loss. The measured blood loss between the two groups was compared, and the association of the measured blood loss with various clinical lab indices and vital signs was investigated. RESULTS: The TSLCB (the experimental group) improved the detection of the measured blood loss compared with visual estimation and the traditional method (the control group) (P < .05). In the experimental group, correlation analysis showed that the measured blood loss at delivery and within 24 h of delivery was significantly associated with the decreased hemoglobin level, red blood cell count, and hematocrit level of patients (r = -0.574, -0.455, -0.437; r = 0.-595, -0.368, -0.374; P < .05). In the control group, only the measured blood loss within 24 h of delivery was associated with the decreased hemoglobin level (r = -0.395, P < .05). No blood transfusion and plasma expanders were required in the treatment of PPH for both groups. CONCLUSIONS: The TSLCB can be used to accurately measure the postpartum blood loss in vaginal delivery by medical personnel.

18F-fluorodeoxyglucose positron emission tomography for the detection of inflammatory lesions of the arterial vessel walls in Wistar rats.

The present study aimed to evaluate the use of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) for detection of high-fat and high-salt diet-induced inflammatory lesions of the arterial vessel walls in Wistar rats. A total of 20 healthy, 8-week-old, male Wistar rats were randomly assigned to the high-fat diet group and the normal diet group. After 16 and 24 weeks of feeding, Wistar rats in the normal diet group and the high-fat diet group (five rats in each group) were injected with 18F-FDG through the tail vein at a dose of 1 mCi/kg after fasting for 12 h. After 1 h, the rats were anesthetized with 2% isoflurane, followed by micro-PET imaging with a 10-min image capture duration and immunohistochemical staining. The standardized uptake values (SUVs) of 18F-FDG were significantly higher in the iliac artery in the high-fat diet group compared with those in the normal diet group at 16 weeks (1.53±0.08 vs. 1.04±0.03; P<0.05) and at 24 weeks (1.96±0.17 vs. 1.12±0.07; P<0.05). The SUVs of 18F-FDG were also significantly greater in the abdominal aorta in the high-fat diet group compared with those in the normal diet group at 16 weeks (1.35±0.08 vs. 1.02±0.02; P<0.05) and at 24 weeks (1.54±0.09 vs. 1.04±0.02; P<0.05). In addition, the SUVs of 18F-FDG in the iliac artery and abdominal aorta were significantly higher at 24 weeks compared with those at 16 weeks in the high-fat diet group (P<0.05). As determined by immunohistochemistry, the percentage of CD68-positive cells in the total number of cells per unit area in each group was 3.20±1.80% in the 24-week normal diet group, 4.70±2.02% in the 16-week high-fat diet group and 6.94±2.02% in the 24-week high-fat diet group; the percentage of CD68-positive cells in the high-fat diet group at 24 weeks was significantly higher than that in the high-fat diet group at 16 weeks and in the normal diet group at 24 weeks (P<0.05). In conclusion, 18F-FDG PET is a noninvasive imaging tool that can continuously monitor inflammatory lesions of the arterial vessel walls in Wistar rats. Further improvement of the Wistar rat atherosclerosis model may provide data to support the early assessment of and intervention in atherosclerosis.

Aerobic Exercise for a Duration of 90 min or Longer Per Week may Reduce the Atherogenic Index of Plasma.

The correlation between the weekly duration of aerobic exercise and atherogenic index of plasma (AIP) is still unknown. A cross-sectional study was conducted involving 27,827 middle-aged Chinese men who had health examinations in our hospital. The correlation between the duration of moderate-intensity aerobic exercise and AIP was determined. The mean AIP levels were 0.1166 ± 0.34475, 0.1167 ± 0.32637, and 0.0765 ± 0.32872 in the non-exercise (PA1), occasional exercise (PA2), and frequent exercise groups (PA3), respectively. Significantly higher AIP levels were observed in the PA1 and PA2 groups than the PA3 group, while no significant difference existed between the PA1 and PA2 groups. Physical activity significantly reduced the AIP after adjustment for age, body mass index, diastolic blood pressure, and fasting blood glucose and uric acid levels. In addition, the percentage of the population at high risk for atherosclerosis (AIP ≥ 0.21) was significantly lower in the PA3 group than the PA1 and PA2 groups. Moderate-intensity aerobic exercise at a weekly duration of 90 min or longer is associated with the reduction of AIP among middle-aged men in southeastern China.

Analysis of illumination uniformity affected by small-scale self-focusing of a pump beam in the radial smoothing scheme.

In the radial smoothing (RS) scheme, small-scale self-focusing (SSSF) can degrade beam quality of a pump beam with a Gaussian pulse train, resulting in the degradation of the smoothing performance of the RS scheme. Considering SSSF of the pump beam in an optical Kerr medium (OKM), the propagation model of the laser beam in the RS scheme has been developed, and the effects of the characteristics of the pump beam and the thickness of the optical Kerr medium on the RS performance have further been numerically simulated and analyzed. The results show that SSSF decreases the illumination uniformity in the RS scheme by inducing distorted wavefront modulation of the pump beam. Consequently, the beam quality of the pump beam should be controlled to avoid the degradation of the RS performance affected by SSSF. In addition, the peak intensity of the pump beam and the thickness of the OKM should be reasonable to ensure RS performance while mitigating the impact of SSSF.

Association between ideal cardiovascular health and the atherogenic index of plasma.

The American Heart Association aims to improve cardiovascular health by encouraging the general population to meet 7 cardiovascular health behaviors and factors. The atherogenic index of plasma (AIP) is an important index. Our aim is to evaluate the relationship between ideal cardiovascular health and the atherogenic index of plasma (AIP) in middle-aged Chinese men.A cross-sectional study was performed. A total of 27,824 middle-aged Chinese men were enrolled. The association between ideal cardiovascular health behaviors and factors and AIP was determined. The 7 cardiovascular health metrics were scored as follows: 0, poor; 1, general; and 2, ideal. The cardiovascular health status was classified according to the total score, as follows: 0 to 4, inadequate; 5 to 9, average; and 10 to 14, optimum. Analyses assessed the prevalence of 7 cardiovascular health metrics, its association with AIP. Logistic regression models were used to calculate odds ratios (ORs), adjusting for age.All 7 cardiovascular health metrics were shown to correlate with AIP (all P values < 0.05), and the strongest correlation existed between body mass and AIP, followed by total cholesterol and AIP. The mean AIP level increased with the decrease in the score of each of the 7 cardiovascular health metrics (all P values < 0.05). The subjects with poor cardiovascular health status had a 4.982-fold increase in the high risk of developing atherosclerosis, whereas a 1-point increase in the cardiovascular health score resulted a 0.046 reduction in AIP and a 22.3% reduction in the high-risk of developing atherosclerosis (OR = 0.777, 95% CI: 0.768-0.787).The ideal cardiovascular health score correlated significantly with AIP, and a 1-point increase in the cardiovascular health score led to a 0.046 reduction in AIP and a 22.3% reduction in the high risk of developing atherosclerosis. These validated the value of ideal cardiovascular health behaviors and factors in the prediction of high risk of developing cardiovascular diseases. Ideal cardiovascular health metrics are of great realistic significance for the prevention and control of atherosclerosis and cardiovascular diseases.