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BACKGROUND: The optimal fluid management strategy for patients undergoing cardiac surgery was controversial regarding fluid volume and intraoperative fluid types. This study aimed to assess the correlation between colloids and crystalloids used for perioperative fluid therapy in cardiac surgery patients and postoperative prognosis. METHODS: The Ovid MEDLINE(R) ALL, Embase, and Cochrane Central Register of Controlled Trials databases were searched for eligible studies on fluid management strategies using colloids and crystalloids for cardiac surgery patients published before August 25th, 2023. RESULTS: Ten randomized controlled trials met the eligibility criteria. Compared to the use of crystalloids, the use of colloids, including hydroxyethyl starch (HES), albumin, and gelatine, did not show any differences in mortality, transfusion, acute kidney injury, and atrial fibrillation rates, postoperative blood loss, the length of hospital stay, or the length of intensive care unit (ICU) stay. The results of this meta-analysis showed that the crystalloid group had significantly reduced postoperative chest tube output compared to the colloid group. In the subgroup analysis, the amount of fresh frozen plasma (FFP) infused was significantly lower when using fluid management in the ICU and when using isotonic crystalloids compared to the colloids. In addition, when using fluid management in the ICU, patients in the colloid group had a significant increase in urine volume 24 h after surgery. However, other related factors, including the type of crystalloid solution, type of colloidal solution, and timing of liquid management, did not affect most outcomes. CONCLUSION: Both colloids and crystalloids could be used as alternatives for perioperative fluid management after cardiac surgery. The use of crystalloids significantly reduced the postoperative chest tube output, and the need for FFP infusion decreased significantly with the use of isotonic crystalloids or fluid management during the ICU stay. ICU patients in the colloid group had higher urine output 24 h after surgery. In addition, although the infusion method was not related to most outcomes, the rates of red blood cell and FFP transfusion and postoperative blood loss in the crystalloid group seemed to be lower, which needed to be further studied in high-quality and large-sample RCTs. TRIAL REGISTRATION: PROSPERO, CRD42023415234.
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Twisted a pair of stacked two-dimensional materials exhibit many exotic electronic and photonic properties, leading to the emergence of flat-band superconductivity, moiré engineering and topological polaritons. These remarkable discoveries make twistronics the focus point of tremendous interest, but mostly limited to the concept of electrons, phonons or photons. Here, we present twist piezoelectricity as a fascinating paradigm to modulate polarization and electromechanical coupling by twisting precisely the stacked lithium niobate slabs due to the interlayer coupling effect. Particularly, the inversed and twisted bilayer lithium niobate is constructed to overcome the intrinsic mutual limitation of single crystals and giant effective electromechanical coupling coefficient k t 2 is unveiled at magic angle of 11 1 ∘ , reaching 85.5%. Theoretical analysis based on mutual energy integrals shows well agreements with numerical and experimental results. Our work opens new venues to flexibly control multi-physics with magic angle, stimulating progress in wideband acoustic-electric, and acoustic-optic components, which has great potential in wireless communication, timing, sensing, and hybrid integrated photonics.
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A cost-effective method to achieve a 2-3 µm wavelength light source on silicon represents a major challenge. In this study, we have developed a novel approach that combines an epitaxial growth and the ion-slicing technique. A 2.1â µm wavelength laser on a wafer-scale heterogeneous integrated InP/SiO2/Si (InPOI) substrate fabricated by ion-slicing technique was achieved by epitaxial growth. The performance of the lasers on the InPOI are comparable with the InP, where the threshold current density (Jth) was 1.3â kA/cm2 at 283â K when operated under continuous wave (CW) mode. The high thermal conductivity of Si resulted in improved high-temperature laser performance on the InPOI. The proposed method offers a novel means of integrating an on-chip light source.
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Electro-optical photonic integrated circuits (PICs) based on lithium niobate (LiNbO3) have demonstrated the vast capabilities of materials with a high Pockels coefficient1,2. They enable linear and high-speed modulators operating at complementary metal-oxide-semiconductor voltage levels3 to be used in applications including data-centre communications4, high-performance computing and photonic accelerators for AI5. However, industrial use of this technology is hindered by the high cost per wafer and the limited wafer size. The high cost results from the lack of existing high-volume applications in other domains of the sort that accelerated the adoption of silicon-on-insulator (SOI) photonics, which was driven by vast investment in microelectronics. Here we report low-loss PICs made of lithium tantalate (LiTaO3), a material that has already been adopted commercially for 5G radiofrequency filters6 and therefore enables scalable manufacturing at low cost, and it has equal, and in some cases superior, properties to LiNbO3. We show that LiTaO3 can be etched to create low-loss (5.6 dB m-1) PICs using a deep ultraviolet (DUV) stepper-based manufacturing process7. We demonstrate a LiTaO3 Mach-Zehnder modulator (MZM) with a half-wave voltage-length product of 1.9 V cm and an electro-optic bandwidth of up to 40 GHz. In comparison with LiNbO3, LiTaO3 exhibits a much lower birefringence, enabling high-density circuits and broadband operation over all telecommunication bands. Moreover, the platform supports the generation of soliton microcombs. Our work paves the way for the scalable manufacture of low-cost and large-volume next-generation electro-optical PICs.
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A reliable, efficient and electrically-pumped Si-based laser is considered as the main challenge to achieve the integration of all key building blocks with silicon photonics. Despite the impressive advances that have been made in developing 1.3-µm Si-based quantum dot (QD) lasers, extending the wavelength window to the widely used 1.55-µm telecommunication region remains difficult. In this study, we develop a novel photonic integration method of epitaxial growth of III-V on a wafer-scale InP-on-Si (100) (InPOS) heterogeneous substrate fabricated by the ion-cutting technique to realize integrated lasers on Si substrate. This ion-cutting plus epitaxial growth approach decouples the correlated root causes of many detrimental dislocations during heteroepitaxial growth, namely lattice and domain mismatches. Using this approach, we achieved state-of-the-art performance of the electrically-pumped, continuous-wave (CW) 1.55-µm Si-based laser with a room-temperature threshold current density of 0.65 kA/cm-2, and output power exceeding 155 mW per facet without facet coating in CW mode. CW lasing at 120 °C and pulsed lasing at over 130 °C were achieved. This generic approach is also applied to other material systems to provide better performance and more functionalities for photonics and microelectronics.
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Alternative polyadenylation (APA) is a widespread mechanism of gene regulation that generates mRNA isoforms with alternative 3' untranslated regions (3' UTRs). Our previous study has revealed the global 3' UTR shortening of host mRNAs through APA upon viral infection. However, how the dynamic changes in the APA landscape occur upon viral infection remains largely unknown. Here we further found that, the reduced protein abundance of CPSF6, one of the core 3' processing factors, promotes the usage of proximal poly(A) sites (pPASs) of many immune related genes in macrophages and fibroblasts upon viral infection. Shortening of the 3' UTR of these transcripts may improve their mRNA stability and translation efficiency, leading to the promotion of type I IFN (IFN-I) signalling-based antiviral immune responses. In addition, dysregulated expression of CPSF6 is also observed in many immune related physiological and pathological conditions, especially in various infections and cancers. Thus, the global APA dynamics of immune genes regulated by CPSF6, can fine-tune the antiviral response as well as the responses to other cellular stresses to maintain the tissue homeostasis, which may represent a novel regulatory mechanism for antiviral immunity.
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Poliadenilación , Virosis , Factores de Escisión y Poliadenilación de ARNm , Humanos , Regiones no Traducidas 3'/genética , Regulación hacia Abajo , Inmunidad/genética , Factores de Escisión y Poliadenilación de ARNm/genética , Factores de Escisión y Poliadenilación de ARNm/metabolismo , ARN Mensajero/genética , ARN Mensajero/metabolismo , Virosis/genética , Ratones , AnimalesRESUMEN
Blood-based biomarkers of immune checkpoint inhibitors (ICIs) response in patients with nasopharyngeal carcinoma (NPC) are lacking, so it is necessary to identify biomarkers to select NPC patients who will benefit most or least from ICIs. The absolute values of lymphocyte subpopulations, biochemical indexes, and blood routine tests were determined before ICIs-based treatments in the training cohort (n = 130). Then, the least absolute shrinkage and selection operator (Lasso) Cox regression analysis was developed to construct a prediction model. The performances of the prediction model were compared to TNM stage, treatment, and Epstein-Barr virus (EBV) DNA using the concordance index (C-index). Progression-free survival (PFS) was estimated by Kaplan-Meier (K-M) survival curve. Other 63 patients were used for validation cohort. The novel model composed of histologic subtypes, CD19+ B cells, natural killer (NK) cells, regulatory T cells, red blood cells (RBC), AST/ALT ratio (SLR), apolipoprotein B (Apo B), and lactic dehydrogenase (LDH). The C-index of this model was 0.784 in the training cohort and 0.735 in the validation cohort. K-M survival curve showed patients with high-risk scores had shorter PFS compared to the low-risk groups. For predicting immune therapy responses, the receiver operating characteristic (ROC), decision curve analysis (DCA), net reclassifcation improvement index (NRI) and integrated discrimination improvement index (IDI) of this model showed better predictive ability compared to EBV DNA. In this study, we constructed a novel model for prognostic prediction and immunotherapeutic response prediction in NPC patients, which may provide clinical assistance in selecting those patients who are likely to gain long-lasting clinical benefits to anti-PD-1 therapy.
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Infecciones por Virus de Epstein-Barr , Neoplasias Nasofaríngeas , Humanos , Infecciones por Virus de Epstein-Barr/complicaciones , Carcinoma Nasofaríngeo/terapia , Herpesvirus Humano 4 , Inmunoterapia , Pronóstico , Antígenos CD19 , Neoplasias Nasofaríngeas/terapia , ADNRESUMEN
A 4H-silicon carbide-on-insulator (4H-SiCOI) has emerged as a prominent material contender for integrated photonics owing to its outstanding material properties such as CMOS compatibility, high refractive index, and high second- and third-order nonlinearities. Although various micro-resonators have been realized on the 4H-SiCOI platform, enabling numerous applications including frequency conversion and electro-optical modulators, they may suffer from a challenge associated with spatial mode interactions, primarily due to the widespread use of multimode waveguides. We study the suppression of spatial mode interaction with Euler bends, and demonstrate micro-resonators with improved Q values above 1 × 105 on ion-sliced 4H-SiCOI platform with a SiC thickness nonuniformity less than 1%. The spatial-mode-interaction-free micro-resonators reported on the CMOS-compatible wafer-scale 4H-SiCOI platform would constitute an important ingredient for the envisaged large-scale integrated nonlinear photonic circuits.
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Cancer cells usually exhibit shortened 3' untranslated regions (UTRs) due to alternative polyadenylation (APA) to promote cell proliferation and migration. Upregulated CPSF6 leads to a systematic prolongation of 3' UTRs, but CPSF6 expression in tumors is typically higher than that in healthy tissues. This contradictory observation suggests that it is necessary to investigate the underlying mechanism by which CPSF6 regulates APA switching in cancer. Here, we find that CPSF6 can undergo liquid-liquid phase separation (LLPS), and elevated LLPS is associated with the preferential usage of the distal poly(A) sites. CLK2, a kinase upregulated in cancer cells, destructs CPSF6 LLPS by phosphorylating its arginine/serine-like domain. The reduction of CPSF6 LLPS can lead to a shortened 3' UTR of cell-cycle-related genes and accelerate cell proliferation. These results suggest that CPSF6 LLPS, rather than its expression level, may be responsible for APA regulation in cancer cells.
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Neoplasias , Poliadenilación , Regiones no Traducidas 3'/genética , Proliferación Celular , Regulación de la Expresión Génica , Factores de Escisión y Poliadenilación de ARNm/genética , Neoplasias/genética , Humanos , Línea Celular TumoralRESUMEN
A Gram-negative, non-motile, facultatively anaerobic, rod-shaped bacterium, designated strain RS1-74T, was isolated from the surface water of Sayram Lake, Xinjiang Uygur Autonomous Region, China. The strain was able to grow optimally at 30 °C and pH 7.0-7.5, and in the presence of 0-0.5â% (v/w) NaCl. Catalase and oxidase activities were present. H2S was produced. Chemotaxonomic analysis showed Q-10 was the sole respiratory quinone. The polar lipids were composed of phosphatidylethanolamine, diphosphatidylglycerol, two glycolipids, phosphatidylglycerol, sphingoglycolipid and two unidentified lipids. Summed feature 3 (C16â:â1 ω7c and/or C16â:â1 ω6c) and summed feature 8 (C18â:â1 ω7c and/or C18â:â1 ω6c) were the predominant fatty acids. Phylogenetic analysis based on 16S rRNA gene sequence showed that strain RS1-74T was closely related to 'Sandaracinobacter neustonicus' JCM 30â734 (98.65â%), 'Sandaracinobacter sibiricus' RB16-17 (98.42â%) and Sandaracinobacteroides hominis SZY PN-1T (97.09%). The genomic DNA G+C content was 66.45âmol%. The average nucleotide identity and DNA-DNA hybridization values among the genomes of strain RS1-74T and 'Sandaracinobacter neustonicus' JCM 30734 and Sandaracinobacteroides hominis SZY PN-1T were 78.2 and 77.22â%, and 22.2 and 20.40â%, respectively. Based on the physiological, biochemical, phylogenetic and genomic data, strain RS1-74T represents a novel species within the genus Sandaracinobacteroides, for which the name Sandaracinobacteroides sayramensis sp. nov. is proposed, with type strain RS1-74T (=KCTC 82674T=MCCC 1K06282T).
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Ácidos Grasos , Fosfolípidos , Ácidos Grasos/química , Fosfolípidos/química , Lagos , Filogenia , ARN Ribosómico 16S/genética , Técnicas de Tipificación Bacteriana , ADN Bacteriano/genética , Análisis de Secuencia de ADN , Composición de Base , AguaRESUMEN
The wafer-scale single-crystal GaN film was transferred from a commercial bulk GaN wafer onto a Si (100) substrate by combining ion-cut and surface-activated bonding. Well-defined, uniformly thick, and large-scale wafer size ReS2 multilayers were grown on the GaN substrate. Finally, ReS2 photodetectors were fabricated on GaN and sapphire substrates, respectively, and their performances were compared. Due to the polarization effect of GaN, the ReS2/GaN photodetector showed better performance. The ReS2/GaN photodetector has a responsivity of 40.12 A/W, while ReS2/sapphire has a responsivity of 0.17 A/W. In addition, the ReS2/GaN photodetector properties have reached an excellent reasonable level, including a photoconductive gain of 447.30, noise-equivalent power of 1.80 × 10-14 W/Hz1/2, and detectivity of 1.21 × 1010 Jones. This study expands the way to enhance the performance of ReS2 photodetectors.
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Recent advancements in integrated soliton microcombs open the route to a wide range of chip-based communication, sensing, and metrology applications. The technology translation from laboratory demonstrations to real-world applications requires the fabrication process of photonics chips to be fully CMOS-compatible, such that the manufacturing can take advantage of the ongoing evolution of semiconductor technology at reduced cost and with high volume. Silicon nitride has become the leading CMOS platform for integrated soliton devices, however, it is an insulator and lacks intrinsic second-order nonlinearity for electro-optic modulation. Other materials have emerged such as AlN, LiNbO3, AlGaAs and GaP that exhibit simultaneous second- and third-order nonlinearities. Here, we show that silicon carbide (SiC) -- already commercially deployed in nearly ubiquitous electrical power devices such as RF electronics, MOSFET, and MEMS due to its wide bandgap properties, excellent mechanical properties, piezoelectricity and chemical inertia -- is a new competitive CMOS-compatible platform for nonlinear photonics. High-quality-factor microresonators (Q = 4 × 106) are fabricated on 4H-SiC-on-insulator thin films, where a single soliton microcomb is generated. In addition, we observe wide spectral translation of chaotic microcombs from near-infrared to visible due to the second-order nonlinearity of SiC. Our work highlights the prospects of SiC for future low-loss integrated nonlinear and quantum photonics that could harness electro-opto-mechanical interactions on a monolithic platform.
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N6-methyladenosine (m6 A) and alternative polyadenylation (APA) are important regulators of gene expression in eukaryotes. Recently, it was found that m6 A is closely related to APA. However, the molecular mechanism of this new APA regulation remains elusive. Here, we show that YTHDC1, a nuclear m6 A reader, can suppress proximal APA sites and produce longer 3' UTR transcripts by binding to their upstream m6 A sites. YTHDC1 can directly interact with the 3' end processing factor FIP1L1 and interfere with its ability to recruit CPSF4. Binding to the m6 A sites can promote liquid-liquid phase separation of YTHDC1 and FIP1L1, which may play an important role in their interaction and APA regulation. Collectively, YTHDC1 as an m6 A "reader" links m6 A modification with pre-mRNA 3' end processing, providing a new mechanism for APA regulation.
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Núcleo Celular , Poliadenilación , ARN Mensajero/genética , ARN Mensajero/metabolismo , Núcleo Celular/metabolismo , Adenosina/metabolismo , Regiones no Traducidas 3'RESUMEN
This article presents shear horizontal surface acoustic wave (SH-SAW) devices with excellent temperature stability and low loss on ultrathin Y42-cut lithium tantalate film on sapphire substrate (LiTaO3-on-sapphire, LTOS). The demonstrated resonators exhibit scalable resonances from 1.76 to 3.17 GHz, effective electromechanical coupling coefficients between 5.1% and 7.6%, and quality factors (Bode-Q) between 419 and 3019. The filter with a center frequency of 3.26 GHz features a suppressed spurious passband, a 3-dB fractional bandwidth (FBW) of 3%, and a minimum insertion loss (IL) of 2.39 dB. In addition, coplanar waveguides (CPWs) and SH-SAW resonators built on LTOS and LiTaO3-on-insulator (LTOI) substrates were compared over a temperature range of 25 °C-150 °C. Due to the extremely high resistivity of the sapphire and the excellent thermal stability of the LiTaO3/sapphire interface, the IL of the CPW and the impedance ratio (in addition to Bode-Q) of the SH-SAW on the LTOS are maintained well even at 150 °C, while those on the LTOI seriously deteriorate. Of these, the impedance attenuation of LTOS-SAW at the antiresonant frequency is only 3.7 dB at 150 °C, whereas that of LTOI-SAW reaches 9.6 dB, demonstrating excellent temperature stability of the LTOS substrate's radio frequency (RF) performance. Overall, the SAW devices on LTOS substrates show great potential for temperature-sensitive and low-loss applications in RF wireless communications.
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Acústica , Transductores , Óxido de Aluminio , Diseño de Equipo , SonidoRESUMEN
Background: To evaluate the effects of four ceramic primers and two cement types on the bonding strength and durability between zirconia and resin cement. Methods: A total of 115 polished and air-abraded zirconia blocks were randomly divided into five groups (with 23 in each group) to test the performance of various primers. Meanwhile, all primer samples were divided into two subgroups randomly to measure the difference between the two cement types. Group No treat - Clearfil SA Cement (NT-C); group No treat - RelyX Unicem Cement (NT-U); group Z-Prime Plus - Clearfil SA Cement (ZPP-C); group Z-Prime Plus - RelyX Unicem Cement (ZPP-U); group Rely X Ceramic Primer - Clearfil SA Cement (RCP-C); group Rely X Ceramic Primer - RelyX Unicem Cement (RCP-U); group Clearfil Ceramic Primer - Clearfil SA Cement (CCP-C); group Clearfil Ceramic Primer - RelyX Unicem Cement (CCP-U); group Monobond-S - Clearfil SA Cement (MS-C); group Monobond-S - RelyX Unicem Cement (MS-U). According to the type of cement, the specimens were randomly selected for electron microscope scanning and energy spectrum analysis, and the tightness of zirconium porcelain resin adhesive interface was observed. The bonding strength of different adhesives and aging experiments were tested by shear test mode, and the shear strength of each experimental group was analyzed by one variable three factor analysis of variance. Results: All primers in the treated groups maintained a pristine structure without micro-crack, while the non-primer treatment sample exhibited obvious micro-cracks. Furthermore, among the four primers, the sample treated with Clearfil Ceramic Primer (CCP) obtained the highest bonding strength, with a statistically significant difference (P<0.05). However, cohesive failure mainly occurred in the CCP group before thermal cycles, and mixed failure occurred after thermal cycles. Conclusions: CCP is the superior primer, and can improve the bonding strength between zirconia and resin cement. Because the thermal cycles have a significantly adverse effect on the shear bond strength, CCP can be helpful in improving the durability of the zirconia bonding strength. Furthermore, the two cement types exhibited a similar bonding performance for zirconia.
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Integration of entangled photon sources in a quantum photonic chip has enabled the most envisioned quantum photonic technologies to be performed in a compact platform with enhanced complexity and stability as compared to bulk optics. However, the technology to generate entangled photon states in a quantum photonic chip that are neither probabilistic nor restricted to low efficiency is still missing. Here, we introduce a hybrid quantum photonic chip where waveguide-coupled self-assembled quantum dots (QDs) are heterogeneously integrated onto a piezoelectric actuator. By exerting an anisotropic stress, we experimentally show that the fine structure splitting of waveguide-coupled quantum dots can be effectively eliminated. This allows for the demonstration of chip-integrated self-assembled QDs for generating and routing polarization-entangled photon pairs. Our results presented here would open up an avenue for implementing on-demand quantum information processing in a quantum photonic chip by employing all-solid-state self-assembled quantum dot emitters.
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@#Abstract: Objective To investigate the molecular characteristic and evolutionary trends of full-genome sequences of coxsackievirus A2 (CV-A2) and A5 (CV-A5) in Changsha City. Methods The CV-A2 and CV-A5 strains were isolated and detected from patients with hand, foot and mouth disease (HFMD) cases. The full-genome sequences of CV-A2 and CV-A5 strains were obtained using NGS sequencing. Homology and phylogenetic tree analysis were performed, and the recombination regions of the strains were examined by SimPlot software. Results The full-genome sequences of CV-A2 and CV-A5 strains were obtained from routine surveillance cases of HFMD in Changsha in 2019. The CV-A2 strain was named S281/Changsha/CHN/2019 with the full-genome sequence of 7 422 bp long; the CV-A5 strain was named S272/Changsha/CHN/2019 with the full-genome sequence of 7 425 bp long. Homology analysis of the isolates by comparison with the nucleic acid sequences of CV-A2 and other CV-A2 strains in China showed that the non-structural protein region shared lower similarity than that of structural protein region. The CV-A2 showed 79.20% similarity with Fleetwood strain (NC038306), showed the highest similarity 95.60% with MN419014 strain from Hubei Province. The non-structural protein 3C and 3D region shared the lowest similarity with MN419014, 90.51 and 92.06%, respectively. Phylogenetic tree analysis showed that 3C and 3D regions were located in the CV-A4 branch. Amino acid mutation sites were found in non-structural protein region, and the amino acid sequence in structural protein region was conserved. SimPlot analysis showed that genetic recombination was found in the 3C and 3D region of CV-A2 strains. The full-genome sequence of CV-A5 showed 80.7% similarity with the Swartz (AY421763) and 97.43% similarity with the strain (MH111030) from Australian. Homology analysis showed that the non-structural protein region shared lower similarity than that of structural protein region, based on full-genome of CV-A5. Phylogenetic tree analysis showed that CV-A5 and MH111030 were in the same branch, indicating that CV-A5 strain not from local. The amino acid sequence of CV-A5 strain was conserved. Conclusions The CV-A2 strain in Changsha City shared genome sequence information with CV-A4, and the CV-A5 strain was imported from abroad. Our findings are expected to understand the molecular and recombination characteristics of CV-A2 and CV-A5, provided the data of evolution and genetic features of the coxsackievirus, and interrupt disease transmission in a timely and effective manner.
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BACKGROUND: The spread of spinal anesthesia was influenced by many factors, and the effect of body height on spinal anesthesia is still arguable. This study aimed to explore the impact of height on the spread of spinal anesthesia and the stress response in parturients. METHODS: A total of ninety-seven parturients were allocated into two groups according to their height: the shorter group (body height was shorter than 158 cm) and taller group (body height was taller than 165 cm). Spinal anesthesia was performed with the same amount of 12 mg plain ropivacaine in mothers of different heights. The primary outcome of the study was the success or failure of the spinal anesthesia. The secondary outcomes of the study were stress response, time to T6 sensory level, the incidence of hypotension, the satisfaction of abdominal muscle relaxation and patient VAS scores. RESULTS: The rate of successful spinal anesthesia in the shorter group was significantly higher than that in the taller group (p = 0.02). The increase of maternal cortisol level in the shorter group was lower than that in the taller group at skin closure (p = 0.001). The incidence of hypotension (p = 0.013), time to T6 sensory block (p = 0.005), the quality of abdominal muscle relaxation (p < 0.001), and VAS values in stretching abdominal muscles and uterine exteriorization (p < 0.001) in the shorter group were significantly different from those in the taller group. Multivariate analysis showed that vertebral column length (p < 0.001), abdominal girth (p = 0.022), amniotic fluid index (p = 0.022) were significantly associated with successful spinal anesthesia. CONCLUSIONS: It's difficult to use a single factor to predict the spread of spinal anesthesia. Patient's vertebral column length, amniotic fluid index and abdominal girth were the high determinant factors for predicting the spread of spinal anesthesia. TRIALS REGISTRATION: ChiCTR-ROC-17012030 ( Chictr.org.cn ), registered on 18/07/2017.