This study aimed to develop and validate a prediction model of cesarean following induction of labor (IOL). A nomogram for the prediction of cesarean following IOL for singleton, cephalic term deliveries was created by comparing combinations of ultrasonographic and nonultrasonographic factors in a retrospective manner using patient data collected from a Chinese hospital between July, 2017 and December, 2023. Model discrimination and calibration were evaluated using the area under the receiver operating characteristic curve (AUROC) and a calibration curve. Subsequently, decision curve analysis (DCA) was conducted to pinpoint the optimal probability threshold for the predictive model to exhibit practical significance for clinical decision-making. A total of 738 women were included. The inclusion of ultrasound factors yielded a higher AUC when combined with nonultrasonographic factors. Of the three ultrasonographic factors analyzed, the most predictive factor for cesarean following IOL was fetal head circumference. After generating a nomogram with eight validated factors, including maternal age, gestational age, height, prior caesarean delivery, previous vaginal delivery, modified Bishop score, body mass index at delivery, and fetal head circumference by ultrasound, the trained and validated AUC values were 0.826 (95% confidence interval 0.786-0.867) and 0.883 (95% confidence interval 0.839-0.926), respectively. Decision curve analysis indicated that the model provided net benefits of between 0% and 80% of the probability threshold, indicating the benefits of using the model to make decisions concerning patients who fall within the identified range of the probability threshold. Our nomogram based on obstetric factors and fetal head circumference as obtained by ultrasound could be used to help counsel women who are considering IOL. The model demonstrates favorable net benefits within a probability threshold range of 0 to 80%.

This study sought to validate the Rossi nomogram in a Chinese population and then to include the Bishop score to see if it has an effect on the accuracy of the nomogram. The Rossi predictive model was applied and externally validated in a retrospective cohort from August 2017 and July 2023 in a Chinese tertiary-level medical center. For the revision and updating of the models, the regression coefficients of all the predictors (except race) were re-estimated and then the cervical Bishop score at the time of induction was added. Each model’s performance was measured using the receiver-operating characteristic and calibration plots. Decision curve analysis determined the range of the probability threshold for each prediction model that would be of clinical value. A total of 721 women met the inclusion criteria, of whom 183 (25.4

Narrative care for families suffering from perinatal loss is rarely provided by medical institutions in China Mainland. However, with the advancement of the Chinese narrative medicine theory and practice, the clinical significance of narrative care has been increasingly recognized. Based on the principles of Chinese narrative medicine, this narrative case study described traumatic narrative foreclosures occuring in a family suffering from stillbirth, and highlighted the multidisciplinary collaboration for practising narrative care in the process of supporting the bereaved in our hospital. Meanwhile, we advocate the establishment of a narrative care ecology by training more obsteticians and nurses with good narrative competence in purpose of helping the family experiencing perinatal losses to overcome their tramatic narrative foreclosures, increasing the chances of another successful pregnancy and childbirth as well as enhancing their quality of life.

We analyzed the clinical characteristics and prognosis of early pregnancy-associated breast cancer (PABC). In this matched case-control study, the PABC patients and non-PABC patients were recruited from Hebei Breast Disease Treatment Center in a ratio of 1:2, involving 40 PABC patients (10 pregnant women, 30 postpartum women) diagnosed between January 2011 and December 2017, and 80 non-PABC patients with matched tumor staging, age (±3 years), and year of diagnosis (± 2 years). The pathological characteristics, disease-free survival (DFS), and overall survival (OS) were compared between the groups. The first gravidity age in PABC patients was significantly older than that of non-PABC patients (26.8 years vs. 23.5 years, P < 0.05). Categorized by receptor status, the ratio of hormone receptor (HR)-positive breast cancer was lower in PABC patients than in non-PABC patients (57.5% vs. 70.0%, P = 0.221), while the incidences of HER2− (42.5% vs. 37.5%, P = 0.692) and triple-negative breast cancer (20% vs. 12.5%, P = 0.578) were higher in PABC patients than in non-PABC patients, although no significant differences were detected. Compared with non-PABC patients, PABC patients delivered the first gravidity at an older age, but showed no differences in pathological characteristics, DFS, and OS.

The aim of this study was to investigate the potential of pregnancy-associated plasma protein A (PAPP-A) and clinical data in predicting gestational diabetes mellitus (GDM). Clinical data of 318 pregnant women with GDM and 200 healthy pregnant women were retrospectively analysed. The age, BMI and caesarean section in GDM were significantly higher than in normal group. Serum and placental levels of PAPP-A were significantly lower in GDM than in normal group. Pearson's correlation analysis showed that serum levels of PAPP-A were negatively correlated with BMI and blood glucose level. Binary logistic regression analysis displayed that PAPP-A were the potential factors influencing GDM. The area under the ROC curve (AUC) for PAPP-A combined with BMI in predicting GDM was 0.941, significantly higher than that of the single one. The potential of PAPP-A in the first trimester is limited in predicting GDM. PAPP-A combined with BMI is highly conductive for predicting GDM.Impact statement What is already known on this subject? GDM not only increases the risk of perinatal morbidity, but also results in an increased risk of long-term sequelae for both mother and child including diabetes, cardiovascular disease obesity. Previous data indicate that besides glycemic control in the second trimester, interventions initiated early in pregnancy can reduce the rate of GDM in pregnant women. The expression of PAPP-A in serum of GDM pregnant women was decreased in the first trimester. Whereas, whether PAPP-A can be as an early predictor of GDM is not clear. What do the results of this study add? The present study shows that PAPP-A MoM was less than 0.6757 in the first trimester of pregnancy is more prone to GDM. The potential of PAPP-A in the first trimester is limited in predicting GDM. PAPP-A combined with BMI is highly conductive for predicting GDM. What are the implications of these findings for clinical practice and/or further research? Early GDM prediction is crucial for prevention and management of GDM, to cope with the rising prevalence of GDM and reduce later life chronic disease of both mother and child. Based on the level of PAPP-A MoM and BMI, interventions such as lifestyle changes initiated early in pregnancy shouldbeenabledin pregnant women.

Here we report an extremely rare case of immature congenital orbital teratoma. The ultrasound scan at the 28 +1 week of gestation revealed a massive, solid, and cystic mass in the left orbital region of the fetus. The lesion site was confirmed by magnetic resonance imaging. Based on clinical examination and imaging, the diagnosis of orbital teratoma without intracranial extension was made. Histopathological examination further confirmed the diagnosis of immature teratoma. The clinical course, radiographic, and histopathological findings of this disease were also summarized.

Background Diabetes mellitus as a chronic metabolic disease is threatening human health seriously. Although numerous clinical trials have been registered for the treatment of diabetes with stem cells, no articles have been published to summarize the efficacy and safety of mesenchymal stem cells (MSCs) in randomized controlled trials (RCTs). Methods and findings The aim of this study was to systematically review the evidence from RCTs and, where possible, conduct meta-analyses to provide a reliable numerical summary and the most comprehensive assessment of therapeutic efficacy and safety with MSCs in diabetes. PubMed, Web of Science, Ovid, the Cochrane Library and CNKI were searched. The retrieval time was from establishment of these databases to January 4, 2020. Seven RCTs were eligible for analysis, including 413 participants. Meta-analysis results showed that there were no significant differences in the reduction of fasting plasma glucose (FPG) compared to the baseline [mean difference (MD) = -1.05, 95% confidence interval (CI) (-2.26,0.16), P<0.01, I-2 = 94%] and the control group [MD = -0.62, 95%CI (-1.46,0.23), P<0.01, I-2 = 87%]. The MSCs treatment group showed a significant decrease in hemoglobin (Hb) A1c [random-effects, MD = -1.32, 95%CI (-2.06, -0.57), P<0.01, I-2 = 90%] after treatment. Additionally, HbA1c reduced more significantly in MSC treatment group than in control group [random-effects, MD = -0.87, 95%CI (-1.53, -0.22), P<0.01, I-2 = 82%] at the end of follow-up. However, as for fasting C-peptide levels, the estimated pooled MD showed that there was no significant increase [MD = -0.07, 95%CI (-0.30, 0.16), P<0.01, I-2 = 94%] in MSCs treatment group compared with that in control group. Notably, there was no significant difference in the incidence of adverse events between MSCs treatment group and control group [relative risk (RR) = 0.98, 95%CI (0.72, 1.32), P = 0.02, I-2 = 70%]. The most commonly observed adverse reaction in the MSC treatment group was hypoglycemia (29.95%). Conclusions This meta-analysis revealed MSCs therapy may be an effective and safe intervention in subjects with diabetes. However, due to the limited studies, a number of high-quality as well as large-scale RCTs should be performed to confirm these conclusions.

OBJECTIVEChlamydia psittaci (Cps) feeds on gram-negative aerobic cells. Respiratory inhalation of Cps or close contact with infected animals can cause psittacosis in humans. Given its challengeable early diagnosis and rapid progression, misdiagnosis or improper antibacterial drugs may lead to multi-organ dysfunction with a high mortality.CASE REPORTA pregnant woman at 29+1 weeks of gestational age had a fever. CT images of the chest showed lamellar consolidations in the inferior lobe of the right lung, light inflammation in the middle lobe of the right lung. Negative results were obtained from multiple times of blood and sputum culture. Next generation sequencing (NGS) results identified that Cps caused severe pneumonia, which was alleviated by specific antibiotic treatment.CONCLUSIONCps can cause severe pneumonia in the pregnant woman and be cured through precise antibiotic treatment. NGS is efficient in the rapid identification of pathogens and accurate diagnosis when bacteriological culture fails.

Background Informal learning refers to learners-sponsored, monitored and regulated learning method, which lays the foundation for medical life-long education of residents with sustainable self-learning ability and permanent learning behaviors. In this article the authors explore the academic value and significance in informal learning to improve the effectiveness for the standardized residency training in the context of “Internet plus” which combines technology with education to promote reforms for learning patterns. Standardized residency training started relatively late in China and there are less empirical studies targeted for the medical students in this phase. Based on it, this study aims to explore online informal learning behavior of medical students in residency training.Methods An empirical study was performed at the Fourth Hospital of Hebei Medical University in China where postgraduate medical education is being conducted. The study was implemented by questionnaire of the following aspects related to informal learning of residents as learning attitude, motivation, behavior and utilization of learning resources. Learning efficiency before and during COVID-19 is specifically surveyed and analyzed. 451 valid samples were collected to understand the situation of informal learning in the context of “Internet plus” and to find out interconnections among variables. The data from questionnaire has been analyzed through descriptive analysis, difference analysis and correlation regression analysis.Results Informal learning attitudes of residents in standardized training are of high recognition and strong learning belief but need better self-management; The intervention between informal learning motivation and behavior among the levels of self-control, learning target and utilization of online resources resulting in great influence of environmental and individual factors on self-efficacy. Relative weak ability appears in choosing, screening and utilizing effective information online without effective guidance from teachers.Conclusions In this study we innovatively propose appropriate and practical suggestions for researching methods in informal learning of postgraduate medical education in clinical setting during intensive online learning during COVID-19 period. The findings of this research have great significance in guiding learning paths, effects and development for informal learning of residents and put forward effective measures for the development of positive and sustainable informal learning in future career of the doctors-to-be.