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Li-Li Zhang,&ast; Wen-Hao Wang,&ast; Yong-Li Hou Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, Taiyuan, 030000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yong-Li Hou, Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, No. 382 of Wuyi Road, Xinghualing District, Taiyuan, 030000, People’s Republic of China, Tel +86 03513382151, Email houyonglihyl@126.comObjective: To investigate the risk factors of intraoperative massive hemorrhage in patients with pernicious placenta previa (PPP) and analyze the value of bilateral internal iliac artery balloon occlusion in Cesarean section for these patients.Methods: The clinical data of 134 patients with PPP admitted to the Second Hospital of Shanxi Medical University from January 2012 to January 2019 were analyzed. A logistic regression analysis was used to analyze the risk factors for intraoperative massive hemorrhage in PPP. The study subjects were divided into the intervention group (38 cases) and the routine group (96 cases) according to whether bilateral internal iliac artery balloon occlusion was conducted during the operation. The differences in some clinical indicators were compared between the two groups.Results: The risk factors for intraoperative massive hemorrhage in PPP were age ≥ 35 years, gestational age ≥ 34 weeks, complete placenta previa, and the presence of placenta accreta. The differences in the operation time, postoperative transfer to the intensive care unit, postoperative length of the hospital stay, and neonatal weight and score were not statistically significant between the intervention group and the routine group (P > 0.05 for all). While the intraoperative blood loss and the transfusion volume in the intervention group were lower than in the routine group, the hospitalization cost was higher in the former than in the latter, and the differences were statistically significant (P < 0.05 for all). Moreover, there was no case of hysterectomy in the intervention group, while there were two cases of hysterectomies in the routine group.Conclusion: The risk factors for intraoperative massive hemorrhage in PPP were age ≥ 35 years, gestational age ≥ 34 weeks, complete placenta previa, and the presence of placenta accreta. Internal iliac artery balloon occlusion during PPP could reduce intraoperative blood loss and the hysterectomy rate.Keywords: pernicious placenta previa, internal iliac artery balloon occlusion, intraoperative bleeding, risk factor

To determine the rate of BRAF gene mutation and the expression of activated extracellular regulated protein kinases (ERK) in nasal mucosa malignant melanomas and compare the results with those in cutaneous melanomas so as to explore the difference in the pathogenesis between nasal mucosa malignant melanomas and cutaneous melanomas.Twenty nasal mucosa melanomas samples were collected. Genomic DNA was extracted and the BRAF mutation detected by PCR (polymerase chain reaction) and direct sequencing analysis. Total protein was obtained and the activated ERK detected by Western blot.BRAF mutation was detected in 5% (1/20) samples of all patients. The mutation rate was much lower than that in cutaneous melanomas. And phosphorylated ERK protein was detected in 60% (12/20). And the result was almost similar to that of cutaneous melanomas.The high expression of activated ERK is not caused mainly by BRAF gene mutation in nasal mucosa malignant melanomas. The pathogenic pathways are different between nasal mucosa malignant melanomas and cutaneous melanomas.